WO2013105906A1

WO2013105906A1 - A bone and joint fixing system

Info

Publication number: WO2013105906A1
Application number: PCT/TH2012/000001
Authority: WO
Inventors: Sunton Wongsiri
Original assignee: Sunton Wongsiri
Priority date: 2012-01-13
Filing date: 2012-01-13
Publication date: 2013-07-18

Abstract

A bone and joint fixing system comprising of: an internal joint fixator omprising at least one rotating means attached to an extended element and a variable attaching element, wherein said extended element provides a connection between said rotating means and said variable attached element. Said bone and joint fixing system may further comprise a tension-plate system. Said bone and joint fixing system may further comprise a dual locking system.

Description

A bone and joint fixing system

BACKGROUND OF THE INVENTION

The invention relates to a specialized instrument used during a surgical procedure of bone and joint in order to assist the motion of joints and to increase the stability of a bone fixation system.

Generally, it is preferred to use a hinge external fixator in the surgery of fracture

dislocations around the joint which allows the joint movement in order to decrease stiffness during and after surgery. For example, in a complex elbow fracture, all the fractures need to be fixed with a locking plate member, and then a hinge external fixator must be added to maintain stability and to gain early range of motion. However, the problems of stability still persist because of the devices of the said locking plate member, and the said hinge external fixator breaking and loosening.

Moreover, such devices do not present only a stability problem but also the problems related to stiffness and discomfort from having the large external fixator passing through the organs or body. Until now such devices are the only available choice for the treatment of complex elbow fractures. Therefore, the risks of said problems still exist.

In the case of a large coronoid fracture, the stability of the joint must derive from

reconstructing the stability of the coronoid which is difficult to accomplish in a load bearing joint. In the loading mechanic feature, the fracture line of the coronoid is perpendicular to the joint line which means that the shearing and distraction forces will make the fracture displaced easily, even where an initial complete stable fixation exists. According to the recent coronoid fixation, the screw fixation alone is not stable enough to allow the elbow motion. Although the plate fixation may be the alternative to provide a stronger joint for loading, in the case of comminuted and unstable fractures, the simple plate fixation is not strong enough for stable movement because of shearing and distraction forces.

In this invention, "the bone and joint fixing system for early joint motion and stabilization" is invented in order to improve the stability of bone fixation that aims to solve the above-stated problems. This invention consists of an internal joint fixator which increases the stable movement; a tension-plate system which provides resistance to the shearing and distraction forces that cause the noted hardware failures; a dual locking system which creates higher stability from two plates; and an internal joint fixator template which provide the guidance for the direction of fixation. SUMMARY OF THE INVENTION

This invention relates to the bone and joint fixing system for early joint motion and stabilization which is used to improve the stable joint movement and stability of bone fixation. The system according to this invention is applicable to the surgical procedure of fracture, dislocation, subluxation or the related injuries thereof.

References

CHEUNG, E., ODRISCOLL, S., & MORREY, B. (2008a). Complications of hinged external fixators of the elbow. Journal of Shoulder and Elbow Surgery, 17(3), 447-453.

doi: 10.1016/j.jse.2007.10.006

DUCKWORTH, A., KULIJDIAN, A., MCKEE, M., & RING, D. (2008). Residual subluxation of the elbow after dislocation or fracture-dislocation: Treatment with active elbow exercises and avoidance of varus stress. Journal of Shoulder and Elbow Surgery, 17(2), 276-280. doi: 10.1016/j.jse.2007.06.006

MD, N. C. C, & MD, A. J. (2010). Hinged External Fixation of the Elbow. Hand Clinics,

26(3), 423-433. Elsevier Ltd. doi: 10.1016/j.hcl.2010.04.004

Morrey, B. F. (2009). Current concepts in the management of complex elbow trauma. The Surgeon, 7(3), 151-161. Royal College of Surgeons of Edinburgh and Royal College of Surgeons in Ireland. doi: 10.1016/S1479-666X(09)80039-5

PAP ANDREA, R., MORREY, B., & ODRISCOLL, S. (2007a). Reconstruction for persistent instability of the elbow after coronoid fracture-dislocation. Journal of Shoulder and Elbow Surgery, 16(1), 68-77. doi: 10.1016/j.jse.2006.03.01 1

