Systems and methods of coupling an alignment guide to an intramedullary nail insertion handle

Abstract

In one example, a system has an insertion handle couplable to an intramedullary nail and including a first coupler defining one of a recess and a protrusion and one of a latch and an abutment surface. The system has an aiming guide including a guide body defining at least one alignment aperture therethrough. The aiming guide includes a second coupler couplable to the first coupler such that the at least one alignment aperture is positioned to direct an instrument toward at least one bone anchor fixation hole of the intramedullary nail. The second coupler defines the other of the recess and the protrusion and the other of the latch and the abutment surface. The first coupler and the second coupler are couplable to one another by receiving the protrusion in the recess and by engaging the latch with the abutment surface.

Description

TECHNICAL FIELD

[0001] The present disclosure relates to systems, assemblies, and methods for inserting and fixing a nail into a medullary canal of a bone. BACKGROUND

[0002] Intramedullary nails are commonly used to treat fractures of long bones of the body, such as fractures of the femur, tibia, and humerus. To treat such fractures, an intramedullary nail is inserted into the medullary canal of the long bone so that the nail spans one or more fractures of the long bone that are separated by one or more bone segments. Bone anchors are then inserted through the bone and into the intramedullary nail at opposite sides of the fracture, thereby fixing the intramedullary nail to the bone. The intramedullary nail can remain in the medullary canal at least until the fracture heals. SUMMARY

[0003] In an example, a system includes an insertion handle and an aiming arm. The insertion handle is configured to be coupled to an intramedullary nail. The insertion handle includes a first coupler that defines one of a recess and a corresponding protrusion and one of a latch and a corresponding latch abutment surface. The system has an aiming guide that includes a guide body defining at least one alignment aperture therethrough. The aiming guide includes a second coupler configured to couple the guide body to the first coupler of the insertion handle so that the at least one alignment aperture is positioned to direct an instrument toward at least one bone anchor fixation hole of the intramedullary nail when the insertion handle is coupled to the intramedullary nail. The second coupler defines the other of the recess and the corresponding protrusion and the other of the latch and the corresponding latch abutment surface. The first coupler and the second coupler are configured to be coupled to each other by receiving the corresponding protrusion in the recess and engaging the latch with the corresponding latch abutment surface.

[0004] In another example, a system includes an insertion handle and an aiming guide and a latch. The insertion handle is configured to be coupled to an intramedullary nail so that the intramedullary nail extends along a longitudinal direction. The aiming guide includes a guide body defining at least one alignment aperture therethrough. The aiming guide is configured to be supported by the insertion handle so that the aiming guide is offset from the intramedullary nail along a transverse direction and the at least one alignment aperture is positioned to direct an instrument toward at least one bone anchor fixation hole of the intramedullary nail when the insertion handle is coupled to the intramedullary nail. The latch is pivotally coupled to a body of one of the insertion handle and the aiming guide. The latch is configured to pivot about a pivot axis extending along a lateral direction to move between a disengaged position in which the latch does not secure the insertion handle and the aiming guide to each other and an engaged position in which the latch engages a corresponding latch abutment surface of the other of the insertion handle and the aiming guide to secure the insertion handle and the aiming guide to each other.

[0005] In yet another example, a method includes moving an aiming guide and an insertion handle of an intramedullary nail toward one another so as to receive a protrusion of one of the aiming guide and the insertion handle into a recess of the other of the aiming guide and the insertion handle. The method includes actuating a latch of one of the aiming guide and the insertion handle so as to cause the latch to engage a latch engagement surface of the other of the aiming guide and the insertion handle and thereby secure the aiming guide and the insertion handle to one another such that, when the insertion handle is coupled to the intramedullary nail, at least one alignment aperture of the aiming guide is positioned to direct an instrument toward at least one bone anchor fixation aperture of the intramedullary nail. BRIEF DESCRIPTION OF DRAWINGS

[0006] The following detailed description of illustrative examples can be better understood when read in conjunction with the accompanying drawings. It should be understood that the potential examples of the disclosed system and method are not limited to the depicted examples.

[0007] Figure 1 A perspective view of an intramedullary nail insertion system is shown in accordance with one example;

[0008] Figure 2 A perspective view of an insertion handle of the intramedullary nail insertion system of Figure 1 is shown;

[0009] Figure 3 A perspective view of an intramedullary nail is shown in accordance with one example;

[0010] Figure 4 A perspective view of an aiming guide of the intramedullary nail insertion system of Figure 1 is shown;

[0011] Figure 5 Another perspective view of the aiming guide of the intramedullary nail insertion system of Figure 1 is shown;

[0012] Figure 6 A side view of the intramedullary nail insertion system of Figure 1 is shown without the intramedullary nail;

[0013] Figure 7 A cross-sectional side view of the intramedullary nail insertion system of Figure 1 is shown without the intramedullary nail;

[0014] Figure 8 A perspective view of an intramedullary nail insertion system is shown in accordance with another example;

[0015] Figure 9 A perspective view of an intramedullary nail insertion system is shown in accordance with yet another example;

[0016] Figure 10 A perspective view of an intramedullary nail insertion system is shown in accordance with yet another example; Figure 9perspective view of the aiming guide of the intramedullary nail insertion system of

[0017] Figure 11 shown is Figure 9 perspective view of the aiming guide of the intramedullary nail insertion system of

[0018] Figure 12 shown is Figure 9 another perspective view of the aiming guide of the intramedullary nail insertion system of

[0019] Figure 13 shown is Figure 9 side view of the intramedullary nail insertion system of

[0020] Figure 14 shown is Figure 9 cross-sectional side view of the intramedullary nail insertion system of

[0021] Figure 15 shown is a perspective view of an intramedullary nail insertion system according to still another example;

[0022] Figure 16 shown is Figure 15 perspective view of the insertion handle of the intramedullary nail insertion system of

[0023] Figure 17 shown is Figure 15 perspective view of the aiming guide of the intramedullary nail insertion system of

[0024] Figure 18 shown is Figure 15 another perspective view of the aiming guide of the intramedullary nail insertion system of

[0025] Figure 19 shown is Figure 15 side view of the intramedullary nail insertion system of

[0026] Figure 20 shown is Figure 15 cross-sectional side view of the intramedullary nail insertion system of

[0027] Figure 21 shown is a perspective view of an intramedullary nail insertion system according to still another example;

[0028] Figure 22 shown is Figure 21 perspective view of the insertion handle of the intramedullary nail insertion system of

[0029] Figure 23 shown is Figure 21 perspective view of the aiming guide of the intramedullary nail insertion system of

[0030] Figure 24 shown is Figure 21Another perspective view of the aiming guide of the intramedullary nail insertion system of

[0031] Figure 25 illustrating Figure 21 a side view of the intramedullary nail insertion system of

[0032] Figure 26 illustrating Figure 21 a cross-sectional side view of the intramedullary nail insertion system of DETAILED DESCRIPTION

[0033] Generally, a nail is implanted by driving an intramedullary nail into the medullary canal of a long bone such as a tibia, fibula, humerus, or femur. Prior to inserting the nail, a medical professional can enlarge the medullary canal to make room for the nail. For example, the medullary canal can be enlarged by inserting a reaming rod along the medullary canal and guiding a reamer head having at least one cutting edge along the reaming rod such that the at least one cutting edge drills out the medullary canal. The reaming rod can be flexible so as to bend with the contours of the medullary canal. After enlarging the medullary canal, the intramedullary nail is then driven down into the enlarged medullary canal. In doing so, a handle can be attached to the nail and a medical professional such as a surgeon can grasp the handle to guide the intramedullary nail into the medullary canal. In some cases, the reamer head can be removed, the reaming rod left in place, and the intramedullary nail can then be guided along the reaming rod into the medullary canal. Thus, as the nail is driven into the medullary canal along the reaming rod, the reaming rod can be received in the cannulation of the intramedullary nail.

[0034] To secure the intramedullary nail to the bone, the intramedullary nail can define at least one bone-anchor fixation hole that extends at least partially through the intramedullary nail. For example, the intramedullary nail can include at least one proximal bone-anchor fixation hole at a proximal portion of the intramedullary nail and at least one distal bone-anchor fixation hole at a distal portion of the intramedullary nail. The intramedullary nail can be secured to the bone by (1) for each bone-anchor fixation hole, drilling a hole in the bone that is aligned with the bone-anchor fixation hole, and (2) for each bone-anchor fixation hole, inserting a bone anchor through the bone and into the bone-anchor fixation hole such that the bone anchor engages the bone on at least one side of the intramedullary nail, such as an opposite side.

[0035] However, this procedure can present several difficulties. For example, the proximal and distal bone anchor fixation holes are not visible to the surgeon because the intramedullary nail is disposed inside the bone. Further, the intramedullary nail can bend an indeterminate amount when the intramedullary nail is driven into the medullary canal. This bending can make it difficult to accurately predict the location and orientation of the bone anchor fixation holes. Accordingly, one or more targeting systems can be employed to determine the location of each bone anchor fixation hole and / or to align a cutting instrument, such as a drill bit, with each bone anchor fixation hole. Once the location of the bone anchor fixation holes is determined and / or the cutting instrument is aligned with the bone anchor fixation holes, holes can be drilled in the bone to reach the bone anchor fixation holes. Bone anchors can then be inserted through the bone and into the bone anchor fixation holes.

[0036] A method of targeting at least one bone anchor fixation hole includes using fluoroscopy to obtain moving X-ray images of a drill bit relative to the location of the bone anchor fixation hole in real time. However, the use of fluoroscopy can overexpose patients, and especially surgeons who will perform a large number of such procedures, to harmful X-rays. As an alternative to fluoroscopy, a targeting guide can be coupled to the intramedullary nail and the targeting guide can be used to target at least one of the bone anchor fixation holes with a cutting instrument, such as a drill bit. Generally, the targeting guide can include an alignment hole that is aligned with the at least one bone anchor fixation hole when the guide is attached to the intramedullary nail. The cutting instrument can then be guided into the alignment hole and through the bone to the bone anchor fixation hole.

[0037] Coupling the targeting guide to the intramedullary nail can be cumbersome, often requiring more than two hands. Discussed herein are attachment mechanisms that are less cumbersome, more intuitive, and take less time to assemble. In at least some examples, the targeting guide can be coupled to the intramedullary nail insertion handle using only two hands, one hand grasping the intramedullary nail or insertion handle and the other hand grasping the targeting guide. However, it should be understood that the examples herein are not limited to two-handed operation.

[0038] Various examples of the present disclosure relate to a system (e.g., 10, 20, 30, 40, 50) and methods of using the same, the system including an insertion handle (e.g., 200, 600, 800, 1000) and a targeting guide (e.g., 300, 700, 900, 1100). The insertion handle (e.g., 200, 600, 800, 1000) is configured to be quickly coupled to and quickly decoupled from the targeting guide (e.g., 300, 700, 900, 1100). The insertion handle (e.g., 200, 600, 800, 1000) is also configured to be coupled to an intramedullary nail (e.g., 400). In some examples, the system (e.g., 10, 20, 30, 40, 50) can include an intramedullary nail (e.g., 400). However, it should be appreciated that the targeting guide (e.g., 300, 700, 900, 1100), the insertion handle (e.g., 200, 600, 800, 1000), and the intramedullary nail (e.g., 400) can be distributed independently of one another, or can be distributed in groups of two or more of the targeting guide (e.g., 300, 700, 900, 1100), the insertion handle (e.g., 200, 600, 800, 1000), and the intramedullary nail (e.g., 400). Accordingly, examples of the present disclosure can include a minimum of one, or more than one, a maximum of all of the targeting guide (e.g., 300, 700, 900, 1100), the insertion handle (e.g., 200, 600, 800, 1000), and the intramedullary nail (e.g., 400).

