FIELD OF THE INVENTION
The present invention relates to an orthopedic plate, which is configured for the fixation of a bone or bones of the foot, hand or wrist in particular following a procedure for fusion of adjacent segments or reconstruction such as various osteotomy procedures.
BACKGROUND OF THE INVENTION
 US 2009/171399 A1
discloses a bone plate being adapted for use in situ to fix a spatial relationship of at least two bone parts. The bone plate has at least one pair of the bone screw apertures that are adjoined by a relief-space contiguous with the open space of the screw apertures themselves. An adjoined aperture pair forms a complex aperture and has a center-to-center distance d of the apertures along an axis running through the centers of the apertures. The center-to-center distance d is equal to or greater than the sum of the radii (r1+r2) of the heads of the individual bone screw used with the aperture pair.
 US 4,936,844
concerns a fixation system for drawing together into engaging relationship mutually opposed fracture surfaces of a pair of bone fragments at a fracture site. An elongated blade with a sharpened leading end is driven into a first bone fragment generally parallel to and spaced from a fracture surface of the first bone fragment. A flange member integral with the blade extends transverse of the blade and overlies the fracture site between the first and second bone fragments. At least one screw fastener with a head and threaded shank extends through an opening in the flange and is threaded into the second bone fragment along an axis which extends away from the blade. With continued tightening of the screw fastener, the head engages the flange and draws the flange against both bone fragments, holds the blade in a deepest seated relationship with the first bone fragment, and imparts a compressive or wedging force to the first and second bone fragments forcing them together at the site of fracture and enabling healing to proceed.
 US 2007/233114 A1
concerns a bone plate particularly suited for fractures that require the intraoperative correction in rotational and lengthwise axis. The bone plate comprises a first, linear plate portion having a longitudinal axis and a first elongate hole extending in a direction of the longitudinal axis. The bone plate further comprises at least one second plate portion which extends substantially perpendicularly to the first plate portion. The second plate portion comprises a second elongate hole which extends roughly perpendicularly to the first elongate hole.
 WO 2009/009057 A1
discloses a surgical drill guide for positioning, aligning, and of holes to be drilled in bone tissue has retaining means that holds the position and alignment of the drill guide body in a releasable manner with respect to a fastener hole in an orthopedic implant. The retaining means is a key guide that mates with a key way or key ways in or around a threaded locking hole of an orthopedic plate for alignment of a pilot hole and method of using the guide. The key guide has 2 to 8 projections that extend in the direction of the axis of the hole, such as hemi-cylindrical projections, and the plate has a corresponding female key way that receives the retaining means.
The feet and the hands both include numerous bones and joints that cooperate together to define quintessential human movement. They are sophisticated, delicate and altogether elegant in function and design. Together the foot and ankle have over 25 bones and 33 joints along with more than 100 named muscles, tendons, and ligaments and a network of blood vessels, nerves, all residing beneath a relatively slim covering of soft tissue and skin. Structurally, the foot has three main anatomical regions: the forefoot, the midfoot, and the hindfoot. These parts work together with the ankle, to provide the body with support, balance, and mobility. A structural flaw or malfunction in any one part can result in the development of problems, which are manifested in other areas of the body. The hand forms a cognate to the foot with 27 bones within the hand and wrist. There are eight small bones within the wrist called the carpals, which join with the radius and the ulna to form the wrist joint. The carpals connect with the five metacarpals to form the palm of the hand, which terminate in the rays (i.e., the thumb and fingers) formed by the phalanges. The three phalanges in each finger are separated by two joints, called interphalangeal joints (IP joints). The one closest to the MCP joint (knuckle) is called the proximal IP joint (PIP joint). The joint near the end of the finger is called the distal IP joint (DIP joint). The thumb only has one IP joint between the two thumb phalanges. The IP joints of the digits also work like hinges when you bend and straighten your fingers and thumb.
