US20120323284A1 - Variable angle locking implant - Google Patents

Abstract

A variable angle locking implant includes a bone plate having a lower surface, an upper surface, and at least one opening extending from the lower surface to the upper surface along an axis. The opening has a plurality of fins oriented along a plane. The axis is non-perpendicular to a tangent of a projection of the lower surface across the opening, the tangent defined at the intersection between the axis and the projected lower surface, and/or the plane is non-parallel to the tangent. The implant includes at least one fastener, and the plurality of fins are deflectable relative to a head portion of the fastener such that the fastener can be inserted and retained at any one of a plurality of angles.

Description

CROSS-REFERENCE TO RELATED APPLICATION
• This application claims priority to and the full benefit of U.S. Provisional Application Ser. No. 61/497,180 filed Jun. 15, 2011, and titled “Variable Angle Locking Implant,” the entire contents of which are incorporated herein by reference.
TECHNICAL FIELD
• This invention relates to a variable angle locking implant.
BACKGROUND
• Variable angle locking implants for repairing bone fractures have been described, for example, in U.S. patent application Ser. No. 12/484,527, filed Jun. 15, 2009, published as U.S. Publication No. 2009/0312803, hereby incorporated herein by reference in its entirety. In particular, U.S. Publication No. 2009/0312803 describes an implant having fastener receiving holes with fins that permit a fastener to be positioned off-axis within the hole.
• Implants such as bone plates have been provided with threaded holes (that may receive either locking screws or non-locking screws), non-threaded holes (for non-locking screws), partially threaded slots to allow either non-locking or locking screws to be used together, and combinations of the above.
SUMMARY
• The variable angle locking implant provides a stable connection between a bone and a bone plate using a fastener that permits different angles to be obtained between the bone plate and the fastener, while the fastener also locks into the bone plate. This allows the surgeon to reach denser areas of bone or capture random bone fragments that are in irregular positions, for example, in cases of severe fractures with highly fragmented bones. The fastener and plate system advantageously allows the surgeon to choose the angle at which the screw is inserted through, and rigidly affixed in, an opening of the plate.
• The variable angle locking implant allows a surgeon to direct the fastener toward bone fragments that are not necessarily located along the axis of the opening in the plate. It also provides flexibility in the placement of the plate in relation to the bone fracture. Allowing surgeons to choose the angle at which the fastener is inserted into the plate leads to better tailoring of the system to the specific nature of the bone fracture to be treated, and allows surgeons to adjust their strategy as necessary after the surgical site has been accessed, but prior to insertion of the fastener into bone material.
• According to one aspect, a variable angle locking implant includes a bone plate having a lower surface, an upper surface, and at least one opening extending from the lower surface to the upper surface along an axis. The opening has an inner surface with a plurality of fins oriented along a plane. The axis is non-perpendicular to a tangent of a projection of the lower surface across the opening, the tangent defined at the intersection between the axis and the projected lower surface, and/or the plane is non-parallel to the tangent.
• Implementations of this aspect may include one or more of the following features.
• For example, the lower surface includes a bone conforming arcuate surface. The lower surface is adapted to contact a distal femur, a proximal femur, a distal tibia, a proximal tibia, a proximal humerus, a distal humerus, a clavicle, a fibula, an ulna, a radius, a distal radius, a rib, pelvis, a vertebra, bones of the foot, or bones of the hand, shaft fractures on long bones, or any of the aforementioned adjacent bones in the case of a joint fusion plate.
• The fins are positioned within the opening. The axis is perpendicular to the tangent and the plane is non-parallel to the tangent. Alternatively, the axis is non-perpendicular to the tangent and the plane is non-parallel to the tangent, for example, the plane is perpendicular to the axis.
