Acromioclavicular hook plate

Abstract

To provide a bone plate for treating acromioclavicular dislocations.SOLUTION: A bone plate includes: a shaft and a hook member. The shaft includes an outside portion and an inside portion connected to the outside portion in a substantially longitudinal direction. The outside portion has a size and a shape to be arranged along an upper surface of a clavicle distal end. Each of the outside portion and the inside portion includes a plurality of opening parts penetrating and extending therein for receiving a plurality of bone fixation elements. A first opening part among the plurality of opening parts of the inside portion is configured as a combination hole defined by the first opening part and a slot part extending from the first opening part. The remaining opening parts among the plurality of opening parts of the inside portion are arranged on both sides of a central axis of the shaft and shifted from each other along a length of the shaft. The hook member extends from the outside portion.SELECTED DRAWING: Figure 12

Description

[Background technology]

[0001] AC joint dislocations caused by tears of the acromioclavicular (AC) and coracoclavicular (CC) ligaments are often treated using osteosynthesis plates that include a hook member for hooking under the acromion and a diaphyseal portion for placement along the lateral portion of the clavicle. However, these osteosynthesis plates are generally not designed exclusively for the treatment of AC joint dislocations. Rather, osteosynthesis plates are generally designed to treat isolated distal clavicle fractures, AC ligament injuries, combined CC ligament injuries and distal clavicle fractures, and isolated AC joint dislocations. Therefore, in some cases, it can be difficult to optimally position the hook member of the osteosynthesis plate under the acromion while simultaneously positioning the diaphyseal portion of the osteosynthesis plate on the distal clavicle. Furthermore, in some cases, osteosynthesis plates may not fit a patient's specific anatomy, leading to conditions such as subacromial impingement and osteolysis, which can cause pain and potentially lead to acromion fracture or premature plate removal. Summary of the Invention [Means for solving the problem]

[0002] The present disclosure relates to a bone plate for treating acromioclavicular dislocation, the bone plate comprising: a shaft including an outer portion sized and shaped to be positioned along an upper surface of a distal clavicle, the shaft including a plurality of openings extending therethrough for receiving a plurality of bone fixation elements; and a hook member that is hooked below the acromion in an operative position and extends from the shaft such that the outer portion of the shaft rests on the upper surface of the distal clavicle, the hook member being movable in either an anterior or posterior direction while the outer portion of the shaft has a substantially rounded shape such that the shaft maintains contact with the upper surface of the clavicle without any portion of the outer portion protruding above the surface of the distal clavicle.

[0003] The present disclosure also relates to a system for treating acromioclavicular dislocation, the system including: a bone plate including a shaft and a hook member extending therefrom, wherein, in an operative position, the hook member is hooked below the acromion and an outer portion of the shaft is positioned on the superior surface of the distal clavicle, the outer portion of the shaft being sized and shaped such that the hook member can be moved in either an anterior or posterior direction while maintaining contact with the superior surface of the clavicle without any portion of the shaft protruding beyond the surface of the distal clavicle; and a reduction device including a base portion configured to be releasably coupled to the shaft of the bone plate and a handle member extending at an angle from the base portion.

[0004] The present disclosure also relates to a method for treating acromioclavicular dislocation, the method including: hooking a hook member of a bone plate under the acromion; reducing the clavicle by pushing the clavicle with the shaft of the bone plate until an outer portion of the shaft is positioned along the superior surface of the distal clavicle; rotating the bone plate to orient the hook member in either an anterior or posterior direction to optimize contact between the acromion and the hook member, wherein the outer portion of the shaft maintains contact with the superior surface of the distal clavicle without any portion of the outer portion protruding from the surface of the distal clavicle during rotation of the bone plate; and securing the bone plate to the clavicle by inserting a plurality of bone fixation elements into a plurality of openings extending through the shaft while maintaining the relative positions of the acromion and the clavicle. [Brief explanation of the drawings]

