US20020062127A1 - Method and apparatus for mandibular osteosynthesis - Google Patents
Method and apparatus for mandibular osteosynthesis Download PDFInfo
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- US20020062127A1 US20020062127A1 US10/047,520 US4752001A US2002062127A1 US 20020062127 A1 US20020062127 A1 US 20020062127A1 US 4752001 A US4752001 A US 4752001A US 2002062127 A1 US2002062127 A1 US 2002062127A1
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- locking plate
- mandible
- fastener
- plate
- bone
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
- A61B17/8047—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers wherein the additional element surrounds the screw head in the plate hole
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
- A61B17/8071—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones for the jaw
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/8605—Heads, i.e. proximal ends projecting from bone
- A61B17/861—Heads, i.e. proximal ends projecting from bone specially shaped for gripping driver
- A61B17/8615—Heads, i.e. proximal ends projecting from bone specially shaped for gripping driver at the central region of the screw head
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8875—Screwdrivers, spanners or wrenches
- A61B17/8877—Screwdrivers, spanners or wrenches characterised by the cross-section of the driver bit
- A61B17/888—Screwdrivers, spanners or wrenches characterised by the cross-section of the driver bit the driver bit acting on the central region of the screw head
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8875—Screwdrivers, spanners or wrenches
- A61B17/8886—Screwdrivers, spanners or wrenches holding the screw head
- A61B17/8888—Screwdrivers, spanners or wrenches holding the screw head at its central region
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S606/00—Surgery
- Y10S606/902—Cortical plate specifically adapted for a particular bone
- Y10S606/903—Cranial and facial plate
- Y10S606/904—Jaw plate
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- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Neurology (AREA)
- Surgical Instruments (AREA)
- Prostheses (AREA)
Abstract
A system for mandibular reconstruction generally includes an elongated locking plate having a plurality of internally threaded apertures and a plurality of fasteners. Each fastener includes a main body portion having an upper threaded shaft and a lower threaded shaft. The lower threaded shaft is adapted to engage the mandible. Each fastener further includes a removable head portion internally threaded for engaging the upper shaft portion and externally threaded for engaging a selected one of the internally threaded apertures of the locking plate. In the preferred embodiment, the thread leads of the head portion and lower shaft of the main body portion are identical. A method of mandibular osteosynthesis utilizes the system of osteosynthesis and generally comprises the steps of temporarily securing the elongated locking plate to the mandible with at least one fastener by engaging the threads of the lower portion with the mandible and threadably engaging the head with the locking plate, unthreading the head portion from the main body of the fastener to thereby allow displacement of the locking plate from the mandible without removing the fasteners from the mandible, performing a surgical procedure (e.g., removal of a cancerous growth), and re-securing the elongated plate to the fastener with the removable head portion.
Description
- This is a continuation-in-part application of U.S. Ser. No. 09/025,140, filed Feb. 18, 1998.
- 1. Field of the Invention
- The present invention relates to surgical applications for the repair of bone fractures and deformities. More particularly, the present invention relates to a method and apparatus for mandibular osteosynthesis.
- 2. Discussion of the Related Art
- In various orthopedic surgical procedures, it is necessary to align and secure two bone portions in a relatively fixed relationship to each other. For example, the need for establishing such a secured relationship is often a result of a fracture which has occurred to the bone. To ensure that the bone can regenerate in the proper orientation and fuse the fracture, it is important that the bone portions be fixed in the desired position during bone regeneration.
- It is known in the art to provide metal plates for the repair of bone fractures. These plates are generally secured to bone portions with screws. Among other applications, such plates and fasteners are used to provide rigid stabilization of orthopedic and craniofacial fractures. The plates conventionally employed for-cranial and facial osteosynthesis generally comprise small, generally flat, elongated sections of metal. The sections contain round and perhaps elongated screw holes at various points along their lengths for fastening the sections to bone.
- Because no surface of the human skeleton is completely flat, existing plates must be extensively twisted, formed and bent during surgery to conform to portions of the skeleton on which they are to be affixed. Significant time is expended during surgery for shaping and re-shaping metal plates adequately to conform to desire bone surfaces. This additional time increases anesthesia requirements and operating room time and also increases the potential for infection.
