Proximal femur plate system

Abstract

To provide a bone plate for treating periprosthetic fractures.SOLUTION: A bone plate 100 includes a head portion 102, sized and shaped so that, in an operative position, a proximal end 114 of the head portion aligns with a vastus ridge of a greater trochanter of a femur. The plate also includes a shaft portion 104 extending distally from the head portion. The shaft portion includes offset holes 106 to receive bone fixation elements therethrough. Each of the offset holes includes a first hole 110 positioned on a first side of a longitudinal axis of the plate and a second hole 112 positioned on a second side of the longitudinal axis opposite the first side, so that the bone fixation elements inserted therethrough extend anterior and posterior of a prosthetic received within the femur. The first and second holes are staggered relative to one another along a length of the shaft portion.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] (Priority Claim) This application claims priority to U.S. Provisional Patent Application Nos. 62 / 470,753 and 62 / 470,766, filed March 13, 2017, the entire disclosures of both of which are expressly incorporated herein by reference. [Background technology]

[0002] Proximal femoral fractures can be treated with a bone plate positioned along the femur to extend across the fracture site. However, in some cases, particularly periprosthetic fractures, fixation of the bone plate can be difficult because the bone fixation elements must be inserted through the bone without interfering with the stem of a previously implanted THA (total hip arthroplasty) system or other intramedullary device. Summary of the Invention [Means for solving the problem]

[0003] An embodiment of the present invention is directed to a bone plate for treating periprosthetic fractures, the bone plate including a head portion, the head portion being sized and shaped such that in a surgical position, a proximal end of the head portion is aligned with the vastus ridge of the greater trochanter of the femur, and a shaft portion extending distally from the head portion, the shaft portion including a pair of offset holes extending therethrough for receiving a bone fixation element therethrough, each of the pair of offset holes including a first hole positioned on a first side of a longitudinal axis of the bone plate and a second hole positioned on a second side of the longitudinal axis opposite the first side, whereby a bone fixation element inserted through the first and second holes extends anteriorly and posteriorly of a prosthesis received within the femur, the first and second holes being staggered relative to each other along a length of the shaft portion and extending beyond a longitudinal edge of the shaft portion. [Brief description of the drawings]

[0004] [Figure 1] 1 illustrates a top view of a proximal femur plate according to an exemplary embodiment of the present disclosure. [Diagram 2] 2 shows a longitudinal cross-sectional view of the proximal femur plate of FIG. 1 taken along line AA. [Diagram 3] 2 illustrates a perspective view of a locking attachment plate connectable to the proximal femur plate of FIG. 1 in accordance with an exemplary embodiment of the present disclosure. [Figure 4] FIG. 4 illustrates a top view of the locking mounting plate of FIG. 3. [Diagram 5] FIG. 4 shows a side view of the locking mounting plate of FIG. [Figure 6] 2 illustrates a top view of a greater trochanter mounting plate connectable to the proximal femur plate of FIG. 1 according to a first exemplary embodiment of the present disclosure. [Figure 7] FIG. 7 shows a longitudinal side view of the greater trochanter mounting plate of FIG. 6. [Figure 8] FIG. 7 shows a bottom view of the greater trochanter mounting plate of FIG. 6. [Figure 9] 7 shows a perspective view of a connection screw for connecting the greater trochanter mounting plate of FIG. 6 with the proximal femur plate of FIG. 1 . [Figure 10] FIG. 10 shows a longitudinal section of the connecting screw of FIG. [Figure 11] 10 shows a top view of the connection screw of FIG. 9 . [Figure 12] FIG. 2 shows a perspective view of a greater trochanter mounting plate connectable to the proximal femur plate of FIG. 1 according to a second exemplary embodiment of the present disclosure. [Figure 13] 13 illustrates another perspective view of the greater trochanter mounting plate of FIG. 12. [Figure 14] FIG. 1 illustrates a side view of a distal condylar plate according to an embodiment of the present invention. [Figure 15] 15 shows a perspective view of the distal condyle plate of FIG. 14. [Figure 16] FIG. 16 shows a perspective view from the plate end of the plate of FIGS. 14 and 15. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0005] The present invention can be understood in conjunction with the following description and the accompanying drawings, in which like elements are referred to by the same reference numerals. The present invention relates to fracture treatment, and in particular to periprosthetic proximal femoral fracture treatment. An exemplary embodiment describes a modular fixation system comprising a proximal femoral plate that can be coupled to a greater trochanter attachment plate and / or a locking attachment plate to treat periprosthetic fractures of the proximal femur. The proximal femoral plate includes a head portion configured to be positioned beneath the greater trochanter and a shaft portion extending distally from the head portion to be positioned along the proximal length of the femur. The proximal femoral plate includes a pair of offset holes, a first of the holes positioned on a first side of a longitudinal axis of the plate and a second of the holes positioned on a second side of the longitudinal axis, such that bone fixation elements can be positioned on both the anterior and posterior sides of the prosthesis (e.g., a THA stem). Each of the holes extends from a longitudinal side of the proximal femoral plate to prevent bone fixation elements inserted through the holes from interfering with the intramedullary implant. The system may further include a greater trochanter attachment plate configured to be coupled to the proximal femoral plate to provide greater trochanter fixation, and / or a locking attachment plate coupleable to the proximal femoral plate to provide additional fixation along a shaft portion of the proximal femoral plate. It is noted that the terms "proximal" and "distal" are intended to refer to directions relative to the bone on which the system is placed. For example, as will be understood by one of ordinary skill in the art, with reference to the femur, proximal refers to a direction toward the hip joint and distal refers to a direction toward the knee.

