阅读说明：本技术 近侧股骨板系统 (Proximal femoral plate system ) 是由 K.郭 J.嘉利 T.普洛斯特 P.法通 B.福里茨 M.布雷斯 G.史密斯 G.J. 于 2018-03-12 设计创作，主要内容包括：本发明提供了一种用于治疗假体周围骨折的骨板,该骨板包括头部部分,该头部部分的尺寸和形状被设定成使得在操作位置,该头部部分的近侧端部与股骨的大转子的股肌脊对齐。该板还包括从头部部分朝远侧延伸的轴部分。该轴部分包括偏移孔以接纳穿过偏移孔的骨固定元件。偏移孔中的每个偏移孔包括定位在板的纵向轴线的第一侧上的第一孔和定位在纵向轴线的与第一侧相对的第二侧上的第二孔,使得穿过第一孔和第二孔插入的骨固定元件在接纳于股骨内的假体的前后延伸。第一孔和第二孔沿轴部分的长度相对于彼此交错并延伸超过轴部分的纵向轴线。(The invention provides a bone plate for treating periprosthetic fractures, the bone plate comprising a head portion sized and shaped such that in an operative position, a proximal end of the head portion is aligned with a femoral muscle ridge of the greater trochanter of a femur. The plate also includes a shaft portion extending distally from the head portion. The shaft portion includes an offset hole to receive a bone fixation element therethrough. Each of the offset holes includes a first hole positioned on a first side of the longitudinal axis of the plate and a second hole positioned on a second side of the longitudinal axis opposite the first side such that a bone fixation element inserted through the first and second holes extends anteroposteriorly of a prosthesis received within the femur. The first and second holes are staggered relative to each other along the length of the shaft portion and extend beyond the longitudinal axis of the shaft portion.)

1. A system for treating periprosthetic fractures, comprising:

a periprosthetic bone plate, the periprosthetic bone plate comprising:

a head portion sized and shaped such that in an operative position, a proximal end of the head portion is aligned with a femoral muscle ridge of a greater trochanter of a femur; and

a shaft portion extending distally from the head portion, the shaft portion including a pair of offset holes extending therethrough to receive bone fixation elements therethrough, each pair of offset holes of the pair of offset holes including a first hole positioned on a first side of a longitudinal axis of the bone plate and a second hole positioned on a second side of the longitudinal axis opposite the first side such that bone fixation elements inserted through the first and second holes extend anteroposteriorly of a prosthesis received within the femur, the first and second holes being staggered relative to each other along a length of the shaft portion and extending beyond a longitudinal edge of the shaft portion.

2. The system of claim 1, wherein a central axis along which the first and second holes of each of the pairs of offset holes extend is aligned with a longitudinal edge of the plate.

3. The system of claim 1, wherein the pair of offset holes extend through a proximal portion of the shaft portion, the shaft portion further comprising a distal portion comprising a plurality of fixation openings extending therethrough.

4. The system of claim 1, wherein the head portion comprises a first set of holes extending therethrough on the first side of the longitudinal axis and a second set of holes extending therethrough on the second side of the longitudinal axis.

5. The system of claim 4, wherein a first axis extends through a central axis along which the first set of holes extend and a second axis extends through a central axis along which the second set of holes extend, the first and second axes tapering toward a distal end of the bone plate relative to the longitudinal axis.

6. The system of claim 1, wherein the first and second holes of each of the pairs of offset holes are variable angle holes, each variable angle hole configured to receive a bone fixation element therethrough at a desired angle relative to a central axis along which the variable angle hole extends.

7. The system of claim 1, further comprising a locking attachment plate sized and shaped to fit over the shaft portion of the prosthesis peripheral plate between adjacent pairs of offset holes, the locking attachment plate including a connecting portion connecting the locking attachment plate to the shaft portion and a pair of wings extending laterally from the connecting portion such that in the operative position, the wings extend beyond the longitudinal edge of the shaft portion in the operative position and a first one of the wings includes a first hole on the first side of the longitudinal axis and a second one of the wings includes a second hole on the second side of the longitudinal axis.

8. The system of claim 7, wherein the first one of the wings includes two first holes and the second one of the wings includes two second holes.

9. The system of claim 7, wherein a locking attachment includes an opening extending through the connecting portion, the opening of the locking attachment aligned with an attachment opening of the prosthesis peripheral plate in the operative position such that a fixation element inserted through the opening of the locking attachment and the attachment opening couples the locking attachment to the prosthesis peripheral plate.

10. The system of claim 1, further comprising a greater trochanter attachment plate configured to be coupled to the head portion of a periprosthetic shaft, the greater trochanter attachment plate comprising a proximal portion that extends proximally from the head portion to extend over a greater trochanter of the bone in the operative position when the greater trochanter attachment plate is attached to the head portion.

11. The system of claim 10, wherein the proximal portion of the greater rotor attachment plate includes a pair of hooks at a proximal end thereof, each hook of the pair of hooks extending from the proximal end along a curve pointing in a distal direction, the proximal portion of the greater rotor attachment plate further including a plurality of pairs of holes extending therethrough from a first surface to a second surface, such that in the operative position, a first hole of each pair of the pairs of holes extends through the proximal portion on the first side of the longitudinal axis and a second hole of each pair of the pairs of holes extends through the proximal portion on a second side of the longitudinal axis.

12. The system of claim 11, wherein the proximal portion of the large rotor attachment plate includes a pair of cable holes extending therethrough from a first longitudinal side surface to a second longitudinal side surface, the proximal portion including an elongated opening extending therethrough from the first surface to the second surface in communication with the pair of cable holes such that a crimp received within the elongated opening can be crimped over a portion of the cable traversing the elongated opening when the cable is inserted through the pair of cable holes.

