text:
Plate holder assembly having bone plate seating confirmation arrangement
An assembly includes a plate holder having a body. The assembly further includes a stop structure movable in relation to the body between a first location and a second location. In addition, the assembly includes a bone plate assembly including (i) a bone plate having a plurality of fastener openings defined therein, the bone plate being attached to the body, and (ii) a fastener guide. One of the bone plate and the fastener guide includes a channel, and the other of the bone plate and the fastener guide includes a projection configured to be received in the channel.
Leyden, Matthew V. (St. Paul, MN, US)
Waffensmith, Jeffrey B. (North Oaks, MN, US)
Bachman, Timothy A. (St. Paul, MN, US)
Wallace, Matthew S. (Fort Wayne, IN, US)
Ruhling, Marc E. (Goshen, IN, US)
Metzinger, Anthony J. (Winona Lake, IN, US)
Christie, Charles D. (Winona Lake, IN, US)
DePuy Products, Inc. (Warsaw, IN, US)
606/70, 606/71, 606/151, 606/286, 606/301
A61B17/70; A61B17/04; A61B17/08; A61B17/58
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COTRONEO, STEVEN J
Schwegman Lundberg & Woessner / Biomet (P.O. Box 2938, Minneapolis, MN, 55402, US)
1. An assembly, comprising: a plate holder having a body; a stop structure movable in relation to said body between a first location and a second location; and an actuator movable between a first position and a second position, wherein movement of said actuator from said first position to said second position causes movement of said stop structure from said first location to said second location.
2. The assembly of claim 1, further comprising a bone plate assembly including (i) a bone plate having a plurality of fastener openings defined therein, said bone plate being attached to said body, and (ii) a fastener guide, wherein one of said bone plate and said fastener guide includes a channel, and wherein the other of said bone plate and said fastener guide includes a projection configured to be received in said channel.
3. The assembly of claim 2, wherein: said bone plate includes a first seating surface, said fastener guide includes a second seating surface, when said projection is received within said channel, said bone plate assembly is positionable between a seated state and an unseated state, when said bone plate assembly is in said seated state, said second seating surface is positioned in contact with said first seating surface, when said bone plate assembly is in said unseated state, said second seating surface is spaced apart from said first seating surface, said stop structure defines a path of movement from said first location to said second location, when said bone plate assembly is in said unseated state, said fastener guide is positioned in said path of movement of said stop structure, and when said bone plate assembly is in said seated state, said fastener guide is spaced apart from said path of movement of said stop structure.
4. The assembly of claim 3, wherein said bone plate assembly further includes a fastener at least partially positioned within said fastener guide.
5. The assembly of claim 1, wherein: said actuator includes a cam, and movement of said cam causes movement of said stop structure.
6. The assembly of claim 5, wherein: said actuator further includes (i) a knob, and (ii) a shaft attached to said knob, said shaft is further attached to said cam, and rotation of said knob causes rotation of said cam.
7. The assembly of claim 6, further comprising (i) a support member attached to said plate holder, (ii) a detent, and (iii) a spring, wherein: said support member defines a first aperture and a second aperture, said detent is interposed between said support member and said knob, said spring is interposed between said detent and said knob, said detent is positioned in said first aperture when said actuator is positioned at said first position, and said detent is positioned in said second aperture when said actuator is positioned at said second position.
8. The assembly of claim 6, wherein: said knob is rotatable about an axis, and rotation of said knob 180° about said axis causes movement of said stop structure from said first location to said second location.
9. The assembly of claim 1, further comprising a guide component attached to said plate holder, said guide component having a plurality of guide holes defined therein.
10. The assembly of claim 9, wherein said guide component includes a handle portion having said plurality of guide holes defined therein.
11. The assembly of claim 1, further comprising a support member that includes (i) a first visual indicator, and (ii) a second visual indicator that is spaced apart from said first visual indicator, wherein: said actuator further includes a knob positioned adjacent to said support member, said actuator defines a viewing opening, said viewing opening is aligned with said first visual indicator when said actuator is positioned at said first position, and said viewing opening is aligned with said second visual indicator when said actuator is positioned at said second position.
12. The assembly of claim 1, wherein: said body of said plate holder defines a viewing hole, said stop structure includes a visual indicator, said viewing hole is aligned with said visual indicator when said actuator is positioned at said second position, and said viewing hole is misaligned with said visual indicator when said actuator is positioned at said first position.
13. An assembly, comprising: a plate holder having a body; a stop structure movable in relation to said body between a first location and a second location; and a bone plate assembly including (i) a bone plate having a plurality of fastener openings defined therein, said bone plate being attached to said body, and (ii) a fastener guide, wherein one of said bone plate and said fastener guide includes a channel, and wherein the other of said bone plate and said fastener guide includes a projection configured to be received in said channel.
14. The assembly of claim 13, wherein: said bone plate includes a first seating surface, said fastener guide includes a second seating surface, when said projection is received within said channel, said bone plate assembly is positionable between a seated state and an unseated state, when said bone plate assembly is in said seated state, said second seating surface is positioned in contact with said first seating surface, when said bone plate assembly is in said unseated state, said second seating surface is spaced apart from said first seating surface, said stop structure defines a path of movement from said first location to said second location, when said bone plate assembly is in said unseated state, said fastener guide is positioned in said path of movement of said stop structure, and when said bone plate assembly is in said seated state, said fastener guide is spaced apart from said path of movement of said stop structure.
15. The assembly of claim 14, wherein said bone plate assembly further includes a fastener at least partially positioned within said fastener guide.
16. The assembly of claim 14, further comprising an actuator configured to move said stop structure between said first location and said second location.
17. The assembly of claim 16, wherein: said actuator includes a cam, and movement of said cam causes movement of said stop structure.
18. The assembly of claim 17, wherein: said actuator further includes (i) a knob, and (ii) a shaft attached to said knob, said shaft is further attached to said cam, and rotation of said knob causes rotation of said cam.
19. The assembly of claim 18, further comprising (i) a support member attached to said plate holder, (ii) a detent, and (iii) a spring, wherein: said support member defines a first aperture and a second aperture, said detent is interposed between said support member and said knob, said spring is interposed between said detent and said knob, said detent is positioned in said first aperture when said stop structure is positioned at said first location, and said detent is positioned in said second aperture when said stop structure is positioned at said second location.
20. The assembly of claim 18, wherein: said knob is rotatable about an axis, and rotation of said knob 180° about said axis causes movement of said stop structure from said first location to said second location.
21. The assembly of claim 13, further comprising a guide component attached to said plate holder, said guide component having a plurality of guide holes defined therein.
22. The assembly of claim 21, wherein said guide component includes a handle portion having said plurality of guide holes defined therein.
23. The assembly of claim 13, further comprising a support member that includes (i) a first indicator, and (ii) a second indicator that is spaced apart from said first indicator, wherein: said actuator further includes a knob positioned adjacent to said support member, said actuator defines a viewing opening, said viewing opening is aligned with said first indicator when said actuator is positioned at said first position, and said viewing opening is aligned with said second indicator when said actuator is positioned at said second position.
24. The assembly of claim 13, wherein: said body of said plate holder defines a viewing hole, said stop structure includes a visual indicator, said viewing hole is aligned with said visual indicator when said actuator is positioned at said second position, and said viewing hole is misaligned with said visual indicator when said actuator is positioned at said first position.
Cross reference is made to copending (i) U.S. patent application Ser. No. 11/______ (Attorney Docket No. 1671-0417), entitled "Plate Holder Assembly having Movable Guide Component" by Richard Kyle, Jeffrey Waffensmith, Matthew Leyden, Tim Bachman, Matthew Wallace, and Marc Ruhling, (ii) U.S. patent application Ser. No. 11/______ (Attorney Docket No. 1671-0419), entitled "Plate Holder and Bone Plate Arrangement" by Matthew Leyden, Jeffrey Waffensmith, Matthew Wallace, and Marc Ruhling, (iii) U.S. patent application Ser. No. 11/______ (Attorney Docket No. 1671-0425), entitled "Apparatus for Measuring an Angle of a Guide Wire Relative to a Bone" by Stuart R. Grant, Anthony J. Metzinger, David A. Hawkes, and Andrew H. Berthusen, and (iv) U.S. patent application Ser. No. 11/______ (Attorney Docket No. 1671-0430), entitled "Guide Assembly for Use in a Medical Procedure" by Matthew Leyden, Aaron Bisek, David A. Hawkes, Marc Ruhling, Jeffrey Waffensmith, and Matthew Wallace, which are assigned to the same assignee as the present invention, and which are filed concurrently herewith. The disclosures of the four above-identified patent applications are herein totally incorporated by reference in their entirety.
The present disclosure relates generally to the reduction of a hip fracture by the placement of a bone plate and associated bone fasteners with instrumentation.
A procedure regularly performed by orthopedic surgeons is the reduction of a hip fracture caused by trauma. The site of this type of fracture typically exists at the proximal portion of the femur below the head. In order to reduce a fracture of this type, an elongated lag screw is threadingly advanced into the shaft, neck, and head of the femur, and secured to a bone plate. Cortical screws are used to secure the bone plate to the femur distal to the fracture site. Tightening of the lag screw compresses the bone fragments together and facilitates healing of the femur. Many devices have been designed for this type of reduction including the devices disclosed in U.S. Pat. Nos. 4,438,762, 3,554,193, and 2,526,959, the disclosures of which are incorporated herein by reference in their entirety.
During the above procedure, it is necessary to advance a bone plate into a seated arrangement with a lag screw barrel through which the lag screw extends. When the hip fracture reduction procedure is performed in a minimally invasive manner, visual confirmation of proper seating of the bone plate with the lag screw barrel may be difficult, if not impossible. Indeed, in a minimally invasive hip reduction procedure, the bone plate and lag screw barrel may be covered in large part by a patient's body tissues such as skin and soft tissue. It would be desirable if the implants and instrumentation used in a hip fracture procedure would facilitate confirmation of proper seating of the bone plate with the lag screw barrel. Moreover, it would be desirable if such implants and instrumentation that would facilitate confirmation of proper seating of the bone plate with the lag screw barrel were relatively easy to use.
What is needed therefore is apparatus that facilitate confirmation of proper seating of a bone plate with a lag screw barrel during a hip fracture reduction procedure. What is also needed is apparatus that facilitate confirmation of proper seating of a bone plate with a lag screw barrel during a minimally invasive hip fracture reduction procedure. What is further needed is such apparatus that are easy to use.
In accordance with one embodiment of the disclosure, there is provided an assembly that includes a plate holder having a body. The assembly further includes a stop structure movable in relation to the body between a first location and a second location. In addition, the assembly includes an actuator movable between a first position and a second position. Movement of the actuator from the first position to the second position causes movement of the stop structure from the first location to the second location.
Pursuant to another embodiment of the disclosure, there is provided an assembly that includes a plate holder having a body. The assembly further includes a stop structure movable in relation to the body between a first location and a second location. The assembly also includes a bone plate assembly including (i) a bone plate having a plurality of fastener openings defined therein, the bone plate being attached to the body, and (ii) a fastener guide. One of the bone plate and the fastener guide includes a channel, and the other of the bone plate and the fastener guide includes a projection configured to be received in the channel.
FIG. 1 is a perspective view of an implant assembly which is implanted in a minimally invasive manner according to the present disclosure;
FIG. 2A is a side elevational view of the lag screw assembly of the implant assembly of FIG. 1;
FIG. 2B is a side elevational view of the lag screw component of the lag screw assembly of FIG. 2A;
FIG. 2C is a cross sectional view of the lag screw component taken along the line 2C-2C of FIG. 2B;
FIG. 2D is a cross sectional view of the sleeve of the lag screw assembly of FIG. 2A;
FIG. 2E is a side elevational view of the fastener guide taken along the line 2E-2E of FIG. 2A;
FIG. 3A is a top elevational view of the bone plate of the implant assembly of FIG. 1;
FIG. 3B is a bottom elevational view of the bone plate of the implant assembly of FIG. 1;
FIG. 3C is a cross sectional view of the bone plate taken along the line 3C-3C of FIG. 3A;
FIG. 3D is an enlarged, fragmentary, cross sectional view of the bone plate showing the portion of FIG. 3C that is encircled and identified as FIG. 3D.
FIG. 4 is a perspective view of the lag screw assembly of FIG. 2A implanted in a femur of a patient according to the present disclosure, with the lag screw assembly being partially visually exposed through an incision in a patient.
FIG. 5 is an exploded, perspective view of an instrument assembly (with the implant assembly not shown) that is used to implant the implant assembly of FIG. 1 in the patient in a minimally invasive manner according to the present disclosure;
