WO2015138542A2 - Système de compression de fracture et de guidage de plaque de réparation de fracture perfectionné - Google Patents

Système de compression de fracture et de guidage de plaque de réparation de fracture perfectionné Download PDF

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Publication number
WO2015138542A2
WO2015138542A2 PCT/US2015/019849 US2015019849W WO2015138542A2 WO 2015138542 A2 WO2015138542 A2 WO 2015138542A2 US 2015019849 W US2015019849 W US 2015019849W WO 2015138542 A2 WO2015138542 A2 WO 2015138542A2
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WO
WIPO (PCT)
Prior art keywords
fracture repair
plate
fracture
bone
apertures
Prior art date
Application number
PCT/US2015/019849
Other languages
English (en)
Other versions
WO2015138542A3 (fr
Inventor
C. Scott HUMPHREY
Stuart LINDQUIST
Justin ROWLAND
Original Assignee
Shoulder Options, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Shoulder Options, Inc. filed Critical Shoulder Options, Inc.
Publication of WO2015138542A2 publication Critical patent/WO2015138542A2/fr
Publication of WO2015138542A3 publication Critical patent/WO2015138542A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—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
    • A61B17/8004—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones
    • A61B17/8019—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with means for distracting or compressing the bone or bones where the means are a separate tool rather than being part of the plate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones

Definitions

  • the present invention relates to devices and system for repairing a fracture of a long bone and more specifically to a fracture repair plate guide plate, drill guide and fracture reduction system that facilitates reduction and fixation of a fracture of a long bone, particularly of the humerus bone, for instance a fracture at the surgical neck of the humerus.
  • a fracture repair plate is fastenable to the surface of a bone at the site of a fracture to aid in a repair of the fracture by stabilizing the fracture. Attaching a fracture repair plate for such a purpose with threaded bone screws is well known in the art.
  • an object of the invention is to provide an enhanced guide system that includes a guide plate engagable with a fracture repair plate, the guide plate including at least one low profile set screw for fixation of the guide plate to the fracture repair plate to facilitate ease of positioning on the bone prior to fracture reduction and compression and insertion of fixation screws.
  • Another object of the invention is to improve and enhance the precise placement of fixation screws by providing a novel drill guide that ensures proper fixation screw thread orientation to match receiving threads in the fixation plate.
  • Yet another object of the invention is to improve and enhance the technique for fracture reduction and compression by providing a reduction device that is improved by being adaptable to bone anatomy, and includes a decoupled drive mechanism that enables controlled reduction and enhanced cleanability.
  • the proximal humerus bone breaks, the fracture lines usually propagate in predictable planes. Based on this, a fracture classification system has been described (the Neer classification system). There are up to 4 large bony fragments that typically result when a proximal humerus bone is fractured. These include: 1) the humeral head, 2) the greater tuberosity, 3) the lesser tuberosity, and 4) the diaphysis or shaft. The rotator cuff tendons attach to the greater and lesser tuberosities. It is usually possible to achieve robust purchase of a screw in the humeral diaphysis and humeral head.
  • screws and anchoring devices are used in connection with fixing fracture repair plates to bone. Screws employed in conventional means and with known fracture repair devices for the repair of a fracture at the head of a long bone have been seen to back out on occasion. In addition, screws tips may cut through the bone, leading to failure of fracture fixation. Additionally, in the case of comminuted fractures the smaller fragments and their soft tissue connections are not amenable to fixation with screws, but may be more effectively repaired using sutures.
  • a fracture fixation plate that cooperates with means for providing a translational force between the bone segments in order to compress or distract the segments in order to reduce the fracture. More particularly there is a need for a fracture fixation plate that provides a means for applying a translational force between bone segments capable of imparting a force sufficient to create an impacted interface at the site of the fracture. In addition there is a need to provide means for imparting a translational force between bone segments that capable of being adapted for use with an anatomic right or left fracture repair plate.
  • a need also exists to provide an anchor, and an anchoring system for fixation of fracture repair plates to bone, improving on the devices and systems currently employed for affixing fracture repair plates to the bone.
  • a need also exists to provide an anchor, and an anchoring system for fixation and anchoring of a proximal humerus to the diaphysis of a long bone, for instance in the case of a fracture at the surgical neck of the humerus bone using a fracture repair plate.
  • an object of the present invention is to provide a fracture repair plate for repairing a fracture at the head of a long bone and more specifically to a fracture repair plate that provides for fixation of a proximal end to the diaphysis of a long bone.
  • Another object of the present invention is to provide fracture repair plate for repairing a fracture at the head of a long bone and more specifically to a fracture repair plate that also provides for fixation of a proximal end to the diaphysis of a long bone and for tendon-to-bone repair that may accompany the fracture between the proximal end to the diaphysis of a long bone.
  • Yet another object of the present invention is to provide a fracture repair plate for repairing a fracture at the head of a long bone specifically designed to account for the anatomy of the rotator cuff, proximal humeral bony anatomy and contour, and vascular supply of the proximal humerus.
  • Another object of the present invention is to provide a fracture repair plate that is optimized to facilitate the use of sutures for augmenting the repair of smaller bony fragments and their soft tissue connections.
  • Another object of the present invention is to improve the devices and systems currently employed for affixing fracture repair plates to the bone.
  • Another object of the present invention is to provide a fracture fixation plate that cooperates with means for providing a translational force between the bone segments in order to compress or distract the segments in aid of reducing the fracture.
  • An additional objective of the present invention is to provide a fracture fixation plate that cooperates with means for providing a translational force between bone segments capable of imparting a force sufficient to create an impacted interface at the site of the fracture.
  • An additional objective of the present invention is to provide means for imparting a translational force between bone segments that capable of being adapted for use with anatomic right and left fracture repair plates.
  • An additional objective of the present invention is to provide means for imparting a translational force between bone segments configured such that the translational force is applied along a plane that intersects the diaphysis and preferably along a plane that lies parallel to and substantially along a longitudinal axis of the diaphysis.
  • An additional objective of the present invention is to provide a device and system for reducing a fracture at the surgical neck of the humerus bone using a fracture repair plate that cooperates with means for providing a translational force between bone segments capable of imparting a force sufficient to create an impacted interface at the site of the fracture.
  • Another object of the present invention is to provide a fracture fixation plate that cooperates with means for providing a translational force between bone segments capable of being adapted for use with an anatomic right or left fracture repair plate.
