Bone fixation system

A modular bone fixation linkage includes a plurality of interconnected links that can angulate with respect to an adjacent one of the links in-plane or out-of-plane. The links can further include fixation holes that are configured to receive fixation members that secure the links to an underlying anatomical structure.

BACKGROUND

This disclosure relates generally to bone fixation implants, and in particular relates to an adaptable bone fixation implant that can be readily shaped to repair or replace a particular bone structure of a patient.

When bones are damaged through trauma, disease, distraction osteogenesis, or orthognathic surgery, bone fixation implants are commonly used to provide anatomical reduction of bone fragments, to maintain their position, and to ensure union in the desired position. Thus, bone fixation implants are typically designed to achieve proper anatomic fit and function. Additionally, because bone fixation implants often support bones that withstand significant mechanical stress in their anatomic function, implants are often composed of strong and rigid materials. However, it is particularly difficult to fashion rigid materials to a particular patient's bone contour.

As one example, achieving the proper shape and fit of a bone fixation implant is of particular emphasis in mandibular reconstruction. An improper fit of a mandibular fixation implant may result in disruption of the normal jaw function or alteration of the occlusion, which can cause discomfort for a patient. Additionally, it is desirable for mandibular fixation implants to be strong and rigid to provide a proper occlusion and withstand related mechanical stresses.

SUMMARY

In accordance with one embodiment, a bone fixation linkage defines an inner end configured to face a bone to which the bone fixation linkage is configured to be attached, and an outer end opposite the inner end. The fixation linkage includes at least a first link of the plurality of interconnected links including a plurality of first locking ribs spaced from each other along a plane, and at least a second link of the plurality of interconnected links including a plurality of second locking ribs. At least one of the second locking ribs is configured to mate with at least one of the first locking ribs so as to lock the first link to the second link The at least one first locking rib can prevent the second link from rotating with respect to the first link about an axis of rotation that is normal to the plane when the at least one second locking rib is mated with the at least one first locking rib.

DETAILED DESCRIPTION

Referring toFIGS. 1-2B, a bone fixation system20is configured to be implanted onto bone so as to stabilize a first anatomical structure22awith respect to at least second anatomical structure22bso as to promote bone healing or bridging of a bone gap. The bone fixation system20can include a bone fixation linkage26that is configured to be attached to each of the first and second anatomical structures22aand22b, and a plurality of fixation members50that are configured to fix the bone fixation linkage26to positionally fix the anatomical structures22aand22bto fix the anatomical structures22aand22brelative to each other. The fixation members28can include bone fixation members28. The bone fixation linkage26includes a plurality of interconnected links30that are configured to be attached to each other and to the underlying anatomical structures. As will be appreciated from the description below, the links30are configured to be manipulated relative to each other so as to fit against the underlying anatomical structure, and adjacent ones of the links30are configured to be locked to each other so as to positionally fix the bone fixation linkage26.

The first anatomical structure22acan be configured as a bone or bone fragment24aas illustrated. The term “bone” can be used to refer collectively to bone or a bone fragment. The second anatomical structure22bcan be configured as another bone fragment24b, separated by a bone gap G, for instance when a bone is fractured, or when an osteotomy is performed on a bone24. The second anatomical structure22bcan also be another bone fragment when a bone is resectioned so as to define a bone gap that separates the first and second bone fragments. Alternatively or additionally, the bone fixation system20is configured to stabilize the first anatomical structure with respect to a bone implant, which can be an artificial implant or a bone graft. In one example, the bone graft can be placed in the bone gap, for instance after resection. Thus, the second anatomical structure22bcan be configured as an implant, or the bone fixation system20can be configured to stabilize the first and second anatomical structures22aand22brelative to each other as described above, and further relative to a third anatomical structure, which can be bone or a bone implant. It should be appreciated, of course, that the bone fixation system20can be configured any number of anatomical structures relative to each other as desired. For instance, the fractured bone can be comminuted, and thus include any number of bone fragments that can be secured relative to each other by the bone fixation system20. Otherwise stated, the bone fixation system20can be configured to be implanted onto bone so as to stabilize the bone with respect to one or more other anatomical structures. Alternatively or additionally, it will be appreciated that the links30can be attached to underlying bone, and adjusted relative to each other so as to reduce a bone gap defined between the bone fragments. Alternatively or additionally still, it will be appreciated that the links30can be attached to underlying bone, and adjusted relative to each other so as to manipulate the bone fragments.

