Locking trocar and method of use

Abstract

The aiming arm system includes an aiming arm and a guide sleeve. The aiming arm has 1) a body, a guide bore extending through the body along a bore axis, and 2) a retaining element supported relative to the body. The aiming arm is configured to be positioned such that the bore axis is aligned with a target location of an anatomical implant. The guide sleeve extends along a linear direction and is sized to be inserted through the guide bore in a linear direction. Relative rotation between the guide sleeve and the retaining element transitions the aiming arm system between an unlocked configuration in which the guide sleeve is insertable through the guide bore and a locked configuration in which the retaining element applies a retaining force to the guide sleeve that substantially prevents further movement of the guide sleeve along the linear direction.

Description

[Technical Field]

[0001] The present disclosure relates to systems, kits, assemblies, and methods for aligning and attaching an aiming guide to a bone plate for attachment to an intramedullary nail within the medullary canal of a bone. [Background technology]

[0002] Intramedullary nails have been used for many years to treat fractures in the body's long bones, such as the femur, tibia, and humerus. To treat such fractures, the intramedullary nail is inserted into the medullary canal of the long bone so that the nail extends across one or more fracture sites in the long bone and into a section of the long bone separated by the one or more fracture sites. A bone anchor is then inserted through the bone and into the intramedullary nail on the opposite side of the fracture site, thereby securing the intramedullary nail to the bone. The intramedullary nail can remain in the medullary canal at least until the fracture heals.

[0003] The foregoing background discussion is intended merely to assist the reader and is not intended to limit the innovations described herein. Thus, the foregoing discussion should not be construed to indicate that any particular element of conventional systems is not suitable for use with the innovations described herein, nor is it intended to indicate that any element is essential to the implementation of the innovations described herein. Summary of the Invention [Means for solving the problem]

[0004] In conventional intramedullary nailing techniques, surgeons must insert the nail into the bone and then lock the nail into both the distal and proximal fracture fragments. To complete this technique, a series of sleeves are used to expose the target screw locations, drill pilot holes along the appropriate trajectory, and provide guidance for inserting screws through the nail. The sleeves can also be used to apply pressure to the bone as a reduction force or to temporarily hold other hardware. Current methods for this technique may be adequate for drilling and inserting screws, but lack the ability to quickly and reliably apply and release pressure.

[0005] The aforementioned needs are largely met by the systems and methods disclosed in the present application.

[0006] According to one aspect of the present disclosure, a guide sleeve assembly in combination with an aiming arm system is configured to apply pressure to an outer mounting plate and / or washer (e.g., a bone plate) to hold the plate to the bone during drilling and / or screwing for a nail locking element. The guide sleeve assembly can be applied in any situation where a surgeon needs to apply outer pressure (e.g., to the bone as a reduction force) to lock the position of the sleeve assembly relative to the plate.

[0007] The aiming arm system includes an aiming arm guide bore for guiding a guide sleeve assembly. The guide sleeve assembly geometry can include a non-cylindrical outer profile formed by removing material from the outer diameter along the length of the outer sleeve guide. The aiming arm guide bore includes a cross pin (e.g., a retaining element) that forms a chord within the guide bore profile. When the outer sleeve guide is inserted in an unlocked orientation, the cross pin passes freely along the sleeve guide. When the outer sleeve guide rotates within the aiming arm guide bore relative to the cross pin, the sleeve guide forms a cam mechanism between the entire outer diameter of the sleeve guide and the cross pin. This creates an interference fit between the outer sleeve guide and the cross pin, creating sufficient friction between the sleeve guide and the pin to substantially prevent axial movement of the sleeve guide within the guide bore.

[0008] According to another aspect of the present disclosure, an aiming arm system is provided. The aiming arm system includes an aiming arm and a guide sleeve. The aiming arm has: 1) an aiming arm body and a guide bore extending through the aiming arm body along a central guide bore axis, the aiming arm being configured to be positioned such that the central guide bore axis is aligned with a target location of an anatomical implant; and 2) a retaining element supported relative to the aiming arm body. The guide sleeve extends along the central guide sleeve axis oriented along a linear direction and is sized to be inserted through the guide bore in a linear direction. Relative rotation between the guide sleeve and the retaining element transitions the aiming arm system between an unlocked configuration in which the guide sleeve is insertable through the guide bore in a linear direction and a locked configuration in which the retaining element applies a retaining force to the guide sleeve that substantially prevents further movement of the guide sleeve in the linear direction.

[0009] According to another aspect of the present disclosure, a method of positioning a guide sleeve within a guide bore is disclosed. The method includes: moving the guide sleeve within a guide bore defined by an aiming arm, the guide bore extending through an aiming arm body along a central guide bore axis, the aiming arm configured to be positioned so that the central guide bore axis is aligned with a target location of an anatomical implant, the aiming arm supporting a retaining element; linearly inserting the guide sleeve, extending along the central guide sleeve axis oriented along a linear direction, into the guide bore; and transitioning the aiming arm between an unlocked configuration in which the guide sleeve is insertable through the guide bore along the linear direction and a locked configuration in which the retaining element applies a retaining force to the guide sleeve that substantially prevents the guide sleeve from moving along the linear direction. The transitioning step is effected by relative rotation between the guide sleeve and the retaining element.

[0010] This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description section. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used to limit the scope of the claimed subject matter. Moreover, the claimed subject matter is not bound by limitations that solve any or all of the disadvantages noted anywhere in this disclosure. [Brief explanation of the drawings]

[0011] The foregoing summary, as well as the following detailed description of exemplary embodiments of the present intervertebral implant, will be better understood when read in conjunction with the accompanying drawings. For the purpose of illustrating the present expandable intervertebral implant, there is shown in the drawings exemplary embodiments. It should be understood, however, that the present application is not limited to the precise arrangements and instrumentalities shown. In the drawings: [Figure 1] 1 shows a perspective view of a system according to one embodiment having a guide sleeve assembly supported by an aiming arm system attached to an intramedullary nail received within the medullary canal of a bone. [Figure 2] FIG. 1 illustrates a top perspective view of an aiming arm body according to one aspect of the present disclosure. [Figure 3] FIG. 3 shows a front view of the aiming arm body shown in FIG. 2. [Figure 4] 4 shows a cross-sectional view of the aiming arm body taken along line 4-4 of FIG. 3. [Figure 5] FIG. 3 shows a top view of the aiming arm body shown in FIG. 2. [Figure 6A] 6 shows an enlarged top view of the aiming arm body shown in box 6 of FIG. 5. [Figure 6B] 6B shows an enlarged top view of an alternative embodiment of the aiming arm body shown in FIG. 6A. [Figure 7] FIG. 3 shows a side view of the aiming arm body shown in FIG. 2. [Figure 8] 8 shows a cross-sectional view of the aiming arm body taken along line 8-8 of FIG. 7. [Figure 9] 1 shows a perspective view of a retaining element according to one aspect of the present disclosure. [Figure 10] 10 shows a side view of the holding element shown in FIG. 9. [Figure 11] 10 shows a top view of the holding element shown in FIG. 9. [Figure 12] 1 shows a perspective view of a bone plate according to one aspect of the present disclosure. [Figure 13] 1 shows a perspective view of a guide sleeve assembly according to one aspect of the present disclosure. [Figure 14] 1 illustrates a top view of an outer guide sleeve according to one aspect of the present disclosure. [Figure 15] 15 shows a cross-sectional view of the outer guide sleeve taken along line 15-15 of FIG. 14. [Figure 16] 13 shows a view of a guide sleeve assembly supporting the bone plate shown in FIG. 12 against a bone, according to one embodiment of the present disclosure. [Figure 17] FIG. 15 shows a front view of the outer guide sleeve shown in FIG. 14. [Figure 18] 15 shows a rear view of the outer guide sleeve shown in FIG. 14. [Figure 19] 1 shows a perspective view of an inner guide sleeve according to one aspect of the present disclosure. [Figure 20] 20 shows a top view of the inner guide sleeve shown in FIG. 19. [Figure 21] 21 shows a cross-sectional view of the inner guide sleeve taken along line 21-21 of FIG. 20. [Figure 22] FIG. 20 shows a front view of the inner guide sleeve shown in FIG. [Figure 23] FIG. 20 shows a rear view of the outer guide sleeve shown in FIG. 19. [Figure 24] 14 illustrates a top view of the aiming arm body shown in FIG. 2 with both the retaining element shown in FIG. 9 and the guide sleeve assembly shown in FIG. 13 positioned within the aiming arm body, according to one embodiment of the present disclosure. [Figure 25A] 25 shows a cross-sectional view of the aiming arm body, retaining element, and guide sleeve assembly taken along line 25-25 shown in FIG. 24 in an unlocked configuration. [Figure 25B] 25 shows a cross-sectional view of the aiming arm body, retaining element, and guide sleeve assembly taken along line 25-25 shown in FIG. 24 in a locked configuration. DETAILED DESCRIPTION OF THE INVENTION

[0012] The present disclosure may be understood more readily by reference to the following detailed description in conjunction with the accompanying drawings and examples, which form a part of this disclosure. It is to be understood that the present disclosure is not limited to the specific devices, methods, applications, conditions, or parameters described and / or illustrated herein, and that the terminology used herein is for the purpose of describing specific embodiments, by way of example, only and is not intended to limit the scope of the present disclosure. Also, as used in the specification, including the appended claims, the singular forms "a," "an," and "the" include plurals, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise.

