PROXIMAL HUMERAL FIXATION PLATE AND METHOD FOR PLACING SUCH A FIXATION PLATE

Abstract

The invention concerns a fixation plate (2) for fixing to a proximal humerus, comprising a head part (3) for attachment distally from the foot plate of the major tubercle (26) of the humerus (25), which is provided with first screw holes (5) with internal screw thread for angularly stable screws (24), of which two arranged furthest from the shaft part (4) are provided as upper screw holes (11) for a downwardly directed screw (29), and suture holes (7), of which one anchoring suture hole (10) for anchoring thereto, by means of suture material (28), a bone anchoring element (9) attached in the apex (31) of the humeral head (32), and a shaft part (4) adjoining this head part (3) at the bottom for being attached to the humeral shaft (27). In addition, the invention concerns a set of such a fixation plate (2) and a side arm (16), and a method for treating a shoulder fracture using such a fixation plate (2).

Claims

1. Fixation plate (2) for fixing to a proximal humerus (25), comprising a head part (3) and a shaft part (4) adjoining the head part at the bottom (3), wherein the head part (3) is designed to be attached distally from the foot plate of the major tubercle (26) of the humerus (25), and for this is provided with: first screw holes (5) with internal screw thread for insertion of angularly stable screws (24) therein; and suture holes (7) for insertion of suture material (28) therein; and wherein the shaft part (4) is designed to be attached to the humeral shaft (27) and for this is provided with second screw holes (8) for insertion of fixing screws (35) therein, characterized in that one of the suture holes (7) is provided as an anchoring suture hole (10) for anchoring thereto, by means of suture material (28), a bone anchoring element (9) attached in the apex (31) of the humeral head (32), and that two first screw holes (5) arranged furthest from the shaft part (4) are provided as upper screw holes (11) for insertion therein of a downwardly directed screw (29).

2. Fixation plate (2) according to claim 1, characterized in that the anchoring suture hole (10) is provided for adjustably arranging suture material (28) therein.

3. Fixation plate (2) according to claim 2, characterized in that the anchoring suture hole (10) comprises a tunnel-like cavity (14), through which the suture material (28) can be inserted and which is provided with adjustment means (15) for adjustably securing the suture material (28) in the tunnel-like cavity (14).

4. Fixation plate (2) according to any of the preceding claims, characterized in that the anchoring suture hole (10) is provided for releasably arranging the suture material (28) therein.

5. Fixation plate (2) according to any of the preceding claims, characterized in that the anchoring suture hole (10) is arranged centrally in the head part (3).

6. Fixation plate (2) according to any of the preceding claims, characterized in that the internal screw thread of each of the two or more upper screw holes (11) comprises a longitudinal axis (A) which is arranged at a downward angle (α) between 10° and 35° relative to a horizontal plane (X).

7. Fixation plate (2) according to claim 6, characterized in that the two or more upper screw holes (11) are each provided with a second internal screw thread which comprises a second longitudinal axis (B) which is arranged at an upward angle (β) of between 10° and 35° with respect to the horizontal plane (X).

8. Fixation plate (2) according to claims 6 and 7, characterized in that the two or more upper screw holes (11) are each substantially designed in a figure-of-eight form with a upper inlet opening (12) and a lower inlet opening (13), and that the upper inlet opening (12) is provided with the first said internal screw thread, and the lower inlet opening (13) is provided with the second internal screw thread.

9. Fixation plate (2) according to any of the preceding claims, characterized in that on its side away from the head part (3), the shaft part (4) is provided with an edge (22) which is concave so as to form a free cavity centrally below the shaft part (4).

10. Set of a fixation plate (2) according to any of the preceding claims, comprising a side arm (16) which is releasably attachable to the head part (3) and is provided with a second anchoring suture hole (17), in order to anchor the side arm (16) medially from the minor tubercle (34) by means of suture material (28) and a second bone anchoring element (33).

11. Set according to claim 10, characterized in that the second anchoring suture hole (17) is designed for adjustable insertion of the suture material (28) therein.

