Guide for drill adjustment for holes drilling in bones

BACKGROUND OF THE INVENTION The present invention relates to a guide for aligning a drill bit for drilling bone holes in the treatment of fractures by a joining plate method. In orthopedic surgery, attention has been paid in recent years to not only joining bone fragments, but also to firmly immobilizing them with the aim of dispensing with external plaster casting. This treatment method is called stable osteosynthesis, or joining bone parts with inserted bone slices and bone screws.

Depending on the type of fracture, anastomosis, including the use of bone slices, may be performed as neutralizing, without preloading of the broken portions and with the application of protective slices, possibly compressed when the fragments compress one another.

During neutralizing anastomosis, surgery is performed using the method described below.

To be used with the screw, the orifice plate is bent according to the shape of the bone, placed on it and temporarily immobilized. Then the holes are drilled into the bone. Simple guides in the form of a short sleeve with a handle are used for drilling bone holes. The lower part of the guide is conically terminated and adapted to the opening in the bone slice.

The guide is adjusted according to the sequentially aligned holes in the wafer in such a way that the hole to be drilled in the guide should be in line and the holes in the wafer, with the axis of the hole also being perpendicular to the bone.

The holes drilled in the bone are thus oriented according to the shape of the wafer and the screws are screwed to connect the wafer to the holes with the bone.

When using a pusher anastomosis, an alignment wafer and a compression apparatus, a guide for the alignment apparatus is used to receive the alignment wafer.

Surgical surgery using a guide for the compression apparatus is performed as follows, the alignment slice is adjusted to the shape of the bone. It is then placed on the bone and fixed in place. By using a handle-shaped guide inserted into the slice holes, the bone holes are drilled so that screws can be screwed into them. These holes drill on the side beyond the fracture gap. The bone screws are then placed about the drilled holes with the carved threads so that the slice is secured on the side of the fracture gap. The compression guide guide pin is inserted into an end hole on the side of the wafer that is not attached to the bone. The guide guide pin is connected via a slice to a simple drill sleeve that remains at a final distance from the end of the slice located on the bone on the other side of the fracture gap. The drill is inserted into the guide, a hole is drilled, and the thread is cut to fit the compression shoe.

The compression apparatus is used to compress that part of the bone that has not been joined by the 8 slice that connects the secured fracture. Next, the other holes in the bone are drilled to match the holes in the wafer, the threads are cut and the screws and compression apparatus are inserted.

Self-compression slices are used for compression anastomosis. These have circular openings at one end and conical compression openings at the other ends. In order to secure the bone slice well, it is necessary to model its shape in such a way that it accurately copies the shape of the broken bone. Then the slice is placed on the bone and threaded holes are drilled using a sleeve-shaped guide.

In addition, the end of the alignment plate with round holes is secured to the bone fragment from the fracture gap by means of screws. After the end of the wafer is locked, the pulling end on the other side of the fracture gap is also secured.

With the end positioned, the holes are then drilled using a long sleeve guide in the teeth that reliably secures the rest of the guide against the bone.

The guide is then placed in the next hole in the wafer_t then the holes are drilled through it and the threads are cut into the holes and the bone screws are inserted so. That causes the bone fragments to compress each other ·

The guides that have hitherto been used to drill bone holes in order to connect the slices to bone screws are used to drill single holes. Construction of single-line guides does not ensure that the borehole axes are perpendicular to the bone surface. Such guides do not allow the application of optimal forces to compress bone fragments.

The quality of anastomosis depends largely on optimal compression of bone fragments. The very strong compression resulting from the use of a compression apparatus results in the ends of the bone fragments being crushed and causing their edges to die, thus preventing proper healing.

On the other hand, too little compression of the bone fragments causes the static forces to be transmitted only by the contracting slices, which can break.

Further work, improving the methodology of fracture healing by the sliced ​​anastomosis method, has led to the development of such an embodiment of the guide which includes some parts of the drill guide. Such a guide consists of two arms provided with drill guide holes. These arms are mounted on the ends of the telescopic connector · The ends of the telescopic connector are connected with one side to the guide arms and the other side to the scale arrow · Around the drill holes Are the arms fitted with knobs · of the drill holes coincides with the alignment axis of the alignment plate · The guide thus prepared is applied to the bone and abuts with its projections. The holes are then drilled so that the drill is always inserted into the next hole in the guide. After drilling the holes in the bone, the holes are threaded, the guide is removed, the suitably shaped connecting plate is secured by means of bone screws which are screwed into the threaded holes.

