Fixation system with multidirectional bone supports

[0001] This application is a divisional of U.S. Ser. No. 10/159,612, filed May 30, 2002, now issued as U.S. Pat. No. 6,767,351 which is hereby incorporated by reference herein in its entirety.

[0002] 1. Field of the Invention

[0003] This invention relates broadly to surgical devices. More particularly, this invention relates to a bone fixation system having multidirectional bone fragment support pegs.

[0004] 2. State of the Art

[0005] Referring to FIG. 1, a Colles' fracture is a fracture resulting from compressive forces being placed on the distal radius 10, and which causes backward displacement of the distal fragment 12 and radial deviation of the hand at the wrist 14. Often, a Colles' fracture will result in multiple bone fragments 16, 18, 20 which are movable and out of alignment relative to each other. If not properly treated, such fractures result in permanent wrist deformity. It is therefore important to align the fracture and fixate the bones relative to each other so that proper healing may occur.

[0006] Alignment and fixation are typically performed by one of several methods: casting, external fixation, interosseous wiring, and plating. Casting is non-invasive, but may not be able to maintain alignment of the fracture where many bone fragments exist. Therefore, as an alternative, external fixators may be used. External fixators utilize a method known as ligamentotaxis, which provides distraction forces across the joint and permits the fracture to be aligned based upon the tension placed on the surrounding ligaments. However, while external fixators can maintain the position of the wrist bones, it may nevertheless be difficult in certain fractures to first provide the bones in proper alignment. In addition, external fixators are often not suitable for fractures resulting in multiple bone fragments. Interosseous wiring is an invasive procedure whereby screws are positioned into the various fragments and the screws are then wired together as bracing. This is a difficult and time consuming procedure. Moreover, unless the bracing is quite complex, the fracture may not be properly stabilized. Plating utilizes a stabilizing metal plate typically against the dorsal side of the bones, and a set of parallel pins extending from the plate into the holes drilled in the bone fragments to provide stabilized fixation of the fragments. However, the currently available plate systems fail to provide desirable alignment and stabilization.

[0007] It is therefore an object of the invention to provide an improved fixation and alignment system for a Colles' fracture and other fractures.

[0008] It is another object of the invention to provide a fixation system which desirably aligns and stabilizes multiple bone fragments in a fracture to permit proper healing.

[0009] It is also an object of the invention to provide a fixation system which is highly adjustable to provide a customizable framework for bone fragment stabilization.

[0010] In accord with these objects, which will be discussed in detail below, a fracture fixation system is provided which generally includes a plate intended to be positioned against a non-fragmented proximal portion of a fractured bone, a plurality of bone screws for securing the plate along the non-fragmented portion of the bone, and a plurality of bone pegs coupled to the plate and extending therefrom into bone fragments adjacent the non-fragment portion.

[0011] According to a preferred embodiment of the invention, the plate is generally a T-shaped volar plate defining an elongate body, a head portion angled relative to the body, a first side which is intended to contact the bone, and a second side opposite the first side. The body portion includes a plurality of countersunk screw holes for the extension of the bone screws therethrough. The head portion includes a plurality of threaded peg holes for receiving the pegs therethrough. The pegs are angularly adjustable relative to the peg holes and can be independently fixed in selectable orientations; i.e., the pegs are multidirectional.

[0012] To stabilize a Colles' fracture, the volar plate is positioned with its first side against the volar side of the radius and bone screws are inserted through the bone screw holes into the radius to secure the volar plate to the radius. The bone fragments are then aligned and, through the peg holes, holes are drilled into and between the bone fragment at angles chosen by the surgeon. The pegs are then inserted into the peg holes and into the drilled holes, and a set screw (or screw cap) is inserted over each peg to lock the peg in the volar plate at the chosen orientation. The volar fixation system thereby stabilizes and secures the bone fragments in their proper orientation.

[0013] The various adjustably directable pegs can also be used in conjunction with fracture fixation plates adapted for fractures of other bones, e.g., the proximal and distal humerus, the proximal and distal ulna, the proximal and distal tibia, and the proximal and distal femur.

[0014] Additional objects and advantages of the invention will become apparent to those skilled in the art upon reference to the detailed description taken in conjunction with the provided figures.

