WO2011163092A2 - Système de plaque pour la prise en charge d'une fracture osseuse - Google Patents

Système de plaque pour la prise en charge d'une fracture osseuse Download PDF

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Publication number
WO2011163092A2
WO2011163092A2 PCT/US2011/040978 US2011040978W WO2011163092A2 WO 2011163092 A2 WO2011163092 A2 WO 2011163092A2 US 2011040978 W US2011040978 W US 2011040978W WO 2011163092 A2 WO2011163092 A2 WO 2011163092A2
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WO
WIPO (PCT)
Prior art keywords
plate
recited
locking screw
horizontal segment
locking
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Legal status (The legal status 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 status listed.)
Ceased
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PCT/US2011/040978
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English (en)
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WO2011163092A3 (fr
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Amit Gupta
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Individual
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Individual
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Publication of WO2011163092A3 publication Critical patent/WO2011163092A3/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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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
    • 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 or setting implements
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • 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
    • 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 or setting implements
    • 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
    • A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
    • A61B17/8042—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being a cover over the screw head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • 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
    • A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
    • A61B17/8057—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded the interlocking form comprising a thread
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • 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
    • A61B17/808—Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • 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
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • A61B17/863—Shanks, i.e. parts contacting bone tissue with thread interrupted or changing its form along shank, other than constant taper
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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 or setting implements
    • 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
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • A61B17/8635—Tips of screws

Definitions

  • the present invention pertains to the management of a bone fracture, and, more particularly, a plate system that is used in a surgical procedure to manage a distal radius or similar bone fracture.
  • a distal radius fracture is a bone fracture of the radius in the forearm, and indeed, it is one of the most common bone fractures. Because of its proximity to the wrist joint, such a fracture is often referred to as a wrist fracture.
  • the palmar surface of the radius is relatively flat and is able accommodate a plate under the thick pronator quadratus muscle that covers this surface.
  • the present invention is a plate system that is used in a surgical procedure to manage a distal radius or similar bone fracture.
  • the plate includes two leg segments extending downwardly from a generally horizontal segment, and further includes an elongated slot defined through the center of the horizontal segment of the plate near its top edge.
  • a subchondral support element is inserted through the elongated slot and advanced into the bone.
  • the plate further defines two holes through the horizontal segment near a respective one of the two leg segments.
  • Locking screws such as variable angle locking screws, are inserted into and locked into the respective holes, with each locking screw advancing into the bone such that a distal tip of each locking screw engages the subchondral support element, thus providing a "kickstand" effect and a robust three-point and subchondral support that is particularly beneficial for managing simple intraarticular fractures and extraarticular fractures in osteoporotic bones.
  • the plate has a generally horseshoe-like shape with the two leg segments extending downwardly from the generally horizontal segment.
  • each elongated slot has a threaded portion at its upper end. Furthermore, there are threaded holes defined through one leg segment along the length of the leg segment, along with threaded holes defined through the other leg segment along the length of the other leg segment.
  • the plate is positioned against and secured to the distal radius (or other bone) to provide stability to a fracture.
  • a paddle screw with an auger-like flight is inserted into each end of the elongated slot defined through the center of the horizontal segment of the plate, and then is advanced into the bone, with the paddle screws serving as the subchondral support element.
  • each paddle screw can be locked into the respective variable angle locking holes at either end of the elongated slot.
  • the distal end of the paddle screw has a number of paddles that collectively define a surface at its distal end.
  • a locking screw is inserted through each of the threaded holes defined through the horizontal segment, and each locking screw is advanced into the bone with the distal tip of each locking screw engaging one or more of the paddles at the distal end of the respective paddle screw.
  • Certain screws are oriented to provide a "kickstand" subchondral support system in combination with a thin metal blade assembly that is positioned in the subchondral space.
  • An exemplary metal blade assembly generally comprises a blade that is a substantially flat plate, but terminates in a curved distal edge. At the opposite end of the blade, there is a substantially perpendicular front plate. As a result of this construction, the blade can be inserted into the elongated slot defined through the center of the horizontal segment of the plate near its top edge.
  • each locking screw is inserted through each of the threaded holes defined through the horizontal segment, and each locking screw is then advanced into the bone with the distal tip of each locking screw engaging the curved distal edge of the blade.
  • the blade and the variable angle locking screws collectively provide the "kickstand" effect and a robust three-point and subchondral support.
