US20110224736A1 - Proximal humerus fracture repair plate and system - Google Patents

Abstract

Devices and systems for repairing bone fractures and more specifically a fracture repair plate that provides for fixation of a metaphysis to the diaphysis of a long bone, for instance a fracture between the proximal humerus and the diaphysis of the humerus. The fracture repair system includes an implantable repair fracture repair plate and a bone anchor for fixing the fracture repair plate to a bone. In one embodiment, the fracture repair plate may also be adapted to serve as an anchor for a suture. The fracture repair system may also include a fracture reduction mechanism attachable to the fracture repair plate for imparting a controlled translational movement between two bone segments along a plane that lies substantially parallel to the surface of the bone to which the fracture repair plate is attached and substantially parallel to the longitudinal axis of the bone shaft.

Description

RELATED APPLICATIONS
• This application claims the benefit of the filing date of a prior-filed Provisional Application Ser. No. 61/312,201 entitled Long Bone Head Fracture Repair Plate, filed Mar. 9, 2010, which is incorporated by reference herein.
BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention relates to a device and system for repairing a fracture of a long bone and more specifically to a fracture repair plate and system that provides for reduction and fixation of a fracture of the humerus bone, for instance a fracture at the surgical neck of the humerus.
• 2. Background
• A fracture repair plate is fastenable to the surface of a bone at the site of a fracture to aid in a repair of the fracture by stabilizing the fracture. Attaching a fracture repair plate for such a purpose with threaded bone screws is well known in the art. As the proximal humerus bone breaks, the fracture lines usually propagate in predictable planes. Based on this, a fracture classification system has been described (the Neer classification system). There are up to 4 large bony fragments that typically result when a proximal humerus bone is fractured. These include: 1) the humeral head, 2) the greater tuberosity, 3) the lesser tuberosity, and 4) the diaphysis or shaft. The rotator cuff tendons attach to the greater and lesser tuberosities. It is usually possible to achieve robust purchase of a screw in the humeral diaphysis and humeral head. However, the greater and lesser tuberosities are often not amenable to screw fixation due to the frailty of these bony fragments. Fortunately, it is still often possible to reduce these fracture fragments to an anatomical position and to achieve acceptable fixation by placing sutures through the rotator cuff tendons at the tendon-bone interface, and then tying those sutures to a plate.
• Fractures at the juncture of the metaphysis and diaphysis of a long bone are relatively common, for instance fractures at the surgical neck of the humerus bone. In those instances where such a fracture is complete, it may be beneficial to provide a force substantially along the axis of the diaphysis of the bone to provide a translational force between the bone segments in order to compress or distract the segments in order to reduce the fracture.
• A variety of screws and anchoring devices are used in connection with fixing fracture repair plates to bone. Screws employed in conventional means and with known fracture repair devices for the repair of a fracture at the head of a long bone have been seen to back out on occasion. In addition, screws tips may cut through the bone, leading to failure of fracture fixation. Additionally, in the case of comminuted fractures the smaller fragments and their soft tissue connections are not amenable to fixation with screws, but may be more effectively repaired using sutures.
• A need exists to provide a fracture repair plate for repairing a fracture of a long bone and more specifically to a fracture repair plate that provides for fixation of a fracture at the surgical neck of the humerus bone. Additionally, a need exists to provide a fracture repair plate that provides for fixation of a proximal humerus to the diaphysis of a long bone. There is also a need for a fracture repair plate for repairing a fracture at the surgical neck of the humerus bone specifically designed to account for the anatomy of the rotator cuff, proximal humeral bony anatomy and contour, and vascular supply of the proximal humerus. Additionally, a need exists for a fracture fixation plate that is optimized to allow the surgeon to use sutures to augment the repair of smaller bony fragments.
• Additionally, there is a need for a fracture fixation plate that cooperates with means for providing a translational force between the bone segments in order to compress or distract the segments in order to reduce the fracture. More particularly there is a need for a fracture fixation plate that provides a means for applying a translational force between bone segments capable of imparting a force sufficient to create an impacted interface at the site of the fracture. In addition there is a need to provide means for imparting a translational force between bone segments that capable of being adapted for use with an anatomic right or left fracture repair plate. While the prior art includes translational devices, in each case these devices apply the translational force in a plane defined generally by the upper surface of a fracture repair plate, a plane defined generally by the surface of the diaphysis or in some cases along a plane that lies above both of these.
