U.S. patent application number 13/747008 was filed with the patent office on 2013-07-25 for compression screw system.
This patent application is currently assigned to SYNTHES USA, LLC. The applicant listed for this patent is SYNTHES USA, LLC. Invention is credited to Nicolas Bouduban, Patrick Burki, Philippe Gedet, Urs Hulliger, Scott Larsen, Beat Lechmann, Wamis Singhatat.
Application Number | 20130190817 13/747008 |
Document ID | / |
Family ID | 47710320 |
Filed Date | 2013-07-25 |
United States Patent
Application |
20130190817 |
Kind Code |
A1 |
Bouduban; Nicolas ; et
al. |
July 25, 2013 |
COMPRESSION SCREW SYSTEM
Abstract
A compression screw comprising a threaded shaft and a head
associated with the proximal end of the shaft. The head has a
plurality of outwardly extending projections spaced from one
another so as to define a plurality of recesses there between for
receiving a screw drive in such a way that rotational force may be
transferred from the screw drive to the screw. The projections of
the head may be provided with suture fixation holes or a suture
coupling may be positioned over the shaft so as to extend between
the projections of the head.
Inventors: |
Bouduban; Nicolas;
(Oberdorf, CH) ; Burki; Patrick; (Oberdorf,
CH) ; Hulliger; Urs; (Oberdorf, CH) ; Gedet;
Philippe; (Oberdorf, CH) ; Lechmann; Beat;
(Oberdorf, CH) ; Singhatat; Wamis; (Paoli, PA)
; Larsen; Scott; (Paoli, PA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
SYNTHES USA, LLC; |
West Chester |
PA |
US |
|
|
Assignee: |
SYNTHES USA, LLC
West Chester
PA
|
Family ID: |
47710320 |
Appl. No.: |
13/747008 |
Filed: |
January 22, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61589947 |
Jan 24, 2012 |
|
|
|
Current U.S.
Class: |
606/232 |
Current CPC
Class: |
A61B 2017/044 20130101;
A61B 17/866 20130101; A61B 2017/0459 20130101; A61F 2002/0858
20130101; A61B 17/0401 20130101; A61B 17/864 20130101; A61B 17/80
20130101; A61B 2017/0414 20130101; A61B 17/8695 20130101; A61F
2002/0823 20130101; A61B 17/862 20130101; A61B 17/8891 20130101;
A61B 2017/0409 20130101; A61B 2017/0456 20130101; A61B 17/8685
20130101; A61B 2017/00004 20130101; A61B 2017/0445 20130101; A61B
2017/0464 20130101; A61B 17/0642 20130101; A61F 2002/0888 20130101;
A61B 2017/00964 20130101 |
Class at
Publication: |
606/232 |
International
Class: |
A61B 17/04 20060101
A61B017/04 |
Claims
1. A compression screw, comprising: a shaft having a proximal end
and a distal end, at least the distal end being threaded to engage
bone; and a head associated with the proximal end of the shaft, the
head having a plurality of outwardly extending projections spaced
from one another so as to define a plurality of recesses there
between.
2. The compression screw of claim 1, wherein the projections of the
head extend radially outwardly.
3. The compression screw of claim 1, wherein at least one of the
projections of the head has at least one suture fixation hole
extending therethrough.
4. The compression screw of claim 1, wherein each of the
projections of the head has at least one suture fixation hole
extending therethrough.
5. The compression screw of claim 3, wherein each of the shaft and
the head has a cannula extending therethrough.
6. The compression screw of claim 1, further comprising a suture
coupling having an opening for receiving the shaft and the suture
coupling configured such that the suture coupling is compressed
between the head of the screw and the bone when the screw is
implanted into the bone and such that the suture coupling extends
between adjacent projections of the head.
7. The compression screw of claim 6, wherein the suture coupling is
constructed of a bio-inert textile material.
8. The compression screw of claim 1, further comprising a suture
coupling having an opening for receiving the shaft of the screw and
the suture coupling configured such that the suture coupling is
compressed between the head of the screw and the bone when the
screw is implanted into the bone and such that the suture coupling
extends between adjacent projections of the head.
9. The compression screw of claim 8, wherein the head has a bone
engaging surface, and wherein the bone engaging surface has a
plurality of teeth configured to engage the suture coupling.
10. The compression screw of claim 8, wherein each of the
projections of the head has a bone engaging surface, and wherein
each of the bone engaging surfaces has a groove configured such
that the grooves cooperate to form an annular groove to receive the
suture coupling.
11. The compression screw of claim 1, wherein the head has a
central opening with a plurality of thread columns formed therein,
and wherein the proximal end of the shaft has a plurality of
threads configured to engage the thread columns of the central
opening to connect the head to the shaft.
12. The compression screw of claim 11, wherein the proximal end of
the shaft has a threaded concave collar, wherein the shaft further
has a neck portion positioned adjacent to the threaded concave
collar, and wherein the head is positioned on the neck portion and
configured to threadingly engage the concave collar.
13. The compression screw of claim 11, wherein the proximal end of
the shaft an inner wall and an outer wall defining an annular space
between the inner and outer wall, the inner wall comprising a neck
portion and a concave collar, wherein the head is positioned on the
neck portion and configured to threadingly engage the concave
collar.
14. A compression screw system, comprising: a screw, comprising: a
shaft having a proximal end and a distal end, at least the distal
end being threaded to engage bone; and a head associated with the
proximal end of the shaft, the head having a plurality of outwardly
extending projections spaced from one another so as to define a
plurality of recesses there between; and a screw drive having a
distal end with a plurality of projections configured to be
received in the recesses of the head of the shaft in such a way
that rotational force may be transferred from the screw drive to
the screw.
15. The compression screw system of claim 14, wherein the
projections of the head extend radially outwardly.
16. The compression screw system of claim 14, wherein at least one
of the projections of the head has at least one suture fixation
hole extending therethrough.
17. The compression screw system of claim 14, wherein each of the
projections of the head has at least one suture fixation hole
extending therethrough.
18. The compression screw system of claim 16, wherein each of the
shaft and the head has a cannula extending therethrough, and
wherein the screw drive has a cannula extending therethrough.
19. The compression screw system of claim 14, further comprising a
suture coupling having an opening for receiving the shaft and the
suture coupling configured such that the suture coupling is
compressed between the head of the screw and the bone when the
screw is implanted into the bone and such that the suture coupling
extends between adjacent projections of the head.
20. The compression screw system of claim 19, wherein the suture
coupling is constructed of a bio-inert textile material.
21. The compression screw system of claim 14, further comprising a
suture coupling having an opening for receiving the shaft of the
screw and the suture coupling configured such that the suture
coupling is compressed between the head of the screw and the bone
when the screw is implanted into the bone and such that the suture
coupling extends between adjacent projections of the head.
22. The compression screw system of claim 21, wherein the head has
a bone engaging surface, and wherein the bone engaging surface has
a plurality of teeth configured to engage the suture coupling.
23. The compression screw system of claim 21, wherein each of the
projections of the head has a bone engaging surface, and wherein
each of the bone engaging surfaces has a groove configured such
that the grooves cooperate to form an annular groove to receive the
suture coupling.
24. The compression screw system of claim 14, wherein the head has
a central opening with a plurality of thread columns formed
therein, and wherein the proximal end of the shaft has a plurality
of threads configured to engage the thread columns of the central
opening to connect the head to the shaft.
25. The compression screw system of claim 24, wherein the proximal
end of the shaft has a threaded concave collar, wherein the shaft
further has a neck portion positioned adjacent to the threaded
concave collar, and wherein the head is positioned on the neck
portion and configured to threadingly engage the concave
collar.
26. The compression screw system of claim 25, wherein the proximal
end of the shaft an inner wall and an outer wall defining an
annular space between the inner and outer wall, the inner wall
comprising a neck portion and a concave collar, wherein the head is
positioned on the neck portion and configured to threadingly engage
the concave collar.
27. A suture coupling, comprising: a pliable, bio-inert material
configured to define a thin, flat body, the body being conformable
to the contour of a surface of a bone when the body is positioned
against the surface of the bone.
28. The suture coupling of claim 27, wherein the body has an
opening configured to receive a shaft of a compression screw such
that the suture body is positionable between a head of the screw
and the surface of the bone.
29. The suture coupling of claim 28, wherein the body has a shape
in the form of at least one of a ring, a disc, a cloverleaf, a
cross, and a wedge.
30. The suture coupling of claim 27, wherein the pliable, bio-inert
material is selected from the group consisting of: a textile
material, a foam material, polyethylene, polyurethane, poly-lactic
acid, poly-lactic-co-glycolic acid, ultra high molecular weight
polyethylene fibers, and combinations thereof.
31. The suture coupling of claim 27, wherein the pliable, bio-inert
material is a textile material selected from the group consisting
of: polyethylene, polypropylene, ultra high molecular weight
polyethylene, poly-ether-ether-ketone, poly-ether-ketone-ketone,
poly-lactic acid, poly-L-lactide, poly-L/D-lactide,
poly-lactic-co-glycolic acid, poly-glucolide, poly-capro-lactone,
nitinol, and combinations thereof.