FIG. 6 is a top elevational view of the instrument assembly of FIG. 5, with the knob of the instrument assembly removed for clarity of viewing;
FIG. 7 is a side elevational view of the instrument assembly of FIG. 5, with the implant assembly not shown;
FIG. 8 is a cross sectional view of the instrument assembly of FIG. 5, with the implant assembly shown;
FIG. 9 is a side elevational view of the plate holder of the instrument assembly of FIG. 5;
FIG. 10 is a cross sectional view of the plate holder of the instrument assembly of FIG. 5;
FIG. 11 is a side elevational view of the coupling component of the instrument assembly of FIG. 5;
FIG. 12 is a top elevational view of the coupling component of the instrument assembly of FIG. 5;
FIG. 13 is a cross sectional view of the coupling component taken along the line 13-13 of FIG. 12;
FIG. 14 is an enlarged, fragmentary, cross sectional view of the instrument assembly showing the portion of FIG. 8 that is encircled and identified as FIG. 14.
FIG. 15 is an enlarged, fragmentary, top elevational view of the guide component of the instrument assembly of FIG. 5;
FIG. 16 is a perspective view of the instrument assembly of FIG. 5 (with the implant assembly attached thereto) and being used to implant the implant assembly in a femur according to the present disclosure, with the femur and the implant assembly being shown removed from the body of a patient P for clarity of viewing;
FIG. 17 is another perspective view of the instrument assembly of FIG. 5 (with the implant assembly attached thereto) and being used to implant the implant assembly in a femur according to the present disclosure, with the femur and the implant assembly being shown removed from the body of a patient P for clarity of viewing;
FIG. 18 is a bottom elevational view of an actuator of the instrument assembly of FIG. 5;
FIG. 19 is a top elevational view of the actuator of FIG. 18;
FIG. 20 is a cross sectional view of the actuator taken along the line 20-20 of FIG. 18;
FIG. 22 is a side elevational view of a spring 76 of the instrument assembly of FIG. 5;
FIG. 23 is a bottom elevational view of a guide component of the instrument assembly of FIG. 5;
FIG. 24 is a cross sectional view of the guide component taken along the line 24-24 of FIG. 23;
FIG. 25 is a perspective view of the instrument assembly of FIG. 5 (with the implant assembly also shown) and being used to implant the implant assembly in a femur according to the present disclosure, with the femur and the implant assembly being shown removed from the body of a patient P for clarity of viewing (note that the bone plate and fastener guide are shown in an unseated state);
FIG. 26 is another perspective view of the instrument assembly of FIG. 5 (with the implant assembly also shown) and being used to implant the implant assembly in a femur according to the present disclosure, with the femur and the implant assembly being shown removed from the body of a patient P for clarity of viewing (note that the bone plate and fastener guide are shown in a seated state) (also note that the knob 116 is shown in a first position in which the "unlocked" icon is displayed);
FIG. 27 is an enlarged, fragmentary, perspective view of the instrument assembly of FIG. 5, however, the stop structure 112 is shown positioned in its lower position;
FIG. 28 is an enlarged, fragmentary, perspective view of the instrument assembly of FIG. 5 showing the knob 116 in a second position in which the "locked" icon is displayed;
FIG. 29 is an exploded, perspective view of the actuator of the instrument assembly of FIG. 5;
FIG. 30 is an exploded, perspective view of the cam, cam riders, and stop structure of the instrument assembly of FIG. 5;
FIG. 31 is a top elevational view of the support member of the instrument assembly of FIG. 5;
FIG. 32 is a cross sectional view of the support member taken along the line 32-32 of FIG. 31;
FIG. 33 is a bottom elevational view of the knob of the actuator of FIG. 29;
FIG. 34 is a top elevational view of the knob of the actuator of FIG. 29; and
FIG. 35 is a fragmentary, perspective view of a patient with a fractured femur.
While the assembly described herein is susceptible to various modifications and alternative forms, specific embodiments thereof have been shown by way of example in the drawings and will herein be described in detail. It should be understood, however, that there is no intent to limit the assembly to the particular forms disclosed, but on the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention as defined by the appended claims.
Instrumentation and Implant Components
Described below are instrumentation and implant components that facilitate reduction of a hip fracture in a minimally invasive manner. As shown in FIGS. 1, 2A-2E, and 3A-3D, the implant components include an implant assembly 2 that includes a lag screw assembly 4, a bone plate 6, and a plurality of bone screws 8A, 8B. The bone screws 8A include two non-locking cortical bone screws, while the bone screws 8B include two locking cortical bone screws. Alternatively, other combinations of locking screws 8A and non-locking screws 8B may be used with the bone plate 6. Further, instead of using a combination of locking and non-locking screws, all locking screws 8B may used with the bone plate 6, or alternatively all non-locking screws 8A may be used with the bone plate 6.
The bone plate 6 has defined therein a plurality of fastener openings 7, 7A configured to receive the bone screws 8A, 8B. Each of the fastener openings 7 include a recess portion RP and a threaded portion TP that are aligned with each other as shown in FIG. 3C. The fastener opening 7A includes a threaded recess portion TRP and a threaded portion TP that are aligned with each other as shown in FIG. 3D. The threaded recess portion TRP defines a set of internal threads 54. The structure of the bone plate 6 that defines the threaded recess portion TRP creates a coupling component 9.
The lag screw assembly 4 includes a lag screw 10 and a fastener guide or barrel 12. The fastener guide 12 defines a passage 13 in which the lag screw 10 is partially positioned. The lag screw 10 includes a lag screw component 14 and a sleeve 16 that are rotatably attached together. The lag screw component 14 has defined therein a plurality of threads 15. The sleeve 16 is configured to slide axially within the passage 13 of the fastener guide 12, but is prevented from being able to rotate in relation to the fastener guide 12 by mating structure (not shown) of the sleeve 16 and fastener guide 12. The sleeve 16 has defined therein a passage 18 that defines a hexagonal shaped recess 19. The lag screw component 14 is freely rotatable in relation to the sleeve 16. However, when a keying mechanism (not shown) is positioned within the recess 19 of the sleeve 16 and a hexagonal-shaped recess 20 of the lag screw component 14, the sleeve 16 and the lag screw component 14 are rotationally or angularly locked together. In other words, rotation of the sleeve 16 causes rotation of the lag screw component 14. Thus, when the keying mechanism is positioned within the recess 19 and the recess 20, the lag screw component 14 is rotationally or angularly locked in relation to the fastener guide 12 since the sleeve 16 is prevented rotating in relation to the fastener guide 12 as discussed above. However, the lag screw component 14 is able to slide axially in relation to the passage 13 of the fastener guide 12.
Alternatively, the sleeve 16 may be permanently fixed in relation to the lag screw component 14 so that, after assembly of these components, rotation of the sleeve 16 causes rotation of the lag screw component 14. An alternative lag screw assembly that may be utilized in the lag screw assembly 4 is the lag screw assembly disclosed in U.S. Patent Application Publication No. US2007/0162011, having a U.S. application Ser. No. 11/303,833, the disclosure of which is herein incorporated by reference in its entirety.
The bone plate 6 cooperates with the lag screw assembly 4 to assume the configuration shown in FIG. 1. In particular, the fastener guide 12 defines a channel 24. The channel 24 is preferably U-shaped. The bone plate 6 defines an access opening 29 through which the fastener guide 12 may advance. The bone plate 6 includes a projection 26. The projection 26 is preferably U-shaped. The projection 26 of the bone plate 6 is configured to be received within the channel 24 of fastener guide 12. In order to mate the bone plate 6 with the lag screw assembly 4, the bone plate 6 is advanced in the direction indicated by arrow 28 (see FIG. 1) so that the fastener guide 12 passes through the access opening 29 of the bone plate whereby the projection 26 of the bone plate is received within the channel 24 of the fastener guide. Continued advancement of the bone plate 6 in relation to the fastener guide 12 in the direction of arrow 28 results in a seating surface SS1 of the fastener guide 12 contacting a seating surface SS2 of the bone plate 6. When seating surface SS1 is positioned in contact with the seating surface SS2, the bone plate 6 and the fastener guide 12 are in an assembled state.
At a particular stage during a hip fracture reduction procedure, the lag screw assembly 4 is secured within a femoral head, neck, and shaft of a femur F of a patient P as shown in FIG. 4. The lag screw assembly 4 is partially visually exposed through an incision I in the patient P as shown in FIG. 4. The femur F has a fracture 22 defined therein as shown in FIG. 4.
Turning now to FIGS. 5-7, there is shown an instrument assembly 30 that is used to facilitate implantation of the bone plate 6 and the bone screws 8A, 8B of the implant assembly 2 into the patient P. FIG. 8 also shows the instrument assembly 30, and a couple of other devices supported thereby.
The instrument assembly 30 includes a plate holder 40 having a body 42 and a coupling component 44 rotatably supported by the body 42. The body 42 is also shown in FIGS. 9-10, while the coupling component 44 is also shown in FIGS. 11-13. The body 42 includes a foot portion 46 that defines a passage 48. The body 42 further includes a neck 43. The foot portion 46 includes a set of internal threads 49 located within the passage 48 as shown in FIG. 14. The coupling component 44 has defined therein a passage 50 extending therethrough. The coupling component 44 includes a flange 45 and a set of external threads 52 that is configured to meshingly engage with the set of internal threads 49 of the foot portion 46. The set of external threads 52 of the coupling component 44 is also configured to meshingly engage with a set of internal threads 54 defined in the bone plate 6 as shown in FIG. 14.
In order to assemble the coupling component 44 to the foot portion 46, the coupling component 44 is advanced into the passage 48 of the foot portion until the set of external threads 52 of the coupling component 44 contact the set of internal threads 49 of the foot portion 46. Thereafter, the coupling component 44 is rotated so that the set of external threads 52 meshing engagement with the set of internal threads 49 of the foot portion 46. Continued rotation of the coupling component 44 in relation to the foot portion 46 results in advancement of the set of external threads 52 through the set of internal threads 49. After the set of external threads 52 are advanced through the set of internal threads 49, the coupling component 44 is rotatably attached to the foot portion 46. In this assembled state, the coupling component 44 is able to rotate freely in relation to the foot portion 46. Further, the coupling 44 is able to move a distance axially within the passage 48, but is prevented from becoming detached from the foot portion 46. Indeed, upward movement of the coupling component 44 in relation to the foot portion 46 is limited by interaction of the set of external threads 52 of the coupling component and the set of internal threads 49 of the foot portion. Also, downward movement of the coupling component 44 in relation to the foot portion 46 is limited by interaction of the flange 56 of the coupling component and a shoulder 51 of the foot portion which is located in the passage 48.
Note that when the set of external threads 52 of the coupling component 44 are mated with the set of internal threads 54 of the bone plate 6, the bone plate 6 is secured to the foot portion 44 of the plate holder 40. Also note that when the set of external threads 52 of the coupling component 44 are mated with the set of internal threads 54 of the bone plate 6, the passageway 50 of the coupling component 44 is aligned with the fastener opening 7A of the bone plate 6.
As shown in FIGS. 5-8, the instrument assembly 30 further includes a guide component 60 that is pivotably secured to the body 42 of the plate holder 40. The guide component 60 includes a handle portion 61 having defined therein a plurality of guide holes 62, 62A. The handle portion further defines a plurality of peripheral slots 63 that are located in the guide hole 62A as shown in FIGS. 5 and 15. The guide component 60 further includes an end portion 64 that includes a cavity 66 defined therein as shown in FIGS. 23-24.
Since the guide component 60 is pivotably connected to the plate holder 40, the guide component 60 is movable in relation to the body 42 of the plate holder 40 between a first position shown in FIG. 16 (see also FIGS. 7-8) and a second position shown in FIG. 17. The guide component 60 pivots about an axis X. (See FIGS. 5 and 8.) Pivoting the guide component 60 180° about the axis X causes the guide component 60 to move from its first position (see FIG. 16) to its second position (see FIG. 17).
When the guide component 60 is located at its first position in relation to the plate holder 40 (see FIG. 16), the plurality of guide holes 62, 62A are respectively aligned with the plurality of fastener openings 7, 7A. For example, as shown in FIG. 8, the left most guide hole 62A is aligned with the left most fastener opening 7A so that an elongate instrument (e.g. a driver 68) may be advanced through the guide hole 62A and present its working end at the fastener opening 7A. Further, for example, as shown in FIG. 8, the fourth guide hole 62 (from the left) is aligned with the fourth fastener opening 7 (from the left) so that an elongate instrument (e.g. a drill assembly 70) may be advanced through the guide hole 62 and present its working end at the fastener opening 7. When the guide component 60 is located at its second position in relation to the plate holder 40 (see FIG. 17), the plurality of guide holes 62, 62A are respectively misaligned with the plurality of fastener openings 7, 7A. Indeed, advancing elongate instruments 68, 70 respectively through the guide holes 62, 62A would not result in the working ends of the elongate instruments being respectively presented at the fastener openings 7, 7A.
Moreover, as can be seen from FIGS. 16 and 17, when the guide component 60 is positioned at its first position in relation to the plate holder 40 (see FIG. 16), the handle portion 61 is positioned over the bone plate 6. On the other hand, when the guide component 60 is positioned at its second position in relation to the plate holder 40 (see FIG. 17), the handle portion 61 is not positioned over the bone plate 6. Positioning of the guide component 60 at its second position (see FIG. 17) facilitates visibility of the bone plate 6 and surrounding area. Moreover, positioning of the guide component 60 at its second position (see FIG. 17) facilitates access of instruments and other devices to the bone plate 6 and surrounding area.
