GB2435429A

GB2435429A - Bone plates

Info

Publication number: GB2435429A
Application number: GB0710463A
Authority: GB
Inventors: Thomas J Ellis; Joel Gillard; Steven P Horst
Original assignee: Oregon Health Science University
Current assignee: Oregon Health Science University
Priority date: 2003-08-28
Filing date: 2004-08-30
Publication date: 2007-08-29
Anticipated expiration: 2024-08-30
Also published as: GB0710463D0; GB2435429B

Abstract

A bone plate 20 for fixing a bone 22 comprises at least two clip portions 24, 26, each clip portion 24, 26 having a pair of arms 34,36 so that each clip portion 24, 26 receives the bone 22 between the pair of arms 34,36, a spanning portion 40 connected to only one of the arms 34, 36 of each clip portion 20, 26 and configured to extend along the bone 22 between the at least two clip portions 24, 26 to span a discontinuity 42 in the bone 22. The bone plate 20 may be used on rib bones. The bone plate may comprise two components, each having a clip portion, being connected via a spanning portion. The bone plates may also comprise a bridge region 38 joining the two arms 34,36, the bridge region may be narrower than the arm region to facilitate bending. Also claimed is a kit for fixing a bone comprising at least one of the afore described bone plates and at least one of a fastener, an instrument for measuring one or more dimensions of the bone, and an instrument for bending at least a portion of at least one bone plate inter-operatively.

Description

I

BONE PLATE& cflcJpPrIa$t ApDllcat1o This application claims the priority under afl applicable national and irtematlonal law of the toll owing.a,ller4Ded applications: U.S. Provisional Patent Application Serial No. 60/498866, filed Auguat 28 2003; U.S. P,uvision& Patent Application Serial No. 601548,885. fled February 28, 2004; and U.S. Patent Application Serial No. 10/927,824, fIled August 27,2004, titled BONE PLATES, and naming Thomas J. Elll Joel Gillard, and Steven P. Horst as inventors. These applications are incorporated herein by reference In their entirety for aft purposes.

The human skeleton is composed of 208 ledMdual bones that p5rform a variety of important functions, inckidlng support, movement, proctlofl, storage of minerals, and formation of blood celia. These bones can be grouped Into two categories, the axial skeleton and the appendkilar skeleton. The axial skeleton consiats of 80 bones that make up the body's center of gravity, and the appendlcular skeleton consists of 126 bones that matce up the body's appendages. The axleJ skeleton Includes the skull, vertebral column, iIs, and atemum, among others, and the appendlotM skeleton Includes the long bones of the upper and loWer limbs, and the clavicles and other, bones that attach these long bones to the axial skeleton, among others. S To ensure that the skeleton retains Its ability to perform its inoitant functions, mat to reduce pain and disfigurement fractured bones should be repaIred promptly and properly. Typically, fractured bones are treated using Ibratlon devioes, which reinforce the fractured bones and keep them aligned during healing. Fixation devices may tske a variety uf forms, Inctuding casts for external fixation and bone plates for internal thratlon, among others. Casts are mh*nally invasive. allowing reduction and ftcallon of simple frathires from oLliside the body. In contrast bone pales are internal devices that mount directly to bone to span a fracture.

Tratina to the torso may result in fracture of one or more ribs.

Frequentiy. a simple rib fracture m nondisplacad. so that reduction andlor internal fixation of the fracbire may not be required. However, Iii cases of more severe frauma to the chest, a single rib may be fractured more severely andfor multiple rib fractures may oir. With muftbe rib fractures, a section of the thoracic waft may become detached from the rest of the chest waft, a condition known to medical practitioners as flai1 thee?. A lieU chest condition often results in paradockat motion of the injured area, in which the freely floating thoracic section is drn In during inspiration. and pushed out during expIration. This condition may result In severs respiratory ditrvss, possibly requiring the patient to be sedated andlor intubated during early stages of healing. Fbong single or multiple rib fractures Intornaly may alleviate paradodcal motion, reduce pain, andlor help to prevent secondary injuries.

Internal fblIon of a rib fracture may be accomplished using a bone plato to span the fracture. A boris plate su1tle for treating fractured ribs may be custom-contoured (ia, bent) by a surgeon 10 conform to a region of a rib spanning a fracture, and then fastened to the rib on both sides of the fracture.

The plate thus fixes the rib to peiTni healing. The plate may be fastened to the fractured nb using fasteners, such as bone screws, wires, andlor suture material, among others. Alternatively, a bone plate may be used that has prongs diappeed along Ito length. The prongs may be crimped eo that they grasp thó rib to fasten the bone plate to the rib.

Each of these plating techniques may have disadvantages for rib fixation. For example, these techniques may not sufficiently stabilize the rib to provide adequate flexural and torsional support for the rib at the fracture alto.

Bone scr may not achieve adequate purchase in ribs to stabliza a bone plate because ribs ore rslathiely thin and the bone density Is low. Wires, suture material, andlor prongs also may not offer sufficient bone plate stabilization because they are not rigid enough. Each of these plating techniques thus may permit movement at the fracture with each breath, causing substantial pain and compromising the healing process. Furthermore, wires, suture material, endlor prongs may press on and damage a newovascijiar bundle disposed on the inferior surface of ribs, If thee. fasteners are placed er this bundle during bone plate instalallon. Placement of these fasteners ben the neuruvascular bundle and bone still may damage the bundle and generally Increases the lime in surgery.

Summary

The present teachings provide sysIem Including meihods, apparatus, and kits, fur fixing bones, such as rib bones, with bone plates1 Btef Deacriatian of th. DrawlA Figure 1 is a view of an aemplary bone plate secured to and tbdng a fractured ilb bone, in accordance with aspects of the present teachings.

FIgure 2 is en exploded vew of the bone plate of Figure 1.

Figije 3 is a view of an ecempIwy assembled configuration for components of the bone plate of Figure 1, in accordance with asps of the present teachings.

Figure 4 is a view of an alternative exemplary assembled contIgLfaftOfl for the components of the bone plate of FIgure 1, in accordance with aspects of the present teachings.

Figure 5A is a fragmentury sectional view of the bone plate of Figure 1 without the rb bone, taken generally along line 5A-5A a? FIgure 1, and illustraling a bone screw extending through a pair of aligned plate apertures including an exeinpiaiy lockkig aperture, In accordance with aspec of the present teachings.

Figure 5B is a fragmentary sectional view of another exemplary k,cldng aperture engaged with a bone screw, In accordance with aspects of the present teachIngs.

Figuiee lea viewof aportlon oftheboneplat.of Figures 1-4, as indicated ii FIgure 2. and including the locking aperture of the pair of apertures of Figure 5A, in accordance with aspects of the present teachings.

Figure 7 is a partially sectional view of a bone caliper being used to measure the thickness of a bone, in accordance with aspe of the present teach8.

Figure 8 is a sectional view cia clip component of a bone plate received on a bendbig die, In accordance with aspects of the present teachings.

FIgure 9 is a partially sectional view of the clip component of Figure 8 being pushed against the bending die of Figure 8, to bend the clip component and aust the contour of the dip component to fit a bone, in accordance with aspects of the present teachings.

Figure 10 ia a partially sectional view of the clip component of FIgure 9 received on a bone and defining a drilling path for a drill bit of a drill foiming a hole in the bone between a pair of apertures of The clip component, with an adjustable depth *,p being used to Imltthedepth of the dril bit In the bone, in accordance with aspects of the present teachings.

Figtze Ills a partially sectional view of the clip component and bone of FIgure 10 altar placement of a bone screw thmth the bone and between the pair of apertures to secure the clip component to the bone, in accordance with aspects of the present teachings.

Flgwe 12 is a partially sectional view of a die a5semb(y holding a plate member bcioie the plate member Is bent Into a clip component, in accordance with aspects of the present teachings.

Figure 13 Is a partially sectional view of the dl. assembly and plate member of Figure 12 after the die assembly has been used to bend the plate member into a dip component, in accordance with aspects of the present teachings.

Figure 14 is a view of another exemplaiy bone plate for 1b*ig a fractured nb bone, with components of the bone plate disposed in an e,mpIary assembled oonflgLMatlon, in accordance with aspects of the present teachings.

Figure 1 is a view of yet mother exemplary bone plate for fixing a fradured rk bone, with components of the bone plate disposed In an exemplary assembled conliguratlon and corresponding to in stiuclure to plate mponents of Figures 1-4, in accordance with aspects of the present teachIngs.

FIgure 16 is a view of still another exemplaiy bone plate for fixing a fractured rib bone with the bone plate configured as a unitary version of the bone plate of Figures 1.4, in accordance with aspects of the present teachings.