• The fins are integrally connected to, and protruding from, the inner surface. The opening has a radius between the inner surface and the top of the fins, and each fin tapers in thickness from the inner surface towards its terminal end. The opening has a jagged circumference formed by protruding fins at the lower surface. The protruding fins form a concave portion of the inner surface. The protruding fins have bases that meet the inner surface along the plane. The fins have a tapered shape or a straight shape. The fins are provided in more than one layer. The fins are trapezoidally-shaped, rounded, oval, rectangular, curved, rhomboid, diamond-shaped, or triangular. The edges of the fins taper inwardly, outwardly, or are about parallel with one another. There are at least 3, but no more than 10, fins integrally connected to, and protruding from, the inner surface. The fins are provided as a series of concavely indented, inwardly protruding fins that are adapted to secure a threaded head of a fastener in place at varying angles.
• The bone plate includes one or more of the following openings: a threaded opening; a non-threaded opening; an opening adapted to receive locking or non-locking fasteners; an opening with fins; a provisional fixation opening; a combination slot; or any combination thereof.
• The implant includes at least one fastener. The fastener is at least partially threaded and has a head portion and a shaft portion. The opening is adapted to receive the fastener without being tapped by the fastener. The plurality of fins are deflectable relative to the head portion of the fastener when the fastener is inserted into the opening such that the fastener can be inserted and retained at any one of a plurality of angles relative to the opening. The fins are deflectable so that the fins are interposed between the threads of the fastener. The inner surface includes threads located above or below the fins.
• According to another aspect, a method for securing a bone plate to a bone includes placing a lower surface of the bone plate against the bone; inserting a fastener into an opening in the bone plate, the opening having an axis that is non-perpendicular to a tangent of a projection of the lower surface across the opening, the tangent defined at the intersection between the axis and the projected lower surface,; selecting a trajectory of the fastener into the bone, the trajectory being up to about 15 degrees off the hole axis; and inserting the fastener into the bone.
• Implementations of this aspect may include one or more of the following features.
• For example, either a locking screw or a non-locking screw is inserted in the opening. The fastener is removed and re-inserted into the opening of the bone plate at any one of a plurality of angles. Inserting the fastener into the bone includes drawing a bone fragment into alignment with an intact bone segment.
• The details of one or more implementations of the invention are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the invention will be apparent from the description and drawings, and from the claims.
DESCRIPTION OF DRAWINGS
• FIG. 1 is an illustration of a variable angle locking implant positioned on a bone.
• FIG. 2 is a cross-sectional view of the variable angle locking implant taken along line2-2 ofFIG. 1.
• FIG. 3 is a perspective view of a bone plate and fastener of the variable angle locking implant.
• FIG. 4 is a perspective view of a bone plate of the variable angle locking implant having a finned opening.
• FIGS. 5A-5E are cross-sectional views of various implementations of the finned opening.
DETAILED DESCRIPTION
• Referring toFIGS. 1 and 2, a variableangle locking implant2 for repairing fractures inbone4 includes abone plate40 and one ormore fasteners90. Afastener90 is shown engaged in afinned opening50 that extends between anupper surface44 and a lower,bone contacting surface42 of thebone plate40. Thefastener90 can be positioned in theopening50 and fixed in theplate40 at various insertion angles to capture “renegade” or random bone fragments that have split from the bone during fracture and secure the bone fragments to theplate40.
• Thefastener90 shows a new trajectory achieved by increasing the range of angles as compared to thescrew90a.For example, thecentral axis96 offastener90 has an approximate 15 degree offset from thecentral axis52 and approximately 30 degree offset from perpendicular to thelower surface42 of thebone plate40. The alternative placement of ascrew90ain a hole having anaxis52 perpendicular to thelower surface42 of theplate40 and a plane59 that is parallel to the bottomlower surface42 illustrates approximately a 15 degree offset from thecentral axis52 and a corresponding approximately 15 degree offset from perpendicular to thelower surface42 of thebone plate40, thus illustrating the greater range of the insertion angle of thefastener90.
• The lockingimplant2 also includes a provisional pin opening102 as well as acombination slot104.