- In one commonly used technique for mandibular reconstruction, a flat plate is drawn against the surface of the mandible with a plurality of fasteners, thereby bending the plate to a desired shape. Subsequently, the fasteners and plate are removed to allow surgical access to the mandible (e.g. for removal of a cancerous growth). Finally, the plate is again fastened to the mandible by engaging the fasteners with existing holes in the mandible.
- While known systems utilizing plates and fasteners for cranial and facial osteosynthesis have proven to be acceptable for certain applications, such systems are nevertheless susceptible to improvements that may enhance their performance. In this regard, many known systems require time consuming surgical attachment. Additionally, known systems which necessitate the insertion, removal and subsequent reinsertion of fasteners into the bone negatively affect fastener purchase. Furthermore, many known techniques for cranial facial osteosynthesis disadvantageously position a plate immediately adjacent to the bone which is particularly susceptible to resorption.
- In one form, the present invention relates to a method for mandibular osteosynthesis which includes the general step of securing an elongated locking plate to a bone with a plurality of fasteners each including a main body portion having an upper shaft portion and a lower shaft portion. Each fastener further includes a head member removably attached to the upper shaft portion. The method of the present invention further includes the general step of removing the locking plate from the bone by removing the removable head member of each fastener from its main body portion.
- In another form, the present invention comprises a system for osteosynthesis of a mandible including an elongated locking plate and at least one fastener. The elongated locking plate has a plurality of internally threaded apertures. Each of the at least one fastener has a main body portion with an externally threaded lower shaft portion and an upper shaft portion. The at least one fastener further has a head member adapted to removably engage the upper shaft portion. The head member is externally threaded for engaging one of the plurality of internally threaded apertures. The externally threaded shaft portion and the externally threaded head member preferably have a common thread lead and an identical thread pitch.
- An advantage of the present invention is the provision of a method and apparatus for mandibular osteosynthesis which quickly and easily contours a plate to the mandible without sacrificing fastener purchase with the bone.
- A related advantage of the present invention is the provision of a method and apparatus for mandibular osteosynthesis which incorporates a threaded fastener having a removable head.
- Another advantage of the present invention is the provision of a method and apparatus for osteosynthesis which incorporates a locking plate with an upwardly curved forward end that more accurately cooperates with the geometry of the human mandible.
- Another advantage of the present invention is the provision of a method and apparatus for mandibular osteosynthesis which incorporates an auxiliary reinforcement member adapted to be removably attached to a locking plate.
- Another advantage of the present invention is the provision of a method and apparatus for mandible osteosynthesis which incorporates a plate reinforcement member which may be selectively secured to a locking plate for increased strength in areas of significant loss of bone mass.
- A related advantage of the present invention is the provision of a method and apparatus for mandible osteosynthesis which incorporates a mesh reinforcement member which may be attached to a reconstruction plate for providing reinforcement where a resection has been made or significant bone mass is otherwise absent.
- FIG. 1 is a perspective view of a mandibular osteosynthesis system constructed in accordance with the teachings of the preferred embodiment of the present invention illustrated in operative association with a human mandible.
- FIG. 2 is an illustration the locking plate shown in FIG. 1 according to the teachings of the preferred embodiment of the present invention.
- FIG. 3 is a cross-sectional view taken along the line3-3 of FIG. 2.
- FIG. 4 is an exploded view of one of the fasteners shown in FIG. 1 according to the teachings of the preferred embodiment of the present invention.
- FIG. 5 is a cross-sectional view taken along the line5-5 of FIG. 4.
- FIG. 6 illustrates an end view of the head of the fastener shown in FIG. 4 according to the teachings of the preferred embodiment of the present invention.
- FIG. 7 is a view of the auxiliary reinforcement member of FIG. 1.
- FIG. 8 is an enlarged cross-sectional view taken along the lines8-8 of FIG. 7.
- FIG. 9 is an illustration of a pair of links in accordance with the teachings of the present invention.
- FIG. 10 is a fragmentary exploded view of the pair of links of FIG. 9 and a cooperating anchor member.