Detailed Deetelon The present teachings provide Systems. Including methods, apparatus, and kits, for ftciig bones, such as rib bones, with bone plates. The bone plates may InClUde at least one clip portion configured to be received on a bone so that the clip portion wraps at t prflally around the bone and gxtenda at least to generaliy opposing surfaces of the bone. The clip portion may include at least one aperture far receiving a fastener, such as a bone screw, pieoed into bone. In some embodlmente, the clip portion may include one or more paWs of aligned apertures for receMng a fastener placed through the bone and extending between the afigned apertures. In some examples, at least one of the aligned apertures may be a locking aperture tl*L restricts axial movement of the fastener. The looking aperture may be circular and/or elongate, with a thread or an offset ftp, among others, to engage the fastener. The bone plates may include at least one spanning portion configured to extend from the clip portion, generally along the bone, so that a fracture or other bone discontinuity le spanned by the plates. In some examples, the bone plates, when Installed on bone, may indude at least two clip portions connected by a spanning portion.

The clip portions and the spanning portion may be formed unit Fly In a single plate component or may be formed by two or more plate components that may be assembled on (and/or off) the bone. The bone plates of the present teachings may be secured more effectively to bones, such as fractured ribs, to provide Improved stthlllzatlon of th. bones, better heeling, less pain, and/or less damage io associated soft tissue.

The bone plates may be part of a kit for fixing bones. The kit may lnck4e, for example, one or more plates and/or plate components, fasteners for securing the plates to bone, and/or apparatus for measuring bane, bending plataslPlate components to fit bone, formmg holes in bone. andFor driving fasteners Into bane, among others. a

These and other aspects of the present teachings are described below, tndudmg, among others, (1) overvIew of the bone plates, (II) accessories and kits, (III) methods of using the bone plates, and (IV) examples.

I. Overviewaf the Ban Plates Figure 1 shows an exeptaiy bone plate 20 ftdng a fracbjred rib bone 22. Bone plate 20 may IncLude one or more dip portIons 24,20 received on the bone and wrapping at least partialy amund the bone. For eamp1e, in the present illustration, the clip portions have been received from the superior side of (from above) the d6 bone to apposo superior surface 28 and generally opposing surfaces 30 32 (such as anterior and posterior outward and Inward, andlor medial and lateral surfaces, among others) of the rib bone. Each cUp portion thus may include a pair of generally opposing arms 34, 38 extending from and oonneded by a brklge region 38 (see Figure 2). Plate 20 also may IncLud, a spanring portion 40 extendIng generally wdaily along the bone end spannIng a fracture 42 in the bone (see Figure 1). The spanning portion may extend between the dip portions, to conned the dip portions.

Bone plate 20 may be secured to bone 22 usIng suitable fasteners, such as bore screws 44. The bone plate thus may define one or more)ertules 48 for receiving th. bone screws. The spertuies may be disposed so that the bone plate can be secured with bone screws to bone pieces 48. 50 created by tIedire 42 and disposed on opposing &de of the fracture. * Figure 2 shows bone plate 20 before assembly, and Figures 3 and 4 show bone plate 20 afier assembly Into dfaramt configurations. The bone plate may be unitary or may Include two or more plate components 52,54 corigursd 26 tobesecuredtooneanotheraridtcbone. lnsameexamnplea,eachplate component may indude a dip portion, and one or more plate components may include a spanning portion. A spannIng portion may be connected to a clip portion is arIy in a plate component, as shown for component 52.

Alternatively, or in addition, a spanning portion in a first plate component may be connected to a dip portion in a second plate component with a fastening mechanism. For example, the plate components may be configured to be placed into an overlapped configuration, shown at 56 In Figure 3,50 that an outer surface 68 of component 52 overlaps and abuts an Inner surface 60 of component 54 (see Figure 2). AlternatIvely, as shown in Figure 4, or in add Won, the plate components may be overlapped so that an inner awiae of component 52 overlaps arid abuts an outer surface of nponent 54.

6 Accordingly, a distal end region 82 of the spanning portion may be interposed between a dip portion and bone (see Figure 3), or may be spaced from bone by the clip portion (a.. Figure 4). The placement shown in Figure 4y apace the inner surface of the spanning portion lom the underlying bone and thus may be used, for wmpIe. in situations where It Is desirable to leave a small gap between th. bone plate and the bone in the vicinity of a fradure. This may promote a relatively greater blood supply to the bone near the fracture, possibly leading to faster healing hi 80MB 95.

Each of the plate components may lndude aria or mare apertures configured to be ar,gned with, and generally abuL a corresponding aperture of the other component, such as et,ufl d aperture pair 64,66 (see Figures 2 and 3). In some emp1es, th. bone plates may have at least two pairs of abutted apertures provided by overlapping plate components, which may secure the plate components to one another more effectively. In some examples, two or more alternative alignments of abutted apertures may be permitted, so that the spacIng between dip portions can be selected from two or more possible spacIngs (see Example 1) Each cl portion may include one or more pans of aligned apertures configured to be disposed sdjaoent generally opposing surfaces of a bone. For example, spaced aperture pair 68, 70 (see Figure 2) may be configured to receive a bone screw 72 that extends throth bone between apertures cf the aperture pair (see Figures 1 and 6A). In some examples, the clip portion may lnckide at least two spaced pairs of apertures, to secure the dip portion to bone more eIlctWeIy and thus provide better stabllization of bone. Mernallvely, the fastener may extend through a single aperture or an abutted apeitise pair into bone, but not ornpletely through the bone. Insriycase, one or more of the apertures may be a locking aperture, that is. an aperture configured to engage

B

the fastaner so that adet movement of the fastener In both axial difedlons Is retridud.

in the present liluba1lon, distal aperture 70 Is an elongate locking aperture (a locking slot) having an citset lip with offset ridges 74,76 (an offset lip) lbnned by opposrng walls of th elongate aperture. The ridges may be at least partially linear, extending parallel to the long axis of the aperture. Ridges 74,75 may be configured to be recthed between adjacent (or nonadjacent) thread segments 78 of a thread 80 formed on the shaft of bone sa'ew 72, ao that engagement between ridges 74, 76 (or one ridge) and the thread segments lode the bone screw to the plate. Furthermore, iulatlori of the bone acrew after the head of the bone screw has engaged the plate may urge the arms of clip porticO rd each other, because the shalt of the screw can advance relattve to the locking aperture 70, whereas the head of the aciew cannot advance relative to proximal aperture 68. Mcordlngly, this rotation may adjust the spacing of the arms end(or compression of the bone by the clip portion.

Figure 5B shows another example of an elongate locking aperture 82 receng a bone screw. In this example, only one of two oppcsrng wale of the locking aperture has a rIdge 84 configured to be received between thread segments of the bone screw Figure 6 shows a portion of the bcne plate including locking aperture 70.

The locking aperture may be formed from an oval aperture flanked by recessed ar,dlor thinned regions 80,88 of the plate formed on Inner aid outer surfaces 90,92 of the plate, respectively, and with opposing wale 94.96 of the aperture.

26 Albarnativehj, only one of the surfaces may be recessed, to form only one ridge or lip region to be received between thread segments (sea FIgure 58). LockIng apertures, and particularly an aligned, spaced pair of apertures that Include a locking feature, may secure the plate to the bone nerO eI1ctIveIy than a nonloddng aperture or aperture pau and thus may provide better fixation of the bone. Further aspeds of loddrig apertures, particularly elongate kdGng apertures, are rnclucled in U.S. Provisional Patent Application Serial No. 60/548,685, fd February 26,2004. which Is Incorporated herein by reference.

Further aspects of the bone plates are described m the following sub-asdjar, including, among others, (A) clip portIons, (8) spanning portions, (C) apertures, and (D) plate components.

A Cic Portions The bone plates oath may include one or more dip portions. A clip portion, as used herein, is any region of a plate configured to be received by a bone so that the dip portion disposed adjacent generally opposing surfaces of the bone. Accordingly, the dip portion may extend ui a generally drcurnfeisntlal dect1on at least partially (or completely) around a bone, to wrap at least partially (or conleIeIy) around the bone. The dip portion may extend along any suitable portion f a bone's circumference, such as about one-fourth to three-fourths.

A dip portion may have any suitable contour or shape. Fur example, the clip portion may maLcIi at least substantially, a surface contour of a bone for which the clip portion is configured. In some examples, the clip portion may be generally U-shaped, V-shaped, or 0-shaped, among others, with a generally curved andlor angular contour. The clip portion thus may contact the bone elong any suitable extant of the inner surface of the chp portion. The clip portion may have first nd second regions (the arms) configured to be disposed adjacent generally opposing bon. surfaces, and a third region (the bridge region) extendtng between the first and second regions. in omp examples, the clip portion may be Included In a plate or plate component having a fourth region (the spanning portion) extending ftorn the clip pardon, such as from only one of the first and second region& In acme examples, bcth The arms (or only one arm) and the bridge region of the dip portion may contact the bone. In sorrie exwnples, the bridge region may be spaced from the bone. The dip portion may be contoured before andlor during Installation according to the shape of bone (see Section III).

