U.S. patent application number 16/886923 was filed with the patent office on 2021-01-07 for orthopedic fastener, retainer, and guide.
This patent application is currently assigned to First Ray, LLC. The applicant listed for this patent is First Ray, LLC. Invention is credited to T. Wade FALLIN, Daniel J. TRIPLETT.
Application Number | 20210000489 16/886923 |
Document ID | / |
Family ID | |
Filed Date | 2021-01-07 |
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United States Patent
Application |
20210000489 |
Kind Code |
A1 |
TRIPLETT; Daniel J. ; et
al. |
January 7, 2021 |
ORTHOPEDIC FASTENER, RETAINER, AND GUIDE
Abstract
Implants, instruments, and methods for connecting and/or
stabilizing first and second bone portions relative to one another
are presented including fasteners and retainers connectable in
axial force transmitting relationship and instruments for their
installation. In one example a guide is configured to clamp two
bone portions together while a fastener is inserted through at
least one of the bone portions to engage a retainer.
Inventors: |
TRIPLETT; Daniel J.;
(Providence, UT) ; FALLIN; T. Wade; (Hyde Park,
UT) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
First Ray, LLC |
Logan |
UT |
US |
|
|
Assignee: |
First Ray, LLC
Logan
UT
|
Appl. No.: |
16/886923 |
Filed: |
May 29, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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15295496 |
Oct 17, 2016 |
10702290 |
|
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16886923 |
|
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62249687 |
Nov 2, 2015 |
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Current U.S.
Class: |
1/1 |
International
Class: |
A61B 17/17 20060101
A61B017/17; A61B 17/68 20060101 A61B017/68; A61B 17/86 20060101
A61B017/86; A61B 17/88 20060101 A61B017/88; A61B 17/16 20060101
A61B017/16 |
Claims
1. A system operable to fix first and second bone portions relative
to one another, the system comprising: a retainer having a receiver
defining a receiver longitudinal axis; a screw threadably
engageable with the receiver, the screw having a shaft portion
defining a longitudinal axis, the shaft having a distal shaft width
dimension perpendicular to the screw longitudinal axis in a width
direction, a proximal shaft width dimension perpendicular to the
screw longitudinal axis in the width direction, the proximal shaft
width dimension being greater than the distal shaft width
dimension; and a guide having a handle, a bone contacting member
mounted to the handle, a retainer supporting member mounted to the
handle opposite the bone contacting member, the retainer supporting
member having a portion operable to releasably support the retainer
opposite the bone contacting member, the bone contacting member and
retainer supporting member being mounted for translation relative
to one another and being resiliently biased toward one another, the
guide being operable to clamp an object between the retainer and
bone contacting member while the screw is engaged with the
retainer.
2. The system of claim 1, wherein the guide comprises a first guide
tube defining an insertion axis and operable to guide a drill
having a diameter less than the proximal shaft width dimension and
operative to permit passage of the screw along the insertion
axis.
3. The system of claim 2, comprising a removable guide tube reducer
having a central bore, the guide tube reducer being removably
received in the first guide tube coaxial with the insertion axis,
the central bore operable to receive a drill to guide the drill
along the insertion axis.
4. The system of claim 2, wherein the first guide tube is rigidly
mounted to the retainer supporting member and the bone contacting
member includes a second guide tube, the first and second guide
tubes being spaced apart longitudinally and coaxially aligned.
5. The system of claim 1, wherein at least one of the bone
contacting member and the retainer supporting member engage the
handle in a rack and pawl arrangement in which a pawl is moveable
between a first position in which a rack is moveable longitudinally
relative to the pawl in a first rack direction but is prevented
from moving longitudinally relative to the pawl in a second rack
direction opposite the first rack direction due to engagement of
the pawl with the rack, and a second position in which the rack is
moveable in the second rack direction, the retainer supporting
member being resiliently biased in the first rack direction.
6. The system of claim 5, wherein the retainer supporting member
comprises a first grip and a second grip such that pressing the
first grip and the handle toward one another moves the bone
contacting member and the retainer supporting member away from one
another and pressing the second grip and the handle toward one
another moves the bone contacting member and retainer supporting
member toward one another.
7. The system of claim 6, wherein the guide is responsive to
pressing the first grip and the handle toward one another to move
the pawl into the second position and move the bone contacting
member and retainer supporting member away from one another to
permit an object to be placed between the bone contacting member
and retainer supporting member, the guide being responsive to
releasing compression between the first grip and the handle to bias
the bone contacting member and retainer supporting member toward
one another under spring pressure to grip the object with a first
compressive force and bias the pawl into the first position, the
guide being responsive to pressing the second grip and the handle
toward one another to grip the object with a second compressive
force greater than the first compressive force and maintain the
second compressive force by engagement of the rack and pawl.
8. The system of claim 1, wherein the retainer supporting member
comprises a retainer seat operable to receive the retainer in a
direction transverse to the receiver longitudinal axis.
9. The system of claim 8, wherein: the retainer and retainer seat
engage in a tongue and groove arrangement that resists translation
of the retainer relative to the retainer seat along the receiver
longitudinal axis; the retainer seat comprises a pair of resilient
arms that grip the retainer; and the arms surround a portion of the
periphery of the retainer, the arms being operable to receive and
release the retainer in a snap-fit relationship.
10. The system of claim 8, further comprising a retainer handle
removably engageable with the retainer, the retainer handle being
engageable with and releasable from the retainer receiver along the
receiver longitudinal axis.
11. The system of claim 8, further comprising a retainer handle
releasably engaged with the retainer and operable to apply a
transverse force to the retainer as it is engaged with the arms,
the retainer handle being removable from the retainer after the
retainer is engaged with the arms.
12. The system of claim 11, wherein the retainer handle is
threadably engageable with the retainer in a first direction
parallel to the motion axis and the screw is threadably engageable
with the retainer in a second direction opposite the first
direction.
13. The system of claim 11, wherein the retainer handle and screw
are threadably engageable with a single threaded bore through the
retainer.
14. A system for fixing first and second bone portions relative to
one another, the system comprising: a retainer; a fastener
engageable with the retainer; a guide comprising: a handle; a bone
contacting member mounted to the handle; a retainer supporting
member mounted to the handle opposite the bone contacting member,
the retainer supporting member having a portion operable to
releasably support the retainer opposite the bone contacting
member, the bone contacting member and retainer supporting member
being mounted for translation relative to one another, the retainer
supporting member having a first grip and a second grip such that
pressing the first grip and the handle toward one another moves the
bone contacting member and retainer supporting member away from one
another and pressing the second grip and the handle toward one
another moves the bone contacting member and retainer supporting
member toward one another.
15. The system of claim 14, wherein the retainer supporting member
engages the handle in a rack and pawl arrangement in which a pawl
is moveable between a first position in which a rack is moveable
longitudinally relative to the pawl in a first rack direction but
is prevented from moving longitudinally relative to the pawl in a
second rack direction opposite the first rack direction due to
engagement of the pawl with the rack, and a second position in
which the rack is moveable in the second rack direction, the
retainer supporting member being resiliently biased in the first
rack direction, the pawl being resiliently biased into the first
position and the pawl including an extension positioned adjacent
the handle such that applying pressure to press the first grip and
the handle toward one another moves the pawl into the second
position allowing the rack to move in the second rack direction and
releasing pressure allows the pawl to be biased to the pawl first
position.
16. The system of claim 15, wherein the guide is responsive to
pressing the first grip and the handle toward one another to move
the pawl into the second position and move the bone contacting
member and retainer supporting member away from one another to
receive a bone portion between the bone contacting member and
retainer supporting member, the guide being responsive to releasing
compression between the first grip and the handle to bias the bone
contacting member and retainer supporting member toward one another
under spring pressure to grip the bone portion with a first
compressive force and bias the pawl into the first position, the
guide being responsive to pressing the second grip and the handle
toward one another to grip the bone portion with a second
compressive force greater than the first compressive force and
maintain the second compressive force by engagement of the rack and
pawl.
