Method of using a volar bone plate on a fracture

Abstract
A volar fixation system includes a plate intended to be positioned against the volar side of the radial bone. The plate includes threaded holes for receiving fasteners which lock relative to the plate.
Description
BACKGROUND OF THE INVENTION

1. Field of the Invention


This invention relates broadly to surgical devices. More particularly, this invention relates to a bone fixation system, and particularly to a fixation system adapted to fixate a distal radius fracture.


2. State of the Art


Referring to FIG. 1, a Colles' fracture is a fracture resulting from compressive forces being placed on the distal radius 10, and which causes backward displacement of the distal fragment 12 and radial deviation of the hand at the wrist 14. Often, a Colles' fracture will result in multiple bone fragments 16, 18, 20 which are movable and out of alignment relative to each other. If not properly treated, such fractures result in permanent wrist deformity. It is therefore important to align the fracture and fixate the bones relative to each other so that proper healing may occur.


Alignment and fixation are typically performed by one of several methods: casting, external fixation, interosseous wiring, and plating. Casting is non-invasive, but may not be able to maintain alignment of the fracture where many bone fragments exist. Therefore, as an alternative, external fixators may be used. External fixators utilize a method known as ligamentotaxis, which provides distraction forces across the joint and permits the fracture to be aligned based upon the tension placed on the surrounding ligaments. However, while external fixators can maintain the position of the wrist bones, it may nevertheless be difficult in certain fractures to first provide the bones in proper alignment. In addition, external fixators are often not suitable for fractures resulting in multiple bone fragments. Interosseous wiring is an invasive procedure whereby screws are positioned into the various fragments and the screws are then wired together as bracing. This is a difficult and time consuming procedure. Moreover, unless the bracing is quite complex, the fracture may not be properly stabilized. Plating utilizes a stabilizing metal plate typically against the dorsal side of the bones, and a set of parallel pins extending from the plate into the holes drilled in the bone fragments to provide stabilized fixation of the fragments. However, the currently available plate systems fail to provide desirable alignment and stabilization.


SUMMARY OF THE INVENTION

It is therefore an object of the invention to provide an improved fixation and alignment system for a Colles' fracture.


It is another object of the invention to provide a volar fixation system which desirably aligns and stabilizes multiple bone fragments in a distal radial fracture to permit proper healing.


In accord with these objects, which will be discussed in detail below, a volar fixation system is provided which generally includes a T-shaped plate intended to be positioned against the volar side of the radial bone, a plurality of bone screws for securing the plate along a non-fractured portion of the radial bone, and a plurality of bone pegs which extend from the plate and into bone fragments of a Colles' fracture.


The plate is generally a T-shaped plate defining an elongate body, a head portion angled relative to the body, a first side which is intended to contact the bone, and a second side opposite the first side. The body portion includes a plurality of countersunk screw holes for the extension of the bone screws therethrough. The head portion includes a plurality of threaded peg holes for receiving the pegs therethrough. According to a first embodiment, the peg holes are preferably non-linearly arranged. According to a second embodiment, the peg holes are preferably linearly arranged. In either embodiment, the peg holes are positioned increasingly distal in a medial to lateral direction along the second side. According to a preferred aspect of the invention, axes through the holes are oblique relative to each other, and are preferably angled relative to each other in two dimensions. The pegs having a threaded head and a relatively smooth cylindrical shaft.


The system preferably also includes a guide plate which temporarily sits on top of the volar plate and includes holes oriented according to the axes of the peg holes for guiding a drill into the bone fragments at the required orientation. The volar plate and guide plate are also preferably provided with mating elements to temporarily stabilize the guide plate on the volar plate during the hole drilling process.


In use, the volar plate is positioned with its first side against the volar side of the radius and bone screws are inserted through the bone screw holes into the radius to secure the volar plate to the radius. The bone fragments are then aligned and the guide plate is positioned on the second side of the volar plate. A drill, guided by guide holes in the guide plate, drills holes into the bone fragments, and the guide plate is then removed.


The pegs are then inserted through the peg holes and into the holes in the bone, and the heads of the pegs are threadably engaged in the volar plate. The volar fixation system thereby secures the bone fragments in their proper orientation.


Additional objects and advantages of the invention will become apparent to those skilled in the art upon reference to the detailed description taken in conjunction with the provided figures.





BRIEF DESCRIPTION OF THE DRAWINGS


FIG. 1 is an illustration of an extremity subject to a Colles' fracture;



FIG. 2 is a top volar view of a right hand volar fixation system according to a first embodiment of the invention;



FIG. 3 is a side view of a bone peg according to the first embodiment of the volar fixation system of the invention;



FIG. 4 is a side view of a bone screw of the volar fixation system of the invention;



FIG. 5 is a side view of the right hand volar plate of the volar fixation system according to the first embodiment of the invention;



FIG. 6 is a front end view of the right hand volar plate of the volar fixation system according to the first embodiment of the invention;



FIG. 7 is an exploded side view of the right hand volar plate and guide plate according to the first embodiment of the fixation system of the invention;



FIG. 8 is a side view of the guide plate positioned on the right hand volar plate to provide drill guide paths in accord with the invention;



FIG. 9 is an illustration of the first embodiment of the volar fixation system provided in situ aligning and stabilizing a Colles' fracture;