[0039] In some examples, the insertion handle (e.g., 200, 600, 800, 1000) includes a coupler (208, 608, 808, 1008) defining one of a recess (e.g., 218, 618, 818, 1018) and a corresponding protrusion (e.g., 316, 716, 916, 1116) and one of a latch (e.g., 314, 714, 914, 1114) and a corresponding latch abutment surface (e.g., 220, 620, 820, 1020). The aiming guide (e.g., 300, 700, 900, 1100) includes a guide body (e.g., 302, 702, 902, 1102) defining at least one alignment aperture (e.g., 306, 706, 906, 1106) therethrough. The aiming guide (e.g., 300, 700, 900, 1100) includes another coupler (e.g., 304, 704, 904, 1104) configured to couple the guide body (e.g., 302, 702, 902, 1102) to the coupler (e.g., 208, 608, 808, 1008) of the insertion handle (e.g., 200, 600, 800, 1000) such that the at least one alignment aperture (e.g., 306, 706, 906, 1106) is positioned to direct an instrument (not shown) such as a drill bit or a reamer toward at least one bone anchor fixation hole (e.g., 422) of the intramedullary nail (e.g., 400) when the insertion handle (e.g., 200, 600, 800, 1000) is coupled to the intramedullary nail (e.g., 400). The other coupler (e.g., 304, 704, 904, 1104) defines the other of the recess (e.g., 218, 618, 818, 1018) and the corresponding protrusion (e.g., 316, 716, 916, 1116) and the other of the latch (e.g., 314, 714, 914, 1114) and the corresponding latch abutment surface (e.g., 220, 620, 820, 1020). The coupler (e.g., 208, 608, 808, 1008) and the other coupler (e.g., 304, 704, 904, 1104) are configured to couple to one another by receiving the corresponding protrusion (e.g., 316, 716, 916, 1116) in the recess (e.g., 218, 618, 818, 1018) and by engaging the latch (e.g., 314, 714, 914, 1114) with the corresponding latch abutment surface (e.g., 220, 620, 820, 1020).

[0040] In some examples, a system (e.g., 10, 20, 30, 40, 50) includes an insertion handle (e.g., 200, 600, 800, 1000), an aiming guide (e.g., 300, 700, 900, 1100), and a latch (e.g., 314, 714, 914, 1114). The insertion handle (e.g., 200, 600, 800, 1000) is configured to be coupled to an intramedullary nail (e.g., 400) such that the intramedullary nail (e.g., 400) extends along a longitudinal direction L. The aiming guide (e.g., 300, 700, 900, 1100) includes a guide body (e.g., 302, 702, 902, 1102) that defines at least one alignment aperture (e.g., 306, 706, 906, 1106) therethrough. The aiming guide (e.g., 300, 700, 900, 1100) is configured to be supported by the insertion handle (e.g., 200, 600, 800, 1000) such that, when the insertion handle (e.g., 200, 600, 800, 1000) is coupled to the intramedullary nail (e.g., 400), the aiming guide (e.g., 300, 700, 900, 1100) is offset from the intramedullary nail along a transverse direction T and the at least one alignment aperture (e.g., 306, 706, 906, 1106) is positioned to direct an instrument toward at least one bone anchor fixation hole (e.g., 422) of the intramedullary nail (e.g., 400). The latch (e.g., 314, 714, 914, 1114) is pivotably coupled to a body of one of the insertion handle (e.g., 200, 600, 800, 1000) and the aiming guide (e.g., 300, 700, 900, 1100). The latch (e.g., 314, 714, 914, 1114) is configured to pivot about a pivot axis A P that extends along a lateral direction A to move between a disengaged position in which the latch (e.g., 314, 714, 914, 1114) does not secure the insertion handle (e.g., 200, 600, 800, 1000) and the aiming guide (e.g., 300, 700, 900, 1100) to one another and an engaged position in which the latch (e.g., 314, 714, 914, 1114) engages a corresponding latch abutment surface (e.g., 220, 620, 820, 1020) of the other one of the insertion handle (e.g., 200, 600, 800, 1000) and the aiming guide (e.g., 300, 700, 900, 1100) to secure the insertion handle (e.g., 200, 600, 800, 1000) and the aiming guide (e.g., 300, 700, 900, 1100) to one another.

[0041] More particularly referring to Figures 1 to 7 , an aiming guide 300 Figure 4 and Figure 5An exemplary system 10, the aiming guide having a connector 304. The connector 304 defines a protrusion 316 and a latch 314. The system 10 also has an insertion handle 200. Figure 2 The insertion handle has a connector 208. The connector 208 defines a recess 218 for receiving the protrusion 316 and a latch base surface 220 for engaging the latch 314. Figure 2 and Figure 3 As shown, the insertion handle 200 has a first lateral end 202 and a second lateral end 204 offset from each other in a lateral direction T. When the insertion handle 200 is coupled to the intramedullary nail 400, the selected lateral direction T can be a radial direction extending radially relative to the axis of the intramedullary nail 400. The insertion handle 200 may have a rearward end 203 and a forward end 205 offset from the rearward end 203 in the insertion direction I. In other words, the forward end 205 can be offset from the rearward end 203 in a rearward direction R. The insertion direction I and the rearward direction R can be unidirectional and can extend in a bidirectional longitudinal direction L. The lateral direction T can be perpendicular to the longitudinal direction L.

[0042] The first lateral end 202 of the insertion handle 200 includes a connector 206 configured to attach to the intramedullary nail 400. When attached, the intramedullary nail 400 can extend in the longitudinal direction L. The connector 206 can be configured to attach to the intramedullary nail 400 to secure the connector 206 about axis A. L The rotational orientation relative to the intramedullary nail 400. In some examples, the connector 206 may have an orientation along axis A. L A cylindrical shape extending along the insertion direction I. Axis A. L It can be the central axis of the connector 206, and can be aligned with the central axis A of the intramedullary nail 400 when the intramedullary nail 400 is connected to the connector 206. N Alignment. The connector 206 may define at least one mating feature, such as at least one protrusion 207, at least one recess 209, or at least one protrusion 207 and at least one recess 209. The connector 206 is configured to engage a corresponding at least one mating feature of the intramedullary nail 400, such as at least one protrusion 414, at least one recess 416, or at least one protrusion 414 and at least one recess 416, to secure the rotational orientation of the insertion handle 200 relative to the intramedullary nail 400. The at least one mating feature may be located at the leading edge end of the connector 206. In some examples, the connector 206 may include a plurality of mating features, such as a plurality of protrusions 207, each mating feature configured to engage a corresponding recess 416 of the intramedullary nail 400. In at least some of these examples, adjacent protrusions of the protrusions 207 may be spaced apart by recesses 209.

[0043] When the insertion handle 200 is coupled to the intramedullary nail 400, the at least one mating feature of the insertion handle 200 engages the at least one mating feature of the intramedullary nail 400 so as to prevent the intramedullary nail 400 from rotating relative to the insertion handle 200. Further, in some examples, the at least one mating feature of the coupler 206 can be configured such that the insertion handle 200 is only coupled to the intramedullary nail 400 in one selected rotational orientation. Thus, the at least one mating feature of the coupler 206 can be configured so as to prevent the insertion handle 200 from being coupled to the intramedullary nail 400 in any other rotational orientation than the selected rotational orientation.

[0044] The insertion handle 200 can define a cannulation 216 that extends through the first lateral end 202 of the insertion handle 200 in the insertion direction I. The insertion handle 200 can be configured (e.g., sized and shaped) such that, when the insertion handle 200 is coupled to the intramedullary nail 400, the cannulation 216 is aligned with the cannulation 426 of the intramedullary nail 400. The cannulation 216 can be configured (e.g., sized and shaped) so as to receive a rod therethrough, such as a guide rod or a reaming rod. The cannulation 216 can extend through the coupler 206.

[0045] In one example, the system can include a fastener 500 that is configured to fasten the insertion handle 200 to the intramedullary nail 400 so as to fixedly position the insertion handle 200 and the intramedullary nail 400 to one another. The fastener 500 can be configured as any suitable fastener, and various such fasteners are known in the art. Figure 2 One example fastener 500 is shown having a first end 502 and a second end 504 that is offset from the first end 502 in the insertion direction I. The fastener 500 can include a shaft that extends between the first end 502 and the second end 504, and the shaft is sized and shaped to be received through the cannulation 216 of the coupler 206 of the insertion handle 200. The second end 504 can include a thread 508 that is configured to engage the thread 410 of the intramedullary nail 400 so as to secure the fastener 500 to the intramedullary nail 400, although it should be appreciated that the second coupler end 504 can include a quick connect / disconnect feature or other suitable feature other than a thread. In one example, the thread 508 can be a male thread that is configured to engage the female thread 410 of the intramedullary nail 400.

[0046] The first end portion 502 may include an engagement surface 506 configured to be engaged by an instrument or medical professional to rotate the fastener 500 so that the thread 508 of the fastener 500 engages with the thread 410 of the intramedullary nail 400. In one example, the engagement surface 506 may be an inner surface defining a non-circular cross-section, such as a hexagon, polygon, or other shape, which may be engaged by a drive instrument such that rotation of the drive instrument causes a corresponding rotation of the fastener 500. In other examples, the engagement surface 506 may be an outer surface or a handle that can be gripped by a tool or a user's hand to secure the fastener 500 to the intramedullary nail 400.

[0047] The fastener 500 may include a stop or shoulder 510 configured to abut the insertion handle 200 when the fastener 500 is secured to the intramedullary nail 400, thereby preventing movement of the insertion handle 200 relative to the intramedullary nail 400 in a rearward direction R opposite to the insertion direction I. The stop or shoulder 510 has a cross-sectional dimension in a plane perpendicular to the insertion direction I. This cross-sectional dimension can be measured from a first point on the stop or shoulder to a second point on the stop or shoulder, the first and second points being on axis A. L On the opposite side. Furthermore, the cross-sectional dimension of the stop or shoulder 510 may be larger than the cross-sectional dimension of the cannula 216, such that the insertion handle 200 restricts the insertion depth of the fastener 500 into the cannula 216 along the insertion direction I. Therefore, when the insertion handle 200 is attached to the intramedullary nail 400, the insertion handle 200 can be trapped between the intramedullary nail 400 and the stop or shoulder 510 of the fastener 500.

[0048] Brief Reference Figure 3 The diagram illustrates an intramedullary nail 400 according to one example. It should be understood that the intramedullary nail 400 is merely an example, and other intramedullary nails may be used with the system described herein. The intramedullary nail 400 has an insertion end or anterior end 402, and a posterior end 404 offset from the anterior end 402 in a rearward direction R opposite to the insertion direction I. The anterior end 402 and the posterior end 404 may be aligned along a central nail axis A, which may be straight or bent. N They are spaced apart from each other. Furthermore, the intramedullary nail 400 has an outer surface 420 extending between an anterior end portion 402 and a rear end portion 404, such as extending from the anterior end portion 402 to the rear end portion 404. In some examples, the intramedullary nail 400 may define a cannula 426 extending between the anterior end portion 402 and the rear end portion 404. The rear end portion 404 may include a fastener 406 configured to receive a fastener 500. For example, the fastener 406 may define a recess or opening 408 configured to receive the fastener end portion 504. The fastener 406 may include a concave thread 410 engaging a protruding thread 508 of the fastener 500, but other fastening mechanisms are also contemplated.

[0049] The trailing edge end 404 can also include a fastener 412 configured to engage the coupler 206 of the insertion handle 200 so as to rotatably fix the insertion handle 200 and the intramedullary nail 400 relative to one another, relative rotation about the central nail axis A N In one example, the fastener 412 can include at least one of a protrusion 414 and a recess 416 configured to engage a corresponding one of a recess and a protrusion of the insertion handle 200. For example, the fastener 412 can include at least one protrusion 414, such as a plurality of protrusions or teeth. Each protrusion 414 can be configured to engage at least one corresponding recess 209 in the insertion handle 200. Each of the at least one protrusion 414 can extend from the trailing edge end surface 405 of the intramedullary nail 400 toward the leading edge end 402 of the nail 400. The fastener 414 can define at least one recess 416, such as a plurality of recesses, that extends into the trailing edge end surface 405 toward the leading edge end 402. Each recess of the at least one recess 416 can be configured to receive a corresponding protrusion 207 of the insertion handle 200. Further, in examples having a plurality of protrusions 414, each recess of the at least one recess 416 can extend between adjacent ones of the protrusions 414. Thus, in such examples, the protrusions 414 and the recesses 416 can alternate about the opening 408.