[0013] Certain terminology is used herein for convenience only and is not limiting. The terms "top," "bottom," "distal," "proximal," "inward," "outward," "inner," "outer," "above," "below," "axial," "transverse," "circumferential," and "radial" designate directions in the drawings to which reference is made. The terms "inner," "internal," and "interior" refer to directions toward the geometric center of the implant and / or implant adjustment tool, and the terms "outer," "external," and "exterior" refer to directions away from the geometric center of the implant and / or implant adjustment tool. The terms "anterior," "posterior," "upper," "lower," "inner," "outer," and related terms and / or expressions are used to designate various positions and orientations in the human body to which reference is made. The term "plurality," as used herein, means more than one. When a range of values ​​is expressed, another embodiment includes from the one particular value and / or to the other particular value. Similarly, when values ​​are expressed in approximation, by the antecedent "about," it will be understood that the particular value forms another embodiment. All ranges are inclusive and combinable. Terms include the above-listed words, derivatives thereof, and words of similar import.

[0014] As used herein, the term "substantially" and its derivatives and words of similar import, when used to describe a size, shape, orientation, distance, spatial relationship, or other parameter, includes the stated size, shape, orientation, distance, spatial relationship, or other parameter and can also include ranges of 10% or more and less than 10% of the stated parameter, including ranges of 5% or more and less than 5%, 3% or more and less than 3%, and 1% or more and less than 1%.

[0015] 1 , a system 10 is shown configured to position the bone plate 30 against the surface of the bone 70 when the bone plate 30 is fastened to the bone 70 and the intramedullary nail 60. Generally, the system 10 includes an aiming arm system 100 that facilitates alignment of the bone plate 30 with the bone 70 and the intramedullary nail 60. The aiming arm system 100 is releasably attached to the proximal end of the intramedullary nail 60 and includes an aiming arm body 101 having at least one aiming guide 104 (e.g., an aiming arm) and a handle 90. The aiming arm system 100 is configured to align the axis A of the bone plate 30 with the bone 70 and the intramedullary nail 60. S1 and A S2 This can facilitate alignment of the bone plate 30 such that the axis A of the bone plate 30 is aligned with the corresponding bone anchor aperture of the intramedullary nail 60. For example, B1 can be aligned with the first aperture of the bone plate 30 and the first bone anchor opening extending through the intramedullary nail 60, and the axis A of the bone plate 30 B2 can be aligned with a second aperture in the bone plate 30 and a second bone anchor opening extending through the intramedullary nail 60.

[0016] The system 10 can further include at least one guide sleeve assembly 300. The aiming arm system 100 supports the guide sleeve assembly 300 to align the guide sleeve assembly 300 with the bone plate 30 and the intramedullary nail 60. For example, as described further below, the axis A of the bone plate 30 can be aligned with the axis A of the bone plate 30. B1 can be aligned with the first guide sleeve assembly 300 and the axis A of the bone plate 30 B2 may be aligned with the second guide sleeve assembly 300. The system 10 may further include at least one retaining element 150 for securing each of the at least one guide sleeve assembly 300 to the aiming arm system 100, as described further herein.

[0017] The system 10 may further include one or more of a bone plate 30, at least one bone anchor 40, such as a bone screw, an aiming arm system 100, an intramedullary nail 60, and one or more guide sleeve assemblies 300. The intramedullary nail 60 is generally elongated along the superior-inferior direction SI and sized to be received within the medullary canal of a long bone, such as the femur, tibia, or humerus.

[0018] The intramedullary nail 60 can be implanted by driving the nail 60 into the medullary canal of the bone 70. Once done, a handle 90 can be attached to the nail 60, and a medical professional, such as a surgeon, can hold the handle to guide the intramedullary nail 60 into the medullary canal.

[0019] To secure the intramedullary nail 60 to the bone 70, the intramedullary nail 60 can define at least one bone anchor fixation hole extending at least partially through the intramedullary nail 60. For example, the intramedullary nail 60 can include at least one proximal bone anchor fixation hole in a proximal portion of the intramedullary nail 60 and at least one distal bone anchor fixation hole in a distal portion of the intramedullary nail 60. The intramedullary nail 60 can be secured to the bone 70 by (1) for each bone anchor fixation hole, drilling a hole in the bone that aligns with the bone anchor fixation hole, and (2) for each bone anchor fixation hole, inserting a bone anchor 40 through the bone 70 and into the bone anchor fixation hole such that the bone anchor 40 engages the bone 70 on at least one side of the intramedullary nail 60, e.g., both sides.

[0020] However, this procedure can present several challenges. For example, because the intramedullary nail 60 is positioned inside the bone 70, the proximal and distal bone anchor holes are not visible to the surgeon. Furthermore, as the intramedullary nail 60 is driven into the medullary canal, the intramedullary nail 60 may bend an indeterminate amount. This bending can make it difficult to accurately predict the location and orientation of the bone anchor holes. Therefore, a targeting system or multiple targeting systems can be used to determine the location of each bone anchor hole and / or to align a cutting instrument, such as a drill bit, with each bone anchor hole. Once the location of the bone anchor hole has been determined and / or the cutting instrument has been aligned with the bone anchor hole, the bone can be drilled toward the bone anchor hole. The bone anchor 40 can then be inserted through the bone and into the bone anchor hole.

[0021] One method of targeting at least one bone anchor fixation hole includes using fluoroscopy to obtain a moving X-ray image of the position of a drill bit relative to the bone anchor fixation hole in real time. However, the use of fluoroscopy can excessively expose patients, and especially surgeons performing many such procedures, to harmful X-rays. As an alternative to fluoroscopy, the aiming arm system 100 can be coupled to the intramedullary nail 60 and used to target at least one of the bone anchor fixation holes with a cutting instrument, such as a drill bit. Generally, the aiming arm system 100 can include an alignment aperture that aligns with the at least one bone anchor fixation hole when the aiming arm system 100 is attached to the intramedullary nail 60. A cutting instrument can then be guided into the alignment aperture and guided through the bone to the bone anchor fixation hole.

[0022] To strengthen the attachment between the bone anchor 40 and the bone 70, the bone anchor 40 can be further secured to a bone plate 30 that is positioned against the outer surface of the bone 70 and further secured to the bone 70 via one or more additional bone anchors. For example, the bone plate 30 can be positioned against the bone, and a first bone anchor can be inserted into an aperture in the plate 30, through the surface of the bone 70, and into the intramedullary nail 60, such that the first bone anchor is attached to the plate 30, the bone 70, and the intramedullary nail 60. Additionally, one or more other bone anchors can be inserted into the plate 30 adjacent to the first bone anchor, such that the one or more other bone anchors terminate within the bone with or without passing through the intramedullary nail 60. The one or more other bone anchors provide additional fixation to the bone, which can reduce the load on the first bone anchor.

[0023] Aligning and supporting the bone plate 30 on the bone 70 while the bone plate is being secured to the bone 70 can present challenges. For example, the bone plate must be gripped and / or secured to the bone to maintain the position of the bone plate 30 relative to the intramedullary nail 60 while inserting the bone anchors 40 through apertures in the plate 30, through the bone 70, and into apertures in the nail 60. If holes are pre-drilled prior to insertion of the bone anchors 40, the position of the plate 30 may also need to be maintained while holes are drilled through the bone 70 and into the apertures in the nail 60. The guide sleeve assembly 300 is configured to secure the bone plate 30 to the bone 70 during the process of securing the bone anchors 40 to the intramedullary nail 60.

[0024] The aiming arm system 100 is configured to quickly couple to and quickly uncouple from the insertion handle 90. The insertion handle 90 is also configured to couple to the intramedullary nail 60. The guide sleeve assembly 300 is configured to support and maintain the position of the bone plate 30 relative to the bone 70. The aiming arm system 100 is configured to support the guide sleeve assembly 300. However, it will be understood that the guide sleeve assembly 300, insertion handle 90, intramedullary nail 60, and guide sleeve assembly 300 may be distributed separately from one another or may be distributed in two or more groups of the aiming arm system 100, insertion handle 90, intramedullary nail 60, and guide sleeve assembly 300. Thus, embodiments of the present disclosure may include only one of the insertion handle 90, intramedullary nail 60, and guide sleeve assembly 300, or two or more of the aiming guide 100, insertion handle 90, intramedullary nail 60, and guide sleeve assembly 300.