RING, D. (2004). Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbowl , * 1. The Journal of Hand Surgery, 29(3), 470-480. doi: 10.1016/j.jhsa.2004.01.005

SEKIYA, H., NEALE, P., ODRISCOLL, S., AN, K., & MORREY, B. (2005). An in vitro biomechanical study of a hinged external fixator applied to an unstable elbow. Journal of Shoulder and Elbow Surgery, 14(4), 429-432. doi: 10.1016/j.jse.2004.09.012

Wong, A. S., & Baratz, M. E. (2009). Elbow Fractures: Distal Humerus. YJHSU, 34(1), 176-190. Elsevier Inc. doi.T0.1016/j.jhsa.2008.10.023 BRIEF DESCRIPTION OF THE DRAWINGS

FIG. la illustrates the components of the bone and joint fixing system, showing the anatomic like motion-system, the tension-plate system, the dual locking system and the tension adjustment system.

FIG. lb illustrates a sectional view of the locking system of adjustable means, which shows the securing of the adjustable mean.

FIG. lc illustrates a sectional view of the locking system of adjustable means, which shows the securing of the adjustable mean.

FIG. 2a illustrates the three components of the circular hinge system, showing the rotating means, the variable attaching element and the extended element.

FIG. 2b illustrates the non-circular hinge system, showing the non-circular hinge and the non-circular rotational rings; the curve adjuster and the external rotation adjuster.

FIG. 2c illustrate sectional views of the rotating means comprises of the rotating ring and the motion control screw.

FIG. 2d illustrate sectional views of the embedded elongation systems.

FIG. 3a illustrates the ligament washer to use for fixation the ligament to bone.

FIG. 3b illustrate views of the limited motion rings.

FIG. 3c illustrate views of the limited motion caps.

FIG. 4a illustrates the triangular shape of the extended element.

FIG. 4b illustrates the standard plate shape of the extended element.

FIG. 4c illustrates the adjustable mean shape of the extended element.

FIG. 4d illustrates the flexible mean shape of the extended element.

FIG. 4e illustrates the extended element bender for adjusting the shape of the adjustable mean shape of the extended element.

FIG. 4f illustrate sectional views of the plate attachment screws.

FIG. 5a illustrate the joint subluxation and the joint reduction by using the internal joint fixator.

FIG. 5b illustrate the different uses of the rotating means; the embedded elongating screw and the threadless embedded elongating screw.

FIG. 5c illustrate the use of the rotating means; the extended angle element. FIG. 5d illustrate the different sizes of the triangular shape of the extended element. FIG. 5e illustrates the use of the triangular shape of the extended element.

FIG. 5f illustrates the use of the adjustable mean shape of the extended element.

FIG. 5g illustrates the use of the standard plate shape of the extended element.

FIG. 5h illustrates the use of the flexible shape of the extended element.

FIG. 6a illustrates views of the tension-plate system and the tension adjustment system. FIG. 6b illustrate views of the wire locking screw system.

FIG. 6c illustrates views of the quick locking system.

FIG. 6d illustrates views of the twisted wire system.

FIG. 7 a illustrate the different types of tension wires.

FIG. 7b illustrates the use of the tension adjustment system to lock the wire by the wire catcher.

FIG. 7c illustrates the use of the tension adjustment system to increase tension by grip the tension element.

FIG. 7d illustrates using of the tension adjustment system to secure the wire with the wire locking screw system by squeeze the quick screwing trigger.

FIG. 7e illustrates using of the tension-plate system in a knee joint.

FIG. 8a illustrates using of the dual locking on the double plates system.

FIG. 8b illustrates using of the proximal locking part and the distal locking part.

FIG. 8c illustrates using of dual locking on the double plates system in an elbow joint.

FIG. 8d illustrates using of dual locking on the double plates system in a knee joint.

FIG. 9a illustrates a view of the proximal guide template.

FIG. 9b illustrates views of the proximal guide template and the distal guide template. FIG. 9c illustrates views of the screw placement template.

FIG. 9d illustrates a view of the screw template of the reduction guide.

FIG. 9e illustrates a view of the sizing template.

COMPLETE DISCLOSERSURE OF INVENTION

For the purposes of explaining the principle of the invention, the illustrations show the samples of the various shapes. However, the illustrated figures are not the limitations in the scope of the invention and its methods of use, including all modifications and additions within the scope of the principle according to the invention.