13. The system of claim 10, wherein the proximal portion of the greater trochanter attachment plate comprises an annular portion and a plurality of extension tabs extending radially from the annular portion, each of the annular portion and the plurality of extension tabs comprising a bone fixation element receiving opening extending therethrough, the annular portion sized and shaped to fit the annular portion over the greater trochanter, the extension portion being bendable relative to the annular portion.

14. The system of claim 13, wherein the annular portion includes suture holes between adjacent bone fixation element receiving openings.

15. The system of claim 10, wherein the prosthesis peripheral plate and the greater trochanter attachment plate include corresponding alignment features for aligning the greater trochanter attachment plate relative to the prosthesis peripheral plate.

16. The system of claim 15, wherein the corresponding alignment feature comprises one of: (a) a shoulder along a bone-facing surface of the greater trochanter attachment plate that abuts a proximal end of the head portion when the greater trochanter alignment plate is aligned with the prosthesis peripheral plate, and (b) a pair of positioning tabs that protrude from the bone-facing surface of the greater trochanter plate such that when the greater trochanter alignment plate is aligned with the prosthesis peripheral plate, the positioning tabs are received within corresponding openings along the first surface of the prosthesis peripheral plate.

Background

Proximal femoral fractures may be treated with a bone plate positioned along the femur to extend across the fracture site. However, in some cases, particularly for periprosthetic fractures, fixation of the bone plate may be difficult because the bone fixation elements must be inserted through the bone without interfering with the rods of previously implanted THA (total hip arthroplasty) systems or other intramedullary devices.

Disclosure of Invention

The present embodiment relates to a bone plate for treating periprosthetic fractures, the bone plate comprising a head portion sized and shaped such that in an operative position, a proximal end of the head portion is aligned with a femoral ridge of the greater trochanter of a femur; and a shaft portion extending distally from the head portion, the shaft portion including a pair of offset holes extending therethrough to receive bone fixation elements therethrough, each pair of offset holes of the pair of offset holes including a first hole positioned on a first side of a longitudinal axis of the bone plate and a second hole positioned on a second side of the longitudinal axis opposite the first side such that bone fixation elements inserted through the first and second holes extend anteroposteriorly of a prosthesis received in the femur, the first and second holes being staggered relative to each other along a length of the shaft portion and extending beyond a longitudinal edge of the shaft portion.

Drawings

Fig. 1 shows a top plan view of a proximal femoral plate according to an exemplary embodiment of the present disclosure;

FIG. 2 shows a longitudinal cross-sectional view of the proximal femoral plate of FIG. 1 along line A-A;

FIG. 3 shows a perspective view of a locking attachment plate that can be coupled to the proximal femoral plate of FIG. 1, according to an exemplary embodiment of the present disclosure;

FIG. 4 shows a top plan view of the locking attachment plate of FIG. 3;

FIG. 5 shows a side view of the lock attachment plate of FIG. 3;

fig. 6 illustrates a top plan view of a greater trochanter attachment plate capable of being coupled to the proximal femoral plate of fig. 1, in accordance with a first exemplary embodiment of the present disclosure;

FIG. 7 shows a longitudinal side view of the large rotor attachment plate of FIG. 6;

FIG. 8 shows a bottom plan view of the large rotor attachment plate of FIG. 6;

FIG. 9 shows a perspective view of a connection screw for connecting the greater trochanter attachment plate of FIG. 6 with the proximal femoral plate of FIG. 1;

FIG. 10 shows a longitudinal cross-sectional view of the attachment screw of FIG. 9;

FIG. 11 shows a top plan view of the attachment screw of FIG. 9;

fig. 12 shows a perspective view of a greater trochanter attachment plate capable of being coupled to the proximal femoral plate of fig. 1, in accordance with a second exemplary embodiment of the present disclosure;

FIG. 13 shows another perspective view of the large rotor attachment plate of FIG. 12;

FIG. 14 illustrates a side view of a distal condyle plate according to an embodiment of the present invention;

FIG. 15 shows a perspective view of the distal condyle plate of FIG. 14; and is

Fig. 16 shows a perspective view of the plate of fig. 14 and 15 from the end of the plate.

Detailed Description

The present invention may be understood with respect to the following description and the accompanying drawings, in which like reference numerals refer to similar elements. The present invention relates to the treatment of bone fractures, and in particular to the treatment of periprosthetic proximal femoral fractures. Exemplary embodiments describe modular fixation systems that include a proximal femoral plate that may be coupled to a greater trochanter attachment plate and/or a locking attachment plate to treat a periprosthetic fracture of a proximal femur. The proximal femoral plate includes a head portion configured to be positioned directly below the greater trochanter; and a shaft portion extending distally therefrom for positioning along a proximal length of the femur. The proximal femoral plate includes a pair of offset holes, a first one of the holes positioned on a first side of the longitudinal axis of the plate and a second one of the holes positioned on a second side of the longitudinal axis such that a bone fixation element may be placed on both the anterior and posterior sides of the prosthesis (e.g., THA rod). Each of the holes extends from a longitudinal side of the proximal femoral plate to prevent a bone fixation element inserted through the hole from interfering with the intramedullary implant. The system may also include a greater trochanter attachment plate configured to be coupled to the proximal femoral plate to provide fixation of the greater trochanter and/or a locking attachment plate configured to be coupled to the proximal femoral plate to provide further fixation along the shaft portion of the proximal femoral plate. It should be noted that the terms a proximal @ and a distal @ are intended to be directions relative to the bone on which the system is to be placed. For example, as understood by those skilled in the art, reference to proximal to the femur refers to a direction toward the hip joint, while distal refers to a direction toward the knee.