The bone24is illustrated as a mandible inFIG. 1, though it should be appreciated that the bone can be defined by any suitable bone as desired in the human body, or other animal body, as desired, such as the pelvis, scapula, clavicle, wrist, spine, and the thorax region, including one or more ribs, the sternum, or the like. As is described in more detail below, the bone fixation linkage26is modular, adjacent ones of the interconnected links can angulate with respect to each other before they are locked to each other. In one example, the interconnected adjacent links can angulate in-plane relative to each other. In another example, the interconnected adjacent links can angulate out-of-plane relative to each other.

The term “in-plane” as used herein refers to a direction that is one or more up to all of 1) substantially parallel to an inner surface of the adjacent links that face the underlying anatomical structure, 2) substantially parallel to an outer surface of the adjacent links that is opposite the inner surface, 3) substantially normal to the central axis of one or more of fixation apertures that extend through one or both of the adjacent links, and 4) a direction whereby the central axis of at least one of the fixation apertures of a first one of the adjacent links and the central axis of at least one of the fixation apertures of a second one of the adjacent links has a relative orientation that is constant before and after in-plane articulation. In one example, the relative orientation can be substantially parallel. In another example, the relative orientation can be angularly offset. The term “substantially” as used herein takes into account manufacturing tolerances and movement that does not alter the nature of fixation to the underlying anatomical structure.

The term “out-of-plane” is used herein to refer to a direction that is one or more of 1) along a fixed or moving axis that is oriented substantially parallel to an inner surface of the adjacent links that face the underlying anatomical structure, 2) along a fixed or moving axis that is oriented substantially parallel to an outer surface of the adjacent links that is opposite the inner surface, 3) along a fixed or moving axis that is oriented substantially normal to one or more of fixation apertures that extend through one or both of the adjacent links, and 4) a direction whereby the central axis of at least one of the fixation apertures of a first one of the adjacent links and the central axis of at least one of the fixation apertures of a second one of the adjacent links defines a first relative orientation prior to out-of-plane articulation, and a second relative orientation different than the first relative orientation after out-of-plane articulation. In one example, the first relative orientation can be substantially parallel, and the second relative orientation can be angularly offset.

The bone fixation linkage26can be made from any suitable biocompatible material, including a metal such as titanium, stainless steel, or alloys thereof, or any suitable alternative implantable material, such as polymers based materials like poly-ether-ether-ketone (PEEK), or PEKK as desired. The material can also be a bio-resorbable material in certain examples.

Referring now toFIG. 2, the bone fixation linkage26, and thus each of the links30, can define an inner end32a, which can define an inner surface, that is configured to face the underlying anatomical structure, such as the bone24, and an outer end32bthat can define an outer surface opposite the inner end32a. In one example, the inner end32aof at least one or more up to all of the links30can be substantially planar. The inner end32acan be said to be spaced from the outer end32bin an inward direction. Similarly, the outer end32bcan be said to be spaced from the inner end32ain an outward direction. Both the inward direction and the outward direction can be oriented along a transverse direction T. Directions within 45 degrees of the transverse direction T can be considered to be oriented along the transverse direction. At least a portion up to an entirety of the inner and outer surfaces can be elongate along a longitudinal direction L that is substantially perpendicular to the transverse direction T. Directions within 45 degrees of the longitudinal direction L can be considered to be oriented along the longitudinal direction. The linkage26can define a width along a lateral direction A that is substantially perpendicular to each of the transverse direction T and the longitudinal direction L. Directions within 45 degrees of the lateral direction A ca be considered to be oriented along the lateral direction. Each of the inner and outer ends32aand32bcan be sized and shaped as desired, and can define any number of surfaces as desired, including at least one or more surfaces.

Each of the links30can include at least one first link34such as a plurality of first links34, and at least one second link36such as a plurality of second links36. The first and second links34and36can be alternatingly arranged with each other, and adjacent first and second links ones of the links30can be attached and locked to each other. When the adjacent ones of the first and second links34and36are attached to each other but unlocked from each other, the adjacent ones of the first and second links34and36can angulate with respect to each other. When the adjacent ones of the first and second links34and36are attached to each other and locked to each other, the adjacent ones of the first and second links34and36are prevented from angulating with respect to each other. As will be described in more detail below, one or more adjacent ones of the first and second links34and36can be configured to angulate in-plane to an in-plane angulated position with each other when unlocked from each other, and fixed in their in-plane angulated position when locked to each other. Alternatively or additionally, one or more adjacent ones of the first and second links34and36can be configured to angulate out-of-plane with each other to an out-of-plane angulated position when unlocked from each other, and fixed in their out-of-plane angulated position when locked to each other.

