US20130150903A1 - Devices and methods for bone fixation using axial implants - Google Patents
Devices and methods for bone fixation using axial implants Download PDFInfo
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- US20130150903A1 US20130150903A1 US13/712,282 US201213712282A US2013150903A1 US 20130150903 A1 US20130150903 A1 US 20130150903A1 US 201213712282 A US201213712282 A US 201213712282A US 2013150903 A1 US2013150903 A1 US 2013150903A1
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- A—HUMAN NECESSITIES
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- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/72—Intramedullary pins, nails or other devices
- A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
- A61B17/7241—Intramedullary pins, nails or other devices with special means of locking the nail to the bone the nail having separate elements through which screws pass
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- A61B2017/681—Alignment, compression, or distraction mechanisms
Definitions
- This invention relates to the field of orthopedic implant devices.
- a typical application is as an intramedullary fixation assembly used for the fixation of bones and the correction of deformities in the foot.
- Charcot arthopathy or Charcot foot
- Charcot arthopathy is a destructive process affecting many regions including joints of the foot and ankle in diabetics. Charcot arthopathy can affect any joint in the body but is often seen in the foot. In the foot, the Charcot process typically affects the tarsal and metatarsal bones and the tarsometatarsal and intertarsal joints which causes the foot to lose its arch. This causes fragmentation, dislocation and fractures that eventually progress to deformity, instability and bony prominences. Foot ulcers may develop which often lead to deep infection and sometimes amputation.
- FIG. 1 depicts a human foot 100 afflicted with Charcot arthopathy. Phalanges 110 , the first metatarsal 120 , medial cuneiform 130 , navicular 140 , and talus 150 bones are depicted in foot 100 . The deformity in the foot will be apparent.
- Surgical treatments include orthopedic fixation devices that fixate the bones in order to fuse them into a stable mass. These orthopedic implant devices realign bone segments and hold them together in compression until healing occurs, resulting in a stable mass.
- the present invention is improved devices and methods for bone fixation.
- the improved devices include a screw for use in fixating the bones and the combination of the screw with at least one transverse element for use in compressing the bones.
- the screw comprises a shaft having first and second ends with spirally wound screw threads beginning near the first end and extending along the shaft.
- the screw is cannulated and screw threads are formed on an interior surface of the cannulation.
- transverse element When the screw is implanted in a patient's foot, at least one transverse element is secured to the screw near its first or second end.
- the transverse elements may be staples, open-ended washers, or open-ended nuts. The screw is then tightened causing the bones along the screw to be compressed.
- the methods of the invention comprise aligning the bones in their desired position, inserting a screw in the aligned bones, inserting at least one transverse element near the head or tip of the screw, and tightening the screw. Further details of the process are set forth below
- Instruments are also disclosed for use in practicing the invention. These include reduction instruments for use in aligning the bones and a drill guide for drilling holes adjacent the screw where one or more transverse elements may be inserted.
- FIG. 1 depicts a human foot afflicted with Charcot arthopathy
- FIG. 2 is a cross-section of an illustrative embodiment of a screw of the present invention
- FIG. 3 is a flow chart depicting illustrative steps of an embodiment of the invention.
- FIG. 4 depicts a reduction instrument used in the practice of the invention
- FIGS. 5 , 6 , 8 - 11 , and 15 depict details of certain of the steps of FIG. 3 ;
- FIG. 7 depicts a drill guide used in the practice of the invention.
- FIGS. 12-14 depict several transverse elements that may be used in the practice of the invention.
- FIG. 2 is a cross-section of an illustrative embodiment of a screw 200 that may be used in the practice of the invention.
- Screw 200 has an elongated shaft 210 having first and second ends 220 , 225 and a longitudinal axis A-A extending along the shaft.
- the shaft is cannulated having a bore 230 that extends from first end 220 to second end 225 .
- On an exterior portion of the shaft near the first end 220 are spirally wound threads 240 that begin at approximately the first end 220 of the shaft.
- the head may be set off from the remainder of the shaft by a recess that circumscribes the shaft such as shown at 252 in FIG. 6 .
- the invention may also be practiced using a screw in which there are threads at the second end of the screw in place of a head.
