WO2013173818A1

WO2013173818A1 - Distraction and reduction facilitating plate system and method

Info

Publication number: WO2013173818A1
Application number: PCT/US2013/041737
Authority: WO
Inventors: Amod P. PARANJPE; Jamie A. RILEY; Gary SCHMIDT, MD
Original assignee: Curax Scientific, Llc
Priority date: 2012-05-18
Filing date: 2013-05-18
Publication date: 2013-11-21

Abstract

The present invention encompasses systems and methods of facilitating orthopedic procedures including devices such as surgical plates and methods of designing/developing/constructing such devices, including plates. The plates often include generally linearly extending apertures suitable for orthopedic access therethrough that are available for temporary or permanent fixation element passage therethrough, as well as procedure enactments such as reductions and distractions. The plates provide greater degrees of freedom including capacitating these procedures for major percentages of the total length and area of the plate. The plates and methods of developing the plates provide capacitation of additional manners of fixation interrelationships as well.

Description

Distraction and Reduction Facilitating Plate System and Method

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] Not applicable.

This application claims the benefit of U.S. Provisional Application S/N 61/648,693, filed May 18, 2012, the entire disclosure of which is hereby incorporated herein by reference.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

[0002] Not applicable.

BACKGROUND OF THE INVENTION

[0003] Technical Field

[0004] The present invention relates generally to systems and methods of developing and utilizing plate devices in orthopedic procedures, and more particularly to systems and methods of developing and utilizing plates suited for orthopedic procedures including those that involve temporary or permanent fixations, reductions, and or distractions, such as fracture repairs and osteotomies.

[0005] Background Art

[0006] In the process of performing orthopedic procedures to correct injuries or disorders of the skeletal system and associated muscles, joints, and ligaments, an ever proliferating variety of devices are employed. Among the requirements that affect what types and compositions of devices can be utilized, are constraints in available working space, since these devices are generally used in surgical procedures that involve constrained spaces. These spatial constraints include the anatomical characteristics of the surgical circumstances in which the devices are normally deployed, (i.e. Many surgical procedures that correct bone disorders in the foot must contend with the density and complexity of bone surfaces caused by the presence of 26 separate bones, not counting the sesamoid, all packed within the confines of even a small foot along with blood vessels, nerves, ligaments, tendons, fascia, muscles, etc.) Generally, parts of the body have to be opened up to get access to where the procedure is needed, and creating this access involves incisions and other forms of collateral damage. [0007] While modern surgical techniques have greatly improved over the years, and advances in approaches to healing after surgery have also been great, it is clear that it is always preferable to produce less damage in the first place. Hence a device that can produce the desired effect, but is smaller, is preferable. The benefits of lesser size include being deployed more flexibly and readily, requiring less space be made available within the body in order to be introduced, allowing more space to effect surgical actions around the device and hence also requiring less space be made available, and providing wider ranges of manners of utilization, which can enable a surgeon to explore more varieties of corrective actions which can in turn enable more efficacious options to be available. A lesser sized device, when providing an equivalent effect as a larger device, is also often preferable in many orthopedic procedures because the corrective action provided is intended to be needed for a limited period of time, but the device is often present for a prolonged period since removing it would cause more damage than benefit. The body, however, is in the vast majority of circumstances better off without the presence of foreign bodies unless immediately necessary, and if they are present it is generally advantageous that their size be minimized.

[0008] Improvements in the manners of utilization, as well as enablement of the development of entirely newly techniques are a highly significant potential benefit of smaller devices. In addition to reduced size, further means of providing greater degrees of freedom for the surgeon are desirable as well. These can include means of enabling more flexible manners of spatial access, means of enabling greater degrees of freedom of use of the space already available, means of enabling composite uses of the space available, among others. The greater flexibility of spatial access could enable a surgeon to approach an particular orthopedic issue with a less damaging approach, or even with a more efficacious approach that would not otherwise be available. The greater degrees of freedom of use of the existing space can enable, for example, both visualization of the surgical site and execution of one or more surgical actions through the same incision, thereby avoiding the injury of multiple incisions. The enabling of composite uses can enable more efficient, as well as more efficacious treatments. Reducing the time required to accomplish a particular surgical intervention is in of itself a major potential benefit, since increased operation durations can be both a burden on the surgeon, possibly reducing the quality of work accomplished and/or reducing the number of patients that can be helped, as well as a burden on the patient since the process of undergoing an operation can be quite taxing on the patient. Evidently, development of these capacities can provide important benefits to both humans as well as other creatures which may need orthopedic procedures, since veterinarians often adapt for use in animals medical techniques originally developed for treatment of humans.