• A need also exists to provide an anchor, and an anchoring system for fixation of fracture repair plates to bone, improving on the devices and systems currently employed for affixing fracture repair plates to the bone. Finally, a need also exists to provide an anchor, and an anchoring system for fixation and anchoring of a proximal humerus to the diaphysis of a long bone, for instance in the case of a fracture at the surgical neck of the humerus bone using a fracture repair plate.
• Therefore an object of the present invention is to provide a fracture repair plate for repairing a fracture at the head of a long bone and more specifically to a fracture repair plate that provides for fixation of a proximal end to the diaphysis of a long bone. Another object of the present invention is to provide fracture repair plate for repairing a fracture at the head of a long bone and more specifically to a fracture repair plate that also provides for fixation of a proximal end to the diaphysis of a long bone and for tendon-to-bone repair that may accompany the fracture between the proximal end to the diaphysis of a long bone. Yet another object of the present invention is to provide a fracture repair plate for repairing a fracture at the head of a long bone specifically designed to account for the anatomy of the rotator cuff, proximal humeral bony anatomy and contour, and vascular supply of the proximal humerus. Another object of the present invention is to provide a fracture repair plate that is optimized to facilitate the use of sutures for augmenting the repair of smaller bony fragments and their soft tissue connections. Another object of the present invention is to improve the devices and systems currently employed for affixing fracture repair plates to the bone.
• Another object of the present invention is to provide a fracture fixation plate that cooperates with means for providing a translational force between the bone segments in order to compress or distract the segments in aid of reducing the fracture. An additional objective of the present invention is to provide a fracture fixation plate that cooperates with means for providing a translational force between bone segments capable of imparting a force sufficient to create an impacted interface at the site of the fracture. An additional objective of the present invention is to provide means for imparting a translational force between bone segments that capable of being adapted for use with anatomic right and left fracture repair plates. An additional objective of the present invention is to provide means for imparting a translational force between bone segments configured such that the translational force is applied along a plane that intersects the diaphysis and preferably along a plane that lies parallel to and substantially along a longitudinal axis of the diaphysis. An additional objective of the present invention is to provide a device and system for reducing a fracture at the surgical neck of the humerus bone using a fracture repair plate that cooperates with means for providing a translational force between bone segments capable of imparting a force sufficient to create an impacted interface at the site of the fracture. Another object of the present invention is to provide a fracture fixation plate that cooperates with means for providing a translational force between bone segments capable of being adapted for use with an anatomic right or left fracture repair plate.
• An additional objective of the invention is to provide an anchor, and an anchoring system for providing fixation of a fracture repair plate to a bone.
SUMMARY OF THE INVENTION
• The present invention is directed to devices and systems for repairing a fracture of a long bone. In the preferred embodiment of the invention, the fracture repair plate provides for fixation of a fracture located between a proximal end and the diaphysis of a long bone, for instance the proximal humerus to the diaphysis of the humerus bone. The present invention also includes systems for repairing a fracture of a long bone that include means for imparting a translational force between bone segments to compress or distract the segments in order to reduce the fracture. In a preferred embodiment of the system, the means for imparting a translational force between bone segments is capable of being adapted for use with an anatomic right or left fracture repair plate. In a preferred embodiment of the system, the means for imparting a translational force between bone segments is configured such that the translational force is applied along a plane that lies substantially parallel to and substantially coplanar with a longitudinal axis of the diaphysis.
• In a preferred embodiment, the contour of the inner face of the fracture repair plate approximates the contour of a long bone against which the fracture repair plate is intended for use in repairing. In a preferred embodiment, while the contour of the inner face of the fracture repair plate approximates the contour of a long bone against which the fracture repair plate is to be used, the inner face is configured such as to minimize the actual surface area of contact of the inner face of the fracture repair plate and the surface of the bone. For example, a fracture repair plate according to the present invention used in the repair of a fracture involving the proximal humerus would include a shaft attachment segment and a head segment each attached and extending from a transitional neck segment. An inner face contour of the fracture repair plate is configured such that the inner face contour of shaft attachment segment approximates a contour of a proximal lateral surface of the humeral shaft including a part of the crest of the lesser tuberosity, the inner face contour of the transitional neck segment would approximate a contour of a proximal lateral aspect of the surgical neck of the humerus including a lateral portion of the crest of the lesser tuberosity. Similarly, an inner face contour of the head segment would approximate a contour of a proximal lateral aspect of the humerus as defined by the greater tuberosity and the lateral metaphysis.