FIG. 10 is a top volar view of a left hand volar fixation system according to the second embodiment of the invention;



FIG. 11 is a lateral side view of the left hand volar fixation system according to the second embodiment of the invention;



FIG. 12 is a bottom view of the left hand volar fixation system according to the second embodiment of the invention;



FIG. 13 is an enlarged side elevation of a bone peg according to the second embodiment of the volar fixation system of the invention;



FIG. 14 is a proximal end view of the bone peg of FIG. 13;



FIG. 15 is first partial top view of the head portion of the left hand volar plate according to the second embodiment of the volar fixation system of the invention;



FIGS. 16-19 are section views across line 16-16, 17-17, 18-18, and 19-19, respectively in FIG. 15;



FIG. 20 is second partial top view of the head portion of the left hand volar plate according to the second embodiment of the volar fixation system of the invention; and



FIGS. 21-24 are section views across line 21-21, 22-22, 23-23, and 24-24, respectively in FIG. 20.





DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Turning now to FIGS. 2 through 4, a first embodiment of a volar fixation system 100 for aligning and stabilizing multiple bone fragments in a Colles' fracture generally includes a substantially rigid T-shaped plate 102 intended to be positioned against the volar side of the radial bone, a plurality of preferably self-tapping bone screws 104 for securing the plate 102 along a non-fractured portion of the radial bone, and a plurality of bone pegs 108 which extend from the plate 102 and into bone fragments of a Colles' fracture.


Referring to FIGS. 2, 5 and 6, more particularly, the T-shaped plate 102 defines a head portion 116, an elongate body portion 118 angled relative to the head portion, a first side 120 which is intended to contact the bone, and a second side 122 opposite the first side. The first side 120 at the head portion is preferably planar, as is the first side at the body portion. As the head portion and body portion are angled relative to each other, the first side preferably defines two planar portions. The angle Ø between the head portion 116 and the body portion 118 is preferably approximately 18° and bent at a radius of approximately 1.00 inch (FIG. 5). The distal edge 121 of the head portion 116 is preferably angled proximally toward the medial side at an angle α, e.g., 5°, relative to a line P, which is perpendicular to the body portion. The head portion 116 preferably has a width of 0.913 inch and a greatest proximal-distal dimension (i.e., from the corner of angle α to the body portion) of approximately 0.69 inch, and the body portion preferably has a width of 0.375 inch and a length of 1.40 inches. The plate 102 preferably has a thickness of approximately 0.098 inch. The plate 102 is preferably made from a titanium alloy, such as Ti-6A-4V.


The body portion 118 includes three preferably countersunk screw holes 124, 126, 128 for the extension of the bone screws 104 therethrough. The first screw hole 124 has a center preferably 0.235 inch from the end of the body portion, the second screw hole 126 has a center preferably 0.630 inch from the end of the body portion, and the third screw hole 128 is preferably generally elliptical (or oval) and defines foci-like locations at 1.020 inches and 1.050 inches from the end of the body portion. The head portion 116 includes four threaded peg holes 130, 132, 134, 136 for individually receiving the pegs 108 therethrough. According to a first preferred aspect of the first embodiment of the invention, the peg holes 130, 132, 134, 136, preferably 0.100 inch in diameter, are preferably non-linearly arranged along the head portion 116, and are provided such that the adjacent peg holes are provided further distally in a medial to lateral direction along the second side. More particularly, according to a preferred aspect of the first embodiment of the invention, the peg holes are preferably arranged along a parabolic curve, with the center of peg hole 130 located approximately 0.321 inch proximal line P and approximately 0.719 inch medial of the lateral edge 137 of the head portion, the center of peg hole 132 located approximately 0.296 inch proximal line P and approximately 0.544 inch medial of the lateral edge 137, the center of peg hole 134 located approximately 0.250 inch proximal line P and approximately 0.369 inch medial of the lateral edge 137, and the center of peg hole 136 located approximately 0.191 inch proximal line P and approximately 0.194 inch medial of the lateral edge 137.


In addition, according to a second preferred aspect of the first embodiment of the invention, the peg holes define axes A1, A2, A3, A4 which are oblique (not parallel) relative to each other, and more preferably are angled in two dimensions (medial/lateral and proximal/distal) relative to each other; i.e., the pegs once inserted into the peg holes are also angled in two dimensions relative to each other. More particularly, the first axis A1 of the first peg hole 130 (that is, the most proximal and medial peg hole) is preferably directed normal to the first side 120 of the head portion 116. The axis A2 of the adjacent peg hole 132, i.e., the second axis, is preferably angled approximately 1-7° distal and lateral relative to the first axis A1, and more preferably approximately 2.5° distal and lateral relative to the first axis A1. The axis A3 of the peg hole 134 laterally adjacent the second peg hole 132, i.e., the third axis, is preferably angled approximately 7-13° distal and lateral relative to the first axis A1, and more preferably approximately 10° distal and lateral relative to the first axis A1. The axis A4 of the peg hole 134 laterally adjacent the third peg hole 132, i.e., the fourth axis, is preferably angled approximately 10-30° distal and lateral relative to the first axis A1, and more preferably approximately 20° distal and lateral relative to the first axis A1. The second side of the head portion 116, distal of the peg holes 130, 132, 134, 136 is preferably beveled.