- the head of the shaft includes a recess 255 open to the end of the shaft that is shaped to receive an instrument such as a screw driver or wrench in driving engagement.
- the recess may be hexagonal in shape so as to receive a hexagonally shaped wrench similar to an Allen wrench or the like; or the recess may be slotted so as to receive the slotted blade of a screw driver.
- the screw may be reinforced at points where forces are concentrated during use of the screw such as the point 242 where exterior screw threads 240 end.
- the threads may also be tapered at point 242 .
- Spirally wound threads may also be formed on an interior surface 232 of the bore 230 . Such threads can facilitate extraction of the screw if that becomes desirable.
- the screw may also be treated by various processes to increase its strength.
- FIG. 3 is a flow chart depicting illustrative steps of an embodiment of the invention used to treat Charcot arthopathy. It will be understood that the flow chart is only illustrative, that the order of execution of some steps may vary, and that some steps may not need to be used in the treatment of a particular patient in accordance with the invention.
- an incision is made in the foot at step 310 to expose the metatarsal.
- the incision is a doral Lis Franc incision.
- the foot is “gunstocked” at step 315 .
- the bones of the foot typically the metatarsal, cuneiform, navicular and talus are then aligned at step 315 in the desired final position using a guide wire (e.g., a K-wire) to secure the bones in the desired alignment.
- a guide wire e.g., a K-wire
- the guide wire is inserted into the bones using a reduction instrument such as instrument 400 of FIG. 4A .
- Instrument 400 comprises a hollow sleeve 410 mounted on a handle 420 .
- Sleeve 410 has a cutting tip 430 on the end of the sleeve remote from the handle.
- a bore 435 extends through sleeve 410 and handle 420 having an inside diameter that is large enough to allow passage of a guide wire 440 .
- the diameter of guide wire 440 that may be used in the practice of the invention can vary considerably depending on the patient and the surgeon's preferences. Illustratively, the diameter is in the range of approximately 1.0 to 4.0 millimeters (mm). Different sleeve lengths may be used in the practice of the invention depending on the size of the bones that are to be aligned.
- instrument 400 is used with guide wire 440 sticking through tip 430 , which allows guide wire 440 to be seated and unseated in the bone.
- the other end of guide wire 440 is keyed in handle 420 so that it can be easily maneuvered by the handle.
- instrument 400 is removed from the guide wire.
- a drill bit is then mounted on the guide wire; and a borehole is drilled at step 325 through one or more of the aligned bones.
- FIG. 5 depicts drill bit 510 on guide wire 440 boring a hole in the aligned bones, in this example, the first metatarsal, the medial cuneiform, the navicular, and the talus bones of a left foot.
- the drill is then removed; and a cannulated screw such as screw 200 of FIG. 2 is mounted on the guide wire at step 330 . Screw 200 is then screwed into the borehole at step 335 using a screw driver 600 as shown in FIG. 6 .
- a drill guide is then mounted on the screw at step 345 .
- the drill guide is used at step 350 to guide a drill bit in forming first and second holes on opposite sides of the screw at a first position that typically is just below the head of the screw. In forming these holes, the drill bit breaks the cortex of the bone on either side of the screw at the first position.
- the drill guide is also used at step 355 to guide an osteotome that cuts the cortex of the bone between the first and second holes at the first position.
- an element of the drill guide is positioned at a second position above the threaded portion of the screw at step 360 . This element is then used at step 365 to form at least one pair of third and fourth holes on opposite sides of the screw at the second position.
- the drill bit breaks the cortex of the bone on either side of the screw in the second position.
- This element is also used at step 370 to guide an osteotome that cuts the cortex of the bone between the third and fourth holes at the second position.
- the drill guide is then withdrawn at step 375 .
- Guide 700 comprises a screw mount 710 that is screwed or clamped onto screw 200 so that it is aligned with the longitudinal axis A-A of screw 200 .
- the guide further comprises a bracket 720 that is mounted on the screw mount 710 and an extension arm 730 that is mounted on bracket 720 so that the arm extends parallel to the longitudinal axis of screw 200 .
- Bracket 720 encloses first and second holes 722 , 724 and a slot 726 that extends between the first and second holes.
