Anterolateral clavicle fracture fixation plate

Abstract

This application provides innovative plates and systems for the fixation of anterior clavicle fractures. The plate conforms better to the anterior and lateral surfaces of the patient's clavicle than conventional plates. This improved conformity reduces tissue irritation and, consequently, the need for a second surgical procedure for plate removal. Furthermore, it allows for superior anatomical reduction of the fracture and greater fixation strength. An instrument included in this application also facilitates faster, more flexible, and more precise plate placement than conventional systems.

Description

Anterolateral clavicle fracture fixation plate Technical field This application relates generally to fracture fixation. More specifically, this application provides an anterior fracture fixation plate with an improved contour. Background One problem that can arise in clavicle fracture fixation is tissue irritation resulting from the fixation devices. In some cases, this tissue irritation can lead to a second surgery to remove the fixation devices. Placing a plate on the superior surface of the clavicle is a method used by surgeons for clavicle fracture fixation that can lead to such tissue irritation. Although superior clavicle plates offer the desired lateral fixation, a technique that can help reduce the likelihood of needing a second surgery is the use of anterior clavicle plates for fracture fixation.Anterior clavicle plates can also provide improved lateral grip than superior clavicle plates, as the screws can be substantially longer when running from anterior to posterior across the clavicle, compared to running from superior to inferior. However, typical anterior clavicle plates have less of a fit or adaptation than desired on the anterior and lateral surfaces of a patient's clavicle, which can increase the incidence of tissue irritation and / or limit the amount of fixation the plate can provide. Therefore, an anterior clavicle plate with a fit that conforms more closely to the patient's clavicle than typical anterior clavicle plates is desirable. US2018256224A1 describes clavicle fixation devices and methods thereof. A clavicle fixation device includes an elongated plate extending between a first and second end, the elongated plate defining a plurality of spaced screw holes. At least one pair of relief cuts extends into the elongated plate on opposite sides thereof, the at least one pair of relief cuts positioned axially between a pair of the spaced screw holes and at least one pair of suture holes along opposite sides of the elongated plate, the at least one pair of suture holes positioned axially between a pair of the spaced screw holes. At least one pair of relief cuts is axially aligned with a pair of suture holes to define combined holes on opposite sides of the elongated plate. Summary of the invention The invention currently claimed is defined by the appended claims. Associated surgical methods are also described herein to aid in understanding the invention. These methods are not part of the claimed invention. Summary of the disclosure This application provides novel and innovative anterior clavicle plates and systems for clavicle fracture fixation. The provided anterior clavicle plate allows for a more precise fit to a patient's clavicle than typical anterior clavicle plates, which may help reduce the incidence of tissue irritation and increase the strength of clavicle fracture fixation. In light of the technical features set forth herein, and without limitation, in a first aspect of the disclosure in this application, which may be combined with any other aspect unless otherwise specified, an anterior clavicle fracture fixation plate includes a contoured body having a first end opposite a second end, a top side opposite a bottom side, and multiple openings along a length of the contoured body from the first end to the second end. A plane extends through a first portion of the contoured body, the first portion being adjacent to the first end, and a second portion of the contoured body curves away from the plane in a first direction, the second portion of the contoured body being adjacent to the second end.The contoured body includes a first curvature along its length that curves at least partially in a second direction perpendicular to the first. The height of the contoured body, measured perpendicular to its length, is greater at the first end than at the second end. A cross-section of the contoured body curves from the top to the bottom. In a second aspect of disclosure in this application, which may be combined with any other aspect (e.g., the 1st aspect) unless otherwise specified, the contoured body includes a second curvature that curves at least partially in a third direction opposite to the second direction. In a third aspect of disclosure in this application, which may be combined with any other aspect (e.g., 2nd aspect) unless otherwise specified, the first bend is closer to the second end than the second bend, and the first bend has a greater degree of bend than the second bend. In a fourth aspect of disclosure in the present application, which may be combined with any other aspect (e.g., 1st through 3rd aspects) unless otherwise specified, the height of the contoured body gradually decreases along its length. In a fifth aspect of disclosure in the present application, which may be combined with any other aspect (for example, aspects 1 through 4) unless otherwise specified, the thickness of a portion of the contoured body adjacent to the upper side, the thickness measured perpendicular to the length of the contoured body, is greater at the second end than at the first end. In a sixth aspect of disclosure in the present application, which may be combined with any other aspect (for example, aspects 1 through 5) unless otherwise specified, for at least one segment of the contoured body, the thickness of a portion of the contoured body adjacent to the lower side is greater than the thickness of a portion of the contoured body adjacent to the upper side, the thickness being measured perpendicular to the length of the contoured body. In a seventh aspect of disclosure in the present application, which may be combined with any other aspect (for example, aspects 1 through 6) unless otherwise specified, a first portion of the openings has respective diameters larger than a second portion of the openings, wherein the first portion of the openings is closer to the first end of the contoured body than the second portion of the openings. In an eighth aspect of disclosure in the present application, which may be combined with any other aspect (for example, aspects 1 through 7) unless otherwise specified, the respective diameters of the plurality of openings along the length of the contoured body decrease from the first end to the second end. In a ninth aspect of disclosure in the present application, which may be combined with any other aspect (e.g., aspects 1 through 8) unless otherwise specified, the anterior clavicle fracture fixation plate further includes an arm extending from the contoured body, the arm configured to contact a superior surface of a clavicle, while the contoured body contacts a lateral surface of the clavicle. In a tenth aspect of disclosure in the present application, which may be combined with any other aspect (for example, the 9th aspect) unless otherwise specified, the arm extends perpendicularly from the contoured body. In an eleventh aspect of disclosure in the present application, which may be combined with any other aspect (for example, the 9th aspect) unless otherwise specified, a portion of the arm is substantially parallel to the second end of the contoured body. In a twelfth aspect of disclosure in the present application, which may be combined with any other aspect (e.g., the 9th aspect) unless otherwise specified, the arm includes a plate having a plurality of openings. In a thirteenth aspect of the disclosure in this application, which may be combined with any other aspect (e.g., aspects 2 through 12) unless otherwise specified, a clavicle fracture fixation system includes the anterior clavicle fracture fixation plate of example 1 and an instrument configured to assist in the insertion of one or