SURGICAL SCREW SYSTEM FOR INJURIES OF THE PELVIS

Abstract

The present invention relates to a surgical screw connection system (100) for use in the region of the pelvic bone. The surgical screw connection system (100) comprises or consists of at least one rod (10) with a first end section (11) and a second end section (13). The rod (10) is cannulated throughout and the first end section (11) consists of or comprises a first threaded section (111). The present invention also relates to an instrument set (200), a treatment set and a method for securing a locking nut (21)

Claims

1. A surgical screw connection system (100) for use in the region of the pelvic bone, comprising or consisting of: at least one rod (10) having a first end section (11) and a second end section (13); wherein the rod (10) is cannulated throughout; and wherein the first end section (11) comprises or consists of a first threaded section (111).

2. The surgical screw connection system (100) according to claim 1, wherein the first threaded section (111) is or comprises a metric thread, preferably a double thread.

3. The surgical screw connection system (100) according to claim 1, wherein the second end section (13) comprises or consists of a second threaded section (133).

4. The surgical screw connection system (100) according to claim 3, wherein the second threaded section (133) is or comprises a cortical thread or self-tapping bone thread.

5. The surgical screw connection system (100) according to claim 1, wherein the rod (10) comprises an intermediate section (15) between the first end section (11) and the second end section (13), which does not have a thread on its outer side and whose outer diameter is preferably smaller than the outer diameter of the second thread.

6. The surgical screw connection system (100) according to claim 1, further comprising at least one locking nut (21).

7. The surgical screw connection system (100) according to claim 1, further comprising a first washer (51).

8. The surgical screw connection system (100) according to claim 1, further comprising at least one compression nut (41).

9. The surgical screw connection system (100) according to claim 1, wherein the compression nut (41) and the first washer (51) are connected by a joint section, which movably connects them to each other.

10. The surgical screw connection system (100) according to claim 1, wherein the compression nut (41) comprises a larger outer diameter than the locking nut (21).

11. The surgical screw connection system (100) according to claim 1, further comprising a second washer (53).

12. The surgical screw connection system (100) according to claim 1, wherein the first washer (51) and/or the second washer (53) are or can be placed on the first and second end section (11, 13) respectively, movable relative to the rod (10).

13. The surgical screw connection system (100) according to claim 1, wherein the second washer (53) is arranged so as to be movable in an axial direction between the second threaded section (133) and a head section (33) of the second end section (13), and is limited by the second threaded section (133) and head section (33) in an axial direction of the rod (10) and/or it is limited in an axial direction in a form-fitting manner by the second threaded section (133) on the one hand and the head section (33) on the other.

14. The surgical screw connection system (100) according to claim 1, wherein the second end section (13) comprises a front-end engagement opening (333) for engaging with the tip or the end section of a rotary tool, e.g. of a screw driver.

15. The surgical screw connection system (100) according to claim 1, comprising a plurality, at least two, rods (10,10a) of different lengths, wherein the difference in length is preferably 5 mm.

16. An instrument set (200) having instruments for the minimally invasive insertion of a surgical screw connection system (100) for use in the region of the pelvic bone, in particular according to claim 1, or for inserting a rod (10) of said screw connection system, comprising: a first cannulated rotary tool (210) for the compression nut (41), wherein the cannula is sized both in diameter and length in order to accommodate a second rotary tool (220) for the locking nut (21).

17. The instrument set (200) according to claim 16, further comprising a second, preferably cannulated, rotary tool (220) for the locking nut (21) for insertion or introduction into the cannula of the first rotary tool (210), in order to preferably in this inserted state reach at least an end region of the cannula of the first rotary tool (210).

18. The instrument set (200) according to claim 16, further comprising an instrument for determining length (230) with marked lengths corresponding to the lengths of the rods (10, 10a) being included in the screw connection system (100).

19. The instrument set (200) according to claim 16, further comprising at least one Kirschner wire.

20. A treatment set, comprising a surgical screw connection system (100) according to claim 1 and an instrument set (200) including a first cannulated rotary tool for the compression nut, wherein the cannula is sized both in diameter and length in order to accommodate a second rotary tool for the locking nut.