[0005] [Figure 1] 1 illustrates a system according to an exemplary embodiment of the present disclosure. [Figure 2] 2 is a perspective view of a plate secured onto the superior surface of the distal clavicle using multiple bone fixation elements according to the exemplary system of FIG. 1; [Figure 3] FIG. 2 is a plan view of the plate of FIG. 1 angled forward. [Figure 4] FIG. 2 is a plan view of the plate of FIG. 1 angled rearward. [Figure 5] FIG. 2 is a bottom view of the plate of FIG. 1 including a plurality of bone fixation elements. [Figure 6] FIG. 2 is an enlarged perspective view of a portion of the plate of FIG. 1. [Figure 7] FIG. 2 is a plan view of the plate of FIG. 1. [Figure 8] FIG. 2 is a side (front-to-back) view of the plate of FIG. 1. [Figure 9] FIG. 1 is a perspective view of a system according to an alternative embodiment of the present disclosure. [Figure 10] FIG. 10 is a perspective view of a reduction device according to an alternative embodiment of the present disclosure. [Figure 11] FIG. 10 is a perspective view of a plate according to another exemplary embodiment of the present disclosure. [Figure 12] FIG. 10 is a perspective view of a plate according to an alternative embodiment of the present disclosure. [Figure 13] FIG. 10 is a perspective view of a plate according to yet another exemplary embodiment of the present disclosure. [Figure 14] FIG. 10 is a perspective view of a plate according to another alternative embodiment of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0006] The present invention can be understood by reference to the following description and the accompanying drawings, in which like elements are designated by the same reference numerals. This embodiment relates to the treatment of the acromioclavicular (AC) joint, and more particularly, to the treatment of AC joint dislocations using a hook plate. The exemplary embodiment describes an AC hook plate having a rounded shaft for placement along the distal clavicle and a hook member extending therefrom. The rounded shaft allows the plate to be angled so that the diaphyseal portion maintains contact with the superior surface of the distal clavicle, while the hook portion can extend in a desired direction to accommodate the patient's particular anatomy. The hook members of one exemplary embodiment extend from the hook plate shaft, which is oriented to extend at an angle relative to an axis perpendicular to the end of the clavicle when the plate is placed in the desired position. The plate is angled relative to the longitudinal axis of the bone when placed in the desired position, increasing the contact area between the hook member and the acromion. It should be noted that all directional terms used herein are intended as anatomical directional terms, and will be understood as such by those skilled in the art.

[0007] 1-8 , a system 100 for treating AC joint dislocation according to one exemplary embodiment of the present disclosure includes an AC hook plate 102 including a rounded shaft 104 configured to be positioned along the superior surface of the distal clavicle and a hook member 106 extending at an angle therefrom. The hook member 106 extends at an angle from the shaft 104 such that the hook member 106 can be hooked under the acromion when the hook plate 102 is in a desired position. The angle of the hook member 106 relative to the shaft is selected to optimize contact between the hook member 106 and the acromion. Specifically, the hook member 106 is angled relative to the shaft 104 such that, when the shaft 104 is seated on the superior surface of the distal clavicle in a desired position and orientation, the hook member 106 extends at an angle relative to a distal clavicle axis L, which extends laterally away from the AC articular surface, through the center of the AC articular surface, and to the conical tuberosity of the distal clavicle, as will be understood by those skilled in the art. That is, hook plate 102 is configured so that hook members 106 extend at a desired angle relative to axis A, which is parallel to distal clavicle axis L, when hook plate 102 is in a desired position and orientation. Furthermore, longitudinal portions 132 of hook members 106, which hook beneath the acromion in the operative position, have a desired inclination relative to axis B, which extends parallel to plane P, which substantially coincides with the superior surface on which plate 102 rests. That is, plate 102 is configured so that, when hook plate 102 is in a desired position on superior surface P, longitudinal portions 132 of hook members 106 are angled relative to axis B, and hook members 106 extend beneath the acromion. The angulation of longitudinal members 132 relative to shaft 104 of plate 102 is selected to correspond to the angle of the inferior surface of the acromion relative to the superior surface of the distal clavicle. In use, longitudinal portion 132 of hook member 106 is hooked under the acromion, and shaft 104 is pressed against the clavicle until it is flush with the superior surface of the distal clavicle. If desired, after hook plate 102 is placed in this initial operating position, rounded shaft 104 may be rotated along the superior surface to orient hook member 106 anteriorly and / or posteriorly to conform hook plate 102 to the patient's particular anatomy.Once in the desired position, shaft 104 maintains contact with the superior surface of the distal clavicle while rotating hook plate 102 to maximize contact area between hook members 106 and the acromion. As shown in FIG. 1, system 100 may further include a reduction device 150 attachable to hook plate 102 for reducing the clavicle and positioning hook plate 102 relative to the AC joint as described above.