  • An additional objective of the invention is to provide an anchor, and an anchoring system for providing fixation of a fracture repair plate to a bone.
  • the present invention is directed to devices and systems for repairing a fracture of a long bone.
  • the fracture repair plate provides for fixation of a fracture located between a proximal end and the diaphysis of a long bone, for instance the proximal humerus to the diaphysis of the humerus bone.
  • the present invention also includes systems for repairing a fracture of a long bone that include means for imparting a translational force between bone segments to compress or distract the segments in order to reduce the fracture.
  • the means for imparting a translational force between bone segments is capable of being adapted for use with an anatomic right or left fracture repair plate.
  • the means for imparting a translational force between bone segments is configured such that the translational force is applied along a plane that lies substantially parallel to and substantially coplanar with a longitudinal axis of the diaphysis.
  • the contour of the inner face of the fracture repair plate approximates the contour of a long bone against which the fracture repair plate is intended for use in repairing.
  • the inner face is configured such as to minimize the actual surface area of contact of the inner face of the fracture repair plate and the surface of the bone.
  • a fracture repair plate according to the present invention used in the repair of a fracture involving the proximal humerus would include a shaft attachment segment and a head segment each attached and extending from a transitional neck segment.
  • An inner face contour of the fracture repair plate is configured such that the inner face contour of shaft attachment segment approximates a contour of a proximal lateral surface of the humeral shaft including a part of the crest of the lesser tuberosity, the inner face contour of the transitional neck segment would approximate a contour of a proximal lateral aspect of the surgical neck of the humerus including a lateral portion of the crest of the lesser tuberosity. Similarly, an inner face contour of the head segment would approximate a contour of a proximal lateral aspect of the humerus as defined by the greater tuberosity and the lateral metaphysis.
  • the fracture repair plate is configured having a bearing surface configured to minimize plate-to-bone contact upon which the fracture repair plate rests against the bone, thereby substantially reducing the surface area of contact of the inner face of the fracture repair plate and the surface of the bone.
  • bone health is improved by avoiding compression of the periosteal tissue by minimizing actual surface area of contact of the inner face of the fracture repair plate and the surface of the bone. This is achieved by purposefully mismatching the radius of curvature of the concave surface of the plate relative to the radius of curvature of the bone.
  • the generally "D" shaped peripheral configuration of the head segment of the fracture repair plate is designed to follow the contour of the intertubercular groove and the lateral portion of the proximal humerus. More particularly, the generally "D" shaped peripheral configuration of the head segment is configured to accommodate the arcuate artery that branches from the anterior humeral circumflex artery and runs superiorly just lateral to the intertubercular groove.
  • a fracture repair plate according to the present invention for use in the repair of a fracture involving the proximal humerus and diaphysis of the right arm would be the mirror image of a fracture repair plate for use in the repair of a fracture involving the proximal humerus and diaphysis of the left arm.
  • Apertures formed through the cross-section of the fracture repair plate may include a variety of configurations adapted for a variety or purposes including threaded and un-threaded apertures adapted to accept locking or non-locking screws as well as apertures of various configurations including oblong or slotted aperture adapted to accept non-locking screws.
  • the present invention is also directed to an anchor and an anchoring system for anchoring a fracture repair plate against a long bone.
  • the anchor includes a shaft portion having a plurality of annular grooves formed about a periphery of the shaft and one or more longitudinal grooves that are formed parallel to a primary axis of the shaft.
  • the anchor also includes a head having an external thread adapted to cooperate with the interior thread formed in an anchor aperture. The anchor is pressed into a hole drilled into the bone such that a "press" or “interference” fit exists between the anchor and the drilled hole. The external thread of the head engages the threads of the anchor aperture and the anchor is tightened and locked to the plate.
  • the annular grooves formed about a periphery of the shaft of the anchor and the longitudinal grooves provide several advantages. First when inserting or withdrawing the anchor from a freshly drilled hole, the longitudinal grooves in particular provide venting for fluid captured in the hole. Additionally as the fracture and the site of insertion of the anchors heal growth of new bone will form in the annular and longitudinal grooves resisting and reducing the possibility of both rotation and pullout of the anchors.
  • an additional advantage of the anchor of the present invention is found in its blunt tip. It is known that stress risers form in materials including bone at the site of angular transitions and the more acute the transition the greater the propensity for that site being the locus of crack propagation and failure. [0018] In some embodiments, the axis of each screw diverges from a plane perpendicular to an outer face of the fracture repair plate, as well as diverging from the axis of each of the remaining screws. Similarly, the axis of each bone anchor diverges from the axis of each of the remaining bone anchors.
  • the present invention is also directed to a fracture repair plate that is further configured having a plurality of suture apertures that provide anchoring for sutures that may be employed in a procedure to reduce a fracture of the head of a long bone.
  • An upper peripheral edge of fracture repair plate is configured having an undercut land.
  • One or more suture apertures are formed along an upper peripheral edge of the fracture repair plate through the undercut land.
  • the suture apertures exhibit an elongated configuration.
  • the undercut peripheral edge of the fracture repair plate contributes to the ease and accommodation of passing a needle and suture through the plate.
  • Fig. 1 is a representative perspective view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention
  • Fig. 2 is a representative perspective view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention
  • FIG. 3 is a representative perspective view of a fracture repair plate according to the present invention
  • Fig. 4 is a representative perspective view of a fracture repair plate according to the present invention
  • Fig. 5 is a representative front view of a non-locking cortical screw according to the present invention.
  • Fig. 6 is a representative front view of a locking bone anchor according to the present invention.
  • Fig. 7 is a representative front view of a locking cortical screw according to the present invention.
  • Fig. 8 is a representative perspective exploded view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention
  • Fig. 9 is a representative perspective exploded view of a reduction mechanism according to the present invention.
  • Fig. 10 is a representative medial side view of a proximal humerus head fracture repair system including a fracture repair plate according to the present invention
  • Fig. 11 is a representative medial side view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention
  • Fig. 12 is a representative proximal view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention
  • FIG. 13 is a first perspective view of a fracture repair system, including a fracture repair plate, a guide plate, and a drill guide as engaged for use according to the present invention
  • FIG. 14 is a second perspective view of a fracture repair system, including a fracture repair plate, a guide plate, and a drill guide as engaged for use according to the present invention
  • Fig. 15 is a third perspective view of a fracture repair system, including a fracture repair plate, a guide plate, and a drill guide as engaged for use according to the present invention
  • FIG. 16 is a representative perspective view of a drill guide according to the disclosure.
