U.S. patent application number 11/125827 was filed with the patent office on 2005-12-01 for apparatus and method for orthopedic fixation.
Invention is credited to Chervitz, Alan, Fallin, T. Wade, Hoy, Robert W..
Application Number | 20050267476 11/125827 |
Document ID | / |
Family ID | 35426373 |
Filed Date | 2005-12-01 |
United States Patent
Application |
20050267476 |
Kind Code |
A1 |
Chervitz, Alan ; et
al. |
December 1, 2005 |
Apparatus and method for orthopedic fixation
Abstract
A filament retaining washer for mounting about the shank of a
bone screw deployed in a bone whereby to retain the filament to the
bone, the filament retaining washer comprising a structure having a
screw hole extending therethrough for receiving therein the shank
of the bone screw deployed in the bone, whereby to secure the
structure to the bone, the screw hole defining a first axis, and
the structure having a filament hole extending therethrough for
receiving a filament therein so as to retain the filament to the
structure, the filament hole defining a second axis extending
substantially perpendicular to the first axis.
Inventors: |
Chervitz, Alan; (Palm
Harbor, FL) ; Fallin, T. Wade; (Hyde Park, UT)
; Hoy, Robert W.; (Logan, UT) |
Correspondence
Address: |
Pandiscio & Pandiscio
470 Totten Pond Road
Waltham
MA
02451
US
|
Family ID: |
35426373 |
Appl. No.: |
11/125827 |
Filed: |
May 10, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11125827 |
May 10, 2005 |
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09981927 |
Oct 17, 2001 |
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09981927 |
Oct 17, 2001 |
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09863174 |
May 23, 2001 |
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6520965 |
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Current U.S.
Class: |
606/232 ;
606/151; 606/308; 606/323 |
Current CPC
Class: |
A61B 17/842 20130101;
A61B 17/80 20130101; A61B 17/82 20130101 |
Class at
Publication: |
606/072 |
International
Class: |
A61B 017/58 |
Claims
1-11. (canceled)
12. A system for securing an object to a bone, said system
comprising: a bone screw; a washer comprising: a body; a downwardly
projecting extension connected to said body and having a screw hole
extending therethrough for receiving therein the shank of said bone
screw deployed in the bone, whereby to secure said downwardly
projecting extension to said bone, said screw hole defining a first
axis, with said second axis being aligned with a bone screw
extending through the screw hole; and an upwardly projecting
extension connected to said body and having a filament hole
extending therethrough, for receiving a filament therein so as to
retain said filament to said upwardly projecting extension, said
filament hole defining a second axis extending substantially
perpendicular to said first axis; and a filament received by said
filament hole, said filament securing the object to said bone.
13. The system of claim 12 wherein said downwardly projecting
extension has a semi-spherical configuration similar to the
semi-spherical underside of the head of the bone screw.
14. The system of claim 12 wherein said body forms a recess aligned
with said screw hole, said recess receiving the head of the bone
screw.
15. The system of claim 12 wherein the filament is a suture.
16. The system of claim 12 wherein the filament is a cable.
17. The system of claim 16 wherein said upwardly projecting
extension is configurable so as to restrain the cable within said
filament hole.
18. The system of claim 17 wherein said upwardly projecting
extension contains a set screw hole communicating with said
filament hole, and a set screw disposed in said set screw hole for
selectively engaging said cable so as to lock said cable relative
to said upwardly projecting extension.
19. The system of claim 17 wherein said upwardly projecting
extension is crimpable.
20. The system of claim 19 wherein said crimpable upwardly
projecting extension has a trapezoidal cross-section.
21. The system of claim 12 further comprising a second upwardly
projecting extension connected to said body and having a filament
hole extending therethrough.
22. The system of claim 12 further comprising a bone plate having a
hole extending therethrough, with the shank of said bone screw
passing therethrough, and said filament retaining washer being
secured about the shank of said bone screw, between said bone and
the head of said bone screw.
23. The system of claim 15 wherein said suture holds a piece of
mesh to the bone.