The combination of in-plane angulation and out-of-plane angulation allows the bone fixation linkage26to conform to the underlying anatomical structure. Further, the bone fixation linkage26can include any number of links30as desired depending on at least one of several factors, including on the desired length of the bone fixation linkage26, the desired maneuverability of the bone fixation linkage26, and the desired geometrical shape of the bone fixation linkage26. In this regard, it should be appreciated that the links30can include any number of in-plane angulation connections between adjacent ones of the links30and out-of-plane angulation between adjacent ones of the links30as desired such that the bone fixation linkage26defines any size and shape so as to conform to the underlying anatomy of the underlying bone, which can be any suitable bone as desired, for instance one or more bones of the mandible, hand or the distal radius, among others. Further, it should be appreciated that the bone fixation linkage26can be configured to join two different types of bone plates. For instance, the bone fixation linkage26can connect to a hand bone plate at one end, and to a distal radius bone plate at another end.

Referring now toFIGS. 2-4A, at least one of the first links34can include a first in-plane attachment end37that includes a plurality of first locking ribs38. At least one of the second links36can include a second in-plane attachment end39that includes a plurality of second locking ribs40. At least one, such as a plurality of up to all, of the first and second in-plane attachment ends37and39of the locking ribs38and40are configured to mate with each other so as to lock the respective first and second links34and36to each other at a plurality of in-plane angulated relative positions between the first and second links34and36. It should be appreciated that one of the first and second in-plane attachment ends37and39can include one locking rib, while the other of the first and second in-plane attachment ends37and39can have a plurality of ribs configured to receive the rib of the one of the first and second in-plane attachment ends37and39therebetween, so as to fix the in-plane position of the corresponding links. Thus, one of the first and second in-plane attachment ends37and39can include at least one rib, and the other of the first and second in-plane attachment ends37and39can include a plurality of ribs. In one example, both the first and second in-plane attachment ends37and39can include respective pluralities of ribs. The first and second locking ribs38and40can be referred to as first and second in-plane locking ribs. Thus, the at least one first locking rib38can mate with the at least one second locking rib40when the first and second links34and36are in a first in-plane position relative to each other. Further, the at least one first locking rib38can mate with the at least one second locking rib40when the first and second links34and36are in a second in-plane position relative to each other and different than the first in-plane position. It should be appreciated that the first and second links34and36are at the same out-of-plane position when the ribs38and40mate with each other in each of the first and second in-plane relative positions. For instance, one or both of the inner and outer surfaces of the first links34are in-plane with the respective one or both of the inner outer surfaces of the second links36when the first and second locking ribs38are mated with each other.

As will be appreciated from the description below, the at least one of the first locking ribs38is configured to mate with at least one of the second locking ribs40so as to lock the first link34to the adjacent second link36without expansion of either of the first and second links34and36relative to the other of the first and second links34and36. For instance, it can be said that the second in-plane attachment end39of the second link36is unexpandable inside the first in-plane attachment end37of the first link341) from a first position whereby the first ribs38are spaced from each other along a first path and the second ribs40are spaced from each other along a second path that is different than the first path such that the at least one first rib38is configured not to mate with the at least one second rib40, 2) to a second expanded position whereby the first and second paths are substantially complementary to each other such that the at least one first rib38is configured to mate with the at least one second rib40. Accordingly, as will be appreciated from the description below, the first and second locking ribs38and40are positioned such that the at least one of the first locking ribs38configured to mate with the at least one of the second locking ribs40so as to positionally lock the first link34to the adjacent second link36prior to insertion of a fixation member50into or through either of respective apertures46and48of the first and second links34and36. Thus, the at least one of the first and second locking ribs38and40are sized and configured to mate with each other both when 1) the first and second locking ribs38and40are offset from each other along a direction perpendicular to the transverse direction T, and 2) the second in-plane attachment end39is configured to be received in the first in-plane attachment end37.

When the at least one first rib38is mated with the at least one second rib40, the first ribs38are spaced from each other along a plane and the second ribs40are spaced from each other along the plane, and the ribs38and40interfere with each other so as to prevent the first and second link34and36from rotating with respect to each other about an axis of rotation that is normal to the plane. For instance, the plane can be substantially parallel to the inner end. Further, the plane can be oriented substantially normal to the transverse direction T. Thus, the in-plane angulation can be along a plane that is oriented substantially normal to the transverse direction T. The axis of rotation can be oriented along the transverse direction T.

The first ribs38can include at least one group of first ribs that can be spaced from each other along an arcuate path. Similarly, the second ribs40of each group of second ribs38can be spaced from each other along a complementary arcuate path. For instance, the arcuate paths can be a substantially cylindrical path. In one example, all of the first ribs38are aligned with each other along the respective substantially cylindrical path. Similarly, all of the second ribs40can be aligned with each other along the respective substantially cylindrical path. One of the arcuate paths can be concave, while the other of the arcuate paths can be convex. In the illustrated example, the arcuate path defined by the first ribs38can be concave, and the arcuate path defined by the second ribs40can be convex. The substantially cylindrical paths can be defined by a substantially cylindrical shape having a central axis oriented along a direction that can be oriented substantially along the transverse direction T. The term “substantially cylindrical” as used herein recognizes that shapes and paths can deviate from a pure cylindrical shape without departing from the scope of the present disclosure.