  • nonlocking screws are also inserted through each of the elongated slots aligned with the leg segments and then advanced into the bone. These non-locking screws help secure the plate to the bone and are used as the initial fixation screws. Having one locking screw and associated elongated slot on either side makes it possible to fine tune the tilt and height of the plate relative to the bone.
  • the elongated slots are also provided with threaded portions at the upper ends of each elongated slot, which can accommodate locking screws if needed.
  • unicortical locking screws are also inserted into each of the threaded holes defined through the respective leg segments of the plate. Each of these unicortical locking screws is locked into the plate at a fixed angle.
  • the additional elongated slots defined through the horizontal segment of the plate can also accommodate additional no n- locking screws.
  • Such non-locking screws can be used: (i) to pull the fracture fragment to the plate, thus finely reducing the fracture and preventing the plate from standing off of the bone as can happen when only locking screws are used and the fracture is incompletely reduced; (ii) as lag screws for large intraarticular fractures such as a coronal split of the lunate fossa (Malone Type IV fracture); and (iii) to compress a radial fragment and an ulnar fragment by virtue of eccentrically placed screws.
  • such non-locking screws would be bicortical and would be inserted into the distal fracture fragment.
  • the plate may also include two variable angle locking holes, one near the extreme radial (or left) edge of the plate and one near the extreme ulnar (or right) edge of the plate.
  • a rotating tab engages and rotates with respect to each of these variable angle locking holes. In a first or down position, each rotating tab provides volar support for the head of a non-locking screw that is received in one of the elongated slots defined through the horizontal segment of the plate. In other words, the head of each non-locking screw can be covered by a respective rotating tab in the down position, thus preventing the backing out of the no n- locking screw and effectively converting it into a "pseudo" locking mode.
  • each rotating tab can provide supplementary support to any ulnar or radial styloid fragment that may otherwise not be captured by the plate.
  • each rotating tab is provided with holes near its upper edge for accommodating Kirschner wires or small screws.
  • the plate may also be provided with hexagonal or other holes near its lower edge that can engage hexagonal protrusions of custom-designed ratchet pliers for pulling the two leg segments toward each other and the central axis of the bone.
  • FIG. 1 is a view of an exemplary plate for use in the plate system of the present invention
  • FIG. 2 is a side view of the exemplary plate of FIG. 1 ;
  • FIG. 3 includes views of various screws used with the exemplary plate of FIG. 1 ;
  • FIG. 4A is a view of a rotating tab that is incorporated into the exemplary plate of
  • FIG. 1 is a diagrammatic representation of FIG. 1 ;
  • FIG. 4B is a side view of the rotating tab of FIG. 4A;
  • FIG. 5A is a front view of an exemplary metal blade assembly for use in one implementation of the plate system of the present invention
  • FIG. 5B is a side view of the exemplary metal blade assembly of FIG. 5 A;
  • FIG. 5C is a top view of the exemplary metal blade assembly of FIG. 5A;
  • FIG. 6 is a view of the exemplary plate of FIG. 1 secured to a radius
  • FIG. 7 is a side sectional view of the exemplary plate of FIG. 6 as secured to the radius;
  • FIG. 8 is a view taken along line 8-8 of FIG. 7;
  • FIG. 9 is a view of the exemplary plate of FIG. 1 secured to a radius in a manner similar to that shown in FIG. 6, but with one rotating tab rotated to the up position;
  • FIG. 10 is a side sectional view of the exemplary plate of FIG. 9 as secured to the radius;
  • FIG. 1 1 is a view of the exemplary plate of FIG. 1 secured to a radius in a manner similar to that shown in FIG. 9, but using the exemplary metal blade assembly of FIG. 5 A;
  • FIG. 12 is a side sectional view of the exemplary plate of FIG. 11 as secured to the radius;
  • FIG. 13 is a view of a set of ratchet pliers for use with the plate system of the present invention;
  • FIG. 14 is a view of another exemplary plate for use in the plate system of the present invention.
  • FIG. 15 is a view of the exemplary plate of FIG. 14 secured to a radius
  • FIG. 16 is a side sectional view of the exemplary plate of FIG. 15 as secured to the radius;
  • FIG. 17 is a view of another exemplary plate for use in the plate system of the present invention.
  • FIG. 18 is a view of another exemplary plate for use in the plate system of the present invention.
  • the present invention is a plate system that is used in a surgical procedure to manage a distal radius or similar bone fracture.
