Craniofacial Fracture Reduction Assembly

Abstract

A Craniofacial Fracture Reduction Assembly is disclosed, the assembly providing a surgeon with precise control over the surgical reduction of fractured craniofacial bone pieces. The fracture reduction assembly may include a reduction platform, and a threaded fragment manipulator. The reduction platform has top and bottom surfaces and at least one receiving hole in communication therewith. The receiving hole is configured to accept a fragment manipulator. The fragment manipulator may comprise an elongated member having a bone engaging portion for engaging a targeted fractured bone piece and a center threaded portion. Working in combination with a reduction nut, the fragment manipulator provides accurate control over the fragment reduction vector. In use, the bone engaging end of the fragment manipulator is inserted through the receiving hole in the reduction platform and then into the fracture region where it engages the targeted fractured bone piece. Thereafter a reduction nut is threaded onto the non-engaged end of the fragment manipulator until the nose of the nut contacts the reduction platform. Continued rotation of the nut causes the fragment manipulator to be drawn up through the reduction nut, pulling the bone fragment toward the reduction platform, thereby reducing the fracture. Also disclosed is an adjustable support assembly, which may be used to position the reduction platform in a wide variety of locations above the fracture region.

1 . A fracture reduction assembly comprising:
 a reduction platform having at least one receiving hole, the reduction platform having a position that is adjustable in three dimensions;   a fragment manipulator having a bone engaging end and a threaded portion, the manipulator having a portion which is sized to fit within the at least one receiving hole, the bone engaging end configured to be inserted into a bone fragment of a bone fracture region and to attach to the bone fragment such that the bone fragment can be pulled toward the reduction platform to reduce the fracture as the fragment manipulator translates through the receiving hole; and   a nut configured to threadably engage the fragment manipulator threaded portion at a location above the reduction platform and to engage a top surface of the platform, the reduction platform being between the nut and the bone engaging end when the manipulator is positioned through the receiving hole.   
   
   
       2 . The reduction assembly of  claim 1 , wherein the fragment manipulator has a second end opposite the bone engaging end, and a central portion extending between the bone engaging end and the second end, the central portion having a first diameter, the at least one receiving hole having a second diameter, the second diameter being larger than the first diameter. 
   
   
       3 . The reduction assembly of  claim 2 , wherein the second end of the fragment manipulator includes a tool engaging portion. 
   
   
       4 . The reduction assembly of  claim 3 , wherein the tool engaging portion has a coupling surface for engaging a drive assembly. 
   
   
       5 . The reduction assembly of  claim 1 , wherein the bone engaging end has a self-drilling tip. 
   
   
       6 . The reduction assembly of  claim 1 , wherein the bone engaging end has a first portion and a second portion, the first portion has threads that increase in diameter as they move away from a tip, while the second portion has uniform diameter threads. 
   
   
       7 . The reduction assembly of  claim 1 , wherein the fragment manipulator comprises an elongated member having a length and a central cross section, the bone engaging end has a first outer diameter, and the central cross section has a second outer diameter, the second outer diameter being larger than the first outer diameter and forming a stop. 
   
   
       8 . The reduction assembly of  claim 1 , wherein the nut further includes a nose for engaging the top surface of the reduction platform, the nose being configured to facilitate angular adjustment of the fragment manipulator with respect to the reduction platform. 
   
   
       9 . The reduction assembly of  claim 8 , wherein the nose is spherical for engaging a countersunk receiving hole formed in the top surface of the reduction platform. 
   
   
       10 . The reduction assembly of  claim 1 , wherein the reduction platform has a plate-like configuration. 
   
   
       11 . The reduction assembly of  claim 10  wherein the reduction platform includes multiple receiving holes sized and configured to receive the fragment manipulator. 
   
   
       12 . The reduction assembly of  claim 11 , wherein at least one of the multiple receiving holes is countersunk. 
   
   
       13 . The reduction assembly of  claim 1 , wherein the reduction platform includes a plurality of support legs for supporting the reduction platform above a targeted bone region. 
   
