US20090248091A1 - Sternal clamp with rib extension - Google Patents

Abstract

A sternal closure clamp device for securing and retaining longitudinally divided halves of a sternum, the device having a pair of body members each having engagement members adapted to abut the sides of the sternal halves, and at least one rib extension member having rib retaining means attached to at least one of said body members, such that the rib extension member can be secured to a rib to reduce the force being applied directly to the sternal halves.

Description

• This application claims the benefit of U.S. Provisional Patent Application Ser. No. 61/069,982, filed Mar. 19, 2008.
BACKGROUND OF THE INVENTION
• This invention generally relates to devices used to rejoin a human sternum that has been severed longitudinally, and more particularly relates to such devices that function in a clamping manner to retain the severed sternum portions in a closed and abutting relationship post-operatively.
• It is often necessary in surgical operations to longitudinally sever the patient's sternum so that the ribs may be spread to provide access to internal organs such as the heart. It is then necessary to secure the sternum halves together for post-operative recovery. Various closure techniques are used to accomplish this task. For example, holes may be drilled into the sternum halves and suture material passed through and tightened to cinch the sternum halves together. Apertured plates may be added to further rigidify the sternum post-operatively, with the suture material being passed through the apertures in the plate and the sternum. Encircling members may be wrapped around the sternum and tightened. Toothed bridging members extending across the cut line may be pressed into the sternum surfaces and/or secured with threaded rods extending between the sternal halves.
• Another sternal closure technique involves the use of clamps having hook-like projections or engagement members on both ends, the clamp being positioned laterally relative to the sternal incision with the projections being disposed between adjoining rib pairs on opposite sides of the sternum. The clamp is then linearly contracted or compressed to shorten the device and force the sternal halves together, the clamp typically comprising two members joined in a linearly telescoping manner. Locking or securing means, either permanent or releasable, maintain the clamp in the contracted configuration so that the sternum can heal.
• Examples of such techniques and devices are described in U.S. Pat. No. 3,473,528 to Mishkin et al., U.S. Pat. No. 4,201,215 to Crossett et al., U.S. Pat. No. 4,279,248 to Gabbay, U.S. Pat. No. 4,583,541 to Barry, U.S. Pat. No. 5,139,498 to Astudillo Ley, U.S. Pat. No. 6,051,007 to Hogendijk et al., U.S. Pat. No. 6,217,580 to Levin, U.S. Pat. No. 6,302,899 to Johnson et al., U.S. Pat. No. 6,540,769 to Miller, III, and U.S. Pat. No. 6,712,821 to Gabbay the disclosures of which are herein incorporated by reference.
• In certain circumstances, the strength and rigidity of the sternum may be insufficient to withstand the compressive forces of the sternal clamp, such that the sternum may be damaged upon compression of the sternal clamp or such that overtime the weakness of the sternum results in damage from the clamp. It is an object of this invention to provide a sternal closure clamp device having at least one rib extension member such that the clamp may be secured directly to the rib a distance away from the sternum, such that the compressive forces of the sternal clamp are dispersed between the sternum and the rib.
SUMMARY OF THE INVENTION
• The invention is in general a sternal closure clamp device for post-operatively closing, securing and supporting a patient's sternum that has been longitudinally severed into two sternal halves. The sternal clamp generally comprises two body members each preferably having a pair of spaced, sternum-engaging engagement members extending rearward from the body member.
• The engagement members are means to engage, secure or otherwise retain the sternal halves in an abutting relationship, with the engagement members comprising hooks, projections, fingers or the like extending in the posterior direction, whereby the engagement members can be disposed against the outer edges of the sternal halves and between adjoining ribs, preferably with the two engagement members located on a given side being positioned in the inter-rib spaces to either side of a single rib.
• Extending from at least one of the two body members is a rib extension member, the rib extension member preferably being attached to the body member in a pivoting manner such that the angle of the rib extension relative to the body member can be adjusted. Rib clamping means are provided on the free end of the rib extension arm member such that the device can be securely affixed to the rib.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a front view of an embodiment of the invention.
• FIG. 2 is a front perspective view of a portion of the embodiment ofFIG. 1, showing the mounting platform for the rib extension member.
• FIG. 3 is a rear perspective view of the rib extension member of the embodiment ofFIG. 1.
• FIG. 4 is a side view of an embodiment of the invention having two rib extension members.
DETAILED DESCRIPTION OF THE INVENTION
• With reference to the drawings, the invention will now be described in detail with regard for the best mode and the preferred embodiment. The invention is a sternal closure clamp device used to close, secure and support a sternum post-operatively, the sternum having been severed longitudinally into left and right lateral sternal halves to provide access to the interior of the chest, wherein the sternal clamp comprises two opposing body members and a rib extension member mounted to at least one of said body members.
• Thesternal clamp10 generally comprises twoopposing body members11 and12 each at least one and preferably a pair of spaced, sternum-engaging engagement members13 extending posteriorly from thebody members11 and12. Thebody members11 and12 are slidingly or telescopically interconnected such that the overall length of thesternal clamp10 can be adjusted. Theengagement members13 are means to engage, secure or otherwise retain the sternal halves in an abutting relationship, with theengagement members13 comprising hooks, projections, fingers or the like extending in the posterior direction from themain bodies11 and12, whereby theengagement members13 are able to be disposed against the outer edges of the sternal halves and between adjoining ribs, preferably with the twoengagement members13 located on a given side being positioned in the inter-rib spaces to either side of a single rib. In use, theclamp10 is positioned on the sternal halves across the longitudinal sternal incision with theengagement members13 located in the inter-rib spaces, such that at least one rib is between the twoengagement members13 on a given side of theclamp10. The sternal halves andopposing body members11 and12 are forced or drawn together to close the longitudinal incision, such that the sternal halves are retained in an abutted relation by theengagement members13 and precluded from separating, theclamp10 comprising means (not shown) to retain or lock theclamp10 in the compressed or contracted position, such as a mechanical fastener, ratchet mechanisms, springs or the like. Such sternal clamps are well known in the art.
• To address the circumstances where the sternum bone material is not strong enough to withstand the compressive force of thesternal clamp10, due to age, injury, disease or the like, thesternal clamp10 comprises arib extension member21 attached to at least one body member, herein shown inFIGS. 1 and 2 as attached tobody member12. A secondrib extension member21 could also be attached tobody member11, as shown inFIG. 4, or alternatively pluralrib extension members21 could be mounted on one side. Therib extension member21 may be rigidly affixed to thebody member12, but preferably is mounted ontobody member12 bymeans30 for pivoting therib extension member21 such that the relative angle between therib extension member21 andbody member12 can be altered. As a representative non-limiting example, in the drawings the pivot means30 is shown to comprise an aperturedbase plate member31 positioned on thebody member12, an aperturedarm plate member32 positioned on the end ofarm member22, and fastener means33, such as a screw, designed to secure thearm plate member32 to thebase plate member31.
• Therib extension member21 further comprises rib securing means23 positioned on the free end ofarm member22, the rib securing means23 being means for securing therib extension member21 directly to a rib at a point distanced from the sternum andbody member12. Rib securing means23 may comprise any suitable clamping or fastening structure, and a non-limiting representative example is shown in the drawings to comprise at least one fixed projection orleg member24, an adjustable projection orleg member25 and securingmeans26, such as a screw, that allows thelegs24 and25 to be clamped tightly onto the rib by spreading apart or extending theleg members25 and26, forcing them together to securely abut the rib, and locking them in place about the rib.
• To utilize the device, theclamp10 is extended and placed about the sternal halves such that theprojection members13 abut the outer sides of the sternal halves.Arm member22 may be angled or curved toward the front or rear to conform to the position of the rib to which it will be attached. Therib extension member21 is pivoted to properly align it with the rib and therib securing means23 are secured to the rib. The sternal halves are then drawn together and theclamp10 is locked so that it cannot be extended. In this manner, the compressive force of thesternal clamp10 is divided between the sternum and the rib (or ribs) when theclamp10 is positioned about the sternal halves and contracted, as opposed to being completely concentrated against the sternal bone.
• It is understood that equivalents and substitutions to elements set forth above may be obvious to one of ordinary skill in the art, and therefore the true scope and definition of the invention is to be as set forth in the following claims.

