U.S. patent application number 12/768508 was filed with the patent office on 2011-01-27 for adjustable bone plates.
This patent application is currently assigned to ACUMED LLC. Invention is credited to Steven P. Horst, Randall J. Huebner.
Application Number | 20110022049 12/768508 |
Document ID | / |
Family ID | 32329194 |
Filed Date | 2011-01-27 |
United States Patent
Application |
20110022049 |
Kind Code |
A1 |
Huebner; Randall J. ; et
al. |
January 27, 2011 |
ADJUSTABLE BONE PLATES
Abstract
Bone plates having an adjustable joint, and methods of using the
bone plates to fix bones.
Inventors: |
Huebner; Randall J.;
(Portland, OR) ; Horst; Steven P.; (Dayton,
OR) |
Correspondence
Address: |
JAMES R. ABNEY;Kolisch Hartwell, P.C.
200 Pacific Building, 520 S.W. Yamhill Street
Portland
OR
97204
US
|
Assignee: |
ACUMED LLC
Hillsboro
OR
|
Family ID: |
32329194 |
Appl. No.: |
12/768508 |
Filed: |
April 27, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11504223 |
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7704251 |
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12768508 |
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Current U.S.
Class: |
606/71 ;
606/286 |
Current CPC
Class: |
A61B 17/1782 20161101;
A61B 17/808 20130101; A61B 17/1728 20130101; A61B 17/8061 20130101;
A61B 17/8085 20130101; A61B 2090/061 20160201; A61B 17/8033
20130101; A61B 17/8052 20130101; A61B 17/80 20130101; A61B 2090/067
20160201; A61B 17/1735 20130101; A61B 17/8004 20130101 |
Class at
Publication: |
606/71 ;
606/286 |
International
Class: |
A61B 17/58 20060101
A61B017/58 |
Claims
1. A bone plate for bone fixation, comprising: a first plate
component defining a longitudinal axis and an aperture elongated
parallel to the longitudinal axis; and a second plate component
mated with the first plate component to form a slidable
interconnection that permits sliding of the second plate component
with respect to the first plate component in a direction parallel
to the longitudinal axis, the second plate component defining a
threaded opening positioned under the aperture such that a threaded
fastener can be placed through the aperture, into threaded
engagement with the opening, and into bone.
2. The bone plate of claim 1, wherein the aperture is a first
aperture, and wherein the first plate component defines a second
aperture elongated parallel to the longitudinal axis.
3. The bone plate of claim 2, wherein the opening is a first
threaded opening, wherein the bone plate includes a second threaded
opening positioned under the second aperture such that a threaded
fastener can be placed through the second aperture, into threaded
engagement with the second threaded opening, and into bone.
4. The bone plate of claim 1, wherein the threaded opening is
included in a first plate portion, further comprising a second
plate portion defining a plurality of openings configured to
receive fasteners that attach the second plate portion to bone.
5. The bone plate of claim 4, wherein the first and second plate
portions are connected by a movable joint.
6. The bone plate of claim 5, wherein the movable joint is a
pivotable joint.
7. A method of bone fixation, comprising: selecting a bone plate
including (a) a first plate component defining a longitudinal axis
and an aperture elongated parallel to the longitudinal axis and (b)
a second plate component mated with the first plate component to
form a slidable interconnection that permits sliding of the second
plate component with respect to the first plate component in a
direction parallel to the longitudinal axis, the second plate
component defining a threaded opening positioned under the
aperture; and placing a threaded fastener through the aperture,
into threaded engagement with the opening, and into bone.
8. The method of claim 7, wherein the threaded fastener includes a
head, and wherein the step of placing includes a step of engaging
the first plate component with the head at the aperture.
9. The method of claim 7, further comprising a step of moving the
opening along the aperture to adjust a position where the opening
aligns with the aperture.
10. The method of claim 7, further comprising a step of locking the
bone plate such that sliding of the second plate component with
respect to the first plate component is prevented.
11. The method of claim 7, further comprising a step of spanning a
discontinuity in bone with the bone plate.
12. The method of claim 11, wherein the step of spanning a
discontinuity includes a step of spanning a fracture in a bone with
the bone plate.
13. The method of claim 7, wherein the aperture is a first
aperture, and wherein the step of selecting selects a bone plate
including a first plate component defining a second aperture
elongated parallel to the longitudinal axis.
14. The method of claim 13, wherein the opening is a first threaded
opening, and wherein the step of selecting selects a bone plate
including a second threaded opening positioned under the second
aperture, further comprising a step of placing a threaded fastener
through the second aperture, into threaded engagement with the
second threaded opening, and into bone.
15. The method of claim 7, wherein the threaded opening is a first
threaded opening included in a first plate portion, wherein the
step of selecting selects a bone plate including a second plate
portion defining a second threaded opening, further comprising a
step of attaching the second plate portion to bone with a fastener
placed in the second threaded opening.
16. A bone plate for bone fixation, comprising: first and second
plate members structured to be placed under skin and each defining
one or more openings configured to receive fasteners that secure
the first and second plate members to portions of at least one
bone, the first and second plate members being connected to provide
(1) a pivotable configuration in which an angular disposition of
the plate members relative to one another is adjustable by pivotal
movement of the first plate member about two or more nonparallel
axes, and (2) a fixed configuration in which the angular
disposition is fixed.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of the following
U.S. patent applications: Ser. No. 11/504,223, filed Aug. 14, 2006,
now U.S. Pat. No. 7,704,251; Ser. No. 11/637,626, filed Dec. 11,
2006; Ser. No. 11/929,026, filed Oct. 30, 2007; Ser. No.
12/175,223, filed Jul. 17, 2008; Ser. No. 12/176,913, filed Jul.
21, 2008; and Ser. No. 12/616,054, filed Nov. 10, 2009.
[0002] U.S. patent application Ser. No. 11/504,223, in turn, is a
continuation of U.S. patent application Ser. No. 10/716,719, filed
Nov. 19, 2003, now U.S. Pat. No. 7,090,676, which, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
the following U.S. provisional patent applications: Ser. No.
60/427,908, filed Nov. 19, 2002; and Ser. No. 60/512,136, filed
Oct. 17, 2003.
[0003] U.S. patent application Ser. No. 11/637,626, in turn, is a
continuation-in-part of the following U.S. patent applications:
Ser. No. 10/625,503, filed Jul. 22, 2003, now U.S. Pat. No.
7,537,603; Ser. No. 10/712,202, filed Nov. 12, 2003, now abandoned;
Ser. No. 10/717,015, filed Nov. 19, 2003, now U.S. Pat. No.
7,539,604; Ser. No. 10/717,399, filed Nov. 19, 2003, now U.S. Pat.
No. 7,326,212; Ser. No. 10/717,401, filed Nov. 19, 2003, now U.S.
Pat. No. 7,153,309; Ser. No. 10/717,402, filed Nov. 19, 2003, now
U.S. Pat. No. 7,189,237; Ser. No. 10/734,017, filed Dec. 10, 2003,
now U.S. Pat. No. 7,147,640; Ser. No. 10/873,522, filed Jun. 21,
2004, now U.S. Pat. No. 7,537,596; Ser. No. 10/993,205, filed Nov.
18, 2004, now U.S. Pat. No. 7,235,079; Ser. No. 11/050,342, filed
Feb. 2, 2005, now abandoned; Ser. No. 11/109,984, filed Apr. 19,
2005, now U.S. Pat. No. 7,578,825; Ser. No. 11/109,985, filed Apr.