• Referring also toFIGS. 3 and 4, theplate40 has aninner surface54 that defines theopening50 and a series of concavely indented, inwardly protrudingfins56 that extend toward acentral axis52 of theopening50. Eachfin56 has abase58 and thebases58 formconcave portions60. Thebases58 of thefins56 all meet, for example, in substantially the same plane59a-59d(FIGS. 5A-5D) and then angle downwardly and inwardly at a similar angle or slope. As discussed further below, thecentral axis52 can be oriented non-perpendicular to thelower surface42 and/or the planes59a-59dcan be oriented non-parallel to thelower surface42 to increase the range of possible insertion angles.
• Theconcave portions60 are smooth and non-threaded, and as illustrated, the entireinner surface54 of thefinned opening50 can be devoid of threads. The lack of threads helps ease the manufacturing of theplate40, and allows theplate40 to be manufactured as thinly as desired. Thebases58 can extend from theinner surface54 at or near anupper circumference62 of the inner surface, at a middle region of the inner surface, or at or near a lower circumference of the inner surface. With thefins56 located adjacent a lower circumference at the lower,bone contacting surface42 ofplate40, the lower circumference appears jagged due to the presence of the fins, while theupper circumference62 is smooth.
• As thefins56 extend towardcentral axis52, they taper to form tapered sides64. Thefins56 end atrounded tips66, althoughtips66 can be pointed, square, rectangular, or any other appropriate configuration. For example, as described in U.S. Patent Application Publication No. 2009/0312803, which is incorporated herein by reference in its entirety, thefins56 can have straight edges or sides and straight ends such that the fins are partially rectangular-shaped with slit-shaped openings between the fins. Alternatively, the fins can be more triangular in shape having sides that taper inwardly and end edges that are flat and small. Other example fin shapes include trapezoidal, square, round, circular, triangular (with a pointed tip).
• The dimensions offins56 are typically dependent at least in part upon the pitch and threads of thefastener90. For example, alarger plate40 for use with a larger fastener90 (for example, for use on a femur bone) will likely be thicker and will have larger andthicker fins56 than a smaller plate40 (for example, for use on a smaller bone). In specific implementations, thefins56 are particularly thin so that they can be moved up or down and deformed under pressure. In some implementations, thefins56 may be pressed toward the edges of thefinned opening50. A non-limiting exemplary range of thicknesses for thefins56 is from about 0.15 mm to about 5 mm, although larger and smaller sizes are possible. Thefins56 are intended to fit betweenthreads98 on the thread form offastener90, as shown inFIG. 3.
• Providing a non-threadedinner surface54 also allows thefastener90 to be inserted into thefinned opening50 at any desired insertion angle, that is the angle defined between a longitudinal axis96 (FIG. 2) of thefastener90 and the central axis52 (FIG. 4) of thefinned opening50. Thecentral axis52 and thelongitudinal axis96 can be co-linear so that the insertion angle is zero, or thecentral axis52 and the longitudinal axis96 (FIG. 1) can be non-co-linear with an insertion angle of up to about +/−15 degrees. Varying the insertion angle is possible because there are not any threads in thefinned opening50 to interfere with the desired insertion angle. Thefins56 are intended to slightly bend or deform in order to secure thefastener90 in place in thefinned opening50. Thefins56 engage thethreads98 or other surface of thefastener90.
• Thefastener90 has ahead94 and ashaft92. Theshaft92 may be threaded or non-threaded. Thehead94 of thefastener90 has at least one set ofthreads98 and abore18 for receiving a driver in order to drive thefastener90 through theplate40 and into bone. Thethreads98 are typically any standard-type thread.
• Referring toFIGS. 5A and 5B, thecentral axis52a,52bof theopening50 can be oriented non-perpendicular to thelower surface42 of theplate40, for example, at an angle, θ, in the range between 0 and 90 degrees. InFIG. 5A, two rows offins56 are illustrated that each lie in aplane59athat is parallel to thelower surface42 of theplate40. InFIG. 5B, thefins56 lie in aplane59bthat is oriented non-parallel to thelower surface42 of theplate40, for example, theplane59bis perpendicular or nearly perpendicular to theaxis52b.In FIG.5C, thefins56 are illustrated lying in aplane59cthat is oriented non-parallel to thelower surface42 of theplate40 and theplane59cis non-perpendicular to theaxis52c.Thefins56 ofFIGS. 5B and 5C are positioned within theopening50, that is, between theupper surface44 andlower surface42 of theplate40.