[0025] 2-8 , the aiming arm system 100 can include an aiming arm body 101. The aiming arm body 101 includes a coupler 102 and at least one aiming arm 104 extending away from the coupler 102. The at least one aiming arm 104 defines at least one guide hole 106 therethrough. The coupler 102 is configured to couple the aiming arm system 100 to the insertion handle 90 such that, when the insertion handle 90 is coupled to the intramedullary nail 60, the at least one guide hole 106 is positioned to guide an instrument, such as the guide sleeve assembly 300, toward the at least one bone anchor fixation hole in the intramedullary nail 60. It will be appreciated that the at least one guide hole 106 can target a location within the bone 70 external to the intramedullary nail 60 (e.g., to imprecisely target the nail 60).

[0026] The aiming arm system 100 has an inner guide surface 108 and an outer guide surface 110 opposite the inner surface 108. The inner guide surface 108 can be positioned closer to the intramedullary nail 60 than the outer guide surface 110 when the aiming arm system 100 is coupled to the intramedullary nail 60. The aiming arm system 100 has a front end 105 and a rear end 107. The front end 105 can be spaced apart from the rear end 107 along the insertion direction I. Each guide hole 106 can extend completely through the aiming arm body 101 from the inner guide surface 108 to the outer guide surface 110.

[0027] The at least one aiming arm 104 may include a pair of aiming arms extending in opposite directions away from the coupler 104. Each aiming arm 104 has a central axis A extending along the insertion direction I. L (See FIG. 1 ). For example, each aiming arm 104 can extend circumferentially around the intramedullary nail 60 when the aiming arm system 100 is coupled to the intramedullary nail 60. Each aiming arm 104 can be coupled to the aiming arm body 101, or each aiming arm 104 can be formed as a single, integral piece with the aiming arm body 101. The aiming arms 104 can have any suitable configuration.

[0028] Each aiming arm 104 has at least one guide hole 106 extending therethrough. Each guide hole 106 has a central guide hole axis A oriented along a first linear direction L1. C The central guide hole axis A extends along the C The first guide hole 106a is aligned with one of the bone anchor fixation holes of the intramedullary nail 60 when the aiming arm system 100 is coupled to the intramedullary nail 60 by the insertion handle 90. For example, the first guide hole 106a is aligned with the axis A of the bone plate 30. B1 A first central guide hole axis A can be aligned with C1 , and the second guide hole 106b can extend along the axis A of the bone plate 30. B2 A second central guide hole axis A can be aligned with C2The first central guide hole axis A can extend along the C1 Axis A of bone plate 30 B1 By aligning the first central guide hole 106a with the first bone anchor opening of the intramedullary nail 60 (e.g., the target location of the anatomical implant), the first central guide hole 106a can be aligned with the first bone anchor opening of the intramedullary nail 60 (e.g., the target location of the anatomical implant). Similarly, the second central guide hole axis A C2 Axis A of bone plate 30 B2 , the second guide hole 106b can be aligned with a second bone anchor opening of the intramedullary nail 60 (eg, another target location of the anatomical implant).

[0029] The aiming arm body 101 can include one or more additional aiming arms 112. For example, each aiming arm 104 can include an aiming arm 112 extending therefrom. In one aspect, each additional aiming arm 112 extends from the respective aiming arm 104 in the insertion direction I. Each additional aiming arm 112 can include an alignment aperture 114 extending therethrough from the medial guide surface 108 to the lateral guide surface 110. Each alignment aperture 114 can be aligned with a corresponding aperture in the bone plate 30 and / or a corresponding bone anchor aperture in the intramedullary nail 60. Each additional aiming arm 112 can be coupled to the aiming arm 104, or each additional aiming arm 112 can be formed as a single, integral piece with the aiming arm body 101.

[0030] The first guide hole 106a and the second guide hole 106b are defined by a first guide hole surface 116a and a second guide hole surface 116b, respectively. Each guide hole surface can be configured substantially similarly, and the aspects described with respect to the first guide hole 106a can also be applied to the aspects of the second guide hole 106b. The first guide hole surface 116a is aligned with the first central guide hole axis A. C11 to form a substantially cylindrical first guide bore 106a. First guide bore 106a extends through aiming arm body 101 from a first opening 118a defined by outer guide surface 110 to a second opening 120a defined by inner guide surface 108. First guide bore 106a is sized to at least partially receive guide sleeve assembly 300 therein.

[0031] Aiming arm body 101 further has at least one retention hole 130 extending at least partially through aiming arm body 104. Each retention hole 130 can extend from an opening 132 defined by a top surface 134 of aiming arm body 101 to a location 137 within aiming arm body 101. Top surface 134 extends between inner guide surface 108 and outer guide surface 110. Alternatively, each retention hole 130 can extend through aiming arm body 101 from top surface 134 to either one of inner guide surface 108 and outer guide surface 110.

[0032] Each retaining hole 130 has a central retaining axis A oriented along a second linear direction L2. R For example, the first retaining hole 130a has a first retaining hole axis A oriented along the second linear direction L2. H1 The second retaining hole 130b can extend along a second retaining hole axis A oriented along a second linear direction L2. H2 The second linear direction L2 can extend along the first linear direction L1. The second linear direction L2 can be angularly offset from the first linear direction L1. In one embodiment, the second linear direction L2 is substantially perpendicular to the first linear direction L1.

[0033] 4 and 6A, the first retaining hole 130a and the second retaining hole 130b are defined by a first retaining hole surface 136a and a second retaining hole surface 136b, respectively. Each of the retaining hole surfaces 136a and 136b can be configured substantially similarly, and the aspects described with respect to the first retaining hole 130a can also be applied to the second retaining hole 136b. The first retaining hole surface 136a is aligned with the first retaining hole axis A.H1 1 to form a substantially cylindrical first retention hole 136a that is sized to at least partially receive a first retention element 150a therein.

[0034] 6B shows an alternative embodiment of first and second retention holes 130a, 130b. First retention hole surface 136a can include a flat portion 138a and a curved portion 140a. Flat portion 138a and curved portion 140a can extend along the length of first retention hole surface 136a from first opening 132a to location 137a within aiming arm body 101. Curved portion 140a extends along first retention hole axis A from a first end of flat portion 138a to a second end of flat portion 138b. H1 In one embodiment, the curved portion 140a can extend at least partially around the first retention hole axis A when viewed along the second linear direction L2. H1 A spherical or partial spherical shape may be formed around first retaining element 150a. First retaining element 150a may include an outer surface defining a shape corresponding to the shape of first retaining hole 130a when viewed along second linear direction L2. It will be understood that each retaining hole 130 may include other alternative sizes and shapes configured to receive retaining element 150 therein, as described further herein.

[0035] 8, each of the first retaining hole 130a and the second retaining hole 130b can intersect with the corresponding first guide hole 106a and the second guide hole 106b in the aiming arm body 101. For example, the first retaining hole axis A of the first retaining hole 130a H1 The first guide hole 106a is aligned with the first central guide hole axis A of the first guide hole 106a such that a first intersecting opening 142a is defined between the first retaining hole surface 136a and the first guide hole surface 116a. C1. Opening 142a can be disposed along first linear direction L1 between first opening 118a of first guide hole 106a and second opening 120a of first guide hole 106a. In one embodiment, opening 142a can be disposed at the center of first guide hole 106a along first linear direction L1. Opening 142a can also be disposed along second linear direction L2 between first opening 132a of first retaining hole surface 136a and position 137a in aiming arm body 101.

[0036] 9-11 , aiming arm system 100 can further include at least one retaining element 150, such as first retaining element 150a and second retaining element 150b. First retaining element 150a includes a retaining body 151a having an outer retaining surface 152a. While first retaining element 150a is shown and described herein, it will be understood that second retaining element 150b or other retaining elements 150 can be included in aiming arm system 100 and configured substantially similarly to first retaining element 150a. Additionally or alternatively, each retaining element 150 can include a different configuration consistent with alternative aspects described herein.