19, 2005, now abandoned; Ser. No. 11/112,858, filed Apr. 22, 2005;
Ser. No. 11/273,811, filed Nov. 14, 2005, now abandoned; Ser. No.
11/274,597, filed Nov. 14, 2005; Ser. No. 11/330,802, filed Jan.
11, 2006; Ser. No. 11/413,631, filed Apr. 28, 2006; Ser. No.
11/449,554, filed Jun. 7, 2006, now abandoned; Ser. No. 11/486,959,
filed Jul. 13, 2006; Ser. No. 11/504,223, filed Aug. 14, 2006; Ser.
No. 11/550,255, filed Oct. 17, 2006; and Ser. No. 11/585,378, filed
Oct. 23, 2006.
[0004] U.S. patent application Ser. No. 10/625,503, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
the following U.S. provisional patent applications: Ser. No.
60/398,075, filed Jul. 22, 2002; and Ser. No. 60/484,262, filed
Jun. 30, 2003.
[0005] U.S. patent application Ser. No. 10/717,015, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/512,323, filed Oct.
17, 2003.
[0006] U.S. patent application Ser. No. 10/717,399, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
the following U.S. provisional patent applications: Ser. No.
60/427,908, filed Nov. 19, 2002; and Ser. No. 60/512,136, filed
Oct. 17, 2003.
[0007] U.S. patent application Ser. No. 10/717,401, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
the following U.S. provisional patent applications: Ser. No.
60/427,910, filed Nov. 19, 2002; and Ser. No. 60/512,322, filed
Oct. 17, 2003.
[0008] U.S. patent application Ser. No. 10/717,402, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
the following U.S. provisional patent applications: Ser. No.
60/427,908, filed Nov. 19, 2002; and Ser. No. 60/512,136, filed
Oct. 17, 2003.
[0009] U.S. patent application Ser. No. 10/734,017, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/454,217, filed Mar.
12, 2003.
[0010] U.S. patent application Ser. No. 10/873,522, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/480,529, filed Jun.
20, 2003.
[0011] U.S. patent application Ser. No. 10/993,205, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/541,414, filed Feb.
2, 2004.
[0012] U.S. patent application Ser. No. 11/109,984, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/563,860, filed Apr.
19, 2004.
[0013] U.S. patent application Ser. No. 11/109,985, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/563,767, filed Apr.
19, 2004.
[0014] U.S. patent application Ser. No. 11/112,858, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/564,853, filed Apr.
22, 2004.
[0015] U.S. patent application Ser. No. 11/273,811, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/627,297, filed Nov.
12, 2004.
[0016] U.S. patent application Ser. No. 11/274,597, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/627,721, filed Nov.
12, 2004.
[0017] U.S. patent application Ser. No. 11/449,554, in turn, is a
continuation of U.S. patent application Ser. No. 10/873,522, which,
in turn, is based upon and claims the benefit under 35 U.S.C.
.sctn.119(e) of U.S. Provisional Patent Application Ser. No.
60/480,529, filed Jun. 20, 2003.
[0018] U.S. patent application Ser. No. 11/486,959, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/699,277, filed Jul.
13, 2005.
[0019] U.S. patent application Ser. No. 11/585,378, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/729,373, filed Oct.
21, 2005.
[0020] U.S. patent application Ser. No. 11/929,026, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/856,128, filed Nov.
1, 2006.
[0021] U.S. patent application Ser. No. 12/175,223, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/961,317, filed Jul.
19, 2007.
[0022] U.S. patent application Ser. No. 12/176,913, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 60/961,317, filed Jul.
19, 2007.
[0023] U.S. patent application Ser. No. 12/616,054, in turn, is
based upon and claims the benefit under 35 U.S.C. .sctn.119(e) of
U.S. Provisional Patent Application Ser. No. 61/112,878, filed Nov.
10, 2008.
[0024] Each of these priority patent applications is incorporated
herein by reference in its entirety for all purposes.
FIELD OF THE INVENTION
[0025] The invention relates to bone plates. More specifically, the
invention relates to bone plates having an adjustable joint.
BACKGROUND
[0026] 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
fixators) and/or internal fixation devices (such as bone plates,
nails, and bone screws), among others.
[0027] Bone plates are sturdy internal devices, usually made of
metal, that mount directly to the bone adjacent the fracture (or
osteotomy). To use a bone plate to repair a discontinuity of a
bone, a surgeon typically (1) selects an appropriate plate, (2)
reduces the discontinuity (e.g., sets the fracture), and (3)
fastens the plate to bone portions disposed on opposite sides of
the discontinuity using suitable fasteners, such as screws and/or
wires, so that the bone portions are fixed in position.
[0028] Despite direct access to the bone portions when applying a
bone plate, the surgeon may have difficulty fixing the bone
portions with the correct alignment. For example, one or more of
the bone portions may be relatively small and/or displaced from the
bone plate. As a specific example, in fixation of fractures of the
distal radius, a distal bone portion(s) may be difficult to
position properly. More generally, during attachment of any bone
plate, fasteners may be misplaced or misdirected so that bone
portions move away from a desired positioning as the fasteners are
tightened. Accordingly, the relative position of bone portions may
need to be adjusted after the bone plate has been secured to a bone
to achieve proper reduction of a fracture.
SUMMARY
[0029] The invention provides bone plates having an adjustable
joint, and methods of using the bone plates to fix bones.
BRIEF DESCRIPTION OF THE DRAWINGS
[0030] FIG. 1 is a series of views of a fractured bone showing its
fracture being reduced and the bone being fixed with a pivotable
bone plate, in accordance with the present teachings.
[0031] FIG. 2 is a lateral view of the bones of the right hand and
distal forearm in which the radius has suffered a Colles' fracture,
displacing and angulating a distal fragment of the radius
dorsally.
[0032] FIG. 3 is a sectional lateral-medial view of the fractured
radius of FIG. 2, with a first example of a bone plate affixed to
the volar surface of the fractured radius and configured for
bending and twisting movement within the bone plate, in accordance
with the present teachings.
[0033] FIG. 4 is a volar view of the fractured radius and bone
plate of FIG. 3.
[0034] FIG. 5 is a partially exploded view of the bone plate of
FIGS. 3 and 4 as seen from a position generally above the outer
surface of the bone plate, in the absence of the distal radius and
in the presence of bone screws.
[0035] FIG. 6 is a fragmentary sectional view of the bone plate of
FIG. 5, viewed generally along line 6-6 of FIG. 5.
[0036] FIG. 7 is an exploded view of a second example of a bone
plate for fixing a fractured distal radius, in which axial and
transverse portions of the bone plate can pivot and slide in
relation to each other, in accordance with the present
teachings.
[0037] FIG. 8 is a sectional view of the bone plate of FIG. 7 when
assembled, viewed generally along line 8-8 of FIG. 7.
[0038] FIG. 9 is an exploded view of a third example of a bone
plate for fixing a fractured distal radius, in which axial and
transverse portions of the bone plate can pivot relative to one
another about spaced orthogonal axes, in accordance with the
present teachings.
[0039] FIG. 10 is an exploded view of a fourth example of a bone
plate for fixing a fractured distal radius, in which axial and
transverse portions of the bone plate can pivot about one axis and
slide translationally relative to one another, in accordance with
the present teachings.
[0040] FIG. 11 is a view of a fifth example of a bone plate for
fixing a fractured distal radius, in which axial and transverse
portions of the bone plate can pivot about a normal axis and slide
along a curved path, in accordance with the present teachings.