[0008] As described above, the shaft 104 of the hook plate 102 is configured to allow the hook plate 102 to be rotated and the hook members 106 to be oriented as needed to accommodate a patient's particular anatomy. Because anatomy varies from patient to patient (e.g., the location of the acromion relative to the clavicle), the hook plate 102 can be rotated to orient the hook members 106 more anteriorly, as shown in FIG. 3 , or more posteriorly, as shown in FIG. 4 , to properly position the hook members 106 as needed. The shaft 104 is configured to maintain contact with the superior surface of the distal clavicle while the hook plate 102 is rotated. In particular, the contour of the shaft 104 is rounded so that no portion of the shaft 104 substantially protrudes beyond the surface of the distal clavicle upon rotation of the hook plate 102. The shaft 104 extends along its length from a first end 108 to a second end 110, with a side 112 and a side 114 extending between the first end 108 and the second end 110. The length of the shaft 104 (i.e., the longest distance between the first end 108 and the second end 110) is selected to be shorter than the length of bone plates typically used to treat AC joint dislocations. For example, the shaft of a bone plate may be 40 mm or longer to extend across a clavicle fracture, while the shaft 104 may be approximately 26 mm long. This length of the shaft 104 is selected to be substantially equal to or less than the width of the superior surface of the distal clavicle, so that when the hook plate 102 is angled, no portion of the shaft 104 protrudes, regardless of its rotational orientation. Additionally, the shorter shaft 104 of the hook plate 102 allows for a less invasive procedure, requiring a smaller incision, reducing the risk of infection and providing a better cosmetic outcome. Those skilled in the art will appreciate that the shorter length of shaft 104 facilitates alignment of plate 102 along the clavicle and acromion and provides more space inside hook plate 102 for additional implants and / or grafts to reconstruct ligaments (such as the CC) in chronic conditions.

[0009] The length of the shaft 104 may be slightly greater than its width (i.e., the longest distance between the sides 112, 114). In one exemplary embodiment, in which the length of the shaft 104 is approximately 26 mm, the width of the shaft 104 may be approximately 23 mm. However, these dimensions are merely exemplary, and one skilled in the art will appreciate that the shaft 104 may have any of a variety of dimensions, so long as the shaft 104 has a substantially round shape and is sized for the particular portion of the clavicle to which it is attached so that it does not protrude above the surface of the distal clavicle when attached at a desired angle in either the anterior or posterior direction. The first and second ends 108, 110 and the sides 112, 114 are all curved, forming the substantially round shape of the shaft 104. The edges of the shaft 104 are also curved to reduce plate protrusion. To further reduce plate protrusion, the thickness of shaft 104 (i.e., the distance between first surface 118 of shaft 104, which faces away from the bone when hook plate 102 is in the operative position, and second surface 120 of shaft 104, which faces the bone when hook plate 102 is in the operative position) may be, for example, 3.4 mm or less, although this thickness is merely an example and can be modified as needed.

[0010] The hook plate 102 may include a plurality of openings 116 extending through the shaft 104 from the first surface 118 to the second surface 120. The openings 116 are configured to receive bone fixation elements 122 for securing the hook plate 102 to bone. The openings 116 may extend through the shaft 104 in various configurations. In one exemplary embodiment, a first opening 116a of the plurality of openings extends through a substantially central portion of the shaft 104, with the remaining openings extending proximate the periphery of the shaft 104 around the first opening 116a. For example, three openings 116b of the plurality of openings may extend along the periphery of the shaft 104 at the second end, and two openings 116c of the plurality of openings may extend through the shaft 104 along the first end 108.

[0011] In one exemplary embodiment, as shown in FIG. 5 , the openings 116 are configured as variable angle holes configured to receive bone fixation elements 122 along an angle relative to a central axis of the openings 116 within an allowable angular range. Thus, a surgeon or other user can insert the bone fixation elements 122 (e.g., screws) along a desired axis to secure the hook plate 102 to bone. It may be desirable to insert the bone fixation elements 122 into the openings 102 so that the axes of the bone fixation elements 122 converge at a point above the second surface 120 to improve fixation of the hook plate 102 to the clavicle. While one exemplary embodiment illustrates and describes all of the plurality of openings 116 as variable angle holes, one skilled in the art will understand that all or some of the plurality of openings 116 may have different configurations for receiving bone fixation elements. For example, in another embodiment, one or more of the plurality of openings 116 may be locking holes extending through the shaft 104 along a locking hole axis such that a bone fixation element 122 inserted therein engages the opening 116 and is locked along the locking hole axis. The openings 116 may be configured such that the locking hole axis converges above the second surface 120 of the shaft 104. Furthermore, although the exemplary embodiments illustrate and describe the bone fixation element 122 as a screw, those skilled in the art will understand that the bone fixation element 122 may include other elements that can be inserted through the openings 116 to secure the hook plate 102 to bone.

[0012] As mentioned above, one or more of the openings 116 may have a different configuration than the remaining openings 116. For example, as shown in FIG. 9 , a first opening 116a′ of the plurality of openings 116′ extending through a central portion of the shaft 104′ may be configured as an elongated hole to facilitate preliminary fixation of the hook plate 102′ to the clavicle, for example, by a wire that can include fasteners or screws (e.g., nonlocking / cortical screws) to compress the plate to the bone and allow adjustment of the position of the shaft 104′ along the clavicle. After the desired position of the hook plate 102′ relative to the clavicle is determined, fixation elements (e.g., variable angle holes and / or locking holes) may be inserted through the remaining openings 116′ to secure the hook plate 102′ to the bone.