  • FIG. 17 is a representative side view of a drill guide plate set screw according to the disclosure.
  • FIG. 18 is a representative view of a fracture reduction and compression system and components thereof according to the disclosure, showing a drill guide plate oriented for use on a fracture plate and drill guides and set screws engaged therewith;
  • FIG. 19 is a representative perspective view of a fracture reduction and compression system and components thereof according to the disclosure, showing a drill guide plate oriented for use on a fracture plate and a reduction system engaged therewith;
  • FIG. 20 is an alternate representative perspective view of a fracture reduction and compression system and components shown in Fig. 19;
  • FIG. 21 is a representative perspective view of a contoured engagement tab of reduction system according to the disclosure.
  • Fig. 22 is a partially exploded representative perspective view of a fracture reduction and compression system and components thereof according to the disclosure
  • Fig. 23 is an exploded perspective view of components of a fracture reduction and compression system according to the disclosure.
  • Fig. 24 is a perspective view of a component of a fracture reduction and compression system according to the disclosure.
  • Fig. 25 is a perspective view of a component of a fracture reduction and compression system according to the disclosure
  • Fig. 26 is an exploded perspective view of certain components of a fracture reduction and compression system according to the disclosure
  • Fig. 27 is an exploded perspective view of certain components of a fracture reduction and compression system according to the disclosure.
  • Fig. 28 is a perspective view of certain assembled components of a fracture reduction and compression system according to the disclosure.
  • Fig. 29 is a side view of the assembled components of a fracture reduction and compression system as shown in Fig. 28;
  • Fig. 29 is a side view of the assembled components of a fracture reduction and compression system as shown in Fig. 28;
  • Fig. 30 is an alternate perspective view in close up of a portion of the assembled components of a fracture reduction and compression system as shown in Fig. 28;
  • Fig. 31 is an alternate perspective view in close up of a portion of the assembled components of a fracture reduction and compression system as shown in Fig. 28;
  • Fig. 32 is an alternate perspective view in close up of a portion of the assembled components of a fracture reduction and compression system as shown in Fig. 28;
  • Fig. 33 is an alternate perspective view in close up of a portion of the assembled components of a fracture reduction and compression system as shown in Fig. 28;
  • Fig. 34 is an alternate perspective view of the fracture reduction and compression system and components thereof showing a drill guide plate oriented for use on a fracture plate and a reduction system engaged therewith, as shown in Fig. 19;
  • FIG. 35 is a perspective view of a first embodiment of a BONE FRACTURE REPAIR PLATE showing my new design
  • FIG. 36 is a front view thereof
  • FIG. 37 is a first side view thereof;
  • FIG. 38 is a second side view thereof, which is a mirror image of the first side view shown in FIG. 37;
  • FIG. 39 is a back view thereof
  • FIG. 40 is a top view thereof
  • FIG. 41 is a bottom view thereof
  • FIG. 42 is a perspective view of an alternate embodiment of a BONE FRACTURE REPAIR PLATE showing my new design
  • FIG. 43 is a front view thereof
  • FIG. 44 is a first side view thereof
  • FIG. 45 is a second side view thereof, which is a mirror image of the first side view shown in FIG. 44;
  • FIG. 46 is a back view thereof
  • FIG. 47 is a top view thereof
  • FIG. 48 is a bottom view thereof
  • FIG. 49 is a perspective view of an alternate embodiment of a BONE FRACTURE REPAIR PLATE showing my new design
  • FIG. 50 is a front view thereof
  • FIG. 51 is a first side view thereof
  • FIG. 52 is a second side view thereof, which is a mirror image of the first side view shown in FIG. 51 ;
  • FIG. 53 is a back view thereof
  • FIG. 54 is a top view thereof
  • FIG. 55 is a bottom view thereof
  • FIG. 56 is a perspective view of an alternate embodiment of a BONE FRACTURE REPAIR PLATE showing my new design; [057] FIG. 57 is a front view thereof;
  • FIG. 58 is a first side view thereof
  • FIG. 59 is a second side view thereof, which is a mirror image of the first side view shown in FIG. 58;
  • FIG. 60 is a back view thereof
  • FIG. 61 is a top view thereof
  • FIG. 62 is a bottom view thereof
  • FIG. 63 is a perspective view of an alternate embodiment of a BONE FRACTURE REPAIR PLATE showing my new design
  • FIG. 64 is a front view thereof
  • FIG. 65 is a first side view thereof
  • FIG. 66 is a second side view thereof, which is a mirror image of the first side view shown in FIG. 65;
  • FIG. 67 is a back view thereof
  • FIG. 68 is a top view thereof
  • FIG. 69 is a bottom view thereof
  • FIG. 70 is a perspective view of an alternate embodiment of a BONE FRACTURE REPAIR PLATE showing my new design
  • FIG. 71 is a front view thereof
  • FIG. 72 is a first side view thereof
  • FIG. 73 is a second side view thereof, which is a mirror image of the first side view shown in FIG. 72;
  • FIG. 74 is a back view thereof
  • FIG. 75 is a top view thereof
  • FIG. 76 is a bottom view thereof; [077] FIG. 77 is a perspective view of an alternate embodiment of a BONE FRACTURE REPAIR PLATE showing my new design;
  • FIG. 78 is a front view thereof
  • FIG. 79 is a first side view thereof
  • FIG. 80 is a second side view thereof, which is a mirror image of the first side view shown in FIG. 79;
  • FIG. 81 is a back view thereof
  • FIG. 82 is a top view thereof.
  • FIG. 83 is a bottom view thereof.
  • a fracture repair system includes a fracture repair plate for repairing a fracture at the head of a long bone, the long bone defined in part by a proximal head, a diaphysis including a longitudinal axis and a lateral aspect defining in part a surface plane of the diaphysis.
  • the fracture repair plate includes a longitudinal axis that is parallel to the diaphysis longitudinal axis, an outer face, and a contoured inner face that includes a bearing surface configured to contact at least a portion of the lateral aspect of the long bone.
  • the plate also includes a head segment at its proximal end in which the contoured inner face approximates a contour of the lateral aspect of the proximal head of the long bone.
  • the plate also includes a transition neck segment in which the contoured inner face approximates a contour of the lateral aspect of the long bone between the head and the diaphysis.
  • the plate also includes a shaft attachment segment at the distal end of the fracture repair plate in which the contoured inner face approximates a contour of the lateral aspect of the diaphysis.
