U.S. patent application number 11/112858 was filed with the patent office on 2005-10-27 for expanded fixation of bones.
Invention is credited to Huebner, Randall J., Tarcau, Benone.
Application Number | 20050240187 11/112858 |
Document ID | / |
Family ID | 35137469 |
Filed Date | 2005-10-27 |
United States Patent
Application |
20050240187 |
Kind Code |
A1 |
Huebner, Randall J. ; et
al. |
October 27, 2005 |
Expanded fixation of bones
Abstract
System, including methods, apparatus, and kits, for expanded
bone fixation with bone plates.
Inventors: |
Huebner, Randall J.;
(Beaverton, OR) ; Tarcau, Benone; (Portland,
OR) |
Correspondence
Address: |
KOLISCH HARTWELL, P.C.
520 S.W. YAMHILL STREET
SUITE 200
PORTLAND
OR
97204
US
|
Family ID: |
35137469 |
Appl. No.: |
11/112858 |
Filed: |
April 22, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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60564853 |
Apr 22, 2004 |
|
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Current U.S.
Class: |
606/71 |
Current CPC
Class: |
A61B 17/8004 20130101;
A61B 17/8061 20130101; A61B 17/80 20130101 |
Class at
Publication: |
606/069 |
International
Class: |
A61B 017/56 |
Claims
We claim:
1. A device for expanded fixation of a bone, comprising: a bone
plate shaped to fit onto a bone such that the bone plate extends
generally longitudinally along the bone, the bone plate defining a
footprint on the bone and including a plurality of openings for
receiving fasteners that secure the bone plate to the bone; and a
plate member configured to be coupled to the bone plate such that
the plate member extends partway around the bone from the bone
plate at least to a position adjacent a surface region on the bone
that is oblique or perpendicular to the footprint.
2. The device of claim 1, wherein the bone plate is shaped to fit
onto a proximal portion of a humerus bone.
3. The device of claim 2, wherein the bone plate is configured to
be secured adjacent a lateral surface of the humerus bone and to
extend at least to a position adjacent an anterior surface region
of the humerus bone, and wherein the anterior surface region is at
least substantially perpendicular to the footprint.
4. The device of claim 1, wherein the plate member includes an
overlapping region that overlaps the bone plate and an extension
region that extends away from the bone plate, and wherein the
extension region includes at least one opening for receiving a
fastener that secures the extension region to the bone outside the
footprint.
5. The device of claim 1, wherein the plate member is contoured
such that the plate member extends over soft tissue in a spaced
relation to the bone.
6. A device for expanded fixation of a bone, comprising: a bone
plate shaped to fit onto a bone to define a footprint on the bone
and including a plurality of openings for receiving fasteners that
secure the bone plate to the bone; and a plate member configured to
be coupled to the bone plate such that an overlapping region of the
plate member overlaps the bone plate and an extension region of the
plate member extends away from the bone plate to a position
adjacent a surface region of the bone that is spaced from the
footprint, wherein the extension region is contoured to extend over
soft tissue in a spaced relation to the bone.
7. The device of claim 6, wherein the bone plate is shaped to fit
onto a proximal portion of a humerus bone.
8. The device of claim 7, wherein the bone plate is configured to
be secured to a lateral surface of the humerus bone, and wherein
the plate member extends at least to a position adjacent an
anterior surface region of the humerus bone.
9. The device of claim 6, wherein the extension region includes at
least one opening for receiving a fastener that secures the
extension region to the bone outside the footprint.
10. A device for expanded fixation of a humerus bone, comprising: a
bone plate shaped to fit onto a proximal portion of a humerus bone
to define a footprint on the humerus bone and including a plurality
of openings for receiving fasteners that secure the bone plate to
the humerus bone; and a plate member configured to be coupled to
the bone plate and including a connective feature that permits the
plate member to be secured to the humerus bone outside the
footprint.
11. The device of claim 10, wherein the bone plate is configured to
be secured adjacent a lateral surface of the humerus bone, and
wherein the plate member is configured to be secured the humerus
bone adjacent an anterior surface region of the humerus bone.
12. The device of claim 10, wherein the plate member includes an
overlapping region that overlaps the bone plate and an extension
region that extends from the bone plate, and wherein the extension
region is contoured to extend over a biceps tendon.
13. The device of claim 10, wherein the plate member includes an
inner surface and at least one projection extending from the inner
surface and configured to be received in one or more of the
plurality of openings of the bone plate when the plate member is
coupled to the bone plate.
14. The device of claim 10, wherein the plate member includes
generally opposing end regions, and wherein each of the opposing
end regions defines one or more apertures.
15. The device of claim 10, wherein the bone plate is configured to
be disposed substantially axially on the humerus bone, and wherein
the plate member is configured to extend from the bone plate
partway around the humerus bone.
16. The device of claim 10, the humerus bone having a lesser
tuberosity and a greater tuberosity, the plate member being
elongate with first and second end regions, wherein the first end
region is configured to overlap the bone plate adjacent the greater
tuberosity, and wherein the second end region is configured to be
disposed is a spaced relation to the bone plate adjacent the lesser
tuberosity.
17. The device of claim 10, wherein the bone plate includes an
outer surface, and wherein the plate member is configured to abut
the outer surface when coupled to the bone plate.
18. The device of claim 10, wherein the bone plate defines a long
axis, and wherein the plate member is configured to extend
substantially transverse to the long axis when coupled to the bone
plate, at least near a point of contact or closest approach between
the bone plate and the plate member.
19. The device of claim 10, the bone plate defining a plane,
wherein the plate member, when coupled to the bone plate, extends
generally parallel to the plane at a position adjacent the bone
plate and generally transverse to the plane at a position spaced
from the bone plate.
20. The device of claim 10, wherein each of the bone plate and the
plate member is formed of a biocompatible material.
Description
CROSS-REFERENCE TO PRIORITY APPLICATION
[0001] This application is based upon and claims the benefit under
35 U.S.C. .sctn. 119(e) of the following U.S. provisional patent
application, which is incorporated herein by reference in its
entirety for all purposes: Ser. No. 60/564,853, filed Apr. 22,
2004.
