Method and apparatus for reducing femoral fractures

Abstract

An improved method and apparatus for reducing a hip fracture utilizing a minimally invasive procedure which does not require incision of the quadriceps. A femoral implant in accordance with the present invention achieves intramedullary fixation as well as fixation into the femoral head to allow for the compression needed for a femoral fracture to heal. To position the femoral implant of the present invention, an incision is made along the greater trochanter. Because the greater trochanter is not circumferentially covered with muscles, the incision can be made and the wound developed through the skin and fascia to expose the greater trochanter, without incising muscle, including, e.g., the quadriceps. After exposing the greater trochanter, novel instruments of the present invention are utilized to prepare a cavity in the femur extending from the greater trochanter into the femoral head and further extending from the greater trochanter into the intramedullary canal of the femur. After preparation of the femoral cavity, a femoral implant in accordance with the present invention is inserted into the aforementioned cavity in the femur. The femoral implant is thereafter secured in the femur, with portions of the implant extending into and being secured within the femoral head and portions of the implant extending into and being secured within the femoral shaft.

1 . A prosthetic implant, comprising: 
 a bag;    a fill access providing access to an interior of said bag; and    a tube, said bag secured to an exterior of said tube.    
     
     
         2 . The prosthetic implant of  claim 1 , further comprising: 
 a lag screw, comprising: 
 a shaft, said shaft having an exterior geometry cooperating with an interior geometry of said tube to allow relative axial displacement of said lag screw and said tube; and  
   a screw head, said screw head rotabably connected to said shaft.    
     
     
         3 . The prosthetic implant of  claim 2 , wherein said lag screw shaft includes an interior elongate aperture, and wherein said screw head includes a drive connector for selective engagement with a rotatable drive instrument, said interior elongate aperture of said lag screw shaft providing access to said drive connector.  
     
     
         4 . The prosthetic implant of  claim 2 , wherein said lag screw shaft is curved from a proximal end thereof to a distal end thereof, and wherein said tube is curved from a proximal end thereof to a distal end thereof, said tube and said lag screw shaft having a similar curvature, whereby said lag screw shaft is slidable relative to said tube when said lag screw shaft is placed within said tube.  
     
     
         5 . The prosthetic implant of  claim 1 , further comprising a fill tube, said fill tube providing said access.  
     
     
         6 . The prosthetic implant of  claim 5 , wherein said fill tube has a length, said length sized to allow retrograde filling of said bag.  
     
     
         7 . The prosthetic implant of  claim 1 , further comprising: 
 a substantially V-shaped expansion bar positioned within said bag.    
     
     
         8 . A guide plate for guiding a plurality of instruments utilized to reduce a bone fracture, comprising: 
 a guide plate body having a central aperture through which said instruments can pass, said guide plate including means for selectively locking an instrument guide thereto; and    a means for affixing said guide plate to the bone.    
     
     
         9 . The guide plate of  claim 8 , wherein said means for affixing said guide plate to the bone comprises a plurality of screws cooperating with a plurality of screw apertures in said guide plate.  
     
     
         10 . The guide plate of  claim 8 , wherein said means for affixing said guide plate to the bone comprises a cannulated fixation screw including a fixation screw head with a plurality of resilient fingers depending therefrom, said resilient fingers having threads thereon, said fixation screw abutting a shoulder of said guide plate when said resilient fingers are positioned through said central aperture.  
     
     
         11 . A straight reamer, comprising: 
 a straight reamer guide tube having an elongate aperture formed therein; and    a straight reamer shaft located in said elongate aperture of said straight reamer guide tube, said reamer shaft including a straight reamer head on a distal end thereof, said straight reamer shaft further including a flange, said straight reamer guide tube positioned intermediate said flange and said straight reamer head.    
     
     
         12 . A swivel reamer, comprising: 
 a swivel reamer guide tube having a pivot pivotally connected thereto, said pivot having a longitudinal aperture;    a swivel reamer shaft located in said longitudinal aperture of said pivot, said swivel reamer shaft having a pair of flanges abutting opposing ends of said pivot; and    a swivel reamer head formed on a distal end of said swivel reamer shaft, said swivel reamer head protruding from said swivel reamer guide tube;    said swivel reamer guide tube including a cutout, whereby said swivel reamer shaft traverses said cutout when said pivot pivots relative to said swivel reamer guide tube.    
     
     
         13 . A curved reamer, comprising: 
 a curved reamer guide tube including a curved guide channel; and    a curved reamer shaft positioned in said curved guide channel, whereby said curved reamer shaft can be advanced through said curved reamer guide channel, said curved reamer shaft including a reamer head on a distal end thereof.    
     
     
         14 . An angled guide tube/retractor, comprising: 
 a tubular distal end including a means for selectively affixing the guide tube/retractor to a guide plate; and    a tubular retractor body, said distal end having a distal end longitudinal axis, said retractor body having a retractor body longitudinal axis, said distal end longitudinal axis forming an acute angle with said retractor body longitudinal axis.    
     
     
         15 . The angled guide tube/retractor of  claim 14 , wherein said acute angle measures 10 degrees.  
     