The anatomical movements of human joints exhibit various differences in their

characteristics, such as the elbow, wrist, shoulder and knee. For the elbow, the major movements involve ligaments and bone which have articulation shaped like a circle that allows the movement in a circular motion with the center of rotation in the humeral bone. A fracture or dislocation around the elbow may affect the loss of this normal circular motion and potentially cause traumatic arthritis. This invention is uniquely designed in order to provide the assistance to any joint to function close to or similar to the normal anatomical motion. The invention shows the assisted system of the motions for instance the motion of elbow and knee without any limitation of use.

Person with skill in the art also can apply the same principle of this invention with any joints which is still within the scope of the invention. By referring to the drawings, particularly to FIG. la, the bone and joint fixing system comprises of the internal joint fixator (10), the dual locking system (30), and the tension-plate system (20) that has the tension adjustment system (50) for assisting of setting tension. The internal joint fixator (10) provides the motions which are similar to normal human anatomical movement. For instance, in the case of the elbow, the hinge motion of the system is designed to allow the motion at the center of elbow motion. The said internal joint fixator (10) consists of the rotating means (100), the variable attaching element (120) and the extended element (130). The tension-plate system (20) creates normal tension by the tension wire (21) attached to the holes of two plates i.e. a proximal bone plate (341) and a distal bone plate (342), which holds the fractured fragments and can resist to the distraction force. The dual locking system (30) comprises of the dual locking screws (31) used for securing the two plates i.e. a proximal bone plate (341) and a distal bone plate (342), which are held together in one unit from two fixations. The said dual locking system (30) provides the stronger fixation system and the resistance to the loading force. The tension adjustment system (50) is a device designed to create tension force and to secure locking. In FIG. lb, the variable attaching element (120) secure to the bottom plate (122) by plate attachment screws. The variable attaching element (120) can be connected to the one end of the said extended element (130) by fusing in one unit. In FIG. lc, the extended element (130) can be connected to the variable attaching element (120) with the locking means of connecting system (1305). The locking means of connecting system (1305) comprises of the one end of the said extended element (130), an opening portion (186) for insertion of the one end of the said extended element (130) and the locking system of opening plate (184) for holding and securing. In FIG. lc, the said locking means of connecting system (1305) consists of the opening portion (186) for inserting the extended element of adjustable mean (1303), the opening slot (181), the two opening plates (185) for increasing room of the opening portion (186), and the locking system of opening plate (184). The said locking means of connecting system (1305) further comprises of the rough surface of extended element (182) and the rough surface of tube (183) for holding strength.

Human joints have difference motion patterns, for example, a circular motion of an elbow joint as shown in FIG. 2a and a non-circular motion of a knee joint, as shown in FIG. 2b. In a case of circular motion the movement of elbow in a natural anatomical fashion is assisted by the internal joint fixator (10) that allows the center of the elbow joint to move in the same spot as the hinge joint at the rotating means (100) as shown in FIG. 2a. In a case of the non-circular motion, the non- circular hinge system (106) is used to allow the motion in the joint as shown in FIG. 2b. The non- circular hinge system (106) comprises of the non-circular hinge (1061) and the non-circular rotational rings (1064); the curve adjuster (1062) and the external rotation adjuster (1063) in order to allow non-concentric motion, to create translation movement and to create the external rotation movement, respectively.

The said rotating means (100) has variety motion features. In the basic of circular motion, the said rotating means (100) comprises of the rotating ring (101) and the motion control screw (102) as shown in FIG. 2c. The said rotating ring (101) has at least two layers rotate on each other as shown in FIG. 2c. In order to reduce the center displacement, the embedded elongation system (107) of the rotating means (100) can be embedded in a bone, as shown in FIG. 2d. The embedded elongation system (107) may use the embedded elongating screw (1072) in order to allow the motion at the neck of the screw or may use the threadless embedded elongating screw (1070) combined with the long locking tube (1071) or the short locking tube (1073) to allow the said motion.