[0041] FIG. 12 is a fragmentary sectional view of the bone plate of
FIG. 11, viewed generally along line 12-12 of FIG. 11.
[0042] FIG. 13 is a sectional view of the bone plate of FIG. 11,
viewed generally along line 13-13 of FIG. 11.
[0043] FIG. 14 is an exploded view of the bone plate of FIG.
11.
[0044] FIG. 15 is an exploded view of a sixth example of a bone
plate for fixing a fractured distal radius, with portions of the
bone plate being pivotable and having reference marks to indicate
the angular disposition of the plate portions, in accordance with
the present teachings.
[0045] FIG. 16 is a fragmentary plan view of the bone plate of FIG.
15 in an assembled configuration, showing further aspects of the
reference marks and illustrating use of the reference marks to
measure the angular disposition of the plate portions.
[0046] FIG. 17 is a plan view of a seventh example of a bone plate
for fixing a fractured distal radius, in which portions of the bone
plate can pivot relative to each other about a plurality of axes,
in accordance with the present teachings.
[0047] FIG. 18 is an exploded view of the bone plate of FIG.
17.
[0048] FIG. 19 is a side elevation view of the bone plate of FIG.
17 positioned on the volar surface of the distal radius for
fixation of a distal radius fracture, in accordance with the
present teachings.
DETAILED DESCRIPTION
[0049] The invention provides bone plates having an adjustable
joint, and methods of using the bone plates to fix bones.
[0050] The bone plates each may include a plurality of plate
members connected by an adjustable (pivotable and/or translational)
joint. The adjustable joint may be configured so that the shape
and/or extent of the bone plate may be changed by adjusting the
angular disposition of the plate members. The angular disposition
may be adjusted by pivotal movement of a plate member about one
axis or about a plurality of axes, and then the angular disposition
may be fixed (locked). Each plate member may define one or more
openings. The plate members may be configured to be secured to
different regions of one bone or secured to different bones using
fasteners placed in the openings.
[0051] The shapes and/or extent of the bone plates may be adjusted
before, during, and/or after securing the bone plates to bone. When
adjusted after attachment, movement of the plate members may change
the relative disposition of attached bone portions, enabling a
surgeon to improve the alignment and/or spacing of fractured or
osteotomized bones, among others. As a result, reduction, fixation,
and/or healing may be facilitated.
[0052] Bone plates having adjustable joints, as described herein,
may be attached to or otherwise associated with bone using any
suitable method or procedure. For example, a surgeon may (1) select
an appropriate plate, (2) reduce (set) any fracture(s) or other
discontinuities in the bone (at least partially), (3) fasten the
plate to opposite sides of the fracture using suitable fasteners,
such as screws and/or wires, (4) adjust the shape of the plate to
adjust reduction of the fracture, and (5) fix the shape, so that
attached portions of the bone are fixed in position. These steps
may be performed manually and/or mechanically, for example, using a
guide system as described in the following patent application,
which is incorporated herein by reference: U.S. patent application
Ser. No. 10/717,401, filed Nov. 19, 2003.
[0053] FIG. 1 shows a series of views of a fractured bone 20 with
its fracture 21 being reduced and the bone being fixed with a
pivotable bone plate 22.
[0054] FIG. 1A shows bone plate 22 secured to bone 20 without
complete reduction of fracture 21. Bone plate 22 may include a
first plate member 24 and a second plate member 26. Each of the
plate members may define one or more openings 28 through which bone
screws 30 (or other fasteners) may be placed into (or otherwise
associated with) bone 20 to secure the plate members to the bone.
The plate members may be secured to different portions or pieces
32, 34 of bone 20 disposed on opposing sides of a bone
discontinuity, such as a fracture 21 or a cut within one bone
(intra-bone fixation), or a joint between different bones
(inter-bone fixation), among others. Plate members 24, 26 may be
connected by a mechanical joint 38. Joint 38 may be configured to
permit plate members 24, 26 to pivot and/or move translationally so
that the angular disposition (the alignment) and/or spacing,
respectively, of the plate members can be adjusted. In the present
illustration, joint 38 permits both pivotal and translational
movement of the plate members.
[0055] FIG. 1B shows an improved alignment of bone portions 32, 34
after pivotal movement, indicated as step 40, of first plate member
24 and second plate member 26 relative to one another. The pivotal
movement may be about one axis, such as about an axis generally
normal to the plate members, or about two or more axes. For
example, joint 38 may be configured so that the first and second
plate members can bend and twist relative to one another about
three orthogonal axes.
[0056] FIG. 1C shows the result of optional translational movement,
indicated as step 42, of first plate member 24 and second plate
member 26 toward one another. The translational movement may adjust
the spacing of the bone portions, for example, compressing (or
distracting) the bone portions toward (or away from) one another,
or shifting a plate member laterally. After pivotal and/or
translational movement of the plate members, further relative
movement of the plate members at joint 38 may be restricted by
adjustment of a detent mechanism 44, such as a screw, to place
joint 38 in a fixed configuration.
[0057] Pivotal and/or translational movement of the plate members
relative to one another may be effected via any suitable mechanism,
including manipulation of the bones and/or body portions connected
to the bones, and/or manipulation of the bone plates and/or handles
or other devices associated with the bone plates. Such manipulation
may be performed by hand and/or using a tool. For example, in FIG.
1, pivotal and/or translational movement may be directed by a
handle (or handles) 46 connected to one or more of the plate
members (see FIGS. 1A and 1B). The handle may be grasped by hand or
with a tool to apply a directional force, such as a torque, to one
of the plate members. To increase torque by increasing the lever
arm, the handle(s) may be positioned relatively far from the
joint(s), and/or be relatively long. The handle may be removed
after plate adjustment has been completed, as shown in FIG. 1C. In
some embodiments, removal of the handle may include disconnecting
the handle, for example, by rotation of the handle to disengage
threads of the handle from a threaded opening of the bone
plate.
[0058] Further aspects of the invention are described in the
following sections, including (I) overview of bone plates, (II)
plate members, (III) joints of bone plates, (IV) reference marks,
and (V) examples.
I. Overview of Bone Plates
[0059] 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 a bone discontinuity
(such as a fracture, a cut, a bone joint, etc.) so that the
fixation device fixes the relative positions of bone portions
disposed on opposing sides of the bone discontinuity. The fixation
device generally is configured to be disposed in contact with an
outer surface of the bone and thus may be positioned at least
substantially exterior to the bone. The bone plate may be left in
place permanently or removed after the associated bone has
partially or completely healed.
[0060] 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. Suitable materials may be biocompatible materials
(such as titanium or titanium alloys, cobalt chromium, stainless
steel, plastic, ceramic, etc.) and/or bioabsorbable materials (such
as polygalactic acid (PGA), polylactic acid (PLA), copolymers
thereof, etc.), among others.
[0061] 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.
[0062] The bone plates may have at least one, and generally two or
more, distinct anchor (or bone-attachment) portions, configured to
be secured to a bone. Each anchor portion may be structured for a
specific portion of a bone, generally to fit against a surface
region of bone adjacent a bone discontinuity. For example, the bone
plates may include a proximal anchor portion for attachment to a
more proximal region of a bone, and a distal anchor portion for
attachment to a more distal region of the same bone. In some
embodiments, the bone plates may include a support (or buttress)
portion connected to an anchor portion. The support portion may
lack connective features that permit a direct connection of the
support portion to the bone with one or more fasteners. Such a
support portion may limit movement of a bone fragment using contact
between the support portion and the fragment, and may include
projections or prongs to engage the fragment more effectively.