17. A system for fixing first and second bone portions relative to
one another, the system comprising: a retainer; a screw threadably
engageable with the retainer; a guide having a bone contacting
portion, an opposed retainer supporting portion operable to
releasably retain the retainer opposite the bone contacting
portion, the bone contacting portion and retainer supporting
portion defining a motion axis and being mounted for axial
translation parallel to the motion axis toward and away from one
another; the retainer supporting portion comprising spaced apart
arms defining a perimeter greater than one half a perimeter of the
retainer and being operable to spread apart to receive the retainer
as the retainer is pressed between the arms and spring back to
positively grip the retainer.
18. The system of claim 17, wherein the retainer and arms engage in
torque transmitting relationship operable to resist rotation of the
retainer as the screw is threadably engaged with the retainer.
19. The system of claim 18, wherein the torque transmitting
relationship is defined by features formed on the retainer and the
arms that engage when the retainer is received by the arms by
pressing the retainer in a direction transverse to the motion axis,
the features being operable to self-align as the retainer engages
the arms.
20. The system of claim 19, further comprising a retainer handle
releasably engaged with the retainer and operable to apply a
transverse force to the retainer as it is engaged with the arms,
the retainer handle being removable from the retainer after the
retainer is engaged with the arms.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 15/295,496 filed on Oct. 17, 2016 entitled,
"Orthopedic Fastener, Retainer, and Guide", which claims the
benefit of U.S. Provisional Application No. 62/249,687, filed on
Nov. 2, 2015, which is hereby incorporated by reference.
FIELD OF THE INVENTION
[0002] Examples of the present invention relate generally to
medical devices for connecting bone portions together and more
particularly to fasteners and retainers connectable in axial force
transmitting relationship and instruments for their
installation.
BACKGROUND
[0003] Various conditions may affect skeletal joints such as the
deterioration, elongation, shortening, or rupture of soft tissues,
cartilage, and/or bone associated with the joint and consequent
laxity, pain, and/or deformity. It may be desirable to change the
angular alignment of a bone or a portion of a bone to restore
function and/or reduce pain. It likewise may be desirable to fuse a
joint to fix the bones of the joint in a better angular alignment
or reduce pain caused by motion at the joint. It may also be
desirable to support a fractured bone to allow healing of the
fracture to occur. To this end, various osteotomy procedures, joint
fusion procedures, fracture fixation procedures, implants and
instruments have been proposed. Such procedures have been performed
throughout the body to make various angular adjustments in, fuse
joints associated with, and/or fuse fractures associated with
tibia, fibula, femur, pelvis, humerus, ulna, radius, carpal,
metacarpal, tarsal, metatarsal, phalangeal and other bones.
SUMMARY
[0004] Examples of the present invention provides medical devices
for connecting bone portions together and more particularly to
fasteners and retainers connectable in axial force transmitting
relationship and guides for their installation.
[0005] In one example of the invention, a system operable to fix
first and second bone portions relative to one another includes a
retainer, a screw and a guide. The retainer has a receiver defining
a receiver longitudinal axis. The screw is threadably engageable
with the receiver and has a shaft portion defining a longitudinal
axis. The shaft has a distal shaft width dimension perpendicular to
the screw longitudinal axis in a width direction and a proximal
shaft width dimension perpendicular to the screw longitudinal axis
in the width direction. The proximal shaft width dimension is
greater than the distal shaft width dimension. The guide has a
handle, a bone contacting member mounted to the handle, and a
retainer supporting member mounted to the handle opposite the bone
contacting member. The retainer supporting member has a portion
operable to releasably support the retainer opposite the bone
contacting member. The bone contacting member and retainer
supporting member are mounted for translation relative to one
another and are resiliently biased toward one another. The guide is
operable to clamp an object between the retainer and bone
contacting member while the screw is engaged with the retainer.
[0006] In another example of the invention, a system for fixing
first and second bone portions relative to one another includes a
retainer, a fastener engageable with the retainer and a guide. The
guide includes a handle, a bone contacting member mounted to the
handle, and a retainer supporting member mounted to the handle
opposite the bone contacting member. The retainer supporting member
has a portion operable to releasably support the retainer opposite
the bone contacting member. The bone contacting member and retainer
supporting member are mounted for translation relative to one
another. The retainer supporting member has a first grip and a
second grip such that pressing the first grip and the handle toward
one another moves the bone contacting member and retainer
supporting member away from one another and pressing the second
grip and the handle toward one another moves the bone contacting
member and retainer supporting member toward one another.
[0007] In another example of the invention, a system for fixing
first and second bone portions relative to one another includes a
retainer, a screw threadably engageable with the retainer, and a
guide. The guide has a bone contacting portion and an opposed
retainer supporting portion operable to releas ably retain the
retainer opposite the bone contacting portion. The bone contacting
portion and retainer supporting portion define a motion axis and
are mounted for axial translation parallel to the motion axis
toward and away from one another. The retainer supporting portion
includes spaced apart arms defining a perimeter greater than one
half a perimeter of the retainer. The arms are operable to spread
apart to receive the retainer as the retainer is pressed between
the arms and spring back to positively grip the retainer.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] Various examples of the present invention will be discussed
with reference to the appended drawings. These drawings depict only
illustrative examples of the invention and are not to be considered
limiting of its scope.
[0009] FIG. 1 is a perspective view of a fastener and retainer
according to one example of the invention;
[0010] FIG. 2 is a top view of the fastener of FIG. 1;
[0011] FIG. 3 is a front view of the fastener of FIG. 1;
[0012] FIG. 4 is a top view of the retainer of FIG. 1;
[0013] FIG. 5 is a front view of the retainer of FIG. 1;
[0014] FIG. 6 is a bottom view of the retainer of FIG. 1;
[0015] FIG. 7 is a perspective view of a guide according to one
example of the invention;
[0016] FIG. 8 is a side view of the guide of FIG. 7;
[0017] FIG. 9 is an exploded perspective view of the guide of FIG.
7;
[0018] FIG. 10 is a detail perspective view of a portion of the
guide of FIG. 7;
[0019] FIG. 11 is a detail top view of the portion of the guide of
FIG. 10 shown receiving the retainer of FIG. 1;
[0020] FIG. 12 is a perspective view of a drill according to one
example of the invention;
[0021] FIG. 13 is a perspective view of a countersink according to
one example of the invention;
[0022] FIG. 14 is a perspective view of a driver according to one
example of the invention;
[0023] FIGS. 15-23 a perspective views of a method of using the
implants and instruments of FIGS. 1-14 according to one example of
the invention;
[0024] FIG. 24 is a perspective view of a guide and retainer
according to one example of the invention;
[0025] FIG. 25 is a detail perspective view of a portion of the
guide of FIG. 24;
[0026] FIG. 26 is a detail perspective view of a portion of the
retainer of FIG. 24;
[0027] FIG. 27 is a partial exploded perspective view of the guide
of FIG. 24, duplicate parts have been omitted for ease of
visualization;
[0028] FIG. 28 illustrates a bone repair according to one example
of the invention using the implants and instruments of FIGS. 1-14
and FIGS. 24-27;
[0029] FIG. 29 is a front view of a compressor instrument according
to one example of the invention;
[0030] FIG. 30 is a side view of a compressor instrument of FIG.
29;
[0031] FIG. 31 is a cross-sectional view of the proximal portion of
the compressor instrument of FIG. 29 taken along line 31-31 of FIG.