     
         16 . An alignment device for choosing a guide tube/retractor through which a medical procedure will be performed, comprising: 
 an insertion member having an exterior geometry cooperating with a hollow interior of the guide tube/retractor to allow insertion of said insertion member into the guide tube/retractor, whereby said insertion member is substantially prohibited from rotating about an axis perpendicular to a longitudinal axis thereof when said insertion member is inserted in the guide tube/retractor;    a transverse bar connected to said insertion member; and    an alignment arm slidably attached to said transverse bar, said alignment arm having a distal end, said distal end having a shape substantially matching a biological landmark, said distal end aligning with said biological landmark when the appropriate guide tube/retractor is utilized.    
     
     
         17 . A combination reamer, comprising: 
 a combination reamer guide tube having a pivot pivotally connected thereto, said pivot having a longitudinal aperture;    a combination reamer shaft located in said longitudinal aperture of said pivot;    a combination reamer head formed on a distal end of said combination reamer shaft, said combination reamer head protruding from said combination reamer guide tube;    said combination reamer guide tube including a cutout, whereby said combination reamer shaft traverses said cutout when said pivot pivots relative to said swivel reamer guide tube;    a reamer shaft tube slidably connected about said combination reamer shaft, said pivot positioned on said combination reamer shaft intermediate a distal flange of said combination reamer shaft and a distal end of said reamer shaft tube;    a lock mechanism for selectively locking said reamer shaft tube to said combination reamer shaft; and    a swivel/plunge reaming selector rotatably connected to said combination reamer guide tube, said swivel/plunge reaming selector having a selector cutout, said swivel/plunge reaming selector being rotatable relative to said combination reamer guide tube to a first position in which said selector cutout is aligned with said combination reamer guide tube cutout to allow for rotation of said pivot to effect swivel reaming, said swivel/plunge reaming selector being further rotatable relative to said combination reamer guide tube to a second position in which said selector cutout is not aligned with said combination reamer guide tube cutout to prevent rotation of said pivot and thereby prevent swivel reaming.    
     
     
         18 . A flexible reamer guide, comprising: 
 a flexible reamer guide tube including a substantially straight elongate guide wire aperture; and    a guide wire positioned in said guide wire aperture, said guide wire including a distal end having a curvature, said guide wire formed from a shape memory substance, whereby said guide wire will retain said curvature after being deflected, whereby said guide wire is deflected when the distal end is positioned in said guide wire aperture.    
     
     
         19 . The flexible reamer guide of  claim 18 , wherein said flexible reamer guide tube further includes an elongate guide channel, said flexible reamer guide further comprising: 
 a guide position in said guide channel, said guide wire secured to said guide, whereby said guide controls the position of said guide wire in said guide wire aperture, and whereby relative axial displacement of said guide relative to said flexible reamer guide tube causes relative axial displacement of said guide wire relative to said flexible reamer guide tube.    
     
     
         20 . The flexible reamer guide of  claim 19 , wherein said flexible reamer guide tube further includes an elongate advance/retract screw aperture, said flexible reamer guide further comprising: 
 an advance/retract screw positioned in said advance/retract screw aperture, said advance/retract screw including an advance/retract screw flange, said guide including a proximal flange, said advance/retract screw threadably connected to said flexible reamer guide tube, whereby rotation of said advance/retract screw in a first direction causes said advance/retract screw to be axially displaced relative to said flexible reamer guide tube and further causes engagement of said advance/retract screw flange with said proximal flange of said guide to thereby effect axial displacement of said guide and said guide wire relative to said flexible reamer guide tube.    
     
     
         21 . A flexible reamer guide wire bender, comprising: 
 a flexible reamer guide wire bender guide tube including an elongate guide wire aperture;    a guide wire positioned in said guide wire aperture;    a means for shaping said guide wire connected to a distal end of said flexible reamer guide wire bender guide tube; and    a means for advancing said guide wire through said means for shaping to thereby shape said guide wire.    
     
     
         22 . The flexible reamer guide wire bender of  claim 21 , wherein said means for shaping said guide wire comprises: 
 a wire shaping head pivotally connected to said flexible reamer guide wire bender guide tube;    a pair of rollers rotatably connected to said wire shaping head; and    an adjustment screw threadably engaged with said flexible reamer guide wire bender guide tube, said adjustment screw having a distal end for contacting said wire shaping head and rotating said wire shaping head relative to said flexible reamer guide wire bender guide tube, whereby said guide wire contacts said rollers and is thereby shaped as said means for advancing advances said guide wire therethrough.    
     
     
         23 . A flexible reamer guide wire bender, comprising: 
 a flexible reamer guide wire bender guide tube including an elongate guide wire aperture;    a guide wire positioned in said guide wire aperture;    a wire shaping head pivotally connected to a distal end of said flexible reamer guide wire bender guide tube;    a pair of rollers rotatably connected to said wire shaping head; and    an adjustment screw threadably engaged with said flexible reamer guide wire bender guide tube, said adjustment screw having a distal end for contacting said wire shaping head and rotating said wire shaping head relative to said flexible reamer guide wire bender guide tube, said guide wire contacting said rollers as said guide wire exits said distal end of said flexible reamer guide wire bender guide tube.    
     
     
         24 . The flexible reamer guide wire bender of  claim 23 , further comprising: 
 a means for advancing said guide wire through said wire shaping head.