U.S. patent application number 15/882338 was filed with the patent office on 2018-09-13 for bone stabilization systems.
The applicant listed for this patent is Globus Medical, Inc.. Invention is credited to David R. Jansen, Jeffrey S. Lueth, David Machamer, Kathryn M. Ward.
Application Number | 20180256222 15/882338 |
Document ID | / |
Family ID | 61627007 |
Filed Date | 2018-09-13 |
United States Patent
Application |
20180256222 |
Kind Code |
A1 |
Lueth; Jeffrey S. ; et
al. |
September 13, 2018 |
BONE STABILIZATION SYSTEMS
Abstract
Bone plates for engaging bone members are described herein. The
bone plates can receive one or more screws to secure the bone
plates to an underlying bone member. The one or more screws can be
inserted into bone plate holes that can be considered locking or
non-locking. The bone plates described herein can have particular
combinations of locking and/or non-locking holes. In addition,
instruments such as distal and proximal aiming guides can accompany
the bone plates to guide one or more screws into the bone
plates.
Inventors: |
Lueth; Jeffrey S.;
(Schwenksville, PA) ; Jansen; David R.;
(Glenmoore, PA) ; Ward; Kathryn M.; (Phoenixville,
PA) ; Machamer; David; (Glen Mills, PA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Globus Medical, Inc. |
Audubon |
PA |
US |
|
|
Family ID: |
61627007 |
Appl. No.: |
15/882338 |
Filed: |
January 29, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15592912 |
May 11, 2017 |
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15882338 |
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62470470 |
Mar 13, 2017 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/8033 20130101;
A61B 17/74 20130101; A61B 17/809 20130101; A61B 17/86 20130101;
A61B 17/8052 20130101; A61B 17/808 20130101; A61B 17/8004 20130101;
A61B 17/8014 20130101; A61B 17/1728 20130101; A61B 17/8061
20130101; A61B 17/8057 20130101 |
International
Class: |
A61B 17/80 20060101
A61B017/80 |
Claims
1. An apparatus for treating a fracture in a bone, comprising: a
first rectangular panel comprising a first side, a second side, a
third side opposite the first side, and a fourth side opposite the
second side, wherein the first and third sides comprise a length
that is greater than the length of the second and fourth sides; a
second rectangular panel comprising dimensions substantially
similar to the first rectangular panel; one or more first metallic
wires selectively positioned in between the first rectangular panel
and the second rectangular panel, wherein the first metallic wires
are selectively positioned to correspond to anatomic axis lines of
a human skeleton; and wherein the first rectangular panel and the
second rectangular panel are operatively connected to one another,
and wherein the first rectangular panel and the second rectangular
panel comprise a radiolucent material.
2. The apparatus of claim 1, further comprising a plurality of
second metallic wires selectively positioned in between the first
rectangular panel and the second rectangular panel, wherein the
second metallic wires are selectively positioned to correspond to
mechanical axis lines.
3. The apparatus of claim 1, further comprising a plurality of
third metallic wires selectively positioned in between the first
rectangular panel and the second rectangular panel, wherein the
third metallic wires are selectively positioned to correspond to a
ruler.
4. The apparatus of claim 1, wherein the position of the one or
more first metallic wires can be compared to an image of a bone
shown on a fluoroscopic image.
5. The apparatus of claim 1, wherein the one or more first metallic
wires corresponding to anatomic axes of a human skeleton are
visible on a fluoroscopic image.
6. The apparatus of claim 1, wherein the first rectangular panel
further comprises an inner surface that is operatively connected to
the second rectangular panel, wherein radiopaque ink is positioned
on the inner surface.
7. The apparatus of claim 2, wherein the first and second metallic
wires are positioned relative to one another to correspond to one
of the medial neck shaft angle (MNSA); the anterior medial proximal
angle (aMPFA); the joint line congruency angle (JLCA); the medial
proximal tibial angle (MPTA); the mechanical lateral proximal
femoral angle (mLPFA); the mechanical lateral proximal femoral
angle (mLPFA); the mechanical lateral distal femoral angle (mLDFA);
the anatomic lateral distal femoral angle (aLDFA); and the lateral
distal tibial angle (LDTA).
8. The apparatus of claim 1, wherein the first rectangular panel,
second rectangular panel, and one or more first metallic wires
comprise a frontal plane guide.
9. The apparatus of claim 1, wherein the first rectangular panel,
second rectangular panel, and one or more first metallic wires
comprise a sagittal plane guide.
10. An apparatus for treating a fracture in a bone, comprising: a
first rectangular panel comprising a first side, a second side, a
third side opposite the first side, and a fourth side opposite the
second side, wherein the first and third sides comprise a length
that is greater than the length of the second and fourth sides; a
second rectangular panel comprising dimensions substantially
similar to the first rectangular panel; one or more first lines of
radiopaque ink selectively positioned in between the first
rectangular panel and the second rectangular panel, wherein the
radiopaque ink is selectively positioned to correspond to anatomic
axis lines of a human skeleton; and wherein the first rectangular
panel and the second rectangular panel are operatively connected to
one another, and wherein the first rectangular panel and the second
rectangular panel comprise a radiolucent material.
11. The apparatus of claim 10, further comprising one or more
second lines of radiopaque ink selectively positioned in between
the first rectangular panel and the second rectangular panel to
correspond to mechanical axis lines.
12. The apparatus of claim 10, further comprising one or more third
lines of radiopaque ink selectively positioned in between the first
rectangular panel and the second rectangular panel to correspond to
a ruler.
13. The apparatus of claim 10, wherein the position of the one or
more first lines of radiopaque ink can be compared to an image of a
bone shown on a fluoroscopic image.
14. The apparatus of claim 10, wherein the one or more first lines
of radiopaque ink corresponding to anatomic axes of a human
skeleton are visible on a fluoroscopic image.
15. The apparatus of claim 10, wherein the first rectangular panel
and the second rectangular panel comprise perforations.
16. The apparatus of claim 10, further comprising one or more
reference indicators that indicates the proper orientation of the
first and second rectangular panels.
17. The apparatus of claim 11, wherein the first and second lines
of radiopaque ink are positioned relative to one another to
correspond to one of the medial neck shaft angle (MNSA); the
anterior medial proximal angle (aMPFA); the joint line congruency
angle (JLCA); the medial proximal tibial angle (MPTA); the
mechanical lateral proximal femoral angle (mLPFA); the mechanical
lateral proximal femoral angle (mLPFA); the mechanical lateral
distal femoral angle (mLDFA); the anatomic lateral distal femoral
angle (aLDFA); and the lateral distal tibial angle (LDTA).
17. The apparatus of claim 10, wherein the first rectangular panel,
second rectangular panel, and one or more first lines of radiopaque
ink comprise a frontal plane guide.
18. The apparatus of claim 10, wherein the first rectangular panel,
second rectangular panel, and one or more first lines of radiopaque
ink comprise a sagittal plane guide.
19. The apparatus of claim 11, wherein the first and second lines
of radiopaque ink are positioned relative to one another to
correspond to one of the anterior neck shaft angle (ANSA); the
anterior distal tibial angle (ADTA); the posterior proximal femoral
angle (PPFA); the posterior distal femoral angle (PDFA); and the
posterior proximal tibia angle (PPTA).
20. The apparatus of claim 10, wherein the one or more first lines
of radiopaque ink are formed as a part of the first rectangular
panel.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of U.S. patent
application Ser. No. 15/592,912, filed on May 11, 2017, which is a
non-provisional application that claims priority to U.S.
Provisional Application 62/470,470, filed Mar. 13, 2017, the
entireties of which are herein incorporated by reference.
FIELD OF THE INVENTION
[0002] The present disclosure relates to surgical devices, and more
particularly, stabilization systems including plates, for example,
for trauma applications.
BACKGROUND OF THE INVENTION
[0003] Bone fractures can be healed using plating systems. During
treatment, one or more screws are placed on either side of a
fracture, thereby causing compression and healing of the fracture.
There is a need for improved plating systems as well as mechanisms
for accurate use of the plating systems.
[0004] Additionally, modern improvements in the treatment of bone
deformities and comminuted traumatic fractures called for the
establishment of "normal" mechanical axes of the human skeleton.
Multiple authors published results of their anatomic studies with a
variety of nomenclatures. Eventually, nomenclature was standardized
and nominal and extreme values for "normal" mechanical and anatomic
axes were settled on. These established angles are used now by
medical professionals, such as orthopedic surgeons, around the
world as a reference for correcting deformity and restoring normal
joint alignment post-trauma. While some existing software packages
aid with this correction in the evaluation of x-rays, there are no
currently available devices for use under fluoroscopy in the
operating room.
SUMMARY OF THE INVENTION
[0005] In accordance with the application, a system for treating a
fracture in a bone is provided. In some embodiments, the system
comprises: a bone plate configured to engage the bone, the bone
plate comprising a proximal end, a distal end, a head portion, a
neck portion and a shaft portion, wherein the head portion
comprises a first row of holes and a second row of holes for
receiving one or more fasteners therein, wherein the shaft portion
comprises at least one additional hole for receiving a fastener
therein; at least one fastener received in the head portion and
positioned in the first row of holes or second row of holes; and at
least one fastener received in the shaft portion and positioned in
the at least one additional hole.
[0006] In other embodiments, the system comprises: a bone plate
configured to engage the bone, the bone plate comprising a proximal
end, a distal end, a head portion, a neck portion and a shaft
portion, wherein the head portion comprises a first row of holes
and a second row of holes for receiving one or more fasteners
therein, wherein the shaft portion comprises at least one
additional hole for receiving a fastener therein; at least one
fastener received in the head portion and positioned in the first
row of holes or second row of holes, wherein the at least one
fastener is non-threaded; and at least one fastener received in the
shaft portion and positioned in the at least one additional
hole.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] A more complete understanding of the present invention, and
the attendant advantages and features thereof, will be more readily
understood by reference to the following detailed description when
considered in conjunction with the accompanying drawings,
wherein:
[0008] FIG. 1 is a top perspective view of a bone plate in
accordance with some embodiments.
[0009] FIG. 2A is a top view of a head of the bone plate of FIG.
1.
[0010] FIG. 2B is a bottom view of a head of the bone plate of FIG.
1.
[0011] FIG. 3 is a side perspective view of a head of the bone
plate of FIG. 1.
[0012] FIG. 4 is a view of the bone plate of FIG. 1 attached to a
bone.
[0013] FIG. 5 is an alternative view of the bone plate of FIG. 1
attached to a bone.
[0014] FIG. 6 is a top view of a shaft of the bone plate of FIG. 1
with a cross-sectional view shown beneath.
[0015] FIG. 7 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0016] FIG. 8 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0017] FIG. 9 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0018] FIG. 10 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0019] FIG. 11 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0020] FIG. 12 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0021] FIG. 13 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0022] FIG. 14 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0023] FIG. 15 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0024] FIG. 16 is a top perspective view of an alternative bone
plate in accordance with some embodiments.
[0025] FIG. 17 is a top perspective view of an aiming guide in
accordance with some embodiments.
[0026] FIG. 18 is a side view of a mount of the aiming guide of
FIG. 17.
[0027] FIG. 19 is an alternative side view of a mount of the aiming
guide of FIG. 17.
[0028] FIG. 20 is a top perspective view of an aiming guide
comprising a distal aiming guide and an optional proximal aiming
guide in accordance with some embodiments.
[0029] FIG. 21 is a top perspective view of the aiming guide of
FIG. 20.
[0030] FIG. 22 is a bottom perspective view of an attachment post
in accordance with some embodiments.
[0031] FIG. 23 is a top perspective view of the proximal aiming
guide of FIG. 20.
[0032] FIG. 24 is a top perspective view of the distal aiming guide
with optional proximal aiming guide of FIG. 20.
