Plate holder instrument and kit comprising a plate holder instrument

Abstract

The present disclosure relates to a plate holder instrument comprising a base and a clamp. The clamp is displaceable relative to the base in a longitudinal direction and forms a plate receiving recess with the base. The clamp is displaceable between a release position allowing a bone plate to be loaded into and taken out of the plate receiving recess and a clamping position locking the bone plate in the plate receiving recess. An actuator is displaceable relative to the base in a first direction to move the clamp into the release position and in a second direction to move the clamp into the clamping position. The present disclosure further relates to a combined guide serving as a drilling guide and a tapping guide and being combinable with the plate holder instrument. In addition, the present disclosure relates to a kit comprising the plate holder instrument and the combined guide.

Description

TECHNICAL FIELD

[0001] The present disclosure relates generally to a plate holder instrument. Further, the present disclosure relates to a combination guide and a kit comprising a plate holder instrument and a combination guide. BACKGROUND

[0002] Spinal fusion is a surgical procedure in which a damaged vertebra is removed and the vertebral bodies adjacent to the removed vertebra are fused together with graft material. The spine must be stabilized during the fusion process. To stabilize the spine, one or more fixation rods are anchored to the vertebrae to limit movement.

[0003] Cervical occipital fixation can be accomplished by using a fixation rod attached to a bone plate which in turn is anchored to the occipital bone at the back of the skull. One example of such a bone plate is described in U.S. Patent No. 8,348,981, assigned to Aesculap Implant Systems, LLC, the contents of which are incorporated by reference in their entirety. The occipital bone plate is attached to the skull with bone screws which are inserted through holes in the bone plate. Prior to insertion of the screws, the holes for the screws must be drilled and tapped.

[0004] Drilling and tapping at the back of the skull is a difficult procedure requiring a great deal of force to penetrate the dense cortical bone. The procedure is further complicated by the required angle of approach of the instruments. In addition, the drilling depth must be precisely controlled, which is difficult to do while also exerting a great deal of force on the drill at a difficult angle of approach.

[0005] Further prior art is known from US 2010 / 100131 Al, US 2013 / 116733 Al, US 4 187 840 A and WO 2009 / 091770 Al. SUMMARY

[0006] The challenges mentioned above are solved in many aspects by the instrument according to the present disclosure.

[0007] In one aspect of the present disclosure, a plate holder instrument includes a base having a proximal end and a distal end opposite the proximal end. The base defines a longitudinal axis extending in a longitudinal direction from the proximal end to the distal end. A clamp is displaceable relative to the base in the longitudinal direction and forms a plate receiving recess with the base. The clamp is displaceable between a release position allowing a bone plate to be loaded into and removed from the plate receiving recess and a clamped position locking the bone plate in the plate receiving recess. An actuator is displaceable relative to the base in a first direction to move the clamp to the release position and is displaceable relative to the base in a second direction to move the clamp to the clamped position.

[0008] In another aspect of the present disclosure, the plate holder instrument has an actuator with a lever arm pivotably mounted to a proximal end of the base by a hinge.

[0009] In another aspect of the present disclosure, the plate holder instrument has an actuator with a link member connected between the lever arm and the clamp.

[0010] In another aspect of the present disclosure, the plate holder instrument has an actuator with a link member having a first link end pivotably coupled to the lever arm and a second link end pivotably connected to the clamp.

[0011] In another aspect of the present disclosure, the plate holder instrument has a base with a first plate holding surface and a clamp with a second plate holding surface.

[0012] In another aspect of the present disclosure, the plate holder instrument has a plate receiving recess extending between the first plate holding surface and the second plate holding surface.

[0013] In another aspect of the present disclosure, the plate holder instrument has a second plate holding surface movable away from the first plate holding surface in response to the actuator moving relative to the base in a first direction.

[0014] In another aspect of the present disclosure, the plate holder instrument has a second plate holding surface movable toward the first plate holding surface in response to the actuator moving relative to the base in a second direction.

[0015] In another aspect of the present disclosure, the plate holder instrument has a first plate holding surface with a first pair of detents protruding from the base and a second plate holding surface with a second pair of detents extending from the clamp.

