US20020029042A1 - Method for treating orthopedic fractures with a fixation member - Google Patents
Method for treating orthopedic fractures with a fixation member Download PDFInfo
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- US20020029042A1 US20020029042A1 US09/812,303 US81230301A US2002029042A1 US 20020029042 A1 US20020029042 A1 US 20020029042A1 US 81230301 A US81230301 A US 81230301A US 2002029042 A1 US2002029042 A1 US 2002029042A1
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- Prior art keywords
- fixation member
- bone fragment
- bone
- fastener
- contact
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/842—Flexible wires, bands or straps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/809—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with bone-penetrating elements, e.g. blades or prongs
Definitions
- the present invention generally relates to a method for treating orthopedic injuries or disease.
- the present invention particularly relates to a method which utilizes a fixation member configured to be utilized in orthopedic surgery for the treatment of periarticular orthopedic fractures.
- a periarticular plate is one type of appliance employed by physicians to treat certain types of orthopedic injuries.
- periarticular plates are used during orthopaedic surgery to engage and stabilize comminuted bone.
- Periarticular plates can also be used to distribute a load in osteopenic bone.
- periarticular plates are configured as flat pieces of titanium, surgical grade stainless steel, or other surgical grade alloys.
- a periarticular plate will typically have multiple holes defined therein such that the periarticular plate can be secured to a piece of bone and/or bone fragments with a number of screws. Once attached to comminuted bone in the above described manner, the periarticular plate functions to inhibit relative movement between bone fragments and thus enhances healing.
- periarticular plates enhance the healing of comminuted bone to some degree, they also suffer from a number of drawbacks.
- the flat “plate like” nature of these appliances result in a relatively large surface area of the periarticular plate being biased against the damaged bone. Having a relatively large surface area of the periarticular plate biased against the damaged bone can occlude or otherwise inhibit blood flow to some areas of the bone and thus delay healing. In extreme cases, necrosis may result from the aforementioned occlusion.
- the flat “plate like” configuration of periarticular plates results in these appliances having a somewhat limited ability to actually inhibit the relative movement between bone fragments. The use of multiple screws to attach the periarticular plate to the bone fragments helps to alleviate the aforementioned problem, however, in many instances the bone fragments are too small or brittle to withstand the insertion of one or more screws.
- a fixation member for treating orthopedic fractures.
- the fixation member includes a body portion having (i) an upper surface, (ii) a lower surface, and (iii) a perimeter edge interposed between the upper surface and the lower surface.
- the fixation member also includes a number of arm members each having a first end and a second end. The first end of each arm member being secured to the perimeter edge such that each arm member extends in a radial direction relative to the body portion.
- the fixation member further includes a penetration structure secured to the second end of each arm member such that each penetration structure extends in an axial direction relative to the body portion.
- the penetration structure is configured so as to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone.
- the penetration structure is further configured to limit the penetration so that the lower surface of the body portion is prevented from contacting the outer surface of the bone when the fixation member is biased against the outer surface of the bone.
- a fixation member for treating orthopedic fractures.
- the fixation member includes a body portion having (i) an upper surface, (ii) a lower surface, (iii) a perimeter edge interposed between the upper surface and the lower surface, and (iv) a fastener hole defined therein.
- the fixation member also includes a number of arm members each having a first end and a second end, the first end of each arm member being secured to the perimeter edge such that (i) each arm member extends in a radial direction relative to a perpendicular central axis of the body portion and (ii) the arm members are spaced apart from one another along the perimeter edge such that a notch is defined between adjacent arm members.
- the fixation member also includes a penetration structure secured to each arm member such that each penetration structure extends in an axial direction relative to the perpendicular central axis of the body portion.
- Each penetration structure is (i) configured so as to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone and (ii) further configured to limit the penetration so that the lower surface of the body portion is prevented from contacting the outer surface of the bone when the fixation member is biased against the outer surface of the bone.
- the fixation member for treating orthopedic fractures.
- the fixation member includes a body portion having (i) an upper surface, (ii) a lower surface, (iii) a perimeter edge interposed between the upper surface and the lower surface, and (iv) a fastener hole defined therein.
- the fixation member also includes a first arm member having a length L 1 .
- the first arm member is secured to the perimeter edge such that the first arm member extends in a radial direction relative to the body portion.
- the fixation member also includes a second arm member having a length L 2 which is greater than length L 1 .
- the second arm member is secured to the perimeter edge such that the second arm member extends in a radial direction relative to the body portion.
- the fixation member further includes a first penetration structure secured to the first arm member such that the first penetration structure extends in an axial direction relative to the body portion.
- the fixation member also includes a second penetration structure secured to the second arm member such that the second penetration structure extends in an axial direction relative to the body portion.
- the first penetration structure and the second penetration structure are both configured so as to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone.
- the first penetration structure and the second penetration structure are both further configured to limit the penetration so that the lower surface of the body portion is prevented from contacting the outer surface of the bone when the fixation member is biased against the outer surface of the bone.
- the fixation member for treating orthopedic fractures.
- the fixation member includes a body portion having (i) an upper surface, (ii) a lower surface, and (iii) a perimeter edge interposed between the upper surface and the lower surface.
- the fixation member also includes a number of arms secured to and extending outward from the perimeter edge of the body portion in a radial direction.
- the fixation member also includes a penetration structure secured to each of the arm members such that each penetration structure extends in an axial direction relative to the body portion.
- Each of the penetration structures is configured so as to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone.
- the fixation member also includes a stop member connected to the body portion.
- the stop member is configured to limit the penetration of the penetration structures so that the lower surface of the body portion is prevented from contacting the outer surface of the bone when the fixation member is biased against the outer surface of the bone.
- a fixation member for treating orthopedic fractures.
- the fixation member includes a body portion and a number of arm members secured to and extending outward from the body portion.
- the fixation member also includes a penetration structure secured to each of the arm members which is configured to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone.
- the fixation member further includes a stop member connected to the body portion. The stop member is configured to limit the penetration of the penetration structures when the fixation member is biased against an outer surface of the bone.
- fixation member configured to be utilized in orthopedic surgery for the treatment of orthopedic fractures which does not inhibit the flow of blood to damaged bone.
