Periprosthetic plate and associated method of use

Abstract

To provide a plate to treat a long bone fracture located near an existing prosthesis that is at the distal or proximal femur.SOLUTION: A periprosthetic plate and a method of use are disclosed, the periprosthetic plate comprising a proximal segment having a top portion and an end portion with at least two curved hooks that are capable of passing through a patient's abductor muscles and rest medially on a tip of a patient's greater trochanter (GT), where the proximal segment includes a plurality of recessed bone screw holes. A periprosthetic proximal femur plate is disclosed that includes a head portion having at least six first polyaxial screw holes and a shaft portion connected to the shaft portion having a plurality of rows of at least two second polyaxial screw holes located at an angle of about 30° to about 60° from the horizontal. A combination periprosthetic proximal femur plate and greater trochanter (GT) plate construct is disclosed that includes a greater trochanter (GT) plate located on top of the periprosthetic proximal femur plate.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] The present disclosure relates generally to plates for treating long bone fractures located near an existing prosthesis, typically in the distal or proximal femur. [Background technology]

[0002] Periprosthetic fractures are long bone fractures that occur adjacent to or around an existing prosthesis, typically in the distal or proximal femur. Due to an aging population, the frequency of these types of fractures is increasing.

[0003] Specialized implants for the proximal femur are required to treat Vancouver Ag, Ag+B, and B fractures. Vancouver Ag fractures are characterized by a fracture of the greater trochanter, and Vancouver B fractures are characterized by a fracture of the diaphysis immediately surrounding the distal tip of a prosthesis, such as a hip stem. The treatment method for a Vancouver B fracture involves a periprosthetic proximal femur plate, while the treatment method for a Vancouver Ag+B or Vancouver Ag fracture involves a greater trochanter ("GT") plate attached to a periprosthetic proximal femur plate. The greater trochanter ("GT") plate is only used in conjunction with a periprosthetic proximal femur plate, not by itself.

[0004] The current design of the periprosthetic proximal femoral plate can cause soft tissue irritation due to the thickness of the plate head, which sits just below the vastus ridge of the proximal femur. The current attachment style of the greater trochanter (GT) plate / periprosthetic proximal femoral plate construct raises similar concerns. The overlap of the two plates near the vastus ridge area results in significant plate construct thickness that can cause soft tissue irritation.

[0005] Furthermore, current designs of greater trochanter (GT) plates include a closed ring structure that provides a suboptimal anatomical fit to the greater trochanter. The fixed geometry of the ring region and the challenge of simultaneously fitting two plates to the bone result in a poor fit.

[0006] The hook segment is a plate with a hook that is intended to go around the tip of the greater trochanter and is fixed with screws. Current hook segment designs may have characteristics that are not ideal for this indication, including but not limited to: 1) being too thick from medial to lateral, which may cause patient discomfort, 2) insufficient screw options to adequately fixate the fracture fragments, and 3) the screws are not targeted to engage the desired bone anatomy.

[0007] Therefore, there is a need in the art for a periprosthetic plate that is less invasive to increase patient comfort, provides screw options for adequate fixation of the fracture fragments, and engages the bone anatomy. Summary of the Invention

[0008] The following objects, features, advantages, aspects, and / or embodiments are not exhaustive and do not limit the entire disclosure. No single embodiment is required to provide each and every object, feature, or advantage. Any of the objects, features, advantages, aspects, and / or embodiments disclosed herein may be fully or partially integrated with one another.

[0009] A primary object, feature, and / or advantage of the present disclosure is to improve or overcome deficiencies in the art.

[0010] A further object, feature, and / or advantage of the present disclosure is a prosthetic perimeter plate comprising a proximal segment having an upper portion and an end portion having at least two curved hooks capable of passing through a patient's abductor muscles and mounted medially on the tip of the patient's greater trochanter (GT), the proximal segment including a plurality of recessed bone screw holes for attachment to the patient's femur with bone screws.

[0011] A further object, feature, and / or advantage of the present disclosure is that the proximal segment includes a hook portion having at least two curved hooks and an attachment portion.

[0012] A further object, feature, and / or advantage of the present disclosure is that the plurality of recessed bone screw holes are recessed such that any inserted bone screws do not extend above an upper portion of the proximal segment.

[0013] In one embodiment of the present disclosure, the plurality of recessed bone screw holes is a set of two recessed bone screw holes that are parallel to one another.

[0014] Another aspect of the present disclosure is a distal segment or shaft that is attached to or integral with the proximal segment.

[0015] In yet another aspect of the present disclosure, the proximal segment includes a hook segment attached to at least two curved hooks and an attachment segment.

[0016] Another feature of the present disclosure is that the hook segment includes a first plurality of recessed bone screw holes, the attachment segment includes a second plurality of recessed bone screw holes, and the distal segment or shaft includes a third plurality of recessed bone screw holes.

[0017] Yet another aspect of the present disclosure is a distal end segment having a first plurality of recessed bone screw holes in two parallel sets, a second plurality of recessed bone screw holes in two parallel sets, and a third plurality of recessed bone screw holes in a staggered left-right arrangement along the longitudinal length of the distal segment or shaft.

[0018] Yet another feature of the present disclosure is that the first plurality of recessed bone screw holes, the second plurality of recessed bone screw holes, and the third plurality of recessed bone screw holes are recessed such that any inserted bone screws do not extend above the top of the proximal segment.