- Extension arm 730 encloses several sets of third and fourth holes 732 , 734 and a slot 736 that extends between the third and fourth holes.
- the first and second holes are located in bracket 720 at a position such that when bracket 720 is securely mounted on screw 200 , the holes are on opposite sides of the screw at the first position on the screw.
- Extension arm 730 can be positioned so that the third and fourth holes are on opposite sides of the screw at the second position on the screw.
- the several sets of holes 732 , 734 and slot 736 make it possible to locate several transverse elements at the second position.
- a ruler on the extension arm allows the surgeon to locate the second position with precision.
- FIG. 8 depicts screw mount 710 and bracket 720 mounted on screw 200 .
- FIG. 9 depicts depicts the use of hole 722 to guide a drill bit 922 in drilling a hole into the cortex adjacent screw 200 in the first position; and
- FIG. 10 depicts the use of slot 726 to guide an osteotome 1026 in breaking a hole in the cortex around screw 200 at the first position.
- FIG. 11 depicts screw mount 710 , bracket 720 and extension arm 730 cooperating to locate the sets of third and fourth holes 732 , 734 and slot 736 at a second position on the screw.
- the two ends of a staple, an open washer, an open nut or the like are inserted into the first and second holes at the first position; and the two ends of one or more staples, open washers, open nuts or the like are inserted into the third and fourth holes at the second position.
- the staples, washers, nuts as the case may be are then driven at step 385 into their final position in the cortex so that they engage the screw at the first position near the head and engage the screw threads at the second position.
- FIG. 12 depicts the profile of an open washer or open nut 1200 .
- FIG. 13 depicts the profile of an open washer or open nut 1300 in position around screw 200 .
- FIG. 14 depicts a staple 1400 in position around screw 200 .
- each washer or nut 1200 , 1300 and each staple 1400 has two spaced-apart ends 1210 , 1212 ; 1310 , 1312 ; 1410 , 1412 joined by a middle portion 1214 , 1314 , 1414 , respectively.
- the middle portion may be straight as in the case of a conventional staple or rounded to varying degrees thereby approximating the curvature of the exterior of the screw.
- the various elements such as staples, open washers, open nuts and the like that may be used in the practice of the invention will be referred to as transverse elements.
- a screw driver is then used at step 390 to turn the screw so as to bring closer together the transverse elements at the first and second position, thereby compressing the bones between these positions.
- FIG. 15 depicts a screw driver 1500 being used to turn screw 200 to move staples 1510 and 1520 closer together.
- the screw driver is then removed and the incision is closed at step 395 .
- transverse elements can be drilled at the second position before they are drilled at the first position; or it may not be necessary to drill the holes at one or both positions because it may be possible to insert the transverse elements at the appropriate positions around the screw using other devices. Similarly, it may not be necessary to use the osteotome at one or both positions.
Abstract
The invention comprises a method for fixating bones in the foot by aligning the bones in their desired position, inserting a screw in the aligned bones, inserting at least one transverse element near the head or tip of the screw, and tightening the screw to compress the bones. The screw comprises a shaft having first and second ends with spirally wound screw threads beginning near the first end and extending along the shaft. Advantageously, the screw is cannulated and screw threads are formed on an interior surface of the cannulation. Illustratively, the transverse elements may be staples, open-ended washers, or open-ended nuts. Reduction instruments and drill guides used in the invention are also disclosed.
Description
- This application claims benefit of provisional application Ser. No. 61/569,464, filed Dec. 12, 2011, the entire contents of which are incorporated herein by reference.
- This invention relates to the field of orthopedic implant devices. A typical application is as an intramedullary fixation assembly used for the fixation of bones and the correction of deformities in the foot.
- Orthopedic implant devices such as intramedullary nails, plates, rods and screws are often used to repair or reconstruct bones and joints affected by deformity and disease such as Charcot arthopathy caused by diabetes in some patients. Charcot arthopathy (or Charcot foot) is a destructive process affecting many regions including joints of the foot and ankle in diabetics. Charcot arthopathy can affect any joint in the body but is often seen in the foot. In the foot, the Charcot process typically affects the tarsal and metatarsal bones and the tarsometatarsal and intertarsal joints which causes the foot to lose its arch. This causes fragmentation, dislocation and fractures that eventually progress to deformity, instability and bony prominences. Foot ulcers may develop which often lead to deep infection and sometimes amputation.
