PROLONGED NAIL

Technical Field

The invention is related to prolonged nail, embedded in a protective case and moving in said case and provided to rotate by externally applying pressure, used in orthopedic bone lengthening surgeries. Background of the Invention (Prior Art)

One of the common fractures in Orthopedics and Traumatology is tubular bone shaft fractures. Increased industrialization causes both increasing of traffic accidents and accidents at work. This situation increases incidence of tubular bone shaft fracture especially in young population.

As tubular bone fractures are often developed due to high-energy trauma, it may be seen with additional injuries. Consequently, death rate is high even in isolated tubular bone fractures.

Purpose of treatment of long bone shaft fractures, is to provide integrity of extremity (arm or leg) and to provide the functions for the patient earlier. Various treatment methods are available for this purpose and today surgical treatment became standard treatment as a result of complications due to long term fixation seen in preventive treatment and complications due to treatment such as angular-rotational deviation, shortness, joint stiffness and sude atrophy, said various treatment methods don't apply to excessive or heavy treatment attempts. Traction, casting and brace can be used for conservative treatment.

External fixation and internal fixation are available amongst surgical treatment methods [osteosynthesis with plate and screw (Putting mechanical devices (screw, wire, nail or plate) in a fractured bone and bringing the ends together and removal process after the fracture union). External fixers provide convenience in wound care in compound fractures but pin tract infection and limitation of movement in adjacent joints are important disadvantages. Advantages of osteosynthesis with plate are; allowing rigid fixation by completely seeing fracture line and allowing earlier movement. But as well as causing a poor image from cosmetic point of view, it causes increase in risk of infection and long boiling time because of large amounts of tissue stripping, fracture hematoma (blood found between the broken bone fragments and starting fracture union) evacuation.

Especially after 1980s, popularity of intramedullary nails in treatment of tubular bone shaft fractures, has steadily increased. Intramedullary nails became golden standard today in treatment of tubular bone shaft fractures because they provide good stabilization, early weight bearing and joint movement, they can be applied by causing less soft tissue injuries, they have less angular and rotational frequency of deformities, they have high fracture union rate. First info about using intramedullary nails in fracture treatment is based on 16 ^lh century. During this period, the Incas and the Aztecs used to drive the resinous wooden nails on medullary canal in treatment of non-union long-bone fractures. In 1986 Bircher et al provided fixation by driving the ivory nails on medullary canal. In 1913 Koning also used ivory nails in treatment. In 1897 Norwegian Nicolaysen published principles of intramedullary nailing. In 1907 in Belgium Lambotte Klavikula, in 1913 i Germany Schone used method of nail placement on medullary canal in treatment of radius and ulna fractures. During World War 1 , in England Hey- groves used intramedullary nails in fracture treatment. But Kuntscher is the founder of standard intramedullary nails used today. During World War 2, Kuntscher first used V and then Y shaped nails in treatment of femur fractures. First book about intramedullary nailing technique written by Kuntscher and Maatz together, has been published and in this book, Kuntscher defined the clover leaf-shaped nails used today and emphasized on difficulty of providing integrity of closed reduction and intramedullary canal.

Captive soldiers returning home after the World War 2, in 1945 have led American surgeons to learn this technique. American surgeons started to use open reduction technique as radiation dosage exposed during nailing is high. In 1953 Stryker described a hole punch tool and hole roughness remover tool (reamer) and in 1953 Modny designed locking screw nail. In 1960s Kaesman described compression nailing technique. In 1970 Ender carried out fracture treatment with bent nails. In 1988 cloverleaf- shaped nails are started to be used commonly and meanwhile anatomic shape of tubular bones are started to be given to the nails. Today intramedullary nails such as Russel-Taylor, Delta, AO solid nails are being used extensively. Intramedullary nails will be used more commonly in the future because of its several advantages and fewer complications than expected and they will be continuously developed.

There are 2 kinds of treatment method for bone healing as follows:

1. Conservative treatment

1.1. Traction

1.2. Brace treatment

1.3. Casting

2. Surgical treatment

2.1. External fixation

2.2. Internal fixation

2.2.1. Intramedullary nailing

2.2.2. Plate fixation

2.2.3. Fixation with screw

2.2.4. Fixation with wire Our invention is related to intramedullary nailing amongst herein surgical treatment methods. Intramedullary nailing is one of the most important surgical inventions in orthopedics history. Long tubular bone shaft fractures can be life-threatening. Today by closed intramedullary nailing while expected union rate in these fractures vary between 95%-99%, infection rate is less than 1% (15,23,72). Poor bone fusion (Mahmion) as a result of wrong placement of fractures after intramedullary nailing in tubular bone shaft fractures, is very rare. Also, adding locking screws to modern nailing systems, expanded indications of this procedure including separated fractures, remote and proximal shaft fractures (8, 14,15). For these reasons, closed locked intramedullary nailing is the preferred treatment method in treatment of long tubular bone shaft fractures. Intramedullary nails used widely today are as follows:

a) Standard intramedullary nails: Nails such as Kiintcsher, AO, Schneider, Samson. They work with stability restoration principle by endo-steal contact from multi-points by filling the canal along the length of the bone. Their indication is istmic regional fractures.

b) Flexible intramedullary nails: Rush and Ender nails are in this group. Ender nail is the most used one in this group in child tubular bone shaft fractures. It acts on the principle of three-point. It is used without reamer (hole punch tool and tool for carving medullary (inner) space of long tubular bone).

