WO2003101321A1 - Fixation system with multidirectional stabilization pegs - Google Patents
Fixation system with multidirectional stabilization pegs Download PDFInfo
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- WO2003101321A1 WO2003101321A1 PCT/US2003/015873 US0315873W WO03101321A1 WO 2003101321 A1 WO2003101321 A1 WO 2003101321A1 US 0315873 W US0315873 W US 0315873W WO 03101321 A1 WO03101321 A1 WO 03101321A1
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- WIPO (PCT)
- Prior art keywords
- peg
- fixation system
- fracture fixation
- pegs
- head
- Prior art date
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
- A61B17/8038—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being inserted in the screw head
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/72—Intramedullary pins, nails or other devices
- A61B17/7208—Flexible pins, e.g. ENDER pins
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
- A61B17/8042—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being a cover over the screw head
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1782—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hand or wrist
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
- A61B17/8047—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers wherein the additional element surrounds the screw head in the plate hole
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/8625—Shanks, i.e. parts contacting bone tissue
- A61B17/863—Shanks, i.e. parts contacting bone tissue with thread interrupted or changing its form along shank, other than constant taper
Definitions
- This invention relates broadly to surgical devices. More particularly, this invention relates to a bone fixation system having multidirectional bone fragment support pegs.
- a Colles' fracture is a fracture resulting from compressive forces being placed on the distal radius 10, and which causes backward displacement of the distal fragment 12 and radial deviation of the hand at the wrist 14.
- a Colles' fracture will result in multiple bone fragments 16, 18, 20 which are movable and out of alignment relative to each other. If not properly treated, such fractures result in permanent wrist deformity. It is therefore important to align the fracture and fixate the bones relative to each other so that proper healing may occur.
- Alignment and fixation are typically performed by one of several methods: casting, external fixation, interosseous wiring, and plating.
- Casting is non-invasive, but may not be able to maintain alignment of the fracture where many bone fragments exist. Therefore, as an alternative, external fixators may be used.
- External fixators utilize a method known as ligamentotaxis, which provides distraction forces across the joint and permits the fracture to be aligned based upon the tension placed on the surrounding ligaments.
- ligamentotaxis which provides distraction forces across the joint and permits the fracture to be aligned based upon the tension placed on the surrounding ligaments.
- external fixators can maintain the position of the wrist bones, it may nevertheless be difficult in certain fractures to first provide the bones in proper alignment.
- external fixators are often not suitable for fractures resulting in multiple bone fragments.
- Interosseous wiring is an invasive procedure whereby screws are positioned into the various fragments and the screws are then wired together as bracing. This is a difficult and time consuming procedure. Moreover, unless the bracing is quite complex, the fracture may not be properly stabilized.
- Plating utilizes a stabilizing metal plate typically against the dorsal side of the bones, and a set of parallel pins extending from the plate into the holes drilled in the bone fragments to provide stabilized fixation of the fragments.
- the currently available plate systems fail to provide desirable alignment and stabilization.
- a fracture fixation system which generally includes a plate intended to be positioned against a non-fragmented proximal portion of a fractured bone, a plurality of bone screws for securing the plate along the non-fragmented portion of the bone, and a plurality of bone pegs coupled to the plate and extending therefrom into bone fragments adjacent the non-fragment portion.
- the plate is generally a T- shaped volar plate defining an elongate body, a head portion angled relative to the body, a first side which is intended to contact the bone, and a second side opposite the first side.
- the body portion includes a plurality of countersunk screw holes for the extension of the bone screws therethrough.
- the head portion includes a plurality of threaded peg holes for receiving the pegs therethrough.
- the pegs are angularly adjustable relative to the peg holes and can be independently fixed in selectable orientations; i.e., the pegs are multidirectional.
- the volar plate is positioned with its first side against the volar side of the radius and bone screws are inserted through the bone screw holes into the radius to secure the volar plate to the radius.
- the bone fragments are then aligned and, through the peg holes, holes are drilled into and between the bone fragment at angles chosen by the surgeon.
- the pegs are then inserted into the peg holes and into the drilled holes, and a set screw (or screw cap) is inserted over each peg to lock the peg in the volar plate at the chosen orientation.
- the volar fixation system thereby stabilizes and secures the bone fragments in their proper orientation.
