CA1329525C - Point contact bone compression plate - Google Patents

Point contact bone compression plate

Info

Publication number
CA1329525C
CA1329525C CA000588337A CA588337A CA1329525C CA 1329525 C CA1329525 C CA 1329525C CA 000588337 A CA000588337 A CA 000588337A CA 588337 A CA588337 A CA 588337A CA 1329525 C CA1329525 C CA 1329525C
Authority
CA
Canada
Prior art keywords
plate
bone
implant
screw
screws
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
CA000588337A
Other languages
French (fr)
Inventor
Stephan M. Perren
Fritz Straumann
Franz Sutter
Slobodan Tepic
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Synthes USA LLC
Original Assignee
Synthes USA LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Family has litigation
First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=25672379&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=CA1329525(C) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
Priority to BR8707937A priority Critical patent/BR8707937A/en
Priority to EP89117774A priority patent/EP0355035B1/en
Priority to MX013546A priority patent/MX170527B/en
Priority to JP63500377A priority patent/JP2564183B2/en
Priority to EP88900013A priority patent/EP0340223A1/en
Priority to DE3789876T priority patent/DE3789876T2/en
Priority to PCT/EP1987/000663 priority patent/WO1989004150A1/en
Application filed by Synthes USA LLC filed Critical Synthes USA LLC
Priority to CA000588337A priority patent/CA1329525C/en
Priority to US07/492,403 priority patent/US5053036A/en
Publication of CA1329525C publication Critical patent/CA1329525C/en
Application granted granted Critical
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

Links

Classifications

    • 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
    • A61B17/8052—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates immobilised relative to screws by interlocking form of the heads and plate holes, e.g. conical or threaded
    • 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
    • A61B17/8028—Cushions, i.e. elements forming interface between bone plate and bone
    • 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
    • A61B17/809—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates with bone-penetrating elements, e.g. blades or prongs

Abstract

ABSTRACT

A bone plate for use in osteosynthesis having a plurality of contact elements extending from its lower surface so that contact between plate and bone is reduced to the minimum contact needed during attachment of the plate to a bone.

Description

~ ~ 3295~5 POINT CONTACT BONE COMPRESSION PLATE

Field of the Invention The invention relates to bone plates used as implants in osteosynthesis.

Backqround of the Invention In conventional treatment of bone fractures a plate is applied to a fractured bone so as to bridge the fracture. The plate is fixed to the bone by a plurality of screws. When the screws are tightened in the bone, they produce compressive stresses between the plate and the bone. Transmission of a functional load from the bone to the plate and back to the bone is achieved mostly by means of friction corresponding to the compressive stresses.
Usually the screws securing the plate to the bone engage both the near and the far wall of the bone cortex. The cortex receives its blood supply from the periosteum on its outer side and from the endosteum on the inner side. Compression of the plate and bone impedes the blood circulation of the cortex region under the plate. This is believed to increase the chances of infection, which is a major complication of operative fracture treatment.
Dead bone under the plate is in due course remodeled and revascularized. Remodeling starts at the periphery of the unperfused bone and proceeds towards the plate. Porosity within , .

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1 32q5~5 the remodelling bone persists for a long time and reduces bone strength. This situation requires keeping the plate on the bone longer than is needed for the fracture to heal. The use of long screws running first through the near cortex, then throuyh the medullary canal, and through the far cortex may further interfere with blood supply of the fractured bone by cutting through larger blood vessels.

Summarv of the Invention In accordance with the invention the noted drawbacks of conventional plates are overcome by means of a bone plate for osteosynthesis comprising an elongated body having an upper surface and a lower surface, a plurality of screw holes traversing said body between said surfaces to attach the plate to a bone and a plurality of contact elements extending from the lower surface for contacting the bone during attachment of the plate to the bone.
Use of the plate according to the invention results in reduced damage to bone, particularly damage to the intramedullary vascular system. Moreover, plates according to the invention make it possible to use short screws which can be made self-tapping, without the problems incidental to the use of long self-tapping screws. An additional advantage is that the plate design according to the invention allows for doubling the strength of the bone plate due to reduced screw hole size. Variation in strength and rigidity along the length of the bone plate according ' .