[0013] As shown in FIG. 6 , the hook plate 102 can include a plurality of suture holes 124 extending through the shaft 104 at the first end 108. The suture holes 124 are configured to receive sutures and / or needles for reattaching soft tissue, such as the superior AC ligament and / or deltoid fascia. The suture holes 124 can extend through an undercut portion 126 of the shaft 104, which has a recess 128 extending to the second surface 120 so as to remain open at the first end 108. The undercut portion 126 allows curved needles and / or sutures to easily pass through the suture holes 124 when the hook plate 102 is positioned against the bone.

[0014] As described above, the hook member 106 extends from the first end 108 of the shaft 104 along a first side 112 (e.g., a posterior side of the shaft 104). The hook member 106 includes a connecting portion 130 that connects the longitudinal portion 132 to the shaft 104 in an offset configuration. In other words, the longitudinal portion 132 is offset from the plane in which the shaft 104 extends so that the hook member 106, and in particular the longitudinal portion 132 of the hook member 106, can be hooked below the acromion when the shaft 104 is positioned along the superior surface of the distal clavicle. The connecting portion 130 extends downward from the first end 108 of the shaft 104, and the longitudinal portion 132 extends laterally from the connecting portion 130. Thus, when the hook plate 102 is in the operative position, the longitudinal portion 132 of the hook member 106 extends laterally toward the acromion.

[0015] As discussed above, the angle / inclination of the hook members 106 can be described with respect to the anatomy of the distal clavicle when the hook plate 102 is positioned in a desired position thereon. The distal clavicle axis L is defined as the axis passing through the center of the AC articular surface and the conical tuberosity of the distal clavicle. As shown in FIG. 7 , the hook members 106 extend from the shaft 104 at an angle relative to axis A. When the shaft 104 is positioned along a substantially flat surface on the upper surface of the distal clavicle such that the shaft 104 extends substantially along or parallel to the distal clavicle L, axis A also extends parallel to the distal clavicle axis L. Axis C extends perpendicular to the distal clavicle axis L through the AC articular surface. In one embodiment, the hook members 106 may be angled 15-30 degrees relative to axis A, and in one particular embodiment, may be angled approximately 20 degrees relative to axis A (i.e., approximately 110 degrees relative to axis C). However, as noted above and described in more detail below, shaft 104 can be rotated and oriented along its superior surface so that the length of shaft 104 is angled relative to distal clavicle axis L to further adapt hook plate 102 to a patient's particular anatomy. In particular, shaft 104 can be rotated and oriented to move hook members 106 in the anterior-posterior direction (FIGS. 3 and 4) and maximize contact between hook members 106 and the acromion according to the patient's particular anatomy.

[0016] As shown in FIG. 8 , the longitudinal portion 132 of the hook member 106 may be angled relative to an axis B that extends parallel to a plane P that extends along the superior surface of the distal clavicle on which the hook plate 102 is positioned. Plane P may be defined by three selected points along the substantially flat surface of the superior surface. In the desired position, the bone-facing surface 134 of the shaft 104 is positioned along the superior surface such that axis B also extends substantially parallel to the bone-facing surface 134. The angle of the longitudinal portion 132 relative to axis B is selected to optimize contact between the hook member 106 and the acromion. For example, the longitudinal portion may be angled downward at an angle of 10-20 degrees relative to axis B, and in one particular embodiment, may be angled at an angle of approximately 15 degrees relative to axis B. Because the acromion is typically angled relative to the clavicle, the angle and angle of the hook member 106 relative to the shaft 104 optimizes contact between the acromion and the hook member 106. Rotation of hook plate 102 in an anterior and / or posterior direction about the superior lateral aspect of the distal clavicle may further optimize contact of hook member 102 with the acromion according to the patient's particular anatomy.

[0017] Those skilled in the art will understand that the angle and inclination of the hook member 106 described above are merely exemplary and may be varied to optimize contact between the hook member 106 and the acromion. The angle and inclination of the hook member 106 may correspond to the position of the acromion relative to the axis of the clavicle when reduced. Studies based on a 3D patient database have shown that the optimized angle of the hook member 106 relative to axis C is 111°±5.2°, and the optimized inclination of the hook member 106 relative to axis B is 15°±4.7°. Those skilled in the art will understand that the angle and inclination may be varied in this manner. However, these optimized values ​​are merely exemplary, and those skilled in the art will also understand that the angle / inclination may extend beyond the ranges described above depending on the patient's specific anatomy.