[0019] Another feature of the present disclosure is that the proximal segment includes at least one fastening cable hole set capable of receiving at least one fastening cable.

[0020] Yet another aspect of the present disclosure is at least one fastening crimp located at the opening in the proximal segment.

[0021] A further feature of the present disclosure is that the proximal segment includes at least one fastening cable set, each capable of receiving a fastening cable, and at least one fastening crimp located in at least one opening in the proximal segment.

[0022] Yet another feature of the present disclosure is a prosthetic perimeter plate comprising: a hook segment having an upper portion and an end portion having at least two curved hooks that can pass through a patient's abductor muscles and that rest medially on the tip of the patient's greater trochanter (GT), the hook segment including a first plurality of recessed bone screw holes that are recessed such that any inserted bone screws do not extend beyond the top of the hook segment and that are a set of two parallel recessed bone screw holes; and an attachment segment attached or integral to the hook segment, the attachment segment including a second plurality of recessed bone screw holes that are two parallel sets that are tapered such that any inserted bone screws do not extend beyond the top of the hook segment and that are a parallel set of two recessed bone screw holes.

[0023] Yet another feature of the present disclosure is a distal segment or shaft attached to or integral with the attachment segment, the distal segment or shaft including a third plurality of recessed bone screw holes staggered side to side along a length of the distal segment or shaft, the third plurality of recessed bone screw holes being tapered such that any inserted bone screws do not extend above the top of the proximal segment.

[0024] Another aspect of the present disclosure is a method of utilizing a prosthetic perimeter plate that includes anchoring a proximal segment into a patient having an upper portion that rests medially on the tip of the patient's greater trochanter (GT) through the patient's abductor muscles and an end portion having at least two curved hooks by inserting bone screws into a first plurality of recessed bone screw holes but avoiding an existing prosthesis or intramedullary nail, where the inserted bone screws do not extend up above the proximal segment.

[0025] An additional feature of the present disclosure is a method for fixating a distal segment or shaft that is attached to or integral with the proximal segment by inserting bone screws into a second plurality of recessed bone screw holes, where the inserted bone screws do not extend above the top of the distal segment or shaft.

[0026] Yet another feature of the method of the present disclosure is inserting bone screws into a second plurality of recessed bone screw holes arranged in a staggered manner side-to-side along the length of the distal segment or shaft.

[0027] Yet another feature of the method of the present disclosure is inserting at least one fastening cable through the multiple holes in the proximal segment for fixation to the patient's bone.

[0028] Another feature of the method of the present disclosure is tensioning the at least one fastening cable and then securing the at least one fastening cable with a fastening crimp located in an opening in the proximal segment.

[0029] Yet another aspect of the present disclosure is a periprosthetic proximal femoral plate including: a head portion having a plurality of first polyaxial screw holes; and a shaft portion connected to the head portion, the shaft portion having a first lateral plate edge and a second lateral plate edge, the shaft portion having a plurality of rows of second polyaxial screw holes positioned at an angle of about 30 degrees to about 70 degrees from the first lateral plate edge and the second lateral plate edge.

[0030] A further object, feature, and / or advantage of the present disclosure is that the first and second polyaxial screw holes have a cone angle in the range of about 25 degrees to about 45 degrees.

[0031] In yet another aspect of the present disclosure, the first and second polyaxial screw holes have a cone angle in the range of about 30 degrees to about 40 degrees.

[0032] In one embodiment of the present disclosure, the plurality of rows of second polyaxial screw holes includes at least three rows.

[0033] In another aspect of the present disclosure, the second polyaxial screw holes include a series of second polyaxial screw holes in a three-hole pattern.

[0034] Another feature of the present disclosure is that the multiple rows of polyaxial screw holes are positioned at an angle of about 40 degrees to about 60 degrees from the first lateral plate edge and the second lateral plate edge.

[0035] In yet another aspect of the present disclosure, the second plurality of rows of polyaxial screw holes are positioned at an angle between about 35 degrees and about 55 degrees from the first lateral plate edge and the second lateral plate edge.

[0036] Yet another feature of the present disclosure is that the head portion includes at least one orientation feature and at least one threaded hole for connection to another plate.

[0037] Another feature of the present disclosure is the multiple k-wire / suture openings.

[0038] Yet another aspect of the present disclosure is at least one polyaxial screw hole for receiving an articulated tension device (ATD) located at the end of the shaft portion of the periprosthetic proximal femoral plate.

[0039] A further feature of the present disclosure is a combination periprosthetic proximal femur plate and greater trochanter (GT) plate structure including: a periprosthetic proximal femur plate having a first lateral plate edge, a second lateral plate edge, and a head portion having a plurality of first polyaxial screw holes, and a shaft portion connected to the head portion and having a plurality of rows of second polyaxial screw holes located at an angle of about 30 degrees to about 70 degrees from the first lateral plate edge and the second lateral plate edge; and a greater trochanter (GT) plate having a base portion located on top of the periprosthetic proximal femur plate and having a plurality of third clearance screw holes aligned with the plurality of second polyaxial screw holes of the periprosthetic proximal femur plate, the greater trochanter (GT) plate having a first arm and a second arm attached to the base portion and extending outwardly to wrap around the patient's greater trochanter (GT).

[0040] Yet another feature of the present disclosure includes a portion of the periprosthetic proximal femoral plate being uncovered from the greater trochanter (GT) plate and either showing at least one first polyaxial screw hole or showing a portion of the periprosthetic proximal femoral plate with the axial screw holes not visible.