• While the contour of the fracture repair plate approximates the contour of the lateral aspect of the proximal humerus, the fracture repair plate is configured having a bearing surface configured to minimize plate-to-bone contact upon which the fracture repair plate rests against the bone, thereby substantially reducing the surface area of contact of the inner face of the fracture repair plate and the surface of the bone.
• It is believed that bone health is improved by avoiding compression of the periosteal tissue by minimizing actual surface area of contact of the inner face of the fracture repair plate and the surface of the bone. This is achieved by purposefully mismatching the radius of curvature of the concave surface of the plate relative to the radius of curvature of the bone.
• The generally “D” shaped peripheral configuration of the head segment of the fracture repair plate is designed to follow the contour of the intertubercular groove and the lateral portion of the proximal humerus. More particularly, the generally “D” shaped peripheral configuration of the head segment is configured to accommodate the arcuate artery that branches from the anterior humeral circumflex artery and runs superiorly just lateral to the intertubercular groove. A fracture repair plate according to the present invention for use in the repair of a fracture involving the proximal humerus and diaphysis of the right arm would be the mirror image of a fracture repair plate for use in the repair of a fracture involving the proximal humerus and diaphysis of the left arm.
• Apertures formed through the cross-section of the fracture repair plate may include a variety of configurations adapted for a variety or purposes including threaded and un-threaded apertures adapted to accept locking or non-locking screws as well as apertures of various configurations including oblong or slotted aperture adapted to accept non-locking screws.
• The present invention is also directed to an anchor and an anchoring system for anchoring a fracture repair plate against a long bone. The preferred anchor includes a shaft portion having a plurality of annular grooves formed about a periphery of the shaft and one or more longitudinal grooves that are formed parallel to a primary axis of the shaft. The anchor also includes a head having an external thread adapted to cooperate with the interior thread formed in an anchor aperture. The anchor is pressed into a hole drilled into the bone such that a “press” or “interference” fit exists between the anchor and the drilled hole. The external thread of the head engages the threads of the anchor aperture and the anchor is tightened and locked to the plate. The annular grooves formed about a periphery of the shaft of the anchor and the longitudinal grooves provide several advantages. First when inserting or withdrawing the anchor from a freshly drilled hole, the longitudinal grooves in particular provide venting for fluid captured in the hole. Additionally as the fracture and the site of insertion of the anchors heal growth of new bone will form in the annular and longitudinal grooves resisting and reducing the possibility of both rotation and pullout of the anchors.
• An additional advantage of the anchor of the present invention is found in its blunt tip. It is known that stress risers form in materials including bone at the site of angular transitions and the more acute the transition the greater the propensity for that site being the locus of crack propagation and failure.
• In the preferred embodiment, the axis of each screw diverges from a plane perpendicular to an outer face of the fracture repair plate, as well as diverging from the axis of each of the remaining screws. Similarly, the axis of each bone anchor diverges from the axis of each of the remaining bone anchors.
• The present invention is also directed to a fracture repair plate that is further configured having a plurality of suture apertures that provide anchoring for sutures that may be employed in a procedure to reduce a fracture of the head of a long bone. An upper peripheral edge of fracture repair plate is configured having an undercut land. One or more suture apertures are formed along an upper peripheral edge of the fracture repair plate through the undercut land. In one embodiment, the suture apertures exhibit an elongated configuration. The undercut peripheral edge of the fracture repair plate contributes to the ease and accommodation of passing a needle and suture through the plate.
DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a representative perspective view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention;
• FIG. 2 is a representative perspective view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention;
• FIG. 3 is a representative perspective view of a fracture repair plate according to the present invention;
• FIG. 4 is a representative perspective view of a fracture repair plate according to the present invention;
• FIG. 5 is a representative front view of a non-locking cortical screw according to the present invention;
• FIG. 6 is a representative front view of a locking bone anchor according to the present invention;
• FIG. 7 is a representative front view of a locking cortical screw according to the present invention;
• FIG. 8 is a representative perspective exploded view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention;
• FIG. 9 is a representative perspective exploded view of a reduction mechanism according to the present invention;
• FIG. 10 is a representative medial side view of a proximal humerus head fracture repair system including a fracture repair plate according to the present invention;