CROSS-REFERENCE TO RELATED APPLICATION
[0002] This application incorporates herein by reference the
following U.S. patent application: Ser. No. ______, filed Apr. 19,
2005, titled "EXPANDED STABILIZATION OF BONES," and naming Randall
J. Huebner as inventor.
INTRODUCTION
[0003] The human skeleton is composed of 206 individual bones that
perform a variety of important functions, including support,
movement, protection, storage of minerals, and formation of blood
cells. To ensure that the skeleton retains its ability to perform
these functions, and to reduce pain and disfigurement, bones that
become damaged should be repaired promptly and properly. Typically,
a fractured or cut bone is treated using a fixation device, which
reinforces the bone and keeps it aligned during healing. Fixation
devices may include external fixation devices (such as casts and/or
fixators) and/or internal fixation devices (such as bone plates,
rods, and/or bone screws), among others.
[0004] Bone plates are sturdy internal devices, usually made of
metal, that mount directly to the bone adjacent a fracture (or
other bone discontinuity). To use a bone plate to repair a bone
discontinuity, a surgeon typically (1) selects an appropriate bone
plate, (2) reduces the discontinuity (e.g., sets the fracture), and
(3) fastens the bone plate to bone fragments disposed on opposite
sides of the discontinuity using suitable fasteners, such as screws
and/or wires, so that the bone plate spans the discontinuity and
the bone fragments are fixed in position.
[0005] Standard bone plates and their associated fasteners may be
insufficient to fix some orthopedic injuries in which bones are
broken into several pieces. For example, a bone plate disposed
axially on a multiply fractured humerus, so that the bone plate
spans and fixes a generally transverse fracture of the humerus, may
not be capable of also spanning and fixing various oblique or axial
fractures of this bone. This problem may be exacerbated further by
bone plates that are pre-shaped to fit onto a particular region of
a target bone.
SUMMARY
[0006] The present teachings provide a system, including methods,
apparatus, and kits, for expanded bone fixation with bone
plates.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] FIG. 1 is a lateral view of an exemplary system for expanded
bone fixation including a left humerus fractured proximally and
fixed with a bone plate and an extension member secured to the bone
plate, in accordance with aspects of the present teachings.
[0008] FIG. 2 is an anterior view of the system of FIG. 1.
[0009] FIG. 3 is a superior view of the system of FIG. 1, taken
generally along line 3-3 of FIG. 1.
[0010] FIG. 4 is a sectional view of the system of FIG. 1, taken
generally along line 4-4 of FIG. 1.
[0011] FIG. 5 is a fragmentary sectional view of the bone plate and
left humerus of FIG. 1, taken generally as in FIG. 4, with another
exemplary extension member secured to the bone plate using a
coupling mechanism distinct from that of FIG. 4, in accordance with
aspects of the present teachings.
[0012] FIG. 6 is a view of the extension member of FIG. 1 in the
absence of the bone plate and bone.
[0013] FIG. 7 is a view of the bone plate of FIG. 1, taken
generally toward the outer surface of the bone plate, with a head
portion of the bone plate in threaded engagement with bone screws
and in the absence of the extension member and bone, in accordance
with aspects of the present teachings.
[0014] FIG. 8 is a view of the bone plate and bone screws of FIG.
7, taken generally toward the inner surface of the bone plate, in
accordance with aspects of the present teachings.
DETAILED DESCRIPTION
[0015] The present teachings provide a system, including methods,
apparatus, and kits, for expanded fixation with bone plates. The
bone plates may include and/or may be coupled to an extension
member (e.g., a plate member) that enlarges the footprint of the
bone plates on bone, such as the footprint on a proximal region of
a humerus bone. The extension member may be formed integrally with
the bone plate or may be attached volitionally (and optionally) to
the bone plate before, during, and/or after the bone plate is
secured to bone. The extension member thus may extend to and may be
secured to a bone surface region that is spaced from the bone
plate, for example, a bone surface region that is disposed axially,
laterally, and/or partway around the bone from the footprint of the
bone plate on bone. In some examples, the extension member may have
opposing end regions that respectively engage a bone plate and
bone, and an intermediate region that is spaced from bone, to, for
example, accommodate soft tissue disposed between the intermediate
region and bone. Overall, the system described herein may increase
the functionality of bone plates, for example, by expanding the
ability of the bone plates to span discontinuities and/or to
reinforce bone.
[0016] FIG. 1 shows an exemplary system 10 for expanded bone
fixation. The system may include a bone, such as a left humerus
bone 12, and a fixation device 14 secured to and reinforcing the
bone. The fixation device may span one or more discontinuities in
the bone. For example, the fixation device may span a transverse
fracture (or other transverse discontinuity) 16 and/or an
additional fracture (or other additional discontinuity) 18 (e.g., a
fracture that extends obliquely and/or axially in the bone). The
fixation device may include a bone plate 20 and an extension member
22 (e.g., an extension plate) secured to (and/or unitary with) the
bone plate. The bone plate and extension member may have any
suitable relative orientations. In some examples, the bone plate
may extend generally along the bone, to span the transverse
discontinuity and stabilize the bone with respect to the transverse
discontinuity (but generally not substantially with respect to the
additional discontinuity). The extension member may extend
partially around the bone, to span the additional discontinuity and
stabilize the bone with respect to the additional discontinuity and
thus expand the fixation capability of the bone plate. The bone
plate and/or extension member may include openings that receive
fasteners, such as bone screws, to secure the bone plate and/or
extension member to bone and/or to each other.
[0017] The following sections describe further aspects of the
present teachings, including, among others, (I) bone plates, (II)
extension members, (III) methods of fixing bones using bone plates
and extension members, (IV) kits, and (V) examples.
[0018] I. Bone Plates
[0019] Bone plates as described herein generally comprise any
relatively low-profile (or plate-like) fixation device configured
to stabilize at least one bone by attachment to the bone. The
fixation device may be configured to span any suitable bone
discontinuity (or discontinuities) so that the fixation device
fixes the relative positions of bone fragments (and/or bones)
disposed on opposing sides of the bone discontinuity (or
discontinuities). Alternatively, or in addition, the fixation
device may reinforce a bone lacking a discontinuity.
[0020] Suitable discontinuities may occur naturally and/or may
result from injury, disease, and/or surgical intervention, among
others. Accordingly, exemplary discontinuities for use with the
fixation devices described herein may include joints, fractures
(breaks in bones), osteotomies (cuts in bones), and/or nonunions
(for example, produced by injury, disease, or a birth defect),
among others.