In addition, a ligament washer (141) can be use to hold ligament (145) to bone for further ligament healing process as shown in FIG. 3a and the motion of the hinge can be adjusted based on the desired degree of motion by using the limited motion rings (103) or the limited motion cap (109) as shown in FIG. 3b and FIG. 3c. In FIG. 3b, the limited motion rings (103) provides the wide range of degrees which can be selected, such as the 120 degrees of motion (1031), the 90 degrees of motion (1032) and the 30 degrees of motion (1033). In FIG. 3b, the limited motion cap (109) also provides the wide range of degrees which can be selected, such as the 120 degrees of motion (1099), the 90 degrees of motion (1098) and the 30 degrees of motion (1097).

In FIGs. 4a, 4b, 4c and 4d the illustrations show the different shapes of the extended element (130). In FIG. 4a, the extended elements of triangular shape (1301) comprises of two side extended elements that create greater stability of fixation during motion. In FIG. 4b, the extended element of standard plate (1302) consists of one extended element which is compatible to the standard plate. In FIG. 4c, the extended element of adjustable mean (1303) can be adjusted in various directions and shapes by using the extended element bender (1304). In FIG. 4c and FIG. lc, the said extended element of adjustable means (1303) can be secured by the locking means of connecting system (1305). In FIG. 4d, the extended element of flexible mean (1306) has flexibility and adaptation which similar to the feature of the collateral ligament structures of the joint. The extended element of flexible mean (1306) composes of a tension member (1308) for holding tension like the ligament and a tension securing screw for securing the said tension member (1308) to plates or bone.

Lastly, the variable attaching element (120) is a system which secures the internal joint fixator (10) to a bone, with various kinds of a plate attachment screw (13) as shown in FIG. 4b. The plate-plate screw (131) is used to secure between a top attachment plate (121) and a bottom plate (122). The plate-screw screw (132) is used to secure the top attachment plate (121) and the screw of the bottom plate (139). The plate-bone screw (133) is used to secure the top attachment plate (121) to the bone (70).

In case of joint subluxation, the reduction can be retained with the minimal equipments of the internal joint fixator (10) as shown in FIG. 5a. In FIG. 5a, the internal joint fixator (10) is used to reduce subluxation by securing the rotating means (100) to the center of rotation of the joint (701) for motion and to secure the variable attaching element (120) to the bone (70) for fixation. In FIG. 5b, the rotating means (100) is moveably connected to the extended element (130) with the threadless embedded elongating screw (1070) or the embedded elongating screw (1072). In FIG. 5c, the rotating means (100) is non-moveably connected to the extended element (130) with the extended angle element (1075). The internal joint fixator (10) can be selected in many embedded types of the rotating means (100), as shown in FIGs. 5b and 5c. In FIG. 5b, the rotating means (100) is an embedded elongating screw (1072) for motion at neck of the said embedded elongating screw (1072) or the threadless embedded elongating screw (1070) with the long locking tube (1071) or the short locking tube (1073) for motion at body of the said threadless embedded elongating screw 1070. In FIG. 5c, the extended angle element (1075) is the rotating mean (100) that is fused to the extended element (130) for improve the strength of connection. Mover, the sizes and shapes of the said internal joint fixator (10) can be selected for a proper use as shown in FIG. 5d and FIGs. 5e, 5f, 5g and 5h, respectively.

In FIG. 6a, the tension-plate system (20) is a system used to create an anti-distraction force to reduce the fracture gap and the fracture displacement. The anti-distraction force is created by the tension wire (21) which is fixed between two plates i.e. a proximal bone plate (341) and a distal bone plate (342). Then, the anti-distraction force is set tension by the tension adjustment system (50) as show in FIG. 6a. The tension wire (21) can be fixed by the wire plate locking screw system (23) as show in FIG. 6a and FIG. 6b, a quick locking system (28) as show in FIG. 6c and a twisted wire system (29) as show in FIG. 6d. In FIG. 6b, the wire plate locking screw system (23) comprises of the wire-locking portion (1351) for wire holding, the locking head with outer thread (1352) for plate holding, the driver part (1353) for screw driver insertion and the inner tube of screw ( 1354) for insertion the tension wire (21) inside. In FIG. 6c, the quick locking system (28) comprises of the quick locking means (281) for wire holding, the quick locking head with outer thread (282) for plate holding, the quick driver part (283) for screw driver insertion, the quick inner tread of locking hole (285) for screw holding and the quick locking hole (284) for insertion the tension wire inside. In FIG. 7a, the tension wire (21) can be selected from difference shape of wires, the regular headless wire (214), the rotatable head threadless wire (21 1), the locking head wire (216) and the anti-rotated head wire (217).