  • the plate there are two or more threaded locking anchor apertures formed through the head segment of the fracture repair plate, each of which has an axis that is divergent from the axis of the others, and there are two or more threaded locking screw apertures formed through the shaft attachment segment of the fracture repair plate.
  • the system also includes at least one drill guide plate that is attachable to at least a portion of the outer face of the fracture repair plate and includes two or more of guide apertures adapted to receive a drill guide and guide a drill at a pre-selected angle.
  • the drill guide plate also includes orienting pins or bosses extending from its plate contact surface (inner face) that engage with corresponding receivers in the plate and enable precise initial alignment of the plates with one another prior to engagement of any fixation elements such as screws or set screws.
  • the system includes a fracture reduction system for use with a fracture repair plate.
  • the fracture reduction mechanism is adapted for quick attachment to a plate, such as a fracture plate or a guide plate.
  • the reduction system is adapted for attachment to a paired fracture plate and guide plate and includes a drive system that is capable of translation along an axis to compress to affixed components.
  • the reduction system when the reduction system is attached at a first position to a plate that is affixed to bone at a first side of a fracture, such as the head of a long bone such as the humerus, and the reduction system is attached at a second position to a bone at a second side of a fracture, such as the diaphysis of the humerus, translation of the drive system effects a reduction in the displacement between the two portions of the bone and compression of the bone to facilitate healing.
  • Fig. 19 shows a perspective view of representative embodiments according to the disclosure, showing a unitary drill guide plate 120 oriented for use on a fracture plate 100 and a reduction and compression system 200 and driver 300 engaged therewith.
  • the system includes at least one drill guide 130 that has a generally cylindrical shape and a central guide axis 132, and has a threaded portion 134 with a non threaded distal end 138 having a first radius, a medial cylindrical portion 136 that is a non threaded guide with a second radius that is greater than the first radius, and a knurled grip 140 at its proximal end.
  • a drill guide 130 is adapted for insertion within a through aperture of a guide plate 120 and at least partial engagement within a fracture plate 100 aperture to provide a guide path for a drill bit along a predetermined axis.
  • the drill apertures of the guide plate are concentric with but are of a diameter that is greater than the diameter of the corresponding apertures of the fracture plate, such that when a guide plate is affixed to a fracture plate, the interface between the drill apertures provides a ledge or shelf at the bottom of a guide plate aperture.
  • the resultant shelf is essentially planar and adapted to match with an essentially planar distal end surface of a drill guide so as to enable a fixed and stable seat for the drill guide when inserted there through, thereby assuring that threads of the drill guide are aligned with the threads of the fracture plate aperture.
  • the system also includes at least one set screw 150 having a low profile, as shown in Fig. 17 and Fig. 18, and comprising an non-threaded central portion 152 suitable for passage through a guide aperture in the drill guide plate 120 and comprising distal threads 154 pitched for engagement with corresponding receiving threads in a locking aperture in the plate, the set screw 150 suitable for fixing engagement between the guide plate 120 and the fracture plate 100 prior to attachment of the fracture plate 100 to a bone.
  • Fig. 17 and Fig. 18, respectively, show an exemplary embodiment of a set screw 150 according to the disclosure, and a coupled fracture 100 and guide plate 120 engaged with four set screws 150, and also in engagement with three representative drill guides 140.
  • drill guide plates as unitary, two or more drill guide plates can be used, each matable with discrete segments of a fracture plate.
  • the plates may be provided with a specific chirality, i.e., right and left oriented, with specific contour engagement features for unique orientation with a right or left long bone, such as a humerus.
  • the representative embodiments shown in Fig. 19 through Fig. 34 include various views of a fracture reduction and compression system and components thereof according to the disclosure, including in certain of the drawings a drill guide plate 120 oriented for use on a fracture plate 100 and a reduction and compression system 200 and components thereof engaged therewith. As shown in Fig.
  • the reduction and compression system 200 includes a contoured engagement tab 220 for attachment to a fracture plate 100 alone or in combination with at least one drill guide plate 120 that is affixed to bone at a point that is on a first side of a fracture to be reduced, a drive mechanism 250, a bone engagement pin 210 for attachment to bone at a point that is on the opposing side of a fracture to be reduced, and a driver 300 engagable with the drive mechanism 250.
  • the contoured engagement tab 220 includes a contoured body 222 that is conformal in shape with and attachable to an outer face of a plate selected from a fracture plate and a fracture plate guide plate, and includes one or more apertures 224 suitable for passage of any engagement fastener that may be threaded or unthreaded.
  • the fastener is selected from any of a threaded screw, threaded drill guide 130, and threaded set screw 150, the threads of which selected screw, drill guide and set screw are pitched for engagement with corresponding receiving threads in a aperture in the plate.
  • the representative embodiment of the contoured engagement tab 220 includes two apertures 224 for engagement with a plate, each of said apertures 224 oriented for engagement along the longitudinal axis of the plate.
  • the contoured engagement tab 220 also includes an elongate dovetail groove 226 oriented substantially in parallel with the longitudinal axis of the plate which couples with other system components as more specifically described herein below to provide the drive path for achieving reduction and compression. It will be appreciated by one of skill in the art that fewer than two and more than two engagement apertures may be used, in any arrangement, for engagement with the plate to allow attachment to the plate at a position on the bone that is proximate to the fracture.
  • the contoured engagement tab 220 also includes a driver seat 230 for receiving a pin on the driver.
  • the drive mechanism 250 includes an elongate drive element 252 that aligns with the elongate drive path (which in the representative embodiment shown in the drawings is shown in Fig. 21 as the dovetail grove 320) oriented along an axis that is parallel to and displaced laterally from an elongate axis of the plate. In use, the drive path traverses the distance between the first and second bone attachment points bounding the fracture.
  • the drive mechanism 250 also includes a driver seat 230 for retaining a driver in engagement with the drive mechanism 250, and a bone pin engagement flange 258 for receiving the bone engagement pin 210 in an orientation that is substantially perpendicular to the drive path. In some specific embodiments, as shown in varying detail in Figs.
  • the representative embodiment of the drive mechanism 250 includes a elongate drive element 252 that comprises in the depicted embodiment an elongate toothed rack 254 that engages with corresponding toothed drive actuator 306 on the driver 300.
  • the drive mechanism 250 follows a drive path that in the depicted embodiment is defined by the elongate dovetail groove 226 on the contoured engagement tab 220 that is substantially parallel with the elongate rack 390 which comprises a elongate drive element 252 dovetail 256 engageable with the elongate dovetail groove 226 on the contoured engagement tab 220.