- the various adjustably directable pegs can also be used in conjunction with fracture fixation plates adapted for fractures of other bones, e.g., the proximal and distal humerus, the proximal and distal ulna, the proximal and distal tibia, and the proximal and distal femur.
- Fig. 1 is an illustration of an extremity subject to a Colles' fracture
- Fig. 2 is a top volar view of a right hand volar fixation system according to a first embodiment of the invention
- Fig. 3 is a side view of a volar plate according to the first embodiment of the volar fixation system of the invention
- Fig. 4 is a section view of the head portion of the volar fixation system according to the invention.
- Fig. 5 is a proximal perspective view of a bone peg according to an embodiment of the invention.
- Figs. 6 and 7 are proximal and distal perspective views, respectively, of a set screw according to the a first embodiment of the invention
- Fig. 8 is a broken section view of a first embodiment of a directable peg assembly for a fracture fixation system according to the invention
- Fig. 9 is a broken perspective view of a peg and set screw according to the first embodiment of the directable peg assembly of the invention.
- Fig. 10 is an illustration of the first embodiment of the volar fixation system provided in situ aligning and stabilizing a Colles' fracture;
- Fig. 11 is a broken section view of a second embodiment of a directable peg assembly for a fracture fixation system according to the invention.
- Fig. 12 is a broken perspective view of a peg and set screw according to the second embodiment of the directable peg assembly for a fracture fixation system according to the invention.
- Fig. 13 is a broken section view of a third embodiment of a directable peg assembly for a fracture fixation system according to the invention.
- Fig. 14 is a broken perspective view of a peg and set screw according to the third embodiment of a directable peg assembly for a fracture fixation system according to the invention.
- Fig. 15 is a broken section view of a fourth embodiment of a directable peg assembly for a fracture fixation system according to the invention.
- Fig. 16 is a broken perspective view of a peg and set screw according to the fourth embodiment of a directable peg assembly for a fracture fixation system according to the invention.
- Fig. 17 is a broken section view of a fifth embodiment of a directable peg assembly for a fracture fixation system according to the invention
- Fig. 18 is a broken perspective view of a peg and set screw according to the fifth embodiment of a directable peg assembly for a fracture fixation system according to the invention
- Fig. 19 is a broken section view of a sixth embodiment of a directable peg assembly for a fracture fixation system according to the invention.
- Fig. 20 is a broken perspective view of a peg and set screw according to the sixth embodiment of a directable peg assembly for a fracture fixation system according to the invention.
- Fig. 21 is a broken section view of a seventh embodiment of directable peg assembly for a fracture fixation system according to the invention.
- Fig. 22 is a broken perspective view of a peg and set screw according to the seventh embodiment of a directable peg assembly of the invention.
- Fig. 23 is a broken section view of an eighth embodiment of directable peg assembly for a fracture fixation system according to the invention.
- Fig. 24 is a broken exploded perspective view of a peg and set screw according to the eighth embodiment of a directable peg assembly of the invention.
- Fig. 25 is a broken section view of a ninth embodiment of directable peg assembly for a fracture fixation system according to the invention, shown with a driver for the peg;
- Fig. 26 is a broken perspective view of a peg, set screw and driver according to the ninth embodiment of a directable peg assembly of the invention.
- Fig. 27 is a broken section view of a tenth embodiment of a directable peg assembly for a fracture fixation system according to the invention.
- Fig. 28 is a top view a set screw extending through a slot in a cap according to the tenth embodiment of the invention.
- a first embodiment of a fracture fixation system 100 is particularly adapted for aligning and stabilizing multiple bone fragments in a Colles' fracture.
- the system 100 generally includes a substantially rigid T-shaped plate 102 intended to be positioned against the volar side of the radial bone, a plurality of preferably self-tapping bone screws 104 for securing the plate 102 along a non-fractured portion of the radial bone, and a plurality of bone pegs 108 which extend from the plate 102 and into bone fragments of a Colles' fracture.
- the T-shaped plate 102 defines a head portion 116, an elongate body portion 118 angled relative to the head portion, a first side 120 which is intended to contact the bone, and a second side 122 opposite the first side.
- the first side 120 at the head portion is preferably planar, as is the first side at the body portion. As the head portion and body portion are angled relative to each other, the first side preferably defines two planar portions.
