U.S. patent application number 14/593375 was filed with the patent office on 2015-04-30 for methods and devices for treating intervertebral disc disease.
The applicant listed for this patent is DePuy Synthes Products, LLC. Invention is credited to Tom OVERES.
Application Number | 20150119894 14/593375 |
Document ID | / |
Family ID | 44168042 |
Filed Date | 2015-04-30 |
United States Patent
Application |
20150119894 |
Kind Code |
A1 |
OVERES; Tom |
April 30, 2015 |
Methods and Devices For Treating Intervertebral Disc Disease
Abstract
An aiming plate for orienting tools toward target features of an
implant. The aiming plate features a first and a second surface and
has a reversible attachment mechanism for attaching to an implant
to orientate one of the first and second surfaces to face the
implant. The aiming plate also features first and second through
holes. The first through hole for receiving a tool extends along a
first hole axis from the first surface to the second surface. The
second through hole for receiving a tool is positioned adjacent the
first through hole and extends along a second hole axis from the
first surface to the second surface. The through holes arranged so
that the first hole axis is divergent with respect to the second
hole axis.
Inventors: |
OVERES; Tom; (Langendorf,
CH) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
DePuy Synthes Products, LLC |
Raynham |
MA |
US |
|
|
Family ID: |
44168042 |
Appl. No.: |
14/593375 |
Filed: |
January 9, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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13089846 |
Apr 19, 2011 |
8945136 |
|
|
14593375 |
|
|
|
|
61325913 |
Apr 20, 2010 |
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Current U.S.
Class: |
606/96 |
Current CPC
Class: |
A61B 17/1778 20161101;
A61B 17/1725 20130101 |
Class at
Publication: |
606/96 |
International
Class: |
A61B 17/17 20060101
A61B017/17 |
Claims
1-12. (canceled)
13. An aiming system for orienting tools toward target features of
an implant, comprising: an implant extending longitudinally from a
proximal end to a distal end and including a first set of target
features; an aiming plate comprising: a reversible attachment
mechanism, a first surface and a second surface, a first through
hole for receiving a tool, the first through hole extending along a
first hole axis from the first surface to the second surface, and a
second through hole for receiving a tool, the second through hole
extending along a second hole axis from the first surface to the
second surface; and an aiming arm for attaching the aiming plate to
the implant, the aiming arm extending from a first end including a
first joining mechanism engageable with the proximal end of the
implant and a second end including a second joining mechanism
engageable with the reversible attachment mechanism; wherein, in a
first configuration, the aiming arm is engaged with the reversible
attachment mechanism to orientate the first through hole to direct
a tool towards a desired target feature on the implant and the
second through hole is arranged to direct a tool away from the
desired target feature and, in a second configuration, the aiming
arm is engaged with the reversible attachment mechanism to
orientate the second through hole to direct a tool towards a
desired target feature on the implant and the first through hole is
arranged to direct a tool away from the desired target feature.
14. The system of claim 11, further comprising a drilling bushing
extending from a first end to a second end, the drill bushing
positionable in a through hole.
15. The system of claim 11, wherein the intramedullary nail
includes a fourth joining mechanism engageable with the second
joining mechanism of the aiming arm to releasably attach the aiming
arm to the intramedullary nail.
16. The system of claim 11, wherein the aiming arm is configured
such that, when the aiming plate and the implant are engaged with
the aiming arm, a longitudinal axis of the implant is substantially
parallel to the first and second surfaces of the aiming plate.
17. A method of aligning a through hole for receiving a tool with a
desired feature of an implant, the method comprising the steps of:
a) identifying a type of implant to be coupled to an aiming plate;
b) determining a correct configuration of an aiming plate according
to the identified implant type; and c) coupling the aiming plate to
an implant of the identified implant type in the determined correct
configuration; wherein the determined correct configuration is one
of: a first configuration in which a first through hole is directed
towards a first target feature on a first implant type and a second
through hole is directed away from the first target feature, and a
second configuration in which the second through hole is directed
towards a second target feature on a second implant type and the
first through hole is directed away from the second target
feature.
18. The method of claim 15, wherein the step of determining further
comprises comparing the identified implant type to a marking on the
aiming plate to determine whether to couple the aiming plate in the
first or in the second configuration.
19. The method of claim 15, wherein when the first and second
implant types are the same implant type, the step of determining
further comprises the step of identifying whether an implant is to
be used in a left hand configuration or a right hand configuration;
and wherein the first target feature is different to the second
target feature on the implant.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a Divisional Patent Application of
Utility application Ser. No. 13/089,846, filed Apr. 19, 2011, that
claims the benefits of priority under 35 U.S.C. .sctn.119 and/or
.sctn.120 from prior filed U.S. Provisional Application Ser. No.
61/325,913 filed on Apr. 20, 2010, which applications are
incorporated by reference in their entirety into this
application.
FIELD OF THE INVENTION
[0002] The present invention generally relates to an aiming device
for guiding a drill bit during the drilling of a hole in a bone.