[0006] 1-11 show a system for treating periprosthetic fractures. The system includes a proximal femoral plate 100 as shown in FIGS. 1-2, which may be used to treat Vancouver Type B fractures, for example, near the stem of a pre-placed THA prosthesis or other intramedullary device. The proximal femoral plate 100 includes a head portion 102 configured to be positioned beneath the greater trochanter of the femur and a shaft portion 104 extending from the head portion 102 to be positioned along the shaft of the femur. The shaft portion 104 includes a pair of offset holes 106 along the shaft portion 104. Each pair includes a first hole 110 on a first side of the longitudinal axis and a second hole 112 on a second side of the longitudinal axis opposite the first side, such that bone fixation elements can be inserted through the first and second holes 110, 112 on either side of the THA to provide fixation on both the anterior side of the prosthesis and the posterior side of the prosthesis. The first and second holes 110, 112 are offset or staggered relative to one another along the length of the shaft portion 104 to prevent bone stress risers. A locking attachment plate 200, shown in FIGS. 3-5, can be mounted on the shaft portion 104 of the proximal femur plate 100 between adjacent pairs of offset holes 106 to provide additional fixation openings, if desired. A greater trochanter (GT) attachment plate 300, shown in FIGS. 6-8, 12, and 13, can be coupled to the head portion 102 of the proximal femur plate 100 to provide fixation of a Vancouver Type A fracture, for example, in the greater trochanter. The proximal femur plate 100 can be modularly coupled with the locking attachment plate 200 and / or the GT attachment plate 300 or 400 to provide targeted fixation designed to treat a patient-specific fracture pattern. Although the proximal femur plate 100 is described as being coupled to the locking attachment plate 200 and / or the GT attachment plate 300, those skilled in the art will appreciate that the proximal femur plate 100 may be used alone along its proximal length to treat a femoral fracture.

[0007] 1-2, a proximal femur plate 100 according to an exemplary embodiment of the present disclosure includes a head portion 102 configured to be positioned in a surgical position beneath the greater trochanter and in line with its opposing lesser trochanter such that a proximal end 114 of the head portion 102 is aligned with the vastus ridge of the femur (i.e., the inferior edge of the greater trochanter). A shaft portion 104 extends distally from the head portion 102 for positioning along the proximal length of the femur and includes a pair of offset holes 106. In one embodiment, the shaft portion 104 may include a proximal portion 108 having the pair of offset holes 106 extending therethrough, and may further include a distal portion 116 including a plurality of fixation holes 118 therealong for fixing the distal portion 116 of the shaft portion 104 to bone. The proximal femur plate 100 may be curved about a longitudinal axis of the femur plate 100, and the length of the shaft 104 may extend along a slight curvature relative to the longitudinal axis to accommodate the shape of the femur along which the proximal femur plate 100 is positioned. The head portion 102 and shaft 104 may be angled slightly relative to one another to accommodate the shape of the femur at the point where the greater trochanter meets the shaft of the femur.

[0008] The head portion 102 extends from a proximal end 114 to a distal end 120 connected to the shaft portion 104. The proximal end 114 in this embodiment includes a curvature that generally corresponds to the curvature of the vastus ridge so that the proximal femoral plate 100 can be positioned correspondingly thereto. The head portion 102 includes a first set of holes 122 extending therethrough on a first side of a longitudinal axis of the proximal femoral plate 100 and a second set of holes 124 extending therethrough on a second side of the longitudinal axis opposite the first side. The first and second sets of holes 122, 124 may be configured to receive bone fixation elements for securing the head portion 102 to bone. In an exemplary embodiment, each of the first and second sets of holes 122, 124 may be configured as a variable angle hole such that a bone fixation element may be inserted through each of the holes along the axis at an angle within a range of angles allowed relative to the central axis. However, one of ordinary skill in the art will appreciate that the holes of the first and second sets of holes 122, 124 may have any of a variety of configurations, so long as the holes 122, 124 are configured to receive a bone fixation element therethrough. For example, the first and second sets of holes 122, 124 may include locking holes. The central axis of the locking hole may be selected to allow a bone fixation element to be inserted therethrough without interfering with any portion of the intramedullary implant. In an exemplary embodiment, the holes 122, 124 may be configured to receive a 3.5 mm hole, which, as one of ordinary skill in the art will appreciate, is not commonly used in femoral bones because typical trauma plates typically include larger holes that are typically used to treat fractures, whether or not the fracture is a periprosthetic fracture. However, in the case of periprosthetic and osteoporotic fractures, smaller holes may be more desirable since there is less bone through which the bone fixation element can be inserted, for example bone that is not blocked by any portion of the THA implant.

[0009] Corresponding holes of the first and second sets of holes 122, 124 may be aligned with one another along the length of the head portion. A first axis L1 extending through a central axis of each of the first set of holes 122 may taper from the proximal end 114 toward the distal end 120 of the head portion 102. Similarly, a second axis L2 extending through a central axis of each of the second set of holes 124 may taper from the proximal end 114 toward the distal end 120. In other words, the most proximal one of the first holes 122 is separated from the most proximal one of the second holes 124 by a distance that is greater than the distance separating the most distal first hole 122 and the most distal second hole 124. The first and second axes L1, L2 of this embodiment taper from the proximal end 114 toward the distal end 120 relative to the longitudinal axis of the proximal femur plate 100, such that when the plate 100 is positioned along the femur in a surgical position, the first and second axes substantially correspond to a tapered shape typically found in the stem of an intramedullary implant. For example, the taper angle between L1 and L2 may be 1E to 40E. One exemplary embodiment includes three first holes 122 and three corresponding second holes 124. However, it will be understood by one of ordinary skill in the art that the device may include any desired number of first and second holes 122, 124.

[0010] The head portion 120 may further include a plurality of suture openings 126, each configured to receive a suture therethrough when suturing surrounding tissue to the proximal femur plate 100. Additionally, as described in further detail below, the head portion 120 includes a first GT attachment opening 128 that is sized and shaped to receive a connecting screw 350, shown in Figures 9-11, when coupling the GT mounting plate 300 to the proximal femur plate 100. The first GT attachment opening 128 may be threaded to engage a threaded portion of the connecting screw 350.