The first in-plane attachment end37of the first link34can define a receptacle42and the second in-plane attachment end39of the second link36can define a plug44that is configured to be received by the receptacle42. For instance, an inner surface of the first link34that at least partially defines the receptacle42can carry the first ribs38. In one example, the first ribs38can be arranged in first and second groups of first ribs38that are disposed on opposite sides of the receptacle42. For instance, the first and second groups of first ribs38can be disposed on opposite sides of the receptacle42along the lateral direction A. The second link36can define a main portion45and an arm47that extends from the main portion45and is monolithic with the main portion45. The arm47can define the plug44. The plug44, and thus the arm47, can carry the second ribs40. The first ribs38can project inwardly from the inner surface. In particular, the first ribs38can project inwardly to distal tips. The distal tips of the first ribs38can be elongate along respective straight lines. The straight lines can be oriented parallel to each other. For instance, the distal tips can be elongate substantially along the transverse direction T. It should be appreciated, of course, that the distal tips can be alternatively shaped as desired. The second ribs40can project outwardly from the plug44. In particular, the second ribs40can project inwardly to respective distal tips. The distal tips of the second ribs40can be elongate along respective straight lines. The straight lines can be oriented parallel to each other. For instance, the distal tips of the second ribs40can be elongate substantially along the transverse direction T. It should be appreciated, of course, that the distal tips can be alternatively shaped as desired.

The receptacle of the first link34can include an opening49that extends into the first link34along the longitudinal direction L, and has a width along the lateral direction A that is sized to receive the arm47of the second link36. Further, the second ribs40can be arranged in first and second groups of second ribs40that extend out from opposite sides of the plug44. For instance, the first and second groups of second ribs40that extend out from opposite sides of the plug44with respect to the lateral direction A. At least one of the first and second ribs38and40of the first groups are configured to mate with each other while at least one of the first and second ribs38and40of the second groups are mated with each other. It should be appreciated that the first ribs38can be arranged in any number of groups as desired, including at least one and a plurality of groups. The groups of first ribs38can be spaced from each other along any direction as desired, including one or both of the transverse direction T and the lateral direction A. Similarly, the first ribs40can be arranged in any number of groups as desired, including at least one and a plurality of groups. The groups of first ribs40can be spaced from each other along any direction as desired, including one or both of the transverse direction T and the lateral direction A.

The plug44is configured to be received in the receptacle42so as to cause the first and second ribs38and40to mate with each other. Thus, it can be said that the first link34receives the second link36when the first and second ribs38and40are mated to each other. During operation, the first and second links36can be oriented as desired relative to each other in-plane, and the ribs38and40can be aligned with each other along the transverse direction T. For instance, the second link36can be brought at least into proximity of, for instance against, the anatomical structure, and the first link34can subsequently be brought down onto the second link36in the inward direction such that the plug44is received in the receptacle42when the links34and36are in the desired second in-plane relative orientation, and the first and second ribs38and40to mate with each other.

The outer surface of the arm47can be recessed with respect to the outer surface of the main portion45along the transverse direction T. That is, the outer surface of the arm47can be offset with respect to the outer surface of the main portion45in the inward direction. Accordingly, then the plug44is disposed in the receptacle42and the ribs38and40are mated with each other, the outer surface of the main portion45can be substantially flush with the outer surface of the first link34.

With continuing reference toFIGS. 2-4A, the first in-plane attachment end37of the first link34defines a respective first fixation aperture46that extends therethrough from the outer end32bto the inner end32aalong a respective central axis. The central axis can be oriented along the transverse direction T. The first fixation aperture46can extend through the receptacle42. Thus, the first and second groups of first ribs38can be disposed on opposite sides of the aperture46. The first in-plane attachment end37of the first link34can define an outer ring56. The outer ring56can be an enclosed outer ring. The outer ring56can define a portion of the outer surface of the first link34. The outer ring56can at least partially define the first fixation aperture46. The outer ring56can be offset from the ribs38along the outward direction. The first link34can further define a shelf58that is offset with respect to the outer ring56in the inward direction, and can extend into the first fixation aperture46. The shelf58can carry the first ribs38. For instance, the first ribs38can project inwardly from the shelf58.

