Surgical Compression Plate

This invention relates to compression plates for use in reducing bone fractures. In particular it relates to an improved compression plate which is easier for the surgeon to use and reduces the danger of placing excessive load on the screws used to secure the plate.

The compression plate described and claimed in U.S. Pat. No. Re 28,841 has one or more elongated holes or slots for receiving screws, preferably round headed screws, in which the sides of the slots are sloped inwardly and downwardly in cylindrical configuration so that when the screw is advanced into the bone the bone fragments are brought together by a camming action and then compressed. Further description of this and other styles of compression plates may be found in the following references:

Allgower et al., The Dynamic Compression Plate DCP, Berlin/Heidelberg/New York, Springer-Verlag (1973)

Mueller et al., Manual der Osteosynthese (AO Technik), 2nd Edition, Berlin/Heidelberg/New York, Spring Verlag (1977)

Swiss Patent Nos:

468 824

600 862

611 147

613 616

613 858

In using compression plates of this general type one may identify three steps in the reduction of the fracture, viz:

A. Longitudinal displacement, in which the fragments are brought into contact

B. Compression, in which the fragments are pressed together

C. Fixation of the plate, the point at which the screw is seated in the hole in the plate.

With prior designs, the screw head moved down into the plate slot in a more or less straight line, i.e., the locus of the successive positions of the center of the screw head as the screw was advanced into the bone was substantially a straight line. Because the resistance to the screw varied as the screw advanced, the torque exerted on the screw increased as a more or less smooth curve. One difficulty with this was that the surgeon inserting the screw could not be certain, from the resistance encountered, when the screw was fully seated. As a result it occasionally happened that screws would be bent or deformed.

In accordance with the present invention these difficulties are avoided by providing a compression plate having elongated holes or slots whose side surfaces are sloped inwardly and downwardly with variable slope, bowing outwardly in the direction of the hole opening or longitudinal screw displacement, the slope being designed to maintain constant torque or gradually increasing torque during the longitudinal displacement and compression stages, with a sudden, abrupt increase in torque as the screw is seated; or, preferably, with a diminution of the torque toward the end of the compression stage followed by a sudden increase as the screw is seated.

The invention will be further described with reference to the accompanying drawings in which:

FIGS. 1A to 1C are views taken in side elevation and partly in vertical section of a plate according to the invention, together with a screw in various positions corresponding to the longitudinal displacement, compression and seating stages.

FIG. 2 is a curve of the points of tangency of a spherical screw head and the wall of the elongated hole or slot in a plate according to the invention.

FIG. 3 is a diagram showing the relationship of forces in the longitudinal displacement phase with a system according to the invention.

FIG. 4 is a diagram showing the relationship of forces toward the end of the compression phase with a system according to the invention.

FIG. 5 is a graph of torque and displacement comparing a plate according to the invention with a more conventional plate.

FIG. 6 is a diagram representing, in a simplified way, the locus of the center of a screw head used with a plate of preferred design according to the invention.

FIG. 7 is a diagrammatic view of a plate according to the invention, illustrating the initial and final positions of the screw.

FIG. 8 is a graph of torque vs. displacement for a plate of preferred design according to the invention.

Referring to FIGS. 1A to 1C, a system according to the invention comprises a plate 1 having an elongated hole or slot 7 and a screw 3 having a head 5 which is preferably, but not necessarily hemispheric in shape. The side walls of the slot are sloped inwardly and downwardly to provide a surface 11 against which the bottom surface of the screw bears as it is advanced vertically downwardly into the bone (not shown). The effect of this plate/screw contact is to move the screw longitudinally along the axis of the plate. FIG. 1A shows the screw at the beginning of its travel. FIG. 1B shows the screw advanced downwardly into the bone and displaced longitudinally to the right. FIG. 1C shows the screw seated in the slot. It will be observed that the screw in FIG. 1C can still have longitudinal displacement. Thus the effect of other screws in the same plate can be provided for.

In accordance with the invention, the travel of the screw longitudinally is not a straight line but is a combination of intersecting straight lines or a curve which bows outwardly in the direction of longitudinal displacement. This can be observed from FIGS. 1A-1C where the locus of a point at the center of the screw head, as displacement occurs, is shown by line 13. As depicted in FIGS. 1A-1C the slope of curve 13 is intended as illustrative rather than definitive.

FIG. 2 is a graph of the points of contact of the plate and screw in a vertical plane through the axis of the plate. As shown in FIG. 2 in phase A the slope of the curve at a point of contact is about 43.degree.; in phase B it increases and at the point shown is 63.degree.. The result of this in terms of forces in the two major directions is shown in FIGS. 3 and 4. In this particular case the relationship between F.sub.XA, the force in the X direction in phase A, and F.sub.XB, the force in the X direction in phase B is

In FIGS. 3 and 4, is a function of the friction between screw and plate.