A clip portion may be configured to be received on and contact any suitable side(s) of a bone. The clip portion thus may be received from a superior, Inferior, anterior, posterior, lateral, andlor medial diredion, among others, onta the bone. The bridge region of the clip portion thus may be p positioned adjacent the corresponding surface ci' the bone or may be rotated after the clip portion Is received so the bridge region is positioned adjacent a different surface of the bone. Furthermore, the arms of the clip portion may be configured to be disposed adjacent any suitable generally opposing bone surfaces, auth as eurlac''e that are posterior and anterior, inward aid outward, medial and lateral, aterior and Infester, or a combination thereof. In exemplary embodiments, for the purposes of musiration, the dip portion may be received from a superior direction onto a rib. The bridge region of the dip portion thus may be disposed adjacent and/or In engagement with a superior surface of the it, and the arms of the clip portion thus may be disposed adjacent and/or In engagement with inward (Internal) and outward external) surfaces of the nb, generally anterior and posterior surfaces undlor medial and lateral surfaces.

Two or more clip portions may have the same or different orientations on bane, to oppose andor oonta the same or different sideslsurfaces of the bone.

A cUp portion may have any auable epadng. structure, and disposition of its arms. Generally the arms may be spaced about the same as the distance between generally opposing surfaces of a target bone, that Is, about the width, thidcness, and/or diameter of the bone where the dip portion will be disposed.

However, in earns examples, the arms may be spaced aomhat greater than thdthordiameter,atleastwhenthedlpporfionisfhstplacedonbone, to facilitate placement. Alternatively, the arms may be spaced somewhat less than this width or diameter, so that the dip portion may be enapperI onto bone. The arnie may be generally linear or may bend along their long axes. Furthermore.

the arms may be noritwiated or may twist. The arms may be at least substardlafly parallel, or may diverge or converge toward their distal ends (spaced from the bridge region).

A clip portion may have any suable width. The width of the clip portion may be measured between opposing edges of the arms and/or the bridge region, far example, generally pamalel to the long axis of the bone when the clip portion is disposed on bone. The width may be substanbally greater than the thickness of the bone plate (generally at least about twice the thklcnese), so that the dip portion Is p1ate-lce rather than rod-like. The width may be generally constant whim each aim and/or within the bridge region AlternatIvely the width may vary within one or both arms, between the arms, within the bridge region, or between the arms and the bridge region. For example, the arms may taper away from the bridge region. Alternatively or in addition, the bridg. region may be narrower than the arms, to fadlitale bending the bridge region (e.g., to facilitate adjielmerit of the spacing of the arms), or the arms may be narrowar than the bridge region (e.g., to facilitate adjustment by bending the arms). In rns embodbnents, the dllp portion may indude one oi more narrowed regions, at which the dip portion may be eeledhdy bent, such as within one or both arms or the bridge regius, andlor at a junctions between a arm and the bridge region. Exemplary widths of the bridge region indude about 2-50 rrvn OF about 5-20 mm, among others.

A cup portion may have any suitable thickness. The thickness may be selected based on various onnalderatlons, such as reducing the profile of the clj portion on bone. prcMdlng a sufficient strength to fix bone, bendablllty, providing a ar.itIIcient thickness to form an offset rip or a thread In an aperture for engaging a fastener thread, and/or the like. Exemplery thicknesses Include abd 0.2-3 mm or about 0.5-2mm, among others.

A dip portion may have any suitable number, shape, and arrangement of apertures. The dllp portion may have no apertures or may have one or more apertures. Each aperture may be dicuier, squaie elengata (such as oval, eflrtIoal, rectanguinr, etc.), and/or the lJce. Each aperture may Includ, or lack a countaibore. The aperture may be locking or nonloddng. Locking apertures generally include a retention structure to engage a fastener, such as throih a thrI of the fastener, end restrict a,dal movement of the fastener in both adal directions. The structure may be one or more ridges formed by the waft of a locking aperture. The ridges may be generally heb, to form a thread, at least partially Ilneai to form a locking slot, and/or the like. Further aspects of locking slots are described above and in U.S. Provisional Patent Application Serial No. 80/548685, Ifted February 26,2004, which is Incorporated herein by referenos.

The apertures may be disposed In the arms and/or the bridge region of the clip portion, if two or more apertures are Included in a dip portion, the apertures may be arrayed across the width andor along the length of one or more arms and#or the bridge region, andlor may have a staggered disposition. In some examples, one or more pairs of apertures may be abgned1 that is. i,nflgured to receiva the sane fastener with each aperture of the pair. Apertures of an aligned pair may be disposed In the arms and/or in the bridge region and one arm, among others. Each aligned pair of apertures may Indude zero, one, or two Ioddng apertures. Apertures of an aligned pair may have the sane general shape, such as oval or càwlar, or may have different shapes, such as oval and circular, among others. Furthermore, apertures of an ellgned parr may be of generalLy the same s, such se about the same length and/or width, or may have different length. and/or widths. In.xenlaiy embodiments, apertures of an aligned pair may be have about the same length, with one of the apeLtJms being narrower than the other to create ratenti on stnrcLure to lock a fastener in position. Providing two or mare aligned pairs of apertures in the clip portion may lead to enhand torsional anWor bending stability of the fracture site, by inhibiting rotation of the clip portion relative to the bone. The thickness of the bone plate adjacent the aperture(s) n the clip portion and/or other portiofl8 of the plate) may be generaly the sane as, less than, or greater than the thickness of the plate away from the aperture(s). Plate thinning near the apertwes may provide a recess for reducing the prohlie of fasteners placed In the apertures, and plate thickening nbc' the apertures may rethforce the epertule.

B. Soanninri Portions The bone plates each may include one or more spanning portions. A spannIng portion, as used herain, is any raglan of a bone plate configured to extend between two or more clip portions of the plate. Accordingly, the spanning portion may extend in a generally axial direction along a bone1 generally spanning a discontinuity (such as a fracture) o?the bone.

A spanning portion may have any suitable contour or shape. For example, the spanning portion may match, at least substantially, a surface contour of a bone for which the spanning portion is configured. For empIe, the spanning portion may be generally linear or bent & It extends batween dip portions (along its spanning axis). if bent, the spanning portion may hme a coriceve and(or convex bend along its inner surface, based, for example, on the surface contour of a bone for which the spanning portion is configured. The spanning portion also may be linear or curved across its width (and on its loner and/or outer surfaces), based, for epis, on a local clrcurnlerential contoix of the bone thetis linear or curved, respectively. The spanning portion thus may be contigurad to cün1act the bone along any suitable xtent of Its Inner surface.

The spanning portion may be bent beibre and(or during irpetillation according to the shape of bone or may be nonbent.

A spanning portion may be configured to be received on any stAtable sideleurface of a bone. The spanning portion thus may be disposed adjacent a superior, inferior, anterior, posterior, isteral, andlor medial bone surface, among others. In some examples, the spanning portiou may be disposed adjacent only erie surface of a bone, such as superior, inferior, outward (external), or inward 16 (ntsrnal; e.g., an Inward surface oVa rib bone). Outward and inward surfaces, as used herein, refer the goneffihly opposing surfaces of the ribe that are flanked by 5uperior and Inferior rib bone surfaces. In some examples, the spanning portion may be disposed adjacent and may contact two or more bone surfaces, such as superior and outward surlaces superior and Inward surfaces; superior. Inward, andoutward surfaces; andlor the like. The spanning portion thus may extend along bone from any suitable raglan(s) of each dip portion.

Exemplary regions Include only one arm, one arm and the bridge region, two arms, or two arms and the bridge region of the cbp portion.

A spanning portion may befe any suitable dimensIons, such as length (L; generally measured along the spanning dimension and along a bone), width CW; generally measured), and thlclcness (1). Hers, L =W>T The length may be measured along the spenning dimension, thet is, along a bone with the bone plate installed. The width may be measured along the ml8rentlal dimension, that is, around the bone with the bone plate installed. However, In acme examples, the spanning dimension may be about the same as or less than the cIrcumferential dimension. For example, the spanning portion may be relatively short and the dip portions relatively long, as measured along bone, or the dips portions may be secured dkaotty to one another or formed unarVy, without a distinct spannh porOfl. The width anWor drctxnfemfltial dmwnsiofl of the spanning portion may be determined, at least paillaly, by the extent each clip porlion from which the spanning portion extends, as described above.

FUrthermore, the width andlor cirimfarenh1al dimension of the spanning portion may be substantialy than the thickness of the bone plate (generally at least about twice the thickness), so tint the spanning portion Is plate-like rather than rod-like. The width may be generally conatant or may vary as the spanning portion extends between the clip portions. In some embodiments, the spanning portion may Include one or more narrowed regions at which the spanning portion may be selectively bent Exemplary average widths of the spanning portion Include about 2-30 mm or about 5-20 mm, ernong others. The thickness of the spanning portion may be about the same as, less than, or greater than the thickness of the dip portions. The thickness may be selected based on various considerations, such as reducing the protle of the spanning portion above bone, a sufficient strength to lix bone, bendabihty, andlor The hke The thickness may be constant or may vary, for example, at regions of overlap wfth another plate component and!or near apertures (as described above). Exemplary thicknesses of the spanning portion include about 02-3 mm or about 0.6.2 mm, among others.