The instrument assembly 30 further includes a locking mechanism 72 that is configured to lock the guide component 60 in relation to the body 42 of the plate holder 40 at its first position as shown in FIG. 16, and at its second position as shown in FIG. 17. The locking mechanism 72 includes an actuator 74 that is partially located in the cavity 66 of the guide component 60. The actuator 74 is movable between a lower position (shown in solid in FIG. 8), and an upper position (shown in phantom in FIG. 8). The locking mechanism 72 includes a plurality of springs 76 configured to bias the actuator 74 toward its lower position. (See FIG. 8.) The springs 76 have an identical configuration with respect to each other, and one spring 76 is shown in FIG. 22. The springs 76 are located in the cavity 66 of the guide component 60. Within the cavity 66, the springs 76 are interposed between the actuator 74 and the guide component 60. In order to move the actuator 74 from its lower position to its upper position against the spring bias of the springs 76, force is applied to the actuator in the direction of arrow 78 thereby urging the actuator upwardly until the actuator 74 contacts a lower surface of the guide component 60. Thereafter, in order to move the actuator 74 from its upper position to its lower position, the upwardly applied force is removed thereby allowing the springs 76 to urge the actuator 74 downwardly to its lower position.
When the actuator 74 is positioned in its lower position, the guide component 60 is locked in relation to the body 42 of the plate holder 40 at its first position (shown in FIG. 16). Thereafter, an upward force is applied to the actuator 74 in the direction of arrow 78 thereby moving the actuator from its lower position (shown in solid in FIG. 8) to its upper position (shown in phantom in FIG. 8). When the actuator 74 is positioned in its upper position, the guide component 60 is free to rotate in relation to the body 42 of the plate holder. Force is then applied to the guide component 60 so that the guide component 60 pivots 180° about the axis X causing the guide component 60 to move from its first position (shown in FIG. 16) to its second position (shown in FIG. 17). Thereafter, the upward force is removed from the actuator 74 thereby allowing the springs 76 to urge the actuator 74 downwardly to its lower position. When the actuator 74 is positioned in its lower position, the guide component 60 is locked in relation to the body 42 of the plate holder 40 at its second position (shown in FIG. 17).
As shown in FIGS. 18-21, the actuator 74 includes a body 80 and a blocking structure 82 supported by the body 80. The body 80 defines a passage 83 therethrough. The blocking structure 82 includes a number of detents 84 attached to the body 80. The body 42 of the plate holder 40 has defined therein a number of detent recesses 86. (See FIGS. 5 and 9.) As shown in FIGS. 23-24, the guide component 60 includes a number of internal walls 85 that are positioned within the passage 66. The internal walls 85 define a number of slots 87.
When the instrument assembly 30 is in an assembled state, the body 80 of the actuator 74 is positioned around the neck 43 of the plate holder 40 so that the neck 43 extends through the passage 83 of the body 80 of the actuator 74 as shown in FIG. 8. The detents 84 are located within the slots 87 of the guide component 60. Thus, the actuator 74 is able to move in the direction of axis X since the detents 84 are able slide axially within the slots 87, however, the internal walls 85 of the guide component 60 prevent rotation of the actuator 74 in relation to the guide component 60. Thus, the actuator 74 is rotationally fixed in relation to the guide component 60.
When the actuator 74 is positioned at its lower position (shown in solid in FIG. 8), the blocking structure 82 is located in the number of detent recesses 86. In particular, one detent 84 is positioned in one detent recess 86, while another detent 84 is positioned in another detent recess 86. As a result, rotation of the actuator 74 in relation to the body 42 of the plate holder 40 is prevented when the actuator 74 is positioned at its lower position. And since the actuator 74 is rotationally fixed in relation to the guide component 60, the guide component 60 is prevented from rotating in relation to the body 42 of the plate holder 40 when the actuator 74 is positioned at its lower position.
In contrast, when the actuator 74 is positioned at its upper position (shown in phantom in FIG. 8), the blocking structure 82 is spaced apart from the number of detent recesses 86. In particular, both detents 84 are spaced apart from both detent recesses 86. Therefore, rotation of the actuator 74 in relation to the body 42 of the plate holder 40 is allowed when the actuator 74 is positioned at its upper position. Thus, the guide component 60 is allowed to be rotated in relation to the body 42 of the plate holder 40 when the actuator 74 is positioned at its upper position. Accordingly, when the actuator 74 is positioned at its upper position, the guide component 60 may be rotated from its position shown in FIG. 16 to its position shown in FIG. 17. Furthermore, when the actuator 74 is positioned at its upper position, the guide component 60 may be rotated from its position shown in FIG. 17 to its position shown in FIG. 16.
Turning again to FIG. 8, the instrument assembly 30 further includes the driver 68. The driver 68 includes a shaft 90. The driver 68 further includes a tip portion 92 attached to the shaft 90 at one end, and a drive portion 94 attached to the shaft 90 at the other end. The drive portion 94 includes a flat drive surface (not shown). The drive portion 94 is configured to be coupled to a chuck of a manual or power drill (not shown). The tip portion 92 includes a drive structure 96. The drive structure 96 includes a plurality of spaced apart linearly extending ribs 98 (see FIG. 8). Note that the coupling component 44 includes a drive structure 100 (see FIGS. 12-13) that is configured to mate with the drive structure 96 of the tip portion 92 when the tip portion 92 is positioned within the passageway 50 of the coupling component 44 as shown in FIG. 8. The drive structure 100 defines a plurality of spaced apart linearly extending slots 102 that is configured to receive respectively the plurality of spaced apart linearly extending ribs 98. It should be appreciated that the slots 102 extend from a proximal end of the coupling component 44 towards the distal end of the coupling component, and terminates prior to arriving at the distal end of the coupling component 44 as shown in FIG. 13. Further, the tip portion 92 of the driver 68 is configured to interact with the structure of the coupling component 44 that defines the slots 102 so that the tip portion 92 of the driver 68 is prevented from being advanced entirely through the passageway 50 of the coupling component 44.
In order to utilize the driver 68 to attach the bone plate 6 to the plate holder 40, the tip portion 92 of the driver needs to be mated with the drive structure 100 of the coupling component 44. To this end, the tip portion 92 is advanced through the guide hole 62A of the guide component 60. As stated above, the handle portion 61 defines a plurality of peripheral slots 63 that are located in the guide hole 62A as shown in FIGS. 5 and 15. In order to advance the tip portion 92 through the guide hole 62A, the plurality of spaced apart ribs 98 of the tip portion are aligned with the plurality of peripheral slots of the handle portion 61. Thereafter, the tip portion 92 is advanced through the guide hole 62A so that the drive structure 96 passes through the peripheral slots 63. Note that the other guide holes 62 of the guide component 60 are not similarly slotted, and are configured to prevent advancement of the tip portion 92 through the guide holes 62. Continued advancement of the tip portion 92 toward the bone plate 6 results in the tip portion 92 being received within the passage 50 of the coupling component 44. When the tip portion 92 is received within the passage 50, the drive structure 96 of the driver 68 is mated with the drive structure 100 of the coupling component 44. When the drive structure 96 of the driver 68 is mated with the drive structure 100 of the coupling component 44, the shaft 90 of the driver 68 extends through the guide hole 62A of the guide component 60.
In order to secure the bone plate 6 to the plate holder 40, the set of external threads 52 of the coupling component 44 of the plate holder 40 are meshingly engaged with the set of internal threads 54 of the bone plate 6. This is accomplished by placing the driver 68 through the guide hole 62A of the guide component 60 and advancing the tip portion 92 of the driver 68 toward the coupling component 44 until the drive structure 96 of the tip portion 92 mates with drive structure 100 of the coupling component 44. Thereafter, the driver 68 is rotated thereby causing the coupling component 44 to be rotated in relation to the bone plate 6. Rotation of the coupling component 44 in relation to the bone plate 6 causes the set of external threads 52 of the coupling component 44 to be meshingly engaged with the set of internal threads 54 of the bone plate 6 thereby securing the bone plate 6 to the plate holder 40.
After the lag screw assembly 4 is secured within a femoral head, neck, and shaft of the femur F of the patient P as shown in FIG. 4, a surgeon manipulates the plate holder 40 (with the bone plate 6 attached thereto) so that the bone plate 6 is advanced through the incision I to a position on the femur F that is spaced apart from the lag screw assembly 4 as shown in FIG. 25. Thereafter, the plate holder 40 is further manipulated to advance the bone plate 6 in the direction of arrow 110 to a position on the femur F in which the seating surface SS1 of the fastener guide 12 is positioned in contact with the seating surface SS2 of the bone plate 6 as shown in FIG. 26. (See also FIG. 1 showing the bone plate 6 seated against the fastener guide 12.) During such advancement of the bone plate 6 in the direction of arrow 110, the fastener guide 12 is advanced through the access opening 29 defined in the bone plate 6. Further, during such advancement of the bone plate 6 in the direction of arrow 110, the projection 26 of the bone plate 6 is mated with the channel 24 of the fastener guide 12. When the seating surface SS2 of the bone plate 6 is positioned in contact with the seating surface SS1 of the fastener guide 12, the bone plate and the fastener guide are in a seated state (shown in FIG. 26). In contrast, when the seating surface SS2 of the bone plate 6 is spaced apart from the seating surface SS1 of the fastener guide 12, the bone plate and the fastener guide are in an unseated state (shown in FIG. 25).
The instrument assembly 30 is operable to verify whether the bone plate 6 and the fastener guide 12 are in a seated state (i.e. the seating surface SS1 of the fastener guide 12 is located in contact with a seating surface SS2 of the bone plate 6) when the bone plate 6 is attached to the plate holder 40 as shown in FIG. 26. In particular, the instrument assembly 30 includes a stop structure 112 that is movable in relation to the body 42 of the plate holder 40 between an upper position (shown in FIG. 8) and a lower position (shown in FIG. 27). The instrument assembly 30 also includes an actuator 114 that is movable between a first position shown in FIG. 26 to a second position shown in FIG. 28. The actuator 114 includes a knob 116, a shaft 118, a cam 120, and a fastener 122 as shown in FIGS. 8 and 29. The shaft 118 is attached to the knob 116 since the shaft 118 and the knob are integrally molded together as one part. The cam 120 is attached to a distal end of the shaft 118 by the fastener 122. In particular, the cam 120 includes a central passage in which the distal portion of the shaft 118 is positioned. The distal portion of the shaft 118 includes an internally threaded recess. The fastener 122 is threadingly received within the internally threaded recess of the shaft 118 to secure the cam 120 to the shaft 118. When the instrument assembly 30 is assembled as shown in FIG. 8, rotation of the knob 116 causes rotation of the cam 120.
The stop structure 112 has defined therein a number of holes 124A, 124B as shown in FIG. 30. The stop structure 112 further includes a number of cam riders 126A, 126B each being secured within a respective hole 124A, 124B, yet partially projecting from the respective hole 124A, 124B as shown in FIG. 8. The cam 120 has defined therein a cam track 128A and a cam track 128B. The cam track 128A defines a cam surface 130A, while the cam track 128B defines a cam surface 130B as shown in FIG. 29. When the instrument assembly 30 is assembled, the cam rider 126A is positioned within the cam track 128A and contacts the cam surface 130A, while the cam rider 126B is positioned within the cam track 128B and contacts the cam surface 130B. Rotation of knob 116 causes rotation of the cam 120. In turn, rotation of the cam 120 causes movement of the stop structure 112 in the direction of the axis X due to the interaction between the cam riders 126A, 126B and the cam surfaces 130A, 130B. Rotation of the knob 116 in a clockwise direction causes the stop structure 112 to move downwardly in a path of movement in the direction of the axis X, while rotation of the knob 116 in a counter-clockwise direction causes the stop structure 112 to move upwardly in the path of movement in the direction of the axis X. (See FIG. 8.)
The stop structure 112 includes a tang 135 located at the distal portion thereof. Downward movement of the stop structure 112 in its path of movement from its upper position (shown in FIG. 8) to its lower position (shown in FIG. 27), causes downward movement of the tang 135 from its upper position (shown in solid in FIG. 8) to its lower position (shown in FIG. 27). Note the phantom depiction of the tang 135 in FIG. 8 also shows the tang 135 at its lower position.
It should be appreciated that if the bone plate 6 and the fastener guide 12 were positioned in an unseated state as shown in FIG. 25, downward movement of the stop structure 112 would be prevented due to the presence of the fastener guide 12 in the path of movement of the tang 135 of the stop structure 112. Indeed, the fastener guide 12 would block the downward movement of the stop structure. Thus, if a surgeon is attempting to rotate the knob 116 from its first position (shown in FIG. 26) to its second position (shown in FIG. 28) and rotation of the knob 116 is prevented at some point therebetween, the surgeon would have positive verification that the bone plate 6 and the fastener guide 12 are in an unseated state.
On the other hand, if the bone plate 6 and the fastener guide 12 were positioned in a seated state as shown in FIG. 26, downward movement of the stop structure 112 would be allowed due to the lack of presence of the fastener guide 12 in the path of movement of the tang 135 of the stop structure. Indeed, the fastener guide 12 would not block the downward movement of the stop structure 112 since the fastener guide 12 would be spaced apart from the path of movement of the tang 135. Thus, if a surgeon rotates the knob 116 from its first position (shown in FIG. 26) to its second position (shown in FIG. 28) without complication, the surgeon would have positive verification that the bone plate 6 and the fastener guide 12 are in a seated state.
The knob 116 is rotatable about the axis X as shown in FIG. 8. Rotation of the knob 116 from its first position (shown in FIG. 26) 180° about the axis X to its second position (shown in FIG. 28) causes the stop structure 112 to move from its upper position (shown in FIG. 8) to its lower position (shown in FIG. 27).
Note that after the stop structure 112 is moved to its lower position (shown in FIG. 27), the tang 135 prevents movement of the bone plate 6 in relation to the fastener guide 12. Thus, the stop structure 112 locks the bone plate 6 and the fastener guide 12 in its seated state when the stop structure 112 is positioned in its lower position (shown in FIG. 27).