- FIG. 11 is a perspective view similar to FIG. 1, illustrating an alternative locking plate and an alternative auxiliary reinforcement member of the mandibular osteosynthesis system of the present invention operatively associated with a human mandible.
- FIG. 12 is a cross-sectional view taken along the line12-12 of FIG. 11.
- FIG. 13 is an illustration of a tool of the mandibular osteosynthesis system of the present invention.
- FIG. 14 is an enlarged view illustrating the detail shown in
circle 14 identified in FIG. 13. - FIG. 15 is an enlarged end view of the tool taken in the direction of
arrow 15 shown in FIG. 14. - FIG. 16 is a perspective view similar to FIG. 1, shown incorporating a mesh reinforcing member of the mandibular osteosynthesis system of the present invention.
- FIG. 17 is an enlarged side view of the mesh reinforcing member of FIG. 16.
- FIG. 18 is a front view of an alternative mesh reinforcing member.
- The following description of the preferred embodiment of the present invention is merely exemplary in nature and is in no way intended to limit the invention or its application or uses.
- Referring to FIG. 1, a system constructed in accordance with a preferred embodiment of the present invention is generally identified with
reference numeral 10. Thesystem 10 is shown operatively associated with ahuman mandibular 12. However, it will become apparent to those skilled in the art that certain aspects of the present invention have applicability for other surgical applications. - With continued reference to FIG. 1 and additional references to FIGS. 2 and 3, the
system 10 of the present invention is shown to include anelongated reconstruction plate 14. Theplate 14 is formed to include a plurality ofapertures 16, each adapted to receive afastener 18 for interconnecting theplate 14 with themandible 12. The apertures preferably include anoval countersink 20 and are internally threaded. For this reason, theplate 14 will be interchangeably referred to herein as a lockingplate 14. - The locking
plate 14 is shown to generally include acentral portion 22, and first and second ends 24 and 26. Thefirst end 24 is precontoured in an anterior-posterior direction to cooperate with the shape of themandible 12. Thesecond end 24 is also curved upwardly in the plane of thecentral portion 22, this curvature of thesecond end 26 cooperates with the contour of thehuman mandible 12 when the lockingplate 14 follows the shape of themandible 12 in a medial-lateral direction. - In one application, the locking
plate 14 is constructed of titanium. More preferably, the lockingplate 14 is constructed from commercially pure, grade 2 or grade 4 titanium. However, it will be appreciated by those skilled in the art that other materials having suitable performance characteristics may be employed. Preferably, the lockingplate 14 is inelastically deformable so as to retain its shape once contoured to cooperate with the shape of themandible 12. - With additional reference to FIGS.4-6, the
fastener 18 of the present invention is shown to generally include amain body 30 and ahead member 32. Themain body 30 includes anupper shaft portion 34 and alower shaft portion 36. Thelower shaft portion 36 is externally threaded and adapted to engage the mandible orbone 12 in a conventional manner. Insertion of the lower shaft portion into the bone is limited by aflange 38 interdisposed between the upper andlower shaft portions upper shaft portion 32 is also externally threaded and adapted to engage an internally threadedaperture 40 of thehead member 32. Thehead member 32 is externally threaded for engaging one of the plurality of internally threadedapertures 16 of the lockingplate 14. - In one application, the thread pitches of the
upper shaft portion 34,lower shaft portion 36 and the thread pitch of the external threads of thehead member 32 are common. The external threads of thehead member 32 and the externally threadedlower shaft portion 36 have a common thread lead. In the exemplary embodiment illustrated, the externally threadedlower shaft portion 36 has a single lead configuration while the external threads of theupper shaft portion 34 andhead member 32 have a double lead configuration. - In use, a malleable template (not shown) is position on the