The second in-plane attachment end39of the second link36can define a respective first fixation aperture48that extends therethrough from the outer end32bto the inner end32aalong a respective central axis. The central axis can be oriented along the transverse direction T. The first fixation aperture48can be spaced from the second ribs40. For instance, the first and second groups of the second ribs40can be disposed on opposite sides of the first fixation aperture48. The first fixation apertures46and48can be aligned with each other both when the first and second ribs38and40are aligned for mating along the transverse direction T, and when the first and second ribs38and40are mated with each other.

Referring also toFIGS. 4B-4C, the first fixation apertures46and48are configured to receive a first fixation member. The fixation member can be configured as the fixation member50. The at least one of the first and second ribs38and40are configured to mate with each other prior to insertion of the first fixation member50through either of the first and second fixation apertures46and48. The first fixation member50can be a bone fixation member28. Thus, the first fixation member50includes a head52and a shaft54that extends from the head52. The shaft54has a length sufficient so as to extend through the first fixation apertures46and48and into the underlying anatomical structure when the head52rests against the first link34. In one example, the shaft54is threaded. It should be appreciated that the second link36, and in particular the plug44, can be captured between the underlying anatomical structure and the first link34when the first fixation member50is driven into the underlying anatomical structure. In one example, the head52of the first fixation member50can sit against the shelf58when fully inserted. Further, the first fixation member50can define a neck60that extends between the head52and the shaft54. The neck60can be threaded. Similarly, the first fixation aperture58of the second link36can be threaded, such that the neck60can threadedly purchase with the second link36in the first fixation aperture58. The shaft54can have a length sufficient to extend into the underlying anatomical structure as described above, such that the first fixation member50is a bone fixation member. Alternatively, the shaft54can be sufficiently short, or the first fixation member50can be devoid of a shaft54, such that the first fixation member50can be configured to secure the first link to the second link without extending into the underlying anatomical structure. For instance, the shaft54can have a length that is extends from the head a distance less than the distance from the outer end32bto the underlying bone along the transverse direction T. For instance, the length of the shaft54can be equal to or less than the distance from the inner end32ato the outer end32balong the transverse direction T.

As described above, the first ribs38can be arranged in at least one group of first ribs38, such that the first ribs38of each group of first ribs38are spaced from each other along a respective arcuate path. Similarly, the second ribs40can be arranged in at last one group of second ribs40, such that the second ribs of each group of second ribs40are spaced from each other along a respective complementary arcuate path. The arcuate path defined by the at least one group of first ribs38can be defined by a plane that is normal to the transverse direction T. In one example, all of the first ribs38of each group of first ribs38are spaced from each other along the plane that is normal to the transverse direction T, and aligned with each other along the plane that is normal to the transverse direction T. In another example, all of the first ribs38of each group of first ribs38can be spaced from each other and aligned with each other along a plane that is oriented substantially normal to the central axis of the first fixation aperture46of the first link34. Similarly, the second ribs40of each group of second ribs40can be spaced from each other along a respective arcuate path. The respective arcuate path can be defined by a plane that is normal to the transverse direction T. In one example, all of the second ribs40of each group of second ribs40are spaced from each other along the plane that is normal to the transverse direction T, and aligned with each other along the plane that is normal to the transverse direction T. In another example, all of the second ribs40of each group of second ribs40can be spaced from each other and aligned with each other along a plane that is oriented normal to the central axis of the first fixation aperture48of the second link36.

The second link36can define a second fixation aperture62that is spaced from the first fixation aperture48and extends from the outer surface of the second link36to the inner surface of the second link36. The second fixation aperture62can extend through the second link along a central axis that is oriented along the transverse direction T. In one example, the second fixation aperture62extends through the main portion45. The second fixation aperture62can be threaded so as to threadedly purchase with a fixation member, such as the bone fixation member28. The second fixation aperture62is configured to receive a bone fixation member28that can include a head and a shaft that extends from the head. The head can be threaded. Alternatively, the bone fixation member28can include a neck that extends between the head and the shaft. The shaft can have a length sufficient to be driven into the underlying bone. Alternatively, the second fixation aperture62can be configured to receive a set screw having a shaft that extends from the head a distance less than the distance from the outer end32bto the underlying bone along the transverse direction T. For instance, the shaft can have a length that is equal to or less than the distance from the inner end32ato the outer end32balong the transverse direction T. It should be appreciated that the second link36can include any number of second apertures62as desired. The second apertures62ca be spaced from each other in any direction as desired. For instance, the second apertures can be spaced from each other along at least one or both of the longitudinal direction L and the lateral direction A. Thus, the second links36can be attached to the underlying bone at any one or more of a number of locations defined by the second apertures62. The first link34can also define at least one up to a plurality of respective second fixation apertures spaced from the respective first fixation aperture46of the first link, the second fixation aperture of the first link34extending therethrough from the outer surface to the inner surface. As described above with respect to the second apertures62, the second fixation apertures of the first link34can be spaced from each other along at least one or both of the longitudinal direction L and the lateral direction A, and can be configured to receive any suitable fixation member, such as a bone screw or a set screw.