[0063] 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.gtoreq.width W.gtoreq.thickness T. In use, the
long axis of the bone plates may be aligned with the long axis of
the corresponding bone or may extend obliquely or even 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 or may have
a nonlinear shape, such as for use near an end of a bone. In some
embodiments, the plates may be generally T-shaped, including an
axial portion, for attachment to a shaft portion of a bone, and a
transverse portion connected to the axial portion, to provide a
wider platform for attachment near an end of the bone. In some
embodiments, the bone plates may be configured for use on both
sides of the body, 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.
[0064] The bone plates described herein may be configured for use
on any suitable bone of the human body and/or of another vertebrate
species. Exemplary bones may include bones of the arms (radius,
ulna, humerus), legs (femur, tibia, fibula, patella), hands, feet,
the vertebrae, scapulas, pelvic bones, cranial bones, and/or the
ribs and clavicles, among others. Particular examples where
pivotable bone plates may be suitable include the distal radius
(such as the volar surface of the distal radius) and the distal
tibia.
[0065] 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 a surface of a target bone (or bones)
for which the bone plates are intended, so that the bone plates
maintain a low profile and fit 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 may correspond in contour to
the bone surface and may be complementary to the inner surface of
the plate.
[0066] The thickness of the bone plates is 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 a smaller bone and/or on a bone or bone
region 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. 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. In this way, the plates may be thicker and
thus stronger in regions where they typically do not need to be
contoured, such as along the shaft of the bone.
[0067] 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, the openings may be
adapted to alter the local rigidity of the plates, to permit the
plates to be manipulated with a tool (such as an attachable
handle), and/or to facilitate blood flow to the fracture or
surgical site to promote healing, among others.
[0068] 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 a
staggered arrangement. In some embodiments, the openings may be
configured so that a set of bone screws can be directed along
nonparallel paths, for example, to increase the purchase of the set
of bone screws on bone. Further aspects of openings configured to
direct bone screws along nonparallel paths are included in the
following patent application, which is incorporated herein by
reference: U.S. Provisional Patent Application Ser. No. 60/512,111,
filed Oct. 17, 2003.
[0069] The openings may have any suitable shape and structure.
Exemplary shapes may include circular, elliptical, rectangular,
elongate, etc. The openings may include counterbores configured,
for example, to receive a head of a bone screw. 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 (slots)
extending axially and/or transversely along each bone plate. The
slots may include counterbores that provide compression when bone
screws are advanced against the counterbores. Alternatively, or in
addition, the slots 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. Further aspects of openings or slots
that may be suitable for pivotable bone plates are described in
more detail in the following patent applications, which are
incorporated herein by reference in their entirety for all
purposes: PCT Patent Application Ser. No. PCT/US02/18623, filed
Jun. 10, 2002; and U.S. patent application Ser. No. 10/717,015,
filed Nov. 19, 2003.
[0070] The fasteners generally comprise any mechanism for affixing
a bone plate to a bone, including screws, pins, and wires, among
others. A preferred fastener is a bone screw, including
unicortical, bicortical, and/or cancellous bone screws. Unicortical
and bicortical bone screws typically have relatively small threads
for use in hard bone, such as typically found in the shaft portion
of a bone, whereas cancellous bone screws typically have relatively
larger threads for use in soft bone, such as typically found near
the ends (periarticular regions) of a long bone. Unicortical bone
screws penetrate the bone cortex once, adjacent the bone plate.
Bicortical bone screws penetrate the bone cortex twice, adjacent
the bone plate and opposite the bone plate. Generally, unicortical
screws provide less support than bicortical screws, because they
penetrate less cortex. The size and shape of the fasteners may be
selected based on the size, shape, and disposition of the openings,
or vice versa. For example, unicortical bone screws may be suitable
with particular arrangements of openings.
II. Plate Members
[0071] The anchor and/or buttress portions of a bone plate may be
defined by separate components of the bone plate, termed plate
members. Each plate member may define a different anchor and/or
buttress portion of the bone plate. The pivotable bone plates
described herein may include two or more plate members. In some
embodiments, the bone plates may include at least three plate
members, with each adjacent pair of plate members connected by a
mechanical joint.
[0072] Plate members may have any suitable size and shape.
Generally plate members may be sized and shaped according to a
target bone portion for which each plate member is intended.
Accordingly, the plate members of a bone plate may be configured to
correspond to the anchor and/or buttress portions of a bone plate
lacking a mechanical joint (that is, a unitary bone plate). In some
embodiments, one or more of the plate members may be generally
linear and/or generally T-shaped.
[0073] The plate members may be configured to be secured to (and/or
engage) different portions of one bone or two or more bones.
Accordingly, each plate member may include one or more connective
features. A connective feature may be any structure of the plate
member that permits coupling of the plate member to a fastener or
to bone. Exemplary connective features may include a threaded
opening to be engaged by a threaded fastener, a nonthreaded opening
to be engaged by any screw and/or a wire, a hook, a pin, a prong,
and/or the like. Each plate member may have no openings (for
example, a plate member configured to buttress bone), one opening,
or two or more openings. With two or more openings, the plate
member may have all threaded openings, all nonthreaded openings,
and/or a combination of threaded and nonthreaded openings, among
others. In some embodiments, a plate member may have an opening
configured to be engaged by a tool, such as a threaded or
nonthreaded handle, to facilitate manipulation of the plate member,
particularly after the plate member and/or its corresponding bone
plate have been attached to bone.
III. Joints of Bone Plates
[0074] The bone plates described herein may include one or more
joints. Each joint may be any connection between plate members that
permits the plate members to move relative to one another. The
joint(s) may be disposed to permit plate members of a bone plate to
move rotationally (bend and/or twist) and/or translationally
relative to one another, so that the angular disposition and/or
spacing of the plate members may be adjusted. Each joint may have
(1) an adjustable configuration in which the plate members can be
moved independently, and (2) a fixed configuration in which the
angular disposition and/or spacing of the plate members are
fixed.
[0075] A joint may be formed at a bridge region between plate
members. The bridge region may be defined by direct contact between
plate members and/or may include one or more additional components,
such as a bridge member, that spans a gap between the plate
members. In some embodiments, the joint may include generally
complementary surfaces of plate members that contact one another to
guide sliding movement (translational and/or pivotal) of the
surfaces (and thus the plate members) relative to one another. The
generally complementary surfaces may have any suitable shape(s),
including semi-spherical (or spherical), planar, curved (such as
semi-cylindrical), etc.
[0076] The joint may be pivotable. A pivotable joint may be
pivotable about a single axis or a plurality of two or more
nonparallel (or parallel) axes. The axis may be the long axis of
the plate (or of a plate member) to achieve twisting of the plate.
Alternatively, or in addition, the axis may be a normal or
"vertical" axis disposed generally orthogonal to a plane defined by
the plate (or one of the plate members). Furthermore, the axis or
axes may be one or more transverse or "horizontal" axes extending
obliquely and/or orthogonally to the long axis of the plate or
plate member. Pivotal movement about the normal and/or transverse
axes provides bending of the plate.
[0077] Any suitable types of pivotable joints may be included in
the bone plates. In some embodiments, the joint may permit pivotal
movement about three orthogonal axes. An exemplary pivotable joint
that allows plate members to be pivoted about three orthogonal axes
is a ball joint (ball-in-socket). The ball joint includes at least
one joint surface shaped generally as a complete sphere or as a
portion of a sphere (semi-spherical). In some embodiments, a ball
joint with a portion of a sphere may be preferred over a full
sphere joint to minimize the profile of the joint. A ball joint may
permit plate members to bend and twist relative to one another.