The instrument assembly 30 is configured to generate a tactile and audible indication of when the stop structure 112 is located at its upper position (shown in FIG. 26) and at its lower position (shown in FIG. 28). In particular, the instrument assembly 30 further includes a support member 134 that includes an upper portion 136 and a lower portion 138 as shown in FIGS. 31-32. (See also FIG. 8.) The lower portion 138 includes a set of external threads 140 that mate with a set of internal thread 142 defined in the neck 43 of the plate holder 40 as shown in FIG. 8. The support member 134 defines a passage 144 through which the shaft 118 of the actuator 114 extends. A sleeve 146 is positioned within the cavity 66 and surrounds both the neck 43 of the plate holder 40 and the lower portion 138 of the support member 134 as shown in FIG. 8.
The knob 116 includes a spring recess 148 and a spring recess 150 as shown in FIGS. 33-34. A spring 152 is positioned in the spring recess 148, while a spring 154 is positioned in the spring recess 150. (See FIG. 5.) The upper portion 138 of the support member 134 has defined therein a detent recess 156 and a detent recess 158 as shown in FIGS. 31-32.
When the knob 116 is positioned in its first position (shown in FIG. 26), a ball detent 160 is interposed between the spring 152 and the detent recess 156 thereby resulting in the ball detent 160 being urged into the detent recess 156 as shown in FIG. 8. Similarly, when the knob 116 is positioned in its first position (shown in FIG. 26), a ball detent 162 is interposed between the spring 154 and the detent recess 158 thereby resulting in the ball detent 162 being urged into the detent recess 158 as shown in FIG. 8.
While the knob 116 is being rotated from its first position (shown in FIG. 26) to its second position (shown in FIG. 28), the ball detent 160 is advanced out of the detent recess 156 and is interposed between the spring 152 and the support member 134. Similarly, while the knob 116 is being rotated from its first position (shown in FIG. 26) to its second position (shown in FIG. 28), the ball detent 162 is advanced out of the detent recess 158 and is interposed between the spring 154 and the support member 134.
Then, when the knob 116 arrives so as to be positioned at its second position (shown in FIG. 28), the ball detent 160 becomes interposed between the spring 152 and the detent recess 158 thereby resulting in the ball detent 160 being urged into the detent recess 158. Similarly, when the knob 116 is positioned at its second position (shown in FIG. 26), the ball detent 162 becomes interposed between the spring 154 and the detent recess 156 thereby resulting in the ball detent 162 being urged into the detent recess 156.
When the knob 116 arrives so as to be positioned at its second position (shown in FIG. 28), a click sound is heard by the surgeon indicating that the stop structure 112 is now positioned at its lower position shown in FIG. 27. Similarly, when the surgeon rotates the knob 116 back to its first position (shown in FIG. 26) from its second position (shown in FIG. 28), arrival of the knob 116 at its first position (shown in FIG. 26) results in a similar click sound being heard by the surgeon. The click sounds are caused by the ball detents 160, 162 being urged into their respective detent recesses 156, 158 by their respective springs 152, 154.
In addition, the instrument assembly 30 is configured to provide a visual indication of when the stop structure 112 is located at its upper position (shown in FIG. 26) and at its lower position (shown in FIG. 28). In particular, the support member 134 includes a "locked" icon 164 and an "unlocked" icon 166 located on an upper surface of the upper portion 136 of the support member 134 as shown in FIG. 31. (See also FIG. 6.) The icons 164, 166 are preferably etched into an upper surface of the upper portion 136 of the support member 134. The icon 164 is preferably colored red, while the icon 166 is preferably colored green. Of course, other color schemes may be used. The knob 116 has defined therein a viewing opening 168 as shown in FIGS. 33-34. As shown in FIG. 26, when the knob 116 is positioned in its first position, the viewing opening 168 is positioned over the "unlocked" icon 166 thereby displaying the "unlocked" icon to the surgeon which informs the surgeon the stop structure 112 is now positioned at its upper position. On the other hand, as shown in FIG. 28, when the knob 116 is positioned in its second position, the viewing opening 168 is positioned over the "locked" icon 164 thereby displaying the "locked" icon to the surgeon which informs the surgeon the stop structure 112 is now positioned at its lower position.
Furthermore, the instrument assembly 30 is configured to provide an additional visual indication of when the stop structure 112 is located at its upper position (shown in FIG. 26) and at its lower position (shown in FIG. 28). In particular, the body 42 of the plate holder 40 has defined therein a number of viewing holes 180 as shown in FIGS. 9-10. The stop structure 112 defines a groove 182 that extends in a circumferential manner around the stop structure as shown in FIG. 30. The groove 182 is preferably colored red. Of course, the groove may be colored with a color other than red, such as yellow, pink, or orange. When the stop structure 112 is located at its upper position (shown in FIG. 26), the red-colored groove 182 of the stop structure 112 is hidden from view of a user of the instrument assembly 30 since the red-colored groove 182 is (i) located within the neck 43 of the body 42 of the plate holder 40, and (ii) located proximal to the viewing opening 180 defined in the body 42 of the plate holder 40. (See, e.g., FIG. 8, as well as, FIG. 7.) In contrast, when the stop structure 112 is located at its lower position (shown in FIG. 28), the red-colored groove 182 of the stop structure 112 is exposed to a user of the instrument assembly 30 since the red-colored groove is (i) located distal to the neck 43 of the body 42 of the plate holder 40, and (ii) aligned with the viewing openings 180 defined in the body 42 of the plate holder 40. (See, e.g., FIGS. 7 and 8.)
Thus, when the knob 116 is positioned in its first position as shown in FIGS. 8 and 26, the red-colored groove 182 is hidden from view thereby informing the surgeon the stop structure 112 is now positioned at its upper position. On the other hand, as shown in FIG. 28, when the knob 116 is positioned in its second position, the red-colored groove 182 is exposed to a user of the instrument assembly 30 which informs the surgeon the stop structure 112 is now positioned at its lower position.
Use of Instrumentation and Implant Components
Use of the instrumentation and implant components described above facilitate reduction of a hip fracture in a minimally invasive manner. In particular, in order to perform such a procedure, a patient P is placed in a supine position on a standard fracture table. The fracture is then reduced and aligned using traction with external rotation followed by approximately 20 degrees of internal rotation to compress the fracture 22 (see FIG. 35). The reduction is then verified using dual-plane image intensification. The hip is then prepared and draped in a conventional manner.
Thereafter, an incision I is made that is 3-8 cm long (depending on the length of the bone plate being used) in the lateral aspect of the hip, with dissection beginning distal to the flare of the greater trochanter down to the vastus ridge and extending distally. (See FIG. 35.) The dissection is carried sharply down through the skin and subcutaneous tissue to the fascia lata. The fascia lata is split longitudinally thereby exposing the vastus lateralis. The vastus lateralis is then retracted anteriorly and the lateral aspect of the femoral shaft is then exposed.
A guide wire (e.g. a 3.2 mm guide wire) (not shown) is exteriorly placed adjacent to the femoral neck to assess lateral positioning and neck angle. The guide wire is then advanced into the shaft, neck, and head of the femur F of the patient P. The guide wire is advanced under image intensification until its threads are secure to subchondral bone in the center of the femoral head in both anterior-posterior and lateral views.
Thereafter, a lag screw drill (not shown) is advanced over the guide wire (under radiography) and into the femur F to create a fastener cavity (not shown). Upon completion of the fastener cavity, the lag screw drill is removed from the femur F, leaving the guide wire in place. The lag screw assembly 4 is then advanced into the fastener cavity with the lag screw component 14 being advanced over the guide wire. The lag screw assembly 4 is secured to the femur F by rotating the lag screw 10 with a driver tool (not shown) until the lag screw assembly 4 assumes a position in relation to the femur F as shown in FIG. 4.
Once the lag screw assembly 4 has been secured within the femur as shown in FIG. 4, the bone plate 6 may be assembled to the fastener guide or barrel 12. This is accomplished with the assistance of the instrument assembly 30. In particular, using the instrument assembly 30 having the bone plate 6 attached thereto (as described above), the bone plate 6 is advanced through the incision I. After being advanced through the incision I, the bone plate 6 is advanced distally until the proximal end of the bone plate 6 is located distal to the lag screw assembly 4 as shown in FIG. 25. The bone plate 6 is then slid toward the lag screw assembly 4 so that the fastener guide 12 is passed through the access opening 29 defined in the proximal end of the bone plate 6. Also during sliding of the bone plate 6 toward the lag screw assembly 4, the projection 26 of the bone plate 6 advances into the channel 24 of the fastener guide 12. Continued advancement of the bone plate 6 in relation to the fastener guide 12 results in the seating surface SS1 of the fastener guide 12 contacting the seating surface SS2 of the bone plate 6 as shown in FIG. 26. When seating surface SS1 is in contact with the seating surface SS2, the bone plate 6 and the fastener guide 12 are in an assembled state.
During the above-described advancement of the bone plate 6 relative to the fastener guide 12, the stop structure 112 of the instrument assembly 30 is located in its upper position. When the stop structure 112 is in its upper position, the knob 116 of the actuator 114 of the instrument assembly 30 is located at its first position (shown in FIG. 26) such that the "unlocked" icon 166 is visible through the viewing opening 168 of the knob 116.
When the surgeon believes the bone plate 6 has been advanced into its assembled state with the fastener guide 12, the surgeon rotates the knob 116 clockwise so that the viewing opening 168 is moved to a second position (shown in FIG. 28) in which the viewing opening 168 is aligned with "locked" icon 164 thereby displaying the "locked" icon 164 through the viewing opening 168. If the knob 116 is prevented from moving to from its first position (shown in FIG. 26) to its second position (shown in FIG. 28), the surgeon is positively notified the bone plate 6 and the fastener guide 12 are not in an assembled state. Thus, the surgeon would need to further mate the bone plate 6 and the fastener guide 12 so that the seating surface SS1 of the fastener guide 12 is positioned in contact with the seating surface SS2 of the bone plate 6. On the other hand, if the knob 116 is allowed to move from its first position (shown in FIG. 26) to its second position (shown in FIG. 28), then a surgeon is positively notified the bone plate 6 and the fastener guide 12 are in their assembled state. When the knob 116 is positioned at its second position (shown in FIG. 28), the stop structure 112 is located at its lower position thereby retaining or locking the bone plate 6 and the fastener guide 12 in their assembled state.
If desired, prior to moving the knob 116 from its first position ("unlocked" icon displayed and red-colored groove 182 hidden from view) to its second position ("locked" icon displayed and red-colored groove 182 exposed to a user), the bone plate 6 may be impacted with an impactor 170 as shown in FIG. 17. In particular, the impactor 170 is manipulated until its distal end is received within an impactor recess 172 of the plate holder 40. Thereafter, the proximal end of the impactor 170 is tapped firmly several times (e.g. three or four) with a mallet (not shown) to transmit force to the bone plate 6 thereby ensuring the bone plate 6 and the lag screw assembly 4 are fully mated.
When the knob 116 is positioned at its second position (shown in FIG. 28), indicating that the bone plate 6 and the fastener guide 12 are in their assembled state, the guide component 60 is moved from its position shown in FIG. 17 to its position shown in FIG. 16. This is accomplished by moving the actuator 74 from its lower position (shown in solid in FIG. 8) to its upper position (shown in phantom in FIG. 8), and thereafter rotating the guide component 180° about the axis X (see FIG. 8) from its position shown in FIG. 17 to its position shown in FIG. 16. Upon arriving at its position shown in FIG. 16, the guide component 60 becomes locked in relation to plate holder 40. At this position, the guide holes 62, 62A of the guide component 60 are respectively aligned with the fastener openings 7, 7A of the bone plate 6.
With the guide component 60 secured in its position shown in FIG. 16 (see also FIG. 8), instruments such as the drill assembly 70 may be advanced through the guide holes 62, 62A and the fastener openings 7, 7A to create fastener cavities (not shown) in the femur that are aligned with the fastener openings 7, 7A. Thereafter, the bone screws 8A, 8B (such as 4.5 mm bone screws) are driven through the fastener openings 7, 7A of the bone plate 6 and into the shaft of the femur F. The bone screws 8A, 8B are driven (one at a time) through an outer sheath S that respectively extends through the guide holes 62, 62A in the guide component. (See, e.g., FIG. 8.)
After placement of the final bone screw 8A, 8B, the driver 68 is advanced through the guide hole 62A of the guide component 60 until the drive structure 96 of the tip portion 92 of the driver mates with drive structure 100 of the coupling component 44. Thereafter, the driver 68 is rotated in the counter-clockwise direction thereby causing the coupling component 44 to be rotated in relation to the bone plate 6. Rotation of the coupling component 44 in relation to the bone plate 6 in the counter-clockwise direction causes the set of external threads 52 of the coupling component 44 to become meshingly disengaged with the set of internal threads 54 of the bone plate 6 thereby detaching (or unlocking) the plate holder 40 from the implanted bone plate 6. Thereafter, the plate holder 40 is removed from the patient P through the incision, and the incision I is closed in a conventional manner.
There is a plurality of advantages arising from the various features of each of the embodiments of the assembly described herein. It will be noted that alternative embodiments of the assembly may not include all of the features described yet still benefit from at least some of the advantages of such features. Those of ordinary skill in the art may readily devise their own implementations of the assembly that incorporates one or more of the features and fall within the spirit and scope of the present invention as defined by the appended claims.
Previous Patent: Plate holder and bone plate arrangement
Next Patent: Locking Screw System With Relatively Hard Spiked Polyaxial Bushing