32. The suture coupling of claim 30, wherein the textile material
is a wool-like textile material.
33. The suture coupling of claim 28, wherein the body has a
reinforced inner edge defining the opening and a reinforced outer
edge.
34. The suture coupling of claim 33, further comprising at least
one suture integrated with the body.
35. The suture coupling of claim 34, wherein the suture forms at
least one loop.
36. The suture coupling of claim 33, wherein suture is threaded
through the body.
37. The suture coupling of claim 36, further comprising a needle
attached to the suture.
38. The suture coupling of claim 33 wherein the reinforced inner
edge further includes a first rigid reinforcing ring, and wherein
the reinforced outer edge further includes a second rigid
reinforcing ring.
39. The suture coupling of claim 28, wherein the body has at least
one suture eyelet configured to receive at least one suture
therein.
40. The suture coupling of claim 39, wherein the suture eyelet has
a reinforced edge.
41. The suture coupling of claim 40, wherein the body has a
plurality of suture eyelets, and wherein the suture eyelets are
arranged in a substantially circular configuration around the
opening.
42. The suture coupling of claim 28, wherein the opening for
receiving the shaft of the screw is a first opening, and wherein
the body has a second opening configured to be inserted over a
shaft of a second compression screw, the second opening being
offset a distance from the first opening.
43. The suture coupling of claim 28, wherein the body is
cross-shaped so to be provided with a plurality of protrusion, at
least a portion of the protrusions having a length so as to be
foldable over at least a portion of the head of the screw.
44. The suture coupling of claim 28, wherein the body has an outer
edge and an inner edge defining the opening and a slit extending
from the outer edge to the inner edge.
45. The suture coupling of claim 44, wherein the outer edge has at
least two closure loops positioned adjacent to the slit and
configured to receive a suture therethrough.
46. The suture coupling of claim 27, further comprising a
reinforcement mesh positioned on at least one side of the body.
47. The suture coupling of claim 28, wherein the body has a narrow
end and a wide end.
48. The suture coupling of claim 47, wherein the opening is
provided adjacent the narrow end.
49. The suture coupling of claim 48, wherein the body is provided
with at least one suture eyelet adjacent the wide end.
Description
INCORPORATION BY REFERENCE
[0001] The entirety of U.S. provisional application Ser. No.
61/589,947, filed on Jan. 24, 2012, is hereby expressly
incorporated herein by reference.
BACKGROUND
[0002] The inventive concepts disclosed herein generally relate to
implantable compression screws, and more particularly, but not by
way of limitation, to a compression screw system with suture
anchoring features and to methods of using same.
[0003] Implantable compression screws are typically used to manage
bone fractures, for example, by implanting a compression screw into
a fractured bone, such that the screw fixes, or compresses,
fractured bone fragments against one another, thus allowing the
bone to heal and re-grow. In certain fractures, an external plate
may be compressed against the bone, typically by more than one
compression screw, in order to reinforce the bone and allow it to
heal.
[0004] Soft tissues, such as tendons and ligaments, are generally
attached to bone by small collagenous fibers. These fibers are
strong, but permit the tendons and ligaments to be flexible. Some
fractures, or other bone injuries, result in soft tissue being torn
away or detached from the bone and requiring repair. Surgeons are
often required to repair the detached soft tissue with one or more
sutures which typically reattach the soft tissue to the bone via a
suture anchor implanted into the bone. Such suture anchors are
usually implanted into a patient's bone through extensive surgical
procedures or through arthroscopic surgical techniques. Generally,
some suture anchors may require a surgeon to tie a knot in the
suture, or may be "knotless," i.e., no knot is required to secure
the soft tissue to the bone because the suture is retained by the
suture anchor and the bone.
[0005] Existing compression screws are implanted into a patient's
bone in a number of ways, which can generally be classified as
those that require drilling of a hole in the bone, and those that
can be implanted without drilling, such as by being pushed-in or
screwed-in the bone, for example. Some compression screws include
threaded tips that are self-tapping, and some compression screws
require that a hole or a channel be drilled or formed into the bone
prior to implanting the compression screw into the bone.
[0006] Once a compression screw is implanted, adjacent soft
tissues, such as muscles, tendons, cartilage, and skin, for
example, may move over the head of the compression screw as a
result of normal body movements of the patient. Currently available
compression screws have bulky heads, which protrude over the
surface of the bone and may cause soft-tissue abrasion, irritation,
and damage, for example. Further, as the bone surfaces surrounding
the compression screw typically have varying angles, the head of
prior art compression screws may not sit level with the surface of
the bone, thus causing further irritation and injury to adjacent
soft tissues.
[0007] While some variable-angle compression screws have been
developed in the prior art, such variable angle compression screws
still have the above disadvantages (see for example U.S. patent
application Ser. No. 11/971,358, the entire disclosure of which is
hereby expressly incorporated herein by reference).
[0008] Another problem with currently existing compression screws
is that they do not allow for sutures to be attached thereto, thus
requiring that separate means for attaching sutures, such as suture
anchors, be used to repair soft tissue injuries which often
accompany a bone fracture. Such separate suture anchors require
separate insertion locations to be selected and additional
insertion holes to be formed into already damaged bone, thereby
resulting in prolonged surgical procedure times, increased
procedure complexity and costs, and increased patient recovery
time.
BRIEF DESCRIPTION OF THE DRAWINGS
[0009] To assist those of ordinary skill in the relevant art in
making and using the inventive concepts disclosed herein, reference
is made to the appended drawings and schematics, which are not
intended to be drawn to scale, and in which like reference numerals
are intended to refer to the same or similar elements for
consistency. For purposes of clarity, not every component may be
labeled in every drawing. Certain features and certain views of the
figures may be shown exaggerated and not to scale or in schematic
in the interest of clarity and conciseness. In the drawings:
[0010] FIG. 1A is a perspective view of an exemplary embodiment of
a compression screw system according to the inventive concepts
disclosed herein.
[0011] FIG. 1B is an enlarged view of circle 1B of FIG. 1A.
[0012] FIG. 2A is a perspective view of an exemplary embodiment of
a screw drive according to the inventive concepts disclosed
herein.
[0013] FIG. 2B is an enlarged view of circle 2B of FIG. 2A.
[0014] FIG. 3A is a top perspective view of an exemplary embodiment
of a compression screw according to the inventive concepts
disclosed herein.
[0015] FIG. 3B is a bottom perspective view of the compression
screw of FIG. 3A.
[0016] FIG. 3C is a side elevational view of another embodiment of
a lateral projection of the compression screw of FIG. 3A.
[0017] FIG. 3D is a plan view of another embodiment of a lateral
projection of the compression screw of FIG. 3A.
[0018] FIG. 3E is a plan view of another embodiment of a lateral
projection of the compression screw of FIG. 3A.
[0019] FIG. 3F is a side elevational view of another embodiment of
a lateral projection of the compression screw of FIG. 3A.
[0020] FIG. 3G is a cross-sectional view of the compression screw
of FIG. 3A shown implanted into a bone.
[0021] FIG. 4A is a top perspective view of an exemplary embodiment
of a compression screw according to the inventive concepts
disclosed herein shown in combination with a suture coupling.
[0022] FIG. 4B is a bottom perspective view of the compression
screw of FIG. 4A.
[0023] FIG. 4C is a cross-sectional view of the compression screw
of FIG. 4A shown implanted into a bone.
[0024] FIG. 4D is a top perspective view of the compression screw
of FIG. 4A.
[0025] FIG. 4E is a bottom perspective view of the compression
screw of FIG. 4A.
[0026] FIG. 5 is a top plan view of an exemplary embodiment of a
suture coupling according to the inventive concepts disclosed
herein.
[0027] FIG. 6A is a top plan view of another embodiment of a suture
coupling.
[0028] FIG. 6B is a top plan view of the suture coupling of FIG. 6A
with sutures shown integrated therein.
[0029] FIG. 6C is a top plan view of the suture coupling of FIG. 6A
showing sutures preloaded therein.
[0030] FIG. 6D is a top plan view of the suture coupling of FIG. 6A
showing sutures preloaded therein.
[0031] FIG. 6E is a top plan view of the suture coupling of FIG. 6A
showing suture loops shown integrated therein.
[0032] FIG. 7 is a top plan view of another embodiment of a suture
coupling.
[0033] FIG. 8A is a top plan view of another embodiment of a suture
coupling.
[0034] FIG. 8B is a top plan view of another embodiment of a suture
coupling.
[0035] FIG. 9 is a top plan view of another embodiment of a suture
coupling.
[0036] FIG. 10 is a top plan view of another embodiment of a suture
coupling.
[0037] FIG. 11A is a top plan view of another embodiment of a
suture coupling.
[0038] FIG. 11B is a top plan view of another embodiment of a
suture coupling.
[0039] FIG. 11C is a top plan view of another embodiment of a
suture coupling.
[0040] FIG. 12 is a top plan view of another embodiment of a suture
coupling.
[0041] FIG. 13A is a top plan view of another embodiment of a
suture coupling.
[0042] FIG. 13B is a top plan view of an alternative embodiment of
the suture coupling of FIG. 13A.
