• 专利附录
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    • 专利摘要:
    compression screw system. a compression screw comprising a threaded shank and a head associated with the proximal end of the shank is shown. the head has a plurality of outwardly extending protrusions spaced from one another to define a plurality of recesses therebetween to receive a screw driver such that rotational force can be transferred from the screw driver. screw to screw. the head protrusions may be provided with holes for suture attachment, or a suture coupling may be positioned over the stem so as to extend between the head protrusions.
    公开号:BR112014018205B1
    申请号:R112014018205-1
    申请日:2013-01-22
    公开日:2021-08-10
    发明作者:Nicolas Bouduban；Patrick Burki；Urs Hulliger；Philippe Gedet；Beat Lechmann；Wamis Singhatat；Scott Larsen
    申请人:Synthes Gmbh；
    IPC主号:
    专利说明:

    INCORPORATION BY REFERENCE
    [001] The entirety of US Provisional Application Serial No. 61/589,947, filed January 24, 2012, is hereby expressly incorporated herein by reference. BACKGROUND
    [002] The inventive concepts presented here refer, in general, to implantable compression screws and, more particularly, but not as a mode of limitation, to a compression screw system with suture anchoring features, and to methods for their use.
    [003] Implantable compression screws are typically used for the management of bone fractures, for example by implanting a compression screw into a fractured bone, so that the screw fixes, or compresses against each other, the bone fragments fractured, thus allowing the bone to consolidate and re-grow. In certain fractures, an external plate can be compressed against the bone, typically by more than one compression screw, in order to strengthen the bone and allow it to consolidate.
    [004] Soft tissues, such as tendons and ligaments, are usually attached to the bone by small collagen fibers. These fibers are strong but allow tendons and ligaments to be flexible. Some fractures, or other bone injuries, cause soft tissue to break or become detached from the bone, requiring repair. Surgeons often need to repair the separated soft tissue with one or more sutures, which typically reconnect the soft tissue to the bone through a suture anchor implanted in the bone. These suture anchors are usually implanted into a patient's bone through extensive surgical procedures or through arthroscopic surgical techniques. In general, some suture anchors may require a surgeon to tie a knot in the suture, or may be "knotless", ie no knot is required to secure the soft tissue to the bone as the suture is retained by the suture anchor. suture and by the bone.
    [005] Currently existing compression screws are implanted into a patient's bone in various ways, which can be generally classified as those that require drilling a hole in the bone, and those that can be implanted without drilling, such as being pushed or threaded into the bone, for example. Some compression screws include threaded ends that are self-tapping, and some compression screws require a hole or channel to be drilled or formed in the bone prior to implanting the compression screw into the bone.
    [006] Once a compression screw is implanted, adjacent soft tissues such as muscles, tendons, cartilage and skin, for example, can move over the head of the compression screw as a result of the patient's normal body movements. Compression screws currently available have bulky heads, which protrude over the bone surface and can cause abrasion, irritation and damage to soft tissue, for example. Additionally, as the bone surfaces surrounding the compression screw typically have different angles, the head of prior art compression screws may not be flush with the bone surface, thus causing irritation and additional damage to the adjacent soft tissue.
    [007] Although some variable angle compression screws have been developed in the prior art, these variable angle compression screws still have the above mentioned disadvantages (see, for example, patent application serial no. US 11/971,358, which description is expressly incorporated herein by reference in its entirety).
    [008] Another problem with currently existing compression screws is that they do not allow sutures to be attached to them, thus requiring that separate means for suture fixation, such as suture anchors, be used to repair the soft tissue injuries that often accompany a bone fracture. These separate suture anchors require separate insertion sites to be selected and additional insertion holes to be formed in already damaged bones, thus resulting in extended surgical procedure times, increased procedural complexity and costs, and longer patient recovery time. BRIEF DESCRIPTION OF THE DRAWINGS
    [009] To assist those skilled in the art to produce and use the inventive concepts presented herein, reference is made to the attached schematic drawings and illustrations, which are not intended to be drawn to scale, and in which similar reference numbers are intended to refer to the same or similar elements, for the sake of consistency. For the sake of clarity, not all components can be identified on each drawing. Certain features and certain views of the figures may be shown exaggerated and out of scale, or in schematic illustration, for the sake of clarity and brevity. In the drawings:
    [0010] Figure 1A is a perspective view of an exemplary embodiment of a compression screw system according to the inventive concepts presented here.
    [0011] Figure 1B is an enlarged view of circle 1B of Figure 1A.
    [0012] Figure 2A is a perspective view of an exemplary embodiment of a screw drive according to the inventive concepts presented here.
    [0013] Figure 2B is an enlarged view of circle 2B of Figure 2A.
    [0014] Figure 3A is a top perspective view of an exemplary embodiment of a compression screw according to the inventive concepts presented here.
    [0015] Figure 3B is a bottom perspective view of the compression screw of Figure 3A.
    [0016] Figure 3C is a side elevation view of another embodiment of a lateral bulge of the compression screw of Figure 3A.
    [0017] Figure 3D is a plan view of another embodiment of a lateral protrusion of the compression screw of Figure 3A.
    [0018] Figure 3E is a plan view of another embodiment of a lateral protrusion of the compression screw of Figure 3A.
    [0019] Figure 3F is a side elevation view of another embodiment of a lateral bulge of the compression screw of Figure 3A.
    [0020] Figure 3G is a cross-sectional view of the compression screw of Figure 3A, shown implanted in a bone.
    [0021] Figure 4A is a top perspective view of an exemplary embodiment of a compression screw according to the inventive concepts presented here, shown in combination with a suture coupling.
    [0022] Figure 4B is a bottom perspective view of the compression screw of Figure 4A.
    [0023] Figure 4C is a cross-sectional view of the compression screw of Figure 4A, shown implanted in a bone.
    [0024] Figure 4D is a top perspective view of the compression screw of Figure 4A.
    [0025] Figure 4E is a bottom perspective view of the compression screw of Figure 4A.
    [0026] Figure 5 is a top plan view of an exemplary embodiment of a suture coupling according to the inventive concepts presented here.
    [0027] Figure 6A is a top plan view of another embodiment of a suture coupling.
    [0028] Figure 6B is a top plan view of the suture coupling of Figure 6A, with sutures shown integrated thereto.
    [0029] Figure 6C is a top plan view of the suture coupling of Figure 6A, showing preloaded sutures therein.
    [0030] Figure 6D is a top plan view of the suture coupling of Figure 6A, showing preloaded sutures therein.
    [0031] Figure 6E is a top plan view of the suture coupling of Figure 6A, showing integrated suture loops.
    [0032] Figure 7 is a top plan view of another embodiment of a suture coupling.
    [0033] Figure 8A is a top plan view of another embodiment of a suture coupling.
    [0034] Figure 8B is a top plan view of another embodiment of a suture coupling.
    [0035] Figure 9 is a top plan view of another embodiment of a suture coupling.
    [0036] Figure 10 is a top plan view of another embodiment of a suture coupling.
    [0037] Figure 11A is a top plan view of another embodiment of a suture coupling.
    [0038] Figure 11B is a top plan view of another embodiment of a suture coupling.
    [0039] Figure 11C is a top plan view of another embodiment of a suture coupling.
    [0040] Figure 12 is a top plan view of another embodiment of a suture coupling.
    [0041] Figure 13A is a top plan view of another embodiment of a suture coupling.
    [0042] Figure 13B is a top plan view of an alternative embodiment of the suture coupling of Figure 13A.
    [0043] Figure 13C is a top plan view of another embodiment of a suture coupling.
    [0044] Figure 13D is a top plan view of another modality of a suture coupling.
    [0045] Figure 14 is a top plan view of another embodiment of a suture coupling.