Similarly, the forefoot includes the five toes (which are also known as the "phalanges") and their connecting long bones (or "metatarsals"). Several small bones together comprise a phalanx or toe. Four of the five toes have three phalanx bones respectively connected by two joints. The big toe (or "hallux") has two phalanx bones distal and proximal with a joint in between called the interphalangeal joint. The big toe articulates with the head of the first metatarsal at the first metatarsophalangeal joint (the "MTP" joint) and there are two tiny, round bones called sesamoids on the plantar side of the metatarsal head. The phalanges are connected to the metatarsals at the ball of the foot. The forefoot balances pressure on the ball of the foot and bears a substantial amount of the body weight.
The bones of the midfoot from medial to lateral are the 1 <st >through 3<rd >cuneiform, the cuboid, and the crescent shaped navicular bone posterior to the cuneiforms, which also forms a joint with the talus that forms the basis for the ankle joint at the hinged intersection of the tibia, the fibula, and the foot. The five tarsal bones of the midfoot act together form a lateral arch and a longitudinal arch which help to absorb shock. The plantar fascia (arch ligament) underlays the bones of the midfoot and along with muscles, forms a connection between the forefoot and the hindfoot. The toes and their associated midfoot bones form the first through fifth rays beginning with the great toe as the first ray. The bones which form the palmate portion of the hand are: the scaphoid, the lunate, the triquetrum, the pisiform, the trapezium, the trapezoid, the capitate, and the hamate, which act in concert to allow the opposition of the thumb with each of the fingers and to permit the uniquely human ability to manipulate objects.
The hindfoot is composed of three joints (subtalar, calcaneocuboid & talonavicular) and links the midfoot to the ankle. The heel bone (or "calcaneus") projects posteriorly to the talus and forms a lever arm to activate the hinged action of the foot so as to allow propulsion of the entire body from this joint. The calcaneus is joined to the talus at the subtalar joint. The mid-foot is often the subject of trauma, such as results from falls, vehicle crashes and dropped objects. These accidents often result in severe fractures and/or dislocations. In addition, there are several conditions which result from congenital deformation or which arise as a result of repeated use type injuries. Surgical intervention that includes surgical sectioning of bone or an "osteotomy" is often used to restructure the bones as a treatment for such conditions. For example, the calcaneal translational osteotomy, with which the present invention might be used, is typically used to treat a condition that is the result of adult acquired flatfoot deformity. The present invention is likewise useful for conditions of the hand that result from prior trauma, surgical intervention or defects from birth or that develop with age (such as rheumatoid arthritis).
Examples of some of the other procedures with which the present invention could be used include hallus valgus and hallus rigidus corrections, and bunionectomies. Other applications which could use the present invention include first and fifth metatarsal chevrons, translational osteotomies, closing wedge osteotomies, pediatric femoral osteotomies, metacarpal and calcaneal rotational osteotomies, intrarticular osteotomies and hand and wrist realignment osteotomies.
Typical surgical treatment of the foot or hand re-establishes a normal anatomy while the fractured bones mend. In some cases, fusion of a joint may be necessary, for example, where arthritis arises in a patient due to use injuries,poor bone or prior unsuccessful surgeries. One current surgical treatment of these conditions requires that pins, wires and/or screws be inserted to, stabilize the bones and joints and hold them in place until healing is complete. For example, a pin or screw may be introduced medially into the internal cuneiform and through the base of the second metatarsal bone. While the use of k-wires, pins, and screws may provide acceptable results for younger and more plastic patients, these methods of fixation are not always satisfactory.
SUMMARY OF THE INVENTION
According to the invention, the osteotomy plate system according to claim 1 is provided.
In accordance with the present invention an orthopedic plate is provided which can be used to good advantage in an osteotomy. In a first embodiment, the plate has a footprint that is a modified rectangle having a first end with rounded corners, and a longitudinally opposing end with a cutting edge that may include a taper or a crescent shape. Either two or three of the four sides of the plate, including both long sides and optionally the proximal end have a raised edge or rails which acts to stabilize the plate, and which is connected with a thinner flat web of material that includes one or more holes for screws or pins. At the cutting end, the rails may terminate in pointed insertion tips which are joined by the web that also includes a tapered cutting surface or the plate may simply include the tapered cutting edge. In a second embodiment, the plate has a simple bar-like footprint with a first end tab and a second end tab extending along the longitudinal axis of the plate and with narrowed waist sections between the tabs. At the first end tab, the plate includes a first portion that is inserted into cancellous bone. This portion includes a rounded or tapered chamfered edge that promotes insertion into the bone. At the second end tab, the opposing portion includes a through hole so that the plate can be fixed to an extramedullary portion of an adjacent bone segment. Optionally, the plate includes a compression or translation slot that extends in a direction and causes compression toward a through hole in the opposing cancellous tab. The width of the plate decreases between the holes to allow for bending if desired. In other embodiments, the footprint may by more "organic" in shape, with a rounded tapered insertion surface, a midsection that flares to accommodate an angled screw hole and a rounded rear section that includes a second perpendicular screw hole. In a further modification of this plate, the plate advantageously includes an angled hole with a shroud that protects the soft tissue from the head of the screw and which aids in optimal compression of the posterior fragment for certain procedures.