mandible 12 and bent to the general shape of the cooperating bone surface. Next, the lockingplate 14 is bent to approximately the shape of the template and positioned on themandible 12 so thatcertain apertures 16 may be selectively used as a guide for drilling holes (not specifically shown) in themandible 12 for receiving thefasteners 18. A first of thefasteners 18 is passed through a selected one of theapertures 16 and rotated so that the externally threadedlower portion 36 is driven into the hole in themandible 12. For example, thefirst end 24 of the lockingplate 14 may be first secured to themandible 12 with afirst fastener 18. As the externally threadedlower portion 36 of thefastener 18 is driven into thebone 12, the external threads of thehead member 32 simultaneously engage the internally threadedaperture 16 of the lockingplate 14. This is possible as a result of the common thread lead shared between thelower portion 36 and thehead member 32. -
Additional fasteners 18 are used to interconnect the lockingplate 14 with thebone 12 in a substantially identical manner. As shown in FIG. 1, four (4) fasteners are used to interconnect the lockingplate 14 with thebone 12. However, it will be appreciated by those skilled in the art that any number offasteners 18 may be employed depending on a particular application. In one application, the order of the fastener insertion linearly progresses along the lockingplate 14 from one end (e.g. the first end 24) to the second end (e.g. the second end 26). As additional fasteners are engaged with thebone 12, the lockingplate 14 is drawn into its operative position adjacent to thebone 12. - At this point of the surgical procedure, the
head members 32 of each of the threadedfasteners 18 are unthreaded from their respectiveupper portions 34. This allows the surgeon to displace the lockingplate 14 from thefasteners 18 and provides access to thebone 12 for accomplishing a desired surgical procedure (e.g., removal of a cancerous growth). When the lockingplate 14 is removed, it retains its shape due to the inelastic deformation. When the surgical procedure is complete, the lockingplate 14 is replaced by inserting theupper portions 34 of thefasteners 18 through theselective apertures 14 and simultaneously threading the internal threads of theaperture 16 with the external threads of theupper portion 34 and the external threads of thehead member 32 with the internal threads of theaperture 16. Since thefasteners 18 are not removed from thebone 12 after initial insertion, fastener/bone purchase is not compromised. - With reference to FIGS.13-15, one suitable tool for use in connection with the
system 10 of the present invention is shown and generally identified withreference numeral 40. The tool includes ahandle 42 having anupper portion 44 and alower portion 46. The upper andlower portions tool 40. Theupper portion 44 is adapted to rotate with afirst drive portion 48, while thelower portion 46 of thehandle 42 is adapted to rotate with asecond drive portion 50. Thefirst drive portion 48 includes a generallyrectangular tip 52 adapted to engage a generallyrectangular aperture 54 provided in atop surface 56 of theupper shaft portion 34 of eachfastener 18. Thesecond drive portion 50 is illustrated to include four (4) drive elements equally spaced about thefirst drive member 48. The drive elements 58 are adapted to engage a corresponding number ofslots 60 equally spaced about thehead member 32 of eachfastener 18. - After the holes are drilled into the
mandible 12, the surgeon selects a fastener with thehead portion 32 threaded onto theupper shaft portion 34 of themain body 30 and engages the drive elements 58 of thetool 40 with theslots 60 of thehead member 32 simultaneously. Simultaneously, thetip 52 of thedrive member 48 engages therectangular aperture 54 of theupper shaft portion 34. The surgeon grasps the upper andlower portions handle 42 and rotates thetool 40 in a conventional manner. This action causes thehead member 32 to threadably engage anaperture 16 of lockingplate 14 and simultaneously causes the threads of thelower shaft portion 36 of thefastener 18 to engage the hole provided in thebone 12. - Once all of the
fasteners 18 are initially inserted into thebone 12, the surgeon again engages thehead 32 with the drive elements 58. The thumb and forefinger are used to rotate thelower portion 46 of thehandle 42 and in turn the rotate thehead portion 32 of thefastener 18 in a counterclockwise direction. Simultaneously, the palm and remaining fingers grasp theupper portion 44 of thehandle 42 so that thelower portion 46 can be rotated relative thereto. This action removes thehead member 32 from itsaperture 16. Since themain body portion 30 of thefastener 18 is not simultaneously rotated, thehead portion 32 is simultaneously unthreaded therefrom. In a similar manner, thehead portion 32 is returned to threaded engagement with both theaperture 16 of theplate 14 and theupper shaft portion 32 of themain body portion 30 after the desired surgical procedure is performed on themandible 12. - When the locking