More particularly, the present invention relates to an
intramedullary nail aiming device for drilling holes in a bone that
are suitable for receiving locking screws of an intramedullary
nail. Exemplary embodiments of the invention relate to a system
comprising an intramedullary nail aiming device and an
intramedullary nail and to a method for drilling the holes in a
bone for inserting locking screws in an intramedullary nail by
using the intramedullary nail aiming device.
BACKGROUND
[0003] Intramedullary nails including fixation screws inserted
through the intramedullary nail in a transverse direction to lock
the intramedullary nail relative to the bone are commonly known. In
particular, proximal humerus nails comprise multiple fixation
screws arranged at different angles relative to each other in the
proximal part of the intramedullary nail to securely fixate bone
fragments.
[0004] These screws are positioned in the intramedullary nail in
corresponding through holes using an aiming arm or aiming block
rigidly connected to the proximal end of the intramedullary nail by
an intermediate member. These aiming blocks feature guiding holes
aligned with the through holes in the intramedullary nail but
arranged at a distance from the bone to leave space for the arm and
shoulder of the patient. Generally, drilling or guiding sleeves are
inserted into the holes in the aiming block drilling tools and
screwdrivers guided through the sleeves are exactly aligned with
the holes in the intramedullary nail. For anatomical reasons,
intramedullary nails are commonly provided in "left" and "right"
embodiments, i.e. in a mirrored configuration. Therefore, the
aiming blocks generally feature through holes matching the left
side and the right side configurations of the intramedullary nail.
Because aiming blocks which preferably include radiolucent carbon
fibre reinforced PEEK material are very costly, it is preferred to
have only one aiming block for both configurations of the
intramedullary nail. Known aiming instruments comprise aiming
blocks with all the through holes for the left side and the right
side configurations of the intramedullary nail in a single aiming
block. These known aiming blocks can pose the risk that the wrong
through holes may be used when preparing the bone, i.e. drilling
the holes in the bone through which the fixation screws will be
positioned. For example, a user may inadvertently drill through a
hole corresponding to the "right side" configuration of the aiming
device while working with a "left side" intramedullary nail. If a
wrong hole is selected the drill bit will collide with the
intramedullary nail and cause unacceptable debris possibly
resulting in a loss of stability of the intramedullary nail and
furthermore, an unnecessary hole drilled into the bone. In order to
prevent this, the through holes in the aiming block are clearly
marked "left" and "right" or are colour coded. In stressful
situations, however, mistakes may still be made.
[0005] German Patent No. DE 101 10 246 C2 ERHARDT discloses an
aiming device for a tibial locking nail which can be used for
placing locking screws for the left as well as for the right tibia
using the same device. However, the tibial nail used with the
system of ERHARDT is of the single type and does not have different
left and right side shapes.
SUMMARY OF THE INVENTION
[0006] The present invention relates to an aiming device and method
for properly guiding a tool or instrument in case of a left side
and a right side configuration of locking screws to be inserted in
an intramedullary nail by clearly preventing from using or even
making it impossible to use a wrong hole.
[0007] In a first aspect, the present invention is directed to an
aiming plate for orienting tools toward target features of an
implant. The aiming plate features a first and a second surface and
has a reversible attachment mechanism for attaching to an implant
to orientate one of the first and second surfaces to face the
implant. The aiming plate also features first and second through
holes. The first through hole for receiving a tool extends along a
first hole axis from the first surface to the second surface. The
second through hole for receiving a tool is positioned adjacent the
first through hole and extends along a second hole axis from the
first surface to the second surface. The through holes arranged so
that the first hole axis is divergent with respect to the second
hole axis.
[0008] The aiming plate may feature an attachment mechanism
attachable to the implant in a first configuration in which a first
surface faces the implant and in a second configuration in which a
second surface faces the implant. The aiming plate may feature a
first through hole for receiving a tool, which may extend along a
first hole axis from the first surface to the second surface. The
aiming plate may also feature a second through hole for receiving a
tool, which may extend along a second hole axis from the first
surface to the second surface. When an implant is coupled to the
aiming plate in the first configuration, the first hole axis may be
directed towards a desired target feature on the implant and the
second hole axis may be directed away from the desired target
feature. When an implant is coupled to the aiming plate in the
second configuration, the second hole axis may be directed towards
a desired target feature on the implant and the first hole axis may
be directed away from the desired target feature.
[0009] The first through hole may be open to the second through
hole. One or both of the first and second surfaces may feature a
compound opening defined by an overlap between a first opening into
the first through hole and a second opening into to the second
through hole.