[0021] The bone plates described herein may be configured for use
on any suitable bone, in any suitable animal species, including
human, equine, canine, and feline species, among others. Exemplary
bones may include bones of the arms (radius, ulna, humerus), legs
(femur, tibia, fibula, patella), hands/wrists (e.g., phalanges,
metacarpals, and carpals), feet/ankles (e.g., phalanges,
metatarsals, and tarsals), vertebrae, scapulas, pelvic bones,
cranial bones, ribs, and/or clavicles, among others. Particular
exemplary regions of bones where the bone plates described herein
may be secured include a proximal portion and/or a lateral surface
of the humerus bone. Particular fractures where the bone plates
described herein may be suitable include bones with multiple
fractures creating a plurality of bone fragments. One or more of
the fragments may not be suitably disposed for securing directly
and/or sufficiently to a bone plate with a fastener placed through
an opening of the bone plate and into the fragment because of, for
example, the size, position, structure, etc., of the one or more
fragments.
[0022] Each bone plate may be configured to be disposed in any
suitable position relative to its target bone. The bone plate (or a
plate portion) may be configured to be disposed in contact with an
exterior surface of the bone and thus may be positioned at least
substantially (or completely) exterior to the bone. Alternatively,
the bone plate may be configured to be disposed at least partially
interior to a bone, that is, apposed to (normally) interior bone
surfaces when secured to the bone. The interior surfaces of the
bone may be accessed during installation of the bone plate (such as
by punching the bone plate through the exterior bone surface)
and/or may be accessible due to a break, a cut, and/or the
like.
[0023] The bone plates may be formed of any suitable material(s).
The bone plates may be of a sturdy yet malleable construction.
Generally, the bone plates should be stiffer and stronger than the
section of bone spanned by the plates, yet flexible (e.g., springy)
enough not to strain the bone significantly. A bone plate of the
present teachings may be at least substantially formed of, or may
include, any suitable biocompatible material(s) and/or
bioresorbable material(s). Exemplary biocompatible materials that
may be suitable for the bone plate include (1) metals/metal alloys
(for example, titanium or titanium alloys, alloys with cobalt and
chromium (such as cobalt-chrome), stainless steel, etc.); (2)
plastics (for example, ultra-high molecular weight polyethylene
(UHMWPE), polymethylmethacrylate (PMMA), polytetrafluoroethylene
(PTFE), polyetheretherketone (PEEK), and/or
PMMA/polyhydroxyethylmethacrylate (PHEMA)); (3) ceramics (for
example, alumina, beryllia, calcium phosphate, and/or zirconia,
among others); (4) composites (for example, carbon-fiber
composites); (5) bioresorbable (bioabsorbable) materials or
polymers (for example, polymers of .alpha.-hydroxy carboxylic acids
(e.g., polylactic acid (such as PLLA, PDLLA, and/or PDLA),
polyglycolic acid, lactide/glycolide copolymers, etc.),
polydioxanones, polycaprolactones, polytrimethylene carbonate,
polyethylene oxide, poly-.beta.-hydroxybutyrate,
poly-.beta.-hydroxypropionate, poly-.beta.-valerolactone,
poly(hydroxyalkanoate)s of the PHB-PHV class, other bioresorbable
polyesters, and/or natural polymers (such as collagen or other
polypeptides, polysaccharides (e.g., starch, cellulose, and/or
chitosan), any copolymers thereof, etc.); and/or the like. In some
examples, one or more of these materials may form the body of a
bone plate and/or a coating thereon.
[0024] The bone plates may be configured to reduce irritation to
the bone and surrounding tissue. For example, the bone plates may
be formed of a biocompatible material, as described above. In
addition, the bone plates may have a low and/or feathered profile
to reduce their protrusion into adjacent tissue and rounded,
burr-free surfaces to reduce the effects of such protrusion.
[0025] The bone plates described herein may be sized and shaped to
conform to particular portions of a bone (or bones). The plates may
be generally elongate, with a length L, a width W, and a thickness
T. Here, length L>width W>thickness T. In use, the long axis
of the bone plates (or of a plate portion) may be aligned with the
long axis of the corresponding bone, and/or may extend obliquely
and/or transversely relative to the bone's long axis. The length
and/or width of the bone plates may be varied according to the
intended use, for example, to match the plates with a preselected
region of bone(s) and/or a particular injury to the bone. For
example, the plates may be generally linear for use on the shaft of
a long bone and/or may have a nonlinear shape, such as for use near
an end of a bone and/or for transverse placement on the shaft,
among others. In some examples, the bone plates (and/or extension
members) may be configured to wrap at least partially around a
bone, so that portions of each plate (and/or extension member) are
disposed on distinct sides and/or generally opposing sides/surfaces
of a bone. In some embodiments, the bone plates may be configured
for use on both sides of the body/skeleton, such as when the bone
plates are bilaterally symmetrical. In some embodiments, the bone
plates may be asymmetrical and configured for use on either the
left or the right side of the body/skeleton, but not both.
[0026] The bone plates may include inner (bone-facing) and outer
(bone-opposing) surfaces. One or both of these surfaces may be
contoured generally to follow an exterior surface of a target bone
(or bones) for which a bone plate is intended, so that the bone
plate maintains a low profile and fits onto the bone(s). For
example, the inner surface of a plate may be generally
complementary in contour to the bone surface. The outer surface of
the plate also may correspond in contour to the bone surface and
may be generally complementary to the inner surface of the plate.
The bone plates may be partially and/or completely precontoured, at
the time of manufacture, allowing practitioners to apply them to
bone(s) with little or no additional bending at the time of
application. Alternatively, or in addition, the bone plates may be
custom-contoured by practitioners before and/or during installation
onto bone.
[0027] The thickness of the bone plates may be defined by the
distance between the inner and outer surfaces of the plates. The
thickness of the plates may vary between plates and/or within the
plates, according to the intended use. For example, thinner plates
may be configured for use on smaller bones and/or on bones or bone
regions where soft tissue irritation is a greater concern.