  • the drive element 252 includes a pair of dovetail 256 elements that enable use of the drive mechanism in left and right orientations. It will be appreciated that in other embodiments, the drive element 252 my include only one dovetail 256 and accordingly separate handed drive elements 252 may be required to adapt usage of the drive mechanism for alternate positioning left or right on bone.
  • the elongate drive element 252 includes an alignment pin 260 that serves to secure and align the elongate drive element 252 with the contoured engagement tab 220 through engagement in a channel 228 in the elongate dovetail groove 226 of the contoured engagement tab 220, the channel 228 being parallel with and coextensive with at least a portion of the drive path.
  • the pin 350 may be insertable after engagement of the drive element dovetail 265 with the elongate dovetail groove 226 and include a stop or other feature that prevents the engaged elongate drive element 252 from sliding out of engagement with the contoured engagement tab 220.
  • the system lacks a pin and in other embodiments, other stop and control means may be used to provide for a positive stop and guidance of the passage of a elongate drive element 252 along a drive path.
  • the system also includes an elongate bone engagement pin 210 that is at least partially threaded along its length engageable at a first, optionally non-threaded end with the bone engagement flange 258, and engageable at a second threaded end with bone.
  • the bone engagement pin 210 may be of varying length, and may be completely threaded or have another shape, texture or combinations of these for engagement with the bone pin engagement flange 258.
  • the engagement of the bone engagement pin 210 and the bone pin engagement flange 258 are advantageous in that the pin position can be varied in both vertical and lateral dimensions relative to the long bone to which it is to be affixed, thus enabling the surgeon to adapt to anatomical differences between patients.
  • a further advantage is the simplicity of the design, which avoids the use of complex and cumbersome components that would otherwise be needed to match patient anatomy.
  • the system also includes a driver 300 having a driver body 302 with a retaining pin 304 for stable insertion and seating with the drive mechanism 250, a toothed drive actuator 306, depicted in the drawings as teeth, at a distal end for engagement with and translation of the elongate drive element 252 along the drive path, and a driver handle 308 at a proximal end.
  • a driver 300 having a driver body 302 with a retaining pin 304 for stable insertion and seating with the drive mechanism 250, a toothed drive actuator 306, depicted in the drawings as teeth, at a distal end for engagement with and translation of the elongate drive element 252 along the drive path, and a driver handle 308 at a proximal end.
  • the contoured engagement tab 220 is affixed to a plate and the distal driver retaining pin 304 is coupled with the driver seat 230, the driver actuator 35 is engaged with the elongate drive element 252 such that actuation of the driver 300 provides translational movement of the bone engagement pin 210 along the longitudinal axis of the plate to move one portion of the fractured bone toward and into compression with the other portion thereof.
  • the driver is a pinion gear
  • the driver retaining pin 304 of the driver is a pin.
  • one or both the contoured engagement tab 220 and the elongate drive element 252 include a spring-biased pawl engageable with the pinion gear to control counter-rotation of the pinion gear.
  • the compression system depicted in the representative embodiments shown in the drawings Fig. 13 through Fig. 34 operates as follows: the elongate dovetail 256 of the elongate drive element 252 engages with the elongate dovetail groove 226 of the contoured engagement tab 220, the retaining pin 304 of the driver 300 couples with the driver seat 230 of the contoured engagement tab 220, and the drive element (pinion gear engages with the rack) along the drive path (defined by the rack) such that rotation of the proximal handle of the driver around a longitudinal axis defined by the proximal and distal ends of the driver provides translational movement of the elongate bone pin (see Fig. 26).
  • this operation reduces the distance between and compresses the portions of bone that are affixed, respectively, to the bone pin and the fracture plate.
  • one or more fixation screws can be driven through the plates into the bone to fix the diaphyseal portion of the plate to the shaft of the bone, thereby completing the fracture fixation with the fracture plate.
  • the compression system can then be disengaged from the plate. Placement of fixation screws into the diaphyseal portion of the bone prior to removal of the compression system ensures that proper reduction and the associated compression is maintained at the fracture site after removal of the compression system.
  • a proximal humerus fracture repair system 10 is shown including fracture repair plate 20A attached to a right humerus bone RH including diaphysis D and proximal humerus PH.
  • Proximal humerus PH is shown including humeral head HH and greater turbercle G.
  • Fracture F is a fracture at the surgical neck of the humerus.
  • Fig. 1 shows proximal humerus fracture repair system 10 including first and second right drill guide plates 30A and 40A respectively fixed to outer face 21 of fracture repair plate 20A.
  • Fracture repair plate 20A is specifically adapted for reduction and fixation of a fracture of the right humerus bone RH as seen in Fig.1.
  • Fig. 2 shows proximal humerus fracture repair system 10 including first and second left drill guide plates 30B and 40B respectively fixed to outer face 21 of fracture repair plate 20B.
  • Reduction mechanism 50 is configured so that it may be adapted for attachment to first right drill guide plate 30A for reduction and fixation of a fracture of the right humerus bone RH as shown in Fig. 1, or in the alternative reduction mechanism 50 may be adapted for attachment to left drill guide plate 30B for reduction and fixation of a fracture of the left humerus bone LH as shown in Fig. 2.
  • Fracture repair plate 20 A is shown specifically adapted for reduction and fixation of a fracture of the right humerus bone.
  • Fracture repair plate 20A includes longitudinal axis LAP, outer face 21 as seen in Fig. 3 and a contoured inner face 22 seen in Fig. 4.
  • inner face 22 of fracture repair plate 20A is formed having a contour that approximates a contour of the lateral aspect of the proximal humerus to which fracture repair plate 20A is to be attached for a fixation.
  • fracture repair plate 20A is configured having bearing surface 29 upon which fracture repair plate 20A rests against humerus bone HB.
  • Bearing surface 29 is configured to minimize plate to bone contact substantially reducing the surface area of contact of the inner face of the fracture repair plate and the surface of the bone.
  • Fracture repair plate 20A is also configured having a plurality of anchor apertures typified by locking bone anchor aperture 23, a plurality of threaded screw apertures typified by locking screw aperture 24 and a pair of slotted screw apertures typified by slotted screw aperture 25. Fracture repair plate 20A also includes a plurality of suture apertures typified by suture aperture 26 formed about upper peripheral edge 27. Referring to Fig. 4 it can be seen that fracture repair plate 20A is formed such that upper peripheral edge 27 includes an undercut land 28 that provides clearance for passage of a suture once fracture repair plate 20A is fastened against the bone.