[0033] FIG. 25A is a view of the distal aiming guide with proximal
aiming guide in a first setting.
[0034] FIG. 25B is a view of the distal aiming guide with proximal
aiming guide in a second setting.
[0035] FIG. 25C is a view of the distal aiming guide with proximal
aiming guide in a third setting.
[0036] FIG. 25D is a view of the distal aiming guide with proximal
aiming guide in a fourth setting.
[0037] FIG. 26 is a cross-sectional view of a dial in the proximal
aiming guide.
[0038] FIG. 27 is a top perspective view of dial in the proximal
aiming guide.
[0039] FIG. 28 is a front view of a bone plate including rafting
screws attached to a bone member.
[0040] FIG. 29 is a side view of the bone plate of FIG. 28.
[0041] FIG. 30 is a top view of the bone plate of FIG. 28.
[0042] FIG. 31 is a top perspective view of a rafting blade in
accordance with some embodiments.
[0043] FIG. 32 is a top view of the rafting blade of FIG. 31.
[0044] FIG. 33 is a side view of the rafting blade of FIG. 31.
[0045] FIG. 34 is a side view of a pair of rafting blades attached
to a plate in accordance with some embodiments.
[0046] FIG. 35A is a front view of the rafting blade of FIG.
31.
[0047] FIG. 35B is a bottom perspective view of the rafting blade
of FIG. 31.
[0048] FIG. 36 is a top perspective view of an insertion guide for
rafting blades in accordance with some embodiments.
[0049] FIGS. 37A and 37B are views of the insertion guide detached
from the rafting blades of FIG. 36.
[0050] FIGS. 38A and 38B are views of the rafting blades following
insertion in accordance with some embodiments.
[0051] FIG. 39 is a top perspective view of rafting blades and an
independent support screw in accordance with some embodiments.
[0052] FIG. 40A is a front view of a blocking mechanism for the
rafting blades in accordance with some embodiments.
[0053] FIG. 40B is a front view of the blocking mechanism of FIG.
40A rotated.
[0054] FIG. 41 is a side view of a rafting blade and locking cap in
accordance with some embodiments.
[0055] FIG. 42 is a top perspective view of the rafting blade
attached to the locking cap of FIG. 41.
[0056] FIG. 43 is a top perspective view of the locking cap of FIG.
41.
[0057] FIG. 44 is a top perspective view of a rafting blade having
deforming ridges in accordance with some embodiments.
[0058] FIG. 45 is a bottom perspective view of the rafting blade
having deforming ridges of FIG. 44.
[0059] FIG. 46 is a diagram showing an alternate embodiment of an
aiming guide according to one embodiment of the present
invention.
[0060] FIG. 47 is a diagram showing a detailed view of the aiming
guide according to one embodiment of the present invention.
[0061] FIGS. 48A-48C show one embodiment of the attachment post and
threaded shaft in more detail.
[0062] FIGS. 49A-49B are diagrams showing exemplary tissue
protection sleeves according to one embodiment of the present
invention.
[0063] FIG. 50 is a diagram showing exemplary instruments passing
through tissue protection sleeves that have been inserted into the
guide holes of the aiming arm.
[0064] FIG. 51A is a top perspective view of the proximal aiming
guide.
[0065] FIG. 51B is a diagram showing another top perspective view
of the proximal aiming guide.
[0066] FIG. 52 shows one exemplary embodiment of a guide according
to the present invention.
[0067] FIG. 53 is a diagram showing a more detailed view of a
frontal plane (AP) guide mechanical and anatomic reference angles
according to one embodiment of the present invention.
[0068] FIGS. 54-57 are diagrams showing examples of the guide being
used to measure anatomic angles during interoperative use.
[0069] FIG. 58 is a diagram showing another embodiment of guide
according to one aspect of the present invention.
[0070] FIGS. 59-60 are diagrams showing the guide of FIG. 58 during
intraoperative use.
[0071] FIG. 61 is a diagram showing a guide that includes dotted
reference lines indicating the limits of each mechanical and
anatomic axis.
[0072] FIG. 62A is a diagram showing an exemplary sagittal and
frontal guide that are formed as a single, foldable element.
[0073] FIG. 62B is a diagram showing an exemplary frontal and
sagittal guides that are positioned adjacent to one another.
[0074] FIG. 63 is a diagram showing an exemplary embodiment of a
guide that includes one or more perforations.
DETAILED DESCRIPTION OF THE INVENTION
[0075] Embodiments of the present application are generally
directed to devices, systems and methods for bone stabilization. In
particular, embodiments are directed to bone plates that extend
across bone members to treat one or more fractures.
[0076] The plates described herein may be adapted to contact one or
more of a femur, a distal tibia, a proximal tibia, a proximal
humerus, a distal humerus, a clavicle, a fibula, an ulna, a radius,
bones of the foot, bones of the hand, or other suitable bone or
bones. The bone plates may be curved, contoured, straight, or flat.
The plates may have a head portion that is contoured to match a
particular bone surface, such as a metaphysis or diaphysis, flares
out from the shaft portion, forms an L-shape, T-shape, Y-shape,
etc., with the shaft portion, or that forms any other appropriate
shape to fit the anatomy of the bone to be treated. The plates may
be adapted to secure small or large bone fragments, single or
multiple bone fragments, or otherwise secure one or more fractures.
In particular, the systems may include a series of trauma plates
and screws designed for the fixation of fractures and fragments in
diaphyseal and metaphyseal bone. Different bone plates may be used
to treat various types and locations of fractures.
[0077] The bone plates may be comprised of titanium, stainless
steel, cobalt chrome, carbon composite, plastic or polymer--such as
polyetheretherketone (PEEK), polyethylene, ultra high molecular
weight polyethylene (UHMWPE), resorbable polylactic acid (PLA),
polyglycolic acid (PGA), combinations or alloys of such materials
or any other appropriate material that has sufficient strength to
be secured to and hold bone, while also having sufficient
biocompatibility to be implanted into a body. Similarly, the bone
plates may receive one or more screws or fasteners that may be
comprised of titanium, cobalt chrome, cobalt-chrome-molybdenum,
stainless steel, tungsten carbide, combinations or alloys of such
materials or other appropriate biocompatible materials. Although
the above list of materials includes many typical materials out of
which bone plates and fasteners are made, it should be understood
that bone plates and fasteners comprised of any appropriate
material are contemplated.
[0078] The bone plates described herein can be considered "locking"
or "non-locking" plates. Locking plates include one or more
openings for accepting one or more locking fasteners. The one or
more openings can be partially or fully threaded. In some
embodiments, these openings include fully threaded or stacked
openings, which accept both locking and non-locking fasteners. In
some embodiments, the locking fasteners include heads that are at
least partially threaded. The locking fasteners can be monoaxial or
polyaxial. One non-limiting example of a locking fastener (among
others) is shown in FIG. 6 of U.S. application Ser. No. 15/405,368,
filed Jan. 13, 2017, which is hereby incorporated by reference in
its entirety.
[0079] Non-locking plates include one or more openings for
accepting one or more non-locking fasteners. The one or more
openings at least in part be non-threaded. In some embodiments,
these openings include non-threaded or stacked openings, which
accept both locking and non-locking fasteners. In some embodiments,
the non-locking fasteners include heads that are non-threaded. The
non-locking fasteners can be monoaxial or polyaxial. One
non-limiting example of a non-locking fastener (among others) is
shown in FIG. 4 of U.S. application Ser. No. 15/405,368, filed Jan.
13, 2017, which is hereby incorporated by reference in its
entirety. In some embodiments, the non-locking fasteners can
include dynamic compression screws, which enable dynamic
compression of an underlying bone.
[0080] Below are various examples of locking and non-locking plates
attachable to bone. In some embodiments, locking plates may be
thicker than non-locking plates. Locking plates may be useful for
patients that have weaker bone, while non-locking plates may be
useful for patients that have strong bone.
[0081] The locking and non-locking plates described below can be
attached to different bones to treat fractures. In particular, the
locking and non-locking plates can be used to treat fractures of
the tibia, though one skilled in the art will appreciate that the
novel plates described herein can be applied to fractures on other
types of bone as well. With respect to the tibia, the locking and
non-locking plates can be considered to be lateral, medial or
posteromedial plates. In other words, the plates can be attached to
a lateral, medial or posteromedial aspect of a tibia. One skilled
in the art will appreciate, however, that the plates are not
limited to their specific locations on the tibia, and that a
surgeon may choose to apply a lateral plate medially or a medial
plate laterally, if desired. In the present application, the bone
plates shown in FIGS. 1 and 7-10 can be viewed as lateral plates,
while the bone plates shown in FIGS. 11-17 can be viewed as medial
or posteromedial plates.
[0082] FIG. 1 is a top perspective view of a bone plate in
accordance with some embodiments. In some embodiments, the bone
plate 10 comprises a lateral locking plate, wherein at least some
of the fasteners received therein are locking fasteners. The bone
plate 10 comprises a proximal end 12 and a distal end 14. The bone
plate 10 further comprises a head portion 22, a shaft portion 26,
and a transitionary neck portion 24 between the head portion 22 and
the shaft portion 26.
[0083] The head portion 22 comprises a widest portion of the bone
plate 10 and is adjacent the proximal end 12. In some embodiments,
the proximal end 12 is chamfered. Advantageously, the proximal end
12 contour and chamfer helps to position the bone plate 10
posterior to Gerdy's tubercle to minimize soft tissue irritation in
a highly affected area. In some embodiments, the head portion 22
will be placed on a bone member (e.g., tibia) near an articular
surface. Certain features of the head portion 22 are advantageously
designed to prevent or resist subsidence of an articular surface.
The head portion 22 comprises a first row of holes 32 and a second
row of holes 34. In some embodiments, these holes 32, 34 are
considered to be "rafting" holes that can receive rafting screws
(e.g., as shown in FIG. 30) that advantageously support an
articular surface of a joint and prevent subsidence. In some
embodiments, the holes 32, 34 are locking holes that are at least
partially threaded and designed to receive one or more polyaxial
locking screws.
[0084] As shown in FIG. 1, the head portion 22 comprises a first
row of holes 32 and a second row of holes 34, wherein the second
row of holes 34 are larger than the first row of holes 32. For
example, in some embodiments, the first row of holes 32 can be
between 2.0 and 3.0 mm (e.g., 2.5 mm), while the second row of
holes 34 can be between 3.0 and 4.0 mm (e.g., 3.5 mm). By providing
two sets of holes 32, 34, the bone plate 10 advantageously
accommodates a greater number of rafting screws, thereby providing
greater support near a joint. In particular, the most proximal set
of holes 32 are especially novel and advantageous, as they are
designed to be adjacent the proximal end 12 of the bone plate 10.
These holes 32 receive rafting screws that are closest to an
articular surface of a joint. These holes 32 are advantageously
smaller in size than holes 34, such that they can accommodate
smaller rafting screws, which may be particularly hard to position
in the limited space adjacent the articular surface. In some
embodiments, the first row of holes 32 are offset from the second
row of holes 34, while in other embodiments, the first row of holes
32 are aligned with the second row of holes 34. In some
embodiments, the first row of holes 32 can have the same number of
holes as the second row of holes, while in other embodiments, the
first row of holes 32 can have a different number of holes as the
second row of holes. In the present embodiment, the bone plate 10
include four holes 32 and four holes 34.
[0085] As shown in FIG. 1, the head portion 22 further comprises
one or more novel multi-purpose holes 36. In some embodiments, the
multi-purpose holes 36 are advantageously designed to accommodate a
k-wire as well as a suture. In some embodiments, the holes 36 are
sized and positioned to receive a k-wire therein, thereby assisting
in placement of the bone plate 10 on a bone member. The holes 36
are formed adjacent and continuously with one or more undercuts 37
(shown in FIGS. 2B and 3) of the bone plate 10. As shown in FIG. 5,
the one or more undercuts 37 advantageously allow access to one or
more sutures through the bone plate 10 even after the bone plate 10
is implanted on bone. The sutures can be used to attach the bone
plate 10 to adjacent tissue, thereby further securing the bone
plate 10 at or near a surgical site.