Referring back to FIG. 3, the pegs 108, preferably approximately 0.872 inch in length, each have a threaded head 138 adapted to threadably engage the threads about the peg holes 130, 132, 134, 136, and have a relatively smooth non-threaded cylindrical shaft 140. The shafts 140 are preferably approximately 0.0675 inch in diameter and 0.765 inch in length. Such dimensions permit the pegs to adequately support the bone fragments such that the bone is able to heal correctly. The pegs 108 are also preferably made from titanium alloy, and may be coated in a ceramic, e.g., titanium nitride, to provide a bone interface which will not adversely affect bone healing.


Turning now to FIGS. 7 and 8, the system 100 preferably also includes a guide plate 146 which temporarily sits on the second side 122 of the volar plate 102 and includes guide holes 148, 150, 152, 154 (illustrated in overlapping section in FIG. 8) oriented according to the axes A1, A2, A3, A4 of the peg holes for guiding a drill into the bone fragments at the required orientation. That is, the guide holes together with the peg holes define a drill guide path along the axes with sufficient depth to accurately guide a drill (not shown) to drill holes at the desired pin orientations. The volar plate 102 and guide plate 146 are also preferably provided with mating elements, such as a plurality of holes 156, 158 on the second side of the volar plate (FIG. 2), and a plurality of protuberances 160 on the mating side of the guide plate (FIG. 7), to temporarily stabilize the guide plate on the volar plate during the hole drilling process.


Referring to FIGS. 2 through 9, in use, the volar plate 102 is positioned with its first side 120 against the volar side of the radius. Bone screws 104 (either self-tapping or inserted with the aid of pre-drilled pilot holes) are inserted through the bone screw holes 124, 126, 128 into the radius bone 10 to secure the volar plate 102 to the radius. The bone fragments 16, 18, 20 are then aligned with the radius 10. Next, the guide plate 146 is positioned on the second side of the volar plate. A drill, guided by a guide path formed by the peg holes and the guide holes, drills holes into and between the bone fragments 16, 18, 20 (and possibly also a portion of the integral radius, depending upon the particular location and extent of the fracture), and the guide plate is then removed. The pegs 108 are then inserted through the peg holes 130, 132, 134, 136 and into the holes drilled into the fragments, and the heads of the pegs are threadably engaged in the volar plate. The pegs 108, extending through the oblique-axis peg holes 130, 132, 134, 136, are positioned immediately below the subchondral bone of the radius and support the bone fragments for proper healing. The volar fixation system thereby secures the bone fragments in their proper orientation.


Referring to FIGS. 10-12, a second embodiment of a volar plate 210, substantially similar to the first embodiment (with like parts having numbers incremented by 100) and used in substantially the same manner as the first embodiment is shown. The plate 210 preferably has a length of approximately 2.35 inches, which is approximately 0.35 inch greater than in the first embodiment. This additional length accommodates an extra bone screw hole 229 in the body of the volar plate such that the volar plate preferably includes four bone screw holes 224, 226, 228, 229. The additional bone screw in screw hole 229 increases plate stability over the three holes of the first embodiment. The plate 210 preferably tapers in thickness from the body portion 218 to the head portion 216. A preferred taper provides a proximal body portion 218 thickness of approximately 0.098 inch and head portion 216 thickness of approximately 0.078 inch. The taper decreases the thickness of the head portion 216 relative to the body such that the weight of the volar plate is reduced and an improved tendon clearance is provided. The distal edge of the head portion 216 has an increased taper (preferably approximately 60° relative to a line normal to the head) to a distal edge 221. The edge 221 is broken (i.e., made blunt) to prevent irritation or disturbance to the surrounding anatomy.


The head portion 216 includes four threaded peg holes 230, 232, 234, 236 for individually receiving pegs 208 therethrough (FIGS. 13 and 14), and a guide hole 256 for alignment of a guide plate. According to a preferred aspect of the second embodiment of the invention, the peg holes 230, 232, 234, 236, preferably 0.100 inch in diameter, are preferably linearly arranged along the head portion 216, and are provided such that the adjacent peg holes are provided further distally in a medial to lateral direction along the first and second sides. Referring to FIG. 15, more particularly, according to a preferred dimensions of the second embodiment of the invention, the center of peg hole 230 is located approximately 0.321 inch proximal line P and approximately 0.750 inch medial of the lateral edge 237 of the head portion, the center of peg hole 232 is located approximately 0.306 inch proximal line P and 0.557 inch medial of the lateral edge 237, the center of peg hole 234 is located approximately 0.289 inch proximal line P and approximately 0.364 inch medial of the lateral edge 237, and the center of peg hole 236 is located approximately 0.272 inch proximal line P and approximately 0.171 inch medial of the lateral edge 237. As such, the distance from each of the peg holes to the distal edge 221 of the volar plate is relatively greater than in the first embodiment, and provides a preferred alignment with respect to the tapered distal edge 221.