Infantilization is described as an action or process with the result that someone remains mentally dependent.The infantilization of public space is a negatively charged word that describes the paternalism or loss of public space as a free place. On the following pages the question was asked whether we do not need a kind of infantilization in our contemporary society and how much paternalism is to be accepted in public space.
In this context, the topics sensation city, experience society, event culture and urban toys in public space were dealt with.
-Gerhard Wahrig (Hrsg.): Fremdwörterlexikon. Bertelsmann, Gütersloh/Berlin/München/Wien 1974.


text:
Q: SVM derivation rescaling Define the hard-margin optimization problem for the seperable case as:
\begin{align}
\max_{\mathbf{w},b,M} \quad & M  \\
\textrm{s.t.} \quad &
\frac{1}{\lvert \lvert \mathbf{w} \rvert \rvert}
y_i(\mathbf{w}\cdot\mathbf{x_i} + b) \geq M \geq 0 \quad \forall{\mathbf{x_i}}, i=\{1,\dots,m\} \\
\end{align}
where $M=\min_{i=1,\dots,m}M_i =  \min_{i=1,\dots,m}y_i\frac{\mathbf{w}\cdot\mathbf{x_i}+b}{\lvert\lvert  \mathbf{w}\rvert\rvert}$
The objective function $y_i\frac{\mathbf{w}\cdot\mathbf{x_i}+b}{\lvert\lvert  \mathbf{w}\rvert\rvert}$ is invariant under scaling if we scale b and w in the same way, which means that we can choose $\lvert \lvert \mathbf{w} \rvert \rvert = \frac{1}{M}$.
Here comes my question:
When I change the scaling for w, I must also change the change b accordingly. This means that I must divide b by M as well which would lead to the following equation:
\begin{align}
\max_{\mathbf{w},b} \quad & \frac{1}{\lvert \lvert \mathbf{w} \rvert \rvert} \\
\textrm{s.t.} \quad & y_i(\frac{1}{M}\frac{1}{\lvert \lvert \mathbf{w} \rvert \rvert}\mathbf{w}\cdot\mathbf{x_i} + \frac{b}{M}) \geq 1 \quad \forall{\mathbf{x_i}}, i=\{1,\dots,m\}
\end{align}
However, all derivations I have seen have the following
\begin{align}
\max_{\mathbf{w},b} \quad & \frac{1}{\lvert \lvert \mathbf{w} \rvert \rvert} \\
\textrm{s.t.} \quad & y_i(\mathbf{w}\cdot\mathbf{x_i} + b) \geq 1 \quad \forall{\mathbf{x_i}}, i=\{1,\dots,m\}
\end{align}
What am I doing wrong?