- the angle 0 between the head portion 116 and the body portion 118 is preferably approximately 23° and bent at a radius of approximately 0.781 inch.
- the distal edge 121 of the head portion 116 is preferably angled proximally toward the medial side at an angle a , e.g. 5°, relative to a line P, which is perpendicular to the body portion.
- the plate 102 preferably has a thickness of approximately 0.1 inch, and is preferably made from a titanium alloy, such as Ti-6A-4V.
- the body portion 118 includes four preferably countersunk screw holes 124, 126, 127, 128 for the extension of the bone screws 104 therethrough.
- One of the screw holes, 128, is preferably generally elliptical (or oval).
- the head portion 116 includes four peg holes 130, preferably closely spaced (e.g., within 0.25 inch of each other) and arranged along a line or a curve, for individually receiving the pegs 108 therethrough.
- each peg can be directed through a range of angles within a respective peg hole and fixed at a desired angle within the range.
- each peg hole 130 in the volar plate 102 includes a cylindrical upper bore 140 provided with threads 146 and a lower portion 148 having a radius of curvature.
- the lower end 154 of each peg hole includes a circumferential bevel 156.
- each peg 108 includes a head 160 and a cylindrical shaft 162.
- the proximal portion 164 of the head 160 includes a cup 167 having an outer radius R 0 substantially corresponding to the radius of the lower portion 148 of the peg holes 130, and a relatively smaller inner radius R; of curvature.
- the head 160 defines preferably approximately 160° of a sphere.
- the shaft 162 includes a slight taper 166 at the intersection with the head 160, and a rounded distal end 168.
- the cylindrical shaft 162 of each peg 108 is first provided with a sphere (not shown) or a hemisphere (not shown) at a proximal end. If a sphere is provided, it is cut to a hemisphere. The hemisphere is then hollowed and further reduced to the 160° shape. Finally, the taper 166 is provided at the intersection.
- the surface 150 of the lower portion 148 of the peg hole 130 and/or the outer surface 152 of the head 160 of the peg 108 is preferably roughened, e.g., by electrical, mechanical, or chemical abrasion, or by the application of a coating or material having a high coefficient of friction.
- each set screw 110 includes a proximal hex socket 170, circumferential threads 172 adapted to engage the threads 146 of the upper bore 140 of the peg hole, and distal substantially hemispherical portion 174 having substantially the same radius of curvature as the inner radius of curvature R ⁇ of the cup 167, and preferably substantially smaller than a radius of the peg holes 130.
- the plate 102 is positioned on the radius 10, and at least one hole is drilled through the elliptical screw hole on the volar plate and into the radius 10. Then, one or more bone screws 104 are inserted through the plate and into the bone. The fractured bones 16, 18, 20 are then adjusted under the plate 102 into their desired stabilized positions, and the bone screws 104 are tightened. Then, through the peg holes 130, the surgeon drills holes into the fracture location for the stabilization pegs 108.
- the holes may be drilled at any angle within a predefined range, and preferably at any angle within a range of 15° relative to an axis normal A N to the lower surface of the head of the volar plate.
- Each hole may be drilled at the same angle or at relatively different angles.
- a peg 108 is inserted therein.
- the bevel 156 at the lower end 154 of the peg hole 130 and the taper 166 on the shaft cooperate to permit the peg to be oriented with greater freedom relative to the axis A N , if required, as interference between the peg hole and peg shaft is thereby reduced.
- one of the set screws 110 is threaded into the upper bore 140 of the peg hole 130.
- the hemispherical portion 174 contacts the head 160 of the peg, seating in the concavity of the cup 167.
- the surface 152 of the head of the peg which may be roughened, is clamped between the set screw 110 and the roughened inner surface 150 of the lower portion of the peg hole 130, thereby securing the peg in the selected orientation.
- the other pegs are similarly positioned and angularly fixed.
- the plate 202 includes threaded peg holes 230 that are generally larger in diameter than the head 260 of the pegs 208 intended for use therethrough. This permits a hole to be drilled through the peg hole 230 at a relatively greater angle than with respect to holes 130.
- the lower end 248 of the peg hole 230 is constricted relative to the upper threaded portion 249.
- the peg 208 includes a spherically-curved head 260, a cylindrical shaft 262, and an optionally constricted neck 266 therebetween.
