US20140316470A1 - Compression brace - Google Patents

Abstract

A surgical device for pressing and retaining adjacent bones against one another comprising a compression brace and separate fasteners. The compression brace has at least two fastener retaining portions. Each fastener retaining portion has a fastener hole therethrough for receiving a fastener, such as a screw or pin. A pair of bridge members are positioned between the fastener retaining portions, and are spaced apart from one another to form a compression opening. The compression bracket can include a plurality of fastener retaining portions and a plurality of compression openings. In some embodiments, the fasteners are maintained in a substantially fixed relation with the fastener retaining portion. The brace is installed on adjacent bones such that a fastener engages each bone. The compression opening is spread apart to draw the fasteners toward one another, and thereby compress the adjacent bones together.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This application is a division of U.S. patent application Ser. No. 12/582,210, filed Oct. 10, 2009, which is a continuation of U.S. patent application Ser. No. 10/940,396, which was filed on Sep. 14, 2004, the entireties of which are herein incorporated by reference.
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT
• Not applicable.
REFERENCE TO A MICROFICHE APPENDIX
• Not applicable.
FIELD OF THE INVENTION
• The present invention relates generally to orthopedic surgery, and more particularly to devices and methods for reduction of fractures and osteotomies by drawing bones together.
BACKGROUND OF THE INVENTION
• U.S. Pat. No. 2,597,342 (Lang) discloses the use of a compressible fastener for joining boards together. The Lang fastener includes a central loop portion and claw members that extend from diametrically opposed sides of the central loop. The loop is preferably a parallelogram. Each claw member has two claws. Each claw has downwardly turned ends with inwardly turned portions which are configured to penetrate and engage boards. In operation, the claw members are set astraddle adjacent board members. The central loop is then expanded outward to draw the opposing arms toward one another and thereby fasten the adjacent boards together.
• The earliest use of a compression opening in a surgical application appears to be U.S. Pat. No. 4,887,601 (Richards). Richards discloses an adjustable surgical staple having a slotted spine and downwardly depending legs on opposing ends of the spine. The legs are bent toward or away from the spine. However, a straight leg embodiment is discussed with reference toFIGS. 7 and 8C. The Richards staple appears to have been intended for use in ophthalmic surgery.
• The use of a compressible bone staples for fracture reduction is disclosed in U.S. Pat. No. 5,449,359 (Groiso); U.S. Pat. No. 5,660,188 (Groiso); U.S. Pat. No. 5,853,414 (Groiso); U.S. Pat. No. 5,947,999 (Groiso); and U.S. Pat. No. 5,993,476 (Groiso) (collectively, “the Groiso patents”). However, the Groiso patents, which are incorporated herein by reference, disclose the use of staples having downwardly depending legs for engaging adjacent bones. The Groiso compression bone staples suffer from several drawbacks. Staples having opposing spaced-apart bridges can be difficult and therefore expensive to manufacture. See e.g. U.S. Pat. No. 5,947,999 (Col. 1, lines 48-52). Positioning holes in the bones such that they align with the legs of the staple can be challenging, and typically requires specialized instrumentation. Additionally, staple legs tend to splay outward during use in vivo, which may reduce the compressive force of the staple. Staples can pull out of the bones. The configuration of staples also reduces intra-operative choices. In order to accommodate varying inter-axis and leg length requirements, it is necessary to provide a wide array of staple sizes, which requires extra inventory. A staple conventionally has legs of the same length and diameter/cross-section, which may make the staple unsuitable for situations in which it is desirable to have a longer or larger leg on one side of the staple. Thus, even with a large inventory of staple sizes, intra-operative choices may be limited.
• One of the Groiso patents, U.S. Pat. No. 5,947,999, discloses a compressible bone staple that has a pair of wing members extending from opposing ends of the staple, each wing member having apertures therein for receiving a screw for fastening the clip member to a bio-organic tissue member.
• However, the '999 patent does not teach elimination of the downwardly depending leg portions of the staple. In fact, Groiso teaches away from elimination of the leg portions by noting “the aim of attaining a desired spacing between bone fragments could be obtained with connecting elements such as plates and screws, but these are much bulkier, require major surgical procedures for the placing thereof and the possibility of trauma is increased.” U.S. Pat. No. 5,947,999 (Col. 2, lines 55-59). Additionally, the '999 patent is direct toward connecting soft tissues (tendons and ligaments) to bone.
• U.S. Pat. No. 4,444,181 (Wevers et al.) discloses a bone clip for repair of bones in vivo including a body having a slot in a central portion thereof and a pair of downwardly depending legs on either end of the body. After the clip is inserted in opposing bones, opposing bridges are compressed toward one another (rather than expanded) to shorten the clip and thereby draw the bones together.