[0016] In another aspect of the present disclosure, the plate holder instrument has a plate receiving recess with a first inclined surface on a first side of the longitudinal axis and a second inclined surface on a second side of the longitudinal axis, the second inclined surface not parallel to the first inclined surface.

[0017] In another aspect of the present disclosure, the plate holder instrument has a base with at least one stop surface and a clamp having at least one stop member configured to abut the at least one stop surface when the clamp is moved to a clamped position.

[0018] In another aspect of the present disclosure, the plate holder instrument has a base and a clamp that together define an opening adjacent to the plate receiving recess, the opening configured to extend behind a plate stabilized in the plate receiving recess.

[0019] In another aspect of the present disclosure, the plate holder instrument has a fastener that detachably couples the guide attachment to the plate holder instrument.

[0020] In another aspect of the present disclosure, the plate holder instrument has a fastener in the form of a clamp.

[0021] In another aspect of the present disclosure, the plate holder instrument has a clamp that is displaceable relative to the base into a cleaning position in which the clamp is separated from the base to facilitate sterilization.

[0022] In another aspect of the present disclosure, the plate holder instrument has an actuator that is movable in a first direction to move the clamp from the release position to the cleaning position.

[0023] Independent of or in addition to the plate holder instrument as defined above, in another aspect of the present disclosure, there is provided a combined guide, preferably for a drilling and tapping guide, configured to be coupled to the plate holder instrument. The combined guide comprises a first end (portion), a second end (portion), and an elongated body extending between the first end (portion) and the second end (portion). The first end (portion) is configured to function as a drilling guide, and the second end (portion) is configured to function as a tapping guide. In this way, the tapping and drilling guides can be implemented by a single combined guide in a simple and compact structure.

[0024] In the following, only the expression “end” has been used, where also alternatively “end portion” is meant.

[0025] In another aspect of the present disclosure, the first end of the combined guide has a cylindrical guide ring adapted to receive a drilling bit, and the second end of the combined guide has a cylindrical guide ring adapted to receive a tapping tool.

[0026] In another aspect of the present disclosure, the first end of the combined guide is connected to the elongated body of the combined guide by a dogleg-shaped section, and the second end of the combined guide is connected to the elongated body of the combined guide by a second dogleg-shaped section.

[0027] In another aspect of the present disclosure, there is provided a kit for attaching a bone plate to a posterior region of a patient’s skull. The kit comprises a plate holder instrument, preferably for holding a bone plate, and a combined guide, preferably for a drilling and tapping guide. In addition, the kit preferably comprises a bone plate.

[0028] In another aspect of the present disclosure, a kit for attaching a bone plate to a posterior region of a patient's skull includes a plate holder instrument. The plate holder instrument includes a base having a proximal end and a distal end opposite the proximal end. The base defines a longitudinal axis extending in a longitudinal direction from the proximal end to the distal end. A clamp is displaceable relative to the base in the longitudinal direction and forms a plate receiving recess with the base. The clamp is displaceable between a release position that allows the bone plate to be loaded into and removed from the plate receiving recess and a clamped position that locks the plate in the plate receiving recess. An actuator is displaceable relative to the base in a first direction to move the clamp to the release position and is displaceable relative to the base in a second direction to move the clamp to the clamped position. At least one guide attachment is configured to be detachably coupled to the plate holder instrument.

[0029] In another aspect of the present disclosure, the kit has at least one guide attachment in the form of at least one drill guide.

[0030] In another aspect of the present disclosure, the kit has at least one guide attachment in the form of at least one drill guide.

[0031] In another aspect of the present disclosure, the kit has at least one bone plate. BRIEF DESCRIPTION OF DRAWINGS

[0032] The foregoing summary, as well as the following detailed description of the application, will be better understood when read in conjunction with the accompanying drawings, in which:

[0033] Figure 1 is a schematic perspective view of a cervical occipital fixation system featuring a bone plate attached to a posterior of a patient's skull;

[0034] Figure 2 is a front perspective view of a plate holder instrument according to the present disclosure;

[0035] Figure 3 is Figure 2 a rear perspective view of the plate holder instrument of

[0036] Figure 4 is Figure 2 another front perspective view of the plate holder instrument of