plate 14 is operatively associated with themandible 12 as shown in FIG. 1, the lockingplate 14 is adjacent to but slightly displaced from thebone 12. In this regard, theflange 38 which is interdisposed between the upper and lower externally threadedportions fasteners 18 limits downward translation of theremovable head member 32. The thickness of thehead member 32 is greater than the thickness of the lockingplate 14. As a result, when ahead members 32 is completely threaded on to theupper portion 34 of an associatedfastener 18, thehead member 32 extends rearward beyond the lockingplate 14 and the lockingplate 14 is displaced from thebone 12. Such spacing reduces absorption of the bone which would otherwise be present if the lockingplate 14 were to directly contact thebone 12. - With continued reference to FIG. 1 and additional reference to FIGS. 7 and 8, an
auxiliary reinforcement member 64 is illustrated. FIG. 1 shows theauxiliary reinforcement member 64 operatively interconnecting a portion of themandible 12 and the lockingplate 14. Theauxiliary reinforcement member 64 is intended to reinforce fractured or otherwise weakened portions of thebone 12. - In the exemplary embodiment illustrated, the
auxiliary reinforcement member 64 is shown to generally include abone attachment portion 66 and a pair ofplate attachment portions 68. Theplate attachment portions 68 are each interconnected to thebone attachment portion 66 through aleg portion 70. In the embodiment illustrated, thebone attachment portion 66 is generally arcuate in shape and includes a plurality ofapertures 72. Each of theapertures 72 includes a countersunkportion 74. Theapertures 72 are each adapted to receive a threadedfastener 76. The threadedfastener 76 includes ahead 78 adapted to seat in the countersunkportion 74 of theaperture 72 and a threaded shaft (not shown) for engaging a portion of themandible 12. Thehead 78 of the threadedfastener 76 further includes a generally rectangular aperture substantially identical to theaperture 54 of the threadedfastener 18. As such, the threadedfastener 76 may be inserted and removed with thefirst drive portion 48 of thetool 40. Alternatively, a separate tool may be used to drive thefastener 76. - The
plate engagement portions 68 of theauxiliary reinforcement member 64 are generally circular in shape and include anaperture 80 having a countersunkportion 82. As shown in FIG. 1, each of theplate engaging portions 68 may be interconnected to theplate 14 with ahead portion 32 of thefastener 18. A tapered flange portion 84 (shown in FIG. 4) of theremovable head 32 seats in thecountersink 74 of theaperture 72 thereby securing theauxiliary reinforcement member 64 to theplate 14 when the external threads of theremovable head 32 are engaged with the internal threads of one of theplate apertures 16. - As shown more specifically in FIG. 8, each of the
legs 70 are connected to its associatedplate engagement portion 68 through an intermediate portion 85. The intermediate portion 85 extends perpendicular to the plane of thebone engagement portion 66 and the plane of theplate engagement portion 68. As a result, theplate engagement portion 66 is stepped down frombone engagement portion 68. - With reference to FIGS. 9 and 10, a
link system 88 constructed in accordance with the teachings of the present invention is illustrated. Thelink system 88 is intended to function as an alternative structure for the lockingplate 14 and generally includes first andsecond links links apertures 16 substantially identical to theapertures 16 of the lockingplate 14. Theapertures 16 of the first andsecond links more fasteners 18 as discussed above. It will be understood by those skilled in the art that either of the first andsecond links - The first and
second links second links second links serrations 98 which circumferentially surround anaperture 100. In the embodiment illustrated, theapertures 100 surrounded by theserrations 98 are not internally threaded. The first andsecond links bone 12 by afastener 18′. Thefastener 18′ is largely identical to thefastener 18 described in connection with FIGS. 4-6. As such, identical reference numerals will be used to identify equivalent elements. Thefastener 18′ differs from thefastener 18 in that the external diameter of thehead 32 is smooth, thereby permitting the first andsecond link members fastener 18′, effectively defining a pivot. - In the embodiment illustrated, the
second link 92 of thelink system 88 is shown to include alongitudinally extending groove 102. Thegroove 102 intersects theapertures 16 of thelink 92 and functions to increase bending strength of thelink 92. It will be understood by those skilled in the art that a similar groove may be added to thefirst link 90 and also incorporated into the lockingplate 14 of FIGS. 1 and 2. - In the preferred embodiment, the