    [0046] Figure 15 is a cross-sectional view of a coupling clip according to the inventive concepts presented here, shown attached to a compression screw.
    [0047] Figure 16 is a cross-sectional view of a coupling clamp according to the inventive concepts presented here.
    [0048] Figure 17A is a perspective view of an embodiment of a compression screw according to the inventive concepts presented here, shown in combination with a suture coupling.
    [0049] Figure 17B is a top plan view of the compression screw of Figure 17A.
    [0050] Figure 17C is a side elevation view of the compression screw of Figure 17A.
    [0051] Figure 17D is an elevation view of the decompression screw of Figure 17A, shown implanted in a bone.
    [0052] Figure 18A is a side elevation view of an exemplary embodiment of a compression screw according to the inventive concepts presented here, shown in combination with a suture coupling.
    [0053] Figure 18B is a top plan view of the compression screw of Figure 18A.
    [0054] Figure 18C is a perspective view of the decompression screw in combination with a suture ring of Figure 18A, with a suture shown pulling the suture coupling.
    [0055] Figure 18D is a top plan view of the compression screw in combination with a suture ring of Figure 18A, with a suture shown pulling the suture coupling.
    [0056] Figure 19A is a side elevation view of an exemplary embodiment of a compression screw according to the inventive concepts presented here, in combination with a suture coupling.
    [0057] Figure 19B is a perspective view of the compression screw of Figure 19A.
    [0058] Figure 20A is a perspective view of an exemplary embodiment of a compression screw according to the inventive concepts presented here, in combination with a suture coupling.
    [0059] Figure 20B is a cross-sectional view of the compression screw in combination with a suture coupling of Figure 20A.
    [0060] Figure 21A is a perspective view of an exemplary embodiment of a compression screw with variable angle according to the inventive concepts presented here.
    [0061] Figure 21B is an enlarged view of circle 21B of Figure 21A.
    [0062] Figure 21C is a cross-sectional view of the variable angle compression screw of Figure 21A.
    [0063] Figure 21D is a cross-sectional view of two variable angle compression screws of Figure 21A, shown implanted in a bone.
    [0064] Figure 22A is a perspective view from below of an exemplary embodiment of a compression screw with variable angle according to the inventive concepts presented here.
    [0065] Figure 22B is a top perspective view of the variable angle compression screw of Figure 22A.
    [0066] Figure 22C is a cross-sectional view of the variable angle compression screw of Figure 22A.
    [0067] Figure 22D is a cross-sectional view of the variable angle compression screw of Figure 22A, shown implanted in a bone.
    [0068] Figure 23A is a top perspective view of an exemplary modality of a compression screw with dynamic locking and variable angle, according to the inventive concepts presented here.
    [0069] Figure 23B is a perspective view from below of the compression screw with dynamic locking and variable angle of Figure 23A.
    [0070] Figure 23C is a cross-sectional view of the variable angle compression screw of Figure 23A.
    [0071] Figure 23D is a cross-sectional view of the variable angle compression screw of Figure 23A, shown implanted in a bone.
    [0072] Figure 24 is a cross-sectional view of an exemplary modality of a bone plate system according to the inventive concepts presented here, shown implanted in a bone.
    [0073] Before explaining in detail at least one modality of the concepts of the invention, it should be understood that such concepts are not limited in their application to the construction details, experiments, exemplifying data and arrangement of components presented in the description below or illustrated in the drawings . The concepts of the invention can be applied to other modalities or be practiced or carried out in various ways. Furthermore, it is to be understood that the phraseology and terminology employed herein is for descriptive purposes only, and should in no way be considered as limiting the inventive concepts presented herein.
    [0074] In the detailed description presented below of the modalities of the inventive concepts, numerous specific details are presented in order to provide a more complete understanding of the inventive concepts. However, it will be apparent to the person skilled in the art that the inventive concepts presented in the present invention can be practiced without these specific details. In other instances, well-known features have not been described in detail to avoid unnecessarily complicating the present description.
    [0075] For use herein, the terms "comprises", "comprising", "includes", "including", "has", "having", or any other variation thereof, are intended to encompass a non-exclusive inclusion . For example, a process, method, article or apparatus that comprises a list of elements is not necessarily limited to only those elements, but may include other elements not expressly mentioned or inherently present therein.
    [0076] Except where expressly stated to the contrary, "or" refers to an inclusive "or" and not an exclusive "or". For example, a condition A or B is satisfied by any of the following: A is true (or is present) and B is false (or is not present), A is false (or is not present) and B is true (or is not present). present), and both A and B are true (or are present).
    [0077] For use herein, the term "or combinations thereof" refers to all permutations and combinations of the aforementioned items that precede the term. For example, "A, B, C or combinations thereof" is intended to include at least one of: A, B, C, AB, AC, BC or ABC and, if order is important in a specific context, also BA, CA, CB, CBA, BCA, ACB, BAC or CAB. Continuing with this example, expressly included are combinations that contain repetitions of one or more items or terms, such as BB, AAA, AAB, BBC, AAABCCCC, CBBAAA, CABABB, and so on. The person skilled in the art will understand that there is typically no limit to the number of items or terms in any combination, except where otherwise evident from the context.
    [0078] Furthermore, the use of "a" or "an" is intended to describe elements and components of embodiments of the present invention. This is done purely for convenience, and to give a general sense to the inventive concepts. This description must be read to include one or at least one, and the singular also includes the plural, unless the intention to the contrary is evident.
    [0079] Additionally, for use in the present invention any reference to "an embodiment" or "the embodiment" means that a specific element, feature, structure or feature described in relation to the embodiment is included in at least one embodiment. The occurrences of the phrase "in an modality" at various points in the specification do not necessarily all refer to the same modality, although the present inventive concepts are intended to cover any and all combinations of the characteristics of the modalities presented herein.
    [0080] For use in the present invention, qualifiers such as "about", "approximately" and "substantially" are intended to mean that the item being qualified is not limited to the exact value specified, but includes some slight variations or deviations from it. , caused by measurement error, manufacturing tolerances, mechanical stress exerted on various parts, wear, or combinations thereof, for example.
    [0081] For use herein, the terms "guidewire", "Kirschner wire", "Kirschner pin" or "k-wire", as well as any variations thereof, include pins or rods used in a variety of Medical procedures. Kirschner wires are typically produced from stainless steel and can be threaded, grooved or smooth, for example. Kirschner wires have been in use since their introduction in 1909, and their structure and their use in medical procedures are considered to be at the level of those skilled in the art, and as such will not be described in detail here to avoid unnecessarily complicating the present. description.
    [0082] The inventive concepts presented in the present invention generally refer to a compression screw that has a low profile head configured to retain one or more sutures, and a driver configured to implant the compression screw in a bone . Compression screws in accordance with the exemplary embodiments of the inventive concepts presented herein allow surgeons to repair fractured bones and reattach torn or separated soft tissue without the use of separate suture anchors.
    [0083] Now with reference to the drawings and, in particular, Figures 1A to 1B, an exemplary embodiment of a compression screw system 100 is illustrated. The compression screw system 100 includes a screw driver 102 and a compression screw 104. Screw driver 102 and compression screw 104 can be cannulated so that compression screw system 100 can be used with a guide wire (not shown), such as a Kirschner wire or another type of wire. guide wire, for example. It should be understood, however, that the present inventive concepts are not limited to a cannulated screw driver 102 and a cannulated compression screw 104 and that, in some exemplary embodiments, a screw driver 102 and a compression screw 104 according to the inventive concepts presented here, they may not be cannulated and may or may not be implanted into a bone by means of a guidewire.
    [0084] Now referring to Figures 2A to 2B, the screwdriver 102 includes a handle 108 and a rod 110, and may have a central cannula (not shown) extending therethrough and configured to allow a guide wire be passed through it.