[0040] Turning now to FIGS. 2 through 4, a first embodiment of a fracture fixation system 100 is particularly adapted for aligning and stabilizing multiple bone fragments in a Colles' fracture. The system 100 generally includes a substantially rigid T-shaped plate 102 intended to be positioned against the volar side of the radial bone, a plurality of preferably self-tapping bone screws 104 for securing the plate 102 along a non-fractured portion of the radial bone, and a plurality of bone pegs 108 which extend from the plate 102 and into bone fragments of a Colles' fracture.

[0041] The T-shaped plate 102 defines a head portion 116, an elongate body portion 118 angled relative to the head portion, a first side 120 which is intended to contact the bone, and a second side 122 opposite the first side. The first side 120 at the head portion is preferably planar, as is the first side at the body portion. As the head portion and body portion are angled relative to each other, the first side preferably defines two planar portions. The angle θ between the head portion 116 and the body portion 118 is preferably approximately 23° and bent at a radius of approximately 0.781 inch. The distal edge 121 of the head portion 116 is preferably angled proximally toward the medial side at an angle α, e.g. 5°, relative to a line P, which is perpendicular to the body portion. The plate 102 preferably has a thickness of approximately 0.1 inch, and is preferably made from a titanium alloy, such as Ti-6A-4V.

[0042] The body portion 118 includes four preferably countersunk screw holes 124, 126, 127, 128 for the extension of the bone screws 104 therethrough. One of the screw holes, 128, is preferably generally elliptical (or oval).

[0043] The head portion 116 includes four peg holes 130, preferably closely spaced (e.g., within 0.25 inch of each other) and arranged along a line or a curve, for individually receiving the pegs 108 therethrough.

[0044] According to the invention, each peg can be directed through a range of angles within a respective peg hole and fixed at a desired angle within the range. Referring to FIGS. 4 and 8, according to a first embodiment of the invention, each peg hole 130 in the volar plate 102 includes a cylindrical upper bore 140 provided with threads 146 and a lower portion 148 having a radius of curvature. The lower end 154 of each peg hole includes a circumferential bevel 156.

[0045] Referring to FIGS. 4, 5 and 8, each peg 108 includes a head 160 and a cylindrical shaft 162. The proximal portion 164 of the head 160 includes a cup 167 having an outer radius R_o substantially corresponding to the radius of the lower portion 148 of the peg holes 130, and a relatively smaller inner radius R_i of curvature. The head 160 defines preferably approximately 160° of a sphere. The shaft 162 includes a slight taper 166 at the intersection with the head 160, and a rounded distal end 168. According to a preferred manufacture of the first embodiment, the cylindrical shaft 162 of each peg 108 is first provided with a sphere (not shown) or a hemisphere (not shown) at a proximal end. If a sphere is provided, it is cut to a hemisphere. The hemisphere is then hollowed and further reduced to the 160° shape. Finally, the taper 166 is provided at the intersection.

[0046] Referring to FIGS. 5 and 8, the surface 150 of the lower portion 148 of the peg hole 130 and/or the outer surface 152 of the head 160 of the peg 108 is preferably roughened, e.g., by electrical, mechanical, or chemical abrasion, or by the application of a coating or material having a high coefficient of friction.

[0047] Turning now to FIGS. 6 through 9, each set screw 110 includes a proximal hex socket 170, circumferential threads 172 adapted to engage the threads 146 of the upper bore 140 of the peg hole, and distal substantially hemispherical portion 174 having substantially the same radius of curvature as the inner radius of curvature R_i of the cup 167, and preferably substantially smaller than a radius of the peg holes 130.

[0048] Referring to FIGS. 4 and 10, to stabilize a Colles' fracture, the plate 102 is positioned on the radius 10, and at least one hole is drilled through the elliptical screw hole on the volar plate and into the radius 10. Then, one or more bone screws 104 are inserted through the plate and into the bone. The fractured bones 16, 18, 20 are then adjusted under the plate 102 into their desired stabilized positions, and the bone screws 104 are tightened. Then, through the peg holes 130, the surgeon drills holes into the fracture location for the stabilization pegs 108. The holes may be drilled at any angle within a predefined range, and preferably at any angle within a range of 15° relative to an axis normal A_N to the lower surface of the head of the volar plate. Each hole may be drilled at the same angle or at relatively different angles. After each hole is drilled, a peg 108 is inserted therein. Referring back to FIG. 8, the bevel 156 at the lower end 154 of the peg hole 130 and the taper 166 on the shaft cooperate to permit the peg to be oriented with greater freedom relative to the axis A_N′ if required, as interference between the peg hole and peg shaft is thereby reduced. Once the peg 108 has been appropriately positioned within the peg hole, one of the set screws 110 is threaded into the upper bore 140 of the peg hole 130. The hemispherical portion 174 contacts the head 160 of the peg, seating in the concavity of the cup 167. As the set screw 110 is tightened, the surface 152 of the head of the peg, which may be roughened, is clamped between the set screw 110 and the roughened inner surface 150 of the lower portion of the peg hole 130, thereby securing the peg in the selected orientation. The other pegs are similarly positioned and angularly fixed.