more screws through openings in the anterior clavicle fracture fixation plate into an anterior surface of a clavicle. In a fourteenth aspect of the disclosure in this application, which may be combined with any other aspect (e.g., aspect 13) unless otherwise specified, the instrument includes a base member, a guide member, and a locking post. The base member is structured to contact the anterior clavicle fracture fixation plate.The guide member includes a groove and an elongated portion with multiple openings. The locking post is positioned through the groove of the guide member and through the base member, thereby coupling the guide member and the base member. In a fifteenth aspect of disclosure in the present application, which may be combined with any other aspect (e.g., the 14th aspect) unless otherwise specified, prior to attaching the locking post to the anterior clavicle fracture fixation plate, the guide member may rotate about a long axis relative to the base member, and subsequent to attaching the locking post to the anterior clavicle fracture fixation plate, the guide member is fixed relative to the base member. In a sixteenth aspect of disclosure in the present application, which may be combined with any other aspect (e.g., the 14th aspect) unless otherwise specified, the guide member includes a first face configured to be adjacent to the anterior clavicle fracture fixation plate and a second face opposite the first face, and the plurality of openings in the guide member includes a larger cross-sectional area on the second face than on the first face. In a seventeenth aspect of disclosure in the present application, which may be combined with any other aspect (e.g., the 13th aspect) unless otherwise specified, the contoured body of the anterior clavicle fracture fixation plate is contoured in such a way as to fit one of an anterior surface of a patient's right clavicle or an anterior surface of a patient's left clavicle. In an eighteenth aspect of the disclosure in this application, which may be combined with any other aspect (e.g., aspects 2 through 17) unless otherwise specified, a method for fixing a clavicle fracture includes installing the anterior clavicle fracture fixation plate of example 1 on at least one anterior surface of the clavicle. Installation of the anterior clavicle fracture fixation plate includes inserting the respective screws through each of the plurality of openings in the anterior clavicle fracture fixation plate and into the clavicle. In a nineteenth aspect of disclosure in the present application, which may be combined with any other aspect (e.g., the 18th aspect) unless otherwise specified, at least some of the respective screws inserted through the openings of the anterior clavicle fracture fixation plate are inserted into the clavicle at an acute or obtuse angle relative to the contoured body. In a twentieth aspect of the disclosure in this application, which may be combined with any other aspect (e.g., the 18th aspect) unless otherwise specified, the installation of the anterior clavicle fracture fixation plate on at least one anterior surface of the clavicle includes, before inserting the respective screws through each of the plurality of openings, aligning the respective axes of the plurality of openings of the anterior clavicle fracture fixation plate with the clavicle by means of an instrument attached to the anterior clavicle fracture fixation plate. The additional features and advantages of the disclosed method and apparatus are described in, and will be evident from, the following Detailed Description and Figures. The features and advantages described herein are not all-inclusive, and in particular, many additional features and advantages will be apparent to someone of ordinary skill in the art from the figures and description. Furthermore, it should be noted that the language used in the specification has been selected primarily for readability and instruction, and not to limit the scope of the inventive subject matter. Brief description of the drawings FIG.1 illustrates a perspective view of an anterior clavicle fracture fixation plate, in accordance with one aspect of this disclosure. FIG. 2 illustrates a top view of the anterior clavicle fracture fixation plate of FIG. 1, in accordance with one aspect of this disclosure. FIG. 3 illustrates a front view of the anterior clavicle fracture fixation plate of FIG. 1, in accordance with one aspect of this disclosure. FIG. 4 illustrates a posterior view of the anterior clavicle fracture fixation plate of FIG. 1, in accordance with one aspect of this disclosure. FIG. 5 illustrates a cross-sectional view of a portion of the anterior clavicle fracture fixation plate of FIG. 1, in accordance with one aspect of this disclosure. FIG. 6 illustrates a perspective view of an anterior clavicle fracture fixation plate positioned on an anterior surface of a clavicle, in accordance with one aspect of this disclosure. FIG. 7A illustrates a perspective view of an anterior clavicle fracture fixation plate having screws inserted through openings positioned in a lateral portion of the plate, according to one aspect of this disclosure. FIG. 7B illustrates a cross-sectional view of a fractured clavicle having a fracture line and anterior clavicle plate without an angled opening, in accordance with one aspect of this disclosure. FIG.7C illustrates a cross-sectional view of a fractured clavicle having a fracture line and an anterior clavicle plate having an angled opening, in accordance with one aspect of the present disclosure. FIG. 8A illustrates an exploded view of an instrument to assist in the installation of an anterior clavicle plate, in accordance with one aspect of this disclosure. FIG. 8B illustrates a perspective view of a system that includes an anterior clavicle fracture fixation plate and an instrument to assist in plate installation, according to one aspect of this disclosure. FIG. 8C illustrates a cross-sectional view of the system shown in FIG. 8B, in accordance with one aspect of this disclosure. FIG.9A illustrates a cross-sectional view of an alternative embodiment of the system shown in FIG.8B, in accordance with one aspect of this disclosure. FIG. 9B illustrates a top view of the guide component shown in FIG. 9A, in accordance with one aspect of this disclosure. FIG.10 illustrates a perspective view of an anterior clavicle fracture fixation plate having an arm, in accordance with one aspect of this disclosure. FIG. 11 illustrates a perspective view of an anterior clavicle fracture fixation plate having an arm that includes a portion substantially parallel to the plate, in accordance with one aspect of this disclosure. FIG. 12 illustrates a perspective view of an anterior clavicle fracture fixation plate having an arm that includes a plate, according to one aspect of this disclosure. Detailed description This application provides for novel and innovative anterior clavicle plates and systems for clavicle fracture fixation. The currently disclosed anterior clavicle plate is shaped to better conform to the anterior and lateral surfaces of a patient's clavicle compared to typical anterior clavicle plates. This improved conformity may help reduce the incidence of tissue irritation, thereby reducing the likelihood of requiring a second surgery to remove the anterior clavicle plate. The improved conformity may also result in anatomically better fracture reduction than typical anterior clavicle plates and increased fixation strength.An additional advantage of the provided anterior clavicle plate and system may be its faster installation compared to typical anterior clavicle plates, thus reducing the length of surgical procedures. For example, the improved fit may help limit how much a surgeon needs to adjust the provided anterior clavicle plate before inserting the screws. Additionally, an instrument provided with this application may help a surgeon install the provided anterior clavicle plate more quickly and with increased flexibility and consistency than typical systems. The currently disclosed anterior clavicle plate shape that allows for the improved fit will be described in the figures below in comparison to typical anterior clavicle plates. Figures 1 to 5 illustrate various views of an example anterior clavicle