    [0085] Cable 108 is configured to be held by a user, and to allow the user to apply a rotational force to cable 108. Cable 108 is produced from any suitable material such as plastic, metals, ceramics, resins, rubbers or combinations thereof, for example. Cable 108 has a proximal end 112 and a distal end 114, including a suture attachment collar 116 which has one or more suture attachment notches 118 formed therein. The suture attachment collar 116 and the suture attachment notches 118 can cooperate to retain one or more sutures therein, and help hold those sutures in place during a surgical procedure, for example.
    [0086] The cable 108 may also include features or surfaces for optimizing grip (not shown), such as grooves, splines, protrusions, serrations, undulations, ridges, crimps or rubberized inserts, or combinations thereof, for example. Additionally, cable 108 may have visual markings (not shown) that allow a user to visually count the number of turns completed by cable 108 in order to estimate the depth and positioning of a compression screw 104 during deployment procedures, by example.
    [0087] The rod 110 includes a proximal end 120 fixedly connected to the handle 108, and a distal end 122 provided with a driver 124. The rod 110 can be produced from any suitable material that has sufficient strength and durability, such as steel stainless, titanium, resins, plastics, metals, ceramics or combinations thereof, for example.
    [0088] The driver 124 has protrusions 126 separated by recesses 128. The recesses 128 are configured to receive, therein, the corresponding protrusions of the compression screw head 104 so that the rotational force can be transferred from the screw driver 102 to compression screw 104, as will be described below, for example. Although four protrusions 126 are shown in Figures 1 to 2, it is to be understood that the inventive concepts presented herein may include any number of longitudinal protuberances 126, such as two, three, five, or more than five longitudinal protuberances 126, for example.
    [0089] Now referring to Figures 3A to 3B, the compression screw 104 includes a head 130 and a rod 132 fixedly attached to the head 130. The compression screw 104 can be produced from any bioinert, biocompatible or bioabsorbable material suitable, such as stainless steel, titanium, polyethylene, polylactic acid (PLA), polylactic coglycolic acid (PLGA), polyurethane, bone tissue, ultra high molecular weight polyethylene fibers, epoxy resins or combinations thereof, for example. Compression screw 104 can be formed using any suitable process, such as molding, machining, casting or combinations thereof, for example.
    [0090] The head 130 is illustrated in Figures 3A and 3B as having a generic cloverleaf shape, with a plurality of protrusions 134 extending radially outward and configured to fit at least partially within the recesses 128, interweaving it engages with the correspondingly shaped protrusions 126 of the driver 124 so that rotational force and rotational movement can be transmitted to the compression screw 104 by the screw driver 102. The head 130 desirably has a low profile so that , when the compression screw 104 is implanted in a bone, the head 130 is substantially flush with the surface of the bone, to minimize the occurrence of irritation and damage to the soft tissue as a result of the interaction of the head 130 with adjacent soft tissue. For use in the present invention, the term "substantially level" is intended to include the head 130 being level with the surface of the bone, and projecting slightly above the surface of the bone, but such slight protrusion is kept as low as possible to avoid irritation or damage to adjacent soft tissue, for example.
    [0091] The head 130 is shown as having four protrusions 134, with each of the protrusions 134 having a suture attachment hole 136 formed therein. It should be understood, however, that the head 130 can be formed to have a variety of configurations and numbers of protrusions. For example, head 130 can be formed to have a number of protrusions equal to two, three, or more than four. The suture attachment holes 136 may be formed within the protrusions 134 in any suitable manner, such as injection molding, drilling, or combinations thereof, for example. The suture attachment holes 136 function to allow one or more sutures to be passed through them so that soft tissue can be attached to the head 130. It should be understood that although four suture attachment holes 136 are shown in Figures 3A to 3B, the inventive concepts presented herein can be implemented with omitted suture attachment holes 136, as will be described below, or with any number of suture attachment holes 136. Additionally, albeit one hole for attachment of suture attachment 136 is shown in each protrusion 134, it should be understood that some protrusions 134 may not have suture attachment holes 136 formed therein, and some bumps 134 may have one or more suture attachment holes 136 formed therein. It should additionally be understood that in some embodiments the holes for suture fixation 136 may be implemented in the form of one or more grooves (Figure 3C), one or more channels (Figure 3D), one or more resilient claws (Figures 3E and 3F), one or more hooks, one or more grooves on the surface of the head 130 engaging the bone, one or more channels or grooves into the side of the head 130 engaging the bone, or combinations thereof, for example. Additionally, in some exemplary embodiments, a suture may be wrapped around shaft 132, and protrusions 134 may be used to compress, capture, secure, or otherwise hold the suture in place.
    Stem 132 has a proximal end 138 securely secured to the head 130, and a distal end 140 that has threads 142 formed on an outer surface thereof. Threads 142 are configured to engage bone tissue so that compression screw 104 is threaded into bone and is retained there when a rotary motion is applied to compression screw 104 by screw driver 102 relative to longitudinal axis 148. It should be understood that a compression screw 104 in accordance with the inventive concepts presented herein may be implanted in any type of bone or tissue, and may have threads 142 configured to engage cortical bone tissue, cancellous bone tissue , cartilage, connective tissue or combinations thereof, for example.
    [0093] Stem 132 is shown as having an unthreaded portion144, but it should be understood that some exemplary embodiments of compression screw 104 may omit the unthreaded portion 144 and may include threads 142 extending along the length of shank 132 Additionally, some exemplary embodiments may include other retaining means or features (not shown), such as ribs, grooves, protrusions, channels, protrusions, or combinations thereof, in place of or in addition to threads 142. Threads 142 may be self-tapping or self-drilling, or a drill or other tool can be used to form an opening or channel in the bone of a suitable size for the threads 142 to engage, for example.
    The compression screw 104 has a central cannula 146 extending through the stem 132 and the head 130, and a longitudinal axis 148. The central cannula 146 is configured to receive a guidewire during deployment of the compression screw 104 in the bone of a patient. It should be understood, however, that a compression screw 104 in accordance with the present inventive concepts may omit central cannula 146 in some exemplary embodiments, and that compression screw without cannula 104 can be implanted with or without use. of a guide wire.
    [0095] Now with reference to Figure 3G, during use the compression screw 104 is implanted into a bone 150 so that the threads 142 engage a spongy portion 152 of the bone 150 and the head 130 is compressed against a surface of a cortical portion 154 of bone 150. Stem 132 may be advanced into bone 150 so that a desired compressive force is applied to said bone 150, for example. Head 130 is shown as being oriented with respect to the longitudinal axis 148 of rod 132, at an angle α. It should be understood that angle α can include any angle, including an angle of 90° and some slight deviations from an angle of 90°, such as deviations due to manufacturing tolerances, and deformation in compression bolt 104 caused by compressive forces exerted on the head 130 by bone 150 when compression screw 104 is implanted in bone 150, or combinations thereof, for example. One or more sutures 151 may be passed through a suture attachment hole 136, for example, so that the one or more sutures 151 are retained by compression screw 104. A soft tissue may be anchored to bone 150 by means of the one or more sutures 151.
    [0096] Now with reference to figures 4A to 4C, an exemplary embodiment of a compression screw 104a is shown in the same, which can be implemented in a similar manner to the compression screw 104, except that the holes for fixing are omitted of suture 136. Compression screw 104a includes a head 160 and a shank 162 having a longitudinal axis 164. Compression screw 104a can be produced from any suitable bioinert or bioabsorbable material, such as stainless steel, titanium, polyethylene, acid polylactic (PLA), polylactic coglycolic acid (PLGA), polyurethane, human bone tissue, ultra high molecular weight polyethylene fibers, epoxy resins or combinations thereof, for example. Compression screw 104a can be formed using any conventional process, such as molding, machining, casting or combinations thereof, for example.