[0010] The aiming plate may also feature third and fourth through
holes. The third through hole may be for receiving a tool and may
extend along a third hole axis from the first surface to the second
surface. The fourth through hole may be for receiving a tool and
may extend along a fourth hole axis from the first surface to the
second surface. When an implant is coupled to the aiming plate in
the first configuration, the third through hole axis is directed
towards a second desired target feature on the implant and the
fourth hole axis is directed away from the second desired target
feature. When an implant is coupled to the aiming plate in the
second configuration, the fourth hole axis may be directed towards
a second desired target feature on the implant and the third hole
axis is directed away from the second desired target feature. The
first and second desired target features may be located in
different regions of the implant. For example, where the implant is
a proximal nail, the first desired target feature may be a locking
hole in a proximal end region and the second desired target feature
may be a locking hole in a distal end region.
[0011] The aiming plate may feature a first marking on the second
surface, the first marking may indicate a type of implant having
the desired target feature towards which the first through hole is
directed in the first configuration. The aiming plate may feature a
second marking on the first surface, the second marking indicating
a type of implant having the desired target feature towards which
the second through hole is directed in the second
configuration.
[0012] Some advantages of the aiming device according to the
invention are that: [0013] the aiming device comprises a single
aiming plate with the guiding holes for the left side configuration
of the intramedullary nail integrated from one side and the guiding
holes for the right side configuration integrated from the opposite
side of the aiming plate wherein the guiding holes of the left and
right side cross each other in such a manner that inserting the
guide sleeves or drill bushings into the wrong hole would result
therein that the guide sleeve or drill bushing is directed far
beside the intramedullary nail, even missing the patient's
shoulder. Therefore, if the wrong hole is taken no harm will
result; [0014] in case of a universal intramedullary nail with only
one configuration for the left side or the right side bone but with
different locking holes to be used when the nail is used for the
left respectively the right side a surgeon can be prevented form
drilling a wrong hole into the bone; and [0015] each side of the
aiming plate can be largely labelled "LEFT" or RIGHT". During
surgery the surgeon only once has to mount the corresponding side
correctly, and only the correct through holes can be used for
targeting the nail.
[0016] In an exemplary embodiment of the aiming device, the first
through hole and the second through hole penetrate each other and
form a compound opening. The compound opening prevents the surgeon
from searching a suitable through hole, the surgeon needs only to
decide into which through hole of the selected compound opening the
drilling bushing is to be inserted.
[0017] In a further exemplary embodiment of the aiming device, the
aiming plate comprises a first set including more than one first
through holes and a second set including more than one second
through holes.
[0018] In another exemplary embodiment of the aiming device, the
aiming plate further comprises a lower end and a central plane
extending between the upper end and the lower end and cutting the
left and right side wherein the first and second hole axes of the
first and second through holes of at least one compound opening are
located in one plane orthogonal to the central plane. This
configuration allows the advantage that identically positioned
anterior and posterior locking holes in the intramedullary nail can
be used in left side and right side intramedullary nails.
[0019] In yet another exemplary embodiment of the aiming device,
the first and second hole axis of the first and second through hole
of at least one compound opening is located in different planes
orthogonal to the central plane and at different distances from the
upper end of the aiming plate. Thus, a particular compound opening
including first and second through holes can be arranged in the
position of the problematic locking holes of a universal
intramedullary nail so that a surgeon is prevented from drilling a
hole into the bone coaxially with a locking hole which is
problematic for anatomical reasons.
[0020] In a further exemplary embodiment of the aiming device, the
aiming plate comprises a middle plane orthogonal to the central
plane and at an equal distance from the left side and from the
right side of the aiming plate and wherein the first and second
hole axis of the first and second through hole of at least one
compound opening cut the middle plane at an equal distance E from
the central plane.
[0021] In yet a further exemplary embodiment of the aiming device,
the first and second hole axis of the first and second through hole
of at least one compound opening define a plane which is orthogonal
to the central plane and orthogonal to the middle plane.
[0022] In still a further exemplary embodiment of the aiming
device, the first hole axes of at least two first through holes
and/or the second hole axes of at least two second through holes
are not arranged in the same plane orthogonal to the central
plane.
[0023] In another exemplary embodiment of the aiming device, the
first hole axis of the first through hole converges towards the
central plane in the direction from the left side towards the right
side. By this means the advantage can be achieved that the surgeon
can visually check whether the aiming plate has been correctly
fixed to the intramedullary nail.
[0024] In yet another exemplary embodiment of the aiming device,
the second hole axis of the second through hole diverges from the
central plane in the direction from the left side towards side
right side. Thus, the surgeon will visually notice at once that the
aiming guide has been wrongly mounted to the intramedullary
nail.
[0025] In a further exemplary embodiment of the aiming device, the
first hole axis of the first through hole encloses an angle .alpha.
with the central plane at a minimum of 5.degree., preferably a
minimum of 15.degree.. By this means the advantage is achieved that
a sufficient angle between the inserted drilling bushings and the
central plane permits a user to check whether the aiming plate is
correctly fixed to the intramedullary nail. Further, the first hole
axes of the first set of through holes can enclose an angle .alpha.
with the central plane at a maximum of 70.degree., preferably a
maximum of 45.degree.. A typical value for the angle .alpha. is,
for example, 30.degree..