[0049] Turning now to FIGS. 11 and 12, a second embodiment of a directable peg assembly for a fracture fixation plate is shown. The plate 202 includes threaded peg holes 230 that are generally larger in diameter than the head 260 of the pegs 208 intended for use therethrough. This permits a hole to be drilled through the peg hole 230 at a relatively greater angle than with respect to holes 130. The lower end 248 of the peg hole 230 is constricted relative to the upper threaded portion 249. The peg 208 includes a spherically-curved head 260, a cylindrical shaft 262, and an optionally constricted neck 266 therebetween. The set screw 210 includes a square opening 270 adapted to receive a square driver, threads 246 about its circumference, and a substantially spherically curved socket 274 adapted to receive the head 260 of the peg 208. As seen in FIG. 12, the lower portion of the set screw 210 includes expansion slots 276 which permit the lower portion of the set screw 210 to temporarily deform to receive the head 260 of the peg 208 (which has a diameter greater than the opening 278 of the spherical socket); i.e., the head 260 can be snapped into the socket 274.

[0050] In use, for each peg hole 230 and peg 208, holes are drilled through the peg holes and into the bone along axes at which it is desired to have pegs extend for stabilization of the fracture fragments. The head 260 of the peg 208 is snapped into the opening 278 of the socket 274. The shaft 262 of the peg 208 is then inserted into a respective bone hole until the set screw 210 meets the peg hole 230. It is appreciated that the set screw 210 can be rotated relative to the peg 208, as the socket 274 and spherical head 260 form a ball and socket coupling. As such, the set screw 210 is rotatably secured in the peg hole 230 to secure the peg 208 at the desired angle within the drilled hole.

[0051] Turning now to FIGS. 13 and 14, a third embodiment of a directable peg assembly for a fracture fixation plate is shown. The plate 302 includes threaded peg holes 330 that preferably have a stepped diameter, with a relatively large countersink portion 380 adapted to receive the head of a set screw 310, a threaded central portion 382, and a relatively smaller lower portion 384. The peg 308 includes a substantially spherically-curved head 360 having a central square opening 386 adapted to receive a driver, and a threaded cylindrical shaft 362. The set screw 310 includes a head portion 388 having a square opening 370 for also receiving a driver, a threaded portion 390, and a lower spherically-curved socket 374.

[0052] In use, for each peg hole 330 and peg 308, a hole is drilled through a respective peg hole and into the bone at the angle at which it is desired to receive a peg for stabilization of the fracture. The peg 308 is then positioned within the peg hole 330 and rotatably driven into the bone with a driver (not shown). Once the peg 308 is fully seated against the lower portion 384 of the peg hole 330, the set screw 310 is threaded into the central portion 390 of the peg hole and urged against the head 360 of the peg 308 to clamp the peg in position. The head portion 388 of the set screw 310 preferably at least partially enters the countersink portion 380 of the peg hole to provide a lower profile to the assembly.

[0053] Turning now to FIGS. 15 and 16, a fourth embodiment of a directable peg assembly for a fracture fixation plate is shown. The plate 402 includes threaded peg holes 430 each with a lower portion 448 having a radius of curvature, and a lower end 454 provided with a preferably circumferential bevel 456. The peg 408 includes a spherically curved head 460 defining a socket 467 extending in excess of 180°, a cylindrical shaft 462, and an optionally tapered neck 466 therebetween. The head 460 about the socket 467 is provided with expansion slots 476. The set screw 410 includes an upper portion 488 having a square opening 470 for a driver, and threads 490, and a lower ball portion 474 adapted in size an curvature to snap into the socket 467.