    [0097] The head 160 is shown as a generically shaped trefoil leaf structure comprising a plurality of protrusions 166 configured to interweave with the correspondingly shaped longitudinal protrusions 126 of the screw driver 102 (e.g., being at least partially positioned within recesses 128) so that rotary motion can be transmitted to compression screw 104a by screw driver 102. Head 130 desirably has a low profile so that when compression screw 104a is deployed in a bone, the head 160 is substantially flush with the surface of the bone, to minimize the occurrence of irritation and damage to the adjacent soft tissue as a result of the interaction of the head 160 with adjacent soft tissue. For use herein, the term "substantially level" includes the head 160 protruding slightly above the surface of the bone, but such slight protrusion is kept as low as possible to avoid irritation or damage to adjacent soft tissue, for example.
    Stem 162 has a proximal end 168 securely fastened to the head 160, and a distal end 170 that has threads 172 formed on an outer surface thereof. The threads 172 are configured to engage a bone (e.g., cortical or cancellous bone tissue) so that the compression screw 104a is threaded into the bone tissue and is retained there when a rotary motion is applied to the screw. of compression 104a by screw driver 102. Stem 162 is shown as comprising a non-threaded portion 174, but it should be understood that some exemplary embodiments of compression screw 104a may omit the non-threaded portion 174 and may include threads 172 extending along the length of the stem 162. Additionally, some exemplary embodiments may include other retaining means or features (not shown) such as ribs, grooves, protrusions, channels, protrusions or combinations thereof, in place of or in addition to, threads 172. Threads 172 may be self-tapping or self-drilling, or a drill or other tool may be used to form an opening or channel in the bone with suitable size for threads 172 to engage, for example.
    [0099] Compression screw 104a has a central cannula 176 extending through stem 162 and head 160. The central cannula 176 is configured to receive a guide wire, such as a Kirschner wire, for example, during screw implantation compression 104a into a patient's bone. It should be understood, however, that a compression screw 104a in accordance with the present inventive concepts may omit the central cannula 176 in some exemplary embodiments, and that such non-cannulated compression screw 104a may or may not be implanted without the use of a guidewire 106.
    [00100] Referring to Figures 4A to 4C and 5, a suture coupling 178 can be used in combination with compression screw 104a to treat or repair soft tissue injuries. Suture coupling 178 includes a thin, flat body 179 that has an opening 180 configured to receive rod 162 of compression screw 104a so that suture coupling 178 is compressed between head 160 of compression screw 104a and the surface of a bone when the compression screw 104a is implanted into the bone. In some embodiments, suture coupling 178 may be sized so that it fits snugly around unthreaded portion 174 of rod 162 to maintain suture coupling 178 substantially centered with respect to said rod 162. suture coupling 178 can be sized to be interposed between a suture anchor (not shown) and a bone surface.
    [00101] Suture coupling 178 is desirably produced from a flexible or malleable bioinert material, such as a textile material (e.g., any cloth, or items produced by weaving, knitting, braiding, twisting or felting, of one or more fibers or other materials), a foam material, polyethylene, polyurethane, PLA, PLGA, ultra high molecular weight polyethylene fibers, and combinations thereof, for example. A flexible or pliable material would allow the suture coupling 178 to conform to the shape of the bone surface and not have sharp edges, thus minimizing soft tissue irritation. Additionally, suture coupling 178 can be bent and inserted through the cannula of an arthroscopic surgical instrument, such as screw driver 102, for example. Suture coupling 178 can be used to secure one or more sutures 182 (Figure 4C) to compression screw 104a, such as tying one or more sutures 182 to suture coupling 178, or sewing one or more sutures 182 in the suture coupling 178, or combinations thereof, for example. Suture coupling 178 can be coated or impregnated with a variety of substances including, but not limited to, antibiotics, healing agents, anti-clotting agents, anti-inflammatory agents, or combinations thereof, for example.
    [00102] The head 160 is shown as being oriented with respect to the longitudinal axis 164 of the rod 162, at an angle α. It should be understood that angle α can include any angle, including an angle of 90° and some slight deviations from an angle of 90°, such as deviations due to manufacturing tolerances, and deformation in compression bolt 104a caused by compressive forces exerted on the head 160 by a bone 184 when the compression screw 104a is implanted in a bone 184, or combinations thereof, for example.
    [00103] As will be understood by those skilled in the art, the use of a compression screw 104a with the suture coupling 178 allows the use of a suture-first technique (e.g., one or more sutures 182 are attached to the suture coupling 178 prior to insertion of suture coupling 178 into compression screw 104a and implantation of compression screw 104a), or an implant-first technique (e.g., suture coupling 178 is inserted into compression screw 104a, compression screw 104a is implanted in bone 184 and then one or more sutures 182 are attached to suture coupling 178). As will be understood by those skilled in the art, a portion of suture coupling 178 extending between two protrusions 166 may remain accessible to a user after compression screw 104a is implanted into bone 184. Compression screw 104a can be advanced inwardly of bone 184, so that a desired compressive force is applied to bone 184, for example.
    [00104] Now with reference to figures 4D to 4E, the compression screw 104a with a suture coupling 186 inserted therein is shown therein. Suture coupling 186 can be implemented similarly to suture coupling 178, except that suture coupling 186 has a body 187 with a substantially rounded surface, while suture coupling body 178 is substantially flat. Additionally, suture coupling 186 may be made of a material relatively stiffer than suture coupling 178, such as reinforced rubber, stainless steel, nitinol, titanium, cobalt chromium, a tight-woven textile product, and combinations thereof, for example. . The rounded surface of suture coupling 186 can further minimize the occurrence of irritation and damage to adjacent soft tissue, and can result in increased strength of suture coupling 186, compared to a suture coupling 178 made of the same or similar material, by example.
    [00105] Now with reference to Figure 6A, an exemplary embodiment of another suture coupling 190 is shown therein. The suture coupling 190 is similar to the suture coupling 178, except that the suture coupling 190 includes a Reinforced inner edge 196 and a reinforced outer edge 198. The reinforced inner edge 196 and the reinforced outer edge 198 can be implemented by braiding or weaving a second layer of woven material to the coupling base, during fabrication of the suture coupling 190, for example, or in any other suitable way.
    [00106] Figure 6B shows suture coupling 190, with sutures 200 that are stitched or otherwise integrated with suture coupling 190. Sutures 200 can be used to secure a soft tissue to suture coupling 190, by example by passing one or more sutures 200 through tissue to be secured, tying sutures 200, and trimming, cutting or otherwise removing any excess portion of sutures 200.
    [00107] Figure 6C shows the coupling of suture 190 with sutures 202 preloaded in it, in order to facilitate the use of slip knots, for example.
    [00108] Figure 6D shows the coupling of suture 190 with sutures 203 preloaded in it. Sutures 203 are provided with needles 204. Needles 204 are shown attached to each suture 203, and can be used for securing sutures 203 to soft tissue, for example.
    [00109] Figure 6E shows suture coupling 190, with suture loops 206 that are stitched or otherwise integrated with suture coupling 190. Suture loops 206 are configured to allow a soft tissue to be attached to the suture coupling 190, as will be understood by those skilled in the art.
    [00110] Now with reference to Figure 7, an exemplary embodiment of another suture coupling 208 is shown therein. The suture coupling 208 is similar to the suture coupling 190, except that the suture coupling 208 includes a reinforced outer edge 212 and a reinforced inner edge 214. The reinforced outer edge 212 has a rigid reinforcement ring 218 and the reinforced inner edge 214 has a rigid reinforcement ring 220. The reinforcement rings 218 and 220 may be in the form of a rigid wire, and can be made of a metal or polymer, or any other suitable material. Rigid reinforcement rings 218 and 220 may be implemented during fabrication of suture coupling 208, for example by interweaving reinforcement rings 218 and 220 with suture coupling 208, or by braiding suture coupling 208 around reinforcement rings 218 and 220, for example.