[0011] The shaft portion 104 extends distally from the distal end 120 of the head portion 102. As described above, the shaft portion 104 includes a proximal portion 108 including a pair of offset holes 106 and a distal portion 116 including a fixation hole 118. In the operative position, the proximal portion 108 extends along a portion of the femur through which, for example, the stem of a THA prosthesis extends. Each pair of offset holes 106 includes a first hole 110 extending through the shaft portion 104 on a first side of the longitudinal axis and a second hole 112 extending through the shaft portion 104 on a second side of the longitudinal axis opposite the first side, such that a bone fixation element can be inserted through these holes along both the anterior and posterior sides of the stem of the prosthesis. The first and second holes 110, 112 are also staggered relative to the length of the shaft portion to minimize stress risers. In one embodiment, since it has been found that in some cases the posterior aspect of the femur has better bone quality, the second hole 112 (e.g., one of the holes 110, 112 on the posterior side of the prosthesis in the surgical position) may be positioned distal to the first hole 110. The corresponding holes 110, 112 may be offset from each other by a distance of 5-15 mm, in an exemplary embodiment, such that an axis connecting the center point of the first hole 110 with the center point of the corresponding second hole 112 forms an angle of about 16.4E-41.4E with respect to the longitudinal axis of the plate 100. It may be desirable to have holes further along the posterior aspect lower (i.e., more distal) so that the bone fixation element can be inserted through the higher quality bone in the lower part of the bone where the cross-sectional area of ​​the stem is smaller, maximizing fixation of the proximal femur plate 100 to the bone.

[0012] The first and second holes 110, 112 of each pair of offset holes 106 extend beyond the first and second longitudinal edges 130, 132, respectively, of the shaft portion 104 to allow the plate to have a smaller width (e.g., the distance between the longitudinal edges of a portion of the shaft 104 between adjacent first holes 110 and between adjacent second holes 112) than conventional trauma plates and to increase the likelihood of placement around the stem prosthesis. In one embodiment, the central axes of the first and second holes 110, 112 may be aligned with the longitudinal edges 130, 132 of the shaft portion 104. The distance between adjacent pairs of offset holes 106 is selected to allow the locking attachment plate 200 shown in FIGS. 3-5 to be mounted thereon without interfering with either the first and second holes 110, 112 of each pair of offset holes 106. In other words, the distal hole of the first and second holes 110, 112 of the first pair of offset holes 106 should be separated from the proximal hole of the first and second holes 110, 112 of the second adjacent pair of offset holes 106 by a distance of at least the length of the locking attachment plate 200 so that the plate 200 can be positioned on the narrow portion of the plate between adjacent first holes 110 on one side of the shaft 104 and between adjacent holes of the second holes 112 on the other side of the shaft 104.

[0013] As described in more detail below, the proximal portion 108 may further include locking attachment openings 134 extending through a portion of the proximal portion 108 between adjacent pairs of offset holes 106 for attaching the mounting plate 200 to the proximal femoral plate 100. A screw or other fixation element is inserted into a portion of the mounting plate 200 and through the locking attachment openings 134 to secure the mounting plate 200 to the proximal femoral plate 100. The locking attachment openings 134 may be configured as variable angle holes or any other holes capable of receiving a fixation element therein. In one embodiment, the proximal portion 108 of the shaft portion 104 may include three pairs of offset holes 106 and two connecting openings 134. However, one skilled in the art will appreciate that the number of pairs of offset holes 106 may vary depending on the desired length of the proximal portion 108 (e.g., the length of the stem prosthesis) and the length of the locking attachment plate 200. If the locking attachment opening 134 is not used to connect the locking attachment plate 200 to the proximal femoral plate, a fixation element, such as, for example, a variable angle positioning pin, can be inserted therein to connect the shaft portion 104 to the bone using a cable. As described in more detail below, the proximal end 136 of the proximal portion 108 may further include a second GT attachment opening 138 for connecting the GT attachment plate 300 to the proximal femoral plate 300 using, for example, a connecting screw 350. Similar to the first GT attachment opening 128, the second GT attachment opening 138 may be threaded to engage the threaded portion of the connecting screw 350.

[0014] The distal portion 116 of the shaft portion 104 may extend along a portion of the femur distal to the stem of the prosthesis in the surgical position. The distal portion 116 includes a number of fixation openings 118 along its length. In one embodiment, one or more of the fixation openings 118 may be offset laterally relative to the longitudinal axis of the shaft portion 104. In other words, the central axis along which the fixation openings 118 extend through the distal portion 116 may extend parallel to the longitudinal axis on either side of the longitudinal axis. However, the fixation openings 118 do not extend beyond either of the first and second longitudinal edges 130, 132 because a bone fixation element inserted therethrough need not extend to the side of the prosthesis. In one embodiment, the fixation openings 118 may be configured as a combination hole including a first portion 140 configured as a variable angle opening and a second portion 142 configured as a compression opening. Thus, a variety of bone fixation elements, such as, for example, variable angle locking screws, compression screws, and variable angle positioning pins with cables, can be inserted into the fixation openings 118. Although the exemplary embodiment of the proximal femur plate 100 is described and shown as including proximal and distal portions 108, 116, as will be described in more detail below, the proximal femur plate 100 may be manufactured as a short plate having a proximal portion 108 with a pair of offset holes 106 extending therethrough and an elongated combination hole formed on the portion extending distally from the proximal portion.

[0015] 3-5, the locking mounting plate 200 extends from a proximal end 202 to a distal end 204 along a longitudinal axis of the mounting plate 200 and is configured to be mounted on the shaft portion 104 of the proximal femur plate 100 between adjacent pairs of offset holes 106. The locking mounting plate 200 includes a body portion 206 sized and shaped to be mounted on the proximal portion 108 of the proximal femur plate 100 with a first laterally extending wing 208 and / or a second laterally extending wing 210 extending from the first laterally extending wing 208. Each of the first and second laterally extending wings 208, 210 includes a bone fixation element receiving opening 212, 214 extending therethrough, respectively. As described in more detail below, the locking mounting plate 200 may be useful when additional fixation of the proximal femur plate 100 is desired and / or when the proximal femur plate 100 must accommodate a larger portion of a stem or other prosthesis.

[0016] The body portion 206 is sized and shaped to be mounted or seated on a surface of the shaft portion 104 of the proximal femur plate 100 facing away from the bone in the operative position. Specifically, the body portion 210 may have a substantially bracket-like shape that extends over the longitudinal edges 130, 132 along the surface of the proximal femur plate 100 in the operative position. The body portion 206 may further include a body opening 224 extending therethrough. A connecting screw or other fixation element may be inserted through the body opening 224 and one of the locking attachment openings 134 of the proximal femur plate 100 to couple the locking attachment plate 200 to the proximal femur plate 100 at a desired position along the proximal femur plate 100. As discussed above, the length of the body portion 206 (i.e., the distance between its proximal and distal ends 202, 204) corresponds to the distance between adjacent pairs of offset holes 106.

