Abstract:
A joint fixation system particularly useful for joints of the hand is disclosed. The joint fixation system includes a joint fixation plate having a distal section, a proximal section, and an intermediate section connecting the distal section and the proximal section. The distal section includes a distal section screw hole, and the proximal section includes a proximal section screw hole. The joint fixation plate is pre-bent such that the distal section and the proximal section form an included angle of less than 180 degrees. The joint fixation system includes a first screw dimensioned to engage an inner surface of the distal section screw hole, and a second screw dimensioned to engage an inner surface of the proximal section screw hole. The first screw is angulated proximally when inserted in the distal screw hole, and the second screw is angulated distally when inserted in the proximal screw hole.

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
       [0001]    This application claims priority from U.S. Provisional Patent Application No. 61/035,270 filed Mar. 10, 2008. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH 
       [0002]    Not Applicable. 
       BACKGROUND OF THE INVENTION 
       [0003]    1. Field of the Invention 
         [0004]    The invention relates to devices for the surgical fixation of a joint to promote bone fusion, and more particularly to surgical devices for interphalangeal joint fusion and metacarpal phalangeal joint fusion. 
         [0005]    2. Description of the Related Art 
         [0006]    Arthrodesis, the surgical fixation of a joint to promote bone fusion, is often indicated for joint pain that cannot be managed by other treatments. Some causes of such joint pain are fractures and arthritis. Arthrodesis is commonly performed on joints in the hand, and ankle, and foot. With respect to the hand, arthrodesis may also be performed in the finger to correct digital abnormalities of the hand. 
         [0007]    The hand includes a distal interphalangeal (DIP) joint, a proximal interphalangeal (PIP) joint, and a metacarpal phalangeal (MCP) joint in each finger, and an interphalangeal (IP) joint and a metacarpal phalangeal (MCP) joint in the thumb. The DIP joints, the IP joint, the PIP joints, and the MCP joints of the hand can be sites for osteoarthritis, and arthrodesis of the DIP, IP, PIP and MCP joints may be used to eliminate pain and improve the alignment and stability of the fingers and thumb. While joint arthroplasty for these joints of the hand may also be an option, there still are numerous cases that cannot be treated with a joint replacement. This is usually secondary to significant soft tissue loss or significant body destruction. 
         [0008]    One current method for obtaining fusion in the interphalangeal and metacarpal phalangeal joints involves taking a small plate and having the surgeon bend it intraoperatively to approximate the angulation that is needed in the joint. The bony surfaces of the hand are prepared with a rongeur or saw, and then the plate is fixed across the joint by screws. Because this method results in a defined fused joint position, it is very important that the two adjacent bones are accurately positioned relative to each other during the method. However, it can be difficult to precisely control the angle when bending the plate, and often a “guesstimation” of the angle that is actually needed must be made by the surgeon. 
         [0009]    Other techniques have the surgeon making bone cuts and then applying one screw in a compressive type fashion, again just with a rough estimation of the joint angle to be achieved. Finally, another common technique that is utilized is tension band wiring. Problems with tension band wiring include again, a “guesstimation” of the angle that is actually needed, as well as backing out the hardware, creating sore points or sore spots for the patient. These nonspecific techniques could result in nonunion of the fusion site. They can also lead to a mish-mash of different angles at different joints, which can make patient use of the hand less functional that would otherwise be achieved if the appropriate angles had been achieved. 
         [0010]    Various joint fusion systems are available for hand joints. For example, an “MCP Fusion Plate”, designed for fusions of the first metacarpal phalangeal joint of the thumb is available from Acumed, Hillsboro Oreg., USA. U.S. Pat. No. 5,667,510 describes a joint fixation system having a screw assembly that provides a compressive force across a finger joint. 
         [0011]    Various joint fusion systems are also available for other joints. A Hallu®-Fix arthrodesis set with an osteosynthesis plate indicated for use in the fixation of fractures, osteotomies and arthrodesis of the first metatarso-phalangeal (MTP) joint is available from Integra Life Sciences, Plainsboro, N.J., USA. MTP joint plates are also shown in U.S. Patent Application Publication Nos. 2003/0060827 and 2006/0241608. The use of MTP joint plates is also described by Kelikian in “Technical Considerations in Hallux Metatarsalphalangeal Arthrodesis”,  Foot Ankle Clin N Am,  Vol. 10, pages 167-190, 2005. 