redpajama_set_name: RedPajamaStackExchange


-Plus: possibility of working with dried flowers.
One 5 hours sessions or sessions of 2 hours and 1/2 each during which the techniques of adapted gardening are applied. An initial 2 1/2 hour meeting followed, over the course of the summer, by 3 hours consultation on how your gardens are progressing.
the number of consultations may vary outside of Montreal region.


text:
Birthday: August 16th, 1954 Place of Birth: Kapuskasing, Ontario, Canada
James Cameron was born in Kapuskasing, Ontario, Canada, on August 16, 1954. He moved to the USA in 1971. The son of an engineer, he majored in physics at California State University but, after graduating, drove a truck to support his screen-writing ambition. He landed his first professional film job as art director, miniature-set builder, and process-projection supervisor on Roger Corman's Battle Beyond the Stars (1980) and debuted as a director with Piranha Part Two: The Spawning (1981) the following year. In 1984, he wrote and directed The Terminator (1984), a futuristic action-thriller starring Arnold Schwarzenegger, Michael Biehn, and Linda Hamilton. It was a huge success. After this came a string of successful science-fiction action films such as Aliens (1986) and Terminator 2: Judgment Day (1991). Cameron is now one of the most sought-after directors in Hollywood. He was formerly married to producer Gale Anne Hurd, who produced several of his films. He married Kathryn Bigelow in 1989.
Diving Deep: The Life and Times of Mike deGruy (2020)
Titanic: 20 Years Later with James Cameron (2017)
T2: Reprogramming The Terminator (2017)
Score: A Film Music Documentary (2016)
Mission Blue (2014)
Reflections on Titanic (2012)
Titanic: 100 Years On (2012)
Avatar: Creating the World of Pandora (2010)
The Exodus Decoded (2006)
Explorers: From The Titanic To The Moon (2006)
Aliens of the Deep (2005)
The Cutting Edge: The Magic of Movie Editing (2004)
Superior Firepower : Making 'Aliens' (2003)
Ghosts of the Abyss (2003)
Other Voices: Creating 'The Terminator' (2001)
The Making of 'Terminator 2 3D' (2000)
Your Studio and You (1995)
The Making of 'The Terminator': A Retrospective (1992)
The Making of the Terminator (1985)
Alien Evolution
Ray Harryhausen: Special Effects Titan
Crew Credits
Avatar 3 (2024)
T2 3-D: Battle Across Time (1996)
The Abyss (1989)
Aliens (1986)
Piranha Part Two: The Spawning (1982)