21. A method for securing a compression nut (41) placed on a minimally invasive inserted rod (10) of a surgical screw connection system (100) according to claim 1 on its first end section (11) using a locking nut (21), with the following steps: placing the first cannulated rotary tool (210) of the instrument set (200) including a first cannulated rotary tool for the compression nut, wherein the cannula is sized both in diameter and length in order to accommodate a second rotary tool for the locking nut, on the compression nut (41) or holding the already attached rotary tool (210) in its attached position; holding of the compression nut (41) by the first cannulated rotary tool (210) in its initial rotating position or further tightening or biasing the same in a first rotating direction; placing the second rotary tool (220) of the instrument set (200) on the locking nut (21), wherein by pushing the second rotary tool (220) through the cannula of the first rotary tool (210) the locking nut (21) is positioned on the rod (10) or on the compression nut (41), or wherein the locking nut (21) has already been screwed onto the rod (10) or against the compression nut (41); and rotating or screwing the locking nut (21) using the second rotary tool (220) against the first rotary tool (210) in a direction of rotation opposite the first direction of rotation, while counter-locking or in order to counter-lock the compression nut (41).

Description

[0075] The present invention is exemplarily explained with regard to the accompanying drawings in which same reference numerals refer to the same or similar components. In the figures the following applies:

[0076] FIG. 1 shows a surgical screw connection system in a first embodiment with a first rod;

[0077] FIG. 1a shows the first rod of FIG. 1 without the compression nut or locking nut;

[0078] FIG. 1b shows in an enlarged, slight perspective representation from the side the compression nut and the first washer of FIG. 1

[0079] FIG. 1c shows in an enlarged, slight perspective representation from the side, the locking nut of FIG. 1;

[0080] FIG. 1d shows in an enlarged sectional representation the interaction of the head end of a rod of the screw connection system in an embodiment and the washer of this embodiment;

[0081] FIG. 2 shows the first rod and a second rod of the surgical screw connection system in a further embodiment having different lengths;

[0082] FIGS. 3a to 3c show an instrument set according to the present invention in a first embodiment; and

[0083] FIG. 4 shows a first rotary tool of the instrument set of FIG. 3, in which a second rotary tool of the instrument set is inserted.

[0084] FIG. 1 shows a surgical screw connection system 100 (hereinafter for short: screw system) in a first embodiment for use in the region of the pelvic bone in a perspective view. It can be used in particular on the sacrum or for fractures of the sacrum or for dislocations of the sacroiliac joint with fixation of the posterior pelvis.

[0085] The screw system 100 comprises or consists of at least one rod 10 with a first end section 11 and a second end section 13. The rod 10 is cannulated throughout, i.e. along its entire longitudinal section. The cannulation allows the screw system 100 to be advanced minimally invasively, i.e. with no or extremely limited visual control by the surgeon, along a previously inserted Kirschner wire and guided by this through tissue and through bone structures (here in particular the pelvis, sacrum).

[0086] The first end section 11 for its part has or comprises a first threaded section 111. The first threaded section 111 can be designed as an internal thread or, as in FIG. 1, as an external thread. The view of the first threaded section 111 is largely obscured in FIG. 1 by an optional, first washer 51 and a compression nut 41, which, like the first washer 51, can be part of the screw system 100.

[0087] Compression nut 41 and washer 51 are both assigned to first end section 11 and can in particular be provided to close off rod 10 or the screw system at the end. The first thread section 111 comprises a metric, preferably double-start or multi-start, thread or consists of such. The mostly metric thread comprises, for example, a cutting edge and is therefore preferably self-tapping.

[0088] The compression nut 41 can be movably connected to the washer 51, in particular in an articulated manner.

[0089] The second end section 13 consists of or comprises an optionally second threaded section 133. The second threaded section 133 can be, preferably as an external thread, a cortical thread and/or self-tapping bone thread or comprise such a thread.

[0090] Between the first end section 11 and the second end section 13, the rod 10 comprises an intermediate section 15, which preferably has no thread on its outside, and the outside diameter of which is preferably smaller than the outside diameter of the second threaded section 133.