         [0012]    While these known joint fusion systems and methods may be acceptable for certain applications, there still exists a need for an improved device for the surgical fixation of an interphalangeal joint or a metacarpal phalangeal joint wherein the surgical devices provide greater precision in achieving a desired fused joint position. 
       SUMMARY OF THE INVENTION 
       [0013]    The present invention addresses the foregoing needs by providing a joint fusion system that supplies the hand surgeon, orthopedic surgeon and plastic surgeon with precontoured and angled joint fixation plates that provide easy ability to fuse interphalangeal or metacarpal phalangeal joints in the appropriate amount of angulation. The joint fixation system allows for easier and more reliable fusion of these joints in the appropriate individual angles for each digit. 
         [0014]    In one aspect of the invention, there is provided a joint fixation system including a joint fixation plate having a distal section, a proximal section, and an intermediate section connecting the distal section and the proximal section. The distal section includes a distal section screw hole, and the proximal section includes a proximal section screw hole. The joint fixation plate is pre-bent such that the distal section and the proximal section form an included angle of less than 180 degrees. The distal section screw hole has a longitudinal axis that is angled with respect to a normal to a surface of the distal section, and the proximal section screw hole has a longitudinal axis that is angled with respect to a normal to a surface of the proximal section. In another form, only one of the distal section screw hole and the proximal section screw hole has a longitudinal axis that is angled with respect to a normal to a surface of the joint fixation plate. The joint fixation system includes a first screw dimensioned to engage an inner surface of the distal section screw hole, and a second screw dimensioned to engage an inner surface of the proximal section screw hole. The first screw is angulated proximally when inserted in the distal screw hole, and the second screw is angulated distally when inserted in the proximal screw hole such that the first screw and the second screw cross. 
         [0015]    Because the joint fixation plate is pre-bent and has screw angles predetermined as well as an option for locking and unlocking screws, operating room time should be minimal compared to current techniques. Also, the accuracy of finger alignment and fusion rates should all be improved. The joint fixation plate has a very low profile in order to minimize the soft tissue irritation because of the very thin soft tissue envelope over the dorsum of the hand. For this same reason, the metal surfaces are rounded and polished. This allows the extensor tendons to glide over the plate without developing significant adhesions or showing signs of irritation. 
         [0016]    In one aspect, the invention provides a joint fixation system for interphalangeal joint fusion or metacarpal phalangeal joint fusion. The system includes a joint fixation plate having a distal section, a proximal section, and an intermediate section connecting the distal section and the proximal section. The distal section engages one bone and includes a first distal section screw hole, and the proximal section engages another bone and includes a first proximal section screw hole. The distal section and the proximal section form an included angle less than 180 degrees. The first distal section screw hole has a longitudinal axis that is angled with respect to a normal to a surface of the distal section, and/or the first proximal section screw hole has a longitudinal axis that is angled with respect to a normal to a surface of the proximal section. Preferably, the longitudinal axis of the first distal section screw hole is angled with respect to the normal to the surface of the distal section, and the longitudinal axis of the first proximal section screw hole is angled with respect to the normal to the surface of the proximal section. In a lateral view of the joint fixation plate, the longitudinal axis of the first distal section screw hole and the longitudinal axis of the first proximal section screw hole cross within the included angle when the joint fixation plate is affixed across the joint. 
         [0017]    In one configuration of the joint fixation system, the first distal section screw hole and the first proximal section screw hole are on opposite sides of a longitudinal axis of the joint fixation plate. The intermediate section of the joint fixation plate can be wider than the distal section, and the intermediate section of the joint fixation plate can be wider than the proximal section. The distal section can include a second distal section screw hole and a third distal section screw hole. The proximal section can include a second proximal section screw hole and a third proximal section screw hole. 