[0018] Hook plates 102 may be manufactured in a variety of sizes and dimensions. In particular, hook plates 102 may be available with various connecting portion 130 lengths. For example, connecting portion 130, whose length corresponds to the distance between second surface 120 of shaft 104 and axis B, may be available in various lengths, such as 10 mm, 13 mm, and 16 mm. Thus, a surgeon may be able to select one of these hook plates 102 based on the patient's particular anatomy. The patient's anatomy may be measured by x-ray, template, or trial implant to determine the appropriate size.

[0019] 1 , reduction device 150 includes a base portion 152 releasably coupleable to shaft 104 of hook plate 102 and a handle member 154 extending from base portion 152. Handle member 154 may extend at an angle from base portion 152 such that, when base portion 152 is coupled to shaft 104, a surgeon or other user can use handle member 154 to reduce a clavicle in an AC dislocation and position hook plate 102. The angle of handle member 154 relative to base portion 152 can be selected to optimize clavicle reduction. In one embodiment, base portion 152 can be sized and shaped to be coupled to first surface 118 of shaft 104, for example, via a screw. In another embodiment, as shown in FIG. 10 , base portion 152″ of handle member 150′ may be coupled to shaft 104 via undercut portion 126. It will be understood by those skilled in the art that base portion 152 of the reduction device may be coupled to hook plate 102 in any of a variety of ways, so long as base portion 152 is coupled to shaft 104 in a manner that allows for insertion of hook members 106 beneath the acromion and movement of handle members 154 to reduce the clavicle. Reduction device 150 may further include indicators, such as wire holes or laser etching, that indicate the hook orientation of hook members 106 of the connected hook plate 106 to facilitate insertion and proper alignment of hook members 106 beneath the acromion.

[0020] According to an exemplary surgical method using the system 100, a reduction device is coupled to the shaft 104 of the hook plate 102 so that the hook plate 102 can be inserted into the patient and positioned as needed to treat an AC joint dislocation. In particular, the hook plate 102 is inserted through a skin incision and moved toward a target site at the AC joint using the handle member 154. The hook plate 102 is moved toward the target site until the hook member 106 is inserted beneath the acromion. Once the hook member 106 is inserted, the surgeon can move the shaft 104 of the hook plate 102 downward until it reaches the clavicle. Once the shaft 104 contacts the superior surface of the distal clavicle, a first (non-locking) bone fixation element can be inserted into one of the holes 116 in the plate 102 or hole 116a' in the plate 102' to temporarily secure the plate 102, 102' to the clavicle. Hook plate 102 can then be angled by rotating shaft 104 about its center point so that hook members 106 are oriented in either an anterior or posterior direction to fit the patient's particular anatomy. In the optimal position, shaft 104 extends along the superior surface while maximizing contact between hook members 106 and the acromion.

[0021] Once the hook plate 102 is positioned as desired, the bone fixation elements 122 are inserted through the openings 116 to secure the hook plate 102 to the clavicle. Securing the hook plate 102 to the clavicle maintains the clavicle and acromion in a desired position relative to one another. The reduction device 150 can then be detached from the hook plate 102, leaving the hook plate 102 connected to the bone. If desired, soft tissue, such as the superior AC ligament and / or deltoid fascia, may be attached to the hook plate 102 via the suture holes 124. Once reduction is complete, the incision may be sutured closed. While this exemplary method describes and illustrates the reduction and positioning of the hook plate 102 via the reduction device 150, those skilled in the art will understand that the hook plate 102 can be similarly positioned to reduce and secure the distal clavicle without the use of the reduction device 150.

[0022] As mentioned above, the length of the shaft 104 of the hook plate 102 allows for the use of additional implants, such as, for example, a clavicle diaphyseal plate, positioned medially within the hook plate 102. However, according to another exemplary embodiment, the hook plate may be configured for the treatment of both AC joint dislocations and associated soft tissue injuries associated with distal clavicle fractures, such as, for example, Neer Type II and Jaeger and Breitner Type II. These hook plates may have a shaft configured to be positioned along the shaft of the distal clavicle and may be manufactured in various lengths. For example, the hook plate may be manufactured in a short length, as shown in FIG. 11, and a long length, as shown in FIG. 12.

[0023] As shown in FIG. 11 , another exemplary embodiment of a hook plate 202 may be configured for treatment of the AC joint. Similar to hook plate 102, hook plate 202 includes a shaft 204 and hook members 206. Hook members 206 may be substantially similar to hook members 106, with hook members 206 angled and / or tilted to optimize contact with the acromion in the operating position. However, shaft 204 includes an outer portion 205 substantially similar to shaft 104 and an inner portion 234 extending medially from outer portion 205 and positioned along the shaft of the clavicle for treatment of fractures and / or soft tissue injuries. The length of shaft 204 of hook plate 202 may be shaped (e.g., curved) to correspond to the shape of the clavicle. For example, the shape of shaft 204 may be determined using a mean-shape bone model or a polynomial derived from a patient-specific bone scan.