Referring to FIGS. 15-24, in addition, as in the first embodiment, the peg holes define axes A1, A2, A3, A4 which are oblique relative to each other, and more preferably are angled in two dimensions (medial/lateral and proximal/distal) relative to each other; i.e., the pegs 208 once inserted into the peg holes are also angled in two dimensions relative to each other. More particularly, as in the first embodiment, the first axis A1 of the first peg hole 230 is preferably directed normal (FIGS. 16 and 21) to the first side 220 of the head portion 216. The axis A2 of peg hole 232 is preferably angled approximately 1-7° distal (FIG. 17) and approximately 1-7° lateral (FIG. 22) relative to the axis A1, and more preferably approximately 2.5° both distal and lateral relative to axis A1. The axis A3 of peg hole 234 is preferably angled approximately 7-13° distal (FIG. 18) and approximately 7-13° lateral (FIG. 23) relative to axis A1, and more preferably approximately 10° both distal and lateral relative to axis A1. Axis A4 of the peg hole 234 is preferably angled approximately 10-30° distal (FIG. 19) and approximately 10-30° lateral (FIG. 24) relative to axis A1, and more preferably approximately 20° both distal and lateral relative to axis A1.


Referring to FIGS. 13 and 16-19, each of the peg holes has a countersunk portion 270, 272, 274, 276, respectively, for receiving the head 238 of peg 208. Countersunk portions 270, 272 are each preferably approximately 0.030 inch deep and threaded according to the head of the pegs, as described below. Countersunk portion 274 is preferably approximately 0.042 inch deep and likewise threaded. Countersunk portion 276 is preferably approximately 0.056 inch deep and also threaded. The respective depths of the countersunk portions are adapted to better accommodate the heads 238 of the pegs 208 relative to the respective axes of the peg holes.


Referring to FIGS. 13 and 14, the pegs 208, preferably approximately 0.872 inch in length, each have a threaded head 238 adapted to threadably engage threads about the peg holes 230, 232, 234, 236, and have a relatively smooth non-threaded cylindrical shaft 240. The heads 238 preferably include a no. 5 thread 280 at a count of 44 per inch. In addition, the heads 238 are rounded and include a hex socket 282 to facilitate stabilized threading into the peg holes. This design accommodates the reduced thickness of the volar plate at the head portion 216. The shafts 240 are preferably approximately 0.0792 inch (2 mm) in diameter and 0.765 inch in length. Such dimensions permit the pegs to adequately support the bone fragments such that the bone is able to heal correctly. The pegs 208 are also preferably made from titanium alloy, and may be ‘tiodized’ to provide a strong finish which does not adversely affect bone healing.


There have been described and illustrated herein embodiments of a volar fixation system and a method of aligning and stabilizing a Colles' fracture. While particular embodiments of the invention have been described, it is not intended that the invention be limited thereto, as it is intended that the invention be as broad in scope as the art will allow and that the specification be read likewise. Thus, while particular materials for the elements of the system have been disclosed, it will be appreciated that other materials may be used as well. In addition, while a particular numbers of screw holes in the volar plates and bone screws have been described, it will be understood another number of screw holes and screws may be provided. Further, fewer screws than the number of screw holes may be used to secure to the volar plate to the radius. Also, fewer or more peg holes and bone pegs may be used, preferably such that at least two pegs angled in two dimensions relative to each other are provided. Moreover, while in the first embodiment it is preferred that the peg holes lie along a parabolic curve, it will be appreciated that they can lie along another curve. In addition, while a particular preferred angle between the head portion and body portion has been disclosed, other angles can also be used. Furthermore, while particular distances are disclosed between the peg holes and line P, it will be appreciated that the peg holes may be provided at other distances relative thereto. Moreover, while particular preferred medial/lateral and proximal/distal angles for the peg hole axes has been disclosed, it will be appreciated that yet other angles may be used in accord with the invention. Also, while a right-handed volar plate is described with respect to the first embodiment, and a left-handed volar plate is described with respect to the second embodiment, it will be appreciated that each embodiment may be formed in either a right- or left-handed model, with such alternate models being mirror images of the models described. In addition, aspects from each of the embodiments may be combined. It will therefore be appreciated by those skilled in the art that yet other modifications could be made to the provided invention without deviating from its spirit and scope as claimed.