- FIG. 1 is an elevational view of an apparatus which incorporates the features of the present invention therein attached to a segment of comminuted bone (note that portions of the apparatus are shown in phantom for clarity of description);
- FIG. 2 is a cross-sectional view of the apparatus and bone segment taken along the line 2 - 2 of FIG. 1 as viewed in the direction of the arrows;
- FIG. 3 is a side elevational view of a fixation member which can be used in the apparatus of FIG. 1;
- FIG. 4 is a bottom elevational view of the fixation member of FIG. 3;
- FIG. 5 is a cross-sectional view taken along the line 5 - 5 of FIG. 4 as viewed in the direction of the arrows;
- FIG. 6 is a side elevational view of another fixation member which can be used in the apparatus of FIG. 1;
- FIG. 7 is a bottom elevational view of the fixation member of FIG. 6;
- FIG. 8 is a cross-sectional view taken along the line 8 - 8 of FIG. 7 as viewed in the direction of the arrows;
- FIG. 9 is a side elevational view of another fixation member which can be used in the apparatus of FIG. 1;
- FIG. 10 is a bottom elevational view of the fixation member of FIG.9;
- FIG. 11 is a cross-sectional view taken along the line 11 - 11 of FIG. 10 as viewed in the direction of the arrows;
- FIG. 12 is a side elevational view of yet another fixation member which can be used in the apparatus of FIG. 1
- FIG. 13 is a bottom elevational view of the fixation member of FIG. 12;
- FIG. 14 is a cross-sectional view taken along the line 14 - 14 of FIG. 13 as viewed in the direction of the arrows;
- FIG. 15 is an enlarged view of FIG. 11;
- FIG. 16 is an enlarged perspective view of a penetration structure
- FIG. 17 is an enlarged side elevational view of a penetration structure.
- apparatus 10 which incorporates the features of the present invention therein.
- apparatus 10 can be utilized to immobilized bone fragments 14 of a comminuted bone 12 (hereinafter referred to as bone 12 ).
- apparatus 10 includes a fixation member 16 , a fixation member 18 , screws 20 , and a k-wire 22 .
- fixation member 16 includes a number of arm members 32 , a stop member 46 , penetration structures 42 , and a body portion 24 .
- Body portion 24 has a fastener hole 52 and a wire hole 66 defined therein.
- Body portion 24 also has an upper surface 26 , a lower surface 28 , and a perimeter edge 30 interposed between upper surface 26 and lower surface 28 .
- body portion 24 is shown as being substantially annular shaped, other shapes are contemplated.
- body portion 24 could be square shaped or have an oblong shape.
- each arm member 32 has an end 34 secured to perimeter edge 30 of body portion 24 so that each arm member 32 extends outwardly in a radial direction relative to a perpendicular central axis 38 of body portion 24 . Moreover, arm members 32 are spaced apart from one another along perimeter edge 30 such that a notch 40 is defined between adjacent arm members 32 . It should be appreciated that arm members 32 can have various lengths. For example, as shown in FIG. 10, arm member 32 a has a length L 1 which is greater than the length L 2 of arm member 32 b .
- arm members 32 of various lengths is an advantage of the present invention since it enhances the ability of fixation member 16 to reach and stabilize a greater surface area of comminuted bone 12 (see FIG. 1).
- the aforementioned advantage allows arm members 32 of fixation member 16 to reach, contact, and thus and stabilize, a greater number of bone fragments 14 (see FIGS. 1 and 2) in comminuted bone 12 .
- fixation member 16 (including arm members 32 ) is preferably made from a material having a relatively low elastic modulus.
- fixation member 16 can be made from titanium. Having fixation member 16 made from a low elastic modulus material allows fixation member 16 to slightly bend or flex when biased against an outer surface 44 of bone 12 with a fastener, such as screw 20 (see FIGS. 1 and 2).
- a fastener such as screw 20 (see FIGS. 1 and 2).
- the above described notches 40 enhance the ability of arm members 32 to slightly bend or flex and thus further allow fixation member 16 to readily conform to the irregular surface features of bone 12 .
- fixation member 16 to readily conform to the irregular surface features of bone 12 and thus exert an equal pressure on outer surface 44 when biased against bone 12 with screw 20 .
- fixation member 16 to slightly bend under a load ensures that penetration structures 42 remains in contact with bone 12 and thus substantially prevent relative movement between bone fragments 14 .
- a penetration structure 42 is secured to an end 36 of each arm member 32 such that each penetration structure 42 extends in an axial direction relative to perpendicular central axis 38 of body portion 24 .
- Each penetration structure 42 is configured so as to penetrate below outer surface 44 of bone 12 when fixation member 16 is biased against outer surface 44 of bone 12 .
- each penetration structure 42 is further configured so as to limit the aforementioned penetration such that lower surface 28 of body portion 24 is prevented from contacting outer surface 44 of bone 12 (see FIGS. 1 and 2) when fixation member 16 is biased against outer surface 44 of bone 12 .
- Each penetration structure 42 is configured to be defined by substantially triangular shaped wall segments 68 , 70 , 72 , and 74 .
- substantially triangular shaped wall segments 68 , 70 , 72 , and 74 are secured together so as to form a pyramid structure 76 having a base 78 and an apex 80 .
- Pyramid structure 76 has a width W 1 (see FIG. 16) and a thickness T 1 (see FIG. 17). It should be appreciated that width W 1 and thickness T 1 of pyramid structure 76 both increase moving along the direction from apex 80 to base 78 . Having the width W 1 and the thickness T 1 of pyramid structure 76 increase from apex 80 to base 78 serves two purposes.
- this configuration functions to allow each penetration structure 42 to penetrate below outer surface 44 of bone 12 to a certain degree when fixation member 16 is biased against outer surface 44 of bone 12 .
- the aforementioned configuration also functions to limit the amount each penetration structure 42 can penetrate below outer surface 44 of bone 12 .
- a penetration structure 42 is urged against outer surface 44 of bone 12 (for example with screw 20 )
- apex 80 of pyramid structure 76 is advanced through outer surface 44 so as to create a hole (not shown) therein.