SUMMARY OF THE INVENTION

[0009] Technical Problem

[0010] The problem at issue involves achieving enhanced capacitation of orthopedic procedures such as reductions and distractions. In general, these procedures are effected in combination with a variety of devices, the most common of which is a surgically implanted plate. The term plate as used herein is intended to be a generalized catch-all label which can include most other similar device labels such as surgical plate, cortical plate, or implantable plate and their functional equivalents. The orthopedic procedures of interest generally involve effecting a revision of an existing orthopedic situation from a condition which is deleterious to one in which improvement is achieved, or is achievable eventually through healing or additional procedures. Among the most common of these procedures are osteotomies, in which a purposeful incision is made to reposition, and sometimes remove a portion of, a bone to correct an undesirable condition; and fracture repairs. Whether a bone discontinuity is purposeful, or due to a misfortune, arranging the bones, joints, ligaments, tendons, and other tissues into a desired alignment for healing often requires the forceful movement of one portion of a bone relative to another portion of the same or another bone. Due to the dynamics of the body, wherein muscles, tendons, ligaments and the like exert forces on the skeletal system in many directions, a bone discontinuity enables these forces to impel the bone(s) affected to be pushed into positions which are undesirable. Hence, in order to properly position the bone portions when a discontinuity is present, a plate device is often employed to enable both fixation of at least one point on one plate to use as leverage to reposition another point on the same or a different plate, prior to its fixation. Movement of these bone portions, and in particular greater degrees of freedom availed to a surgeon for effecting these movements, are among the primary problems addressed by the systems and methods realized by the embodiments of the present invention.

[0011] Solution to Problem

[0012] The embodiments of the present invention provide a number of variations of the desired functionalities, including a first aspect of a plate suitable for orthopedic procedures, including reductions and distractions, comprising a generally linearly extending plate portion having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, the first aperture defining a linearly extending boundary of access to the body from the first area; wherein a first length is the plate's maximum extent and a second length is the aperture boundary's maximum extent, said first and second lengths aligned closer than not to parallel and the second length sufficiently large to admit orthopedic access therethrough for a majority of the first length.

[0013] Additional aspects auxiliary to the first aspect of the present invention can comprise the second length providing capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, and an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, such that a distraction or reduction procedure is effectible between the first and second fixation points throughout a majority of the first length; or comprise the second length providing capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, and an aperture transiting temporary or permanent third fixation, relative to the first or second fixation points, of a third body point, such that a first distraction or reduction procedure is effectible between the first and second fixation points, and a second distraction or reduction procedure is effectible between the first and third fixation points throughout a majority of the first length; or can comprise the second length providing capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, an aperture transiting temporary or permanent third fixation, relative to plate portion, of a third body point, and an aperture transiting temporary or permanent fourth fixation, relative to the third fixation point, of a fourth body point, such that both a first distraction or reduction procedure between the first and second fixation points, and a second distraction or reduction procedure between the third and fourth fixation points are simultaneously enactable throughout a majority of the first length.

[0014] Further aspects auxiliary to the first aspect of the present invention can also comprise the aperture accommodating permanent fixation elements continuously throughout the second length; or can comprise a portion of a surface of the aperture being arranged to be alterable by a process of fixating the plate portion with a fixation element passing through the aperture such that the aperture surface alteration facilitates anchoring of the relative positions of the fixation element and the plate portion; or can comprise the alterable portion of the aperture surface being initially arranged with a roughed surface, such that tightening a fixation screw within the aperture anchors the screw, relative to the plate portion, by at least partially imbedding itself within the initially roughed surface; or can comprise the alterable portion of the aperture surface being initially arranged with a grooved surface, such that tightening a fixation screw within the aperture anchors the screw, relative to the plate portion, by at least partially imbedding itself within the grooved surface; or can comprise a portion of a surface of the aperture being constituted with one or more topographic grooves; or can comprise the above grooves being arrayed parallel to the second length direction; or can comprise the grooves being arrayed at an acute angle relative to the second length direction; or can comprise one or more grooves being arrayed on only one side of the aperture; or can comprise one or more grooves being arrayed in different directions on either side of the aperture; or can comprise one or more grooves being arrayed in different directions on either side of the aperture.

[0015] Yet more aspects auxiliary to the first aspect of the present invention can further comprise a first path through the access boundary for disposing temporary or permanent fixation to the body being accommodated by the first aperture, said first path dispositionable across the entirety of the boundary and, when the temporary or permanent fixation is disposed along the first path, the aperture accommodates continuous movement of the fixation to any other point within the boundary; or can comprise the access boundary accommodating temporary or permanent fixation to the body along any first and second paths through the first aperture, and for distractions or reductions there between, said accommodating continuously provided for a span of first and second fixation path dispositions ranging from adjacency to separation by the second length; or can comprise the second length providing capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, and an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, such that a distraction or reduction procedure is effectible between the first and second fixation points throughout at least a quarter of the first length.