fasteners - Turning to FIGS. 11 and 12, a
link reinforcement member 104 of thesystem 10 of the present invention is illustrated. FIG. 11 illustrates thelink reinforcement member 104 operatively interconnected to a lockingplate 14 which is substantially identical to that described above with respect to FIGS. 1 and 2. The lockingplate 14 is in turn secured to themandible 12. FIG. 12 is a cross-sectional view illustrating the cooperating relationship between the lockingplate reinforcement member 104 and the lockingplate 14. Thelink reinforcement member 104 is intended to reinforce the lockingplate 14 at areas where significant bone mass may be absence. - The
reinforcement member 104 is illustrated to include a plurality ofapertures 106 adapted to align withapertures 16 of the lockingplate 14. As shown most clearly in FIG. 12, the lockingplate reinforcement member 104 defines agroove 108 adapted to receive the lockingplate 14. In use, theplate reinforcement member 104 is placed over the lockingplate 14 such that the lockingplate 14 is positioned within thegroove 108 and theapertures 106 are aligned with theapertures 16. To secure thereinforcement member 104 to theplate 14, ahead portion 32 of thefastener 18 is used in a manner substantially identical to the interconnection of theauxiliary reinforcement plate 64 and the lockingplate 14. In this regard, the taperedportion 84 of theremoval head 32 seats in acountersink portion 108 of theaperture 106 and theremovable head 32 threadably engages an aligningaperture 16 of the lockingplate 14. If desired, amain body portion 30 of thefastener 18 may also be employed for purposes of providing an additional point of attachment to themandible 12. - Turning to FIGS. 16 and 17, a
mesh reinforcement member 110 of thesystem 10 of the present invention is illustrated. FIG. 16 illustrates themesh reinforcement member 110 operatively interconnected to areconstruction plate 14 which is substantially identical to that described above with respect to FIGS. 1 and 2. Theplate 14 is in turn secured to themandible 12. FIG. 17 is an enlarged side view illustrating of themesh reinforcement member 110. Themesh reinforcement member 110 provides another manner for reinforcement at areas of themandible 12 where a resection has been made or significant bone mass is otherwise absent. In the embodiment illustrated, the reconstruction plate is a lockingplate 14. However, it will become apparent that themesh reinforcement member 110 may alternatively be used with a non-locking plate (not specifically shown). - In one application, the
mesh reinforcement member 110 is constructed from a flexible, memory-retaining material such as titanium. In other applications, it may be desirable to construct themesh reinforcement member 110 from a resorbable material. One such material includes LactoSorb®, which is commercially available from W. Lorenz Surgical, Inc. of Jacksonville, Fla. LactoSorb® is a registered trademark of Biomet, Inc. of Warsaw, Ind. It will be readily appreciated that still other biocompatable materials may be used within the scope of the present invention. - The
mesh reinforcement member 110 of the present invention is illustrated to include a repeating pattern havinglarger holes 112 aligned in rows and columns. The repeating pattern additionally includessmaller holes 114 similarly aligned in rows and columns. Thesmaller holes 114 are arranged such that eachsmaller hole 114 is positioned equally between fourlarger holes 112 for the repeating pattern. In other applications, theholes holes smaller holes 114 are spaced so as to align withapertures 16 of theplate 14. - In use, the
mesh reinforcing member 110 is provided in a generally U-shaped curved configuration. Themesh reinforcing member 110 is adjusted to the general shape of the cooperating bone surface. In the exemplary use shown in FIG. 16, a lower portion of themesh reinforcing member 110 wraps around a lower edge of themandible 12. The adjusted configuration of themesh reinforcement member 110 is shown in side view in FIG. 17. Typically, desired surgical procedures are made to thebone 12 and themesh reinforcement member 110 is subsequently adjusted to the particular desired configuration. - In one application, the
mesh reinforcement member 110 may be secured to theplate 14 and in turn secured to themandible 12 by thefasteners 18 which otherwise secure theplate 14 to themandible 12. Alternatively, themesh reinforcement member 110 can be secured to theplate 14 and theplate 14 can be independently secured to thebone 12, or the mesh reinforcement member can be independently secured to thebone 12 and subsequently secured to theplate 14. - FIG. 16 illustrates a pair of