- penetration structure 42 becomes embedded in, or penetrates into, bone 12 such that a portion of each substantially triangular shaped wall segment 68 , 70 , 72 , and 74 comes into contact with bone tissue.
- each penetration structure 42 can penetrate below outer surface 44 of bone 12 in the above described manner ensures that lower surface 28 of body portion 24 is prevented from contacting outer surface 44 of bone 12 when fixation member 16 is biased against outer surface 44 of bone 12 .
- penetration structures 42 configured such that they only penetrate outer surface 44 of bone 12 to a limited degree is an important aspect of the present invention.
- the piercing of penetration structures 42 into outer surface 44 of bone 12 ensures that arm members 32 of fixation member 16 remain securely attached to bone fragments 14 .
- Having arm members 32 securely attached to bone fragments 14 ensures that fixation member 16 functions to effectively inhibit relative movement between bone fragments 14 and thus enhances the healing of bone 12 .
- limiting the penetration of penetration structures 42 ensures that a space 122 (see FIG. 2) is maintained between outer surface 44 of bone 12 and lower surface 28 of body portion 24 .
- Having space 122 interposed between outer surface 44 and lower surface 28 ensures that an adequate blood supply is provided to bone 12 . Ensuring that at an adequate blood supply is provided to bone 12 also enhances the healing of bone 12 .
- fastener hole 52 has an edge 58 and a center as illustrated by center line 56 .
- Edge 58 includes a convex wall portion 60 which extends towards center line 56 .
- Convex wall portion 60 is configured to contact a convex wall segment 124 defined on screw 20 (see FIG. 2) when screw 20 is inserted through fastener hole 52 and utilized to secure fixation member 16 to bone 12 .
- Having convex wall portion 60 serve as a bearing surface for convex wall segment 124 reduces the contact surface area between screw 20 and edge 58 as compared to having a flat edge acting as a bearing surface for a flat screw wall segment. Reducing the contact surface area between screw 20 and edge 58 reduces the probability that small pieces of metal or other material will be sheared off of edge 58 or convex wall segment 124 as screw 20 is rotated relative to, and biased against, edge 58 .
- edge 58 further includes a land portion 62 secured to a lower end 64 of convex wall portion 60 .
- Land portion 62 enhances the structural strength of body portion 24 in the area surrounding fastener hole 52 .
- fastener hole 52 is eccentrically located relative to perpendicular central axis 38 of body portion 24 . Having faster hole 52 eccentrically located relative to perpendicular central axis 38 cooperates with other features of fixation member 16 so as to allow a surgeon to secure fixation member 16 to a relatively large bone fragment 14 with screw 20 while still being able to reach smaller bone fragments 14 with penetration structures 42 .
- fixation member 16 to be secured to a relatively large bone fragment 14 while still allowing penetration structures 42 to reach and secure relatively small bone fragments 16 .
- wire hole 66 is defined in body portion 24 such that wire hole 66 is spaced apart from fastener hole 52 .
- Wire hole 66 is configured so that wire 22 can be inserted through wire hole 66 in a well known manner so as to stabilize fixation member 16 prior to securing fixation member 16 to bone 12 with screw 20 .
- stop member 46 is connected to lower surface 28 of body portion 24 .
- Stop member 46 is also configured to limit the penetration of penetration structures 42 so that lower surface 28 of body portion 24 is prevented from contacting outer surface 44 of bone 12 when fixation member 16 is biased against outer surface 44 of bone 12 .
- stop member 46 is an annular ridge 48 secured to a lower edge 127 of land portion 62 such that annular ridge 48 extends away from lower surface 28 of body portion 24 . (Note securing annular ridge 48 in the above described manner results in annular ridge 48 being in a concentric relationship with fastener hole 52 .)
- other structural configurations of stop member 46 are contemplated.
- Stop member 46 i.e. annular ridge 48
- annular ridge 48 functions to prevent lower surface 28 of body portion 24 from coming into contact with outer surface 44 of bone 12 in the following manner.
- fixation member 16 is urged against outer surface 44 of bone 12 (for example with screw 20 )
- lower surface 28 is advanced toward outer surface 44 until an end surface 50 of annular ridge 48 contacts outer surface 44 of bone 12 whereupon the advancement of lower surface 28 toward outer surface 44 is stopped. Since annular ridge 48 extends outwardly from lower surface 28 a certain distance, space 122 is maintained between lower surface 28 and outer surface 44 of bone 12 . Therefore, it should be appreciated that stop member 46 also prevents body portion 24 from coming into contact with outer surface 44 of bone 12 and thus ensures that an adequate blood supply is provided to bone 12 .
- stop member 46 can be disposed on other areas of fixation member 16 .
- a stop member 46 can be disposed on penetration structures 42 .
- a stop member 46 could be disposed on each arm member 32 if desired.
- stop member 46 could be configured as a ridge extending from arm members 32 . In this configuration a ridge is interposed between each penetration structure 42 and body portion 24 so as to limit the penetration of penetration structures 42 .
- fixation member 16 can be equipped with both (i) penetration structures 42 and (ii) stop member 46 so these elements can cooperate to prevent lower surface 28 of body portion 24 from coming into contact with outer surface 44 of bone 12 .
- fixation member 16 can also be equipped with just penetration structures 42 , or just stop member 46 , since either one of these elements are sufficient to prevent lower surface 28 of body portion 24 from coming into contact with outer surface 44 of bone 12 .
- fixation members 18 , 92 , and 110 three additional embodiments of fixation members which can be used in the present invention.
- the aforementioned fixation members are substantially similar to fixation member 16 .
- the aforementioned fixation members function, and have the same advantages, as discussed above with regard to fixation member 16 .
- fixation members 18 , 92 , and 110 can be substituted for fixation member 16 , or be used in conjunction with fixation member 16 . Therefore, only a relatively brief description of these fixation members is provided below.
- fixation member 18 includes a body portion 90 and a number of arm members 86 .
- fixation member 18 has a fastener hole which is concentric with a perpendicular central axis 104 .
- fixation member 18 is structurally different from fixation member 16 in that fixation member 18 has arm members 86 which are angled downward relative to body portion 90 in the direction indicated by arrow 129 .