The invention can be used in a variety of indications including for example, calcaneal osteotomies Dwyer osteotomy, cotton osteotomy, isolated TMT fusion, Navicular fracture, Evans osteotomy and metacarpal rotational osteotomies, or intrarticular osteotomies or hand and wrist realignment osteotomies. Other applications which could use the present invention include first and fifth metatarsal chevrons, translational osteotomies, and closing wedge osteotomies.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1a is a medial view of a foot with an orthopedic plate in accordance with a first embodiment positioned for use in a translational calcaneal osteotomy procedure;
FIG. 1b is a medial posterior view of a foot with a further embodiment of the plate of the present invention also for use in a translational calcaneal osteotomy procedure;
FIG. 2 is a top view of the orthopedic plate of FIG. 1;
FIG. 3 is a side view of the plate shown in FIG. 2;
FIG. 4 is an end view of the plate shown in FIG. 3;
FIG. 5 is a top perspective of the plate shown in FIG. 2;
FIG. 6 is a end perspective of the plate shown in FIG. 2;
FIG. 7 is a bottom perspective of the plate shown in FIG. 2;
FIG. 8 is a side perspective of the plate shown in FIG. 2;
FIG. 9 is a top view of a second embodiment of the orthopedic plate useful for understanding the invention;
FIG. 10 is a side view of the plate shown in FIG. 9;
FIG. 11 is an end view of the plate shown in FIG. 10;
FIG. 12 is a top perspective of the plate shown in FIG. 9;
FIG. 13 is a end perspective of the plate shown in FIG. 9;
FIG. 14 is a bottom perspective of the plate shown in FIG. 9;
FIG. 15 is a side perspective of the plate shown in FIG. 9;
FIG. 16 is a top view of a third embodiment of the orthopedic plate of the present invention;
FIG. 17 is a side view of the plate shown in FIG. 16;
FIG. 18 is an end view of the plate shown in FIG. 17;
FIG. 19 is a top perspective of the plate shown in FIG. 16;
FIG. 20 is a end perspective of the plate shown in FIG. 16;
FIG. 21 is a bottom perspective of the plate shown in FIG. 16;
FIG. 22 is a side perspective of the plate shown in FIG. 16;
FIG. 23 is a side perspective of the fourth embodiment of the orthopedic plate of the present invention;
FIG. 24 is a side perspective of the fifth embodiment of the orthopedic plate useful for understanding the invention;
FIG. 25 is a side perspective of the plate driver;
FIG. 26 is a top view of the plate driver shown in FIG. 25
FIG. 27 is a side view of the plate driver shown in FIG. 25;
FIG. 28 is a bottom view of the plate driver shown in FIG. 26;
FIG. 29 is a first end view of the plate driver shown in FIG. 25;
FIG. 30 is a second end view of the plate driver shown in FIG. 25;
FIG. 31 is a bottom perspective of the plate loosely attached to the plate driver in accordance with the invention;
FIG. 32 is a side view of the plate and driver in accordance with the invention during insertion; and
FIG. 33 is a side view of the plate and driver in accordance with the invention during insertion.
DETAILED DESCRIPTION OF THE INVENTION
FIG. 1 shows a skeletal version of a foot from the lateral side with a particularly preferred embodiment of the plate 210 of the present invention in place between the junction of the talus and the calcaneus with an angled screw inserted into the Sustentaculum Tali. Thus, FIG. 1 illustrates the plate used in a translational osteotomy of the calcaneus for treatment of flatfoot syndrome. Similarly, it can be used for fixation of other bone segments following osteotomies as previously mentioned.