plate 100 to show the various aspects of the anterior clavicle plate 100's construction. Figure 1 illustrates a perspective view of the example anterior clavicle plate 100. The anterior clavicle plate 100 includes a contoured body 102. The contoured body 102 can be constructed of a suitable medical-grade material, such as a metal. For example, a suitable metal might be titanium or stainless steel. Another suitable example material might be carbon fiber-reinforced PEEK. The contoured body 102 includes a first end 104 opposite a second end 106. The contoured body 102 includes a top side 110 opposite a bottom side 108. The top side 110 and the bottom side 108 each extend the entire length of the contoured body 102.The contoured body 102 also includes an outer face 116 opposite an inner face 202 (FIGS.2 and 4). Contoured body 102 is shaped / contoured to be specific for either the left or right side. Put another way, contoured body 102 is shaped / contoured to fit either a patient's right clavicle or a patient's left clavicle, but not both. The illustrated example contoured body 102 is shaped for a left-specific anterior clavicle plate 100. Therefore, it should be appreciated that a right-specific clavicle plate 100 includes a contoured body 102 that is a mirror image of the illustrated contoured body 102. The contoured body 102 includes multiple openings 112 along its length, from its first end 104 to its second end 106. In some aspects, the multiple openings 112 may include at least one opening 120 that is angled with respect to the contoured body 102 at a different angle than the remaining openings 112. In some examples of such aspects, the contoured body 102 may include a guide 118 for each of the at least one opening 120. In such examples, the guide 118 may assist in the insertion of a screw at an acute or obtuse angle relative to the contoured body 102. The opening 120 and the guide 118 are described in relation to Figure 7 below.Only one of the 112 openings, other than opening 120, is indicated with a reference number in the figures for illustrative clarity only, and therefore the description of openings 112 applies equally to the other illustrated openings. Screws can be inserted through openings 112 to secure the anterior clavicle plate 100 to a clavicle. In some aspects, openings 112 may include threading that can engage with the threading of a screw. A further description of openings 112 is given in conjunction with the description in Figure 3 below. In some aspects, the contoured body 102 may include at least one reduced portion 114 relative to a given contoured body 102 height. For example, the contoured body 102 illustrated in FIG. 1 includes four reduced portions 114. In other examples, the contoured body 102 may include more or fewer reduced portions 114. The reduced portions 114 can help avoid stress concentrators at the openings 112. The reduced portions 114 can also help allow the plate to curve at the reduced portions 114 (for example, the two portions adjacent to a reduced portion 114 can be brought closer together by one degree), so that a surgeon can better fit the plate to the contour of a bone. Figure 2 illustrates a top view of the example anterior clavicle plate 100. The top view of anterior clavicle plate 100 best illustrates the curvature of the contoured body 102 in the anterior and posterior directions along its length from its first end 104 to its second end 106. For example, between the dashed line 208 and the second end 106, the contoured body 102 includes a first curvature 204, and between the first end 104 and the dashed line 208, the contoured body 102 includes a second curvature 206. The first curvature 204 curves at least partially in a direction opposite to the curvature direction of the second curvature 206, as illustrated. As used herein, a direction of a curvature or bend refers to a direction of a radius of the bend or bend at a given point on the bend or bend.The first curvature 204 and the second curvature 206 do not curve in directly opposite directions due to the curvature of the contoured body 102 in the lower direction (e.g., on the page in FIG. 2) nearest to the second end 106, as best illustrated in FIGS. 3 and 4 discussed below. In some respects, the first curvature 204 includes an inconsistent or asymmetrical radius of curvature. For example, the radius of curvature of the first curvature 204 may be greater near the second end 106 than toward the middle portion (e.g., the dashed line 208) of the contoured body length 102. In some respects, the second curvature 206 may have a consistent or symmetrical radius of curvature. In other respects, the second curvature 206 may have an inconsistent or asymmetrical radius of curvature. The curvature described above along the length of the contoured body 102 helps the anterior clavicle plate 100 conform to the anatomy of a patient's left clavicle. For example, the increased radius of curvature of the first curvature 204 closer to the second end 106 may help the anterior clavicle plate 100 conform to the lateral portion of the patient's left clavicle. Figure 3 illustrates a front view of the example anterior clavicle plate 100. The plane AA shown in Figure 3 will be referred to in relation to Figure 5 below. The front view of the anterior clavicle plate 100 best illustrates the curvature of the contoured body 102 in the inferior direction along its length. For example, a plane 302 extends only through a portion of the contoured body 102 adjacent to the first end 104. Another portion of the contoured body 102 adjacent to the second end 106 curves away from plane 302. In Figure 3, the anterior and posterior curvature of the contoured body 102 (e.g., described in Figure 2) is on and off the page. As such, at least a portion of the curvature of contoured body 102 in the lower direction curves in a direction that is perpendicular to at least a portion of the anterior and / or posterior curvature of contoured body 102. Typical anterior clavicle plates do not include the inferior curvature described above and shown in Figure 3. However, a patient's clavicle anatomy typically includes a curvature in the inferior direction. Therefore, typical anterior clavicle plates will not fit the anatomy of the lateral portion of a patient's clavicle without the surgeon flattening the patient's fractured clavicle or significantly curving the typical anterior clavicle plate. Curving the plates requires operative time and also plastically deforms the plate, which can lead to weakening and reduced fatigue life.The currently available anterior clavicle plate 100, with its lower curvature described above, reduces the amount a surgeon needs to bend the plate to fit the patient's clavicle anatomy. This is because the plate is initially closer to an average patient's anatomy than typical anterior clavicle plates. The reduced curvature required can help shorten operating time and increase the fatigue life of the plate compared to typical anterior clavicle plates. Furthermore, by having an initial lower curvature that more closely matches average patient anatomy, the Anterior Clavicle Plate 100 can also help a surgeon more closely adapt the plate to the lateral portion of the patient's clavicle anatomy compared to typical anterior clavicle plates, as less adjustment is needed. The advantage of a better fit to the anatomy of the patient's lateral clavicle helps ensure that fixation points (e.g., screws through openings 112) are central to the patient's clavicle to provide the desired screw grip in the clavicle bone and the desired stability for the Anterior Clavicle Plate 100.Designed differently, the enhanced fit helps the Anterior Clavicle Plate 100, after implantation, maintain fixation of one or more clavicle fractures better than typical anterior clavicle plates. The enhanced fit can also help ensure a more anatomical restoration of the patient's fractured clavicle. In some aspects, the height of contoured body 102 may change along its length from the first end 104 to the second end 106. The height of contoured body 102 is measured from the outermost edge of the upper side 110 to the outermost edge of the lower side 108. In such aspects, as best shown in FIG. 3, the height of contoured body 102 is greater toward the first end 104 and smaller