• FIG. 11 is a representative medial side view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention; and
• FIG. 12 is a representative proximal view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention.
DETAILED DESCRIPTION
• Referring toFIG. 1, proximal humerusfracture repair system10 is shown includingfracture repair plate20A attached to a right humerus bone RH including diaphysis D and proximal humerus PH. Proximal humerus PH is shown including humeral head HH and greater turbercle G. Fracture F is a fracture at the surgical neck of the humerus.FIG. 1 shows proximal humerusfracture repair system10 including first and second rightdrill guide plates30A and40A respectively fixed toouter face21 offracture repair plate20A. Fracturerepair plate20A is specifically adapted for reduction and fixation of a fracture of the right humerus bone RH as seen inFIG. 1.FIG. 2 shows proximal humerusfracture repair system10 including first and second leftdrill guide plates30B and40B respectively fixed toouter face21 offracture repair plate20B.Reduction mechanism50 is configured so that it may be adapted for attachment to first rightdrill guide plate30A for reduction and fixation of a fracture of the right humerus bone RH as shown inFIG. 1, or in thealternative reduction mechanism50 may be adapted for attachment to leftdrill guide plate30B for reduction and fixation of a fracture of the left humerus bone LH as shown inFIG. 2.
• Referring toFIGS. 3 and 4fracture repair plate20A is shown specifically adapted for reduction and fixation of a fracture of the right humerus bone. Fracturerepair plate20A includes longitudinal axis LAP,outer face21 as seen inFIG. 3 and a contouredinner face22 seen inFIG. 4. Preferably,inner face22 offracture repair plate20A is formed having a contour that approximates a contour of the lateral aspect of the proximal humerus to whichfracture repair plate20A is to be attached for a fixation. While the contour ofinner face22 approximates the contour of the lateral aspect of the proximal humerus and diaphysis,fracture repair plate20A is configured having bearing surface29 upon whichfracture repair plate20A rests against humerus bone HB. Bearingsurface29 is configured to minimize plate to bone contact substantially reducing the surface area of contact of the inner face of the fracture repair plate and the surface of the bone.
• Fracturerepair plate20A is also configured having a plurality of anchor apertures typified by lockingbone anchor aperture23, a plurality of threaded screw apertures typified by lockingscrew aperture24 and a pair of slotted screw apertures typified by slottedscrew aperture25. Fracturerepair plate20A also includes a plurality of suture apertures typified bysuture aperture26 formed about upperperipheral edge27. Referring toFIG. 4 it can be seen thatfracture repair plate20A is formed such that upperperipheral edge27 includes an undercutland28 that provides clearance for passage of a suture oncefracture repair plate20A is fastened against the bone.
• A variety of fasteners are use to secure the fracture repair plate of the present invention.FIG. 5 shows non-lockingcortical screw60 includinghead61 adapted to accept a polygonal head type driver for instance a hex-headed driver. Non-lockingcortical screw60 also includesthreads62 andself tapping tip63.
• FIG. 6 shows lockingbone anchor65 includinghead66 also adapted to accept a polygonal head type driver for instance a hex-headed driver. Lockingbone anchor65 is configured having threadedhead66 adapted to cooperate with a thread formed in each of the anchor apertures typified by lockingbone anchor aperture23, (shown inFIGS. 2 and 3). Lockingbone anchor65 includesshaft67 havingblunt tip64, a plurality ofannular grooves68 formed aboutshaft67 and a plurality oflongitudinal grooves69 formed parallel to a primary axis ofshaft67. Lockingbone anchor65 is pressed into a hole drilled into the bone such that a “press” or “interference” fit exists betweenshaft67 and the drilled hole. Threadedhead66 of engages the threads of the threaded anchor aperture and the anchor is tightened and locked. As a fracture and the site of insertion of the locking bone anchors65 heal, growth of new bone will form inannular grooves68 andlongitudinal grooves69 resisting and preventing both rotation and pullout of lockingbone anchor65.
• FIG. 7 shows lockingdiaphyseal screw70 including threadedhead71 also adapted to accept a polygonal head type driver for instance a hex-headed driver. Lockingdiaphyseal screw70 also includesthreads73 formed onshaft72 andself tapping tip74. In the preferred embodiment threadedhead71 includes a thread formed at a first thread pitch P1 andthreads73 formed onshaft72 includes a thread formed at a second thread pitch P2. This feature reduces the tendency of lockingdiaphyseal screw70 to back out over time.
• Referring toFIG. 8, right humerus bone RH is shown including diaphysis D and proximal humerus PH that includes humeral head HH and greater tuberosity G. Fracture F is a commonly seen surgical neck fracture. Right humerus bone RH is shown positioned in a routinely implemented “beach chair position” for reduction and fixation to demonstrate the advantageous positioning ofreduction mechanism50 during a procedure. Proximal humerusfracture repair system10 is shown withfracture repair plate20A partially attached to a generally lateral surface of right humerus bone RH with upperperipheral edge27fracture repair plate20A extending over a proximal lateral aspect of the proximal humerus defined in part by the greater tuberosity G.Fracture repair plate20A includes a plurality of anchor apertures typified by lockingbone anchor aperture23, through which a plurality of locking bone anchors65 are set. As shown,fracture repair plate20A includes a pair of slotted screw apertures typified by slottedscrew aperture25. Non-lockingcortical screw60 is shown engaging left humerus LH through slottedscrew aperture25. Fracturerepair plate20A also includes a plurality of threaded screw apertures typified by lockingscrew aperture24. A plurality of suture apertures typified bysuture aperture26, are formed through upperperipheral edge27 offracture repair plate20A.