[0041] Yet another feature of the present disclosure is the multiple k-wire / suture openings in both the periprosthetic proximal femur plate and the greater trochanter (GT) plate.

[0042] In another aspect of the present disclosure, the first arm includes a plurality of fourth polyaxial screw holes and the second arm includes a plurality of fifth polyaxial screw holes.

[0043] Yet another feature of the method of the present disclosure is a plurality of cylindrical recesses in the head portion of the periprosthetic proximal femoral plate for receiving a plurality of downward cylindrical protrusions of the greater trochanter (GT) plate, the plurality of cylindrical recesses being centrally located within the plurality of cylindrical protrusions such that a plurality of threaded openings in both the periprosthetic proximal femoral plate and the greater trochanter (GT) plate are secured together with a plurality of threaded bolts.

[0044] Yet another aspect of the present disclosure includes at least one slot in a head portion of the periprosthetic proximal femur plate for receiving a downwardly projecting angled bar of the greater trochanter (GT) plate, and a cylindrical recess in the head portion of the periprosthetic proximal femur plate for receiving a downwardly projecting cylindrical protrusion having a threaded opening centrally located in the cylindrical protrusion such that the periprosthetic proximal femur plate and the greater trochanter (GT) plate can be secured together with a threaded bolt.

[0045] Yet another feature of the method of the present disclosure is to utilize a combined periprosthetic proximal femoral plate and greater trochanter (GT) plate construct, comprising: inserting bone screws into a plurality of first polyaxial screw holes of a periprosthetic proximal femoral plate having a head portion, a first lateral plate edge, and a second lateral plate edge; and inserting bone screws into a plurality of rows of second polyaxial screw holes located in a shaft portion connected to the head portion, the plurality of rows of second polyaxial screw holes being positioned between the first lateral plate edge and the second lateral plate edge. and inserting bone screws into a plurality of third clearance screw holes located in a base portion of a greater trochanter (GT) plate located on top of the periprosthetic proximal femoral plate, the plurality of third clearance screw holes being aligned with the plurality of second polyaxial screw holes of the periprosthetic proximal femoral plate, the first arm and the second arm being attached to the base portion and extending outwardly to wrap around the patient's greater trochanter (GT).

[0046] Yet another feature of the method of the present disclosure includes utilizing a combined periprosthetic proximal femoral plate and greater trochanter (GT) plate construct and inserting an articulating tensioning device (ATD) located at the end of a shaft portion of the periprosthetic proximal femoral plate.

[0047] These and / or other objects, features, advantages, aspects, and / or embodiments will become apparent to those of ordinary skill in the art after reviewing the following brief and detailed description of the drawings. The present disclosure encompasses (a) combinations of the disclosed aspects and / or embodiments, and / or (b) reasonable modifications not shown or described. [Brief description of the drawings]

[0048] Certain embodiments in which the present disclosure may be practiced are illustrated and described in detail, and like reference characters represent like components throughout the several views. The drawings are presented for illustrative purposes and may not be to scale unless otherwise indicated. [Figure 1]1 shows a schematic diagram of a prosthetic perimeter plate including a proximal segment, a distal segment or shaft, screw holes, and hooks. [Diagram 2] 2 is a bottom view of the prosthetic perimeter plate of FIG. 1 showing the proximal segment, distal segment or shaft, screw holes, and hooks. [Diagram 3] FIG. 2 is a top view of the proximal segment shown in FIG. 1 without the distal segment or shaft. [Figure 4] FIG. 4 is a bottom view of the proximal segment shown in FIG. 3 without the distal segment or shaft. [Diagram 5] FIG. 1 is a perspective view of a prosthetic periphery plate mounted on the greater trochanter (GT) and adjacent to the prosthesis. [Figure 6] FIG. 13 is a perspective view of a prosthetic perimeter plate with fastening crimps and fastening cable holes. [Figure 7] FIG. 1 is a perspective view of a prosthetic perimeter plate mounted over the greater trochanter (GT) and secured with fastening cables. [Figure 8] FIG. 1 shows a perspective view of a periprosthetic proximal femoral plate mounted on a femur. [Figure 9] 1 shows a periprosthetic proximal femoral plate including a head and a shaft. [Figure 10] FIG. 1 shows a superior view of a combination greater trochanter (GT) plate and periprosthetic proximal femur plate construct. [Figure 11] FIG. 11 shows a lateral view of the combination of the periprosthetic proximal femur plate and greater trochanter (GT) shown in FIG. 10 . [Figure 12] 1 shows a first embodiment of a connection mechanism for connecting a greater trochanter (GT) plate to a periprosthetic proximal femoral plate. [Figure 13] 13 shows a second embodiment of a connection mechanism for connecting a trochanteric (GT) plate to a periprosthetic proximal femoral plate. [Figure 14] A schematic diagram of the greater trochanter (GT) plate cylindrical boss protrusion is shown. [Figure 15]15 shows a side view of a proximal femur plate cylindrical recess that interlocks with the cylindrical boss protrusion of FIG. 14. FIG. [Figure 16] 13 shows a third embodiment of a connection mechanism for connecting a trochanteric (GT) plate to a periprosthetic proximal femoral plate. [Figure 17] FIG. 13 shows a top view of a threaded hole with a bolt in the greater trochanter (GT) plate for the periprosthetic proximal femur plate connection.