[0024] In particular, like shaft 104, outer portion 205 is sized to be positioned on the superior surface of the distal clavicle and may have a substantially rounded shape to allow hook members 206 to be angled anteriorly and / or superiorly to conform to the patient's particular anatomy (i.e., the location of the acromion relative to the clavicle). Outer portion 205 may include all of the features of shaft 104, including, but not limited to, openings 216 extending therethrough for receiving bone fixation elements, and suture holes 224 for receiving sutures / needles for attaching soft tissue. The lateral portion 205 may include one or more additional suture holes 236 proximate the second end 210 thereof, along the anterior side 214 and / or posterior side 212 thereof, and / or along the diaphyseal portions 204, 234, for reattachment to the deltoid, pectoralis major, and / or any other muscles, tendons, and / or ligaments attached to the distal clavicle, and / or any bone fragments that may or may not be attached to these muscles, tendons, or ligaments. Although the lateral portion 205 is shown and described as having a rounded shape, one skilled in the art will understand that the lateral portion 205 may have other shapes, so long as the lateral portion 205 is sized and shaped to be positioned along the superior surface of the distal clavicle. For example, as shown in FIG. 12, an outer portion 205' of a shaft 204' of a plate 202' may taper from a first end 208' to a second end 210' of the shaft 204'.

[0025] The inner portion 234 may extend inward from the outer portion 205 and may connect to the outer portion 205 via a narrow portion 238 of the hook plate 202. The narrow portion 238, defined by a recess 239, extends toward the posterior side 212 and / or the anterior side 214 of the hook plate 202. The narrow portion 238 facilitates bending adjustment of the outer portion 205 relative to the inner portion 234. The inner portion 234 may include a plurality of openings 239. The openings 239 may have any of a variety of configurations, including, for example, variable angle holes, locking holes, combined variable angle compression holes, etc. In one exemplary embodiment, a first opening of the plurality of openings 240a adjacent the narrow portion 238 may be configured as a combined variable angle compression hole. The compression portion of the first opening 240a may be used for out-of-plane bending. The remaining openings 240b-240e may be configured as variable angle holes and / or locking holes. The openings 240b, 240c and 240d, 240e may be located on opposite sides of the central axis of the shaft 204 and may be offset from one another along the length of the shaft 204. However, this configuration of the openings 240 is merely exemplary, and one skilled in the art will appreciate that the inner portion 234 may include any number of openings 210 having any of a variety of configurations that allow for fixation of the shaft 204 to the clavicle and / or reduction of a clavicle fracture. The inner end 210 of the plate shaft 204 may include a portion in which the thickness and / or width of the plate 202 gradually decreases toward the end of the plate 202. This helps reduce the protrusion of the end 210 of the plate 202 and the potential for inducing pain and discomfort to the patient.

[0026] In another embodiment, as shown in FIG. 13 , hook plate 302 may be substantially similar to hook plate 202 and may have the same features as hook plate 202, except for a longer length. Like hook plate 202, hook plate 302 includes hook members 306 connected to shaft 304, which includes outer portion 305 and inner portion 334 connected to each other via first narrow portion 338. Outer portion 305 may be substantially similar to shaft 104 of plate 102 or outer portion 205 of plate 202. Like plate 202, outer portion 305 may be rounded, as shown in FIG. 13 . However, outer portion 305 may have any of a variety of shapes, so long as outer portion 305 is configured to be positioned along the superior surface of the distal clavicle. For example, as shown in FIG. 14, an outer portion 305' of a shaft 304' of a plate 302' may taper from a first end 308' of the shaft 304' to a second end 310' of the shaft 304'.

[0027] However, the inner portion 334 is longer than the inner portion 234. The inner portion 334 may include an additional opening 342 disposed outwardly of the opening 340a. In one exemplary embodiment, the additional opening 342 may be configured as a combination variable-angle compression hole. However, it will be understood by those skilled in the art that the opening 342 may have any of a variety of configurations for receiving a bone fixation element. The first portion 344 of the inner portion 334, including the additional opening 342, may be connected to the second portion 346 of the inner portion 334, including the remaining opening 340, via a second narrow portion 348. The second narrow portion 348 may be substantially similar to the first narrow portion. The second narrow portion 348 is defined via a recess 349 extending to the posterior and anterior sides 312, 314 of the shaft 304, allowing for bending adjustment between the first portion 344 and the second portion 346 of the inner portion 334 of the shaft 304 to better fit the patient's particular anatomy. In a further embodiment, one or more additional narrow sections may be added along the shaft 304 inwardly of the second narrow section 348. The shaft 304 may be curved along these narrow sections according to the patient's anatomy.