[0016] A second aspect of the present invention involves a method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate portion, said aperture crossing through the plate between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part so that the body is accessible from the first area; and arranging for the aperture boundary's maximum dimension of a second length to be sufficiently large and aligned closer than not to parallel to the plate portion's maximum dimension of a first length so that the second length admits orthopedic access therethrough for a majority of the first length.

[0017] A third aspect of the present invention includes a plate suitable for orthopedic procedures, including reductions and distractions, comprising a generally linearly extending plate portion having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, the first aperture defining a boundary of access to the body from the first area; wherein a first length is the plate portion's maximum extent and a second length is the aperture boundary's maximum extent, said first and second lengths aligned closer than not to parallel, the second length is sufficient to admit orthopedic access therethrough for a significant fraction of the first length, and the second length's entirety is continuously available for fixation element passage therethrough.

[0018] Aspects auxiliary to the third aspect of the present invention can further comprise the plate further including one or more additional apertures suited for reception of a permanent fixation element, said permanent fixation elements including surgical screws; or can comprise the permanent fixation element being a locking surgical screw, and the aperture providing a cooperative surface that facilitates said screw's locking function; or can comprise the plate further including one or more additional apertures suited for reception of a smaller sometimes temporary fixation elements such as a working implements anchor member and k-wires: or can comprise the plate including no additional apertures suited for reception of a permanent fixation element, said permanent fixation elements including surgical screws; or can comprise the plate being at least partially constituted of titanium, steel, or alloys thereof.

[0019] A fourth aspect of the present invention involves a method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate portion, said aperture crossing through the plate between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part so that the body is accessible from the first area; and arranging for the aperture boundary's maximum dimension of a second length to be sufficient to admit orthopedic access therethrough for a significant fraction of the plate portion's maximum dimension of a first length, and the second length's entirety is continuously available for fixation element passage therethrough.

[0020] A fifth aspect of the present invention involves a plate suitable for orthopedic procedures, including reductions and distractions, comprising an implantable plate having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, said first aperture defining a linearly extending boundary of access to the body from the first area; wherein the access boundary encompasses at least a quarter of the first surface area. [0021] Aspects auxiliary to the fifth aspect of the present invention can further comprise the access boundary including no more than a half of the first surface area; or can comprise the access boundary including no more than a third of the first surface area; or can comprise the access boundary including no more than a quarter of the first surface area; or can comprise the access boundary providing capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, and an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, such that a distraction or reduction procedure is effectible between the first and second fixation points throughout a majority of the first length; or can comprise the aperture accommodating permanent fixation elements continuously throughout the portion of the first area encompassed by the access boundary; or can comprise a portion of a surface of the aperture being arranged to be alterable by a process of fixating the plate portion with a fixation element passing through the aperture such that the aperture surface alteration facilitates anchoring of the relative positions of the fixation element and the plate portion; or can comprise the access boundary, in combination with a limited height of the plate portion, being sufficiently large to accommodate orthopedic access to the body beneath the plate from directions that span at least 60 degrees in transverse angle of approach; or can comprise the access boundary, in combination with a limited height of the plate portion, being sufficiently large to accommodate orthopedic access to the body beneath the plate from directions that span at least 90 degrees in transverse angle of approach; or can comprise the access boundary, in combination with a limited height of the plate portion, being sufficiently large to accommodate orthopedic access to the body beneath the plate from directions that span at least 120 degrees in transverse angle of approach; or can comprise the access boundary, in combination with a limited height of the plate portion, is sufficiently large to accommodate orthopedic access to the body beneath the plate from directions that span at least 150 degrees in longitudinal angle of approach for at least 90% of the access boundary.

[0022] A sixth aspect of the present invention involves a method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate portion, said aperture crossing through the plate between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part so that the body is accessible from the first area; and said access boundary encompasses at least a quarter of the first surface area.

[0023] A seventh aspect of the present invention involves a plate suitable for orthopedic procedures, including reductions and distractions, comprising a linearly extending plate portion having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, the first aperture defining a linearly extending boundary of access to the body from the first area; wherein the access boundary's transverse extent is greater than the transverse extent of a side of the portion of the plate in which the aperture is formed. An aspect auxiliary to the seventh aspect of the present invention can comprise the access boundary's transverse extent being also greater than the combined transverse extent of both sides of the portion of the plate in which the aperture is formed.