[0037] The outer support surface 152a extends from the first end 154 to the second end 156 along a central support axis A. R1 Extends around the central holding axis A R1 is the first holding axis A R1 The first retaining hole axis A of the first retaining hole 130a H1 When the first retaining element 150a is disposed in the first retaining hole 130a, the first retaining element 150a is oriented along a second linear direction L2 so as to be substantially parallel to the first retaining axis A. The outer retaining surface 152a defines a first protrusion 158 and a second protrusion 160 spaced apart from the first protrusion 158 in the second linear direction L2. Each of the first protrusion 158 and the second protrusion 160 is oriented along the first retaining axis A. R1The outer retaining surface 152a can extend at least partially radially outward from the first protrusion 158. The outer retaining surface 152a further defines a recessed portion 162 extending between the first protrusion 158 and the second protrusion 160 in the second linear direction L2. The first protrusion 158 and the second protrusion 160 are aligned with the central retaining axis A. R1 162. The recessed portion 162 is spaced radially outward from the recessed portion 162.

[0038] The first outer retention surface 152a further includes a contact portion 164 and a curved portion 166. The contact portion 164 and the curved portion 166 can extend along the length of the first retention body 151a from the first end 154 to the second end 156. The contact portion 164 extends along the central retention axis A from the first end 154 to the second end 156 of the retention body 101. R1 11 , the curved portion 166 extends from a first end 168 of the contact portion 164 to a second end 170 of the contact portion 164 along a central retention axis A. Alternatively, the contact portion 164 may be curved or may include any suitable alternatively shaped surface as desired. Referring to FIG. 11 , the curved portion 166 extends from a first end 168 of the contact portion 164 to a second end 170 of the contact portion 164 along a central retention axis A. R1 The curved portion 166 can extend circumferentially around the first retaining axis A when viewed along the second linear direction L2. R1 A spherical or partial spherical shape can be defined around the

[0039] 10 and 11 , the recessed portion 162 of the first outer support surface 152a can extend substantially linearly along the second linear direction L2, thereby defining a second flat portion of the first support body 151a. The first outer support surface 152a further includes a first neck portion 172 that extends at least partially radially outward from the recessed portion 162 to the first protrusion 158. The first outer support surface 152a further includes a second neck portion 174 that extends at least partially radially outward from the recessed portion 162 to the second protrusion 160. The first neck portion 172 and the second neck portion 174 can include a curved configuration, a straight configuration, a combination of curved and straight portions, or another shape. The configuration of the first and second protrusions 158, 160, the first and second neck portions 172, 174, and the recessed portion 162 is such that the central retention axis A is aligned with the first and second neck portions 172, 174, as will be further described below. R1 162 radially outward.

[0040] The first outer retaining surface 152a of the first retaining body 151a further includes a first inclined edge 176 and a second inclined edge 178. The first inclined edge 176 extends at least partially in the second linear direction L2 from the first end 154 toward the first protrusion 158. The second inclined edge 178 extends at least partially in the opposite direction to the second linear direction L2 from the second end 156 toward the second protrusion 160. The first inclined edge 176 and / or the second inclined edge 178 are aligned with the first retaining hole axis A. H1The first retaining element 150a can be inserted into the first retaining hole 130a along the axis of the first retaining element 150a. In one aspect, the first retaining element 150a can be substantially symmetrical about its center. The center of the first retaining element 150a is between the first end 154 and the second end 156 of the first retaining body 151a. The symmetry of the first retaining element 150a allows either the first end 154 to be inserted through the first opening 132a of the first retaining hole 130a, followed by the second end 156, or the second end 156 to be inserted through the first opening 132a of the first retaining hole 130a, followed by the first end 154.

[0041] 12 , the bone plate 30 includes a bone-facing surface 202 and an outer surface 204 opposite the bone-facing surface 202. The bone plate 30 can have first and second lateral sides 206, 208 opposed to one another. The first and second lateral sides 206, 208 can extend from the bone-plate-facing surface 202 to the outer surface 204. The bone plate 30 can additionally or alternatively have first and second lateral sides 210, 212 opposed to one another. The first and second lateral sides 210, 212 can extend from the bone-plate-facing surface 202 to the outer surface 204. The first and second lateral sides 210, 212 can extend from the first lateral side 206 to the second lateral side 208. It will be understood that embodiments of the present disclosure are not limited to the particular bone plate shown in FIG. 9, and alternative bone plates are contemplated.

[0042] The bone plate 30 defines at least one bone anchor aperture 218, such as a plurality of bone anchor apertures 218. One or more of the bone anchor apertures 218 are aligned with an axis A B1 For example, the first bone anchor aperture 218a is configured to extend along an axis A B1 and the second bone anchor aperture 218b can extend along axis A B2 The bone plate 30 can extend along each axis A. S1 and AS2 can be positioned on the bone 70 such that the bone anchor holes 218 can be aligned with corresponding target locations (e.g., bone anchor holes) of the intramedullary nail 60. At least one bone anchor aperture 218 extends through the bone plate 30 from the outer surface 204 to the bone-facing surface 202. At least one of the bone anchor apertures 218 can be threaded to receive a threaded head of a bone anchor. Further, each bone anchor aperture 218 can define variable angle threads that allow a bone anchor to be inserted into the bone anchor aperture 218 at various angles. Alternatively, each additional bone anchor aperture 218 may be unthreaded.

[0043] The first bone anchor aperture 218a is aligned with the axis A of the first bone anchor aperture 218a when the bone plate 30 is fastened to the intramedullary nail 60. B1 is the axis A of the second bone anchor aperture 218b. B2 The second bone anchor aperture 218b is spaced from the first bone anchor aperture 218b so as to be offset from (i.e., not aligned with) the first bone anchor aperture 218b.

[0044] The bone plate 30 may also define additional bone anchor apertures 214 and 216. The bone anchor apertures 214 and 216 may be configured to receive a bone plate placement tool, alignment tool, support tool, or other tool that releasably fastens to the bone plate 30 to facilitate alignment and / or support of the bone plate 30 while it is secured to the intramedullary nail 60. Thus, the shaft of the tool extends at least partially through the additional bone anchor apertures 214 and 216 when the bone plate 30 is fastened to the nail 60. Furthermore, the additional bone anchor apertures 214 and 216 may be positioned and / or angled over a full range of angles to minimize obstruction of the path of the bone anchor or drill bit. The additional bone anchor apertures 214 and 216 may extend through the bone plate 30 from the outer surface 204 to the bone-facing surface 202. The additional bone anchor apertures 214 and 216 can be configured to receive a bone anchor to further attach the bone plate 30 to the bone 70. The additional bone anchor apertures 214 and 216 can be threaded to receive a threaded head of the bone anchor. Furthermore, the additional bone anchor apertures 214 and 216 can define variable angle threads that allow the bone anchor to be inserted into the additional bone anchor apertures 214 and 216 at various angles. Alternatively, the bone anchor apertures 214 and 216 can be unthreaded.

[0045] 13 , the guide sleeve assembly 300 includes an outer guide sleeve 302 and an inner guide sleeve 304. The inner guide sleeve 304 is insertable through the outer guide sleeve 302. The inner guide sleeve 304 is coupled to the outer guide sleeve 302 to substantially prevent movement between the inner guide sleeve 304 and the outer guide sleeve 302. The guide sleeve assembly 300 is configured to be inserted through at least one guide hole 106 of the aiming arm system 100 to align with the bone plate 30 and the intramedullary nail 60. Aligning the guide sleeve assembly 300 with the bone plate 30 and the intramedullary nail 60 allows bone anchors and / or drills to be inserted through the guide sleeve assembly 300 and into and / or through the bone plate 30, bone 70, and nail 60.

[0046] 14-18, the outer guide sleeve 302 includes an outer guide body 303 and an outer sleeve handle 306. The outer sleeve handle 306 is configured to be grasped and / or controlled by a surgeon during a medical procedure to align the outer guide sleeve 302 with respect to the inner guide sleeve 304 and / or to align the outer guide sleeve 302 with respect to the aiming arm system 100. The outer guide body 303 is configured to align the first central guide hole axis A of the first guide hole 106a when the guide sleeve assembly 300 is inserted into the first guide hole 106a. C1 The center outer guide sleeve axis A can be aligned with S1 The outer guide sleeve axis A extends along the center S1 is the other central guide hole axis A of the guide hole 106 defined by the aiming arm 104 C It will be appreciated that the central outer guide sleeve axis A may be aligned with the central outer guide sleeve axis A. S1 When the guide sleeve assembly 300 is inserted into the second guide hole 106b, the second central guide hole axis A of the second guide hole 106b is aligned with the second central guide hole axis A of the second guide hole 106b. C2The outer guide sleeve 302 is configured and sized to be inserted into and extend through the guide bore 106 corresponding to the first linear direction L1, thereby aligning with the central outer guide sleeve axis A. S1 is directed along a first linear direction L1.