[0028] Hook plates 202 and 302 may be used in a manner substantially similar to hook plate 102 of system 100. In particular, hook plates 202, 302 may be implanted in the body using a reduction device substantially similar to reduction device 150 of system 100. Hook members 206, 306 may be hooked under the acromion and shafts 204, 304 may be pressed against the shaft of the clavicle to reduce the clavicle. Those skilled in the art will appreciate that hook plates 202, 302 may be tailored to fit a patient's particular anatomy (i.e., the shape of the patient's clavicle) by angling, for example, by bending the plates at narrow portions 238, 338, 348. Outer portions 205, 305 are positioned along the superior surface of the distal clavicle and secured thereto via bone fixation elements, as described above with respect to plate 102. The medial portion 234 , 334 is positioned along the shaft of the clavicle and secured thereto via any number of bone fixation elements inserted through the openings 240 , 340 , 342 .

[0029] Those skilled in the art will understand that modifications and variations can be made to the structure and method of these embodiments without departing from the spirit or scope of these embodiments. Thus, it is intended that the present invention cover the modifications and variations of these embodiments provided they come within the scope of the appended claims and their equivalents.

[0030] [Embodiment] (1) A bone plate for treating acromioclavicular dislocation, comprising: a shaft including an outer portion sized and shaped to be positioned along a superior surface of a distal lateral clavicle, the shaft including a plurality of openings extending therethrough for receiving a plurality of bone fixation elements; a hook member that, in an operative position, is hooked under the acromion and extends from the shaft such that the outer portion of the shaft rests on the upper surface of the distal clavicle, the outer portion of the shaft having a substantially rounded shape such that the shaft maintains contact with the upper surface of the distal clavicle while the hook member is movable in either an anterior or posterior direction without any portion of the outer portion of the shaft protruding beyond the surface of the distal clavicle; A bone plate comprising: (2) The bone plate of embodiment 1, wherein the hook member extends from the shaft at an angle relative to the longitudinal axis of the shaft. (3) The bone plate of embodiment 2, wherein the angle of the hook member relative to the longitudinal axis of the shaft is in the range of between 15 degrees and 30 degrees. (4) The bone plate of embodiment 3, wherein the angle of the hook member relative to the longitudinal axis of the shaft is 21 degrees. (5) A bone plate according to embodiment 1, wherein the hook member includes a connecting portion and a longitudinal portion, the longitudinal portion being inclined downwardly relative to the longitudinal axis of the clavicle to which the bone plate is attached.

[0031] (6) The bone plate of embodiment 5, wherein the inclination of the longitudinal portion relative to the bone-facing surface of the shaft ranges between 10 and 20 degrees. (7) The bone plate of embodiment 6, wherein the inclination of the longitudinal portion relative to the bone-facing surface is 15 degrees. (8) The bone plate of embodiment 1, wherein the shaft is defined by first and second ends and anterior and posterior sides extending therebetween, and the hook member extends from the first end along the posterior side. (9) The bone plate of embodiment 1, wherein the maximum length of the outer portion of the shaft is selected so as not to exceed the width of the surface of the upper surface of the clavicle. (10) The bone plate of embodiment 1, wherein each of the plurality of openings is configured as one of a variable angle hole and a locking hole.

[0032] (11) The bone plate of embodiment 1, further comprising an elongated opening extending through a central portion of the outer portion of the shaft. (12) The bone plate of embodiment 1, further comprising a plurality of suture holes extending through the outer portion of the shaft for attaching soft tissue thereto. (13) The bone plate of embodiment 12, wherein the plurality of suture holes extend through an undercut portion of the shaft. (14) The bone plate of embodiment 1, wherein the shaft includes an inner portion extending inwardly from the outer portion, the inner portion extending along a diaphyseal portion of the clavicle in the operating position, and the inner portion includes a plurality of openings extending therethrough for receiving a plurality of bone fixation elements. (15) The bone plate of claim 14, wherein the inner portion is connected to the outer portion via a narrowed portion that allows bending adjustment of the bone plate between the outer portion and the inner portion.

[0033] (16) A system for treating acromioclavicular dislocation, comprising: a bone plate including a shaft and a hook member extending therefrom, wherein, in an operative position, the hook member is hooked under the acromion, an outer portion of the shaft is positioned on the superior surface of the distal clavicle, the outer portion of the shaft being sized and shaped such that the hook member can move in either an anterior or posterior direction while maintaining contact with the superior surface of the distal clavicle without any portion of the shaft protruding beyond the surface of the distal clavicle; a reduction device including a base portion configured to be releasably coupled to the shaft of the bone plate and a handle member extending at an angle from the base portion; A system comprising: (17) The system of embodiment 16, wherein the base portion is coupled to a surface of the shaft facing away from the bone in the operating position. (18) The system of embodiment 16, wherein the base portion is coupled to an undercut portion of the shaft. (19) The system of embodiment 16, wherein the base portion is coupled to a bone fixation element receiving opening in the shaft. (20) The system of embodiment 16, wherein the shaft includes an inner portion connected to the outer portion such that, in the operating position, the shaft extends along the diaphyseal portion of the clavicle.