30;
[0032] FIG. 32 is n exploded perspective view of the compressor
instrument of FIG. 29;
[0033] FIGS. 33 and 34 are perspective views illustrating a method
of using the compressor instrument according to one example of the
invention; and
[0034] FIG. 35 is a detail view of a portion of the compressor
instrument.
DESCRIPTION OF THE ILLUSTRATIVE EXAMPLES
[0035] The following illustrative examples describe methods,
implants, and instruments for connecting bone portions together and
more particularly to fasteners and retainers connectable in axial
force transmitting relationship and instruments for their
installation. The bone portions may be portions of the same bone
that have become separated due to a fracture or a cut. The bone
portions may be portions of different bones. In particular, the
methods, implants, and instruments are particularly well suited to
joining bone portions such as portions separated due to fractures
or osteotomies or in an arthrodesis performed to fuse a joint. The
invention may be used on any bone or joint including but not
limited to bones such as a tibia, fibula, femur, pelvis, humerus,
ulna, radius, carpal, metacarpal, tarsal, metatarsal, phalange and
joints associated therewith. The term "transverse" is used herein
to mean crossing as in non-parallel and includes but is not limited
to perpendicular.
[0036] FIGS. 1-6 illustrate a fastener 100 and mating retainer 150
according to one example of the invention. The fastener has a
longitudinal axis 102 extending between a proximal end 104 and a
distal end 106. The retainer 150 includes a receiver 152 having a
receiver longitudinal axis 154. In the illustrative example of
FIGS. 1-6, the fastener 100 is coaxially engageable with the
retainer 150 in axial force transmitting relationship along the
fastener and receiver longitudinal axes 102, 154. The fastener 100
is engageable with the retainer 150 in a first direction along the
receiver longitudinal axis and the engagement resists translation
of the fastener 100 away from the retainer 150 in a second
direction along the fastener and receiver longitudinal axes
opposite the first direction. In the illustrative example of FIGS.
1-6, the fastener includes a shaft portion 108 with a shaft width
dimension 110 perpendicular to the fastener longitudinal axis in a
width direction. The fastener further includes a head 112 at the
proximal end 104 having a head width dimension 114 perpendicular to
the fastener longitudinal axis in the width direction. The head
width 114 is greater than the shaft width 110. In the illustrative
example of FIGS. 1-6, the fastener 100 is in the form of a screw
with a threaded shaft 108 and the retainer 150 is in the form of a
nut with a threaded receiver 152 for receiving the threaded shaft
in threaded engagement. The head 112 includes a tapered bottom
surface 116 receivable in a countersink formed in a bone surface.
The head further includes a socket 118 for engaging a driver to
rotate the screw into engagement with the retainer 150. The distal
end 106 of the fastener includes a smooth portion 120 with a
diameter equal to or slightly less than the minor diameter of the
female threads in the receiver 152 and is further tapered distally
to a point 122. In use, the point 122 enters the retainer threads
first followed by the smooth portion 120 to axially align the
fastener and retainer to facilitate thread engagement and to avoid
cross threading.
[0037] In the illustrative example of FIGS. 1-6, the retainer 150
includes a plurality of axially projecting teeth 155 formed on a
first, proximal, bone engaging side 151 to aid in gripping the
bone. The retainer 150 includes a counter torque coupling 156
formed on a second, distal side. In the illustrative example of
FIGS. 1-6, the counter torque coupling is a polygonal projection
engageable with a guide for resisting rotation of the retainer 150
as the fastener 100 is engaged with the retainer. The torque
coupling has a width 158, e.g. the distance between sides, and
radiused vertices 160 between the sides. The radii of the vertices
preferably are chosen so that the torque coupling self-aligns when
it is pressed sideways, e.g. normal to the receiver axis 154, into
an engaging polygonal feature on a guide. In other words, the radii
are chosen to be sufficiently large so that a misaligned torque
coupling will rotate into alignment as it is pressed into a
receiving feature but sufficiently small so that once engaged,
there is sufficient flat side engagement to transmit the required
torque. Preferably, the radii of the vertices are in the range of
15-35 percent of the width 158. More preferably the radii are in
the range of 20-30 percent of the width 158. In the illustrative
example of FIGS. 1-6, the torque coupling is a square projection
having radiused vertices 160 with radii approximately 25 percent of
the width 158. The retainer 150 is also engageable with a guide in
tongue and groove fashion to resist translation of the retainer
along the receiver longitudinal axis. In the illustrative example
of FIGS. 1-6, the retainer 150 includes an external circumferential
groove 162 engageable with a tongue on a guide. In the illustrative
example of FIGS. 1-6, the fastener 100 and retainer 150 are
provided with a multi-lead thread, e.g. a double lead thread. It
has been found by the present inventors that the engagement of the
double lead male thread of the fastener 100 with the double lead
female thread of the receiver 150 provides tactile feedback similar
to that of a bone screw threaded into bone. Surgeons are familiar
with installing bone screws into bone and the tactile sense for
when the proper torque has been applied. Typical machine screw
threads used with bolts and nuts are finer pitch than bone screw
threads and consequently generate more mechanical advantage. For
the same tactile feedback as bone screws, typical machine screws
generate too much compressive force. By using a dual lead thread,
thread strength is maintained while reducing the mechanical
advantage and thus producing a familiar tactile feedback at an
appropriate compression level.
[0038] A retainer handle 170 may be provided to facilitate storage,
retrieval, and handling of the retainer 150. The handle 170 is
releasably engageable with the retainer such that the handle may be
used to position the retainer 150 and then may be removed. The
handle may engage the retainer in a press fit, snap fit, tongue and
groove arrangement, threaded engagement, or other suitable
engagement. Preferably the handle 170 is engageable with the
retainer in a direction orthogonal to the direction in which the
retainer engages a guide. For example, if the retainer engages a
guide radially, it is preferable that the handle 170 engage the
retainer 150 axially such that forces generated in engaging the
retainer 150 with the guide 200 do not tend to disengage the handle
170. This is especially true if the handle engages in a press fit
arrangement. Where the handle 170 engages the retainer 150 axially,
it is preferable that the handle 170 be engageable in an axial
direction with the second side of the retainer 150 or in other
words opposite the side from which the fastener engages the
retainer. In the illustrative example of FIGS. 1-6, the retainer
handle 170 engages the retainer axially in a threaded engagement.
The retainer handle 170 may be threaded into the retainer from
either side but is preferably threaded into the second side so that
it may be readily removed after the retainer 150 is engaged with a
guide.
[0039] While the illustrative example of FIGS. 1-6 have shown a
screw and nut, the fastener and retainer engagement may take many
other forms including for example, partial turn engagements,
ratcheting engagements like a cable tie, snap lock engagements, and
other suitable axial force transmitting engagements.
[0040] FIGS. 7-11 illustrate a guide 200 usable with the fastener
and retainer of FIGS. 1-6 according to one example of the
invention. The guide 200 includes a bone contacting portion 203 and
a retainer supporting portion 205 opposite the bone contacting
portion. The bone contacting portion and retainer supporting
portion are mounted for axial translation parallel to a motion axis
201 toward and away from one another in a clamping arrangement.
[0041] In the illustrative example of FIGS. 7-11, the bone
contacting portion 203 is part of a bone contacting member 204
(FIG. 9) and the retainer supporting portion 205 is part of a
separate and opposed retainer supporting member 206. The retainer
supporting portion 205 is configured to releasably support the
retainer 150 opposite the bone contacting portion 203 with the
receiver axis 154 in predetermined relationship to the guide 200.
The guide 200 is configured to guide a drill coaxial with the
receiver axis 154 and to allow passage of a fastener 100 coaxial
with the receiver axis 154 into engagement with the retainer 150
while the guide remains in clamping engagement with the bone.