The steps of using the tension adjustment system (50) comprises of the insertion of the tension wire inside as shown in FIG. 6a, locking the tension wire by the wire catcher (59) as shown in FIG. 7b, squeezing the tension element (58) for increasing the tension as shown in FIG. 7c, and squeezing the quick fastener (56) for securing the tension wire with the wire plate locking screw system (23) as shown in FIG. 7d or the quick locking system (28) as shown in FIG. 7d. The tension- plate system (20) can be used in any part of bone fixation with the principle of using tension-plate system (20) such as in elbow as shown in FIG. 6a and in knee as shown in FIG.7e.

The dual locking system (30) is a system used to create stability between two plates i.e. a proximal bone plate (341) and a distal bone plate (342), by locking both ends of the screw as shown in FIG. 8a. In FIG. 8a, the dual locking system (30) can receive the loading force that occurs on the broken bone. Then, loading force is transfered to two plates i.e. a proximal bone plate (341) and a distal bone plate (342), and bone (70) for increasing the broken bone stability. In FIG. 8b, the distal locking system (312) can be secured by using the locking nut (3121) to hold the screw into the plate locking hole. In case of direct distal locking without the locking nut (3121), the end of the dual locking screw (31) is secured to the bottom reverse locking hole (314), which has an internal thread at the bottom which matches the outer thread of the dual locking screw (31) as shown in FIG. 8b. The dual locking system (30) can be used in any bones and joints such as the knee, elbow or wrist in order to increase the stability of fixation, as shown in FIGs. 8c and 8d. The drill jig (33) is an additional tool to guide the direction of screw insertion.

In FIGs. 9a and 9b, the center guiding system (40) is a tool to guide the direction of center motion and screw placement. The center guiding system (40) comprises of the proximal guide means (440) to guide the center of rotation of the joint (701) as shown in FIG. 9a, the distal guide means (443) to guide the center at the distal part as shown in FIG. 9b and the screw guide template (441) to guide the screw landmark as shown in FIG. 9c. The proximal guide means (440) contains the articular surface grasper (4401), the center entry portion (4402), the system connector (4404) and the proximal plate guide element (4403), as shown in FIG. 9a. The articular surface grasper (4401) can be use to match and hold the condyle. The articular surface grasper (4401) are made flexible for matching then the center entry portion (4402) will locate the center of rotation of the joint (701). In FIGs. 9a and 9b, the system connector (4404) is an attachable part to connect the distal guide means (443) to the proximal guide means (440). The center entry portion (4402) is used to find the center of rotation of the joint (701) and allows insert pin. In FIG. 9a, the proximal plate guide element (4403) is the extended element of the proximal guide means (440) that are used to guide the direction of plate placement and to guide the drilling direction with the guiding screw hole 447. In FIG. 9b, the distal guide means (443) is the distal guide which attaches to the proximal guide means (440) via the attachment slot (4433). The distal guide means (443) is composed of the distal condylar matcher (4435), the body of the distal guide (4434), the attachment slot (4433), the aimer handle (4432) and the distal aimer (4431). The distal condylar matcher (4435) has a shape like a circle ring that matches to the shape of distal circle condyle. The body of distal guide (4434) is the body that connects the distal condylar matcher (4435) to the distal aimer (4431) that guides the distal center point. In FIG. 9c, the screw guide template (441) is comprises of the adjustable condyle shape (4415) for matching the condyle space and the distal plate guide element (4416) with the guiding screw hole (447) for guiding the screw placement. The adjustable condyle shape (4415) can be adjusted to various sizes by turning the adjustable ring (4414).

In FIGs. 9d and 9e, the reduction system (48) is comprises of the reduction template (481) for reduction the joint and the sizing template (485) for matching the size of the extended element (130). In FIG. 9d, the center guide element (4812) is inserted in the hole of center rotation of the joint (701) then the reduction template (481) is placed on the bone. Temporary pins are inserted in the adjustment pining hole (481 1) and then the guiding screw holes (447) are used to guide the drilling direction. After removing the reduction template (481), the sizing template (485) is placed in the same position by using screws fixed in the guiding screw hole (447). The sizing marker (4851) will show the proper size of the internal fixator (10).