[0047] The outer sleeve handle 306 is connected to the center outer guide sleeve axis A. S1 The outer guide body 303 extends along a central outer guide sleeve central axis A from the outer sleeve body 303 to the first end 308 of the outer sleeve guide 302. S1 The outer guide body 303 extends from the outer sleeve handle 306 to the second end 310 along a central outer guide sleeve axis A S1 1. The outer sleeve surface 312 includes a reduced cross-sectional dimension portion 314 and a curved portion 316. The curved portion 316 extends from a first end 318 of the reduced portion 314 to a second end 320 of the reduced portion 314 about a central outer guide sleeve axis A. S1 The curved portion 316 can extend along the length of the outer sleeve surface 312 from the handle 306 to the second end 310. Alternatively, the curved portion 316 can extend along a portion of the outer sleeve surface 312 between the handle 306 and the second end 310. For example, the curved portion 316 can extend from the second end 310 to a position on the outer sleeve surface 312 between the handle 306 and the second end 310.

[0048] The curved portion 316 is aligned with the central outer guide sleeve axis A. S1 The first dimension R1 is spaced apart from the central outer guide sleeve axis A. S1The curved portion 316 extends substantially perpendicular to the handle 306. The curved portion 316 can have a substantially constant first dimension R1 along the length of the outer sleeve surface 312 from the handle 306 to the second end 310. Alternatively, the curved portion 316 may vary in size and / or dimension along the length of the outer sleeve surface 312. For example, the curved portion 316 can have a first dimension R1 along the length of the outer sleeve surface 312 between the handle 306 and a location 315 between the handle 306 and the second end 310, and the curved portion 316 can have a first dimension R'1 between that location and the second end 310, whereby the first dimension R'1 is smaller than the first dimension R1. The reduced first dimension R'1 can facilitate insertion of the outer sleeve guide 302 into the corresponding guide hole 106. Additionally, the second end 310 of the outer sleeve guide 302 can include a beveled edge to further facilitate insertion of the outer sleeve guide 302.

[0049] The reduced portion 314 can extend along the length of the outer sleeve surface 312 from the handle 306 to the second end 310. Alternatively, the reduced portion 314 can extend along a portion of the outer sleeve surface 312 between the handle 306 and the second end 310. For example, the reduced portion 314 can extend from a first location 326 on the outer sleeve surface 312 disposed between the handle 306 and the second end 310 to a second location 328 on the outer sleeve surface 312 disposed between the handle 306 and the second end 310.

[0050] The reduced portion 314 is located at the center outer guide sleeve axis A. S1 The second dimension R2 is spaced from the central outer guide sleeve axis A. S1The second dimension R2 of the reduced portion 314 may vary along the width of the reduced portion 314 between the first end 318 and the second end 320 of the reduced portion 314. For example, the second dimension R2 at the first end 318 and the second end 320 may be greater than the second dimension R2 between the first end 318 and the second end 320 of the reduced portion 314. The second dimension R2 of the reduced portion 314 is less than the first dimension R1 of the curved portion 316 that extends from the first end 318 to the second end 320 of the reduced portion 314. The size of the second dimension R2 of the reduced portion 314 relative to the size of the first dimension R1 of the curved portion 316 allows movement of the guide sleeve assembly 300 within the guide bore 106 when the aiming arm system 100 is in the unlocked configuration, as described further below.

[0051] In one aspect, the reduced portion 314 can define a substantially flat plane. In an alternative aspect, the reduced portion 314 can be substantially planar, extending from the first end 318 to the second end 320 of the reduced portion 314 along the central outer guide sleeve axis A. S1 For example, reduced portion 314 may have a substantially constant second dimension R2 along the circumferential width of outer sleeve surface 312 from first end 318 to second end 320 of reduced portion 314, and along the length of outer sleeve surface 312 from a first location 326 to a second location 328 on outer sleeve surface 312.

[0052] The outer guide sleeve 302 extends from a first end 308 to a second end 310 of the outer guide sleeve 302 along a central outer guide sleeve axis A. S1The outer guide sleeve 302 further includes an inner guide surface 330 defining an outer guide aperture 331 extending through the outer guide sleeve 302 about the first end 308 of the handle 306. The inner guide surface 330 includes a first coupler 332. The first coupler 332 may include a threaded portion, a snap-fit ​​element, a recess, a protrusion, or other coupling element configured to couple the outer guide sleeve 302 to the inner guide sleeve 304 when the inner guide sleeve 304 is inserted and positioned within the outer guide aperture 331. The first coupler 332 may be positioned along the inner guide surface 330 between the first end 308 and the second end 310 of the outer guide sleeve 302. In one aspect, the first coupler 332 is positioned on a portion of the inner guide surface 330 within the handle 306.

[0053] 19-23 , the inner guide sleeve 304 includes an inner guide body 350 and an inner sleeve handle 352. The inner sleeve handle 352 is configured to be grasped and / or controlled by a surgeon before or during a medical procedure to align the inner guide sleeve 304 with respect to the outer guide sleeve 302 and / or to align and couple the inner guide sleeve 304 to the bone plate 30. The inner guide body 350 is aligned with the central guide hole axis A of the guide hole 106 when the guide sleeve assembly 300 is inserted into the guide hole 106. C The center inner guide sleeve axis A can be aligned with S2 The inner guide sleeve 302 is configured and sized to be inserted into and extend through the outer guide aperture 331 of the outer guide sleeve 302 in a first linear direction L1, thereby extending along a central inner guide sleeve axis A. S2 is directed along a first linear direction L1.

[0054] The inner sleeve handle 352 is connected to the center inner guide sleeve axis A. S2 Extends from the inner guide body 350 to a first end 358 (e.g., proximal end) of the inner sleeve guide 304 along a central inner guide sleeve axis A. S2The inner guide body 350 extends from the inner sleeve handle 352 to the second end 360 (e.g., distal end) of the inner sleeve guide 304 along a central inner guide sleeve axis A between the inner sleeve handle 352 and the second end 360 of the inner sleeve guide 304. S2 The inner guide sleeve 304 includes an outer sleeve surface 362 extending around the outer guide aperture 331. The outer sleeve surface 362 of the inner sleeve guide 304 includes a second coupler 364. The second coupler 364 may include a threaded portion, a snap-fit ​​element, a recess, a protrusion, or other coupling element configured to couple with the first coupler 332 of the outer guide sleeve 302 when the inner guide sleeve 304 is inserted and positioned within the outer guide aperture 331. The second coupler 364 is configured to couple with the first coupler 332 such that the inner guide sleeve 304 is substantially prevented from moving along the first linear direction L1 within the outer guide aperture 331 of the outer guide sleeve 302.

[0055] The second coupler 364 can be positioned along the outer guide surface 364 of the inner guide sleeve 304 between the first end 358 and the second end 360 of the inner guide sleeve 304. The position of the second coupler 364 can correspond to the position of the first coupler 332 on the inner guide surface 330. For example, the second coupler 364 can be positioned relative to the first coupler 332 such that when the first coupler 332 and the second coupler 364 are coupled to each other (e.g., in the coupled position), the inner guide sleeve 304 extends through the opening 311 defined by the second end 310 of the outer guide sleeve 302 and the second end 360 of the inner guide sleeve 304 is located outside the outer guide sleeve 302. When the first and second couplers 332 are uncoupled (e.g., in the uncoupled position), the inner guide sleeve 304 can be retracted within the outer guide sleeve 302 in a direction opposite to the first linear direction L1. In one aspect, when the inner guide sleeve 304 and the outer guide sleeve 302 are in the decoupled position, the second end 360 of the inner guide sleeve 304 can be positioned within the guide aperture 331 of the outer guide sleeve 302 .

[0056] The inner guide sleeve 304 extends along a central inner guide sleeve axis A from a first end 358 to a second end 360 of the inner guide sleeve 304. S2 The inner guide sleeve 304 further includes an inner guide surface 370 defining an inner guide aperture 371 extending through the inner guide sleeve 304 about the first end 358. The inner guide aperture 371 of the inner guide sleeve 304 can have a substantially cylindrical shape such that the cross-sectional dimension (e.g., diameter) of the inner guide aperture 371 is substantially the same along the length of the inner guide sleeve 304 from the first end 358 to the second end 360. Alternatively, the inner guide aperture 371 can be aligned with the plate axis A of the bone plate 30. B The bone anchor and / or drill bit may include other shapes, such as a cone shape, a reduced diameter portion, a combination thereof, or another shape or shapes, to facilitate alignment and placement of the bone anchor and / or drill bit along the bone anchor and / or drill bit.