[0043] FIG. 13C is a top plan view of another embodiment of a
suture coupling.
[0044] FIG. 13D is a top plan view of another embodiment of a
suture coupling.
[0045] FIG. 14 is a top plan view of another embodiment of a suture
coupling.
[0046] FIG. 15 is a cross-sectional view of a coupling clip
according to the inventive concepts disclosed herein shown attached
to a compression screw.
[0047] FIG. 16 is a cross-sectional view of a coupling staple
according to the inventive concepts disclosed herein.
[0048] FIG. 17A is a perspective view of an embodiment of a
compression screw according to the inventive concepts disclosed
herein shown in combination with a suture coupling.
[0049] FIG. 17B is a top plan view of the compression screw of FIG.
17A.
[0050] FIG. 17C is a side elevational view of the compression screw
of FIG. 17A.
[0051] FIG. 17D is an elevational view of the compression screw of
FIG. 17A shown implanted into a bone.
[0052] FIG. 18A is a side elevational view of an exemplary
embodiment of a compression screw according to the inventive
concepts disclosed herein shown in combination with a suture
coupling.
[0053] FIG. 18B is a top plan view of the compression screw of FIG.
18A.
[0054] FIG. 18C is a perspective view of the compression screw in
combination with a suture ring of FIG. 18A with a suture shown
pulling on the suture coupling.
[0055] FIG. 18D is a top plan view of the compression screw in
combination with a suture ring of FIG. 18A with a suture shown
pulling on the suture coupling
[0056] FIG. 19A is a side elevational view of an exemplary
embodiment of a compression screw according to the inventive
concepts disclosed herein in combination with a suture
coupling.
[0057] FIG. 19B is a perspective view of the compression screw of
FIG. 19A.
[0058] FIG. 20A is a perspective view of an exemplary embodiment of
a compression screw according to the inventive concepts disclosed
herein in combination with a suture coupling.
[0059] FIG. 20B is a cross-sectional view of the compression screw
in combination with a suture coupling of FIG. 20A.
[0060] FIG. 21A is a perspective view of an exemplary embodiment of
a variable angle compression screw according to the inventive
concepts disclosed herein.
[0061] FIG. 21B is an enlarged view of circle 21B of FIG. 21A.
[0062] FIG. 21C is a cross-sectional view of the variable angle
compression screw of FIG. 21A.
[0063] FIG. 21D is a cross-sectional view of two variable angle
compressions screws of FIG. 21A shown implanted into a bone.
[0064] FIG. 22A is a bottom perspective view of an exemplary
embodiment of a variable angle compression screw according to the
inventive concepts disclosed herein.
[0065] FIG. 22B is a top perspective view of the variable angle
compression screw of FIG. 22A.
[0066] FIG. 22C is a cross-sectional view of the variable angle
compression screw of FIG. 22A.
[0067] FIG. 22D is a cross-sectional view of the variable angle
compression screw of FIG. 22A shown implanted into a bone.
[0068] FIG. 23A is a top perspective view of an exemplary
embodiment of a variable angle dynamic locking compression screw
according to the inventive concepts disclosed herein.
[0069] FIG. 23B is a bottom perspective view of the variable angle
dynamic locking compression screw of FIG. 23A.
[0070] FIG. 23C is a cross-sectional view of the variable angle
compression screw of FIG. 23A.
[0071] FIG. 23D is a cross-sectional view of the variable angle
compressions crew of FIG. 23A shown implanted into a bone.
[0072] FIG. 24 is a cross-sectional view of an exemplary embodiment
of a bone plate system according to the inventive concepts
disclosed herein shown implanted into a bone.
DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS
[0073] Before explaining at least one embodiment of the inventive
concepts in detail, it is to be understood that the inventive
concepts disclosed herein are not limited in their application to
the details of construction, experiments, exemplary data, and the
arrangement of the components set forth in the following
description or illustrated in the drawings. The inventive concepts
are capable of other embodiments or of being practiced or carried
out in various ways. Also, it is to be understood that the
phraseology and terminology employed herein is for purposes of
description only and should not be regarded as limiting the
inventive concepts disclosed herein in any way.
[0074] In the following detailed description of embodiments of the
inventive concepts, numerous specific details are set forth in
order to provide a more thorough understanding of the inventive
concepts. However, it will be apparent to one of ordinary skill in
the art that the inventive concepts disclosed herein may be
practiced without these specific details. In other instances,
well-known features have not been described in detail to avoid
unnecessarily complicating the instant disclosure.
[0075] As used herein, the terms "comprises," "comprising,"
"includes," "including," "has," "having" or any other variation
thereof, are intended to cover a non-exclusive inclusion. For
example, a process, method, article, or apparatus that comprises a
list of elements is not necessarily limited to only those elements
but may include other elements not expressly listed or inherently
present therein.
[0076] Unless expressly stated to the contrary, "or" refers to an
inclusive or and not to an exclusive or. For example, a condition A
or B is satisfied by anyone of the following: A is true (or
present) and B is false (or not present), A is false (or not
present) and B is true (or present), and both A and B are true (or
present).
[0077] The term "or combinations thereof" as used herein refer to
all permutations and combinations of the listed items preceding the
term. For example, "A, B, C, or combinations thereof" is intended
to include at least one of: A, B, C, AB, AC, BC, or ABC, and if
order is important in a particular context, also BA, CA, CB, CBA,
BCA, ACB, BAC, or CAB. Continuing with this example, expressly
included are combinations that contain repeats of one or more item
or term, such as BB, AAA, AAB, BBC, AAABCCCC, CBBAAA, CABABB, and
so forth. A person of ordinary skill in the art will understand
that typically there is no limit on the number of items or terms in
any combination, unless otherwise apparent from the context.
[0078] In addition, use of the "a" or "an" are employed to describe
elements and components of the embodiments herein. This is done
merely for convenience and to give a general sense of the inventive
concepts. This description should be read to include one or at
least one and the singular also includes the plural unless it is
obvious that it is meant otherwise.
[0079] Further, as used herein any reference to "one embodiment" or
"an embodiment" means that a particular element, feature,
structure, or characteristic described in connection with the
embodiment is included in at least one embodiment. The appearances
of the phrase "in one embodiment" in various places in the
specification are not necessarily all referring to the same
embodiment, although the instant inventive concepts are intended to
encompass any and all combinations of the features of the
embodiments disclosed herein.
[0080] As used herein qualifiers such as "about," "approximately,"
and "substantially" are intended to signify that the item being
qualified is not limited to the exact value specified, but includes
some slight variations or deviations therefrom, caused by measuring
error, manufacturing tolerances, stress exerted on various parts,
wear and tear, or combinations thereof, for example.
[0081] As used herein the terms "guide wire," "Kirschner wire,"
"K-wire," or "k-wire," and any variations thereof, include pins or
rods used in a variety of medical procedures. K-wires are typically
made of stainless steel and may be threaded, grooved, or smooth,
for example. K-wires have been in use since their introduction in
1909, and their structure and use in medical procedures are deemed
to be within the level of ordinary skill in the art, and as such
will not be described herein in detail to avoid unnecessarily
complicating the instant disclosure.
[0082] The inventive concepts disclosed herein are generally
directed to a compression screw having a low-profile head
configured to hold one or more sutures and a drive configured to
implant the compression screw into a bone. Compression screws
according to exemplary embodiments of the inventive concepts
disclosed herein allow surgeons to repair fractured bone, and to
reattach torn or detached soft tissues without the use of separate
suture anchors.
[0083] Referring now to the drawings, and in particular to FIGS.
1A-1B, an exemplary embodiment of a compression screw system 100 is
illustrated. The compression screw system 100 includes a screw
drive 102 and a compression screw 104. The screw drive 102 and the
compression screw 104 may be cannulated, such that the compression
screw system 100 may be used with a guide wire (not shown), such as
a K-wire or another type of guide wire, for example. It is to be
understood, however, that the instant inventive concepts are not
limited to a cannulated screw drive 102 and a cannulated
compression screw 104, and that in some exemplary embodiments, a
screw drive 102 and a compression screw 104 according to the
inventive concepts disclosed herein may not be cannulated, and may,
or may not, be implanted into a bone via a guide wire.
[0084] Referring now to FIGS. 2A-2B, the screw drive 102 includes a
handle 108 and a shaft 110, and may have a central cannula (not
shown) extending therethrough and configured to allow a guide wire
to be passed therethrough.
[0085] The handle 108 is configured to be held by a user, and to
allow the user to impart rotational force to the handle 108. The
handle 108 is made of any suitable material such as plastic,
metals, ceramics, resins, rubbers, or combinations thereof, for
example. The handle 108 has a proximal end 112, and a distal end
114 including a suture fixation collar 116 having one or more
suture fixation notches 118 formed therein. The suture fixation
collar 116 and the suture fixation notches 118 may cooperate to
retain one or more sutures therein and help hold such sutures in
place during a surgical procedure, for example.