As viewed from the top in FIG. 2, it can be seen that the first embodiment of the plate 10 useful for understanding the invention has a rectangular shape with a first end 12 and an opposing cutting end 14 aligned along the longitudinal axis of the plate. The peripheral edges 16 of the plate are raised on three sides, including the two long sides 18, 19 and the squared short wall 20. These edges form rails that help to provide stability for the plate and in particular to inhibit torsion of the plate during insertion and during the recuperation period in which the injury fuses. The rails are rounded at the corners of the squared short wall 20. The opposing short wall includes a chamfered cutting surface 22, which is illustrated as a crescent shape between the two forward extending insertion tips 24 that are coextensive with the long wall edges. The body of the plate is formed by a thinner flat web 25 that extends between the raised edges and includes a number of openings. Preferably, the web 25 includes a first opening 26, or hole in the portion of the plate which extends into the bone and which accepts a screw or a pin in order to help hold the plate in place and to keep it from rotating within the bone. Rearward of that, and somewhere beyond halfway along the long axis of the plate, the plate includes a compression slot 27 that accepts a screw to cause compression toward the first opening. Typically, the compression slot includes a shoulder 28 along its internal edge 29 that slopes in the direction that compression occurs. In the rearward portion, toward the squared end, the plate includes a locking hole 30 which includes a mechanism to cause locking, such as internal threads that mate with external threads on the head of a locking screw to lock this portion of the plate to the extramedullulary portion of an adjacent bone fragment.
In a second embodiment useful for understanding the invention, the plate 110 has a simple bar-like profile that is comprised of a first end with a tab and a second end with a longer tab. The longer tab 112 has a rounded end at its proximal end that necks in slightly into the body of the first tab 112, and the rounded end includes a deep chamfer 115 which tapers from the lateral edge of the plate to an through hole 116 which can receive a screw or pin that helps to secure the plate in the cancellous portion of the bone against rotation or movement. The longer tab also includes an obround translation or compression slot 120 at the distal end of the first tab. The plate width Hairs slightly around the slot to preserve the metal which defines the slot (preferably to reinforce the slot to inhibit deformation of the slot during any option bending procedures, or even during insertion. Again the plate necks in slightly at the transition between the first tab and the second tab and the distal most 114 of the pair of tabs includes a screw hole 122 (which preferably includes locking means such as internal threads or a variable locking mechanism, so as to form a locking interface between the plate and the respective bone or bone fragment by means of the rigid fastening of the screw in the screw hole in the plate.) The locking hole optionally further includes keyways for a drill guide. The compression slot is configured so as to cause compression along the longitudinal axis of the plate in the direction of the locking screw hole. The plate includes incurvatures 123 between the openings to form waist sections that minimize the material used and maximizes the fit of the plate, as well as allowing additional contouring of the plate in these areas, should it be desired.
In a third embodiment, the plate 210 corresponds in shape and function to the second embodiment. Specifically it has a first rounded tab end having a deep chamfer that permits the plate to be inserted into bone and a second rounded end having a threaded locking screw hole. In this embodiment, the compression slot is replaced by an angled non-locking screw hole 220 which includes a hole shroud 222 forming an arc or a portion of a cylinder raised above the top surface of the body of the plate in order to sufficiently support the screw that is received in this hole and to shroud the head of the screw to help minimize the possibility of soft tissue irritation that the screw head might otherwise provide. The shroud also provides some support and compression within the bone into which it projects. The non-locking hole is angled so that the axis of the screw forms an angle of about 10° to about 45°, and preferably about 15° to about 40°, and more preferably about 25° to about 35° to the longitudinal axis and the hole allows for about 30°, preferably about 20°, and most preferably about 15° of conical rotation of the screw within the screw hole of the plate which is provided to enable the surgeon to capture the sustentaculum. This screw is intended to capture the anterior portion of the calcaneus in a calcaneal osteotomy.