Claims
  • 1. A method of stabilizing a fracture of a distal radius bone, the distal radius bone having subchondral bone that defines an articular surface with a concave curvature, the method comprising: a) providing or obtaining a rigid volar plate, the volar plate having a proximal body portion and a distal head portion, each of the body portion and the head portion including a bone contacting first surface and an opposite second surface, the head portion angled upward with respect to a plane containing the body portion when the bone contacting first surface of the body portion is facing downward, the head portion including at least three first holes arranged in a generally medial to lateral direction, each of the at least three first holes defining a respective fixed central axis that is at a defined angle, each defined angle being at a different number of degrees from the other of the at least three first holes, wherein a first hole of the at least three first holes has a central axis that is oriented parallel to a line normal to a plane containing the head portion, a third hole of the at least three first holes has a central axis that is angled at 7 to 13 degrees relative to the central axis of the first of the at least three first holes, and a second hole of the at least three first holes has a central axis that is situated at an angle between an angle of the central axis of the first hole and an angle of the central axis of the third hole, and the body portion includes a plurality of second holes;b) positioning the bone contacting first surface of the body portion against the volar side of the radius bone;c) inserting at least one bone screw through at least one of the second holes and into the radius bone to secure the volar plate against the volar side of the radius bone;d) reducing the fracture;e) inserting each peg of a first plurality of pegs into a corresponding one of the at least three first holes in the head portion and into the volar side of the radius bone, each peg having a threaded head; andf) threadedly coupling the threaded head of each peg of the first plurality of pegs with the corresponding one of the at least three first holes of the head portion of the plate such that a shaft of each peg of the first plurality of pegs extends immediately below the subchondral bone of the radius bone and is axially fixed relative to the head portion of the plate, wherein the shaft of each peg of the first plurality of pegs extends divergently relative to the other pegs from the bone contacting first surface of the plate in both a medial-lateral direction and a proximal-distal direction, and wherein at least the at least three pegs and the head portion of the bone plate cooperate to form a stabilizing construct for the subchondral bone that conforms to the concave curvature of the articular surface.
  • 2. The method according to claim 1, wherein: the second of the first holes is angled at 1 to 7 degrees relative to the first hole of the first holes.
  • 3. The method according to claim 2, wherein: the first holes includes a fourth hole, the third hole located between the second hole and the fourth hole, and the fourth hole is angled at 10 to 20 degrees relative to the first hole of the first holes.
  • 4. The method according to claim 1, further comprising: before inserting each peg of the first plurality of pegs, drilling into the radius bone to define bone holes for the shafts of each peg of the first plurality of pegs.
  • 5. The method according to claim 4, wherein: the drilling is performed through a plurality of guide holes disposed in a guide plate situated above the second surface of the plate, each of the guide holes having a bore axis coaxial with a respective one of the fixed central axes.
  • 6. The method according to claim 1, wherein: the volar plate includes four first holes.
  • 7. A method of stabilizing a fracture of a distal radius bone, the distal radius bone having subchondral bone that defines an articular surface with a concave curvature, the method comprising: a) providing or obtaining a rigid volar plate, the volar plate having a proximal body portion and a distal head portion, each of the body portion and the head portion including a bone contacting first surface and an opposite second surface, the head portion angled upward with respect to a plane containing the body portion when the bone contacting first surface of the body portion is facing downward, the head portion including four first holes arranged in a generally medial to lateral direction, each of the four first holes defining a respective fixed central axis that is at a defined angle, each defined angle being at a different number of degrees from the other of the four first holes, wherein a first hole of the four first holes is oriented parallel to a line normal to a plane containing the head portion, a fourth hole of the four first holes is angled at 10 to 30 degrees relative to the first hole, and each of the second hole and third hole of is situated at an angle between an angle of the first hole and an angle of the fourth hole, and the body portion includes a plurality of second holes;b) positioning the bone contacting first surface of the body portion against the volar side of the radius bone;c) inserting at least one bone screw through the second holes and into the radius bone to secure the volar plate against the volar side of the radius bone;d) reducing the fracture;e) inserting each peg of a plurality of pegs through a corresponding one of the four first holes in the head portion and into the volar side of the radius bone, each peg having a threaded head; andf) threadedly coupling the threaded head of each peg of the plurality of pegs with the corresponding one of the four first holes in the head portion of the plate such that a shaft of each peg of the plurality of pegs extends immediately below the subchondral bone of the radius bone and is axially fixed relative to the head portion of the plate, wherein the shaft of each peg of the plurality of pegs extends divergently relative to the other pegs from the bone contacting first surface of the plate in both a medial-lateral direction and a proximal-distal direction, wherein at least the plurality of pegs and the bone plate and cooperate to form a stabilizing construct for the subchondral bone that conforms to the concave curvature of the articular surface.
  • 8. The method according to claim 7, wherein: the second hole is angled at 1 to 7 degrees relative to the first hole.
  • 9. The method according to claim 7, further comprising: before inserting the plurality of pegs, drilling into the radius bone to define bone holes for the shafts of the plurality of pegs.
  • 10. The method according to claim 9, wherein: the drilling is performed through a plurality of guide holes disposed in a guide plate situated above the second surface of the plate, each of the guide holes having a bore axis coaxial with a respective one of the fixed central axes of the four first holes.
CROSS-REFERENCE TO RELATED CASES

This application is a continuation of U.S. Ser. No. 13/789,959, filed Mar. 8, 2013, which is a continuation of U.S. Ser. No. 12/823,738, filed Jun. 25, 2010 and now issued as U.S. Pat. No. 8,403,967, which is a continuation of U.S. Ser. No. 11/181,354, filed Jul. 14, 2005 and now abandoned, which is a continuation of U.S. Ser. No. 10/762,695, filed Jan. 22, 2004 and now abandoned, which is a continuation-in-part of U.S. Ser. No. 10/315,787, filed Dec. 10, 2002 and now issued as U.S. Pat. No. 6,706,046, which is a continuation-in-part of U.S. Ser. No. 10/159,611, filed May 30, 2002 and now issued as U.S. Pat. No. 6,730,090, which is a continuation-in-part of U.S. Ser. No. 09/735,228, filed Dec. 12, 2000 and now issued as U.S. Pat. No. 6,440,135, which is a continuation-in-part of U.S. Ser. No. 09/524,058, filed Mar. 13, 2000 and now issued as U.S. Pat. No. 6,364,882, and is a continuation-in-part of U.S. Ser. No. 09/495,854, filed Feb. 1, 2000 and now issued as U.S. Pat. No. 6,358,250, the complete disclosures of which are hereby incorporated by reference herein.