[0086] The handle 108 may further include grip-enhancing features
or surfaces (not shown), such as grooves, striations, bumps,
knurls, crimps, ridges, rubberized inlays or inserts, or
combinations thereof, for example. Further, the handle 108 may have
visual markings (not shown) enabling a user to visually count the
number of turns the handle 108 has completed, in order to estimate
the depth and position of a compression screw 104 during
implantation procedures, for example.
[0087] The shaft 110 includes a proximal end 120 fixedly connected
to the handle 108, and a distal end 122 provided with a drive 124.
The shaft 110 may be made of any suitable material having
sufficient strength and durability, such as stainless steel,
titanium, resins, plastics, metals, ceramics, or combinations
thereof, for example.
[0088] The drive 124 has projections 126 separated by recesses 128.
The recesses 128 are configured to receive corresponding
projections of the head of the compression screw 104 therein, such
that rotational force may be transferred from the screw drive 102
to the compression screw 104 as will be described herein below, for
example. While four projections 126 are shown in FIGS. 1-2, it is
to be understood that the inventive concepts disclosed herein may
include any number of longitudinal projections 126, such as two,
three, five, or more than five longitudinal projections 126, for
example.
[0089] Referring now to FIGS. 3A-3B, the compression screw 104
includes a head 130 and a shaft 132 fixedly attached to the head
130. The compression screw 104 may be made of any suitable
bio-inert, biocompatible, or bio-absorbable material, such as
stainless steel, titanium, polyethylene, poly-lactic-acid (PLA),
poly lactic co-glycolic acid (PLGA), polyurethane, bone tissue,
ultra-high molecular weight polyethylene fibers, epoxy resins, or
combinations thereof, for example. The compression screw 104 may be
formed using any suitable process, such as molding, machining,
casting, or combinations thereof, for example.
[0090] The head 130 is illustrated in FIGS. 3A and 3B as having a
generally cloverleaf shape with a plurality of projections 134
extending radially outwardly and configured to at least partially
fit into the recesses 128 and interlock with correspondingly shaped
projections 126 of the drive 124 such that rotational force and
rotational motion may be imparted to the compression screw 104 by
the screw drive 102. The head 130 is desirably of low profile such
that when the compression screw 104 is implanted into a bone the
head 130 is substantially level with the surface of the bone to
minimize soft tissue irritation and injury as a result of the head
130 interacting with adjacent soft tissues. As used herein
substantially level is intended to include the head 130 being level
with the surface of the bone, and protruding slightly over the
surface of the bone, but such slight protrusion is kept as low as
possible to avoid irritating or damaging adjacent soft tissues, for
example.
[0091] The head 130 is shown as having four projections 134 with
each of the projections 134 having a suture fixation hole 136
formed therein. It is to be understood, however, that the head 130
may be formed to have a variety of configurations and number of
projections. For example, the head 130 may be formed to have
projections numbering two, three, or more than four. The suture
fixation holes 136 may be formed into the projections 134 in any
suitable manner, such as injection molding, drilling, or
combinations thereof, for example. The suture fixation holes 136
function to allow for one or more sutures to be passed therethrough
so that a soft tissue may be attached to the head 130. It is to be
understood that while four suture fixation holes 136 are shown in
FIGS. 3A-3B, the inventive concepts disclosed herein may be
implemented with suture fixation holes 136 omitted as will be
described below, or with any number of suture fixation holes 136.
Further, while a suture fixation hole 136 is shown on each
projection 134, it is to be understood that some projections 134
may have no suture fixation holes 136 formed therein, and some
projections 134 may have one or more suture fixation holes 136
formed therein. It is to be further understood that in some
embodiments, suture fixation holes 136 may be implemented as one or
more grooves (FIG. 3C), one or more channels (FIG. 3D), one or more
resilient jaws (FIGS. 3E and 3F), one or more hooks, one or more
grooves on the surface of the head 130 engaging the bone, one or
more channels or grooves into the side of the head 130 engaging the
bone, or combinations thereof, for example. Further, in some
exemplary embodiments a suture may be wound around the shaft 132
and the projections 134 may be used to compress, catch, trap, or
otherwise retain the suture in place.
[0092] The shaft 132 has a proximal end 138 fixedly attached to the
head 130 and a distal end 140 having threads 142 formed on an
external surface thereof. The threads 142 are configured to engage
bone tissue such that the compression screw 104 is screwed into the
bone and retained therein when rotational motion is applied to the
compression screw 104 by the screw drive 102 relative to the
longitudinal axis 148. It is to be understood, that a compression
screw 104 according to the inventive concepts disclosed herein may
be implanted into any type of bone or tissue, and may have threads
142 configured to engage cortical bone tissue, cancellous bone
tissue, cartilage, connective tissue, or combinations thereof, for
example.
[0093] The shaft 132 is shown as having an unthreaded portion 144,
but it is to be understood that some exemplary embodiments of the
compression screw 104 may omit the unthreaded portion 144 and may
include threads 142 extending along the length of the shaft 132.
Further, some exemplary embodiments may include other retention
means or features (not shown) such as ribs, grooves, bumps,
channel, protrusions, or combinations thereof, instead of, or in
addition to, the threads 142. The threads 142 may be self-tapping
or self-drilling, or a drill or other tool may be used to form a
suitable size opening or channel into the bone for the threads 142
to engage, for example.
[0094] The compression screw 104 has a central cannula 146
extending through the shaft 132 and the head 130, and a
longitudinal axis 148. The central cannula 146 is configured to
receive a guide wire during the implantation of the compression
screw 104 into a patient's bone. It is to be understood, however,
that a compression screw 104 according to the instant inventive
concepts may omit the central cannula 146 in some exemplary
embodiments, and such uncannulated compression screw 104 may be
implanted with, or without, the use of a guide wire.
[0095] Referring now to FIG. 3G, in use the compression screw 104
is implanted into a bone 150 such that the threads 142 engage a
cancellous portion 152 of the bone 150, and the head 130 is
compressed against a surface of a cortical portion 154 of the bone
150. The shaft 132 may be advanced into the bone 150 so that a
desired compressive force is applied to the bone 150, for example.
The head 130 is shown as being oriented relative to the
longitudinal axis 148 of the shaft 132 at an angle .alpha.. It is
to be understood that the angle .alpha. may include any angle,
including an angle of 90.degree. and some slight deviations from an
angle of 90.degree., such as deviations due to manufacturing
tolerances, and deformation in the compression screw 104 caused by
compressive forces exerted on the head 130 by the bone 150 when the
compression screw 104 is implanted into the bone 150, or
combinations thereof, for example. One or more sutures 151 may be
threaded through a suture fixation hole 136, for example, so that
the one or more sutures 151 are held by the compression screw 104.
A soft tissue may be anchored to the bone 150 via the one or more
sutures 151.
[0096] Referring now to FIGS. 4A-4C, shown therein is an exemplary
embodiment of a compression screw 104a, which may be implemented
similarly to compression screw 104, except that the suture fixation
holes 136 are omitted. The compression screw 104a includes a head
160 and a shaft 162 having a longitudinal axis 164. The compression
screw 104a may be made of any suitable bio-inert or bio-absorbable
material, such as stainless steel, titanium, polyethylene,
poly-lactic-acid (PLA), poly lactic co-glycolic acid (PLGA),
polyurethane, human bone tissue, ultra-high molecular weight
polyethylene fibers, epoxy resins, or combinations thereof, for
example. The compression screw 104a may be formed using any
conventional process, such as molding, machining, casting, or
combinations thereof, for example.
[0097] The head 160 is shown as a generally cloverleaf shaped
structure comprising a plurality of projections 166 configured to
interlock with correspondingly shaped longitudinal projections 126
of the screw drive 102 (e.g., by being at least partially
positioned into recesses 128), such that rotational motion may be
imparted to the compression screw 104a by the screw drive 102. The
head 160 is desirably of low profile, such that when the
compression screw 104a is implanted into a bone, the head 160 is
substantially level with the surface of the bone, to minimize
adjacent soft tissue irritation and injury as a result of the head
160 interacting with adjacent soft tissues. As used herein
substantially level includes the head 160 protruding slightly over
the surface of the bone, but such slight protrusion is kept as low
as possible to avoid irritating or damaging adjacent soft tissues,
for example.
[0098] The shaft 162 has a proximal end 168 fixedly attached to the
head 160, and a distal end 170 having threads 172 formed on an
external surface thereof. The threads 172 are configured to engage
a bone (e.g., cortical or cancellous bone tissue) such that the
compression screw 104a is screwed into the bone tissue and retained
therein when rotational motion is applied to the compression screw
104a by the screw drive 102. The shaft 162 is shown as comprising
an unthreaded portion 174, but it is to be understood that some
exemplary embodiments of the compression screw 104a may omit the
unthreaded portion 174 and may include threads 172 along the length
of the shaft 162. Further, some exemplary embodiments may include
other retention means or features (not shown), such as ribs,
grooves, bumps, channels, protrusions, or combinations thereof,
instead of, or in addition to, the threads 172. The threads 172 may
be self-tapping or self-drilling, or a drill or other tool may be
used to form a suitable size opening or channel into the bone for
the threads 172 to engage, for example.