Fig. 1-11 illustrate a system for treating periprosthetic fractures. The system includes a proximal femoral plate 100 as shown in fig. 1-2, which may be used to treat, for example, a wingowski-type B fracture near the stem of a previously placed THA prosthesis or other intramedullary device. The proximal femoral plate 100 includes a head portion 102 configured to be positioned directly under the greater trochanter of the femur; and a shaft portion 104 extending therefrom for positioning along the axis of the femur. The shaft portion 104 includes a pair of offset holes 106 along the shaft portion 104. Each pair includes a first hole 110 on a first side of the longitudinal axis and a second hole 112 on a second side of the longitudinal axis opposite the first side, such that bone fixation elements may be inserted through the first and second holes 110, 112 on opposite sides of the THA to provide fixation on both the anterior side of the prosthesis and the posterior side of the prosthesis. The first and second holes 110, 112 are offset or staggered relative to each other along the length of the shaft portion 104 to prevent stress risers in the bone. As shown in fig. 3-5, the locking attachment plate 200 may be mounted over the shaft portion 104 of the proximal femoral plate 100 between adjacent pairs of offset holes 106 to provide additional fixation openings, if desired. As shown in fig. 6-8, 12, and 13, a Greater Trochanter (GT) attachment plate 300 may be coupled to the head portion 102 of the proximal femoral plate 100 to provide fixation of, for example, a wingowski type a fracture in the greater trochanter. The proximal femoral plate 100 may be coupled with the locking attachment plate 200 and/or the GT attachment plate 300 or 400 in a modular fashion to provide directional fixation designed to treat a particular fracture pattern of a patient. Although the proximal femoral plate 100 is described as being coupled to the locking attachment plate 200 and/or the GT attachment plate 300, one skilled in the art will appreciate that the proximal femoral plate 100 may be used alone to treat a femoral fracture along its proximal length.

As shown in fig. 1-2, a proximal femoral plate 100 according to an exemplary embodiment of the present disclosure includes a head portion 102 configured in an operative position to be positioned directly below the greater trochanter, in line with the lesser trochanter on an opposite side of the head portion, such that a proximal end 114 of the head portion 102 is aligned with the femoral muscle ridge of the femur (i.e., the inferior border of the greater trochanter). A shaft portion 104 extends distally from the head portion 102 to be positioned along the proximal length of the femur and includes a pair of offset holes 106. In one embodiment, the shaft portion 104 may include a proximal portion 108 through which the pair of offset holes 106 extend, and may also include a distal portion 116 including a plurality of fixation holes 118 therealong for securing the distal portion 116 of the shaft portion 104 to the bone. The proximal femoral plate 100 may be curved about the longitudinal axis of the femoral plate 100, and the length of the shaft 104 may extend along a slight curve relative to the longitudinal axis to correspond to the shape of the femur along which the proximal femoral plate 100 will be positioned. The head portion 102 and the shaft 104 may be angled slightly relative to each other to correspond to the shape of the femur at the point where the greater trochanter meets the shaft of the femur.

Head portion 102 extends from proximal end 114 to a distal end 120 connected to shaft portion 104. In this embodiment, the proximal end 114 includes a curve that generally corresponds to the curvature of the femoral muscle ridge, such that the proximal femoral plate 100 may be positioned in conformance with the curve. The head portion 102 includes a first set of holes 122 extending through the head portion 102 on a first side of the longitudinal axis of the proximal femoral plate 100 and a second set of holes 124 extending through the head portion 102 on a second side of the longitudinal axis opposite the first side. The first and second sets of holes 122, 124 may be configured to receive bone fixation elements for securing the head portion 102 to bone. In an exemplary embodiment, each of the first and second sets of holes 122, 124 may be configured as a variable angle hole such that a bone fixation element may be inserted through the variable angle hole at an angle within a permitted range of angles along the axis relative to a central axis of the variable angle hole. However, those skilled in the art will appreciate that the holes in the first and second sets of holes 122, 124 may have any of a variety of configurations so long as the holes 122, 124 are configured to receive a bone fixation element therethrough. For example, the first and second sets of apertures 122, 124 may include locking apertures. The central axis of the locking hole may be selected to allow insertion of a bone fixation element through the locking hole without disturbing any portion of the intramedullary implant. In one exemplary embodiment, the holes 122, 124 may be configured to receive 3.5mm holes, as those skilled in the art will recognize, which have not been widely used for femurs because common trauma plates (whether fractures are periprosthetic fractures or not) typically used to treat fractures typically include larger holes. However, smaller holes may be preferable for periprosthetic and osteoporotic fractures because there is less bone through which a bone fixation element may be inserted, e.g., the bone is not occupied by any portion of the THA implant.

Corresponding ones of the first and second sets of holes 122, 124 may be aligned with respect to each other along the length of the head portion. A first axis L1 extending through a central axis of each of the first set of holes 122 may taper from the proximal end 114 toward the distal end 120 of the head portion 102. Similarly, a second axis L2 extending through the central axis of each hole of the second set of holes 124 may taper from the proximal end 114 toward the distal end 120. In other words, the proximal-most one of the first apertures 122 is separated from the proximal-most one of the second apertures 124 by a distance greater than the distance separating the distal-most first aperture 122 and the distal-most second aperture 124. In this embodiment, the first and second axes L1, L2 taper from the proximal end 114 toward the distal end 120 relative to the longitudinal axis of the proximal femoral plate 100 such that when the plate 100 is positioned along the femur in the operative position, the first and second axes substantially correspond to the tapers typically present in the rods of intramedullary implants. For example, the cone angles between L1 and L2 may be between 1 and 40 Ε. One exemplary embodiment includes three first apertures 122 and three corresponding second apertures 124. However, one skilled in the art will appreciate that the device may include any desired number of first apertures 122 and second apertures 124.