24-29. (canceled)
30. The system of claim 12 wherein said downwardly projecting
extension is configured to engage a corresponding recess formed in
a bone plate so as to prevent rotation of said filament retaining
washer relative to the bone plate.
31-32. (canceled)
33. The system of claim 16 wherein said cable is braided cable.
34. The system of claim 16 wherein said cable is wire.
35-36. (canceled)
37. A method for securing an object to a bone, said method
comprising: providing a screw, a filament and a suture retaining
washer, said suture retaining washer comprising: a structure having
a screw hole extending therethrough for receiving therein the shank
of the bone screw deployed in the bone, whereby to secure said
structure to said bone, said screw hole defining a first axis, and
said structure having a filament hole extending therethrough for
receiving a filament therein so as to retain said filament to said
structure, said filament hole defining a second axis extending
substantially perpendicular to said first axis, with said second
axis being aligned with a bone screw extending through the screw
hole; securing said washer to the bone with said screw, with said
filament extending through said filament hole; and using said
filament to secure the object to the bone.
38. (canceled)
39. A filament retaining washer for mounting about the shank of a
bone screw deployed in a bone whereby to retain the filament to the
bone, said filament retaining washer comprising: a structure having
a screw hole extending therethrough for receiving therein the shank
of the bone screw deployed in the bone, whereby to secure said
structure to said bone, said screw hole defining a first axis, and
said structure having a filament hole so as to retain said filament
to said structure, said filament hole defining a second axis
extending substantially perpendicular to said first axis, with said
second axis extending parallel to a third axis extending through
said first axis.
40. A filament retaining washer according to claim 39 wherein said
screw hole comprises a spherical recess about its upper end for
receiving therein the underside of the head of a bone screw whose
shank passes through the screw hole.
41-42. (canceled)
43. A filament retaining washer according to claim 39 wherein said
filament hole is configured so that a filament extending
therethrough will be locked to the washer when a bone screw
extending through the screw hole is fully tightened down.
44. A filament retaining washer according to claim 39 wherein said
filament hole is configured so that a filament extending
therethrough will be movable relative to the washer when a bone
screw extending through the screw hole is fully tightened down.
Description
REFERENCE TO PENDING PRIOR PATENT APPLICATION
[0001] This application is a continuation-in-part of pending U.S.
patent application Ser. No. 09/863,174, filed May 23, 2001 by T.
Wade Fallin et al. for APPARATUS AND METHOD FOR ORTHOPEDIC FIXATION
(Attorney's Docket No. MED-8), which patent application is hereby
incorporated herein by reference.
FIELD OF THE INVENTION
[0002] This invention relates to surgical apparatus and methods in
general, and more particularly to surgical apparatus and methods
for fixing bone and soft tissue in place during trauma and
reconstructive surgery.
BACKGROUND OF THE INVENTION
[0003] Bone fixation, sometimes also referred to as fracture
fixation, is an established art. Fixation screws, and fixation
screws in combination with metal plates, are widely used in the art
to stabilize bone so as to facilitate healing.
[0004] Surgical cables, and surgical cables in combination with
metal plates, are also well known in the bone fixation art. Cables,
and cables in combination with plates, are generally used in
situations where the use of screws, or screws in combination with
plates, is not suitable. By way of example, cables, and cables in
combination with plates, are frequently used in the fixation of
long oblique fractures resulting from high energy trauma such as a
motor vehicle accident. By way of further example, screw fixation
is frequently not adequate for fractures that are highly
comminuted, and fixation with cables, or cables in combination with
plates, is required.
[0005] Cables are also sometimes used in conjunction with screws,
and in conjunction with screws in combination with plates. By way
of example, cables may be used in conjunction with screws, and
screws in combination with plates, where a screw strips its threads
in deployment, or where screws, or screws in combination with
plates, are deemed insufficient for the fixation at hand.
[0006] With cable fixation, it is customary to encircle the subject
bone with the body of the cable, and then to secure the two free
ends of the cable together with a deformable crimp so as to effect
fixation.