[0049] Those skilled in the art need not view the nearly infinite number of separate combinations of features described in the following detailed description in separate figures in order to facilitate an understanding of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0050] The present disclosure is not limited to what is described herein. Mechanical, electrical, chemical, procedural, and / or other changes may be made without departing from the spirit and scope of the present disclosure. Unless otherwise indicated, features shown or described are not essential to enable the basic operation of the present disclosure.

[0051] 1 and 2, a prosthetic perimeter plate is generally designated by the numeral 10. The prosthetic perimeter plate 10 includes a distal segment or shaft 12 and a proximal segment 14. The prosthetic perimeter plate 10 may or may not include a distal segment or shaft 12. The version without the distal segment or shaft 12 is intended for simple Ag fractures. Also, it will be available in multiple sizes to match the greater trochanter (GT) 40 anatomy (shown in FIG. 5) of various patients. The prosthetic perimeter plate 10 can have multiple lengths of the distal segment or shaft 12, the longest of which can span the entire femur of the patient.

[0052] Bone plates use biocompatible materials such as stainless steel (SS), cobalt-based alloys, titanium alloys, bioceramics, composites, pure titanium, composites, and non-resorbable and bioresorbable polymers. These materials fall into categories such as bioinert, bioactive, bioresorbable, and porous. Bioinert materials are typically utilized for bone plates because if bioactive materials were bonded to bone or other soft tissue, problems could arise if removal of the bone plate or corrective surgery were required. The thickness of the bone plate depends on the specific material utilized and the patient's bone type, and potentially the patient's specific anatomy.

[0053] The distal segment or shaft 12 includes holes 16 which are preferably beveled. The optimal depth of the distal segment or shaft 12 is only slightly higher than the heads of the bone screws 11 shown in FIG. 5 to minimize patient discomfort. Preferably, but not necessarily, the holes 16 are located in a staggered arrangement to minimize the distance along the distal segment or shaft 12 that does not include the bone screws 11 and ensure that both sides of the distal segment or shaft 12 are secured to the bone.

[0054] 1 and 2, the proximal segment 14 includes a connected together, or preferably integral, attachment segment 13 and hook segment 15. There is a series of holes 18 for the attachment segment 13, which are preferably, but not necessarily, in parallel rows with the same preferred taper to minimize any protrusion of the bone screws 11.

[0055] 3 and 4, the hook segment 15 also includes a series of holes 20. The attachment segment 13 preferably includes a series of holes 18 in parallel rows with the same preferred beveling to minimize any protrusion of the bone screws 11, as shown in FIG. 5, but this is not necessary. As shown in FIG. 5, there are at least two hooks 22 that go around the tip of the patient's greater trochanter (GT) 40 and are secured with the bone screws 11. The prosthetic perimeter plate 10 can be positioned laterally or posterolaterally so that the hooks 22 pass through the patient's abductor muscles and rest medially against the tip of the greater trochanter (GT) 40. If necessary, the prosthetic perimeter plate 10 is tensioned to reduce the fracture. To secure the prosthetic perimeter plate 10, screws are placed into the patient's greater trochanter (GT) 40 through the holes 16, 18, and 20 of the prosthetic perimeter plate 10.

[0056] 5, the position of the periprosthetic plate 10 is shown in relation to the greater trochanter (GT) 40, the lesser trochanter 42, and the prosthesis 44. The bone screws 11 in the greater trochanter (GT) 40 are positioned to achieve two results. First, the bone screws 11 must not interfere with an existing prosthesis 44 or intramedullary nail (IM) (not shown) that passes through the greater trochanter (GT) 40 and into the medullary canal.

[0057] Second, the trajectories of the nominal (coaxial with the hole) screw holes 16, 18, and 20 must target the area of ​​the proximal femur with the best (densest) bone. This bone is typically around the lesser trochanter (LT) 42. Thus, the two posterior bone screws 11 target the lesser trochanter (LT) 42 area. The anterior bone quality of the greater trochanter (GT) 40 varies by fracture and patient, but still requires placement of bone screws 11. There are at least four bone screws 11 in the greater trochanter (GT) 40, two anterior and two posterior.

[0058] There is at least one fastening cable hole set, each having four holes. In Figures 3 and 4, there is a first cable hole set 24, a second cable hole set 26, and a third cable hole set 28. Preferably, but not necessarily, there is a first groove pair 30 and a second groove pair 32 on each side of the opening in the top center 31 of the prosthesis perimeter plate 10 corresponding to the first cable hole set 24, the second cable hole set 26, and the third cable hole set 28. Thus, each of the cable hole sets 24, 26, 28 accommodates a single fastening cable 52, as shown in Figure 7. The at least one cable 52 may pass through at least one fastening crimp 50, which is recessed along the top center 31 of the prosthesis perimeter plate 10, as shown in Figure 6. When pulled, the at least one crimp 50 may deform to secure the at least one cable 52. The first pair of grooves 30 and second pair of grooves 32 on each side of the opening in the central 31 opening on the top of the prosthetic perimeter plate 10 can alternatively be grooves / recesses along the top (sides) of the prosthetic perimeter plate 10 instead of holes through the plate, either of which are intended to maintain the position of the fastening cables after they are tensioned.