[0091] On the first end section 11, the screw system 100 also comprises an optional locking nut 21. This is provided in order to brace the rod 10 or the screw system 100. For this purpose, it may comprise an internal thread 23 (see FIG. 1c). Furthermore, it can be provided to close off the end section at its end, i.e. to form its end.

[0092] In certain embodiments of the screwing system 100, the compression nut 41 and the first washer 51 are connected to a joint section which connects them movably to one another. Optionally, they are unreleasably connected to one another, in any case, preferably without having to cause any damage.

[0093] It can be clearly seen in the example in FIG. 1 that the compression nut 41 comprises a larger outer diameter than the locking nut 21. This can also be different or vice versa in some embodiments.

[0094] In some embodiments, such as that shown in FIG. 1, the screw system 100 according to the present invention also comprises a second washer 53. This can be assigned to the second end section 13 and be provided in order to close off the rod 10 or the screw system 100 at the end.

[0095] The second washer 53 can have a through opening for the second end section 13, which comprises a diameter, a dimension or an opening area which is at least 125% of the corresponding value of the rod at the point at which the washer is placed on the rod in order to remain there.

[0096] The second washer 53 is movably arranged in an axial direction between the second threaded section 133 and a head section 33 of the second end section 13. Here, their freedom of movement in the axial direction is limited by the second threaded section 133 and the head section 33 of the rod 10 and/or in a form-fitting manner by the second threaded section 133 on the one hand and the head section 33 on the other hand. During the production of the rod 10 after the second washer 53 has been threaded onto the rod 10, the head section 33 may have been reshaped by compressing the second end section 13 into a diameter which prevents the second washer 53 from slipping down the rod 10.

[0097] The second end section 13 preferably comprises a front-end engagement opening 333 (or drive) for engaging with the tip of a rotary tool, for example the end of a screwdriver.

[0098] The screw system 100 can comprise a plurality of, at least, two rods 10, 10a configured according to the example in FIG. 1 in different lengths (see FIG. 2).

[0099] It may be provided in accordance with the present invention to identify the second washer 53 or other section of the rod 10, 10a with the length of the corresponding rod.

[0100] FIG. 1a shows the first rod 10 of FIG. 1 without compression nut 41 and without locking nut 21. To avoid repetition, reference is made to the description of FIG. 1.

[0101] FIG. 1b shows an enlarged, slightly perspective representation of the compression nut 41 and the first washer 51 of FIG. 1.

[0102] The same component can be used as washer 51, 53 for both the rod 10 and the compression nut 41.

[0103] FIG. 1c shows an enlarged, slight perspective representation of the locking nut 21 of FIG. 1.

[0104] The internal thread 23 of the locking nut 21 can be clearly seen in FIG. 1c. This is used to screw the locking nut 21 to the first threaded section 111 in order to securely fix the compression nut 41 and thus the rod 10, 10a to or in the pelvis.

[0105] An engagement or drive for placing the rotary tool 220 on the front-end, see exemplary FIG. 3b, can be seen. The locking nut 21 may comprise a Torx engagement or other engagement, in particular for receiving the end section of a rotary tool.

[0106] FIG. 1d shows, in an enlarged sectional representation, the interaction between the head section 33 of a rod 10 (shown only in sections) of the surgical screw connection system 100 in an embodiment and the second washer 53 of this embodiment.

[0107] The second washer 53 has an upperside 55 and an underside 57. The latter faces the center of the rod 10, and the former faces the end of the rod 10.

[0108] The second washer 53 is placed on the head section 33 or the head section 33 is completely or partially inserted into the through opening of the washer 53.

[0109] A first diameter D.sub.U1 and a second diameter D.sub.U2 can be seen in FIG. 1d, wherein the first diameter D.sub.U1 is arranged above (with reference to the representation in FIG. 1d) the second diameter D.sub.U2.

[0110] In the specific example of FIG. 1d it can also be seen that the first diameter D.sub.U1 optionally delimits the opening from the underside 57, and that the second diameter D.sub.U1 optionally delimits the opening on the upperside 55 or forms its end.