• The non-perpendicular orientation of thecentral axis52a,52b,52dand/or the non-parallel orientation of theplane59b-dincreases the useful range of possible insertion angles as compared to abone plate40 having thecentral axis52 perpendicular to thelower surface42 and the plane59 parallel to thelower surface42. For example, referring toFIG. 5B, assuming θ is 15 degrees, afastener90 could be inserted with thefastener axis96 aligned withaxis52b,and thus 15 degrees off from perpendicular to thelower surface42, or thefastener axis96 could be tilted up to, for example, +/−15 degrees, such that thefastener axis96 is perpendicular to thelower surface42 or up to 30 degrees off from perpendicular to reach bone fragments. Increasing the range of angles allows the surgeon to target new fastener trajectories in the bone as shown inFIG. 2.
• The screw90 (FIG. 2) shows a new trajectory achieved by increasing the range of angles as compared to thescrew90a.Thefastener90 is shown positioned in the hole ofFIG. 5B and having a 15 degree offset from thecentral axis52 and 30 degree offset from perpendicular to thelower surface42 of thebone plate40. The alternative placement of ascrew90ain a hole having anaxis52 perpendicular to thelower surface42 of theplate40 and a plane59 that is parallel to thelower surface42 illustrates a 15 degree offset from thecentral axis52 and only a corresponding 15 degree offset from perpendicular to thelower surface42 of thebone plate40, thus illustrating the greater range of the insertion angle of thefastener90. Angling the screw greater than 15 degrees from thecentral axis52 of an opening having anaxis52 perpendicular to thelower surface42 of theplate40 and a plane59 that is parallel to thelower surface42 produces inconsistent failure loads. Therefore, to achieve a screw trajectory greater than 15 degrees from thelower surface42 of theplate40 while maintaining the ability to capture and secure bone fragments, the angle of thecentral axis52 is offset from perpendicular to thelower surface42 and thescrew axis96 tilted to reach a maximum of 30 degrees offset.
• Referring toFIG. 5D, the range of insertion angles can also be increased by orienting theaxis52dof theopening50 perpendicular to thelower surface42 of theplate40, while thefins56 lie in aplane59dthat is non-parallel to the lower surface, for example, at an angle, α, in the range between 0 and 90 degrees.
• Thefinned opening50 can include about five to eightfins56, as illustrated, two or threefins56, or ten or twenty ormore fins56, depending upon theplate40 for which thefinned opening50 is intended for use. The finned holes can optionally include threads112 (FIG. 5B) formed above or below the fins in the inner surface of the hole. The region of the opening above the fins can taper inwardly from the upper surface of the plate, for example, at an angle of about 5 to 15 degrees, and the region of the opening below the fins can taper outwardly toward the lower surface of the plate, for example, at an angle of about 40 to 50 degrees. Thefinned opening50 can optionally be a slot hole or combination hole with half or more of the length of the opening can be finned with the remainder of the opening being non-threaded for sliding compression.
• The primary purpose offins56 is to grasp one ormore threads98 of thefastener90 in order to secure thefastener90 in place in thebone plate40 at any desired insertion angle.Fasteners90 received in differentfinned openings50 can be inserted at the same or different insertion angles. As afastener90 is inserted, itsthreads98 start to engage thefins56, as shown inFIG. 3. As discussed above, thefins56 can be very thin so that as thethreads98 start to grab thefins56, thefins56 can move up or down as appropriate to engage thethreads98 and secure thefastener90 in thefinned opening50. Thethreads98 engage thefins56 so that thefins56 fit between thethreads98. The movement offins56 can be a permanent deformation, so that thefins56 cannot flex back and allow thefastener90 to work its way out.
• Thefinned openings50 can be provided on all types ofbone plates40 and can be combined with other types of openings. As illustrated inFIG. 1, there can be finnedopenings50, a threadedopening30, and aprovisional pin opening102. Other options are holes that can be used with either a threaded or non-threaded fastener, as well ascombination slots104. For example, a slot having fins mounted on either or both ends of the slot for static locking and no threads or fins in the middle portion of the slot for dynamic locking These various types of openings may be used on any type of bone plate, in any combination and in any size. The inclusion of a plurality of finnedopenings50 in thebone plate40 can help achieve better fixation of a fractured bone, for example, where numerous fragments have shattered in various directions, because thefasteners90 can be inserted at various angles to capture “renegade” or random bone fragments that have split from the bone during fracture, but still secure the bone fragments to theplate40.