[0007] In general, cable fixation on the shaft of a so-called "long
bone" does not present a significant problem with migration,
inasmuch as this portion of the bone is substantially tubular in
geometry. However, the ends of these long bones typically have a
significant flare in their geometry. As a result, tightening of the
encircling cable often causes the cable (and crimp) to migrate
toward the narrower section of the bone. Such migration can
displace the cable sufficiently far from its intended location as
to significantly loosen, or render ineffective, encirclement of the
bone segments.
[0008] Thus, there is a need for an improved apparatus and method
which will permit bone fixation to be effected with screws and
cable.
[0009] There further exists a need for an improved apparatus and
method for effecting bone fixation with cable, such that the cable
will not slide along the bone during tightening of the cable.
[0010] In addition to the foregoing, in many situations, soft
tissue may need to be attached to bone. By way of example, a
ligament may need to be attached to bone during trauma and
reconstructive surgery. In some of these situations, bone fixation
may also be necessary, and such bone fixation may involve the use
of screws, and/or cables and plates, either alone or in combination
with one another.
[0011] Thus, there is a need for an improved apparatus and method
for attaching soft tissue to bone.
[0012] There further exists a need for an improved apparatus and
method for attaching soft tissue to bone, where screws may be used
to help effect fixation to bone.
SUMMARY OF THE INVENTION
[0013] Accordingly, one object of the present invention is to
provide improved apparatus for use in bone fixation.
[0014] Another object of the present invention is to provide
improved apparatus for use in bone fixation which involves the use
of bone screws, metal plates and/or cables.
[0015] Still another object of the present invention is to provide
an improved method for bone fixation.
[0016] Yet another object of the present invention is to provide
improved apparatus for attaching soft tissue to bone.
[0017] And another object of the present invention is to provide
improved apparatus for attaching soft tissue to bone, where screws
may be used to help effect fixation to bone.
[0018] A further object of the present invention is to provide an
improved method for attaching soft tissue to bone.
[0019] These and other objects of the present invention are
addressed by the provision and use of a novel filament retaining
washer for mounting about the shank of a bone screw deployed in a
bone whereby to retain the filament to the bone, the filament
retaining washer comprising a structure having a screw hole
extending therethrough for receiving therein the shank of the bone
screw deployed in the bone, whereby to secure the structure to the
bone, the screw hole defining a first axis, and the structure
having a filament hole extending therethrough for receiving a
filament therein so as to retain the filament to the structure, the
filament hole defining a second axis extending substantially
perpendicular to the first axis, with the second axis being aligned
with a bone screw extending through the screw hole.
[0020] In another form of the invention, there is provided a
filament retaining washer for mounting about the shank of a bone
screw deployed in a bone whereby to retain the filament to the
bone, the filament retaining washer comprising a body; a downwardly
projecting extension connected to the body and having a screw hole
extending therethrough for receiving therein the shank of the bone
screw deployed in the bone, whereby to secure the downwardly
projecting extension to the bone, the screw hole defining a first
axis; and an upwardly projecting extension connected to the body
and having a filament hole extending therethrough for receiving a
filament therein so as to retain the filament to the upwardly
projecting extension, the filament hole defining a second axis
extending substantially perpendicular to the first axis, with the
second axis being aligned with a bone screw extending through the
screw hole.
[0021] And in another form of the invention, there is provided a
system for securing an object to a bone, the system comprising a
bone screw; a washer comprising a body, a downwardly projecting
extension connected to the body and having a screw hole extending
therethrough for receiving therein the shank of the bone screw
deployed in the bone, whereby to secure the downwardly projecting
extension to the bone, the screw hole defining a first axis, and an
upwardly projecting extension connected to the body and having a
filament hole extending therethrough, for receiving a filament
therein so as to retain the filament to the upwardly projecting
extension, the filament hole defining a second axis extending
substantially perpendicular to the first, axis, with the second
axis being aligned with a bone screw extending through the screw
hole; and a filament received by the filament hole, the filament
securing the object to the bone.