Thickness may be varied within the plates. For example, the plates
may become thinner as they extend over protrusions (such as
processes, condyles, tuberosities, and/or the like), reducing their
profile and/or rigidity, among others. Alternatively, or in
addition, the thickness may vary as an interior portion of the bone
plate extends into bone, for example, becoming thinner to
facilitate insertion of this interior portion or thicker to
increase structural stability. The thickness of the plates also may
be varied to facilitate use, for example, to make the plates
thinner where they typically need to be deformed by bending and/or
twisting the plates, such as at a junction (or bridge region)
between plate portions. In this way, the plates may be thicker and
thus stronger in regions where they may not need to be contoured,
such as along the shaft of the bone. In some examples, the inner
and/or outer surface of a bone plate may define a recess in which
an extension plate may be received. This recess may reduce the
profile of the extension plate above (or below) the bone plate.
[0028] The bone plates generally include a plurality of openings.
The openings may be adapted to receive fasteners for securing the
plates to bone. Alternatively, or in addition, one or more of the
openings may be configured to alter the local rigidity of the
plates, to permit the plates to be manipulated with a tool (such as
an attachable handle), to facilitate blood flow to bone regions
where the bone plates are installed, to promote healing, and/or the
like. In some examples, one or more of the openings may be adapted
to receive a fastener that attaches the plate to a corresponding
extension member and/or to receive a projection of the extension
member. These openings may extend through the bone plates (between
inner and outer surfaces) and/or may extend at least substantially
parallel to the inner and/or outer surfaces of the bone plates.
[0029] The openings may have any suitable positions, sizes, and/or
densities within each portion of a bone plate. The openings may be
arrayed generally in a line along a portion of the plate, for
example, centered across the width of the plate. Alternatively, the
openings may be arranged nonlinearly, for example, disposed in an
arcuate, staggered, or other two-dimensional (or three-dimensional)
arrangement.
[0030] The openings may have any suitable shape and structure.
Exemplary shapes may include circular, elongate (such as
elliptical, rectangular, oval), etc. The openings may include
counterbores. The counterbores may be configured, for example, to
receive a head of a bone screw, to reduce or eliminate protrusion
of the head above the outer surface of the plate. The openings may
be threaded or nonthreaded, and each bone plate may include one or
more threaded and/or nonthreaded openings. In some embodiments, the
plates may include one or a plurality of elongate openings (for
example, oval openings) extending axially, obliquely, and/or
transversely within each bone plate. The elongate openings may be
compression slots that include contoured counterbores to provide
compression when heads of bone screws are advanced against the
counterbores. Alternatively, or in addition, the elongate openings
may be used to adjust the position of bone plates and/or plate
portions relative to bone before the plates are fully secured to
the bone.
[0031] In some examples, the bone plates may include one or more
projections. The projections may extend, for example generally
orthogonal from the inner surface of the bone plates toward bone.
Alternatively, or in addition, the projections may extend generally
outward from the outer surface of the bone plates. In either
configuration, the projections may be configured to engage
corresponding openings of extension members. The projections may be
sharp or blunt according to their intended use. For examples, sharp
projections may be configured as prongs that penetrate bone to
restrict movement of the bone plates. Prongs may be used in place
of, or in addition to, bone fasteners, for one or more portions of
each bone plate. Blunt (or sharp) projections, such as ridges or
knobs (or tines), may be configured for mating with
openings/depressions of extension members or as spacing members
that elevate the bone plates from the bone surface.
[0032] The bone plates may have at least one, and generally two or
more, plate portions (or anchor portions) configured to be secured
to different regions of a bone (or bones). Each plate portion may
be structured for a specific region of a bone. For example, the
bone plates may include a proximal plate portion for attachment to
a more proximal region of a bone, and a distal plate portion for
attachment to a more distal region of the same bone. Alternatively,
or in addition, the bone plates may include an exterior plate
portion configured to fit against an exterior surface region of
bone adjacent a bone discontinuity, and/or an interior plate
portion configured to be received in an interior (e.g., recessed,
resected, and/or excavated) region of bone adjacent the bone
discontinuity.
[0033] The plate portions of a bone plate may have any suitable
connection. In some examples, the plate portions may be formed
integrally, so that one piece of the bone plate includes the plate
portions. Alternatively, plate portions may be formed as separate
pieces. The separate pieces may be connected by any suitable
connection and/or joint, including a fastener(s), welding, a hinge
joint, a ball-in-socket joint, and/or the like. Further aspects of
bone plates having adjustable joints are described in the following
patent application, which is incorporated herein by reference: U.S.
patent application Ser. No. 10/716,719, filed Nov. 19, 2003.
[0034] The plate portions of a bone plate may have any suitable
relative disposition. The plate portions may be disposed such that
they are substantially collinear and/or parallel, oblique, or
substantially transverse to one another. The relative disposition
may be fixed and/or adjustable. In some examples, the plate
portions may be connected integrally by a deformable bridge region,
so that the bone plate can be bent pre- and/or peri-operatively to
adjust the relative disposition of the plate portions.
Alternatively, the plate portions may be distinct pieces connected,
for example, through an adjustable joint, as described above.
[0035] Each plate portion may have one or more openings and/or
other receiving structures. Each opening may be configured to
receive a fastener for placement of the bone fastener into bone
and/or for connection of the plate portion to an extension
member.
[0036] II. Extension Members
[0037] Each fixation device may include an extension member (or a
plurality of extension members) joined to and/or securable to a
bone plate. The extension member may include any support structure
that extends beyond the perimeter of the bone plate to increase the
footprint of the bone plate on bone. The extension member may be
configured as an ancillary plate member or a plate portion for a
bone plate. Accordingly, the extension member may have any of the
properties described above for bone plates. Alternatively, the
extension member may have comparable cross-sectional dimensions
such that the extension member includes a wire or a wire-like
structure.
[0038] The extension member may have any suitable shape. The
extension member may be configured to be plate-like, so that the
extension member may have a length and a width that are
substantially greater than the thickness of the extension member.
The extension member may be elongate or may have a length that is
approximately equal to the width of the extension member. The
extension member may have a contour that conforms generally to the
contour of a bone surface onto which the extension member fits, so
that the extension member generally follows the bone surface.