For method of using the bone and joint fixing system (1), surgeons may select any means of the said bone and joint fixing system 1 including the use of at least internal joint fixator (10), or the tension plate system (20) or the dual locking system (30), or the combination thereof, for holding broken bone pieces or preventing joints displacement.

This invention can be further explained by the following examples.

Example 1 : Use of the internal joint fixator (10) for preventing joint displacement. The said internal joint fixator (10) can be use in the case of fracture with dislocation, dislocation alone or subluxation. The steps of using the said internal joint fixator (10) comprises of:

selecting the rotating means (100), the variable attaching element (120) and the extended element (130) to match with requirement;

- inserting the guide pin (4436) to the center of rotation of the joint (701);

inserting the selected the internal joint fixator (10); and

securing the internal joint fixator (10) to at least one bone or plate using fasteners.

Example 2: Use of the tension-plate system (20) for holding broken bone pieces. The said tension-plate system (20) can be used in the case of fractures or the fractures with dislocation which may need the said internal joint fixator (10) in addition. The steps of using the said tension-plate system (20) comprises of:

selecting the tension wire (21) for proper using;

inserting the tension wire (21) in the bone tunnel and at least one plate hole; - using the tension adjustment system (50) to set a proper tension of the tension wire (21); and securing the tension wire (21) to the locking hole 601 1.

Example 3: Use of the dual locking system (30) for holding broken bone pieces. The said dual locking system (30) can be used in the case of fractures or the fractures with dislocation. It can be use together with the internal joint fixator (10). The steps of using the said dual locking system (30) comprises of:

using the drill jig (33) to create tunnel between two plate holes;

- inserting the dual locking screw (31) in the tunnel between two plate holes;

using the proximal locking system (32) to secure the dual locking screw (3 1) attach to the proximal bone plate (341); and

- using the distal locking system (312) to secure the dual locking screw (31) attached to the distal bone plate (342).

Claims

1. A bone and joint fixing system wherein the said system comprises of:

an internal joint fixator 10 wherein the said internal joint fixator 10 comprises of at least one rotating means 100 attached to an extended element 130 and a variable attaching element 120 wherein the said extended element 130 provides a connection between the said rotating means 100 and the said variable attached element 120.

2. A bone and joint fixing system according to claim 1 wherein the said system further comprises of a tension-plate system 20.

3. A bone and joint fixing system according to claim 1 or 2 wherein the said system further comprises of a dual locking system 30.

4. A bone and joint fixing system according to any claim of claims 1 to 3 wherein the variable attaching element 120 additionally comprises of a locking means of a connecting system 1305 wherein the said locking means of the connecting system 1305 comprises of a receiving part of the said extended element 130 , an opening portion 186 for insertion of the said extended element 130 and the said locking system of an opening plate 184 for securing the said variable attaching element 120 with the said extended element 130.

5. A bone and joint fixing system according to any claim of claims 1 to 4 wherein the said rotating means 100 comprises of at least one rotating part in the bone.

6. A bone and joint fixing system according to any claim of claims 1 to 4 wherein the said rotating means 100 comprises of at least one rotating part outside the bone.

7. A bone and joint fixing system according to any claim of claims 1 to 6 wherein the said rotating means 100 comprises of a hinge system 108.

8. A bone and joint fixing system according to claim 7 wherein the said hinge system 108 is a non- circular hinge system 106.

9. A bone and joint fixing system according to claim 8 wherein the said non-circular hinge system 106 comprises of a non-circular hinge 1061 and a curve adjuster 1062.

10. A bone and joint fixing system according to any claim of claims 1 to 9 wherein the said rotating means 100 further comprises of a ligament washer 141.

1 1. A bone and joint fixing system according to any claim of claims 1-10 wherein the said rotating means 100 further comprises of a limited movement system for motion control.

12. A bone and joint fixing system according to claim 1 1 wherein the said limited movement system comprises of a limited motion ring 103 for motion control.

13. A bone and joint fixing system according to claim 1 or 2 wherein the said limited movement system comprises of the limited motion cap 109 for motion control.

14. A bone and joint fixing system according to any claim of claims 1 to 13 wherein the said internal joint fixator 10 comprises of at least one extended element 130.

15. A bone and joint fixing system according to any claim of claims 1 to 14 wherein one end of the said extended element 130 is connected to the said rotating means 100 and the other end of the said extended element 130 is connected to the said variable attaching element 120.