[0026] In yet a further exemplary embodiment of the aiming device,
the second hole axis of the second through hole encloses an angle
.beta. with the central plane of minimum 5.degree., preferably
minimum 15.degree.. This configuration allows the advantage that on
the one hand identically positioned locking holes in the
intramedullary nail can be used in a left side and a right side
intramedullary nail and on the other hand the prolongations of the
second hole axes extend beside the intramedullary nail and even
beside the bone where the nail is inserted so unambiguously
indicating to the surgeon that the aiming guide is wrongly fixed to
the intramedullary nail.
[0027] In still a further exemplary embodiment of the aiming
device, the aiming plate comprises an additional compound opening
of a left side through hole with a left side hole axis and a right
side through hole with a right side hole axis wherein the left side
hole axis and the right side hole axis are located in the central
plane and diverge relative to each other in the direction from the
left side towards the right side. The left side hole axis and the
right side hole axis lie in or are parallel to the central plane.
The left side hole axis and the right side hole axis can enclose an
angle .gamma. at a minimum of 10.degree., preferably a minimum of
20.degree.. Further, The left side hole axis and the right side
hole axis can enclose an angle .gamma. at a maximum of 140.degree.,
preferably a maximum of 90.degree..
[0028] In another exemplary embodiment, the aiming device further
comprises an aiming arm with a first end including a first joining
means and a second end including a second joining means and wherein
the first joining means is attachable to the aiming plate and the
second joining means is attachable to an intramedullary nail
allowing to reversibly fix the aiming plate to an intramedullary
nail in an aligned left position and in an aligned right
position.
[0029] In yet another exemplary embodiment of the aiming device,
the aiming plate comprises a third joining means engageable with
the first joining means at the aiming arm in an aligned left
position and in an aligned right position.
[0030] In another exemplary embodiment, the aiming arm has a length
allowing to reversibly fix the aiming plate with the middle plane
at a distance A>0 from a nail axis of an intramedullary nail. In
case of an intramedullary nail suitable for a fixation of a
fracture of the radius the distance A is a minimum of 15 mm,
preferably a minimum of 50 mm and a maximum of 200 mm, preferably a
maximum of 180 mm.
[0031] In a further exemplary embodiment, the aiming device further
comprises at least one drilling bushing with a front end and a rear
end. The prolongation of the second hole axis can be at a distance
B of minimum 10 mm, preferably minimum 30 mm from the central plane
measured at the front end of the drilling bushing when inserted in
one of the second through holes of the second set.
[0032] In an exemplary embodiment, the aiming device can consist of
a carbon fibre reinforced PEEK, aluminum or stainless steel.
[0033] In accordance with a second aspect of the present invention,
the aiming plate may be for orienting tools toward target features
of an intramedullary nail, comprising an attachment mechanism at a
proximal end of the aiming plate configured for attachment to a
proximal end of an intramedullary nail in first a configuration in
which a first surface of the aiming plate faces a nail to which it
is coupled and in a second configuration in which a second surface
of the aiming plate faces a nail to which it is coupled and a first
compound opening extending through the aiming plate from the first
surface to the second surface, the first compound opening including
first and second through holes open to one another, the first
through hole extending along a first hole axis configured to align
with a corresponding locking hole in a nail coupled to the plate in
the first configuration, the second through hole extending along a
second hole axis configured to align with a corresponding locking
hole in a nail coupled to the aiming plate in the second
configuration, the first and second through holes being sized and
shaped to receive a drill bushing therethrough and wherein, the
first and second hole axes intersect one another such the first
hole axis does not align with any portion of a nail coupled to the
aiming plate in the second configuration and the second hole axis
does not align with any portion of a nail coupled to the aiming
plate in the first configuration.
[0034] In accordance with another aspect of the present invention,
a system is provided for drilling the holes in a bone for inserting
locking screws in an intramedullary nail by using the
intramedullary nail aiming device, the system comprising an
intramedullary nail aiming device according to the first or second
aspect of the invention and an intramedullary nail with a nail
axis.
[0035] In an exemplary embodiment of the system, the intramedullary
nail comprises a fourth joining means engageable with the second
joining means of the aiming arm for reversibly fixing the aiming
arm to the intramedullary nail in an aligned position.
[0036] In a further exemplary embodiment of the system, the aiming
arm has a length allowing to reversibly fix the aiming plate with
the middle plane at a distance A of minimum 70 mm, preferably
minimum 50 mm from the nail axis of the intramedullary nail.
[0037] In another exemplary embodiment of the system, the aiming
arm is configured in such a manner that the nail axis extends
parallel to the middle plane when the aiming device is fixed to the
intramedullary nail.