• The use of bone screws and bone plates to reduce fractures is well known in the art. However, as far as the applicant is aware, no attempt has been made to provide a brace and screw combination that has the ability to pull bone fragments together in the efficient and highly effective manner described herein. There is thus a need for a surgical device having the following characteristics and advantages over the prior art.
OBJECTS AND SUMMARY OF THE INVENTION
• It is an object of the invention to provide an improved means of compressing adjacent bones together in surgical applications.
• It is an object of the invention to provide a substitute for surgical compression staples that has superior anchorage in bone.
• It is an object of the invention to increase intra-operative choices by allowing a surgeon to select desired lengths and diameters of fasteners. It is an object of the invention to reduce inventory by allowing a surgeon to mix and match between braces and fasteners.
• The foregoing objects and advantages are achieved by providing a surgical device for pressing and retaining adjacent bones against one another comprising a compression brace and separate fasteners. The compression brace has at least two fastener retaining portions. Each fastener retaining portion has a fastener hole therethrough for receiving a fastener. A pair of bridge members are positioned between the fastener retaining portions, and are spaced apart from one another to thereby form a compression opening between the fastener retaining portions. Each bridge member is preferably substantially V-shaped. The fasteners are sized and configured to pass through the fastener hole and retain the compression bracket on bones. The fasteners preferably have a lengthwise shaft sized to pass through the fastener hole and an upper retainer portion sized and configured to retain the fastener in the fastener hole. In one embodiment, the fasteners are screws having a lower thread positioned to engage bone. In an alternative embodiment, the fasteners are pins. The compression bracket can include a plurality of fastener retaining portions and a plurality of compression openings.
• The device is preferably provided with a means for selectively locking the fasteners in the fastener holes to maintain the fasteners in a substantially fixed relation with the fastener retaining portion. Alternatively, the fastener hole of the brace member may be substantially smooth. The shaft of at least one of the fasteners can be sized to provide play between the shaft and the fastener hole, such that the fastener can be selectively angled into bone during use of the device.
• The foregoing and other objects, features, aspects and advantages of the invention will become more apparent from the following detailed description of the invention when considered in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a top view of one preferred embodiment of a compression brace of the invention, showing the brace in an uncompressed configuration.
• FIG. 2 is a top view of the compression brace ofFIG. 1, showing the brace in a compressed configuration and featuring a pair of screws disposed in the brace.
• FIG. 3 is a side cross-section of view taken along3-3 ofFIG. 1.
• FIG. 4 is a side partial cross-section view illustrating use of the compression brace of the invention to reduce a fracture by drawing adjacent bones together, featuring the brace in an uncompressed configuration prior to reduction of the fracture.
• FIG. 5 is a side partial cross-section view illustrating use of the compression brace of the invention to reduce a fracture by drawing adjacent bones together, featuring the brace in a compressed configuration.
• FIG. 6 is a top view of a preferred embodiment of the compression brace of the invention, featuring an unthreaded fastener hole.
• FIG. 7 is a side cross-section view taken along7-7 ofFIG. 6, and illustrating radial play of a screw within the unthreaded fastener hole.
• FIGS. 8A-8C show views of one preferred embodiment of the invention, featuring a pair of compression brackets joined end-to-end.
• FIGS. 9A,9B, and9C provide isometric, top, and cross-sectional views, respectively, of one preferred embodiment of the invention, featuring a plurality of clip members radiating from a shared fastener retaining portion.
• FIGS. 10A,10B, and10C provide isometric, top, and side views, respectively, of one preferred embodiment of the invention, featuring a plurality of compression brackets joined end-to-end via shared fastener retaining portions, and including a branching compression bracket.
• FIG. 11A is a side view of a preferred embodiment of a screw type fastener for use in the invention.
• FIG. 11B is an isometric view of the screw type fastener illustrated inFIG. 11A in accordance with some embodiments.
• FIG. 11C is a top side view of the screw type fastener illustrated inFIG. 11A in accordance with some embodiments.
• FIG. 12A is an isometric view of a pin-type fastener in accordance with some embodiments.
• FIG. 12B is a side perspective view of the pin-type fastener illustrated inFIG. 12A in accordance with some embodiments.
• FIG. 12C is a top side view of the pin-type fastener illustrated inFIG. 12A.
• FIGS. 13A-13C provide isometric, top side, and side views, respectively, of one preferred embodiment of the invention, featuring a pair of compression brackets joined end-to-end via a shared fastener retaining portion.
• FIGS. 14A,14B, and14C provide isometric, top, and cross-sectional views, respectively, of another example of a compression brace and fasteners in accordance with some embodiments.
