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1. WO2020117155 - FINGER CONTRACTURE OPEN I NG FIXATOR

Note: Text based on automatic Optical Character Recognition processes. Please use the PDF version for legal matters

[ EN ]

FI NGER CONTRACTURE OPENI NG FI XATOR

This invention is related to a fixator structure used in opening finger contractures in the medical field.

The disorder that is referred as contracture (contracture) in medicine is a condition which is caused as a result of permanent hardening of soft tissues due to contracting and shortening. The finger contracture may occur as a consequence of shrinkage of the skin due to burns, fractures, and Dupuytren's disease or it may be congenital. Dupuytren's disease is an orthopedic disorder that usually occurs with the thickening and hardening of palmar aponeurosis which is the tissue in the palm of the hand under the skin, and as a result of this thickening and hardening the finger bends together with contraction. I f the contracture is left untreated, in a short period of time the finger may lose its mobility completely.

Looking at the state of the art ;

1 . Case Study 1 - Dupuytren's Contracture - Hand Biomechanics Lab

The drawbacks of the system mentioned in the article

https://handbiolab.com/pnutucts/digit-widget/dupuytrens-contracture/ :

a) The fixation of the device to the bone was fixed rigidly with two schanz screws on one side (distal side) however on the other side (proximal) , loose and primitive methods have been used such as band-aids and patches.

But with this invention, both sides of the system are rigidly fixed to the bone with two Schanz screws.

b) Bone fixation with 2 schanz screws is done on the dorsal side of the finger (from the back) and there is a possibility of damaging the extensor tendons of the finger (tendon may wrap around the screw) ; to reduce this possibility, an open surgical procedure may be required in the sections where the screws will pass through, increasing the risk of infection. This invention uses the most preferred sides (inner side, outer side) .

(The side that is away from the tendons, vessels and nerves)

c) The fixation of the bone with 2 schanz screws is applied on the dorsal side of the finger, causing the correction direction to be in the same plane as the deformity (contracture) , which increases the possibility of the screws to dislodge abruptly after a certain period of time.

I n the invention, the schanz screws are positioned at 90 degrees in the direction of movement.

d) The system operates in one plane and can only be used in flexion deformity (flexion contracture) .

I n the invention, the system operates in two planes and can be used for the treatment of both flexion and extension deformities (contracture) .

2. Correction of long term joint contractures of the hand by distraction. A case report P. Natividade da Silva* , R. Barbosa, P. Ferreira, A. Ferreira, E. Malheiro, . Silva, J.

Reis, J. Amarante

Department of Plastic and Reconstructive Surgery, Oporto Medical School, Sa o Joa o Hospital, Oporto, Portugal. Received 5 August 2004; accepted 26 April 2005, is the system referred to in the publication;

a) I n the study mentioned above and similar studies that have used a fixator which functions in a single, linear plane (axial plane) , and which is also used for fracture treatment and extension, will cause excessive stretching and distraction of joints while correcting the deformity and will cause permanent damage to the joint because the device has been developed for extension purposes.

As for the invention, the operation of the system does not cause tension in the joints since it is from the horizontal to the linear plane.

Although physical therapy is enough in mild cases of finger contracture treatment, open surgical procedures are required especially in case of progression of discomfort. The most commonly used open surgical procedure is contracture release. Open surgical procedures cause many problems as the body tissue is cut open. The fact that the body tissue is being cut and the surgical procedure lasts for 1 -1 .5 hours this brings about the requirement for anesthesia is and the risks of anesthesia together with it. Postoperatively, the cut tissue cannot always be closed directly and a second operation, such as skin patches called skin grafts, may be needed. The fact that the procedure is performed by cutting the body tissue and the length of the operation, increases the risk of infection significantly. Especially in diabetic patients, as the healing process of the tissue is prolonged, the risk of infection increases and the healing process becomes an agony. When complete correction is performed in patients who have had contractures for a long time as a result of open surgical procedure, blood may not return and necrosis at the fingertip due to contraction and / or occlusion of the veins in the fingers can be seen.