A method for attaching the bone fixation linkage26to an underlying anatomical structure can include the step of placing the second link36against an underlying anatomical structure. The method can further include the step of bringing the first link34over the second link36so as to mate at least one of the first ribs38with at least one of second ribs40while the first link34is at one of a plurality of orientations relative to the second link36, wherein at last one of the first ribs is configured to mate with at least one of the second ribs at each of the plurality of orientations. The orientations can be in-plane orientations. The method can further include the step of, inserting a bone fixation member through at least one of the first and second links34and36so as to attach the linkage to bone. The inserting step can be performed after the bringing step. The placing step can be performed before or after the bringing step. The method can further include the step of reducing at least first and second bone fragments, wherein the inserting step comprises attaching the linkage to each of the first and second bone fragments. The inserting step can include inserting the bone fixation member through at least one of the first and second links so as to attach the linkage to a first bone fragment of the bone. The method can further include the step of reducing a gap between the first bone fragment and a second bone fragment of the bone after the inserting step. After the reducing step, the method can include the step of inserting the bone fixation member through at least one of the first and second links so as to attach the linkage to the second bone fragment. The method can include the step of articulating the first and second links relative to each other so as to bring the first and second bone fragments toward each other. The articulating step can be performed before the ribs of the first and second links are mated with each other. Alternatively, mated ribs can be unmated to articulate the links relative to each other.

In-plane attachment ends of the first and second links34and36configured to lock to each other have been described above with respect toFIGS. 2-4C. Referring now toFIGS. 2 and 5-7B, at least one of the first links34can define a first out-of-plane attachment end63, and at least one of the second links36can define a second out-of-plane attachment end65that are configured to lock to each other. The first out-of-plane attachment end63of the first link34can each include a plurality of first locking ribs64. The second out-of-plane attachment end65of the second link36can each include a plurality of second locking ribs66. At least one, such as a plurality of up to all, of the first and second locking ribs64and66are configured to mate with each other so as to lock the respective first and second links34and36to each other at a plurality of out-of-plane angulated relative positions between the first and second links34and36. It should be appreciated that one of the first and second out-of-plane attachment ends63and65can include one locking rib, while the other of the first and second out-of-plane attachment ends63and65can have a plurality of ribs configured to receive the rib of the one of the first and second out-of-plane attachment ends63and65therebetween, so as to fix the in-plane position of the corresponding links. Thus, one of the first and second out-of-plane attachment ends63and65can include at least one rib, and the other of the first and second out-of-plane attachment ends63and65can include a plurality of ribs. In one example, both the first and second out-of-plane attachment ends63and65can include respective pluralities of ribs. The first ribs64can extend out to respective distal tips that can be elongate along respective straight lines. The straight lines can be oriented parallel to each other. For instance, the distal tips can be elongate substantially along the lateral direction A. It should be appreciated, of course, that the distal tips can be alternatively shaped as desired. The second ribs66can extend out to respective distal tips that elongate along respective straight lines. The straight lines can be oriented parallel to each other. For instance, the distal tips of the second ribs66can be elongate substantially along the lateral direction A. It should be appreciated, of course, that the distal tips can be alternatively shaped as desired.

The first and second locking ribs64and66can be referred to as first and second out-of-plane locking ribs. Thus, at least one first locking rib64of the first out-of-plane attachment end63can mate with at least one second locking rib66of the second out-of-plane attachment end65when the first and second links34and36are in a first out-of-plane position relative to each other. Further, the at least one first locking rib64can mate with the at least one second locking rib66when the first and second links34and36are in a second out-of-plane position relative to each other that is different than the first out-of-plane position. It should be appreciated that the first and second links34and36are at the same in-plane position when the ribs64and66mate with each other in each of the first and second out-of-plane relative positions. One or both of the inner and outer surfaces of the first links34are out-of-plane with the respective one or both of the inner outer surfaces of the second links36when the first and second locking ribs64and66in at least one of the first and second out-of-plane positions relative to each other.