    [00111] Now with reference to Figure 8A, there is shown an exemplary embodiment of yet another suture coupling 222. The suture coupling 222 is similar to the suture coupling 190 except that the suture coupling 222 is provided with an opening 230 and has one or more suture grommets 232. The suture grommets 232 can be defined by a reinforced edge 234 so that a suture can be passed therethrough. The suture grommets 232 are configured to allow one or more sutures to be passed therethrough, but it should be understood that the sutures may also be sewn into, or passed through, suture coupling 222, or passed through the opening 230, or combinations thereof, for example.
    [00112] Figure 8B illustrates suture coupling 222a, which is similar to suture coupling 222, except that suture coupling 222a is provided with a plurality of reinforcement segments 231. Reinforcement segments 231 may extend radially from an opening 230a, to the outer edge, so as to define a plurality of suture sections 231a. Suture coupling 222a is shown as having four gusset segments 231, but it should be understood that the number of gusset segments may vary.
    [00113] Now with reference to Figure 9, there is shown an exemplary embodiment of a 236 suture coupling. The 236 suture coupling is similar to the 190 suture coupling except that the 236 suture coupling is shown to have an oval shape and a pair of openings 242a and 242b to receive a pair of screws therein. One or more sutures may be passed through suture coupling 236, opening 242a, or opening 242b. Although suture coupling 236 has been illustrated as having an oval shape and two openings 242a and 242b, it should be understood that suture coupling 236 can be constructed in a variety of shapes and with more than two openings 242a and/or 242b , for example.
    [00114] Now with reference to Figure 10, an exemplary embodiment of a 246 suture coupling is shown therein. The 246 suture coupling is similar to the 190 suture coupling, except that the 246 suture coupling is shown as being substantially cross-shaped, so as to include a plurality of protrusions 248 and 249. Protrusions 248 are illustrated as having a length greater than the length of protrusions 249, to allow protrusions 248 to be wrapped around the head of a compression screw, such as compression screw 104 or 104a, for example. Once wrapped around the head (for example, the head 130 or the head 160 of a compression screw 104 or 104a), the protrusions 248 can be stitched or otherwise secured together to secure the suture coupling. 246 around the head of the compression screw, thus minimizing irritation to adjacent soft tissue.
    [00115] Now with reference to Figure 11A, another embodiment of a suture coupling 254 is shown therein. The suture coupling 254 is similar to the suture coupling 190, except that the suture coupling 254 is provided with a slit 264 that extends from the outer edge to the inner edge. Slit 264 allows suture coupling 254 to be positioned around screw 104 or 104a after screw 104 or 104a has been inserted at least partially into bone. The outer edge has two or more closing loops 266 that allow a suture (not shown) to be passed through the closing loops 266 and tightened to close the suture coupling 254, once positioned around screw 104 or 104a, by example.
    [00116] Figure 11B shows another suture coupling 254a, which is similar to suture coupling 254, except that suture coupling 254a is provided with a plurality of reinforcement segments 231a. Reinforcement segments 231a may extend radially from an opening 230b, to the outer edge, so as to define a plurality of suture sections 231b. Suture coupling 254a is shown as having four bracing segments 231a, but it should be understood that the number of bracing segments may vary. Suture coupling 254a is further shown to include a plurality of suture eyelets 255.
    [00117] Figure 11C illustrates a suture coupling 254b. Suture coupling 254b is similar to suture coupling 254a, except that suture coupling 254b is provided with a plurality of nubs 258. of one or more edges of a bone plate, such as bone plate 482 shown in Figure 24, when the suture coupling is secured between the bone plate and a bone. The suture coupling 254a may be provided with an opening 259 for receiving a screw and a slot 254a extending from the opening 259 to the outer edge. The protuberances 258 may additionally be provided with one or more suture eyelets 260.
    [00118] Now with reference to Figure 12, an exemplary embodiment of a suture coupling 270 is shown therein. The suture coupling 270 is similar to the suture coupling 190, except that the suture coupling 270 is provided with a reinforcing mesh 286 on at least one side of the body of the suture coupling 270. The reinforcing mesh 286 may resemble a spider's web, and may be made of a rigid metal, a polymer, or any other suitable material. . Reinforcement mesh 286 functions to provide rigidity and minimize tissue detachment during use of suture coupling 270.
    [00119] Referring now to Figure 13A, an exemplary embodiment of a suture coupling 290 is shown therein. The suture coupling 290 is flower-shaped so as to be provided with a plurality of petals or bulges 294. Flower-shaped suture coupling 290 can be constructed using conventional weaving techniques, for example, and can have its edges reinforced, such as by braiding or weaving a second layer of woven material with the coupling base during the fabrication of the suture coupling 290. The protrusions 294 are provided with suture grommets 298, which may be implemented and function similarly to suture grommets 232, for example.
    [00120] Now with reference to Figure 13B, another embodiment of a suture coupling 290a is shown therein. Suture coupling 290a is similar to suture coupling 290, except that suture coupling 290a is formed of a wool-like textile product. It should be understood that, for use herein, the term "wool-like textile product" is intended to include a relatively softer and less dense textile material as compared to suture coupling 290. The wool-like textile product it can be manufactured, for example, from one material or a combination of materials, including non-absorbable polymers such as polyethylene, polypropylene, ultra high molecular weight polyethylene, polyether ether ketone (PEEK), polyether -ketone ketone (PEKK), absorbable polymers such as polylactic acid (PLA), poly-L-lactide (PLLA), poly-L/D-lactide (PLDLA), polylactic-co-glycolic acid (PLGA), poly- glycolide or poly-glycolic acid (PGA), poly-caprolactone (PCL), or soft metals such as nitinol. Suture coupling 290a may have its edges and suture eyelets reinforced, such as by braiding or weaving a second layer of woven material with the coupling base during fabrication of suture coupling 290, for example.
    [00121] Now with reference to Figure 13C, another embodiment of a suture coupling 290b is shown therein. Suture coupling 290b is similar to suture coupling 290, except that suture coupling 290b is configured to have a generic trefoil shape so as to be provided with a plurality of petals or bulges 294b. The protrusions 294b are provided with suture grommets 298b, which may be implemented and function similarly to suture grommets 232, for example.
    [00122] Figure 13D shows a suture coupling 290c, which is generally cam-shaped or wedge-shaped. As such, suture coupling 290c has a narrow end 299a and a wide or flared end 299b. The narrow end 299a is provided with an opening 300a for receiving a shank of a compression screw. The wide end 299b may be provided with suture eyelets 300b.
    [00123] Now with reference to Figure 14, an exemplary embodiment of a 304 suture coupling is shown therein. The 304 suture coupling is similar to the 190 suture coupling except that the 304 suture coupling is not initially provided of an opening. In this way, a user can cut or otherwise form a hole to receive an implant, such as a compression screw or an anchor, where desired in suture coupling 304, for example.
    [00124] Now with reference to Figure 15, there is shown a coupling cap 310 according to the inventive concepts presented here. Coupling cap 310 can be inserted, clip-attached, or otherwise fixed to a surgical screw head (e.g. 104 or 104a) so that coupling cap 310 prevents a suture coupling 318 lifts up, or is lifted, away from a bone 316. For example, the coupling cap 310 can be affixed within a screw driver 312 of a surgical screw 314, after the surgical screw 314 is implanted in a bone 316 , such that a peripheral edge 317 of coupling cap 310 is positioned adjacent to or in contact with at least one of suture coupling 318 or a suture 319 secured to and extending from the coupling of suture 318. It should be understood that coupling cap 310 may be used with any of the suture couplings presented herein, and may be used with prior art suture couplings, in some exemplary embodiments.