  • Fig. 5 shows non- locking cortical screw 60 including head 61 adapted to accept a polygonal head type driver for instance a hex-headed driver.
  • Non-locking cortical screw 60 also includes threads 62 and self tapping tip 63.
  • Fig. 6 shows locking bone anchor 65 including head 66 also adapted to accept a polygonal head type driver for instance a hex-headed driver.
  • Locking bone anchor 65 is configured having threaded head 66 adapted to cooperate with a thread formed in each of the anchor apertures typified by locking bone anchor aperture 23, (shown in Figs. 2 and 3).
  • Locking bone anchor 65 includes shaft 67 having blunt tip 64, a plurality of annular grooves 68 formed about shaft 67 and a plurality of longitudinal grooves 69 formed parallel to a primary axis of shaft 67. Locking bone anchor 65 is pressed into a hole drilled into the bone such that a "press” or “interference” fit exists between shaft 67 and the drilled hole.
  • Threaded head 66 of engages the threads of the threaded anchor aperture and the anchor is tightened and locked.
  • annular grooves 68 and longitudinal grooves 69 resisting and preventing both rotation and pullout of locking bone anchor 65.
  • Fig. 7 shows locking diaphyseal screw 70 including threaded head 71 also adapted to accept a polygonal head type driver for instance a hex-headed driver.
  • Locking diaphyseal screw 70 also includes threads 73 formed on shaft 72 and self tapping tip 74.
  • threaded head 71 includes a thread formed at a first thread pitch PI and threads 73 formed on shaft 72 includes a thread formed at a second thread pitch P2. This feature reduces the tendency of locking diaphyseal screw 70 to back out over time.
  • right humerus bone RH is shown including diaphysis D and proximal humerus PH that includes humeral head HH and greater tuberosity G.
  • Fracture F is a commonly seen surgical neck fracture.
  • Right humerus bone RH is shown positioned in a routinely implemented "beach chair position" for reduction and fixation to demonstrate the advantageous positioning of reduction mechanism 50 during a procedure.
  • Proximal humerus fracture repair system 10 is shown with fracture repair plate 20A partially attached to a generally lateral surface of right humerus bone RH with upper peripheral edge 27 fracture repair plate 20A extending over a proximal lateral aspect of the proximal humerus defined in part by the greater tuberosity G.
  • Fracture repair plate 20A includes a plurality of anchor apertures typified by locking bone anchor aperture 23, through which a plurality of locking bone anchors 65 are set. As shown, fracture repair plate 20A includes a pair of slotted screw apertures typified by slotted screw aperture 25. Non- locking cortical screw 60 is shown engaging left humerus LH through slotted screw aperture 25. Fracture repair plate 20A also includes a plurality of threaded screw apertures typified by locking screw aperture 24. A plurality of suture apertures typified by suture aperture 26, are formed through upper peripheral edge 27 of fracture repair plate 20A.
  • Proximal humerus fracture repair system 10 also includes first right drill guide plate 30A having a plurality of locking screw guide apertures typified by locking screw guide aperture 32 and a plurality of slotted screw guide apertures typified by slotted screw guide aperture 33. As shown first right drill guide plate 30A may be located against outer face 21 of fracture repair plate 20A by inserting a pair of locator pins typified by first drill guide plate locator pin 31 into a pair of corresponding locator pin apertures typified by first drill guide plate locator pin aperture 37.
  • First right drill guide plate 30A may be secured to fracture repair plate 20 A by inserting first drill guide 36 through one of several locking screw guide apertures typified by locking screw guide apertures 32 and threadedly engaging the end of first drill guide 36 with one of the plurality of threaded screw apertures typified by locking screw aperture 24.
  • Proximal humerus fracture repair system 10 also includes second drill guide plate 40A having a plurality of bone anchor apertures typified by bone anchor aperture 42.
  • Second drill guide plate 40A may be located against fracture repair plate 20A by inserting second drill guide plate locator pin 41 into a corresponding suture aperture 26 which serves as a locator pin aperture.
  • Second drill guide plate 40A is secured to fracture repair plate 20A by inserting second drill guide 43 through one of several threaded bone anchor apertures typified by bone anchor aperture 42 and threadedly engaging the end of second drill guide 43 with one of the plurality of locking bone anchor apertures typified by locking bone anchor aperture 23.
  • Both first right drill guide plate 30A and second drill guide plate 40 A are adapted to guide a drill at a pre-selected angle.
  • proximal humerus fracture repair system 10 also includes reduction mechanism 50.
  • Reduction mechanism 50 includes reduction mechanism body 51 that may be located against upper edge 38 of first right drill guide plate 30A by inserting a pair of reduction mechanism locator pins typified by reduction mechanism locator pin 52 into a corresponding pair of reduction mechanism locator pin apertures typified by reduction mechanism locator pin aperture 34 located on upper edge 38 of first right drill guide plate 3 OA.
  • Reduction mechanism body 51 is secured against upper side 38 of first right drill guide plate 30A by threadedly engaging a pair of captured screws typified by captured screw 53 with the corresponding threaded aperture located on upper side 38 of first right drill guide plate 3 OA.
  • non-locking screw 80 is inserted through bushing 44 and traction arm aperture 45 and is subsequently driven into diaphysis D of right humerus RH along a traction plane T that lies substantially parallel to surface plane SP said traction plane T passing through a longitudinal axis of diaphysis LAS.
  • Spring biased pawl 55 assures that the position of traction arm 57 may be accurately maintained with respect to reduction mechanism body 51 throughout a procedure.
  • Fig. 9 shows reduction mechanism 50 adapted for attachment to first left drill guide plate 30B, (as shown in Fig. 2), for reduction and fixation of a fracture of the left humerus bone LH, (as shown in Fig. 2).
  • reduction mechanism body 51 is rotated one -hundred and eighty degrees about dovetail groove axis GA and traction arm 57 is rotated one-hundred and eighty degrees about traction arm axis TA that is perpendicular to dovetail 58 of traction arm 57.
  • Dovetail 58 of traction arm 57 then slideably engages with left dovetail groove 56B with left side rack gear 59B of traction arm 57 engaging left side pinion 54B of reduction mechanism body 51.
  • non-locking screw 80 may be inserted through bushing 44 and traction arm aperture 45 in preparation to driving into diaphysis D of left humerus LH, (as shown in Fig. 2).