• FIGS. 15A,15B, and15C provide isometric, top, and cross-sectional views, respectively, of another example of a compression brace in accordance with some embodiments.
• FIGS. 16A,16B, and16C provide isometric, top, and cross-sectional views, respectively, of another example of a compression brace in accordance with some embodiments.
• FIGS. 17A,17B, and17C provide isometric, top, and cross-sectional views, respectively, of another example of a compression brace in accordance with some embodiments.
• FIGS. 18A,18B, and18C provide isometric, top, and cross-sectional views, respectively, of another example of a compression brace in accordance with some embodiments.
• FIGS. 19A,19B,19C, and19D provide isometric, top, cross-sectional, and side views, respectively, of another example of a compression brace in accordance with some embodiments.
• FIG. 20 is a perspective view of one embodiment of a drill guide instrument for use in installing the compression brackets of the invention.
• FIGS. 21A and 21B provide perspective views of drivers for use with the drill guide instrument ofFIG. 20 in accordance with some embodiments.
• FIGS. 22A,22B,22C, and22D provide isometric, side, cross-sectional, and detail views, respectively of a snap-off screw for use with the compression brace in accordance with some embodiments.
PREFERRED EMBODIMENTS OF THE INVENTION
• In the following detailed description of the preferred embodiments, reference is made to the accompanying drawings which form a part hereof, and in which are shown by way of illustration specific embodiments in which the invention may be practiced. It is to be understood that other embodiments may be utilized and structural changes may be made without departing from the scope of the present invention.
• As shown inFIGS. 4 and 5, the invention is a surgical device for pressing and retainingadjacent bones301,302 against one another, such as to reduce a fracture. As shown in the uncompressed configuration ofFIG. 4, the invention includes, generally, acompression brace1 andfasteners100 for securing the brace onbones301,302. As indicated in the compressed configuration ofFIG. 5, compression of thebrace1 presses the adjacent bone fragments301,302 together.
• As shown inFIG. 1, in a preferred embodiment thecompression brace1 has at least twofastener retaining portions10. Eachfastener retaining portion10 has a fastener hole or bore20 therethrough for receiving afastener100. In a preferred embodiment shown inFIG. 3, athread22 is provided in thefastener hole20. As indicated in the side view ofFIG. 3, thebrace1 can be considered to have a tissue orosteo side2, which sits against the bones during use, and an opposing side orouter surface3. As shown inFIG. 3, thefastener retaining portion10 preferably has acounterbore30 formed in theouter surface3. Thecounterbore30 is preferably substantially in axial alignment with thefastener hole20. Thecounterbore30 is preferably spherical. Thecounterbore30 is sized and configured to provide countersinking of anupper retainer portion150 of afastener100 in thefastener retaining portion10 of thecompression brace1.
• A pair ofbridge members50A,50B are positioned between thefastener retaining portions10. Thebridge members50A,50B preferably extend directly from thefastener retaining portions10, but may be spaced from one or both of the fastener retaining portions, such as by a shared extension portion disposed between thebridge members50A,50B andfastener retainer portions10. Thebridge members50A,50B are spaced apart from one another to form a compression opening70 between thefastener retaining portions10. Thebridge members50A,50B and the compression opening70 are used to compress thefastener retaining portions10 andfasteners100 toward one another, in a manner described in further detail below.
• In the preferred embodiment shown inFIG. 1, thebridge members50A,50B are substantially V-shaped. The V-shape is preferably formed by generallylinear portions51,52, which normally join one another at an obtuse angle when thebrace10 is in an uncompressed configuration. When opposing expansion forces are applied to thebridges50A,50B substantially along lines of force F inFIG. 1, central portions of thebridge members50A,50B expand outward, thus drawing or compressing thefastener retaining portions10 toward one another.FIG. 2 demonstrates the configuration of the compression brace ofFIG. 1 after it has been compressed a selected amount. Note that inFIG. 2, thecompression brace1 has contracted generally along its lengthwise axis, while the opposingbridge members50A,50B have expanded in directions generally transverse to the lengthwise axis. Alternatively, thebridge members50A,50B can be pinched toward one another. Pinching will tend to force thefastener retaining portions10 apart, particularly when using a V-shaped opening, which can be useful for certain surgical applications, such as distractions. In this manner, thecompression brace1 can be used both for compression and distraction, as well as to provide for fine-tuning of bone gap sizes and compressive forces. Pinching can also be used to force thefastener retaining portions10 toward one another, resulting in compression.
• Bridge members50A,50B may alternatively have curved, arcuate, straight, or other deformable configurations, provided thatbridges50A,50B are configured to form a deformable compression opening70. InFIG. 6, thebridge members50A,50B are shortened and form a tighter angle along the compression opening70.FIG. 6 also shows an embodiment in which a chamfer is formed along the upper edge of thecompression brace1.