         [0018]    In one form, the first distal section screw hole and the first proximal section screw hole are on opposite sides of a longitudinal axis of the joint fixation plate, and the first distal section screw hole and the second proximal section screw hole are on opposite sides of the longitudinal axis of the joint fixation plate, and the first proximal section screw hole and the second distal section screw hole are on opposite sides of a longitudinal axis of the joint fixation plate. The first distal section screw hole can be further from the longitudinal axis of the joint fixation plate than the second proximal section screw hole, and the first proximal section screw hole can be further from the longitudinal axis of the joint fixation plate than the second distal section screw hole. 
         [0019]    The joint fixation system can further include a first screw dimensioned to engage an inner surface of the first distal section screw hole, and a second screw dimensioned to engage an inner surface of the first proximal section screw hole. In a lateral view of the joint fixation plate, when the first screw engages the inner surface of the first distal section screw hole and the second screw engages the inner surface of the first proximal section screw hole, the first screw and the second screw cross within the included angle of the joint fixation plate. The first screw can be a non-locking screw or a locking screw, and the second screw can be a non-locking screw or a locking screw. 
         [0020]    The joint fixation system can further include a drill guide having threads for engaging threads on an inner surface of the first distal section screw hole and/or engaging threads on an inner surface of the first proximal section screw hole. The joint fixation system can further include another drill guide including a guide body having an end dimensioned for placement in the first distal section screw hole and/or the first proximal section screw hole. This drill guide also includes means for variably adjusting relationship of a longitudinal axis of the guide body to a longitudinal axis of the first distal section screw hole and/or to a longitudinal axis of the first proximal section screw hole. 
         [0021]    In another aspect, the invention provides a kit for fixing one or more bone joints for fusion such as an interphalangeal joint or a metacarpal phalangeal joint. The kit includes two or more different joint fixation plates. A first joint fixation plate has a distal section, a proximal section, and an intermediate section connecting the distal section of the first joint fixation plate and the proximal section of the first joint fixation plate. The distal section of the first joint fixation plate can include a first distal section screw hole, and the proximal section of the first joint fixation plate can include a first proximal section screw hole. The distal section of the first joint fixation plate and the proximal section of the first joint fixation plate form a first included angle less than 180 degrees. The first distal section screw hole of the first joint fixation plate can have a longitudinal axis that is angled with respect to a normal to a surface of the distal section of the first joint fixation plate, and/or the first proximal section screw hole of the first joint fixation plate can have a longitudinal axis that is angled with respect to a normal to a surface of the proximal section of the first joint fixation plate. Preferably, the longitudinal axis of the first distal section screw hole is angled with respect to the normal to the surface of the distal section of the first joint fixation plate, and the longitudinal axis of the first proximal section screw hole is angled with respect to the normal to the surface of the proximal section of the first joint fixation plate. 
         [0022]    A second joint fixation plate of the kit has a distal section, a proximal section, and an intermediate section connecting the distal section of the second joint fixation plate and the proximal section of the second joint fixation plate. The distal section of the second joint fixation plate can include a first distal section screw hole, and the proximal section of the second joint fixation plate can include a first proximal section screw hole. The distal section of the second joint fixation plate and the proximal section of the second joint fixation plate form a second included angle less than 180 degrees. The distal section screw hole of the second joint fixation plate has a longitudinal axis that is angled with respect to a normal to a surface of the distal section of the second joint fixation plate, and/or the proximal section screw hole of the second joint fixation plate has a longitudinal axis that is angled with respect to a normal to a surface of the proximal section of the second joint fixation plate. Preferably, the longitudinal axis of the first distal section screw hole is angled with respect to the normal to the surface of the distal section the second joint fixation plate, and the longitudinal axis of the first proximal section screw hole is angled with respect to the normal to the surface of the proximal section the second joint fixation plate. 
         [0023]    In the kit, the first included angle of the first joint fixation plate and the second included angle of the second joint fixation plate kit are different. In addition, in the kit of the invention, any number of differently angled joint fixation plates can be included. For example, a differently angled joint fixation plate can be provided for each of the distal interphalangeal joint, the proximal interphalangeal joint, and the metacarpal phalangeal joint in each finger, and for the interphalangeal joint and the metacarpal phalangeal joint in the thumb. In one non-limiting example kit, joint fixation plates having included angles of 15°, 20°, 25°, 30°, 35°,40°, 45°, and 50° are provided. 