[0086] The neck portion 24 is a transitionary portion between the
head portion 22 and the shaft portion 26. The neck portion 24 is
less wide than the head portion 22, but has at least some portions
that of equal or greater width than the shaft portion 26. As shown
in FIG. 1, the neck portion 24 comprises a pair of locking holes
42, an instrument attachment hole 44, alignment indentations 46, a
positioning slot, and three kickstand holes 52. Each of these
features is described below.
[0087] The pair of locking holes 42 are positioned beneath the
rafting holes 32, 34. In some embodiments, the locking holes 42
comprise polyaxial locking holes that are at least partially
threaded. The pair of locking holes 42 are configured to receive
one or more bone fasteners or screws to secure the bone plate 10 to
an underlying bone member. In some embodiments, the pair of locking
holes 42 are the same or similar width to the holes 34. In some
embodiments, each of the locking holes 42 has a width between 3.0
and 4.0 mm (e.g., 3.5 mm).
[0088] Below the pair of locking holes 42 are indentations 46 and
an instrument attachment hole 44. The indentations 46 and
instrument attachment hole 44 are designed to cooperate with an
aiming guide, as shown in FIGS. 18 and 21. The aiming guide is
particularly useful with lateral plates, and can be used to
accurately guide one or more bone screws or fasteners into
respective holes in a bone plate 10. In some embodiments, the
indentations 46 comprise spherical indentations. Unlike other holes
or openings in the bone plate 10, the indentations 46 do not extend
completely through a plate. Rather, the indentations 46 are engaged
by one or more ball-end pins (shown in FIG. 22) that extend
outwardly from an attachment post of an aiming guide. The
indentations 46 advantageously help to stabilize and position the
aiming guide relative to the bone plate 10. While the bone plate 10
is shown as having three indentations 46, the bone plate 10 can
include one, two, or more than three indentations 46. Between the
indentations 46 is an instrument attachment hole 44. The instrument
attachment hole 44 comprises a threaded hole that is designed to
receive a threaded shaft (shown in FIG. 22) that also extends
outwardly from an attachment post of an aiming guide. Once the
aiming guide is stabilized via the indentations 46, the aiming
guide can be attached to the bone plate 10 via threading of the
threaded shaft.
[0089] A positioning slot 48 is located distally and beneath the
indentations 46 and instrument attachment hole 44. The positioning
slot 48 comprises an elongated opening that is designed to receive
a first bone screw or fastener therein before finalizing a position
of a bone plate 10 on bone. As the positioning slot 48 is
elongated, the bone plate 10 can be slightly adjusted around a
first bone fastener is needed. In some embodiments, the positioning
slot 48 has a length that is greater than a length of any of the
other holes that receive bone screws therein. In some embodiments,
the positioning slot 48 has a length that is at least twice the
length of a length of any of the other holes that receive bone
screws therein. The first bone fastener can be provisionally placed
in the positioning slot 48 prior to final tightening of the first
bone screw. Upon proper orientation and placement of the bone plate
10, the first bone fastener can be finally tightened.
[0090] One or more kickstand holes 62 are provided distally from
the positioning slot 48. In some instances, lateral plates may be
preferred over medial plates, as they can often be implanted via a
smaller incision with less risk to surrounding tissue. The one or
more kickstand holes 62 are capable of receiving one or more bone
fasteners that can treat medial fractures if desired. In other
words, the kickstand holes 62 advantageously allow a medial
fracture to be treated via support from just the lateral side. As
shown in FIG. 1, the bone plate 10 includes at least three
kickstand holes 62. In some embodiments, the kickstand holes 62 are
fixed angle, stacked locking holes. By providing a triple kickstand
construct with three kickstand holes 62, this advantageously
accommodates up to three bone fasteners to better support a medial
fracture. In some embodiments, the triple kickstand construct
serves as a novel collection of kickstand holes 62 aimed at the
anterior, middle, and posterior aspects of the medial proximal
tibia, thereby providing the surgeon with options and enhanced
versatility. The triple kickstand construct advantageously provides
a surgeon with options for which fragments to target and allows the
surgeon to customize construct rigidity with one or more screws or
fasteners. In other embodiments, the kickstand construct will have
a single kickstand hole, two kickstand holes, or more than three
kickstand holes.
[0091] The shaft portion 26 comprises a distal portion of the bone
plate 10 relative to the head portion 22 and neck portion 24. In
some embodiments, the shaft portion 26 comprises a longest and
narrowest portion of the bone plate 10. The shaft portion 26
comprises a number of openings or holes therein for receiving one
or more bone fasteners. In the present embodiment, the shaft
portion 26 comprises a plurality of holes 62 (e.g., five) that
serve as fixed angled, stacked locking holes. These fixed angle,
stacked locking holes allow mono-axial insertion of bone fasteners
that can be locking or non-locking. In addition, as shown in FIG.
1, the shaft portion 26 of the bone plate 10 also comprises a
bi-direction, dynamic compression slot 64 that is positioned in
between the locking holes 62. The bi-directional dynamic
compression slot 64 advantageously allows for static insertion of
non-locking screws into the shaft of bone. They also allow for
compression (e.g., 0.5 mm-2 mm) along the shaft of the bone through
eccentric insertion of a non-locking screw. The holes 62 and slot
64 are capable of receiving one or more screws therein to secure
the bone plate 10 to bone.
[0092] The distal portion of the shaft portion 26 further comprises
a tapered tip 18. In some embodiments, the tapered tip 18 serves as
an insertion tip that allows the plate 10 to be inserted beneath
skin to a surgical site. The bone plate 10 can be positioned
adjacent to bone (e.g., a tibia), whereby it can be fixed to the
bone. In some embodiments, the tapered tip allows for simplified
submuscular plate insertion to minimize incision length. As shown
in FIG. 1, an underside of the shaft portion 26 of the bone plate
10 comprises a plurality of scallops 66. The scallops 66 form a
scalloped contact surface which provides better frictional contact
with a bone member. In some embodiments, the scalloped contact
surface minimizes impact to the periosteal blood supply and allows
some bending of the shaft portion 26 of the bone plate 10 without
deforming threaded holes.
[0093] In some embodiments, the bone plate 10 provides an anatomic
contour that accommodates a lateral aspect of the proximal tibia.
In some embodiments, the bone plate 10 includes a proximal anterior
portion (e.g., chamfered portion) that sits just posterior to
Gerdy's tubercle, thereby assisting with positioning while
minimizing soft tissue irritation.
[0094] FIG. 2A is a top view of a head of the bone plate of FIG. 1.
The head portion 22 comprises a widest most portion of the bone
plate 10. As shown in FIG. 2A, the head portion 22 accommodates a
first row of holes 32a, 32b, 32c, 32d and a second row of holes
34a, 34b, 34c, 34d. As noted above, the first row holes of holes
and second row of holes can serve as "rafting" holes to accommodate
rafting screws therein. In some embodiments, the first row of holes
32 are smaller than the second row of holes 34. In addition, in
some embodiments, the first row of holes 32 are offset from the
second row of holes 34. As shown in FIG. 2A, a pair of novel
multi-purpose holes 36a, 36b are also provided through the head
portion 22 of the bone plate 10. The multi-purpose holes 36a, 36b
are each configured to receive a k-wire and/or suture therethrough.
Also shown in FIG. 2A are features of the neck portion 24,
including the locking holes 42a, 42b, the indentations 46a, 46b,
46c and the instrument attachment hole 44.
[0095] FIG. 2B is a bottom view of a head of the bone plate of FIG.
1. From the bottom view, one can see the underside of the head
portion 22 of the bone plate 10. In particular, one can see the
underside of the multi-purpose holes 36a, 36b and how they are
formed adjacent and continuously with undercuts 37a, 37b formed on
the bone plate 10. As shown in FIG. 5, the undercuts 37a, 37b
advantageously allow a suture to be threaded between a bone plate
10 and an underlying bone 2, even when the bone plate 10 is
positioned adjacent the bone 2. As shown in FIG. 2B, the undercuts
37a, 37b surround the perimeters of each of the multi-purpose holes
36a, 36b.
[0096] FIG. 3 is a side perspective view of a head of the bone
plate of FIG. 1. From this view, one can see the curved angle of
the head portion 22 of the bone plate 10. In addition, one can see
how the undercuts 37a, 37b follow the curved contour of the bone
plate 10 and are curved themselves.
[0097] FIG. 4 is a view of the bone plate of FIG. 1 attached to a
bone. The bone plate 10 includes a plurality of screws or fasteners
6 received therein. Screws 6 that are received in the holes 32a,
32b, 32c, 32d, as well as in the holes 34a, 34b, 34c, 34d, can be
considered rafting screws. As shown in FIG. 4, the rafting screws
are positioned close to an articular surface 4 of the bone 2 (e.g.,
tibia) and advantageously help to provide support for the articular
surface 4. In other words, the rafting screws help to serve as
rebar for the articular surface 4. From this view, one can also see
a suture undercut 37a that is formed at a corner of the bone plate
10.
[0098] FIG. 5 is an alternative view of the bone plate of FIG. 1
attached to a bone. From this view, one can see how the undercut 37
forms an opening between the bone plate 10 and bone 2 such that
there is access to thread a suture even when the bone plate 10 is
implanted on bone 2.
[0099] FIG. 6 is a top view of a shaft of the bone plate of FIG. 1
with a cross-sectional view shown beneath. The shaft portion 26
includes a number of holes or openings for receiving different bone
screws (e.g., locking or non-locking) therein. In some embodiments,
the shaft portion 26 can vary in length to accommodate different
bones in different sized patients. As shown in FIG. 6, each of the
vertical perforated lines represents a possible cutoff or end of a
bone plate 10. For patients with smaller bones, the cut-off could
be sooner, while for patients with larger bones, the cut-off could
be later. In some embodiments, the shaft portion 26 accommodates a
unique hole or opening pattern whereby the hole immediate preceding
a plate end will be a fixed angle, stacked hole 62. By providing a
stacked hole 62 that precedes a plate end, the bone plate 10 can
accommodate either a locking or a non-locking screw, thereby
providing a large number of options for a surgeon implanting the
plate. In some embodiments, the novel pattern of holes or openings
in the shaft portion 26 includes holes that are spaced apart (e.g.,
12-14 mm) center-to-center and allows plate lengths to be offered
in two-hole increments while maintaining that the last hole will
always be a stacked hole. In some embodiments, bi-directional
compression slots 64 can be worked into the hole pattern, but can
appear less than the stacked holes 62 as they may be used less
frequently. The unique hole pattern maximizes equidistant locking
and non-locking options in the shaft portion 26 while still
providing dynamic compression capabilities. In addition, the last
hole before the plate end allowing a statically placed locking or
non-locking screw is preserved in all two-hole plate increments, as
shown in FIG. 6.
[0100] FIG. 7 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 10 comprises a lateral non-locking plate wherein at
least some of holes or openings therein receive non-locking
fasteners. The bone plate 10 includes similar features to the bone
plate in FIG. 1, including a proximal end 12 and a distal end 14, a
head portion 22, a neck portion 24 and a shaft portion 26. The head
portion 22 accommodates different sized rafting screws via a first
row of rafting holes 32 and a second row of rafting holes 34. The
head portion 22 also includes multi-purpose holes 34 capable of
receiving a k-wire and/or suture therein. However, the bone plate
10 can include additional non-locking holes for receiving
non-locking fasteners, as will be discussed in greater detail
herein.