• Thethreads98 onfastener90 can be any type of standard or non-standard thread. For example, thethreads98 can be a continuous ridge or a non-continuous ridge. Thethreads98 can form a portion of a revolution, one complete revolution, multiple revolutions, a single lead, or multiple leads, or any other threads known in the art. Additionally or alternatively, thehead94 offastener90 can include any other surface that will engage with and seat within thefins56 of thefinned opening50. For example, thehead94 can have a series of dimples, ridges, bumps, textured areas, or any other surface that can securefastener90.
• Thefastener90 may be any typical fastener, made out of any appropriate material. Thefastener90 typically has abore18 for receiving a driver in order to drive thefastener90 through theplate40 and into bone. Thebore18 may be any size and shape, for example, it may have a hexagonal configuration to receive a corresponding hexagonal driver, a Phillips screw head, a flat-head, a star configuration, Torx, or any other appropriate configuration that can cooperate with a driver to drive thefastener90 into theplate40.
• Theshaft92 may be fully threaded, partially threaded, or a helical blade, and/or may include one or more tacks, deployable talons, expandable elements, or any feature that allowsshaft92 to engage bone. It is also possible thatshaft92 is not threaded, so thatfastener90 takes the form of a peg or a pin. This alternative implementation may be preferred in certain procedures where, for instance, the main goal is to prevent tilting of a bone segment or in procedures where there is no concern offastener90 pulling out from the bone and hence no need forshaft92 to be threaded or otherwise configured to engage bone. The end ofshaft92 may be a self-tapping or self-drilling tip.
• Thebone plate40 may be adapted to contact one or more of a distal femur, a proximal femur, a distal tibia, a proximal tibia, a proximal humerus, a distal humerus, a clavicle, a fibula, an ulna, a radius, a distal radius, a rib, pelvis, a vertebra, bones of the foot, or bones of the hand, shaft fractures on long bones, or any of the aforementioned adjacent bones in the case of a joint fusion plate. Thebone plate40 may be curved, contoured, straight, or flat. The lower,bone contacting surface42 can have an arcuate shape that conforms to the bone. For example, referring toFIG. 5E, thebone plate40 is shown with abone contacting surface42 having an arcuate or curved shape. In the implementation shown, thecentral axis52 of theopening50 can be oriented non-perpendicular to a tangent line or tangent plane T-T of the projected arcuatebone contacting surface42 that intersects thecentral axis52 at a point P along the projectedbone contacting surface42, for example, at an angle, θ, in the range of between 0 and 90 degrees. InFIG. 5E, a row offins56 is illustrated that each lie in aplane59ethat is oriented non-parallel to the tangent line or plane T-T. Thefins56 can alternatively be located at thelower surface42 and also have an arcuate shape that conforms to the bone. The plate can be a periarticular plate or a straight plate. The plate may have a head portion that is contoured to conform to a particular bone surface, such as a metaphysis or diaphysis, that flares out from the shaft portion, that forms an L-shape, T-shape, Y-shape, with the shaft portion, or that forms any other appropriate shape to fit the bone to be treated.
• Thebone plate40 can be made from metal, a resorbable or non-resorbable plastic, ceramic, or composite materials. Suitable materials may include, for example, titanium, stainless steel, cobalt chrome, polyetheretherketone (PEEK), polyethylene, ultra high molecular weight polyethylene (UHMWPE), resorbable polylactic acid (PLA), polyglycolic acid (PGA), combinations or alloys of such materials or any other appropriate material that has sufficient strength to be secured to and hold bone, while also having sufficient biocompatibility to be implanted into a body.
• Turning now to the methods of implantation, the surgeon accesses the surgical site of interest, which can be an internal site at which a bone fracture is located that requires stabilization to ensure proper healing. The fracture may be reduced with conventional forceps and guides (which are known to those in the art), and abone plate40 of appropriate size and shape is placed over the fracture site. In some instances, thebone plate40 may be temporarily secured to thebone4 using provisional fixation pins. The provisional fixation pins may be used through either theprovisional pin openings102, or any other opening in theplate40. Provisional fixation provides for temporarily securing thebone plate40 to thebone4 before placing fixation screws through thebone plate40, so that one can be certain thebone plate40 is properly positioned before placing bone screws for permanent fixation of thebone plate40 to thebone4. Moreover, with provisional fixation, x-rays can be taken of the bone plate/construct without excess instruments in the field of view.