- the set screw 210 includes a square opening 270 adapted to receive a square driver, threads 246 about its circumference, and a substantially spherically curved socket 274 adapted to receive the head 260 of the peg 208.
- the lower portion of the set screw 210 includes expansion slots 276 which permit the lower portion of the set screw 210 to temporarily deform to receive the head 260 of the peg 208 (which has a diameter greater than the opening
- holes are drilled through the peg holes and into the bone along axes at which it is desired to have pegs extend for stabilization of the fracture fragments.
- the head 260 of the peg 208 is snapped into the opening 278 of the socket 274.
- the shaft 262 of the peg 208 is then inserted into a respective bone hole until the set screw 210 meets the peg hole 230.
- the set screw 210 can be rotated relative to the peg 208, as the socket 274 and spherical head 260 form a ball and socket coupling.
- the set screw 210 is rotatably secured in the peg hole 230 to secure the peg 208 at the desired angle within the drilled hole.
- the plate 302 includes threaded peg holes 330 that preferably have a stepped diameter, with a relatively large countersink portion 380 adapted to receive the head of a set screw 310, a threaded central portion 382, and a relatively smaller lower portion 384.
- the peg 308 includes a substantially spherically-curved head 360 having a central square opening 386 adapted to receive a driver, and a threaded cylindrical shaft 362.
- the set screw 310 includes a head portion 388 having a square opening 370 for also receiving a driver, a threaded portion 390, and a lower spherically-curved socket 374.
- each peg hole 330 and peg 308 a hole is drilled through a respective peg hole and into the bone at the angle at which it is desired to receive a peg for stabilization of the fracture.
- the peg 308 is then positioned within the peg hole 330 and rotatably driven into the bone with a driver (not shown).
- the set screw 310 is threaded into the central portion 390 of the peg hole and urged against the head 360 of the peg 308 to clamp the peg in position.
- the head portion 388 of the set screw 310 preferably at least partially enters the countersink portion 380 of the peg hole to provide a lower profile to the assembly.
- the plate 402 includes threaded peg holes 430 each with a lower portion 448 having a radius of curvature, and a lower end 454 provided with a preferably circumferential bevel 456.
- the peg 408 includes a spherically curved head 460 defining a socket 467 extending in excess of 180°, a cylindrical shaft 462, and an optionally tapered neck 466 therebetween.
- the head 460 about the socket 467 is provided with expansion slots 476.
- the set screw 410 includes an upper portion 488 having a square opening 470 for a driver, and threads 490, and a lower ball portion 474 adapted in size an curvature to snap into the socket 467.
- each peg hole 430 and peg 408 holes are drilled through the peg hole and into the bone at the angles at which it is desired to receive pegs for stabilization of fragments of the fracture.
- the ball portion 474 of the set screw 410 is snapped into the socket 467, with the socket 467 able to expand to accept the ball portion 474 by provision of the expansion slots 476.
- the shaft 462 of the peg 408 is then inserted into a respective bone hole until the set screw 410 meets the peg hole 430. It is appreciated that the set screw 410 can rotate relative to the peg 408, as the ball portion 474 and socket 467 are rotatably coupled to each other. As such, the set screw 410 is then rotatably secured in the peg hole 430 to secure the peg 408 in the bone.
- the head 560 of the peg 508 includes two sets of pin slots 594a, 594b defining two planes Pj and P 2 oriented transverse to each other.
- the head 560 includes radial expansion slots 576.
- the ball portion 574 of the set screw 510 includes two pins 598a, 598b extending through a center thereof and oriented transverse to each other.
- the ball portion 574 is snapped into the socket 567 defined by the head 560 of the peg 508, and pins 598a, 598b are positioned through the pin slots 594a, 594b to rotatably lock the peg and set screw together, yet permit the peg 508 to articulate relative to the set screw 510.
- the fifth embodiment is suitable for rotatably inserting threaded pegs 508 into a bone hole via rotation of the set screw 510, and may be used in a similar manner to the fourth embodiment.
- the assembly includes a peg 608 having a substantially spherically curved head 660 provided with four nubs 680 (two shown) arranged in 90° intervals about the periphery of the head 660.
- the set screw 610 includes lower walls 682 defining a socket 674 for the head 660.
- the walls 682 define slots 684 through which the nubs 680 can move.