A spanning portion may have any suItable rnirnber, shape, and arrangement of apertures. The spanning portion may hays no apertures or may have one or more apertures. Each aperture may be circular, square, ekingate (such as ovel, elliptical, rectangi.dar, etc.), andlor the like. Each aperture may 26 Include or lack a counterbora The aperture may be locking or nonlocklng, as described above for clip portions. if t or more apertures are Included In a spanning portion, the apertures may be arrayed across the width anrilor along the length, and/cr may have a staggered disposition, among others. In some examples, one or more sperturee of the spanning portion may be configured to be aligned with, and generally abut, corresponding apertures of a clip portion.

AordIngly, the spanning portion may have two or more apertures that align with two or more apertures of a clip portion, to fadhitate securing the spanning portion to the dip ptxtion with fasteners. In some examples, the spanning portion may have three or more apertures corlgured to permit the clip portion to be aligned alternatively with two or more paks of the apertures. In same examples, the spanning portion may have apertures configured so that or more cl" portions can be secured to the spanning portion with fasteners at nonoverlapping positions of the spanning portion. These apertures may be arranged for securing the clip portions to opposing end regions of the spanning portion andlor to one or more lntannadiale regions of the spanning portion, among others.

C. Aoerturea The bone plates may have apertures to perform any suitable fiict1ons.

For kislance, apertures may be configured to receive fasteners for securing plate components to each other and/or to a fractured bone. Alternatively, or in addition, apertises may be provided that are adapted to alter the local rigidity of the plates end/or to faditate blood flow to the fraure to promote healing.

The apertures may have any suitable geometry(Ioa). For example, some aperhirea may b. oval, whereas other apertures may be substantialy circular. Oval spertises may be used, for example, to permit flexbilty in placement of a fastener In a range of translational and/or angular positions within the aperture. Furthermore, oval apertures may permit a bone plate and/or plate component to slide parallel to the long axis of an oval aperture, to facilitate adjustment of the plate andlor plate cçrnponent position, after a fastener has been received In the aperture and in bone. Oval apertures also may function as compression slots that bias a fastener toward or away from a disconthuity In the underg bone. Cb'cidar apertures may be locking ($uth as threaded) or nonlocldng apertures. AftBrnatlveiy, or In addition, to engage a threaded fastener, the drouler (or other) apertures may be configured such that a nut dip, andfor other retaining device can engage an end or other portion of th. fastener where it extends from the aperture. Furthermore, circular apertures may be used to receive additional fasteners, such as pms. after the plate is finally positioned. The apertures may Include couritarbores that albw the head of fasteners to have a reduced profile above the bone plate andlOt to lie substantially flush with the top surface of the plate.

The apertures of the bone plates may have various sizes, depending on their intended usege. For exan If used with fasteners, the apertires may be 6 sIzed for d1flrent sized fasteners, such as bone screws with diameters of 2.1, 2.7,3.5, and/or 4.0 ivan. Generally, the larger the p the larger the flLmther (andftr size) of apertures, so that larger plates may allow relatively larger numbers of scswa (and(or larger screws) to be used Thus, bone plates used to treat larger bones may Include relatively lwer apertins, or relatively larger numbers of apertures. Providing relatively greater numbers of apertures to accept bone fasteners may lead to relatively greater torsional and/or bending stabllty of the fiadure site, when the bone plate is installed on a bone. The apertures in a particular plate may have a hybrid arrangement such as a size of 3.5 mm In one region of ihe plate, end a size of 2.7 mm In another region cl the plate, aiiong others.

In genera!, the apertures may have any eultable armngament In the plate. For emple, the apertures may be clustered together at end regions of the bone plate, to increase the number of screws that can be used to lix the associated segment(s) of bone(s) via the plate, or they may be spaced sLtstantlatly evenly along the length of the plate. including regions of the plate that do not have a corresponding opposing portion disposed adjacent an opposing side of the bone. The apertures may be positioned side-by-side, with preceding andkr subsequent apertures positioned along a common ads of the plate or arranged In a two-dimensional pattern. increasing the density of screws thatmaybeused.

0. Plate Comoonenle and Fa$eners The bone plates may have any suitable number of plate components.

For example, the bone plates may be unitary or may have two or more pieces corfvured to be secured to one another and to bone with fasteners. In some embodiments, first and second components of a bone plate may be supplemented by a third, fourth, or even hiaher number analogous component with each component Independently formed integrally or separately from each other component. The various components of the plate may be used ak,ne or In any 5UitabIe combination, as appropriat, or deal red tw a given application. The vanous components also may be configured to have the same or different -and slzss.

The components of a bone plate may be configured to be assenthied In an overlapping configuration The overlapping configuration may abut an Inner surface regIon of on. ci the components with an cuter surface of another of the components. The regions of overlap of the components may be geomeiaic&liy elmitar to adjacent nonovorlapping regions, or they may be spera1Iy configured to facilitate the overlap. For example, the thickness of one or both components may be reduced in the region of overlap. In same embodiments the overlapping regions may be beveled, andlor tapered, so that the boundary betert the overlapping end nonovedapping regions of a plate component may be relatively smooth abng the inner (bone-facing) andlor outer (non-bone-facing) surfaces of the bone plate. AfterrIvely, or In addition, the surfaces of the plates that contact one another may be configured andlor treated (e.g., roughened) to reduce slippage or the like. Exemplary configurations to reduce slippage may include one or more complementary depre5slons and projections (such as pins and holes) formed on mating surfaces ci the plate components.

The components Ma bone platemay be secured to one anotherand to bone with any stab1e fastenirs and at any suitab1e time. The fasteners generally comprise any fastener mechanism, including screws, boils, nuts, pins, hooks, suture material, andlor wires, among others. (In some cases, the fasteners may include adhesives andfor other nonmechantcal mechanisms.) pta,', om may be machine scre to secure plate components to one another and/or bane screws. Each bone screw may be received in bone and In a single aperture of the bone plate, a paW of aligned apertures disposed adjacent generally opposing bone surface (such as aligned apertures of a citp portion), arid/or three or more aligned aperbires provided by two or more plate components. The components may be secured to each other oil of bone and!or on bone. is

The bone screws may be uricortical1 bicortical, and/cr cancellous bone screwS, among others. Unkorthl and bloorfical bone screws typically have relativelysmallthreadsforuse such as nearthe middle ofa davicle, whereas cancellous bone screws typically have relatively larger threads for use ifl soft bone, such as In a rib. UniixrtIcal bone screws penetrate the bone cortex once, adjacent a abIe surface of the bone. Blcrxtlcal bone screws penetrate the bone cortex at one suiface of the bone, pass through the bone and then penetral the cortex sgah adjacent a generally opposing surface of the bone. Generally1 unicortical screws provide lees support than bicortlcal screws, because they penetrah less cortex.

The slzo and shape of the fasteners may be seleoted based on the size and shape of the apertures or vice versa. An exemplary fastener Is a threaded bone scrv having features specifically adapted to fit the plate construction.

The bone screw may have a head wider than the width or diameter of an aperture defined by the bone plate, a length approximating the width of the bridge region of a clip portion (and/or of bone), and a thread configured to engage a lip or thread of an aperture of the bone plate.

E. Plate Materials The bone plates may be formed of any suitable materiel(s). Generally, zo the bone plates should be t least as stiff and strong as the ecIlon of bone spanned by tile plates (typically, as stiff and strong the bone th the absence of any discordinuity), yet flexible, bendable, ondlor springy enough not to strain the boris enificanuIy. Suitable materials for forming the bone plates may include metal, polymer, plastic, ceran composite, and/or the h1c. Such materials may be biocompalible. Exemplary blocampatible materials may Include rnetalahnetal alloys (fOr gcaniple, titanium or titanium alloys; alloys with cobalt chromvm, and/or molybdenum; stainless steel. etc) and/or blorasorbable materials (such as potygaladic acid (PGA), polylaclic acid (PLA), polycaprolactonea, polydloxanones, copolymers Thereof, etc.), among others.

IL Accessories and Kite The bone plates described herein may be used with various asssorles and/or may be supplied in a kit. These accessories may be used, alone or from a kit, during the preparation, iateUa1Ion, and/or removal of hone plates (noluding the aseociatd fasteners), emong others. Exemplary accessories may include bone calipet's. dies, holeforming devices, drivers, andlcr the like.

A bone caRper may be used to measure the size of a bone to be fixed.