[0038] In accordance with another aspect, a method is provided for
aligning a through hole for receiving a tool with a desired feature
of an implant. The method comprising the steps of: [0039] a)
identifiying a type of implant to be coupled to an aiming plate;
[0040] b) determining a correct configuration of an aiming plate
according to the identified implant type; and [0041] c) coupling
the aiming plate to an implant of the identified implant type in
the determined correct configuration;
[0042] Once the correct configuration is determined the aiming
plate may be positioned in one of two configurations. In a first
configuration, a first through hole of the aiming plate is directed
towards a first target feature on a first implant type and a second
through hole of the aiming plate is directed away from the first
target feature. In a second configuration, the second through hole
is directed towards a second target feature on a second implant
type and the first through hole is directed away from the second
target feature.
[0043] The method may also have a step of determining by comparing
the identified implant type to a marking on the aiming plate to
determine whether to couple the aiming plate in the first or in the
second configuration.
[0044] The method may also have the step of recognising that the
same implant type is usable as a first implant type in the first
configuration and a second implant type in the second
configuration. The step of determining may further have a step of
identifying whether an implant is to be used in a left hand
configuration or a right hand configuration, where the first target
feature may be different to the second target feature on the
implant.
[0045] In accordance with another aspect, a method is provided for
drilling the holes in a bone for inserting locking screws in a left
side or in a right side intramedullary nail by using the
intramedullary nail aiming device. The method comprises the steps
of:
a) positioning the left side or the right side of the aiming plate
with respect to the intramedullary nail according to which of the
left side or right side configuration of the intramedullary nail is
to be used during the surgical procedure; b) fixing the aiming
plate to the intramedullary nail; c) inserting at least one
drilling bushing into one of the through holes of the first or
second set; d) checking whether the drilling bushing has been
inserted in a correct through hole of the first set in case of a
left side nail or in a correct through hole of the second set in
case of a right side nail, and
[0046] if the drilling bushing has been inserted in a wrong through
hole of the second set in case of a left side nail or a wrong
through hole of the first set in case of a right side nail; [0047]
inserting the drilling bushing into the other through hole of the
first respectively second set; and [0048] repeating step d); or
[0049] if the drilling bushing has been inserted in a correct
through hole of the first set in case of a left side nail or in a
correct through hole of the second set in case of a right side
nail, then:
e) drilling at least one hole in a bone where the intramedullary
nail is inserted by using the drilling bushing for guiding a drill
bit.
[0050] In an exemplary embodiment the method further comprises the
step of inserting a fixation screw through the drilling
bushing.
[0051] In accordance with another aspect of the present invention,
a method is provided for drilling the holes in a bone for inserting
locking screws in a universal nail having only one configuration
for the left and right side bone but having two locking bores or
two sets of locking bores, one when implanted in a left side bone
and another when implanted in a right side bone. The method
comprises the steps of:
i) positioning the left side or the right side of the aiming plate
with respect to the intramedullary nail according to which of the
left side or right side bone is to be treated during the surgical
procedure; ii) fixing the aiming plate to the intramedullary nail;
iii) inserting at least one drilling bushing into one of the
through holes of the first or second set; iv) checking whether the
drilling bushing has been inserted in a correct through hole of the
first set in case of using the universal nail at a left side bone
or in a correct through hole of the second set in case of using the
universal nail at a right side bone, and
[0052] if the drilling bushing has been inserted in a wrong through
hole of the second set in case of using the universal nail at a
left side bone or in a wrong through hole of the first set in case
of using the universal nail at a right side bone; [0053] inserting
the drilling bushing into the other through hole of the first
respectively second set; or
[0054] if the drilling bushing has been inserted in a correct
through hole of the first set in case of using the universal nail
at a left side bone or in a correct through hole of the second set
in case of using the universal nail at a right side bone:
v) drilling at least one hole in a bone where the intramedullary
nail is inserted by using the drilling bushing for guiding a drill
bit.
BRIEF DESCRIPTION OF THE DRAWINGS
[0055] A plurality of embodiments of the invention will be
described in the following by way of example and with reference to
the accompanying drawings in which:
[0056] FIG. 1 illustrates a perspective view of an embodiment of
the aiming device according to the invention;
[0057] FIG. 2 illustrates a perspective view of the embodiment of
FIG. 1 with the drilling bushings inserted in the wrong through
holes;
[0058] FIG. 3 illustrates a perspective view of another embodiment
of the aiming device according to the invention in case of an
application at the left side humerus;
[0059] FIG. 4 illustrates a perspective view of the embodiment of
FIG. 3 in case of an application at the right side humerus; and
[0060] FIG. 5 illustrates a perspective view of the embodiment of
FIG. 4 with one drill bushing inserted in a wrong hole.