The head portion 120 may further include a plurality of suture openings 126, each of the suture openings 126 configured to receive a suture therethrough when suturing surrounding tissue to the proximal femoral plate 100. In addition, the head portion 120 includes a first GT attachment opening 128 sized and shaped to receive a connection screw 350 as shown in fig. 9-11 when coupling the GT attachment plate 300 to the proximal femoral plate 100, as will be described in greater detail below. The first GT attachment opening 128 may be threaded for engaging the threads of the connection screw 350.

The shaft portion 104 extends distally from a distal end 120 of the head portion 102. As described above, the shaft portion 104 includes a proximal portion 108 including the pair of offset holes 106 and a distal portion 116 including the fixation holes 118. In the operative position, the proximal portion 108 extends along a portion of the femur (e.g., through which the stem of the THA prosthesis extends). Each pair of offset holes 106 includes a first hole 110 extending through the shaft portion 104 on a first side of the longitudinal axis and a second hole 112 extending through the shaft portion 104 on a second side of the longitudinal axis opposite the first side, such that bone fixation elements can be inserted through the first and second holes along both the anterior and posterior sides of the stem of the prosthesis. The first and second holes 110, 112 are also staggered with respect to the length of the shaft portion to minimize stress risers. In one embodiment, the second hole 112 (e.g., one of the holes 110, 112 on the posterior side of the prosthesis in the operative position) may be positioned distal to the first hole 110, as in some cases, the posterior side of the femur has been found to have better bone quality. In an exemplary implementation, the corresponding holes 110, 112 will be offset from each other by a distance of 5-15 mm, such that the axis connecting the center points of the first holes 110 with the center points of their corresponding second holes 112 will form an angle of approximately 16.4 ° to 41.4 ° with the longitudinal axis of the plate 100. It may be desirable to have a lower (i.e., more distal) hole along the posterior side so that the bone fixation element may be inserted through a better quality bone lower on the bone where the cross-sectional area of the stem is smaller, thereby maximizing the fixation of the proximal femoral plate 100 to the bone.

The first and second holes 110, 112 of each of the pairs of offset holes 106 extend beyond the first and second longitudinal edges 130, 132, respectively, of the shaft portion 104 to allow for a plate having a smaller width (e.g., the distance between adjacent first holes 110 and between adjacent second holes 112 between longitudinal edges in a portion of the shaft 104) than conventional trauma plates and to increase the chance of bypassing the rod prosthesis. In one embodiment, the central axes of the first and second holes 110, 112 may be aligned with the longitudinal edges 130, 132 of the shaft portion 104. The distance between adjacent pairs of offset holes 106 is selected to allow the locking attachment plate 200 as shown in fig. 3-5 to be mounted thereon without interfering with either of the first and second holes 110, 112 in each pair of offset holes 106. In other words, the distal one of the first and second holes 110, 112 of the first pair of offset holes 106 should be separated from the proximal one of the first and second holes 110, 112 of the adjacent second pair of offset holes 106 by a distance that locks at least the length of the attachment plate 200 so that the plate 200 can be placed over the reduced width portion of the plate between adjacent first holes 110 on one side of the shaft 104 and between adjacent ones of the second holes 112 on the other side of the shaft 104.

The proximal portion 108 may also include a locking attachment opening 134 extending therethrough between adjacent pairs of offset holes 106 for attaching the attachment plate 200 to the proximal femoral plate 100, as will be described in greater detail below. A screw or other fixation element is inserted into a portion of the attachment plate 200 and through the locking attachment opening 134 to secure the attachment plate 200 to the proximal femoral plate 100. The lock attachment openings 134 may be configured as variable angle holes or any other hole capable of receiving a fixation element therein. In one embodiment, the proximal portion 108 of the shaft portion 104 may include three (3) pairs of offset holes 106 and two (2) attachment openings 134. However, those skilled in the art will appreciate that the number of pairs of offset holes 106 may vary depending on the desired length of the proximal portion 108 (e.g., the length of the stem prosthesis) and the length of the locking attachment plate 200. For the case where the locking attachment opening 134 is not used to couple the locking attachment plate 200 to the proximal femoral plate, a fixation element, such as, for example, a variable angle dowel pin, may be inserted therein to couple the shaft portion 104 to the bone with a cable. The proximal end 136 of the proximal portion 108 may also include a second GT attachment opening 138 for coupling the GT attachment plate 300 to the proximal femoral plate 300 with, for example, a connecting screw 350, as will be described in more detail below. Similar to the first GT attachment opening 128, the second GT attachment opening 138 may be threaded to engage the threads of the connection screw 350.

The distal portion 116 of the shaft portion 104 may extend along a portion of the distal femur of the stem of the prosthesis in the operative position. The distal portion 116 includes a plurality of fixation openings 118 along its length. In one embodiment, one or more of the fixation openings 118 may be laterally offset relative to the longitudinal axis of the shaft portion 104. In other words, a central axis along which the fixation opening 118 extends through the distal portion 116 may extend parallel to the longitudinal axis on either side thereof. However, the fixation opening 118 does not extend beyond either of the first and second longitudinal edges 130, 132, as a bone fixation element inserted through the fixation opening need not extend to the side of the prosthesis. In one embodiment, the fixed opening 118 may be configured as a combination hole including a first portion 140 configured as a variable angle opening and a second portion 142 configured as a compression opening. Accordingly, various bone fixation elements (such as, for example, variable angle locking screws, compression screws, and variable angle fixation pins with cables) may be inserted into the fixation openings 118. Although the exemplary embodiment of the proximal femoral plate 100 is described and shown as including a proximal portion 108 and a distal portion 116, the proximal femoral plate 100 may also be manufactured as a short plate having a proximal portion 108 with a pair of offset holes 106 extending therethrough and an elongated combination hole formed on a portion extending distally from the proximal portion, as described in more detail below.