Claims (16)

1. A sternal closure clamp for holding the sternal halves of a longitudinally severed sternum in abutting relation, said clamp comprising:

a pair of slidingly interconnected body members whereby the overall length of said clamp is adjustable and whereby said body members can be locked into a fixed relative position;

at least one sternal engagement member connected to each said body member, said sternal engagement members extending to the rear of said body members and;

at least one rib extension member connected to said at least one of said body members, said rib extension member comprising means for securing said rib extension member directly onto a rib;

whereby with said sternal engagement members positioned abutting the sides of a severed sternum, said rib extension members are securable directly onto a rib in order to reduce the force applied to a sternum by said sternal engagement members when the sternal clamp is contracted.

2. The clamp ofclaim 1, wherein said at least one rib extension member is angularly adjustable relative to said at least one of said body members.

3. The clamp ofclaim 1, further comprising another rib extension member, wherein each of said rib extension members is connected to a different said body member.

4. The clamp ofclaim 3, wherein both of said rib extension members are angularly adjustable relative to said body members.

5. The clamp ofclaim 1, comprising a pair of sternal engagement members connected to each said body member, said sternal engagement members being spaced apart such that a rib may be received therebetween.

6. The clamp ofclaim 5, wherein said at least one rib extension member is angularly adjustable relative to said at least one of said body members.

7. The clamp ofclaim 5, further comprising another rib extension member, wherein each of said rib extension members is connected to a different said body member.

8. The clamp ofclaim 7, wherein both of said rib extension members are angularly adjustable relative to said body members.

9. A sternal closure clamp comprising:

a pair of slidingly interconnected body members whereby the overall length of said clamp is adjustable;

at least one sternal engagement member connected to each said body member;

a rib extension member connected to one of said body members, said rib extension member comprising means for securing said rib extension member directly onto a rib;

whereby said rib extension member are securable to a rib in order to reduce the force applied to a sternum by said sternal engagement members when the sternal clamp is contracted.

10. The clamp ofclaim 9, wherein said rib extension member is angularly adjustable relative to said one of said body members.

11. The clamp ofclaim 9, wherein a second rib extension member is connected to the other of said body members.

12. The clamp ofclaim 11, wherein said rib extension member is angularly adjustable relative to said one of said body members and wherein said second rib extension member is angularly adjustable relative to said other of said body members.

13. The clamp ofclaim 1, comprising a pair of sternal engagement members connected to each said body member, said sternal engagement members being spaced apart such that a rib may be received therebetween.

14. The clamp ofclaim 13, wherein said rib extension member is angularly adjustable relative to said one of said body members.

15. The clamp ofclaim 13, wherein a second rib extension member is connected to the other of said body members.

16. The clamp ofclaim 15, wherein said rib extension member is angularly adjustable relative to said one of said body members and wherein said second rib extension member is angularly adjustable relative to said other of said body members.

Images