toward the second end 106. In some aspects, the height of contoured body 102 may gradually decrease along its length toward the second end 106. These differences in the height of contoured body 102 may increase the fit with a clavicle, because the lateral portion of the anterior surface of the clavicle tends to be narrower than the middle portion of the clavicle.In several respects, the height of the contoured body 102 decreases or narrows in the region of the contoured body 102 that is positioned against this narrower lateral portion of the anterior surface of the clavicle after the installation of the anterior clavicle plate 100. Figure 3 also clearly illustrates the multiple openings 112 in the contoured body 102. In several respects, as illustrated, the openings 112 closest to the first end 104 have larger diameters than the openings 112 closest to the second end 106. In at least some respects, the region of the contoured body 102 closest to the second end 106 (e.g., the region including the four openings 112 closest to the second end 106) is positioned on the lateral portion of a patient's clavicle when the anterior clavicle plate 100 is installed. A higher screw density on the lateral portion of the patient's clavicle, compared to the medial or intermediate portions, can be beneficial for clavicle fracture compression. The smaller-diameter openings 112 accommodate smaller screws, thus allowing for a higher screw density.The lateral portion of the patient's clavicle is also narrower than the medial or intermediate portions and therefore the smaller diameter screws are better suited to fit the narrower bone, which accommodates the smaller diameter openings 112. Figure 4 illustrates a posterior view of the example anterior clavicle plate 100. The posterior view of anterior clavicle plate 100 helps illustrate the lateral curvature of the contoured body 102 with respect to a long axis extending through the center of the contoured body 102 along its length. For example, the portions of the contoured body 102 adjacent to the openings 112 may extend into the page, and the lower side 108 and the upper side 110 may each extend out of the page. However, this aspect of curvature is best illustrated in Figure 5, which is described below. Figure 5 illustrates a cross-sectional view of the example anterior clavicle plate 100 in plane AA shown in Figure 3. The illustrated cross-sectional view of anterior clavicle plate 100 better illustrates the lateral curvature of the contoured body 102 with respect to its long axis described above. For example, the outer face 116 and the inner face 202 of the contoured body 102 are each curved. This lateral curvature with respect to its long axis can help the inner face 202 of anterior clavicle plate 100 conform to the lateral surface of a patient's clavicle. One advantage of the anterior clavicle plate provided 100 is that the contoured body 102 has a reduced thickness in at least some areas where low prominence is key to reducing or avoiding tissue irritation when implanted in a patient. The reduced thickness helps the anterior clavicle plate 100 to have a low profile when implanted. The contoured body 102 also has increased thickness in at least some areas where added strength is beneficial. For example, the cross-sectional view of the anterior clavicle plate 100 shown in FIG. 5 illustrates a portion of the contoured body 102 adjacent to the upper side 110 that has a thickness of 502. A portion of the contoured body 102 adjacent to the lower side 108 is shown to have a thickness of 504. The thickness 502 is less than the thickness 504.Each of thicknesses 502 and 504 is measured perpendicular to the length of contoured body 102 at any segment or cross-section (e.g., in plane AA) of contoured body 102. In at least some respects, the thickness 502 of the portion of contoured body 102 adjacent to the upper side 110 may be reduced compared to the body adjacent to the upper side of at least some typical anterior clavicle plates. In at least some respects, the thickness 504 of the portion of contoured body 102 adjacent to the lower side 108 may be greater than the body adjacent to the lower side of at least some typical anterior clavicle plates. In some examples, a portion of the contoured body 102 adjacent to the upper side 110 has a reduced thickness along the entire length of the contoured body 102. In some aspects of such examples, the thickness of the portion adjacent to the upper side 110 may gradually decrease from the first end 104 to the second end 106. In other aspects of such examples, the portion adjacent to the upper side 110 may have segments of constant thickness and segments of decreasing thickness. In other examples, only a segment of the length of the contoured body 102 includes a portion adjacent to the upper side 110 that has a reduced thickness, such as a segment adjacent to the first end 104 and that includes plane AA. The sections of the contoured body 102 that have a portion adjacent to the upper side 110 with reduced thickness have reduced strength. In one example, such as the one illustrated in FIG. 5, the portion adjacent to the lower side 108 in these sections of the contoured body 102 may have increased thickness to counteract this reduction in strength on the upper side 110. In some examples, a portion of the contoured body 102 adjacent to the lower side 108 has increased thickness along the entire length of the contoured body 102. In some aspects of such examples, the thickness of the portion adjacent to the lower side 108 may increase gradually along the contoured body 102 (for example, the thickness of the portion adjacent to the lower side 108 increases gradually as the thickness of the portion adjacent to the upper side 110 gradually decreases along the length of the contoured body 102).In other aspects of such examples, the portion adjacent to the lower side 108 may have segments of constant thickness and segments of increasing thickness. In other examples, only one segment of the contoured body length 102 includes a portion adjacent to the lower side 108 that has an increased thickness. Figure 6 illustrates a perspective view of anterior clavicle plate 100 positioned relative to clavicle 600, prior to screw insertion. Clavicle 600 is a patient's left clavicle and includes an anterior surface 602 and a superior surface 604. As shown, anterior clavicle plate 100 is positioned over the anterior surface 602 of clavicle 600. In view of the above description of the shape / contour of anterior clavicle plate 100, the contoured body 102 of anterior clavicle plate 100 conforms to the contour of the anterior surface 602. FIG. 7A illustrates a perspective view of the anterior clavicle plate 100 having a screw 702 inserted through opening 120 and screws 704-708 inserted through openings 112 in a lateral segment of the contoured body 102. When the anterior clavicle plate 100 is fitted over a fractured clavicle, screws 702-708 gain grip on the clavicle to help fix the clavicle fragments and the anterior clavicle plate 100 to each other and promote healing by compressing one or more fractures. In several respects, at least some of the openings 112 are configured such that a screw is substantially perpendicular to the contoured body 102 when inserted through a respective opening 112. For example, each of the screws 704, 706, and 708 is substantially perpendicular to the contoured body 102. It can be useful for fracture compression to obtain as much grip as possible across a fracture line with a screw. However, in some cases, it can be difficult to obtain much grip across a fracture line with a screw that is substantially perpendicular to the contoured body 102. For example, a fracture line in the lateral curvature of a clavicle may itself be substantially perpendicular, or nearly perpendicular (e.g., 60° to 80°), to the contoured body 102. Figure 7B illustrates such an example. In Figure 7B, a clavicle 710 includes a fracture with a fracture line 712. A screw 702 is substantially perpendicular to the contoured body 102 and is substantially or nearly parallel to the fracture line 712. Therefore, only a small portion of the screw 702 can obtain grip across the fracture line 712.In other examples, the 702 screw might not get grip through any fracture