[0017] First and second laterally extending wings 208, 210 extend from first and second longitudinal sides 212, 214, respectively, of the body portion 206. One skilled in the art will appreciate that the wings 208, 210 may be contoured (e.g., bent) by a user to better fit a patient's anatomy. Thus, in a surgical position, the first and second laterally extending wings 208, 210 extend laterally beyond the longitudinal edges 130, 132 of the proximal femoral plate 100 to contact the bone. Each of the first and second laterally extending wings 208, 210 includes a bone fixation element receiving opening 216, 218 extending therethrough. In one embodiment, each of the first and second wings 208, 210 includes two bone fixation element receiving openings 216, 218. Preferably, the two bone fixation elements may be inserted at an angle relative to one another through the openings 216, 218 (a first fixation element through one of the openings 216 extending through the first wing 208, and a second fixation element through one of the openings 218 extending through the second wing 210) such that the bone fixation elements are staggered along the length of the bone. Similar to the offset holes 106 of the proximal femur plate 100, this may be done to prevent stress risers. In one embodiment, the bone fixation element receiving openings 216, 218 may be configured as variable angle holes.

[0018] A connecting portion 220 of the locking attachment plate 200 connecting the body portion 206 with the first and / or second wings 208 may include a groove 22 extending along the connecting portion 220 to allow the first and second wings 208, 210 to flex relative to the body portion 206 to conform the attachment plate 200 to a particular patient's bone. As discussed above, the first and second wings 208, 210 should contact the bone when the assembly of the proximal femur plate 100 and the locking attachment plate 200 is positioned along the bone.

[0019] Because the first and second wings 208, 210 extend beyond the longitudinal edges 130, 132 of the proximal femur plate, the locking attachment plate 200 may be particularly useful in situations where the proximal femur plate 100 must be secured to a portion of a bone that has a large portion of the stem of a prosthesis extending therethrough. In other words, the distance between the openings 216, 218 is greater than the distance between the first hole 110 and the second hole 112 of the pair of offset holes 106 to accommodate a larger portion of the stem. Alternatively or additionally, the locking attachment plate 200 may be used to provide fixation in addition to that provided by the pair of offset holes 106.

[0020] As shown in Figures 6-8, the GT mounting plate 300 is configured to be attached to the head portion 102 of the proximal femoral plate 100 to treat fractures of the greater trochanter. The GT mounting plate 300 extends along a longitudinal axis from a proximal end 302 to a distal end 304. As shown in Figures 9-11, the GT mounting plate 300 includes a distal portion 306 having a first connecting opening 308 and a second connecting opening 310, through which the GT mounting plate 300 is coupled to the proximal femoral plate 100 via a connecting screw 350. Although the GT mounting plate 300 is described as being secured in a fixed position to the plate 100 via the connecting screw 350, one skilled in the art will appreciate that the position of the GT plate 300 relative to the plate 100 may be adjustable (e.g., by providing multiple connection points on either the GT plate 300 or the plate 100, including an elongated hole into which the connecting screw may be attached, etc.). The proximal portion 312 extends along a curvature that corresponds to the curvature of the portion of the greater trochanter on which it is positioned, such that when the GT mounting plate 300 is assembled with the proximal femur plate 100, the proximal portion 312 extends proximally from the proximal end 114 of the proximal femur plate to extend along the greater trochanter. The proximal end 302 includes a pair of hooks 314 configured to engage an upper ridge at the proximal end of the greater trochanter. The GT mounting plate 300 may be secured to the greater trochanter via a bone fixation element inserted through one or more of a pair of holes 330 extending through the proximal portion 312 and / or a cable inserted through a cable hole 316 extending through the proximal portion 312.

[0021] The GT mounting plate 300 may be defined via a first surface 318 that faces away from the bone when the GT mounting plate 300 is in a surgical position on the bone, and a second surface 320 that faces the bone when the GT mounting plate 300 is in a surgical position on the bone. The first and second surfaces 318, 320 are connected to one another via longitudinal sides 322, 324. As described above, the GT mounting plate 300 is connected to the proximal femoral plate 100 by placing the distal portion 306 on the proximal femoral plate 100 such that the first and second connecting openings 308, 310 are aligned with the first and second GT mounting openings 128, 138, respectively. Once the openings 308, 128, and 310, 138 are aligned, a connecting screw 350 that may be captured within the GT mounting plate 300 may be threaded into the proximal femoral plate 100. Alternatively, the connection screws may be inserted into openings in the GT mounting plate 300 to connect the plate 300 to the femoral plate 100.

[0022] The GT mounting plate 300 and the proximal femur plate 100 may further include corresponding features to aid in alignment and provide rotational resistance. For example, the GT mounting plate 300 may include a pair of locating pins 326 projecting from the second surface 320 for receipt within correspondingly sized, shaped, and positioned locating openings 144 of the proximal femur plate 100 when the distal portion 306 is properly aligned and superimposed with the proximal femur plate 100. The GT mounting plate 300 may also include a shoulder 328 extending along the second surface 320 such that the shoulder abuts the proximal end 114 of the proximal femur plate 100 when the GT mounting plate 300 is properly aligned with the proximal femur plate 100. The shoulder 328 is sized, shaped, and positioned along the second surface 320 to correspond to the proximal end 114. Thus, when the shoulder 328 and locating pin 326 engage the proximal end 114 and locating opening 144, respectively, the GT mounting plate 300 is properly aligned with the proximal femur plate 100 and prevented from rotating relative to the proximal femur plate 100.