[0022] In another form of the invention, there is provided a method
for securing an object to a bone, the method comprising providing a
screw, a filament and a suture retaining washer, the suture
retaining washer comprising a body, a downwardly projecting
extension connected to the body and having a screw hole extending
therethrough for receiving therein the shank of a bone screw
deployed in the bone, whereby to secure the downwardly projecting
extension to the bone, the screw hole defining a first axis, and an
upwardly projecting extension connected to the body and having a
filament hole extending therethrough for receiving a filament
therein so as to retain the filament to the upwardly projecting
extension, the filament hole defining a second axis extending
substantially perpendicular to the first axis, with the second axis
being aligned with a bone screw extending through the screw hole;
securing the washer to the bone with the screw, with the filament
extending through the filament hole; and using the filament to
secure the object to the bone.
[0023] And in another form of the invention, there is provided a
method for securing an object to a bone, the method comprising
providing a screw, a filament and a suture retaining washer, the
suture retaining washer comprising a structure having a screw hole
extending therethrough for receiving therein the shank of the bone
screw deployed in the bone, whereby to secure the structure to the
bone, the screw hole defining a first axis, and the structure
having a filament hole extending therethrough for receiving a
filament therein so as to retain the filament to the structure, the
filament hole defining a second axis extending substantially
perpendicular to the first axis, with the second axis being aligned
with a bone screw extending through the screw hole; securing the
washer to the bone with the screw, with the filament extending
through the filament hole; and using the filament to secure the
object to the bone.
[0024] In another form of the invention, there is provided a
filament retaining washer for mounting about the shank of a bone
screw deployed in a bone whereby to retain the filament to the
bone, the filament retaining washer comprising: a body; a
downwardly projecting extension connected to the body and having a
screw hole extending therethrough for receiving therein the shank
of the bone screw deployed in the bone, whereby to secure the
downwardly projecting extension to the bone, the screw hole
defining a first axis; and an upwardly projecting extension
connected to the body and having a filament hole extending
therethrough for receiving a filament therein so as to retain the
filament to said upwardly projecting extension, the filament hole
defining a second axis extending substantially perpendicular to the
first axis, with the upwardly projecting extension being displaced
laterally and longitudinally from the downwardly projecting
extension.
[0025] In another form of the invention, there is provided a
filament retaining washer for mounting about the shank of a bone
screw deployed in a bone whereby to retain the filament to the
bone, the filament retaining washer comprising: a structure having
a screw hole extending therethrough for receiving therein the shank
of the bone screw deployed in the bone, whereby to secure the
structure to said bone, the screw hole defining a first axis, and
the structure having a filament hole so as to retain the filament
to the structure, the filament hole defining a second axis
extending substantially perpendicular to the first axis, with the
second axis extending parallel to a third axis extending through
the first axis.
[0026] The above and other features of the invention, including
various novel details of construction and combinations of parts,
will now be more particularly described with reference to the
accompanying drawings and pointed out in the claims. It will be
understood that the particular devices, assembly and method
embodying the invention are shown by way of illustration only and
not as limitations of the invention. The principles and features of
this invention may be employed in various and numerous embodiments
without departing from the scope of the invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0027] These and other objects and features of the present
invention will be more fully disclosed or rendered obvious by the
following detailed description of the preferred embodiments of the
invention, which is to be considered together with the accompanying
drawings wherein like numbers refer to like parts, and further
wherein:
[0028] FIG. 1 is a perspective view showing a novel surgical
fastening system securing together two bone segments;
[0029] FIG. 2 is perspective view of a cable retaining washer which
forms part of the surgical fastening system shown in FIG. 1;
[0030] FIG. 3 is an exploded side view, in section, of a bone
screw, cable retaining washer and bone plate which form part of the
surgical fastening system shown in FIG. 1;
[0031] FIG. 4 is a perspective view of an alternate form of cable
retaining washer formed in accordance with the present
invention;
[0032] FIG. 5 is a perspective view of another alternative form of
cable retaining washer formed in accordance with the present
invention;
[0033] FIG. 6 is a perspective view of still another alternative
form of cable retaining washer formed in accordance with the
present invention;
[0034] FIG. 7 is a perspective view of yet another alternative form
of cable retaining washer formed in accordance with the present
invention;
[0035] FIG. 8 is a perspective view of a bone screw, cable
retaining washer and bone plate which comprise another embodiment
of the present invention;
[0036] FIG. 9 is a side view, in section, of the apparatus shown in
FIG. 8;
[0037] FIG. 10 is a side view, partially in section, showing a bone
screw securing the cable retaining washer of FIG. 2 directly to a
bone;
[0038] FIG. 11 is a perspective view showing an alternative form of
surgical fastening system formed in accordance with the present
invention;
[0039] FIG. 12 is a perspective view of a suture retaining washer
which forms part of the surgical fastening system shown in FIG.