Alternatively, the joint may be a hinge joint (a pin in a hole)
that permits pivotal movement about only one axis. In some
embodiments, the joint may be two or more joints that permit
pivotal movement about spaced axes, such as spaced orthogonal axes
(see Example 4 below). In some embodiments, the joint (or joints)
may permit changes of angular disposition coupled with
translational movement (see Example 5 below).
[0078] Any pivotable joint may be locked with a detent mechanism,
to fix the angular disposition of the plate members. An exemplary
detent mechanism includes a fastener, such as a screw or bolt. The
fastener may be received threadedly to engage, compress, and/or
expand a plate member(s) and/or an associated component, such as
bridge member, to provide, for example, frictional engagement and
thus restrict movement. In some embodiments, the detent mechanism
may compress plate members together. In some embodiments, the
detent mechanism may include a conical screw that expands a joint
component, as the conical screw is advanced.
[0079] Any suitable structures may be included at the joint to
guide and/or limit movement of plate members. Such guiding/limiting
structures may include ridges and/or other projections that slide
in grooves, a pin or fastener guided by a slot, and/or
teeth/serrations received by a corresponding set of depressions or
complementary teeth/serrations, among others. The guiding/limiting
structures may allow continuous adjustment (for example, a ridge
sliding in a groove or a ball rotating in a socket), or discrete
adjustment positions (for example, serrations received by
depressions). The guiding/limiting structures may restrict
separation of the plate members (for example, a dovetail ridge
received in a corresponding dovetail groove).
[0080] Sliding may be permitted by the guiding/limiting structures
along one or plural axes. For example, sliding may be permitted
along the long axis of the plate, to adjust the length of the
plate. Alternatively, or in addition, sliding may be permitted
transversely, for example, to offset plate members or to adjust the
transverse position of a transversely extending plate member, such
as in a T-shaped bone plate.
[0081] A slidable junction may be locked in position by any
suitable detent mechanism. The detent mechanism may provide a
continuous range of locked positions or only discrete locked
positions. For example, the detent mechanism may be a fastener,
such as a screw (or screws). The screw may be positionable within a
slot defined by one plate member to allow a continuous range of
adjustments. Alternatively, the screw may be received in one of a
limited set of aligned apertures defined by the plate members to
provide discrete locked positions. In other embodiments, the detent
mechanism for translational (and/or pivotal) movement may be a tab
or button that is bent, depressed, or otherwise moved into a
retaining position.
[0082] Further aspects of adjustable bone plates having pivotable
and/or sliding joints (and/or deformable portions) are described in
the Examples below and in the following patent application, which
is incorporated herein by reference in its entirety for all
purposes: U.S. patent application Ser. No. 10/717,402, filed Nov.
19, 2003.
IV. Reference Marks
[0083] The bone plates may include reference marks. The reference
marks may be disposed adjacent a pivotable joint, a linearly
slidable joint, and/or a slot, among others. The reference marks
may indicate an angular disposition and/or a linear disposition of
one portion of a bone plate relative to another. Alternatively, the
reference marks may indicate a position of a bone screw within a
slot. The reference marks may be any visible indicia on the bone
plate. These indicia may be formed onto or into the plate during
initial production, for example, by casting the plate using a mold
configured to form the indicia (e.g., ridges or grooves in the mold
to form grooves or ridges in the plate, respectively).
Alternatively, or in addition, the indicia may be added to the
plate after production, for example, by etching or cutting them
into existing components of the plate, and/or adding them as
additional components of the plate. In some cases, indicia may
alternatively or additionally be included on a guide or template
that is placed in apposition to the plate before or during
installation, and then removed before the end of installation.
Exemplary reference marks may include dots, dashes, symbols,
numbers, letters, words, shapes, and/or colors, among others.
[0084] In some embodiments, a first plate member of a bone plate
may have an arcuate (or linear) array of reference marks, and a
second plate member of the bone plate may have a single reference
mark or landmark. The arcuate array may include numbers or letters
corresponding to different angular (or translational) positions.
The numbers may include positive and negative numbers to indicate
opposite directions of pivotal movement. The array of reference
marks may be compared against the landmark during relative rotation
(or translational movement) of one of the plate members relative to
the other, to measure an angular (or translational) adjustment.
Such an angular (or translational) adjustment may be predetermined,
for example, by analysis of an x-ray, the bone itself, or tissue
supported by the bone. Toward this end, corresponding or
complementary reference marks may be included on instruments or
tools used to select and/or install the bone plate, such as x-ray
templates, measuring guides, and so on. Alternatively, or in
addition, standard or typically used settings for the reference
marks may be noted on the plate, for example, by identifying these
marks using additional indicia (such as a star "*"). The adjustment
may be assigned a numerical value, such as an angle or a distance.
The reference marks may be configured to indicate a range of angle
or distances, so that these marks indicate when the numerical value
of adjustment has been reached during movement of the plate
members. Pivotable bone plates with reference marks may be suitable
for fixing osteotomies or fractures, or fixing different bones
across bone joints, among others.
[0085] Further aspects of pivotable bone plates with reference
marks are described in Example 7 below and in the following patent
application, which is incorporated by reference herein in its
entirety for all purposes: U.S. patent application Ser. No.
10/717,399, filed Nov. 19, 2003.
V. Examples
[0086] The following examples describe selected aspects and
embodiments of the invention, including pivotable bone plates and
exemplary uses of the pivotable bone plates to fix bones. These
examples are included for illustration and are not intended to
limit or define the entire scope of the invention.
Example 1
Exemplary Fracture for Fixation with Pivotable Bone Plates
[0087] This example describes an exemplary fracture that may be
fixed with pivotable bone plates of the present teachings; see FIG.
2.
[0088] FIG. 2 shows an upper right extremity 60 exhibiting a
Colles' fracture 62, which is a very common fracture of the distal
radius 64 typically caused by using an outstretched hand to break a
fall. The position of the fracture is indicated relative to the
skin of the distal forearm 66 and hand 68, which is shown in
phantom outline. In Colles' fracture 62, a smaller, distal bone
fragment 70 may be displaced dorsally from a larger, proximal bone
segment 72 of the radius bone. Colles' fracture 62 may be reduced
and fixed with the pivotable bone plates described herein by
placement of a bone plate on the volar (anterior or lower) side 74
of the radius. This placement may reduce or avoid tendon irritation
that may occur with flexion when the bone plate is attached to the
dorsal (posterior or upper) side 76 of the radius. Alternatively,
the bone plates described herein may be used on the dorsal surface
of the distal radius or on any other suitable bone(s) or bone
surface(s).
Example 2
Bone Plate with Joint for Pivotal Movement about Three Axes
[0089] This example describes a bone plate, for use on a fractured
distal radius, in which portions of the bone plate can bend and
twist relative to each other; see FIGS. 3-6.
[0090] FIGS. 3 and 4 show a lateral-medial sectional view and a
volar view, respectively, of fractured radius 64 with a pivotable
bone plate 80 affixed to radius adjacent volar surface 74.
Pivotable bone plate 80 may include a proximal plate member 82 and
a distal plate member 84 connected by a pivotable joint 86.
[0091] Proximal plate member 82 may have its long axis disposed
generally parallel to the long axis of the radius. Plate member 82
may be generally linear. Plate member 82 may be secured to proximal
segment 72 of the radius with a plurality of bone screws 88. Bone
screws 88 may be bicortical bone screws or may be unicortical bone
screws, as shown here. Bone screws 88 may be directed along
parallel or nonparallel paths defined by openings 90-94 of the
proximal plate member.