[0111] If the first diameter D.sub.U1, as in the example in FIG. 1d, is less than the maximum diameter D.sub.Smax of the head section 33, the second washer 53 cannot slip over the head section 33 and off the rod 10 (upwards in FIG. 1d).

[0112] The changing of a diameter of the washer to the first diameter D.sub.U1 required for this may have been created by pressing or some other deformation of the second washer 53 by the manufacturer.

[0113] The second diameter D.sub.U2 of the through opening may correspond to the maximum diameter D.sub.Umax of the through opening, but this is optional.

[0114] The washer 53 can optionally have a protrusion 59 or a deformation at the upper end of its through opening, which is suitable for reducing the diameter of the through opening at this end so that D.sub.U2<D.sub.Umax applies. This can prevent the washer 53 from sliding over the head section 33 and possibly off the rod 10 (downwards in FIG. 1d).

[0115] What is stated with reference to FIG. 1d for the second washer 53 and the head section 33 can apply analogously to the connection between the first washer 51 and the compression nut 41. They can also be matched to each other by the choice or creation of the diameter ratios described above in such a way that the first washer 51 cannot detach from the compression nut 41, but can still rotate and remain movable in angle, i.e. can tilt.

[0116] FIG. 2 shows a second rod 10a next to the first rod 10. They differ here in their different lengths.

[0117] The design of the rods 10, 10a is analogous to FIG. 1, but without the first washer 51, without the compression nut 41 and without the locking nut 21. To avoid repetition, reference is therefore made to the description of FIG. 1.

[0118] The screw system 100 may comprise a plurality, at least two, of rods 10, 10a of different lengths, the difference in length preferably being 5 mm. In this respect, the shortest rod may preferably be 150 mm, and the longest rod may preferably be 250 mm. However, other lengths are also encompassed by the present invention. The rods may be closed or be able to be closed at each end.

[0119] The rods preferably have a diameter of 7.5 mm. Larger or smaller diameters are also encompassed within the present invention.

[0120] FIG. 3a shows a first rotary tool 210 as part of the instrument set according to the present invention in an embodiment.

[0121] The first rotary tool 210 is designed or dimensioned, in particular cannulated, to receive a second rotary tool 220 (see FIG. 3b), preferably within its entire length. Furthermore, it is designed to be able to screw in or unscrew or tighten or loosen the compression nut 41 via its blade end 210b.

[0122] At the end of the first rotary tool 210 opposite the blade end 210b, a handle section 210a for holding or gripping the rotary tool 210 is provided.

[0123] FIG. 3b shows a second rotary tool 220 as component of the instrument set according to the present invention in an embodiment in a sectional representation.

[0124] The second rotary tool 220 is designed or dimensioned to be able to be inserted into a first rotary tool 210 (see FIG. 3a) and to be able to screw in or unscrew or tighten or loosen the locking nut 21 via its blade end 220b. It is of corresponding length.

[0125] The second rotary tool can preferably be cannulated.

[0126] At that end of the second rotary tool 220 opposite the blade end 220b, a handle section 220a is provided, which in turn serves to make it easier to grip, hold or mechanically operate the rotary tool 200a, or to make this possible.

[0127] FIG. 3c FIG. 3c shows an instrument for determining length 230 as an optional component of an instrument set according to the present invention.

[0128] The instrument for determining length 230 comprises markings or a scale along its longitudinal section. In some embodiments, the markings or the scale can correspond to the lengths of the rods 10, 10 a contained in the screw system 100. In use, the instrument for determining length 230 can advantageously specify or indicate the length of a rod 10, 10a that is to be preferred, to be used, in particular to be inserted, in the sense of a suggestion addressed to the surgeon.

[0129] In certain embodiments, the instrument set 200 further comprises at least one Kirschner wire (not shown in the figures), matched in length and diameter to the dimensions in the field of application of the present invention, preferably having a diameter of 2.8 mm and a length of e.g. 300 mm.

[0130] FIG. 4 shows the first rotary tool 210 of the instrument set according to the present invention of FIG. 3 with the second rotary tool 220 of the instrument set inserted.