[0101] In some embodiments, the neck portion 24 can comprise holes
42 beneath the rafting holes. The holes 42 comprise a trio of
non-locking holes capable of receiving non-locking fasteners
therein. Beneath the holes 42 comprises an elongated positioning
slot 48 for receiving a first bone screw, as discussed above.
[0102] In some embodiments, the shaft portion 26 comprises a number
of non-locking holes. Shaft portion 26 comprises a non-locking hole
62 for receiving a non-locking fastener. In addition, shaft portion
26 comprises a series of bi-directional dynamic compression slots
64 (which can also be viewed as non-locking openings) for receiving
one or more bone fasteners therein. The distal end 14 of the bone
plate 10 comprises a tapered tip 18 that aids in insertion of the
bone plate 10. An underside of the shaft portion 26 comprises a
plurality of scallops 66.
[0103] FIG. 8 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 10 comprises a lateral plate 10 having one or more
locking holes for receiving locking fasteners. In some embodiments,
the thickness of the lateral bone plate 10 varies from 2.2 mm
proximally to 3.4 mm distally, with the thickness transition
occurring in the neck of the bone plate 10. The bone plate 10
includes many features as the bone plate in FIG. 1, including a
proximal end 12, a distal end 14, a head portion 22, a neck portion
24, and a shaft portion 26. The head portion 22 is the widest
portion of the bone plate 10 and includes a pair of rows of rafting
holes 32, 34, as well as a pair of multi-functional holes 36 for
receiving a k-wire and/or suture therein. The neck portion 24 is
also similar to that of the bone plate in FIG. 1, as it includes a
pair of polyaxial locking holes 42, a trio of spherical alignment
indentations 46, a threaded instrument attachment hole 44, a
positioning slot 48 and a trio of kickstand holes 52. However, the
shaft portion 26 of the bone plate 10 of FIG. 8 comprises a
different pattern of holes as will be discussed herein.
[0104] As shown in FIG. 8, the shaft portion 26 comprises a
plurality of holes 62, 64. The holes 62 comprise fixed angle
locking holes (e.g., 3.5 mm), while the adjacent holes 64 comprise
dynamic compression slots. The shaft portion 26 comprises several
pairs of fixed angle locking holes 62 adjacent the dynamic
compression slots 64, which can be viewed as non-locking.
[0105] FIG. 9 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 10 comprises a lateral plate 10 having one or more
locking holes for receiving locking fasteners. The bone plate 10
includes many features as the bone plate in FIG. 1, including a
proximal end 12, a distal end 14, a head portion 22, a neck portion
24, and a shaft portion 26. The head portion 22 is the widest
portion of the bone plate 10 and includes a pair of rows of rafting
holes 32, 34. In contrast to the bone plate in FIG. 1, the head
portion 22 includes a k-wire recess therein 22 that is separate
from a pair of suture holes 74.
[0106] The neck portion 24 is also similar to that of the bone
plate in FIG. 1, as it includes a pair of polyaxial locking holes
42, a trio of spherical alignment indentations 46, a threaded
instrument attachment hole 44, a positioning slot 48 and a trio of
kickstand holes 52. However, the shaft portion 26 of the bone plate
10 of FIG. 9 comprises a different pattern of holes as will be
discussed herein.
[0107] As shown in FIG. 9, the shaft portion 26 comprises a
plurality of fixed angle, locking holes 62. Unlike the prior
embodiments, there is no compression slot or hole positioned
adjacent the locking holes 62. In some embodiments, the fixed
angle, locking holes are spaced evenly, while in other embodiments,
the fixed angle, locking holes are not spaced evenly. In addition
to these locking holes 62, the shaft portion 26 further comprises a
tapered tip 18 and a scalloped contact surface.
[0108] FIG. 10 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 110 comprises a medial plate which can be placed on a
bone (e.g., tibia) via a medial approach. In some embodiments, the
thickness of the medial bone plate 110 varies from 2.2 mm
proximally to 3.4 mm distally, with the thickness transition
occurring in the neck of the bone plate 110. The bone plate 110
comprises a proximal end 112 and a distal end 114. A head portion
122, neck portion 124 and shaft portion 126 extend between the
proximal end 112 and distal end 114.
[0109] The head portion 122 comprises a widest most portion of the
bone plate 110, and includes a series of holes 134 for receiving
fasteners therein. In the present embodiment, the holes 134
comprise polyaxial locking holes configured to receive one or more
locking fasteners therein. In the present embodiment, the head
portion 122 comprises four locking holes 134. In other embodiments,
the head portion 122 can comprise one, two, three or more than four
locking holes 134. In some embodiments, the holes are between 2.5
mm and 4.5 mm, such as approximately 3.5 mm. The head portion 122
further comprises one or more k-wire openings 136. The k-wire
openings 136 (of which three are shown) are positioned near the
proximal end 112 of the plate 110 and are configured to receive one
or more k-wires therethrough. In some embodiments, the head portion
122 can be sized and configured to extend to an anterior portion of
a bone (e.g, a tibia).
[0110] The neck portion 124 comprises a pair of holes 142 for
receiving one or more fasteners therein. In some embodiments, the
holes 142 comprise polyaxial locking holes that are between 2.5 mm
and 4.5 mm (e.g., 3.5 mm). In some embodiments, the locking holes
are threaded so as to receive one or more threaded locking
fasteners. A positioning slot 148 is positioned between the locking
holes 142. The positioning slot 148 is an elongated slot (e.g.,
greater than two times the length of the adjacent holes 142) that
is configured to receive a first screw therein.
[0111] The shaft portion 126 comprises a plurality of holes 162, as
well as a compression slot 164. In some embodiments, the plurality
of holes 162 comprise fixed angle, stacked locking holes that are
between 2.5 mm and 4.5 mm, such as 3.5 mm. In some embodiments, the
compression slot 1645 comprises a bi-directional dynamic
compression slot. The shaft portion 126 further comprises a tapered
tip 118 that assists the bone plate 110 during insertion. In
addition, the shaft portion 126 comprises an underside having one
or more scallops 166 forming a scalloped contacting surface.
[0112] FIG. 11 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 110 comprises a medial plate. The bone plate 110 is
similar to the bone plate in FIG. 10, and includes a proximal end
112, a distal end 114, a head portion 122, a neck portion 124 and a
shaft portion 126. However, the shape and size of the head portion
122 is distinguishable. In contrast to the head portion of the bone
plate in FIG. 10, which is substantially symmetrical along a
longitudinal axis of the bone plate, in FIG. 11, the head portion
122 is offset from a longitudinal axis of the bone plate. In some
embodiments, the offset head allows the bone plate 110 to reach a
posterior portion of a bone member (e.g., tibia).
[0113] FIG. 12 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 110 comprises a posteromedial plate that can be inserted
through an incision over a posteromedial aspect of a bone (e.g,.
tibia). The bone plate 110 includes a number of similar features as
the medial plates in FIGS. 10 and 11, including a proximal end 112,
a distal end 114, a head portion 122, a neck portion 124, and a
shaft portion 126. However, in the present embodiment, the bone
plate 110 includes several non-locking holes 134 in the head
portion 122, as well as several stacked locking holes 162 in the
shaft portion 126.
[0114] In particular, as shown in FIG. 12, the head portion 122
comprises a row of non-locking holes 134 (e.g., between 2.5 mm and
4.5 mm) that are positioned below a row of k-wire holes. In
addition, the head portion 122 comprises a single non-locking hole
142 positioned below the row of non-locking holes 134. The shaft
portion 126 comprises a series of fixed angle, stacked locking
holes 162 (e.g., between 2.5 mm and 4.5 mm) including a
bi-directional dynamic compression slot 164 therebetween.
[0115] FIG. 13 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 110 comprises a medial plate that is inserted through an
incision over a medial aspect of a bone (e.g., tibia). The bone
plate 110 is similar to the bone plate in FIG. 11, but includes a
different hole pattern along the shaft portion 126. In the present
embodiment, the shaft portion 126 comprises several pairs of
holes--a fixed angled locking hole 162 (between 2.5 mm and 4.5 mm)
adjacent a dynamic compression slot 164.
[0116] FIG. 14 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 110 comprises a medial plate that is inserted through an
incision over a medial aspect of a bone (e.g., tibia). The bone
plate 110 is similar to the bone plate in FIG. 13, except the head
portion 122 of the bone plate 110 includes a plurality of
non-locking holes 134, 142 (between 2.5 mm and 4.5 mm) rather than
locking holes.
[0117] FIG. 15 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 110 comprises a medial plate that is inserted through an
incision over a medial aspect of a bone (e.g., tibia). The bone
plate 110 includes a proximal end 112, a distal end 114, a head
portion 122, a neck portion 124 and a shaft portion 126. The head
portion comprises a row of polyaxial locking holes 134 (between 2.5
mm and 4.5 mm). The locking holes 134 are formed distally beneath
suture holes 174. The suture holes 174 are independent from a
recess 172 for a k-wire. The head portion 122 also includes a fixed
angle locking hole 142 (between 2.5 mm and 4.5 mm). The neck
portion 124 comprises a positioning slot 148 and an additional
fixed angle locking hole 142. The shaft portion 126 comprises a
plurality of alternating locked or unlocked holes 162 and
compression slots 164.
[0118] FIG. 16 is a top perspective view of an alternative bone
plate in accordance with some embodiments. In some embodiments, the
bone plate 110 comprises a posteromedial plate that is inserted
through an incision over a posteromedial aspect of a bone (e.g.,
tibia). The bone plate 110 includes similar features as prior
embodiments, including a head portion 122 having polyaxial locking
holes 134 (between 2.5 mm-4.5 mm), suture holes 174 and a k-wire
recess 172. The neck portion 124 includes a pair of fixed angle
locking holes 142 (between 2.5 mm and 4.5 mm) and a positioning
slot 148 therebetween. The shaft portion 126 comprises a series of
in-line openings or holes 162 that can accommodate a locking or
non-locking fastener therein.
[0119] In some embodiments, an aiming guide can be provided to
assist a surgeon in placing one or more screws or fasteners into a
patient. The aiming guide can be mounted to a bone plate, and can
include guide holes that align with holes in the bone plate such
that screws or fasteners can be accurately implanted into a
patient. In some embodiments, the guide holes can accept aiming
sleeves that interface with drill guides, trocars, k-wires and
screws. These sleeves can be secured to the aiming guide by a
ratcheting or clipping mechanism. While the aiming guide can be
particularly useful for lateral plates, the aiming guide can also
be used for medial and posteromedial plates.
[0120] FIG. 17 is a top perspective view of an aiming guide in
accordance with some embodiments. The aiming guide 200 can be
mounted to an underlying plate 10, and includes an aiming arm 210
and an aiming mount 230.
[0121] The aiming arm 210 comprises a plurality of guide holes
262a, 262b, 262c, 262d that correspond with holes 62a, 62b, 62c,
62d of the plate 10. The purpose of the guide holes 262 is to help
guide one or more fasteners or screws into the corresponding holes
62 with precision and accuracy. In some embodiments, the guide
holes 262 can receive aiming sleeves that interface with drill
guides, trocars, k-wires or screws. The aiming arm 210 includes an
opening 264 on one end for receiving an arm fixation bolt 236
therein and an opening 266 on the opposing end for receiving a
distal locking bolt 238 therein. The arm fixation bolt 236 is
configured to extend and secure the aiming arm 210 to the aiming
mount 230. The distal locking bolt 238 is configured to engage an
opening near a distal end of a bone plate 10, thereby providing a
stable construct. In some embodiments, the aiming arm 210 is formed
of a non-metal, such as a carbon fiber. By forming the aiming arm
210 of a non-metal, this advantageously prevents it from being
visible on an x-ray.