redpajama_set_name: RedPajamaCommonCrawl


The Reviews for Fight Club (1999) 1080p. "Fight Club" an aggressive, confrontational, often brutal satire that is quite possibly a brilliant masterpiece. Taking the "Choose life," anti-consumerism rant at the beginning of "Trainspotting," and carrying it to its logical -- albeit extreme -- conclusion this is a big budget, mainstream film that takes a lot of risks by biting the hand that feeds it.
The film's narrator (Edward Norton) is an insignificant cog in the drab, corporate machine, dutifully doing his job and what he's told without question. He's an insomniac slave to his IKEA possessions and only finds joy in going to as many self-help/dealing with terminal diseases sessions as he can.
Vizionează filmul « Fight club (1999)» încărcat de movie play pe Dailymotion.
It provides him with an escape from his sleepless nights. That is, until Marla Singer (Helena Bonham Carter), a trashy chain-smoking poser, enters his life and upsets his routine. The narrator also meets Tyler Durden (Brad Pitt), a charismatic soap salesman whose straightforward honesty, candor and sleazy lounge-lizard outfits are a breath of fresh air. One night, after the two men have bonded over beers, Tyler asks the narrator to hit him. At first, it seems like an absurd request but after they pound on each other for a bit, a strange feeling overcomes them. They feel a kind of release and satisfaction at inflicting pain on one another. In a world where people are desensitized to everything around them, the physical contact of fighting wakes them up and makes them feel truly alive.
Cb01 film gratis streaming e download hd. " Fight Club " è un'aggressiva e conflittuale satira, spesso brutale, che è molto probabilmente un grande capolavoro. An insomniac office worker, looking for a way to change his life, crosses paths with a devil-may-care soap maker, forming an underground fight club that evolves. Fight Club 2 ( Бойцовский клуб 2) — графический роман, написанный кино ( HD Video) » Скачать торрент Бойцовский клуб / Fight Club (Дэвид Финчер.. Жизнь главного героя была спокойной и размеренной, пока однажды в самолете он не повстречался с Тайлером Дарденом, человеком, плюющим на.
Others soon join in and pretty soon Fight Club becomes an underground sensation. However, it becomes readily apparent that Tyler has more elaborate plans than just organizing brawls at the local bar. David Fincher has taken the dark, pessimistic worldview of "Seven" and married it with the clever plot twists and turns of "The Game" and assembled his strongest effort to date. "Fight Club" is a $50+ million studio film that remains true to its anti-consumer, anti-society, anti-everything message -- right up to the last, sneaky subliminal frame. What makes "Fight Club" a subversive delight is not only its refreshing anti-corporate message but how it delivers said message. As Fincher has explained in interviews, you don't really watch the film but rather download it. Its structure is extremely playful as it messes around with linear time to an incredible degree.
The narrative bounces back and forth all over the place like a novel, or surfing on the Internet -- even making a hilarious dead stop to draw attention to itself in a funny, interesting way that completely works. Yet Norton's deadpanned narration holds everything together and allows the viewer to get a handle on what's happening. This is the way films should be made. Why must we always have to go through the A+B+C formula? "Fight Club" openly rejects this tired, clearly outdated structure in favour of a stylized frenzy of jump cuts, freeze frames, slow motion and every other film technique in the book that only reinforces its anarchistic message. A film like this would have never been greenlighted by a major studio if Brad Pitt had not been attached to the project. Once you see the film, it becomes obvious that he was the only choice for Tyler Durden. Like he did with "Kalifornia" and "Twelve Monkeys", Pitt grunges himself down and disappears completely into his role to a frighteningly convincing degree.
During many of the brutal fight scenes, he is transformed into a bloody, pulpy mess that'll surely have the "Legends of the Fall" fans running for the exits. It is an incredible performance -- probably his best -- for the simple fact that he becomes the character so completely. If Pitt has the flashy, gonzo role, Edward Norton is his perfect foil as the seemingly meek yet sardonic narrator. It's a deceptively understated performance as the last third of the film reveals but Norton nails it perfectly. He is clearly our surrogate, our introduction into this strange world and his wry observations on our consumer-obsessed culture are right on the money. They are the perfect setup for Tyler's introduction and his view on the world which is clearly a call to arms of sorts, a manifesto that rejects the notion that we are what we own. And ultimately, that is what "Fight Club" tries to do.
The film is a cinematic punch to the head as it challenges the status quo and offers a wakeup call to people immersed in a materialistic world where those who have the most stuff, "win. " I think that Fincher's film wants us to tear all that down, reject corporate monsters like Starbucks and Blockbuster, and try to figure out what we really want out of life. It's almost as if the film is suggesting salvation through self-destruction. And it is these thought-provoking ideas that makes "Fight Club" a dangerously brilliant film that entertains as well as enlightens. The Plot Summary for Fight Club (1999) 1080p. A ticking-time-bomb insomniac and a slippery soap salesman channel primal male aggression into a shocking new form of therapy. Their concept catches on, with underground "fight clubs" forming in every town, until an eccentric gets in the way and ignites an out-of-control spiral toward oblivion.


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Who hasn't heard of Alexander the Great? How about Suliman the Magnificent? How about Braveheart or Robert the Bruce? Or Louis XIV, the Sun King. Seems like people way back when had names that certainly were more than the ordinary. Don't you think it's time to go back to this tradition? I do. So the story I will tell you is about a kid who thought he could be "great" too. His parents had named him Jack, but as he got older he begged and pleaded with them to change his name to "Jack the Great."
"Not so fast, young man." said his father, "you may be great someday, but not yet you're not."
That didn't stop Jack from continuing to pester. He even tried his hardest to do great things, both at home and at school to support his cause. In fact he even won the elementary school science fair with an excellent project on tadpole evolution. His parents had to admit that was pretty great. "But there are other areas that need work," his mother told him. "You could try to do a great job of cleaning up your room." That was really hard, but Jack worked diligently and did it. His mother was impressed. Of course his parents thought Jack was just a great kid. So did his grandparents too and all his teachers and playmates. But they just didn't think he was up to the level of history's Alexander.
Jack kept pleading. Finally, just to shut him up, his parents decided they would officially change his name to "Jack the Pretty Good." This would only be temporary they told him. It could be changed again if he deserved it, or if he wasn't truly great by the time he graduated from high school, his name would go back to just plain Jack.
What his parents didn't tell him was that they hadn't actually "officially" changed anything. They supposed it was technically possible and legal, but would be difficult to explain, especially to Grandpa. As much as they loved him, they didn't really expect that he would achieve true greatness, not on a name-changing scale anyway. They were also secretly hoping that this strange urge of his would pass as he got a little older. But they did allow him to use "the Pretty Good" as part of his signature. His teacher that year, Mrs. Hollingsworth, wasn't so sure she agreed with Jack's parents, but she did agree to go along with it for awhile, as long as it didn't disrupt the classroom.
As it turned out, all of his friends at school thought this was a pretty neat idea. They didn't tease him about it at all. A few did make fun of it at first, but the novelty wore off quickly. All of his school friends had to admit that Jack was a great kid, always at the top of his class, and really great at dodge ball at recess too. He even got the lead role in the school play that spring, "The Wizard Comes Back To Oz", and did a great job
Jack was definitely living up to the "Pretty Good" part of his new name, but then his parents knew he would, because he was just continuing to be the good kid he naturally was. "What would make Jack really 'great'?", his father asked his mother one evening after dinner, while Jack was off playing with his friend Ernie across the street. "He is only twelve years old remember."
"How old was Alexander when he first had the word 'Great' added to his name?" Jack's mother pondered? They looked it up on the internet and discovered that Alexander was only 22 when he won the first of his many battles. They also found out he was dead ten years later. "He didn't get to be great for long, did he?"
"If our Jack ever becomes really great, I hope he can enjoy it for a long long time." added Jack's father.
Meanwhile, Jack had all his many brain cells thinking furiously – what could he do that would be so really really really great that the matter would be closed? "Hmmmmmm," he thought. There are hundreds of doctors at work coming up with cures for dreaded diseases – too late for that. Astronauts have already been to the moon and to space stations. Jack had actually designed and built a rocket when he was only nine, with some help from Ernie to be fair, but it never made it into space. It crashed and burned right there in the driveway. You can still see the slightly melted spot of asphalt. He thought about Alexander – what had made him great? As near as he could remember from school it was that conquering the world thing. "Wow, would that be fun," Jack said out loud, it excited him so. But then Alexander was the King of Macedonia and had an army of thousands of soldiers. All Jack had was himself, and Ernie. Jack also remembered that ever since Napoleon, guys who set out to conquer the world hadn't had much lasting success, so maybe that was no longer the way to go.
He tried his hand at inventing. Removing the wheels from his skateboard, he fastened fourteen slinkys there instead and hopped off the garage roof, fully expecting to bounce. But of course he had forgotten that the normal mode of a slinky is compression, not expansion, and so he broke his right leg in two places. "Well, that wasn't such a great idea after all." Jack freely admitted.
One afternoon, Jack and Ernie were busy attaching some of those Slinkys from the skateboard onto legs from old GI Joe dolls and having gladiator fights with the resulting characters. "Reminds me of a robot," said Ernie.
"Hmmmmmm." said Jack, as another idea formulated itself in his mind. Over the next several months, he and Ernie created just that – a robot. It had rubber tracks from an Erector set, lots of Lego components, a small battery operated motor, a CD player, lots of blinky diode lights, a motion detector, all built around a coffee maker and a George Forman grill. They thought it was great. In fact they named it JAEARG, which meant Jack and Ernie Are Really Great.
To be honest, the boys' mothers were quite impressed, mostly because it would bring them fresh coffee and hot sausages in the morning. Neither one of them was a morning person. Jack's mother got JAEARG Monday, Tuesday, and Wednesday; Ernie's mother got it on Thursday, Friday, and Saturday. Sunday they let it rest. Everyone else was a little less impressed, but all had to admit that it was a clever device.
The biggest effect the robot had was on Jack. Working with Ernie had been fun. He hadn't fully realized that Ernie was as intelligent and creative as he liked to think he was. If he was great, Ernie was just as great. He began to suspect that maybe there were other kids who were pretty great too. Jack decided to quit pursuing greatness. He would just be the best he could be and let greatness find him! One night at the dinner table, he asked his parents if they would change his name back to just plain Jack? After much "Hmmmm"ing and scratching their chins, they agreed to take care of that request, "But only if you're really sure?"
Needless to say, Jack continued to be a joy to his parents. Of course he and his younger siblings annoyed each other much of the time, but nothing out of the ordinary. He excelled in school, was an accomplished Bassoonist and Ping-Pong player, got a couple of college degrees, and, the last I heard, is a petroleum engineer somewhere in northern Manitoba. Did he ever achieve greatness? Who's to say?


