Bone fractures lead to complex tissue injuries involving both the bone and the surrounding soft tissue. Treated in a conservative way, fractures often result in malalignment or non-unions and may also lead to stiffness of adjacent joints. To reduce the occurrence of these problems, open reduction and internal fixation of the bone can be carried out. Anatomical reduction and stable internal fixation with plates and screws are very successful in treating bone fractures.
Good bone healing can also result from relative stability, where the clinical outcome is often dependent on obtaining correct length, axis, and rotation of the fractured bone rather than on precise anatomical reduction and absolute stability. To achieve this, while at the same time minimizing the amount of additional soft tissue trauma, treatment of multi-fragmented metaphyseal and diaphyseal fractures with plates and screws was developed.
An existing solution is plate and screw systems where the screws are locked in the plate. The plate and screws form one stable system and the stability of the fracture is dependent upon the stiffness of the construct. No compression of the plate onto the bone is required, which reduces the risk of primary loss of reduction and preserves bone blood supply. Locking the screw into the plate to ensure angular, as well as axial, stability eliminates the possibility for the screw to toggle, slide, or be dislodged and thereby strongly reduces the risk of postoperative loss of reduction. As the relationship between the locking screws and the plate is fixed, locking screws provide a high resistance to shear or torsional forces, but locking screws have a limited capability to compress bone fragments.
Furthermore, existing plates with openings that accept locking screws typically only accept certain screw sizes with specified types of screw heads. For example, an existing plate and screw system includes a lag screw with a shallow thread form and a conical screw head. This limits the angulation of the screw, and the thread form is not optimal for lagging bone pieces together. This may be limiting in certain cases, for example with a distal femur fracture where a surgeon desires to lag the condyles. Because such existing plates do not accept large screws with spherical screw heads, surgeons are limited to lagging fragments outside the plate or using screws which are poorly designed for this application.
Because of these shortcomings, many surgeons began expressing the desire to have plate and screw systems (or bone plate assemblies) where the surgeon can choose intraoperatively whether to use the bone plate with compression screws (also referred to as cortical or cancellous screws), locking screws, or with a combination of both. This led to the development of a combination slot, a compression slot combined with a partially threaded opening, that could receive either a compression screw or a locking screw.
Bone plate assemblies that combine compression screws and locking screws are ideal in certain clinical situations. Bone plates with combination slots, including partially threaded openings, are well known to those skilled in the art. The partially threaded portions allow either locking or compression screws to be used. Because the slots are only partially threaded, the locking screws may not be able to maintain the fixed angular relationship between the screws and plate under physiological loads. Specifically, the locking screws within the plate are only partially captured and thus only partially surrounded by threads. Under high stress and loading conditions, the slot may distort and allow the fixed angular relationship between the locking screw and plate to change. This can result in loss of fixation or loss of established intraoperative plate orientation. Because of the slot geometry, translation of the plate with compression screws may be limited to a single direction, which may be disadvantageous in reduction and manipulation of fragments.
Additionally, bone plates that allow for a surgeon to use provisional fixation techniques are also desirable. Provisional fixation of a bone plate to the bone allows the surgeon to fix the plate to the bone without the use of clamps or similar tools. In this way, the surgeon may place the bone plate in the proper position before inserting all of the locking screws into the bone plate and bone, while at the same time keeping excess instruments, such as clamps, out of the field of view of the surgeon and allowing for higher quality x-rays of the bone and bone plate construct during surgery.
Accordingly, there is a need for improved bone plates that may be used with both compression and locking screws for improved stabilization and compression of parts of a fractured bone. There is also a need for improved bone plates with holes that may be used for locking a bone plate to the bone, but that also accept different size screws with varying types of screw heads. Finally, there is need for improved bone plates that accept provisional fixation pins through the holes of the plate.