[0057] The outer guide surface 362 of the inner guide sleeve 304 further defines a beveled edge 374. The beveled edge 374 extends from the second end 360 of the inner guide sleeve 304 toward the first end 358 of the inner guide sleeve 304. The beveled edge 274 has a smallest cross-sectional dimension (e.g., diameter) at the second end 358 and a largest diameter spaced from the second end 358 toward the first end 358. The beveled edge 358 is configured to be at least partially disposed within the bone anchor apertures 218 of the bone plate 30 to provide a temporary connection between the bone plate 30 and the guide sleeve assembly 300 to support the plate 30 while a hole is drilled in the bone 70 and / or a bone anchor is disposed in one or more bone anchor apertures of the bone plate 30. In one aspect, the beveled edge 374 can correspond to the beveled edges of the bone anchor apertures 218 to strengthen the connection between the guide sleeve assembly 300 and the plate 30.

[0058] 24, 25A, and 25B, a guide sleeve assembly 300 is disposed within the first guide aperture 106a, and another guide sleeve assembly 300 is disposed within the second guide aperture 106b. The guide sleeve assemblies 300 are aligned along a central outer guide sleeve axis A of the outer guide sleeve 302. S1 and the central inner guide sleeve axis A of the inner guide sleeve 304 S2 is the central guide hole axis A C The guide hole 106 is inserted in the first linear direction L1 so as to be substantially parallel to the first linear direction L2.

[0059] The first holding element 150a and the second holding element 150b are aligned along a first holding axis A. R1 and second holding axis A R2 is the first retaining hole axis A H1 and the second first retaining hole axis A H2 The first and second retaining elements 150a, 150b can be inserted into the respective retaining holes 130a, 130b in a second linear direction L2 so as to be substantially parallel to the guide sleeve assembly 300. The first and second retaining elements 150a, 150b can be inserted into the respective retaining holes 130a, 130b either before or after the guide sleeve assembly 300 is inserted into the guide hole 106.

[0060] After the retaining elements 150 are inserted into their respective retaining holes 130, the aiming arm system 100 comprises an unlocked configuration in which the guide sleeve assembly 300 is insertable through the guide holes 106 along the first linear direction L1, and a retaining force F that substantially prevents the guide sleeve from further movement along the first linear direction L1. R and a locked configuration in which retention element 150 applies a force to outer guide sleeve 304. Outer guide sleeve 304 can transition between an unlocked position (e.g., FIG. 25A ) in which aiming arm system 100 is in the unlocked configuration and a locked position (e.g., FIG. 25B ) in which aiming arm system 100 is in the locked configuration, such that central guide bore axis A is aligned within guide bore 106. CIn one aspect, the retaining element 150 is configured to rotate about the retaining bore axis A relative to the outer guide sleeve 304 between the unlocked and locked positions. H The rotating shaft is configured to rotate around the axis of rotation.

[0061] With the outer guide sleeve 304 in the unlocked position, the surgeon can move the guide sleeve assembly 300 to a desired position, such as adjacent to the bone anchor aperture 218 of the bone plate 30, and lock the guide sleeve assembly 300 in place by rotating the outer guide sleeve 304.

[0062] In the first rotational position of the guide sleeve 302, the outer sleeve surface 312 is aligned with the central guide sleeve axis A. S1 The outer sleeve surface 312 defines a first outer dimension D1 extending in a first transverse direction T1 through the first retaining element 150a. The transverse direction T includes the first transverse direction T1 and a second transverse direction T2 opposite the first transverse direction T1. The transverse direction T, and therefore the first transverse direction T1 and the second transverse direction T2, are each oriented perpendicular to the first linear direction L1 and the second linear direction L2. The first outer dimension D1 can be defined by a first point and a second point on the outer sleeve surface 312 that are opposite each other and aligned with each other along the transverse direction T. Specifically, the first outer dimension D1 extends from the first point to a second point along the transverse direction T. Furthermore, the first point and the second point are aligned with the respective first retaining element 150a or second retaining element 150b along the transverse direction T. It should be understood that the first point and the second point can be selected at any selected location along the length of the outer guide sleeve in a first linear direction L1 (see FIG. 13 ) that is aligned with the respective retention element along the lateral direction T. In the first rotational position, the contact portion 164 of the retention element 150 faces the reduced portion 314 of the outer sleeve surface 312 in the first lateral direction T1. Furthermore, one of the first point and the second point is located on the reduced portion 314, and the other of the first point and the second point is located on the curved portion 316.

[0063] The retaining element 150 defines a third dimension D3 extending from a first point on the surface of the contact portion 164 of the retaining element 150 to a second point on the inner guide surface 116 of the guide bore 106 opposite the contact portion 164 along the lateral direction T. The third dimension D3 is greater than the first dimension D1 when the guide sleeve 302 is in the first rotational position, thereby spacing the retaining element 150 from the outer guide sleeve 302 along the lateral direction T. Because the third dimension D3 is greater than the first dimension D1, the retaining element 150 and the guide sleeve 302 are movable relative to one another along the first linear dimension L1 (see FIG. 13 ). In other words, the retaining element does not interfere with movement of the guide sleeve 302 relative to the retaining element 150, and therefore relative to the aiming guide 104, along the first linear dimension L1. Therefore, the first rotational position of the guide sleeve can be referred to as an unlocked position of the outer guide sleeve 302.

[0064] The guide sleeve 302 is aligned with its central outer guide sleeve axis A S1 , from a first rotational position to a second rotational position. As will be understood from the following description, the second rotational position of the guide sleeve 302 can be referred to as a locked position. In the second rotational position of the guide sleeve 302, the outer sleeve surface 312 is aligned along the lateral direction T with respect to the central guide sleeve axis A. S1The second dimension D2 defines a second dimension D2 extending through the guide sleeve 302. The second dimension D2 may be defined by a third point and a fourth point facing each other along the lateral direction T and facing the outer sleeve surface 312 aligned with each other. Specifically, the second dimension D2 extends from the third point to the fourth point along the lateral direction T. Furthermore, the third point and the fourth point may be located at selected positions along the length of the guide sleeve 302 aligned with the retaining element 150 along the lateral direction T. The second dimension D2 is greater than the first dimension D1. Thus, the outer sleeve surface 312 of the outer guide sleeve 302 contacts the retaining element 150 in the locked position. Specifically, the outer sleeve surface 312 contacts the surface of the contact portion 164 of the retaining element 150. Thus, the outer sleeve surface 312 can bias the contact portion 164 of the retaining element 150 to compress along the lateral direction T when the guide sleeve 302 is rotated from the first rotational position to the second rotational position. For example, the recessed portion 162 of the retaining element 150 defines a region of reduced thickness on the retaining element 150 that allows the retaining element 150 to flex laterally away from the guide sleeve 302. Alternatively or additionally, a compressible material can define an outer surface of the guide sleeve 302 that compresses along the lateral direction T when the guide sleeve 302 is rotated from the first rotational position to the second rotational position. The retaining element 150 can be positioned within the retaining bore 130 such that the outer sleeve surface 312 contacts the contact portion 164 of the outer retaining surface 152 of the retaining element 150. The contact portion 164 can be positioned opposite the recessed portion 162 along the lateral direction T. The recessed portion 162 is aligned with the central guide bore axis A of the guide bore 106. C In the locked position of the outer guide sleeve 302, the recessed portion 162 of the retaining element 150 is biased away from the central guide bore axis A c by a distance greater than the distance that the retaining element 150 is spaced from the central guide bore axis Ac. C can be placed away from

[0065] In the locked position, the third dimension D3 defined by the retaining element 150 is naturally smaller than the second dimension D2, bringing the retaining element 150 into contact with the outer guide sleeve 302 and applying a retaining force F in the first lateral direction T1. R1 The inner guide surface 116 of the guide hole 106 provides an opposing retaining force F' to the outer guide sleeve 302 in the second lateral direction T2. R1 It will be appreciated that the second lateral direction T2 may be applied. The second lateral direction T2 is oriented perpendicular to each of the first linear direction L1 and the second linear direction L2. Furthermore, the second lateral direction T2 is opposite to the first lateral direction T1. The contact between the retaining element 150 and the outer guide sleeve 302 may form an interference fit connection, whereby a retaining force F R1 comprises the friction force exerted by the retaining element 150 on the outer guide sleeve 302 in a direction opposite to the direction of movement of the outer guide sleeve 302 within the guide bore 106 .

[0066] In an alternative embodiment, the retaining element 150 can be configured to rotate within the retaining bore 130 between an unlocked position, in which the aiming arm system 100 is in an unlocked configuration, and a locked position, in which the aiming arm system 100 is in a locked configuration. For example, the outer sleeve surface 312 of the outer guide sleeve 302 can be substantially cylindrical along the length of the outer guide body 303. The retaining element can transition between an unlocked position and a locked position. In the unlocked position, the retaining element 150 is spaced apart from the outer sleeve surface 312. In the locked position, the retaining element 150 contacts the outer sleeve surface 312 of the outer guide body 302, such that the contact on the outer retaining surface 152 of the retaining element 150 is at a position on the outer retaining surface 152 opposite the recessed portion 162. The contact between the outer retaining surface 152 and the outer sleeve surface 312 causes the retaining element 150 to apply a retaining force F to the outer sleeve guide 302. R1 , the recessed portion 162 is biased away from the outer sleeve surface 312.