• As shown inFIG. 4,fasteners100 are used to secure thebracket1 toadjacent bones301,302. Eachfastener100 is sized and configured to pass through afastener hole20 and to retain thecompression bracket1 onbones301,302.Fasteners100 of differing diameter can be used. For example, if angulation of thefastener100 is desired, a smaller diameter may be used. Thefasteners100 may be locking or non-locking In a preferred embodiment shown inFIGS. 11A-11C, eachfastener100 has alengthwise shaft110 sized to pass through at least one of the fastener holes20, and anupper retainer portion150 sized and configured to retain thefastener100 in thefastener hole20. As shown inFIGS. 11A-11C, theretainer portion150 is preferably a circumferential head of the type used in conventional screws. Thehead150 is preferably provided with a self-retaining drive mechanism, such as press-fit drive slots155.
• As shown inFIGS. 11A-11C, thefastener100 is preferably ascrew100, in which case theshaft110 is provided with alower thread112 that is positioned to engage bone. Thelower thread112 is preferably self-tapping and self-drilling in bone. To facilitate tapping of thelower thread112 into bone, a cutting means115 is preferably provided on or adjacent the tip of thescrew100. Cutting means are well known to those of skill in the art of surgical screws.
• As shown inFIGS. 12A-12C, an alternativepreferred fastener100 is apin100. Thepin100 shown inFIGS. 12A-12C has an enlarged head orfastener retainer portion150 configured to retain thepin100 in thefastener retainer member10. Theshaft110 of thepin100 preferably has a substantially smooth outer surface.
• In a preferred embodiment shown inFIGS. 11A-11C, anupper thread120 is provided on theshaft110 adjacent the head of thefastener100 for use in engaging theinternal thread22 in thefastener hole20. In a preferred embodiment, theupper thread120 of thefastener100 and theinternal thread22 of thecompression brace1 serve to maintain thefastener100 in a substantially fixed relation to thefastener retaining portion10. For example, inFIG. 5, anupper thread120 has maintained thefasteners100 in a substantially perpendicular relation to thefastener retainer portion10. In the preferred embodiment ofFIG. 5, thefasteners100 have maintained a substantially fixed relation even after thecompression bracket1 has been compressed to draw thebones301,302 together. A substantially fixed relationship can also be obtained by providing a snug-fit screw head appropriately sized to thefastener hole20 andcounterbore30. In the prior art uni-body compression staples disclosed in the Groiso patents, the pins of the staples tend to splay outward significantly during use in vivo, decreasing the compressive strength of the staples.
• The invention may be provided with ameans130 for selectively locking thefastener100 in thefastener hole20. In the preferred embodiment shown inFIGS. 11A-11C, the locking means130 is provided by forming theupper thread120 from double-lead threads132,133. The double-lead threads132,133 provide selective locking of thefastener100 in thefastener hole20 via locking interaction with the singleinternal thread22 of thefastener hole20. One advantage of a double-lead type of locking means130 is that the threads can be configured such that thecompression bracket1 can be reused, for example if it becomes necessary to remove and replace or reposition theoriginal fastener100. Other locking means include mismatched threads.
• As shown inFIG. 7, the surgical device may be configured such that there is play between thefastener100 and thefastener retaining portion10. In the preferred embodiment shown inFIG. 7, thefastener hole20 of the brace member is substantially smooth, i.e. unthreaded. Additionally, theshaft110 of thefastener100 is sized to provide play between theshaft100 and thefastener hole20. As indicated inFIG. 7, this configuration allows thefastener100 to be selectively angled into bone during use of the device.
• Snap-off screws, such as the type shown inFIGS. 22A-22D, can be used asfasteners100. The snap-off surgical screw shown inFIG. 22B is similar to the screws described above in that it has ahead150, an upper threadedpart120 providing alocking thread130 distal to the head, and abore thread112 distal to the lockingthread130. Additionally, ashaft extension160 extends above the poly-axial head for use in rotating and driving the screw. Theshaft extension160 is axially aligned with thescrew100. A distal end of theshaft extension160 is fixedly connected to thehead150 of the screw by anarrow shaft161. After thescrew100 is inserted, theshaft160 is broken off of thescrew100 at the point of thenarrow shaft161.
• FIGS. 14A-17C provide views of various embodiments ofcompression brackets1 of the invention. The bracket shown inFIGS. 14A-14C has an elongated compression opening70.FIGS. 15A-15C show acompression bracket1 having a spaced apartbridge members50A,50B, such that the opposing ends of thebridge members50A,50B are not directly adjacent one another.FIGS. 16A-16C show acompression bracket1 having spaced apartbridge members50A,50B. Additionally, the spaced apartbridge members50A,50B ofFIGS. 16A-16C are straight, and thus lack the V-shaped configuration of other embodiments. The configuration ofFIGS. 16A-16C is particularly adapted for situations in which it may be desirable to obtain compression by bending thebridge members50A,50B toward one another rather than by spreading the bridge members apart, although thebridges50A,50B can also be spread. The bracket shown inFIGS. 17A-17C has a straight and generally narrow compression opening70, but is provided with diametrically opposed distal curved portions for use in engaging thebridge members50A,50B during spreading of the compression opening70.