11;
[0040] FIG. 13 is a partial sectional view of a bone screw and
suture retaining washer which form part of the surgical fastening
system shown in FIG. 11;
[0041] FIG. 14 is a perspective view showing a suture loop
attaching a piece of surgical mesh to a suture retaining
washer;
[0042] FIG. 15 is a view similar to that of FIG. 11, except showing
the assembly of FIG. 14 secured to a bone;
[0043] FIGS. 18-16 are schematic views showing another alternative
form of cable retaining washer;
[0044] FIG. 19 is a schematic view showing another alternative form
of cable retaining washer;
[0045] FIG. 20 is a schematic view showing still another
alternative form of cable retaining washer;
[0046] FIG. 21 is a schematic view of yet another form of cable
retaining washer;
[0047] FIG. 22 is a schematic view of another form of cable
retaining washer;
[0048] FIG. 23 is a schematic view of another form of cable
retaining washer; and
[0049] FIG. 24-26 are schematic views showing an alternative form
of suture retaining washer.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0050] Looking first at FIGS. 1-3, there is shown a surgical
fastening system 5 which comprises one preferred form of the
invention.
[0051] Surgical fastening system 5 generally comprises a bone plate
6, a plurality of bone screws 9, a plurality of cable retaining
washers 12, and a plurality of cable loops 15. As used herein, the
term "cable" is intended to encompass braided cable, wire and the
like.
[0052] Bone plate 6 is deployed so that the bone plate extends
across the fracture line 18 of two bone segments 20, 21. The heads
25 (FIG. 3) of bone screws 9 engage cable retaining washers 12,
while the shanks 27 of bone screws 9 extend through screw holes 30
in cable retaining washers 12, through screw holes 33 in bone plate
6 and into bone segments 20, 21, whereby to secure bone plate 6 to
bone segments 20, 21 and, the in process, to secure bone segments
20, 21 together. Additionally, cable loops 15 encircle bone
segments 20, 21 and are secured to cable retaining washers 12,
whereby cable loops 15 further secure bone segments 20, 21 to bone
plate 6 and, as a result, to one another.
[0053] Bone plate 6 is of the sort well known in the art. By way of
example but not limitation, bone plate 6 generally comprises an
elongated body 35 penetrated by the aforementioned screw holes 33.
The bone plate's top surface 36 generally includes recesses 40
about the top ends of screw holes 33; in conventional bone plate
applications, recesses 40 receive the semi-spherical undersides of
the heads 25 of bone screws 9.
[0054] Bone screws 9 are also of the sort well known in the art.
Bone screws 9 comprise the aforementioned head 25 and the
aforementioned shank 27.
[0055] Cable restraining washer 12 comprises a body 45 having a
bottom surface 48 (FIG. 3) for engaging the top surface 36 of bone
plate 6, a downwardly projecting extension 50 for seating in a
recess 40 in bone plate 6, and an upwardly projecting extension 55
for receiving and restraining at least one cable loop 15.
[0056] Downwardly projecting extension 50 preferably has a
semi-spherical configuration similar to the semi-spherical
underside of a head 25 of a bone screw 9 so as to seat in one of
the recesses 40 commonly formed in bone plate 6.
[0057] A recess 60 is formed in body 45, in alignment with the
downwardly projecting extension 50 and screw hole 30. Recess 60 is
sized so as to receive the head 25 of a bone screw 9, and screw
hole 30 is sized so as to receive the shank 27 of a bone screw 9.