However, in some examples, the extension member may be contoured
also or alternatively to extend over a (non-bone) soft tissue
structure, such as a tendon or a muscle. In exemplary embodiments,
the extension member may be configured to extend over the biceps
tendon disposed in the bicipital groove of the humerus (see Example
1). In some examples, the bone plate may be configured to be
secured adjacent (and/or engage) the outer surface (or inner
surface) of a bone plate, and thus may be configured to bend toward
(or away from) bone as the extension member extends beyond the bone
plate perimeter, to reduce (or increase) the profile of the
extension member. In some examples, the bone plate and the
extension member may be or may include elongate portions, disposed
in use in substantially transverse directions (at least near their
point(s) of contact with one another). For example, the bone plate
may have a long axis that is aligned generally with a long axis of
a bone, and the extension member(s) may include a curved portion
that forms an arm that extends in use at least partially around
rather than along a bone.
[0039] The extension member may have any suitable size. The
extension member may be configured to extend any suitable distance
beyond the perimeter of a bone plate. Accordingly, the extension
member may be configured as a tab that extends beyond the bone
plate perimeter by a distance that is less than the width of the
bone plate, or as an arm that extends by a distance that is greater
than the width of the bone plate. The extension member may be wider
than, about equal in width, or narrower than its corresponding bone
plate. The extension member may have a thickness that is greater
than, about the same as, or less than that of the corresponding
bone plate. In some examples, an extension member that is
relatively thinner than its corresponding bone plate may provide a
reduced profile on bone relative to relatively thicker extension
members.
[0040] The extension member may have any suitable disposition
relative to a corresponding bone plate and to bone. The extension
member thus may extend generally transverse of and/or in parallel
to the long axis of the bone plate and/or bone. Accordingly, the
extension member may extend axially and/or laterally from a bone
plate, and from the end(s) and/or the side edge(s) of the bone
plate. In some examples, the extension member may extend from the
bone plate at least about one-eight or one-fourth of the
circumference of the bone. In some examples, the extension member
may extend at least to a surface region on the bone that is
nonparallel and/or at least substantially perpendicular to a
footprint defined on the bone by the bone plate. Accordingly, the
extension member may extend substantially parallel to a plane
defined by the bone plate, in a region adjacent the bone plate, and
may extend substantially transverse to the plane, in a region
spaced from the bone plate. The extension member may overlap the
bone plate, for example, abutting the inner (bone-facing) surface
and/or outer (bone-opposing) surface of the bone plate.
Alternatively, the extension member may be nonoverlapping with the
inner/outer surfaces of the bone plate, for example, disposed
adjacent and/or in abutment with an edge of the bone plate. The
extension member may connect to a bone plate near an end of the
extension member, so that the extension member extends away from
the bone plate from one edge of the bone plate. Alternatively, the
extension member may connect to a bone plate nearer the middle of
the extension member, so that the extension member extends beyond
the bone plate from opposing edges of the bone plate.
[0041] The extension member may have any suitable composition.
Suitable compositions may include any of the biocompatible
materials (e.g., metal) described above for bone plates. The
composition of the extension member may be similar or identical to
that of its corresponding bone plate, or may be different (e.g., a
stainless steel (or titanium alloy) extension member secured to a
bone plate formed of a titanium alloy (or stainless steel)).
[0042] The extension member may have any suitable connection to a
bone plate. The extension member thus may be formed integrally with
the bone plate, or may be a discrete component configured to be
connected to the bone plate after its formation. The extension
member thus may be an optional addition to a fixation device, which
may be included in or omitted from the device, as appropriate. The
extension member may include one or more connective features, such
as openings, projections, brackets, etc. configured to permit
connection to a corresponding bone plate. For example, the
extension member may include an opening(s) that can be aligned with
a corresponding opening(s)/projection(s) of a bone plate. In some
embodiments, the extension member may include an opening configured
to be aligned with an opening or projection of the bone plate, and
one or more projections configured to be received in openings of
the bone plate. In some examples, the extension member may be
configured to be secured to a bone plate using one or more openings
of the bone plate that also or alternatively may receive fasteners
to secure the bone plate to bone (e.g., if the extension member is
not used for fixation).
[0043] The extension member may have any suitable connective
features for securing the extension member to bone (and/or for
engaging the bone) at a bone surface position spaced from the
footprint of the bone plate on bone. A distal portion of the
extension member (that is, a portion spaced from the bone plate)
thus may include one or more connective features, such as openings,
projections from the inner surface (such as prongs, pins, etc.),
and/or the like, that permit the distal portion to be secured to
and/or to engage bone. In some examples, the one or more connective
features may include one or more openings of any suitable
structure. Thus, the one or more openings may be locking (e.g.,
threaded), nonlocking (nonthreaded), circular, oval, and/or the
like, generally as described above for bone plates in Section I. In
some embodiments, the one or more openings may include an elongate
opening with offset retention structures. Offset retention
structures are described in more detail in the following patent
application, which is incorporated herein by reference: U.S. patent
application Ser. No. 11/071,050, filed Feb. 28, 2005.
[0044] Further aspects of extension members that may be suitable
for the system of the present teachings are described in the
following patent application, which is incorporated herein by
reference: Ser. No. ______, filed Apr. 19, 2005, titled "EXPANDED
STABILIZATION OF BONES," and naming Randall J. Huebner as
inventor.
[0045] III. Methods of Fixing Bones using Bone Plates and Extension
Members
[0046] The system of the present teachings may include methods of
fixing bones by installing bone plates and corresponding extension
members on the bones. The methods may include any suitable
combination of the following steps, performed in any suitable order
and any suitable number of times.
[0047] A bone for fixation may be selected. Any suitable bone may
be selected having one, two, or more discontinuities, such as a
humerus bone fractured at two or more positions to create three or
more bone fragments.
[0048] A bone plate may be selected for fixation of the bone. The
bone plate may have any suitable combination of the features
described elsewhere in the present teachings. For example, the bone
plate may be sized and shaped for use on the particular bone and
bone region that is fractured.
[0049] The bone plate may be secured to the bone, before, during,
and/or after reduction. (Bone plates secured before or during
reduction typically would be secured only partially until the
reduction is completed.) Securing the bone plate may be performed
by placing one or more fasteners, such as screws, wires, pins,
etc., through openings of the bone plate and into the fractured
bone. Generally, the bone plate may be secured to opposing sides of
a discontinuity, such as a fracture, in the bone.