• Proximal humerusfracture repair system10 also includes first rightdrill guide plate30A having a plurality of locking screw guide apertures typified by lockingscrew guide aperture32 and a plurality of slotted screw guide apertures typified by slottedscrew guide aperture33. As shown first rightdrill guide plate30A may be located againstouter face21 offracture repair plate20A by inserting a pair of locator pins typified by first drill guideplate locator pin31 into a pair of corresponding locator pin apertures typified by first drill guide platelocator pin aperture37. First rightdrill guide plate30A may be secured to fracturerepair plate20A by insertingfirst drill guide36 through one of several locking screw guide apertures typified by lockingscrew guide apertures32 and threadedly engaging the end offirst drill guide36 with one of the plurality of threaded screw apertures typified by lockingscrew aperture24.
• Proximal humerusfracture repair system10 also includes seconddrill guide plate40A having a plurality of bone anchor apertures typified bybone anchor aperture42. Seconddrill guide plate40A may be located againstfracture repair plate20A by inserting second drill guide plate locator pin41 into a correspondingsuture aperture26 which serves as a locator pin aperture. Seconddrill guide plate40A is secured to fracturerepair plate20A by insertingsecond drill guide43 through one of several threaded bone anchor apertures typified bybone anchor aperture42 and threadedly engaging the end ofsecond drill guide43 with one of the plurality of locking bone anchor apertures typified by lockingbone anchor aperture23. Both first rightdrill guide plate30A and seconddrill guide plate40A are adapted to guide a drill at a pre-selected angle.
• With continued reference toFIG. 8, proximal humerusfracture repair system10 also includesreduction mechanism50.Reduction mechanism50 includesreduction mechanism body51 that may be located againstupper edge38 of first rightdrill guide plate30A by inserting a pair of reduction mechanism locator pins typified by reductionmechanism locator pin52 into a corresponding pair of reduction mechanism locator pin apertures typified by reduction mechanismlocator pin aperture34 located onupper edge38 of first rightdrill guide plate30A.Reduction mechanism body51 is secured againstupper side38 of first rightdrill guide plate30A by threadedly engaging a pair of captured screws typified by capturedscrew53 with the corresponding threaded aperture located onupper side38 of first rightdrill guide plate30A.
• Withreduction mechanism body51 is secured againstupper side38 of first rightdrill guide plate30A, dovetail58 oftraction arm57 is slideably engaged withright dovetail groove56A ofreduction mechanism body51 with rightside rack gear59A offraction arm57 engaging right pinion54A ofreduction mechanism body51.Traction arm57 is positioned with respect toreduction mechanism body51 so that as right pinion54A is rotated against rightside rack gear59A,traction arm57 moves towards the proximal humerus PH of right humerus RH. Oncetraction arm57 is positioned as desired,non-locking screw80 is inserted throughbushing44 andtraction arm aperture45 and is subsequently driven into diaphysis D of right humerus RH along a traction plane T that lies substantially parallel to surface plane SP said traction plane T passing through a longitudinal axis of diaphysis LAS. Springbiased pawl55 assures that the position oftraction arm57 may be accurately maintained with respect toreduction mechanism body51 throughout a procedure.
• FIG. 9 showsreduction mechanism50 adapted for attachment to first leftdrill guide plate30B, (as shown inFIG. 2), for reduction and fixation of a fracture of the left humerus bone LH, (as shown inFIG. 2). For use in the reduction and fixation of a fracture of the left humerus bone,reduction mechanism body51 is rotated one-hundred and eighty degrees about dovetail groove axis GA andtraction arm57 is rotated one-hundred and eighty degrees about traction arm axis TA that is perpendicular to dovetail58 oftraction arm57.Dovetail58 oftraction arm57 then slideably engages withleft dovetail groove56B with leftside rack gear59B oftraction arm57 engagingleft side pinion54B ofreduction mechanism body51. Oncetraction arm57 is positioned as desired,non-locking screw80 may be inserted throughbushing44 andtraction arm aperture45 in preparation to driving into diaphysis D of left humerus LH, (as shown inFIG. 2). Springbiased pawl55 assures that the position oftraction arm57 may be accurately maintained with respect toreduction mechanism body51 throughout a procedure.
• FIG. 10 shows left humerus bone LH having fracture F located between diaphysis D and proximal humerus PH. Proximal humerusfracture repair system10 is shown withfracture repair plate20B partially attached to a generally lateral surface of left humerus bone LH. In use, once secondary or tertiary fractures if any of proximal humerus PH have been stabilized,fracture repair plate20B is positioned against diaphysis D of left humerus bone LH with upperperipheral edge27fracture repair plate20B extending over a proximal lateral aspect of proximal humerus PH defined in part by the greater tuberosity G. A pair of pilot holes are drilled into diaphysis D, one each at location corresponding to the pair of slotted apertures typified by slottedaperture25, (shown inFIG. 8). A pair of non-lockingcortical screws60 are set into each of the pair of drilled pilot holes and fracturerepair plate20B is adjusted lengthwise on diaphysis D along an axis of the slotted apertures to a desired position relative to the bone and non-lockingcortical screws60 are tightened.