         [0024]    The kit can include non-locking screws or locking screws for engaging the inner surface of the distal section screw hole of the first joint fixation plate and for engaging the inner surface of the proximal section screw hole of the first joint fixation plate and for engaging the inner surface of the distal section screw hole of the second joint fixation plate and for engaging the inner surface of the proximal section screw hole of the second joint fixation plate. The kit can include a drill guide having threads for engaging threads on an inner surface of the distal section screw hole of the first joint fixation plate and for engaging threads on an inner surface of the distal section screw hole of the second joint fixation plate. 
         [0025]    In one form of the joint fixation plates in the kit, the longitudinal axis of the distal section screw hole of the first joint fixation plate is angled with respect to the normal to the surface of the distal section of the first joint fixation plate, and the longitudinal axis of the proximal section screw hole of the first joint fixation plate is angled with respect to the normal to the surface of the proximal section of the first joint fixation plate. The longitudinal axis of the distal section screw hole of the second joint fixation plate can be angled with respect to the normal to the surface of the distal section of the second joint fixation plate, and the longitudinal axis of the proximal section screw hole of the second joint fixation plate can be angled with respect to the normal to the surface of the proximal section of the second joint fixation plate. 
         [0026]    In yet another aspect, the invention provides a method for fixing a bone joint for fusion. In the method, a joint fixation plate is affixed to adjacent bones of the bone joint, such as an interphalangeal joint or a metacarpal phalangeal joint. The joint plate has a distal section, a proximal section, and an intermediate section connecting the distal section and the proximal section. The distal section includes a distal section screw hole, and the proximal section including a proximal section screw hole. The distal section and the proximal section form an included angle of less than 180 degrees. The joint fixation plate can be provided pre-bent to the included angle. The distal section screw hole has a longitudinal axis that is angled with respect to a normal to a surface of the distal section, and/or the proximal section screw hole has a longitudinal axis that is angled with respect to a normal to a surface of the proximal section. In the method, a first screw is driven through the distal section screw hole such that the first screw engages an inner surface of the distal section screw hole and the adjacent bones, and a second screw is driven through the proximal section screw hole such that the second screw engages an inner surface of the proximal section screw hole and the adjacent bones. The distal section can include a second distal section screw hole, and the proximal section includes a second proximal section screw hole, and the method can further include the steps of driving a third screw through the second distal section screw hole such that the third screw engages an inner surface of the distal section screw hole and one of the adjacent bones, and driving a fourth screw through the second proximal section screw hole such that the fourth screw engages an inner surface of the second proximal section screw hole and one of the adjacent bones. 
         [0027]    It is therefore an advantage of the invention to provide surgical methods and devices for interphalangeal and metacarpal phalangeal joint fusion wherein the devices provide greater precision in achieving a desired fused joint position. 
         [0028]    It is another advantage of the invention to provide a joint fixation plate that can be used in cases where a prosthesis had to be removed because of infection or other reasons. 
         [0029]    It is yet another advantage of the invention to provide a kit for interphalangeal and metacarpal phalangeal joint fusion wherein the kit includes joint fixation plates, screws, and a drill guide for drilling a pilot hole in each bone for receiving a screw. 
         [0030]    These and other features, aspects, and advantages of the present invention will become better understood upon consideration of the following detailed description, drawings, and appended claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0031]      FIG. 1  is a lateral view of a left human index finger having a joint fixation plate according to the invention fixed at the proximal interphalangeal joint. 
           [0032]      FIG. 2  is an antero-posterior view of the index finger of  FIG. 1  having the joint fixation plate of  FIG. 1  fixed at the proximal interphalangeal joint. 
           [0033]      FIG. 3  is a cross-sectional view of the joint fixation plate taken along line  3 - 3  of  FIG. 2 . 
           [0034]      FIG. 4  is a detailed view of the joint fixation plate taken along line  4 - 4  of  FIG. 3 . 
           [0035]      FIG. 5  is a cross-sectional view, similar to  FIG. 3 , of the joint fixation plate before the mounting of a drill guide in an opening of the joint fixation plate. 