16. A bone and joint fixing system according to any claim of claims I to 15 wherein the said extended element 130 and variable attaching element 120 are fused together.

17. A bone and joint fixing system according to any claim of claims 1 to 16 wherein the said extended element 130 is connected to the said variable attaching element 120 by the locking means of connecting system 1305.

18. A bone and joint fixing system according to any claim of claims 1 to 17 wherein the said variable attaching element 120 has at least one variable screw hole 121 1 for connecting the said variable attaching element 120 to other plate system or bone.

19. A bone and joint fixing system according to any claim of claims 1-18 wherein the said tension- plate system 20 comprises of:

- one or more tension wire 21 from which the said tension wire was hold from a proximal bone plate 341 to a distal bone plate 342 or bone wherein the said tension wire 21 provides the anti- distraction force to reduce the fracture gap,

- one or more wire locking system of the internal bone plate 34 for securing the tension wire 21 to the internal bone plate 34, and

- a tension adjustment system 50 for adjusting the tension of the said tension wire.

20. A bone and joint fixing system according to claim 19 wherein the said wire locking system comprises of a wire holding system and a plate holding system.

21. A bone and joint fixing system according to claim 19 or 20 wherein the said wire locking system is a wire twisting system wherein at least two tension wires are twisted together on top of the internal bone plate 34.

22. A bone and joint fixing system according to any claim of claims 19 to 21 wherein the said tension wire 21 comprises of at least one opening end to secure with the said wire locking system.

23. A bone and joint fixing system according to any claim of claims claims 19 to 22 wherein the said tension wire 21 is a curved shape with two opening ends to secure with the said wire locking system.

24. A bone and joint fixing system according to claims 3 wherein the said dual locking system 30 comprises of:

one dual locking screw 31 passing from a proximal bone plate 341 to a distal bone plate 342 wherein the said dual locking screw 31 provides transfer holding force and loading force to both internal bone plates 34,

one proximal locking system 32 wherein the head of said dual locking screw 31 is secured to one of the internal bone plates 34 with locking thread, and

one distal locking system 312 wherein a distal end of said dual locking screw 31 is secured to the internal bone plate 34.

25. A bone and joint fixing system according to claim 24 wherein the said distal locking system 312 comprises of a bottom reverse locking hole 314 wherein the said bottom reverse locking hole 314 provides an internal thread compatible with an external thread of the distal end of said dual locking screw 31 for securing a distal end of said dual locking screw 31 to the internal bone plate 34.

26. A bone and joint fixing system according to claim 24 or 25 wherein the said distal locking system 312 comprises of a locking nut 3121 wherein the said locking nut 3121comprises of an external thread compatible with an internal thread of a locking hole 601 1 an internal thread compatible with an external thread of the distal end of said dual locking screw 31 for securing the distal end of said dual locking screw 31 to internal bone plates 34.

27. A bone and joint fixing system 1 according to any claim of claims 1-3 wherein the said system further comprises of at least one non-attachable element for assistive surgery.

28. A bone and joint fixing system 1 according to claim 27 wherein the said non-attachable element is a center guiding system 40.

29. A bone and joint fixing system 1 according to claim 28 wherein the said center guiding system 40 comprises of a proximal guide means 440.

30. A bone and joint fixing system 1 according to claim 8 or 29 wherein the said center guiding system 40 has a distal guide means 443.

31. A bone and joint fixing system 1 according to any claim of claims 27-30 wherein the said non- attachable element is a reduction system 48.

32. A bone and joint fixing system 1 according to claim 31 wherein the said reduction system 48 comprises of a reduction template 481 for joint reduction and guiding screw placement.

33. A bone and joint fixing system 1 according to claim 31 or 32 wherein the said reduction system 48 comprises of a sizing template 481 for measuring the proper size of the internal joint fixator 10.

34. A method of using the bone and joint fixing system 1 according to any claim of the claims above for holding broken bone pieces.

35. A method of using the bone and joint fixing system 1 according to any claim of the claims above for preventing joints displacement.

36. A method of using the bone and joint fixing system 1 according to claim 34 or 35 comprises of the use of at least internal joint fixator 1 or the tension plate system 20 or the dual locking system

30 or the combination thereof.