line. Returning to FIG. 7A, to aid in obtaining a grip through a fracture line that is substantially perpendicular, or nearly perpendicular, to the contoured body 102, the contoured body 102 includes at least one opening 120 configured such that a screw is at a non-perpendicular (i.e., acute / obtuse) angle to the contoured body 102 when inserted through such at least one opening 120. For example, screw 702 is at an acute / obtuse angle to the contoured body 102. It should be appreciated that screw 702 is illustrated in front of screw 704 in FIG. 7A due to the lower curvature of the contoured body 102 described above. In at least some respects, the contoured body 102 may include a guide 118 that protrudes from the contoured body 102 into the opening 120 to assist in the insertion of the screw 702 at an acute / obtuse angle to the contoured body 102.For example, without guide 118, the angled nature of opening 120 results in the inner perimeter of opening 120, defined by the contoured body 102, having a larger surface area on one side compared to the other. This difference in surface area of ​​opening 120 can make it difficult to insert screw 702 concentrically with opening 120. Guide 118 extends from the contoured body 102 to equalize the surface area of ​​the perimeter of opening 120, which helps in inserting screw 702 concentrically with opening 120. The opening 120 can help achieve grip across a fracture line by allowing the screw 702 to approach the fracture line at a different angle than if the opening 120 were configured so that the screw 702 is substantially perpendicular to the contoured body 102 (e.g., configured as an opening 112 as in FIG. 7B). The approach angle enabled by the opening 120 helps a larger portion of the screw 702 gain grip across the fracture line, as illustrated in FIG. 7C, which shows a larger portion of screw 702 through fracture line 712 compared to FIG.7B. For the reasons mentioned above regarding a fracture line in a lateral curvature of the clavicle, one or more openings 120 may be particularly useful in the first curvature 204 of the contoured body 102, which is positioned in the lateral curvature of a clavicle after installation of the anterior clavicle plate 100. For example, the opening 120 shown in the example in FIG. 7 is located in the first curvature 204 with three openings 112 between the second end 106 and opening 120. In other examples, the contoured body 102 may include more than one opening 120 within the first curvature 204 or may include one or more openings 120 outside the first curvature 204. This application further provides an insertion instrument that can assist in the installation of the provided anterior clavicle plate (e.g., anterior clavicle plate 100). Figure 8A illustrates an exploded view of an example instrument 802. Drilling through the center of the clavicle when installing an anterior clavicle plate is preferred because the center of the clavicle is the longest portion of the clavicle, allowing the use of the longest possible screws for fixation. A longer screw provides greater fixation strength. Drilling, and subsequently installing a screw, through the center of the clavicle can also help ensure the desired bone grip. If the drill bit fails to reach the center and exits the clavicle either from the top or bottom, this could result in a protruding installed screw and / or a shorter screw. However, in some cases, drilling through the center of a clavicle can be challenging for a surgeon. For example, surgeons typically use their eyes and fingers to determine a suitable trajectory for a screw. At least some surgeons may additionally use a locking guide to help drill along their predetermined trajectory. However, the surgeon's trajectory determination using these methods could be improved, such as the consistency with which the surgeon determines a path through the center of the clavicle. The time it takes a surgeon to determine the drilling trajectory for each of the 112 openings (and, in some cases, the 120 opening) can also be reduced, which can help shorten surgical procedure times. The example instrument 802 can help surgeons make these improvements. In several respects, the instrument 802 includes a guide component 804, a base component 806, and a locking post 808. The guide component 804 includes a body 842 having a groove 810. The locking post 808 can be positioned through the groove 810 along the shaft 844. In several respects, the guide component 804 includes multiple openings 812 in the body 842. Only one of the multiple openings 812 is indicated by the reference number 812 for illustrative clarity only, although it should be appreciated that the description of the openings 812 applies equally to each of the illustrated openings 812. Each of the openings 812 is configured to guide a drill bit through the opening 812. In some respects, the guide component 804 may include an opening 814 in the body 842 configured to guide a wire or another wire. of appropriate guide.In at least some respects, the body 842 of the guide component 804 includes a curved or rounded surface 816 (best illustrated in FIG. 8B). The curved or rounded surface 816 can be interconnected with the base component 806. In some aspects, the guide component 804 includes wings 838A, 838B that extend integrally or fixedly from the body 842. Wings 838A, 838B may each include an extension 836. For example, in some aspects, the base component 806 may be removably attached to the guide component 804, and wings 838A, 838B may be attached to the base component 806 to accomplish this. In other instances, the base component 806 may be fixedly attached to the guide component 804, and in such instances, the guide component 804 may not have wings 838A, 838B. In several respects, the base component 806 includes a body 840 having a first surface 818 and a second surface 820. The first surface 818 may be shaped to interconnect with the outer face 116 of the anterior clavicle plate 100. The second surface 820 may be curved or rounded and interconnects with the curved or rounded surface 816 (FIG. 8B) of the guide component 804. In some examples, the body 840 of the base component 806 includes a notch 834 on opposite sides, each of which engages with extensions 836 of the guide component 804 to couple the base component 806 to the guide component 804. In other examples, the base component 806 may be coupled to the guide component 804 by another suitable mechanism. In other examples still, the base component 806 might not include the notches 834, such as examples in which the base component 806 and the guide component 804 are fixedly coupled together.In at least some respects, the base component 806 includes a channel 822 that extends through the guide component 804 from the first surface 818 to the second surface 820. In at least some respects, a portion of the inside of the base component 806 in the channel 822 may include an internal thread 846 (FIG. 8C). The locking post 808 may be positioned through the channel 822 along the axis 842. In at least some respects, the locking post 808 is shaped like a cylindrical rod. In several respects, the locking post 808 includes a reduced portion 826 and a non-reduced portion 830. The reduced portion 826 is dimensioned so that it can be positioned through the groove 810 of the guide component 804 and the channel 822 of the base component 806. At one end of the reduced portion 826, the locking post 808 includes a coupling end 828. For example, in some respects, the coupling end 828 may be threaded. In such respects, the threaded coupling end 828 can be adjustablely coupled with the threading of an opening 112 of the contoured body 102. For example, the further the threaded coupling end 828 is inserted into an opening 112, the more threads of the threaded coupling end 828 and of the opening 112 are coupled, and vice versa.This adjustable coupling helps control the movement of the guide component 804, which is described below. In other respects, the locking post 808 can be adjustableally coupled to an opening 112 of the contoured body 102 by means of a suitable mechanism other than threading. In some respects, the locking post 808 may include a grip or handle 832 at one end. In at least some respects, the unreduced portion 830 of the locking post 808 is