As shown in fig. 3-5, the locking attachment plate 200 extends from a proximal end 202 to a distal end 204 along a longitudinal axis of the attachment plate 200 and is configured to be mounted over the shaft portion 104 of the proximal femoral plate 100 between adjacent pairs of offset holes 106. The locking attachment plate 200 includes a main body portion 206 that is sized and shaped to fit over the proximal portion 108 of the proximal femoral plate 100, along with a first laterally extending wing 208 and/or a second laterally extending wing 210 extending therefrom. Each of the laterally extending first wing portion 208 and the laterally extending second wing portion 210 includes a bone fixation element receiving opening 212, 214, respectively, extending therethrough. As will be described in greater detail below, the locking attachment plate 200 may be used in situations where additional fixation of the proximal femoral plate 100 is desired and/or where the proximal femoral plate 100 must accommodate a larger portion of a rod or other prosthesis.

The body portion 206 is sized and shaped so that it fits or seats over the surface of the shaft portion 104 of the proximal femoral plate 100 that faces away from the bone in the operative position. In particular, the body portion 210 may have a substantially bracket-like shape that extends along the surface of the proximal femoral plate 100 and over the longitudinal edges 130, 132 in the operative position. The body portion 206 may also include a body opening 224 extending therethrough. A connecting screw or other fixation element may be inserted through the body opening 224 and one of the locking attachment openings 134 of the proximal femoral plate 100 to couple the locking attachment plate 200 to the proximal femoral plate 100 along its desired position. As described above, the length of the body portion 206 (i.e., the distance between the proximal end 202 and the distal end 204 of the body portion) corresponds to the distance between adjacent pairs of offset holes 106.

The first and second laterally extending wings 208, 210 extend from first and second longitudinal sides 212, 214, respectively, of the main body portion 206. Those skilled in the art will appreciate that these wings 208, 210 may be contoured (e.g., bent) by the user to better fit the anatomy of the patient. Thus, in the operative position, the laterally extending first wing 208 and the laterally extending second wing 210 extend laterally beyond the longitudinal edges 130, 132 of the proximal femoral plate 100 to contact the bone. Each of the laterally extending first wing portion 208 and the laterally extending second wing portion 210 includes a bone fixation element receiving opening 216, 218 extending therethrough. In one embodiment, each of the first and second wings 208, 210 includes two bone fixation element receiving openings 216, 218. Preferably, two bone fixation elements can be inserted through the openings 216, 218 at opposite corners relative to each other-through a first fixation element extending through one of the openings 216 of the first wing 208 and a second fixation element extending through one of the openings 218 of the second wing 210 such that the bone fixation elements are staggered along the length of the bone. Similar to the offset hole 106 of the proximal femoral plate 100, this is done to prevent stress risers. In one embodiment, the bone fixation element receiving openings 216, 218 may be configured as variable angle holes.

The connecting portion 220 of the locking attachment plate 200 that connects the body portion 206 with the first and/or second wings 208, 210 can include a groove 22 extending therealong such that the first and second wings 208, 210 can flex relative to the body portion 206 to adjust the attachment plate 200 to the bone of a particular patient. As described above, when the proximal femoral plate 100 and locking attachment plate 200 assembly is positioned along a bone, the first and second wings 208, 210 should come into contact with the bone.

Because the first and second wings 208, 210 extend beyond the longitudinal edges 130, 132 of the proximal femoral plate, the locking attachment plate 200 may be particularly useful in situations where the proximal femoral plate 100 must be secured to a portion of a bone through which a significant portion of the stem of the prosthesis extends. In other words, the distance between the openings 216, 218 is greater than the distance between the first and second apertures 110, 112 of the pair of offset apertures 106 to accommodate a greater portion of the rod. Alternatively or in addition, the locking attachment plate 200 may be used to provide fixation in addition to the fixation provided by the pair of offset holes 106.

As shown in fig. 6-8, the GT attachment plate 300 is configured to attach to the head portion 102 of the proximal femoral plate 100 to treat a fracture of the greater trochanter. The GT attachment plate 300 extends along a longitudinal axis from a proximal end 302 to a distal end 304. The GT attachment plate 300 includes a distal portion 306 having a first connection opening 308 and a second connection opening 310 through which the GT attachment plate 300 is coupled to the proximal femoral plate 100 via connection screws 350 as shown in fig. 9-11. Although GT attachment plate 300 is described as a fixed position secured to plate 100 via connecting screws 350, those skilled in the art will appreciate that the position of GT plate 300 relative to plate 100 may be made adjustable (e.g., by providing multiple connection points on GT plate 300 or plate 100, by including elongated holes in which connecting screws may be mounted, etc.). The proximal portion 312 extends along a curve corresponding to the curve of the portion of the greater trochanter over which it is to be positioned, such that when the GT attachment plate 300 is assembled with the proximal femoral plate 100, the proximal portion 312 extends proximally from the proximal end 114 of the proximal femoral plate to extend along the greater trochanter. The proximal end 302 includes a pair of hooks 314 configured to engage an upper ridge at the proximal end of the greater trochanter. The GT attachment plate 300 may be secured to the greater trochanter via bone fixation elements inserted through one or more of the pair of holes 330 extending through the proximal portion 312 and/or cables inserted through the cable holes 316 extending through the proximal portion 312.