[0042] In the illustrative example of FIGS. 7-11, the bone
contacting member 204 includes a handle 202 having first and second
finger loops 208, 210 (FIG. 8) having a longitudinal axis 212 and
inner and outer gripping surfaces. A spring tube 214 is fixed to
the handle 202 and has a longitudinal axis 216 extending transverse
to the finger loop axis 212 and parallel to the motion axis 201.
The distal end 218 of the spring tube is at least partly closed to
provide a distal stop for containing a spring. The proximal end 219
of the spring tube is at least partly open to receive a portion of
the retainer supporting member. The outside of the spring tube 214
includes indicia 220 indicating the recommended length of fastener
100 corresponding to different distances between the bone
contacting portion 203 and retainer supporting portion 205. A main
spring 222 is disposed in the spring tube 214. A guide tube 213 is
fixed to the spring tube 214 and defines a longitudinal axis 224
extending between an open distal end and an open proximal end. The
bone contacting portion 203 is formed on the distal end of the
guide tube 213 and includes a plurality of teeth 226 to enhance the
grip of the guide 200 on a bone surface. A slot 228 in the side of
the guide tube 213 permits access to a screw head if needed. For
example, a pair of forceps or a probe may be inserted through the
slot to remove a screw that is the wrong size.
[0043] In the illustrative example of FIGS. 7-11, a guide tube
reducer 230 is receivable in the guide tube 213 to reduce the inner
diameter of the guide tube 213 from the inner diameter of the guide
tube to the diameter of the bore 231 in the guide tube reducer 230.
For example, the guide tube reducer 230 may be used for guiding a
drill in the bore 231 and then removed to permit passage of another
tool or fastener having a portion with a larger diameter than the
drill. The guide tube reducer 230 has a cylindrical portion 232
sized for a slip fit within the guide tube 213 and an enlarged head
234. The head 234 has a semi-circular portion 233 and an arm 236
extending from the semi-circular portion 233 forming a notch 238
between the arm 236 and semi-circular portion 233. The guide tube
reducer 230 is placed in the guide tube 213 with the notch 238
facing the spring tube 214 to clear a tab 240 projecting from the
spring tube 214. Once the guide tube reducer 230 is seated in the
guide tube 213, the head 234 is rotated so that the semi-circular
portion 233 of the head is under the tab 240. The arm 236 provides
extra leverage, if needed, for rotating the guide tube reducer 230
and rotates into contact with the spring tube 214 to serve as a
rotation stop. The position of the tab 240 overlying the head 234
retains the guide tube reducer 230 in the guide tube 213. To remove
the guide tube reducer 230, it is rotated until the notch 238 is
aligned with the tab 240 and then withdrawn axially.
[0044] In the illustrative example of FIGS. 7-11, the bone
contacting member 204 includes a passage 242 (FIG. 9) having a
longitudinal axis 244 parallel to the motion axis 201 for receiving
the retainer supporting member 206 for axial translation. A pawl
246 is mounted to the handle 202 for rotation about a pivot pin
248. A free end 250 of the pawl is extendable within the passage
242. A cantilevered spring 252 extends from the pawl and presses
against the handle to bias the free end 250 into a first position
toward the passage axis 244. An actuator 254 extends from the pawl
and extends into the first finger loop 208. The actuator 254 is
curved to follow the contour of the upper inner surface of the
first finger loop 208. Upward pressure on the actuator 254
overcomes the force of the spring 252 and pivots the pawl into a
second position in which the free end 250 is pivoted away from the
passage axis 244.
[0045] In the illustrative example of FIGS. 7-11, the retainer
supporting member 206 includes an elongated body 260 defining a
longitudinal axis 262 extending between a proximal end 264 and a
distal end 266. The body 260 is sized and shaped to engage the
passage 242 in axial translating relationship. A rack 268 is formed
on a side of the body 260 facing the free end 250 of the pawl 246.
The retainer supporting portion 205 extends from the retainer
supporting member 206 and forms a seat 270 (FIG. 10) operable to
receive the retainer 150. Preferably the seat 270 receives the
retainer 150 in a direction transverse to the receiver longitudinal
axis 154. In the illustrative example of FIGS. 7-11, the seat 270
includes a tongue 272 receivable within the groove 162 of the
retainer 150 to restrain the retainer from movement parallel to the
receiver longitudinal axis 154. The tongue defines a perimeter 274
that extends more than one half the perimeter of the groove 162 of
the retainer so that the tongue 272 engages the groove 162 in
snap-fit relationship for positive retention of the retainer.
[0046] In the illustrative example of FIGS. 7-11, the retainer 150
and seat 270 engage in torque transmitting relationship that
resists rotation of the retainer 150 as the fastener 100 is engaged
with the retainer 150. The seat 270 includes a recess 276
complimentary in shape to and able to receive the counter torque
coupling 156 of the retainer 150. The seat 270 is split to form a
pair of opposed resilient arms 278, 280 that flex outwardly as the
retainer is inserted into the seat such that they resiliently grip
the retainer 150.
[0047] In the illustrative example of FIGS. 7-11, a cap 282 is
fixed to the proximal end 264 of the elongated body 260. The cap
282 includes a spring follower 284 received in the spring tube 214
against which the main spring 222 presses to bias the retainer
supporting member 206 proximally (upwardly) so that the retainer
supporting portion 205 is biased toward the bone contacting portion
203. The cap 282 includes a finger grip 286 extending above the
handle 202. The finger grip 286 is engageable by a user and
pressable toward the handle in a squeezing motion to oppose the
spring bias and move the retainer supporting portion 205 away from
the bone contacting portion 203. Another finger grip 288 extends
from the distal end 266 of the elongated body 260 below the handle
202. The finger grip 288 is engageable by a user and pres sable
toward the handle to move the retainer supporting portion 205
toward the bone contacting portion 203. A cap guide tube 290 is
fixed to the cap 282 and defines a longitudinal axis 291 coaxial
with the longitudinal axis 224 of the handle guide tube 213. A cap
guide tube reducer 292 configured like the handle guide tube
reducer 230 is engageable in similar manner with the cap guide tube
290 including retention by tab 294. The guide tube reducers 292 and
230 may be identical. The cap guide tube reducer 292 has a
thickness 293 above the guide tube 290. The cap 282 further
includes an index mark 296 (FIG. 8) readable relative to the
indicia 220 of the spring tube 214 to indicate a recommended length
of fastener 100 corresponding to different distances between the
bone contacting portion 203 and retainer supporting portion
205.
[0048] FIGS. 12-14 illustrate instruments useable with the guide
and implants of FIGS. 1-11 according to one example of the
invention. FIG. 12 depicts an illustrative example of a drill 300
having a distal cutting tip 302, flutes 304, a smooth shank portion
306, a proximal drive connection 308, and a longitudinal axis 310
extending between the proximal and distal ends. A shoulder 312 at
the junction of the shank 306 and drive connection 308 may be used
as a depth stop. The portion of the drill 300 distal of the
shoulder 312 has a length 314. The portion of the drill 300 distal
of the shoulder has a diameter 316 sized to slip fit within the
bore 231 of the guide tube reducer 230.
[0049] FIG. 13 depicts an illustrative example of a counter sink
330 having a distal cylindrical guide point 332, cutting flutes
334, a smooth shank 336, a proximal drive connection 338, and a
longitudinal axis 340 extending between the proximal and distal
ends. A shoulder 342 at the distal end of the shank 336 may be used
as a depth stop. The guide point 332 has a diameter 344 sized for a
slip fit in a hole drilled with the drill 300. The shank 336 has a
diameter 346. A scale 348 is inscribed on the shank 336.