The guide of such an embodiment also has many disadvantages ·

Due to the rigid design of the shoulders, the non-adherent protrusions do not adhere to their entire length, although the guide has been applied to bone fragments due to different shapes of bone curvature · This can cause an unstable position of the guide-drill assembly and

Due to the low stability of the above system, it is not possible to prevent the bore axis from deviating from the axis perpendicular to the bone surface. It is therefore not possible to maintain the exact location of the axes of consecutive holes.

The holes created as described above will cause difficulties in the correct axial insertion and tightening of the screws and the correct assembly of bone fragments - the amount of tightening force achieved varies greatly. This leads to a breach of bone adhesion. Furthermore, the application of the guide tends to cause the arms to be inclined and thus to render the bolts with the nut connecting the arms to the telescopic connectors unavailable.

Guides can be used for only one slice length and allow drilling with only one pitch. · During surgery, the guides cover the work area and are not suitable for joining fractures to the transversal gap, which are very large.

In practice, we encounter in principle a three-hole placement, i.e. openings that allow the bone fragments to be joined without contracting, with a moderate contraction and with very strong compression. The choice of withdrawal depends on the fracture. Research in the field of biomechanics of bone fracture joining allowed to establish the relationship between the underlying structure, fragment placement and contraction force ·

In order to determine the correct medical treatment by the method of joining bone fragments with a splice plate, it was an object of the invention to provide a new embodiment of a drill alignment guide for drilling bone holes for introducing bone screws that secure the splice plate.

The aforementioned drawbacks are overcome and the object is solved by a drill guide having a body with openings in which drill sleeves provided on the cutting edge contacting part and the insert for the securing clips are inserted, according to the invention, characterized in that the drill sleeves are provided with locking nuts on their top. On a guide body having a circular cross-section, the openings are arranged in a row and arranged so that their placement in a successive row corresponds to a different contraction of bone fragments.

The guide body may also consist of two parts which are slidably connected. When the guide body consists of two flat-shaped parts, these parts are slidably connected by pins and screws. On the other hand, when the guide body consists of two parts of circular cross-section, these parts are slidably connected by means of guide pins and a coaxially grooved nut with a scale engraved thereon.

Further attachment of the bone-shaped guide body parts is made possible by a recess holder, the shape of which is adapted to the shape of the connecting plate attached to the holder. The edge of the body is provided along the longer side with fastening screws with a diameter corresponding to the diameter of the holes in the connecting plate. On the top surface of the guide body is a mark to indicate the compression pressure and direction.

The main advantage of the guide according to the invention is to achieve optimal compression of the bone fragments as a function of their placement. Drill sleeves located in a row in the guide body can be adjusted to different heights depending on the anatomical arc of the broken bone. This allows the guide to surround the bone along its entire body and the blades at the bottom of the drill sleeves prevent the guide from slipping during drilling.

To reliably secure the guide, its body is provided with locking inserts for the clamps surrounding the bone and keep the guide in one position during operation. The placement of the guide holes in a single plate allows the bore to be guided perpendicular to the bone by the drill sleeves and all holes to be drilled in one clamping of the guide. As a result, the spacing of the subsequent holes can be accurately maintained. The holes made in this way do not cause any problems with correct axial insertion and attachment of the bone screws.

If the guide body has a circular cross-section of 8 holes arranged in a row in a manner corresponding to a given amount of compression of bone fragments, one guide may be used to adjust the compression of the individual bone fragments correctly and the drill sleeves are positioned correctly in line.

On the other hand, if the body consists of two parts capable of moving towards and away from each other, the compression of the bone fragments can be regulated continuously.

The sliding connection of the two guide body parts allows the arms to be deflected, which has not been possible so far. The sliding joint is in the form of wedges and screws or guides with coaxially positioned nuts with engraved scale and allows the use of predetermined compression forces.

Locks located at the ends of the body allow the guide to be extended by adding an additional connecting element and a series of additional drill sleeves to match the length of the connecting plate. The guide, the body of which consists of two parts secured by a connecting plate placed in the holder, allows the bone to be connected to the transverse gap. Bolts are mounted in the holes in the connector plate and then secured with nuts.

The individual bones may differ from each other by the axis of placement of the bolts and holes for the drill sleeves, depending on the relative displacement of these axes, the individual bone fragments of the broken bone may be compressed by different force. When the axes are precisely connected, no withdrawal is necessary.

In order to compress the bone parts with the required force, a number and an arrow are engraved into the bone, corresponding to the magnitude of the compressive force in millimeters and the desired sense of compression.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a side elevational view of a guide half shown in section and having a plate-like body; FIG. 2 a top view of the same guide; FIG. 3 a front view 4 shows a side view of the guide of FIG. 3 / FIG. 5 Fig. 6 shows a top view of the same guide, Fig. 7 shows a front view with a partial cross-section of a guide whose body consists of Fig. 8 shows a side view of the guide according to Fig. 7; 9 - a front view of a leash, the body of which consists of two bone-shaped parts, FIG. 10 - a view of the leash plate of FIG. 9a, FIG. 11 - a side view of the leash of FIG.