[0050] The intramedullary nail further defines a set of one or more trailing edge bone anchor fixation holes 422 extending through the outer surface 420 at the trailing edge end 404, and a set of one or more leading edge bone anchor fixation holes 424 extending through the outer surface 420 at the leading edge end 402. The set of one or more trailing edge holes 422 is configured to be disposed on a first side of a fracture of a bone defining a medullary canal, and the set of one or more leading edge holes 424 is configured to be disposed on a second side of the fracture of the bone. Thus, the nail 400 can be configured such that the fracture is disposed between the set of one or more trailing edge holes 422 and the set of one or more leading edge holes 424. Each trailing edge hole 422 and each leading edge hole 424 is configured to receive a bone anchor such that the bone anchor fixedly attaches the intramedullary nail 400 to the bone. Each bone anchor fixation hole 422 and 424 can be a locking hole having a thread configured to be engaged by a thread of a bone screw, or can be a non-locking hole.

[0051] Referring back to Figure 2The insertion handle 200 may include a gripping portion 210 extending between a first lateral end 202 and a second lateral end 204 of the insertion handle 200. The gripping portion 210 may be between the connector 206 and the connector 208. The gripping portion 210 may include an outer surface 212 extending between the first lateral end 202 and the second lateral end 204. For example, the outer surface 212 may extend in the lateral direction T. The size and shape of the outer surface 212 may be configured for gripping by a medical professional's hand. Therefore, the insertion handle 200 can be used to guide the intramedullary nail 400 into the medullary canal of bone along a guide bar or reamer during insertion of the intramedullary nail 400; however, it should be understood that the intramedullary nail 400 may be inserted without a guide bar or reamer.

[0052] The second lateral end 204 of the insertion handle 200 includes a connector 208 configured to engage the insertion handle 200 to the aiming guide 300. The connector 208 includes at least one latching base surface 220 configured to be engaged by the latch 314 of the aiming guide 300. Figure 5 The coupling 208 engages to connect the insertion handle 200 and the aiming guide 300 to each other in a first position. The coupling 208 further defines a recess 218 configured to receive a protrusion 316 of the aiming guide 300. Figure 5 This allows the insertion handle 200 and the aiming guide 300 to be coupled to each other in the second position. The first and second positions can be offset from each other in the longitudinal direction L. For example, in Figures 1 to 7 In this case, the second position is offset from the first position along the insertion direction I. Therefore, the recess 218 can be offset from the latch base surface 220 relative to the insertion direction I.

[0053] The coupler 208 can have a coupler body 214 extending from the grip portion 210 in the insertion direction I. The coupler body 214 can have an inner end 214a and an outer end 214b offset from one another along the transverse direction T. The coupler body 214 can have opposing sides 214c offset from one another along the lateral direction A. The lateral direction A can be angularly offset from the longitudinal direction L and the transverse direction T. In one example, the lateral direction A can be perpendicular to the longitudinal direction L and the transverse direction T. The opposing sides 214c can extend between the inner end 214a and the outer end 214b. The latch abutment surface 220 can extend away from the sides 214c of the body portion 214. For example, the latch abutment surface 220 can extend along the lateral direction A. In one example, the coupler 208 can include the latch abutment surface 220 and a second latch abutment surface 220 extending away from a respective one of the opposing sides 214c of the coupler body 214. The coupler 208 can include a pin 222 defining each latch abutment surface 220. Each pin 222 can extend outwardly from a respective one of the sides 214c of the coupler body 214. It will be appreciated that the latch abutment surface 220 can alternatively be defined between the opposing sides 214c of the coupler body 214 or by a structure other than a pin.

[0054] The coupler 208 can include a hook portion 224 extending from the coupler body 214 along the transverse direction T. For example, the hook portion 224 can extend away from the first transverse end 202 of the insertion handle 200 along the transverse direction T. The recess 218 can extend into the hook portion 224 along the insertion direction I. The recess 218 can terminate before the leading end 205 of the insertion handle 200. In one example, the recess 218 can have a “U” shape, with the arms of the “U” shape offset from one another along the transverse direction T. The recess 218 can be defined by the outer end 214b of the coupler body 214, a bottom surface 226 extending away from the coupler body 214, and an inner surface 228 extending from the bottom surface 220 along the rearward direction R, the inner surface 228 facing the outer end 214b of the coupler body 214. In some examples, the recess 218 can extend completely through the insertion handle 200 along the lateral direction A. The inner surface 228 of the hook portion 224 and the outer end 214b of the coupler body 214 can provide an obstruction to the protrusion 316 of the aiming guide 300 when the protrusion 316 is received in the recess 218, preventing the protrusion 316 from translating relative to the insertion handle 200 along the transverse direction T. When the protrusion 316 is received in the recess 218, the protrusion 316, and thus the aiming arm 300, can pivot within the recess 218 about an axis extending along the lateral direction A.

[0055] The outer end 214b of the coupler body 214 can define an outer surface configured to face a corresponding surface 318 of the aiming guide 300 when the insertion handle 200 and the aiming guide 300 are coupled to one another.Figure 5 ). In at least some examples, the outer surface of the coupler body 214 is configured to abut a corresponding surface 318 of the aiming guide 300. The coupler 208 can define at least one alignment recess 230 that extends into the outer end 214b of the coupler body 214. For example, the coupler 208 can define a pair of alignment recesses 230 that extend into the outer end 214b of the coupler body 214. Each alignment recess 230 can be configured to receive a corresponding alignment pin 332 of the aiming guide 300 (shown in FIG. 3). It will be appreciated that in alternative examples, one or both of the recesses 230 can alternatively be implemented as a pin that is received in a corresponding alignment recess of the aiming guide 300. Figure 5

[0056] Referring to Figure 4 and Figure 5 , the aiming guide 300 includes a guide body 302 and a coupler 304. The guide body 302 defines at least one alignment bore 306 therethrough. The coupler 304 is configured to couple the aiming guide 300 to the insertion handle 200 such that, when the insertion handle 200 is coupled to the intramedullary nail 400, the at least one alignment bore 306 is positioned to direct an instrument, such as a drill bit or reamer, toward at least one bone anchor fixation hole 422 of the intramedullary nail 400.

[0057] The aiming guide 300 has an inner guide surface 308 and an outer guide surface 310 opposite the inner surface 308. The inner guide surface 308 can be positioned closer to the intramedullary nail 400 than the outer guide surface 310 when the aiming guide 300 is coupled to the intramedullary nail 400. The aiming guide 300 has a leading edge end 305 and a trailing edge end 307. The leading edge end 305 can be spaced apart from the trailing edge end 307 along an insertion direction I. Each alignment bore 306 can extend completely through the guide body 302 from the inner guide surface 308 to the outer guide surface 310. The guide body 302 can include at least one aiming arm 312 that extends away from the coupler 304. For example, the guide body 302 can include a pair of aiming arms 312 that extend away from the coupler 304 in opposite directions. Each aiming arm 312 can extend partially about a central axis A L extending along the insertion direction I. For example, each aiming arm 312 can extend along a circumferential direction that extends circumferentially about the intramedullary nail 400 when the aiming guide 300 is coupled to the intramedullary nail 400. The aiming arm 312 can have any suitable configuration.

[0058] Each aiming arm 312 can include at least one alignment bore 306. Each alignment bore 306 can have a central axis A C ​When the aiming guide 300 is coupled to the intramedullary nail 400 by the insertion handle 200, the central axis is aligned with one of the bone anchor fixation holes 422 of the intramedullary nail 400. In some examples, the at least one alignment hole 306 can have an axis A C that is aligned with another one of the alignment holes 306. C For example, the alignment hole 306 defined by a first one of the aiming arms 312 can have a central axis A P that is aligned with the alignment hole 306 defined by a second one of the aiming arms 312.

[0059] The coupler 304 includes a latch 314 that is configured to engage the at least one latch abutment surface 220 of the insertion handle 200 so as to couple the insertion handle 200 and the aiming guide 300 to one another at a first position. The coupler 304 further defines a protrusion 316 that is configured to be received in the recess 218 of the insertion handle 200 so as to couple the insertion handle 200 and the aiming guide 300 to one another at a second position. The first position and the second position can be offset from one another along the longitudinal direction L. For example, in Figures 1 to 7 the second position is offset from the first position along the insertion direction I. Accordingly, the protrusion 316 can be offset from the latch 314 relative to the insertion direction I. However, it should be appreciated that the positions of the protrusion 316 and the latch 314 can be reversed in alternative examples such that the latch 314 is offset from the protrusion 316 relative to the insertion direction I.

[0060] The coupler 304 can have a coupler body 318 that extends along the insertion direction I. The coupler body 318 can have an inner end 318a and an outer end 318b that are offset from one another along the transverse direction T. The coupler body 318 can have opposite sides 318c that are offset from one another along the lateral direction A. Each aiming arm 312 can extend from one of the opposite sides 318c. The opposite sides 318c can extend between the inner end 318a and the outer end 318b.

[0061] The latch 314 can be configured to pivot about a pivot axis A P . The pivot axis A P may extend along the lateral direction A. Accordingly, the latch 314 can be configured to pivot between a disengaged position in which the latch 314 does not engage the latch abutment surface 220 of the insertion handle 200 and an engaged position in which the latch 314 engages the latch abutment surface 220 of the insertion handle 200. The latch 314 can include a spring 315 that biases the latch 314 toward the engaged position.

[0062] The latch 314 can include at least one engagement surface 317 configured to engage the latch abutment surface 220 of the insertion handle 200 when the latch 314 is in the engaged position. The latch 314 can include at least one hook 320 configured to engage the latch abutment surface 220 of the insertion handle 200 when the latch 314 is in the engaged position. For example, the latch 314 can include a pair of hooks 320 each configured to engage a respective latch abutment surface 220 of the insertion handle 200. The pair of hooks 320 can be offset from one another along the lateral direction A. For example, the hooks 320 can be disposed on opposite sides 318c of the coupler body 318. Each hook 320 can include an inner engagement surface 317 configured to engage a respective latch abutment surface 220. In some examples, at least one of the hooks 320 can have a ramped surface 321 that can be configured to assist in moving the latch 314 from the engaged position to the disengaged position, as described below. Each ramped surface 321 can be opposite the engagement surface 317.

[0063] The latch 314 can include an actuation member 322 configured to be depressed and released by a user, such as a medical professional, in order to move the latch 314 between the engaged position and the disengaged position. For example, the latch 314 can be configured such that when the actuation member 322 is depressed, the at least one hook 320 is moved to the disengaged configuration, and when the actuation member 322 is released, the spring 315 moves the at least one hook 320 to the engaged position.

[0064] The latch 314 can include a first latch end 314a and a second latch end 314b that are offset from one another along the transverse direction T. The first latch end 314a can include the at least one hook 320, and the second latch end 314b can include the actuation member 322. In some examples, the actuation member 322 can extend from one of the hooks 320 to the other of the hooks 320. The pivot axis A P The pivot axis A can extend between the first latch end 314a and the second latch end 314b along the lateral direction A.

[0065] The latch 314 can include at least one arm 323 coupled to the coupler body 318. The coupler 304 can include a pivot pin 324 that couples the at least one arm 323 to the coupler body 318 such that the latch 314 pivots about the pivot pin 324. Thus, the at least one arm 323 can be pivotably coupled to the coupler body 318. In some examples, the latch 314 can include a pair of arms 323 that are offset from one another along the lateral direction A. The pair of arms 323 can be coupled to opposite sides 318c of the coupler body 318. Each arm 323 can define one of the hooks 320. The pivot axis A PThe protrusion 316 can extend from one of the arms 323 to the other of the arms 323. However, it should be appreciated that the protrusion 316 can be configured in another suitable manner in alternative examples.

[0066] In some examples, the aiming guide 300 can include a pair of opposing grip surfaces 326 (shown in FIG. 3) that are offset from one another along the insertion direction I. The grip surfaces 326 can face one another. The actuation member 322 can be spaced apart between the grip surfaces 326. The grip surfaces 326 can protect the actuation member 322 from accidental actuation. Further, the grip surfaces 326 can be gripped by a user, such as by a thumb and index finger, in order to position the aiming arm 300 for coupling to the insertion handle 200. However, it should be appreciated that examples of the present disclosure can be devoid of opposing grip surfaces 326. Figure 7

[0067] The protrusion 316 can include an outer surface that extends along the lateral direction A. The protrusion 316 can be a pin having a central axis that extends along the lateral direction A. The aiming guide 300 can define a recess 328 into the leading end 305 toward the trailing end 307. In one example, the recess 328 can have a “U” shape. The recess 328 can extend completely through the aiming guide 300 from the inner surface 308 to the outer surface 310. The aiming guide 300 can include opposing inner surfaces 330 that are offset from one another along the lateral direction A and define the recess 328. The protrusion 316 can be disposed within the recess 328. For example, the protrusion 316 can extend from one of the inner surfaces 330 to the other of the inner surfaces 330. In alternative examples, the protrusion 316 can be configured in another suitable manner. For example, the aiming guide 300 can be devoid of the recess 328, and the protrusion 316 can alternatively extend from the leading end 305 of the aiming guide 300 along the insertion direction I. See, for example, the aiming guide 300 discussed below with respect to FIG. 6. Figure 8 .