• Once theplate40 is secured at a desired location in relation to the fracture (typically using one or more provisional fixation pins, although any other appropriate method may be used), the surgeon then identifies an insertion angle at which thefastener90 is to be inserted through a selectedopening50 and driven intobone material4. If thebone plate40 includes more than oneopening50, the surgeon also selects thespecific opening50 to be used. After selecting the desired insertion angle and theopening50, the surgeon inserts theshaft92 of thefastener90 through theopening50 until the tipcontacts bone material4. In some cases, a hole may need to be drilled or tapped into thebone4 along the insertion angle to facilitate the initial tapping or insertion of thefastener90. The surgeon then uses an appropriate driving tool in thebore18 of thehead94 to manipulate thefastener90 into place.
• Because thefastener90 can be inserted at angles up to about 60 degrees from perpendicular to the lower surface of the plate, thefastener90 can be used to grab and/or secure bone fragments that are out of line with the traditional angle at which a locking screw would normally be inserted. The surgeon may need to toggle or maneuver thefastener90 in order to secure and draw in displaced bone fragments.
• Once the bone fragment is secured, thefastener90 is ready to be secured to theplate40. As thefastener90 is driven further intobone4, it is also drawn further into theplate40. As thethreads98 of thefastener head94 begin to contact thefins56, thefins56 engage within thethreads98 to hold thefastener90 in place at the desired insertion angle. The action of engagement between thefins56 and thethreads98 rigidly affixes thefastener90 to thebone plate40 at the desired insertion angle.
• The surgeon may then use traditional locking and/or non-locking screws in other openings on theplate40. This can help further secure thebone plate40 to the bone fracture if needed.
• Once all the fasteners and/or screws are placed, the surgeon may place covers over the unused openings, particularly if there are any unused openings that cross the fracture, to strengthen theplate40. Additionally or alternatively, the surgeon may use bone graft material, bone cement, bone void filler, and any other material to help heal the bone.
• In practice, a first screw is initially inserted through abone plate40 and into abone4 on one side of a fracture and then a second screw is inserted through thebone plate40 on the opposite side of the fracture. In particular, after the first screw is in place, an axial compression screw is inserted through a hole in thebone plate40 on a side of the fracture opposite the side of the first screw. The compression screw may be inserted through the hole and into thebone4 such that as the compression screw is fully inserted, thebone plate40 is drawn over to a desired position. By moving thebone plate40, the tissue is pulled together to reduce the fracture. Once the compression screw has been used to move thebone plate40 into the desired position, the compression screw may be removed from thebone4 andbone plate40 and a locking screw may be inserted through theopening50 in thebone plate40 and in thebone4 in the space formerly occupied by the compression screw. The locking screw can then be tightened to lock theplate40 into position. The replacement of the compression screw with the locking screw is not required, but a locking screw may provide more stability and rigid fixation than leaving the compression screw in place. In some modes of operation, a locking screw is placed directly in a locking hole without first inserting a compression screw in the hole.
• A number of implementations of the invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention. Accordingly, other implementations are within the scope of the following claims. For example, locking screws, non-locking screws, or other fasteners may be used. One or more openings having a non-perpendicular orientation of thecentral axis52 and/or the non-parallel orientation of the plane59 can be employed to receive a fastener in implants other than plates, such as in an acetabular cup or glenoid base component, to increase the useful range of possible insertion angles of the fastener. According to another implementation, the head of thescrew94 can include thefins56 and theopening50 can be threaded, with the opening having a non-perpendicular orientation of itscentral axis52 and/or the plane59 defined by thefins56 having a non-parallel orientation.