[0023] As discussed above, the GT mounting plate 300 may be attached to the proximal femoral plate 100 using connection screws 350, shown in Figures 9-11. Each connection screw 350 includes a head portion 352 and a shaft portion 354 extending from the head portion 352. The shaft portion includes an unthreaded portion 356 directly adjacent the head portion 352 and a threaded portion 358 extending therefrom. The head portion 352 includes a recess 360 for receiving a correspondingly sized and shaped portion of a driver, as will be understood by those skilled in the art. As discussed above, once the GT mounting plate 300 and the proximal femoral plate 100 are aligned, the first connection screw 350 is driven through the first connection opening 308 and the first GT mounting opening 128 until the head portion 352 abuts the first surface 318 of the mounting plate 300. The unthreaded portion should reside within the first connection opening 308 while the threaded portion engages with the corresponding threads of the first GT mounting opening 128. Similarly, the second connection screw 350 is inserted through the second connection opening 310 and the second GT mounting opening 138 until the head portion 352 abuts the first surface 318 and the unthreaded portion 356 rests within the second connection opening 310 while the threaded portion 358 engages with the corresponding threaded second GT mounting opening 138. As mentioned above, the connection screw 350 may be driven into the corresponding openings by a driver received in the recess 360.

[0024] As discussed above, when the assembly of the GT mounting plate 300 and the proximal femur plate 100 is placed in a desired position along the femur, the proximal portion 312 of the GT mounting plate 300 extends along the greater trochanter. Thus, the proximal portion 312 extends along a curvature that corresponds to the shape of the portion underlying the greater trochanter. The proximal end 302 includes a pair of hooks 314 for engaging the greater trochanter along with a pair of holes 330 and a cable hole 316 to provide fixation.

[0025] Each of the hooks 314 curves from the proximal end 312 toward the distal end 304 of the GT mounting plate 300 such that at the desired location on the bone, each of the hooks 314 engages with the superior prominence of the greater trochanter. As will be appreciated by those skilled in the art, the hooks 314 may vary in length and / or radius of curvature to accommodate asymmetries in the anatomy of the underlying portion of the greater trochanter. The GT mounting plate 300 includes two hooks 314 such that the hooks 314 do not interfere with any portion of the prosthesis. Specifically, one hook 314 extends anteriorly relative to the prosthesis and the other hook extends posteriorly relative to the prosthesis.

[0026] The pair of holes 330 extend through the proximal portion 312 from the first surface 318 to the second surface 320. Each of the pair of holes 330 includes a first hole 332 on a first side of the longitudinal axis of the GT mounting plate and a second hole 334 on a second side of the longitudinal axis opposite the first side, such that a bone fixation element inserted through the first hole 332 and the second hole 334 can extend anteriorly and posteriorly of the prosthesis. The first and second holes 332, 334 of each of the pair of holes 330 may be substantially aligned along the length of the GT mounting plate 300. Similar to the pair of offset holes 106 of the proximal femur plate, the first and second holes 332, 334 may extend beyond the longitudinal edges of the GT mounting plate 300. In one embodiment, the central axis along which each of the first and second holes 332, 334 extends may be substantially aligned with the longitudinal edge. The first and second holes allow for the placement of bone fixation elements anterior-inferior and posterior-inferior positions of the prosthesis toward the femoral calcaneus. The first and second holes 332, 334 may be configured as variable angle holes such that the bone fixation elements may be inserted at angles within an allowable range of angulation relative to the central axis. However, one skilled in the art will appreciate that one or more of the first and second holes 332, 334 of each of the paired holes 330 may have different configurations for receiving bone fixation elements. In one embodiment, the proximal portion 312 may include three paired holes 314. However, the number of paired holes 314 may vary.

[0027] The GT mounting plate 300 may further include one or more extension tabs 315 extending laterally from a portion of the proximal portion 312 that includes the first and second holes 332, 334. In one particular embodiment, each extension tab 315 may extend substantially perpendicular to the longitudinal axis of the GT mounting plate 300. Each extension tab 315 includes an opening 335 extending through an end for receiving a bone fixation element. The opening 335 may also be configured as a variable angle hole. The number of extension tabs 315 may vary depending on the desired fixation of the GT mounting plate 300 and / or the anatomy of the greater trochanter over which the GT mounting plate 300 is to be placed. The extension tabs 315 may be curved as desired to accommodate a patient-specific anatomy.

[0028] The proximal portion 312 may also include a pair of cable lumens 316, with each lumen 316a, 316b sized and shaped to receive a portion of a cable therein. Each of the lumen 316a, 316b of the pair of cable lumens 316 extends through the proximal portion 312 from the first longitudinal side 322 to the second longitudinal side 324. Each of the pair of cable lumens 316 extends between adjacent pairs of lumen 330 such that placement of the cable does not interfere with placement of a bone fixation element through the lumen 332, 334 of the pair of lumen 330. As will be appreciated by those skilled in the art, a cable may be routed around the proximal end of the femur such that portions of the cable are received within the first and second cable lumens 316a, 316b. The cables are tensioned and ends of the cables are secured to the GT mounting plate 300, for example by crimps, to secure the GT mounting plate 300 to the bone and / or to provide greater trochanter fixation. The proximal portion 312 may include an elongated opening 336 extending therethrough along the longitudinal axis of the GT mounting plate 300 from the first surface 318 to the second surface 320 to accommodate a crimp for securing the cables therein. Specifically, the elongated opening 336 is in communication with the cable holes 316a, 316b, such that the cables passing through the first and second cable holes 316a, 316b must also pass laterally through the elongated opening 336. The cables may wrap around the proximal end of the femur (e.g., extend around the lesser trochanter of the femur) such that portions of the cables extend through the first and second holes 316a, 316b that pass laterally through the elongated opening 336. The crimps received within the elongated opening 336 may be crimped onto the portion of the cable passing through the elongated opening 336 to maintain the cable in a tensioned configuration. The crimps may be positioned within the elongated opening 336 such that no portion of the crimp protrudes substantially beyond the first surface 318. In one exemplary embodiment, the proximal portion includes two pairs of cable holes 316.

[0029] 12-13, a GT mounting plate 400 according to another exemplary embodiment may be similarly assembled with the proximal femoral plate 100 so as to be positioned over the greater trochanter of the femur. Similar to the GT mounting plate 300, the GT mounting plate 400 includes a distal portion 406 for connecting the GT mounting plate 400 to the proximal femoral plate 100 and a proximal portion 412 for placement over the greater trochanter. The distal portion 406 is substantially similar to the distal portion 306, and may similarly be attached to the proximal femoral plate using a connecting screw 350 inserted through first and second connecting openings 408, 410 that align with the first and second GT mounting openings 128, 138 of the proximal femoral plate 100, respectively. Similar to the GT mounting plate 300, the position of the GT mounting plate 400 relative to the plate 100 may be adjustable (e.g., by providing multiple connection points on either the GT mounting plate 400 or the plate 100, including slotted holes into which the connection screws 350 may be attached, etc.). The GT mounting plate 400 may further include similar alignment features, such as, for example, a locating pin 426 protruding from a surface 420 of the GT mounting plate 400 that faces toward the bone in the surgical position, and / or a shoulder 428 extending along the second surface 420. The locating pin 426 and shoulder 428 may engage the opening 144 and proximal end 114 of the proximal femur plate 100, respectively.