   
       14 . The reduction assembly of  claim 13 , wherein the support legs include a fixation end sized and adapted for connection with a fixation element formed in the reduction platform. 
   
   
       15 . The reduction assembly of  claim 1 , wherein the reduction platform is supported above a targeted bone region by a supporting system. 
   
   
       16 . The reduction assembly of  claim 15 , wherein the supporting system comprises an external frame including a head support plate and a plurality of post assemblies. 
   
   
       17 . The reduction assembly of  claim 16 , further comprising an adjusting mechanism for varying the location of the post assemblies with respect to the head support plate. 
   
   
       18 . The reduction assembly of  claim 17 , wherein the adjusting mechanism includes at least one sliding track adjustment assembly and at least one sliding plate sized and configured to slidably engage the sliding track to permit the position of the post assembly to be adjusted with respect to the head support plate. 
   
   
       19 . The reduction assembly of  claim 17 , wherein the adjustment mechanism comprises a plurality of hole adjustment assemblies placed at various locations on the head support plate for engaging the post assemblies. 
   
   
       20 . The reduction assembly of  claim 17 , wherein the adjustment mechanism comprises a combination of sliding track adjustment assemblies and hole adjustment assemblies. 
   
   
       21 . The reduction assembly of  claim 16 , wherein the post assembly comprises a vertical connecting post having a first end and a second end, a connecting rod having a first end and a second end, and an adjustable clamp, the first end of the vertical connecting post is sized and configured to engage the head support table, the first end of the connecting rod is sized and configured to engage the reduction platform, and the second end of the vertical connecting rod and the second end of the connecting rod are sized and configured to engage the adjustable clamp. 
   
   
       22 . The reduction assembly of  claim 21 , wherein the adjustment clamp is configured to permit three dimensional adjustment of the reduction platform with respect to the head support plate. 
   
   
       23 . The reduction assembly of  claim 21 , wherein the first end of the connecting rod is connected to the reduction platform by a universal joint. 
   
   
       24 . The reduction assembly of  claim 16 , wherein the support system further includes at least one head stabilizing assembly having a support plate engaging portion sized and configured to engage the head support plate and a fixation pin engaging portion sized and configured for receiving a skull fixation pin. 
   
   
       25 . The reduction assembly of  claim 1 , wherein the reduction platform is a mask-like structure. 
   
   
       26 . The reduction assembly of  claim 25 , wherein the mask-like structure includes a plurality of fixation elements sized and configured to permit connection of the mask to a support assembly for positioning the mask-like structure above the patient's skull. 
   
   
       27 . The reduction assembly of  claim 1 , wherein the reduction platform is a rectangular plate having an arched profile. 
   
   
       28 . The reduction assembly of  claim 27 , wherein the arched profile rectangular plate is sized and configured to extend from one side of a patient's bone to another side, with the top of the arched platform positioned over the targeted bone region. 
   
   
       29 . The reduction assembly of  claim 28 , further comprising a head support table having a plurality of post assemblies, each of the post assemblies being sized and configured to engage an end of the arched profile rectangular plate. 
   
   
       30 . The reduction assembly of  claim 29 , wherein each post assembly comprises a vertical connecting post having a first end sized and configured for fixation to the head support plate, and a post to platform clamp sized and adapted to interconnect the post assembly with the arched profile rectangular plate. 
   
   
       31 . The reduction assembly of  claim 1 , wherein the reduction platform is a cylindrical bar. 
   
   
       32 . The reduction assembly of  claim 31 , wherein the cylindrical bar includes at least a portion having a flat surface. 
   
   
       33 . The reduction assembly of  claim 31 , further comprising a supporting system sized and configured to position the cylindrical bar over a targeted bone region. 
   
   
       34 . The reduction assembly of  claim 33 , wherein the support system includes a head support plate and a plurality of support members having an arched profile sized and configured to extend from one side of the head support plate to another side of the head support plate, with the top of the arch support members being configured to extend over the patient's targeted bone. 
   