[0037] Figure 5 is Figure 2 another front perspective view of the plate holder instrument of

[0038] Figure 6 is Figure 2 a magnified cutaway perspective view of the plate holder instrument of

[0039] Figure 7 is Figure 2 another enlarged cutaway perspective view of the plate holder instrument with the bone plate stabilized in one end;

[0040] Figure 8 is a front perspective view of a combination guide according to a first example of the disclosure;

[0041] Figure 9 is a front perspective view of a combination guide according to a second example of the disclosure;

[0042] Figure 10 is a front perspective view of a combination guide according to the first example attached to a plate holder instrument and a bone plate according to the disclosure; Figure 2

[0043] Figure 11 is a rear perspective view of a combination guide according to the first example attached to a plate holder instrument and a bone plate according to the disclosure; Figure 10

[0044] Figure 12 is a schematic side view of a combination guide according to the first example attached to a plate holder instrument and a bone plate according to the disclosure, shown during drilling of a screw hole; Figure 10

[0045] Figure 13 is an enlarged perspective view showing details of a combination guide, a plate holder instrument and a bone plate according to the first example during drilling of a screw hole;

[0046] Figure 14 is an enlarged perspective view showing details of a combination guide, a plate holder instrument and a bone plate according to the first example during tapping of a screw hole;

[0047] Figure 15 is an enlarged perspective view showing details of a plate holder instrument and a bone plate during insertion of a screw through the bone plate and into the tapped screw hole;

[0048] Figure 16 is a perspective view of another plate holder instrument and a bone plate attached to a combination guide according to a third example of the disclosure;

[0049] Figure 17 is a schematic perspective view of a plate holder instrument, a plate and a combination guide with a tapping instrument according to the disclosure; Figure 16

[0050] is a schematic perspective view of a plate holder instrument according to the disclosure detached from a bone plate after the bone plate has been anchored to a patient's occiput; Figure 18

[0051] is a schematic perspective view of a plate holder instrument according to the disclosure detached from a bone plate after the bone plate has been anchored to a patient's occiput;​​​Figure 19 is Figure 2 another front perspective view of the plate holder instrument with the plate removed and the actuator moved to a cleaning position to allow for sterilization of the components; and

[0052] Figure 20 is a perspective view of another plate holder instrument according to the present disclosure. DETAILED DESCRIPTION

[0053] The following sections describe different instruments for fixing the cervical spine according to the present disclosure.

[0054] In the present disclosure, "distal" essentially means "in a direction away from the user / surgeon towards the patient" and "proximal" essentially means "in a direction towards the user / surgeon away from the patient".

[0055] Figure 1 A cervical occipital fixation system 100 is shown featuring a bone plate 110 attached to the back of the patient's skull. The bone plate 110 is anchored to the occiput with four bone screws 120. The bone screws 120 are driven into holes 112 in the body portion 114 of the bone plate. A pair of legs 130 extend outwardly from the body portion 114. Each leg 130 has a socket 132 configured to support a cervical fixation rod 140. The cervical fixation rod 140 is connected to a bone anchor assembly 150 implanted in the spine.

[0056] Figure 2 and Figure 3 A plate holder instrument 200 is shown. The plate holder instrument 200 is configured to hold a bone plate in a desired position where the plate holder instrument will be attached to the occiput. As will be described, the plate holder instrument 200 also functions with other accessories to drill and tap screw holes in the occiput. In addition, the plate holder instrument 200 can be used to hold the bone plate in place when bone screws are driven through the tapped screw holes to anchor the bone plate to the occiput.

[0057] Plate holder instruments according to the present disclosure have components that move relative to one another to engage and disengage a bone plate. These components can have various structures. Relatively long and thin components having a small thickness allow the plate holder instruments to have a long and thin profile so that the instruments can access the occiput while occupying a minimum of space. In the present example, plate holder instrument 200 has a plate-like base 210 having an axial length 210L, a width 210W, and a thickness 210T. Thickness 210T is a small fraction of width 210W, and width 210W is a small fraction of axial length 210L. Base 210 has a proximal end 212 and a distal end 214 opposite proximal end 212. Base 210 also defines a longitudinal axis 216 extending in a longitudinal direction from proximal end 212 to distal end 214.