12. Set according to claim 10 or 11, characterized in that the side arm (16) is provided with a fixing body (18) for fixing said side arm (16) to the head part (3).

13. Set according to claim 12, characterized in that the head part (3) is provided with a recess (50) in which the fixing body (18) may be arranged for fixing the fixing body (18) to the head part (3).

14. Set according to claim 12 or 13, characterized in that the fixing body (18) is provided with attachment pins (20) which can be inserted in said suture holes (7) of the head part (3) which are configured as attachment holes (35) for fixing the fixing body (18) to the head part (3).

15. Set according to any of claims 10 to 13, characterized in that the side arm (16) can be height-adjustably attached to the fixation plate (2).

16. Method for treating a shoulder fracture, wherein a fixation plate (2) according to any of claims 1 to 9 is attached to a proximal humerus (25), wherein the head part (3) is placed distally from the foot plate of the major tubercle (26) of the humerus (25), the shaft part (4) is attached to the humeral shaft (27) by means of fixing screws (35) in the second screw holes (8), two angularly stable screws (29), each pointing downward, are inserted in a first upper screw hole (11) and end in the calcar, a bone anchoring element (9) provided with suture material (28) is attached subchondrally to the apex (31) of the humeral head (32), and the suture material (28) is conducted through the supra- and infraspinatus tendon insertion site (36) and secured in the anchoring suture hole (10).

17. Method according to claim 16, wherein the fixation plate (2) forms part of a set according to any of claims 10 to 13, the side arm (16) is attached to the head part (3) of the fixation plate (2) so that this bridges the bicipital groove (45) and projects over the medial edge of the bicipital groove (45), a second bone anchoring element (33) provided with suture material (28) is subchondrally attached medially from the tuberculum minus foot plate (34), (45), and the suture material (28) is secured to the second bone anchoring element (33) through the subscapularis tendon in the second anchoring suture hole (17).

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0063] FIG. 1 shows a fixation system according to this invention attached to a humerus, in front view;

[0064] FIG. 2 shows the fixation system and the humerus from FIG. 1 in side view;

[0065] FIG. 3 shows the fixation system and the humerus from FIG. 1 in a longitudinal cross section, cut through the humerus and centrally through the fixation plate;

[0066] FIG. 4 shows the fixation plate of the fixation system from FIG. 1 separately in longitudinal section;

[0067] FIG. 5 shows the fixation plate of the fixation system from FIG. 1 separately in a rear view;

[0068] FIG. 6 shows the fixation plate of the fixation system from FIG. 1 with angularly stable screws inserted in the upper screw holes, in side view;

[0069] FIG. 7 shows the fixation system and the humerus from FIG. 1 in top view;

[0070] FIG. 8 shows a fixation system and the humerus from FIG. 1 in cross-section, cut centrally through the side arm;

[0071] FIG. 9 shows the side arm of the fixation system from FIG. 1 separately in perspective;

[0072] FIG. 10 shows the side arm of the fixation system from FIG. 1 separately in top view;

[0073] FIG. 11 shows the side arm of the fixation system from FIG. 1 separately in front view;

[0074] FIG. 12 shows a second embodiment of a side arm from the fixation system from FIG. 14 separately, in perspective from the left side;

[0075] FIG. 13 shows the side arm from FIG. 12 in perspective from the rear;

[0076] FIG. 14 shows a second embodiment of a fixation system according to this invention, in perspective from the front left;

[0077] FIG. 15 shows the fixation plate from the fixation system from FIG. 14 separately, in perspective from the front;

[0078] FIG. 16 shows the fixation system from FIG. 14 in perspective from the left rear; and

[0079] FIG. 17 shows a part of the fixation system from FIG. 14 at the level of the head part, in exploded state.

DETAILED DESCRIPTION

[0080] In this detailed description, by means of reference signs, reference is made to the appended drawings in which:

[0081] The proximal humoral fixation systems (1) illustrated comprise a fixation plate (2), a side arm (16) which can be releasably attached thereto, bone anchoring elements (9, 33), screws (24, 35), and suture material (28).

[0082] The fixation plate (2) also comprises a head part (3) and a shaft part (4) adjoining this head part (3) at the bottom.