SHAWNEE TOWNSHIP — For the first eight minutes of Thursday's Western Buckeye League girls basketball encounter with Ottawa-Glandorf, Shawnee did what it needed to do.
Shawnee battled toe-to-toe with O-G early on and was down just 15-11 by the end of the first quarter.
However, in the following eight minutes of action, it all fell apart for the Indians.
Shawnee committed a total of nine turnovers and O-G outscored the Indians 22-4 in the second quarter, as O-G went on to defeat Shawnee 60-33 at Lappin Gymnasium.
For the game, Shawnee committed 27 turnovers.
O-G's Kadie Hempfling (5-foot-8, freshman), who split time between junior varsity and varsity Thursday, led the Titans (9-2, 2-1 WBL) with 11 points. Hempfling also had four rebounds and three steals.
Danielle Schroeder scored 10 points and made two steals for the Titans. Teammate Kylie White added nine points and had a game-high 10 rebounds.
Rachel Evans led Shawnee (4-8, 1-3) with 16 points, including three 3-pointers in the third quarter. Evans also came away with six rebounds.
"I think the girls were a little nervous, or just agitated in the first quarter," O-G coach Troy Yant said. "We allowed them to play with us a little longer than what we thought they would.
For the game, O-G shot 38 percent from the field. Shawnee countered with 34 percent shooting from the floor.
At the free throw line, O-G made 11-of-21 (52 percent), while Shawnee connected on just 3-of-14 (21 percent) from the charity stripe.
O-G won the battle of the boards, 39-30.
Yant was pleasantly surprised by the effort of Hempfling, who came off the bench and gave her team a boost in the first half.
For Shawnee, it came down to how it handled the second quarter.
O-G led 51-29 by the end of the third quarter. In the final stanza, the Titans outscored the Indians 9-4. In the fourth quarter, O-G was just 4-of-12 from the floor.
"In all, it was a nice effort, but we have a lot of things to work on," Yant said.


Featuring over 200 custom instrument patches programmed for Sibelius, custom instrument staves, extended playback dictionary with special lines and more. Easy access to all techniques in the library including speed variations, with automatic and manual loading options.
Special thanks to Native Instruments for making this integration possible!
The Session Strings Pro Sibelius sound set is available for $22.00 - see the Session Strings Pro product page for more information.
Not your Native Instruments library? Check out all of our Native Instruments integrations or tell us what you need and we can make it happen!


Algorithmic difficulty is the design and placement of game content to correspond to an escalating 'difficulty level' in the game: either by generating content to correspond to a difficulty level, or by assigning a difficulty level to already generated content.
This is typically seen in Diablo style RPGs and some roguelikes which use instancing of in-game entities to create randomized items. Less frequently it can be used to determine the relative difficulty of hand-designed content to be subsequently placed procedurally, as can be seen with the monster design in Unangband. For example, the designer can rapidly create content, but leaves it up to the game to determine how challenging that content is to overcome, and consequently where in the procedurally generated environment this content will appear. Notably the Touhou series of bullet hell shooters uses algorithmic difficulty. Though the users are only allowed to choose certain difficulty values, several community mods enable ramping the difficulty beyond the offered values.
Algorithmic difficulty can either attempt to estimate relative power based on the combination of content attributes (ontogenetic) or simulate an idealized player encountering or using the content to determine it's relative effectiveness (teleological).
What distinguishes algorithmic difficulty from adaptive difficulty is that the difficulty level remains fixed in the game and does not adapt to player actions: usually by having different geographical zones correspond to different difficulty levels. This still allows the player to 'adapt' to differing difficulty by moving between geographic zones, but only in the sense that switching the game off allows the player to adapt to an abrupt difficulty spike.


First things first: my CT scan came back clear (or unremarkable) with no new mets and no changes in the existing spots, which means that I'm still stable. Yay!
We watched the most amazing, thought-provoking movie tonight: Synecdoche, New York. The story is about a theatre producer's life and his life's work, where he builds a replica of New York in an abandoned warehouse.
The movie is funny, poignant, and surreal... by the end, it's hard to know who is who and what is what. Everything hinges on the title, specifically, synecdoche, which can mean either something that refers to a part of that thing, or a part of a thing that refers to the whole of the thing. So there are layers upon layers upon layers in the movie (even for the characters!).
This isn't the kind of movie you can start and then walk away from; almost *everything* has meaning, one way or another. If you're going to watch this movie, then commit to watching it all the way through, pausing it if you have to leave the room or are otherwise distracted. It is a masterpiece of a movie, but it is also a movie that requires a lot of attention and can be difficult to watch. This is part of this movie's greatness.
We watched the movie with a few other people and we spent some time afterward trying to figure out what the whole movie was about and also some of the imagery. It's a wonderful film and one that I'll definitely see again (in part to see if I can understand the motifs and metaphors this time... I think this is a movie that needs to be seen twice). I highly recommend it.


A civilised way to enjoy the day after Christmas.
Lunch served in our Mary Beale Restaurant whilst enjoying the accompaniment of our resident pianist.
Why not enjoy a refreshing walk around the 35 acres of beautiful grounds surrounding the hotel?


Woman Forward leader Nana Ngobese wants the practice of ukuthwala stopped. Photo: Molaole Montsho.
RUSTENBURG - The practice of ukuthwala must be eliminated, Woman Forward said on Tuesday.
"The practice, which is barbaric and backwards, occurs mainly in rural parts of South Africa, in particular, the Eastern Cape, KwaZulu-Natal and Mpumalanga. The Basotho call it tjhobediso. The girls, who are young and naive, lose their virginity and end up being with that man because no one would accept somebody who has been deflowered by another man," said party leader Nana Ngobese.
Ukuthwala is the practice of abducting young girls and forcing them into marriage, often without the consent of their parents.
She said the practice also leads to female genital mutilation, which is recognised as a violation of the human rights of women and girls.
"Female genital mutilation reflects deep-rooted inequality between the sexes and constitutes an extreme form of discrimination against women. It violates a person's right to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment and the right to life when the procedure results in death."
She said the party would also regulate lobola as some people use it as a business.
"The purpose of lobola is to thank the brides family for their efforts in the upbringing of their daughter. Now other families charge high prices of up to about R250,000 as if the bride is a commodity. The practice is a thank you and it should be just that. The way it is done these days it has lost its meaning. The so-called damages should be limited to R500 only and the lobola to R2,500 only," she said.
Woman Forward is one of the 48 parties contesting the May 8 general election.


This entry was posted in All Videos and tagged bitmap2lcd features, Bitmap2lcd Presentation Video, bitmap2lcd Videos on 3 December 2018 by Bernie.
This entry was posted in All Videos, GLCD Font Editor, GLCD Fonts and tagged GLCD font, international Font for GLCD, Unicode Font on 2 December 2018 by Bernie.
You can find various TUTORIALS on-line on the Bitmap2LCD BLOG.
tool, using the internal Web Browser.
How to find information here ?
Already have discovered the presentation slide show on the website ?
It's the same sideshow as the one included in the demo/trial version of the software tool. A general info about what this is it all about.
Bitmap2LCD is a floating multi-window application and supports dual screen.
List of the windows : Main window, LCD Viewer, Configuration Settings, File explorer, Graphic and Editors Window, Tool menu, Work Canvas, Adjustments, Font Panel and internal Web Browser.
It's the GRAPHIC EDITOR, the paintbox , You can draw pixels and shapes, import graphics into it. It has a user defined "color depth" which is the same as the target GLCD of the project.
LOADING A GRAPHIC USING A STANDARD WINDOWS DIALOG OR LOADING IT FIRST INTO PREVIEW ?
In the list of files, click to select your particular graphic file you want to load (fig6 blue arrow) , it appears in the GRAPHICS PREVIEW window at the right side.
Resize or turn/tilt the preview image using the buttons located at the top of the GRAPHIC PREVIEW.
If the graphic is larger than the WORK CANVAS a message box will ask you if you want resize the image to fit the canvas or not.
MOVING THE GRAPHIC IMPORTED INSIDE THE FLOATING SELECTION LAYER ?
THRESHOLD LEVEL OR DITHERING ?
If you're loading a COLOR graphic file to convert to black and white for MONOCHROME GLCDs you have the choice of applying a Black and White THRESHOLD level (red arrow), or applying a DITHERING (green arrow) with monochrome color reduction.
Converting a bitmap to GLCD data.
Fig 10) Bitmap has been converted to the Hexadecimal, decimal or binary file in the text editor.
If you work on different GLCD projects, you can save the "current" settings inside a Project name. It's the easiest and fastest way to switch from one to another.
You can select the foreground (PEN COLOR) and background colors (BRUSH COLOR) for painting and WRITING text by clicking in the color boxes of the menu window.
You can copy foreground color to background colors or swap them when clicking in the small boxes around the colors boxes.
A feature you would like to see implemented not yet available ?
submit us your Idea ! Need support ? Contact us !
This entry was posted in Quick tutorial for Bitmap2LCD on 1 December 2018 by Bernie.
This entry was posted in GLCD Editable Fonts, GLCD Fonts and tagged Export System Font To Editable Font, Font Editor, GLCD Custom Font, GLCD Editable Font on 19 October 2018 by Bernie.
Bitmap2LCD is a multi-window application and supports dual screen.
You can show or hide (minimize) the windows, move them to the secondary monitor.
This entry was posted in Quick tutorial for Bitmap2LCD on 4 December 2017 by Bernie.


With our new online registration system, all families will need to register online. Online payments will be accepted (VISA or M/C only) at time of registration. Payment must be made at time of registration to confirm your placement. If VISA or M/C is not available to you, payment can be made at Marian by debit or cheque. Online registrations without payment will be removed after one hour. Payment for a spot in a class will remove an unpaid spot, in order of date of registration.
If you do not have access to a computer, you can register online at Marian. Computers will be available for you to use on registration day. Payment in person can be made by VISA, MC, debit or cheque. No cash will be accepted.
Click payment option tab at bottom of page.
Online payment: only credit card (VISA or MC) accepted.
Class registration is not complete until payment is made.
Checkout when all payment information is completed.
Online registrations without payment will be removed after 24 hrs. Payment for a spot in a class will remove an unpaid spot, in order of date of registration.