[0050] FIG. 14 depicts an illustrative example of a fastener driver
360 having a distal driver portion 362 engageable with the socket
118 of the fastener 100, e.g. a polygonal drive extension
engageable with a polygonal socket for torque transmission, a shank
364 having a shank diameter 366, a proximal drive connection 368,
and a longitudinal axis 369. A scale 370 is inscribed on the shank
364.
[0051] FIGS. 15-23 illustrate a method of using the implants and
instruments of FIGS. 1-14 according to one example of the
invention.
[0052] In FIG. 15, the retainer 150 is manipulated with the
attached handle 170 and is pressed laterally, transverse to the
receiver axis 154, into the seat 270 of the guide 200. After the
retainer 150 is seated, the handle 170 is removed distally along
the receiver axis.
[0053] In FIG. 16, a user places fingers in the finger loops 208,
210 and presses the finger loops and the finger grip 286 of the cap
282 together. With the guide gripped in this manner, the user's
finger naturally rests on the actuator 254 and pressing the finger
loops and the finger grip 286 together produces upward pressure on
the actuator 254 and pivots the pawl 246 into the second position
in which it is disengaged from the rack 268. Further pressing moves
the retainer supporting member 206 distally relative to the handle
and increases the space between the retainer supporting portion 205
and the bone contacting portion 203 so that one or more bone
portions may be received between them such as, for example, bone
portions 400 and 402 created by a corrective osteotomy 403. The
arrangement of the actuator 254 within the handle causes the pawl
246 to disengage from the rack 268 as a natural consequence of
pressing the finger loops 208, 210 and finger grip 286 together so
that no additional unlocking step or other deliberate action by the
user is required.
[0054] In FIG. 17, the guide has been placed over the bone portions
400, 402 and the pressure on the finger loops 208, 210 and finger
grip 286 has been reduced so that the main spring 222 moves the
retainer supporting member 206 proximally relative to the handle to
move the retainer supporting portion 205 toward the bone contacting
portion 203 so that the bone contacting portion 203 and the
retainer 150 supported on the retainer supporting member 206 act as
jaws to grip the bone with a first compressive force. Also, with
pressure reduced on the actuator 254, the pawl spring 252 biases
the pawl into the first position in which it engages the rack 268
and prevents the retainer supporting portion 205 and the bone
contacting portion 203 from moving apart and releasing the bone
portions 400, 402. If additional compression is desired on the bone
portions 400, 402, the user may grip the distal finger grip 288 and
the handle 202, e.g. the outer upper surface of the finger loops or
the lower inner surface of the finger loops, and press them toward
one another. The pressure applied by the user will generate a
second compressive force, greater than the first compressive force
generated by the main spring alone. This additional force results
in the retainer 150 moving closer to the bone contacting portion
203 as they grip the bone even tighter. The pawl 246 ratchets over
the teeth on the rack 268 to allow motion in this first rack
direction and engages the teeth to prevent motion in the opposite,
or second, rack direction.
[0055] In FIG. 18, the drill 300 is guided in the guide tube
reducers 292, 230 coaxial to the receiver axis 154 to form a hole
406 (FIG. 19) through the bone portions. The proximal cap guide
tube 290 is rigidly linked to the retainer supporting portion 205
and the cap guide tube reducer 292 has a predetermined thickness
293. The drill 300 has a predetermined length 314 below the
shoulder 312 sized so that with the shoulder 312 abutting the top
of the cap guide tube reducer 292 the distal cutting tip 302 of the
drill will reach, but not extend through, the retainer 150 as it is
supported on the retainer supporting portion 205 and pressed
against the bone.
[0056] In FIG. 19, the drill and guide tube reducers 230, 292 have
been removed. The countersink 330 is driven into the hole 406 to
form a countersunk hole into the bone surface. The countersink 330
may be guided by engagement of the cylindrical guide point 332 with
the hole 406. Alternatively, or in addition, the countersink 330
may be guided by the guide tubes 213, 290. For example, the
diameter 346 of the countersink shaft 346 may be sized to be a slip
fit within the guide tubes 213, 290, as shown in the example of
FIG. 19. Once the countersink has been driven to a desired depth,
the scale 348 on the shank of the countersink may be read relative
to the proximal edge 295 of the cap guide tube. The cap guide tube
290 is rigidly linked to the retainer supporting portion 205 and
the scale is arranged to indicate the length of screw that when
seated in the countersunk hole will engage with the retainer 150 a
preferred distance.
[0057] In FIG. 20, the fastener 100 is engaged with the driver 360
and the distal end of the fastener is passed through the guide
tubes 213, 290, through the hole 406, and into engagement with the
retainer 150. The fastener and retainer are tightened to fix the
bone portions together. The fastener 100 may be guided by the hole
406. Alternatively, or in addition, the fastener 100 may be guided
by engagement of the driver 360 with the guide tubes 213, 290; e.g.
the driver shank 364 may be sized to be a slip fit within the guide
tubes as shown in the example of FIG. 20. The scale 370 may be read
relative to the proximal edge 295 of the cap guide tube to indicate
when the screw is seated in the countersunk hole. If after
evaluating the compression of the bone portions, the surgeon
determines that more compression is desired, the screw may be
driven further to achieve the desired compression. The scale 370
may then be read again to determine a second size screw shorter
than the initial screw and the initial screw may be removed and
replaced with the second screw if it is desired to limit screw
protrusion from the retainer 150.
[0058] In FIG. 21, the driver 360 and the guide 200 have been
removed. The guide 200 is removed by pressing the handle 202 and
cap finger grip 286 together to disengage the pawl 246 and compress
the main spring 222. The guide 200 is then moved laterally to
disengage the retainer supporting portion 205 from the retainer
150. The fastener 100 is shown with its head 112 seated in the
countersunk hole 408 formed by the countersink tool 330 and engaged
with the retainer 150 with the distal end 106 extending beyond the
retainer.
[0059] In FIG. 22, the protruding distal end 106 has been trimmed
off such as, for example, with a rod cutter. The illustrative bone
repair construct 420 of FIG. 22 includes a scarf osteotomy 422
dividing a metatarsal bone into first and second bone portions 400,
402. The fastener 100 and retainer 150 compress the bone portions
together to secure the osteotomy.
[0060] In FIG. 23, the instruments and implants of FIGS. 1-14 have
been used to fix the bone portions 400, 402 using multiple
fasteners. The fasteners may be placed independently of one another
with varying lengths and trajectories and with any arbitrary
desirable entrance and exit for the holes 412, 414. The
illustrative bone repair construct is similar to that of FIG. 21
but with the additional fastener it provides enhanced rotational
stability.
[0061] FIGS. 24-27 illustrate an alternative guide 500, similar to
the guide of FIGS. 7-11, according to one example of the invention.
The primary difference between the guide 500 of FIGS. 24-27 and the
guide 200 of FIGS. 7-11 is that the guide 500 of FIGS. 24-27
includes a plurality of spring tubes 514 supporting a plurality of
distal guide tubes 513 and the retainer supporting member 506
includes a corresponding plurality of proximal guide tubes 590
aligned with the distal guide tubes such that the guide 500 can be
used to place multiple fasteners with a single clamping step.
Another difference between the guides 200, 500 is that the spring
tubes 514 of the guide 500 of FIGS. 24-27 are not fixed to the
handle 502 but are mounted for axial translation relative to the
handle 502. This allows the bone contacting portions 503 to be
axially offset with respect to one another so that the main springs
522 can independently bias the bone contacting portions into
contact with different screw placement areas of a bone portion
having non-uniform thickness. The indicia 520 on the spring tubes
514 will independently indicate the screw length needed for each
screw placement area on the bone portion. The guide 500 may be
configured to support multiple retainers similar to retainer 150.