[0131] The cannulated first rotary tool 210 for the compression nut 41 is dimensioned both in diameter and length such that it can receive the second rotary tool 220 for the locking nut 21 in its cannulation, at least up to an end region of the cannulation. This is indicated in FIG. 4 via a double arrow.

[0132] In particular, the first rotary tool 210 is configured to retain the compression nut 41 and thus prevent it from rotating with the locking nut 21 when the locking nut 21 is tightened or loosened by the second rotary tool 220.

[0133] A typical application of the present invention may be as follows:

[0134] Access is made through a stab incision over the planned rod entry site on the sacral bone (also: sacrum, level of vertebral body S1).

[0135] The first sacral vertebral body S1 is located with the aid of an image converter.

[0136] The Kirschner wire is inserted in the lateral beam/ray path up to the opposite cortical bone according to the anatomical conditions.

[0137] This is followed by inlet and outlet images and, if necessary, a correction of the wire's position.

[0138] The correct position of the Kirschner wire is preferably verified via a 3D scan. The Kirschner wire should run at an angle of approx. 90° to the fracture gap. Alternatively, the Kirschner wire can be inserted using 3D navigation.

[0139] Using a cannulated twist drill, which may be part of the instrument set 200 according to the present invention, the cortical bone is drilled via the Kirschner wire through the drill sleeve. The Kirschner wire must be completely over-drilled. The over-drilled Kirschner wire is then removed.

[0140] The guide wire (e.g. length 520 mm) is now pushed through the cannulated twist drill which remained in the body. A replacement sleeve, which may also be part of the instrument set 200 according to the present invention, is advanced over the guide wire as far as it will go. The guide wire must be flush with the replacement sleeve.

[0141] The instrument for determining length 230 is then introduced over the guide wire to the opposite cortical bone. For this purpose, it can be wholly or partially cannulated. It can have a longitudinal groove.

[0142] The required rod length can be read directly from the scale of the instrument for determining length 230.

[0143] The instrument for determining length 230 is preferably open on one long side so that the upper part, but less than the full circumference, of the guide wire remains visible in order to be able to compare the end of the guide wire with the scale on the instrument for determining length 230. If the bar length determined in this way lies between two scale values, the longer bar length is preferably selected. The scale thus indicates rod lengths, which is not done in cm or inches, but in allocations to available rods.

[0144] The rod 10 of the screw system 100 according to the present invention is introduced over the guide wire with a cannulated rotary tool, such as a screwdriver.

[0145] The rod 10 most be screwed in until the washer 53 of the second end section 13 rests against the bone.

[0146] From the opposite side, using the first rotary tool 210, the compression nut 41 with washer 51 is screwed over the guide wire onto the first end section 11 of the rod 10 and the desired compression is set.

[0147] Finally, the second rotary tool 220 is used to insert the locking nut 21 through the first rotary tool 210. The distal end of the second rotary tool 220 reaches the end of the cannulation of the first rotary tool 210. While countering the compression nut 41, e.g. by holding the first rotary tool 210, the locking nut 21 can be hand-tightened using the second rotary tool 220.

LIST OF REFERENCE NUMERALS

[0148] 100 surgical screw connection system [0149] 10 rod [0150] 10a rod [0151] 11 first end section [0152] 13 second end section [0153] 15 intermediate section [0154] 21 locking nut [0155] 23 locking nut internal thread [0156] 33 head section [0157] 333 engagement opening [0158] 41 compression nut [0159] 51 first washer [0160] 53 second washer [0161] 55 upperside of the second washer [0162] 57 underside of the second washer [0163] 59 protrusion; deformation [0164] 111 first threaded section [0165] 133 second threaded section [0166] 200 instrument set [0167] 210 first rotary tool (for compression nut) [0168] 210a handle section of first rotary tool [0169] 210b blade end of first rotary tool [0170] 220 second rotary tool (for locking nut) [0171] 220a handle section of second rotary tool [0172] 220b blade end of second rotary tool [0173] 230 instrument for determining length

[0174] D.sub.U1 first diameter of through opening of washer (underside) [0175] D.sub.U2 second diameter of through opening of washer (upperside) [0176] D.sub.Umax maximum diameter of through opening of washer [0177] D.sub.Smax maximum rod diameter (head section)