[0050] An extension member may be selected for additional fixation
of the bone. The extension member may be selected from a set of
extension members differing in overall size, shape, length, width,
handedness, connection site on the bone plate, etc. The extension
member may be further contoured pre- and/or peri-operatively (such
as by bending the extension member), for example, to adjust how the
extension member fits onto the bone plate, bone, and/or over soft
tissue, or the extension member may be used without further
contouring. In examples where the extension member is formed
integrally with the bone plate, and/or supplied in a connected
configuration, selection of the bone plate may also select the
extension member.
[0051] The extension member may be coupling to the bone plate. This
step of coupling may be performed before, during, and/or after the
bone plate is secured to the bone. Coupling may connect the
extension member to the bone plate in an adjustable configuration
(e.g., movable pivotably and/or translationally with respect to the
bone plate) and/or in a fixed configuration. Coupling may include
apposing the extension member to a surface of the bone plate, such
as the inner or outer surface of the bone plate. This apposition
may align connective features of the bone plate and the extension
member. Accordingly, this apposition also may include placing a
projection(s) of the extension member into an opening(s) of the
bone plate, and/or a projection(s) of the bone plate into an
opening(s) of the extension member. The projections may be
configured to restrict pivotal and/or translational motion of the
extension member relative to the bone plate. The projections thus
may fit snugly into the openings.
[0052] The step of coupling the extension member to the bone plate
may include placing a fastener(s) through an opening(s) of the bone
plate and/or extension member. In some examples, the fastener may
have an external thread that engages an internal thread of an
opening of the bone plate and/or of the extension member.
Alternatively, or in addition, the fastener may be received in
underlying bone, such as when the fastener extends through aligned
openings of the bone plate and the extension member and threads
into bone. The head of the fastener may engage the bone plate
and/or the extension member, based, for example, on the relative
disposition of these components and the direction in which the
fastener is placed through the openings.
[0053] The extension member may be connected to bone at a surface
position of the bone that is spaced from the bone plate. Connection
of the extension member at this spaced position may include placing
prongs or other projections of the extension member into bone.
Alternatively, or in addition, the connection of the extension
member to bone may include securing a spaced portion of the
extension member to bone by placement of a fastener(s) through an
opening(s) of the extension member and into the bone.
[0054] The steps described above may be used to fix multiply
fractured bones. For example, the bone plate may fix a bone
relative to a first fracture of a bone, and the extension member
may fix the bone relative to a second fracture of the bone.
[0055] IV. Kits
[0056] The system of the present teachings may provide kits for
fixing bones. The kits may include one or more bone plates, one or
more extension members for coupling to the bone plates, fasteners
(such as bone screws, wires, or the like) for securing the bone
plate(s) and/or extension member(s) to bone and/or each other, a
measurement device, a guide device, a positioning jig, a drill(s),
one or more clamps, instructions for use, and/or the like. Some or
all of the components of each kit may be provided in a sterile
condition, such as packaged in a sterile container, and/or may be
sterilizable (e.g., autoclavable).
[0057] In some examples, the kits may include a set of two or more
extension members. The extension members may differ in contour,
size (such as overall length and/or length of their extension
regions, width, thickness, etc.), handedness (such as plate members
for use on left and right bone plates), site of plate attachment,
composition, target bone, distance extended along/around bone,
and/or the like.
V. EXAMPLES
[0058] The following examples describe selected aspects and
embodiments of the present teachings, including methods and
apparatus for expanded bone fixation. These examples and the
various features and aspects thereof are included for illustration
and are not intended to define or limit the entire scope of the
present teachings.
Example 1
An Exemplary Fixation Device for the Proximal Humerus
[0059] This example describes an exemplary fixation device,
including a bone plate and an optional extension plate, for use on
a proximal region of the humerus; see FIGS. 1-7. Selected aspects
of FIG. 1 are described above in an overview of the present
teachings.
[0060] FIGS. 1-3 show various views of left humerus 12 fractured in
a proximal portion of the bone and fixed with a fixation device 14
for disposition on the exterior surface of the bone. The fixation
device may include bone plate 20 and extension plate (or extension
member) 22, which is affixable or affixed to the bone plate.
[0061] The bone plate may be shaped to fit on a lateral surface of
the humerus. The bone plate may include a head portion 42 disposed
proximally and adjacent to a body portion 44 disposed distally on
the humerus (see FIG. 1). The head portion and body portion may
include any suitable openings, which may be locking (e.g.,
threaded) or nonlocking (nonthreaded).
[0062] The head portion may be disposed toward a proximal end of
the humerus, adjacent a metaphyseal (end) region of the bone. The
head portion may define a plurality of threaded openings 46, oblong
(elongate) openings 48, and holes 50. Locking openings 46 may be
threadably engaged with threaded fasteners, such as bone screws, or
may receive fasteners without threaded engagement. The oblong
openings and holes may receive any suitable fasteners, such as
screws, pins, and/or wires, among others.
[0063] The body portion may be disposed longitudinally on the
humerus, generally parallel to the long axis the humerus and
adjacent a diaphyseal (shaft) region of the bone. The body portion
may define one or more oblong openings 52, circular openings
(locking or nonlocking) 54, and/or smaller holes (such as for
wires). The openings may include (or lack) counterbores 56 to, for
example, reduce protrusion of fastener heads above the outer
surface of the bone plate and/or facilitate or provide axial
compression (or distraction).
[0064] The extension plate may be configured to be mounted on the
bone plate and secured to the humerus. The extension plate may
include an overlapping region 60 that abuts the bone plate (for
example, engages the outer surface 62 (or inner surface 64) of the
bone plate) and an extension region 66 that extends to a surface
region of bone disposed outside the footprint of the bone plate on
bone. For example, the extension region may extend partway around
the humerus, to a position adjacent an anterior surface 68 of the
humerus (see FIGS. 2 and 3 also). The overlapping region and/or the
extension region may include one or more apertures and/or
projections. In particular, the overlapping region may define a
coupling aperture 70 (and, optionally, a projection extending
boneward from the inner surface of the overlapping region).
Furthermore, the extension region may define a spaced aperture 72
for receiving a fastener, such as a bone screw, shown at 74, and/or
a hole 76 for receiving a wire (see FIG. 2). In some examples, hole
76 may be used to couple a humerus fragment provisionally to the
extension plate, before a bone screw is placed through spaced
aperture 72 and into the fragment.