[0068] The inner end 318a of the coupler body 318 can define an inner surface that is configured to face a corresponding outer surface of the insertion handle 200 when the insertion handle 200 and the aiming guide 300 are coupled to one another. In at least some examples, the inner surface of the coupler body 318 is configured to abut a corresponding surface of the outer end 214b of the insertion handle 200. The coupler 304 can define at least one alignment pin 332 that extends from the inner end 318a of the coupler body 318. For example, the coupler 304 can include a pair of alignment pins 332 that extend from the inner end 318a of the coupler body 318. Each alignment pin 332 can be configured to be received in a corresponding alignment recess 230 of the insertion handle 200. It should be appreciated that one or both of the alignment pins 332 can alternatively be implemented as an alignment recess that receives a corresponding alignment pin of the insertion handle 200 in alternative examples.​

[0069] In operation and with reference to Figure 6 and Figure 7 The system 20 can be assembled by moving the aiming guide 300 toward the insertion handle 200 in the insertion direction I so as to receive the protrusion 316 of the aiming guide 300 in the recess 218 of the insertion handle 200. The recess 218 is configured such that when the recess 218 receives the protrusion 316, the insertion handle 200 restricts translational movement of the aiming guide 300 relative to the insertion direction I. However, the aiming guide 300 can pivot or rotate relative to the insertion handle 200 about the protrusion 316 such that the trailing edge end 307 of the aiming guide 300 moves toward the insertion handle 200. As the aiming guide 300 pivots, each alignment pin 322 can be received in a corresponding alignment recess in the alignment recesses 230. Additionally or alternatively, the inner end 318a of the coupler body 318 can abut the outer end 214b of the insertion handle 200.

[0070] The latches 314 can then be actuated so as to cause the latches 314 to engage the latch engagement surfaces 220 and thereby secure the aiming guide 300 and the insertion handle 200 to one another such that when the insertion handle 200 is coupled to the intramedullary nail 400, the at least one alignment bore 306 of the aiming guide is positioned to direct an instrument toward the at least one bone-anchor fixation hole 422 of the intramedullary nail 400. In some examples, as the aiming guide 300 pivots, the at least one ramped surface 321 of the latches 314 can travel along the at least one latch abutment surface 220 of the insertion handle 200 so as to move the latches 314 from the engaged position to the disengaged position. As the ramped surface 321 moves past the latch abutment surface 220, the latches 314 can spring back toward the engaged position such that the at least one hook 320 engages the at least one latch abutment surface 220. In other examples, as the aiming guide 300 pivots, a user can depress the actuation member 322 so as to move the latches 314 from the engaged position to the disengaged position. As the at least one hook 320 moves past the at least one latch abutment surface 220, the user can release the actuation member 322, thereby allowing the latches 314 to spring back toward the engaged position such that the at least one hook 320 engages the at least one latch abutment surface 220. When the at least one latch 314 engages the at least one latch abutment surface 220, the insertion handle 200 can be rotationally fixed to the aiming guide 300 relative to translation along the insertion direction I, translation along the transverse direction T, and rotation away from the aiming guide 300. The latches 314 can provide audible and / or tactile feedback, such as a click, when the latches 314 engage the at least one latch abutment surface 220.

[0071] To disengage the aiming guide 300 from the insertion handle 200, the user can press the actuation member 322 to move the latch 314 from the engaged position to the disengaged position. The user can then pivot the aiming guide 300 about the protrusion 316 relative to the insertion handle 200 such that the trailing edge end 307 of the aiming guide 300 moves away from the insertion handle 200, and the user can remove the protrusion 316 of the aiming guide 300 from the recess 218 of the insertion handle 200 in the rearward direction R.

[0072] Referring briefly to Figure 8 , another alternative example of a system 20 is shown. The system 20 has a handle 200 that is configured in a similar manner to that described above. In addition, the system 20 has an aiming guide 300 that is configured in a similar manner to that described above (with a few notable differences). First, each aiming arm 312 has an alternative shape to that shown Figures 1 to 7 . Second, the aiming guide 300 does not have a recess 328, and the protrusion 316 extends from the leading edge end 305 of the aiming guide 300.

[0073] Turning now to Figures 9 to 14 , an example system 30 is shown as having an aiming guide 700( Figure 12 ) and having an insertion handle 600( Figure 10 ) that has a coupler 608 that defines a recess 618 that receives the protrusion 716 and a latch abutment surface 620 that engages the latch 714. As Figure 10 shown, the insertion handle 600 has a first lateral end 602 and a second lateral end 604 that are offset from one another in the lateral direction T. The insertion handle 600 can have a trailing edge end 603 and a leading edge end 605 that is offset from the trailing edge end 603 in the insertion direction I.

[0074] The first lateral end 602 of the insertion handle 600 includes a coupler 606 that is configured to couple to the intramedullary nail 400. The coupler 606 can be similar to that described above with respect to Figures 1 to 7The coupling 606 can be configured in the same manner as the coupling 206 described above. Accordingly, the description of the coupling 206 described above can equally apply to the coupling 606. The insertion handle 600 can further define a cannulation 616 extending through the first lateral end 602 of the insertion handle 600 in the insertion direction I. The insertion handle 600 can be configured (e.g., sized and shaped) such that, when the insertion handle 600 is coupled to the intramedullary nail 400, the cannulation 616 is aligned with the cannulation 426 of the intramedullary nail 400. The cannulation 616 can be configured (e.g., sized and shaped) to receive a rod therethrough, such as a guide rod or a reaming rod. The cannulation 616 can extend through the coupling 606. In some examples, the system 30 can include a fastener 500 configured and arranged (or in another suitable manner) to fasten the insertion handle 600 to the intramedullary nail 400 so as to fixedly position the insertion handle 600 and the intramedullary nail 400 relative to one another. Figures 1 to 7 The fastener 500 can be configured and arranged (or in another suitable manner) to fasten the insertion handle 600 to the intramedullary nail 400 so as to fixedly position the insertion handle 600 and the intramedullary nail 400 relative to one another.

[0075] The insertion handle 600 can include a gripping portion 610 extending between the first lateral end 602 and the second lateral end 604 of the insertion handle 600. The gripping portion 610 can be between the coupling 606 and the coupling 608. The gripping portion 610 can include an outer surface 612 extending between the first lateral end 602 and the second lateral end 604. For example, the outer surface 612 can extend in the transverse direction T. The outer surface 612 can be sized and shaped to be gripped by a hand of a medical professional. Accordingly, the insertion handle 600 can be used to guide the intramedullary nail 400 along a guide rod or a reaming rod into the medullary canal of a bone during insertion of the intramedullary nail 400, although it will be appreciated that the intramedullary nail 400 can be inserted without a guide rod or a reaming rod.

[0076] The second lateral end 604 of the insertion handle 600 includes a coupling 608 configured to couple the insertion handle 600 to the aiming guide 700. The coupling 608 includes at least one latching abutment surface 620 configured to be engaged by a latching 714 (shown in Figure 11 ) of the aiming guide 700 so as to couple the insertion handle 600 and the aiming guide 700 to one another at a first position. The coupling 608 further defines a recess 618 configured to receive a protrusion 716 (shown in Figure 11 ) of the aiming guide 700 so as to couple the insertion handle 600 and the aiming guide 700 to one another at a second position. The first position and the second position can be offset from one another along the longitudinal direction L. For example, in Figures 9 to 19 , the first position is offset from the second position along the insertion direction I. Accordingly, the latching abutment surface 620 can be offset from the recess 618 relative to the insertion direction I.

[0077] The coupler 608 can have a coupler body 614 extending from the grip portion 610 in the insertion direction I. The coupler body 614 can have an inner end 614a and an outer end 614b offset from one another along the transverse direction T. The coupler body 614 can have opposing sides 614c offset from one another along the lateral direction A. The opposing sides 614c can extend between the inner end 614a and the outer end 614b. A latch land surface 620 can be defined at the leading edge end 605 of the coupler 608, such as at a terminal end of the coupler 608. In some examples, the coupler 608 can include a protrusion that opposes the latch land surface 620 and extends from the coupler body 614 in the insertion direction I. In other examples, the latch land surface 620 can be defined at a leading edge end of the coupler body 614. The latch land surface 620 can be defined at the inner end 614a of the coupler body 614a. Thus, the latch land surface 620 can face toward the first transverse end 602 of the insertion handle 600 along the transverse direction T. The latch land surface 620 can extend along the lateral direction A. It will be appreciated that the latch land surface 620 can be defined in other ways.

[0078] The coupler 608 can include a shoulder 624 extending from the coupler body 614 along the transverse direction T. For example, the shoulder 624 can extend away from the first transverse end 602 of the insertion handle 600 along the transverse direction T. The recess 618 can extend into the shoulder 624 along the insertion direction I. The recess 618 can have a closed shape in a plane extending along the lateral direction A and the transverse direction T. An inner surface of the recess 618 can provide an obstruction to the protrusion 716 of the aiming guide 700 when the protrusion 716 is received in the recess 618, preventing the protrusion 716 from translating relative to the insertion handle 600 along the transverse direction T. The shoulder 624 can provide an obstruction to the aiming guide 700, preventing the aiming guide 700 from moving relative to the insertion handle 600 along the rearward direction R.

[0079] The outer end 614b of the coupler body 614 can define an outer surface configured to face a corresponding surface 718a (shown in FIG. 7) of the aiming guide 700 when the insertion handle 600 and the aiming guide 700 are coupled to one another. In at least some examples, the outer surface of the coupler body 614 is configured to abut the corresponding surface 718a (shown in FIG. 7) of the aiming guide 700 when the insertion handle 600 and the aiming guide 700 are coupled to one another. Figure 12 Figure 12 ​The coupler 608 can define at least one alignment recess 630 that extends into the outer end 614b of the coupler body 614. Each alignment recess 630 can be configured to receive a corresponding alignment pin 732 of the aiming guide 700. It will be appreciated that in alternative examples, one or both of the alignment recesses 630 can alternatively be implemented as an alignment pin configured to be received in a corresponding alignment recess of the aiming guide 700.

[0080] Referring to Figure 11 and Figure 12 The aiming guide 700 includes a guide body 702 and a coupler 704. The guide body 702 defines at least one alignment aperture 706 therethrough. The coupler 704 is configured to couple the aiming guide 700 to the insertion handle 600 such that, when the insertion handle 600 is coupled to the intramedullary nail 400, the at least one alignment aperture 706 is positioned to direct an instrument, such as a drill bit or reamer, toward at least one bone anchor fixation hole 422 of the intramedullary nail 400.

[0081] The aiming guide 700 has an inner guide surface 708 and an outer guide surface 710 opposite the inner surface 708. The inner guide surface 708 can be positioned closer to the intramedullary nail 400 than the outer guide surface 710 when the aiming guide 700 is coupled to the intramedullary nail 400. The aiming guide 700 has a leading edge end 705 and a trailing edge end 707. The leading edge end 705 can be spaced apart from the trailing edge end 707 along the insertion direction I. Each alignment aperture 706 can extend completely through the guide body 702 from the inner guide surface 708 to the outer guide surface 710. The guide body 702 can include at least one aiming arm 712 that extends away from the coupler 704. For example, the guide body 702 can include a pair of aiming arms 712 that extend away from the coupler 704 in opposite directions. Each aiming arm 712 can extend partially around a central axis A L ( Figure 9 that extends along the insertion direction I. For example, each aiming arm 712 can extend along a circumferential direction that extends circumferentially around the intramedullary nail 400 when the aiming guide 700 is coupled to the intramedullary nail 400. The aiming arm 712 can have any suitable configuration.

[0082] Each aiming arm 712 can include at least one alignment aperture 706. Each alignment aperture 706 can have a central axis A C that is aligned with one of the bone anchor fixation holes 422 of the intramedullary nail 400 when the aiming guide 700 is coupled to the intramedullary nail 400 by the insertion handle 600. In some examples, the at least one alignment aperture 706 can have an axis A CFor example, the alignment aperture 706 defined by a first one of the sighting arms 712 can have a central axis A C that is aligned with the alignment aperture 706 defined by a second one of the sighting arms 712.