• FIGS. 18A-18C show yet another embodiment in which the opposing bridge, and hence the compression opening70, are eliminated in favor of asingle bridge50. Thesingle bridge50 can be bent in order to draw the opposingfastener retaining portions10 together. Otherwise, the embodiment shown inFIGS. 18A-18C can be provided with the various threaded and unthreaded variations described above.
• FIGS. 19A-19D show an embodiment that combines the features of prior art surgical staples with the advantages provided by thecompression bracket1 of the present invention. As shown inFIG. 19A, the combined staple-compression bracket includes opposingbridge members50A,50B and afastener retaining portion10 having the configuration and characteristics described above. However, the opposing end of the device is provided with a downwardly dependingleg200. The downwardly dependingleg200 is preferably provided with means for securing theleg200 in bone, such as the proximal201 and distal202 teeth or serrations shown inFIG. 19C.
• As shown inFIGS. 8A-10C and13A-13C, thecompression bracket1 can include a plurality offastener retaining portions10 and a plurality of compression openings70. In the embodiment shown inFIGS. 8A-8C, a pair of compression brackets are joined end-to-end in a unitary or unibody compression bracket structure.FIGS. 13A-13C show an end-to-end configuration in whichbridge members50A,50B are joined by a sharedfastener retaining portion10. InFIGS. 9A-9C, a plurality ofbridge members50A,50B radiate from a sharedfastener retaining portion10. InFIGS. 10A-10C, a plurality ofcompression brackets1 are joined end-to-end via sharedfastener retaining portions10.FIGS. 10A-10C also include a compression bracket that branches off from the main chain via a sharedfastener retaining portion10. Multi-part compression brackets can also be configured to include adjacent compression openings that are not separated by afastener retaining member20. Multi-compression brackets such as those shown inFIGS. 8A-10C are particularly suited for fixation or distraction of multi-part fractures, such as when a bone fractures into more than two fragments. The multi-compression bracket embodiments shown inFIGS. 8A-10C are merely exemplary preferred embodiments of the invention, and are intended to provide those with skill in the art with the building blocks necessary to configure a wide variety of multi-compression bracket configurations, all of which would fall within the scope of the invention.
• One of the advantages of the invention over the prior art is that it enables a surgeon to intra-operatively select various combinations of brace and fastener sizes and configurations to accommodate the operative condition of a particular surgical site, thus providing greater options while decreasing staple inventory. To further enhance options, compression braces1 can be provided with a combination of threaded and unthreaded holes. Such a configuration could be used, for example, in situations where it is desirable to provide a perpendicularly locked fastener on one end of thebrace1, while providing selective angulation of thefastener100 on the opposing end of the brace. The same effect can be obtained by selecting afastener100 sized to permit angulation through a relatively larger threadedhole20, such that the threads of thehole20 do not substantially impinge on the selected degree of angulation. Similarly, a combination of locking and non-locking threads can be used.
• Thecompression brace1 is used primarily for fixation of arthrodeses and osteotomies. Thecompression brace1 can also be used in place of conventional plates, such as cuboid plates, hind or mid-foot plates, or calcaneal plates.
• In operation, thecompression brace1 is used as follows. After preparation of the surgical site, thecompression brace1 is placed onadjacent bones301,302 such that one of the fastener holes is on the first bone orbone fragment301 and one of the fastener holes302 is on the second bone or bone fragment (seeFIG. 4). The first andsecond bones301,302 may of course be fragments or segments of the same bone, i.e. after fracture. Thecompression brace1 is secured on thefirst bone301 by inserting afastener100 through one of the fastener holes20 and into thefirst bone301. Thecompression brace1 is secured to thesecond bone302 by inserting afastener100 through one of the fastener holes20 and into the second bone. Thebridge members50A,50B of thecompression brace1 are then spread apart to draw thefasteners100 and thebones301,302 toward one another. During spreading of thebridge members50A,50B during compression, sufficient force can be applied to pressadjacent bones301,302 against one another to substantially eliminate agap300 between thebones301,302. Alternatively, sufficient force can be applied to move thebones301,302 toward one another a selected distance, but without removing thegap300. With fractures having more than two bone fragments, more than onecompression brace1 can be used to fix the fracture. Alternatively, a multi-compression bracket such as the embodiments shown inFIGS. 8A-10C can be used to fix the various bone fragments. In one embodiment of the method, holes are drilled into thebones301,302 through the fastener holes20, and thefasteners100 are then installed in the drilled holes. Pre-drilling is unnecessary if self-drilling fasteners100 are used.