US Referenced Citations (222)
Number Name Date Kind
388000 Rider Aug 1888 A
472913 Taylor Apr 1892 A
1151861 Brumback Aug 1915 A
2056688 Peterka et al. Oct 1936 A
2500370 McKibbin Mar 1950 A
2526959 Lorenzo Oct 1950 A
3025853 Mason Mar 1962 A
3236141 Smith Feb 1966 A
3489143 Halloran Jan 1970 A
3645161 Wesker Feb 1972 A
3709218 Halloran Jan 1973 A
3717146 Halloran Feb 1973 A
3741205 Markolf et al. Jun 1973 A
3842825 Wagner Oct 1974 A
3939498 Lee et al. Feb 1976 A
RE28841 Allgower et al. Jun 1976 E
4011863 Zickel Mar 1977 A
4119092 Gil Oct 1978 A
4135507 Harris Jan 1979 A
4153953 Grobbelaar May 1979 A
4169470 Ender et al. Oct 1979 A
4172452 Forte et al. Oct 1979 A
4408601 Wenk Oct 1983 A
4467793 Ender Aug 1984 A
4473069 Kolmert Sep 1984 A
4483335 Tornier Nov 1984 A
4484570 Sutter et al. Nov 1984 A
4488543 Tornier Dec 1984 A
4493317 Klaue Jan 1985 A
4506662 Anapliotis Mar 1985 A
4565193 Streli Jan 1986 A
4651724 Berentey et al. Mar 1987 A
4712541 Harder et al. Dec 1987 A
4733654 Marino Mar 1988 A
4776330 Chapman et al. Oct 1988 A
4794919 Nilsson Jan 1989 A
4800874 David et al. Jan 1989 A
4867144 Karas et al. Sep 1989 A
4915092 Firica et al. Apr 1990 A
4923471 Morgan May 1990 A
4943292 Foux Jul 1990 A
4955886 Pawluk Sep 1990 A
5006120 Carter Apr 1991 A
5013314 Firica et al. May 1991 A
5015248 Burstein et al. May 1991 A
5035697 Frigg Jul 1991 A
5041113 Biedermann et al. Aug 1991 A
5057110 Kranz et al. Oct 1991 A
5085660 Lin Feb 1992 A
5127912 Ray et al. Jul 1992 A
5151103 Tepic et al. Sep 1992 A
5190544 Chapman et al. Mar 1993 A
5197966 Sommerkamp Mar 1993 A
5201733 Etheredge, III Apr 1993 A
5275601 Gogolewski et al. Jan 1994 A
5304180 Slocum Apr 1994 A
5352228 Kummer et al. Oct 1994 A
5352229 Goble et al. Oct 1994 A
5356253 Whitesell Oct 1994 A
5356410 Pennig Oct 1994 A
5364399 Lowery et al. Nov 1994 A
5382248 Jacobson et al. Jan 1995 A
5437667 Papierski et al. Aug 1995 A
5458654 Tepic Oct 1995 A
5472444 Huebner et al. Dec 1995 A
5484438 Pennig Jan 1996 A
5486176 Hildebrand et al. Jan 1996 A
5527311 Procter et al. Jun 1996 A
5531745 Ray Jul 1996 A
5531746 Errico et al. Jul 1996 A
5536127 Pennig Jul 1996 A
5549612 Yapp et al. Aug 1996 A
5558674 Heggeness et al. Sep 1996 A
5578035 Lin Nov 1996 A
5586985 Putnam et al. Dec 1996 A
5591168 Judet et al. Jan 1997 A
5601553 Trebing et al. Feb 1997 A
5603715 Kessler Feb 1997 A
5607426 Ralph et al. Mar 1997 A
5662655 Laboureau et al. Sep 1997 A
5665086 Itoman et al. Sep 1997 A
5665087 Huebner Sep 1997 A
5665089 Dall et al. Sep 1997 A
5669915 Caspar et al. Sep 1997 A
5676667 Hausman Oct 1997 A
5709682 Medoff Jan 1998 A
5709686 Talos et al. Jan 1998 A
5718705 Sammarco Feb 1998 A
5728099 Tellman et al. Mar 1998 A
5733287 Tepic et al. Mar 1998 A
5749872 Kyle et al. May 1998 A
5766174 Perry Jun 1998 A
5772662 Chapman et al. Jun 1998 A
5776194 Mikol et al. Jul 1998 A
5785711 Errico et al. Jul 1998 A
5807396 Raveh Sep 1998 A
5851207 Cesarone Dec 1998 A
5853413 Carter et al. Dec 1998 A
5879350 Sherman Mar 1999 A
5931839 Medoff Aug 1999 A
5935128 Carter et al. Aug 1999 A
5938664 Winquist et al. Aug 1999 A
5941878 Medoff Aug 1999 A
5951557 Luter Sep 1999 A
5951604 Scheker Sep 1999 A
5954722 Bono Sep 1999 A
5964763 Incavo et al. Oct 1999 A
5967046 Muller Oct 1999 A
5968046 Castleman Oct 1999 A
5968047 Reed Oct 1999 A
5989254 Katz Nov 1999 A
6007535 Rayhack et al. Dec 1999 A
6010503 Richelsoph Jan 2000 A
6010505 Asche et al. Jan 2000 A
6022350 Ganem Feb 2000 A
6053917 Sherman et al. Apr 2000 A
6096040 Esser Aug 2000 A
6123709 Jones Sep 2000 A
6129730 Bono et al. Oct 2000 A