  • the plate includes two leg segments extending downwardly from a generally horizontal segment, and further includes an elongated slot defined through the center of the horizontal segment of the plate near its top edge.
  • a subchondral support element is inserted through the elongated slot and advanced into the bone.
  • the plate further defines two holes through the horizontal segment near a respective one of the two leg segments.
  • the plate 10 has a generally horseshoe-like shape with two leg segments 40, 60 extending downwardly from a generally horizontal segment 20. Such a shape with two columns keeps the central area of the bone (i.e., between the leg segments 40, 60) free and accessible.
  • unicortical locking screws can be used to secure the plate 10 to the bone as twice the number of screws can be used as compared to a prior art plate with a single central vertical segment.
  • elongated slot 22 defined through the center of the horizontal segment 20 of the plate 10 near the top edge, with variable angle locking holes 22a, 22b at either end of the elongated slot 22.
  • threaded holes 28, 30 defined through the horizontal segment 20 near the two leg segments 40, 60.
  • elongated slots 24, 26 defined through the horizontal segment 20 of the plate 10, one near the left edge of the plate 10 and one near the right edge of the plate 10, with threaded portions 24a, 26a at the inside ends of each elongated slot 24, 26. The importance of these elongated slots 22, 24, 26 and threaded holes 28, 30 is discussed in further detail below.
  • each elongated slot 42, 62 has a threaded portion 42a, 62a at its upper end. Furthermore, there are threaded holes 44, 46, 48 defined through one leg segment 40 along the length of the leg segment 40, as well as threaded holes 64, 66, 68 defined through the other leg segment 60 along the length of the other leg segment 60. The importance of these elongated slots 42, 62 and threaded holes 44, 46, 48, 64, 66, 68 is also discussed in further detail below. Referring now to FIG. 2, it should also be noted that the plate 10 has a curvature that mimics the curvature of the distal radius, so that it can be placed against and engage the bone, as is also discussed in further detail below.
  • the plate 10 is actually comprised of two sections 10a, 10b that are joined together, with a cavity defined between the two sections 10a, 10b on either side of the plate 10 for accommodating a rotating tab 120, which is discussed below.
  • FIG. 3 shows multiple screws that are used with the plate 10 of FIGS. 1 and 2.
  • the first screw is a "paddle" screw 80, in that it has a number of paddles 80a that collectively define a surface at its distal end.
  • This paddle screw 80 also has an auger-like flight 81 that is tapered from the head of the paddle screw 80 to its distal end.
  • the second screw is a variable angle locking screw 82 with a drill- like distal tip 82 a.
  • the third screw is another variable angle locking screw 84.
  • the fourth and fifth screws are non-locking screws 86, 88.
  • the sixth and final screw is a unicortical locking screw 90. The use and function of these various screws 80, 82, 84, 86, 88, 90 is also discussed in further detail below.
  • the plate 10 is positioned against and secured to the distal radius (or other bone) to provide stability to a fracture.
  • certain screws are oriented to provide a "kickstand" subchondral support system (which may be referred to by the acronym KISS).
  • KISS a "kickstand" subchondral support system
  • a paddle screw 80 with the auger-like flight 81 is inserted into each end of the elongated slot 22 defined through the center of the horizontal segment 20 of the plate 10, and then advanced into the bone.
  • the paddle screws 80 serve as the subchondral support element.
  • the head of each paddle screw 80 can be locked into the respective variable angle locking holes 22a, 22b at either end of the elongated slot 22.
  • the distal end of the paddle screw 80 has a number of paddles 80a that collectively define a surface at its distal end.
  • a variable angle locking screw 82 (having a drill-like distal tip 82a in this example) is inserted through each of the threaded holes 28, 30 defined through the horizontal segment 20, and each variable angle locking screw 82 is advanced into the bone with the distal tip 82a of each variable angle locking screw 82 engaging one or more of the paddles 80a at the distal end of the respective paddle screw 80.
  • the screw could be provided with a conical or other structure at its distal end (instead of paddles) to provide an engagement surface for the distal tip 82a of the variable angle locking screw 82.
  • each paddle screw 80 and the associated variable angle locking screw 82 which are both locked to the plate 10, make contact on the far side of the subchondral and subcortical space of the radius, thus providing a "kickstand" effect and a robust three-point and subchondral support.
  • Such an arrangement is particularly beneficial for managing simple intraarticular fractures and extraarticular fractures in osteoporotic bones.