In designing a plate according to the invention the movement of the screw head can be considered in terms of two straight lines of different slope. This is illustrated in FIG. 6 where the screw moves from the initial point of contact A along an upper path 30 which makes an angle .theta..sub.1 with the horizontal to a point (X.sub.1, Y.sub.1). At the lower section of its travel, from a point (X.sub.2, Y.sub.2) to point B, the path 31 of the screw head is more nearly vertical, making an angle .theta..sub.2 with the horizontal. In some instances the points (X.sub.1, Y.sub.1) and (X.sub.2, X.sub.2) may coincide, i.e., the travel may be two intersecting straight lines. However, in many instances it will be impractical for the two paths to meet at an angle, and points (X.sub.1, Y.sub.1) and (X.sub.2, Y.sub.2) will be joined by a curve 32 which is preferably the arc of a circle having a radius Rc. Useful values for Rc may be determined by the following relationship, where t and .delta. are the total vertical and maximum horizontal screw travels, respectively.

It is to be understood, however, that it is not critical for Rc to have a value conforming to this relationship.

A complete description of the screw travel (locus of the center of the screw head) can be expressed mathematically as follows: ##EQU1##

In order that the surgeon may have the clearest possible indication that the screw has been fully inserted, it is desirable that the torque just prior to the seating phase be minimized to provide a constrast with the increase in torque observed at seating. Hence, it is desirable that the slope angle of the terminal section of the slot surface be maximized. Given a few basic conditions maximum values for the slope of the terminal section and the minimum initial angle can be calculated by trial and error using any conventional computer.

The chief constraints to be considered are minimum and maximum plate thickness, minimum and maximum horizontal travel and the minimum vertical travel for the terminal portion of the screw travel. The plate thickness is obviously determined by the particular application, but typically is from 3.6 to 3.9 mm. Horizontal travel also depends on the purpose but is typically 1-2 mm. The minimum vertical travel will depend on screw size and pitch but should conform to at least 270.degree. of screw rotation, or in general at least 1.27 mm.

If desired, a more refined determination can be made, taking additional constraints into account. One of these is the ratio, travel length (of the center of the screw head)/contact length, which is a measure of the plate abrasion. Referring to FIG. 6, points D and E represent the initial and final contact points (or contact lines) between the plate and the screw head, R.sub.s being the radius of the screw head (shown greatly foreshortened in FIG. 6). To a first approximation, the ratio referred to, designated FR, is: ##EQU2## where DE is the distance between D and E, t is the total vertical travel, and .delta. is the maximum horizontal travel.

It has been found experimentally that this ratio should be approximately 2.0.

Another constraint which may be taken into account is the so-called corner sharpness, the abruptness of transition from the initial angle, to the terminal angle. To estimate this factor, the travel path is represented by a third order polynomial.

The constants are solved for using the initial and final points and slopes:

1. When X=0, Y=t

2. When X=.delta., Y=0

3. At X=0, dy/dx=-tan .theta..sub.1

4. At X=.delta., dy/dx=-tan .theta..sub.2

The "corner sharpness" is then the second derivative of Y with respect to X,

To allow for the effect of the area in which the transition occurs, the product (.delta..multidot.t).sup.-1 is taken with the above, to give the final factor, designated SH: ##EQU3## A value of 0.55 or less has been found acceptable for this factor.

The following program (Fortran 77) has been developed for obtaining the maximum final angle and minimum initial angle and the other parameters of the system, namely, the location of the screw head at the initial and final positions relative to a chosen origin (R.sub.1, R.sub.2), the total horizontal travel, the total vertical travel, the vertical travel in the steep portion (YC), the FR factor, the SH factor and the plate thickness, give limiting values for horizontal travel (minimum and maximum) minimum vertical travel for the steep portion, maximum FR, maximum SH, and minimum and maximum plate thickness. Referring to FIG. 7, the radii R.sub.1 and R.sub.2 at the initial and final positions of the screw are taken from an arbitrary origin at the level of the bottom of the screw head when fully seated and at a point 7.25 mm from the center of the screw when fully seated. Any other convenient origin could equally well be chosen. Distances a, b and c represent the longitudinal distances along the axis of the plate corresponding to displacement, compression and seating. Distances a' and b' represent travel of the center of the screwhead on plates a and b. The point c' is the position of the center of the screwhead when the screwhead is seated. ##SPC1##

As an example, using the foregoing program and given a horizontal travel of 1-2 mm, a minimum vertical travel in the steep portion of 1.27 mm, an FR maximum of 2.50, an SH maximum of 0.55 and a plate thickness of 3.6-3.9 mm, a maximum final angle of 71.3.degree. was obtained with a minimum initial angle of 51.0.degree.. For this the radii R.sub.1 and R.sub.2 of the initial and final positions were 8.00 mm. The total horizontal travel was 1.36 mm, total vertical travel was 2.47 mm, vertical travel in the steep portion was 1.36 mm, FR was 2.05, SH was 0.51 and plate thickness 3.89 mm.

Using a plate so defined, with an Rc of 2 mm, when torque is plotted against displacement, the results are qualitatively shown in FIG. 8. As shown in that figure, the torque decreases sharply as the screw nears the end of the compression stage, and encounters the steep slope indicated at 31 in FIG. 6. When it finally enters the seating phase the sudden increase in torque is easily appreciated by the surgeon who is thus notified in unmistakeable terms that the screw has been seated.

When the invention has been described in terms of a hemispherically shaped screw head, it is obvious that other shapes may be used, requiring only a suitable variation in the shape of the milling tool.