[0067] The retaining element 150 can be disposed outside the aiming arm body 101. For example, the retaining element 150 can be separate from the aiming arm body 101 and coupled to the aiming arm body 101. For example, the retaining element 150 can be coupled to the inner guide surface 108 or the outer guide surface 110, or another surface of the aiming arm body 101. The retaining element 150 can be coupled to a surface of the aiming arm body 101 such that a third dimension D3 is defined between two surfaces of the retaining element 150. The two surfaces can face each other in the first lateral direction T1 and can form a portion of the guide hole 106. The third dimension D3 defined between the two surfaces of the retaining element 150 is smaller than the first dimension D1 defined by two points facing the outer sleeve surface 312, and when the outer guide sleeve 302 is rotated to the locked position, the retaining element 150 contacts the outer guide sleeve 302 and applies a retaining force F in the first lateral direction T1. R1 and a holding force F' acting against the outer guide sleeve 302 in the second lateral direction T2. R1 Alternatively, the holding element 150 may be integral with the aiming arm body 101.

[0068] During use of the system 10, the central guide hole axis A C is aligned with the target location of the intramedullary nail 60 and the aiming arm system 100 is transitioned to the locked configuration, a posterior bone anchor screw and / or drill bit can be inserted through the inner guide aperture 371 of the inner guide sleeve 304 and through the bone plate 30, the bone 70, and / or the intramedullary nail 60. After the bone anchor is inserted, the aiming arm system 100 can be transitioned to the unlocked configuration and the guide sleeve assembly 300 can be removed from the guide hole 106.

[0069] Although the present disclosure has been described in detail, it should be understood that various changes, substitutions, and alterations may be made herein without departing from the spirit and scope of the present invention, as defined by the appended claims. Additionally, any of the embodiments disclosed herein may incorporate features disclosed with respect to any of the other embodiments disclosed herein. Furthermore, the scope of the present disclosure is not limited to the specific embodiments described herein. As one skilled in the art would readily appreciate from the process, any now-existing or later-developed machine, manufacture, composition of matter, means, method, or step that performs substantially the same function or achieves substantially the same result as the corresponding embodiment described herein may be utilized in accordance with the present disclosure.

[0070] [Embodiment] (1) A targeting arm system, an aiming arm having: 1) an aiming arm body and a guide hole extending through the aiming arm body along a central guide hole axis, the aiming arm being configured to be positioned such that the central guide hole axis is aligned with a target location of an anatomical implant; and 2) a retaining element supported relative to the aiming arm body; a guide sleeve extending along a linear central guide sleeve axis and sized to be inserted into the guide bore; Including, Relative rotation between the guide sleeve and the retaining element transitions the aiming arm system between an unlocked configuration in which the guide sleeve is movable within the guide bore along the central guide bore axis and a locked configuration in which the retaining element applies a retaining force to the guide sleeve that resists movement of the guide sleeve along the central guide bore axis. Aiming arm system. (2) The system of embodiment 1, wherein the guide sleeve is configured to rotate within the guide hole between an unlocked position in which the aiming arm system is in the unlocked configuration and a locked position in which the aiming arm system is in the locked configuration. (3) The system of embodiment 2, wherein the guide sleeve has an outer sleeve surface extending about the central guide sleeve axis, the outer sleeve surface defining a first dimension extending laterally through the central guide sleeve axis when the guide sleeve is in the unlocked position and a second dimension extending laterally through the central guide sleeve axis when the guide sleeve is in the locked position, the second dimension being greater than the first dimension, the second dimension extending laterally through the central guide sleeve axis when the guide sleeve is in the locked position, the laterally direction being substantially perpendicular to the central guide bore axis, and the retaining force being applied laterally to the guide sleeve by the retaining element. (4) The system of embodiment 3, wherein the outer sleeve surface of the guide sleeve includes a substantially flat portion and a curved portion extending about the central guide sleeve axis from a first end of the flat portion to a second end of the flat portion, the first dimension being defined by a distance extending between a point on the substantially flat portion of the outer sleeve surface and a point on the curved portion of the outer sleeve surface, and the second dimension being defined by a distance extending between two points on the curved portion of the outer sleeve surface. (5) The system of embodiment 4, wherein the retaining element has a retaining surface including a substantially flat portion, and in the unlocked configuration of the substantially flat portion of the retaining element, faces the substantially flat portion of the guide sleeve in the lateral direction.

[0071] (6) The system of embodiment 3, wherein the retaining element has a first retaining surface and a second retaining surface, the second retaining surface being spaced apart from the first retaining surface by a retaining dimension extending laterally, and wherein in the unlocked configuration of the aiming arm system, the retaining dimension is greater than the first dimension of the guide sleeve and the retaining dimension is less than the second dimension of the guide sleeve. (7) The system of embodiment 6, wherein the retention force is a first retention force, the lateral direction is a first lateral direction, the first retention force is applied by the first retention surface of the retention element, and in the locked configuration, the retention element applies a second retention force to the guide sleeve in a second lateral direction opposite the first lateral direction. (8) The system of embodiment 3, wherein the retaining element has a first retaining surface, the guide hole of the aiming arm body is at least partially defined by an inner guide surface opposing the first retaining surface by the laterally extending retaining dimension, and in the unlocked configuration of the aiming arm system, the retaining dimension is larger than the first dimension of the guide sleeve and the retaining dimension is smaller than the second dimension of the guide sleeve. (9) The system of embodiment 8, wherein the retention force is a first retention force, the lateral direction is a first lateral direction, the first retention force is applied by the first retention surface of the retention element, and in the locked configuration, the inner guide surface applies a second retention force to the guide sleeve in a second lateral direction opposite the first lateral direction. (10) The system of embodiment 1, wherein the holding element is configured to rotate between an unlocked position in which the aiming arm system is in the unlocked configuration and a locked position in which the aiming arm system is in the locked configuration.

[0072] (11) The guide sleeve is an outer guide sleeve having an inner guide surface defining an outer guide aperture extending through the outer guide sleeve along the central guide sleeve axis, the inner guide surface including a first coupler, and the system further comprises: an inner guide sleeve extending along a central inner guide sleeve axis, the inner guide sleeve being sized to be inserted into the outer guide aperture and having an outer guide surface including a second coupler; the first coupler and the second coupler are configured to couple to one another such that the inner guide sleeve is substantially prevented from moving within the outer guide aperture. A system as described in embodiment 1. (12) The system of embodiment 11, wherein the inner guide sleeve is configured to move between a decoupled position in which the first coupler and the second coupler are decoupled from each other and a distal end of the inner guide sleeve is disposed within the outer guide aperture of the outer guide sleeve, and a coupled position in which the first coupler and the second coupler are coupled to each other and a portion of the inner guide sleeve extends through a distal opening defined by the distal end of the outer guide sleeve and the distal end of the inner guide sleeve is positioned outside the outer guide sleeve. (13) The system of embodiment 1, wherein the retaining element extends along a central retaining axis, the aiming arm further has a retaining hole extending at least partially through the aiming arm body along a central retaining hole axis, and the retaining element is sized to be inserted through the retaining hole. (14) The retaining element includes a retaining body having an outer retaining surface extending about the central retaining axis, the outer retaining surface defining a first protrusion and a second protrusion spaced from the first protrusion, the outer retaining surface further defining a recessed portion extending between the first protrusion and the second protrusion; In the unlocked configuration of the aiming arm system, the recessed portion is located at a first radial distance from the central guide hole axis of the alignment guide hole, and in the locked position of the outer guide sleeve, the recessed portion is located at a second radial distance from the central guide hole axis that is greater than the first radial distance. A system as described in embodiment 13. (15) The system of embodiment 13, wherein the retaining element is substantially rotatably fixed within the retaining bore about the central retaining bore axis.