FIGS. 3 and 4 illustrate the edge on views of the first embodiment of the plate in along a first length and along the second shorter length, which is perpendicular to the first length. As can be seen the web of the plate has a generally uniform thickness between the inward surface 27 which opposes and optimally, but not necessarily engages the bones, and the outward surface 29. Similarly, the second embodiment is illustrated in edge on views in FIGS. 10 and 11 in which it can be seen that this embodiment that the plate is flat and of a uniform thickness between the bone-facing surface of the cortical portion of the plate. Optionally, the inward surface 127 of the plate 110 could includes a generally uniform radius of curvature along the longitudinal axis so that the plate would have the shape of a segment of a cylinder which maximizes the ability to place the plate as desired without the need for additional pre-surgical contouring for certain applications, although the plate thickness allows for bending if necessary Also optionally for this design, the distal edge of the plate can be of a larger radius or thicker width to provide a broader shoulder 136 so that the proximal portion of the plate can be driven into the bone.
FIGS. 23 illustrate another embodiment 310 of the orthopedic plate of the present invention that illustrate how different features of the previous embodiments could be combined, including the straight taper cutting edge, and with the compression slot or with the angled screw hole and shroud. FIGS. 24, useful for understanding the invention, illustrate another example 410 of the orthopedic plate with the compression slot.
FIGS. 25 through 30 illustrate the plate driver 500. The driver 500 includes a plate holder portion 510, which has at one end a recess or pocket 515 that captures the end of the plate 600 (see FIG. 31) having the locking hole. Specifically, the plate holder 510 includes a knob 517 joined to a shaft 518 that is journaled within a bore 519 in the plate holder 510. The end of the shaft 518 includes threads that can engage the internal threads of the locking hole in the plate to hole the plate within the plate holder as well as relative to the plate driver. The plate driver further includes a handle 520 that allows the surgeon to hold the plate driver. The plate holder portion holds the plate with the long axis in line with the long axis of the handle, but offset from the plate which gives the surgeon better visibility to the surgical site. Further, the handle 520, includes fenestrations 522 which lighten the weight of the plate driver, and at the end of the handle, there is a buttressed area 525, which has a wider flat surface that can be used to tap the plate into the bone. FIGS. 32 and 33 illustrate a plate 600 being inserted into the cortical section of a calcaneus using the plate driver 500.
The screws useful with the plate of the present invention are self-starting, self-tapping screws including the option of partial or full cannulation. The screws include a cutting end having multiple flutes, and preferably 2 or 3 flutes about a conical recess. The screws further include a partial taper of the inner diameter in the proximal end over the first several thread turns, for example over 2-8, and preferably over 3-5 turns in order to increase the fatigue life of the screw as well as providing potential physiological advantages in use. The screws further include a torque driving recess. The screws have a threaded distal end and a head including a torque driving recess. The head of the locking screw includes locking means, such as a variable locking mechanism, which could be a bushing that mates with the screw head so as to lock the screw relative to the plate at a desired angle, or could include external screw threads that mate with internal threads in the locking screw hole at a pre-selected angle, in this instance, the screw axis is perpendicular to the longitudinal axis of the plate. The screw used in the compression slot has a rounded rear shoulder (such as a hemisphere, or a torroid) which mates with the concavely rounded groove of the compression slot so as to maximize surface contact between the screw head and the inclined geometry of the compression slot. The lateral edge of the compression slot further includes an inclined shoulder that slopes downward toward the bone-contacting surface of the plate and which is engaged by the screw head to cause the translation of the screw and attached bone fragment along the long axis of the slot and towards the locking hole.
The plate is formed of a biocompatible material, and preferably a metal such as surgical grade stainless steel, titanium or a titanium alloy or a cobalt chromium alloy. Preferably, the plate web has a thickness of between about 1.0 and about 2.5 millimeters, more preferably between about 1.5 and about 2 millimeters, and most preferably between about 1.5 and about 1.8 millimeters. The plate includes a raised continuous outer edge 16 which is defined between the top and the bottom surface and which has a total thickness of about 2 and 5 millimeters, or roughly twice the width of the web portion of the plate.
In addition, the plate can include a small through hole sized to receive a K-wire or other similar guide wire.