[0092] The paths the bone screws travel may be defined by a fit
between fasteners (such as bone screws or pins) and the openings.
The fit may be a close fit that at least substantially defines the
angle at which a fastener travels through the bone plate and into
bone, for placement of the fastener at a predefined angle.
Alternatively, the fit may be a less restrictive fit that permits
placement of the fastener at a selected angle within a range of
angles. The type of fit for each fastener may be determined by a
surgeon during installation of the bone plate by selection of each
fastener.
[0093] A close fit may be defined by threaded or nonthreaded
engagement of the fastener with the wall of the opening. The close
fit may be defined by threaded engagement of a threaded fastener
with a correspondingly threaded opening. The threaded engagement
may predefine the angle and lock the axial position of the fastener
relative to the screw's long axis. Alternatively, or in addition,
the close fit may be defined by a close correspondence of the
diameter of the fastener's shank and the diameter of the opening,
particularly a cylindrical portion of the opening. The diameter of
the fastener may be defined by a threaded or nonthreaded segment of
the shank of the fastener (generally adjacent the head of the
fastener). The diameter of the opening may be defined by a
nonthreaded or threaded opening. Accordingly, a close fit at a
predefined angle may be achieved by a nonthreaded or threaded shaft
segment engaged by either of a threaded or nonthreaded opening.
[0094] A less restrictive fit may be defined by the size and/or
shape of the opening in relation to the size and/or shape of the
fastener. For example, the opening may have a diameter sufficiently
greater than the diameter of the fastener to permit the fastener to
achieve different angular dispositions within the opening.
Alternatively, or in addition, the opening may have angled or
curved walls to permit the fastener to pivot to different angular
dispositions.
[0095] One or more of the openings, such as openings 92, 94, may be
elongate openings or slots. The slots may be disposed axially
and/or transversely on the plate member(s). The slots may have
reference marks 98 disposed adjacent the slots (see FIG. 5). The
reference marks may be configured to measure movement of the bone
plate in the direction in which each slot extends. In some
embodiments, the slots may be configured to permit axial and
angular adjustment of the proximal plate member 82 with bone screws
placed into bone from one or both of slots 92, 94, and before
additional bone screws are placed through openings 90 and into
bone. Further aspects of slots for positioning bone plates are
included in the following patent application, which is incorporated
herein by reference: U.S. patent application Ser. No. 10/717,015,
filed Nov. 19, 2003.
[0096] Distal plate member 84 may have its long axis disposed
transverse of the long axis of the radius. Plate member 84 may be
generally T-shaped or fan-shaped. Plate member 84 may be secured to
distal fragment 70 of the radius with a plurality of unicortical or
bicortical bone screws 102 placed through openings 104 of the
distal plate member and into bone. Openings 104 may be threaded,
nonthreaded, or a mixture thereof. The bone screws may be selected
for threaded or nonthreaded engagement with openings 104.
Furthermore, each bone screw may be selected so that the angle of
placement of a particular bone screw (or other fastener) is
predefined by opening 104 or selectable within a range of angles,
as described above for openings 90-94.
[0097] Pivotable joint 86 may be configured to permit bending and
twisting of distal plate member 84 relative to proximal plate
member 82, before, during, and/or after the plate members are
secured to the distal radius. FIG. 5 indicates bending movements
106, 108 about two axes and twisting movement 110 for the distal
plate member.
[0098] FIGS. 3 and 4 show the position of bone plate 80 before
final pivotal adjustment of the plate members and thus before final
reduction of fracture 62. Pivotal adjustment may be accomplished,
for example, by (1) placing joint 86 in an adjustable configuration
by loosening lock screw 112, (2) rotating distal plate member 84
about one or more axes (such as clockwise in both FIGS. 3 and 4),
by corresponding movement of connected handle 114, and (3) placing
joint 86 in a fixed configuration by tightening lock screw 112 to
fix the relative positions of the plate members and their attached
bone portions.
[0099] FIGS. 5 and 6 shows additional aspects of pivotable bone
plate, particularly aspects of pivotable joint 86. Joint 86 may
include upper and lower semi-spherical surfaces 122, 124 included
in the plate members. Semi-spherical surfaces 122, 124 may be
convex and concave, respectively, and may have a similar radius of
curvature. Accordingly, upper surface 122 may slide along lower
surface 124 to achieve pivotal movement about three orthogonal
axes. The upper and lower surfaces may be held in apposition by a
semi-spherical retainer 126, generally in the form of a washer, and
lock screw 112. The semi-spherical retainer may be configured to be
received in a semi-spherical cavity 128 defined by the distal plate
member. The retainer and semi-spherical cavity may have similar
radiuses of curvature.
[0100] Pivotable joint 86 may include a detent mechanism 129 to
restrict pivotal movement. In particular, the detent mechanism may
include lock screw 112 received in openings 130, 132 of the
retainer and distal plate member, respectively, and rotated into
threaded engagement with a threaded bore 134 of the proximal plate
member. The lock screw thus may be advanced or retracted to define
the amount of frictional engagement between plate member surfaces
122, 124, to determine whether these surfaces are movable or fixed
relative to one another. In some embodiments, the proximal plate
member may include lower surface 124 and the distal plate member
may include upper surface 126. Alternatively, or in addition, other
aspects of the pivotable joint may be inverted from the
configuration shown here, so that retainer 126 may be threaded and
configured to serve as a nut disposed adjacent the bone. In this
case, lock screw 112 may be placed through openings in each of the
plate members from the outer surfaces of the plate members and into
threaded engagement with the retainer.
[0101] Bone plate 80 may include inner surfaces 140, 142 and outer
surfaces 144, 146 (see FIG. 6) on the plate members. Inner surfaces
140, 142 may be configured to be generally coplanar when the bone
plate is in a neutral adjustment position, as shown here, or may
not be coplanar. Openings, such as opening 90, may be defined
between the inner and outer surfaces. The openings may include
counterbores 148 and bores 150. Bores 150 may be cylindrical or may
be flared toward the inner surface, among others.
Example 3
Bone Plate with Joints for Pivotal and Translational Movement
[0102] This example describes a bone plate, for use on a fractured
distal radius, in which portions of the bone plate can bend, twist,
and slide translationally relative to each other; see FIGS. 7 and
8.
[0103] Bone plate 170 may include a proximal plate member 172, a
distal plate member 84, and a bridge member 174 connecting the two
plate members. The bone plate may include two joints that permit
pivotal and translational movement of the plate members, pivotable
joint 86 and translational joint 175. Pivotable joint 86 may be
configured as described above for Example 2 and will not be
addressed further here.
[0104] Translational joint 175 may be defined by a telescoping
relation of bridge member 174 with proximal plate member 172. In
particular, bridge member 174 may include opposing, elongate ridges
or guides 176 configured to be received in complementary elongate
recesses or tracks 178 defined by the proximal plate member.
[0105] The axial position of bridge member 174 may be fixed by a
detent mechanism 180. The detent mechanism may include a retainer
182 (such as a washer) and a fastener 184 (such as a screw or
bolt). The fastener may be placed through the retainer and into
threaded engagement with a threaded bore 186 of bridge member 174.
Advancement of the fastener into the threaded bore may push
retainer 182 into engagement with retention surfaces 188 of the
proximal plate member 172, thereby restricting translation
movement. The retainer may be loosened to permit further sliding at
joint 175.