  • Spring biased pawl 55 assures that the position of traction arm 57 may be accurately maintained with respect to reduction mechanism body 51 throughout a procedure.
  • Fig. 10 shows left humerus bone LH having fracture F located between diaphysis D and proximal humerus PH.
  • Proximal humerus fracture repair system 10 is shown with fracture repair plate 20B partially attached to a generally lateral surface of left humerus bone LH.
  • fracture repair plate 20B is positioned against diaphysis D of left humerus bone LH with upper peripheral edge 27 fracture repair plate 20B extending over a proximal lateral aspect of proximal humerus PH defined in part by the greater tuberosity G.
  • a pair of pilot holes are drilled into diaphysis D, one each at location corresponding to the pair of slotted apertures typified by slotted aperture 25, (shown in Fig. 8).
  • a pair of non-locking cortical screws 60 are set into each of the pair of drilled pilot holes and fracture repair plate 20B is adjusted lengthwise on diaphysis D along an axis of the slotted apertures to a desired position relative to the bone and non-locking cortical screws 60 are tightened.
  • first left drill guide plate 30B and second left drill guide plate 40B are attached to outer face 21 of fracture repair plate 20B and a plurality of bone anchor holes typified by bone anchor hole 75 are drilled employing second left drill guide plate 40B.
  • a pattern of bone anchor holes are drilled into proximal humerus PH or bone fragments thereof.
  • each bone anchor hole drilled for one of the plurality of bone anchors is drilled at a specified angle so that an axis of each hole differs and diverges from the angle of the axes of each of the remaining holes.
  • a fit between each locking bone anchor 65 and its respective bone anchor hole 75 is characterized as a "press" or "interference" fit.
  • reduction mechanism body 51 of reduction mechanism 50 is secured against upper side 39 of first left drill guide plate 30B by a pair of captured screws typified by captured screw 53.
  • Traction arm 57 slideably engages reduction mechanism body 51 and traction arm 57 is positioned so that adequate forward travel of traction arm 57 may be achieved.
  • traction are 57 is secured to diaphysis D of left humerus bone LH by non- locking screw 60. As seen in Fig.
  • diaphysis D and proximal humerus PH of left humerus bone LH are each capable only of a single degree of movement with respect to one another, that being movement along a line defined by longitudinal axis of the diaphysis LAD, while secured by the placement of locking bone anchors 65, the two non-locking cortical screws 60 placed through fracture repair plate 20B and non-locking cortical screw 80 set through traction arm 57 of reduction mechanism 50.
  • Translational force TF between diaphysis D and proximal humerus PH is sufficient to create an impacted interface or impacted zone at the site of the fracture.
  • FIGs. 11 and 12 show fracture repair plate 20B attached to a generally lateral surface of left humerus bone LH against diaphysis D with upper peripheral edge 27 fracture repair plate 20B extending over a proximal lateral aspect of proximal humerus PH defined in part by the greater tuberosity G.
  • locking diaphyseal screws 70A - 70C may be set. Pilot holes are drilled for locking diaphyseal screws 70A - 70C using drill guide 36 to assure that the screw are set at the determined angles.
  • Each pilot hole for locking diaphyseal screws 70A - 70C is drilled on a screw axis SA that is divergent from the longitudinal axis of the diaphysis LAD, that angle also being divergent from a screw axis SA of each of the remaining locking diaphyseal screws 70A - 70C. As shown in Fig.
  • screw axis SA for first diaphyseal screw 70A measures ninety degrees
  • the screw axis SA for second diaphyseal screw 70B measures one-hundred
  • the screw axis SA for third diaphyseal screw 70B measures one-hundred and ten degrees.
  • Figs. 11 and 12 also show the divergence of anchor axes A of locking bone anchors 65.
  • each of the plurality of locking bone anchors 65 is pressed into a hole drilled on anchor axis AA that is divergent from the longitudinal axis of the diaphysis LAD and surface plane SP, (Shown in Fig. 11), that angle also being divergent from an anchor axis AA of each of the remaining locking bone anchors 65.
  • the individual components of the implant assembly may be made using a variety of materials, including metal and plastic and combinations of these.
  • materials include but are not limited to: metals such as, for example, stainless steel, titanium alloys, cobalt alloys, cobalt chrome, superelastic metals, such as nitinol, polymers, such as polyester and polyethylene, polyether ether ketone (PEEK), carbon and carbon fiber materials.
  • Porous coatings may be provided for any or a portion of the components, and specifically as described herein or as otherwise known in the art.
  • the components may be provided with HA either dispersed on all or a portion of a surface, dispersed within all or a portion of the material of manufacture, and combinations of these.
  • proximal to the extent used herein in connection with any object refers to the portion of the object that is closest to the operator of the object (or some other stated reference point), and to the extent used herein, the term “distal” refers to the portion of the object that is farthest from the operator of the object (or some other stated reference point).
  • surgeon and “operator” to the extent used herein are used interchangeably herein and each is intended to mean and refer to any professional or paraprofessional who delivers clinical care to a medical patient, particularly in connection with the delivery of care, including but not limited to a surgeon.
  • patient and “subject” to the extent used herein are used interchangeably herein and each is intended to mean and refer to any clinical animal subject, including a human medical patient, particularly in connection with the delivery of care thereto by anyone, including a surgeon or operator to the extent those terms are used herein.
  • an item may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly.
  • the terms “cephalad,” “cranial” and “superior” indicate a direction toward the head
  • the terms “caudad” and “inferior” and “distal” indicate a direction toward the feet.
  • the terms “dorsal” and “posterior” indicate a direction toward the back
  • the terms “ventral” and “anterior” indicate a direction toward the front.
  • lateral indicates a direction toward a side of the body
  • medial indicates a direction toward the mid line of the body, and away from the side
  • ipsalateral indicates a direction toward a side that is proximal to the operator or the object being referenced
  • “contralateral” indicates a direction toward a side that is distal to the operator or the object being referenced. More generally, any and all terms to the extent used herein providing spatial references to anatomical features shall have meaning that is customary in the art.