[0059] Aspects of the disclosed technology include that the thickness of the prosthetic perimeter plate 10 across the lateral greater trochanter (GT) 40 is minimized to reduce prominence. The trajectories of the bone screws 11 are optimized to target the densest bone. The bone screws 11 are positioned to avoid interference with the prosthesis 44. Additionally, the distal segment or the hook segment 15 without the shaft 12 can optionally be designed such that a portion of the hook segment 15 distal to the vastus ridge is not connected as shown in Figures 3 and 4. Because they are not connected, the anterior segment shown in Figure 3 and the posterior segment shown in Figure 4 of the prosthetic perimeter plate 10 can be individually contoured to match the respective anatomy of the patient.

[0060] Another variation of a periprosthetic plate is a periprosthetic proximal femoral plate, generally designated by the numeral 54 in FIG. 8, which rests on the patient's femur 56. The periprosthetic proximal femoral plate 54 is designed to seat below the vastus eminence of the femur 56 and has a thinner, chamfered proximal end 58 to reduce soft tissue irritation, with the shaft of the periprosthetic proximal femoral plate 54 tapering off at a distal portion 60. This thinner distal portion 60 allows for easier flexion of the periprosthetic proximal femoral plate 54 to better conform to the condyles, which are the articulation and rotation points at the end of the femur 56, when desired.

[0061] 9, the periprosthetic proximal femoral plate 54 is shown in a top view. The head of the periprosthetic proximal femoral plate 54 is generally designated 62. Preferably, but not necessarily, the head 62 can include eight bone screw holes. This includes a first head bone screw hole 64, a second head bone screw hole 66, a third head bone screw hole 68, a fourth head bone screw hole 70, a fifth head bone screw hole 72, a sixth head bone screw hole 74, a seventh head bone screw hole 76, and an eighth head bone screw hole 78. Optimally, all head bone screw holes 62, 64, 66, 68, 70, 72, 74, 76, and 78 can be 3.5 millimeter screw holes with a 40 degree cone angle. An alternative embodiment has four to six head bone screw holes that are 4.5 millimeter polyaxial screw holes with a 30 degree cone angle, with only the seventh head bone screw hole 76 and the eighth head bone screw hole 78 at the proximal end of head 62 being 3.5 millimeter screw holes with a 40 degree cone angle. Optimally, the cone angle can range from 0 to 30 degrees for the 4.5 millimeter polyaxial screws and 0 to 40 degrees for the 3.5 millimeter polyaxial screws.

[0062] There is a first threaded hole for the greater trochanter (GT) plate connection 82, a second threaded hole for the greater trochanter (GT) plate connection 84, and at least one orientation feature. There is also a slotted orientation feature for the greater trochanter (GT) plate 86, which can be of various shapes, preferably rectangular or circular. At the proximal tip and along the sides of the periprosthetic proximal femoral plate 54, there are a series of k-wire / suture holes 80.

[0063] The shaft of the periprosthetic proximal femoral plate 54 is generally indicated at 88. There is a first lateral plate edge 79 and a second lateral plate edge 81. The periprosthetic proximal femoral plate 54 is considered to be simply one length of plate 54. There are multiple lengths available ranging from 119 mm to 388 mm, up to about 35 mm increments. There are various bone screw holes located in various patterns with the shaft 88. This includes a first shaft bone screw hole 90, a second shaft bone screw hole 92, a third shaft bone screw hole 94, a fourth shaft bone screw hole 96, a fifth shaft bone screw hole 98, a sixth shaft bone screw hole 100, a seventh shaft bone screw hole 102, an eighth shaft bone screw hole 104, a ninth shaft bone screw hole 106, a tenth shaft bone screw hole 108, and an eleventh shaft bone screw hole 110. The bone screw holes are staggered across the width of the periprosthetic proximal femoral plate 54 at intervals of about 4 mm to about 7 mm, preferably 5.50 mm, and spaced apart from one another along the inferior aspect of the periprosthetic proximal femoral plate 54 at intervals ranging from about 10 mm to about 15 mm, optimally 12.95 mm.

[0064] Preferably, the bone screw holes are angled from the first lateral plate edge 79 and the second lateral plate edge 81 of the periprosthetic proximal femur plate 54 at about 20 degrees to about 30 degrees, optimally about 23 degrees.

[0065] Optimally, the three-hole pattern 114 is preferably approximately 45 degrees from the first lateral plate edge 79 and the second lateral plate edge 81 of the shaft 88. These three-hole patterns allow for screw fixation around existing implants. The first shaft bone screw hole 90 and the second shaft bone screw hole 92 form a series of only two-hole patterns and are located near the head 62 of the periprosthetic proximal femoral plate 54. From there, the third shaft bone screw hole 94, the fourth shaft bone screw hole 96, and the fifth shaft bone screw hole 98 form a first three-hole pattern. The sixth shaft bone screw hole 100, the seventh shaft bone screw hole 102, and the eighth shaft bone screw hole 104 form a second three-hole pattern, and the ninth shaft bone screw hole 106, the tenth shaft bone screw hole 108, and the eleventh shaft bone screw hole 110 form a third three-hole pattern. There is a shaft threaded hole that accepts an articulating tension device (ATD) 112. Preferably, this can be a 4.5 millimeter polyaxial threaded hole with a 30 degree angle cone, but this is not necessarily the case.

[0066] 10 , the periprosthetic proximal femur plate 54 can be combined with the greater trochanter (GT) plate 116 to form a combined construct 160. The proximal femur plate 54 and the greater trochanter (GT) plate 116 are connected by at least one, and preferably two, threaded connections including a first threaded hole in the GT plate for the periprosthetic proximal femur plate connection 122 and a second threaded hole in the GT plate 124 for the periprosthetic proximal femur plate connection that connects to the first threaded hole in the periprosthetic proximal femur plate for the GT plate 82 and the second threaded hole in the periprosthetic proximal femur plate for the GT plate connection 84.