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t 32q525 to the invention is also much less than in conventional plates.
This facilitates plate adaptation to curved bone surfaces.

Descri~tion of the Drawinqs The invention will be disclosed more fully in connection with the accompanying drawings in which:
Figure 1 is a schematic view of a fractured bone with a conventional bone plate;
Figure 2 is a cross-section of the bone plate o~ Figure l;
Figure 3 is a cross-section of a bone plate according to the invention with short screws;
Figure 4 is a view in side elevation and partly in vertical section of the bone plate of Figure 3;
Figure 5 is a cross-section of a bone plate according to the invention with resorbable studs at the plate undersurface;
Figure 6 is a cross-section of a bone plate according to the invention with an expandable spherical insert;
Figure 6A is a perspective of the spherical insert of Figure 6;
Figure 7 is a cross-section of a bone plate according to the invention with a screw head expandable by a conical insert;
Figure 8 is a cross-section of a bone plate according to the invention with removable clip-on springs; and Figure 9 is a perspective view of a section of the bone plate according to Figure 8 showing a clip-on spring.

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Detailed Description 1 3 2 9 5 2 5 Referring to Fig. l, a conventional bone plate 1 for the treatment of bone fractures is fixed to the bone 2 by means of a number of screws 4. Screws 4 are tightened in the bone 2 producing compressive stresses 5 (Fig. 2) between the plate 1 and the bone 2. As shown in Figure 2, transmission of functional load from the bone 2 to the conventional plate 1 and back to the bone 2 is achieved mostly by means of friction between plate and bone corresponding to the compressive stresses 5, indicated by arrows. Both the near and far walls of the cortex of bone 2 are usually engaged by the screws 4. Bone cortex is supplied by blood from the periosteum, or outer side 6, and from the endosteum or inner side 7. Compressive stresses 5 between the conventional plate 1 and bone 2 impede the blood perfusion of the cortex region 8 under the conventional plate 1. This is believed to increase the likelihood of infection - a major complication of operative fracture treatment.
Dead bone in region 8 is in due course remodelled and revascularized. This remodelling activity starts at periphery 9 of the unperfused part of the bone and proceeds towards plate 1.
Porosity within the remodelling bone persists for a long time and reduces bone strength, particularly in fatigue. It is therefore necessary to keep the conventional plate 1 on the bone for a period longer than is needed for the fracture to heal. Long screws 4, by running first through the near cortex 10, then through the medullary canal 11 and through the far cortex 12, may ~, . ,: :
- . ~ , . , .. .

-' ~ 3~9 5~5 further interfere with blood supply to the fractured bone by cutting through larger blood vessels.
Referring now to Fig. 3, a plate 21 according to the invention is attached to the bone 2 by means of a plurality of short screws 22, which are inserted through conical screw holes 28 in the plate. The undersurface of the plate is shaped so as to permit contact with the bone only at points ~3. In a preferred embodiment, this is achieved by arching the underside of the plate 24 at a transverse curvature ~f smaller radius than that of the bone's outer contour 25. In the longitudinal direction, as shown in Figure 4, the underside of the plate is also shaped with a plurality of arches 26 between the screws ~2. Therefore, the only contact between plate and bone is at points 23.
The area of contact with the bone is reduced to the minimum practicable. Preferably this is less than 5% of the total area of the lower surface of the plate and most preferably less than 2~.
As shown in Figure 3, the plate according to the invention may be attached to the bone by a screw 22 having a conical head 27 which upon insertion locks safely in a conical hole 28 of the plate 21. The cone angle of the screw is the same as the cone angle of the screw hole. Since the angle is very small, the plate does not come loose and fall down onto the bone. In other words, the angle oi the cone on the screw head 27 is smaller than the friction angle. The taper of the cone is preferably between 1:5 and 1:20.