6146384 Lee et al. Nov 2000 A
6152927 Farris et al. Nov 2000 A
6183475 Lester et al. Feb 2001 B1
6197028 Ray et al. Mar 2001 B1
6206881 Frigg et al. Mar 2001 B1
6221073 Weiss et al. Apr 2001 B1
D443060 Benirschke et al. May 2001 S
6228285 Wang et al. May 2001 B1
6231576 Frigg et al. May 2001 B1
6235033 Brace et al. May 2001 B1
6235034 Bray May 2001 B1
6238395 Bonutti May 2001 B1
6241736 Sater et al. Jun 2001 B1
6248109 Stoffella Jun 2001 B1
6258089 Campbell et al. Jul 2001 B1
6270499 Leu et al. Aug 2001 B1
6283969 Grusin et al. Sep 2001 B1
6290703 Ganem Sep 2001 B1
6322562 Wolter Nov 2001 B1
6331179 Freid et al. Dec 2001 B1
6355041 Martin Mar 2002 B1
6355043 Adam Mar 2002 B1
6358250 Orbay Mar 2002 B1
6364882 Orbay Apr 2002 B1
6379359 Dahners Apr 2002 B1
6383186 Michelson May 2002 B1
6409768 Tepic et al. Jun 2002 B1
6440135 Orbay et al. Aug 2002 B2
6454769 Wagner et al. Sep 2002 B2
6454770 Klaue Sep 2002 B1
6458133 Lin Oct 2002 B1
6468278 Muckler Oct 2002 B1
6508819 Orbay Jan 2003 B1
6527775 Warburton Mar 2003 B1
6540748 Lombardo Apr 2003 B2
6595993 Donno et al. Jul 2003 B2
6599290 Bailey et al. Jul 2003 B2
6602255 Campbell et al. Aug 2003 B1
6623486 Weaver et al. Sep 2003 B1
6626908 Cooper et al. Sep 2003 B2
6645212 Goldhahn et al. Nov 2003 B2
6669700 Farris et al. Dec 2003 B1
6679883 Hawkes et al. Jan 2004 B2
6692503 Foley Feb 2004 B2
6706046 Orbay et al. Mar 2004 B2
6712820 Orbay Mar 2004 B2
6719758 Beger et al. Apr 2004 B2
6730090 Orbay et al. May 2004 B2
6730091 Pfefferle et al. May 2004 B1
6755831 Putnam et al. Jun 2004 B2
6761719 Justis et al. Jul 2004 B2
6767351 Orbay et al. Jul 2004 B2
6780186 Errico et al. Aug 2004 B2
6866665 Orbay Mar 2005 B2
6926720 Castaneda Aug 2005 B2
6955677 Dahners Oct 2005 B2
6974461 Wolter Dec 2005 B1
7090676 Huebner et al. Aug 2006 B2
7153309 Huebner et al. Dec 2006 B2
7905909 Orbay et al. Mar 2011 B2
20010001119 Lombardo May 2001 A1
20010011172 Orbay et al. Aug 2001 A1
20010021851 Eberlein et al. Sep 2001 A1
20020032446 Orbay Mar 2002 A1
20020049445 Hall, IV et al. Apr 2002 A1
20020058939 Wagner et al. May 2002 A1
20020058941 Clark et al. May 2002 A1
20020111629 Phillips Aug 2002 A1
20020147452 Medoff et al. Oct 2002 A1
20020151899 Bailey et al. Oct 2002 A1
20020156474 Wack et al. Oct 2002 A1
20030045880 Michelson Mar 2003 A1
20030078583 Biedermann et al. Apr 2003 A1
20030083661 Orbay et al. May 2003 A1
20030105461 Putnam Jun 2003 A1
20030135212 Chow Jul 2003 A1
20030153919 Harris Aug 2003 A1
20030216735 Altarac et al. Nov 2003 A1
20040030339 Wack et al. Feb 2004 A1
20040059334 Weaver et al. Mar 2004 A1
20040059335 Weaver et al. Mar 2004 A1
20040068319 Cordaro Apr 2004 A1
20040073218 Dahners Apr 2004 A1
20040097934 Farris et al. May 2004 A1
20040097950 Foley et al. May 2004 A1
20040102778 Huebner et al. May 2004 A1
20040111090 Dahners Jun 2004 A1
20040193163 Orbay Sep 2004 A1
20040260291 Jensen Dec 2004 A1
20050004574 Muckter Jan 2005 A1
20050010226 Grady Jan 2005 A1
20050080421 Weaver et al. Apr 2005 A1
20050085818 Huebner Apr 2005 A1
20050131413 O'Driscoll et al. Jun 2005 A1
20050154392 Medoff et al. Jul 2005 A1
20050165400 Fernandez Jul 2005 A1
20050187551 Orbay et al. Aug 2005 A1
20050238459 Levey Oct 2005 A1
20060004362 Patterson Jan 2006 A1
20060004462 Gupta Jan 2006 A1
20060009771 Orbay Jan 2006 A1
20060015101 Warburton et al. Jan 2006 A1
20070088360 Orbay et al. Apr 2007 A1
Foreign Referenced Citations (37)
Number Date Country
2174293 Oct 1997 CA
675531 Oct 1990 CH
1379642 Nov 2002 CN
3301298 Feb 1984 DE
4004941 Aug 1990 DE
19542116 May 1997 DE