[0058] Plate holder instrument 200 includes a plate-like clamp 230. Clamp 230 has a proximal end 232 and a distal end 234 opposite proximal end 232. Additionally, clamp 230 is connected to base 210 in an axially displaceable arrangement. In this arrangement, clamp 230 is displaceable relative to base 210 in the longitudinal direction. Clamp 230 forms a plate-receiving recess 240 with base 210. Plate-receiving recess 240 is sized to receive and support a bone plate. Clamp 230 is displaceable relative to base 210 between a release position and a clamped position. In the release position, clamp 230 allows a bone plate, such as bone plate 110, to be loaded into and removed from plate-receiving recess 240. In the clamped position, clamp 230 stably engages bone plate 110 in plate-receiving recess 240 so that bone plate 110 is locked in plate-receiving recess 240.

[0059] Plate holder instrument 200 further includes an actuator 250. Actuator 250 is displaceable relative to base 210 in a first direction A to move clamp 230 to the release position. Actuator 250 is also displaceable relative to base 210 in a second direction B to move clamp 230 to the clamped position.

[0060] Figure 4 and Figure 5 Plate holder instrument 200 is shown with bone plate 110 loaded into plate-receiving recess 240. When actuator 250 is moved in first direction A as shown, clamp 230 is moved to the release position. In this position, plate-receiving recess 240 is enlarged, thereby providing a gap to allow bone plate 110 to be loaded into plate-receiving recess 240 between base 210 and clamp 230. When actuator 250 is moved in second direction B as shown, clamp 230 is moved to the clamped position. In this position, plate-receiving recess 240 is constricted, thereby stably engaging bone plate 110 in plate-receiving recess 240. Figure 4 Figure 5 ​As shown, the clamp 230 is moved to a clamped position when moved in the second direction B. In this position, the plate receiving recess 240 is contracted or reduced in size to enclose the bone plate 110 on both sides. In this arrangement, the base 210 and the clamp 230 collectively form a vise 202 that can be opened and closed via the actuator 250 to release or clamp the bone plate 110.

[0061] As shown, the actuator 250 can be moved in the first direction A beyond the released position to a cleaning position. In this position, the clamp 230 is detached from the base 210, which allows the components to be sterilized. Figure 19

[0062] Returning to Figure 4 and Figure 5 , the actuator 250 includes a lever arm 252 that is pivotably mounted to the proximal end 212 of the base 210 by a hinge 218. The actuator 250 also includes a link member 254 that is connected between the lever arm 252 and the clamp 230. The link member 254 has a first link end 256 that is pivotably coupled to the lever arm 252 and a second link end 258 that is pivotably connected to the clamp 230.

[0063] Referring to Figure 6 , the base 210 includes a first plate retention surface 211 and the clamp 230 includes a second plate retention surface 231. The plate receiving recess 240 extends between the first plate retention surface 211 and the second retention surface 231. The second plate retention surface 231 is movable away from the first plate retention surface 211 in response to the actuator 250 being moved in the first direction A relative to the base 210. The second plate retention surface 231 is movable toward the first plate retention surface 211 in response to the actuator 250 being moved in the second direction B relative to the base 210.

[0064] Occipital bones generally have a curvature. Bone plates having a flat profile are difficult to stabilize to a curved bone surface. As such, it is often desirable for a bone plate to be curved or otherwise shaped so as to have a curved profile or face that conforms to the natural curvature of an occipital bone. For example, the plate can be curved such that the side of the plate that is stabilized against an occipital bone has a concave shape.

[0065] The plate holder instrument and plate receiving recesses according to the present disclosure can have one or more surfaces that conform to the curvature of a curved bone plate. Referring to Figure 7 ​In particular, the plate-receiving recess 240 includes a first inclined surface 244 on a first side 216A of the longitudinal axis 216. The plate-receiving recess 240 also includes a second inclined surface 246 on a second side 216B of the longitudinal axis 216. The second inclined surface 246 is not parallel to the first inclined surface 244. Further, the first inclined surface 244 and the second inclined surface 246 are skewed toward one another as they extend toward the longitudinal axis 216. In this arrangement, the first inclined surface 244 and the second inclined surface 246 collectively form a V-shaped or U-shaped support surface 246 that conforms to the curvature of the bone plate 110’.