fasteners 18 securing themesh reinforcing member 110 to theplate 14. Thefasteners 18 are shown to extend through one of thesmaller holes 114 in themesh reinforcing member 110. It will be understood that additional fasteners (not specifically shown) may be used to further secure themesh reinforcing member 110 to the mandible. Such additional fasteners may pass through other of theapertures 16 in theplate 14, or directly through one of thesmaller holes 114 orlarger holes 112 of themesh reinforcing member 110. It will be further understood that a variety of screws can be used to secure theplate 14, including but not limited to reconstruction screws, standard fracture screws, or dedicated screws. - With final reference to FIG. 18 of the drawings, an alternative
mesh reinforcing member 120 is illustrated. Themesh reinforcement member 120 is milled from titanium or other suitable material. A substantially identical mesh material is commercially available from W. Lorenz Surgical, Inc. of Jacksonville, Fla. for cranial mesh applications. The alternativemesh reinforcement member 120 has a repeating pattern including a plurality ofsmaller holes 122 joined by awebbing 124. The alternativemesh reinforcement member 120 may be more easily bent and configured to a desired contour. In certain applications, it may be desirable to incorporate larger holes into the alternativemesh reinforcement member 120 to accommodate standard screws for attachment to the bone. - The foregoing discussion discloses and describes merely exemplary embodiments of the present invention. One skilled in the art will recognize from such discussion and from the accompanying drawings and claims, that various changes, modifications and variations can be made therein without departing from the spirit and scope of the invention. For example, the configuration of the
plate 14 shown in the drawings is one example of a plate suitable for use with the teachings of the present invention. It will be understood by those skilled in the art that various other shapes may be employed. For example, theplate 14 may be straight, angled, curved or any combination thereof. In certain applications, theplate 14 may extend about theentire mandible 12.
Claims (1)
1. A method of surgically repairing a bone, the method comprising the steps of:
providing a mesh reinforcing member including a plurality of holes;
providing an elongated plate having a plurality of apertures;
placing the mesh reinforcing member adjacent the bone;
placing the elongated plate adjacent to the mesh reinforcing member; and
securing the elongated plate to the bone by passing a fastener through one of the plurality of apertures in the elongated plate and one of the plurality of holes in the mesh reinforcing member.
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/047,520 US20020062127A1 (en) | 1998-02-18 | 2001-10-29 | Method and apparatus for mandibular osteosynthesis |
US10/081,166 US7052499B2 (en) | 1998-02-18 | 2002-02-22 | Method and apparatus for bone fracture fixation |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/025,140 US6129728A (en) | 1998-02-18 | 1998-02-18 | Method and apparatus for mandibular osteosynthesis |
US09/394,287 US6325803B1 (en) | 1998-02-18 | 1999-09-10 | Method and apparatus for mandibular osteosynthesis |
US10/047,520 US20020062127A1 (en) | 1998-02-18 | 2001-10-29 | Method and apparatus for mandibular osteosynthesis |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/394,287 Continuation US6325803B1 (en) | 1998-02-18 | 1999-09-10 | Method and apparatus for mandibular osteosynthesis |
Related Child Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10/081,166 Continuation-In-Part US7052499B2 (en) | 1998-02-18 | 2002-02-22 | Method and apparatus for bone fracture fixation |
Publications (1)
Publication Number | Publication Date |
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US20020062127A1 true US20020062127A1 (en) | 2002-05-23 |
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Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/394,287 Expired - Lifetime US6325803B1 (en) | 1998-02-18 | 1999-09-10 | Method and apparatus for mandibular osteosynthesis |
US10/047,520 Abandoned US20020062127A1 (en) | 1998-02-18 | 2001-10-29 | Method and apparatus for mandibular osteosynthesis |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/394,287 Expired - Lifetime US6325803B1 (en) | 1998-02-18 | 1999-09-10 | Method and apparatus for mandibular osteosynthesis |
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US (2) | US6325803B1 (en) |
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