[0054] In use, for each peg hole 430 and peg 408, holes are drilled through the peg hole and into the bone at the angles at which it is desired to receive pegs for stabilization of fragments of the fracture. The ball portion 474 of the set screw 410 is snapped into the socket 467, with the socket 467 able to expand to accept the ball portion 474 by provision of the expansion slots 476. The shaft 462 of the peg 408 is then inserted into a respective bone hole until the set screw 410 meets the peg hole 430. It is appreciated that the set screw 410 can rotate relative to the peg 408, as the ball portion 474 and socket 467 are rotatably coupled to each other. As such, the set screw 410 is then rotatably secured in the peg hole 430 to secure the peg 408 in the bone.

[0055] Turning now to FIGS. 17 and 18, a fifth embodiment of a directable peg assembly for a fracture fixation plate, substantially similar to the fourth embodiment, is shown. In the fifth embodiment, the head 560 of the peg 508 includes two sets of pin slots 594a, 594b defining two planes P₁ and P₂ oriented transverse to each other. In addition, the head 560 includes radial expansion slots 576. The ball portion 574 of the set screw 510 includes two pins 598a, 598b extending through a center thereof and oriented transverse to each other. The ball portion 574 is snapped into the socket 567 defined by the head 560 of the peg 508, and pins 598a, 598b are positioned through the pin slots 594a, 594b to rotatably lock the peg and set screw together, yet permit the peg 508 to articulate relative to the set screw 510. The fifth embodiment is suitable for rotatably inserting threaded pegs 508 into a bone hole via rotation of the set screw 510, and may be used in a similar manner to the fourth embodiment.

[0056] Turning now to FIGS. 19 and 20, a sixth embodiment of a directable peg assembly for a fracture fixation plate is shown. The assembly includes a peg 608 having a substantially spherically curved head 660 provided with four nubs 680 (two shown) arranged in 90° intervals about the periphery of the head 660. The set screw 610 includes lower walls 682 defining a socket 674 for the head 660. In addition, the walls 682 define slots 684 through which the nubs 680 can move.

[0057] In use, the assembly of the peg 608 with its set screw 610 functions substantially similar to a universal joint. The peg 608 is then inserted through a respective peg hole 630 and into a drilled hole in a bone until threads 690 on the set screw 610 engage mating threads 692 in the peg hole. The set screw 610 is then rotated, which causes rotation of the peg 608 within the drilled hole. When the set screw 610 is fully seated in the peg hole 630, the peg 608 is secured in the bone.

[0058] Turning now to FIGS. 21 and 22, a seventh embodiment of a directable peg assembly for a fracture fixation plate is shown. The peg holes 730 in the plate 702 each include a threaded cylindrical upper portion 746 and a spherically-curved lower portion 748 having a smaller hole diameter than the upper portion. Each peg 708 has a head 760 with a lower relatively larger spherically curved portion 762 and an upper relatively smaller spherically curved portion 764, and a shaft 766. The lower curved portion 762 preferably spherically curves through substantially 150°, while the upper curved portion 764 preferably spherically curves through substantially 210°. The peg shaft is optionally provided with threads 769, and when so provided, the lower curved portion 762 of the peg is provided with driver notches 768. The set screw 710 includes an upper portion 788 having a slot 770 or other structure for engagement by a driver, threads 790, and a lower socket 792.

[0059] In use, for each peg 708, a hole is drilled through a respective peg hole into the bone at an orientation desirable for receiving that particular peg for stabilization of the fracture. A peg 708 is then inserted through the peg hole 730 and into the drilled hole until the curved lower surface 762 of the head 760 of the peg seats against the curved lower portion 748 of the peg hole. If the peg has threads 769, a driver (not shown) may be coupled to the peg 708 at the notches 768 to rotationally drive the peg into the drilled hole. The set screw 710 is then threaded into the peg hole 730 until the socket 792 extends over the upper portion 764 of the head 760 of the peg and presses thereagainst to force the lower portion 762 of the head against spherically-curved lower portion 748 of the peg hole 730 to clamp the peg 708 in position. In the seventh embodiment, the socket 792 of the set screw 710 does not necessarily capture (i.e., extend more than 180° about) any portion of the head 760 of the peg 708. However, the socket 792 may be modified to enable such capture.