           [0036]      FIG. 6  is a cross-sectional view, similar to  FIG. 5 , of the joint fixation plate after the mounting of a drill guide in a screw opening of the joint fixation plate. 
           [0037]      FIG. 7  is a cross-sectional view, similar to  FIG. 3 , of the joint fixation plate before the mounting of another version of a drill guide in a screw opening of the joint fixation plate. 
           [0038]      FIG. 8  is a cross-sectional view of the drill guide of  FIG. 7  taken along line  8 - 8  of  FIG. 7  with the drill guide body in the central position of the alignment base. 
       
    
    
       [0039]    Like reference numerals will be used to refer to like parts from Figure to Figure in the following description of the drawings. 
       DETAILED DESCRIPTION OF THE INVENTION 
       [0040]    Looking first at  FIGS. 1 to 4 , there is shown one example embodiment of a joint fixation system  10  according to the invention. While the joint fixation system  10  is shown fixed on the proximal interphalangeal (PIP) joint of the left index finger, other embodiments of the invention can be used for any proximal interphalangeal (PIP) joint in the other fingers, a metacarpal phalangeal (MCP) joint in any finger, an interphalangeal (IP) joint in the thumb, or a metacarpal phalangeal (MCP) joint in the thumb. 
         [0041]    The joint fixation system  10  includes a joint fixation plate  12 . The surgical approach for the joint fixation system  10  can be dorsally for the IP, PIP and MCP joints. A cannulated cup and cone reamer system can be used to create matched mating surfaces for fusion of the opposed bone surfaces of the joint. Example reamer systems include: (1) the Small Joint Reamer available from Acumed, Hillsboro Oreg., USA; and (2) the Hallu®-Ream reamer system available from Integra Life Sciences, Plainsboro, N.J., USA. Different sized cannulated cup and cone reamer systems can provide appropriate surface preparation in different sized patients and different sized joints. The cannulated reamer system allows for consistent surface preparation. In the example of  FIG. 1 , the reamer system can be used create mating bone surfaces in the proximal phalanx  13  and the intermediate phalanx  14 . 
         [0042]    The joint fixation plate  12  of the joint fixation system  10  has a first screw hole  16 , a second screw hole  18 , and a third screw hole  22  on a proximal section  24  of the joint fixation plate  12 . The joint fixation plate  12  also has a fourth screw hole  26 , a fifth screw hole  28 , and a sixth screw hole  32  on a distal section  34  of the joint fixation plate  12 . The first screw hole  16 , the second screw hole  18 , the fifth screw hole  28 , and the sixth screw hole  32  can be configured to accommodate either locking screws or non-locking screws. The joint fixation plate  12  of the joint fixation system  10  has a longitudinal axis L p  shown in  FIG. 2 . The proximal section  24  and the distal section  34  of the joint fixation plate  12  from an included angle I (see  FIG. 3 ) of less than 180 degrees. 
         [0043]    In  FIG. 4 , there is shown a locking cancellous second screw  38  threaded into the second screw hole  18  of the joint fixation plate  12 . There are external threads  42  on the head  44  of the screw  38  which engage internal threads  46  on the interior surface of the second screw hole  18 . This type of threaded engagement for the locking screw  38  and the second screw hole  18  can also be used for the first screw hole  16 , the fifth screw hole  28 , and the sixth screw hole  32 . Looking at  FIG. 1 , it can be seen that the first screw hole  16 , the fifth screw hole  28 , and the sixth screw hole  32  engage the first locking cancellous screw  52 , the fifth locking cancellous screw  54 , and the sixth locking cancellous screw  56 , respectively. 
         [0044]    Advantageous aspects of the joint fixation system  10  include the third screw  62  and the fourth screw  64 . The third screw  62  and the fourth screw  64  can be non-locking screws in order to provide compression. Preferably, the screw thread type is cancellous as shown in the third screw  62  in  FIG. 4 . The third screw  62  is angulated distally when inserted in the third screw hole  22  as shown in  FIG. 4 . The third screw hole  22  is countersunk to provide a chamfer  68  that engages frustoconical head  66  of the third screw  62 . The fourth screw  64  is angulated proximally when inserted in the fourth screw hole  26  as shown in  FIG. 1 . The fourth screw hole  26  may also be countersunk to provide a chamfer that engages a frustoconical head of the fourth screw  64  (as in the third screw  62  and the third screw hole  22 ). 