Measurement of the size may fwilie uleIon of a suitable bone platmlata component(s), a suitable die for bending a bone plate/plate component(s), and/or suitable fastener. (such as by length) for securing the bone platelplale component(s) to bone, wilong uthera The dl. may permit a bone plate to be shaped pie-and/or intrsoperati, for example, by a surgeon insteliing the plate. Furthemiom the die may permit the bone plate to be shaped to conform at least eid,stuntiafly to a particular fraobAred bone (or segment of a bone) such as a fraclured rib. A hale-forming device such as a dr with an a Justable drm slop may be used to drill a hole fri the bone to a desired depth, based, for example, on the measured sire of the bone. A driver such as a screIrlver may be used to install and/or remove fasteners. Further aspects of accessories end IdLe are described below.

k Bone Caliosra The bone plates optlonaliy may be used with any suitable measuring devices, such as bone calipers, to measure one or more dimensions of a bone Iobeftced. Furexampie, FigureTahowsen exemplarybonecaIper 110 beIng used to measure the thickness of a rib bone 112. CaRper 110 may iridida an arcuate end portion 114, whIch Is configured to conform to a preselected (e.g., superior) surface of the rib bone, and which also may be configured to wrap partia1y around another (e.g., posterior) surface of the bone. More generally, 26 end portion 114 (and other portions) of the ca1er may be adapted to conform to the size and/or shape of any desired bone(s), so that a sirniar instrument may be used to measure the thickness of various bones other than ribs. Caliper also may include a clamping member 116, whIch may be attached to a movable measurement scale 118. Once end portion 114 of the caliper has been placed adjacent the bone being measured, scale 118 may be moved until member 116 makes contact with the bone. Then, as hidicated at 120, the approximate thickness of the bone may be read from the scale.

The dimensions of a axed bone, measured as above or otherwise kJ'ao, may be used for any e'illhIa purpose. For example, the dimensions may be usat to select an appropriate bone plate or plate axriponeflt from a set of plates or components, .nWor they may be used to pro-or kitisoperatively shapeabcnoplatetolftthebone.

B. Repdirpa Dies and jmun gTooI* The bone plates oplionalty may be used with any sullatle dies andlor hole-forming tools. The dies may be configured to bend the plates fwm a planar confuration andlor to adjust the shape of the plates from a bent configuratIon. The hdeorinlnq tools may be used to form holes in bone anWor in bone plates, generally to facilitate placement of fasteners.

Figures 8 and 9 show an exemplary bending dl. 130 being used to shape a bone plate 132, or a component thereof, to fit a rib bone. In Figure B, the die has received the plate in partlaly bent configuration, and in Figure 9, the die is being bent with applatIon of a compressive forte through compression members 134.130.

Die 130 may have a se and shape that approximates one or more cress sectional dimensions of a rib bone1 to facilitate contouring a bone pIat&late component to match these dimensions at least ststantia1ty. In particular, the die may facilitate contouring plate component 132 to rnaioh the size (e.g., thickness) of the bone, and to match the áhape or curvature of a preseleded (e.g., superior) surface of the bone. To coribir a bone plate, or a component thereof, using the bending die, a flat or partially contoured plate may be shaped around Uie die manually. Alternatively, or in addition, a tool such as pliers or another clamping rriechanlam may be used to add precision andlor mechanicel advantage during bending. In some embodiments,-the die may be narrower and tapered more than the actual shape of the bone, so that bone plates shaped by th. die may be configured to compress the bone slightly even before being fixed Into position on the bone. DIe 130 may be configured to appro,dmate the size and shape Of a nb bone; hover, more generally, dies may be provided that facilitate contouring of plates to match the dimensions Of other bones, such as clavicles, among others.

Figures 11) and 11 show the use ci' a drill, drill stop, and fastener for moungabo,*platBtOabOfle.

FIgure 10 shows a drIll 140 Including a drill bit 142 dnlTing ttwough a boris 144. BIt 142 has been gilded into bone through an spertse 146 of bone plate 132, while the bone plate Is in position on the bone. The drill bit may adjustable depth stop 152 may be disposed and secured along the dli bit at a selected adaI position o? the bit, so that a suitable length of the drlng tip denda beyond the depth stop. Securing the depth eto to the bit in this manner prevents the bit from penetrating the bone beyond a desired depth, and may inhibit damage to tissue behind the bone, when the bone Is drilled. Depth stop.152 may be secured to th. bit by any suitable mechanism, such as en Allen bolt 164, andlor engagement with grooves or elois provided along the length of shaft 148. The shaft of the dill! bit may be prrMded with a scale, generally Indicated at 156, far poeltlor*ig the depth stop at predefined distances ffcm the distal tj of the drill bit Alternatively, or m addition, the depth atop may be positioned by measuring a desired distance from the distal tip with any standard measuring devca, su*i as a ruler, tape measure, or caliper, among otherL Figure 11 thou bone plate 132 attached to bone 144 with a ttweaded bone screw 160, in the hole lbrmed by the drill bit (see Figur 10). Screw 160 may be selected based on the measured thickness ci' the bone. In parlicular. a threaded screw may be chosen that Is long enough to reach and engage a bddng aperhire 162 adjacent an opposing 8UrIaCO 164 of the bone, bat not so long that a distal end 166 of th. screw protrudes. or protrudes xcessIve1y, through the bone plate. This configuration may allow the screw to engage the plate securely and compress the plate end the underlying bone. while reducing or ellrnkiatlng unnecessary physiological damage or discomfort to the patieriL Figures 12 and 13 show an empIary die assembly 180 before (Figure 12) and after (Figure 13) bending a plate member 182 Into a clip portion 184.

The die assembly may include an anvil 186 wiflgured to fit into a receiver 188, wilhi a gap sufficient to accommodate the plate member disposed beiween the anvil and the receiver. Th. anvil may be configured to be pressed into the receiver, such as with a dau device or one or more blows from a hammer, among c*here. The receiver may be conflured to position the plat member over a cayy 190 of the receiver. For empfe, the receiver may Include a recessed etructure 192, projectIons, or the Ike to restrict lateral movenierI of the plate member before andlcr ck*tg bending.

A bending die endlor die assembly maybe adjustable andlor available sa part of a set to accommodate bones of different sizes d shapeS. Thue, while the exemplaly dies described ee may have lbced dimensions, in some embodiments thee, dies may be Internaly acustable, for example, using one or moze Internet set scr, such that the overall size and/or shape of the die may be set by adjusting the set screws. Alternatively, a plurality of bending * dies, fixed andlor acustab1ö, may be piovided for each size, shape, and/or te of bone, so that bone plate components may be shaped to any desired size.

The range of sizes of the dies provided may correspond to an expected range in sizes of the type of bone being treated. For example, for contouring bone plates suitable for rib bones, dues may be provided that have maidmtin wklthe ranging between approdmatety 0.10 inches (about 2.5 rom) and approdmatcly 0.50 Inches (about 13 mm), or between approxImately 0.15 inches (about 3.8 mm) and approxImately 0.38 inches (about 10mm), among others. c. jc

The bone plates, fasteners, accessories, etc. desanbed above may be provided eingly and/ores a kit, in conubmation with one another and/or yet other accessories. The kits may include, among others, a set of bane plates constructed to fit varioue bones and/or regions of bones. For example, the kit may Include plates configured to lit ribs andr clavicles of various sizes and shapes aswe I as to mon various regions of a rib and/or a clavicle In addlon, the kit may Include Inafrumenlatlon for measuring one or more dimensions of the bane, and/or far inbaoperatlvely bending and Installing a bone plate (or portIon thereof). For example, the InstrumentatIon may Include a bone caliper, an adjustable bending die, and/or a dnl bit including a depth stop. The ki also may include a case or organizer, Instructions. mounting hardware such as bone sor of various lengths andior diameters, drivers such as screwdrivers for installing andlcr remo*ig mounting hardware and!or other accessories related to bone plates.

IN. L!elliqda of Using thBovwPIate Bone plates of the present teachings may be Installed on bones by any suitable methods. This section desor,ea exemplary method steps that may be suitable to fix bones with the bone plates. These steps and those described elsewhere in the present teachings may be performed In any sulle order, in any suitable combination, and any suitable number of lines., A bone to be fixed may be selected. Exemplary bones may indude ribs andfor davicles. Other exemplaiy bones may include bones of the ani (radIus, ulna, humerus), legs (femur, tibia, flbula. pateffa). handat*rlats (e.g., phalanges, metacarpale, and carpets), feet/anldes (e.g., phalanges, metatarsais, and tareals), vertebrae, a,uiss,. peMe bones, and(cr cranial bones, emong others. The bone may be selected from any suitable species, including human, equini, canine, andfor Mne species, among others. The bone may lack or include a discontinuity, which may occur naturally ndkir as a resuft of injury, disease, andlor surgical lntervention among others.

Accordingly, exemplary discordinuities for use with the bone plates described hereIn may include Joints, fractures breake in bones), ceteotornies (cuts in bones), and/or nonunion. (for example, produced by injury, disease, or a birth defect), among others. -. A dlacontlnulty In the bone may be reduced. For exmplo. a fractured bone may be set. Reduction of the discontinuity may be performed before, during, andfor afler a bone plate is secured to the bone.