DETAILED DESCRIPTION
[0061] FIGS. 1 and 2 illustrate an embodiment of the intramedullary
nail aiming device 1 used with a left side and a right side
configuration of an intramedullary nail 8, wherein the
intramedullary nail aiming device 1 comprises an aiming plate 2
with a first surface 5, a second surface 6, a distal end 12 and a
proximal end 7 attachable to an aiming arm 9 which is fixed to an
intramedullary nail 8. In a left side configuration, the first
surface 5 faces away from the bone while the second surface 6 faces
toward the bone. In a right side configuration, the first surface 5
faces toward the bone while the second surface 6 faces away from
the bone. The aiming plate 2 further includes a plurality of
compound openings extending through the aiming plate 2 from the
first surface 5 to the second surface 6. In a preferred embodiment,
the aiming plate 2 includes four compound openings. However, as
would be understood by those skilled in the art, any number of
compound openings depending on the characteristics of the
intramedullary nails to be used with the aiming plate. Each
compound opening comprises a first through hole 3 and a second
through hole 13 which are open to one another. The first through
holes 3 form a first set of four first through holes 3 and the
second through holes 13 form a second set of four second through
holes 13.
[0062] The aiming plate 2 comprises a longitudinal central plate
portion 29 extending along a longitudinal axis 15, a first lateral
side surface 41 and a second lateral side surface 42. Furthermore,
the aiming plate 2 includes two parallel first arms 43 protruding
laterally from the first lateral side surface 41 of the central
plate portion 29 and two parallel second arms 44 protruding
laterally from the second lateral side surface 42 of the central
plate portion 29. The first arms 43 and the second arms 44 are
staggered along the longitudinal axis 15 and have different
lengths. A central plane 11 extending between the proximal end 7
and the distal end 12 and cutting the first and second surfaces 5,
6 is substantially perpendicular to the first and second surfaces
5,6. Additionally, a middle plane 28 orthogonal to the central
plane 11 extends through the aiming plate 2 substantially parallel
to the first and second surfaces 5,6. Each first through hole 3
defines a first hole axis 10 and each second through hole 13
defines a second hole axis 14, wherein the first and second through
holes 3, 13 of each compound opening are arranged in such a way
that the first hole axis 10 and the second hole axis 14 intersect
one another along the middle plane 28. In the present embodiment
the first and second hole axes 10, 14 of the first and second
through holes 3, 13 of each compound opening intersect one another
along the middle plane 28 at an equal distance E from the central
plane 11. The first and second hole axes 10, 14 of the first and
second through holes 3, 13 of each compound opening define a plane
orthogonal to the middle plane 28 and orthogonal to the central
plane 11. Further, the four compound openings are arranged so that
the first and second hole axes 10, 14 of each of the first and
second through holes 3, 13 of one compound opening define a
different plane orthogonal to the middle plane 28 and orthogonal to
the central plane 11.
[0063] The first through holes 3 are sized and shaped to receive a
drill bushing 4 and/or drill bit from the first surface 5 along the
central axis 10 aligned with a corresponding locking hole (not
shown) in a left side configuration intramedullary nail 8 coupled
to the aiming plate 2. The second through holes 13 are sized and
shaped to receive a drill bushing 4 and/or drill bit from the
second surface 6 along the central axis 14 aligned with a
corresponding locking hole in a right side configuration
intramedullary nail 8 coupled to the aiming plate 2. The first hole
axes 10 of the first through holes 3 converge toward the central
plane 11 in a direction from the first surface 5 toward the second
surface 6 while the second hole axes 14 of the second through holes
13 diverge from the central plane 11 in the direction from the
first surface 5 toward the second surface 6. Thus, each first hole
axis 10 of the first through holes 3 forms an angle .alpha..sub.i
with the central plane 11 while each second hole axis 14 of the
second through holes 13 forms an angle .beta..sub.i with the
central plane 11. The present embodiment may comprise four compound
openings such that i=1 to 4. If identically positioned anterior and
posterior locking holes in the intramedullary nail 8 are used in
left side and right side intramedullary nails 8, the angle
.beta..sub.i=.alpha..sub.i for the first and second through holes
3, 13 of each compound opening.
[0064] The aiming plate 2 may further comprise an additional
compound opening through the central portion 29 of the aiming
plate. The additional compound opening includes first and second
through holes 16, 18. A first central axis of the 17 of the first
through hole 16 corresponds to a locking hole of a left side
configuration intramedullary nail 8 while a second central axis 19
of the second through hole corresponds to a locking hole of a right
side configuration intramedullary nail 8. Thus, a drill bushing 4
should be inserted through the first through hole 16 along the
first central axis 17 from the first surface 5 to the second
surface 6 and through the second through hole 18 along the second
central axis 19 from the second surface 6 to the first surface 5.
The first central axis 17 and the second central axis 19 lie in the
central plane 11 and diverge relative to each other in the
direction from the first surface 5 towards the second surface 6.
Measured in the central plane 11 the first central axis 17 and the
second central axis 19 of the additional compound opening form an
angle .gamma..