Claims (31)

1. A variable angle locking implant comprising:

a bone plate having

a lower surface;

an upper surface; and

at least one opening extending from the lower surface to the upper surface along an axis, the opening having an inner surface with a plurality of fins oriented along a plane, wherein the axis is non-perpendicular to a tangent of a projection of the lower surface across the opening, the tangent defined at the intersection between the axis and the projected lower surface, and/or the plane is non-parallel to the tangent.

2. The implant ofclaim 1 wherein the lower surface comprises a bone conforming arcuate surface.

3. The implant ofclaim 2 wherein the lower surface is adapted to contact a distal femur, a proximal femur, a distal tibia, a proximal tibia, a proximal humerus, a distal humerus, a clavicle, a fibula, an ulna, a radius, a distal radius, a rib, pelvis, a vertebra, bones of the foot, or bones of the hand.

4. The implant ofclaim 2 wherein the fins are positioned within the opening.

5. The implant ofclaim 1 wherein the axis is perpendicular to the tangent and the plane is non-parallel to the tangent.

6. The implant ofclaim 1 wherein the axis is non-perpendicular to the tangent and the plane is non-parallel to the tangent.

7. The implant ofclaim 1 wherein the axis is non-perpendicular to the tangent and the plane is perpendicular to the axis.

8. The implant ofclaim 1 wherein the fins are integrally connected to, and protruding from, the inner surface.

9. The implant ofclaim 8 wherein the opening has a radius between the inner surface and a top surface of the fins, and each fin tapers in thickness from the inner surface towards its terminal end.

10. The implant ofclaim 8 wherein the opening is further defined by a jagged circumference formed by protruding fins at the lower surface.

11. The implant ofclaim 8 wherein the protruding fins form a concave portion of the inner surface.

12. The implant ofclaim 8 wherein the protruding fins have bases that meet the inner surface along the plane.

13. The implant ofclaim 1 wherein the fins have a tapered shape or a straight shape.

14. The implant ofclaim 1 wherein the fins are provided in more than one layer.

15. The implant ofclaim 1 wherein the fins are trapezoidally-shaped, rounded, oval, rectangular, curved, rhomboid, diamond-shaped, or triangular.

16. The implant ofclaim 1 wherein the edges of the fins taper inwardly, outwardly, or are about parallel with one another.

17. The implant ofclaim 1 comprising at least3, but no more than10, fins integrally connected to, and protruding from, the inner surface.

18. The implant ofclaim 1 wherein the fins are provided as a series of concavely indented, inwardly protruding fins that are adapted to secure a threaded head of a fastener in place at varying angles.

19. The implant ofclaim 1 wherein the bone plate further comprises one or more of the following openings: a threaded opening; a non-threaded opening; an opening adapted to receive locking or non-locking fasteners; an opening with fins; a provisional fixation opening; a combination slot; or any combination thereof.

20. The implant ofclaim 1 further comprising at least one fastener, the fastener being at least partially threaded and having a head portion and a shaft portion, wherein the opening is adapted to receive the fastener without being tapped by the fastener, wherein the plurality of fins are deflectable relative to the head portion of the fastener when the fastener is inserted into the opening such that the fastener can be inserted and retained at any one of a plurality of angles relative to the opening.

21. The implant ofclaim 20 wherein the fins are deflectable so that the fins are interposed between the threads of the fastener.

22. The implant ofclaim 1 wherein the inner surface comprises threads located above or below the fins.

23. A method for securing a bone plate to a bone, comprising:

placing a lower surface of the bone plate against the bone;

inserting a fastener into an opening in the bone plate, the opening having an axis that is non-perpendicular to a tangent of a projection of the lower surface across the opening, the tangent defined at the intersection between the axis and the projected lower surface;

selecting a trajectory of the fastener into the bone, the trajectory being up to about 15 degrees off the hole axis; and

inserting the fastener into the bone.

24. The method ofclaim 23 wherein either a locking screw or a non-locking screw is inserted in the opening.

25. The method ofclaim 23 wherein the fastener is removed and re-inserted into the opening of the bone plate at any one of a plurality of angles.

26. The method ofclaim 23 wherein inserting the fastener into the bone comprises drawing a bone fragment into alignment with an intact bone segment.

27. The implant ofclaim 1 wherein at least one opening has an axis that is non-perpendicular to the tangent and at least one opening has an axis that is perpendicular to the tangent.

28. The implant ofclaim 1 wherein at least one opening has an axis that is non-perpendicular to the tangent and at least one opening is threaded.

29. The implant ofclaim 1 wherein at least one opening has an axis that is non-perpendicular to the tangent and at least one opening is non-threaded.

30. The implant ofclaim 1 wherein at least one opening has an axis that is perpendicular to the tangent and at least one opening is threaded.

31. The implant ofclaim 1 wherein at least one opening has an axis that is perpendicular to the tangent and at least one opening is non-threaded.

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