[0083] The coupler 704 includes a latch 714 that is configured to engage at least one latch abutment surface 620 of the insertion handle 600 to couple the insertion handle 600 and the sighting guide 700 to one another at a first position. The coupler 704 further defines a protrusion 716 that is configured to be received in a recess 618 (shown in Figure 10 ) of the insertion handle 600 to couple the insertion handle 600 and the sighting guide 700 to one another at a second position. The protrusion 716 can extend from the coupler 704 in a rearward direction R. The first position and the second position can be offset from one another along the longitudinal direction L. For example, in Figures 9 to 14 , the first position is offset from the second position along the insertion direction I. Accordingly, the latch 714 can be offset from the protrusion 716 along the insertion direction I. However, it should be appreciated that the positions of the protrusion 716 and the latch 714 can be reversed in alternative examples such that the protrusion 716 is offset from the latch 714 along the insertion direction I.

[0084] The coupler 704 can have a coupler body 718 that extends along the insertion direction I. The coupler body 718 can have an inner end 718a and an outer end 718b that are offset from one another along the transverse direction T. The coupler body 718 can have opposite sides 718c that are offset from one another along the lateral direction A. Each of the sighting arms 712 can extend from one of the opposite sides 718c. The opposite sides 718c can extend between the inner end 718a and the outer end 718b.

[0085] The latch 714 can be configured to pivot about a pivot axis A P . The pivot axis A P may extend along the lateral direction A. Accordingly, the latch 714 can be configured to pivot between a disengaged position (shown in Figure 12 ) in which the latch 714 is positioned to not engage the latch abutment surface 620 of the insertion handle 600 and an engaged position (shown in Figure 11 ) in which the latch 714 is positioned to engage the latch abutment surface 620 of the insertion handle 600. The latch 714 can include a spring that biases the latch 714 toward the engaged position, but the latch 714 can be free of a spring in other examples.

[0086] The latch 714 can include at least one engagement surface 717 that is configured to engage the latch abutment surface 620 of the insertion handle 600 when the latch 714 is in the engaged position. The at least one engagement surface 717 can be offset from the pivot axis AP The latch 714 can define an opening 720 between the at least one engagement surface 717 and the pivot axis A P The latch 714 can be configured to pivot between a disengaged position in which the latch abutment surface 620 of the inserted handle 600 is not received in the opening 720 and an engaged position in which the latch abutment surface 620 is received in the opening 720. The opening 720 can extend along a plane. The plane can extend along the lateral direction A in at least one of the disengaged position and the engaged position. The latch 714 can define a closed shape about the opening 720 in the plane, although it should be appreciated that the latch 714 can define an open shape in alternative examples. The opening 720 can extend at least partially along a direction perpendicular to the plane, such as extending completely through the latch 714.

[0087] The latch 714 can include at least one arm 723 coupled to the coupler body 718. The coupler 704 can include a pivot pin 724 coupling the at least one arm 723 to the coupler body 718 such that the latch 714 pivots about the pivot pin 724. Thus, the at least one arm 723 can be pivotably coupled to the coupler body 718. In some examples, the latch 714 can include a pair of arms 723 offset from one another along the lateral direction A. The pair of arms 723 can be coupled to opposite sides 718c of the coupler body 718. The pivot axis A P may extend from one of the arms 723 to the other of the arms 723. In some examples, the at least one engagement surface 717 can extend between the pair of arms 723, such as from one of the arms 723 to the other of the arms 723. The latch 714 can include a first latch end 714a and a second latch end 714b offset from one another. The pivot axis A P may extend between the first latch end 714a and the second latch end 714b along the lateral direction A. The pivot pin 724 can extend through the latch 714 adjacent the first latch end 714a and the at least one engagement surface 717 can be disposed adjacent the second latch end 714b. However, it should be appreciated that the latch 714 can be configured in another suitable manner in alternative examples.

[0088] The inner end 718a of the coupler body 718 can define an inner surface that is configured to face a corresponding outer surface of the insertion handle 600 when the insertion handle 600 and the aiming guide 700 are coupled to one another. In at least some examples, the inner surface of the coupler body 718 is configured to abut the corresponding surface of the outer end 614b of the insertion handle 600. The coupler 704 can define at least one alignment pin 732 that extends from the inner end 718a of the coupler body 718. For example, the coupler 704 can include a pair of alignment pins 732 that extend from the inner end 718a of the coupler body 718. Each alignment pin 732 can be configured to be received in a corresponding alignment recess 630 of the insertion handle 600. It will be appreciated that in alternative examples, one or both of the alignment pins can alternatively be configured as an alignment recess that is configured to mate with a corresponding alignment pin of the insertion handle 600.

[0089] In operation and with reference to Figure 13 and Figure 14 The system 30 can be assembled by moving the aiming guide 700 in the rearward direction R toward the insertion handle 600 so as to receive the protrusion 716 of the aiming guide 700 in the recess 618 of the insertion handle 600. The recess 618 is configured such that when the recess 618 receives the protrusion 716, the insertion handle 600 restricts translational movement of the protrusion 716 of the aiming guide 700 relative to the rearward direction R. However, the aiming guide 700 can be pivoted or rotated relative to the insertion handle 600 about the protrusion 716 such that the trailing edge end 707 of the aiming guide 700 moves toward the insertion handle 600. As the aiming guide 700 is pivoted, each alignment pin 732 can be received in a corresponding one of the alignment recesses 630. Additionally or alternatively, the inner end 718a of the coupler body 718 can abut the outer end 614b of the insertion handle 600. The latches 714 can then be actuated so as to cause the latches 714 to engage the latch engagement surfaces 620 and thereby secure the aiming guide 700 and the insertion handle 600 to one another such that the at least one alignment bore 706 of the aiming guide is positioned to direct an instrument toward the at least one bone-anchor fixation hole 422 of the intramedullary nail 400 when the insertion handle 600 is coupled to the intramedullary nail 400. For example, the at least one latch 714 can be moved from a disengaged position to an engaged position such that the abutment surface 717 abuts the latch abutment surface 620. When the at least one latch 714 engages the at least one latch abutment surface 620, the insertion handle 600 can be rotationally fixed to the aiming guide 700 relative to translation in the insertion direction I, translation in the transverse direction T, and away from the aiming guide 700. The latches 714 can provide audible and / or tactile feedback, such as a click, when the latches 714 engage the at least one latch abutment surface 620.

[0090] To disengage the aiming guide 700 from the insertion handle 600, the user can move the latch 714 to move the latch from the engaged position to the disengaged position. The user can then pivot the aiming guide 700 relative to the insertion handle 600 about the protrusion 716 such that the trailing edge end 707 of the aiming guide 700 moves away from the insertion handle 600 and the user removes the protrusion 716 of the aiming guide 700 from the recess 618 of the insertion handle 600 in the rearward direction R.

[0091] Turning now to Figures 15 to 20 , the example system 40 is shown with an aiming guide 900 Figure 18 ) having a coupler 904 defining a protrusion 916 and a latch 914 and with an insertion handle 800 Figure 16 ) having a coupler 808 defining a recess 818 that receives the protrusion 916 and a latch abutment surface 820 that engages the latch 914. As Figure 16 shown, the insertion handle 800 has a first lateral end 802 and a second lateral end 804 that are offset from each other in the transverse direction T. The insertion handle 800 can have a trailing edge end 803 and a leading edge end 805 that is offset from the trailing edge end 803 in the insertion direction I.

[0092] The first lateral end 802 of the insertion handle 800 includes a coupler 806 that is configured to couple to the intramedullary nail 400. The coupler 806 can be configured in a manner similar to that described above with respect to the coupler 806 of the Figures 1 to 7 insertion handle 200. Accordingly, the above-described description of the coupler 206 can equally apply to the coupler 806. The insertion handle 800 can also define a cannulation 816 that extends through the first lateral end 802 of the insertion handle 800 in the insertion direction I. The insertion handle 800 can be configured (e.g., sized and shaped) such that, when the insertion handle 800 is coupled to the intramedullary nail 400, the cannulation 816 is aligned with the cannulation 426 of the intramedullary nail 400. The cannulation 816 can be configured (e.g., sized and shaped) to receive a rod therethrough, such as a guide rod or a reamer rod. The cannulation 816 can extend through the coupler 806. In some examples, the system 40 can include a fastener 500 that is configured as described above with respect to the fastener 500 of the Figures 1 to 7 insertion handle 200 (or in another suitable manner) and is configured to fasten the insertion handle 800 to the intramedullary nail 400 so as to fixedly position the insertion handle 800 and the intramedullary nail 400 to each other.

[0093] The insertion handle 800 can include a gripping portion 810 extending between a first lateral end 802 and a second lateral end 804 of the insertion handle 800. The gripping portion 810 can be between the coupler 806 and the coupler 808. The gripping portion 810 can include an outer surface 812 extending between the first lateral end 802 and the second lateral end 804. For example, the outer surface 812 can extend along the transverse direction T. The outer surface 812 can be sized and shaped to be gripped by a hand of a medical professional. Thus, the insertion handle 800 can be used to guide the intramedullary nail 400 along a guide rod or reaming rod into the medullary canal of a bone during insertion of the intramedullary nail 400, although it will be appreciated that the intramedullary nail 400 can be inserted without a guide rod or reaming rod.

[0094] The second lateral end 804 of the insertion handle 800 includes the coupler 808 configured to couple the insertion handle 800 to the aiming guide 900. The coupler 808 includes at least one latch abutment surface 820 configured to be engaged by the latch 914 (shown in Figure 18 The coupler 808 further defines a recess 818 configured to receive the protrusion 916 (shown in Figure 18 The first position and the second position can be offset from each other along the longitudinal direction L. For example, the first position can be offset from the second position along one of the insertion direction I and the rearward direction R. Thus, the latch abutment surface 820 can be offset from the recess 818 relative to one of the insertion direction I and the rearward direction R. In some examples, the coupler 808 can define a second recess 818 configured to receive a second protrusion 916 (shown in Figure 18 The first position and the second position can be offset from each other along the longitudinal direction L. For example, the first position can be offset from the second position along one of the insertion direction I and the rearward direction R. Thus, the latch abutment surface 820 can be offset from the recess 818 relative to one of the insertion direction I and the rearward direction R. In some examples, the coupler 808 can define a second recess 818 configured to receive a second protrusion 916 (shown in

[0095] The coupler 808 can have a coupler body 814 extending from the grip portion 810 in the insertion direction I. The coupler body 814 can have an inner end 814a and an outer end 814b offset from one another along the transverse direction T. The coupler body 814 can have opposing sides 814c offset from one another along the lateral direction A. The opposing sides 814c can extend between the inner end 814a and the outer end 814b. A latching abutment surface 820 can be defined between the leading edge end 805 and the trailing edge end 803 of the insertion handle 800. The latching abutment surface 820 can be an inner surface at least partially defining a locking recess 821 extending into the outer end 814b of the coupler 808. The latching abutment surface 820 can face toward the first transverse end 802 along the transverse direction T. The locking recess 821 can extend into the outer end 814b and be turned toward the rearward direction R such that the latching abutment surface 820 extends generally along the rearward direction R. In alternative examples, the locking recess 821 can be turned toward the insertion direction I. It will be appreciated that the latching abutment surface 820 can be defined in other ways.

[0096] The at least one recess 818 can extend into the outer end 814b. In some examples, the at least one recess 818 can include a pair of recesses 818 offset from one another along the insertion direction I. Each recess 818 can also be considered an alignment recess. When the protrusion 916 of the aiming guide 900 is received in the corresponding recess 818, an inner surface of the recess 818 can provide an obstruction to the protrusion 916, preventing the protrusion 916 from translating in at least one of the insertion direction I and the rearward direction R. It will be appreciated that in alternative examples, each recess 818 can alternatively be implemented as a protrusion received in a recess of the aiming guide 900. The outer end 814b of the coupler body 814 can define an outer surface configured to face a corresponding surface 918a (shown in Figure 18 of the aiming guide 900 when the insertion handle 800 and the aiming guide 900 are coupled to one another. In at least some examples, the outer surface of the coupler body 814 is configured to abut the corresponding surface 918a (shown in Figure 18 of the aiming guide 900.