[0099] The compression screw 104a has a central cannula 176
extending through the shaft 162 and through the head 160. The
central cannula 176 is configured to receive a guide wire, such as
a K-wire, for example, during the implantation of the compression
screw 104a into a patient's bone. It is to be understood however,
that a compression screw 104a according to the instant inventive
concepts may omit the central cannula 176 in some exemplary
embodiments, and such non-cannulated compression screw 104a may or
may not be implanted without the use of a guide wire 106.
[0100] Referring to FIGS. 4A-4C and 5, a suture coupling 178 may be
used in combination with the compression screw 104a to treat or
repair soft tissue injuries. The suture coupling 178 includes a
thin, flat body 179 having an opening 180 configured to receive the
shaft 162 of the compression screw 104a, such that the suture
coupling 178 is compressed between the head 160 of the compression
screw 104a and the surface of a bone when the compression screw
104a is implanted into the bone. In some embodiments, the suture
coupling 178 may be sized such that it fits snugly around the
unthreaded portion 174 of the shaft 162, to keep the suture
coupling 178 substantially centered relative to the shaft 162. In
other embodiments, the suture coupling 178 may be sized to be
interposed between a suture anchor (not shown) and a surface of the
bone.
[0101] The suture coupling 178 is desirably made of a soft or
pliable bio-inert material, such as a textile material (e.g., any
cloth, or goods produced by weaving, knitting, braiding, twisting,
or felting, of one or more fibers or other materials), a foam
material, polyethylene, polyurethane, PLA, PLGA, Ultra High
Molecular Weight Polyethylene fibers, and combinations thereof, for
example. A soft or pliable material would allow the suture coupling
178 to conform to the shape of the surface of the bone, and to have
no sharp edges, thereby minimizing soft tissue irritation. Further,
the suture coupling 178 may be folded and inserted thought the
cannula of an arthroscopic surgical instrument such as the screw
drive 102, for example. The suture coupling 178 may be used to
attach one or more sutures 182 (FIG. 4C) to the compression screw
104a, such as by tying one or more sutures 182 to the suture
coupling 178, or by sewing one or more sutures 182 into the suture
coupling 178, or combinations thereof, for example. The suture
coupling 178 may be coated or impregnated with a variety of
substances, including but not limited to antibiotics, healing
agents, anti-clotting agents, anti-inflammatory agents, or
combinations thereof, for example.
[0102] The head 160 is shown as being oriented relative to the
longitudinal axis 164 of the shaft 162 at an angle .alpha.. It is
to be understood that the angle .alpha. may include any angle,
including an angle of 90.degree. and some slight deviations from an
angle of 90.degree., such as deviations due to manufacturing
tolerances, and deformation in the compression screw 104a caused by
compressive forces exerted on the head 160 by a bone 184 when the
compression screw 104a is implanted into a bone 184, or
combinations thereof, for example.
[0103] As will be appreciated by persons of ordinary skill in the
art, the use of a compression screw 104a with the suture coupling
178 allows for using a suture first technique (e.g., one or more
sutures 182 are attached to the suture coupling 178 prior to the
inserting the suture coupling 178 on the compression screw 104a and
implanting the compression screw 104a), or an implant first
technique (e.g., the suture coupling 178 is inserted on the
compression screw 104a, the compression screw 104a is implanted
into the bone 184, and then one or more sutures 182 are secured to
the suture coupling 178). As will be understood by persons of
ordinary skill in the art, a portion of the suture coupling 178
extending between two projections 166 may remain accessible to a
user after the compression screw 104a is implanted into the bone
184. The compression crew 104a may be advanced into the bone 184 so
that a desired compressive force is applied to the bone 184, for
example.
[0104] Referring now to FIGS. 4D-4E, shown therein is the
compression screw 104a with a suture coupling 186 inserted thereon.
The suture coupling 186 can be implemented similarly to the suture
coupling 178, except that the suture coupling 186 has a body 187
with a substantially rounded surface, whereas the body of the
suture coupling 178 is substantially flat. Further, the suture
coupling 186 may be constructed of a relatively stiffer material
than the suture coupling 178, such as reinforced rubber, stainless
steel, nitinol, titanium, Cobalt Chromium, a tightly woven textile,
and combinations thereof, for example. The rounded surface of the
suture coupling 186 may further minimize adjacent soft tissue
irritation and damage, and may result in increased strength of the
suture coupling 186 as compared with a suture coupling 178
constructed of the same, or similar material, for example.
[0105] Referring now to FIG. 6A, shown therein is an exemplary
embodiment of another suture coupling 190. The suture coupling 190
is similar to the suture coupling 178 with the exception that the
suture coupling 190 includes a reinforced inner edge 196 and a
reinforced outer edge 198. The reinforced inner edge 196 and the
reinforced outer edge 198 may be implemented by braiding or weaving
a second layer of material interlinked with the coupling base
during the manufacture of the suture coupling 190, for example, or
in any other suitable manner.
[0106] FIG. 6B shows the suture coupling 190 with sutures 200 that
are sewn to or otherwise integrated with the suture coupling 190.
The sutures 200 may be used to attach a soft tissue to the suture
coupling 190, such as by, for example, threading one or more suture
200 through the tissue to be attached, tying off the sutures 200,
and clipping, cutting, or otherwise removing any excess portion of
the sutures 200.
[0107] FIG. 6C shows the suture coupling 190 with sutures 202
preloaded therein so as to facilitate the use of sliding knots, for
example.
[0108] FIG. 6D shows the suture coupling 190 with sutures 203
preloaded therein. The sutures 203 are provided with needles 204.
Needles 204 are shown attached to each suture 203 and may be used
for attaching the sutures 203 to soft tissue, for example.
[0109] FIG. 6E shows the suture coupling 190 with suture loops 206
sewn to or otherwise integrated with the suture coupling 190. The
suture loops 206 are configured to allow for a soft tissue to be
attached to the suture coupling 190, as will be understood by
persons of ordinary skill in the art.
[0110] Referring now to FIG. 7, shown therein is an exemplary
embodiment of another suture coupling 208. The suture coupling 208
is similar to the suture coupling 190 except the suture coupling
208 includes a reinforced outer edge 212 and a reinforced inner
edge 214. The reinforced outer edge 212 has a rigid reinforcing
ring 218 and the reinforced inner edge 214 has a rigid reinforcing
ring 220. The reinforcing rings 218 and 220 may be in the form of a
rigid wire, and may be constructed of a metal or polymer, or of any
other suitable material. The rigid reinforcing rings 218 and 220
may be implemented during the manufacture of the suture coupling
208, such as, for example, by interlinking the reinforcing rings
218 and 220 with the suture coupling 208, or by weaving the suture
coupling 208 around the reinforcing rings 218 and 220, for
example.
[0111] Referring now to FIG. 8A, shown therein is an exemplary
embodiment of yet another suture coupling 222. The suture coupling
222 is similar to the suture coupling 190 except the suture
coupling 222 is provided with an opening 230 and with one or more
suture eyelets 232. The suture eyelets 232 may be defined by a
reinforced edge 234 such that a suture may be threaded
therethrough. The suture eyelets 232 are configured to allow one or
more sutures to be threaded therethrough, but it is to be
understood that the sutures may also be sewn into, or threaded
through, the suture coupling 222, or passed through the opening
230, or combinations thereof, for example.
[0112] FIG. 8B illustrates a suture coupling 222a which is similar
to the suture coupling 222 except that the suture coupling 222a is
provided with a plurality of reinforcement segments 231. The
reinforcement segments 231 may extend radially from an opening 230a
to the outer edge so as to define a plurality of suture sections
231a. The suture coupling 222a is shown to have four reinforcement
segments 231, but it will be appreciated that the number of
reinforcement segments may be varied.
[0113] Referring now to FIG. 9, shown therein is an exemplary
embodiment of a suture coupling 236. The suture coupling 236 is
similar to the suture coupling 190 except the suture coupling 236
is shown as having an oval shape and a pair of openings 242a and
242b for receiving a pair of screws therein. One or more sutures
may be threaded through the suture coupling 236, the opening 242a,
or the opening 242b. While the suture coupling 236 has been
illustrated as being oval shaped and as having two openings 242a
and 242b, it should be appreciated that the suture coupling 236 may
be constructed in a variety of shapes and with more than two
openings 242a and/or 242b, for example.
[0114] Referring now to FIG. 10, shown therein is an exemplary
embodiment of a suture coupling 246. The suture coupling 246 is
similar to the suture coupling 190 except the suture coupling 246
is shown to be substantially cross-shaped so as to include a
plurality of projections 248 and 249. The projections 248 are
illustrated as having a length greater than the length of the
projections 249 to permit the projections 248 to be wrapped around
the head of a compression screw, such as the compression screw 104
or 104a, for example. Once wrapped around the head (e.g., the head
130 or the head 160 of a compression screw 104 or 104a), the
projections 248 may be stitched or otherwise attached to one
another to secure the suture coupling 246 around the head of the
compression screw and thereby minimize irritation to adjacent soft
tissues.