dimensioned so that it cannot be moved through the groove 810 of the guide component 804 or the channel 822 of the base component 806. In some respects, the coupling end 828 may be dimensioned so that it cannot be moved through the groove 810 of the guide component 804 or the channel 822 of the base component 806. In the examples where the unreduced portion 830 and the coupling end 828 are both dimensioned in this way, the guide component 804 and the base component 806 are coupled to the locking post 808 between the coupling end 828 and the unreduced portion 830 of the locking post 808 when the instrument 802 is fully assembled.In some aspects, the guide component 804, the base component 806, and the locking post 808 are fixedly coupled together so that they cannot be disengaged. In such aspects, the reduced portion 826 can be positioned through the groove 810 during the initial assembly of the instrument 802. In other aspects, the guide component 804, the base component 806, and the locking post 808 can be separated from each other, for example, for cleaning or sterilization. In such other aspects, the coupling end 828 can be sized so that it can be moved through the groove 810 and the channel 822. FIG. 8B illustrates an example system 850 that includes the anterior clavicle plate 100 and the fully constructed instrument 802. The wings 838A, 838B of the guide component 804 are not illustrated in FIG. 8B in order to illustrate the curved surface 816 of the guide component 804 interlocking with the second surface 820 of the base component 806. In this example, the mating end 828 of the locking post 808 is threaded. To attach the instrument 802 to the anterior clavicle plate 100, a surgeon can first position the base component 806 in contact with the anterior clavicle plate 100 and over a threaded opening (for example, an opening 112) of the anterior clavicle plate 100 such that the threaded coupling end 828 of the locking post 808 is aligned with the opening 112.Once positioned, the surgeon can advance the locking post 808 into engagement with the opening 112 (for example, by rotating the locking post 808 so that it engages with the threading of the opening 112). After initial coupling, the instrument 802 is attached to the anterior clavicle plate 100, although the guide component 804 can still be adjusted. For example, the surgeon can rotate the guide component 804 about its long axis in the direction of arrow 842A or arrow 842B. The second curved or rounded surface 820 of the base component 806 and the curved or rounded surface 816 of the guide component 804 interlock as the guide component 804 is rotated. In one example, the surgeon can adjust the guide component 804 to a position where the surgeon believes the openings 812 will guide the screws toward the center of the clavicle. Once the guide component 804 is in the surgeon's desired position, the surgeon can advance the locking post 808 further into engagement with the opening 112, thereby locking the guide component 804 in position.The guide component 804 is locked in position due to the compressive force created between the anterior clavicle plate 100 and the unreduced portion 830 of the locking post 808 by the coupling of the threaded coupling end 828 with the threaded opening 112. Figure 8C illustrates a cross-sectional view of the 850 system with the guide component 804 locked in position by the locking post 808. As shown, the extensions 836 of the guide component 804 are within the notches 834 of the base component 806. The mating end 828 of the locking post 808 engages with the threaded opening 112 of the anterior clavicle plate 100. Furthermore, the unreduced portion 830 of the locking post 808 is in contact with the guide component 804, thereby compressing the base component 806 between the guide component 804 and the anterior clavicle plate 100. As previously stated, in at least some respects, the base component 806 may include an internal thread 846, illustrated in FIG. 8C. The internal thread 846 allows the guide component 804, base component 806, and locking post 808 to remain together as a single unit when the locking post 808 is disengaged from the threaded opening 112 of the anterior clavicle plate 100, by preventing the coupling end 828 from moving through the base component 806. Instead, the locking post 808 must be rotated to engage and then disengage the coupling end 828 using the internal thread 846 to remove the locking post 808 from the base component 806 and subsequently from the guide component 804.The coupling of the coupling end 828 with the internal thread 846 limits or prevents movement between the guide component 804, the base component 806 and the locking post 808 when the instrument 802 is uncoupled from the anterior clavicle plate 100. Keeping the guide component 804, base component 806, and locking post 808 together when the instrument 802 is detached from the anterior clavicle plate 100 can be useful to a surgeon so that one or more components do not fall into a patient's cavity during surgery, or onto the floor, when removing the instrument 802. Instead, the surgeon can hand the instrument 802 as a single piece to another medical professional. Keeping the guide component 804, base component 806, and locking post 808 together can also be helpful for a surgeon when attaching the instrument 802 to the anterior clavicle plate 100. For example, the coupling end 828 can be engaged with the internal thread 846 to help limit or prevent movement between the guide component 804, base component 806, and locking post 808 until the surgeon wishes to adjust the instrument 802 when attaching it to the anterior clavicle plate 100. Additionally, in at least some aspects, when the instrument 802 is positioned against the anterior clavicle plate 100, a pocket is formed between the internal thread 846 and the threaded opening 112. In such aspects, a surgeon can advance the coupling end 828 of the locking post 808 so that it is within this pocket, allowing the surgeon to adjust the instrument 802 before coupling the coupling end 828 with the threaded opening 112. It will be appreciated that FIG. 8C is not drawn to scale to show a pocket of sufficient size to fit the coupling end 828, although consistent with the preceding disclosure, the pocket may be large enough to fit the coupling end 828. Returning to FIG. 8B, with the guide component 804 locked in place, the surgeon can insert screws through each of the openings 812, through the respective openings 112 in the anterior clavicle plate 100, and into the clavicle. In this way, the guide component 804 helps the surgeon avoid having to align a screw path for each opening 112 of the anterior clavicle plate 100. Instead, the surgeon aligns a path once by adjusting the guide component 804 and then proceeds to insert each screw, reducing the surgeon's setup time for the anterior clavicle plate 100 and thus reducing the surgical procedure time. The guide component 804 also helps increase the consistency of the surgeon's screw path, since the path is consistent for each of the openings 812 with the guide component 804 locked in place. In some cases, a surgeon may test the trajectory provided by the locked guide component 804 at a given time by using the opening 814, which is sized to guide a ku wire or other suitable guide wire. For example, the surgeon may drill a ka wire through opening 814 and into the clavicle. In some aspects of such an example, the anterior clavicle plate 100 may include an opening 824 that corresponds to opening 814 and allows the k wire to be passed through the anterior clavicle plate 100 as the k wire is drilled into the clavicle. In other aspects, opening 814 may be positioned in the guide component 804 such that a k wire inserted through opening 814 is directed to the clavicle outside the lateral end of the anterior clavicle plate 100, rather than through the anterior clavicle plate 100. With the k-wire inserted, the surgeon can image (e.g., radiographically or fluoroscopically) the clavicle to visualize the k-wire's trajectory. If the surgeon is satisfied with the k-wire's trajectory, they remove the k-wire and install the screws. If the surgeon is not satisfied with the k-wire's trajectory, they remove the k-wire, partially disengage the locking post 808, adjust