- fixation member 18 does not include a stop member such as ridge 48 discussed above.
- arm members 86 are angled relative to perpendicular central axis 104 such that a linear extension of a top surface 106 of arm members 86 defines an obtuse angle a between perpendicular central axis 104 and linear extension of top surface 106 .
- fixation member 92 includes a body portion 94 , a number of arm members 112 , and a stop member 96 configured as an annular ridge 98 .
- arm members 112 of fixation member 92 extend radially from body portion 94 in the direction indicated by arrow 100 such that a linear extension of a top surface 108 of each arm member 112 defines a right angle, between the linear extension and a perpendicular central axis 102 .
- fixation member 110 includes a body portion 114 , a number of arm members 120 , and a stop member 116 configured as an annular ridge 118 .
- Arm members 120 of fixation member 110 radially extend from body portion 114 as previously discussed above for fixation members 18 , 92 , and 16 , however each arm member 120 of fixation member 110 has an arcuate shape.
- fixation member 110 may be utilized with a relatively large screw, while fixation members 18 and 92 can be utilized with a relatively small screw.
- apparatus 10 can be used in the following manner. Initially a surgeon places fixation member 16 in an appropriate location on outer surface 44 of bone 12 . In particular, fixation member 16 is positioned so that penetration structures 42 contact several bone fragments 14 . Once fixation member 16 is positioned, an end of wire 22 is advanced through wire hole 66 while the other end of wire 22 is inserted into bone 12 . Utilizing wire 22 in the aforementioned manner stabilizes fixation member 16 until screw 20 is inserted through fastener hole 52 and screwed into a bone fragment 14 . Screwing screw 20 into bone fragment 14 causes fixation member 16 to be urged against outer surface 44 of bone 12 so that penetration structures 42 penetrate outer surface 44 in the previously described manner.
- Screwing screw 20 into bone fragment 14 also causes stop member 46 to contact outer surface 44 of bone 12 .
- both penetration structures 42 and stop member 46 function to ensure that space 122 is maintained between body portion 24 and outer surface 44 of bone 12 . Therefore, fixation member 16 effectively stabilizes bone fragments 14 while ensuring that an adequate flow of blood is provided to bone 12 .
- fixation member 16 can be used in conjunction with another fixation member, such as fixation member 18 .
- Fixation member 18 is used in the same manner as described above for fixation member 16 .
- wire 22 can be secured to both of the screws 20 used to fasten fixation members 16 and 18 so as to further stabilize bone fragments 14 . Once both fixation members 16 and 18 are in place, wire 22 can be removed or left in place depending upon the surgeon's desire.
- the present invention provides fixation members which effectively stabilize bone fragments 14 of comminuted bone 12 without substantially occluding blood flow.
- the fixation members of the present invention are capable of stabilizing a plurality of bone fragments 14 without using a large number of screws 20 .
- the fixation members of the present invention can stabilize a plurality of bone fragments 14 (including bone fragments 14 which are to small to have a screw 20 inserted therein) with the use of a single screw 20 .
Abstract
Description
- This application is a continuation of co-pending Application Ser. No. 09/495,138, filed on Jan. 31, 2000.
- The present invention generally relates to a method for treating orthopedic injuries or disease. The present invention particularly relates to a method which utilizes a fixation member configured to be utilized in orthopedic surgery for the treatment of periarticular orthopedic fractures.
- Physicians utilize various appliances to treat orthopedic conditions or injuries. For example, a periarticular plate is one type of appliance employed by physicians to treat certain types of orthopedic injuries. In particular, periarticular plates are used during orthopaedic surgery to engage and stabilize comminuted bone. Periarticular plates can also be used to distribute a load in osteopenic bone.
- Typically, periarticular plates are configured as flat pieces of titanium, surgical grade stainless steel, or other surgical grade alloys. In addition, a periarticular plate will typically have multiple holes defined therein such that the periarticular plate can be secured to a piece of bone and/or bone fragments with a number of screws. Once attached to comminuted bone in the above described manner, the periarticular plate functions to inhibit relative movement between bone fragments and thus enhances healing.
- While periarticular plates enhance the healing of comminuted bone to some degree, they also suffer from a number of drawbacks. For example, once attached to the bone, the flat “plate like” nature of these appliances result in a relatively large surface area of the periarticular plate being biased against the damaged bone. Having a relatively large surface area of the periarticular plate biased against the damaged bone can occlude or otherwise inhibit blood flow to some areas of the bone and thus delay healing. In extreme cases, necrosis may result from the aforementioned occlusion. In addition, the flat “plate like” configuration of periarticular plates results in these appliances having a somewhat limited ability to actually inhibit the relative movement between bone fragments. The use of multiple screws to attach the periarticular plate to the bone fragments helps to alleviate the aforementioned problem, however, in many instances the bone fragments are too small or brittle to withstand the insertion of one or more screws.
- Therefore, there is a need for a method for treating periarticular orthopedic fractures which addresses one or more of the above described drawbacks.
- In accordance with one embodiment of the present invention, there is provided a fixation member for treating orthopedic fractures. The fixation member includes a body portion having (i) an upper surface, (ii) a lower surface, and (iii) a perimeter edge interposed between the upper surface and the lower surface. The fixation member also includes a number of arm members each having a first end and a second end. The first end of each arm member being secured to the perimeter edge such that each arm member extends in a radial direction relative to the body portion. The fixation member further includes a penetration structure secured to the second end of each arm member such that each penetration structure extends in an axial direction relative to the body portion. The penetration structure is configured so as to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone. The penetration structure is further configured to limit the penetration so that the lower surface of the body portion is prevented from contacting the outer surface of the bone when the fixation member is biased against the outer surface of the bone.
- Pursuant to another embodiment of the present invention, there is provided a fixation member for treating orthopedic fractures. The fixation member includes a body portion having (i) an upper surface, (ii) a lower surface, (iii) a perimeter edge interposed between the upper surface and the lower surface, and (iv) a fastener hole defined therein. The fixation member also includes a number of arm members each having a first end and a second end, the first end of each arm member being secured to the perimeter edge such that (i) each arm member extends in a radial direction relative to a perpendicular central axis of the body portion and (ii) the arm members are spaced apart from one another along the perimeter edge such that a notch is defined between adjacent arm members. The fixation member also includes a penetration structure secured to each arm member such that each penetration structure extends in an axial direction relative to the perpendicular central axis of the body portion. Each penetration structure is (i) configured so as to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone and (ii) further configured to limit the penetration so that the lower surface of the body portion is prevented from contacting the outer surface of the bone when the fixation member is biased against the outer surface of the bone.