[0122] The aiming mount 230, which is attached to the aiming arm
210, serves as a mount on the plate 10. The aiming mount 230 (shown
in FIGS. 18 and 19) comprises an upright post portion including a
pair of openings 244 for receiving an anti-rotation bolt 234
therein and an opening 244 for receiving a fixation bolt 232
therein. The fixation bolt 232 serves to attach the aiming mount
230 (and thus the entire aiming guide 200) to a plate 10. The
fixation bolt 232 can be received in an attachment hole 44 (shown
in FIG. 1) of the plate 10. The anti-rotation bolt 234 can be
inserted into either of the mono-axial openings 244 to provide
additional rigidity during insertion. In some embodiments, the
aiming mount 230 can be a different material from aiming arm 210,
as the aiming mount 230 does not obstruct viewing of the holes 62
in the plate 10. In some embodiments, the aiming mount 230 can be
formed of metal while the aiming arm 210 can be formed of
non-metal. The means of connecting the aiming arm 210 to the aiming
mount 230 will not be described in more detail.
[0123] FIG. 18 is a side view of a mount of the aiming guide of
FIG. 17. The aiming mount 230 comprises an upright post having an
upper section and a lower section. The upper section comprises a
plurality of openings 235 (shown in FIG. 19) for receiving
stabilizing pins 240 therein. The aiming arm 210 attaches to the
aiming mount 230 by sliding over the stabilizing pins 240 and
tightening the arm fixation bolt 236. The arm fixation bolt 236 is
received in a threaded mounting hole 237 (shown in FIG. 19) that is
formed on the upper section of the aiming mount 230.
[0124] The aiming mount 230 further comprises a lower section
including openings 244 for receiving one or more anti-rotation
bolts 234 (shown in FIG. 17). The one or more anti-rotation bolts
234 provide additional rigidity to the aiming mount 230. The lower
section includes another opening 231 through which the fixation
bolt 232 (shown in FIG. 17) extends therethrough. The lower section
can further include a positioning feature 239 that guides and
orients the aiming mount 230 into a proper position relative to the
underlying bone plate 10.
[0125] FIG. 19 is an alternative side view of a mount of the aiming
guide of FIG. 17. From this view, one can see specific features of
the upper section and lower section of the aiming mount 230. In
particular, in the upper section, one can see the plurality of
openings 235 for receiving stabilizing pins 240 therein. In
addition, one can see the threaded mounting hole 237 that receives
the arm fixation bolt 236 to secure the aiming arm 210 to the
aiming mount 230. Between the upper section and the lower section
of the aiming mount 230 is an opening 231 for receiving the
fixation bolt 232 therein. From this view, one can see the openings
244 in the lower section for receiving one or more anti-rotation
bolts 234 therein.
[0126] FIG. 20 is a top perspective view of an aiming guide
comprising a distal aiming guide and an optional proximal aiming
guide in accordance with some embodiments. The distal aiming guide
210 is capable of guiding one or more fasteners or screws into
distal openings or holes (such as holes or slots 62, 64) of the
bone plate 10, while the proximal aiming guide 310 is capable of
guiding one or more fasteners or screws into proximal openings or
holes (such as rafting holes 32, 34) of the bone plate 10. In some
embodiments, both the distal and proximal aiming guides 210, 310
are capable of accepting one or more aiming sleeves that interface
with drill guides, trocars, k-wires, and screws. These sleeves can
be secured to the respective guide by a ratcheting or clipping
mechanism.
[0127] The distal aiming guide 210 comprises an arm including a
plurality of guide holes 262 formed therein. The plurality of guide
holes 262 are sized and configured to receive one or more aiming
sleeves 270 that interface with drill guides, trocars, k-wires and
screws. In some embodiments, the one or more aiming sleeves 270
help guide screws into holes or slots 62, 64. The arm includes an
extension portion 263 that includes one or more additional guide
holes 265 for receiving one or more aiming sleeves 270 therein. The
one or more sleeves 270 received in the one or more guide holes 265
can be used to direct screws or fasteners into one or kickstand
holes of the bone plate 10. The distal aiming guide 210 further
comprises at least one opening for receiving an attachment post 280
therethrough. The attachment post 280 is configured to attach to
the bone plate 10.
[0128] The proximal aiming guide 310 comprises one or more guide
holes 362 that can be used to direct screws or fasteners into the
rafting holes 32, 34 of the bone plate 10. In the proximal aiming
guide 310, each of the guide holes 362 is formed of a pair of
overlapping openings or circles. For example, as shown in FIG. 23,
guide hole 362a is formed of a pair of overlapping openings or
circles, as are guide holes 362b, 362c, 362d. By providing a pair
of overlapping openings or circles, each of the guides holes 362a,
362b, 362c, 362d can effectively guide one or more fasteners or
screws into a rafting hole in a first row or a second row, based on
surgeon preference. For example, as shown in FIGS. 25A-25D, guide
hole 362a will guide a screw into rafting hole 32a, guide hole 362b
will guide a screw into rafting hole 32b, guide hole 362c will
guide a screw into rafting hole 32c, and guide hole 362d will guide
a screw into rafting hole 32d. In some embodiments, the dial 360 of
the proximal aiming guide 310 can assume four different positions
at 20 degrees apart for targeting holes in the underlying plate 10
that are coaxial with the holes 362 in the guide. In some
embodiments, the proximal aiming guide 310 can rotate out of the
way to allow for easier visualization of the plate 10.
[0129] In some embodiments, the proximal aiming guide 310 comprises
a dial 360 that indicates which of the guide holes 362a, 362b,
362c, 362d will be available for use. In some embodiments, only a
single guide hole 362a, 362b, 362c, 362d will be available in each
setting, thereby reducing the risk of confusion to a surgeon. The
dial is rotatable and has a setting that corresponds with each of
the guide holes 362, 362b, 362c, 362d.
[0130] FIG. 21 is a top perspective view of the distal aiming guide
of FIG. 20. As shown in the figure, the distal aiming guide 210
comprises an arm having a plurality of guide holes 262 extending
along a length of the arm. The guide holes 262 correspond to one or
more holes or slots in the bone plate 10, thereby allowing a screw
to be easily guided into a proper position on the plate. In some
embodiments, the guide holes 262 are coaxial with holes or slots in
the bone plate 10. In some embodiments, the guide holes 262 accept
a guide (e.g., a sleeve) in different positions to target
non-locking plate holes in either a static or eccentric position.
This facilitates percutaneous insertion of non-locking screws
either statically or for dynamic compression. In some embodiments,
the distal aiming guide 210 includes guide holes 262 that
correspond with holes or slots in the shaft portion 26 of the bone
plate 10, as well as guide holes 265 that correspond with kickstand
holes in the neck portion 24. In some embodiments, the guide holes
262 that correspond with holes or slots in the shaft portion 26
accepts only one type of aiming sleeve 270, while the guides holes
265 that correspond with the kickstand holes in the neck portion 26
accept another type of aiming sleeve 270. In some embodiments, the
distal aiming guide 210 can be formed of a radiolucent material to
prevent obstruction of fluoroscopic imaging while in an operating
room.
[0131] The distal aiming guide 210 includes a pair of attachment
arms 267, 269. The first attachment arm 267 comprises a first
connection 281a and the second connection arm 269 comprises a
second connection 281b. Each of these connections 281a, 281b is
capable of attachment to an optional proximal aiming guide 310. By
providing two connections 281a, 281b, the distal aiming guide 210
is advantageously reversible such that it is can be acceptably used
via left hand or right hand.
[0132] FIG. 22 is a bottom perspective view of an attachment post
in accordance with some embodiments. The attachment post 280 is
insertable through a connection opening 381 in the proximal aiming
guide 310 (shown in FIG. 20), as well as through a connection 281
(shown in FIG. 21) in the distal aiming guide 210 (shown in FIG.
21). The attachment post 280 is configured to engage an underlying
bone plate 10. The attachment post 280 comprises one or more
ball-end pins 282 for engaging alignment indentations 44 (shown in
FIG. 1) of the bone plate 10. In addition, the attachment post 280
comprises a threaded shaft 284 for threadingly attaching to an
instrument attachment hole 44 in the bone plate 10. The attachment
post 280 further comprises a stabilizing feature 287 that assists
with alignment during attachment.
[0133] FIG. 23 is a top perspective view of the proximal aiming
guide of FIG. 20. From this view, one can see the guide holes 362a,
362b, 362c, 362d, as well as the dial 360 that determines which of
the guide holes 362a, 362b, 362c, 362d is available for use. In
addition, FIG. 23 shows neighboring guide holes 392 through which
one or more additional aiming sleeves can be inserted. In addition,
a connection opening 381 is shown through which an attachment post
280 can be received therein. In some embodiments, the connection
opening 381 in the proximal aiming guide 310 is coaxial with a
connection 281 in the distal aiming guide 210, such that the
attachment post 280 can extend through both the proximal aiming
guide 310 and the distal aiming guide 210.
[0134] FIG. 24 is a top perspective view of the distal aiming guide
with proximal aiming guide of FIG. 20. From this view, one can see
how the attachment post 280 extends through the connection opening
381 of the proximal aiming guide 310 and into the connection 281 in
the distal aiming guide 210 before engaging the bone plate 10. The
attachment post 280 advantageously serves as a means to secure the
distal aiming guide 210 with the proximal aiming guide 310.
[0135] FIG. 25A is a view of the distal aiming guide with proximal
aiming guide in a first setting. In this first setting of the dial
360, the aiming sleeve 270 is capable of being inserted into guide
hole 362a.
[0136] FIG. 25B is a view of the distal aiming guide with proximal
aiming guide in a second setting. In this second setting of the
dial 360, the aiming sleeve 270 is capable of being inserted into
guide hole 362b.
[0137] FIG. 25C is a view of the distal aiming guide with proximal
aiming guide in a third setting. In this third setting of the dial
360, the aiming sleeve 270 is capable of being inserted into guide
hole 362c.
[0138] FIG. 25D is a view of the distal aiming guide with proximal
aiming guide in a fourth setting. In this fourth setting of the
dial 360, the aiming sleeve 270 is capable of being inserted into
guide hole 362d.
[0139] FIG. 26 is a cross-sectional view of a dial in the proximal
aiming guide. FIG. 27 is a top perspective view of dial in the
proximal aiming guide. The dial 360 comprises a rotating mechanism
that uses a variation of a Hirth coupling 382 and a spring 384 that
accommodates different settings. As the dial 360 is rotated by
hand, the top coupling 382a of the Hirth coupling 382 exerts a
force on the bottom coupling 382b causing it to translate axially
along a shaft. Once clearance is achieved, the dial 360 will
complete its designed rotation (e.g., 20 degrees) with a click. The
retention cap 387 holds the dial 360 in place axially along the
shaft and counteracts the force of the spring 384 which forces the
bottom coupling 382b to translate down with the rotation.
[0140] As noted above, embodiments of the bone plates can include
one or more rows of rafting openings or holes for receiving rafting
screws therein. These rafting screws can be provided at or near an
articular joint of a bone, thereby reducing the risk of subsidence
at the articular joint. More details regarding the rafting screws,
as well the optional use of non-threaded rafting blades, are
provided below.
[0141] FIG. 46 is a diagram showing an alternate embodiment of an
aiming guide according to one embodiment of the present invention.
In the illustrated embodiment, the aiming guide 452 may be
operatively connected to an underlying plate 10, and includes an
attachment post 454 and a threaded shaft 456. The aiming guide 452
illustrated in FIG. 46 and its individual components are similar to
the aiming guide 200 described with respect to FIGS. 17-22 above,
with some modifications. The modifications to the aiming guide 200
will be described in turn below.