- the assembly of the peg 608 with its set screw 610 functions substantially similar to a universal joint.
- the peg 608 is then inserted through a respective peg hole 630 and into a drilled hole in a bone until threads 690 on the set screw 610 engage mating threads 692 in the peg hole.
- the set screw 610 is then rotated, which causes rotation of the peg 608 within the drilled hole.
- the peg 608 is secured in the bone.
- the peg holes 730 in the plate 702 each include a threaded cylindrical upper portion 746 and a spherically-curved lower portion 748 having a smaller hole diameter than the upper portion.
- Each peg 708 has a head 760 with a lower relatively larger spherically curved portion 762 and an upper relatively smaller spherically curved portion 764, and a shaft 766.
- the lower curved portion 762 preferably spherically curves through substantially 150°, while the upper curved portion 764 preferably spherically curves through substantially 210°.
- the peg shaft is optionally provided with threads 769, and when so provided, the lower curved portion 762 of the peg is provided with driver notches 768.
- the set screw 710 includes an upper portion 788 having a slot 770 or other structure for engagement by a driver, threads 790, and a lower socket 792.
- each peg 708 a hole is drilled through a respective peg hole into the bone at an orientation desirable for receiving that particular peg for stabilization of the fracture.
- a peg 708 is then inserted through the peg hole 730 and into the drilled hole until the curved lower surface 762 of the head 760 of the peg seats against the curved lower portion 748 of the peg hole.
- a driver (not shown) may be coupled to the peg 708 at the notches 768 to rotationally drive the peg into the drilled hole.
- the set screw 710 is then threaded into the peg hole 730 until the socket 792 extends over the upper portion 764 of the head 760 of the peg and presses thereagainst to force the lower portion 762 of the head against spherically-curved lower portion 748 of the peg hole 730 to clamp the peg 708 in position.
- the socket 792 of the set screw 710 does not necessarily capture (i.e., extend more than 180° about) any portion of the head 760 of the peg 708.
- the socket 792 may be modified to enable such capture.
- the peg holes 830 of the plate each include a spherically-curved portion 848 preferably having a roughened relatively high friction surface.
- Each peg 808 has a substantially spherically-curved head 860 provided with a preferably roughened outer surface 861, an upper threaded axial bore 863, and wall 899 defined between the outer surface 861 and the bore 863, and a plurality of radial slots 865 within the wall 899.
- the set screw 810 includes an upper slot 870 adapted to receive a driver and tapered threads 890.
- each peg 808 a hole is drilled through a respective peg hole into the bone at an orientation desirable for receiving that particular peg for stabilization of the fracture.
- a peg 808 is then inserted through the peg hole 830 and into the drilled hole.
- the set screw 810 in threadably inserted into the bore 863.
- the set screw 810 has a diameter slightly larger than the bore 863.
- the head 860 of the peg 808 is enlarged at the slots 865 to accommodate the screw 810, and the high friction surfaces 861, 848 are forced against each other thereby locking the peg 808 in the peg hole 830 at its chosen axial orientation.
- a ninth embodiment of a directable peg assembly for a fracture fixation plate is shown.
- the peg holes 930 and threaded pegs 908 are substantially similar to the peg holes 330 and pegs 308 of the third embodiment (Figs. 13 and 14). It is noted that the lower end of the peg hole 930 has a lower curving taper 931.
- the set screw 910 includes a central hole 969, an upper slot 970 extending across the hole 969, helical threads 990, a lower socket 992, and a plurality of compression slots 994 about the socket.
- each peg 908 a hole is drilled through a respective peg hole 930 into the bone at an orientation desirable for receiving that particular peg for stabilization of the fracture.
- a driver 1000 having a shaft 1001 provided with a distalmost square end 1002 and relatively proximal flanges 1004 is then used for the assembly.
- the threaded peg 908 is positioned at the entry of the bone hole, and the set screw 910 is positioned thereover, with the socket 992 of the set screw resting on the head 960 of the peg.
- the square end 1002 of the driver is then inserted through the hole 969 and into a square opening 986 at the head 960 of the peg, and the flanges 1004 of the driver 1000 are inserted into the upper slot 970.
- the driver 1000 is rotated to threadably insert the peg 908 into the bone hole.