  • non-locking screws 88 are inserted through each of the elongated slots 42, 62 aligned with the respective leg segments 40, 60 and then advanced into the bone. These non- locking screws 88 help secure the plate 10 to the bone and are used as the initial fixation screws. Also, having one locking screw 88 and associated elongated slot 42, 62 on either side makes it possible to fine tune the tilt and height of the plate 10 relative to the bone. As mentioned above, the elongated slots 42, 62 are also provided with threaded portions 42a, 62a at the upper ends of each elongated slot 42, 62, which can accommodate locking screws if needed.
  • a unicortical locking screw 90 is inserted into each of the threaded holes 44, 46, 48, 64, 66, 68 defined through the respective leg segments 40, 60 of the plate 10.
  • Each of these unicortical locking screws 90 is locked into the plate 10 at a fixed angle.
  • using six unicortical locking screws 90, as opposed to fewer bicortical locking screws (as in prior art systems) will provide for similar strength; however, the advantage of unicortical locking screws is that there is less risk of dorsal structure irritation with mistakenly applied long screws. Moreover, there will be space for a plate and screws on the dorsal side should there be a need for that type of fixation.
  • FIGS. 9-10 illustrate another implementation and use of the plate system of the present invention, which is particularly useful for managing a comminuted intraarticular fracture, especially when there is a central "die-punch" or depression fracture.
  • certain screws are oriented to provide a "kickstand" subchondral support system in combination with a thin metal blade assembly that is positioned in the subchondral space.
  • FIGS. 5A-5C are various views of an exemplary metal blade assembly 100, which serves as the subchondral support element.
  • the exemplary metal blade assembly 100 generally comprises a blade 104 that is a substantially flat plate, but terminates in a curved distal edge 104a. At the opposite end of the blade 104, there is a substantially perpendicular front plate 102.
  • the blade 104 can be inserted into the elongated slot 22 defined through the center of the horizontal segment 20 of the plate 10 near its top edge, as shown in FIGS. 9-10.
  • a variable angle locking screw 82 (again having a drill-like distal tip 82a in this example) is inserted through each of the threaded holes 28, 30 defined through the horizontal segment 20, and each variable angle locking screw 82 is then advanced into the bone with the distal tip 82a of each variable angle locking screw 82 engaging the curved distal edge 104a of the blade 104.
  • the blade 104 and the variable angle locking screws 82 collectively provide the "kickstand" effect and a robust three-point and subchondral support similar to that provided in the implementation discussed above with respect to FIGS. 6-8.
  • a unicortical locking screw 90 is inserted into each of the variable angle locking holes 22a, 22b at either end of the elongated slot 22, thus securing and maintaining the position of the metal blade assembly 100 relative to the plate 10.
  • the plate system of the present invention is used for management of a distal radius fracture
  • a kickstand subchondral support system KISS
  • KISS kickstand subchondral support system
  • other bones where articular collapse fractures are encountered, including, for example, in the upper tibia, in the distal tibia (pilon fractures), in the proximal and distal humerus, in the radial head along with proximal and distal ulna, and also in the hip region.
  • the additional elongated slots 24, 26 defined through the horizontal segment 20 of the plate can also accommodate additional non-locking screws 86, as shown in FIGS. 1 1-12.
  • Such non- locking screws 86 can be used: (i) to pull the fracture fragment to the plate 10, thus finely reducing the fracture and preventing the plate 10 from standing off of the bone as can happen when only locking screws are used and the fracture is incompletely reduced; (ii) as lag screws for large intraarticular fractures such as a coronal split of the lunate fossa (Malone Type IV fracture); and (iii) to compress a radial fragment and an ulnar fragment by virtue of eccentrically placed screws.
  • the plate 10 shown in FIGS. 1 and 2 also includes two variable angle locking holes 32, 34, one near the extreme radial (or left) edge of the plate 10 and one near the extreme ulnar (or right) edge of the plate 10.
  • Each of these two variable angle locking holes 32, 34 can accommodate additional locking screws, if needed.
  • a rotating tab 120 as shown in FIGS. 4A and 4B, engages and rotates with respect to each of these variable angle locking holes 32, 34.
  • each rotating tab 120 has a raised circumferential lip 122 that fits in and engages one of the variable angle locking holes 32, 34.
  • each rotating tab 120 can rotate approximately 210° within its respective cavity. In a first or down position, each rotating tab 120 can provide volar support for the head of a non-locking screw 86 that is received in one of the elongated slots 24, 26 defined through the horizontal segment 20 of the plate 10, for example, as shown in the elongated slot 26 in FIGS. 11 and 12.