[0097] Referring to Figure 17 and Figure 18 , the aiming guide 900 includes a guide body 902 and a coupler 904. The guide body 902 defines at least one alignment aperture 906 therethrough. The coupler 904 is configured to couple the aiming guide 900 to the insertion handle 800 such that when the insertion handle 800 is coupled to the intramedullary nail 400, the at least one alignment aperture 906 is positioned to direct an instrument, such as a drill bit or a reamer, toward the at least one bone anchor fixation hole 422 of the intramedullary nail 400.

[0098] The aiming guide 900 has an inner guide surface 908 and an outer guide surface 910 opposite the inner surface 908. When the aiming guide 900 is coupled to the intramedullary nail 400, the inner guide surface 908 can be positioned closer to the intramedullary nail 400 than the outer guide surface 910. The aiming guide 900 has a leading edge end 905 and a trailing edge end 907. The leading edge end 905 can be spaced apart from the trailing edge end 907 along the insertion direction I. Each alignment hole 906 can extend completely through the guide body 902 from the inner guide surface 908 to the outer guide surface 910. The guide body 902 can include at least one aiming arm 912 extending away from the coupler 904. For example, the guide body 902 can include a pair of aiming arms 912 extending away from the coupler 904 in opposite directions. Each aiming arm 912 can extend partially around a central axis A L ( Figure 15 extending around a circumference direction extending circumferentially around the intramedullary nail 400 when the aiming guide 900 is coupled to the intramedullary nail 400. The aiming arms 912 can have any suitable configuration.

[0099] Each aiming arm 912 can include at least one alignment hole 906. Each alignment hole 906 can have a central axis A C that aligns with one of the bone anchor fixation holes 422 in the intramedullary nail 400 when the aiming guide 900 is coupled to the intramedullary nail 400 by the insertion handle 800. In some examples, at least one alignment hole 906 can have an axis A C that aligns with another one of the alignment holes 906. For example, the alignment hole 906 defined by a first one of the aiming arms 912 can have a central axis A C that aligns with the alignment hole 906 defined by a second one of the aiming arms 912.

[0100] The coupler 904 includes a latch 914 configured to engage at least one latch abutment surface 820 of the insertion handle 800 so as to couple the insertion handle 800 and the aiming guide 900 to each other at a first position. The coupler 904 further defines a protrusion 916 configured to be received in a recess 818 Figure 16 in the insertion handle 800 so as to couple the insertion handle 800 and the aiming guide 900 to each other at a second position. The protrusion 916 can extend from the coupler 904 along a transverse direction T. For example, the first position and the second position can be offset from each other along a longitudinal direction L. For example, the first position can be offset along one of the insertion direction I and the rearward direction R. In some examples, the coupler 904 can define a second protrusion 916 configured to be received in a second recess 818Figure 16 As shown in the diagram, the insertion handle 800 and the aiming guide 900 are coupled to each other in the third position. A second protrusion 916 can extend from the connector 904 in the lateral direction T. The first position can be offset from the third position in another direction, either the insertion direction I or the rearward direction R. In an alternative example, one or both protrusions 916 may optionally be implemented as recesses receiving corresponding protrusions of the aiming guide 900.

[0101] The connector 904 may have a connector body 918 extending in the insertion direction I. The connector body 918 may have an inner end 918a and an outer end 918b offset from each other in the lateral direction T. The connector body 918 may have opposing sides 918c offset from each other in the lateral direction A. Each aiming arm 912 may extend from one of the opposing sides 918c. The opposing side 918c may extend between the inner end 918a and the outer end 918b.

[0102] Latch 914 can be configured to be positioned about pivot axis A P Pivoting. Pivot axis A P It can extend in the lateral direction A. Therefore, latch 914 can be configured in the disengaged position ( Figure 17 (shown in) and the engagement position ( Figure 18 The latch 914 pivots between the two positions (shown in the diagram), in which the latch 914 is positioned not to engage the latch base surface 820 of the insert handle 800, and in which the latch 914 is positioned to engage the latch base surface 820 of the insert handle 800. The latch 914 may include a spring biasing the latch 914 toward the engaged position, but in other examples the latch 914 may be without a spring.

[0103] The latch 714 may include at least one engaging surface 917 configured to engage the latch base surface 820 of the insert shank 800 when the latch 914 is in the engaged position. The at least one engaging surface 917 may extend in a lateral direction A. In some examples, the at least one engaging surface 917 may be defined by a pin extending along a central axis in a lateral direction. The latch 914 may be configured to pivot between a disengaged configuration and an engaged position, in which at least one engaging surface 917 is not received in the locking recess 821 of the insert shank 800, and in the engaged position, in which at least one engaging surface 917 is received in the locking recess 821 of the insert shank 800.

[0104] The latch 914 can include at least one arm 922 coupled to the coupler body 918. The coupler 904 can include a pivot pin 924 that couples the at least one arm 922 to the coupler body 918 such that the latch 914 pivots about the pivot pin 924. Thus, the at least one arm 922 can be pivotably coupled to the coupler body 918. In some examples, the latch 914 can include a pair of arms 922 that are offset from one another along the lateral direction A. The pair of arms 922 can be coupled to opposite sides 918c of the coupler body 918. The pivot axis A P The at least one engagement surface 917 can extend from one of the arms 922 to the other of the arms 922. In some examples, the at least one engagement surface 917 can extend between the pair of arms 922, such as from one of the arms 922 to the other of the arms 922. However, it will be appreciated that the latch 914 can be configured in another suitable manner in alternative examples.

[0105] The inner end 918a of the coupler body 918 can define an inner surface that is configured to face a corresponding outer surface of the insertion handle 800 when the insertion handle 800 and the aiming guide 900 are coupled to one another. In at least some examples, the inner surface of the coupler body 918 is configured to abut the corresponding surface of the outer end 814b of the insertion handle 800. The at least one protrusion 916 can extend from the inner end 918a of the coupler body 918.

[0106] In operation and with reference to Figure 19 and Figure 20 The system 40 can be assembled by moving one of the insertion handle 800 and the aiming guide 900 toward one another along the transverse direction T so as to receive the at least one protrusion 916 of the aiming guide 900 in the at least one recess 818 of the insertion handle 800. The at least one recess 818 is configured such that when the at least one recess 818 receives the at least one protrusion 916, the insertion handle 800 restricts translational movement of the protrusion 916 of the aiming guide 900 relative to the insertion direction I and the rearward direction R. When the at least one protrusion 916 is received in the at least one recess 818, the inner end 918a of the coupler body 918 can abut the outer end 814b of the insertion handle 800.

[0107] Then, latch 914 can be actuated to engage latch engagement surface 820, thereby securing aiming guide 900 and insertion shank 800 to each other such that when insertion shank 800 is coupled to intramedullary nail 400, at least one alignment hole 906 of the aiming guide is positioned toward at least one bone anchoring hole 422 of the intramedullary nail 400 guiding the instrument. For example, at least one latch 914 can be moved from a disengaged position to an engaged position such that abutment surface 917 is received in locking recess 821 and abuts latch abutment surface 820. When at least one latch 914 engages at least one latch abutment surface 820, insertion shank 800 can be secured to aiming guide 900 by translation relative to insertion direction I, translation in lateral direction T, and rotation away from aiming guide 900. When latch 914 engages at least one latch abutment surface 820, latch 914 can provide auditory and / or tactile feedback, such as a clicking sound.

[0108] To disengage the aiming guide 900 from the insertion handle 800, the user can move the latch 914 to move it from the engaged position to the disengaged position. The user can then move one of the aiming guide 900 and the insertion handle 800 relative to each other in the lateral direction T to remove at least one protrusion 916 from at least one recess 818.

[0109] Now for reference Figures 21 to 26 The exemplary system 50 is shown as having an aiming guide 1100 and an insertion handle 1000, the aiming guide having a connector 1104 defining a protrusion 1116 and a latch 1114. Figure 24 The insertion handle has a recess 1018 defining a receiving protrusion 1116 and a connector 1008 that engages with a latch base surface 1020 of the latch 1114. Figure 22 ).like Figure 22 As shown, the insertion handle 1000 has a first lateral end 1002 and a second lateral end 1004 offset from each other in a lateral direction T. When the insertion handle 1000 is coupled to the intramedullary nail 400, the selected lateral direction T can be a radial direction extending radially relative to the axis of the intramedullary nail 400. The insertion handle 1000 may have a rear edge end 1003 and a front edge end 1005 offset from the rear edge end 1003 in the insertion direction I.

[0110] The first lateral end 1002 of the insertion handle 1000 includes a connector 1006 configured to attach to the intramedullary nail 400. The connector 1006 may be configured similarly to the above description. Figures 1 to 7The coupling 1006 can be configured in the same manner as the coupling 206 described above. Accordingly, the description of the coupling 206 described above can equally apply to the coupling 1006. The insertion handle 1000 can also define a cannulation 1016 that extends through the first lateral end 1002 of the insertion handle 1000 in the insertion direction I. The insertion handle 1000 can be configured (e.g., sized and shaped) such that, when the insertion handle 1000 is coupled to the intramedullary nail 400, the cannulation 1016 is aligned with the cannulation 426 of the intramedullary nail 400. The cannulation 1016 can be configured (e.g., sized and shaped) to receive a rod therethrough, such as a guide rod or a reaming rod. The cannulation 1016 can extend through the coupling 1006. In some examples, the system 50 can include a fastener 500 configured and arranged (or in another suitable manner) to fasten the insertion handle 1000 to the intramedullary nail 400 so as to fixedly position the insertion handle 1000 and the intramedullary nail 400 relative to one another. Figures 1 to 7 The coupling 1006 can be configured in the same manner as the coupling 206 described above. Accordingly, the description of the coupling 206 described above can equally apply to the coupling 1006. The insertion handle 1000 can also define a cannulation 1016 that extends through the first lateral end 1002 of the insertion handle 1000 in the insertion direction I. The insertion handle 1000 can be configured (e.g., sized and shaped) such that, when the insertion handle 1000 is coupled to the intramedullary nail 400, the cannulation 1016 is aligned with the cannulation 426 of the intramedullary nail 400. The cannulation 1016 can be configured (e.g., sized and shaped) to receive a rod therethrough, such as a guide rod or a reaming rod. The cannulation 1016 can extend through the coupling 1006. In some examples, the system 50 can include a fastener 500 configured and arranged (or in another suitable manner) to fasten the insertion handle 1000 to the intramedullary nail 400 so as to fixedly position the insertion handle 1000 and the intramedullary nail 400 relative to one another.

[0111] The insertion handle 1000 can include a gripping portion 1010 that extends between the first lateral end 1002 and the second lateral end 1004 of the insertion handle 1000. The gripping portion 1010 can be between the coupling 1006 and the coupling 1008. The gripping portion 1010 can include an outer surface 1012 that extends between the first lateral end 1002 and the second lateral end 1004. For example, the outer surface 1012 can extend in the lateral direction T. The outer surface 1012 can be sized and shaped to be gripped by a hand of a medical professional. Accordingly, the insertion handle 1000 can be used to guide the intramedullary nail 400 along a guide rod or a reaming rod into the medullary canal of a bone during insertion of the intramedullary nail 400, although it will be appreciated that the intramedullary nail 400 can be inserted without a guide rod or a reaming rod.

[0112] The second lateral end 1004 of the insertion handle 1000 includes the coupling 1008 configured to couple the insertion handle 1000 to the aiming guide 1100. The coupling 1008 includes at least one latch abutment surface 1020 configured to be engaged by the latch 1114 of the aiming guide 1100 (shown in FIG. 11) so as to couple the insertion handle 1000 and the aiming guide 1100 to one another at the first position. In some examples, the at least one latch abutment surface 1020 can include a pair of opposing latch abutment surfaces 1020 that are offset from one another in the lateral direction A. The coupling 1008 further defines a recess 1018 configured to receive the protrusion 1116 of the aiming guide 1100 (shown in FIG. 11) so as to couple the insertion handle 1000 and the aiming guide 1100 to one another at the first position. Figure 24 Figure 24 ​The first and second positions can be offset from one another along the longitudinal direction L. For example, the first position can be offset from the second position along the rearward direction R. Thus, the latching abutment surface 1020 can be offset from the recess 1018 relative to the rearward direction R.