[0030] However, rather than extending along the greater trochanter and engaging the greater trochanter with a hook at its proximal end, the proximal portion 412 includes a substantially ring-shaped portion 440 configured to seat on the greater trochanter, with a central opening of the ring-shaped portion positioned to avoid the trochanteric bursa, particularly the area where the tendon connects to the bone, and a plurality of extension tabs 414 extending radially therefrom. Each of the extension tabs 414 and the ring-shaped portion 440 includes a bone fixation element receiving hole extending therethrough, respectively, for securing the GT mounting plate 400 to the bone. The ring-shaped portion 440 is sized and shaped to seat on the greater trochanter and includes a plurality of first holes 432 extending therethrough. In one embodiment, the first holes 432 may be equidistantly spaced around the ring-shaped portion 440. The first holes 432 may be configured as variable angle holes for receiving bone fixation elements therein at a desired angle relative to a central axis along which the first holes extend. In the illustrated example, the ring-shaped portion includes six first holes 432. However, one skilled in the art will appreciate that the number of first holes 432 may vary depending on the size of the ring-shaped portion 440. The GT mounting plate 400 may be manufactured in a variety of sizes having ring-shaped portions 440 of different sizes so that a GT mounting plate 400 suitable for a patient's specific anatomy may be selected.

[0031] Ring-shaped portion 440 may further include a number of suture holes 442 extending therethrough. Each suture hole 442 may be positioned between two adjacent first holes 432 and may extend through a portion of ring-shaped portion 440 having an undercut such that ring-shaped portion 440 may be sutured to surrounding tissue through suture holes 442.

[0032] The extension tabs 414 extend radially away from the ring-shaped portion 440, with each extension tab 414 including a second hole 434. The extension tabs 414 may be bent as desired to accommodate a patient's specific anatomy. Each extension tab 414 may extend from a portion of the ring-shaped portion 440 that includes the first opening 432. However, depending on the anatomy over which it is desired that the extension tabs 414 extend, it is not necessary that the extension tabs 414 extend from each of the first openings 432. The second holes 434 may be configured as variable angle holes as well. In one embodiment, the GT mounting plate 400 includes five extension tabs 414. However, one skilled in the art will appreciate that the number of tabs 414 may vary depending on the dimensions of the ring-shaped portion 440, the number of first holes 432, and / or the anatomy of the greater trochanter over which the GT mounting plate 400 is disposed. The first and second holes 432, 434 in the GT mounting plate 400 allow for the insertion of bone fixation elements anterior-inferior, posterior-inferior, and superior to the prosthesis toward the femoral calcaneus.

[0033] According to an exemplary surgical method using the above-described system, a surgeon or other user can evaluate the type of periprosthetic fracture and the patient's specific anatomy to determine which plate 100, 200, 300 should be utilized. In some cases, such as when the fracture extends only along the proximal shaft portion of the femur, the surgeon can determine that the proximal femoral plate 100 may be utilized alone. If a greater trochanteric fracture is also present and / or additional fixation is required, the surgeon can determine to utilize the proximal femoral plate 100 in conjunction with the GT attachment plate 300 (or 400) and / or the locking attachment plate 200. The following method describes the use of an assembly including all of the plates 100, 200, and 300. However, one skilled in the art will appreciate that the proximal femoral plate 100 may be utilized alone in a substantially similar manner.

[0034] If two or more plates are utilized, the plates should be assembled prior to embedding within the body. Specifically, a connecting screw 350 may be used to connect the distal portion 306 of the GT mounting plate 300 to the proximal femoral plate 100, as described above. Similarly, a fixation element may be used to connect the locking mounting plate 200 between adjacent pairs of offset holes 106 along the proximal portion 108 of the shaft portion 104 of the proximal femoral plate 100, as described above. Once the plates 100, 200, and 300 are assembled, the assembly is positioned along the proximal femur such that the hook 314 of the GT mounting plate 300 engages the superior ridge of the greater trochanter such that the proximal portion 312 of the GT mounting plate 300 extends along the greater trochanter and the proximal femoral plate 100 may extend distally therefrom along the length of the femur. Specifically, the proximal end 114 of the proximal femur plate 100 should be aligned with the vastus ridge of the greater trochanter.

[0035] Once the assembly is positioned along the proximal femur, bone fixation elements can be inserted through the desired ones of the first and second holes 108, 110 of the pair of offset holes 106, the first and second sets of holes 122, 124, the first and second bone fixation element receiving holes 216, 218 of the mounting plate 200, and the first and second holes 332, 334 of the pair of holes 330. As mentioned above, all of these holes may be configured as 3.5 mm variable angle holes. Inserting the bone fixation elements into these holes allows for insertion of the bone fixation elements anteriorly and posteriorly relative to the prosthesis. The bone fixation elements can be inserted through the desired ones of the fixation holes 118 along the distal portion 116 of the proximal femur plate to provide fixation of the plate assembly distal to the prosthesis.

[0036] One or more cables may be inserted into the pair of cable holes 316 to provide compression of the greater trochanter. Once the cables are wrapped around the proximal end of the femur and tensioned, a crimp placed within the elongated opening 336 may be crimped onto the cables to maintain the cables in a tensioned configuration. While the cable(s) provide compression, the bone fixation elements inserted through the first and second holes 332, 334 provide resistance to rotational and translational forces. As described, once the plate assembly is secured, surrounding tissue may be sutured to the plate assembly via the suture holes 316 and / or suture holes 126.