- Pursuant to yet another embodiment of the present invention there is provided a fixation member for treating orthopedic fractures. The fixation member includes a body portion having (i) an upper surface, (ii) a lower surface, (iii) a perimeter edge interposed between the upper surface and the lower surface, and (iv) a fastener hole defined therein. The fixation member also includes a first arm member having a length L1. The first arm member is secured to the perimeter edge such that the first arm member extends in a radial direction relative to the body portion. The fixation member also includes a second arm member having a length L2 which is greater than length L1. The second arm member is secured to the perimeter edge such that the second arm member extends in a radial direction relative to the body portion. The fixation member further includes a first penetration structure secured to the first arm member such that the first penetration structure extends in an axial direction relative to the body portion. The fixation member also includes a second penetration structure secured to the second arm member such that the second penetration structure extends in an axial direction relative to the body portion. The first penetration structure and the second penetration structure are both configured so as to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone. The first penetration structure and the second penetration structure are both further configured to limit the penetration so that the lower surface of the body portion is prevented from contacting the outer surface of the bone when the fixation member is biased against the outer surface of the bone.
- Pursuant to still another embodiment of the present invention there is provided a fixation member for treating orthopedic fractures. The fixation member includes a body portion having (i) an upper surface, (ii) a lower surface, and (iii) a perimeter edge interposed between the upper surface and the lower surface. The fixation member also includes a number of arms secured to and extending outward from the perimeter edge of the body portion in a radial direction. The fixation member also includes a penetration structure secured to each of the arm members such that each penetration structure extends in an axial direction relative to the body portion. Each of the penetration structures is configured so as to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone. The fixation member also includes a stop member connected to the body portion. The stop member is configured to limit the penetration of the penetration structures so that the lower surface of the body portion is prevented from contacting the outer surface of the bone when the fixation member is biased against the outer surface of the bone.
- Pursuant to yet another embodiment of the present invention there is provided a fixation member for treating orthopedic fractures. The fixation member includes a body portion and a number of arm members secured to and extending outward from the body portion. The fixation member also includes a penetration structure secured to each of the arm members which is configured to penetrate below an outer surface of a bone when the fixation member is biased against the outer surface of the bone. The fixation member further includes a stop member connected to the body portion. The stop member is configured to limit the penetration of the penetration structures when the fixation member is biased against an outer surface of the bone.
- It is therefore an object of the present invention to provide a new and useful apparatus for treating orthopedic injuries or disease.
- It is another object of the present invention to provide an improved apparatus for treating orthopedic injuries or disease.
- It is still another object of the present invention to provide a new and useful fixation member configured to be utilized in orthopedic surgery for the treatment of orthopedic fractures.
- It is another object of the present invention to provide an improved fixation member configured to be utilized in orthopedic surgery for the treatment of orthopedic fractures.
- It is also an object of the present invention to provide a fixation member configured to be utilized in orthopedic surgery for the treatment of orthopedic fractures which does not inhibit the flow of blood to damaged bone.
- It is still another object of the present invention to provide a fixation member configured to be utilized in orthopedic surgery for the treatment of orthopedic fractures which effectively inhibits the relative movement between bone fragments of comminuted bone.
- The above and other objects, features, and advantages of the present invention will become apparent from the following description and attached drawings.
- FIG. 1 is an elevational view of an apparatus which incorporates the features of the present invention therein attached to a segment of comminuted bone (note that portions of the apparatus are shown in phantom for clarity of description);
- FIG. 2 is a cross-sectional view of the apparatus and bone segment taken along the line2-2 of FIG. 1 as viewed in the direction of the arrows;
- FIG. 3 is a side elevational view of a fixation member which can be used in the apparatus of FIG. 1;
- FIG. 4 is a bottom elevational view of the fixation member of FIG. 3;
- FIG. 5 is a cross-sectional view taken along the line5-5 of FIG. 4 as viewed in the direction of the arrows;
- FIG. 6 is a side elevational view of another fixation member which can be used in the apparatus of FIG. 1;
- FIG. 7 is a bottom elevational view of the fixation member of FIG. 6;
- FIG. 8 is a cross-sectional view taken along the line8-8 of FIG. 7 as viewed in the direction of the arrows;
- FIG. 9 is a side elevational view of another fixation member which can be used in the apparatus of FIG. 1;
- FIG. 10 is a bottom elevational view of the fixation member of FIG.9;
- FIG. 11 is a cross-sectional view taken along the line11-11 of FIG. 10 as viewed in the direction of the arrows;
- FIG. 12 is a side elevational view of yet another fixation member which can be used in the apparatus of FIG. 1
- FIG. 13 is a bottom elevational view of the fixation member of FIG. 12;
- FIG. 14 is a cross-sectional view taken along the line14-14 of FIG. 13 as viewed in the direction of the arrows;
- FIG. 15 is an enlarged view of FIG. 11;
- FIG. 16 is an enlarged perspective view of a penetration structure; and
- FIG. 17 is an enlarged side elevational view of a penetration structure.
- While the invention is susceptible to various modifications and alternative forms, a specific embodiment thereof has been shown by way of example in the drawings and will herein be described in detail. It should be understood, however, that there is no intent to limit the invention to the particular form disclosed, but on the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention as defined by the appended claims.