[0113] The coupler 1008 can have a coupler body 1014 extending from the grip portion 1010 along the insertion direction I. The coupler body 1014 can have an inner end 1014a and an outer end 1014b offset from one another along the transverse direction T. The coupler body 1014 can have opposing sides 1014c offset from one another along the lateral direction A. The opposing sides 1014c can extend between the inner end 1014a and the outer end 1014b. Each latching abutment surface 1020 can face toward the first transverse end 1002 of the insertion handle 1000. Each latching abutment surface 1020 can at least partially define a locking recess 1022 configured to receive the abutment surface 1120 of the latch 1114. Each locking recess 1022 can extend into the insertion handle along the insertion direction I such that the locking recess 1022 is open at the trailing edge end 1003. Additionally or alternatively, each locking recess 1022 can extend into the insertion handle along the transverse direction T toward the first transverse end 1002 such that the locking recess 1022 is open toward the second transverse end 1004. Additionally or alternatively, each locking recess 1022 can extend into the insertion handle 1000 along the lateral direction A such that the locking recess 1022 is open at a respective one of the sides of the insertion handle 1000.

[0114] The coupler 1008 can include a hook portion 1024 that can be similar to the hook portion 1024 described above with respect to the coupler 108 of the aiming guide 100 (see FIG. 6), so as to couple the insertion handle 1000 and the aiming guide 1100 to one another at the second position. The first and second positions can be offset from one another along the longitudinal direction L. For example, the first position can be offset from the second position along the rearward direction R. Thus, the latching abutment surface 1020 can be offset from the recess 1018 relative to the rearward direction R. Figures 1 to 7The hook portion 1024 can extend from the coupler body 1014 in the transverse direction T. The hook portion 1024 can extend away from the first transverse end 1002 of the insertion handle 1000 in the transverse direction T. The recess 1018 can extend into the hook portion 1024 in the insertion direction I. The recess 1018 can terminate before the leading end 1005 of the insertion handle 1000. In one example, the recess 1018 can have a “U” shape, with the arms of the “U” shape offset from one another in the transverse direction T. Thus, the recess 1018 can be defined by an outer end 1014b of the coupler body 1014, a bottom surface 1026 extending away from the coupler body 1014, and an inner surface 1028 extending from the bottom surface 1026 in the rearward direction R, the inner surface 1028 facing the outer end 1014b of the coupler body 1014. In some examples, the recess 1018 can extend completely through the insertion handle 1000 in the lateral direction A. The inner surface 1028 of the hook portion 1024 and the outer end 1014b of the coupler body 1014 can provide an obstruction to the protrusion 1116 of the aiming guide 1100 when the protrusion 1116 is received in the recess 1018, preventing the protrusion 1116 from translating in the transverse direction T relative to the insertion handle 1000.

[0115] The outer end 1014b of the coupler body 1014 can define an outer surface that is configured to face a corresponding surface 1118 of the aiming guide 1100 when the insertion handle 1000 and the aiming guide 1100 are coupled to one another (shown in FIG. 11). In at least some examples, the outer surface of the coupler body 1014 is configured to abut the corresponding surface 1118 of the aiming guide 1100. The coupler 1008 can define at least one alignment recess 1030 that extends into the outer end 1014b of the coupler body 1014. Each alignment recess 1030 can be configured to receive a corresponding alignment pin 1132 of the aiming guide 1100 (shown in FIG. 11). It will be appreciated that in alternative examples, the recesses 1030 can alternatively be implemented as pins that are received in corresponding alignment recesses of the aiming guide 1100. Figure 24 Figure 22 The outer end 1014b of the coupler body 1014 can define an outer surface that is configured to face a corresponding surface 1118 of the aiming guide 1100 when the insertion handle 1000 and the aiming guide 1100 are coupled to one another (shown in FIG. 11). In at least some examples, the outer surface of the coupler body 1014 is configured to abut the corresponding surface 1118 of the aiming guide 1100. The coupler 1008 can define at least one alignment recess 1030 that extends into the outer end 1014b of the coupler body 1014. Each alignment recess 1030 can be configured to receive a corresponding alignment pin 1132 of the aiming guide 1100 (shown in FIG. 11). It will be appreciated that in alternative examples, the recesses 1030 can alternatively be implemented as pins that are received in corresponding alignment recesses of the aiming guide 1100.

[0116] Referring to Figure 23 and Figure 24 , the aiming guide 1100 includes a guide body 1102 and a coupler 1104. The guide body 1102 defines at least one alignment aperture 1106 therethrough. The coupler 1104 is configured to couple the aiming guide 1100 to the insertion handle 1000 such that when the insertion handle 1000 is coupled to the intramedullary nail 400, the at least one alignment aperture 1106 is positioned to direct an instrument, such as a drill bit or a reamer, toward the at least one bone-anchor fixation hole 422 of the intramedullary nail 400. ​

[0117] The aiming guide 1100 has an inner guide surface 1108 and an outer guide surface 1110 opposite the inner surface 1108. When the aiming guide 1100 is coupled to the intramedullary nail 400, the inner guide surface 1108 can be positioned closer to the intramedullary nail 400 than the outer guide surface 1110. The aiming guide 1100 has a leading edge end 1105 and a trailing edge end 1107. The leading edge end 1105 can be spaced apart from the trailing edge end 1107 along the insertion direction I. Each alignment hole 1106 can extend completely through the guide body 1102 from the inner guide surface 1108 to the outer guide surface 1110. The guide body 1102 can include at least one aiming arm 1112 extending away from the coupler 1104. For example, the guide body 1102 can include a pair of aiming arms 1112 extending away from the coupler 1104 in opposite directions. Each aiming arm 1112 can extend partially around a central axis A L extending along the insertion direction I. For example, when the aiming guide 1100 is coupled to the intramedullary nail 400, each aiming arm 1112 can extend along a circumferential direction extending circumferentially around the intramedullary nail 400. The aiming arm 1112 can have any suitable configuration.

[0118] Each aiming arm 1112 can include at least one alignment hole 1106. Each alignment hole 1106 can have a central axis A C that aligns with one of the bone anchor fixation holes 422 in the intramedullary nail 400 when the aiming guide 1100 is coupled to the intramedullary nail 400 by the insertion handle 1000. In some examples, at least one alignment hole 1106 can have an axis A C that aligns with another one of the alignment holes 1106. For example, the alignment hole 1106 defined by a first one of the aiming arms 1112 can have a central axis A C that aligns with the alignment hole 1106 defined by a second one of the aiming arms 1112.

[0119] The coupler 1104 includes a latch 1114 configured to engage at least one latch abutment surface 1020 of the insertion handle 1000 to couple the insertion handle 1000 and the aiming guide 1100 to each other at a first position. The coupler 1104 further defines a protrusion 1116 configured to be received in the recess 1018 of the insertion handle 1000 to couple the insertion handle 1000 and the aiming guide 1100 to each other at a second position. The first position and the second position can be offset from each other along the longitudinal direction L. For example, the second position can be offset from the first position along the insertion direction I. Accordingly, the protrusion 1116 can be offset from the latch 1114 relative to the insertion direction I. It will be appreciated, however, that the positions of the protrusion 1116 and the latch 1114 can be reversed in alternative examples such that the latch 1114 is offset from the protrusion 1116 relative to the insertion direction I.

[0120] The coupler 1104 can have a coupler body 1118 extending along the insertion direction I. The coupler body 1118 can have an inner end 1118a and an outer end 1118b offset from each other along the transverse direction T. The coupler body 1118 can have opposite sides 1118c offset from each other along the lateral direction A. Each aiming arm 1112 can extend from one of the opposite sides 1118c. The opposite sides 1118c can extend between the inner end 1118a and the outer end 1118b.

[0121] The latch 1114 can be configured to pivot about a pivot axis A P The pivot axis A P may extend along the lateral direction A. Accordingly, the latch 1114 can be configured to pivot between a disengaged position in which the latch 1114 does not engage the latch abutment surface 1020 of the insertion handle 1000 and an engaged position in which the latch 1114 engages the latch abutment surface 1020 of the insertion handle 1000. The latch 1114 can include a spring 1115 biasing the latch 1114 toward the engaged position, although examples of the present disclosure are not limited thereto.

[0122] The latch 1114 can include at least one engagement surface 1117 configured to engage the latch abutment surface 1020 of the insertion handle 1000 when the latch 1114 is in the engaged position. The latch 1114 can include at least one protrusion 1120 defining the at least one engagement surface 1117. For example, the latch 1114 can include a pair of engagement surfaces 1117 each configured to engage a respective latch abutment surface 1020 of the insertion handle 1000. The pair of engagement surfaces 1117 can be offset from each other along the lateral direction A.

[0123] The latch 1114 can include a first latch end 1114a and a second latch end 1114b that are offset from one another along the transverse direction T. The first latch end 1114a can include the at least one engagement surface 1117. The second latch end 1114b can include an actuation member 1122 that is configured to be depressed and released by a user, such as a medical professional, in order to move the latch 1114 between the engaged position and the disengaged position. For example, the latch 1114 can be configured such that when the actuation member 1122 is depressed, the at least one engagement surface 1117 is moved to the disengaged configuration, and when the actuation member 1122 is released or lifted, the at least one engagement surface 117 is moved to the engaged position.

[0124] The latch 1114 can include at least one arm 1123 that is coupled to the coupler body 1118. The coupler 1104 can include a pivot pin 1124 that couples the at least one arm 1123 to the coupler body 1118 such that the latch 1114 pivots about the pivot pin 1124. Thus, the at least one arm 1123 can be pivotably coupled to the coupler body 1118. In some examples, the latch 1114 can include a pair of arms 1123 that are offset from one another along the lateral direction A. The pair of arms 1123 can be coupled to opposite sides 1118c of the coupler body 1118. Each engagement surface 1117 can extend from one of the arms 1123. For example, each engagement surface 1117 can extend inwardly from one of the arms 1123. The pivot axis A P may extend from one of the arms 1123 to the other of the arms 1123. However, it will be appreciated that the latch 1114 can be configured in another suitable manner in alternative examples.

[0125] The protrusion 1116 can include an outer surface that extends along the lateral direction A. The protrusion 1116 can be a pin having a central axis that extends along the lateral direction A. The aiming guide 1100 can define a recess 1128 into the leading edge end 1105 toward the trailing edge end 1107. In one example, the recess 1128 can have a “U” shape. The recess 1128 can extend completely through the aiming guide 1100 from the inner surface 1108 to the outer surface 1110. The aiming guide 1100 can include opposite inner surfaces 1130 that are offset from one another along the lateral direction A and define the recess 1128. The protrusion 1116 can be disposed within the recess 1128. For example, the protrusion 1116 can extend from one of the inner surfaces 1130 to the other of the inner surfaces 1130. In alternative examples, the protrusion 1116 can be configured in another suitable manner. For example, the aiming guide 1100 can be devoid of the recess 1128, and the protrusion 1116 can alternatively extend from the leading edge end 1105 of the aiming guide 1100 along the insertion direction I.

[0126] The inner end 1118a of the coupler body 1118 can define an inner surface that is configured to face a corresponding outer surface of the insertion handle 1000 when the insertion handle 1000 and the aiming guide 1100 are coupled to one another. In at least some examples, the inner surface of the coupler body 1118 is configured to abut a corresponding surface of the outer end 1014b of the insertion handle 1000. The coupler 1104 can define at least one alignment pin 332 extending from the inner end 1118a of the coupler body 1118. Each alignment pin 332 can be configured to be received in a corresponding alignment recess 1030 of the insertion handle 1000. It will be appreciated that in alternative examples, each alignment pin 332 can alternatively be implemented as an alignment recess that receives a corresponding alignment pin of the insertion handle 1000.

[0127] In operation and with reference to Figure 25 and Figure 26 The system 50 can be assembled by moving the aiming guide 1100 in the insertion direction I toward the insertion handle 1000 so as to receive the protrusion 1116 of the aiming guide 1100 in the recess 1018 of the insertion handle 1000. The recess 1018 is configured such that when the recess 1018 receives the protrusion 1116, the insertion handle 1000 restricts translational movement of the aiming guide 1100 relative to the insertion direction I. However, the aiming guide 1100 can be pivoted or rotated relative to the insertion handle 1000 about the protrusion 1116 such that the trailing edge end 1107 of the aiming guide 1100 moves toward the insertion handle 1000. As the aiming guide 1100 is pivoted, each alignment pin 332 can be received in a corresponding one of the alignment recesses 1030. Additionally or alternatively, the inner end 1118a of the coupler body 1118 can abut the outer end 1014b of the insertion handle 1000.