As will be appreciated from the description below, the at least one of the first locking ribs64is configured to mate with at least one of the second locking ribs66so as to lock the first link34to the adjacent second link36without expansion of either of the first and second links34and36relative to the other of the first and second links34and36. For instance, it can be said that the second out-of-plane attachment end65of the second link36is unexpandable inside the first in-plane attachment end63of the first link341) from a first position whereby the first ribs64are spaced from each other along a first path and the second ribs66are spaced from each other along a second path that is different than the first path such that the at least one of the first ribs is configured not to mate with the at least one second rib66, 2) to a second expanded position whereby the first and second paths are substantially complementary to each other such that the at least one first rib64mates with the at least one second rib66. Accordingly, though in accordance with this example, the first at least one locking rib64in fact mates with the at least one second locking rib66upon insertion of a fixation member50through respective apertures82and62of the first and second links34and36, the first and second locking ribs64and66are nevertheless positioned such the at least one of the first locking ribs64is configured to mate with at least one of the second locking ribs66so as to positionally lock the first link34to the adjacent second link36prior to insertion of the fixation member50into or through either of the apertures82and62. Thus, the at least one of the first and second locking ribs64and66are sized to mate with each other both when 1) the first and second locking ribs64and66are offset from each other along a direction perpendicular to the transverse direction T, and 2) the second out-of-plane attachment end65is configured to be received in the first out-of-plane attachment end63.

When the at least one first rib64is mated with the at least one second rib66, the first ribs64are spaced from each other along a plane and the second ribs66are spaced from each other along the plane, and the ribs64and66interfere with each other so as to prevent the first and second link34and36from rotating with respect to each other about an axis of rotation that is normal to the plane. For instance, the plane can include the transverse direction T. Thus, the plane can be substantially orthogonal to the inner end of the first and second links34and36. Thus, the out-of-plane angulation can be along a plane that is partially defined by the transverse direction T. The plane can be further defined by the longitudinal direction L defined as the direction of elongation of the first link34, or at least a portion of the first link34that includes the out-of-plane attachment end. The axis of rotation for out-of-plane angulation can be oriented along a direction perpendicular to the transverse direction T. For instance, the axis of rotation for out-of-plane angulation can be oriented along the lateral direction A.

The first ribs64can be arranged in at least one group of first ribs64that are spaced from each other along an arcuate path. Similarly, the second ribs66can be arranged in at least one group of second ribs that are spaced from each other along a complementary arcuate path. One of the arcuate paths can be concave, while the other of the arcuate paths can be convex. For instance, the arcuate paths can be a substantially cylindrical path. In one example, all of the first ribs64are aligned with each other along the respective substantially cylindrical path. Similarly, all of the second ribs66can be aligned with each other along the respective substantially cylindrical path. In the illustrated example, the arcuate path defined by the first ribs64can be concave, and the arcuate path defined by the second ribs66can be convex. The substantially cylindrical paths can be defined by a cylinder having a central axis oriented along a direction angularly offset with respect to the transverse direction T. For instance, the direction can be oriented substantially along the lateral direction A.

The first out-of-plane attachment end63of the first link34can define a receptacle68and the second out-of-plane attachment end65of the second link36can define a plug70that is configured to be received by the receptacle68. Thus, the plug70can extend in the receptacle68along a respective central axis that is oriented along the lateral direction A. In particular, the plug70of the second link36is configured to be received in the receptacle68of the first link34both when the first and second ribs64and66are mated with each other, and when the first and second ribs64and66are spaced from each other. For example, when the plug70is disposed in the receptacle68, the first ribs64can be slidable with respect to the second ribs66between an unlocked position whereby the first and second ribs64and66are spaced from each other, and a locked position whereby at least one of the first ribs64is mated with at least one of the second ribs66. The second link36can define a main portion45and an arm72that extends out from the main portion45and is monolithic with the main portion45. The arm72can define a neck74and the plug70that extends from the neck74. The plug70, and thus the arm72, can carry the second ribs66. The outer surface of the neck74can be recessed with respect to the outer surface of the main portion45.

The receptacle68of the first link34can include an opening76that extends into the first link34along the longitudinal direction L, and has a width along the lateral direction A that is sized to receive the neck74of the second link36. When the outer surface of the neck74abuts the inner surface of the first link34in the receptacle68, the outer surface of the main portion45can be substantially flush with the outer surface of the first link34. Thus, the out-of-plane angulation in the outward direction can be limited to where the outer surface of the main portion45is substantially flush with the outer surface of the first link34.

The first link34receives the second link36when the first and second ribs38and40are mated to each other. During operation, the first and second links36can be oriented as desired relative to each other out-of-plane, and the ribs64and66can be aligned with each other along the transverse direction T. For instance, the second link36can be brought into proximity, for instance against, the anatomical structure, and the first link34can subsequently be brought down onto the second link36in the inward direction such that the plug70is received in the receptacle68when the links34and36are in the desired second out-of-plane relative orientation. The first ribs64can be moved relative to the second ribs66to the locked position whereby at least one of the first ribs64mates with at least one of the second ribs66. At least one bone fixation member28can attach one or both of the first and second links34and36to the underlying anatomical structure.