         [0045]    Looking at  FIG. 2 , the joint fixation plate  12  is widened laterally at an intermediate section  72  where the proximal section  24  and the distal section  34  of the joint fixation plate  12  are connected such that neither of the third screw  62  and the fourth screw  64  will interfere with the other when inserted into the proximal phalanx  13  and the intermediate phalanx  14 . 
         [0046]    The third screw hole  22  and the fourth screw hole  26  can be milled at specific angles A 1 , A 2  (see  FIGS. 3 and 4 ) depending on the angle of the joint fixation plate  12 . For example, a plate angle B (see Angle B in  FIG. 3 ) of 35° would require a much steeper angle of the compression screws in order to maintain the third screw  62  and the fourth screw  64  within the bony confines of the proximal phalanx  13  and the intermediate phalanx  14 . Conversely, a greater fusion angle B, such as 50°, would require a less steep compression angle for the screws. Referring to  FIG. 3 , angle A 2  of the fourth screw hole  26  is created between a longitudinal axis L 2  of the fourth screw hole  26  and a normal N 2  to a surface  67  of the distal section  34 . Referring to  FIG. 4 , angle A 1  of the third screw hole  22  is created between a longitudinal axis L 1  of the third screw hole  22  and a normal N 1  to a surface  69  of the proximal section  24 . In an alternative embodiment (not shown), the longitudinal axis L 2  of the fourth screw hole  26  can be normal to the surface  67  of the distal section  34 , and angle A 1  of the third screw hole  22  is created between the longitudinal axis L 1  of the third screw hole  22  and the normal N 1  to the surface  69  of the proximal section  24 . In yet another alternative embodiment (not shown), the longitudinal axis L 1  of the third screw hole  22  can be normal to the surface  69  of the proximal section  24 , and angle A 2  of the fourth screw hole  26  is created between the longitudinal axis L 2  of the fourth screw hole  26  and the normal N 2  to the surface  67  of the distal section  34 . 
         [0047]    Looking at  FIG. 5 , the third screw hole  22  and the fourth screw hole  26  can have internal threads for screwing in a drill guide  74 . In  FIG. 5 , the fourth screw hole  26  has internal threads  76  that engage external threads  77  on an end  75  of the drill guide  74 . The drill guide  74  has a generally cylindrical tubular body  78  and a flared end  79 . The body  78  of the drill guide  74  can taper slightly from the flared end  79  to the threaded end  75 . As shown in  FIG. 6 , the drill guide  74  can be threaded into the fourth screw hole  26  to guide a drill  80  into bone to create a second screw guide bore  98  in the intermediate phalanx  14  (see  FIG. 7 ). The end  75  of the drill guide  74  can be threaded into the third screw hole  22  to guide the drill  80  into bone to create a first screw guide bore  97  in the proximal phalanx  13  (see  FIG. 7 ). 
         [0048]    Another option is instead of designing the joint fixation plate  12  with a predetermined compression angle is the use of a variable angle drill guide  82 . Looking at  FIGS. 7 and 8 , the drill guide  82  includes an alignment base  84  having spaced apart side walls  85 . The interior surface of the side walls  85  includes a series of spaced protrusions  86 . The drill guide  82  has a generally cylindrical tubular body  88  having a longitudinal axis A g , and a flared end  89 . The alignment base  84  is placed on the distal section  34  of the joint fixation plate  12  as shown in  FIG. 7 . An end  91  of the body  88  of the drill guide  82  is then placed in the fourth screw hole  26  and then the body  88  can be moved into an immobilized position between any adjacent spaced protrusions  86 . Thus, the spaced protrusions  86  provide a means for variably adjusting the angular relationship of the longitudinal axis A g  of the guide body  88  to the longitudinal axis L 2  of the fourth screw hole  26 . The body  88  can be positioned as desired to guide a drill  80  into the intermediate phalanx  14  to create a second screw guide bore  98  in the intermediate phalanx  14 . Likewise, the variable angle drill guide  82  can be positioned with the body  88  in the third screw hole  22  at a desired angle to guide the drill  80  into the proximal phalanx  13  to create a first screw guide bore  97  in the proximal phalanx  13 . 