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The use of short screws 22 in place of conventional long screws is made possible because screw 22 can be locked into the plate 21. This prevents tilting of the screw 22 within the cortex of bone 2. Loads between the bone 2 and the plate 21 are transferred directly through the screws 22 which now act as pegs (under shear) rather than anchors (under tension), which would be the case if a long screw reached through the medullary canal to the far cortex. In addition to reducing damage to bone 2 and in particular to the intramedullary vascular system, short screws 22 can be made self-tapping without the problems incidental to the use of long sel~-tapping screws.
The undercutting of the plate 21 with arches 24 in the transverse direction and arches 26 in the longitudinal direction has advantages in addition to reducing the plate-bone contact to points 23. The strength and rigidity of conventional plates is lowest at the sections which have screw holes. Overall plate strength is limited by the weakest section. While keeping outer dimensions similar to those of a conventional plate, the plate design according to the invention allows for doubling plate strength. This is largely due to the reduced size of the screw holes. Variation of strength and rigidity along the plate is much smaller than in conventional plates. These characteristics facilitate plate adaptation to curved bone surfaces.
Figure 5 shows another embodiment of the invention in which contact between the plate 21 and the bone 22 is reduced. Small studs 29 are added to the undersurface of the plate. These studs .

.

.

~ '`' 13~9525 may be made from a material which is resorbable or even dissolvable in the body (e.g. polysaccacharides), so that after the plate is positioned they will disappear entirely. This is possible because the studs are only necessary to support the plate during the procedure of inserting and locking the screw 22 into the plate 21.
Figure 6 shows a plate 21 according to the invention combined with a long screw 32 which may be locked into the plate 21 via a spherical insert 30. The screw is thus given substantial freedom of angular placement as indicated at 31. As it is forced into sphere 30, ~see Figure 6A) the conical head 27 of the screw 32 compresses the slotted sphere 30 against the plate, locking itself and the sphere 30 in the plate 21. The taper of the cone angle is again smaller than the friction angle, preferably between 1:5 and 1~20.
Figure 7 shows another embodiment of the invention where the locking of the screw 34 in the plate 21 is achieved by the conical insert 35, which when driven down expands the slotted screw-head 33, thereby forming a rigid connection at the cylindrical interface 36.
Figures 8 and 9 show a further embodiment of the invention where the reduced plate contact with the bone 2 is achieved through removable clip-on springs 37 which provide stud-like extensions 38 on the undersurface of plate 21. Springs 37 may be removed following insertion and locking of screw 22 in the plate 21. Hooks 39 facilitate removal following screw tightening.

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The plate may be constructed with one or more self-compressing screw holes of the type described in U.S. Patent No.
Re. 31,628.

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Claims (29)