   
       35 . The reduction assembly of  claim 34 , wherein the cylindrical bar includes a connection clamp having a first bore and a second bore, the first bore being sized and configured to receive the cylindrical bar and the second bore being sized and configured to receive the arched support member. 
   
   
       36 . The reduction assembly of  claim 35 , further comprising a thumb wheel having an internally threaded sleeve for engaging an externally threaded portion on the cylindrical bar wherein the sleeve of the thumb wheel is sized and configured to be installed between the first bore and the cylindrical bar for incrementally adjusting the position of the bar with respect to the supporting system. 
   
   
       37 . The reduction assembly of  claim 1 , wherein the at least one receiving hole includes an insert, the insert having an axial bore sized and configured to receive the fragment manipulator. 
   
   
       38 . The reduction assembly of  claim 37 , wherein the insert is articulable within at least a portion of the receiving hole to permit angulation of the fragment manipulator with respect to the reduction platform. 
   
   
       39 . The reduction assembly of  claim 37 , wherein the insert is an articulating washer having a nut engaging portion and a spherical portion, the nut engaging portion being sized and configured to provide a bearing surface for the nut while the spherical portion is sized and configured to engage the at least one receiving hole. 
   
   
       40 . The reduction assembly of  claim 37 , wherein the insert is a collar with at least one vertical slot and a spherical outer surface sized and configured to articulate within a correspondingly spherical inner surface of the at least one receiving hole. 
   
   
       41 . A fracture reduction assembly for manipulating bone pieces comprising:
 a reduction platform having at least one receiving hole;   a supporting system, the supporting system attached to the reduction platform in at least two locations; and   a fragment manipulator having a bone engaging end, a portion sized to fit within the at least one receiving hole, and a threaded section extending into the receiving hole and beyond a surface of the reduction platform opposite the bone engaging end when the fragment manipulator is positioned through the receiving hole, the threaded section configured to allow translation of the fragment manipulator through the receiving hole to reduce a patient's bone, the bone engaging end having a thread attachable to a bone fragment such that the bone fragment can be pulled toward the reduction platform as the fragment manipulator translates.   
   
   
       42 . The assembly of  claim 41 , further comprising a nut, the nut having a threaded portion configured to threadably engage the threaded section, the nut further having an exterior surface configured to engage a top surface of the platform opposite the bone engaging end. 
   
   
       43 . The assembly of  claim 41 , wherein at least a portion of the receiving hole has threads configured to threadably engage the threaded section of the fragment manipulator. 
   
   
       44 . The assembly of  claim 41 , wherein the fragment manipulator has a second end opposite the bone engaging end, and a central portion extending between the bone engaging end and the second end, the central portion having a first diameter, the at least one receiving hole having a second diameter, the second diameter being larger than the first diameter. 
   
   
       45 . The assembly of  claim 44 , wherein the second end of the fragment manipulator includes a tool engaging portion. 
   
   
       46 . The assembly of  claim 41 , wherein the bone engaging end has a self-drilling tip. 
   
   
       47 . The assembly of  claim 41 , wherein the fragment manipulator comprises an elongated member having a length and a central cross section, the bone engaging end has a first outer diameter, and the central cross section has a second outer diameter, the second outer diameter being larger than the first outer diameter and forming a stop. 
   
   
       48 . The assembly of  claim 41 , wherein the reduction platform has a plate-like configuration. 
   
   
       49 . The assembly of  claim 41 , wherein the reduction platform includes a plurality of support legs for supporting the reduction platform above a targeted bone region. 
   
   
       50 . The assembly of  claim 41 , wherein the support legs include a fixation end sized and adapted for connection with a fixation element formed in the reduction platform. 
   
   
       51 . The assembly of  claim 41 , wherein the reduction platform is supported above a targeted bone region by the supporting system. 
   
   
       52 . The assembly of  claim 51 , wherein the supporting system comprises an external frame including a head support plate and a plurality of post assemblies. 
   
   
       53 . The assembly of  claim 52 , further comprising an adjusting mechanism for varying the location of the post assemblies with respect to the head support plate. 
   