GT attachment plate 300 is defined via a first surface 318 that faces away from the bone when GT attachment plate 300 is in an operative position on the bone and a second surface 320 that faces toward the bone when GT attachment plate 300 is in an operative position on the bone. The first surface 318 and the second surface 320 are connected to each other via longitudinal side surfaces 322, 324. As described above, the GT attachment plate 300 is connected to the proximal femoral plate 100 by laying the distal portion 306 over the proximal femoral plate 100 such that the first and second connection openings 308, 310 are aligned with the first and second GT attachment openings 128, 138, respectively. When the openings 308, 128 and 310, 138 have been aligned, a connection screw 350, which may be captive in the GT attachment plate 300, may be screwed into the proximal femoral plate 100. Alternatively, a connecting screw may be inserted into an opening in GT attachment plate 300 to couple to plate 300 and femoral plate 100.

The GT attachment plate 300 and the proximal femoral plate 100 may additionally include corresponding features to aid in alignment and provide rotational resistance. For example, the GT attachment plate 300 may include a pair of locating pins 326 that protrude from the second surface 320 to be received within correspondingly sized, shaped and positioned locating openings 144 of the proximal femoral plate 100 in proper alignment with the proximal femoral plate 100 when the distal portion 306 overlaps the proximal femoral plate 100. The GT attachment plate 300 may also include a shoulder 328 extending along the second surface 320 such that when the GT attachment plate 300 is properly aligned with the proximal femoral plate 100, the shoulder abuts the proximal end 114 of the proximal femoral plate 100. The shoulder 328 is sized, shaped, and positioned along the second surface 320 to correspond to the proximal end 114. Thus, when the shoulder 328 and the locating pin 326 engage the proximal end 114 and the locating opening 144, respectively, the GT attachment plate 300 is properly aligned with and prevented from rotating relative to the proximal femoral plate 100.

As described above, the GT attachment plate 300 may be attached to the proximal femoral plate 100 using the connection screw 350 as shown in fig. 9-11. Each connection screw 350 includes a head portion 352 and a shaft portion 354 extending from the head portion. The shaft portion includes an unthreaded portion 356 proximate the head portion 352 and a threaded portion 358 extending from the unthreaded portion. The head portion 352 includes a recess 360 for receiving a correspondingly sized and shaped portion of the drive device, as will be understood by those skilled in the art. Once the GT attachment plate 300 and the proximal femoral plate 100 have been aligned, as described above, the first connection screw 350 is driven through the first connection opening 308 and the first GT attachment opening 128 until the head portion 352 abuts the first surface 318 of the attachment plate 300. The unthreaded part should reside within the first connection opening 308, while the threaded part engages corresponding threads of the first GT attachment opening 128. Similarly, the second connection screw 350 is inserted through the second connection opening 310 and the second GT attachment opening 138 until the head portion 352 abuts the first surface 318 and the unthreaded portion 356 resides within the second connection opening 310, while the threaded portion 358 engages the correspondingly threaded second GT attachment opening 138. As described above, the connection screw 350 may be driven into the corresponding opening via a drive device received within the recess 360.

As described above, when the assembly of GT attachment plate 300 and proximal femoral plate 100 is placed in a desired position along the femur, proximal portion 312 of GT attachment plate 300 extends along the greater trochanter. Thus, the proximal portion 312 extends along a curve corresponding to the shape of the lower portion of the greater trochanter. The proximal end 302 includes a pair of hooks 314 for engaging the greater trochanter along with a pair of holes 330 and cable holes 316 for providing securement.

Each of the hooks 314 is curved from the proximal end 312 toward the distal end 304 of the GT attachment plate 300 such that each of the hooks 314 engages the upper spine of the greater trochanter at a desired location on the bone. As will be appreciated by those skilled in the art, the hooks 314 may differ in length and/or radius of curvature to accommodate asymmetries in the structure of the lower portion of the large rotors. The GT attachment plate 300 includes two hooks 314 such that the hooks 314 do not interfere with any portion of the prosthesis. Specifically, one of the hooks 314 extends anteriorly relative to the prosthesis, while the other of the hooks extends posteriorly relative to the prosthesis.

Pairs of apertures 330 extend through proximal portion 312 from first surface 318 to second surface 320. Each of the pairs of holes 330 includes a first hole 332 on a first side of the longitudinal axis of the GT attachment plate and a second hole 334 on a second side of the longitudinal axis opposite the first side, such that bone fixation elements inserted through the first and second holes 332, 334 may extend anteriorly and posteriorly of the prosthesis. The first and second apertures 332, 334 of each pair of apertures 330 may be substantially aligned along the length of the GT attachment plate 300. Similar to the pair of offset holes 106 of the proximal femoral plate, the first and second holes 332, 334 may extend beyond the longitudinal edges of the GT attachment plate 300. In one embodiment, the central axis along which each of the first and second apertures 332, 334 extends may be substantially aligned with the longitudinal edge. The first and second holes allow placement of the bone fixation elements antero-inferior and postero-inferior of the prosthesis toward the femoral condyle. The first and second holes 332, 334 may be configured as variable angle holes such that a bone fixation element may be inserted into the variable angle holes at an angle within a permitted range of angles relative to the central axis. However, one skilled in the art will appreciate that one or more of the first and second holes 332, 334 of each of the pairs of holes 330 may have different configurations for receiving bone fixation elements. In one embodiment, the proximal portion 312 may include three pairs of apertures 314. However, the number of pairs of holes 314 may vary.

GT attachment plate 300 may also include one or more extension tabs 315 extending laterally from portions of proximal portion 312 that include first and second apertures 332, 334. In a particular embodiment, each extension tab 315 may extend substantially perpendicularly relative to a longitudinal axis of the GT attachment plate 300. Each extension tab 315 includes an opening 335 extending through an end thereof for receiving a bone fixation element. Opening 335 may similarly be configured as a variable angle hole. The number of extending tabs 315 may vary depending on the desired fixation of the GT attachment plate 300 and/or the anatomy of the greater trochanter over which the GT attachment plate 300 is to be placed. The extension tab 315 can be bent as needed to fit the particular anatomy of the patient.