[0024] An eighth aspect of the present invention involves a method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate portion, said aperture crossing through the plate between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part so that the body is accessible from the first area; and said aperture boundary on access to the body from the first area has a transverse extent greater than the transverse extent of a side of the portion of the plate in which the aperture is formed. An aspect auxiliary to the eighth aspect of the present invention can comprise the aperture boundary on access to the body from the first area having a transverse extent that is also greater than the combined transverse extent of both sides of the portion of the plate in which the aperture is formed.

[0025] A ninth aspect of the present invention involves a plate suitable for orthopedic procedures, including reductions and distractions, comprising a linearly extending plate having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, the first aperture defining a linearly extending boundary of access to the body from the first area; wherein the aperture is generally congruent and proportional with an outline of the plate.

[0026] Aspects auxiliary to the ninth aspect of the present invention can comprise the region encompassed by the access boundary being at least a third as large as the region encompassed by the plate outline; or can comprise the region encompassed by the access boundary being between one half and seven eighths as large as the region encompassed by the plate outline; or can comprise the transverse width of a side of the portion of the plate in which the boundary is formed being less than 10 millimeters; or can comprise the transverse width of a side of the portion of the plate in which the boundary is formed being less than 5 millimeters.

[0027] A tenth aspect of the present invention involves a method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate, said aperture crossing through the plate between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part so that the body is accessible from the first area; and said aperture is generally congruent and proportional with an outline of the plate.

[0028] An eleventh aspect of the present invention involves a plate suitable for orthopedic procedures, including reductions and distractions, comprising a linearly extending plate portion having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, the first aperture defining a linearly extending boundary of access to the body from the first area; wherein a second length is the aperture boundary's maximum extent and said aperture capacitates effecting distraction or reduction procedures within the access boundary between a first point and any second point lying within a 360 degree circle of radius equal to the second length, centered on the first point. [0029] Aspects auxiliary to the eleventh aspect of the present invention can further comprise the aperture accommodating permanent fixation elements continuously throughout the second length; or can comprise a portion of a surface of the aperture being arranged to be alterable by a process of fixating the plate portion with a fixation element passing through the aperture such that the aperture surface alteration facilitates anchoring of the relative positions of the fixation element and the plate portion; or can comprise the alterable portion of the aperture surface being initially arranged with a roughed surface, such that tightening a fixation screw within the aperture anchors the screw, relative to the plate portion, by at least partially imbedding itself within the initially roughed surface; or can comprise the alterable portion of the aperture surface being initially arranged with a grooved surface, such that tightening a fixation screw within the aperture anchors the screw, relative to the plate portion, by at least partially imbedding itself within the grooved surface; or can comprise a portion of a surface of the aperture being constituted with one or more topographic grooves; or can comprise grooves of the above type being arrayed parallel to the second length direction; or can comprise the grooves being arrayed at an acute angle relative to the second length direction; or can comprise one or more grooves being arrayed on only one side of the aperture; or can comprise one or more grooves being arrayed in different directions on either side of the aperture.

[0030] A twelfth aspect of the present invention involves A method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate portion, said aperture crossing through the plate between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part so that the body is accessible from the first area; and capacitating said aperture to facilitate distraction or reduction procedures between a first point within the aperture accessibility boundary and any second point lying within a 360 degree circle centered on the first point, and having a radius equal to the second length.

[0031] Advantageous Effects of Invention [0032] The circumstances that surgeons must attend to in most orthopedic surgical procedures can be characterized as a contest of constraints. There is a need to minimize incision size; a need to apply often significant force in specific manners that can be both temporarily deployed when needed as well as permanently enacted when needed; a need to accommodate multiple instruments, viewing and manipulating access, as well as space to apply beneficial substances potentially during, as well as immediately upon fixation application; a need to find suitable means to access often convoluted and/or multi-faceted fracture/disorder sites from directions that are not always best for working on the site; as well as many others. The various embodiments of the present invention provide enhanced manners of access; provide greater degrees of freedom of numbers, varieties, and combinations of orthopedic related actions accommodated; bestow more flexibility of corrective effect employment and enable greater numbers and types of constraints to be surmounted.

[0033] Other objects and features will be in part apparent and in part pointed out hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

[0034] Fig. 1 shows an elevated plan view of a first embodiment of the present invention.

[0035] Fig. 2 shows an elevated perspective view of the first embodiment of the present invention.

[0036] Fig. 3 shows an underside plan view of the first embodiment of the present invention.

[0037] Fig. 4 shows a longitudinal end view of the first embodiment of the present invention.

[0038] Fig. 5 shows an underside perspective view of the first embodiment of the present invention.

[0039] Fig. 6 shows a transverse side view of a second embodiment of the present invention.

[0040] Fig. 7 shows an elevated plan view of the second embodiment of the present invention.

[0041] Fig. 8 shows an elevated perspective view the second embodiment of the present invention.

[0042] Fig. 9 shows an expanded detail cross-section view of a portion of the second embodiment of the present invention.