- Referring to FIGS. 1 and 2, there is shown an
apparatus 10 which incorporates the features of the present invention therein. As discussed in greater detail below,apparatus 10 can be utilized to immobilized bone fragments 14 of a comminuted bone 12 (hereinafter referred to as bone 12). In the exemplary embodiment ofapparatus 10 shown in FIGS. 1 and 2,apparatus 10 includes afixation member 16, afixation member 18, screws 20, and a k-wire 22. - As shown more clearly shown in FIGS. 9, 10,1 1, and 15,
fixation member 16 includes a number ofarm members 32, astop member 46,penetration structures 42, and abody portion 24.Body portion 24 has afastener hole 52 and awire hole 66 defined therein.Body portion 24 also has anupper surface 26, alower surface 28, and aperimeter edge 30 interposed betweenupper surface 26 andlower surface 28. It should be understood that whilebody portion 24 is shown as being substantially annular shaped, other shapes are contemplated. For example,body portion 24 could be square shaped or have an oblong shape. - Still referring to FIGS. 9, 10,11, and 15, each
arm member 32 has anend 34 secured to perimeter edge 30 ofbody portion 24 so that eacharm member 32 extends outwardly in a radial direction relative to a perpendicularcentral axis 38 ofbody portion 24. Moreover,arm members 32 are spaced apart from one another alongperimeter edge 30 such that anotch 40 is defined betweenadjacent arm members 32. It should be appreciated thatarm members 32 can have various lengths. For example, as shown in FIG. 10,arm member 32 a has a length L1 which is greater than the length L2 of arm member 32 b. Havingarm members 32 of various lengths is an advantage of the present invention since it enhances the ability offixation member 16 to reach and stabilize a greater surface area of comminuted bone 12 (see FIG. 1). In other words, the aforementioned advantage allowsarm members 32 offixation member 16 to reach, contact, and thus and stabilize, a greater number of bone fragments 14 (see FIGS. 1 and 2) incomminuted bone 12. - It should be understood that fixation member16 (including arm members 32) is preferably made from a material having a relatively low elastic modulus. For example,
fixation member 16 can be made from titanium. Havingfixation member 16 made from a low elastic modulus material allowsfixation member 16 to slightly bend or flex when biased against anouter surface 44 ofbone 12 with a fastener, such as screw 20 (see FIGS. 1 and 2). In addition, it should be understood that the above describednotches 40 enhance the ability ofarm members 32 to slightly bend or flex and thus further allowfixation member 16 to readily conform to the irregular surface features ofbone 12. The above described ability to slightly flex allowsfixation member 16 to readily conform to the irregular surface features ofbone 12 and thus exert an equal pressure onouter surface 44 when biased againstbone 12 withscrew 20. Moreover, the ability offixation member 16 to slightly bend under a load ensures thatpenetration structures 42 remains in contact withbone 12 and thus substantially prevent relative movement between bone fragments 14. - As shown more clearly in FIGS. 15, 16, and17, a
penetration structure 42 is secured to anend 36 of eacharm member 32 such that eachpenetration structure 42 extends in an axial direction relative to perpendicularcentral axis 38 ofbody portion 24. Eachpenetration structure 42 is configured so as to penetrate belowouter surface 44 ofbone 12 whenfixation member 16 is biased againstouter surface 44 ofbone 12. In addition, eachpenetration structure 42 is further configured so as to limit the aforementioned penetration such thatlower surface 28 ofbody portion 24 is prevented from contactingouter surface 44 of bone 12 (see FIGS. 1 and 2) whenfixation member 16 is biased againstouter surface 44 ofbone 12. - Each
penetration structure 42 is configured to be defined by substantially triangular shapedwall segments wall segments pyramid structure 76 having a base 78 and an apex 80.Pyramid structure 76 has a width W1 (see FIG. 16) and a thickness T1 (see FIG. 17). It should be appreciated that width W1 and thickness T1 ofpyramid structure 76 both increase moving along the direction from apex 80 tobase 78. Having the width W1 and the thickness T1 ofpyramid structure 76 increase from apex 80 tobase 78 serves two purposes. First, this configuration functions to allow eachpenetration structure 42 to penetrate belowouter surface 44 ofbone 12 to a certain degree whenfixation member 16 is biased againstouter surface 44 ofbone 12. Second, the aforementioned configuration also functions to limit the amount eachpenetration structure 42 can penetrate belowouter surface 44 ofbone 12. In particular, as apenetration structure 42 is urged againstouter surface 44 of bone 12 (for example with screw 20),apex 80 ofpyramid structure 76 is advanced throughouter surface 44 so as to create a hole (not shown) therein. Aspenetration structure 42 is further urged againstouter surface 44,penetration structure 42 becomes embedded in, or penetrates into,bone 12 such that a portion of each substantially triangular shapedwall segment pyramid structure 76 increase from apex 80 tobase 78, an increasing amount of force is required to further advancepenetration structure 42 intobone 12. This force continues to increase aspenetration structure 42 is advanced further intobone 12 until the force required to still further advancepenetration structure 42 intobone 12 approaches a point that exceeds the amount of force capable of being realistically generated by the biasing mechanism (e.g. screw 20). Once the force begins to approach the aforementioned point, the advancement ofpenetration structure 42 intobone 12 stops. It should be understood thatpenetration structures 42 are constructed so that the point where they can no longer be advanced intobone 12 occurs well beforelower surface 26 comes into contact withbone 12. Therefore, it should be appreciated that limiting the amount eachpenetration structure 42 can penetrate belowouter surface 44 ofbone 12 in the above described manner ensures thatlower surface 28 ofbody portion 24 is prevented from contactingouter surface 44 ofbone 12 whenfixation member 16 is biased againstouter surface 44 ofbone 12. - Having