[0067] The greater trochanter (GT) plate 116 has a first arm 116 and a second arm 120 that wrap around the greater trochanter region 40 extending anteriorly and posteriorly.

[0068] This combined construct 160 of the proximal femur plate 54 and greater trochanter (GT) plate 116 offers significant advantages over prior art overlaps just below the vastus eminence, where the plate overlap increases the thickness of the construct 160 and can cause the construct 160 to protrude above the vastus eminence, which can increase the risk of soft tissue irritation and patient discomfort, potentially leading to revision surgery.

[0069] This combined structure 160 is designed to intentionally minimize plate thickness near the vastus eminence by avoiding overlap of the two plates, the proximal femoral plate 54 and the greater trochanter (GT) plate 116, in this region. When the greater trochanter (GT) plate 116 is installed, the seventh head bone screw hole 76 and the eighth head bone screw hole 78 of the proximal femoral plate 54 are not covered to reduce plate build-up in this region closest to the vastus eminence. The preferred design of the greater trochanter (GT) plate 116 includes a ridge or eyebrow 126 to build smoothly around the first threaded hole of the GT plate 116 for the periprosthetic proximal femoral plate connection 122 and around the second threaded hole of the GT plate 116 for the periprosthetic proximal femoral plate connection 124 to help prevent soft tissue irritation from the bolt heads protruding above the surface of the greater trochanter (GT) plate 116.

[0070] The first head bone screw hole 64 of the periprosthetic proximal femoral plate is aligned with the first head clearance screw hole 128 of the greater trochanter (GT) plate, the second head bone screw hole 66 of the periprosthetic proximal femoral plate is aligned with the second head clearance screw hole 130 of the greater trochanter (GT) plate, and the third head bone screw hole 68 of the periprosthetic proximal femoral plate is aligned with the third head clearance screw hole 132 of the greater trochanter (GT) plate; The fourth head bone screw hole 70 of the periprosthetic proximal femoral plate is aligned with the fourth head clearance screw hole 134 of the greater trochanter (GT) plate, the fifth head bone screw hole 72 of the periprosthetic proximal femoral plate is aligned with the fifth head clearance screw hole 136 of the greater trochanter (GT) plate, and the sixth head bone screw hole 74 of the periprosthetic proximal femoral plate is aligned with the sixth head clearance screw hole of the greater trochanter (GT) plate 138.

[0071] Preferably, these six clearance holes, i.e., 128, 130, 132, 134, 136, and 138, in the greater trochanter (GT) plate 116 correlate to the 3.5 mm polyaxial holes, i.e., 64, 66, 68, 70, 72, and 74, in the periprosthetic proximal femoral plate 54, but this is not necessarily the case.

[0072] A first arm 118 of the greater trochanter (GT) plate and a second arm 120 of the greater trochanter (GT) plate wrap around the greater trochanter 40 to avoid the apex of the area and reduce soft tissue irritation, the first arm 118 of the greater trochanter (GT) plate including a first polyaxial screw hole 140, a second polyaxial screw hole 142, a third polyaxial screw hole 144, a fourth polyaxial screw hole 146, and a fifth polyaxial screw hole 148. The second arm 120 of the greater trochanter (GT) plate includes a first polyaxial screw hole 150, a second polyaxial screw hole 152, a third polyaxial screw hole 154, a fourth polyaxial screw hole 156, and a fifth polyaxial screw hole 158.

[0073] The open shape of the greater trochanter (GT) plate 116 provides a better fit to the greater trochanter anatomy by allowing flexion, in stark contrast to the prior art with its rigid ring-like structures that make it more difficult to fit various greater trochanter anatomies.

[0074] Some of the other features of the greater trochanter (GT) plate 116 include clearance holes for k-wire / suture holes 80, which may also include being located between the screw holes 128, 130, 132, 134, 136, and 138 for suturing through the greater trochanter GT plate 116. Another feature is the seventh polyaxial screw hole 76 and the eighth polyaxial screw hole 78 of the periprosthetic proximal femoral plate 54. There are a number of screw holes 140, 142, 144, 146, 148, 150, 152, 154, 156, and 158 on the first arm 118 and second arm 120 of the trochanter (GT) plate, preferably ten, i.e., as described above, that provide multiple fixation options at the greater trochanter (GT) 40.

[0075] 11, there is shown a side view of the greater trochanter (GT) 40, including the apex 162 of the GT 40. Also shown is the ridge or eyebrow 126 on the upper surface of the trochanter (GT) plate 40, as well as the uncovered portion of the periprosthetic proximal femoral plate 54.

[0076] There are various ways to connect the trochanteric (GT) plate 40 to the periprosthetic proximal femoral plate 54. Referring now to FIG. 12, in a first embodiment generally designated by the numeral 161, there is a first partially threaded bolt 164 and a second partially threaded bolt 166. There is an angled rod 168 in the greater trochanteric (GT) plate 116, which slides into the slotted orientation feature 86 of the periprosthetic proximal femoral plate 54 for proper orientation, as shown in FIG. 9. The angled rod 168 is oriented proximally upward to help resist tension applied by the abductor muscles. This provides a mechanical advantage with respect to the stability of the combined greater trochanteric (GT) plate and periprosthetic proximal femoral plate construct 160. In this first embodiment, there are preferably two threaded connections. There is a first partially threaded bolt 164 and a second partially threaded bolt 166 that can be received within threads 172 and 173, respectively, located in the greater trochanter (GT) plate 116. Optionally, the threads 172 and 173 in the greater trochanter (GT) plate 116 allow a bolt, for example, an M5 x 0.8 bolt, to be pre-assembled and retained within the greater trochanter (GT) plate 116. The first partially threaded bolt 164 and the second partially threaded bolt 166 are partially threaded to allow threads 170 and 171, respectively, in the greater trochanter (GT) plate 116 and the peri-prosthetic proximal femoral plate 54 to be properly oriented prior to connecting them.