Locked intramedullary nails: They are obtained by adding proximal and/or remote locking screws to intramedullary nail. Locking screws are sent to both cortexes. Basically there are two methods in fracture fixation with intramedullary nail.

- Static locking

- Dynamic locking

Static locking means placement of proximal and remote locking screws. This method is used in comminuted fractures and in less cortical contact such as for example femur Winquist Hansen Type 3 and 4 fractures.

Dynamic locking is defined as placement of one of the proximal or remote locking screws. It is necessary for the fractures in stable and istmic areas such as femur Winquist Hansen Type 1 and 2. On some nails, there is dynamic locking screw hole. Locking screw can move in the dynamic screw hole along the long shaft of the bone and thus formation of fracture callus can be accelerated by mobilizing the fracture fragments. Length and rotation is under control in static locking. If dynamic method is especially used in comminuted fractures, it can't control the rotation and the length. Intramedullary nails are designed mainly to ensure load carrying and to minimize the movement in the fracture zone.

Locked intramedullary nails can generally be used in open fractures to Type 3a if foreign objects or non-viable tissues are cut out and if wound is cared.

Locking of intramedullary nails can be carried out by a big professional team as it is very difficult to apply it as the holes on the nail are in the bone. In intramedullary nail locking, holes on the nail can be found by following techniques:

External guide is placed on the in bone nail and locking (screwing) process is carried out by applying screw and by determining the screw holes, by drilling them and by using x- ray machine in the guidance of external guide after sending the nail to the bone. • Locking (screwing) process is carried out by applying screw and by determining the screw holes, by drilling them and by using x-ray machine by free-hand technique without external guide after sending the in bone nail to the bone.

• Locking (screwing) process is carried out by applying screw and by determining the screw holes, by dril ing them and by seeing the screw holes and by removing a piece of bone from the front side of the bone by placing an external guide on in bone nail after sending the nail to the bone.

Description of the figures

Figure 1 Perspective view of our invention

Figure 2 Perspective view of our invention in opened form

Figure 3 Detailed perspective view of our invention in combined form Description of the references

1. Outer case

2. Nail

3. Articulated Apparatus

4. Screw

5. Resistance spring

6. Spring blocking part

7. Reducer

8. One-way locked bearing

9. Spring

10. Distal holes

11. Proximal hole

12. Articulation Description of the invention

The invention is related to prolonged nail, embedded in a protective case and moving in said case and provided to rotate by externally applying pressure, used in orthopedic bone lengthening surgeries characterized with an outer case (1 ), a nail (2), an articulated apparatus (3), a screw (4), a resistance spring (5), a spring blocking part (6), a reducer (7), a one-way locked bearing (8), a spring (9), Distal holes (10), proximal holes(l 1) and articulation (12).

After the system is driven in the leg by intramedullary nail methods, nail (2) is prolonged by means of articulated apparatus (3) moving with pressure applied externally, consequently the leg is prolonged.

The system consists of an endless screw (4), a nail (2) which is the extending part of the system and which acts as nut in which this screw (4) can enter, one-way locked bearing (8), small spring (9) which will return this one-way locked bearing (8) to its previous position, articulated apparatus (3) rotating the locked bearing (8) by applying force on it, reducer (7), big resistance spring (5) pushing the nail (2) and resisting to pull back force applied by leg muscles and an outer case (1 ) protecting the system.

Before endless screw (4) is screwed on the prolonged part (2) of the system, resistance spring (5) which will resist to pull back force applied by leg muscles, is attached and endless screw (4) is screwed on the moving part with nail (2). Spring blocking part (6) is put in the other end of the screw (4) to prevent shifting backwards of the spring (5) on the screw (4) and this end of the screw (4) is connected to a reducer (7). Other end of the reducer (7) is mounted in the one-way locked bearing (8). Rotation of the screw (4) is provided by the articulated apparatus (3) having an articulation (12) on one end rotating the one-way locked bearing (8), said articulated apparatus moving with an external pressure out of one-way locked bearing (8). By putting a small spring (9) under the place on which one-way locked bearing (8) is mounted, it is provided to return the system to its previous position when the force on the system is removed. Screw driving process is made to one-way locked bearing (8) from outside of the bone by drilling the bone and after the outer case (1) of the system is placed.

After installing all the parts, the system is fixed to the bone from the proximal hole (11) on the outer case (1 ) and from the distal holes (10) on the nail (2).

The system is ready to operate in this state. After the surgery is completed, bone is prolonged by applying pressure to the articulated apparatus (3) moving by a pressure out of the skin after the desired time.