• Next, first leftdrill guide plate30B and second leftdrill guide plate40B are attached toouter face21 offracture repair plate20B and a plurality of bone anchor holes typified bybone anchor hole75 are drilled employing second leftdrill guide plate40B. A pattern of bone anchor holes are drilled into proximal humerus PH or bone fragments thereof. According to the preferred embodiment of the invention each bone anchor hole drilled for one of the plurality of bone anchors is drilled at a specified angle so that an axis of each hole differs and diverges from the angle of the axes of each of the remaining holes. As the bone anchor holes75 are drilled bone anchors65 are set. Preferably a fit between each lockingbone anchor65 and its respectivebone anchor hole75 is characterized as a “press” or “interference” fit.
• Once proximal humerus PH is anchored againstfracture repair plate20B,reduction mechanism body51 ofreduction mechanism50 is secured againstupper side39 of first leftdrill guide plate30B by a pair of captured screws typified by capturedscrew53.Traction arm57 slideably engagesreduction mechanism body51 andtraction arm57 is positioned so that adequate forward travel oftraction arm57 may be achieved. Once so positioned, traction are57 is secured to diaphysis D of left humerus bone LH bynon-locking screw60. As seen inFIG. 10 another unique aspect of the present invention lies in the fact that diaphysis D and proximal humerus PH of left humerus bone LH are each capable only of a single degree of movement with respect to one another, that being movement along a line defined by longitudinal axis of the diaphysis LAD, while secured by the placement of locking bone anchors65, the two non-lockingcortical screws60 placed throughfracture repair plate20B and non-lockingcortical screw80 set throughtraction arm57 ofreduction mechanism50.
• Oncereduction mechanism50 is secured against first leftdrill guide plate30B,non-locking screws60 are loosened so that diaphysis D of left humerus bone LH is free to move with the advance oftraction arm57.Left pinion54B is rotated against leftside rack gear59B such that controlled movement oftraction arm57 and therefore the attached diaphysis D towards proximal humerus PH is achieved. Springbiased pawl55 assures that the position oftraction arm57 is accurately maintained as a translational force TF is applied substantially along a longitudinal axis of the diaphysis LAD of left humerus bone LH. Translational force TF between diaphysis D and proximal humerus PH is sufficient to create an impacted interface or impacted zone at the site of the fracture. Once diaphysis D is positioned as desired with respect to proximal humerus PH,non-locking screws60 are once again tightened so that diaphysis D will maintain the desired position with respect to proximal humerus PH.
• Referring toFIGS. 11 and 12, showfracture repair plate20B attached to a generally lateral surface of left humerus bone LH against diaphysis D with upperperipheral edge27fracture repair plate20B extending over a proximal lateral aspect of proximal humerus PH defined in part by the greater tuberosity G. Referring toFIG. 11, once an impacted zone IZ has been established as described above, lockingdiaphyseal screws70A-70C may be set. Pilot holes are drilled for lockingdiaphyseal screws70A-70C usingdrill guide36 to assure that the screw are set at the determined angles. Each pilot hole for lockingdiaphyseal screws70A-70C is drilled on a screw axis SA that is divergent from the longitudinal axis of the diaphysis LAD, that angle also being divergent from a screw axis SA of each of the remaining lockingdiaphyseal screws70A-70C. As shown inFIG. 11, an angle of screw axis SA for each lockingdiaphyseal screw70A-70C and correspondingly an angle of an axis at which each of the lockingscrew apertures24 are formed relative toouter face21 and surface plane SP, defined generally as the surface of the lateral aspect of left humerus bone LH increases progressively as the location of thediaphyseal screws70A-70C move further distally down diaphysis D and fracturerepair plate20B. More particularly, in the preferred embodiment, screw axis SA for firstdiaphyseal screw70A measures ninety degrees, the screw axis SA for seconddiaphyseal screw70B measures one-hundred, and the screw axis SA for thirddiaphyseal screw70B measures one-hundred and ten degrees. This configuration provides an increased resistance to pullout of the screws which in turn would lead to a failure of the repair.
• FIGS. 11 and 12 also show the divergence of anchor axes A of locking bone anchors65. As seen in the referenced figures, each of the plurality of locking bone anchors65 is pressed into a hole drilled on anchor axis AA that is divergent from the longitudinal axis of the diaphysis LAD and surface plane SP, (Shown inFIG. 11), that angle also being divergent from an anchor axis AA of each of the remaining locking bone anchors65. Correspondingly each of thebone anchor apertures23, shown inFIG. 8, diverge from an anchor axis AA of each of the remainingbone anchor apertures23.
• While this invention has been described with reference to the described embodiments, this is not meant to be construed in a limiting sense. Various modifications to the described embodiments, as well as additional embodiments of the invention, will be apparent to persons skilled in the art upon reference to this description. It is therefore contemplated that the appended claims will cover any such modifications or embodiments as fall within the true scope of the invention.