[0073] (16) The system of embodiment 1, wherein in the locked configuration of the aiming arm system, the retaining force applied to the guide sleeve by the retaining element is a frictional force such that the retaining element and the guide sleeve form an interference fit connection. (17) A method comprising: moving a guide sleeve within a guide bore defined by an aiming arm, the guide bore extending through the aiming arm along a central guide bore axis, the aiming arm configured to be positioned such that the central guide bore axis is aligned with a target location of an anatomical implant, the aiming arm supporting a retention element; Inserting the guide sleeve extending along a central guide sleeve axis into the guide hole; rotating one of the guide sleeve and the retaining element relative to the other of the guide sleeve and the retaining element to transition the aiming arm between an unlocked configuration in which the guide sleeve is insertable into the guide slot and a locked configuration in which the retaining element applies a retaining force to the guide sleeve that resists movement of the guide sleeve within the guide slot; A method comprising: (18) The guide sleeve is configured to rotate within the guide hole, and the transitioning step includes: rotating the guide sleeve between an unlocked position in which the aiming arm system is in the unlocked configuration and a locked position in which the aiming arm system is in the locked configuration; 18. The method of embodiment 17, further comprising: (19) Inserting the retaining member into a retaining hole along a central retaining hole axis before rotating the guide sleeve to the locked position, the retaining hole being defined by the aiming arm such that at least a portion of the retaining element extends into the guide hole; 18. The method of embodiment 17, further comprising: (20) The guide sleeve is an outer guide sleeve having an inner guide surface defining an outer guide aperture extending through the outer guide sleeve along the central guide sleeve axis, the inner guide surface including a first coupler, and the method further comprises: inserting an inner guide sleeve into the outer guide aperture of the outer guide sleeve, the inner guide sleeve extending along a central inner guide sleeve axis, the inner guide sleeve having an outer guide surface including a second coupler; coupling the first coupler of the outer guide sleeve to the second coupler of the inner guide sleeve to lock the inner guide sleeve against translation relative to the outer guide sleeve along the central guide sleeve axis; 18. The method of embodiment 17, further comprising:

Claims

1. 1. A targeting arm system, comprising: an aiming arm having: 1) an aiming arm body and a guide hole extending through the aiming arm body along a central guide hole axis, the aiming arm being configured to be positioned such that the central guide hole axis is aligned with a target location of an anatomical implant; and 2) a retaining element supported relative to the aiming arm body; a guide sleeve extending along a linear central guide sleeve axis and sized to be inserted into the guide bore; Including, Relative rotation between the guide sleeve and the retaining element causes the aiming arm system to transition between an unlocked configuration in which the guide sleeve is movable within the guide bore along the central guide bore axis and a locked configuration in which the retaining element applies a retaining force to the guide sleeve that resists movement of the guide sleeve along the central guide bore axis; the guide sleeve is an outer guide sleeve having an inner guide surface defining an outer guide aperture extending through the outer guide sleeve along the central guide sleeve axis, the inner guide surface including a first coupler; the aiming arm system an inner guide sleeve extending along a central inner guide sleeve axis, the inner guide sleeve being sized to be inserted into the outer guide aperture and having an outer guide surface including a second coupler; the first coupler and the second coupler are configured to couple to one another such that the inner guide sleeve is substantially prevented from moving within the outer guide aperture. Aiming arm system.

2. 2. The aiming arm system of claim 1, wherein the guide sleeve is configured to rotate within the guide hole between an unlocked position in which the aiming arm system is in the unlocked configuration and a locked position in which the aiming arm system is in the locked configuration.

3. 3. The aiming arm system of claim 2, wherein the guide sleeve has an outer sleeve surface extending about the central guide sleeve axis, the outer sleeve surface defining a first dimension extending laterally through the central guide sleeve axis when the guide sleeve is in the unlocked position and a second dimension extending laterally through the central guide sleeve axis when the guide sleeve is in the locked position, the second dimension being greater than the first dimension, the second dimension extending laterally through the central guide sleeve axis when the guide sleeve is in the locked position, the lateral direction being substantially perpendicular to the central guide bore axis, and the retaining force being applied to the guide sleeve in the lateral direction by the retaining element.

4. 4. The aiming arm system of claim 3, wherein the outer sleeve surface of the guide sleeve includes a substantially flat portion and a curved portion extending about the central guide sleeve axis from a first end of the substantially flat portion to a second end of the substantially flat portion, the first dimension being defined by a distance extending between a point on the substantially flat portion of the outer sleeve surface and a point on the curved portion of the outer sleeve surface, and the second dimension being defined by a distance extending between two points on the curved portion of the outer sleeve surface.

5. 5. The aiming arm system of claim 4, wherein the retaining element has a retaining surface including a substantially flat portion, the substantially flat portion of the retaining element facing laterally toward the substantially flat portion of the guide sleeve in the unlocked configuration.

6. 4. The aiming arm system of claim 3, wherein the retaining element has a first retaining surface and a second retaining surface, the second retaining surface being spaced apart from the first retaining surface by the laterally extending retaining dimension, and wherein in the unlocked configuration of the aiming arm system, the retaining dimension is greater than the first dimension of the guide sleeve and the retaining dimension is less than the second dimension of the guide sleeve.

7. 7. The aiming arm system of claim 6, wherein the retention force is a first retention force, the lateral direction is a first lateral direction, the first retention force is exerted by the first retention surface of the retention element, and wherein in the locked configuration, the retention element exerts a second retention force on the guide sleeve in a second lateral direction opposite the first lateral direction.

8. 4. The aiming arm system of claim 3, wherein the retaining element has a first retaining surface, the guide hole of the aiming arm body is at least partially defined by an inner guide surface opposing the first retaining surface by the laterally extending retaining dimension, and in the unlocked configuration of the aiming arm system, the retaining dimension is greater than the first dimension of the guide sleeve and the retaining dimension is less than the second dimension of the guide sleeve.

9. 9. The aiming arm system of claim 8, wherein the retention force is a first retention force, the lateral direction is a first lateral direction, the first retention force is exerted by the first retention surface of the retention element, and wherein in the locked configuration, the inner guide surface exerts a second retention force on the guide sleeve in a second lateral direction opposite the first lateral direction.

10. 2. The aiming arm system of claim 1, wherein the retaining element is configured to rotate between an unlocked position in which the aiming arm system is in the unlocked configuration and a locked position in which the aiming arm system is in the locked configuration.

11. 2. The aiming arm system of claim 1, wherein the inner guide sleeve is configured to move between a decoupled position in which the first coupler and the second coupler are decoupled from each other and a distal end of the inner guide sleeve is disposed within the outer guide aperture of the outer guide sleeve, and a coupled position in which the first coupler and the second coupler are coupled to each other and a portion of the inner guide sleeve extends through a distal opening defined by the distal end of the outer guide sleeve and the distal end of the inner guide sleeve is located outside of the outer guide sleeve.

12. 2. The aiming arm system of claim 1, wherein the retaining element extends along a central retaining axis, the aiming arm further having a retaining hole extending at least partially through the aiming arm body along a central retaining hole axis, the retaining element being sized to be inserted through the retaining hole.

13. the retaining element includes a retaining body having an outer retaining surface extending about the central retaining axis, the outer retaining surface defining a first protrusion and a second protrusion spaced from the first protrusion, the outer retaining surface further defining a recessed portion extending between the first protrusion and the second protrusion; In the unlocked configuration of the aiming arm system, the recessed portion is located at a first radial distance from the central guide hole axis of the guide hole, and in a locked position of the outer guide sleeve when the aiming arm system is in the locked configuration, the recessed portion is located at a second radial distance from the central guide hole axis that is greater than the first radial distance.

13. The aiming arm system of claim 12.

14. The aiming arm system of claim 12 , wherein the retaining element is substantially rotatably fixed within the retaining bore about the central retaining bore axis.

15. 2. The aiming arm system of claim 1, wherein in the locked configuration of the aiming arm system, the retaining force applied to the guide sleeve by the retaining element is a frictional force such that the retaining element and the guide sleeve form an interference fit connection.

16. A targeting arm system, comprising: an aiming arm having: 1) an aiming arm body and a guide hole extending through the aiming arm body along a central guide hole axis, the aiming arm being configured to be positioned such that the central guide hole axis is aligned with a target location of an anatomical implant; and 2) a retaining element supported relative to the aiming arm body; a guide sleeve extending along a linear central guide sleeve axis and sized to be inserted into the guide bore; Including, Relative rotation between the guide sleeve and the retaining element causes the aiming arm system to transition between an unlocked configuration in which the guide sleeve is movable within the guide bore along the central guide bore axis and a locked configuration in which the retaining element applies a retaining force to the guide sleeve that resists movement of the guide sleeve along the central guide bore axis; the retaining element extends along a central retaining axis, the aiming arm further includes a retaining bore extending at least partially through the aiming arm body along a central retaining bore axis, the retaining element being sized to be inserted through the retaining bore; the retaining element includes a retaining body having an outer retaining surface extending about the central retaining axis, the outer retaining surface defining a first protrusion and a second protrusion spaced from the first protrusion, the outer retaining surface further defining a recessed portion extending between the first protrusion and the second protrusion; In the unlocked configuration of the aiming arm system, the recessed portion is located at a first radial distance from the central guide hole axis of the guide hole, and in a locked position of the guide sleeve when the aiming arm system is in the locked configuration, the recessed portion is located at a second radial distance from the central guide hole axis that is greater than the first radial distance. Aiming arm system.

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