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FIG. 1 depicts ahuman foot 100 afflicted with Charcot arthopathy.Phalanges 110, the first metatarsal 120, medial cuneiform 130, navicular 140, andtalus 150 bones are depicted infoot 100. The deformity in the foot will be apparent. - Early treatment for Charcot foot includes the use of therapeutic footwear, immobilization of the foot, and/or non-weightbearing treatment. Surgical treatments include orthopedic fixation devices that fixate the bones in order to fuse them into a stable mass. These orthopedic implant devices realign bone segments and hold them together in compression until healing occurs, resulting in a stable mass.
- Infection and complications are a major concern in these procedures. Wound closure is technically demanding for the surgeon, and devices that add surface prominence such as plates or exposed screws, add to the difficulty by requiring greater tissue tension during incision reapproximation. This increases the risk of post-operative wound infections and dehiscence that may ultimately result in limb amputation.
- There is therefore a need for improvements in intramedullary fixation assembly and methods of use that overcome some or all of the previously described drawbacks of prior art fixation assemblies and processes.
- The present invention is improved devices and methods for bone fixation.
- The improved devices include a screw for use in fixating the bones and the combination of the screw with at least one transverse element for use in compressing the bones. In a preferred embodiment, the screw comprises a shaft having first and second ends with spirally wound screw threads beginning near the first end and extending along the shaft. Advantageously the screw is cannulated and screw threads are formed on an interior surface of the cannulation.
- When the screw is implanted in a patient's foot, at least one transverse element is secured to the screw near its first or second end. By way of example but not limitation, the transverse elements may be staples, open-ended washers, or open-ended nuts. The screw is then tightened causing the bones along the screw to be compressed.
- Broadly, the methods of the invention comprise aligning the bones in their desired position, inserting a screw in the aligned bones, inserting at least one transverse element near the head or tip of the screw, and tightening the screw. Further details of the process are set forth below
- Instruments are also disclosed for use in practicing the invention. These include reduction instruments for use in aligning the bones and a drill guide for drilling holes adjacent the screw where one or more transverse elements may be inserted.
- Numerous variations may be practiced in the preferred embodiment.
- These and other objects and advantages of the present invention will be apparent to those of ordinary skill in the art in view of the following detailed description in which:
-
FIG. 1 depicts a human foot afflicted with Charcot arthopathy; -
FIG. 2 is a cross-section of an illustrative embodiment of a screw of the present invention; -
FIG. 3 is a flow chart depicting illustrative steps of an embodiment of the invention; -
FIG. 4 depicts a reduction instrument used in the practice of the invention; -
FIGS. 5 , 6, 8-11, and 15 depict details of certain of the steps ofFIG. 3 ; -
FIG. 7 depicts a drill guide used in the practice of the invention; and -
FIGS. 12-14 depict several transverse elements that may be used in the practice of the invention. -
FIG. 2 is a cross-section of an illustrative embodiment of ascrew 200 that may be used in the practice of the invention.Screw 200 has anelongated shaft 210 having first andsecond ends bore 230 that extends fromfirst end 220 tosecond end 225. On an exterior portion of the shaft near thefirst end 220 are spirallywound threads 240 that begin at approximately thefirst end 220 of the shaft. There may be ahead 250 on the shaft at itssecond end 225. The diameter of the head may be wider than the diameter of the shaft. Alternatively, the head may be set off from the remainder of the shaft by a recess that circumscribes the shaft such as shown at 252 inFIG. 6 . The invention may also be practiced using a screw in which there are threads at the second end of the screw in place of a head. - The head of the shaft includes a recess 255 open to the end of the shaft that is shaped to receive an instrument such as a screw driver or wrench in driving engagement. For example, by way of illustration but not limitation, the recess may be hexagonal in shape so as to receive a hexagonally shaped wrench similar to an Allen wrench or the like; or the recess may be slotted so as to receive the slotted blade of a screw driver. Alternatively, there may be no recess in the head; and the head may be shaped, for example, in a hexagon, to receive an instrument such as a socket wrench or the like.