In this way, cable restraining washer 12 can be mounted to bone
plate 6 so that the washer's downwardly projecting extension 50
seats in a recess 40 formed in bone plate 6, and a bone screw 9 may
be passed through the cable retaining washer 12 so that the head 25
of the screw 9 is seated in the washer's recess 60 and so that the
shank 27 of the bone screw 9 passes through the washer's screw hole
30, through the screw hole 33 formed in bone plate 6, and into a
bone segment 20, 21, whereby to secure the cable retaining washer
12 and bone plate 6 to one another, and to a bone segment 20,
21.
[0058] Cable retaining washer 12 also comprises the upwardly
projecting extension 55 for receiving and retaining one or more
cable loops 15. More particularly, cable retaining washer 12 also
comprises at least one cable hole 65 extending perpendicular to the
axis of the washer's screw hole 30. Cable hole 65 is sized to
slidingly receive a cable loop 15. A threaded set screw hole 67
extends downwardly from the top surface 70 of the washer's upwardly
projecting extension 55. The bottom end of set screw hole 67
intersects the at least one cable hole 65 (FIG. 3). A set screw 73
is positioned in set screw hole 67. Set screw 73 may be tightened
down so as to engage a cable loop 15 extending through a cable hole
65, whereby to secure that cable loop to the cable retaining washer
12 and, as a result, to secure that cable loop to a bone segment
20, 21.
[0059] Surgical fastening system 5 is intended to be used as
follows.
[0060] First, bone plate 6 is positioned against bone segments 20,
21. Then bone screws 9 are used to secure cable retaining washers
12 and bone plate 6 to one another and to bone segments 20, 21.
Next, cable loops 15 are passed through cable holes 65 in the cable
retaining washers 12, and then set screws 73 are used to lock cable
loops 15 to the washers.
[0061] Looking next at FIG. 4, there is shown a cable retaining
washer 112 which comprises an alternative form of the invention.
Cable retaining washer 112 is substantially the same as the cable
retaining washer 12 described above, except that it also includes a
second upwardly projecting extension 55, along with that
extension's associated cable holes(s) 65, set screw hole 67, and
set screw 73.
[0062] Looking next at FIG. 5, there is shown a cable retaining
washer 212 which comprises another alternative form of the
invention. Cable retaining washer 212 is substantially the same as
the cable retaining washer 12 described above, except that its
upwardly projecting extension 255 lacks the set screw hole 67 and
set screw 73 for locking a cable loop 15 within a cable hole 65.
Instead, with cable retaining washer 212, upwardly projecting
extension 255 is formed so as to be crimpable, whereby to
mechanically lock a cable loop 15 within a cable hole 65. In one
preferred form of the invention, upwardly projecting extension 255
is formed with a trapezoidal cross-section such as that shown in
FIG. 5, whereby to facilitate crimping of the upwardly extending
projection 255 about the cable.
[0063] Looking next at FIG. 6, there is shown a cable retaining
washer 312 which comprises another alternative form of the
invention. Cable retaining washer 312 is substantially the same as
the cable retaining washer 212 described above, except that it
includes a second upwardly projecting extension 255.
[0064] Looking next at FIG. 7, there is shown a cable retaining
washer 412 which comprises another alternative form of the
invention. Cable retaining washer 412 is substantially the same as
the cable retaining washer 312 described above, except that each of
the upwardly projecting extensions 255 has only one cable hole 65
formed therein.
[0065] In the cable retaining washers 12, 112, 212, 312 and 412
described above, the downwardly projecting extension 55 has a
semi-spherical configuration so as essentially replicate the
semi-spherical underside of the head 25 of a bone screw 9, whereby
it may be received in the recess 40 formed in bone plate 6.
However, forming the downwardly projecting extension 55 with a
semi-spherical configuration can sometimes result in the cable
retaining washer turning somewhat about the axis of its screw hole
30 as bone screw 9 is screwed into a bone segment 20, 21. This can
present an inconvenience to the surgeon.