[0115] Referring now to FIG. 11A, shown therein is another
embodiment of a suture coupling 254. The suture coupling 254 is
similar to the suture coupling 190 except the suture coupling 254
is provided with a slit 264 extending from the outer edge to the
inner edge. The slit 264 allows the suture coupling 254 to be
positioned about a screw 104 or 104a after the screw 104 or 104a
has been inserted at least partially into bone. The outer edge has
two or more closure loops 266 that permit a suture (not shown) to
be threaded through the closure loops 266 and tightened to close
the suture coupling 254 once positioned about the screw 104 or
104a, for example.
[0116] FIG. 11B shows another suture coupling 254a which is similar
to the suture coupling 254 except that the suture coupling 254a is
provided with a plurality of reinforcement segments 231a. The
reinforcement segments 231a may extend radially from an opening
230b to the outer edge so as to define a plurality of suture
sections 231b. The suture coupling 254a is shown to have four
reinforcement segments 231a, but it will be appreciated that the
number of reinforcement segments may be varied. The suture coupling
254a is further shown to include a plurality of suture eyelets
255.
[0117] FIG. 11C illustrates a suture coupling 254b. The suture
coupling 254b is similar to the suture coupling 254a except that
the suture coupling 254b is provided with a plurality of
projections 258. The projections 258 may be provided with a length
sufficient to extend a distance from one or more edges of a bone
plate, such as bone plate 482 shown in FIG. 24, when the suture
coupling is secured between the bone plate and a bone. The suture
coupling 254 a may be provided with an opening 259 for receiving a
screw and a slit 254a extending from the opening 259 to the outer
edge. The projections 258 may further be provided with one or more
suture eyelets 260.
[0118] Referring now to FIG. 12, shown therein is an exemplary
embodiment of a suture coupling 270. The suture coupling 270 is
similar to the suture coupling 190 except the suture coupling 270
is provided with a reinforcement mesh 286 on at least one side of
the body of the suture coupling 270. The reinforcement mesh 286 may
resemble a spider web and may be fabricated of a rigid metal,
polymer, or any other suitable material. The reinforcement mesh 286
functions to provide rigidity and to minimize tissue liftoff during
use of the suture coupling 270.
[0119] Referring now to FIG. 13A, shown therein is an exemplary
embodiment of a suture coupling 290. The suture coupling 290 is
flower-shaped so as to be provided with a plurality of petals or
protrusions 294. The flower shaped suture coupling 290 may be
constructed by using standard weaving techniques, for example, and
may have its edges reinforced, such as by braiding or weaving a
second layer of material interlinked with the coupling base during
the manufacture of the suture coupling 290. The protrusions 294 are
provided with suture eyelets 298 which may be implemented and
function similarly to the suture eyelets 232, for example.
[0120] Referring now to FIG. 13B, shown therein is another
embodiment of a suture coupling 290a. The suture coupling 290a is
similar to the suture coupling 290 except the suture coupling 290a
is formed of a wool-like textile. It should be understood that the
term wool-like textile as used herein is intended to include a
relatively softer and less dense textile material as compared with
the suture coupling 290. The wool-like textile may be fabricated,
for example, from one or a combination of materials including
non-resorbable polymers such as polyethylene, polypropylene, ultra
high molecular weight polyethylene, Poly-ether-ether-ketone (PEEK),
Poly-ether-ketone-ketone (PEKK), resorbable polymers, such as
poly-lactic acid (PLA), poly-L-lactide (PLLA), poly-L/D-lactide
(PLDLA), poly-lactic-co-glycolic acid (PLGA), Poly-glycolide or
Poly-glycolic acid (PGA), Poly-capro-lactone (PCL), or soft metals,
such as nitinol. The suture coupling 290a may have its edges and
suture eyelets reinforced, such as by braiding or weaving a second
layer of material interlinked with the coupling base during the
manufacture of the suture coupling 290, for example.
[0121] Referring now to FIG. 13C, shown therein is another
embodiment of a suture coupling 290b. The suture coupling 290b is
similar to the suture coupling 290 except the suture coupling 290ba
is configured to have a generally clover shape so as to be provided
with a plurality of petals or protrusions 294b. The protrusions
294b are provided with suture eyelets 298b which may be implemented
and function similarly to the suture eyelets 232, for example.
[0122] FIG. 13D shows a suture coupling 290c which is generally cam
shaped or wedge shaped. As such, the suture coupling 290c has a
narrow end 299a and a wide or flared end 299b. The narrow end 299a
is provided with an opening 300a for receiving a shaft of a
compression screw. The wide end 299b may be provided with suture
eyelets 300b.
[0123] Referring now to FIG. 14, shown therein is an exemplary
embodiment of a suture coupling 304. The suture coupling 304 is
similar to the suture coupling 190 except the suture coupling 304
is not initially provided with an opening. As such, a user may cut
or otherwise form a hole for receiving an implant, such as a
compression screw or anchor where desired in the suture coupling
304, for example.
[0124] Referring now to FIG. 15, shown therein is a coupling cap
310 according to the inventive concepts disclosed herein. The
coupling cap 310 may be inserted, clipped-on, or otherwise attached
to a head of a surgical screw (e.g., 104 or 104a), such that the
coupling cap 310 prevents a suture coupling 318 from lifting, or
being lifted, away from a bone 316. For example, the coupling cap
310 may be affixed inside a screw drive 312 of a surgical screw
314, after the surgical screw 314 is implanted into a bone 316 such
that a peripheral edge 317 of the coupling cap 310 is positioned
adjacent to or in contact with at least one of the suture coupling
318 or a suture 319 attached to and extending from the suture
coupling 318. It is to be understood that the coupling cap 310 may
be used with any of the suture couplings disclosed herein, and may
be used with prior art suture couplings in some exemplary
embodiments.
[0125] Referring now to FIG. 16, shown therein is an exemplary
embodiment of a coupling staple 320 according to the inventive
concepts disclosed herein. One or more coupling staples 320 may be
used in combination with any of the suture couplings disclosed
herein, and may function to prevent suture coupling rotation and
lift-off, for example. The coupling staple 320 may be implanted
into a bone 316 after a suture coupling 318 having a suture 319
attached thereto is already implanted via a surgical screw 314, of
may be pre-assembled with the suture coupling 318, depending on the
surgical procedure needs, or surgeon preference, for example. The
coupling staple 320 may be constructed of any suitable material,
such as metals, metal polymers, plastics, ceramics, resins,
polymers, or combinations thereof, for example. The coupling staple
320 may be inserted through the suture coupling 318 and into the
bone 316, such as by driving the coupling staple 320 into the bone
316 via a suitable surgical tool (not shown), for example.
[0126] Referring now to FIGS. 17A-17C, shown therein is the
compression screw 104 with a suture ring 186 inserted thereon. A
suture 322 is shown threaded through the suture ring 186 and
pulling the suture ring 186 slightly away from the shaft 144 of the
compression screw 104. As can be seen in FIG. 17D, the suture ring
186 is compressed between the compression screw 104 and a bone 324,
preventing the suture 322 from pulling the suture ring 186 away
from the compression screw 104.
[0127] Referring now to FIGS. 18A-18D, shown therein is an
embodiment of a compression screw 326 with a suture ring 186
inserted thereon according to the inventive concepts disclosed
herein. The compression screw 326 may be implemented similarly to
the compression screw 104, except that the projections 328 are
longer than the projections 134 of the compression screw 104, for
example. This allows the suture ring 186 to remain attached to the
compression screw 326 as a suture 329 is pulling the suture ring
186 away from the compression screw 326.
[0128] Referring now to FIGS. 19A-19B, shown therein is an
embodiment of a compression screw 330 according to the inventive
concepts disclosed herein. The compression screw 330 may be
implemented similarly to the compression screw 104a, and has one or
more teeth 332 formed in a bone engaging surface 333 of a head 334.
The teeth 332 function to engage a suture ring 186 (e.g., by
compressing the suture ring 186 against a bone) and prevent the
suture ring 186 from being pulled away from the head 334. It is to
be understood, however, that a compression screw 330 may be used in
combination with any of the suture couplings and suture rings
described herein, as well as with any conventional suture
couplings, as will become apparent to a person of ordinary skill in
the art having the benefit of the instant disclosure.
[0129] Referring now to FIGS. 20A-20B, shown therein is an
embodiment of a compression screw 336, shown in combination with a
suture ring 186. The compression screw 336 may be implemented
similarly to the compression screw 104a, except that the
compression screw 336 has an annular groove 338 formed in a bone
engaging surface 340 of a head 342 thereof. The annular groove 338
is sized such that it may house at least a portion of the suture
ring 186 therein, such that the suture ring 186 is compressed
between the surface 340 and a bone, and is prevented from being
pulled away from the compression screw 336 by one or more sutures.
It is to be understood that a cylindrical annular groove (not
shown) may be formed in the bone engaging surface 340 in some
exemplary embodiments configured to house a suture coupling
constructed according to the inventive concepts disclosed
herein.
[0130] Referring now to FIGS. 21A-21D, shown therein is an
exemplary embodiment of a variable angle compression screw 350
according to the instant inventive concept. The variable angle
compression screw 350 has a head 352 in combination with a shaft
354 having a longitudinal axis 356, a proximal end 358, and a
distal end 360.