[0034] (21) A method for treating acromioclavicular dislocation, comprising: Hooking the hook member of the bone plate under the acromion; reducing the clavicle by pushing the shaft of the bone plate against the clavicle until an outer portion of the shaft is positioned along the superior surface of the distal clavicle; rotating the bone plate to orient the hook members in either an anterior or posterior direction to optimize contact between the acromion and the hook members, wherein the outer portion of the shaft maintains contact with the upper surface during rotation of the bone plate without any portion of the outer portion protruding from the surface of the distal clavicle; maintaining the relative position of the acromion and the clavicle and securing the bone plate to the clavicle by inserting a plurality of bone fixation elements into a plurality of openings extending through the shaft; A method comprising: (22) The method of claim 21, further comprising pre-fixing the bone plate to the clavicle by inserting a bone fixation element into an elongated opening extending through a central portion of the outer portion of the shaft. 23. The method of claim 21, further comprising treating the clavicle fracture by positioning a clavicle shaft plate medially along the length of the clavicle and within the lateral portion of the shaft. 24. The method of claim 21, further comprising treating the distal clavicle fracture by positioning the interior portion of the shaft along the length of the clavicle. (25) The method of claim 24, further comprising adjusting the bone plate relative to the clavicle by bending the outer portion relative to the inner portion.

[0035] (26) The method of embodiment 21, further comprising reattaching the soft tissue to the clavicle by suturing the soft tissue to the bone plate through a plurality of suture holes extending through a portion of the shaft.

Claims

1. 1. A bone plate for treating acromioclavicular dislocation, comprising: a shaft including an outer portion and an inner portion substantially longitudinally connected to the outer portion, the outer portion sized and shaped to be positioned along a superior surface of a distal clavicle, the outer portion and the inner portion each including a plurality of openings extending therethrough for receiving a plurality of bone fixation elements, a first of the plurality of openings in the inner portion configured as a mating hole defined by the first opening and a slot extending from the first opening, and the remaining openings in the inner portion being disposed on opposite sides of a central axis of the shaft and offset from one another along the length of the shaft; a hook member that, in an active position, is hooked under the acromion and extends from the outer portion of the shaft such that the outer portion rests on the superior surface of the distal clavicle; A bone plate comprising:

2. 2. The bone plate of claim 1, wherein the hook member includes a connecting portion and a longitudinal portion, the longitudinal portion being inclined downwardly relative to an axis extending parallel to a plane extending along the upper surface of the distal clavicle in which the shaft is disposed.

3. 2. The bone plate of claim 1, wherein the hook member includes a connecting portion and a longitudinal portion, the longitudinal portion being inclined downwardly at a given angle relative to an axis extending parallel to a plane extending along the upper surface of the distal clavicle in which the shaft is disposed, the given angle being in the range of between 10 degrees and 20 degrees.

4. The bone plate of claim 3 , wherein the given angle is 15 degrees.

5. The bone plate of claim 1 , wherein each of the plurality of openings is configured as one of a variable angle hole and a locking hole.

6. The bone plate of claim 1 , further comprising a plurality of suture holes extending through the outer portion of the shaft for attaching soft tissue to the shaft.

7. The bone plate of claim 6 , wherein the plurality of suture holes extend through an undercut portion of the shaft.

8. 10. The bone plate of claim 1, wherein the inner portion is connected to the outer portion through a narrowed portion that allows bending adjustment of the bone plate between the outer and inner portions.

9. The bone plate of claim 1 , wherein the slot opens to the first opening.

10. The bone plate of claim 1 , wherein the slot extends from the first opening in a direction away from the outer portion.

11. The bone plate of claim 1 , wherein the combination holes are combination variable angle compression holes.

12. 2. The bone plate of claim 1, wherein the inner portion further includes a second opening extending therethrough, the second opening configured as a combination hole defined by the second opening and a slot extending from the second opening.

13. 13. The bone plate of claim 12, wherein the inner portion includes a first portion and a second portion connected to the first portion via a narrow portion, the first opening and the remaining openings being disposed in the second portion, and the second opening being disposed in the first portion.

14. The bone plate of claim 13 , wherein the first portion of the inner portion is positioned between the outer portion and the second portion of the inner portion.

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