[0066] To guard against this, and looking now at FIGS. 8 and 9,
there is shown a bone plate 506 which is provided with an elongated
recess 540 and a cable retaining washer 512. Cable retaining washer
512 is substantially the same as the cable retaining washer 212
shown in FIG. 5, except that the downwardly projecting extension 50
of cable retaining washer 212 (FIG. 5) has been replaced with a
downwardly projecting extension 550 having a cross-sectional
profile matching that of the bone plate's elongated recess 540. If
desired, the cable retaining washers 12, 112, 312, and 412 may also
have their downwardly projecting extensions 50 replaced with
similar downwardly projecting extensions 550, whereby they can mate
securely with recesses 540 of a bone plate 506.
[0067] It is also possible to use the cable retaining washers of
the present invention without a bone plate. In this case, the bone
screw passes through the cable retaining washer and directly into a
bone segment 20, 21. If desired, cable retaining washers 12, 112,
212, 312, 412 and/or 512 may be used in this way, with the
downwardly projecting extensions bearing against, and generally
penetrating into, bone segment 20, 21. See, for example, FIG. 10,
where cable retaining washer 12 is shown engaging a bone segment
20, 21.
[0068] Alternatively, if desired, the bottom surface of the cable
retaining washer can be modified so as to reduce, or entirely
remove, the downwardly projecting extension.
[0069] Looking next at FIGS. 11-13, there is shown a suture
retaining washer 612 which comprises another form of the invention.
Suture retaining washer 612 comprises a body 645. Suture retaining
washer 612 also comprises a downwardly projecting extension 650 for
seating in a recess 40 of a bone plate 6 or for engaging the outer
surface of a bone segment 20, 21. Suture retaining washer 612 also
comprises at least one upwardly projecting extension 655 for
receiving and retaining at least one suture loop 615.
[0070] A screw hole 30 is formed in downwardly projecting extension
650 and a recess 60 is formed in body 645. Recess 60 is sized to
receive the head 25 of a bone screw 9, and screw hole 30 is sized
to receive the shank 27 of bone screw 9. In this way, suture
retaining washer 612 can be mounted to bone plate 6 so that the
downwardly projecting extension 650 seats in a corresponding recess
40 in bone plate 6, and a bone screw 9 may be passed through the
suture retaining washer 612 so that the head 25 of the screw 9 is
seated in the washer's recess 60 and the shank 27 of the bone screw
9 passes through the washer's screw hole 30, through the screw hole
33 in bone plate 6, and into a bone segment 20, 21, whereby to
secure suture retaining washer 612 and bone plate 6 to one another,
and to a bone segment 20, 21. Alternatively, suture retaining
washer 612 can be mounted directly to a bone segment 20, 21 by
seating downwardly projecting extension 650 against a bone segment
20, 21, and then passing a bone screw 9 through the suture
retaining washer 612 so that the head 25 of the screw 9 is seated
in the washer's recess 60 and the shank 27 of the bone screw 9
passes through the washer's screw hole 30 and into a bone segment
20, 21.
[0071] Suture retaining washer 612 also comprises at least one
upwardly projecting extension 655 for receiving and retaining one
or more loops 615. More particularly, suture retaining washer 612
also comprises at least one upwardly projecting extension 655, with
each upwardly projecting extension having at least one suture hole
65 extending perpendicular to the axis of the washer's screw hole
30. Suture hole 65 is sized to slidingly receive a suture loop
615.
[0072] If desired, suture loops 615 can be used to secure soft
tissue to bone segments 20, 21. Alternatively, and looking next at
FIGS. 14 and 15, suture loops 615 can be used to attach a surgical
mesh 675 to bone segments 20, 21, or to attach other objects to
bone segments 20, 21.
[0073] Looking next at FIGS. 16-18, there is shown a cable
retaining washer 712 which comprises an alternative form of the
invention. Cable retaining washer 712 is substantially the same as
the cable retaining washer 212 described above, except that its
upwardly projecting extension 755 has its one or more cable holes
65 extending along an axis substantially aligned with the head 25
of screw 9. Again, the upwardly projecting extension 755 may be
crimped about a cable loop 15 extending through a cable hole
65.