An aspect of th. bone may be measured, generally In the vicinity of the discontinuity. Measurement may be performed with any suitable rneasudng device or method, such as caUpers, a ruler, a tape measure, a fluoroscope (e.g., by fluorography), and(or the like. The aspect may correspond to a characteristic dimension (such as thickness, wtdth, length, and/or diameter, among others). Alternatively, or hi addition, the aspect may correspond to a curvature or surface contour of the bone, among others.

A bone plate may be aelecled for InstallatIon on the bone. The bone plate may be seleded from a set of available bone platee. For exampla, the set may include bone plates with dlffarard Ieg-to.leg spacmgs and/or radii of curvature their clamp portions andlcr different lengths of spanning portions, among others. Selection may be performed based on the type, ste, and/or contour of the bone among others, and thus may be based on the type of bone and/or on a measured, average, anwOr expected aspe (such as thidcnees) of the bone. The bone plate may be pra.b.nt ICr the bone selected andlor may be custom coritoized r a partloular bone, bone region. andlor for the particular anatomy of the patient CuDtoni contouring (generally, bending) may be performed pro. and/or Inttaoperatlvely by hand1 with a bending tool and/or with a die, among dhers.

The bone plate selected may be positioned on bone. The step of positioning may Include placing a unitary bone plate or two or more plate components on the bone, from any suitable dieclion. In exemplary embodiments, the bone plate and/or a plate component(s) may be placed on a bane from at,ove the bone (from a superior direction). With two or more plate components, the plate components may be placed an bone in any suitable order. In some embodiments, a first plate component including a fret clip portion end a spanning portion may be placed onto bone. and then a second plate component Jndudlng a second clip portion may be Placed onto bone, overlapping and outside of the spanning portion. In some embodiments, this order and/or disposition of plaoement may be reversed. Furthermore, additional plate components aiso may be placed on the bone. In some examples, a c portion a! the bone plate may have a Eeg-to4eg spacing that is less than the thlclmesiMldthldlemeter of the bone, so the dip portion "snap? in place on the bone.

The seL.dlon and/or positioning of bone plates, as described. in the present teachings, may take advantage of the diftereritisi cheracteristis andlor acc,stbIIfty of different portions or surfaces of a given bone. Fur empIe, a bone plate with clip and spannmg portions may be selected and positioned such that the spanning portion and/or clip portion (or a region(s) thereof such as en arm andlor bridge region) Is loosted along a more aeeeIe andlor less vascularizid or innervated portion of the bone, such as the outward or anterior surface of a rib. In this way, relatively mum bone plate Ia positioned adjacent more accessible and(or less sensitive portions of the bone, and relatively lass bone plate (eg., just one or two anne of the dip portion(s)) is positioned adjacent less aooeaslb and/or more sensitive portions of the bone.

One or more boles may be formed In the bone. The holes may be formed with a hole-forming device, such as a drill, a punch, and/or a self-dnlllng bone screw, among others. If formed with a dnlI, a drill stop, such as the drill stop of Fure 10, may be used to prevent Ibrining a hole that Is too deep, which may cause unnecessary tissue damage ar*lIor remove bone unnecessaiily. The holes may be formed before or after one or more plate components are positioned on the bone. If fanned after a plate component Is positioned on the bone, the hole may be formed in alnrnent with one aperture, or two, three, or more aligned apertures of one plate component, or tw or more overlappitig plate components. Accanilogly, the aperture(s) may function as a guide for the hole-forming tool The holes may extend from an aperture into bone and/or throth bone. In some examples, a hole may extend between a pair of aligned. spaced apertures of a chp portion.

The bone plate may be secured to th. bone with one or more fasteners.

such as bone screws. One or more fasteners thus. may be selected. The fasteners may be seletted, for example, to have a shaft diameter less than the wtdthFdiameter of a target aperture, and to have a thread confurutiou corresponding to the size/uil'at of art aperture Hp (for an elongate luddng aperture) or to the pitch of an aperture thread (for a circular locking aperture).

The fasteners also or alternatively may be selected to have a length (particularly a shaft length) about the same as the measured or expected vgclcnessMidthMiameter of the bone. The fasteners may be placed through apertures arid into pie-formed holes or may lbrm holes themselves-The fasteners may engage a plate component edjaoent one side of the bone and/or adjacent generely opposing surfaces of the bone, among others. Each fastener may extend through a single plate component or two or moreoveilapping plate components. Aooosdingty, the fastener may secure t or more plate components together andlor to bone. In some examples, the fastener may lock to one or more plate components, adjacent only one aide of the bone or adjacent each of two generally opposing surfaces of the bone. In some examples, the fastener may be tightened r,mUI generally opposi'ig regions of a plate component or bone plate are compressed against the bone. The fasteners may be placed into apertures of the bone plate in any suitable order.

Far example, a liret plate component may be partially ot completely secured to the boris first, and then a second plate component secured to the bone, or the plate components may be aectred to bone at least initially wIth the same fastener(s). The fasteners rrwy be irmtalted and(ar removed by hand and/or wIth the assistance of a suItable drKer, such as a screwdilver.

lV Examnise The folbiving examples desonbe selected aspeda arid embodiments of the present teachings, Including exemplary bone plates and e3oarnplaTy configurations for assembly of bone plates from plate components. These examples and the vaious features and aspeda thereof are Included for IDustratlon and are not intended to define or Itmit the antis scope of the present teachings.

Example 1. Son. Ptatit with a Multi-srture Sonhia Porfton This example cjescribes exemplary bone plates having a sparin(ng portion with a plurality of apertures. The sperb.ztee may be arranged so that a clip component can be assembled with and secured to a spanning portion at t or more positions along the spanning portion.

FIgure 14 shows an exemplay bone plate 210 for fixing a fractured rib bone. The boris plate may Include a spanning component 212 having a spanning portion 214 and a fEet clip portIon 216 formed unitardy. The bone plate may include one or more additional dip. portions, such as clip components 218, 220.formed as separate coniporisnis.

Spanning portion 214 may include a plurality of spanning apertures 222 arrayed aleng the length of this portion. Spanning apertures 22Z and partictiarly subsets of these apertures, may be configured to be aligned with one or more clip apertures 224 of each dip portion. In the present illuatratlon, adjacent pelts of the spanning apertures may be aligned with and abutted to adj*erd pairs of clip apertures, shown at 226. AccordIngly, each clip portion may be disposed at a plurality of selected positions along the spanning portion.

ape'twe of the spanning portion may have any suitable spacing.

The apertures may have an equal epadng, as shown here, or may have an unequal spacing. For example, the apertures may be configured as groups (audi as paws, triplets, etc.) with unequal spaclng.between the groups, so that a clip component, .1th a correepordng number of apertures as each group, may be secured In alignment with a selected group. Alternatively, an unequal spacing may be ulIe if each clip portion uses only one aperture assembly with the spanning portion.

In use, spanning component 212 may be positioned on a fractured rib, and one or more clip components 218,220 may be positioned In alignment with apertures of the spanning portion. For example, the dip cononents may be positioned so that pairs of clip portions flank fractured regions of the rib.

Accordmgly, more seterely fractured rth3 may use a greater number of clip components fri combination with the spanning component In some examples, the spanning portion may be cut to a suitable length aording to the length of bone or bone region to be spanned by the bone plate. Aoooidingly, a greater or lesser length of the spanning portion (or none) may be removed based on a lesser or greater number, respectively, of clip comporiente to be used and/or a shorter or longer region, respectively, of bone to be fixed. Spanning portion 214 may be jt before or after spanning component 212 Is positioned on andlor ae*ired to bone.

Alternative configurations may be suitable. In some embodbnents, the spanning component may be selected from a set of spanning components with different lengths of spanning portions andlcr dliterant numbers/spacings of apertures. In some embodiments, the spanning portion may be formed of a selectable number of modUles, to adjust the length of the spanning portion.

and/orthe spanning portion maybe a separate module (ore setof separate modijes of various lengths) Ut can be selected for aeaentty with clip cononents.

EnpIe 2. eon. Plate. with Array of Plate Comaonenta This example describes bone plates that may be assembled as arrays of plate components.

Figure 15 show. a bone plate 240 including a tandem array of spanng ccrnponents 242, 244 that ovedap and cen be secured to one another with fasteners received in aligned apertures, shown at 248. Each apanrng component may Include a dip portion nd a spannrng portion. My suttthlo number of spanning components, of similar or disfinot configuration, may be arrayed. One or more dip components may be secured to a spanr*g component, or the bone plale may lack a distinct clip component Example 3. en Plates of Unitary Construction This emple deectibea exen'iplary bone plates having a unitary construction.

Figure 16 shows an exemplary bone plale 260 for Thdng a tactured rib.