Claims (20)

1. A fracture repair plate for repairing a fracture at the head of a long bone, the fracture repair plate comprising:

a longitudinal axis, an outer face and a contoured inner face including a bearing surface configured to minimize a contact surface area between the fracture repair plate and the bone;

two or more threaded locking anchor apertures formed through a cross-section of the fracture repair plate, each of the two or more threaded locking anchor aperture having an axis that is divergent from the axis of each remaining two or more locking anchor apertures; and

two or more threaded locking screw apertures, each of the threaded locking screw apertures having an axis, an angle of the axis of each of the threaded locking screw apertures relative to the outer face of the fracture repair plate increasing progressively as a location of the locking screw apertures progresses down a length of the fracture repair plate.

2. The fracture repair plate ofclaim 1 further comprising:

an upper peripheral edge including an undercut land; and

one or more suture apertures formed along the upper peripheral edge of the plate through the undercut land.

3. A fracture repair system adapted for fixation of a fracture to a bone, the fracture repair system comprising:

a fracture repair plate having a longitudinal axis, an outer face and a contoured inner face including a bearing surface configured to minimize a contact surface area between the fracture repair plate and the bone;

two or more threaded locking anchor apertures formed through a cross-section of the fracture repair plate, each of the two or more threaded locking anchor aperture having an axis that is divergent from the axis of each remaining two or more locking anchor apertures;

two or more threaded locking screw apertures formed through a cross-section of the fracture repair plate, each of the threaded locking screw apertures having an axis, an angle of the axis of each of the threaded locking screw apertures relative to the outer face of the fracture repair plate increasing progressively as a location of the locking screw apertures progresses down a length of the fracture repair plate;

two or more locking bone anchors adapted for placement through one of the two or more threaded locking anchor apertures, each of the two or more locking bone anchors including a plurality of annular grooves formed about a shaft of the locking bone anchor and a plurality of longitudinal grooves formed parallel to a primary axis of the shaft, each of the two or more locking bone anchors including a head attached to the shaft, the head having an external thread adapted to cooperate with the thread formed in one of the two or more threaded locking anchor apertures; and

two or more locking cortical screws adapted for placement through one of the one or more threaded locking screw apertures, each of the two or more locking cortical screws including a head attached to a threaded shaft, each of the one or more locking cortical screws adapted for threaded engagement with the bone, the head of each of the two or more locking cortical screws including an external thread adapted to cooperate with one of the two or more threaded locking screw apertures.

4. The fracture repair system ofclaim 3 further comprising:

an upper peripheral edge including an undercut land; and

one or more suture apertures formed along the upper peripheral edge of the plate through the undercut land.

5. The fracture repair system ofclaim 3 further comprising:

one or more slotted apertures formed through the cross-section of the fracture repair plate; and

one or more screws adapted for placement through one of the one or more slotted apertures, each of the one or more screws adapted for threaded engagement with the bone.

6. The fracture repair system ofclaim 3 further comprising a drill guide plate attachable to the outer face of the fracture repair place, the drill guide plate including a plurality of guide apertures adapted to guide a drill at a pre-selected angle.

7. A fracture repair system adapted for reduction and fixation of a fracture of a humerus bone, the humerus bone defined in part by a proximal humerus, a diaphysis including a longitudinal axis and a lateral aspect defining in part a surface plane of the diaphysis, the fracture repair system comprising:

a fracture repair plate having a longitudinal axis, an outer face and a contoured inner face including a bearing surface configured to minimize a contact surface area between the fracture repair plate and the humerus bone;

two or more threaded locking screw apertures formed through a cross-section of the fracture repair plate, each of the threaded locking screw apertures having an axis, an angle of the axis of each of the threaded locking screw apertures relative to the outer face of the fracture repair plate increasing progressively as a location of the locking screw apertures progresses down a length of the fracture repair plate;

two or more locking cortical screws adapted for placement through one of the one or more locking screw apertures, each of the two or more threaded locking cortical screws including a head attached to a threaded shaft, the head of each of the two or more threaded locking cortical screws including a thread, each of the one or more locking cortical screws adapted for threaded engagement with the bone, the thread of the head each of the two or more threaded locking cortical screws adapted to engage one of the two or more threaded locking screw apertures; and

a drill guide plate attachable to the outer face of the fracture repair place, the drill guide plate including a plurality of guide apertures adapted to guide a drill at a pre-selected angle.

8. The fracture repair system ofclaim 7 further comprising:

two or more threaded locking anchor apertures formed through a cross-section of the fracture repair plate, each of the two or more threaded locking anchor aperture having an axis that is divergent from the axis of each remaining two or more locking anchor apertures; and

two or more locking bone anchors adapted for placement through one of the two or more threaded locking anchor apertures, each of the two or more locking bone anchors including a plurality of annular grooves formed about a shaft of the locking bone anchor and a plurality of longitudinal grooves formed parallel to a primary axis of the shaft, each of the two or more locking bone anchors including a head attached to the shaft, the head having an external thread adapted to cooperate with the thread formed in one of the two or more threaded locking anchor apertures.

9. The fracture repair system ofclaim 7 further comprising:

one or more slotted apertures formed through a cross-section of the fracture repair plate; and

one or more screws adapted for placement through one of the one or more slotted apertures, the one or more screws adapted for engagement with the humerus bone.

10. The fracture repair system ofclaim 7 further comprising:

an upper peripheral edge including an undercut land; and

one or more suture apertures formed along the upper peripheral edge of the plate through the undercut land.