         [0049]    Whether using the drill guide  74  or the variable angle drill guide  82 , a compression angle is created between the first screw guide bore  97  in the proximal phalanx  13  and the second screw guide bore  98  in the intermediate phalanx  14  so that the third screw  62  and the fourth screw  64  cross the joint at the midpoint of the joint so that the compressive forces applied across the joint surface area would be maximized. By maximizing these compression forces over the large prepared surface area, a higher success rate of obtaining fusion would be encountered clinically. 
         [0050]    The joint fixation plate  12  can also have Kirschner wire (K wire) holes  92  (see  FIGS. 2 and 3 ) that allow for temporization of the joint fixation plate  12  on the phalanx or metacarpals so that the third screw  62  and the fourth screw  64  could be placed prior to committing the first locking cortical or cancellous screw  52 , the second locking cortical or cancellous screw  38 , the fifth locking cortical or cancellous screw  54 , and the sixth locking cortical or cancellous screw  56 . These K-wire holes  92  can be oblong to create longitudinal play along axis L p  so that as the third screw  62  and the fourth screw  64  were are tightened, the K-wires would be able to accommodate this change of position. The K-wires  94  have globe shaped beads  95  (see  FIG. 1 ) on their end so that the globe shaped beads  95  help hold the joint fixation plate  12  against the proximal phalanx  13  and the intermediate phalanx  14 . 
         [0051]    In order to attain functionality of the hand after fusion, different digits are fused at different angles. Non-limiting examples of the fusion angles for the proximal interphalangeal joint are: index finger at 35°, the long finger at 40°, the ring finger at 45°, and the small finger at 50°, with the thumb interphalangeal joint having a plate at 15°. Certainly, if the surgeon chooses to change the combination of plates, that would up to him or her. However, these plates should preferably not be bent by the surgeon because of the specific compression screw angles that would change if the angle of the plate were disturbed. Non-limiting examples of the fusion angles of the metacarpal phalangeal joints fusion are: 25° for the index finger, 30° for the long finger, 35° for the ring finger, and 40° for the small finger, with the thumb metacarpal phalangeal joint being fused at 15°. It is possible that one set of plates may be able to accommodate proximal interphalangeal and metacarpal phalangeal joint fusions. In this case, potentially having joint fixation plates angled from 15° to 50° in 5° increments, or at least from 20° to 50° in 5° increments would suffice for a majority of cases This would mean seven to eight different types of joint fixation plates being available. An example single kit can be supplied with: (1) any number (such as seven or eight) of different types of joint fixation plates  12 ; (2) locking screws (such as  38 ) of different lengths; (3) non-locking screws (such as  62 ) of different lengths; and (4) K-wires (such as  94 ) of different lengths. 
         [0052]    The joint fixation plate and the screws may be formed from various materials such as, without limitation: (i) a metal or metal alloy such as a titanium alloy (e.g., titanium-6-aluminum-4-vanadium), a cobalt alloy, a stainless steel alloy, or tantalum; (ii) a nonresorbable ceramic such as aluminum oxide or zirconia; (iii) a nonresorbable polymeric material such as polyethylene or polyetheretherketone available under the product name PEEK-OPTIMA®; or (iv) a nonresorbable composite material such as a carbon fiber-reinforced polymers (e.g., polysulfone or PEEK-Optima®). 
         [0053]    Thus, the invention provides a joint fusion system that supplies the hand surgeon, orthopedic surgeon and plastic surgeon with precontoured and angled joint fixation plates that provide easy ability to fuse interphalangeal or metacarpal phalangeal joints in the appropriate amount of angulation. The joint fixation system allows for easier and more reliable fusion of these joints in the appropriate individual angles for each digit. 
         [0054]    Although the present invention has been described in detail with reference to certain embodiments, one skilled in the art will appreciate that the present invention can be practiced by other than the described embodiments, which have been presented for purposes of illustration and not of limitation. Therefore, the scope of the appended claims should not be limited to the description of the embodiments contained herein.