- Optionally, numerous other refinements may be made in the construction of the screw. For example, the screw may be reinforced at points where forces are concentrated during use of the screw such as the
point 242 whereexterior screw threads 240 end. The threads may also be tapered atpoint 242. Spirally wound threads may also be formed on an interior surface 232 of thebore 230. Such threads can facilitate extraction of the screw if that becomes desirable. The screw may also be treated by various processes to increase its strength. -
FIG. 3 is a flow chart depicting illustrative steps of an embodiment of the invention used to treat Charcot arthopathy. It will be understood that the flow chart is only illustrative, that the order of execution of some steps may vary, and that some steps may not need to be used in the treatment of a particular patient in accordance with the invention. Initially, an incision is made in the foot atstep 310 to expose the metatarsal. Illustratively, the incision is a doral Lis Franc incision. Next, the foot is “gunstocked” atstep 315. The bones of the foot, typically the metatarsal, cuneiform, navicular and talus are then aligned atstep 315 in the desired final position using a guide wire (e.g., a K-wire) to secure the bones in the desired alignment. - Illustratively, the guide wire is inserted into the bones using a reduction instrument such as
instrument 400 ofFIG. 4A .Instrument 400 comprises a hollow sleeve 410 mounted on a handle 420. Sleeve 410 has acutting tip 430 on the end of the sleeve remote from the handle. A bore 435 extends through sleeve 410 and handle 420 having an inside diameter that is large enough to allow passage of aguide wire 440. - The diameter of
guide wire 440 that may be used in the practice of the invention can vary considerably depending on the patient and the surgeon's preferences. Illustratively, the diameter is in the range of approximately 1.0 to 4.0 millimeters (mm). Different sleeve lengths may be used in the practice of the invention depending on the size of the bones that are to be aligned. Advantageously,instrument 400 is used withguide wire 440 sticking throughtip 430, which allowsguide wire 440 to be seated and unseated in the bone. Advantageously, the other end ofguide wire 440 is keyed in handle 420 so that it can be easily maneuvered by the handle. - After the bones are aligned on the guide wire as described above,
instrument 400 is removed from the guide wire. Returning to the flow chart ofFIG. 3 , a drill bit is then mounted on the guide wire; and a borehole is drilled atstep 325 through one or more of the aligned bones. This step is illustrated inFIG. 5 which depictsdrill bit 510 onguide wire 440 boring a hole in the aligned bones, in this example, the first metatarsal, the medial cuneiform, the navicular, and the talus bones of a left foot. The drill is then removed; and a cannulated screw such asscrew 200 ofFIG. 2 is mounted on the guide wire atstep 330.Screw 200 is then screwed into the borehole atstep 335 using ascrew driver 600 as shown inFIG. 6 . - A drill guide is then mounted on the screw at
step 345. The drill guide is used atstep 350 to guide a drill bit in forming first and second holes on opposite sides of the screw at a first position that typically is just below the head of the screw. In forming these holes, the drill bit breaks the cortex of the bone on either side of the screw at the first position. The drill guide is also used atstep 355 to guide an osteotome that cuts the cortex of the bone between the first and second holes at the first position. Next, an element of the drill guide is positioned at a second position above the threaded portion of the screw atstep 360. This element is then used atstep 365 to form at least one pair of third and fourth holes on opposite sides of the screw at the second position. Again, the drill bit breaks the cortex of the bone on either side of the screw in the second position. This element is also used atstep 370 to guide an osteotome that cuts the cortex of the bone between the third and fourth holes at the second position. The drill guide is then withdrawn atstep 375. - The drill guide is shown as
guide 700 inFIG. 7 and its use is depicted inFIGS. 8-11 .Guide 700 comprises ascrew mount 710 that is screwed or clamped ontoscrew 200 so that it is aligned with the longitudinal axis A-A ofscrew 200. The guide further comprises abracket 720 that is mounted on thescrew mount 710 and anextension arm 730 that is mounted onbracket 720 so that the arm extends parallel to the longitudinal axis ofscrew 200.Bracket 720 encloses first andsecond holes slot 726 that extends between the first and second holes.Extension arm 730 encloses several sets of third andfourth holes slot 736 that extends between the third and fourth holes. The first and second holes are located inbracket 720 at a position such that whenbracket 720 is securely mounted onscrew 200, the holes are on opposite sides of the screw at the first position on the screw.Extension arm 730 can be positioned so that the third and fourth holes are on opposite sides of the screw at the second position on the screw. The several sets ofholes -