11. The fracture repair system ofclaim 7 further comprising a reduction mechanism including a body adapted for attachment to the drill guide plate and a traction arm adapted to engage the body, the traction arm adapted for controlled translational movement relative to the body, the traction arm further adapted for attachment to the bone, such that as a translational force is applied to the traction arm, the translational force is applied to the bone along a plane that lies substantially parallel to the surface plane and substantially parallel to the longitudinal axis of the diaphysis.

12. The fracture repair system ofclaim 11 wherein the reduction mechanism is adaptable for attachment to the drill guide to apply the translational force between two bone segments of a right humerus or a left humerus bone.

13. The fracture repair system ofclaim 11 wherein the reduction mechanism further comprises:

the body including a right dovetail groove and a left dovetail groove;

the traction arm including a dovetail slideably engageable with the right dovetail groove for use in applying the translational force between two bone segments of a right humerus, the dovetail alternately slideably engageable with the left dovetail groove for use in applying the translational force between two bone segments of a left humerus bone.

14. The fracture repair system ofclaim 11 wherein the reduction mechanism further comprises:

a pinion gear connected to the body, the pinion gear rotatable relative to the body; and

the traction arm including a rack gear engageable with the pinion gear such a rotational force applied to the pinion gear provides a translational movement of the fraction arm; and

a spring biased pawl attached to the body and engageable with the pinion to eliminate counter-rotation of the pinion.

15. A fracture repair system adapted for reduction and fixation of a fracture of a humerus bone, the humerus bone defined in part by a proximal humerus a diaphysis including a longitudinal axis and a lateral aspect defining in part a surface plane of the diaphysis, the fracture repair system comprising:

a fracture repair plate having a longitudinal axis, an outer face and a contoured inner face having a bearing surface configured to minimize a contact surface area between the fracture repair plate and the humerus bone;

two or more threaded locking anchor apertures formed through a cross-section of the fracture repair plate, each of the two or more threaded locking anchor aperture having an axis that is divergent from the axis of each remaining two or more locking anchor apertures;

two or more threaded locking screw apertures formed through a cross-section of the fracture repair plate, each of the threaded locking screw apertures having an axis, an angle of the axis of each of the threaded locking screw apertures relative to the outer face of the fracture repair plate increasing progressively as a location of the locking screw apertures progresses down a length of the fracture repair plate;

two or more locking bone anchors adapted for placement through one of the two or more locking anchor apertures, each of the two or more locking bone anchors including a plurality of annular grooves formed about a shaft of the locking bone anchor and a plurality of longitudinal grooves formed parallel to a primary axis of the shaft, each of the two or more locking bone anchors including a head attached to the shaft, the head having an external thread adapted to cooperate with the thread formed in one of the two or more locking anchor apertures; and

two or more locking cortical screws adapted for placement through one of the one or more threaded locking screw apertures, each of the two or more locking cortical screws including a head attached to a threaded shaft, each of the one or more locking cortical screws adapted for threaded engagement with the bone, the head of each of the two or more locking cortical screws including an external thread adapted to engage with one of the two or more threaded locking screw apertures;

a drill guide plate attachable to the outer face of the fracture repair place, the drill guide plate including a plurality of guide apertures adapted to guide a drill at a pre-selected angle; and

a reduction mechanism including a body adapted for attachment to the drill guide plate and a traction arm adapted to engage the body, the traction arm adapted for controlled translational movement relative to the body, the traction arm further adapted for attachment to the bone at a point that lies, such that as a translational force is applied to the traction arm, the translational force is applied to the bone along a plane that lies substantially parallel to the surface plane and substantially parallel to the longitudinal axis of the diaphysis.

16. The fracture repair system ofclaim 15 wherein the fracture repair plate further comprises:

an upper peripheral edge including an undercut land; and

one or more suture apertures formed along the upper peripheral edge of the plate through the undercut land.

17. The fracture repair system ofclaim 15 wherein the fracture repair plate further comprises:

one or more slotted apertures formed through a cross-section of the fracture repair plate; and

one or more screws adapted for placement through one of the one or more slotted apertures, the one or more screws adapted for engagement with the humerus bone.

18. The fracture repair system ofclaim 13 wherein the reduction mechanism further comprises:

the body including a right dovetail groove and a left dovetail groove;

the traction arm including a dovetail slideably engageable with the right dovetail groove for use in applying the translational force between two bone segments of a right humerus, the dovetail alternately slideably engageable with the left dovetail groove for use in applying the translational force between two bone segments of a left humerus bone.

19. The fracture repair system ofclaim 15 wherein the reduction mechanism further comprises a pinion gear rotatable relative to the body, the traction arm including a rack gear engageable with the pinion and a spring biased pawl attached to the body and engageable with the pinion to eliminate counter-rotation of the pinion.

20. A locking bone anchor adapted for anchoring a fracture repair plate, the locking bone anchor comprising:

an anchor shaft including a length and a longitudinal axis;

a plurality of annular grooves formed along the length of the shaft; and

a plurality of longitudinal grooves formed parallel to the longitudinal axis of the shaft.

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