1. A compression plate for osteosynthesis, said plate having a longitudinal axis, an upper surface, a lower surface and a plurality of screw holes spaced in the direction of the longitudinally axis, said lower surface being arched concavely transversely to the longitudinal axis of the plate, in combination with open sections along the side edges of the plate between the screw holes, said open sections, with the concave lower surface of the plate, forming studs along the side edges of the lower surface for contact with a bone.
2. A compression plate according to claim 1 wherein said screw holes are conical and traverse said plate between said upper and lower surface, such that the narrow end of the cone is towards the lower surface, said holes adapted to receive screws having conical heads of a predetermined cone angle, such that the plate will not slide down the heads of the screw.
3. A bone plate according to claim 2 wherein the taper of the conic section is in the range of 1:5 to 1:20.
4. A bone plate according to claim 1 wherein one screw hole is a self-compressing hole.
5. A bone plate according to claim 1 wherein the contact elements are less than 5% of the total area of the lower surface of the plate.
6. A bone plate according to claim 1 wherein the contact elements are less than 2% of the total area of the lower surface of the plate.
7. A metallic compression plate for osteosynthesis, said plate having a longitudinal axis, an upper surface, a lower surface, side walls joining said upper and lower surfaces and a plurality of screw holes spaced in the direction of said longitudinal axis, in combination with a plurality of individual, non-metallic, support studs attached to the lower surface of the plate at the sides of said lower surface and longitudinally spaced in the direction of said axis, said studs providing bone contact, at selected points along the ides of said plate, and spacing the central portion of the lower surface of said plate along the longitudinal axis from the bone.
8. A bone plate according to claim 7 wherein the contact elements comprise studs made of material which is resorbable or dissolvable in body fluids.
9. A bone plate assembly comprising a compression bone plate and a plurality of bone screws for attaching said plate to a bone, said plate having a longitudinal axis, an upper surface, a lower surface and a plurality of screw holes for receiving said screws, spaced in the direction of the longitudinal axis, said lower surface being arched concavely transversely to the longitudinal axis of the plate, in combination with open sections along the side edges of the plate between the screw holes, said open sections, with the concave undersurface of the plate, forming studs for bone contact along the side edges of the lower surface of the plate.
10. A bone plate assembly according to claim 9 wherein the crews have heads which are expandable by mean of a body inserted into said head.
11. A bone plate assembly according to claim 9 and comprising a body fitted into the screw hole, said body being expandable by a conical screw head which has a cone angle smaller than the resulting friction angle.
12. A bone plate assembly according to claim 11 wherein the taper of the cone angle is in the range of 1:5 to 1:20.
13. A bone plate assembly according to claim 9 wherein said screws are of a length that permits engagement of the screw with only one side of the bone cortex.
14. A compression plate for osteosynthesis, said plate having a longitudinal axis, an upper surface, a lower surface and a plurality of screw holes spaced in the direction of the longitudinal axis, said lower surface being arched concavely, transversely to the longitudinal axis of the plate, in combination with arcuate cut out sections between the holes, the intersection of surfaces formed by said cut out sections and the concave lower surface of the plate forming studs for hone contact.
15. A compression plate for osteosynthesis, said plate having a longitudinal axis, an upper surface, a concave lower surface, side walls joining said upper and lower surfaces and a plurality of screw holes spaced in the direction of said longitudinal axis, in combination with a plurality of clips removably attached to said plate and spaced along the length of said plate, each of said clips extending across the upper surface of the plate, down the side walls thereof and having elements extending below the lower surface of said plate to provide a limited area of bone contact.
16. An implant for osteosynthesis comprising a biocompatible device for attachment to a bone, and a plurality of screws for attaching the device to the bone, the heads of said screws and the device having a predetermined friction angle relative to one another, said screws having conical heads and said device having complementary conical holes for receiving said heads in surface contact therewith, the cone angle of the conical holes being less than the friction angle between the holes and the screw head, thereby locking said screws to said device to prevent said device from sliding down the screw heads.
17. The implant claimed in claim 16, wherein the cone defining the hole has a cone taper of from about 1:5 to about 1:20.
18. The implant claimed in claim 16, wherein said device includes a plurality of clearance holes, each of said clearance holes having a compressible insert, each insert having one of said conical holes.
19. The implant claimed in claim 16, wherein the screws are self-tapping.
20. The implant claimed in claim 16, wherein the length of the screws are such that they will engage only one of the cortices of the bone to which the device is applied.
21. The implant claimed in claim 16, wherein the contact of the underside of said device with said bone is at a plurality.
of points.
22. The implant claimed in claim 16, wherein the device has an undersurface for application to the surface of a bone to be treated, the bone contact areas of said undersurface being less than 5% of the full undersurface area.
23. The implant claimed in claim 22, wherein the bone contact area is less than 2% of the full undersurface area.
24. The implant as claimed in claim 22, wherein the bone contact areas of the undersurface consist of contact studs made of a material which is resorbable or dissoluble in body fluids.
25. The implant claimed in claim 16 and comprising clip-on springs mounted on said device and forming extensions on the undersurface of said device.
26. The implant claimed in claim 16, wherein said device is a plate.
27. The implant claimed in claim 16, wherein the heads of said screws have sockets and including elements for insertion into the sockets of said screw heads to expand said screw heads.
28. The implant claimed in claim 16, wherein the device includes a self-compressing screw hole.
29. The implant claimed in claim 28, wherein the device includes a self-compressing screw hole.
CA000588337A 1987-11-03 1989-01-16 Point contact bone compression plate Expired - Lifetime CA1329525C (en)