[0043] Fig. 10 shows an elevated plan view of a third embodiment of the present invention.

[0044] Fig. 11 shows an elevated perspective view of the third embodiment of the present invention.

[0045] Fig. 12 shows a longitudinal side view of the third embodiment of the present invention. [0046] Fig. 13 shows an elevated perspective view of a fourth embodiment of the present invention.

[0047] Fig. 14 shows an elevated perspective view of a fifth embodiment of the present invention.

[0048] Fig. 15 shows an elevated perspective view of a sixth embodiment of the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0049] In the following description, identical numbers indicate identical elements. Where an element has been described in one Figure, and is unaltered in detail or relation in any other Figure, said element description applies to all Figures.

[0050] A first embodiment of the present invention, depicted in an overhead plan view in Fig. 1, is a 4 x 2 screw hole plate 110 having a maximum length 112. An aperture 114 has an internal, often beveled, surface 116 that defines a linearly extended access boundary 118 that has a maximum length 120 and a maximum transvers width 122. Additional aspects of the 4 x 2 screw hole plate 110 include the circular screw holes 124 suited for reception of permanent fixation screws, which many be locking or unlocking, with the internal surface of the screw holes 124 generally being adapted for the intended type of screw to be received; as well as a working anchor hole 126 that is commonly utilized for temporary fixation to the body and/or application of leverage to the plate. The aperture 114 provides access to a part of the body across an area 128, which is a variable percentage of the total area of the 4 x 2 screw hole plate 110, which including the aperture 114 access boundary area 128. The range of potential percentages of the 4 x 2 screw hole plate 110 total area encompassed by the aperture 114 access boundary area 128 can range, in different versions of the 4 x 2 screw hole plate 110, between 10 and 75%, with differing amounts separated by just 5% increments also being included since each increment can be the best option for a given orthopedic situation. When the portions of the 4 x 2 screw hole plate 110 engaged in forming the screw holes 124 is discounted, the percentage of area of the aperture 114 access boundary area 128 can approach 90% of the 4 x 2 screw hole plate 110 total area. In addition, the range of percentages of the 4 x 2 screw hole plate 110 maximum length 112 covered by the maximum length 120 of the access boundary 118 can vary between 40 and 95%, with differing amounts separated by just 5% increments also being included since each increment can be the best option for a given orthopedic situation. [0051] The 4 x 2 screw hole plate 110 is also depicted in an elevated perspective view in Fig. 2, which illustrates a possible angle of approach to the 4 x 2 screw hole plate 110 that may be utilized for a particular purpose during an orthopedic procedure. The expanded area 128, and/or expanded length 120 of the 4 x 2 screw hole plate 110 aperture 114 can be seen to accommodate, and hence makes available for orthopedic access, a greater range of effects and/or means of approach and/or expanded portions of the body. As is common for many plates, it can be seen in Fig. 2 that the 4 x 2 screw hole plate 110 has a moderately rounded longitudinal end profile, which provides enhanced fit to a rounded bone, but may also reduce the number of ways in which the body underneath the 4 x 2 screw hole plate 110 can be accessed, a reduction in access which is remediable with the enhanced access provided by embodiments of the present invention.

[0052] Fig. 3 depicts an underside plan view of the 4 x 2 screw hole plate 110, which markedly visualizes the relative proportions of the access boundary area 128 to that of 4 x 2 screw hole plate 110 as a whole, the 4 x 2 screw hole plate 110 is depicted in an underside perspective view in Fig. 5 that illustrates the constraints involved in working with these plates and their limitations on the access to the body. The internal surface 116 has a limited depth, and still even with the enhanced access provided by the 4 x 2 screw hole plate 110 a relatively small amount of space is seen to be available for orthopedic access through the aperture 114 even at the modest angle of the perspective view line of sight. The utility of the present invention is hence seen since substantially less space is available with conventional plates constructions. Fig. 4 depicts a longitudinal end view of the 4 x 2 screw hole plate 110, showing a plate surface first area 410 suited for orthopedic access and a plate surface second area 412. The available transverse angle 414 of orthopedic access ranges between directional access limits 416 that are geometrically defined by the transverse width 122 of the aperture 114 access boundary 118, as well as by the particular configuration of the internal surfaces 116. The transverse angle 414 can range from 30 to 120 degrees, a total available angular span that also can vary in amount across that full range separated by just 5% increments, since each increment can be the best option for a given orthopedic situation. [0053] Fig. 6 depicts a transvers side view of a no-screw-hole plate 610 embodiment of the present invention which is slightly curved downward at each longitudinal end 612. Longitudinal orthopedic access direction limits 614 demarcate a lengthwise access angle range 616 which can range from 40 to 165 degrees, a total available angular span that also can vary in amount across that full range separated by just 5% increments, since each increment can be the best option for a given orthopedic situation. Fig. 7 depicts an overhead plan view of the no-screw-hole plate 610 which illustrates well the substantial portion of the no-screw-hole plate 610 total area which is encompassed by the aperture 114 access boundary area 128. Fig. 8 depicts a perspective view from a modest angle of the no-screw-hole plate 610 to illustrate the enhanced degrees of freedom afforded for orthopedic procedures by the substantial range of access afforded by the no-screw-hole plate 610 aperture 114.