19629011 Jan 1998 DE
9321544 Oct 1999 DE
4343117 Nov 1999 DE
20200705 Mar 2002 DE
0451427 May 1990 EP
0382256 Aug 1990 EP
0689800 Jan 1996 EP
1250892 Oct 2002 EP
1996120 Dec 2008 EP
2233973 Jan 1975 FR
2405062 May 1979 FR
2855391 Dec 2004 FR
5-501666 Apr 1993 JP
7-10734 Mar 1995 JP
9-504213 Apr 1997 JP
11-000337 Jan 1999 JP
11-47170 Feb 1999 JP
2000-189436 Jul 2000 JP
200189438 Jul 2000 JP
2003-210479 Jul 2003 JP
2003-245283 Sep 2003 JP
2004-049633 Feb 2004 JP
WO9747251 Dec 1997 WO
WO0004836 Feb 2000 WO
WO0036984 Jun 2000 WO
WO0066011 Nov 2000 WO
WO0112081 Feb 2001 WO
WO0119267 Mar 2001 WO
WO0156452 Aug 2001 WO
WO2004032751 Apr 2004 WO
WO2004096067 Nov 2004 WO
Non-Patent Literature Citations (20)
Entry
ACE Medical Company, Curves in All the Right Places, ACE Symmetry Titanium Upper Extremity Plates, 1996.
“Advances in Distal Radius Fracture Management (D),” transcript of American Academy of Orthopaedic Surgeons 2001 Conference, pp. 134-151, Feb. 28, 2001.
Berger, Richard A., et al., Distal Radioulnar Joint Instability, Orthopedic Procedures, 2004, p. 337-354, vol. 1, Lippincott Williams & Wilkins.
Chung, Kevin C., et al., Treatment of Unstable Distal Radial Fractures with the Volar Locking Plating System, J. Bone Joint Surg. Am., 2006; p. 2687-2694, vol. 88.
The Distal Radius Plate Instrument and Implant Set; Technical Guide, Synthes, Paoli, PA; (1995).
Moftakhar, Roham, M.D. and Trost, Gregory R., M.D., “Anterior Cervical Plates: a Historical Perspective”, Jan. 2004, pp. 1-5.
Nelson, “Volar Plating with Anatomic Placement and Fixed-Angle Screws”, Quick Reference Guide for Contours VPS Volar Plate System by Orthofix, May 2005, www.orthofix.com.
Nelson, David L., MD, Internal Fixation for the Distal Radius, eRadius, International Distal Radius Fracture Study Group, last updated Jan. 28, 2006, www.eradius.com/infix.htm.
Polyaxial and Monoaxial Spinal Screws, Xia.TM. Spinal System, www.osteonics.com/osteonics/spine/xia2.html, Jun. 25, 2002.
“SCS /D Distal Radius Plate System: Dorsal”, Avanta, 1997.
“SCS/V Distal Radius Plate: Volar”, Avanta, 1998.
Smith, Dean W., MD, et al., Volar Fixed-Angle Plating of the Distal Radius, J. Am. Acad. Orth. Surg., Jan./Feb. 2005, p. 28-36, vol. 13, No. 1.
“SMARTLock Locking Screw Technology,” Stryker Corporation, website description, 2004, www.stryker.lcom.
Summary of Safety and Effectiveness Information for Synthes Condylar Buttress Plates; Synthes USA (Approx. Jul. 29, 1998).
Synthes-Stratec Annual Report, 2001.
The Titanium Distal Radius Plate; Technique Guide, Synthes, Paoli, PA (1996).
“Universal Distal Radius System”, Stryker Corporation, website description, 2004, www.stryker.com.
“Volar Radius Plate with Angular Stability”, I.T.S. (Implant Technology Systems), 510(k) Summary of Safety and Effectiveness, Feb. 6, 2004.
“Volare Winkelstabile Radiusplatte”, I.T.S. (Implant Technology Systems), Spectromed, brochure, 2005, Austria.
M.E. Müller al., 3rd edition (revised), AO Manual for Internal Fixation, 2001.
Related Publications (1)
Number Date Country
20140100615 A1 Apr 2014 US
Continuations (4)
Number Date Country
Parent 13789959 Mar 2013 US
Child 14101786 US
Parent 12823738 Jun 2010 US
Child 13789959 US
Parent 11181354 Jul 2005 US
Child 12823738 US
Parent 10762695 Jan 2004 US
Child 11181354 US
Continuation in Parts (5)
Number Date Country
Parent 10315787 Dec 2002 US
Child 10762695 US
Parent 10159611 May 2002 US
Child 10315787 US
Parent 09735228 Dec 2000 US
Child 10159611 US
Parent 09524058 Mar 2000 US
Child 09735228 US
Parent 09495854 Feb 2000 US
Child 09524058 US