[0065] The intramedullary nail aiming device 1 may further
comprises an aiming arm 9 which may be attached to the proximal end
of the intramedullary nail 8. The aiming arm 9 has a first end 20
including a first joining mechanism 24 and a second end 21
including a second joining mechanism 25. The first joining
mechanism 24 of the aiming arm 9 may be coupled to a third joining
mechanism of the aiming plate 2. The first joining mechanism 24
comprises two pins 45, axes of which lie in the central plane 11
and are spaced apart from one another. The third joining mechanism
26 may include bores 46 at a proximal end 7 of the aiming plate 2
for receiving the pins 45 of the first joining mechanism 24
therethrough. Further, the first joining mechanism 24 includes a
screw 47 penetrating a respective hole (not shown) in the aiming
plate 2 to releasably couple the aiming plate 2 to the aiming arm
9. The second joining mechanism 25 of the aiming arm 9 comprises
two further pins 49 and a fastener 48 for releasably coupling the
aiming arm 9 to the intramedullary nail 8. The intramedullary nail
8 comprises a fourth joining mechanism 27 including, for example,
two lateral holes and a coaxial hole engageable with the second
joining mechanism 25 of the aiming arm 9 to allow the releasable
coupling of the aiming arm 9 to the intramedullary nail 8 in an
aligned position.
[0066] As illustrated in FIG. 2, if a drill bushing 4 is
inadvertently inserted through the second through holes 13 from the
first surface 5 past the second surface 6, while in the aiming
plate 2 is in the left side configuration, the drill bushing 4
would not be aligned with any portion of the intramedullary nail 8.
Similarly, a drill bushing 4 wrongly inserted into the second
through hole 18 of the additional compound opening from the first
surface 5 to the second surface 6 would not align with a locking
hole of the intramedullary nail 8 and would immediately be
recognized as incorrect since the angle .gamma. has a value that
can be readily recognized as such.
[0067] The embodiment of the intramedullary nail aiming device 1
according to FIGS. 1 and 2 is used with a left side or a right side
configuration of an intramedullary nail 8. The method for drilling
holes in a bone coaxially to the locking holes of the
intramedullary nail 8 comprises the steps of: [0068] 1) positioning
the aiming plate in the left or right side configuration depending
on whether it is to be used with a right side or left side
configuration intramedullary nail 8. In the left side
configuration, the first surface 5 faces away from the bone while
the second surface 6 faces the bone. In the right side
configuration, the first surface 5 faces the bone and the second
surface 6 faces away from the bone. The aiming plate 2 is then
coupled to the intramedullary nail 8 via, for example, the aiming
arm 9. [0069] 2) inserting a drilling bushing 4 through one of the
through holes 3, 13 of the compound opening. When the aiming plate
2 is in the left side configuration, the drilling bushing 4 is
inserted through the first through hole 3 and when the aiming plate
2 is in the right side configuration, the drill bushing is inserted
through the second through hole 13. [0070] 3) checking whether the
drilling bushing 4 has been inserted through a correct one of the
first and second through holes 3, 13 (e.g., through the first
through hole 3 in the case of a left side intramedullary nail 8 or
through the second hole 13 in the case of a right side
intramedullary nail 8). When the drilling bushing 4 has been
inserted in a wrong one of the through holes 3, 13 (e.g., through
the second through hole 13 in the case of a left side
intramedullary nail 8 or through a first through hole 3 in the case
of a right side intramedullary nail 8), inserting the drilling
bushing 4 into the other of the through holes 3, 13 and repeating
step 3); and [0071] 4) when the drilling bushing 4 has been
inserted in a correct one of the through holes 3, 13, drilling at
least one hole in a bone into which the intramedullary nail 8 has
been inserted using the drilling bushing 4 for guiding a drill
bit.
[0072] Alternatively, the above steps 2)-4) can be performed for
each of the first or second through holes 3, 13 separately and
repeated for the respective number of first or second through holes
3, 13 to be applied in the procedure.
[0073] FIGS. 3 to 5 show another embodiment of the aiming device 1
mounted to an intramedullary nail 8 configured as a universal
intramedullary nail 8 with only one configuration for both left
side and right side bones. Depending on the application of the
universal intramedullary nail 8 for the left side or the right side
bone, the locking of the intramedullary nail 8 in the bone does not
necessarily include insertion of a locking screw 40 in every one of
the proximal and distal locking holes 31, 32 of the intramedullary
nail 8. In some cases (for anatomical reasons) one or more of the
proximal and distal locking holes 31, 32 of the intramedullary nail
8 will not be used for insertion of a locking screw 40. For
example, when inserting a universal intramedullary nail 8 into the
proximal humerus, a locking screw 40 is often not inserted into the
most anterior proximal locking hole 33 (FIGS. 3 and 5) because it
might penetrate the biceps tendon. When using a universal
intramedullary nail 8 on the left side humerus (FIG. 3) the second
locking screw 40 from the proximal end 35 of the universal
intramedullary nail 8 may be problematic. Similarly, when inserting
a universal intramedullary nail 8 in the right side humerus (FIGS.
4 and 5), the third locking screw 40 from the proximal end 35 of
the universal intramedullary nail 8 may be problematic (FIG.