Alternatively, the guide 500 may be configured as shown to support
a retainer 560, such as a plate, with multiple receivers 562. In
the illustrative example of FIGS. 24-27, the retainer supporting
portion 505 includes projections 566 engageable with holes 568 in
the retainer 560 to releasably secure the retainer 560 to the
retainer supporting portion 505. A circumferential spring 570
mounted on each projection 566 presses into a groove 572 in each
hole 568 to secure the retainer 560 in snap fit relationship.
Preferably the receivers 562 are positioned outboard relative to
the holes 568 in the retainer to maximize the fastener span on the
retainer 560. The guide tube axes 524 are oriented to intersect the
retainer coaxial with the receiver axes 554. In FIG. 27, duplicate
parts have been omitted for ease of visualization. In the
illustrative example of FIGS. 24-27, the guide 500 provides for
placing two fasteners with predetermined relative spacing and
trajectories.
[0062] FIG. 28 illustrates a bone repair construct 574 created
using the implants and instruments of FIGS. 1-14 and FIGS. 24-27.
First and second fasteners 576 and a retainer 550 are placed using
the guide 500 of FIGS. 24-27 according to one example of the
invention. A third fastener 100 and a retainer 150 are
independently placed using the guide 200 of FIGS. 7-11. The
illustrative bone repair construct 574 of FIG. 28 includes a scarf
osteotomy 580 dividing a metatarsal bone into first and second bone
portions 582, 584. The plate like retainer 550 coupled with two
fasteners 576 spans the proximal portion of the osteotomy cut on
the plantar side of the osteotomy to secure the osteotomy where it
is in tension. The third fastener 100 and retainer 150 secures the
distal portion of the osteotomy and provides rotational stability
to the osteotomy.
[0063] FIGS. 29-32 illustrate a compressor instrument 600 according
to one example of the invention useable with the implants,
instruments, and methods of the examples of FIGS. 1-28. The
compressor 600 includes a body 602, a handle 604, and a shaft 606.
The shaft 606 is axially translatable within the body by
manipulating the handle. The details of these components will be
explained in reference to the drawings and in particular with
reference to FIGS. 31 and 32.
[0064] The body 602 is an elongate hollow structure defining a
longitudinal axis 610 extending between a proximal end 612 and a
distal end 614. The body may be made as a single piece or as an
assembly of pieces. In the example of FIGS. 29-32 the body 602 is a
two-part assembly including a proximal body portion 616 distal body
portion 618 joined together. The portions may be joined by any
suitable method including welding, pinning, threading, and/or other
joining method. In the example of FIGS. 29-32, the proximal body
portion 616 and distal body portion 618 are threaded together and
then welded. The body 602 includes an axial passage 620 for
receiving the shaft 606. At least a portion of the passage 620 has
a hexagonally shaped cross-section. Preferably the proximal portion
of the passage is hexagonal and a shoulder 621 is formed in the
passage 620. In the example of FIGS. 29-32, the proximal body
portion includes a hexagonal passage and the distal body portion
includes a cylindrical passage. The cylindrical passage has a
diameter less than the distance across corners of the hexagonal
passage such that a shoulder 621 is formed where the two passages
join. The distal portion 618 of the body is a narrow tube and the
distal end 614 approximates the size and shape of the tapered
bottom surface 116 of the head of the fastener 100 of FIGS. 1-3. A
mid portion 622 of the body, formed on the distal end of the
proximal body portion 616, includes an elongated slot 624
communicating with the passage 620. A scale 626 is positioned
adjacent the slot 624. The proximal end of the proximal body
portion 616 flares outwardly to form an enlarged receiver 630. The
outer surface of the receiver 630 includes elongate grooves 632
spaced axially about the receiver. The grooves are closed distally
and open at the proximal end 612. One of the grooves 634 is
undercut to receive a handle lock 636 in axial sliding
relationship. A ball 640 and spring 642 are captured in a recess
(not shown) in the handle lock 636 and cooperate with a pair of
detents 644 to create 2 distinct positions for the handle lock. The
handle lock may be moved distally into a handle unlocked position
and proximally into a handle locked position. The receiver includes
pin holes 637.
[0065] The shaft 606 defines a longitudinal axis 650 extending
between a proximal end 652 and a distal end 654. Drive threads 656
are formed adjacent the proximal end 652. The distal end of the
shaft is sized and shaped to correspond with the distal end of
fastener 100 of FIGS. 1-3 including a tapered point 658 and screw
threads 660. The mid portion of the shaft 606 includes a
hexagonally shaped portion 662 sized to slide within the hexagon
portion of the passage 620 to allow the shaft to translate axially
while preventing the shaft from rotating relative to the body 602.
The hexagonal portion 662 abuts the shoulder 621 to limit distal
motion of the shaft. An indicator 664 on the shaft is visible
through the slot 624 in the body so that the indicator position may
be read relative to the scale 626. In the example of FIGS. 29-32,
the indicator is a line etched across a flat of the hexagonally
shaped portion 662. A relieved portion 668 of the shaft has a
reduced diameter beginning just proximal to the distal threads 660
to prevent the shaft from binding when it is inserted into a
passage in a bone. A spring bore 665 is formed into the shaft from
the proximal end.
[0066] The handle 604 includes an elongated stepped cylindrical
body 670 defining a longitudinal axis 672 extending between a
proximal end 674 and a distal end 676. A distal portion 678 of the
handle has a reduced diameter sized to fit coaxially within the
receiver 630 of the body 602 in rotating relationship. A
circumferential groove 680 is formed in the distal portion 678 of
the handle and aligns with the pin holes 637 in the body such that
with the distal portion 678 of the handle inserted into the
receiver 630, pins 682 may be inserted into the pin holes 637 and
tangentially within the groove 680 to secure the handle 604 in the
body 602 axially while permitting the handle to rotate relative to
the body. The handle includes notches 684 that may be aligned with
the elongate grooves 632 of the body. The handle lock 636 may be
moved proximally so that it engages one of the notches 684 to lock
the handle and body together for rotation. The handle lock 636 may
be moved distally so that it is disengaged from the notches 684 to
permit the handle to rotate relative to the body. A quick release
686 is mounted in a cavity 688 in the side of the handle for
translation into and out of the cavity 688. A quick release spring
690 biases the quick release outwardly. A passage 692 axially
through the quick release includes half-threads 694 formed on one
side of the passage 692. The shaft is assembled to the other
components by inserting the distal end of the shaft 606 into the
proximal end 674 of the handle 604, through the quick release 686,
through the body and out the distal end 614. A shaft spring 698 is
inserted into the spring bore 655 of the shaft. A spring retainer
698 is inserted into the shaft spring and coupled to the handle
604. In the example of FIGS. 29-32, the spring retainer 698 has an
enlarged threaded head that threads into a corresponding thread in
the proximal end of the handle 604. The shaft spring 698 biases the
shaft distally. The quick release spring biases the half-thread 694
of the quick release into engagement with the drive thread 656
formed on the proximal end of the shaft.
[0067] In use, pressing the quick release inwardly, disengages the
half-thread 694 from the drive thread 656. With the half-thread 694
disengaged, the shaft is free to translate distally relative to the
body 602 under the influence of the shaft spring 696. Likewise,
with the half-thread 694 disengaged, the shaft may be pressed
proximally back into the body 602 against the shaft spring 696.
Releasing pressure from the quick release allows the quick release
spring 690 to bias the half-threads into engagement with the drive
threads. With the half-threads engaged, the shaft is no longer
freely translatable but must be translated by rotating the handle
604 relative to the body 602 to threadingly advance or retract the
shaft 606.