During the surgery the joints are first prepped which may include de-articulation between the bones to be fused and removal of any bone as part of the osteotomy, and as necessary, the plate is bent to contour to the bone surface. A pilot hole may be drilled into the bone into which the plate will be inserted. The plate is inserted into the plate recess in the plate driver and secured by tightening the plate upward in the plate holder using the plate holder having an end that has threads which mate with the locking threads of the locking hole in the plate. The plate is tamped into the cancellous portion of the bone fragment optionally by tapping the plate driver with a one pound mallet as is necessary to insert the plate. The plate should be driven until the recess or pocket makes contact with the anterior portion of the calcaneus. Once the plate is sunk, a drill guide is mated to the plate drive, and a hole is drilled for the locking screw. The plate can be held in position using olive wires (thru the non-locking hole and into the bone). The plate is located such that all of the screws are aimed into the targeted bones and away from the joint, fracture, or bone interface. The olive wire is removed if used, and a pilot hole is drilled at the end of the plate that includes the first hole and this hole is pinned or screwed. A second pilot hole may be drilled for the non-locking screw at the desired angle given an optional 15° of conical rotation within the non-locking hole and a non-locking screw is inserted into this pilot hole and tightened. As the screw is tightened in the angled hole, it will drive compression toward the fusion site and the first hole. The plate allows for up to 1.5 millimeters of compression. Finally, a pilot hole is drilled in the cortical surface of the second bone fragment, for example using a drill guide such as a guide including keyway guides (i.e. lobes) that interlock with corresponding keyway openings in the locking screw hole and a locking screw is secured in this hole. The plate is viewed radiographically, and the soft tissues are closed in the usual manner.
This invention has been described in detail with reference to specific embodiments thereof, including the respective best modes for carrying out each embodiment. It shall be understood that these illustrations are by way of example and not by way of limitation.
1. Osteotomie-Plattensystem zur Verwendung in einem assoziierten Knochen, aufweisend eine Verriegelungsschraube mit distalen Gewindegängen und einem Kopf mit externen Gewindegängen, eine Nichtverriegelungsschraube mit distalen Gewindegängen und einem Kopf mit einer gerundeten Oberfläche, und eine Platte mit einem ersten Ende und einem entgegengesetzten zweiten Ende, die entlang einer Längsachse der Platte (210) ausgerichtet und durch einen mittleren Abschnitt verbunden sind, der eine Breite in der Richtung senkrecht zu der Längsachse hat, wobei das erste Ende ein Nichtverriegelungsloch für die Nichtverriegelungsschraube enthält und das zweite Ende ein Verriegelungsloch für die Verriegelungsschraube enthält, eine dritte Schraube mit einer Längsachse, und wobei die Platte weiterhin ein drittes Schraubloch (220) enthält, wobei das dritte Schraubloch (22) keine inneren Gewindegänge enthält, dadurch gekennzeichnet, dass das erste Ende in einer Schneidkante endet und das dritte Schraubloch eine Schraublochachse definiert, die einen Winkel bildet, der schräg mit Bezug auf die Längsachse der Platte ist, wobei das dritte Schraubloch (220) weiterhin ein Abdeckblech (222) enthält.
2. Plattensystem nach Anspruch 1, bei dem die Schraubachse der Schraube innerhalb des dritten Schraublochs (220) mit Bezug auf die Schraublochachse um bis zu 20° konischer Drehung geändert werden kann.
3. Plattensystem nach Anspruch 1, weiterhin enthaltend einen Plattenantrieb (500), der eine Vertiefung (515), die die Platte für das Einsetzen in den Knochen sichert, und einen Handgriff mit einer Längsachse, die in einer Richtung parallel zu der Platte vorsteht, wenn sie in der Vertiefung sitzt, enthält.
4. Plattensystem nach Anspruch 3, bei dem der Plattenantrieb weiterhin einen Plattenhaltebereich (510) enthält, der die Plattenvertiefung und einen Handgriff (520) mit einer Längsachse, die in einer Richtung parallel zu der Platte vorsteht, wenn sie in der Vertiefung sitzt, und der derart an dem Handgriff angebracht ist, dass, wenn die Platte in der Vertiefung sitzt, die Längsachse der Platte gegenüber der Längsachse des Handgriffs versetzt ist, enthält.