I n the treatment of this condition, there is no fully functional device that can be used during a closed treatment.

Structures used in closed treatment processes of finger contracture have been created by modification of systems used in the treatment of other disorders and remain inadequate in treatment. They are also designed in a way that can damage the tendon and joint capsules of the fingers. The fixation of said device to the bone has been conducted by means of two schanz screws rigidly from the distal side and on the other side (proximal) , methods such as bands and patches that probably will come loose have been used for the fixation process. The non-rigid fixation on the proximal side and loosening during the treatment process may cause the process to be started over or may cause delay in the treatment process. I n the aforementioned system , fixation to the bone is performed on the dorsal side of the finger (back side) with 2 schanz screws. Extensor tendons pass over the dorsal side of the finger. Screw fixation on the dorsal side of the finger increases the chance of damaging the extensor tendons of the finger. During the tightening of the screws, the tendon may wrap around the screw and may be ruptured. To reduce this possibility, open surgical procedures may be required in the sections where the screws will pass and this increases the risk of infection. At the same time, the fixation of the bone with the schanz screw on the dorsal face of the finger causes the plane to be in the same plane as the correction direction of the deformity, resulting in a vertical force on the screws. After a certain time, it is possible for the screws to detach from the bone. The existing system operates in one plane and can only be used in flexion deformity.

I n the treatment of finger contractures, fixators operating in single linear plane (axial plane) are used for fracture treatment and extension. I n these and similar studies; since the device is developed for lengthening purposes, it causes excessive stretching and distraction in the joints while correcting the deformity and may cause permanent damage to the joint.

The fixator that is the subject of this invention overcomes the problems mentioned above by angular adjustment of the lateral plane of the finger bones and by using closed surgical procedure. Finger contractures were closed and corrected at 3 degree angles per day.

The fixator that is the subject of this invention is described hereinafter by way of illustrations and by examples.

Figure-1 Fully open front perspective view of the finger contracture opening fixator subject of the invention.

Figure-2 Fully open back perspective view of the finger contracture opening fixator subject of the invention.

Figure-3 Perspective view of the female ball joint part.

Figure-4 Perspective view of the male ball joint part.

Figure-5 Perspective view of the fixing washer.

Figure-6 Perspective view of the tension nut

Figure-7 Perspective view of the tension nut.

Figure-8 Perspective view of the screw.

Figure-9 Perspective view of the application of the fixator subject of the invention to the finger,

Figure-10 Perspective view of a different application of the finger contracture opening fixator subject of the invention.

Figure-1 1 Perspective view of a different application of the female ball joint part.

Figure-12 Perspective view of a different application of the female ball joint part from a different angle.

Figure-13 Bottom perspective view of a different application of the female ball joint part. Figure-14 Perspective view of a different application of the male ball joint part.

Figure-15 Perspective view of a different application of the male ball joint part from a different angle.

Figure-16 Perspective view of a different application of the tension nut.

Figure-17 Perspective view of a different application of the hinge pin.

Description of reference numbers used in images:

1 - Female ball joint part

1 .A- A different application of the female ball joint part

1 .1 - Male ball joint part housing

1 .2- Hinge pin hole

2 Male ball joint part

2. A- A different application of male ball joint part

2.1 - Pin hole

3 Hinge pin

3. A- A different application of hinge pin

4 Tension nut

4. A- A different application of tension nut

5 Tensioning screw

6 Screw

7 Kirschner wire schanz screw

8 Wire fixing washer

8.1 - Wire fixing washer nut hole

9 Fixing washer housing

I 0 Kirschner wire / schanz screw housing (wire / screw housing)

I I - Screw hole

1 2 Tension nut housing

1 3 Tension nut hole

1 4 Bone of the finger that the treatment is applied to

The finger contracture opening fixator subject to the invention consists of a female ball joint part (1 ) , male ball joint part (2) , hinge pin (3) , tension nut (4) , tensioning screw (5) and fixing washer (8) . The fixing washer (8) has a wire fixing washer screw hole (8.1 ) , which allows the screw (6) to reach the female and male ball joint parts (1 , 2) , and comprises a Kirschner wire / schanz screw housing (10) (wire / screw housing) that tightens the Kirschner wire / schanz screw (7) and provides bearing thereto.