[0106] Before and/or after fixing joint 175, bone screws 190 may be
placed through openings 192 of proximal plate member 172 and into
bone. Bridge member 174 may include elongate passages 194 to permit
the bone screws to be received over a continuous range of axial
positions of the bridge member. The passages may be configured to
permit the heads of bone screws to advance through the passages, or
the heads of the bone screws may be engaged by the bridge
member.
Example 4
Bone Plate with Spaced Pivotable Joints
[0107] This example describes a bone plate with a plurality of
spaced joints configured for pivotal movement about orthogonal
axes; see FIG. 9.
[0108] Bone plate 210 may include two pivotable joints 212, 214
connecting proximal plate member 216 and distal plate member 218
using bridge member 220. Pivotable joint 212 may permit pivotal
movement, shown at 222 about a normal axis 224. Joint 212 may be
defined by apposition of distal plate member 218 with bridge member
220 at contact surfaces 226, 228 of these members. Contact surfaces
226, 228 may be generally planar. The contact surfaces may include
serrations or other complementary structures to restrict pivotal
movement when a detent mechanism 230 is actuated.
[0109] Detent mechanism 230 may be provided by a connector 232,
such as a screw, that passes through an opening 234 in distal plate
member 218 and into threaded engagement with a threaded bore 236 of
bridge member 220. Advancement of connector 232 may compress the
distal plate member and the bridge member together to restrict
pivotal movement. Surface features of contact surfaces 226, 228 may
facilitate restricting movement when the detent mechanism is
actuated.
[0110] Hinge joint 214 may permit pivotal movement, shown at 240,
about a transverse axis 242. The hinge joint may be formed between
bridge member 220 and proximal plate member 216. Detent mechanism
244 of the hinge joint may include a lock screw 246 that acts
axially on the hinge joint, to compress the hinge joint parallel to
axis 242. In some embodiments, the detent mechanism may act
radially on the hinge joint, among others.
Example 5
Bone Plate with Integrated Joint for Sliding and Pivoting
[0111] This example describes a bone plate, for fixing a fractured
radius, in which the plate an integrated joint for sliding and
pivoting; see FIG. 10.
[0112] Bone plate 270 may include a proximal plate member 272 and a
distal plate member 274 connected at joint 276. Joint 276 may
permit axial movement, shown at 278, and pivotal movement, shown at
280, about axis 282. The plate members may include contact surfaces
284, 286 that slide translationally and pivot relative to one
another. The plate members may be connected by connectors 288, 290
(such as screws), that extend through elongate openings 292, 294
and into a threaded hole 296 and a threaded slot 29, respectively.
The plate members may be adjusted positionally by pivotal and
translational movement of the plate members, and then fixed in
position by advancing connectors 288, 290 until their heads apply a
compressive force to the counterbore surfaces 302, 304 of distal
plate member 274.
Example 6
Bone Plate with Coupled Translational and Pivotal Movement
[0113] This example describes a bone plate, for fixing a fractured
radius, in which the bone plate couples translational and pivotal
movement; see FIGS. 11-14.
[0114] FIG. 11 shows a bone plate 320 having a proximal plate
member 322 and a distal plate member 324 connected by two joints
326, 328. First joint 326 permits pivotal movement, shown at 330,
about normal axis 332 and thus is similar to joint 212 of Example
4. Second joint 328 may be disposed under or over the first joint,
among others, and may be configured to permit the plate members to
slide translationally. However, the path along which the plate
members slide may be arcuate, as described further below, so that
the second joint permits coupled translational and circular
movement.
[0115] FIG. 12 shows an axial sectional view of selected portions
of bone plate 320. The plate members 322, 324 may be connected via
a bridge member 340 that contacts the plate members on opposing
surfaces 342, 344 of the bridge member. Upper surface 342 may
provide a contact surface for pivotal movement of proximal plate
member 322 at first joint 326. Lower surface 344 may provide a
contact surface that defines a curved path, indicated at 346, along
which distal plate member 324 slides. The curved path may be along
a circular path, as indicated by an alternate position of proximal
plate member 322 achieved by sliding along path 346, shown in
phantom outline at 348.
[0116] FIGS. 13 and 14 show a transverse sectional view and an
exploded view, respectively, of bone plate 320. Joints 326, 328 may
include a detent mechanism 350 having a connector 352. The
connector may be a screw, among others, that extends through
openings in proximal plate member 322 and bridge member 340. The
screw may be received by a threaded nut 354 retained in a slot 356
defined by distal plate member 324. Slot 356 may be narrowed
adjacent the bridge member to define walls 358 that engage shelves
360 of the nut, to retain the nut in slot 356.
Example 7
Bone Plate with Reference Marks
[0117] This example describes a bone plate with reference marks
configured to measure angular and/or translational adjustment of
the plate; see FIGS. 15 and 16.
[0118] FIG. 15 shows a bone plate 390 in an exploded view. Bone
plate 390 may be configured, for example, to fix the position of
cut bone portions after an osteotomy. Bone plate 390 may include an
axial (or proximal) plate member 392 and a transverse (or distal)
plate member 394 connected by a pivotable joint 396. Pivotable
joint 396 may enable transverse plate member 394 to pivot, shown at
397, about one axis, such as normal axis 398. Alternatively, the
pivotable joint may be configured to permit pivotal movement about
two or more axes, as described elsewhere in the present teachings.
Pivotable joint 396 may be adjustable and then fixable with a lock
screw 402 or other detent mechanism.
[0119] Bone plate 390 may include an angular indicator mechanism
404 including angular reference marks 406 and a landmark 408.
Angular reference marks 406 and landmark 408 may be disposed on
different plate members 392, 394, respectively, or vice versa.
[0120] The bone plate also may include slot 410 and a linear
indicator mechanism 412 that provides an axial measure of plate
adjustment. Slot 410 may extend in alignment with the long axis of
axial plate member 392. Slot 410 may receive a bone screw that
guides linear sliding of the bone plate in relation to the bone
screw (and thus underlying bone). Linear sliding may provide axial
adjustment of the bone plate before the bone screw is fully
tightened and/or before other bone screws are placed into bone from
additional openings 414 of the bone plate. Linear sliding may be
performed before and/or after bone screws have been placed into
bone from openings 416 of the opposite (e.g., transverse) plate
member(s). Positions within linear slot 410 may be indicated by
reference marks 418 arrayed parallel to the slot adjacent an edge
of the slot. Linear reference marks may have any suitable spacing
and orientation, and may have any suitable form, including
alphanumeric characters (such as numbers or letters), symbols,
and/or other indicia that identify and/or distinguish individual
marks.
[0121] FIG. 16 shows a plan view of angular indicator mechanism 404
of bone plate 390. Mechanism 404 may include angular reference
marks 406 arrayed in an arcuate arrangement. The reference marks
may include line segments that extend radially from pivot axis 398
and/or may include dots and/or dashes, among others. Adjacent pairs
of reference marks 406 may define any suitable angle with pivot
axis 398 of pivotable joint 396. For example, adjacent reference
marks may define an angle of 1, 2, 5, or 10 degrees, among others.
In some embodiments, reference marks 406 may include major and
minor marks that are visibly distinguishable, such as longer marks,
shown at 420, spaced here by thirty degrees, and flanking shorter
marks, shown at 422, spaced here by ten degrees, among others.
Indicator mechanism 404 also or alternatively may include
alphanumeric characters, such as numbers 424, which identify
particular references marks and/or serve as such marks. In some
cases, standard (e.g., preferred and/or typically used) settings
for the reference marks may be noted on the plate, for example, by
using an alternative font, symbol, or size, and/or by identifying
these marks using additional "standard setting" marks 426 (such as
a star "*").