[0131] The shaft 354 includes a central cannula 362 extending
therethrough. The central cannula 362 is configured to allow for
the insertion of a guide wire (not shown), such as a K-wire, for
example. It is to be understood, however, that some exemplary
embodiments of the variable angle compression screw 350 according
to the instant inventive concepts may omit the central cannula 362
and may, or may not, be implanted into a bone over a guide
wire.
[0132] The proximal end 358 of the shaft 354 includes a convex
portion 364 having threads 366 formed thereon. The threads 366 are
desirably oriented radially relative to the longitudinal axis 356
of the shaft 354. The threads 366 may be any suitable threads 366
having any suitable pitch, and may be formed into the convex
portion 364 in any suitable manner, such as molding, cutting,
machining, or combinations thereof, for example.
[0133] The proximal end 358 further has a hexagonal drive 368
(FIGS. 21C-21D), which is configured to receive the head of a
conventional hexagonal driver (not shown) such that rotational
motion may be imparted to the shaft 354 relative to the
longitudinal axis 356. It is to be understood, however, that the
proximal end 358 may include a drive configured to engage any
conventional drive instead of a hexagonal drive 368 in some
exemplary embodiments of the instant inventive concepts, such as
Phillips drive, flat drive, cross drive, octagonal drive, and
star-shaped drive, for example.
[0134] The distal end 360 of the shaft 354 has threads 370 formed
therein, the threads 370 configured to engage a bone, such that the
variable angle compression screw 350 may be implanted into the bone
and retained therein. The shaft 354 is shown as comprising an
unthreaded portion 372, but it is to be understood that some
exemplary embodiments of a variable angle compression screw 350 may
omit the unthreaded portion 372 and may have threads 370 along the
length of the shaft 354. Further, some exemplary embodiments of a
shaft 354 may include other retention means or features (not shown)
such as ribs, grooves, bumps, channels, protrusions, or
combinations thereof, instead of, or in addition to, the threads
370. The threads 370 may be self-tapping or self-drilling, or a
drill may be used to pre-drill a suitable size opening or channel
into the bone at any desired angle for the threads 370 to engage,
for example.
[0135] The head 352 is shown as being a cloverleaf shaped structure
with a plurality of projections 374 each with a suture fixation
hole 376 formed therein. The head 352 further includes a central
opening 378 having columns of threads 380 formed in an internal
surface thereof. The central opening 378 is configured to
threadingly receive the convex portion 364 of the shaft 354
therein, such that the threads 380 engage with the threads 366 of
the shaft 354 to secure the head 352 to the shaft 354 at any
desired angle. It is to be understood that while four columns of
threads 380 are shown in FIG. 21C, the instant inventive concepts
may be used with continuous threads 380, for example, or with less
than four, or more than four columns of threads 380.
[0136] An exemplary embodiment of using the variable angle
compression screw 350 includes forming an opening into a bone 382.
The shaft 354 of a variable angle compression screw 350 may then be
advanced into the opening such as by applying rotational motion to
the shaft 354 with a driver (not shown) relative to the
longitudinal axis 356. Once the proximal end 358 of the shaft 354
is level with the surface of the bone 382, or is just below the
surface of the bone 382, the head 352 may be held against the
surface of the bone 382 (e.g., via the screw drive 102), such that
the central opening 378 is aligned with the opening in the bone
382. In one exemplary embodiment, the shaft 354 may be backed out
of the bone 382 such that the threads 366 engage with the threads
380 to securely attach the head 352 to the shaft 354. In another
exemplary embodiment, the head 352 may be screwed onto the shaft
354. As will be understood by a person of ordinary skill in the art
having the benefit of the instant disclosure, when the head 352 is
connected to the shaft 354, the head 352 may have a varying angle
.alpha. relative to the longitudinal axis 356 of the shaft 354, and
such angle .alpha. may range in a predetermined range between about
90.degree. and about 135.degree., or between about 90.degree. and
about 120.degree. in either direction from the longitudinal axis
356, including any ranges and sub-ranges therebetween, for
example.
[0137] Further, one or more sutures (not shown) may be secured to
the head 352 via a suture fixation hole 376 prior to securing the
head 352 to the shaft 354, for example. It is to be understood that
in some exemplary embodiments, suture fixation holes 376 may be
omitted, and/or a suture coupling may be used to secure one or more
sutures to the variable angle compression screw 350 by positioning
such suture coupling between the head 352 and the bone 382, and
using the shaft 354 to secure the head 352 and suture coupling to
the bone 382 as described above, for example. Further, in some
embodiments a suture fixation hole 376 may be used to secure one or
more sutures to the head 352 and one or more suture couplings may
be used to secure one or more sutures to the head 352, or
combinations thereof, for example.
[0138] Referring now to FIGS. 22A-22D, shown therein is an
exemplary embodiment of a compression screw 384 according to the
inventive concepts disclosed herein. The compression screw 384
includes a shaft 386 having a longitudinal axis 388 and a head
390.
[0139] The shaft 386 has a proximal end 392 and a distal end 394
and a central cannula 396 extending therethrough. The proximal end
392 includes a neck portion 398 and a concave collar 400 having
threads 402 formed on the concave surface thereof. The proximal end
392 further includes a hex drive 404 configured to receive a hex
driver (not shown) such that rotational motion may be imparted onto
the shaft 386 relative to the longitudinal axis 388. The distal end
394 has threads 406 formed therein, the threads 406 configured to
engage a bone. It is to be understood that while the shaft 386 is
shown as comprising an unthreaded portion 408, the shaft 386 may
include threads 406 along its entire length in some embodiments of
the inventive concepts disclosed herein. Further, it is to be
understood that some exemplary embodiments may omit the hex drive
404, and may have any conventional screw drive capable of imparting
rotational force, or motion, to the shaft 386.
[0140] The head 390 has an opening 410 and one or more projections
412. The opening 410 is sized so that the head 390 is slidably
positioned about the neck portion 398 of the shaft 386, and so that
the head 390 may slide along the neck portion 398 of the shaft 386.
It is to be understood that while the head 390 is shown as
comprising a clover-leaf shape having four projections 412, any
suitable shape head 390 may be used with the inventive concepts
disclosed herein, such as a three-leaf clover shaped head 390, a
circular head 390, and a square head 390, for example. In some
exemplary embodiments, the outer edges of the head 390 may taper
down, such that the head 390 has a convex shaped cross-section
rather than a rectangular cross section, in order to reduce soft
tissue irritation/injury.
[0141] The one or more projections 412 may include suture fixation
holes 414 configured to secure one or more sutures (not shown)
therein.
[0142] The opening 410 tapers inwardly from the proximal end 392
towards the distal end 394 of the shaft 386, and includes four
columns of threads 416 configured to engage the threads 402 on the
concave collar 400. As will be understood by persons of ordinary
skill in the art, such arrangement of the threads 416 and 402
allows the concave collar 400 to engage the opening 410 of the head
390 so that the head 390 is oriented at an angle .alpha. relative
to the longitudinal axis 388, which angle .alpha. may vary from
about 90.degree. to about 120.degree., including any ranges and
sub-ranges therebetween, for example. This allows for the
compression screw 384 to have a variable angle between the head 390
and the shaft 386, such that the head 390 sits as level as possible
with the surface of a bone 418 when the compression screw 384 is
implanted into the bone 418.
[0143] The compression screw 384 may be made by any suitable
process, such as injection molding, machining, casting, or
combinations thereof, for example. In a non-limiting embodiment,
the shaft 386 may include a first portion 420 and a second portion
422 slidably received in the first portion 420 and welded, glued,
or otherwise secured therein. To assemble the compression screw
384, the head 390 is slid onto the neck portion 398 of the second
portion 422, and the second portion 422 is slid into the first
portion 420, and secured therein as described above. For an example
of such two-portion compression screw see U.S. patent application
Ser. No. 12/332,756, the entire contents of which are hereby
incorporated herein by reference. It is to be understood, however
that the compression screw 384 may have a shaft 386, and the head
390 may have two portions joined to one another such that the head
390 is slidably positioned onto the neck portion 398 of the shaft
386, for example.
[0144] In operation, the shaft 386 is gradually advanced into the
bone 418, such as by imparting rotational motion to the shaft 386
via a hex driver (not shown) engaging the hex drive 404, for
example. The compression screw 384 may or may not be implanted over
a guide wire (not shown) inserted through the central cannula 396
(FIG. 22C) extending through the shaft 386, for example. Just as
the neck portion 398 begins to advance under the surface of the
bone 418, the threads 416 of the head 390 are engaged by the
threads 402 of the concave collar 400, at an angle .alpha.
reflecting the angle of the surface of the bone 418 with which the
head 390 is in contact as shown in FIG. 22C. The compression screw
384 may be advanced further, until a desired compressive force is
applied to the bone 418 by the head 390, for example.
[0145] Referring now to FIGS. 23A-23D shown therein is an exemplary
embodiment of a variable-angle dynamic locking screw (DLS) 430
according to the instant inventive concepts. The variable angle DLS
430 includes a shaft 432, a longitudinal axis 434, and a head
436.