[0077] A first partially threaded bolt 164, with threads 170 in the periprosthetic proximal femur plate 54 and threads 172 in the greater trochanter (GT) plate 116, is positioned in a first threaded hole in the periprosthetic proximal femur plate for the GT plate connection 82 and a first threaded hole in the GT plate for the periprosthetic proximal femur plate connection 122. A second partially threaded bolt 166, with threads 171 in the periprosthetic proximal femur plate 54 and threads 173 in the greater trochanter (GT) plate 116, is positioned in a second threaded hole in the periprosthetic proximal femur plate for the GT plate connection 84 and a second threaded hole in the GT plate for the periprosthetic proximal femur plate connection 124.

[0078] A second embodiment for connecting the trochanteric (GT) plate to the periprosthetic proximal femoral plate is generally indicated by the numeral 174 in FIG. 13. There is a first partially threaded bolt 164 and a second partially threaded bolt 166 that can be received in threads 172 and 173, respectively, located in the greater trochanteric (GT) plate 116. Optionally, the threads 172 and 173 in the greater trochanteric (GT) plate 116 allow a bolt, for example, an M5 x 0.8 bolt, to be pre-assembled and retained in the greater trochanteric (GT) plate 116. The first partially threaded bolt 164 and the second partially threaded bolt 166 are partially threaded to allow threads 170 and 171, respectively, in the greater trochanteric (GT) plate 116 and the periprosthetic proximal femoral plate 54 to be properly oriented prior to connecting them.

[0079] A first partially threaded bolt 164 with threads 172 is positioned in a first threaded hole 170 of the periprosthetic proximal femur plate 82 and a first threaded hole of the GT plate for the periprosthetic proximal femur plate connection 122. A second partially threaded bolt 166 with threads 173 is positioned in a second threaded hole 171 of the periprosthetic proximal femur plate 84 and a second threaded hole of the GT plate for the periprosthetic proximal femur plate connection 124. Instead of an angled bar, the connection is made through a cylindrical boss protrusion 178 of the greater trochanter (GT) plate, which is located around the threaded connection 172 in the greater trochanter (GT) plate 116 and also serves as an orientation feature. These cylindrical boss projections 178 on the underside of the greater trochanter (GT) plate 116 fit into cylindrical recesses 176 in the periprosthetic proximal femoral plate 54. An advantage of this second embodiment 174 is that the heads of the partially threaded bolts 164 and 166 can be lowered compared to the first embodiment 161.

[0080] 14, the cylindrical boss protrusion 178 on the underside of the greater trochanter (GT) plate 116 is more clearly seen. Now, referring to FIG. 15, the cylindrical recess 176 of the periprosthetic proximal femoral plate 54 is more clearly seen.

[0081] The third embodiment includes a thinner profile than the first and second embodiments that connects the trochanter (GT) plate 116 to the periprosthetic proximal femoral plate 54, and is generally indicated by the numeral 180. This design reduces soft tissue irritation as much as possible. The connection mechanism has one threaded connection and two orientation features. Now, referring to FIG. 16, there is a second partially threaded bolt 166 that can be received within threads 173 located on the greater trochanter (GT) plate 116. Optionally, the threads 173 in the greater trochanter (GT) plate 116 allow a bolt, for example an M5×0.8 bolt, to be preassembled and retained within the greater trochanter (GT) plate 116. This second partially threaded bolt 166 is partially threaded to allow the threads 171 in the greater trochanter (GT) plate 116 and the periprosthetic proximal femoral plate 54 to be properly oriented prior to connecting them.

[0082] The connection is made through a cylindrical boss protrusion 178 on the greater trochanter (GT) plate, which is located around the threaded connection 173 in the greater trochanter (GT) plate 116 and also serves as an orientation feature. This cylindrical boss protrusion 178 on the underside of the greater trochanter (GT) plate 116 fits into a cylindrical recess 176 in the periprosthetic proximal femoral plate 54. There is an angled rod 168 in the greater trochanter (GT) plate 116, which slides into the slotted orientation feature 86 for the GT plate in the periprosthetic proximal femoral plate 54 for proper orientation, as shown in FIG. 9. The angled rod 168 is directed upwards in the proximal direction to help resist tension applied by the abductor muscles. This provides a mechanical advantage with respect to the stability of the combined greater trochanter (GT) plate and periprosthetic proximal femoral plate construct 160.

[0083] 17, the plate bolt attachment holes 124 on the periprosthetic proximal femoral plate 54 are shown in greater detail.

[0084] From the above, it can be seen that the present disclosure accomplishes at least all of its stated objectives.

[0085] List of reference characters The following list of reference letters and descriptors is neither exhaustive nor limiting, and includes reasonable equivalents. Where possible, elements identified by the following reference letters and / or elements that are more or less ubiquitous in the art can be substituted or supplemented with any element identified by another reference letter.