penetration structures 42 configured such that they only penetrateouter surface 44 ofbone 12 to a limited degree is an important aspect of the present invention. In particular, the piercing ofpenetration structures 42 intoouter surface 44 ofbone 12 ensures thatarm members 32 offixation member 16 remain securely attached to bone fragments 14. Havingarm members 32 securely attached to bone fragments 14 ensures thatfixation member 16 functions to effectively inhibit relative movement between bone fragments 14 and thus enhances the healing ofbone 12. On the other hand, limiting the penetration ofpenetration structures 42 ensures that a space 122 (see FIG. 2) is maintained betweenouter surface 44 ofbone 12 andlower surface 28 ofbody portion 24. Havingspace 122 interposed betweenouter surface 44 andlower surface 28 ensures that an adequate blood supply is provided tobone 12. Ensuring that at an adequate blood supply is provided tobone 12 also enhances the healing ofbone 12. - In contrast to the present invention, other mechanisms utilized to inhibit the relative movement between bone fragments either do not have (i) structures configured to penetrate the bone surface, and thus do not adequately immobilize the bone fragments, or (ii) penetrating structures which are configured so as to limit their penetration of the bone surface. Mechanism which do not have penetrating structures configured to limit the penetration thereof, allow the body portion (e.g. a plate) of the mechanism to come into contact with the bone surface. As discussed above, allowing the body or plate portion to come into contact with the bone can cause the blood supply of the bone to become occluded and thus inhibit healing. Therefore, based upon the above discussion it should be appreciated that the configuration of
fixation member 16 provides significant advantages over other mechanisms utilized to immobilize bone fragments. - As shown in more detail in FIG. 15,
fastener hole 52 has anedge 58 and a center as illustrated bycenter line 56.Edge 58 includes aconvex wall portion 60 which extends towardscenter line 56.Convex wall portion 60 is configured to contact aconvex wall segment 124 defined on screw 20 (see FIG. 2) whenscrew 20 is inserted throughfastener hole 52 and utilized to securefixation member 16 tobone 12. Havingconvex wall portion 60 serve as a bearing surface forconvex wall segment 124 reduces the contact surface area betweenscrew 20 andedge 58 as compared to having a flat edge acting as a bearing surface for a flat screw wall segment. Reducing the contact surface area betweenscrew 20 andedge 58 reduces the probability that small pieces of metal or other material will be sheared off ofedge 58 orconvex wall segment 124 asscrew 20 is rotated relative to, and biased against,edge 58. - Moreover, edge58 further includes a
land portion 62 secured to alower end 64 ofconvex wall portion 60.Land portion 62 enhances the structural strength ofbody portion 24 in the area surroundingfastener hole 52. Furthermore,fastener hole 52 is eccentrically located relative to perpendicularcentral axis 38 ofbody portion 24. Havingfaster hole 52 eccentrically located relative to perpendicularcentral axis 38 cooperates with other features offixation member 16 so as to allow a surgeon to securefixation member 16 to a relativelylarge bone fragment 14 withscrew 20 while still being able to reach smaller bone fragments 14 withpenetration structures 42. In particular, as shown in FIGS. 1 and 2, having (i) an eccentrically locatedfastener hole 52 and (ii)arm members 32 of varying lengths allowsfixation member 16 to be secured to a relativelylarge bone fragment 14 while still allowingpenetration structures 42 to reach and secure relatively small bone fragments 16. - Still referring to FIG. 15,
wire hole 66 is defined inbody portion 24 such thatwire hole 66 is spaced apart fromfastener hole 52.Wire hole 66 is configured so thatwire 22 can be inserted throughwire hole 66 in a well known manner so as to stabilizefixation member 16 prior to securingfixation member 16 tobone 12 withscrew 20. - Referring now to FIGS. 9, 10,11, and 15,
stop member 46 is connected tolower surface 28 ofbody portion 24.Stop member 46 is also configured to limit the penetration ofpenetration structures 42 so thatlower surface 28 ofbody portion 24 is prevented from contactingouter surface 44 ofbone 12 whenfixation member 16 is biased againstouter surface 44 ofbone 12. In the exemplary embodiment shown in FIGS. 9, 10, 11, and 15,stop member 46 is anannular ridge 48 secured to alower edge 127 ofland portion 62 such thatannular ridge 48 extends away fromlower surface 28 ofbody portion 24. (Note securingannular ridge 48 in the above described manner results inannular ridge 48 being in a concentric relationship withfastener hole 52.) However, as discussed below, other structural configurations ofstop member 46 are contemplated. - Stop member46 (i.e. annular ridge 48) functions to prevent
lower surface 28 ofbody portion 24 from coming into contact withouter surface 44 ofbone 12 in the following manner. Asfixation member 16 is urged againstouter surface 44 of bone 12 (for example with screw 20),lower surface 28 is advanced towardouter surface 44 until anend surface 50 ofannular ridge 48 contactsouter surface 44 ofbone 12 whereupon the advancement oflower surface 28 towardouter surface 44 is stopped. Sinceannular ridge 48 extends outwardly from lower surface 28 a certain distance,space 122 is maintained betweenlower surface 28 andouter surface 44 ofbone 12. Therefore, it should be appreciated thatstop member 46 also preventsbody portion 24 from coming into contact withouter surface 44 ofbone 12 and thus ensures that an adequate blood supply is provided tobone 12. - It should also be appreciated that
stop member 46 can be disposed on other areas offixation member 16. For example, astop member 46 can be disposed onpenetration structures 42. Additionally, astop member 46 could be disposed on eacharm member 32 if desired. For example, it is contemplated thatstop member 46 could be configured as a ridge extending fromarm members 32. In this configuration a ridge is interposed between eachpenetration structure 42 andbody portion 24 so as to limit the penetration ofpenetration structures 42. It should be further appreciated thatfixation member 16 can be equipped with both (i)penetration structures 42 and (ii)stop member 46 so these elements can cooperate to preventlower surface 28 ofbody portion 24 from coming into contact withouter surface 44 ofbone 12. On the other hand,fixation member 16 can also be equipped with justpenetration structures 42, or just stopmember 46, since either one of these elements are sufficient to preventlower surface 28 ofbody portion 24 from coming into contact withouter surface 44 ofbone 12. - Referring now to FIGS.3-8, 12, 13, and 14 there is shown three additional embodiments of fixation members (i.e.