• Thecompression bracket1 can also be used as a distraction plate, such as for opening osteotomies (e.g. HTO or spine distraction). By applying a force to bridgemembers50A,50B, a space can be created or widened, thus forcing thefasteners100 apart. Thedevice1 can be used to open a space to allow insertion of a spacer, and then used to close the space in order to sandwich the spacer between adjacent bones.
• Thecompression bracket1 can be installed with or without specialized instrumentation.FIG. 20 shows a preferreddrill guide instrument300 for use in installing the compression braces1. Thedrill guide300 includes a handle or mountingarm310 having anextension portion312. Astationary guide base318 is fixedly mounted on an upper end of theextension portion312. As shown inFIG. 20, anadjustable guide base328 is slideably and adjustably engaged to thestationary guide base318 via anadjustment member320 having alengthwise opening321 therethrough. A locking means312 is provided for selectively locking theadjustable guide base328 relative to thestationary guide base318. In the embodiment shown inFIG. 20, the locking means is aring330 threaded on theextension portion312.
• Afirst drill guide301 is fixedly mounted on thestationary guide base318, while asecond drill guide302 is fixedly mounted on theadjustable guide base328. The drill guides301,302 are preferably removable from the drill guide instrument in order to accommodate selected sizes and configurations offasteners100 and compression braces1. A distal end of thedrill guide301,302 is provided with a counter bore having aside slot304 therethrough for accommodating acompression brace1, in the manner shown inFIG. 20.
• As indicated inFIG. 20, eachdrill guide301,302 has a lengthwise cylindrical sleeve (not shown) passing therethrough. As shown inFIG. 20, the sleeves are sized to receive and provide rotational guidance to driver components such as drill bit380 (preferred embodiment shown inFIG. 21A) or a screwdriver390 (preferred embodiment shown inFIG. 21B). As shown inFIGS. 21A and 21B, thedriver components380,390 have acylindrical shaft portion384 sized to permit guided rotation within the drill guides301,302. Astop386 is provided on theshaft384. Thestop386 is sized and positioned to abut against thedrill guide301,302, theguide base318,328 or another selected portion of thedrill guide instrument300 to prevent over drilling. Thedrive components380,390 are provided with a conventional388 mount on an upper end for selective engagement with a drive means, in a manner known to those of skill in the art. As shown inFIG. 21A, the drillbit driver component380 is provided with adrill bit381. As shown inFIG. 21B, thescrew driver component390 is provided with ascrew driver head391 configured to match thefasteners100. Various sizes and types ofdrill bits381 andscrewdrivers391 can be used with thedrill guide instrument300, depending on intra-operative conditions. A tamping driver (not shown) can be provided for insertingpins100 with thedrill guide instrumentation300.
• As indicated inFIG. 20, thedrill guide instrument300 can be adjusted to the size of a selectedcompression brace1 simply by sliding thesecond drill guide302 relative to thefirst drill guide301 until a suitable position is reached, and then locking thesecond drill guide302 in place via the locking means330. Thedrill guide instrument300 aligns the axes of thedriver components380,390 with those of the fastener holes20, which enables precise drilling or threading of fastener screws100.
• Spreading of thebridge members50A,50B is preferably accomplished using a spreader, such as the type shown in FIG. 10 of U.S. Pat. No. 5,660,188 (Groiso). If crimping of thebridge members50A,50B is desired, pliers can be used.
• The device and method can be used to join, fix and maintain bones in various procedures, including: LisFranc arthrodesis; mono or bi-cortical osteotomies in the forefoot; first metatarsophalangeal arthrodesis; Akin osteotomy; midfoot and hindfoot arthrodeses or osteotomies; fixation of osteotomies for hallux valgus treatment (Scarf and Chevron); and arthrodeses of the metatarsocuneiform joint to reposition and stabilize the metatarsus primus varus; carpal bone fusion; wrist fusion; elbow fracture; and metacarpal fractures.
• Thecompression brace1 andfasteners100 are preferably made of suitable biocompatible materials having sufficient mechanical strength and elasticity for the desired applications of theinvention1. Suitable materials include medical grade titanium alloys, medical grade stainless steel, and cobalt chrome. A memory metal, such as nitinol, can be incorporated into the invention. Suitable non-metallic biocompatible materials can also be used. Further, thebrace1 orfasteners100 can be made of a suitable bio-absorbable material, such that the components are eventually absorbed by the body after healing of the bone parts.
• Unless the context indicates otherwise, the term “bone” as used herein includes whole bones as well as bone fragments (i.e. the two or more fragments of a particular bone that remain after the bone has been fractured, either completely or incompletely).
• Although the present invention has been described in terms of specific embodiments, it is anticipated that alterations and modifications thereof will no doubt become apparent to those skilled in the art. It is therefore intended that the following claims be interpreted as covering all alterations and modifications that fall within the true spirit and scope of the invention.