the guide component 804, and re-engage the locking post 808 to lock the guide component 804. In some cases, the surgeon may try the trajectory again. In other cases, the surgeon may be satisfied with the adjustment and install the screws. In this way, the instrument 802 can help at least some surgeons improve the accuracy and / or consistency with which they insert the screws into the center of the clavicle. In some aspects of this application, one or more of the openings 812 in the guide component 804 may be shaped so that a surgeon can adjust an angle at which the surgeon installs a screw in a clavicle through such one or more openings 812. For example, FIG. 9A illustrates a cross-sectional view of an example system 900 that includes an anterior clavicle plate 100 and an example instrument 802 having a guide component 804 with angled openings 904. Only one opening 904 is indicated with reference numbers, although it should be appreciated that the following description applies equally to both illustrated openings 904. The indicated opening 904 is shaped with angled surfaces 906 and 908, such that the opening 904 has a larger cross-sectional area on a first side 910 of the guide component 804 than on a second side 912 of the guide component 804.As such, the configuration of opening 904 allows a surgeon to advance a screw equidistant from both angled surfaces 906 and 908, or to tilt a screw toward the angled surface 906 or toward the angled surface 908 when advancing the screw. Figure 9B illustrates a top view of the example guide component 804 shown in Figure 9A, which has angled openings 904. As shown in Figure 9B, in some examples, the opening 904 may have a rectangular or rounded rectangular cross-section from the first side 910 to the second side 912. In at least some respects, this rectangular or rounded rectangular shape allows a surgeon to adjust the angle of a screw only along a single axis (e.g., the long side of the opening 904). In some respects, adjacent openings 904 may meet at the first side 910 due to this shape.In those aspects where the guide component 804 has angled openings 904, a surgeon can adjust a screw trajectory in the superior / inferior direction of the clavicle by adjusting the guide component 804 as described above, and can adjust a screw trajectory in the lateral / intermediate direction of the clavicle by tilting the screw within the angled opening 904. The instrument 802 can therefore help provide surgeons with increased flexibility over typical systems for the trajectories in which they insert screws when installing the provided anterior clavicle plate. The increased screw trajectory flexibility can, in some cases, help surgeons achieve greater compression across a clavicle fracture than with typical systems.In at least some cases, clavicle plates installed on the superior surface of a clavicle ("superior clavicle plates") may offer better lateral fixation than anterior clavicle plates because a superior clavicle plate allows screws to be installed in the clavicle in the superior / inferior direction. To help provide at least some of these same benefits with a superior clavicle plate, in some aspects of this application, the anterior clavicle plate provided may include an arm extending from the contoured body of the anterior clavicle plate to allow fixation on the superior surface of a clavicle.Such aspects of the provided anterior clavicle plate, including an arm for superior surface fixation, can provide the low-profile, contour-enhanced benefits of the anterior clavicle plate 100 described above with at least some of the lateral fixation benefits of a superior clavicle plate. Figure 10 illustrates a perspective view of an example anterior clavicle plate 1000 having an arm 1008. The anterior clavicle plate 1000 includes a contoured body 102 having a first end 102 opposite a second end 106. In various aspects, the anterior clavicle plate 1000 includes an arm 1008 extending from the contoured body 102. The arm 1008 may extend substantially perpendicularly from the contoured body 102 or at some other suitable angle. In some aspects, the arm 1008 may be curved so that it is centered, or substantially centered, about a single plane. The arm 1008 includes one or more openings 1010 configured so that a screw can be inserted through a respective opening 1010. In some aspects, at least some of the one or more openings 1010 may be threaded to engage with the threading of a screw. In some examples, the arm 1008 may be located on the contoured body 102 as illustrated, although in other examples, the arm 1008 may be located in other suitable locations along the contoured body 102. In some examples, the anterior clavicle plate 1000 may include more than one arm 1008. The example anterior clavicle plate 1000 may include any one or more of the features described above in relation to the anterior clavicle plate 100. For example, although the anterior clavicle plate 1000 is shown without a guide 118 or an angled opening 120, the anterior clavicle plate 1000 may include one or more guides 118 and / or angled openings 120 in other examples. In some examples, an arm of the provided anterior clavicle plate may extend laterally in any direction over the upper surface 504 of the clavicle 500, compared to arm 1008, which does not. For example, FIG. 11 illustrates a perspective view of an example anterior clavicle plate 1200 having an arm 1204 that extends laterally over the upper surface 504 of the clavicle 500. The lateral extension of arm 1204 may help provide additional lateral fixation from the upper surface 504 compared to arm 1008. In some examples, such as the one illustrated, a portion of arm 1204 is substantially parallel to the contoured body 1202 because arm 1204 extends laterally over the upper surface 504. Similar to the example arm 1008 described above, the example arm 1204 may include a plurality of openings (for example, opening 1206) aligned with the upper surface 504. A screw (for example, screw 1208) can be inserted through the openings and into the upper surface 504 of the clavicle 500. Only one opening 1206 and one screw 1208 are indicated by a reference number for illustrative clarity, and it should therefore be appreciated that the description of openings 1206 and screw 1208 applies equally to all those illustrated. In some respects, at least some of the one or more openings 1206 may be threaded to engage the threading of a screw. In several respects, the example anterior clavicle plate 1200 may include any one or more of the features described above in relation to the anterior clavicle plate 100. For example, although the anterior clavicle plate 1200 is shown without a guide 118 or an angled opening 120, the anterior clavicle plate 1200 may include one or more guides 118 and / or angled openings 120 in other examples. In another example from this disclosure, the anterior clavicle plate provided may have an arm that includes a plate with multiple screw openings. For example, FIG. 12 illustrates a perspective view of an example anterior clavicle plate 1300 having an arm 1304 that includes a plate 1306. The arm 1304 extends from the contoured body 1302 of the anterior clavicle plate 1300, such that the plate 1306 is substantially aligned with the upper surface 504 of the clavicle 500. In several respects, plate 1306 includes multiple (e.g., 4, 5, 6, 7, 8, etc.) openings 1308. Only one opening 1308 of plate 1306 is indicated with a reference number for illustrative clarity only. In some respects, at least some of the multiple openings 1306 may be threaded to engage with the threading of a screw. Plate 1306 can provide a higher density of openings 1308, and therefore a higher screw density, at a particular location on the upper surface 504 of the clavicle 500 than example arms 1008 and 1204. A high screw density may be beneficial for the fixation of a fracture in a lateral portion of the clavicle 500. The example anterior clavicle plate 1300 may include any one or more of the features described above in relation to the anterior clavicle plate 100. For example, although the anterior clavicle plate 1300 is shown without a guide 118 or an angled opening 120, the anterior clavicle plate 1300 may include one or more guides 118 and / or angled openings 120 in other examples.