fixation members fixation member 16. In addition, the aforementioned fixation members function, and have the same advantages, as discussed above with regard tofixation member 16. Furthermore,fixation members fixation member 16, or be used in conjunction withfixation member 16. Therefore, only a relatively brief description of these fixation members is provided below. - Now referring to FIGS. 3, 4, and5,
fixation member 18 includes abody portion 90 and a number ofarm members 86. In contrast tofixation member 16,fixation member 18 has a fastener hole which is concentric with a perpendicularcentral axis 104. In addition,fixation member 18 is structurally different fromfixation member 16 in thatfixation member 18 hasarm members 86 which are angled downward relative tobody portion 90 in the direction indicated byarrow 129. Furthermore,fixation member 18 does not include a stop member such asridge 48 discussed above. With respect to the aforementioned angling,arm members 86 are angled relative to perpendicularcentral axis 104 such that a linear extension of atop surface 106 ofarm members 86 defines an obtuse angle a between perpendicularcentral axis 104 and linear extension oftop surface 106. - Now referring to FIGS. 6, 7, and8,
fixation member 92 includes abody portion 94, a number ofarm members 112, and astop member 96 configured as anannular ridge 98. In contrast tofixation member 18,arm members 112 offixation member 92 extend radially frombody portion 94 in the direction indicated byarrow 100 such that a linear extension of atop surface 108 of eacharm member 112 defines a right angle, between the linear extension and a perpendicularcentral axis 102. - Referring now to FIGS. 12, 13, and14,
fixation member 110 includes abody portion 114, a number ofarm members 120, and astop member 116 configured as anannular ridge 118.Arm members 120 offixation member 110 radially extend frombody portion 114 as previously discussed above forfixation members arm member 120 offixation member 110 has an arcuate shape. - It should be understood that the above discussed different configurations of
arm members fixation members fixation member 110 may be utilized with a relatively large screw, whilefixation members - Referring now to FIGS. 1 and 2,
apparatus 10 can be used in the following manner. Initially a surgeon placesfixation member 16 in an appropriate location onouter surface 44 ofbone 12. In particular,fixation member 16 is positioned so thatpenetration structures 42 contact several bone fragments 14. Oncefixation member 16 is positioned, an end ofwire 22 is advanced throughwire hole 66 while the other end ofwire 22 is inserted intobone 12. Utilizingwire 22 in the aforementioned manner stabilizesfixation member 16 untilscrew 20 is inserted throughfastener hole 52 and screwed into abone fragment 14. Screwingscrew 20 intobone fragment 14 causesfixation member 16 to be urged againstouter surface 44 ofbone 12 so thatpenetration structures 42 penetrateouter surface 44 in the previously described manner. Screwingscrew 20 intobone fragment 14 also causesstop member 46 to contactouter surface 44 ofbone 12. Thus, it should be appreciated that bothpenetration structures 42 and stopmember 46 function to ensure thatspace 122 is maintained betweenbody portion 24 andouter surface 44 ofbone 12. Therefore,fixation member 16 effectively stabilizes bone fragments 14 while ensuring that an adequate flow of blood is provided tobone 12. - As shown in FIGS. 1 and 2,
fixation member 16 can be used in conjunction with another fixation member, such asfixation member 18.Fixation member 18 is used in the same manner as described above forfixation member 16. Furthermore,wire 22 can be secured to both of thescrews 20 used to fastenfixation members fixation members wire 22 can be removed or left in place depending upon the surgeon's desire. - Based upon the above description it should be appreciated that the present invention provides fixation members which effectively stabilize
bone fragments 14 ofcomminuted bone 12 without substantially occluding blood flow. In addition, the fixation members of the present invention are capable of stabilizing a plurality of bone fragments 14 without using a large number ofscrews 20. In particular, the fixation members of the present invention can stabilize a plurality of bone fragments 14 (including bone fragments 14 which are to small to have ascrew 20 inserted therein) with the use of asingle screw 20. - While the invention has been illustrated and described in detail in the drawings and foregoing description, such illustration and description is to be considered as exemplary and not restrictive in character, it being understood that only the preferred embodiments have been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.
Claims (20)
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GB2331244A (en) * | 1997-11-18 | 1999-05-19 | Univ Hull | Fracture fixation devices |
GB9801986D0 (en) * | 1998-01-31 | 1998-03-25 | Depuy Int Ltd | A fixation device for a bone fracture |
US6228087B1 (en) * | 2000-01-31 | 2001-05-08 | Depuy Orthopaedics, Inc. | Fixation member for treating orthopedic fractures |
-
2000
- 2000-01-31 US US09/495,138 patent/US6228087B1/en not_active Expired - Lifetime
-
2001
- 2001-01-22 AU AU16377/01A patent/AU771800B2/en not_active Ceased
- 2001-01-26 EP EP01300715A patent/EP1121904B1/en not_active Expired - Lifetime
- 2001-01-26 DE DE60102718T patent/DE60102718T2/en not_active Expired - Lifetime
- 2001-01-26 AT AT01300715T patent/ATE256995T1/en not_active IP Right Cessation
- 2001-01-30 JP JP2001022383A patent/JP4326708B2/en not_active Expired - Lifetime
- 2001-03-20 US US09/812,303 patent/US6361538B1/en not_active Expired - Lifetime
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20050137608A1 (en) * | 2000-07-27 | 2005-06-23 | Synthes (Usa) | Cranial flap clamp instrument |
US7361178B2 (en) | 2000-07-27 | 2008-04-22 | Synthes (U.S.A.) | Cranial flap clamp and instrument for use therewith |
US7993349B2 (en) | 2000-07-27 | 2011-08-09 | Synthes Usa, Llc | Cranial flap clamp instrument |
US20050177179A1 (en) * | 2004-02-10 | 2005-08-11 | Baynham Bret O. | Surgical cable system |
US9351765B2 (en) | 2007-04-06 | 2016-05-31 | DePuy Synthes Products, Inc. | Securing device to secure fixation devices to bone portions |
US10052143B2 (en) | 2014-04-30 | 2018-08-21 | DePuy Synthes Products, Inc. | Tensioning instrument and related bone fixation systems and methods |
Also Published As
Publication number | Publication date |
---|---|
DE60102718D1 (en) | 2004-05-19 |
AU771800B2 (en) | 2004-04-01 |
EP1121904A3 (en) | 2002-02-13 |
AU1637701A (en) | 2001-08-02 |
EP1121904B1 (en) | 2004-01-02 |
DE60102718T2 (en) | 2005-01-27 |
JP4326708B2 (en) | 2009-09-09 |
US6361538B1 (en) | 2002-03-26 |
EP1121904A2 (en) | 2001-08-08 |
US6228087B1 (en) | 2001-05-08 |
JP2001245895A (en) | 2001-09-11 |
ATE256995T1 (en) | 2004-01-15 |
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