Claims (3)

What is claimed is:

1. A method, comprising:

receiving a compression brace in a drill guide such that a first fastener retainer of the compression brace is received within a first counterbore of the drill guide, a second fastener retainer of the compression brace is received within a second counterbore of the drill guide, and a first bridge member that extends directly from an outer surface of the first and second fastener retaining portions is received within slide slots defined by the first and second counterbores;

inserting a first threaded shaft of a first fastener into a first threaded opening defined by the first fastener retainer;

driving the first threaded shaft into a first bone segment until threads of a first head of the first fastener engage the first threaded opening;

inserting a second threaded shaft of a second fastener into a second threaded opening defined by the second fastener retainer;

driving the second threaded shaft into a second bone segment until threads of a second head of the second fastener engage the second threaded opening;

removing the drill guide from its engagement with the compression brace; and

deforming the first bridge member to adjust a distance between the first and second fastener retaining portions to thereby provide one of distraction or compression to the first and second bone segments.

2. The methodclaim 1, wherein the compression brace includes a second bridge member that extends directly from an outer surface of the first and second fastener retaining portions and defines a compression opening with the first bridge member.

3. The method ofclaim 2, further comprising deforming the second bridge member to adjust a distance between the first and second fastener retaining portions to thereby provide one of distraction or compression to the first and second bone segments.

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