[0066] The first plate-retaining surface 211 includes a first pair of detents 213 that protrude from the base 210. Similarly, the second plate-retaining surface 231 includes a second pair of detents 233 that protrude from the clamp 230. The first and second pairs of detents 213, 233 contact the bone plate 110’ at only four locations along the bone plate perimeter.

[0067] A plate-retainer instrument according to the present disclosure can include a stop mechanism for limiting displacement of the clamp relative to the bone plate when the bone plate is moved to the clamped position. The stop mechanism can be used to prevent the bone plate from being clamped too tightly, which can deform and damage the bone plate. In the present example, the base 210 includes a pair of stop surfaces 215 that face the proximal end 212 of the base 210. Additionally, the clamp 230 includes a pair of stop members 235 that define the distal end 234 of the clamp 230. The stop members 235 are configured to abut the stop surfaces 215 when the clamp 230 is moved to the clamped position, thereby preventing the second plate-retaining surface 231 from moving closer to the first plate-retaining surface 211.

[0068] The base 210 and the clamp 230 collectively define an opening 248 adjacent the plate-receiving recess 240. The opening 248 is configured to extend behind a hole of a bone plate stabilized in the plate-receiving recess 240, e.g., as shown in Figure 7 The opening 248 is configured to extend behind a hole of a bone plate stabilized in the plate-receiving recess 240, e.g., as shown in

[0069] A plate-retainer instrument according to the present disclosure can have various plate-retaining structures and configurations. For example, a plate-retaining surface can include a single detent, rather than a pair of detents. See, e.g., FIG. 6. Figure 20The plate holder 200' is shown with a first plate holding surface 21 1'that includes a single detent 213' and a second plate holding surface 231'that includes a pair of detents 233'. In this arrangement, the single detent 213' and the pair of detents 233' contact the bone plate at three locations along the bone plate perimeter. The plate holder 200' also includes a guard 290' that limits how far the actuator 250' can be pivoted in the first direction A.

[0070] The plate holder instrument according to the present disclosure is configured to work with different accessories, including guides that facilitate drilling and tapping pilot holes in the occipital bone, and guides for driving screws through the bone plate. In the present example, the plate holder instrument 200 includes a fastener in the form of a clip 260, a rearward facing portion of which is shown in Figure 3 and Figure 10 The clip 260 is configured to detachably couple a guide accessory to the plate holder instrument.

[0071] The plate holder instrument according to the present disclosure can be sold as a standalone instrument. Alternatively, the plate holder instrument according to the present disclosure can be sold with one or more accessories. Further, the plate holder instrument according to the present disclosure can be sold as part of a surgical kit that includes various surgical instruments, bone plates, screws, tools, taps, depth gauges, screwdrivers, and other accessories.

[0072] For example, a kit according to the present disclosure can include an accessory for drilling pilot holes in the occipital bone. Such an accessory can include a surgical drill, a drill bit, and a drill guide. A kit according to the present disclosure can also include an accessory for tapping screw holes in the occipital bone. Tapping a screw hole can involve driving a tap into a pilot hole to create threads in the screw hole. Accordingly, a kit according to the present disclosure can include a tap and a tap guide.

[0073] A kit according to the present disclosure can also include one or more bone plates. For example, a kit can include a set of bone plates, where the bone plates differ in their size, curvature, hole diameter, hole arrangement, and / or other design parameters.

[0074] A guide accessory according to the present disclosure can include a combined guide that features a first end for guiding drilling of pilot holes and a second end for guiding tapping of screw holes. Figure 8One example of a combination guide 300 is shown for tapping a screw hole to receive a 4.5 mm screw in a mini-open procedure. The combination guide 300 has a first end 302, a second end 304, and an elongated body 306 extending between the first end 302 and the second end 304. The first end 302 has a cylindrical guide ring 308 adapted to receive a drill bit for use as a drilling guide 310. The second end 304 has a cylindrical guide ring 312 adapted to receive a tapping tool for use as a tapping guide 314. The first end 302 is connected to the elongated body 306 by a first dogleg section 316, and the second end 304 is connected to the elongated body 306 by a second dogleg section 318.