    [00125] Now with reference to Figure 16, there is shown an exemplary embodiment of a coupling clamp 320, in accordance with the inventive concepts presented here. One or more coupling clips 320 may be used in combination with any of the suture couplings presented herein, and may function to prevent rotation and detachment of the suture coupling, for example. Coupling clip 320 can be implanted into a bone 316, after a suture coupling 318 having a suture 319 attached thereto is already implanted by means of a surgical screw 314, or it can be pre-assembled with the suture coupling 318 , depending on the needs of the surgical procedure, or the surgeon's preference, for example. Coupling clamp 320 can be made of any suitable material, such as metals, metal polymers, plastics, ceramics, resins, polymers or combinations thereof, for example. Coupling clip 320 can be inserted through suture coupling 318, and into bone 316, such as by driving coupling clip 320 into bone 316, by means of a suitable surgical tool (not shown), by example.
    [00126] Now with reference to figures 17A to 17C, the compression screw 104 with a suture ring 186 inserted therein is shown therein. A suture 322 is shown passed through suture ring 186 and slightly pulling suture ring 186 away from shaft 144 of compression screw 104. As seen in Figure 17D, suture ring 186 is compressed between the screw. of compression 104 and a bone 324, preventing suture 322 from pulling suture ring 186 away from compression screw 104.
    [00127] Now with reference to figures 18A to 18D, an embodiment of a compression screw 326 with a suture ring 186 inserted therein is shown therein, in accordance with the inventive concepts presented here. Compression screw 326 can be implemented similarly to compression screw 104, except that protrusions 328 are longer than protrusions 134 of compression screw 104, for example. This allows suture ring 186 to remain attached to compression screw 326, as suture 329 is pulling suture ring 186 away from compression screw 326.
    [00128] Now with reference to figures 19A to 19B, an embodiment of a compression screw 330 is shown therein, in accordance with the inventive concepts presented here. Compression screw 330 may be implemented in a similar manner to compression screw 104a, and has one or more teeth 332 formed on a surface for engagement with bone 333 of a head 334. Teeth 332 function to engage with a suture ring 186 (eg, by compressing suture ring 186 against a bone) and prevent suture ring 186 from being pulled away from head 334. It should be understood, however, that a compression screw 330 can be used in combination with any of the suture couplings and suture rings described herein, as well as with any conventional suture couplings, as will be apparent to the person skilled in the art having the benefit of the present description.
    [00129] Now with reference to figures 20A to 20B, there is shown an embodiment of a compression screw 336, shown in combination with a suture ring 186. The compression screw 336 can be implemented similarly to the compression screw 104a, except that the compression screw 336 has an annular groove 338 formed in a surface for engagement with the bone 340 of a head 342 thereof. The annular groove 338 is dimensioned such that it can house within it at least a portion of the suture ring 186, so that the suture ring 186 is compressed between the surface 340 and a bone, and is prevented from being pulled away from the compression screw 336 by one or more sutures. It should be understood that a cylindrical annular groove (not shown) may be formed in the surface for engagement with bone 340 in some exemplary embodiments configured to house a suture coupling constructed in accordance with the inventive concepts presented herein.
    [00130] Now with reference to figures 21A to 21D, an exemplary embodiment of a compression screw with variable angle 350 is shown therein, according to the present inventive concept. The variable angle compression screw 350 has a head 352 in combination with a shank 354 that has a longitudinal axis 356, a proximal end 358, and a distal end 360.
    [00131] Stem 354 includes a central cannula 362 extending therethrough. The central cannula 362 is configured to allow the insertion of a guide wire (not shown), such as a Kirschner wire, for example. It should be understood, however, that some exemplary modalities of the variable angle compression screw 350, in accordance with the present inventive concepts, may omit the central cannula 362 and may or may not be implanted in a bone over a guidewire .
    The proximal end 358 of stem 354 includes a convex portion 364 having threads 366 formed thereon. Threads 366 are desirably oriented radially with respect to longitudinal axis 356 of rod 354. Threads 366 may be any suitable threads 366 having any suitable pitch, and may be formed on convex portion 364 in any suitable manner, such as by molding, cutting, machining or combinations thereof, for example.
    [00133] The proximal end 358 additionally has a hex driver 368 (Figures 21C to 21D), which is configured to receive the head of a conventional hex screwdriver (not shown), so that rotational motion can be transmitted to rod 354 with respect to longitudinal axis 356. It should be understood, however, that proximal end 358 may include an actuator configured to engage any conventional actuator in place of a hex actuator 368, in some exemplary embodiments of the present concepts inventive, such as a Phillips actuator, a flat actuator, a cross actuator, an octagonal actuator and a star-shaped actuator, for example.
    The distal end 360 of the rod 354 has threads 370 formed therein, the threads 370 being configured to engage a bone so that the variable angle compression screw 350 can be implanted into the bone and retained therein. Stem 354 is shown as comprising an unthreaded portion 372, but it should be understood that some exemplary embodiments of a variable angle compression screw 350 may omit unthreaded portion 372 and may have threads 370 along the length of shank 354 Additionally, some exemplary embodiments of a rod 354 may include other retaining means or features (not shown), such as ribs, grooves, protrusions, channels, protrusions, or combinations thereof, in place of or in addition to threads 370. Threads 370 may be self-tapping or self-drilling, or a drill may be used to pre-drill a suitable sized opening or channel into the bone, at any desired angle, for threads 370 to engage, for example.
    [00135] The head 352 is shown as having a trefoil leaf-shaped structure, with a plurality of protrusions 374, each with a suture attachment hole 376 formed therein. Head 352 additionally includes a central opening 378 which has threaded columns 380 formed on an inner surface thereof. The central opening 378 is configured to receive therein, by threading, the convex portion 364 of the rod 354 so that the threads 380 engage with the threads 366 of the rod 354 to secure the head 352 to the rod 354 at any angle wanted. It should be understood that although four columns of threads 380 are shown in Figure 21C, the present inventive concepts may be used with continuous threads 380, for example, or with fewer than four or more than four columns of threads 380.
    [00136] An exemplary embodiment of the use of the variable angle compression screw 350 includes forming an opening in a bone 382. The shank 354 of a variable angle compression screw 350 can then be advanced into the opening, as by swiveling rod 354 with a screwdriver (not shown), relative to longitudinal axis 356. Once the proximal end 358 of rod 354 is flush with the surface of bone 382, or is just below the surface of bone 382, head 352 may be placed against the surface of bone 382 (e.g., via screw driver 102), so that central opening 378 is aligned with opening in bone 382. In an exemplary embodiment, the rod 354 may be recessed away from bone 382 so that threads 366 engage with threads 380 to securely secure head 352 to rod 354. In another exemplary embodiment, head 352 may be threaded. positioned on the rod 354. As will be understood by one of skill in the art having the benefit of the present description, when the head 352 is connected to the rod 354, the head 352 may have a variable angle α with respect to the longitudinal axis 356 of the rod 354, and that angle α may be in a predetermined range between about 90° and about 135°, or between about 90° and about 120°, in any direction from longitudinal axis 356, including any intervals and sub-intervals between the same, for example.
    [00137] Additionally, one or more sutures (not shown) may be secured to head 352 via a suture attachment hole 376, prior to securing head 352 to stem 354, for example. It should be understood that, in some exemplary embodiments, the suture attachment holes 376 may be omitted, and/or a suture coupling may be used to attach one or more sutures to the variable angle compression screw 350 by positioning such suture coupling between head 352 and bone 382, and using rod 354 to secure head 352 and suture coupling to bone 382, as described above, for example. Additionally, in some embodiments a suture attachment hole 376 may be used to secure one or more sutures to head 352, and one or more suture couplings may be used to secure one or more sutures to head 352, or combinations thereof, for example.