   
       54 . The assembly of  claim 53 , wherein the adjusting mechanism includes at least one sliding track adjustment assembly and at least one sliding plate sized and configured to slidably engage the sliding track to permit the position of the post assembly to be adjusted with respect to the head support plate. 
   
   
       55 . The assembly of  claim 53 , wherein the adjustment mechanism comprises a plurality of hole adjustment assemblies placed at various locations on the head support plate for engaging the post assemblies. 
   
   
       56 . The assembly of  claim 53 , wherein the adjustment mechanism comprises a combination of sliding track adjustment assemblies and hole adjustment assemblies. 
   
   
       57 . The assembly of  claim 52 , wherein the post assembly comprises a vertical connecting post having a first end and a second end, a connecting rod having a first end and a second end, and an adjustable clamp, the first end of the vertical connecting post is sized and configured to engage the head support table, the first end of the connecting rod is sized and configured to engage the reduction platform, and the second end of the vertical connecting rod and the second end of the connecting rod are sized and configured to engage the adjustable clamp. 
   
   
       58 . The assembly of  claim 57 , wherein the adjustment clamp is configured to permit three dimensional adjustment of the reduction platform with respect to the head support plate. 
   
   
       59 . The assembly of  claim 52 , wherein the support assembly further includes at least one head stabilizing assembly having a support plate engaging portion sized and configured to engage the head support plate and a fixation pin engaging portion sized and configured for receiving a skull fixation pin. 
   
   
       60 . The assembly of  claim 41 , wherein the reduction platform is a mask-like structure. 
   
   
       61 . The assembly of  claim 60 , wherein the mask-like structure includes a plurality of fixation elements sized and configured to permit connection of the mask to a support assembly for positioning the mask-like structure above the patient's skull. 
   
   
       62 . The assembly of  claim 41 , wherein the reduction platform is a rectangular plate having an arched profile. 
   
   
       63 . The assembly of  claim 62 , wherein the arched profile rectangular plate is sized and configured to extend from one side of a patient's bone to another side, with the top of the arched platform positioned over the targeted bone region. 
   
   
       64 . The assembly of  claim 63 , further comprising a head support table having a plurality of post assemblies, each of the post assemblies being sized and configured to engage an end of the arched profile rectangular plate. 
   
   
       65 . The assembly of  claim 64 , wherein each post assembly comprises a vertical connecting post having a first end sized and configured for fixation to the head support plate, and a post to platform clamp sized and adapted to interconnect the post assembly with the arched profile rectangular plate. 
   
   
       66 . The assembly of  claim 41 , wherein the reduction platform is a cylindrical bar. 
   
   
       67 . The assembly of  claim 66 , wherein the cylindrical bar includes at least a portion having a flat surface. 
   
   
       68 . The assembly of  claim 67 , wherein the supporting system is sized and configured to position the cylindrical bar over a targeted bone region. 
   
   
       69 . The assembly of  claim 68 , wherein the support system includes a head support plate and a plurality of support members having an arched profile sized and configured to extend from one side of the head support plate to another side of the head support plate, with the top of the arch support members being configured to extend over the patient's targeted bone. 
   
   
       70 . The assembly of  claim 69 , wherein the cylindrical bar includes a connection clamp having a first bore and a second bore, the first bore being sized and configured to the receive the cylindrical bar and the second bore being sized and configured to receive the arched support member. 
   
   
       71 . The reduction assembly of  claim 70 , further comprising a thumb wheel having an internally threaded sleeve for engaging an externally threaded portion on the cylindrical bar wherein the sleeve of the thumb wheel is sized and configured to be installed between the first bore and the cylindrical bar for incrementally adjusting the position of the bar with respect to the supporting system. 
   
   
       72 . The assembly of  claim 41 , wherein the supporting system comprises a head support plate and a plurality of support members, wherein the plurality of support members support the reduction platform. 
   
   
       73 . The assembly of  claim 72 , wherein the plurality of support members are configured to translate linearly in an anterior-posterior direction in relation to the head support plate. 
   
   
       74 . The assembly of  claim 73 , wherein the plurality of support members are arched.