[0037] Condyle plate 500 according to an embodiment of the present invention shown in Figures 14 and 15 is sized and configured to be attached to the distal end of a femoral plate, such as plate 100 of Figure 1. Specifically, plate 500 is designed to be mounted on a distal portion of a femoral plate, such as plate 100, to extend support from the distal end of the femoral plate distally to the femoral condyle to protect against secondary fractures, as will be appreciated by those skilled in the art. Specifically, the bone-facing side of plate 500 forms a cavity 502 sized to receive the distal portion of a bone plate attached to the femur. Plate 500 includes a shaft portion 504 and a head portion 506 separated from one another by a gap 508. As will be appreciated by those skilled in the art, gap 508 facilitates bending or otherwise contouring plate 500 to more accurately fit the patient's anatomy so that head portion 506 can conform as closely as possible to the condyle surface to minimize irritation of surrounding tissues. As seen in FIG. 15 , the head portion 506 includes a number (four in this embodiment) of variable angle locking holes 510, each configured to receive a bone fixation element (e.g., a bone screw) therethrough for securing the head portion 506 to the condyle. The shaft portion 504 in this embodiment includes four fixation element receiving holes 512, any or each of which may have a bone fixation element inserted therein and pass through holes in the underlying bone plate and into the bone. For example, any or all of the holes 512 may be aligned with one or more of the mating holes 118 of the plate 100 when the plate 500 is optionally mounted on a bone plate, such as the plate 100. As will be appreciated by those skilled in the art, the head portion 506 is preferably shaped to provide a desired number of bone fixation element receiving holes (four variable angle locking holes in this embodiment) while simultaneously minimizing the footprint of the plate 500 on the condyle. As will be appreciated by those skilled in the art, the condyle plate 500 may, if desired, be mounted onto the proximal end of a femoral plate (provided the proximal end of the femoral plate is sized and shaped similarly to the distal end of plate 100) so that the head portion 506 can be mounted on the surface of the greater trochanter.As will be appreciated by one of ordinary skill in the art, the plates 500 may be shaped as mirror images with a first plate 500 shaped for mounting on the left distal condyle that is also suitable for mounting on the right greater trochanter, and a second plate 500 shaped for mounting on the right distal condyle that can also be mounted on the proximal portion of the femoral plate to extend to the left greater trochanter.

[0038] Although not described in detail, one of ordinary skill in the art will appreciate that the plate assembly may utilize GT mounting plate 400 in place of GT mounting plate 300 depending on the desired fixation configuration of the greater trochanter. GT mounting plate 400 may be assembled with proximal femur plate 100 and utilized in a manner substantially similar to that described above.

[0039] It will be apparent to those skilled in the art that modifications and variations can be made to the structure and method of the present invention without departing from the spirit or scope of the present invention. Thus, it is intended that the present invention cover the modifications and variations of the present invention provided they come within the scope of the appended claims and their equivalents.

[0040] [Embodiment] (1) A system for treating a periprosthetic fracture, comprising: 1. A periprosthetic bone plate comprising: a head portion sized and shaped such that, in a surgical position, a proximal end of the head portion is aligned with the vastus ridge of the greater trochanter of the femur; a shaft portion extending distally from the head portion, the shaft portion including a pair of offset holes extending therethrough for receiving a bone fixation element therethrough, each of the pair of offset holes including a first hole positioned on a first side of a longitudinal axis of the bone plate and a second hole positioned on a second side of the longitudinal axis opposite the first side, whereby a bone fixation element inserted through the first and second holes extends anteriorly and posteriorly of a prosthesis received within the femur, the first and second holes being staggered with respect to one another along a length of the shaft portion and extending beyond a longitudinal edge of the shaft portion; A periprosthetic bone plate comprising: (2) The system of embodiment 1, wherein the central axis along which each of the first and second holes of the pair of offset holes extends is aligned with the longitudinal edge of the plate. (3) The system of embodiment 1, wherein the pair of offset holes extend through a proximal portion of the shaft portion, the shaft portion further comprising a distal portion including a plurality of fixation openings extending therethrough. (4) The system of claim 1, wherein the head portion includes a first set of holes extending through the head portion on the first side of the longitudinal axis and a second set of holes extending through the head portion on the second side of the longitudinal axis. (5) The system of embodiment 4, wherein a first axis extends through a central axis along which the first set of holes extend and a second axis extends through a central axis along which the second set of holes extend, the first and second axes tapering relative to the longitudinal axis toward a distal end of the bone plate.

[0041] (6) The system of embodiment 1, wherein the first and second holes of each of the pair of offset holes are variable angle holes, and each variable angle hole is configured to receive a bone fixation element therethrough along a desired angle relative to a central axis along which the variable angle hole extends. (7) The system of embodiment 1, further comprising a locking attachment plate sized and shaped to be mounted on the shaft portion of the periprosthetic plate between adjacent pairs of offset holes, the locking attachment plate including a connecting portion connecting the locking attachment plate to the shaft portion and a pair of wings extending laterally from the connecting portion, such that in the surgical position, the wings extend beyond the longitudinal edge of the shaft portion in the surgical position, a first one of the wings including a first hole on the first side of the longitudinal axis and a second one of the wings including a second hole on the second side of the longitudinal axis. (8) The system of embodiment 7, wherein the first one of the wings includes two first holes and the second one of the wings includes two second holes. (9) The system of embodiment 7, wherein the locking attachment portion includes an opening extending through the connection portion, the opening of the locking attachment portion aligning with an attachment opening of the periprosthetic plate at the surgical position, whereby the opening of the locking attachment portion and a fixation element inserted through the attachment opening connect the locking attachment portion to the periprosthetic plate. (10) The system of embodiment 1, further comprising a greater trochanter mounting plate configured to be coupled to the head portion of the periprosthetic shaft, the greater trochanter mounting plate including a proximal portion extending proximally from the head portion and extending over the greater trochanter of the bone at the surgical position when the greater trochanter mounting plate is attached to the head portion.