[0122] Landmark 408 may be configured to provide a site against
which the reference marks 406 are compared, for example, to
identify one of the reference marks that is most closely aligned
with the landmark. For example, in the present illustration
landmark 408 is aligned with the reference mark labeled as "-30" to
indicate a 30 degree rotation of the transverse plate member from a
neutral position of zero degrees. Angular reference mechanism 404
may be used to adjust the angular position of transverse plate
member 392 by a predetermined angle. The angle may be predetermined
by any suitable analysis, such as examining an x-ray of the bone to
which the plate is attached, measuring the angle of bone or limb
misalignment with an external measuring device, etc.
[0123] The uses for reference marks in bone plates with reference
marks may extend to pre- and/or postoperative analysis. For
example, before installing a bone plate, a surgeon could "dial in"
or otherwise preset approximate settings for the bone plate. The
preset value could be determined from preoperative analysis (e.g.,
using x-ray templates and/or other measurement tools having
corresponding or complementary reference marks), comparison with a
corresponding uninjured feature on an opposite side of a patient's
body (e.g., using measurements of an uninjured left radius to
determine suitable preset values for an injured right radius),
comparison with statistical data collected from a variety of
patients (e.g., in the form of a lookup table), and so on.
Alternatively, or in addition, after installing a bone plate, a
surgeon could record the final settings, for possible postoperative
use. In some cases, reference marks may be readable in situ using
x-rays, magnetic resonance, and/or similar techniques, to allow
noninvasive monitoring of the continued proper placement and
adjustment of the plate postoperatively. Suitable reference marks
for such use include changes or alterations in the thickness,
profile, and/or composition of the plate, among others.
Example 8
Pivotable Bone Plate
[0124] This example describes another pivotable bone plate, for use
on a fractured distal radius, in which portions of the bone plate
can bend and twist relative to each other; see FIGS. 17-19. Some
aspects of this bone plate are shared with the bone plate described
above in Example 2 and are described in more detail therein.
[0125] FIG. 17 shows a bone plate 450 configured for use on a volar
surface of the distal radius. Bone plate 450 may be asymmetrical
and configured for use on only one side of the body, on the left
radius in the present illustration. Bone plate 450 may include a
proximal anchor portion 452, a distal anchor portion 454, and a
pivotable joint 456 connecting the proximal and distal anchor
portions.
[0126] Proximal anchor portion 452 may be an axial portion
configured to be generally aligned with the long axis of the
radius. Proximal anchor portion 452 may define a plurality of
openings, 458-464, for receiving fasteners, such as bone screws.
Proximal opening 464 may be a slot disposed in general alignment
with the long axis of proximal anchor portion 452. Each of the
openings may be threaded or nonthreaded and may include or lack a
counterbore. In some embodiments, one or more of the openings, such
as opening 458, may be configured as a transverse slot. At least a
subset of the openings may be disposed in a staggered arrangement,
such as on opposing sides of a central axis 466 of the plate, to
direct bone screws along staggered, nonparallel paths, as described
in U.S. Provisional Patent Application Ser. No. 60/512,111, filed
Oct. 17, 2003. Accordingly, openings of this subset may define
different paths of travel for bone screws based on different
orientations of the walls of the openings and/or threads thereof.
The perimeter of proximal anchor portion 452 may generally follow
the disposition of the openings, shown at 468, to create a wavy or
wiggly appearance to the proximal anchor portion when viewed from a
position normal to a plane defined by the plate. Proximal anchor
portion 452 also may include one or more smaller openings 470,
configured, for example, to receive a fastener of smaller diameter,
such as a wire.
[0127] Distal anchor portion 454 may be configured to be secured to
the widened distal region of the radius. Accordingly, distal anchor
portion 454 may be wider than proximal anchor portion 452 and may
flare distally, to produce a fan-like shape, so that the plate
overall is generally T-shaped. Distal anchor portion 454 may define
a plurality of openings 472, 474 arrayed in a direction generally
transverse to central axis 466 of the proximal anchor portion 452,
when the plate is adjusted to a neutral position as shown here.
Openings 472, 474 may be arrayed in one or more linear or arcuate
rows, among others.
[0128] The distal openings may be threaded, shown at 472, or
nonthreaded, shown at 474, or a combination thereof, as in the
present illustration (see FIG. 18 also). Each opening may be
configured to receive a bone screw or other fastener (such as a
pin) at a fixed angle or at a selected angle with a range of
angles. The choice between a fixed or variable angle may be defined
by how closely the screw or other fastener fits into the opening,
and/or whether threaded engagement is used to fix the angle of the
screw/fastener, as described above in more detail in Example 2.
[0129] Distal anchor portion 454 may include one or more additional
openings 476 disposed distally of openings 472, 474. Distal opening
476 may be used, for example, to receive a fastener placed into the
styloid process of the distal radius, particularly when the styloid
process has been fractured or cut.
[0130] Distal anchor portion 454 may be contoured to fit on the
volar surface of the distal radius. Accordingly, the distal anchor
portion 454 may have an inner surface 478 that is transversely
convex and an outer surface 480 that is transversely concave,
particularly in a proximal section 482 of distal anchor portion
454. A distal section 484 of distal anchor portion 454 may be
configured to be disposed distally of a volar-distal rim of the
radius. Accordingly, distal anchor portion 454 may include a
transverse contour 486, such as a slight depression, at the
junction between proximal and distal sections 482, 484. Transverse
contour 486 may be configured to receive the volar-distal rim 488
of the radius (see FIG. 19). The perimeter of distal anchor portion
454 may be shaped to correspond generally to the outline of the
distal radius. For example, the distal-lateral perimeter 490 of the
distal anchor portion 454 may be more angular and the distal-medial
perimeter 492 more rounded.
[0131] FIG. 18 shows bone plate 450 and particularly pivotable
joint 456 in an exploded view. The pivotable joint may include
semi-spherical surfaces 502, 504 of the proximal and distal anchor
portions 452, 454, respectively. These semi-spherical surfaces may
be complementary so that they can slide on each other about three
orthogonal axes. A retainer 506 may include a semi-spherical cavity
508 so that the retainer can be received by a second semi-spherical
surface 510 of the proximal anchor portion 452. A fastener 512,
such as a screw, may be placed through the retainer and proximal
anchor portion 452 and into threaded engagement with a threaded
bore 514 of distal anchor portion 454. The fastener may be turned
in opposing directions to provide adjustable and fixed
configurations of the bone plate. In some embodiments, joint 456
may permit pivotal movement about one or two axes and/or may permit
translational movement, as described elsewhere the present
teachings. The relative disposition of anchor portions 452, 454 may
be adjusted with a tool that engages one or both of the portions,
such as in one or more of the openings of the plate.
[0132] FIG. 19 shows bone plate 450 disposed on the volar surface
of distal radius 530. Proximal anchor portion 452 may be secured to
proximal bone region 532, and distal anchor portion 454 to distal
bone region 534. Pivotable joint 456 may be disposed adjacent a
distal fracture 536 of the bone. Distal anchor portion 454 may
extend over volar-distal rim 488 so that styloid process 538 may be
secured to distal anchor portion 454 using a fastener placed in
opening 476. Accordingly, a styloid discontinuity 540 (such as a
fracture) may be spanned by distal anchor portion 454. The outer
surface of the bone plate may be longitudinally concave and the
inner surface longitudinally convex, as shown here, to follow the
contour of the volar surface of the distal radius.
[0133] 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.
* * * * *