[0128] The latches 1114 can then be actuated so as to cause the latches 1114 to engage the latch engagement surfaces 1020 and thereby secure the aiming guide 1100 and the insertion handle 1000 to one another such that the at least one alignment bore 1106 of the aiming guide is positioned to direct an instrument toward the at least one bone-anchor fixation hole 422 of the intramedullary nail 400 when the insertion handle 1000 is coupled to the intramedullary nail 400. For example, the at least one latch 1114 can be moved from a disengaged position to an engaged position such that the abutment surface 1117 abuts the latch abutment surface 1020. When the at least one latch 1114 engages the at least one latch abutment surface 1020, the insertion handle 1000 can be rotationally fixed to the aiming guide 1100 relative to translation along the insertion direction I, translation along the transverse direction T, and rotation away from the aiming guide 1100. The latches 1114 can provide audible and / or tactile feedback, such as a click, when the latches 1114 engage the at least one latch abutment surface 1020.

[0129] To disengage the aiming guide 1100 from the insertion handle 1000, the user can move the latch 1114 from the engaged position to the disengaged position. The user can then pivot the aiming guide 1100 relative to the insertion handle 1000 about the protrusion 1116 such that the trailing edge end 1107 of the aiming guide 1100 moves away from the insertion handle 1000, and the user can remove the protrusion 1116 of the aiming guide 1100 from the recess 1018 of the insertion handle 1000 in the rearward direction R.

[0130] It will be appreciated that in alternative examples, the insertion handle can include a latch that engages the aiming guide.

[0131] It will be appreciated that the insertion handle can alternatively be referred to as a spacer that is configured to couple the aiming guide to the intramedullary nail so as to space the aiming guide from the intramedullary nail.

[0132] In one example, a system includes an insertion handle and an aiming arm. The insertion handle is configured to couple to an intramedullary nail. The insertion handle includes a coupler that defines one of a recess and a protrusion and one of a latch and a latch abutment surface. The aiming guide includes a guide body that defines at least one alignment aperture therethrough. The aiming guide includes another coupler that is configured to couple the guide body to the coupler of the insertion handle such that the at least one alignment aperture is positioned to direct an instrument toward at least one bone-anchor fixation hole of the intramedullary nail when the insertion handle is coupled to the intramedullary nail. The other coupler defines the other of the recess and the protrusion and the other of the latch and the abutment surface. The coupler and the other coupler are configured to couple to one another by receiving the protrusion in the recess and by engaging the latch with the abutment surface.

[0133] In another example, an intramedullary nail insertion handle includes a first end and a second end that are offset from one another in a lateral direction. The nail includes a first coupler that is configured to couple the insertion handle to the intramedullary nail and a second coupler that is offset from the first coupler in the lateral direction. The second coupler is configured to couple the insertion handle to an aiming arm. The second coupler defines one of a recess and a protrusion that is configured to engage the other of a recess and a protrusion of the aiming arm and one of a latch and a latch abutment surface that is configured to engage the other of a latch and an abutment surface of the aiming arm.

[0134] In yet another example, the aiming guide includes a guide body and a coupler. The guide body defines at least one alignment hole therethrough. The coupler is configured to couple the guide body to the insertion handle such that the at least one alignment hole is positioned to direct an instrument toward at least one bone-anchor fixation hole of the intramedullary nail when the insertion handle is coupled to the intramedullary nail. The coupler defines one of a recess and a protrusion that is configured to engage the other of a recess and a protrusion of the aiming arm; and one of a latch and a latch abutment surface that is configured to engage the other of a latch and an abutment surface of the aiming arm.

[0135] It should be understood that the description of features, such as components or steps, herein referring to "one" or "a" does not exclude additional features or multiples of features. For example, referring to an apparatus having or defining "one" of a feature does not exclude the apparatus from having or defining more than one of the feature, as long as the apparatus has or defines at least one of the feature. Similarly, referring to "one" of a plurality of features herein does not exclude the present application from including two or more of the features. For example, referring to an apparatus having or defining "one of a protrusion and a recess" does not exclude the apparatus from having both a protrusion and a recess, or more than one protrusion or more than one recess.

[0136] It should be noted that the illustrations of the examples described herein are included for illustrative purposes only and should not be construed as limiting the present disclosure. Those skilled in the art will know of various examples that the present disclosure contemplates. In addition, it should be understood that the concepts described above using the examples described above can be used alone or in combination with any other example described above. It should also be understood that various alternative examples described above in relation to one illustrated example can be applicable to all examples as described herein, unless otherwise specified.

[0137] Unless specifically stated otherwise, each numerical value and range should be interpreted as approximately as the word "about," "approximately," or "substantially" preceding the value or range. The terms "about," "approximately," and "substantially" can be understood to describe a range that is within 15% of the specified value, unless otherwise specified.

[0138] Conditional language, such as "can," "could," "might," "may," "e.g.," and the like, unless specifically stated otherwise, is understood as generally preceding and conveying a specification of potentialities that do not necessarily materialize into results (e.g., maybe, can not, could not, do nothing that materializes a potentiality). Accordingly, conditional language is not generally intended to imply that a possibility that a feature, element, or step will be experienced, but rather, is understood to express a possibility that the potentiality can or will be experienced. Thus, the use of conditional language is not intended to imply that a feature, element, or step is necessarily included in every example of the application. The terms "comprise," "comprising," "include," "including," and the like are synonymous and are used in the sense of "including" and not by way of "consisting only of." The terms "comprise," "comprising," "include," "including," and the like are synonymous and are used in the sense of "including" and not by way of "consisting only of."

[0139] While certain examples have been described, these examples have been presented by way of example only, and are not intended to limit the scope of the inventions disclosed herein. Thus, none of the foregoing description is intended to be limiting in nature. Indeed, the new methods and systems described herein can be embodied in a variety of other forms; furthermore, various omissions, substitutions and changes in the form of the methods and systems described herein can be made without departing from the spirit of the applications disclosed herein. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the specific applications disclosed herein.

[0140] It should be understood that the steps of the exemplary methods set forth herein are not necessarily required to be performed in the order described, and the order of the steps of such methods should be understood to be only exemplary. Likewise, additional steps can be included in such methods, and certain steps can be omitted or combined, in accordance with various examples of the methods.

[0141] Although elements in the following method claims, if any, are recited in a particular sequence with corresponding labeling, unless the claim recitations otherwise imply a particular sequence it is not necessarily intended that the order of elements should be limited to that sequence as described. Nor does it necessarily imply that all elements must follow that sequence.

[0142] The words "inwardly," "outwardly," "upper," "lower," "distal," and "proximal," refer to directions toward or away from the geometric center of the intramedullary nail, respectively.

Claims

1. A system for coupling a targeting guide to an insertion handle, comprising: the insertion handle, the insertion handle configured to be coupled to an intramedullary nail, the insertion handle including a first coupler, the first coupler defining one of a recess and a corresponding protrusion and one of a latch and a corresponding latch abutment surface; and the targeting guide, the targeting guide including a guide body defining at least one alignment aperture therethrough, the targeting guide including a second coupler configured to couple the guide body to the first coupler of the insertion handle such that, when the insertion handle is coupled to the intramedullary nail, the at least one alignment aperture is positioned to direct an instrument toward at least one bone-anchor fixation hole of the intramedullary nail, the second coupler defining the other of the recess and the corresponding protrusion and the other of the latch and the corresponding latch abutment surface, wherein the first coupler and the second coupler are configured to be coupled to one another by receiving the corresponding protrusion in the recess and engaging the latch with the corresponding latch abutment surface; wherein the latch includes at least one arm pivotably coupled to a body of a respective one of the first coupler and the second coupler; and wherein the at least one arm includes a pair of arms and the latch includes an engagement surface extending between the pair of arms, the engagement surface configured to engage the corresponding latch abutment surface.

2. The system of claim 1, wherein: the insertion handle is configured to be coupled to the intramedullary nail such that the intramedullary nail extends along a longitudinal direction; the latch is configured to engage the latch abutment surface at a first position; and the recess is configured to receive the corresponding protrusion at a second position offset from the first position along the longitudinal direction.

3. The system of claim 1, comprising a pivot pin coupling the latch to the body of a respective one of the first coupler and the second coupler such that the latch pivots about the pivot pin.

4. The system of claim 1, wherein the first coupler and the second coupler are configured to be coupled to one another by first receiving the protrusion in the recess, then rotating the insertion handle and the targeting guide relative to one another, and engaging the latch with the corresponding latch abutment surface.

5. The system of claim 1, wherein the latch includes a pin defining the engagement surface, the pin extending along a central axis extending from one of the arms to the other of the arms, and the corresponding latch abutment surface at least partially defines a locking recess configured to receive the pin.

6. The system of claim 1, wherein the at least one arm defines a hook configured to engage the corresponding latch abutment surface.

7. The system of claim 1, wherein the first coupler defines the recess and the second coupler defines the corresponding protrusion.

8. The system of claim 1, wherein the first coupler defines the corresponding latching abutment surface and the second coupler defines the latch.

9. The system of claim 1, wherein: the insertion handle is configured to be coupled to the intramedullary nail such that the intramedullary nail extends in a longitudinal direction; the aiming guide is configured to be supported by the insertion handle so as to be offset from the intramedullary nail in a transverse direction; and the latch is configured to pivot about an axis extending in a direction that is angularly offset from the longitudinal direction and the transverse direction.

10. A system for coupling an aiming guide to an insertion handle, comprising: the insertion handle, the insertion handle being configured to be coupled to an intramedullary nail such that the intramedullary nail extends in a longitudinal direction; the aiming guide, the aiming guide including a guide body defining at least one alignment aperture therethrough, the aiming guide being configured to be supported by the insertion handle such that, when the insertion handle is coupled to the intramedullary nail, the aiming guide is offset from the intramedullary nail in a transverse direction and the at least one alignment aperture is positioned to direct an instrument toward at least one bone-anchor fixation hole of the intramedullary nail; and a latch pivotably coupled to a body of one of the insertion handle and the aiming guide, the latch being configured to pivot about a pivot axis extending in a lateral direction so as to move between a disengaged position in which the latch does not secure the insertion handle and the aiming guide to one another and an engaged position in which the latch engages a corresponding latching abutment surface of the other of the insertion handle and the aiming guide so as to secure the insertion handle and the aiming guide to one another; wherein the latch includes at least one arm that is pivotably coupled to the body of the one of the insertion handle and the aiming guide; and wherein the at least one arm includes a pair of arms and the latch includes an engagement surface extending between the pair of arms, the engagement surface being configured to engage the corresponding latching abutment surface.

11. The system of claim 10, wherein the lateral direction is angularly offset from the longitudinal direction and the transverse direction.

12. The system of claim 10, comprising a pivot pin that couples the latch to the body of the one of the insertion handle and the aiming guide such that the latch pivots about the pivot pin.

13. A method for coupling an aiming guide to an insertion handle, comprising: moving the aiming guide and the insertion handle of an intramedullary nail toward one another so as to receive a protrusion of one of the aiming guide and the insertion handle into a recess of the other of the aiming guide and the insertion handle; and actuating a latch of one of the aiming guide and the insertion handle so as to cause the latch to engage a latch engagement surface of the other of the aiming guide and the insertion handle, and thereby secure the aiming guide and the insertion handle to one another such that, when the insertion handle is coupled to the intramedullary nail, the at least one alignment aperture of the aiming guide is positioned to direct an instrument toward the at least one bone-anchor fixation aperture of the intramedullary nail; wherein the latch includes at least one arm pivotably coupled to a body of the one of the insertion handle and the aiming guide; and wherein the at least one arm includes a pair of arms, and the latch includes an engagement surface extending between the pair of arms, the engagement surface being configured to engage the corresponding latch abutment surface.

14. The method of claim 13, wherein the step of actuating includes pivoting the latch about a pivot axis extending through the body of the one of the aiming guide and the insertion handle.

15. The method of claim 13, including, after the step of moving and before the step of actuating, rotating the insertion handle and the aiming guide toward one another about the protrusions.

16. The method of claim 13, wherein the step of moving includes engaging an alignment pin on one of the insertion handle and the aiming guide with a recess of the other of the insertion handle and the aiming guide so as to align the insertion handle and the aiming guide to one another.

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