[0054] Fig. 9 depicts a partial cross-section view, taken on dashed line 9 of Fig. 7, of an upper portion of the internal surface 116. Between the first surface area 410 and the internal boundary surface 118, is a beveled intermediate surface 910, which is not limited in shape or number of surfaces to that shown. The beveled surface 910 can have a roughed finish of limited hardness, shown with a compound line, that will be degraded and/or indented by a fixation screw (not shown) being forced downward, since the screw will normally be of a greater hardness. The indenting of the screw seats it in a self-made pocket (not shown) that aids in restraining the screw form longitudinal motion. An alternative approach to achieve the same effect can involve a ridge 912 that projects outward from the beveled surface 910. The ridge 912 is constructed of a small enough width, or of a less hard material, to be unable to resist the a similar form of seating of the screw, relative to the no-screw-hole plate 610, when it is driven with force into a bone. The ridge 912 can also be arranged to at least partially aid in guiding the screw when being driven by acting at least partially as a thread for the screw to follow. The ridge 912 can be of varying directions (not shown) and can even be multiple in number, differ on each side 116 of the aperture 114, be present on only one side 116, or can even be directed at various angles, depending, for example, on the desired effects on a screw when it is being fixated to bone. Normally, it is unlikely that both the roughing of beveled intermediate surface 910 will not be used in combination with the ridge 912, though a combination of such is within the scope of the present invention.

[0055] Fig. 10 depicts an elevated plan view of a combination aperture plate 1010 comprising a pair of longer arms 1012a and 1012b with respectively congruent apertures 1014a and 1014b. The longer arm 1012a and 1012b are connected with a bridge portion 1016 that also has a congruent aperture 1014c formed within it. In principle, there are no limits on the number of linearly extending arms, there interrelations, relative angles, and relative numbers or sizes of apertures that can be included to embodiments of the present invention. The combination aperture plate 1010 can be of particular utility in treating a Lisfranc injury. Fig. 11 depicts an elevated perspective view of the combination aperture plate 1010 to illustrate the variety of enhanced degrees of freedom of access provided by embodiments of the present invention. Fig. 12 depicts a longitudinal end view of the combination aperture plate 1010 showing a gentle curvature with the first surface area 410 being moderately convex, and the second surface area 412 being moderately concave.

[0056] Figs. 13, 14, and 15 depict additional illustrative embodiments of the present invention which demonstrate a small degree of the wide range of embodiment variations within the scope of the present invention. Fig. 13 shows an asymmetrical three screw hole plate 1310, Fig. 14 shows a transversely symmetrical four screw hole plate 1410, and Fig. 15 shows a longitudinally and transversely symmetrical 6 screw hole plate 1510.

[0057] In view of the above, it will be seen that the various objects and features of the invention are achieved and other advantageous results obtained. The examples contained herein are merely illustrative and are not intended in a limiting sense.

Claims

WHAT IS CLAIMED IS:

1. A plate suitable for orthopedic procedures, including reductions and distractions, comprising:

a generally linearly extending plate portion having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, the first aperture defining a linearly extending boundary of access to the body from the first area;

wherein a first length is the plate portion's maximum extent and a second length is the aperture boundary's maximum extent, said first and second lengths aligned closer than not to parallel and the second length sufficiently large to admit orthopedic access therethrough for a majority of the first length.

2. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 1, wherein said second length provides capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, and an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, such that a distraction or reduction procedure is effectible between the first and second fixation points throughout a majority of the first length.

3. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 1, wherein said second length provides capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, and an aperture transiting temporary or permanent third fixation, relative to the first or second fixation points, of a third body point, such that a first distraction or reduction procedure is effectible between the first and second fixation points, and a second distraction or reduction procedure is effectible between the first and third fixation points throughout a majority of the first length.

4. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 1, wherein said second length provides capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, an aperture transiting temporary or permanent third fixation, relative to plate portion, of a third body point, and an aperture transiting temporary or permanent fourth fixation, relative to the third fixation point, of a fourth body point, such that both a first distraction or reduction procedure between the first and second fixation points, and a second distraction or reduction procedure between the third and fourth fixation points are simultaneously enactable throughout a majority of the first length.

5. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 1, wherein said aperture accommodates permanent fixation elements continuously throughout the second length.

6. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 1, wherein a portion of a surface of the aperture is arranged to be alterable by a process of fixating the plate portion with a fixation element passing through the aperture such that the aperture surface alteration facilitates anchoring of the relative positions of the fixation element and the plate portion.

7. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 6, wherein the alterable portion of the aperture surface is initially arranged with a roughed surface, such that tightening a fixation screw within the aperture anchors the screw, relative to the plate portion, by at least partially imbedding itself within the initially roughed surface.

8. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 6, wherein the alterable portion of the aperture surface is initially arranged with a grooved surface, such that tightening a fixation screw within the aperture anchors the screw, relative to the plate portion, by at least partially imbedding itself within the grooved surface.

9. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 1, wherein a portion of a surface of the aperture is constituted with one or more topographic grooves.

10. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 9, wherein said grooves are arrayed parallel to the second length direction.

11. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 9, wherein said grooves are arrayed at an acute angle relative to the second length direction.

12. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 9, wherein said one or more grooves are arrayed on only one side of the aperture.

13. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 9, wherein said one or more grooves are arrayed in different directions on either side of the aperture.

14. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 1, wherein a first path through the access boundary for disposing temporary or permanent fixation to the body is accommodated by the first aperture, said first path dispositionable across the entirety of the boundary and, when the temporary or permanent fixation is disposed along the first path, the aperture accommodates continuous movement of the fixation to any other point within the boundary.

15. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 1, wherein the access boundary accommodates temporary or permanent fixation to the body along any first and second paths through the first aperture, and for distractions or reductions there between, said accommodating continuously provided for a span of first and second fixation path dispositions ranging from adjacency to separation by the second length.

16. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 1, wherein said second length provides capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, and an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, such that a distraction or reduction procedure is effectible between the first and second fixation points throughout at least a quarter of the first length.

17. A method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of:

forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate portion, said aperture crossing through the plate between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part so that the body is accessible from the first area; and

arranging for the aperture boundary's maximum dimension of a second length to be sufficiently large and aligned closer than not to parallel to the plate portion's maximum dimension of a first length so that the second length admits orthopedic access therethrough for a majority of the first length.

18. A plate suitable for orthopedic procedures, including reductions and distractions, comprising:

a generally linearly extending plate portion having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, the first aperture defining a boundary of access to the body from the first area; wherein a first length is the plate portion's maximum extent and a second length is the aperture boundary's maximum extent, said first and second lengths aligned closer than not to parallel, the second length is sufficient to admit orthopedic access therethrough for a significant fraction of the first length, and the second length's entirety is continuously available for fixation element passage therethrough.

19. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim

18, wherein said plate further includes one or more additional apertures suited for reception of a permanent fixation element, said permanent fixation elements including surgical screws.

20. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim

19, wherein said permanent fixation element is a locking surgical screw, and the aperture provides a cooperative surface that facilitates said screw's locking function.

21. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 18, wherein said plate further includes one or more additional apertures suited for reception of a smaller sometimes temporary fixation elements such as a working anchor or a k-wire.

22. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 18, wherein said plate includes no additional apertures suited for reception of a permanent fixation element, said permanent fixation elements including surgical screws.

23. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 18, wherein said plate is constituted at least partially of titanium, steel, or alloys thereof.

24. A method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of:

forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate portion,

said aperture crossing through the plate between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part so that the body is accessible from the first area; and

arranging for the aperture boundary's maximum dimension of a second length to be sufficient to admit orthopedic access therethrough for a significant fraction of the plate portion's maximum dimension of a first length, and the second length's entirety is continuously available for fixation element passage therethrough.

25. A plate suitable for orthopedic procedures, including reductions and distractions, comprising:

an implantable plate portion having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, said first aperture defining a linearly extending boundary of access to the body from the first area;

wherein the access boundary encompasses at least a quarter of the first surface area.

26. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein said access boundary includes no more than a half of the first surface area.

27. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein said access boundary includes no more than a third of the first surface area.

28. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein said access boundary includes no more than a quarter of the first surface area.

29. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein said access boundary provides capacitation for both an aperture transiting temporary or permanent first fixation of a first body point, relative to the plate portion, and an aperture transiting temporary or permanent second fixation, relative to the first fixation point, of a second body point, such that a distraction or reduction procedure is effectible between the first and second fixation points throughout a majority of the first area.

30. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein said aperture accommodates permanent fixation elements continuously throughout the portion of the first area encompassed by the access boundary.

31. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein a portion of a surface of the aperture is arranged to be alterable by a process of fixating the plate portion with a fixation element passing through the aperture such that the aperture surface alteration facilitates anchoring of the relative positions of the fixation element and the plate portion.

32. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein said access boundary, in combination with a limited height of the plate portion, is sufficiently large to accommodate orthopedic access to the body beneath the plate from directions that span at least 60 degrees in transverse angle of approach.

33. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein said access boundary, in combination with a limited height of the plate portion, is sufficiently large to accommodate orthopedic access to the body beneath the plate from directions that span at least 90 degrees in transverse angle of approach.

34. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein said access boundary, in combination with a limited height of the plate portion, is sufficiently large to accommodate orthopedic access to the body beneath the plate from directions that span at least 120 degrees in transverse angle of approach.

35. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 25, wherein said access boundary, in combination with a limited height of the plate portion, is sufficiently large to accommodate orthopedic access to the body beneath the plate from directions that span at least 150 degrees in longitudinal angle of approach for at least 90% of the access boundary.

36. A method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of:

said aperture crossing through the plate portion between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part so that the body is accessible from the first area; and

said access boundary encompasses at least a quarter of the first surface area.

37. A plate suitable for orthopedic procedures, including reductions and distractions, comprising:

a linearly extending plate portion having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, the first aperture defining a linearly extending boundary of access to the body from the first area;

wherein the access boundary's transverse extent is greater than the transverse extent of a side of the plate in which the aperture is formed.

38. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 37, wherein the access boundary's transverse extent is also greater than the combined transverse extent of both sides of the portion of the plate in which the aperture is formed.

39. A method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of: forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate portion,

said aperture boundary on access to the body from the first area has a transverse extent greater than the transverse extent of a side of the portion of the plate in which the aperture is formed.

40. A method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, according to claim 39, wherein said aperture boundary on access to the body from the first area has a transverse extent that is also greater than the combined transverse extent of both sides of the portion of the plate in which the aperture is formed.

41. A plate suitable for orthopedic procedures, including reductions and distractions, comprising:

a linearly extending plate having a first aperture therethrough crossing between a plate surface first area suited for orthopedic access and a plate surface second area suited for engagement with a body part, the first aperture defining a linearly extending boundary of access to the body from the first area; wherein the aperture is generally congruent and proportional with an outline of the plate portion.

42. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 41, wherein the region encompassed by the access boundary is at least a third as large as the region encompassed by the plate outline.

43. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 41, wherein the region encompassed by the access boundary is between one half and seven eighths as large as the region encompassed by the plate outline.

44. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 41, wherein the transverse width of a side of the portion of the plate in which the boundary is formed is less than 10 millimeters.

45. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 41, wherein the transverse width of a side of the portion of the plate in which the boundary is formed is less than 5 millimeters.

46. A method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of:

forming a first aperture, defined by a linearly extending boundary, in a generally linearly extending plate,

said aperture is generally congruent and proportional with an outline of the plate.

47. A plate suitable for orthopedic procedures, including reductions and distractions, comprising:

wherein a second length is the aperture boundary's maximum extent and said aperture capacitates effecting distraction or reduction procedures within the access boundary between a first point and any second point lying within a 360 degree circle of radius equal to the second length, centered on the first point.

48. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 47, wherein said aperture accommodates permanent fixation elements continuously throughout the second length.

49. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 47, wherein a portion of a surface of the aperture is arranged to be alterable by a process of fixating the plate portion with a fixation element passing through the aperture such that the aperture surface alteration facilitates anchoring of the relative positions of the fixation element and the plate portion.

50. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 49, wherein the alterable portion of the aperture surface is initially arranged with a roughed surface, such that tightening a fixation screw within the aperture anchors the screw, relative to the plate portion, by at least partially imbedding itself within the initially roughed surface.

51. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 49, wherein the alterable portion of the aperture surface is initially arranged with a grooved surface, such that tightening a fixation screw within the aperture anchors the screw, relative to the plate portion, by at least partially imbedding itself within the grooved surface.

52. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 47, wherein a portion of a surface of the aperture is constituted with one or more topographic grooves.

53. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 52, wherein said grooves are arrayed parallel to the second length direction.

54. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 52, wherein said grooves are arrayed at an acute angle relative to the second length direction.

55. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 52, wherein said one or more grooves are arrayed on only one side of the aperture.

56. A plate suitable for orthopedic procedures, including reductions and distractions, according to claim 52, wherein said one or more grooves are arrayed in different directions on either side of the aperture.

57. A method of developing and/or providing capacitation of orthopedic procedures, including reductions and distractions, comprising the steps of:

capacitating said aperture to facilitate distraction or reduction procedures between a first point within the aperture accessibility boundary and any second point lying within a 360 degree circle centered on the first point, and having a radius equal to the second length.