[0042] (11) The system of embodiment 10, wherein the proximal portion of the greater trochanter mounting plate includes a pair of hooks at a proximal end thereof, each of the pair of hooks extending from the proximal end along a distally directed curved portion, and the proximal portion of the greater trochanter mounting plate further includes a plurality of pairs of holes extending therethrough from a first surface to a second surface thereof, such that, in the surgical position, a first hole of each of the pairs of holes extends through the proximal portion on the first side of the longitudinal axis and a second hole of each of the pairs of holes extends through the proximal portion on a second side of the longitudinal axis. (12) The system of embodiment 11, wherein the proximal portion of the greater trochanter mounting plate includes a pair of cable holes extending therethrough from a first longitudinal side to a second longitudinal side, and the proximal portion includes an elongated opening extending therethrough from the first surface to the second surface and in communication with the pair of cable holes, such that when a cable is inserted through the pair of cable holes, a crimp received within the elongated opening is crimpable onto a portion of the cable passing through the elongated opening. (13) The system of embodiment 10, wherein the proximal portion of the greater trochanter mounting plate includes a ring-shaped portion and a plurality of extension tabs extending radially from the ring-shaped portion, the ring-shaped portion and each of the plurality of extension tabs including a bone fixation element receiving opening extending therethrough, the ring-shaped portion being sized and shaped to fit over the greater trochanter, and the extension portion being bendable relative to the ring-shaped portion. (14) The system of embodiment 13, wherein the ring-shaped portion includes a suture hole between adjacent bone fixation element receiving openings. (15) The system of claim 10, wherein the periprosthetic plate and the greater trochanter mounting plate include corresponding alignment features for aligning the greater trochanter mounting plate relative to the periprosthetic plate.

[0043] (16) The system of claim 15, wherein the corresponding alignment feature includes one of: (a) a shoulder along a bone-facing surface of the greater trochanter mounting plate that abuts a proximal end of the head portion when the greater trochanter alignment plate is aligned with the periprosthetic plate; and (b) a pair of positioning protrusions protruding from the bone-facing surface of the greater trochanter plate, whereby the positioning protrusions are received in corresponding openings along the first surface of the periprosthetic plate when the greater trochanter alignment plate is aligned with the periprosthetic plate.

Claims

1. 1. A system for treating a periprosthetic fracture, comprising:

1. A periprosthetic bone plate comprising: a head portion sized and shaped such that, in a surgical position, a proximal end of the head portion is aligned with the vastus ridge of the greater trochanter of the femur; a shaft portion extending distally from the head portion, the shaft portion including a pair of offset holes extending therethrough for receiving bone fixation elements therethrough, each of the pair of offset holes including a first hole positioned on a first side of a longitudinal axis of the periprosthetic bone plate and a second hole positioned on a second side of the longitudinal axis opposite the first side, whereby bone fixation elements inserted through the first and second holes extend anteriorly and posteriorly of a prosthesis received within the femur, the first and second holes being staggered relative to one another along a length of the shaft portion and extending beyond a longitudinal edge of the shaft portion; a periprosthetic bone plate including: The system further comprises a greater trochanter mounting plate configured to be coupled to the head portion of the periprosthetic bone plate, the greater trochanter mounting plate including a proximal portion extending proximally from the head portion and extending over the greater trochanter of the bone in the surgical position when the greater trochanter mounting plate is attached to the head portion; the proximal portion of the greater trochanter mounting plate includes a pair of hooks at a proximal end thereof, each of the pair of hooks extending from the proximal end along a distally directed curve, and the proximal portion of the greater trochanter mounting plate further includes a plurality of pairs of holes extending therethrough from a first surface to a second surface thereof, such that in the surgical position a first hole of each of the pairs of holes extends through the proximal portion on the first side of the longitudinal axis and a second hole of each of the pairs of holes extends through the proximal portion on a second side of the longitudinal axis.

2. 2. The system of claim 1, wherein the proximal portion of the greater trochanter mounting plate includes a pair of cable lumens extending therethrough from a first longitudinal side to a second longitudinal side, and the proximal portion includes an elongated opening extending therethrough from the first surface to the second surface and in communication with the pair of cable lumens, such that when a cable is inserted through the pair of cable lumens, a crimp received within the elongated opening is crimpable onto a portion of the cable passing through the elongated opening.

3. 1. A system for treating a periprosthetic fracture, comprising:

1. A periprosthetic bone plate comprising: a head portion sized and shaped such that, in a surgical position, a proximal end of the head portion is aligned with the vastus ridge of the greater trochanter of the femur; a shaft portion extending distally from the head portion, the shaft portion including a pair of offset holes extending therethrough for receiving bone fixation elements therethrough, each of the pair of offset holes including a first hole positioned on a first side of a longitudinal axis of the periprosthetic bone plate and a second hole positioned on a second side of the longitudinal axis opposite the first side, whereby bone fixation elements inserted through the first and second holes extend anteriorly and posteriorly of a prosthesis received within the femur, the first and second holes being staggered relative to one another along a length of the shaft portion and extending beyond a longitudinal edge of the shaft portion; a periprosthetic bone plate including: The system further comprises a greater trochanter mounting plate configured to be coupled to the head portion of the periprosthetic bone plate, the greater trochanter mounting plate including a proximal portion extending proximally from the head portion and extending over the greater trochanter of the bone in the surgical position when the greater trochanter mounting plate is attached to the head portion; the proximal portion of the greater trochanter mounting plate includes a ring-shaped portion and a plurality of extension tabs extending radially from the ring-shaped portion, the ring-shaped portion and each of the plurality of extension tabs including a bone fixation element receiving opening extending therethrough, the ring-shaped portion sized and shaped to fit over the greater trochanter, and the extension portion being bendable relative to the ring-shaped portion.

4. The system of claim 3 , wherein the ring-shaped portion includes suture holes between adjacent bone fixation element receiving openings.

5. 4. The system of claim 1 or 3, wherein the periprosthetic bone plate and the greater trochanter mounting plate include corresponding alignment features for aligning the greater trochanter mounting plate relative to the periprosthetic bone plate.

6. 6. The system of claim 5, wherein the corresponding alignment feature includes one of: (a) a shoulder along a bone-facing surface of the greater trochanter mounting plate that abuts a proximal end of the head portion when the greater trochanter mounting plate is aligned with the periprosthetic bone plate; and (b) a pair of positioning protrusions protruding from the bone-facing surface of the greater trochanter mounting plate such that when the greater trochanter mounting plate is aligned with the periprosthetic bone plate, the positioning protrusions are received in corresponding openings along the first surface of the periprosthetic bone plate.

Images