[0142] FIG. 47 is a diagram showing a detailed view of the aiming
guide 452 according to one embodiment of the present invention. The
embodiment of the aiming guide 452 shown in FIG. 47 may provide one
advantage of allowing a single rigid connection between the aiming
guide 452 and the bone plate 10, as described in more detail below.
When the rigid connection is in place, the corresponding holes 262
of the aiming arm 458 and the holes 62 of the bone plate 10 are
coaxial. In the illustrated embodiment, the aiming guide 452
includes an aiming arm 458 and an attachment guide 460. The aiming
arm 458 is substantially similar to the aiming arm 210 described
with respect to FIG. 17, and includes one or more guide holes 262
that help guide one or more fasteners, screws, or other instruments
into the corresponding holes 62 of the plate 10 with accuracy. In
contrast to the FIG. 17 embodiment, the aiming guide 452 of the
FIG. 46-47 embodiment, does not include an aiming mount 230.
Instead, the aiming guide 452 includes an attachment guide 460 that
is configured and dimensioned to extend from a portion of the
aiming arm 458.
[0143] In one embodiment, the attachment guide 460 may extend from
one side 459 of the aiming arm 458, as shown in FIG. 47. The
attachment guide 460 may be positioned such that it is near one
end, e.g., the distal 461 or proximal end 463, of the aiming arm
458. In some embodiments, it may be desirable for the attachment
guide 460 to comprise an arm that extends from the aiming arm 458,
as shown in FIG. 47. At least a portion of the attachment guide 460
may be configured and dimensioned to be angled such that it can
guide the attachment post 454 into the instrument attachment hole
44 in the bone plate 10. Alternately, the attachment hole 462
itself, through which the attachment post 454 passes, may be
configured and dimensioned to include an angle that allows the
attachment post 454 to be guided into the instrument attachment
hole 44. In such an embodiment, the attachment guide 460 may be
angled and may lie in the same plane as the aiming arm 458. In
other embodiments, both the attachment guide 460 and the attachment
hole 462 may be configured and dimensioned to include angles.
Alternately, the attachment guide 460 may be configured and
dimensioned such that the attachment hole 462 is coaxial with a
hole in the neck portion of the bone plate 10, such as the
instrument attachment hole 44.
[0144] The aiming guide 452, according to one embodiment, may
include "left" or "right" configurations to assist with guiding the
insertion of screws or other instruments through plates 10 of
various configurations. In a left configuration, shown in FIG. 47,
the attachment guide 460 is configured and dimensioned as an arm
that extends from one side 459 of the aiming arm 458. Although a
left configuration is shown in FIGS. 46-47, a right configuration
may comprise an attachment guide 460 that extends from the opposite
side 465 of the aiming arm 458. In some embodiments, both a "left"
and a "right" configuration may be included if desired, i.e., both
a left and right arm may be attached to the aiming arm 458, with
one extending from a first side 459 and another extending from the
opposite side 465.
[0145] The attachment guide 460 includes an attachment hole 462
through which the attachment post 454 may pass. In one embodiment,
the attachment hole 462 also allows the attachment post 454 to be
operatively connected to the attachment guide 460. Other holes may
also be configured and dimensioned in the attachment guide 460,
such as kickstand targeting holes 464. The kickstand targeting
holes 464 may allow one or more instruments to pass through to
engage with kickstand holes 52, 62 in the bone plate 10, as
described above.
[0146] FIGS. 48A-48C show one embodiment of the attachment post 454
and threaded shaft 456 in more detail. The threaded shaft 456 shown
in FIG. 48A is substantially similar to the threaded shaft 284
described above. FIG. 48B shows a bottom perspective view of an
attachment post 454 in accordance with one embodiment. The
attachment post 454 is substantially similar to the attachment post
280 described with respect to FIG. 22 above.
[0147] In this embodiment, the attachment post 454 is configured to
engage an underlying bone plate 10. The attachment post 454 also
includes one or more ball-end pins 282 for engaging alignment
indentations 44 (shown in FIG. 1) of the bone plate 10. In
addition, the attachment post 454 includes a threaded opening
operable to receive the threaded shaft 456 for threadingly
attaching to an instrument attachment hole 44 in the bone plate 10.
In other embodiments, at least a portion of the opening in the
attachment post 454 may not be threaded, which provides the
advantage of allowing the attachment post 454 to slide over the
threaded shaft 456. The attachment post 454 further comprises a
stabilizing feature 287 that assists with alignment during
attachment.
[0148] The bottom surface of the attachment post 454 may be offset
and contoured to match the contour of the bone plate 10 at the
attachment location. The attachment post 454 may be operatively
connected to the bone plate 10 using a nut threading onto the
threaded shaft 456. In addition, at least a portion of the outer
surface of the attachment post 454 may be threaded so that it can
be attached to the attachment guide 460 using the attachment hole
462. In this embodiment, the end of the attachment post 454 distal
from the end attached to the bone plate 10 may be threaded and may
be operatively connectable to corresponding threading on the inner
surface of the attachment hole 462.
[0149] As shown in FIG. 48C, an upper portion 467 of the attachment
post 454 may include a lip 466 that is configured and dimensioned
along its upper end, distal from the end that is attached to the
bone plate 10. The upper portion 467 of the attachment post 454 may
also be tapered such that it results in an interference fit with
the attachment hole 462. The attachment post 454 may be secured to
the attachment guide 460 using an arm attachment nut 468, as shown
in FIG. 48C. A post attachment nut 470 may also be included to
secure the attachment post 454 to the arm attachment nut 468, the
threaded shaft 456, or both.
[0150] As described above, the aiming guide 452 includes one or
more guide holes 262 that help guide one or more fasteners, screws,
or other instruments into the corresponding holes 62 of the plate
10 with accuracy. In one embodiment, the guide holes 262 of the
aiming guide 452 may accept one or more tissue protection sleeves
472. The tissue protection sleeves 472 provide a portal into small
incisions through which various instruments may pass. Examples of
instruments that may pass through the tissue protection sleeves 472
include, but are not limited to, trocars 496, drill sleeves 488,
DCP sleeves 492, drills 490, drivers, screws, and the like. The
tissue protection sleeves 472 may operatively connect to the guide
holes 262 in a desired orientation. When operatively connected to
the guide holes 262, the tissue protection sleeves 472 allow an
accurate and rigid interface with the aiming guide 452.
[0151] FIGS. 49A-49B are diagrams showing exemplary tissue
protection sleeves according to one embodiment of the present
invention. The tissue protection sleeve 472 may be inserted through
a guide hole 262 and then operatively connected thereto. As shown
in FIG. 49A, one embodiment of the tissue protection sleeve 472 may
include a head 474 and a tip 476. The tip 476 may be configured and
dimensioned to fit into the holes 62 of the bone plate 10. The head
474 may comprise a relief cut 478 and a retention ledge 480. The
relief cut 478 is configured and dimensioned such that a portion of
the head 474 comprises a movable arm 482 that can flex between an
open (expanded) and closed (compressed) position. The movable arm
482 is operable to flex about a pivot point at the bottom of the
relief cut 478, as shown best in FIG. 49B. The movable arm 482 may
also include a retention ledge 480 on its outer surface.
[0152] The guide holes 262, according to one embodiment, may be
configured and dimensioned to include complementary features that
interact with the head 474 of the tissue protection sleeve 472. In
this embodiment, each guide hole 262 may include a recess 484 in a
top portion of the hole 262. The recess 484 is configured and
dimensioned to allow a bottom portion of the head 474 to sit inside
the guide hole 262. A portion of the hole 262 may also include an
undercut 486 that is operable to interact with the retention ledge
480 configured on the movable arm 482. The undercut 486 may be
configured and dimensioned to house the retention ledge 480 when
the movable arm 482 is in its steady-state, expanded configuration,
as shown in FIG. 49B. Similarly, the retention ledge 480 may be
configured and dimensioned to fit within the undercut 486 in its
steady-state, expanded configuration. The retention ledge 480 is
also configured and dimensioned such that it can move axially
within the hole 262 when the movable arm 482 is compressed towards
the head 474.
[0153] When the tissue protection sleeve 472 is inserted into the
hole, the head 474 rests inside the recess 484, according to one
embodiment. During insertion, the movable arm 482 is compressed
towards the head 474, allowing the retention ledge 480 to pass into
the hole 262. When the head 474 fully rests inside the recess 484,
the retention ledge 480 is positioned below the undercut 486,
allowing the arm 482 to expand into its steady-state, expanded
position, as shown in FIG. 49B. When inserted in this manner,
tactile feedback or an audible sound, e.g., a click, may be felt or
heard as the retention ledge 480 grabs the undercut 486. In order
to release the tissue protection sleeve 472, the arm 482 may be
compressed towards the head 474, allowing the retention ledge 480
to be removed from the undercut 486. With the retention ledge 480
no longer operatively connected to the undercut 486 and restricted
from axial movement, it may be moved out of the hole 262.
[0154] As discussed above, a tissue protection sleeve 472 provides
a portal into small incisions through which various instruments may
pass. FIG. 50 is a diagram showing exemplary instruments passing
through tissue protection sleeves 472 that have been inserted into
the guide holes 262 of the aiming arm 458. A drill sleeve 488, for
example, may be inserted into the tissue protection sleeve 472 and
operatively connected to the bone plate 10. In one embodiment, the
drill sleeve 488 aligns a drill 490 to a center axis of the hole
262. Alternatively, a DCP sleeve 492 may be inserted to allow
off-axis insertion of a drill 490. One advantage of using an
off-axis sleeve is that it allows for off-axis predrilling that can
set up compression through a DCP hole that is offset in either
direction. For instance, a DCP sleeve 492 may allow compression of
1 mm through a DCP hole in either direction.
[0155] In other embodiments, a hole marker 494 may also be inserted
into a hole 262 in the aiming arm 458 to allow for marking of a
hole. This may be advantageous, for example, to allow for marking
of the last hole 262 used, or to indicate a hole which has already
been filled with a device, such as a screw. Still other embodiments
may allow for other devices, such as a round-tip trocar 496, to be
inserted into the tissue protection sleeve 472. Those skilled in
the art will understand that one or more tissue protection sleeves
472 and corresponding devices may be using in combination with the
present invention as desired. Although FIG. 50 illustrates multiple
tissue protection sleeves 472 and devices inserted into the aiming
arm 458 at the same time, this is done for illustrative purposes
only. One or more sleeves 472 and/or other devices may be used at
one time if desired. In other embodiments, only one sleeve 472
and/or device maybe used at one time.
[0156] According to one embodiment, the aiming guide 452 attaches
to the bone plate 10 using a single attachment post 454 and the
threaded shaft 456. As described above, the attachment post 454 is
aligned to the bone plate 10 based on the ball-end pins 282 and the
stabilizing feature 287. According to one embodiment, the threaded
shaft 456 is assembled onto the plate 10 first. The attachment post
454 may then slide over the threaded shaft, and the ball-end pins
282 align with alignment indentations 44 in the bone plate 10. The
stabilizing feature 287 assists with alignment during attachment of
the attachment post 454. The attachment post 454 is then
operatively connected to the bone plate 10 using a nut threading
onto the threaded shaft 456. In this manner, the attachment post
454 may be rigidly fixed to the bone plate 10 and may be used as an
insertion handle. The attachment guide 460 slides over top of the
attachment post 454 and is fastened into place with the arm
attachment nut 468. A post attachment nut 470 may be optionally
used to operatively connect the attachment guide 460 to at least
one of the attachment post 454, the arm attachment nut 468, and/or
the threaded shaft 456.
[0157] According to one embodiment, the aiming arm 452 may comprise
a radiolucent material in order to prevent the obstruction of
lateral imaging during a medical procedure. The "left" and "right"
configurations allow for guiding insertion of screws, fasteners, or
other devices through either side of a bone plate 10. The
associated tissue protection sleeves 472, drill sleeves 488, and
other instrumentation described herein may be used with the aiming
guide 452 in both the left and right configurations.