Proximal portion 312 may also include a pair of cable holes 316, each hole 316a, 316b sized and shaped to receive a portion of a cable therein. Each of the holes 316a, 316b in the pair of cable holes 316 extends through the proximal portion 312 from the first longitudinal side surface 322 to the second longitudinal side surface 324. Each pair of cable holes 316 extends between an adjacent pair of holes 330 such that placement of the cables does not interfere with placement of bone fixation elements through the holes 332, 334 in the pair of holes 330. As will be understood by those skilled in the art, the cable may be looped around the proximal end of the femur such that a portion of the cable is received within the first and second cable holes 316a, 316 b. The cable is tensioned and the end of the cable is fixed relative to the GT attachment plate 300 via, for example, crimps (crimp) to secure the GT attachment plate 300 to the bone and/or provide fixation of the greater trochanter. Proximal portion 312 may include an elongated opening 336 extending therethrough from first surface 318 to second surface 320 along the longitudinal axis of GT attachment plate 300 to accommodate a crimp for securing a cable therein. Specifically, the elongated opening 336 communicates with the cable holes 316a, 316b such that cables passing through the first and second cable holes 316a, 316b must also pass laterally through the elongated opening 336. The cable may be looped around the proximal end of the femur (e.g., to extend around the lesser trochanter of the femur) such that a portion of the cable extends through the first and second holes 316a, 316b laterally through the elongated opening 336. The crimp received within the elongated opening 336 may be crimped over the portion of the cable passing through the elongated opening 336 to maintain the cable in a tensioned configuration. The curl may reside within the elongated opening 336 such that no portion of the curl substantially protrudes beyond the first surface 318. In an exemplary embodiment, the proximal portion includes two pairs of cable holes 316.

As shown in fig. 12-13, a GT attachment plate 400 according to another exemplary embodiment may be assembled similarly to a proximal femoral plate 100 to be positioned over the greater trochanter of the femur. Similar to GT attachment plate 300, GT attachment plate 400 includes a distal portion 406 for connecting GT attachment plate 400 to proximal femoral plate 100 and a proximal portion 412 for placement over the greater trochanter. The distal portion 406 is substantially similar to the distal portion 306 and may be similarly attached to the proximal femoral plate using a connection screw 350 inserted through its first and second connection openings 408, 410 aligned with the first and second GT attachment openings 128, 138, respectively, of the proximal femoral plate 100. Similar to GT attachment plate 300, the position of GT attachment plate 400 relative to plate 100 may be made adjustable (e.g., by providing multiple connection points on GT attachment plate 400 or plate 100, by including elongated holes within which connection screws 350 may be mounted, etc.). GT attachment plate 400 may also include similar alignment features, such as, for example, alignment pins 426 that protrude from a surface 420 of GT attachment plate 400 that faces the bone in the operative position, and/or shoulders 428 that extend along second surface 420. The locating pin 426 and the shoulder 428 may engage the opening 144 and the proximal end 114, respectively, of the proximal femoral plate 100.

However, rather than extending along the greater trochanter and engaging the greater trochanter via a hook at its proximal end, the proximal portion 412 includes a substantially annular portion 440 configured to seat over the greater trochanter with the central opening of the annular portion positioned to avoid the area of the trochanter sac, particularly where the tendon connects to the bone; and a plurality of extending tabs 414 extending radially from the annular portion. Each of the extending tabs 414 and the annular portion 440 includes bone fixation element receiving holes extending therethrough for securing the GT attachment plate 400 to bone. The annular portion 440 is sized and shaped to seat over the greater trochanter and includes a plurality of first apertures 432 extending therethrough. In one embodiment, the first apertures 432 may be equally spaced about the annular portion 440. The first hole 432 may be configured as a variable angle hole for receiving a bone fixation element therein at a desired angle relative to a central axis along which the first hole extends. In the example shown, the annular portion includes six (6) first apertures 432. However, those skilled in the art will appreciate that the number of first apertures 432 may vary depending on the size of the annular portion 440. The GT attachment plate 400 may be manufactured in a variety of sizes with different sizes of the ring portion 440 so that a GT attachment plate 400 may be selected that is suitable for the particular anatomy of the patient.

The loop portion 440 may also include a plurality of suture openings 442 extending therethrough. Each suture hole 442 may be positioned between two adjacent first holes 432 and may extend through a portion of the annular portion 440 having an undercut such that the annular portion 440 may be sutured to surrounding tissue via the suture hole 442.

The extending tabs 414 extend radially away from the annular portion 440, each extending tab 414 including a second aperture 434. The extension tab 414 can be bent as needed to fit the particular anatomy of the patient. Each extending tab 414 may extend from a portion of the annular portion 440 that includes the first opening 432. However, the extension tab 414 need not extend from each of the first openings 432, depending on the anatomy over which the extension tab 414 is desired to extend. The second aperture 434 may be similarly configured as a variable angle aperture. In one embodiment, the GT attachment plate 400 includes five (5) extension tabs 414. However, those skilled in the art will appreciate that the number of tabs 414 may vary depending on the size of the annular portion 440, the number of first holes 432, and/or the anatomy of the greater trochanter on which the GT attachment plate 400 is to be placed. The first and second holes 432, 434 of the GT attachment plate 400 allow insertion of bone fixation elements antero-inferior, postero-inferior and superior to the prosthesis towards the femoral calcar.