  • each rotating tab 120 can provide supplementary support to any ulnar or radial styloid fragment that may otherwise not be captured by the plate 10.
  • each rotating tab 120 is provided with holes 124 (as shown in FIG. 5) near its upper edge for accommodating Kirschner wires or small screws. Such use of the rotating tabs 120 can be particularly important for a volar ulnar fragment that is notoriously missed in a standard volar plate fixation.
  • threaded portions 24a, 26a at the inside ends of each elongated slot 24, 26.
  • these threaded portions 24a, 26a can receive a locking screw, such as bicortical locking screw, to provide supplemental fixation. This may be of particular importance when the associated rotating tab 120 is in a second or up position, and thus can not be used to prevent the backing out of the non-locking screw 86.
  • the plate 10 may be provided with hexagonal or other holes near its lower edge that can engage hexagonal protrusions of custom-designed ratchet pliers 200, as shown in FIG. 13.
  • ratchet pliers 200 would be used to pull the two leg segments 40, 60 toward each other and the central axis of the bone.
  • the generally horizontal segment 20 of the exemplary plate 10 can thus be characterized as having three rows.
  • the elongated slot 22, including the variable angle locking holes 22a, 22b, and the variable angle locking holes 32, 34 are in the first (or upper) row.
  • the two additional elongated slots 24, 26 are in the second (or middle) row.
  • the threaded holes 28, 30 are in the third (or lower) row.
  • an exemplary method for managing a fracture of a bone comprises the steps of: providing a plate with two leg segments extending downwardly from a generally horizontal segment, said plate further including an elongated slot defined through the generally horizontal segment near its top edge, and two holes, each said hole defined through the generally horizontal segment near a respective one of the two leg segments; positioning the plate against the bone; inserting a subchondral support element through the elongated slot defined through the generally horizontal segment of the plate and into the bone; and inserting at least two screws through the respective holes defined through the generally horizontal segment of the plate, and advancing each screw into the bone until a distal tip of each screw engages the subchondral support element.
  • the plate 310 again has a generally horseshoe-like shape with two leg segments 340, 360 extending downwardly from a generally horizontal segment 320. Again, such a shape with two columns keeps the central area of the bone (i.e., between the leg segments 340, 360) free and accessible. It is also believed that it is much easier to align the ends of the plate 310 to the edges of the bone, thereby obtaining a better centered construct. Furthermore, in this exemplary embodiment, the plate 310 is again comprised of two sections 310a, 310b that are joined together.
  • the plate 310 is positioned against and secured to the distal radius (or other bone) to provide stability to a fracture.
  • certain screws are again oriented to provide a "kickstand" subchondral support system.
  • a variable angle locking screw 82 is inserted into each of the variable angle locking holes 322, 323 in the first (or upper) row of the generally horizontal segment 320 of the plate 310, and then advanced into the bone. These two variable angle locking screws 82 serve as the subchondral support element.
  • a second pair of variable locking screws 82' is inserted through each of the spaced variable angle locking holes 328, 330 in the third (or lower) row of the generally horizontal segment 320, and each variable angle locking screw 82' is advanced into the bone with the distal tip of each variable angle locking screw 82' converging toward and meeting the variable angle locking screw 82 above it.
  • the result is that each variable locking screw 82 passing through the first (or upper) row of the generally horizontal segment 320 of the plate 310 meets with a variable locking screw 82' passing through the third (or lower) row of the generally horizontal segment 320 of the plate 310, thus providing the desired "kickstand" effect and a robust three-point and subchondral support.
  • the plate 310 also includes two additional variable angle locking holes 332, 334 in the first (or upper) row of the generally horizontal segment 320, one near the extreme radial (or left) edge of the plate 310 and one near the extreme ulnar (or right) edge of the plate 310.
  • Each of these two variable angle locking holes 332, 334 can accommodate additional locking screws, if needed
  • the plate 310 also includes two elongated slots 324, 326 in the second (or middle) row of the generally horizontal segment 320, one near the left edge of the plate 310 and one near the right edge of the plate 310.
  • elongated slots 324, 326 can each receive a non-locking screw, which can be selectively covered by a respective rotating tab 420 in the down position, thus preventing the backing out of the non- locking screw and effectively converting it into a "pseudo" locking mode.