- the set screw 910 meets the peg hole 930, it is also threaded therein with the driver, and when a lower portion 911 of the set screw contacts the curving taper 931 of the peg hole, the set screw is compressed about the compression slots 994 to secure the peg 908 in position.
- the peg holes 1130 in the volar plate are substantially similar to the peg holes 830 (Fig. 23) of the eighth embodiment in that the peg holes each include a spherically-curved portion 1148 without any threaded portion.
- the pegs 1108 include a shaft 1166 and a head portion 1160.
- the head portion 1160 includes a flat upper surface 1200 that defines a plane oblique relative to the axis A s of the shaft 1166 and an axial threaded screw hole 1202.
- a cap element 1204 includes a flat angled lower surface 1206 and when positioned against the head portion 1160 of the peg 1108 defines a complementary shape therewith such that the head portion 1160 and the cap 1204 substantially correspond to a spherical shape with upper and lower truncations.
- the cap 1204 also includes a narrow slot 1208 which extends transverse to the peg axis A s .
- a screw 1210 is also provided and has a shaft 1212 dimensioned to extend through the slot 1208 and thread into the screw hole 1202 of the head portion 1160 of the peg 1108, and a head 1214 which is larger than a transverse dimension of the slot 1208 in the cap 1204.
- the cap 1204 and head portion 1160 are forced axially together.
- the surfaces translate a portion of that force laterally and cause the shape defined by the head portion 1160 and the cap 1204 to effectively increase in diameter along the direction of the lateral force to lock the peg 1108 in the peg hole 1130.
- the head of a peg is clamped between a portion of the fixation plate and a set screw, preferably with the head of the peg and fixation plate thereabout being treated to have, or having as material properties, high friction surfaces.
- a set screw preferably with the head of the peg and fixation plate thereabout being treated to have, or having as material properties, high friction surfaces.
- peg holes and bone pegs may be used, preferably such that at least two pegs angled in two dimensions relative to each other are provided.
- a right-handed volar plate is described with respect to an embodiment of the invention, it will be appreciated that right- or left-handed model, with such alternate models being mirror images of the models described.
- the pegs may be directed through a range of 15°, the peg holes and pegs may be modified to permit a greater, e.g. up to 30°, or smaller, e.g. 5°, range of such angular direction.
Abstract
Description
Claims
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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AU2003239525A AU2003239525A1 (en) | 2002-05-30 | 2003-05-19 | Fixation system with multidirectional stabilization pegs |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US10/159,612 | 2002-05-30 | ||
US10/159,612 US6767351B2 (en) | 2000-02-01 | 2002-05-30 | Fixation system with multidirectional stabilization pegs |
Publications (1)
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WO2003101321A1 true WO2003101321A1 (en) | 2003-12-11 |
Family
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PCT/US2003/015873 WO2003101321A1 (en) | 2002-05-30 | 2003-05-19 | Fixation system with multidirectional stabilization pegs |
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US (5) | US6767351B2 (en) |
AU (1) | AU2003239525A1 (en) |
WO (1) | WO2003101321A1 (en) |
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US7794482B2 (en) | 2001-12-24 | 2010-09-14 | Synthes Usa, Llc | Device for osteosynthesis |
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US10499964B2 (en) | 2010-03-08 | 2019-12-10 | Biedermann Technologies Gmbh & Co. Kg | Locking element for a polyaxial bone anchor, bone plate assembly and tool |
US11547458B2 (en) | 2010-03-08 | 2023-01-10 | Biedermann Technologies Gmbh & Co. Kg | Locking element for a polyaxial bone anchor, bone plate assembly and tool |
US11925396B2 (en) | 2010-03-08 | 2024-03-12 | Biedermann Technologies Gmbh & Co. Kg | Locking element for a polyaxial bone anchor, bone plate assembly and tool |
Also Published As
Publication number | Publication date |
---|---|
US20020143338A1 (en) | 2002-10-03 |
US20040260294A1 (en) | 2004-12-23 |
US6767351B2 (en) | 2004-07-27 |
US20040260295A1 (en) | 2004-12-23 |
US20040260293A1 (en) | 2004-12-23 |
US7780711B2 (en) | 2010-08-24 |
AU2003239525A1 (en) | 2003-12-19 |
US20040260292A1 (en) | 2004-12-23 |
US7527639B2 (en) | 2009-05-05 |
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