Priority Applications (9)

Application Number Priority Date Filing Date Title
DE3789876T DE3789876T2 (en) 1987-11-03 1987-11-03 Bone plate with conical holes.
MX013546A MX170527B (en) 1987-11-03 1987-11-03 IMPLEMENTATION FOR OSTEOSYNTHESIS
JP63500377A JP2564183B2 (en) 1987-11-03 1987-11-03 Bone graft
EP88900013A EP0340223A1 (en) 1987-11-03 1987-11-03 Implant for osteosynthesis
BR8707937A BR8707937A (en) 1987-11-03 1987-11-03 PROSTHESIS FOR OSTEOSYNTHESIS
PCT/EP1987/000663 WO1989004150A1 (en) 1987-11-03 1987-11-03 Implant for osteosynthesis
EP89117774A EP0355035B1 (en) 1987-11-03 1987-11-03 Bone plate with conical holes
CA000588337A CA1329525C (en) 1987-11-03 1989-01-16 Point contact bone compression plate
US07/492,403 US5053036A (en) 1987-11-03 1990-03-08 Point contact bone compression plate

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
PCT/EP1987/000663 WO1989004150A1 (en) 1987-11-03 1987-11-03 Implant for osteosynthesis
CA000588337A CA1329525C (en) 1987-11-03 1989-01-16 Point contact bone compression plate

Publications (1)

Publication Number Publication Date
CA1329525C true CA1329525C (en) 1994-05-17

Family

ID=25672379

Family Applications (1)

Application Number Title Priority Date Filing Date
CA000588337A Expired - Lifetime CA1329525C (en) 1987-11-03 1989-01-16 Point contact bone compression plate

Country Status (8)

Country Link
US (1) US5053036A (en)
EP (1) EP0340223A1 (en)
JP (1) JP2564183B2 (en)
BR (1) BR8707937A (en)
CA (1) CA1329525C (en)
DE (1) DE3789876T2 (en)
MX (1) MX170527B (en)
WO (1) WO1989004150A1 (en)

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US6679883B2 (en) 2001-10-31 2004-01-20 Ortho Development Corporation Cervical plate for stabilizing the human spine
US7766947B2 (en) 2001-10-31 2010-08-03 Ortho Development Corporation Cervical plate for stabilizing the human spine
US8100955B2 (en) 2005-03-17 2012-01-24 Spinal Elements, Inc. Orthopedic expansion fastener
US9220547B2 (en) 2009-03-27 2015-12-29 Spinal Elements, Inc. Flanged interbody fusion device
US10758361B2 (en) 2015-01-27 2020-09-01 Spinal Elements, Inc. Facet joint implant
US11382769B2 (en) 2018-09-20 2022-07-12 Spinal Elements, Inc. Spinal implant device
US11911284B2 (en) 2020-11-19 2024-02-27 Spinal Elements, Inc. Curved expandable interbody devices and deployment tools

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DE69838856T2 (en) * 1997-02-11 2008-12-11 Warsaw Orthopedic, Inc., Warsaw Plate for the anterior cervical spine with fixation system for one screw
JP4467647B2 (en) 1997-02-11 2010-05-26 ウォーソー・オーソペディック・インコーポレーテッド Bone plating system
US5853413A (en) * 1997-04-18 1998-12-29 Bristol-Myers Squibb Company Wrist fusion plate
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US5954722A (en) * 1997-07-29 1999-09-21 Depuy Acromed, Inc. Polyaxial locking plate
US6454769B2 (en) * 1997-08-04 2002-09-24 Spinal Concepts, Inc. System and method for stabilizing the human spine with a bone plate
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DE19832513A1 (en) * 1998-07-20 2000-02-17 Impag Gmbh Medizintechnik Fastening arrangement
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