The female ball joint part (1 ) includes, a male ball joint part housing (1 .1 ) in which the motion is carried out in which the male ball joint part (2) is housed, a tension nut housing (12) in which the tension nut (4) is housed, a tension nut connection hole (13) which allows the connection of the tension nut (4) , a hinge pin hole (1 .2) through which the hinge pin (3) passes, a fixing washer housing (9) in which the wire fixing washer (8) is seated, a screw hole (1 1 ) allowing the wire fixing washer (8) to be connected with the screw (6) and a wire / screw housing (10) in which the Kirschner wire (7) is housed.

The male ball joint part (2) having a similar structure; includes a tension nut housing (12) in which the tension nut (4) is housed, a tension nut connection hole (13) to which allows the connection of the tension nut (4) , a pin hole (2.1 ) through which the hinge pin (3) passes, a fixing washer housing (9) in which the wire fixing washer (8) is seated, screw hole (1 1 ) which allows the wire fixing washer (8) to be connected with the screw (6) and a wire / screw housing (10) in which the Kirschner wire (7) is housed. The male and female ball joint parts (1 ,2) are connected to each other by the hinge pin (3) by means of the hinge pin hole (1 .2) and they perform their movements around the hinge pin (3) .

The tension nut (4) of the male and female ball joint parts (1 ,2) is inserted into the tension nut housing (12) using the tension nut holes (13) . The tension screw (5) mounted into the tension nuts (4) also perform by means of the tension nuts (4) the tightening or loosening of the embodiment. The fixing washer (8) is fixed to the fixing washer house (9) of the male and female joint parts (1 ,2) by means of the screw (6) and the Kirschner wire and / or schanz screw (7) which is located in the wire / screw housing (10) is tightened or loosened by means of the screw (6) . The finger contracture opening fixator of the present invention is applied to the patient by an orthopedic doctor or hand surgeon specialist under operating room conditions.

Different applications of the male and female ball joint parts (1 ,2) (1 .A; 2. A) have been in Figure-10. Together with this a different application of the hinge pin (3. A) that allows the installation of different applications of the male and female ball joint parts (1 .A; 2. A) and a different application of the tension nut (4. A) are shown in Figure-16 and Figure-17.

The finger contracture opening fixator subject to the invention is applied as closed surgery instead of conventional open surgery. The finger contracture opening fixator subject to the invention is fixed rigidly to the finger bone (14) with two Kirschner wires and / or schanz screws from the distal side and on the other side, the Kirschner wire and / or schanz screw (7) is used in the proximal fixation process. The device is therefore rigidly applied to the patient. The finger contracture opening fixator that is subject to the invention is applied from the side of the finger to which the tendons, vessels and nerves are distant. I n this way, damage to tendons, vessels and nerves is prevented.

The finger contracture opening fixator subject to the invention is positioned on the side of the finger to be treated, and thus the Kirschner wire and / or schanz screw (7) that is inserted into the bone (14) is perpendicular to the direction of stretching of the finger, so that a vertical contact on the Kirschner wire and / or schanz screw (7) is made. This prevents the formation of force and prevents the Kirschner wire and / or schanz screw (7) from being detached from the bone.

The finger contracture opening fixator subject to the invention can operate in two planes. Thus, it can be used in the treatment of both flexion and extension deformities (contracture) .

Once the finger contracture opening fixator subject to the invention is applied to the patient, the patient can adjust the fixator on his own, without going to the hospital, without the need of any orthopedic doctor. When adjusting the finger contracture opening fixator subject of the present invention, the tensioning or loosening is performed by turning the tensioning screw (5) . When the tensioning screw (5) is rotated, the power transmission is applied on the male and female ball joint parts (1 , 2) by means of the tension nuts (4) and performs a circular motion around the hinge pin (3) . With this circular motion, the uncomfortable finger is stretched or loosened.