  • each rotating tab 420 In a second or up position, each rotating tab 420 can provide supplementary support to any ulnar or radial styloid fragment that may otherwise not be captured by the plate 310.
  • the plate 310 also includes an elongated slot 342 defined through and aligned with one leg segment 340, and there is an identical elongated slot 362 defined through and aligned with the other leg segment 360. Furthermore, there are threaded holes 344, 346, 348 defined through one leg segment 340 along the length of the leg segment 340, as well as threaded holes 364, 366, 368 defined through the other leg segment 360 along the length of the other leg segment 360. Referring again to FIGS. 15-16, in some implementations and uses of the plate system of the present invention, non- locking screws 88 are inserted through each of the elongated slots 342, 362 aligned with the leg segments 340, 360 and then advanced into the bone.
  • non- locking screws 88 help secure the plate 310 to the bone and are used as the initial fixation screws. Also, having one locking screw 88 and associated elongated slot 342, 362 on either side makes it possible to fine tune the tilt and height of the plate 310 relative to the bone.
  • a unicortical locking screw 90 is inserted into each of the threaded holes 344, 346, 348, 364, 366, 368 defined through the respective leg segments 340, 360 of the plate 310.
  • Each of these unicortical locking screws 90 is locked into the plate 310 at a fixed angle.
  • using six unicortical locking screws 90, as opposed to fewer bicortical locking screws (as in prior art systems) will provide for similar strength; however, the advantage of unicortical locking screws is that there is less risk of dorsal structure irritation with mistakenly applied long screws. Moreover, there will be space for a plate and screws on the dorsal side should there be a need for that type of fixation.
  • the plate 510 is substantially identical to that described above with reference to FIGS. 14-16.
  • the plate 510 again has a generally horseshoe-like shape with two leg segments 540, 560 extending downwardly from a generally horizontal segment 520.
  • the plate 510 also includes two additional variable angle locking holes 532, 534 in the first (or upper) row of the generally horizontal segment 520, one near the extreme radial (or left) edge of the plate 510 and one near the extreme ulnar (or right) edge of the plate 510.
  • the plate 510 includes two elongated slots 524, 526 in the second (or middle) row of the generally horizontal segment 520, one near the left edge of the plate 510 and one near the right edge of the late 510.
  • the plate 510 also includes an elongated slot 542 defined through and aligned with one leg segment 540, and there is an identical elongated slot 562 defined through and aligned with the other leg segment 560.
  • the plate 510 is not comprised of multiple sections, but rather is a single, unitary plate. Accordingly, it does not include any rotating tabs that would interact with two elongated slots 524, 526 in the second (or middle) row of the generally horizontal segment 520 near the left and right edges of the plate 510.
  • the plate 610 is substantially identical to that described above with reference to FIG. 17.
  • the plate 610 again has a generally horseshoe-like shape with two leg segments 640, 660 extending downwardly from a generally horizontal segment 620.
  • the plate 610 also includes two additional variable angle locking holes 632, 634 in the first (or upper) row of the generally horizontal segment 620, one near the extreme radial (or left) edge of the plate 610 and one near the extreme ulnar (or right) edge of the plate 610.
  • the plate 610 also includes an elongated slot 642 defined through and aligned with one leg segment 640, and there is an identical elongated slot 662 defined through and aligned with the other leg segment 660.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Neurology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un système de plaque utilisé dans une opération chirurgicale pour prendre en charge une fracture du radius distal ou fracture osseuse similaire. Une plaque du système de plaque comprend deux segments formant pattes s'étendant vers le bas depuis un segment généralement horizontal, et comprend en outre une fente allongée définie à travers le centre du segment horizontal de la plaque près de son bord supérieur. Un élément de soutien sous-chondral est inséré à travers la fente allongée et est poussé dans l'os. La plaque définit en outre deux trous à travers le segment horizontal respectivement près des deux segments formant pattes. Des vis de blocage, comme des vis de blocage à angle variable, sont insérées et verrouillées dans les trous respectifs, chaque vis de blocage avançant dans l'os de façon à ce qu'une pointe distale de chaque vis de blocage entre en prise avec l'élément de soutien sous-chondral, apportant ainsi un soutien trois points.