Claims

1. An anterior clavicle fracture fixation plate (100, 1000, 1300) comprising: a contoured body (102) including a first end (104) opposite a second end (106), an upper side (110) opposite a lower side (108), and a plurality of openings (112) along a length of the contoured body from the first end to the second end, wherein a plane (302) extends through a first portion of the contoured body, the first portion being adjacent to the first end, and a second portion of the contoured body curves away from the plane in a first direction, the second portion of the contoured body being adjacent to the second end, wherein the contoured body includes a first curvature (204) along its length that curves at least partially in a second direction perpendicular to the first direction, wherein a height of the contoured body, measured perpendicular to the length,is greater at the first end than at the second end, and wherein a cross-section of the contoured body curves from the upper side to the lower side, and wherein the thickness of a portion of the contoured body adjacent to the upper side, the thickness measured perpendicular to the length of the contoured body, is greater at the second end than at the first end.

2. The anterior clavicle fracture fixation plate of claim 1, wherein the contoured body includes a second curvature (206) that curves at least partially in a third direction opposite to the second direction, and wherein optionally the first curvature is closer to the second end than the second curvature, and wherein the first curvature has a greater degree of curvature than the second curvature.

3. The anterior clavicle fracture fixation plate of claim 1,wherein the height of the contoured body gradually decreases along its length.

4. The anterior clavicle fracture fixation plate of claim 1, wherein, for at least one segment of the contoured body, the thickness of a portion of the contoured body adjacent to the lower side is greater than the thickness of a portion of the contoured body adjacent to the upper side, the thickness being measured perpendicular to the length of the contoured body.

5. The anterior clavicle fracture fixation plate of claim 1, wherein a first portion of the openings has respective diameters greater than a second portion of the openings,and wherein the first portion of the openings is closer to the first end of the contoured body than the second portion of the openings; or wherein the respective diameters of the plurality of openings along the length of the contoured body decrease from the first end to the second end.

6. The anterior clavicle fracture fixation plate (1000, 1300) of claim 1, further comprising an arm (1008, 1304) extending from the contoured body, the arm being configured to contact a superior surface of a clavicle while the contoured body contacts a lateral surface of the clavicle, and optionally wherein either the arm extends perpendicularly from the contoured body or a portion of the arm is substantially parallel to the second end of the contoured body.

7. The anterior clavicle fracture fixation plate (1300) of claim 6,wherein the arm (1304) includes a plate (1306) having a plurality of openings (1308).

8. The anterior clavicle fracture fixation plate of claim 1, wherein the plurality of openings comprises at least one opening (120) that is angled with respect to the contoured body at a different angle than the remaining openings of the plurality of openings, such that a screw, when inserted through the at least one opening, is at an angle not perpendicular to the contoured body.

9. The anterior clavicle fracture fixation plate of claim 8, wherein the angle is acute or obtuse.

10. The anterior clavicle fracture fixation plate of claim 8 or 9,further comprising a respective guide projecting from the contoured body in at least one opening to assist in inserting the screw concentrically into the at least one opening.

11. A system (850) for clavicle fracture fixation comprising: the anterior clavicle fracture fixation plate (100, 1000, 1300) of any preceding claim; and an instrument (802) configured to assist in the insertion of one or more screws through the openings of the anterior clavicle fracture fixation plate into an anterior surface of a clavicle.

12. The system of claim 11, wherein the instrument includes: a base component (806) configured to contact the anterior clavicle fracture fixation plate, a guide component (804) including a body (842) having a groove (810) and a plurality of openings (812), and a locking post (808),wherein the locking post is positioned through the groove of the guide component and through the base component, thereby coupling the guide component and the base component.

13. The system of claim 12, wherein prior to coupling the locking post to the anterior clavicle fracture fixation plate, the guide component is configured to rotate about a long axis relative to the base component, and wherein subsequent to coupling the locking post to the anterior clavicle fracture fixation plate, the guide component is fixed relative to the base component.

14. The system of claim 12, wherein the guide component includes a first face (912) configured to be adjacent to the anterior clavicle fracture fixation plate and a second face (910) opposite the first face,and wherein the plurality of openings (904) of the guide component includes a larger cross-sectional area on the second face than on the first face.

15. The system of claim 11, wherein the contoured body of the anterior clavicle fracture fixation plate is contoured such that it fits either an anterior surface of a patient's right clavicle or an anterior surface of a patient's left clavicle.

Images