5).
[0074] The embodiment of the intramedullary nail aiming device 1
illustrated in FIGS. 3 to 5 differs from the embodiment of FIGS. 1
and 2 only in that the aiming plate 2 includes only one arm 44
protruding from the second lateral side 42 and the aiming plate 2
comprises only one compound opening including a first through hole
3 with a first hole axis 10 and a second through hole 13 with a
second hole axis 14. Additionally, the aiming plate 2 includes a
number of central through holes 50 extending through the central
portion 29 of the aiming plate 2 at different distances from the
proximal end 7 of the aiming plate 2. The central through holes 50
have hole axes lying in the central plane 11 and extending
orthogonally to the middle plane 28. Thus, locking screws 40
inserted into the proximal locking holes 31 extend parallel to the
frontal plane of the patient. The first and second through holes 3,
13 are arranged in the arm 44. Further, the first and second hole
axes 10, 14 of the first and second through holes 3, 13 of the
compound opening are arranged in different planes orthogonal to the
middle plane 28 and orthogonal to the central plane 11. Therefore,
in the embodiment of the aiming plate 2 of FIGS. 3 to 5 the first
and second hole axes 10, 14 are skew lines. The first through hole
3 is suitable for receiving a drill bushing 4 from the left side 5
in a predetermined direction coinciding with the corresponding
third locking hole 31 from the proximal end 35 of the universal
intramedullary nail 8 (FIG. 3). The second through hole 13 is
suitable for receiving a drill bushing 4 from the right side 6
(FIG. 4) in a predetermined direction coinciding with the
corresponding second locking hole 31 of the universal
intramedullary nail 8. As illustrated in FIG. 5, if the drill
bushing 4 is inserted through the first through hole 3 from the
second surface 6 to the first surface 5, the drill bushing is not
aligned with any portion of the intramedullary nail 8 so that the
surgeon realizes at one glance that the drill bushing 4 is inserted
in the wrong hole.
[0075] The embodiment of the intramedullary nail aiming device 1
shown in FIGS. 3 to 5 is configured for use with a universal
intramedullary nail 8 having only one configuration for both left
and right side bones. The method for drilling holes in a bone
coaxially to the desired locking holes 31, 32 of the intramedullary
nail 8 comprises the steps of: [0076] 1) positioning the aiming
plate 2 in the left or right side configuration depending on
whether intramedullary nail 8 is being used to treat a left side or
a right bone and fixing the aiming plate 2 to the intramedullary
nail 8; [0077] 2) inserting a drilling bushing 4 into one of the
first and second through holes 3, 13; [0078] 3) checking whether
the drilling bushing 4 has been inserted in a correct through hole
3, 13 (i.e., the first through hole 3 when the universal nail is
inserted in a left side bone or in a second through hole 13 when
the universal nail is inserted in a right side bone). If the
drilling bushing 4 has been wrongly inserted in the second through
hole 13 in case of a left side bone or wrongly in the first through
hole 3 in case of a right side bone, the drilling bushing 4 is
inserted into the other through hole 3, 13 of the first
respectively second through holes 3, 13. If the drilling bushing 4
has been correctly inserted in the first through hole 3 in case of
using a left side bone or correctly inserted in the second through
hole 13 in case of a right side bone, the user drills at least one
hole in a bone into which the intramedullary nail 8 has been
inserted using the drilling bushing 4 to guide the drill bit.
[0079] The embodiment of the intramedullary nail aiming device 1
shown in FIGS. 1 to 5, is aligned with the intramedullary nail to
ensure that a correct through hole for receiving a tool is aligned
with a desired feature of an implant. To achieve this alignment, a
method can be used, which has the steps of: [0080] a) identifying a
type of implant to be coupled to an aiming plate; [0081] b)
determining a correct configuration of an aiming plate according to
the identified implant type; and [0082] c) coupling the aiming
plate to an implant of the identified implant type in the
determined correct configuration;
[0083] The determined correct configuration is one of the left side
configuration or right hand side configuration described
previously. The same applies for the universal intramedullary nail
shown in FIGS. 3 to 5. Markings "LEFT" and "RIGHT" on opposed
surfaces of the aiming plate 1 are also used to determine the
correct configuration. That is, the marking "LEFT" indicates the
surface a user should see when the other surface is facing towards
the nail in the left side configuration, and the marking "RIGHT"
indicates the surface a user should see when the other surface is
facing towards the nail in the right side configuration.
[0084] Although the invention and its advantages have been
described in detail, it should be understood that various changes,
substitutions, and alterations may be made herein without departing
from the spirit and scope of the invention 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, machine, manufacture, composition 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 present invention, processes, machines,
manufacture, composition 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 present invention.
[0085] It will be appreciated by those skilled in the art that
various modifications and alterations of the invention can be made
without departing from the broad scope of the appended claims. Some
of these have been discussed above and others will be apparent to
those skilled in the art.
* * * * *