PCT/US2011/040978 2010-06-25 2011-06-17 Système de plaque pour la prise en charge d'une fracture osseuse Ceased WO2011163092A2 (fr)

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US35855810P 2010-06-25 2010-06-25
US61/358,558 2010-06-25

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WO2014140886A3 (fr) * 2013-03-15 2015-03-05 Merete Medical Gmbh Dispositif de fixation et procédé d'utilisation pour une procédure d'hallux valgus plantaire du type lapidus
USD740943S1 (en) 2009-04-01 2015-10-13 Merete Medical Gmbh Bone plate
US9161795B2 (en) 2009-12-22 2015-10-20 Merete Medical Gmbh Bone plate system for osteosynthesis
USD745162S1 (en) 2014-01-27 2015-12-08 Merete Medical Gmbh Bone plate
US9668793B2 (en) 2011-08-31 2017-06-06 Aristotech Industries Gmbh Anatomically customized plantar bone plate and bone plate system
US9788874B2 (en) 2012-05-03 2017-10-17 Aristotech Industries Gmbh Bone plate system for osteosynthesis
US9820787B2 (en) 2009-04-07 2017-11-21 Aristotech Industries Gmbh Apparatus for the constant-angle fixation and compression of a fracture or osteotomy of a bone
WO2018095830A1 (fr) * 2016-11-24 2018-05-31 Vetsos Ltd Appareil orthopédique
EP3375392A1 (fr) * 2017-03-13 2018-09-19 Globus Medical, Inc. Systèmes de stabilisation d'os
US10368928B2 (en) 2017-03-13 2019-08-06 Globus Medical, Inc. Bone stabilization systems
EP3539492B1 (fr) * 2015-02-05 2024-03-27 Paragon 28, Inc. Plaques osseuses

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US7537604B2 (en) * 2002-11-19 2009-05-26 Acumed Llc Bone plates with slots
FR2827500B1 (fr) * 2001-07-17 2004-04-02 Tornier Sa Plaque d'osteosynthese de l'extremite superieure de l'humerus
US7780710B2 (en) * 2004-01-23 2010-08-24 Depuy Products, Inc. System for stabilization of fractures of convex articular bone surfaces including subchondral support structure
US20100256687A1 (en) * 2009-04-01 2010-10-07 Merete Medical Gmbh Fixation Device and Method of Use for a Ludloff Osteotomy Procedure

Cited By (17)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
USD740943S1 (en) 2009-04-01 2015-10-13 Merete Medical Gmbh Bone plate
US9820787B2 (en) 2009-04-07 2017-11-21 Aristotech Industries Gmbh Apparatus for the constant-angle fixation and compression of a fracture or osteotomy of a bone
US9161795B2 (en) 2009-12-22 2015-10-20 Merete Medical Gmbh Bone plate system for osteosynthesis
US9668793B2 (en) 2011-08-31 2017-06-06 Aristotech Industries Gmbh Anatomically customized plantar bone plate and bone plate system
US9788874B2 (en) 2012-05-03 2017-10-17 Aristotech Industries Gmbh Bone plate system for osteosynthesis
USD860456S1 (en) 2013-03-15 2019-09-17 Aristotech Industries Gmbh Plantar lapidus plate
US9545276B2 (en) 2013-03-15 2017-01-17 Aristotech Industries Gmbh Fixation device and method of use for a lapidus-type plantar hallux valgus procedure
WO2014140886A3 (fr) * 2013-03-15 2015-03-05 Merete Medical Gmbh Dispositif de fixation et procédé d'utilisation pour une procédure d'hallux valgus plantaire du type lapidus
USD745162S1 (en) 2014-01-27 2015-12-08 Merete Medical Gmbh Bone plate
EP3539492B1 (fr) * 2015-02-05 2024-03-27 Paragon 28, Inc. Plaques osseuses
WO2018095830A1 (fr) * 2016-11-24 2018-05-31 Vetsos Ltd Appareil orthopédique
US11357553B2 (en) 2016-11-24 2022-06-14 VetSOS Ltd. Orthopaedic apparatus
US10368928B2 (en) 2017-03-13 2019-08-06 Globus Medical, Inc. Bone stabilization systems
US10905477B2 (en) 2017-03-13 2021-02-02 Globus Medical, Inc. Bone stabilization systems
US11058467B2 (en) 2017-03-13 2021-07-13 Globus Medical, Inc. Bone stabilization systems
EP3375392A1 (fr) * 2017-03-13 2018-09-19 Globus Medical, Inc. Systèmes de stabilisation d'os
US12089883B2 (en) 2017-03-13 2024-09-17 Globus Medical, Inc. Bone stabilization systems

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