[0075] Figure 9 Another example of a combination guide 400 is shown for tapping a screw hole to receive a 5.5 mm screw in a mini-open procedure. The combination guide 400 has a first end 402, a second end 404, and an elongated body 406 extending between the first end 402 and the second end 404. The first end 402 has a cylindrical guide ring 408 adapted to receive a drill bit for use as a drilling guide 410. The second end 404 has a cylindrical guide ring 412 adapted to receive a tapping tool for use as a tapping guide 414. The first end 402 is connected to the elongated body 406 by a first dogleg section 416, and the second end 404 is connected to the elongated body 406 by a second dogleg section 418.

[0076] The elongated bodies 306, 406 of the combination guides 300, 400 are configured to be inserted into the clip 260 of the plate holder instrument 200 and releasably retained by the clip 260. Referring to Figure 10 and Figure 11 The plate holder instrument 200 is shown with the combination guide 300 inserted into the clip 260 and aligned with a bone plate 110' loaded in the plate holder instrument 200. It will be appreciated that the combination guide 400 can be inserted into the clip 260 and used in the same manner with the plate holder instrument 200 and the bone plate 110'. Thus only the structural and functional aspects of the combination guide 300 will be described, it being appreciated that the structural and functional aspects of the combination guide 400 are identical in all respects, with the only difference being the size of the guide rings.

[0077] The first and second dogleg sections 316, 318 create offsets that allow the guide rings 308, 312 to be positioned flush with the bone plate 110', while the elongate body 306 is positioned outward from the bone plate 110'. These offsets are necessary to allow the guide rings 308, 312 to be positioned as close to the bone plate 110' as possible, while allowing the elongate body 306 to be coupled over the top of the plate holder instrument 200 in an over-the-top arrangement.

[0078] Plate holder instruments according to the present disclosure can also be used with angled instruments for guiding surgical drills and tapping instruments. Figure 12 and Figure 13 The plate holder instrument 200 is shown holding the bone plate 110 against the occipital bone during drilling of a pilot hole. The angled gear instrument 500 with drill bit 600 and depth stop 700 drills the pilot hole using torque provided by the drill driver 800. In this case, the combined guide 300 is coupled to the plate holder instrument 200 with the guide ring 308 on the first end 302 aligned with the hole 112 in the bone plate 110.

[0079] Figure 14 The plate holder instrument 200 is shown holding the bone plate 110 against the occipital bone during tapping of a screw hole. The angled gear instrument 500 has a tap 602 and a depth stop 702. In this case, the combined guide 300 is coupled to the plate holder 200 with the guide ring 312 on the second end 304 aligned with the hole 112 in the bone plate 110.

[0080] Figure 15 The plate holder instrument 200 is shown holding the bone plate 110 against the occipital bone as the bone plate 110 is anchored to the occipital bone. In this case, the tapped screw hole is ready, and the combined guide 300 is thus removed from the plate holder 200. The first plate screw 900 is placed on the driver tip 604 attached to the angled gear instrument 500. Torque applied to the angled gear instrument 500 drives the first plate screw 900 through the first hole in the bone plate 110 and into the tapped hole to anchor the bone plate 110 to the occipital bone. Once the first plate screw 900 is driven into the screw hole, the angled gear instrument 500 can be disassembled, loaded with a second plate screw, and manipulated to a second hole in the bone plate 110 to drive the second plate screw through the second hole and into the occipital bone. This process can be repeated for any other screw holes tapped behind the bone plate 110.

[0081] Figure 16 and Figure 17An alternative combination guide 1000 that can be used in open surgery is shown. The combination guide 1000 has a first end 1002, a second end 1004, and an elongated body 1006 extending between the first end 1002 and the second end 1004. The first end 1002 has a cylindrical guide ring 1008 adapted to receive a drill bit or a tapping drill bit. The second end 1004 also has a cylindrical guide ring 1012 adapted to receive a drill bit or a tapping drill bit. Figure 16 A tapping drill bit 1100 in the guide ring 1012 is shown, and Figure 17 A tapping drill bit 1200 in the guide ring 1008 is shown. Unlike the combination guides 300, 400, the combination guide 1000 does not have a dogleg section between the elongated body 1006 and the guide ring.