[0068] FIGS. 33-35 illustrate the use of the compressor 600 in a
surgical procedure. In one example, the compressor may be used in
the method illustrated in FIGS. 15-23 before inserting the screw as
shown in FIG. 20. The handle lock 636 is moved to its proximal
position to lock the handle and body rotationally. The quick
release 686 is depressed to release the half-thread and allow the
shaft to extend distally. The quick release may then be released.
As shown in FIG. 33 the shaft is inserted through the bone to
engage the threaded distal end of the shaft with the retainer 150.
The handle, body, and shaft are rotated together to thread the
shaft into the retainer as far as it will go. The quick release 686
is then depressed to disengage the half-thread and the handle and
body are pressed downwardly over the shaft until the distal end 614
of the body contacts the bone as shown in FIG. 34. The handle lock
636 is moved to its distal position to free the handle. The handle
is rotated relative to the body such that the half-thread 694
drives the drive thread 656 to retract the shaft into the body and
compress the bone between the distal end 614 of the body and the
retainer 150. The handle is rotated until a desired level of
compression is achieved. In the example of FIGS. 29-35, the
indicator 626 will indicate on the scale 626 the length of screw
necessary to achieve the current level of compression. If the
indicated length corresponds to an available screw length, then
that screw size is selected. If the indicated length falls between
two available screw lengths, then the longer length is selected to
insure sufficient engagement of the screw with the retainer. In the
example of FIGS. 29-35, screws are provided in 2 mm increments and
this method will result in a construct with the tip of the screw
recessed slightly in the retainer, 0.5 mm at a minimum, or with the
screw tip extending slightly from the retainer, 1.5 mm at a
maximum. While the compressor is still in position, the guide 200
may be tightened again as shown in FIG. 17 to retain the
compression achieved by the compressor. The compressor is then
removed and the appropriate length screw implanted. By using the
compressor, the bone is fully compressed to a desired level prior
to inserting the screw such that accurately sized blunt tipped
screws may be used and the step of cutting off the tip of the screw
as shown in FIG. 22 may be omitted.
[0069] Various examples have been illustrated and described
including the following list of examples. The examples are
illustrative but not limiting of the scope of the invention. The
various examples may be substituted and combined and other
alterations made within the scope of the invention. For example,
among other substitutions, male and female features may be
reversed. [0070] 1. A system operable to fix first and second bone
portions relative to one another, the system comprising: [0071] a.
a retainer having a receiver defining a receiver longitudinal axis;
[0072] b. a screw threadably engageable with the receiver, the
screw having a shaft portion defining a longitudinal axis, the
shaft having a distal shaft width dimension perpendicular to the
screw longitudinal axis in a width direction, a proximal shaft
width dimension having a width dimension perpendicular to the screw
longitudinal axis in the width direction greater than the distal
shaft width dimension; and [0073] c. a guide having a handle, a
bone contacting member mounted to the handle, a retainer supporting
member mounted to the handle opposite the bone contacting member,
the retainer supporting member having a portion operable to
releasably support the retainer opposite the bone contacting
member, the bone contacting member and retainer supporting member
being mounted for translation relative to one another and being
resiliently biased toward one another, the guide being operable to
clamp an object between the retainer and bone contacting member
while the screw is engaged with the retainer. [0074] 2. The system
of example number 1 wherein the guide comprises a first guide tube
defining an insertion axis and operable to guide a drill having a
diameter less than the proximal shaft width dimension and operative
to permit passage of the screw along the insertion axis. [0075] 3.
The system of example number 2 comprising a removable guide tube
reducer having a central bore, the guide tube reducer being
removably received in the first guide tube coaxial with the
insertion axis, the central bore operable to receive a drill to
guide the drill along the insertion axis. [0076] 4. The system of
example number 2 wherein the first guide tube is rigidly mounted to
the retainer supporting member and the bone contacting member
includes a second guide tube, the first and second guide tubes
being spaced apart longitudinally and coaxially aligned. [0077] 5.
The system of example number 1 wherein at least one of the bone
contacting member and the retainer supporting member engage the
handle in a rack and pawl arrangement in which a pawl is moveable
between a first position in which a rack is moveable longitudinally
relative to the pawl in a first rack direction but is prevented
from moving longitudinally relative to the pawl in a second rack
direction opposite the first rack direction due to engagement of
the pawl with the rack, and a second position in which the rack is
moveable in the second rack direction, the retainer supporting
member being resiliently biased in the first rack direction. [0078]
6. The system of example number 5 wherein the retainer supporting
member comprises a first grip and a second grip such that pressing
the first grip and the handle toward one another moves the bone
contacting member and the retainer supporting member away from one
another and pressing the second grip and the handle toward one
another moves the bone contacting member and retainer supporting
member toward one another. [0079] 7. The system of example number 6
wherein the guide is responsive to pressing the first grip and the
handle toward one another to move the pawl into the second position
and move the bone contacting member and retainer supporting member
away from one another to permit an object to be placed between the
bone contacting member and retainer supporting member, the guide
being responsive to releasing compression between the first grip
and the handle to bias the bone contacting member and retainer
supporting member toward one another under spring pressure to grip
the object with a first compressive force and bias the pawl into
the first position, the guide being responsive to pressing the
second grip and the handle toward one another to grip the object
with a second compressive force greater than the first compressive
force and maintain the second compressive force by engagement of
the rack and pawl. [0080] 8. The system of example number 1 wherein
the retainer supporting member comprises a retainer seat operable
to receive the retainer in a direction transverse to the receiver
longitudinal axis. [0081] 9. The system of example number 8 wherein
the retainer and retainer seat engage in a tongue and groove
arrangement that resists translation of the retainer relative to
the retainer seat along the receiver longitudinal axis. [0082] 10.
The system of example number 9 wherein the retainer seat comprises
a pair of resilient arms that grip the retainer. [0083] 11. The
system of example number 10 wherein the arms surround a portion of
the periphery of the retainer, the arms being operable to receive
and release the retainer in a snap-fit relationship. [0084] 12. The
system of example number 8 further comprising a retainer handle
removably engageable with the retainer, the retainer handle being
engageable with and releasable from the retainer receiver along the
receiver longitudinal axis. [0085] 13. The system of example number
10 further comprising a retainer handle releasably engaged with the
retainer and operable to apply a transverse force to the retainer
as it is engaged with the arms, the retainer handle being removable
from the retainer after the retainer is engaged with the arms.