FIG. 8 depictsscrew mount 710 andbracket 720 mounted onscrew 200.FIG. 9 depicts depicts the use ofhole 722 to guide a drill bit 922 in drilling a hole into the cortexadjacent screw 200 in the first position; andFIG. 10 depicts the use ofslot 726 to guide anosteotome 1026 in breaking a hole in the cortex aroundscrew 200 at the first position.FIG. 11 depictsscrew mount 710,bracket 720 andextension arm 730 cooperating to locate the sets of third andfourth holes - Returning to the flow chart of
FIG. 3 , atstep 380, the two ends of a staple, an open washer, an open nut or the like are inserted into the first and second holes at the first position; and the two ends of one or more staples, open washers, open nuts or the like are inserted into the third and fourth holes at the second position. The staples, washers, nuts as the case may be are then driven atstep 385 into their final position in the cortex so that they engage the screw at the first position near the head and engage the screw threads at the second position. -
FIG. 12 depicts the profile of an open washer or open nut 1200.FIG. 13 depicts the profile of an open washer oropen nut 1300 in position aroundscrew 200.FIG. 14 depicts a staple 1400 in position aroundscrew 200. In each case, each washer ornut 1200, 1300 and each staple 1400 has two spaced-apart ends 1210, 1212; 1310, 1312; 1410, 1412 joined by amiddle portion 1214, 1314, 1414, respectively. The middle portion may be straight as in the case of a conventional staple or rounded to varying degrees thereby approximating the curvature of the exterior of the screw. For convenience, the various elements such as staples, open washers, open nuts and the like that may be used in the practice of the invention will be referred to as transverse elements. - A screw driver is then used at
step 390 to turn the screw so as to bring closer together the transverse elements at the first and second position, thereby compressing the bones between these positions. This is illustrated inFIG. 15 which depicts ascrew driver 1500 being used to turnscrew 200 to movestaples step 395. - As will be apparent to those skilled in the art, numerous variations may be practiced within the spirit and scope of the present invention. For example, a variety of different tools—screw drivers, wrenches, reduction instruments and drill guides—may be used in the practice of the invention. Screws of different sizes and different shapes may be used. Likewise different transverse elements may be used. There may also be variation in the procedure used to implant the screw and transverse elements in the foot. For example, certain steps can be skipped or combined with other steps and certain steps can be performed in a different order. In some procedures it may not be necessary to insert transverse elements at both the first and second positions. For example, it may be possible to develop sufficient compression between the head of the screw and one or more transverse elements located on the screw threads that a transverse element near the head of the screw is not needed. Alternatively, it may be possible to develop sufficient compression between the screw threads and a transverse element mounted near the screw head that one or more transverse elements mounted on the screw threads are not needed. When transverse elements are used at both the first and second positions, the holes can be drilled at the second position before they are drilled at the first position; or it may not be necessary to drill the holes at one or both positions because it may be possible to insert the transverse elements at the appropriate positions around the screw using other devices. Similarly, it may not be necessary to use the osteotome at one or both positions.
Claims (25)
1. A method for compressing bones comprising:
aligning the bones in a desired configuration,
inserting a screw into a borehole in the aligned bones,
inserting a first transverse element adjacent the screw at a first position, and
tightening the screw to compress the bones.
2. The method of claim 1 wherein the step of inserting a first transverse element adjacent the screw at a first position comprises the steps of:
drilling first and second holes on opposite sides of the screw at the first position, and
inserting the first transverse element into the first and second holes.
3. The method of claim 1 further comprising the step of inserting a second transverse element adjacent the screw at a second position.
4. The method of claim 3 wherein the steps of inserting a first transverse element adjacent the screw at a first position and inserting a second transverse element adjacent the screw at a second position comprise the steps of:
drilling first and second holes on opposite sides of the screw at the first position,
drilling third and fourth holes on opposite sides of the screw at the second position;
inserting the first transverse element into the first and second holes, and inserting the second transverse element into the third and fourth holes.