[0082] Figure 18 An anchor to the occipital bone is shown 110. The actuator 250 of the plate holder instrument 200 is moved to the release position to disengage the bone plate 110 from the plate receiving recess 240.

[0083] The instruments described herein can be manufactured using various materials, including but not limited to various stainless steel alloys. The grade of the alloy can be selected based on the desired strength, hardness, corrosion resistance, wear properties, and other performance criteria.

Claims

1. A plate retainer instrument (200), comprising: A base (210) having a proximal end (212) and a distal end (214) opposite to the proximal end (212), the base (210) defining a longitudinal axis (216) extending in the longitudinal direction from the proximal end (212) to the distal end (214); A clamp (230) is displaceable relative to the base (210) in the longitudinal direction and forms a plate receiving groove (240) with the base (210). The clamp (230) is displaceable between a release position and a clamping position, wherein the release position allows the bone plate (110) to be loaded into and removed from the plate receiving groove (240), and the clamping position locks the bone plate (110) in the plate receiving groove (240). as well as An actuator (250) is displaceable relative to the base (210) in a first direction to move the clamp (230) to the release position, and is displaceable relative to the base (210) in a second direction to move the clamp (230) to the clamping position. The plate retainer instrument (200) further includes fasteners that detachably connect the guide accessory to the plate retainer instrument (200).

2. The plate retainer instrument (200) according to claim 1, wherein, The actuator (250) includes a lever arm (252) which is pivotally mounted to the proximal end (212) of the base (210) via a hinge (218).

3. The plate retainer instrument (200) according to claim 2, wherein, The actuator (250) also includes a linkage member (254) connected between the lever arm (252) and the clamp (230).

4. The plate retainer instrument (200) according to claim 3, wherein, The linkage member (254) has a first link end (256) pivotally connected to the lever arm (252) and a second link end (258) pivotally connected to the clamp (230).

5. The plate retainer instrument (200) according to claim 1, wherein, The base (210) includes a first plate holding surface (211), and the clamp (230) includes a second plate holding surface (231).

6. The plate retainer instrument (200) according to claim 5, wherein, The plate receiving groove (240) extends between the first plate holding surface (211) and the second plate holding surface (231).

7. The plate retainer instrument (200) according to claim 5 or 6, wherein, The second plate holding surface (231) is capable of moving away from the first plate holding surface (211) in response to the actuator (250) moving relative to the base (210) in the first direction.

8. The plate retainer instrument (200) according to claim 5 or 6, wherein, The second plate holding surface (231) is capable of moving toward the first plate holding surface (211) in response to the actuator (250) moving relative to the base (210) in the second direction.

9. The plate retainer instrument (200) according to claim 5 or 6, wherein, The first plate holding surface (211) includes a first pair of pawls (213) protruding from the base (210), and the second plate holding surface (231) includes a second pair of pawls (233) protruding from the clamp (230).

10. The plate retainer instrument (200) according to claim 1 or 2, wherein, The plate receiving groove (240) includes a first inclined surface (244) on a first side (216A) of the longitudinal axis (216) and a second inclined surface (246) on a second side (216B) of the longitudinal axis (216), the second inclined surface (246) being not parallel to the first inclined surface (244).

11. The plate retainer instrument (200) according to claim 1 or 2, wherein, The base (210) includes at least one stop surface (215), and the clamp (230) includes at least one stop member (235) configured to abut the stop surface (215) when the clamp (230) is moved to the clamping position.

12. The plate retainer instrument (200) according to claim 1, wherein, The fastener includes a clip (260).

13. The plate retainer instrument (200) according to claim 1 or 2, wherein, The clamp (230) can be further moved relative to the base (210) to a cleaning position, in which the clamp (230) is separated from the base (210) for disinfection.

14. The plate retainer instrument (200) according to claim 13, wherein, The actuator (250) is movable in the first direction to move the clamp (230) from the release position to the cleaning position.

15. A kit for attaching a bone plate to a posterior region of a patient's skull, the kit comprising: The plate retainer instrument (200) according to any one of claims 1 to 14.

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