[0065] Left humerus 12 may be multiply fractured (or cut). For
example, humerus 12 may include a transverse fracture 16 spanned
and stabilized by the bone plate. The bone plate may be secured to
the humerus on opposing sides of the transverse fracture using bone
screws, or other suitable fasteners, received in openings of the
body and head portions of the bone plate and extending into bone.
In particular, the bone screws may be received, for example, in
elongate openings 52 of the plate's body portion (and/or head
portion). The elongate openings may extend, for example, axially on
the bone plate. Furthermore, the bone screws also may be received
in openings 46 defined by the head portion. Humerus 12 also may
include at least one additional fracture, such as a generally
longitudinal fracture 18 extending axially and/or obliquely in the
bone, generally along a path disposed between greater tuberosity 80
and lesser tuberosity 82 (see FIG. 3). The longitudinal fracture
(or any other suitable discontinuity) may be spanned and fixed by
the extension plate. In particular, the extension plate may be
secured to the bone plate and/or bone using coupling aperture 70
and spaced aperture 72 (see FIGS. 1, 2, and 4).
[0066] FIGS. 3 and 4 show an exemplary contour of the extension
plate as viewed from a position superior to the humerus (FIG. 3) or
superior to a transverse section through the humerus (FIG. 4). The
extension plate may include opposing end regions, for example, a
proximal end region 92 that overlaps the bone plate and a distal
end region 94 spaced from the bone plate and secured adjacent a
surface region of the bone disposed partway around the humerus
(FIG. 3). The opposing end regions may be connected by an
intermediate region 96 that generally follows the surface contour
of the humerus and/or that extends away from the humerus surface so
that the intermediate region is spaced from the humerus surface. In
some examples, the intermediate region may form a gap 98 between an
inner surface 102 of the extension plate and an exterior surface
region 104 of the humerus. The gap may allow, for example, soft
tissue, such as a biceps tendon 106, to extend between the
extension plate and bone (see FIG. 4). The overlapping region of
the extension plate may generally follow the exterior surface of
the bone plate. In some examples, the extension plate may bend
toward the bone, shown at 110 (see FIG. 3), as the extension plate
extends beyond the perimeter of the bone plate. The extension plate
also may bend outward, to achieve a spaced relation to bone, as the
extension plate extends over bicipital groove 112 and its overlying
biceps tendon (see FIG. 4). The extension plate then may bend
inward to the bone, so that a spaced region (the distal end region)
of the extension plate is apposed to the bone surface, for receipt
of a fastener that secures the spaced region of the extension plate
to bone, outside of the footprint of the bone plate on bone.
[0067] The extension plate may be secured to the bone plate by any
suitable mechanism. In some examples, the extension plate may be
coupled (and/or secured) to the bone plate in a predefined
disposition(s), for example, based on connective features (such as
openings/projections) included in the bone plate and the extension
plate. In some examples, the extension plate may be coupled to the
bone plate using a coupling mechanism that restricts (and/or
allows) pivotal motion and/or translational motion of the extension
plate relative to the bone plate. In some examples, the extension
plate may include an elongate aperture that guides translational
adjustment of the extension plate before the extension plate is
fixed in position.
[0068] FIG. 4 shows an exemplary coupling mechanism that may be
used to couple the extension plate to the bone plate. The extension
plate may have a projection 120, such as a post, extending from the
inner surface of the extension plate. The projection may be sized
and positioned to cooperate with opening 70 of the plate extension
for alignment with a pair of locking (or nonlocking) openings 46 of
the bone plate. In particular, the projection may be received in
one of the bone plate openings and the plate extension positioned
(e.g., pivoted) so that another of the bone plate openings is
aligned with opening 70 of the plate extension. A bone screw 122
may be placed through the aligned openings of the plate extension
and bone plate and into bone, to couple the plate extension to the
bone plate.
[0069] FIG. 5 shows an alternative coupling arrangement with a
slightly modified extension plate 130. A projection 132 of the
extension plate may be received in one of the locking openings and
a fastener 134 (such as a screw) placed through an opening 136 of
the extension plate and into threaded engagement, shown at 138,
with the wall of a locking opening of the bone plate. Fastener 134
may not extend into bone, as shown in the present illustration, or
may be long enough to also extend into and engage bone. In some
examples, the bone plate may include two or more sets of openings
with the same spacing as the projection and the opening of the
extension plate, so that the extension plate may be selectively
placed and coupled to the bone plate in different configurations.
In some examples, the extension plate may include two or more
openings in the overlapping region of the extension plate, so that
two or more fasteners may be used to couple the extension plate to
the bone plate (and/or bone). In some examples, the extension plate
may be coupled to the bone plate with a fastener placed through a
single opening of the extension plate (and without the use of a
projection).
[0070] FIG. 6 shows a close-up view of extension plate 22, taken
generally toward a superior edge 140 of the extension plate.
Selected features of the extension plate described above in
relation to FIGS. 1-4 are labeled here.
Example 2
Exemplary Bone Plate for Fixation of the Proximal Humerus
[0071] This example describes an exemplary bone plate for fixation
of the proximal humerus, with or without an optional extension
plate coupled to the bone plate; see FIGS. 7-8.
[0072] FIG. 7 shows bone plate 20 (also see FIGS. 1-4) in threaded
engagement with bone screws 150 (and not coupled to the extension
plate). Bone plate 20 may be secured to the humerus, particularly a
proximal portion of the left humerus, such as on a lateral surface
thereof. This bone plate may have a mirror-image counterpart for
the right humerus. Alternatively, this bone plate may be configured
to be secured to each of the left and right sides of the body, for
example, by making the bone plate more bi-laterally
symmetrical.
[0073] Head portion 42 of the bone plate may include a plurality of
openings. The head portion may define openings 46 for receiving
threaded fasteners, such as bone screws. Each opening 46 may be
nonlocking (nonthreaded) or locking (e.g., with an internal
thread). A subset of the openings, such as the openings shown at
152, may be configured to be aligned with connective features of an
extension plate, as described above in Example 1, rather than, or
in addition to, receiving bone screws, as shown in the present
illustration. The head portion also may define one or more suture
openings 48 for receiving sutures. Suture openings 48 may be
disposed adjacent the perimeter of the head portion (and/or the
body portion) of the bone plate. The suture openings may be oblong,
such as the ovals shown, and/or wider than standard suture
openings. The suture openings may be configured to permit sutures
(and a suture guiding structure, such as a needle) to be received
with the plate secured to bone.