    [00138] Now with reference to Figures 22A to 22D, an exemplary embodiment of a compression screw 384 is shown therein, according to the inventive concepts presented here. Compression screw 384 includes a shank 386 that has a longitudinal axis 388 and a head 390.
    Stem 386 has a proximal end 392 and a distal end 394, and a central cannula 396 extending therethrough. Proximal end 392 includes a neck portion 398 and a concave collar 400 that have threads 402 formed on the concave surface thereof. Proximal end 392 additionally includes a hex driver 404 configured to receive a hex screwdriver (not shown) so that rotational motion can be transmitted to rod 386 with respect to longitudinal axis 388. Distal end 394 has threads 406 formed therein, the threads 406 being configured to engage with a bone. It should be understood that, although rod 386 is shown as comprising an unthreaded portion 408, rod 386 may include threads 406 along its entire length, in some embodiments of the inventive concepts presented herein. Additionally, it should be understood that some exemplary embodiments may omit the hex driver 404, and may have any conventional screw driver capable of imparting rotational force, or motion, to the rod 386.
    [00140] The head 390 has an opening 410 and one or more protrusions 412. The opening 410 is sized so that the head 390 is slidably positioned around the neck portion 398 of the rod 386, and so that the head 390 can slide along the neck portion 398 of the stem 386. It should be understood that while the head 390 is shown as comprising a trefoil leaf shape with four protrusions 412, any suitable head shape 390 can be used with the inventive concepts presented here, such as a three-leaf clover shaped head 390, a circular head 390, and a square head 390, for example. In some exemplary embodiments, the outer edges of the head 390 may be tapered so that the head 390 has a convex-shaped cross-section rather than a rectangular cross-section to reduce the occurrence of irritation/injury to tissue. soft.
    The one or more protrusions 412 may include suture attachment holes 414 configured to secure one or more sutures (not shown) therein.
    [00142] Aperture 410 tapers inward from proximal end 392 and toward distal end 394 of stem 386, and includes four threads 416 configured to engage threads 402 on concave collar 400. skilled in the art, this arrangement of threads 416 and 402 allows the concave collar 400 to engage the opening 410 of the head 390, so that the head 390 is oriented at an angle α with respect to the longitudinal axis 388, said angle α can range from about 90° to about 120°, including any intervals and sub-ranges in between, for example. This allows the compression screw 384 to have a variable angle between the head 390 and the shank 386 so that the head 390 is as flush as possible with the surface of a bone 418 when the compression screw 384 is implanted into the bone 418.
    [00143] Compression screw 384 can be produced by any suitable process such as injection molding, machining, casting or combinations thereof, for example. In a non-limiting embodiment, rod 386 may include a first portion 420 and a second portion 422 slidably received in the first portion 420 and welded, glued or otherwise secured therein. To assemble compression screw 384, head 390 is slid over neck portion 398 of second portion 422, and second portion 422 is slid into first portion 420 and secured therein, as described above. For an example of this type of compression screw with two portions see patent application serial no. US 12/332,756, the contents of which are incorporated herein by reference in their entirety. It should be understood, however, that the compression screw 384 may have a shank 386, and the head 390 may have two portions joined together so that the head 390 is slidably positioned over the neck portion 398 of the shank. 386, for example.
    [00144] During operation, rod 386 is gradually advanced into bone 418, such as by transmitting rotational motion to rod 386 by means of a hex screwdriver (not shown) engaging hex driver 404, for example. Compression screw 384 may or may not be implanted over a guidewire (not shown) inserted through central cannula 396 (Figure 22C) and extending through rod 386, for example. Once the neck portion 398 begins to advance under the surface of the bone 418, the threads 416 of the head 390 are engaged by the threads 402 of the concave collar 400 at an angle α that reflects the angle of the surface of the bone 418 with which the head 390 is in contact as shown in Figure 22C. Compression screw 384 can be further advanced, until a desired compressive force is applied to bone 418 by head 390, for example.
    [00145] Now with reference to figures 23A to 23D, there is shown an exemplary embodiment of a dynamic locking screw (DLS) 430, according to the present inventive concepts. The Variable Angle DLS 430 includes a shank 432, a longitudinal axis 434 and a head 436.
    Stem 432 has a cannula 438 extending therethrough, as well as a proximal end 440 and a distal end 442. The proximal end 440 includes an outer wall 444 and an inner wall 446 spaced a distance apart, such that an annular space 448 is defined by the outer wall 444 and the inner wall 446. The annular space 448 functions to allow the inner wall 446 to move toward and away from the outer wall 444 in a radial direction. with respect to the longitudinal axis 434.
    [00147] The rod 432 has a first portion 450 with an open end defining a cylindrical space, and a second portion 452 configured to be slidably received in the cylindrical space and secured therein, so that the annular space 448 is defined by first portion 450 and second portion 452. First portion 450 and second portion 452 may be secured together in any suitable manner, such as welding, ultrasonic welding, adhesives or combinations thereof, for example. For an exemplary method of producing a dynamically locking screw, see patent applications with serial numbers US 12/332,756 and 12/940,531, the contents of which are incorporated herein by reference in their entirety.
    [00148] The proximal end 440 additionally includes a neck portion 454 and a collar 456 extending above the first portion 450 of the stem 432. The collar 456 is substantially concave and tapers inwardly with respect to the longitudinal axis 434, the from the proximal end 440 towards the distal end 442. The collar 456 has threads 458 on the concave surface 460 thereof. Collar 456 additionally has a hex driver 462 configured to accept a hex screwdriver (not shown) so that rotational motion can be transmitted to rod 432 through hex driver 462 with respect to longitudinal axis 434.
    Distal end 442 includes threads 464 configured to engage a spongy portion 466 of bone tissue 468 so that rod 432 can be retained therein.
    [00150] Head 436 is slidably disposed around neck portion 454, and includes a central opening 470 which tapers inwardly toward longitudinal axis 434 from proximal end 440 and toward distal end 442 Head 436 may be disposed around neck portion 454, prior to joining first portion 450 with second portion 452 of rod 432, for example.
    [00151] The central opening 470 additionally has four rows of threads 472 configured to engage with the threads 458 of the collar 456. The threads 472 engage with the threads 458 so that the head 436 is oriented with respect to the longitudinal axis 434 in an angle α, said angle α can range from about 90° to about 130°, including any intervals and sub-intervals therebetween, for example.
    [00152] The head 436 additionally has one or more protrusions 474 that have suture attachment holes 476 formed therein. The suture attachment holes 476 are configured to secure one or more sutures (not shown), such as by compressing one or more sutures between the head 436 and the bone 468, for example.
    [00153] During operation, rod 432 is advanced into bone 468 at any suitable angle as described above. Stem 432 can be advanced by means of self-tapping or self-tapping threads 464, or a suitable sized channel or opening can be formed in bone 468, into which stem 432, for example, is advanced. Threads 458 of collar 456 engage threads 472 to secure head 436 to rod 432 so that head 436 is oriented with respect to longitudinal axis 434 at an angle α as described above. Stem 432 may be advanced into bone 468 so that a desired compressive force is applied to said bone 468, for example. During use, as forces are applied to head 436 and/or shank 432 in a radial direction relative to longitudinal axis 434, the variable angle DLS 430 is able to at least partially absorb these forces through bending or deflection such that inner wall 446 moves within annular space 448 relative to outer wall 444, as shown in Figure 23D, for example.
    [00154] It should be understood that, in some exemplary embodiments, the variable angle DLS 430 may omit suture attachment holes 476, and/or may include a suture coupling (not shown) that can be implemented and operated substantially as described above. Additionally, in some exemplary embodiments the variable angle DLS 430 may include more than one annular space 448, as will be understood by those skilled in the art having the benefit of the present disclosure. Additionally, in some embodiments, one or more sutures may be wrapped around rod 432, and may be pressed against bone 468 by head 436, when variable angle DLS 430 is implanted into bone 468, for example.