Bone plate 260 may be formed as one component, so that a spanning portion 262 is joined to. and flanked by, clip portIons 264.266.

ibmpl. 4 Selected Embodimente This section describes selected embodiments of the present leadings, presented as a series of Indexad paragrapis.

1. A bone plate for ftdng a frscbne of a bone. comprising (1) first and second bone-fadng surfaces configured to face at least substantlafly opposite surfaces of a fractured bone, each bone4ac!ng surface defining at 26 least one aperture configured to accept a fastener for attachg the bone plate to the fractured bone; and (2) a third bone-facing surface connecting the first and second surfaces and having width approximating a width of the fractured bone.

2. The bone plate of paragraph 1, wherein the first and second surfaces are substantially parafleL 3. The bone plate of paragraph 1. whereIn the third surface conforms at least partially to a surface of the fractured bone.

4. The bone plate ol paragraph 3, the bone plate being configured to fix a rib bone, whemb the third surface canlorms at least partially to a super or surfaceciftieribbone 5. The bone plate of paragraph 3, the bone plate being configured to f a clavicle bone, whereii the third surface conforms at least partially to a superior surface of the clavicle bone.

8. The bone plate of paragraph 1, wherem at least one of the apertures is configured to engage a threaded fastener.

7. The bone plate bf paragraph 1, wherein the apertures define at least one aligned pair of apertures configured to accept a threaded fastener.

B. The bone plate of paragraph 1, whereIn the bone plate Includes a ?rst anchor portion Wi which the first and second surfaces are overiepp!ng, a spanning portion hi which a longer one of the first and second surfaces is configured to span a fracture, and a second anchor portion includIng a detachable anchor clip.

9. The bone plate of paragraph 8. wherein each anchor portion hiclades at least one pair of aligned apertures configured to accept a fastener for 1*Ig the bone plate to the bone, and wherein at least one aperture of each aigned paIr Is configured to engage a threaded bone screw.

10. The bone plate of paragraph 9, whereIn exactly one aperture of each ahgned pair io configured to engage a threaded bone screw, and wherein exactly one aperture of each aligned per defines en elongate reduction slot 11. Th. bane plate of paragraph 8, wherein the anchor clip iicludes a first engagement portion configured to at least partially overlap and engage wIth the longer.bone..fadng surface, a escond engagement portion opposing the first engageelent portion, and a bridge portion connecting the engagement portions and having a width approxinating the width of the fractured bona 12. The bone plate of paragraph 8, wherein the anchor clip Is configured to mount to the spanning portion an an opposite side of the fracture from the first anchor portion.

13. Theboneplateofparagraph8,whnaponofthcr clip is configured to mount abomat!vely to a bone-lacing surface of the 3 epaiming portion, such that the anchor dip lIS between the spanning portion and the bone, or to a non-bone-facing surface ci the spanning portion1 such that the spanning portion lies between the anchor clip and the bone.

14. A bone plate lbr ftdng a fracture ci a rib, comprising (1) a first bone4aclng surface for q4endlng along one surface of the rIb; (2) a second bone-facing surface opposing the first bone-facing surface, for extending along another surface of the rib; and (3) a third bone-facing surface connecting the first end second bone-facing surfaces.

15. The bone plate of paragraph 14, wherein the third bone-facing surface is shaped to at least partially confonn to a superior surface of the rlb 16. The bone plate of peragreph 14, whereIn the first and second bane-facing surfaces each define at least one aperture configured to accept a fastener for attaching tie bone plate to the rb.

17. The bone plate of paragraph 18, wherein at Isast one of the apertures contbured to engage a threaded bone screw.

18. The bone plate of paragraph 18, the plate including a first region in which the first and second bone-facing surfaces ovedap, and a second region in which the first bone-facing surface la configured to extend beyond the secord bone-facing surface along the rib.

19. The bone plate of paragraph 18. further comprising a U-shaped anchbr clip attachable to the first bone-facing surface In th.second ron.

20. The bone plate of 18, wherein the second region is configured to span the fl'acture.

21. The bone plate of paragraph 18, where the anchor clip defines at least one aperture configured to aept a fastener for attaching the bone plate toth. rib.

22. Aboneplateforfldngafrceofadb,comprsing(1)aflst component including first and second opposing bone-facing surfaces connected by a thIrd bone-facing surfaca, wherein at least one of the opposing surfaces ddlnes a spanning portion configured to span the fracture; and (2) a second component including first and second opposing bone4aciig engagement portions connected by a bone-facing bridge portion wherein at least one of the engagement portions Is configured to pazliaJly overlap and engage with the first component.

23. The bone plate of paragraph 22. wherein each component defines at least one aligned pair of apertures configured to accept a fastener for attaching the bone plate to the rIb.

24. The bone plate of paragraph 23, wherein one aperture of each a1ned pah is a reduction slot and wherein the other aperture of each aligned paIr Is confL,jred to securely engage a threaded bone screw.

25. The bane plate a? paragraph 22, wherein the ftat arid second surfaces of the that component are at least substantlely paralel, and wherein the that and second podioris of the second component are at least subeteritlally paralleL 28. The bone plate of paragraph 22, wherein the third bone-lacing surface of the first component and the bridge portion of the secind component eachcofoanatlaastpaitiallytoaeupedoraurfaceofadbbone.

27. A method of fbdng a fracture of a bone, comprising (1) positioning a first bone plate component with three bone-facing surfaces of the first component d6pased eubstantlaUy adjacent three surfaces cia fractured bone, wherein exactly one of the three bone-facing surf spans the fracture; (2) positioning a second bone plate component with two bonefaclng surfaei of the second component disposed subsbnllally adjacent two surfaces of the fractured bone and with a third surface of the second component disposed substantlauy adjacent the exactly one bone-facing surface of the flat component that spans the fracture; (3) attaching the second component to the first component and (4) attachIng the first and second components to the bone 28. The method al paragraph 27. wherein the fractured bone Is a rib.

20. The method of paragraph 27. wherein the fractured be is a davlcIe 30. The method of paragraph 27, wherein the exactly one bone-facIng surface of the first component faces an external surface of the fractured bone.

31. The method of paragraph 27, whereIn the thhd surface of the second component is disposed substantially adjacent a surface of the fractured bone.

32. The method of paragraph 27, further comprising measuring the fractured bone to delerrrine appropriate dbnensions of the first and second bone plate components.

33. The mathod of paragraph 32, further comprising bending the liret and second bone plate components to fit the fractured bone.

34. The method of paragraph 33, wherein the step of bending the components Is performed intraoperatively.

35. A method of thdrig a fractured rib, comprIsing (1) measurIng a thickness of the rib; (2) irraoperettwely contouring at least a first component of a bone plate to at least substantially rnah the measured thickness of the rib; (3) posItioning the bone plate component on the rib such that at least a portion of the component spans the fracture; and (4) attaching the bone plate component to the rib.

36. The method of paragraph 35, further comprishig drlilkig at least one hole throth the rib for attaching the component to the rib.

37. The method ci paragraph 36. the step of drilling being performed using a drill bit, further comprising adjusting a depth stop on the deli bit to match the thickness of the rib.

38. The method of paragraph 36 whereIn the step of attaching Includes aligning at least one aperture in the bone plate with the at least one hole throu the rib, and kisertlig a fastener through the aperture and Into the hole.

39. The method of paragraph 36, whereIn the step of attaching Includes aligning at least t apertures in the bone plate with the at least one hole through the rib, and Inserting athreaded bone screwlhrough the at least two apertures and through the hole, at least one of the at least two apertures being configured to securely engage one or more threads of the bone screw.

40. The method of peragraph 35, further comprising (4) contouring a second component of the bane plate to at least substantially match the thidcnese a! the rib; and (5) ettathlng the second component to at least one of the first component and the nb.

The dclosure sat ith above may encompass multiple disnct Inventions with independent utlity. AItIugh each el these inventions has been dlaclosed In fts preferred form(s), the specific embodiments thereof as disclosed and Iflusbated herein are not to be consktered in a limiting sense, because numerous variations are possible. The subjeot rustler of the Inventions kickidas al novel and nonobvlous combinations and aubcornbirietioiis of the various elements, featLres, functions, endlor properties disclosed herein. The followIng claims paitiwlarly point out,ta1n combinations and subcomblnatlons regarded as novel arid nonobvlous. Inventions embodied in other combinations and stg, continaticns of features, functions, elements, and(or properties may be claimed In a pbtiuns claiming priority from this or a related application. Such claims. whether directed to a drerent Invention or to the same rnvention, and whether broader. nanver. equal, or dtIlrent in scope to the original claims, also are regarded as Included within the subject matter of

the inventions of the present disclosure.

Claims

CLAIMS

1. A bone plate for fbcing a bone, comprising: at least two dip portions, each clip portion having a pair of arms configured so Itiat the dip portion receives the bone between the p of arms; a spanning portion connected to the dip portion, at least eubetantleHy through only one of the arms of each clip portion and configured to extend along the bone between the at least two clip portions, to span a discontinuity in the bone.