[0083] As can be seen from FIGS. 1 to 3, the shaft part (4) is designed to be attached to the humeral shaft (27).

[0084] For this purpose, in each case several screw holes (8) are provided in the shaft part (4), for insertion of fixing screws (35) therein. The insertion of such fixing screws (35) is known from the prior art and is illustrated in the second embodiment. A centrally arranged screw hole (23) is here configured elongate so that a first fixing screw (35) may be arranged therein and still allow some play of the fixation plate (2) with respect to the humerus (25). Thus the fixation plate (2) may then if necessary be positioned more precisely with respect to the humerus (25) before any further screws (35) are inserted in further screw holes (8) in the shaft part (4). These screw holes (8) may furthermore be designed similarly to the screw holes in shaft parts of fixation plates according to the prior art. As can be seen more clearly from FIG. 5, the screw holes (8) are not arranged in a line but these are offset with respect to a vertical line. In this way, several fixing screws (35) may be arranged above one another without splitting the humeral shaft (27).

[0085] On its side facing away from the head part (3), the shaft part (4) is also provided with an edge (22) which is designed concave so that a free cavity is formed centrally below the shaft part (4), which opens towards the rear side of the fixation plate (2) and preferably extends transversely to the shaft part (4). The application of the fixation plate (2) on the humerus is hindered as little as possible by the tendon insertion present there. Fixation plates according to the prior art may equally well be provided with such a concave end in order to ensure that only a minimum of tendon need be detached in order to be able to apply the fixation plate.

[0086] The head part (3) of the fixation plates (2) depicted is designed to be attached just distally from the foot plate of the major tubercle (26), as can be seen in FIGS. 1 to 3. The head part (3) may thus be applied around 5 to 7 mm distally from the foot plate. For this purpose, several screw holes (5) are provided in the head part (3) for insertion of angularly stable screws (24) therein.

[0087] The two most proximal screw holes (11) are configured in a figure-of-eight shape and are provided with the upper inlet opening (12) and a lower inlet opening (23). The upper inlet opening (12) is provided with a first internal screw thread which has a first longitudinal axis (A) which is arranged at a downward angle (α) of around 16° with respect to the horizontal plane (X), as can be seen in FIG. 6. The lower inlet opening (13) is provided with a second internal screw thread having a second longitudinal axis (B) which is arranged at an upward angle (β) of around 24° with respect to the horizontal plane (X), as can be seen in FIG. 6.

[0088] The horizontal plane (X) is arranged transversely to the vertical plane (Y) which substantially corresponds to the plane in which the shaft part (4) mainly extends and which substantially coincides with an ideal support plane of the shaft part (4) on the humeral shaft (27).

[0089] FIGS. 1 to 3, and 6 to 8, each show for illustration a downwardly directed screw (29) arranged in the one most proximal screw hole (11), while an upwardly directed screw (30) is arranged in the other most proximal screw hole (11). In practice, normally either downwardly directed screws (29), as shown in FIGS. 14 and 16 - 17, or upwardly directed screws (30) are arranged in both most proximal screw holes (11).

[0090] In alternative embodiments, instead of said figure-of-eight shaped screw holes (11), separate screw holes may also be provided for downwardly directed screws and separate screw holes for upwardly directed screws. As a further alternative, only two or more proximal screw holes may be provided for downwardly directed screws, so that this fixation plate is then only used for operations in which the above-mentioned complications are feared, and an alternative fixation plate with only proximal screw holes for upwardly directed screws is used for operations where these complications are not expected.

[0091] The fixation plates (2) depicted may be attached both to a left humerus or to a right humerus of the human body. Alternatively, it is also possible to produce fixation plates (2) for a fixation system (1) according to this invention which are similar to the prior art, and only designed to be applied to the left humerus or only designed to be applied to a right humerus.

[0092] As well as said screw holes (5, 8) the fixation plate (2) is also provided with several suture holes (7). Suture threads (28) may be arranged in these suture holes (7).

[0093] Several suture holes (7) are provided for suture threads to be pulled through, as in the prior art, wherein these are pulled through tendons around the humeral head for securing the fixation plate (2).