[0086] 14. The system of example number 13 wherein the retainer
handle is threadably engageable with the retainer in a first
direction parallel to the motion axis and the screw is threadably
engageable with the retainer in a second direction opposite the
first direction. [0087] 15. The system of example number 27 wherein
the retainer handle and screw are threadably engageable with a
single threaded bore through the retainer. [0088] 16. A system for
fixing first and second bone portions relative to one another, the
system comprising: [0089] a. a retainer; [0090] b. a fastener
engageable with the retainer; [0091] c. a guide comprising: [0092]
i. a handle; [0093] ii. a bone contacting member mounted to the
handle; [0094] iii. a retainer supporting member mounted to the
handle opposite the bone contacting member, the retainer supporting
member having a portion operable to releasably support the retainer
opposite the bone contacting member, the bone contacting member and
retainer supporting member being mounted for translation relative
to one another, the retainer supporting member having a first grip
and a second grip such that pressing the first grip and the handle
toward one another moves the bone contacting member and retainer
supporting member away from one another and pressing the second
grip and the handle toward one another moves the bone contacting
member and retainer supporting member toward one another. [0095]
17. The system of example number 16 wherein the retainer supporting
member engages the handle in a rack and pawl arrangement in which a
pawl is moveable between a first position in which a rack is
moveable longitudinally relative to the pawl in a first rack
direction but is prevented from moving longitudinally relative to
the pawl in a second rack direction opposite the first rack
direction due to engagement of the pawl with the rack, and a second
position in which the rack is moveable in the second rack
direction, the retainer supporting member being resiliently biased
in the first rack direction, the pawl being resiliently biased into
the first position and the pawl including an extension positioned
adjacent the handle such that applying pressure to press the first
grip and the handle toward one another moves the pawl into the
second position allowing the rack to move in the second rack
direction and releasing pressure allows the pawl to be biased to
the pawl first position. [0096] 18. The system of example number 17
wherein the guide is responsive to pressing the first grip and the
handle toward one another to move the pawl into the second position
and move the bone contacting member and retainer supporting member
away from one another to receive a bone portion between the bone
contacting member and retainer supporting member, the guide being
responsive to releasing compression between the first grip and the
handle to bias the bone contacting member and retainer supporting
member toward one another under spring pressure to grip the bone
portion with a first compressive force and bias the pawl into the
first position, the guide being responsive to pressing the second
grip and the handle toward one another to grip the bone portion
with a second compressive force greater than the first compressive
force and maintain the second compressive force by engagement of
the rack and pawl. [0097] 19. A system for fixing first and second
bone portions relative to one another, the system comprising:
[0098] a. a retainer; [0099] b. a screw threadably engageable with
the retainer; [0100] c. a guide having a bone contacting portion,
an opposed retainer supporting portion operable to releasably
retain the retainer opposite the bone contacting portion, the bone
contacting portion and retainer supporting portion defining a
motion axis and being mounted for axial translation parallel to the
motion axis toward and away from one another; the retainer
supporting portion comprising spaced apart arms defining a
perimeter greater than one half a perimeter of the retainer and
being operable to spread apart to receive the retainer as the
retainer is pressed between the arms and spring back to positively
grip the retainer. [0101] 20. The system of example number 21
wherein the retainer and arms engage in torque transmitting
relationship operable to resist rotation of the retainer as the
screw is threadably engaged with the retainer. [0102] 21. The
system of example number 20 wherein the torque transmitting
relationship is defined by features formed on the retainer and the
arms that engage when the retainer is received by the arms by
pressing the retainer in a direction transverse to the motion axis,
the features being operable to self-align as the retainer engages
the arms. [0103] 22. The system of example number 21 further
comprising a retainer handle releasably engaged with the retainer
and operable to apply a transverse force to the retainer as it is
engaged with the arms, the retainer handle being removable from the
retainer after the retainer is engaged with the arms. [0104] 23. A
method of fixing first and second bone portions together, the
method comprising: [0105] a. separating opposing jaws of a clamp
counter to a resilient biasing member; [0106] b. positioning the
jaws adjacent the first and second bone portions; [0107] c.
allowing the resilient biasing member to bias the jaws into
clamping engagement with the first and second bone portions, the
resilient biasing member creating a first clamping pressure between
the jaws and the first and second bone portions; [0108] d. pressing
the jaws together to create a second clamping pressure between the
jaws and the first and second bone portions, the second clamping
pressure being greater than the first clamping pressure; [0109] e.
preventing the jaws from moving apart. [0110] 24. The method of
example number 23 wherein preventing the jaws from moving apart
comprises engaging a pawl with a rack [0111] 25. The method of
example number 23 wherein separating opposing jaws comprises
pressing a first handle and a second handle toward one another,
wherein pressing one of the handles disengages a pawl from a rack
to permit the handles to move toward one another. [0112] 26. The
method of example number 23 further comprising: [0113] a. using the
clamp to guide a drill to form a hole in at least one of the first
and second bone portions; [0114] b. using the clamp to support a
retainer adjacent the bone; and [0115] c. passing a fastener
through the hole and into engagement with the retainer while the
clamp is engaged with the bone portions. [0116] 27. The method of
example number 26 further comprising trimming a portion of the
fastener that extends through the retainer. [0117] 28. The method
of example number 26 further comprising using the clamp to guide a
countersink to countersink the hole. [0118] 29. A method of fixing
first and second bone portions together, the method comprising:
[0119] a. clamping the first and second bone portions together with
a clamp, the clamp supporting a retainer against a surface of the
bone; [0120] b. inserting a fastener through at least one of the
first and second bone portions; [0121] c. engaging the fastener
with the retainer in axial force transmitting relationship; [0122]
d. trimming a portion of the fastener that extends beyond the
retainer; and [0123] e. removing the clamp. [0124] 30. The method
of example number 29 wherein trimming a portion of the fastener is
done after the clamp is removed. [0125] 31. A method of fixing
first and second bone portions together, the method comprising:
[0126] a. clamping the first and second bone portions between first
and second jaws of a bone clamp, the clamp supporting a retainer
against a first surface of at least one of the first and second
bone portions; [0127] b. inserting a compressor through the first
and second bone portions; [0128] c. engaging a first portion of the
compressor with the retainer and a second portion of the compressor
with a second surface of at least one of the first and second bone
portions; and [0129] d. actuating the compressor to move the first
portion of the compressor toward the second portion of the
compressor and compress the first and second bone portions between
the retainer and the second portion of the compressor. [0130] 32.
The method of example number 31 further comprising, after actuating
the compressor, reading indicia associated with the compressor to
determine a fastener length. [0131] 33. The method of example
number 32 further comprising tightening the clamp to maintain the
compression created by the compressor. [0132] 34. The method of
example number 33 further comprising, after tightening the clamp,
disengaging the compressor from the retainer. [0133] 35. The method
of example number 34 further comprising, after disengaging the
compressor, selecting a fastener corresponding to the determined
fastener length, inserting the fastener through the first and
second bone portions, engaging the fastener with the retainer,
tightening the fastener to fix the first and second bone portions
together. [0134] 36. The method of example number 35 further
comprising, before engaging the first portion of the compressor
with the retainer, extending the first portion of the compressor
away from the second portion of the compressor.
[0135] 37. The method of example number 36 wherein extending the
first portion of the compressor away from the second portion of the
compressor comprises actuating a quick release mechanism allowing
the first and second portion of the compressor to move apart under
a resilient biasing force. [0136] 38. The method of example number
37 wherein actuating the compressor to move the first portion of
the compressor toward the second portion of the compressor
comprises rotating a first threaded portion of the compressor
relative to a second threaded portion of the compressor. [0137] 39.
The method of example number 38 further comprising releasing an
anti-rotation lock prior to rotating the first threaded portion of
the compressor relative to a second threaded portion of the
compressor. [0138] 40. A method of fixing first and second bone
portions together, the method comprising: [0139] a. clamping the
first and second bone portions together with a clamp, the clamp
supporting a retainer against a surface of the bone, the clamp
having a first guide member aligned with a first receiver
associated with the retainer, the clamp having a second guide
member aligned with a second receiver associated with the retainer;
[0140] b. guiding a hole forming instrument with the first guide
member to form a first hole through at least one of the first and
second bone portions and aligned with the first receiver; [0141] c.
guiding a hole forming instrument with the second guide member to
form a second hole through at least one of the first and second
bone portions and aligned with the second receiver; [0142] d.
inserting a first fastener through the first hole and into
engagement with the first receiver in axial force transmitting
relationship; [0143] e. inserting a second fastener through the
second hole and into engagement with the second receiver in axial
force transmitting relationship; and [0144] f. removing the clamp.
[0145] 41. The method of example number 40 wherein the clamp has a
first bone contacting portion and a second bone contacting portion,
the first and second bone contacting portions being independently
translatable relative to the bone, each of the first and second
bone contacting portions being independently resiliently biased
into contact with the bone. [0146] 42. The method of example number
41 wherein each of the bone contacting portions has linked to it
indicia indicating a recommended fastener length, the method
further comprising reading the indicia associated with each bone
contacting portion and selecting corresponding first and second
fasteners.
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