    [00155] Referring now to Figure 24, an exemplary embodiment of a bone plate assembly 480 is shown therein. Bone plate assembly 480 includes a bone plate 482 and one or more compression screws 484.
    [00156] Bone plate 482 can be produced from any suitable bioinert, biocompatible or bioabsorbable material, such as stainless steel, titanium, polyethylene, polylactic acid (PLA), polylactic coglycolic acid (PLGA), polyurethane, bone tissue, fiber ultra high molecular weight polyethylene, epoxy resins or combinations thereof, for example.
    The bone plate 482 may include a plate body 486 having a geometric axis 488, an upper surface 490, a bone facing surface 492, and one or more fixation apertures 494 formed therein. The fixation openings 494 taper outward from the upper surface 490 to the bone facing surface 492, i.e. the fixation openings 494 are narrower on the upper surface 490 and wider on the bone facing surface 492. The attachment openings 494 additionally include four threads 496 formed therein, the threads 496 being configured to engage the threads of one or more compression screws 484, as will be described below.
    [00158] The one or more compression screws 484 include a shank 498 having a longitudinal axis 500 and a cannula 502 extending therethrough. Stem 498 has a proximal end 504 and a distal end 506.
    [00159] Proximal end 504 includes a head 508 having a convex surface with threads 510 formed therein and configured to enter an aperture for attachment 494 on surface 492 and threadedly engage with one or more of the threads 496 in the attachment opening 494.
    [00160] Distal end 506 has threads 512 configured to engage with bone tissue so that compression screw 484 can be retained therein.
    [00161] During operation, one or more of the compression screws 484 are implanted into a bone 514 and advanced into the bone 514 so that the head 508 of the one or more compression screws 484 is flush with, or positioned thereafter. below the surface of bone 514. A bone plate 482 is then placed against bone 514 so that one of the fixation openings 494 of bone plate 482 is aligned with the head 508 of one or more compression screws 484. the one or more compression screws 484 are then backed out so that the threads 510 of the one or more compression screws 484 engage with the threads 496 of the attachment opening 494 so as to secure the bone plate 482 to one or more compression bolts 484. One of the one or more compression bolts 484 may be oriented such that the longitudinal axis 500 of compression bolt 484 intersects with geometry axis 488 at an angle α, which can vary between about about 30° and about 120°, including any intervals and sub-ranges in between, for example. Additionally, one or more of the compression screws 484 may be oriented such that the longitudinal axis 500 of the compression screw 484 intersects with the geometric axis 488 at an angle β, which can vary between about 30° and about 120° , including any ranges and sub-ranges in between, for example. In some exemplary embodiments of the inventive concepts presented here, angles α and β may be different, while in other exemplary embodiments angles α and β may be the same or substantially equal to each other.
    [00162] It should be understood that, although only two compression screws 484 are shown in Figure 24, a bone plate 482 in accordance with the inventive concepts presented herein can be secured to a bone 514 with one or more compression screws 484, for example. Additionally, a compression screw other than the compression screw 484 can be used to secure the bone plate 482 to the bone 514, such as a DLS, for example. In addition, it should be understood that one or more of the suture couplings described above, particularly the 254b suture coupling (Figure 11C), can be used in conjunction with the 480 bone plate system.
    [00163] Additionally, although bone plate 482 is shown as having a rectangular cross section in Figure 24, a bone plate 482 in accordance with the inventive concepts presented herein may have any suitable cross section such as concave, convex, rounded or combinations of the for example, in order to minimize the occurrence of injury or irritation to adjacent soft tissues.
    [00164] It should be understood that the steps presented here can be performed simultaneously or in any desired order, and can be performed by a human or by a machine, and combinations thereof, for example. For example, one or more of the steps presented here can be omitted, one or more steps can be further divided into one or more substeps, and two or more steps or substeps can be combined into a single step, for example. Additionally, in some exemplary embodiments, one or more steps may be repeated one or more times, whether that repetition is performed sequentially or interspersed with other steps or sub-steps. Additionally, one or more of the other steps or sub-steps can be performed before, after, or between the steps presented here, for example.
    [00165] Although the inventive concepts disclosed and claimed herein, and the advantages thereof, have been described in detail, it should be understood that various exchanges, substitutions and alterations can be made to the present invention without deviating from the character and scope of the same as defined by the appended claims. Furthermore, the scope of this application is not intended to be limited to the specific modalities of process, apparatus, items of manufacture, compositions of substances, means, methods and steps described in the descriptive report. As will be readily understood by the person skilled in the art from the description of the inventive concepts presented and claimed herein, various processes, apparatus, items of manufacture, compositions of substances, means, methods or steps, currently existing or to be further developed, that substantially perform the same function or achieve substantially the same results as the corresponding embodiments described herein, can be used in accordance with the inventive concepts presented and claimed herein. Accordingly, the appended claims are intended to include within their scope such processes, apparatus, items of manufacture, compositions of substances, means, methods or steps.
    权利要求:
    Claims (7)
    [0001]
    1. Compression screw system, comprising: a screw (350) comprising: a shank (354) having a proximal end (358) and a distal end (360), at least the distal end (360) being threaded to engage the bone; and a head (352) associated with the proximal end (358) of the stem (354), the head (352) having a plurality of outwardly extending protrusions (374) spaced apart from one another so as to define a plurality of recesses between they, wherein at least one of the protrusions (374) of the head (352) has at least one suture attachment hole (376) extending therethrough, wherein the head (352) has a central opening (378) and the proximal end (358) of the stem (354) has a plurality of threads (366), characterized in that the central opening (378) of the head (352) has a plurality of thread columns (380) formed therein, and the plurality of threads (366) of the proximal end (358) of the stem (354) are configured to engage the threaded posts (380) of the central opening (378) to connect the head (352) to the stem (354).
    [0002]
    2. Compression screw system according to claim 1, characterized in that the protrusions (374) of the head (352) extend radially outward.
    [0003]
    3. Compression screw system according to claim 1 or 2, characterized in that each of the protrusions (374) of the head (352) has at least one suture fixation hole (376) that extends through of the same.
    [0004]
    4. Compression screw system according to any one of claims 1 to 3, characterized in that each of the rod (354) and the head (352) has a cannula (362) that extends through it .
    [0005]
    5. Compression screw system according to any one of claims 1 to 4, characterized in that the proximal end (392) of the rod (386) has a concave threaded collar (400), in which the rod (386) ) further has a neck portion (398) positioned adjacent the threaded concave collar (400) and wherein the head (390) is positioned on the neck portion (398) and configured to threadedly engage the concave collar (400).
    [0006]
    6. Compression screw system according to any one of claims 1 to 5, characterized in that the proximal end (440) of the rod (432) has an inner wall (446) and an outer wall (444) defining an annular space (448) between the inner and outer wall (446, 444), the inner wall (446) comprising a neck portion (454) and a concave collar (456), wherein the head (436) is positioned in the neck portion (454) and configured for threaded engagement with the concave collar (456).
    [0007]
    7. Compression screw system according to any one of claims 1 to 6, characterized in that it further comprises a screw driver (102) with a plurality of protrusions (126) configured to be received in the head recesses ( 352) of the rod (354) in such a way that the rotational force can be transferred from the screw driver (102) to the screw (350).
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    JP2015506759A|2015-03-05|
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    法律状态:
    2018-12-04| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|
    2019-12-17| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|
    2021-06-01| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|
    2021-08-10| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 22/01/2013, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    US201261589947P| true| 2012-01-24|2012-01-24|
    US61/589,947|2012-01-24|
    PCT/US2013/022569|WO2013112477A1|2012-01-24|2013-01-22|Compression screw system|
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