[0086] [Table 1] [Table 2]

[0087] Glossary Unless otherwise defined, all technical and scientific terms used above have the same meaning as commonly understood by one of ordinary skill in the art to which the embodiments of the present disclosure pertain.

[0088] The terms "a," "an," and "the" include both singular and plural referents.

[0089] The term "or" is equivalent to "and / or" and means any one member or combination of members of a particular list.

[0090] As used herein, the word "exemplary" refers to an example, instance, or illustration and, unless otherwise specified, does not refer to a preferred embodiment.

[0091] As used herein, the term "about" refers to slight variations in a quantity for any quantifiable variable. Unintentional errors may result, for example, through the use of typical measuring techniques or equipment, or from differences in manufacture, source, or purity of the components.

[0092] The term "substantially" refers to a great or significant degree. Thus, "substantially" can refer to a plurality, a majority, and / or a supermajority of the quantifiable variable in question, given the appropriate context.

[0093] The term "generally" encompasses both "about" and "substantially."

[0094] The term "configured" describes a structure that is capable of performing a task or adopting a particular configuration. The term "configured" may be used interchangeably with other similar phrases such as built, arranged, adapted, manufactured, etc.

[0095] Terms characterizing order, position, and / or orientation are not limiting and are merely referenced according to the figures presented.

[0096] "Invention" is not intended to refer to any single embodiment of a particular invention, but rather encompasses all possible embodiments as described in the specification and claims. The "scope" of the disclosure is defined by the appended claims, along with the full scope of equivalents to which such claims are entitled. The scope of the disclosure will be further modified as including any possible modifications to any of the aspects and / or embodiments disclosed herein, which modifications will result in other embodiments, combinations, subcombinations, etc., that will be apparent to those skilled in the art.

Claims

1. 1. A periprosthetic plate comprising:

1. A prosthetic perimeter plate comprising: a proximal segment having an upper portion and an end portion having at least two curved hooks capable of passing through a patient's abductor muscles and mounted medially on a tip of the patient's greater trochanter (GT), the proximal segment including a plurality of recessed bone screw holes for attachment to the patient's femur with bone screws.

2. The prosthetic perimeter plate of claim 1 , wherein the proximal segment includes a hook portion having the at least two curved hooks and an attachment portion.

3. 2. The prosthetic perimeter plate of claim 1, wherein the plurality of recessed bone screw holes are tapered such that any inserted bone screws do not extend above the upper portion of the proximal segment.

4. The prosthetic perimeter plate of claim 1 , wherein the plurality of recessed bone screw holes are parallel sets of two recessed bone screw holes.

5. The prosthetic perimeter plate of claim 4 , wherein the plurality of recessed bone screw holes are two parallel sets of at least two recessed bone screw holes.

6. The prosthetic perimeter plate of claim 1 further comprising a distal segment or shaft attached to or integral with the proximal segment.

7. The prosthetic perimeter plate of claim 6 , wherein the proximal segment includes a hook segment attached to the at least two curved hooks and an attachment segment.

8. 8. The prosthetic perimeter plate of claim 7, wherein the hook segment includes a first plurality of recessed bone screw holes, the attachment segment includes a second plurality of recessed bone screw holes, and the distal segment or shaft includes a third plurality of recessed bone screw holes.

9. 9. The prosthetic perimeter plate of claim 8, wherein the first plurality of recessed bone screw holes are in two parallel sets, the second plurality of recessed bone screw holes are in two parallel sets, and the third plurality of recessed bone screw holes are staggered side to side along a longitudinal length of the distal segment or shaft.

10. 10. The prosthetic perimeter plate of claim 9, wherein the first plurality of recessed bone screw holes, the second plurality of recessed bone screw holes, and the third plurality of recessed bone screw holes are tapered such that no inserted bone screws extend above the upper portion of the proximal segment.

11. The prosthetic perimeter plate of claim 1 , wherein the proximal segment includes at least one fastening cable hole set capable of receiving at least one fastening cable.

12. The prosthetic perimeter plate of claim 11 further comprising at least one fastening crimp located at an opening in the proximal segment.

13. 2. The prosthetic perimeter plate of claim 1, wherein the proximal segment includes at least one fastening cable set, each capable of receiving a fastening cable, and at least one fastening crimp located in at least one opening in the proximal segment.

14. a hook segment having an upper portion and an end portion having at least two curved hooks that can pass through the patient's abductor muscles and that rest medially on the tip of the patient's greater trochanter (GT), the hook segment being tapered so that any inserted bone screws do not extend above the upper portion of the hook segment, and including a first plurality of recessed bone screw holes that are a parallel set of two recessed bone screw holes; an attachment segment attached to or integral with said hook segment, the attachment segment including a second plurality of recessed bone screw holes, the second plurality of recessed bone screw holes being two parallel sets that are tapered so that any inserted bone screws do not extend above the upper portion of the hook segment, and the second plurality of recessed bone screw holes being two parallel sets of recessed bone screw holes; A prosthetic perimeter plate comprising:

15. 15. The prosthetic perimeter plate of claim 14, further comprising a distal segment or shaft attached to or integral with the mounting segment, the distal segment or shaft including a third plurality of recessed bone screw holes staggered side-to-side along a length of the distal segment or shaft, the third plurality of recessed bone screw holes being tapered such that any inserted bone screws do not extend above the upper portion of the proximal segment.

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