The plate-shaped guide body 2 of Figures 1 and 2 has holes in which the drill sleeves 2 for guiding the drill bits and the securing insert 3 for fastening the clamp are screwed. The drill bushes 2 and the clamp inserts 3 are symmetrically spaced on both sides of the body relative to their transverse axis in such a way that the clamp insert 3 is between the drill sleeves 2. Near the transverse axis of symmetry of the body 1 are two recesses 4 which are used to attach additional clamps that fix the guide at the desired location · the drill sleeves 2 have blades 5 at the bottom. Before drilling the holes into the bone, the drill sleeves 2 are screwed accordingly They respect the anatomical arches of the bone, so that each of them rests with its blades 5 on the bone. Furthermore, clamps are fastened around the bone so that they engage recesses 4 and inserts 3. With the guide assembled in this way, the guide body 1 is lifted above the fracture gap, so that the orthopedist can still monitor the drilling progress. The drill is guided through the drill sleeve 2 of the guide and the subsequent holes are drilled in the bone, the drill is removed from the clamp bone and the entire guide after drilling. · At the same time, bone fragments are prepared to insert the screws and attach the connecting plates.

In the exemplary embodiment of the guide shown in Figures 3 and 4, the tubular body has three rows of threaded holes positioned suitably for joining bones without compression, medium compression and high compression. The drill sleeves 2 provided in the lower portions of the blade 5 are screwed into the threaded holes. The drill bushes 2 are provided with a lock nut 6 located on the upper part of the body. The handle 7 is mounted in the central part of the body. The drill guide sleeves 2 are screwed into the threaded holes in the body 2 in such a way that each drill sleeve 2 rests on the bone surface with its lip 5 · the screwed sleeves 2 are then secured by the lock nuts 6 so that the sleeve cannot move broken bones.

For joining the bone fragments without compression, the drill sleeves 2 are screwed in a series of holes whose axes correspond to the axes of the holes in the shrink disk.

The guide body J shown in Figures 5 and 6 consists of two parts shaped in the form of plates interconnected by a pin 8 and an adjusting screw 9. The drill sleeves 2 and the clamp mounting inserts 3 are introduced into the holes drilled in the body 1. · Ends of the drill sleeves 2 are provided with blades 5. The body 1, together with the sleeves 2 and the clamp inserts 3, are applied to the broken bone, the sleeves 2 being screwed in such a way that each of them rests with the lip 5 on the bone.

The relative position of the two body parts 11 is adjusted by the adjusting screw 9. Due to the appropriate displacement of the borehole hole axes 2 relative to the holes in the joint plate, a moderate compression of the bone fragments after the bolts and the joint plate have been mounted, guide CS 271339 B2

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a side view of a guide half of which is shown in section and whose body is plate-shaped; FIG. 2 is a top view of the same guide; FIG. 3 is a front view; Fig. 4 shows a side view of the leash of Fig. 3; Fig. 5 shows a front view of a leash whose half is shown in section and whose body consists of two plate-shaped parts; . 6 Fig. 7 shows a top view of the same guide, Fig. 7 shows a front view 8 in partial section of a guide whose body consists of two parts of circular cross-section; Fig. 8 shows a side view of the guide according to Fig. 7, Fig. 9 Fig. 10 is a view of the leash plate of Fig. 9; and Fig. 11 is a side view of the leash of Fig. 9.

The plate-shaped guide body 1 of Figs. 1 and 2 has holes in which the drill sleeves 2 for guiding the drills and the locking inserts 3 for fastening the clamp are screwed. The drill bushes 2 and the clamp inserts 3 for clamping are clamped symmetrically on both sides of the body 1 relative to their transverse axis in such a way that the clamp insert 3 for clamping the clamp is between the drill bushes 2. Near the transverse symmetry axis of the body 11 There are two recesses 4 which are used to attach additional clamps that fix the guide at the desired location. The drill bushes 2 have blades 5 at the bottom. Before drilling the holes in the bone, the drill bushes 2 are appropriately screwed in such a way as to respect the anatomical arches of the bone so that each is supported by its blades 5 against the bone. that they fit into recesses 4 and inserts 3. With the guide assembled in this way, the guide body 1 is lifted above the fracture gap, so that the orthopedist can still monitor the drilling process. Drill The drill sleeve is guided by 2 guides and the subsequent holes are drilled in the bone, after drilling the hole, the clamp bone and the entire guide are removed from the bone. At the same time, bone fragments are prepared for insertion of the screws and attachment of the connecting plates.