[0060] Turning now to FIGS. 23 and 24, an eighth embodiment of a directable peg assembly for a fracture fixation plate is shown. The peg holes 830 of the plate each include a spherically-curved portion 848 preferably having a roughened relatively high friction surface. Each peg 808 has a substantially spherically-curved head 860 provided with a preferably roughened outer surface 861, an upper threaded axial bore 863, and a plurality of radial slots 865 extending between the outer surface and the bore. The set screw 810 includes an upper slot 870 for adapted to receive a driver and tapered threads 890.

[0061] In use, for each peg 808, a hole is drilled through a respective peg hole into the bone at an orientation desirable for receiving that particular peg for stabilization of the fracture. A peg 808 is then inserted through the peg hole 830 and into the drilled hole. When the peg 808 is fully seated in the peg hole 830 and at the desired angle, the set screw 810 in threadably inserted into the bore 863. The set screw 810 has a diameter slightly larger than the bore 863. As such, as the screw 810 is inserted, the head 860 of the peg 808 is enlarged at the slots 865 to accommodate the screw 810, and the high friction surfaces 861, 848 are forced against each other thereby locking the peg 808 in the peg hole 830 at its chosen axial orientation.

[0062] Turning now to FIGS. 25 and 26, a ninth embodiment of a directable peg assembly for a fracture fixation plate is shown. The peg holes 930 and threaded pegs 908 are substantially similar to the peg holes 330 and pegs 308 of the third embodiment (FIGS. 13 and 14). It is noted that the lower end of the peg hole 930 has a lower curving taper 931. Also according to the ninth embodiment, the set screw 910 includes a central hole 969, an upper slot 970 extending across the hole 969, helical threads 990, a lower socket 992, and a plurality of compression slots 994 about the socket.

[0063] In use, for each peg 908, a hole is drilled through a respective peg hole 930 into the bone at an orientation desirable for receiving that particular peg for stabilization of the fracture. A driver 1000 having a shaft 1001 provided with a distalmost square end 1002 and relatively proximal flanges 1004 is then used for the assembly. The threaded peg 908 is positioned at the entry of the bone hole, and the set screw 910 is positioned thereover, with the socket 992 of the set screw resting on the head 960 of the peg. The square end 1002 of the driver is then inserted through the hole 969 and into a square opening 986 at the head 960 of the peg, and the flanges 1004 of the driver 1000 are inserted into the upper slot 970. The driver 1000 is rotated to threadably insert the peg 908 into the bone hole. When the set screw 910 meets the peg hole 930, it is also threaded therein with the driver, and when a lower portion 911 of the set screw contacts the curving taper 931 of the peg hole, the set screw is compressed about the compression slots 994 to secure the peg 908 in position.

[0064] There have been described and illustrated herein several embodiments of a volar fixation system, as well as directable peg systems suitable for numerous applications related to the fixation of various bone fractures. In each of the embodiments, the head of a peg is clamped between a portion of the fixation plate and a set screw, preferably with the head of the peg and fixation plate thereabout being treated to have, or having as material properties, high friction surfaces. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. Thus, while particular materials for the elements of the system have been disclosed, it will be appreciated that other materials may be used as well. In addition, fewer or more peg holes and bone pegs may be used, preferably such that at least two pegs angled in two dimensions relative to each other are provided. Also, while a right-handed volar plate is described with respect to an embodiment of the invention, it will be appreciated that right- or left-handed model, with such alternate models being mirror images of the models described. In addition, while it is disclosed that the pegs may be directed through a range of 15°, the peg holes and pegs may be modified to permit a greater, e.g. up to 30°, or smaller, e.g. 5°, range of such angular direction. Furthermore, while several drivers for applying rotational force to set screws and pegs have been disclosed, it will be appreciated that other rotational engagement means, e.g., a Phillips, slotted, star, multi-pin, or other configuration may be used. Also, the plate and pegs may be provided in different sizes adapted for implant into different size people. Furthermore, while four screw holes are described, it is understood that another number of screw holes may be provided in the plate, and that the screw holes may be located at positions other than shown. In addition, individual aspects from each of the embodiments may be combined with one or more aspects of the other embodiments. Moreover, while some elements have been described with respect to the mathematically defined shapes to which they correspond (e.g., spherical), it is appreciated that such elements need only correspond to such shapes within the tolerances required to permit the elements to adequately function together; i.e., the elements need only be “substantially” spherical in curvature. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as claimed.