2. The bone plate arxordlng to claim 1, whereIn spanning portion Is disposed axially on a rib bone.

3. The bone plate according to claim I cr2, wherein every clip portion of the bone plate extending tranaversely from the spanning portion In the same general direction and extending to an opposing side of the rib bone.

4. Th. bone plateof daim 1.2or3wherethospanning portion has opposing edges and each dip portion extends fmrn the same oppusmg edge 5. The bone plate according to any preceding claim, wherein the pair of anne are spaced apart at a cistance lass than the diameter or width of the bone.

26 6. Aboneplateforthdngbonee,00mprieMg: a first plate component Indudlng a first clip portion configured to wrap partially around a bone, and a spannWig portion configured to extend from the clip portion along the bone; and a seóond plate component configured to be conneded to the first plate component via the spanning portion arid Inoludhig a second dip portion configured to wap partially around the bone.

7. The bone plate aon1ing to claim, wherein the bone plate components are esoured to one another with fasteners.

8. A bone plate for fbdng a bone, comprising: at east two generally U-shaped clip portions configured to receive a bone so that each cup portion Is disposed adjacent generally opposing surfaces of the bone; and a non-U-shaped spanning portion connecting the at least t dip portions and configured to span a discontinufty in the bone when the dip portIons receive the bone.

. Aboneplateforfbdngadbbons,OmprIslng; a spanning portion configured to be posed on a rib bone; and a plurality of dip portions connected to the spanning portion, every clip portIon of the bone plate extending transversely from the spanning portion in the same general direction and extending to an opposing side of the r bone when the spanning portion is disposed axialy on the rib bone.

10. A bone plate for fixing a rib bone, comprising: a spanning portion configured to be disposed axially on a rib bone and having opposing edges; and two or more dip portions connected to the epennkig portion and extending generally from the same opposing edge, wherein no clip portions extend from the other opposing edge.

11. The bone plate accordbig to any preceding clakn, wherein the dip portions extend along between one-fourth and three-fourths of a bone's drcumlorence.

12. The bone plate according to any preceding dalni, wherein the clip portions have an arm region end a bridge region ar.d wherein the bkjge region is narrow than the arm region to fadiftato bending of the arms.

13. The bone plate accordIng to any preceding claim, wherein the cap.

portions have one or more apertures which may be locking or nonlocki9 -S.

14. The bone plate accordtng to any preceding dekii, wherein the spanning portkn has one or rrr, apertures which may be locking or rtonlocklng apertures.

15. Aboneplatsformdngafracumbofls,00rflpIiaIflg(l)flrst and second bone-facing surfaces confjured to face at least substantially opposite surfaces of a fractured bone. each bone-facing surfaoe deilning at Least one aperture cordigured to accept a fastener for attaching the bone plate to the fractured bone; and (2) a third bone-facing surface connecting the first and second surfaces and having width approximating a width of the fractured bone 18. The bone plate of claIm 15, wherein the fk and second surfaces are substantiaUy parallel.

17.. The bone plate of claIm 15 or claim 16, wherein the third surface coriforma at least partially to a surface of the fractured bone.

18. The bone plate of daim 17, whereIn the bone plate being configured tofbce rib bone, wherein the third eurleconformsatleestpar(ialIy to a superlorswfaoe of the iib bone.

19. The bone plate of claim IT, the bone plate being configured to fix a clavicle bone, wherein the third surface conforms at least partiaLly to a superIor surface of the clavicle bone.

20. The bone plate of any of claIms 15 to 19. whereir at least one of the apertures is configured to engage a threaded fastener.

21. TheboneplateofanyofdaIme15to2O,Whereiflth8aPt1I0 6 deline at least one aligned pair of ertures configured to accept a threaded fastener.

22. The bone plate ci any of claIms 15 to 21, wherein the bone plate includes a first anchor portion In which the lirat id second surfaces are 3ppjng,aspanningpodoninwhkhaloflgerOfledthefiretafld5ecofld surfaces is configured to span a fracture, and a second anchor pwtion lnudIng a d,td.habIe anchor clip.

23. The bone plate of claim 22, whereIn each anchor portion Indudes at least one pas of aligned apertures configured to accept a fastenet for attaching the bone plate to the bone, and wherein at least one apeTture of each aligned pair is configured to engage a threaded bone screw.

24. The bonO plate of claIm 23, whereIn exactly one apeiture of each alIgned pair Is configured to engage a threaded bone screw, and wherein exactly one aperture of each allgned pair dairies an elongate reduction skt 25. The bone plate of any of claIms 72 to 24, whereIn the anchor dip Includes a first engagement portion configured to at least partially overtop and engage with the longer bone-facing surface, a second engagement portion opposing the first engagement portion, end a bridge portion connecting the engagement portions and having a width approximating the width of the fractured bone.

28. The bone plate of any of claIms 22 to 25, whereIn the anchor d Is configured to mount to the spanning portion on an opposite skis of the fracture from the first anchor portion.

27. Theboneplateo oahyaflto28,wher9ina portlcnofthe anchor clip la configured to mount alternatively to a bone-facing surface of the spanning portion, such that the anchor clip Des between the spanning portion end the bone, or to a non-bone-facing surlace of the spanning portion, such that the spanning portion lies between the anchor clip and the bone.

28. Abonoplateforlbdng sfrscteofarlb,00mprieiflg(1)8fi1M bone-facing surface for extending along one surface of the rib; (2) a second bone-facing surface opposing the fkst bone-facing surface, for extending along another surface of the rib; and (3) a third bone-facing surface connecting the first and second bone-facing surfaces.

29. The bone plate of claim 28, whereIn the third bone-facing surface ieshapedtoatieastpallYcoflfOrmtoasupeltorsurfaceofthedb.

30. The bone plate of claim 28 or claim 29, wherein the first and second bone-facing surfaces each dstine at least one epeiture configured to accept a fastener for attaching the bone plate to the rib.

31. The bone plate of claim 30, wherein at leaet one of the apertures configured in engage a threaded bone screw.

32. The bone plate of claim 31. the plate including a first region In which the first and second bone-facing surfaces overlap, and seecond re on In which the first bone-facing surface Is cordlgtwed to extend beyond the second bone-facing surface along the rib.

33. The bone plate of claim 32, flirther compdsing a U-shaped anchor clip attachable to the first bone-fadng surface in the second region.

34. The bone plate of daim 32 or claim 33, wherein the sço,d reon Is configured to span the fracture.

35. The bone plate of any of dalme 32 to 34. where the anchor dip deflnes at least one aperture configured to accept a fastener for attaching the bone plate tothe Tib.

36. A bone plate for fbdng a fracture of a rib, comprIsing; (1) a first component including first and aoond opposing bone-facing aurfacea connected by a third bono-fadng surface, wherein at least one of the opposing surfaces deilnee a spanning portion configured to span the fracb.ira; and (2) a second component including first and second opposing boneaciig engagement portions connected by a bone-facing bridge portion, wherein at least one of the engagement portions Is configered to partially overlap and engage with the first component 37. The bone plate of claim 36, whereIn each component defines at least one agned pair of apertures configured to accept a fastener for attaching * thebonepiatetothedb.

38. The bone plate of daiTi 31 wherein one aperture of each augnud pairisareduction slot, adwheren the otherapertureofeach aligned pains configured to securely engage a threaded bone screw.

3a. TheboneplateofanyofdaimS36tO38,WhereiflthSt3fld second surfaces of the first coniponent are at least substantially paralel. and wherein the first and second portions of the second component are at lOast substantially parallel.

40. The bone plate of any of claIms 36 to 39, wherein the third bone-facing surface of the first component, and the bridge portion of the second component each conform at least partially to a superior surface of a rib bone.

41. Akitlbrlbdnga bno,comprlslng Itonebonepaanyoneofdam1tO4O8fldalt0fl80 fastener, an kstrument for measuring one or more dimensions of the bone, end an Ins rnent for bending at least a portion of at least one 01! the at least bone plates Wraoperetively.

42. A kltforfbdng a bone, comprising: at least one bone plate having first and second clip portions and a spanning portion, and configured to be escrired to a bone so that each of the clip portions Is disposed adjacent generdy opposing eurraces of the bone and so that the spanning portion extends predominantly or excIu$IeIy along only one of the generally oppoemg surfaces to connect the clip portions; and at least on. of a fastener, an instrument lbr measuring one or more dimensIons of the bone, and an Instrument for bending at least a portion of at least one of the at least bone plates lntraoperat NoSy.

43. A bone plate of claIms 1, 5to 8. 15.28 and 36 for fixing a bone sut)StantIally as heratnbeb described with reference to, or as ustrated by, the accompanying draw1n..

44. A kit of claim 40cr claim 41 for fbdng a bone subetantlally as herelnbefore described with reference to. or as illustrated by, the accompanying drawings.