According to an exemplary surgical method using the above-described system, a surgeon or other user may evaluate the type of periprosthetic fracture and the particular anatomy of the patient to determine which plate 100, 200, 300 should be utilized. In some cases, such as, for example, when the fracture extends only along the proximal shaft portion of the femur, the surgeon may determine that the proximal femoral plate 100 may be utilized alone. In cases where there is also a fracture of the greater trochanter and/or additional fixation is required, the surgeon may decide to use the proximal femoral plate 100 in conjunction with the GT attachment plate 300 (or 400) and/or the locking attachment plate 200. The following method will describe the use of an assembly comprising all the plates 100, 200 and 300. However, those skilled in the art will appreciate that the proximal femoral plate 100 alone may be used in a substantially similar manner.

Where more than one plate is utilized, the plates should be assembled prior to implantation in the body. Specifically, the connection screw 350 may be used to couple the distal portion 306 of the GT attachment plate 300 to the proximal femoral plate 100, as described above. Similarly, fixation elements may be used to couple the locking attachment plate 200 between adjacent pairs of offset holes 106 along the proximal portion 108 of the shaft portion 104 of the proximal femoral plate 100, as described above. Once the plates 100, 200, and 300 have been assembled, the assembly may be placed along the proximal femur such that the hooks 314 of the GT attachment plate 300 engage the upper spine of the greater trochanter, such that the proximal portion 312 of the GT attachment plate 300 extends along the greater trochanter, and the proximal femoral plate 100 extends distally therefrom along the length of the femur. Specifically, the proximal end 114 of the proximal femoral plate 100 should be aligned with the femoral muscle ridge of the greater trochanter.

Once the assembly has been positioned along the proximal femur, bone fixation elements can be inserted through the desired ones of the first and second holes 108, 110 of the pair of offset holes 106, the first and second sets of holes 122, 124, the first and second bone fixation element receiving holes 216, 218 of the attachment plate 200, and the first and second holes 332, 334 of the pair of holes 330. As described above, all of these holes can be configured as 3.5mm variable angle holes. Inserting bone fixation elements through these holes allows the bone fixation elements to be inserted on both the anterior and posterior sides relative to the prosthesis. The bone fixation elements may be inserted through desired ones of the fixation holes 118 along the distal portion 116 of the proximal femoral plate to provide fixation of the plate assembly distal to the prosthesis.

One or more cables may be inserted through the pairs of cable holes 316 to provide compression of the large rotors. The cable may be looped and tensioned around the proximal end of the femur, with the crimp residing within the elongated opening 336 being crimped over the cable to maintain the cable in a tensioned configuration. When compression is provided by the one or more cables, the bone fixation elements inserted through the first and second holes 332, 334 provide resistance to rotational and translational forces. In securing the plate assembly, as described, surrounding tissue may be sutured to the plate assembly via the suture hole 316 and/or the suture hole 126.

As shown in fig. 14 and 15, a condylar plate 500 according to an embodiment of the present invention is sized and configured to attach the condylar plate to a distal end of a femoral plate (such as plate 100 of fig. 1). Specifically, the plate 500 is designed to be mounted over a distal portion of a femoral plate, such as plate 100, to extend a support distally from the distal end of the femoral plate to the femoral condyle to prevent a secondary fracture, as will be understood by those skilled in the art. Specifically, the bone-facing side of the plate 500 forms a cavity 502 that is sized to receive a distal portion of a bone plate mounted to a femur. The plate 500 includes a shaft portion 504 and a head portion 506 separated from each other by a gap 508. As will be appreciated by those skilled in the art, the gap 508 facilitates bending or otherwise trimming the plate 500 to more accurately fit the anatomy of the patient so that the head portion 506 may follow the surface of the condyle as closely as possible to minimize irritation of the surrounding tissue. As can be seen in fig. 15, the head portion 506 includes a plurality (4 in this embodiment) of variable angle locking holes 510, each configured to receive a bone fixation element (e.g., a bone screw) therethrough to anchor the head portion 506 to the condyle. The shaft portion 504 of this embodiment includes 4 fixation element receiving holes 512 through either or each of which bone fixation elements may be inserted to penetrate into the bone via holes in the underlying bone plate. For example, any or all of the holes 512 may be aligned with one or more of the combination holes 118 of the plate 100 when the plate 500 is installed over a bone plate, such as plate 100, as desired. As will be appreciated by those skilled in the art, the head portion 506 is preferably shaped to minimize the footprint of the plate 500 on the condyle while providing the desired number of bone fixation element receiving holes (in this embodiment, 4 variable angle locking holes). As will be understood by those skilled in the art, if desired, the condylar plate 500 may be mounted over the proximal end of a femoral bone plate (if the proximal end of the femoral bone plate is sized and shaped similar to the distal end of the plate 100) such that the head portion 506 may be mounted on the surface of the greater trochanter. As will be appreciated by those skilled in the art, the plates 500 may be shaped as mirror images, with a first plate 500 shaped to fit over the left distal condyle and also adapted to fit over the right greater trochanter, and a second plate 500 shaped to fit over the right distal condyle and also over the proximal portion of the femoral plate to extend to the left greater trochanter.

Although not described in detail, those skilled in the art will appreciate that the plate assembly may utilize a GT attachment plate 400 in place of the GT attachment plate 300, depending on the desired fixed configuration of the large rotor. The GT attachment plate 400 may be assembled with the proximal femoral plate 100 and utilized in a manner substantially similar to the methods described above.

It will be understood by those skilled in the art that modifications and variations can be made in the structure and method of the present invention without departing from the spirit or scope of the invention. Thus, it is intended that the present invention cover the modifications and variations of this invention provided they come within the scope of the appended claims and their equivalents.