[0158] In one embodiment, the aiming guide 452 may also be used
with a proximal aiming guide 498. In this embodiment, the proximal
aiming guide 498 comprises a plate that may be operatively
connected to the bone plate 10 separately from the aiming guide
452. The proximal aiming guide 498 may be used with or without the
aiming guide 452. FIG. 51A is a top perspective view of the
proximal aiming guide 452. The proximal aiming guide 452 includes
one or more guide holes 500.
[0159] In one embodiment, the proximal aiming guide 452 includes a
fastening mechanism that allows it to be operatively connected to
the bone plate 10. For example, the proximal aiming guide 452 may
include clips 502 that are configured and dimensioned to allow the
guide 452 to be operatively connected to the bone plate 10. In one
embodiment, the clips 502 may be formed as a part of the proximal
aiming guide 452. Alternately, the clips 502 can be separate
elements. In other embodiments, clips 502 maybe formed as a part of
the bone plate 10. The clips 502 may be positioned near one or more
edges of the proximal aiming guide 452 in order to secure it to the
bone plate, as shown in FIG. 51A.
[0160] The proximal aiming guide 498 may also include openings 504
that are selectively positioned in one or more different locations.
The openings 504 may be configured and dimensioned near the
perimeter of the proximal aiming guide 498, as shown in FIG. 51A,
in order to guide the proximal aiming guide 498 into the correct
placement on the bone plate 10. The openings 504 may be configured
to receive protrusions, such as pegs 506, that facilitate the
alignment of the guide holes 500 and the corresponding holes in the
bone plate 10. In this embodiment, the pegs 506 may be configured
and dimensioned as part of the bone plate 10. In another
embodiment, the bone plate 10 may include openings through which
pegs that protrude from the proximal aiming guide 498 may pass in
order to facilitate alignment of the guide holes 500 and the
corresponding holes 62 in the bone plate 10.
[0161] FIG. 51B is a diagram showing another top perspective view
of the proximal aiming guide 498. When the proximal aiming guide
498 is operatively connected to the bone plate 10, it allows for
the insertion of tools, such as drill sleeves 508, through the
guide holes 500, as shown in FIG. 51B. The insertion of drill
sleeves 508 allows for the targeting of the nominal angle of the
proximal holes in the bone plate 10. After drilling, the drill
sleeve 508 may be removed and a screw or other fastener may be
inserted through the proximal aiming guide 498. When all fasteners,
e.g., screws, have been placed, the proximal aiming guide 498 may
be removed. Removal of the proximal aiming guide 498 may be
accomplished by hand, or by using a tool such as a drill sleeve to
pry it off of the bone plate 10.
[0162] FIG. 28 is a front view of a bone plate including rafting
screws attached to a bone member. The bone plate 10 can be any of
the bone plates described above and can include fasteners or screws
6 extending therethrough. As shown in the figure, the upper row of
screws 6 can be considered rafting screws. These rafting screws not
only help to treat a bone fracture, but they have to prevent
subsidence near the articular joint.
[0163] FIG. 29 is a side view of the bone plate of FIG. 28. From
this view, one can see the rafting screws extending across a
fracture in the bone. The rafting screws are positioned adjacent to
the articular joint to prevent subsidence near the articular
joint.
[0164] FIG. 30 is a top view of the bone plate of FIG. 28. From
this view, one can see how the rafting screws serve as rebar and
provide support for the articular joint.
[0165] In addition to these rafting screws, which are threaded,
non-threading rafting blades can be provided. In some embodiments,
these non-threaded blades help to (i) provide better support of an
articular surface, (ii) minimize time in surgery due to ease of
insertion; and (iii) have a reduced risk of post-operative back
out.
[0166] FIG. 31 is a top perspective view of a rafting blade in
accordance with some embodiments. The rafting blade 406 can be used
in addition to, or as an alternative to, the threaded rafting
screws described previously. In some embodiments, one or more
rafting blades 406 can be inserted through a bone plate that has
been secured to bone via one or more fasteners or screws. The one
or more blades can then be locked to the bone plate to prevent
post-operative back out.
[0167] The rafting blade 406 comprises a proximal end 412 and a
distal cutting end 414. The distal cutting end 414 advantageously
enables the rafting blade 406 to be inserted into bone with ease,
simply by impacting the proximal end 412 of the rafting blade 406.
In some embodiments, the rafting blade 406 is curved or arced. In
some embodiments, the rafting blade 406 is concave, thereby forming
a concave rafting surface. In some embodiments, the rafting blade
406 comprises a structural rib 422 that extends along a
longitudinal axis of the rafting blade 406. The structural rib 422
and concave rafting surface advantageously improve the bending
moment along the length of the rafting blade 406, thereby providing
support against failure during and after insertion.
[0168] FIG. 32 is a top view of the rafting blade of FIG. 31. From
this view, one can see how the structural rib 406 extends along a
central longitudinal axis of the rafting blade 406. In some
embodiments, the structural rib 406 extends along a majority of the
length of the central longitudinal axis of the rafting blade
406.
[0169] FIG. 33 is a side view of the rafting blade of FIG. 31. From
this view, one can see the concave curvature of the rafting blade
406.
[0170] FIG. 34 is a side view of a pair of rafting blades attached
to a plate in accordance with some embodiments. The plate 10
comprises a curved or domed plate contact surface that facilitates
rotation in one plane allowing the rafting blades 406 to be
inserted parallel to an articular surface regardless of plate
position. In some embodiments, rafting blades 406 can be inserted
at a similar angle to one another. In other embodiments, rafting
blades 406 can be inserted at different angles from one
another.
[0171] FIG. 35A is a front view of the rafting blade of FIG. 31.
From this view, one can see how the rafting blade 406 comprises a
k-wire hole 430. The rafting blade 406 can be cannulated to allow
guided insertion by k-wire. In some embodiments, the rafting blade
406 can be tapped into bone via use of a slotted hammer.
[0172] FIG. 35B is a bottom perspective view of the rafting blade
of FIG. 31. From this view, one can see the underside of the
rafting blade 406 and its cannulated k-wire hole 430.
[0173] FIG. 36 is a top perspective view of an insertion guide for
rafting blades in accordance with some embodiments. FIG. 37 is a
top view of the insertion guide detached from the rafting blades of
FIG. 36. The insertion guide 500 allows for a set of parallel or
variable angled rafting blades 406 to be inserted simultaneously
into a bone member. In other embodiments, a rafting blade can be
individually installed. By accommodating a set of rafting blades,
the insertion guide 500 advantageously reduces the time in surgery.
In some embodiments, the insertion guide 500 comprises a block that
can temporarily engage or attach to a bone plate after the bone
plate has been secured to bone. The block can include a series of
channels or openings through which the rafting blades 406 can be
inserted therein. In some embodiments, a plurality of rafting
blades 406 are preloaded into the insertion guide 500. In other
embodiments, the insertion guide 500 can be used without preloading
rafting blades 406, thereby allowing a surgeon to select lengths
that best suit a particular patient. With the insertion guide 500
in place, the rafting blades 406 can be tapped into bone in
sequence. As shown in FIG. 36, in some embodiments, three rafting
blades 406 can be inserted in the insertion guide 500. In some
embodiments, the middle blade can be shaped in such a way to
prevent back out of the other two rafting blades, as shown in FIG.
38.
[0174] FIG. 38 is a top view of the rafting blades following
insertion in accordance with some embodiments. Three rafting blades
406 are provided in the insertion guide 500. The blades 406 include
first blade 406a, second blade 406b, and third blade 406c. The
blades 406 are tapped in a particular sequence such that the third
blade 406c prevents backout of the first and second blades 406a,
406b. In particular, by tapping first blade 406a and second blade
406b prior to tapping the third blade 406c, the third blade 406c
can be sized and configured (e.g., via its proximal head portion)
to prevent inadvertent backout of the first blade 406a and the
second blade 406b.
[0175] FIG. 39 is a top perspective view of rafting blades and an
independent support screw in accordance with some embodiments. In
the present embodiment, rafting blades 406 that are inserted into a
bone plate 10 through rafting holes 432 are accompanied by a
support screw 506. The support screw 506 advantageously supports
the tips of the rafting blades 406 after insertion.
[0176] FIG. 40A is a front view of a blocking mechanism for the
rafting blades in accordance with some embodiments. FIG. 40B is a
front view of the blocking mechanism of FIG. 40A rotated. In some
embodiments, the blocking mechanism 520 comprises a blocking screw.
In some embodiments, the blocking mechanism 520 comprises a
rotating member that allows insertion of rafting blades 406 in one
configuration, but prevents the rafting blades 406 from backing out
in another rotated configuration. In the embodiment in FIG. 38, in
which a middle rafting blade 406c prevents backout of adjacent
rafting blades 406a, 406b, the blocking mechanism 520 can simply be
installed behind the middle rafting blade 406.
[0177] FIG. 41 is a side view of a rafting blade and locking cap in
accordance with some embodiments. The locking cap advantageously
prevents the rafting blade from toggling within a bone plate and
keeps it within the bone plate. In some embodiments, a locking cap
440 can be used to collapse over a spherical head 410 of a rafting
blade 406. The outside of the locking cap 440 can have a conical
surface with cutouts 442 around its diameter. In some embodiments,
the cutouts 442 are zig-zagged or z-shaped. In other embodiments,
the cutouts 442 are slits. The inside of the locking cap 440 can be
spherical to allow the variable angle installation of a rafting
blade 406. The locking cap 440 can be threaded. As the locking cap
440 is threaded into a bone plate, its conical geometry and cutouts
442 allow it to collapse over the spherical head 410, grip to the
grooved surface of the spherical head 410 and lock it into plate
within a bone plate.
[0178] FIG. 42 is a top perspective view of the rafting blade
attached to the locking cap of FIG. 41. From this view, one can see
how the head of the rafting blade 406 is received in the locking
cap 440.
[0179] FIG. 43 is a top perspective view of the locking cap of FIG.
41. From this view, one can see the inner portion of the threaded
locking cap 440. In addition, one can see how the cutouts 442 are
formed around a perimeter of the locking cap 440. As shown in FIG.
43, cutouts 442 can be initiated at a top or bottom section of the
locking cap 440.
[0180] FIG. 44 is a top perspective view of a rafting blade having
deforming ridges in accordance with some embodiments. FIG. 45 is a
bottom perspective view of the rafting blade having deforming
ridges of FIG. 44. In some embodiments, the rafting blade 406 can
comprises one or more ridges 450 where it contacts a bone plate.
These one or more ridges 450 can cause a small amount of
deformation in the bone plate as the bone plate is inserted, which
would advantageously help to lock the rafting blade 406 in place.
As shown in FIG. 44, the rafting blade 406 can comprise a pair of
ridges 450, each of which is off-center from a longitudinal axis of
the rafting blade 406.
[0181] According to one aspect of the present invention, a
radiolucent panel with radiopaque anatomic and/or mechanical
references is included. The radiolucent panel may be used, for
example, to assist with the intraoperative restoration of normal
femoral and tibial anatomy under fluoroscopy in the operating room.
As used herein, each angle is measured relative to a mechanical (m)
or anatomic (a) axis. The angle may be measured medial (M), lateral
(L), anterior (A), or posterior (P) to the axis line. In addition,
the angle may refer to the proximal (P) or distal (D) joint
orientation angle of either the femur (F) or tibia (T). For
example, mLDFA as used herein refers to the mechanical lateral
distal femoral angle in the frontal plane and the PPTA refers to
the posterior proximal tibia angle in the sagittal plane.