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Abstract

La présente invention concerne des dispositifs et des systèmes destinés à réparer des fractures osseuses et plus spécifiquement une plaque de réparation de fracture qui permet la fixation d'une métaphyse à la diaphyse d'un os long, par exemple une fracture entre l'humérus proximal et la diaphyse de l'humérus. Le système de réparation de fracture comprend une plaque de réparation de fracture implantable et un élément d'ancrage osseux pour la fixation de la plaque de réparation de fracture à un os. Selon un premier mode de réalisation, la plaque de réparation de fracture peut être également conçue pour servir d'élément d'ancrage pour une suture. Le système de réparation de fracture peut également comprendre un mécanisme de réduction de fracture pouvant être fixé à la plaque de réparation de fracture pour conférer un mouvement de translation commandé entre deux segments osseux le long d'un plan qui est sensiblement parallèle à la surface de l'os auquel est fixée la plaque de réparation de fracture et sensiblement parallèle à l'axe longitudinal du corps d'os.
PCT/US2015/019849 2014-03-11 2015-03-11 Système de compression de fracture et de guidage de plaque de réparation de fracture perfectionné WO2015138542A2 (fr)

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WO2018136427A1 (fr) * 2017-01-17 2018-07-26 Biomet Manufacturing, Llc Système de placage osseux comprenant un gabarit de perçage doté d'éléments de verrouillage
WO2019014356A1 (fr) * 2017-07-11 2019-01-17 Paragon 28, Inc. Système de fixation osseuse, ensemble, implants, dispositifs, guides d'insertion et méthodes d'utilisation
CN109758224A (zh) * 2019-02-20 2019-05-17 绍兴市上虞中医医院 跟骨骨折电动牵引撬拨复位器
USD849948S1 (en) 2017-06-28 2019-05-28 Paragon 28, Inc. Bone plate
US10327829B2 (en) 2012-12-28 2019-06-25 Paragon 28, Inc. Alignment guide apparatus, methods and systems
CN110495942A (zh) * 2019-09-19 2019-11-26 山东中医药大学附属医院 一种肱骨近端结节间沟解剖型辅助钢板
WO2020010111A1 (fr) 2018-07-03 2020-01-09 Trimed, Incorporated Procédé et système pour modifier la configuration d'un os
US10610241B2 (en) 2016-10-24 2020-04-07 Paragon 28, Inc. Osteotomy systems, devices and methods
US10888338B2 (en) 2017-02-27 2021-01-12 Paragon 28, Inc. Intramedullary nail alignment guides, fixation guides, devices, systems, and methods of use
US10918431B2 (en) 2017-03-30 2021-02-16 Paragon 28, Inc. Bone fixation system, assembly, implants, devices, alignment guides, and methods of use
US11179168B2 (en) 2017-02-27 2021-11-23 Paragon 28, Inc. Targeting instruments, systems and methods of use
US11925364B2 (en) 2019-02-13 2024-03-12 Paragon 28, Inc. Implant, alignment guides, system and methods of use

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RU2238055C1 (ru) * 2003-02-03 2004-10-20 Мухаметов Фарит Фагимович Пластина-имплантат для остеосинтеза
US20110224736A1 (en) * 2010-03-09 2011-09-15 Humphrey C Scott Proximal humerus fracture repair plate and system

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US10327829B2 (en) 2012-12-28 2019-06-25 Paragon 28, Inc. Alignment guide apparatus, methods and systems
US11395691B2 (en) 2012-12-28 2022-07-26 Paragon 28, Inc. Alignment guide apparatus, methods and systems
US11642142B2 (en) 2016-10-24 2023-05-09 Paragon 28, Inc. Osteotomy systems, devices and methods
US10610241B2 (en) 2016-10-24 2020-04-07 Paragon 28, Inc. Osteotomy systems, devices and methods
WO2018136427A1 (fr) * 2017-01-17 2018-07-26 Biomet Manufacturing, Llc Système de placage osseux comprenant un gabarit de perçage doté d'éléments de verrouillage
CN110177512A (zh) * 2017-01-17 2019-08-27 拜欧米特制造有限责任公司 包括具有锁定元件的钻具夹具的骨板接系统
US10898209B2 (en) 2017-01-17 2021-01-26 Biomet Manufacturing, Llc Bone plating system including a drill jig with locking elements
US11779358B2 (en) 2017-02-27 2023-10-10 Paragon 28, Inc. Targeting instruments, systems and methods of use
US11666345B2 (en) 2017-02-27 2023-06-06 Paragon 28, Inc. Intramedullary nail alignment guides, fixation guides, devices, systems, and methods of use
US11179168B2 (en) 2017-02-27 2021-11-23 Paragon 28, Inc. Targeting instruments, systems and methods of use
US10888338B2 (en) 2017-02-27 2021-01-12 Paragon 28, Inc. Intramedullary nail alignment guides, fixation guides, devices, systems, and methods of use
US10918431B2 (en) 2017-03-30 2021-02-16 Paragon 28, Inc. Bone fixation system, assembly, implants, devices, alignment guides, and methods of use
US11779381B2 (en) 2017-03-30 2023-10-10 Paragon 28, Inc. Bone fixation system, assembly, implants, devices, alignment guides, and methods of use
USD849948S1 (en) 2017-06-28 2019-05-28 Paragon 28, Inc. Bone plate
US10799276B2 (en) 2017-07-11 2020-10-13 Paragon 28, Inc. Bone fixation system, assembly, implants, devices, insertion guides, and methods of use
US11559316B2 (en) 2017-07-11 2023-01-24 Paragon 28, Inc. Bone fixation system, assembly, implants, devices, insertion guides, and methods of use
WO2019014356A1 (fr) * 2017-07-11 2019-01-17 Paragon 28, Inc. Système de fixation osseuse, ensemble, implants, dispositifs, guides d'insertion et méthodes d'utilisation
EP3817677A4 (fr) * 2018-07-03 2022-04-13 Trimed, Inc. Procédé et système pour modifier la configuration d'un os
WO2020010111A1 (fr) 2018-07-03 2020-01-09 Trimed, Incorporated Procédé et système pour modifier la configuration d'un os
US11529174B2 (en) 2018-07-03 2022-12-20 Trimed, Incorporated Method for changing a configuration of a bone
US11925364B2 (en) 2019-02-13 2024-03-12 Paragon 28, Inc. Implant, alignment guides, system and methods of use
CN109758224B (zh) * 2019-02-20 2023-10-03 绍兴市上虞区中医医院 跟骨骨折电动牵引撬拨复位器
CN109758224A (zh) * 2019-02-20 2019-05-17 绍兴市上虞中医医院 跟骨骨折电动牵引撬拨复位器
CN110495942A (zh) * 2019-09-19 2019-11-26 山东中医药大学附属医院 一种肱骨近端结节间沟解剖型辅助钢板

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