[0094] An anchoring suture hole (10) is now also provided centrally in the fixation plate (2). This anchoring suture hole (10) is designed tunnel-like with a first inlet opening (40) at the upper edge of the head part (3), and a second inlet opening (41) centrally in the head part (3). Centrally between these two inlet openings (40, 41) is a screw hole (15) which opens into the tunnel-like cavity (14) of the anchoring suture hole (10). Via the inlet openings (40, 41), suture thread (28) can be introduced into the tunnel-like cavity (14), as can be seen in FIGS. 3, 14 and 17. By means of a setscrew (47) in the screw hole (15), this suture thread (28) can be adjustably and reversibly secured in this tunnel-like cavity (14).

[0095] A first bone anchoring element (9) of said bone anchoring elements (9, 33) of the fixation systems (1) depicted is provided in each case, to be anchored subchondrally in the apex (31) of the humeral head (32), medially from the foot plate of the major tubercle onto which the supra- and infraspinatus tendons (36) are inserted. Suture thread (28) is attached to this first bone anchoring element (9) and is inserted through the supra- and infraspinatus tendon (36) and secured in the anchoring suture hole (10) just described.

[0096] A second bone anchoring element (33) of said bone anchoring elements (9, (33) of the fixation systems (1) depicted is in each case designed to be anchored subchondrally, medially from the minor tubercle foot plate to which the subscapularis tendon is inserted. Suture thread (28) is attached to this bone anchoring element (33), inserted through the subscapularis tendon insertion (37) and secured in a second anchoring suture hole (17) in a side arm (16).

[0097] The side arm (16) is for this releasably attachable to the head part (3) of the fixation plate (2) and thus bridges the bicipital groove (45) so as to leave the biceps tendon unobstructed. In the embodiments depicted, the side arm (16) is attached at the front to the fixation plate (2). In alternative embodiments, this side arm (16) may also be attached at the rear to the fixation plate (2).

[0098] In each case, a tunnel-like cavity (17) is provided in this side arm (16) and has two inlet openings (42, 43) for insertion of the suture thread (28). A screw hole (44) is arranged transversely to this tunnel-like cavity (17) and opens into the tunnel-like cavity (17). Via the inlet opening (42, 43), the suture thread (28) can be introduced into the tunnel-like cavity (17), as can be seen in FIGS. 8, 14, 16 and 17. By means of a setscrew (48) in the screw hole (44), this suture thread (28) can be adjustably and reversibly secured in this tunnel-like cavity (17).

[0099] To attach the side arm releasably to the head part (3), this side arm (16) is in each case provided with a fixing body (18).

[0100] In the first embodiment depicted, this fixing body (18) extends over the complete width of the head part (3) and is attached on either side of this head part (3).

[0101] In the second embodiment depicted, the front face of this head part (3) is provided on either side with a recess (50) corresponding to the fixing body (18), in which the fixing body (18) can be arranged for fixing to the fixation plate (2). In this embodiment, the side arm (16) is designed symmetrically so that this can be attached either on the left to the fixation plate (2) as shown, or twisted through 180° on the right to the fixation plate (2).

[0102] In order to attach the fixing body (18) to the fixation plate (2), this fixing body (18) in both embodiments is provided with attachment pins (20) which can be inserted in suture holes (7) which are configured as attachment holes (35).

[0103] Also, both the fixing body (18) and the head part (3) may be provided with one or more corresponding fixing screw holes (38, 39), through which one or more screws may be introduced for screwing the fixing body (18) to the head part (3).

[0104] In the first embodiment, the fixing screw holes (39) in the head part (3) are here provided on opposite side edges of the head part (3). In the second embodiment, such a fixing screw hole (39) is provided in each of said recesses (50).

[0105] In the first embodiment, the fixing body (18) is provided with a cutout (21) to allow the unobstructed insertion of the most proximal angularly stable screws (24) in the head part (3).

[0106] The bone anchoring elements (9) may assume any form known from the prior art. One example of such bone anchoring elements suitable for this is known under the name Lupine® DePuy Synthes.