[0074] Looking next at FIG. 19, there is shown a cable retaining
washer 812 which comprises another alternative form of the
invention. Cable retaining washer 812 is substantially the same as
the cable retaining washer 712 described above, except that it
includes a second upwardly projecting extension 755 which also has
its one or more cable holes 65 substantially aligned with the head
25 of screw 9. Again, the upwardly projecting extensions may be
crimped about a cable loop 15 extending through a cable hole
65.
[0075] Looking next at FIG. 20, there is shown a cable retaining
washer 912 which comprises another alternative form of the
invention. Cable retaining washer 912 is substantially the same as
the cable retaining washer 12 described above, except that its
upwardly projecting extension 955 has its one or more cable holes
extending along an axis substantially aligned with the head 25 of
screw 9. Again, set screw 78 may be tightened down so as to secure
a cable loop 15 to the cable retaining washer.
[0076] Looking next at FIG. 21, there is shown a cable retaining
washer 1012 which comprises another alternative form of the
invention. Cable retaining washer 1012 is substantially the same as
the cable retaining washer 912 described above, except that it
includes a second upwardly projecting extension 955 which also has
its one or more cable holes 65 substantially aligned with the head
25 of screw 9. Again, a set screw 78 may be tightened down so as to
secure a cable loop 15 to the cable retaining washer.
[0077] Looking next at FIG. 22, there is shown a cable retaining
washer 1112 which comprises another alternative form of the
invention. Cable retaining washer 1112 is substantially the same as
the cable retaining washer 212 described above, except that the
upwardly projecting extension 255 is replaced with a displaced
extension 1155 having one or more cable holes 65 extending
therethrough. More particularly, displaced extension 1155 is
preferably formed in the same plane as body 45 and downwardly
projecting extension 50, and is displaced both laterally (i.e.,
along the axis labeled "X" in FIG. 22) and longitudinally (i.e.,
along the axis labeled "Y" in FIG. 22) from downwardly projecting
extension 50. By displacing extension 1155 laterally and
longitudinally away from downwardly projecting extension 50, access
to the extension 1155 with a crimping tool is enhanced.
[0078] Looking next at FIG. 23, there is shown a cable retaining
washer 1212 which comprises another alternative form of the
invention. Cable retaining washer 1212 is substantially the same as
the cable retaining washer discussed above, except that it includes
a second displaced extension 1155. In one preferred embodiment, the
one or more cable holes 65 of one displaced extension 1155 are
aligned with the one or more cable holes 65 of the other displaced
extension 1155. In another preferred embodiment, the two displaced
extensions 1155 may be diametrically opposed from one another.
[0079] Looking next at FIGS. 24-26, there is shown a suture
retaining washer 1312 which comprises another alternative form of
the invention. Suture retaining washer 1312 is substantially the
same as the suture retaining washer 612 described above, except
that body 645 and upwardly projecting extensions 655 are omitted,
and the at least one suture hole 65 is formed directly in the side
wall of downwardly projecting extension 650. Preferably at least
two suture holes 65 are provided, and the two suture holes are
aligned with one another so as to receive a single suture loop 615
therethrough, such as is shown in FIG. 26. Preferably each suture
hole 65 has its entrances and rounded somewhat so as to permit the
suture to be slidingly adjusted therethrough prior to fully
tightening down bone screw 9. However, suture retaining washer 1312
may, optionally, be constructed so that the head of the bone screw
will lock the suture to the washer when the bone screw is fully
tightened down. Suture retaining washer 1312 may be secured
directly to a bore segment 20, 21 if desired, or it may be secured
to a bone plate which is disposed between suture retaining washer
1312 and a bone segment 20, 21. Suture retaining washer 1312 is
preferably formed so that it has a diameter substantially the same
as the head of a bone screw 9 passing therethrough, so that the
washer can fit beneath the head of the bone screw and thereby
present a minimal peripheral profile.
* * * * *