[0074] FIG. 8 shows bone plate 20 and bone screws 150 viewed toward
the inner surface of the bone plate. Locking openings of the bone
plate may have internal threads configured to direct the bone
screws along parallel and/or nonparallel paths, such as divergent
and/or convergent paths, as shown here. In some cases, bone screws
directed along nonparallel paths may improve the holding ability of
the bone screws in bone.
Example 3
Selected Embodiments
[0075] This example describes selected embodiments of the present
teachings, presented as a series of indexed paragraphs.
[0076] 1. A method of fixing a humerus bone having first and second
discontinuities, comprising: (A) securing a bone plate to a humerus
bone such that the bone plate stabilizes the humerus bone with
respect to a first discontinuity of the humerus bone; and (B)
coupling a plate member to the bone plate and also to the humerus
bone such that the plate member stabilizes the humerus bone with
respect to a second discontinuity of the humerus bone, wherein the
second discontinuity is not stabilized substantially by the step of
securing.
[0077] 2. The method of paragraph 1, wherein the step of securing
includes a step of securing the bone plate to a lateral surface of
a proximal portion of the humerus bone.
[0078] 3. The method of paragraph 2, the humerus bone having a
greater tuberosity and a lesser tuberosity, wherein the step of
securing includes a step of securing the bone plate to the humerus
bone adjacent the greater tuberosity, and wherein the step of
coupling include a step of coupling the plate member to the humerus
bone adjacent the lesser tuberosity.
[0079] 4. The method of any preceding paragraph, wherein the step
of securing stabilizes the humerus bone with respect to a
transverse fracture of the humerus bone, and wherein the step of
coupling stabilizes the humerus bone with respect to a
substantially longitudinal fracture of the humerus bone.
[0080] 5. The method of any preceding paragraph, the plate member
including at least first and second openings, wherein the step of
coupling includes (1) a step of placing a fastener through the
first opening and into an aligned aperture of the bone plate, and
(2) a step of placing another fastener through the second opening
in a spaced relation to the bone plate and into the humerus
bone.
[0081] 6. The method of any preceding paragraph, wherein the step
of coupling is performed after the step of securing.
[0082] 7. The method of any preceding paragraph, wherein of the
step of coupling includes a step of disposing the plate member in
an overlapping configuration with the bone plate to define an
overlapping region that overlaps the bone plate and an extension
region that extends partway around the humerus bone from the bone
plate.
[0083] 8. The method of any preceding paragraph, wherein the step
of coupling disposes soft tissue between the plate member and the
humerus bone.
[0084] 9. A method of fixing a bone, comprising: (A) securing a
bone plate to a bone to define a footprint of the bone plate on the
bone; and (B) coupling a plate member to the bone plate such that
the plate member overlaps the bone plate and also extends away from
the bone plate at least to a position adjacent a surface region of
the bone that is at least substantially perpendicular to the
footprint.
[0085] 10. The method of paragraph 9, wherein the step of coupling
includes a step of placing a fastener through an opening of the
plate member and through the surface region of the bone.
[0086] 11. The method of paragraph 9 or 10, wherein the step of
securing includes a step of securing the bone plate to a humerus
bone.
[0087] 12. The method of paragraph 11, wherein the step of securing
includes a step of securing the bone plate to a lateral surface of
a proximal portion of the humerus bone.
[0088] 13. The method of paragraph 12, wherein the step of securing
include a step of coupling the plate member to the humerus bone
adjacent an anterior surface of the humerus bone.
[0089] 14. A method of fixing a bone, comprising: (A) securing a
bone plate to a bone to define a footprint of the bone plate on the
bone; and (B) coupling a plate member to the bone plate such that
the plate member overlaps the bone plate and also extends away from
the bone plate and over soft tissue to a position adjacent a
surface region of the bone that is disposed outside the
footprint.
[0090] 15. The method of paragraph 14, wherein the step of coupling
includes a step of placing a fastener through an opening of the
plate member and through the surface region of the bone.
[0091] 16. The method of paragraph 14 or 15, wherein the step of
securing includes a step of securing the bone plate to a humerus
bone.
[0092] 17. The method of paragraph 16, wherein the step of securing
includes a step of securing the bone plate to a lateral surface of
a proximal portion of the humerus bone.
[0093] 18. The method of paragraph 17, wherein the step of coupling
includes a step of coupling the plate member to the humerus bone
adjacent an anterior surface of the humerus bone.
[0094] 19. The method of any of paragraphs 14-18, wherein the step
of coupling disposes the plate member along a path extending
partway around the bone.
[0095] 20. A kit for fixing a bone, comprising: (A) a bone plate
shaped to fit onto a proximal portion of a humerus bone; and (B) a
plate member corresponding to the bone plate and configured to be
affixed to the bone plate and also to the humerus bone in a spaced
relation to the bone plate.
[0096] 21. The kit of paragraph 20, the bone plate being a first
bone plate, further comprising at least a second bone plate.
[0097] 22. The kit of paragraph 21, wherein the first and second
bone plates differ in at least one of size, shape, and
composition.
[0098] 23. The kit of any of paragraphs 20-22, the plate member
being a first plate member, further comprising at least a second
plate member.
[0099] 24. The kit of paragraph 23, wherein the first and second
plate members differ in at least one of size, shape, and
composition.
[0100] 25. The kit of any of paragraphs 20-24, further comprising
at least one fastener capable of affixing the bone plate and/or
plate member to bone.
[0101] The disclosure set forth above may encompass multiple
distinct inventions with independent utility. Although each of
these inventions has been disclosed in its preferred form(s), the
specific embodiments thereof as disclosed and illustrated herein
are not to be considered in a limiting sense, because numerous
variations are possible. The subject matter of the inventions
includes all novel and nonobvious combinations and subcombinations
of the various elements, features, functions, and/or properties
disclosed herein. The following claims particularly point out
certain combinations and subcombinations regarded as novel and
nonobvious. Inventions embodied in other combinations and
subcombinations of features, functions, elements, and/or properties
may be claimed in applications claiming priority from this or a
related application. Such claims, whether directed to a different
invention or to the same invention, and whether broader, narrower,
equal, or different in scope to the original claims, also are
regarded as included within the subject matter of the inventions of
the present disclosure.
* * * * *