[0146] The shaft 432 has a cannula 438 extending therethrough and a
proximal end 440 and a distal end 442. The proximal end 440
includes an outer wall 444, and an inner wall 446 spaced apart at a
distance, such that an annular space 448 is defined by the outer
wall 444 and the inner wall 446. The annular space 448 functions to
allow the inner wall 446 to move towards and away from the outer
wall 444 in a radial direction relative to the longitudinal axis
434.
[0147] The shaft 432 has a first portion 450 having an open end
defining a cylindrical space and a second portion 452 configured to
be slidably received in the cylindrical space and secured therein,
such that the annular space 448 is defined by the first portion 450
and the second portion 452. The first portion 450 and the second
portion 452 may be secured to one another in any suitable manner,
such as welding, ultrasonic welding, adhesives, or combinations
thereof, for example. For an exemplary method of making a dynamic
locking screw see U.S. patent application Ser. Nos. 12/332,756, and
12/940,531 the entire contents of which are hereby incorporated
herein by reference.
[0148] The proximal end 440 further includes a neck portion 454 and
a collar 456 extending above the first portion 450 of the shaft
432. The collar 456 is substantially concave and tapers inwardly
relative to the longitudinal axis 434 from the proximal end 440
towards the distal end 442. The collar 456 has threads 458 on the
concave surface 460 thereof. The collar 456 further has a hex drive
462 configured to accept a hex driver (not shown) such that
rotational motion may be imparted on the shaft 432 via the hex
drive 462 relative to the longitudinal axis 434.
[0149] The distal end 442 includes threads 464 configured to engage
a cancellous portion 466 of a bone tissue 468, such that the shaft
432 may be retained therein.
[0150] The head 436 is slidably disposed about the neck portion 454
and includes a central opening 470 which tapers inward towards the
longitudinal axis 434 from the proximal end 440 towards the distal
end 442. The head 436 may be disposed about the neck portion 454
prior to joining the first portion 450 and the second portion 452
of the shaft 432, for example.
[0151] The central opening 470 further has four rows of threads 472
configured to engage the threads 458 of the collar 456. The threads
472 engage the threads 458 such that the head 436 is oriented
relative to the longitudinal axis 434 at an angle .alpha., which
angle .alpha. may vary from about 90.degree. to about 130.degree.,
including any ranges and sub-ranges therebetween, for example.
[0152] The head 436 further has one or more projections 474 having
suture fixation holes 476 formed therein. The suture fixation holes
476 are configured to secure one or more sutures (not shown), such
as by compressing one or more sutures between the head 436 and the
bone 468, for example.
[0153] In operation, the shaft 432 is advanced into the bone 468 at
any suitable angle as described above. The shaft 432 may be
advanced via self-tapping or self-drilling threads 464, or a
suitable size channel or opening may be formed into the bone 468,
into which the shaft 432 is advanced, for example. The threads 458
of the collar 456 engage the threads 472 to secure the head 436 to
the shaft 432, such that the head 436 is oriented relative to the
longitudinal axis 434 at an angle .alpha. as described above. The
shaft 432 may be advanced into the bone 468 so that a desired
compressive force is applied to the bone 468, for example. During
use, as forces are applied to the head 436 and/or to the shaft 432
in a radial direction relative to the longitudinal axis 434, the
variable angle DLS 430 is able to at least partially absorb such
forces by flexing or bending, such that the inner wall 446 moves
inside the annular space 448 relative to the outer wall 444 as
shown in FIG. 23D, for example.
[0154] Is it to be understood that in some exemplary embodiments of
the variable angle DLS 430 may omit the suture fixation holes 476,
and/or may include a suture coupling (not shown) which may be
implemented and may function substantially as described above.
Further, in some exemplary embodiments, the variable angle DLS 430
may include more than one annular space 448 as will be understood
by persons of ordinary skill in the art having the benefit of the
instant disclosure. Further, in some embodiments, one or more
sutures may be wound around the shaft 432 and may be compressed
against the bone 468 by the head 436 when the variable angle DLS
430 is implanted into the bone 468, for example.
[0155] Referring now to FIG. 24, shown therein is an exemplary
embodiment of a bone plate assembly 480. The bone plate assembly
480 includes a bone plate 482 and one or more compression screws
484.
[0156] The bone plate 482 may be constructed of any suitable
bio-inert, biocompatible, or bio-absorbable material, such as
stainless steel, titanium, polyethylene, poly-lactic-acid (PLA),
poly lactic co-glycolic acid (PLGA), polyurethane, bone tissue,
ultra-high molecular weight polyethylene fibers, epoxy resins, or
combinations thereof, for example.
[0157] The bone plate 482 may include a plate body 486 having an
axis 488, a top surface 490, a bone surface 492, and one or more
attachment openings 494 formed therein. The attachment openings 494
taper outwardly from the top surface 490 to the bone surface 492,
i.e., the attachment openings 494 are narrower at the top surface
490 and wider at the bone surface 492. The attachment openings 494
further includes four columns of threads 496 formed therein, the
threads 496 configured to engage threads of one or more compression
screws 484 as will be described below.
[0158] The one or more compression screws 484 include a shaft 498
having a longitudinal axis 500 and a cannula 502 extending
therethrough. The shaft 498 has a proximal end 504 and a distal end
506.
[0159] The proximal end 504 includes a head 508 having a convex
surface with threads 510 formed therein and configured to enter an
attachment opening 494 at the bone surface 492 and threadingly
engage one or more of the columns of threads 496 in the attachment
opening 494.
[0160] The distal end 506 has threads 512 configured to engage a
bone tissue, such that the compression screw 484 may be retained
therein.
[0161] In operation, one or more of the compression screws 484 are
implanted into a bone 514 and advanced into the bone 514 such that
the head 508 of the one or more compression screws 484 is level
with, or sits just below, the surface of the bone 514. A bone plate
482 is then placed against the bone 514 such that one of the
attachment openings 494 of the bone plate 482 is aligned with the
head 508 of one or more compression screws 484. The one or more
compression screws 484 are then backed out such that the threads
510 of the one or more compression screws 484 engage with the
threads 496 of the attachment opening 494 in order to attach the
bone plate 482 to the one or more compression screws 484. One of
the one or more compression screws 484 may be oriented such that
the longitudinal axis 500 of the compression screw 484 intersects
with the axis 488 at an angle .alpha., which may vary between about
30.degree. and about 120.degree., including any ranges and
sub-ranges therebetween, for example. Further, one or more of the
compression screws 484 may be oriented such that the longitudinal
axis 500 of the compression screw 484 intersects with the axis 488
at an angle .beta., which may vary between about 30.degree. and
about 120.degree., including any ranges and sub-ranges
therebetween, for example. In some exemplary embodiments of the
inventive concepts disclosed herein, the angles .alpha. and .beta.
may be different, while in other exemplary embodiments the angles
.alpha. and .beta. may be equal or substantially equal to one
another.
[0162] It is to be understood that while only two compression
screws 484 are shown in FIG. 24, a bone plate 482 according to the
inventive concepts disclosed herein may be attached to a bone 514
with one or more compression screw 484, for example. Further, a
compression screw other than the compression screw 484 may be used
to attach the bone plate 482 to the bone 514, such as a DLS for
example. In addition, it will be understood that one or more of the
suture couplings described above, in particular the suture coupling
254b (FIG. 11C), may be used in conjunction with the bone plate
system 480.
[0163] Further, while the bone plate 482 is shown as having a
rectangular cross-section in FIG. 24, a bone plate 482 according to
the inventive concepts disclosed herein may have any suitable
cross-section, such as concave, convex, rounded-off, or
combinations thereof, for example, in order to minimize adjacent
soft tissue injury or irritation.
[0164] It is to be understood that the steps disclosed herein may
be performed simultaneously or in any desired order, and may be
carried out by a human, or by a machine, and combinations thereof,
for example. For example, one or more of the steps disclosed herein
may be omitted, one or more steps may be further divided in one or
more sub-steps, and two or more steps or sub-steps may be combined
in a single step, for example. Further, in some exemplary
embodiments, one or more steps may be repeated one or more times,
whether such repetition is carried out sequentially or interspersed
by other steps or sub-steps. Additionally, one or more other steps
or sub-steps may be carried out before, after, or between the steps
disclosed herein, for example.
[0165] Although the inventive concepts disclosed and claimed herein
and the advantages thereof have been described in detail, it should
be understood that various changes, substitutions and alterations
can be made herein without departing from the spirit and scope
thereof as defined by the appended claims. Moreover, the scope of
the present application is not intended to be limited to the
particular embodiments of the process, apparatus, items of
manufacture, compositions of matter, means, methods, and steps
described in the specification. As one of ordinary skill in the art
will readily appreciate from the disclosure of the presently
disclosed and claimed inventive concepts, various processes,
apparatus, items of manufacture, compositions of matter, means,
methods, or steps, presently existing or later to be developed that
perform substantially the same function or achieve substantially
the same result as the corresponding embodiments described herein
may be utilized according to the presently disclosed and claimed
inventive concepts. Accordingly, the appended claims are intended
to include within their scope such processes, apparatus, items of
manufacture, compositions of matter, means, methods, or steps.
* * * * *