5. The method of claim 1 wherein the screw is cannulated and the step of inserting the screw into the borehole comprises:
mounting the screw on a guide wire in the borehole, and
inserting the screw into the borehole on the guide wire.
6. The method of claim 1 wherein the bones that are compressed are in a human foot.
7. The method of claim 1 wherein the first transverse element is a staple, open washer or open nut.
8. The method of claim 1 wherein the screw has threads at one end and the first transverse element engages the threads when it is inserted adjacent the screw.
9. A method for compressing bones comprising:
aligning the bones in a desired configuration,
forming a borehole on the aligned bones,
inserting a screw into the borehole,
attaching a guide element to the screw in the borehole,
using the guide element to drill first and second holes on opposite sides of the screw at a first position,
inserting a first transverse element into the first and second holes, and
tightening the screw to compress the bones.
10. The method of claim 9 further comprising the steps of:
using the guide element to drill third and fourth holes on opposite sides of the screw at a second position, and
inserting a second transverse element into the third and fourth holes.
11. The method of claim 9 further comprising the step of using the guide element at the first and/or second position to guide an osteotome in cutting bone around the screw.
12. The method of claim 9 wherein the screw is cannulated and the step of inserting the screw into the borehole comprises:
mounting the screw on a guide wire in the borehole, and
inserting the screw into the borehole on the guide wire.
13. The method of claim 9 wherein the bones that are compressed are in a human foot.
14. The method of claim 9 wherein the first and second transverse elements are staples, open washers or open nuts.
15. The method of claim 9 wherein the screw has threads at one end and the first transverse element engages the threads when it is inserted adjacent the screw.
16. A screw assembly comprising:
a shaft having first and second ends,
threads on the shaft near the first end,
a head on the shaft at the second end,
a first transverse element that engages the threads on the shaft.
17. The screw assembly of claim 16 further comprising a second transverse element that engages the shaft at a second position.
18. The screw assembly of claim 16 wherein the first and second transverse elements are staples, open washers or open nuts.
19. The screw assembly of claim 16 wherein the shaft is cannulated.
20. The screw assembly of claim 16 wherein the cannulated shaft has an interior surface that is threaded.
21. A guide element for drilling holes adjacent a screw comprising:
a first element for mounting on the longitudinal axis of the screw,
a second element enclosing first and second holes, the second element being located in the guide element such that when the first element is mounted on the axis of the screw, the first and second holes are located at a position such as to guide a drill to make holes on opposite sides of the screw at a first desired position along the axis of the screw, and
a third element enclosing at least third and fourth holes, the third element being located in the guide element such that when the first element is mounted on the axis of the screw, the third and fourth holes are located at a position such as to guide a drill to makes holes on opposite sides of the screw at a second desired position along the axis of the screw.
22. The guide element of claim 21 further comprising a slot between at least one of the first and second holes and the third and fourth holes that is large enough to guide an osteotome.
23. The guide element of claim 21 further comprising a first slot between the first and second holes and a second slot between the third and fourth holes, each slot being large enough to guide an osteotome.
24. The guide element of claim 21 wherein the third element is mounted in the second element so that it can be moved in a direction substantially parallel to the longitudinal axis of the screw.
25. A reduction instrument for use in positioning a guide wire in bone comprising:
a handle with a central bore, and
a shaft mounted on the handle, the shaft having a cutting tip at an end remote from the handle and a central bore that extends from the handle to the cutting tip and is aligned with the bore in the handle, the central bore of the handle and tip having an inside diameter sufficient to pass a guide wire.
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Also Published As
Publication number | Publication date |
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US11197698B2 (en) | 2021-12-14 |
US20150150608A1 (en) | 2015-06-04 |
US9713484B2 (en) | 2017-07-25 |
US10226286B2 (en) | 2019-03-12 |
US20150134015A1 (en) | 2015-05-14 |
US20220096133A1 (en) | 2022-03-31 |
US20170071642A1 (en) | 2017-03-16 |
US20190201060A1 (en) | 2019-07-04 |
US9498265B2 (en) | 2016-11-22 |
WO2013090392A1 (en) | 2013-06-20 |
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