Additionally, the JLCA is the joint line congruency angle referring
to the angle between the distal femur and the proximal tibia. The
ANSA and MNAS are the anterior and medial neck shaft angles,
respectively, which measure the angle between the center of the
femoral neck and the proximal femoral shaft.
[0182] According to one embodiment, the present invention includes
a guide that comprises a panel with one or more references. The
references may include, but are not limited to, lines, points,
rulers, letters, dashes, pictures, shapes, arrows, and the like.
For instance, any medical reference may be included, including
those known to medical professionals, e.g., surgeons or the like.
In one embodiment, anatomic and mechanical axis lines may be
included, for example. The exemplary guide may also include a ruler
for measurements during a medical procedure. Any units of
measurement may be used for the ruler, including the metric or U.S.
system of measurement. The ruler may be used to measure the length
of body parts, such as limbs, or alternately may be used to measure
medical devices for insertion or as a frame of reference for
placement of screws, fasteners, trauma treatment instruments and
implants, including external fixators, ring fixators, rods, and
other plates.
[0183] It may be desirable and advantageous for one embodiment of
the guide to be used during medical procedures, such as
intraoperative procedures. As such, one embodiment of the guide
comprises a radiolucent panel. Any radiolucent material known to
those skilled in the art may be used including, but not limited to,
plastic, carbon, fibers, composites, and combinations thereof. In
some embodiments, it may be desirable for the references included
in the guide to be formed from one or more radiopaque materials. In
such embodiments, at least one of the references may comprise
metallic wire or radiopaque ink, for example. References such as
anatomic and/or mechanical axis lines may also include metallic
wire or radiopaque ink in some embodiments.
[0184] In such embodiments, the metallic wire or radiopaque ink may
be positioned on an inner or outer surface of the guide.
Alternately, the metallic wire or radiopaque ink may be formed as a
part of the guide. It may desirable in other embodiments for the
metallic wire or radiopaque ink to be formed between layers of the
guide, i.e., if the guide is formed of two or more layers, the
metallic wire or radiopaque ink may be positioned in between the
two or more layers. When the guide is formed of two or more layers,
it may be desirable to include ink on an inner or outer surface of
one or more of the layers.
[0185] As discussed above, the guide may comprise a panel in one
embodiment. The shape and dimensions of the panel may be varied as
desired for a particular application. For instance, one embodiment
of the guide 510 may comprise a single rectangular panel having a
length that is greater in magnitude than its width, as shown in
FIG. 52. One embodiment of the guide 510 may comprise a single,
reversible guide that has references for left limbs on one side and
right limbs on the other side. Alternately, the guide 510 may be
one sided and have separate guides for left limbs and right
limbs.
[0186] FIG. 52 shows one exemplary embodiment of a guide according
to one embodiment, as discussed above. As shown in the figure, the
guide 510 may comprise a panel that is reversible. In this
embodiment, the guide 510 may include a side reference 511 that
indicates the proper orientation for which side of the body it is
to be used with. In the FIG. 52 embodiment, the guide 510 on the
left (in the figure) may be used with limbs on the left side of a
person's body, while the guide 510 on the right (in the figure) may
be used with limbs on the right side of a person's body. The proper
orientation is evident when the "left" or "right" side reference
511 is legible.
[0187] The references included on the guide 510 may also include
anatomic and mechanical axis lines 512, as shown in FIG. 52. The
references may include a ruler 514. As shown in the FIG. 52
embodiment, the ruler may be positioned along the perimeter of the
guide 510.
[0188] FIG. 53 is a diagram showing a more detailed view of a
frontal plane (AP) guide mechanical and anatomic reference angles
according to one embodiment. According to one embodiment, the guide
510 may include several mechanical and anatomic axis lines 512 or
other indicators for comparison to adjacent anatomy. For example,
the reference lines 512 may be at their nominal normal values for
comparison to the anatomy shown on a fluoroscopic image. Although
the guide 510 may include reference text labeling of the axes in
angles in some embodiments, reference text labeling may not be
included in other embodiments.
[0189] As best seen in FIG. 64, the mechanical and anatomic
reference lines 512 or any other indicators may be in the form of
ink, wires, or the like. For example, the lines 512 may be made of
one or more metallic wires, metallic ink, or other radiopaque
materials configured to be visible on fluoroscopy or other imaging
during a surgical procedure. The guide 510 may comprise a first
rectangular panel 510a and a second rectangular panel 510b, for
example, formed of a radiolucent material, comprising dimensions
substantially similar to one another. The wires, ink, or other
reference markers may be positioned in between the first and second
rectangular panels 510a, 510b and the first and second rectangular
panels 510a, 510b may be operatively connected to one another, for
example, by adhesive, melting the panels together, or other
suitable means. For example, the wires, ink, or other reference
markers may be positioned on one of the panels 510a, 510b before
sandwiching them together.
[0190] The exemplary guide 510 shown in FIG. 53 may be of
assistance with, for example, aligning the knee joint, the proximal
and distal femur, the femoral neck, and the proximal and distal
tibia. The guide 510 may also enable limb length measurement during
repair of a fractured limb by comparison to the contralateral
anatomy. As shown in FIG. 53, the guide 510 may include various
references that allow for the determination of mechanical or
anatomical angles.
[0191] As shown in FIG. 53, one embodiment may include reference
lines 512 that allow for the determination of the medial neck shaft
angle (MNSA) 516, which may be a comparison between two overlapping
reference lines 512. The MNSA may be between about 124 degrees to
about 136 degrees, or about 130 degrees. In addition, guide 510 may
include reference lines 512 that allow for the determination of the
anterior medial proximal angle (aMPFA) 518, which may be between
about 80 degrees and about 89 degrees, or about 84 degrees.
Reference lines 512 may also allow for the determination of the
joint line congruency angle (JLCA) 520, which may be between about
0 degrees and about 2 degrees, or about 1 degree. The medial
proximal tibial angle (MPTA) 522 may also be measured using the
references 512 included in the guide 510. The MPTA 522 may be
between about 85 degrees and about 90 degrees, or about 87 degrees,
as shown in FIG. 53.
[0192] The guide 500 may include any number of references or
indicators. In other embodiments, the guide 510 may include
reference lines 512 that allow the mechanical lateral proximal
femoral angle (mLPFA) 524 to be measured. The mLPFA 524 may range
between about 85 degrees and about 95 degrees, or about 90 degrees,
for example. The mechanical lateral distal femoral angle (mLDFA)
526 may also be measured using reference lines 512 included in the
guide 510, and may range between about 85 degrees and about 90
degrees, or about 88 degrees. Reference lines 512 may also be
included to measure the anatomic lateral distal femoral angle
(aLDFA) 528, which may range between about 79 degrees and about 83
degrees, or about 81 degrees. One embodiment of the guide 510 also
allows for the measurement of the lateral distal tibial angle
(LDTA) 530, which may range between about 86 degrees and about 92
degrees, or about 89 degrees.
[0193] FIGS. 54-57 are diagrams showing examples of the guide 510
being used to measure anatomic angles during interoperative use.
FIG. 54, for example, shows how the guide 510 can be used during
intraoperative use to measure the knee joint, distal femur, and
proximal tibia alignment. FIG. 55 is a diagram that shows how the
guide 510 may be used during intraoperative use to measure the
proximal femur and femoral neck alignment. FIG. 56 is a diagram
that shows how the guide 510 may be used during intraoperative use
to measure the distal tibia alignment. FIG. 57 is a diagram that
shows how the guide 510 may be used during intraoperative use to
perform a limb length comparison using the ruler 514.
[0194] During surgical procedures, it is sometimes desirable to
obtain lateral images. FIG. 58 is a diagram showing another
embodiment of guide 510 according to one aspect of the present
invention. One embodiment of the guide 510 shown in FIG. 58
comprises a sagittal plane guide that may assist with lateral
imaging. The guide 510 comprises similar materials to the guide
described with respect to FIGS. 52-58 above. In contrast to the
embodiments described in FIGS. 52-58, the references may comprise
mechanical and anatomic axes at their nominal normal angles for the
sagittal plane. The references may also include text labeling the
axes and angles, as described above. The FIG. 58 embodiment of
guide 510 may be used, for example, to align the knee joint, the
proximal and distal femur, the femoral neck, and the proximal and
distal tibia.
[0195] As shown in FIG. 58, the guide 510 may include references
that allow for the measurement of various anatomic angles. For
example, reference lines 512 may be included that allow the
anterior neck shaft angle (ANSA) 532 to be measured, and may range
between about 165 degrees and about 175 degrees, or about 170
degrees. In addition, reference lines 512 may be included that
allow the anterior distal tibial angle (ADTA) 534 to be measured,
and may range between about 78 degrees and about 82 degrees, or
about 80 degrees. In some embodiments, reference lines 512 may be
included that allow the posterior proximal femoral angle (PPFA) 536
to be measured, and may range between about 88 degrees and about 92
degrees, or about 90 degrees. Reference lines 512 may also be
included that allow the posterior distal femoral angle (PDFA) 538
to be measured, which may range between about 79 degrees and about
87 degrees, or about 83 degrees. Additionally, reference lines 512
may be included that allow the posterior proximal tibia angle
(PPTA) 540 to be measured, which may range between about 77 degrees
and about 84 degrees, or about 81 degrees.
[0196] FIGS. 59-60 are diagrams showing the guide 510 of FIG. 58
during intraoperative use. FIG. 59, for example, is a diagram that
shows the guide 510 being used to evaluate the proximal femur and
femoral neck alignment. FIG. 60 is a diagram that shows the guide
510 being used to evaluate the distal tibia alignment.
[0197] In some embodiments, the guide 510 may include reference
lines indicating the normal limits of the mechanical and anatomic
axes. FIG. 61 is a diagram showing a guide 510 that includes dotted
reference lines 542 indicating the limits of each mechanical and
anatomic axis 512. The guide 510 on the left of FIG. 61 is an
exemplary frontal guide and the guide 510 on the right of FIG. 61
is an exemplary sagittal guide that include dotted reference lines
542.
[0198] In various embodiments, the guides 510 may come packaged
together or as part of a kit. In one embodiment, a sagittal and
frontal guide may be formed as a single, foldable element, as shown
in FIG. 62A. In embodiments where the guides 510 are foldable, the
sagittal guide may be positioned at an angle, e.g., a 90 degree
angle, to the frontal guide using a support, such as a bracket or
the like (not shown) in FIG. 62A. One advantage of including a
support is that it would facilitate holding the guides 510 in place
during imaging, such as lateral fluoroscopic imaging. In other
embodiments, such as the embodiment shown in FIG. 62B, the frontal
and sagittal guides may be positioned adjacent to one another.
[0199] In one embodiment, it may be desirable for the guides 510 to
be sterilized and packaged. The guides 510 may comprise various
shapes and dimensions, and may be packaged together with guides 510
of similar shapes and dimensions or with guides 510 of varying
shapes and dimensions. The guides 510 may be configured and
dimensioned in different sizes to fit into different cases 546 as a
reusable guide 510. To aid with sterilization, the guides 510 may
include one or more perforations 544, as shown in FIG. 63. The
perforations 544 may provide the advantage of allowing
sterilization, e.g., steam sterilization, for example, in a graphic
case.
[0200] One skilled in the art will appreciate that the embodiments
discussed above are non-limiting. While bone plates may be
described as suitable for a particular approach (e.g., medial or
lateral), one skilled in the art will appreciate that the bone
plates can be used for multiple approaches. In addition, while bone
plates are described as having particular holes (e.g., locking or
non-locking), one skilled in the art will appreciate that any of
the bone plates can include locking, non-locking or a combination
of locking and non-locking holes. In addition to the bone plates,
screws and instruments described above, one skilled in the art will
appreciate that these described features can be used with a number
of trauma treatment instruments and implants, including external
fixators, ring fixators, rods, and other plates and screws.
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