In one example, the first out-of-plane attachment end63of the first link34includes a latch78that is movable between a locked position whereby the first and second locking ribs64and66are mated with each other, and an unlocked position whereby the first and locking ribs64and66are spaced from each other. The latch78can be disposed in the receptacle68. In particular, the first link34includes a first link body80that carries the latch78. The latch78can carry the first ribs64. The latch78is slidable with respect to the first link body80between the locked position and the unlocked position. For instance, the latch78can be slidable along the longitudinal direction with respect to the first link body80between the locked position and the unlocked position. The longitudinal direction L can be defined by a direction of elongation of the first link34, or at least a portion of the first link34that defines the first out-of-plane attachment end63. Further, in certain examples, the first link34can define a pair of apertures that extend from the first end32ato the second end32band are spaced from each other along the longitudinal direction L. The first link body80can define the outer surface of the first link34, and the latch78can be nested in the inner end of the first link34. In one example, the inner end of the latch78does not protrude beyond the inner end of the first link body80. The first and second links34and66can angulate out-of-plane with respect to each other at the respective first and second out-of-plane attachment ends63and65when the first ribs64are in the unlocked position. Thus, it can be said that the first and second links34and66can angulate out-of-plane with respect to each other at the respective first and second out-of-plane attachment ends63and65when the latch78is in the unlocked position.

The first out-of-plane attachment end63of the first link34can define a fixation aperture82that extends at least into the first link body80along a first aperture axis. The fixation aperture82can extend through the first link body80from the inner surface to the outer surface. The first aperture axis of the aperture82can be oriented along the transverse direction T. Further, the first fixation aperture82can be open to the latch78along a direction that is perpendicular to the aperture axis. For instance, the aperture82can be open to the latch78along the longitudinal direction L.

As described above, the first ribs64can include at least one group of first ribs64that are spaced from each other along a respective arcuate path, and the second ribs66can include at least one group of second ribs66that are spaced from each other along a respective complementary arcuate path. The arcuate path defined by the at least one group first ribs64can be defined by a plane that includes the transverse direction T. In one example, all of the first ribs64of each group of first ribs are spaced from each other along the respective plane that includes the transverse direction T, and aligned with each other along the plane that includes the transverse direction T. In another example, all of the first ribs64of each group of first ribs can be spaced from each other and aligned with each other along a respective plane that is substantially parallel to the central axis of the fixation aperture82of the first link34. The plane can further include the central axis of the fixation aperture82of the first link34. The plane of the arcuate path of the first ribs64can also include the longitudinal direction L. The at least one group of first ribs64can include one group or a plurality of groups that are spaced from each other in any direction as desired. For instance, the groups of first ribs64can be spaced from each other along one or both of the lateral direction A and the transverse direction T.

Similarly, the second ribs66of each group of second ribs66can be spaced from each other along a respective arcuate path. The respective arcuate path can be defined by a plane that includes the transverse direction T. In one example, all of the second ribs66of each group of second ribs66are spaced from each other along the plane that includes the transverse direction T, and aligned with each other along the plane that includes the transverse direction T. In another example, all of the second ribs66of each group of second ribs66can be spaced from each other and aligned with each other along a plane that is oriented parallel to the central axis of the fixation aperture82. The plane of the arcuate path of the second ribs66can also include the longitudinal direction L. The at least one group of second ribs64can include one group or a plurality of groups that are spaced from each other, for instance along the lateral direction A.

The first out-of-plane attachment end63can be configured to receive a fixation member50in the fixation aperture82. The shaft54of the fixation member50is configured to urge the latch78to move from the unlocked position to the locked position. In particular, when the shaft of the fixation member50is inserted into the fixation aperture82and moved to a position in alignment with the latch78along a direction perpendicular to the transverse direction T, the shaft54urges the latch78to move from the unlocked position to the locked position. Further, the shaft54can interfere with the latch78so as to prevent the latch78from moving from the locked position to the unlocked position. When the shaft54is removed from the fixation aperture82, the latch78can be moved from the locked position to the unlocked position. When the fixation member50is inserted in the fixation aperture82, the shaft54can terminate without extending into the underlying anatomical structure. Alternatively, the fixation member50can be configured as a bone fixation member28whereby the shaft54has a length sufficient to extend into the underlying anatomical structure. The fixation aperture82can be threaded, and the fixation member50can similarly be threaded so as to threadedly purchase with the first link34in the fixation aperture82. For instance, the head52of the fixation member50can be threaded.

A method for attaching the bone fixation linkage26to an underlying anatomical structure can include the step of placing the second link36against an underlying anatomical structure. The method can further include the step of bringing the first link34over the second link36so as to mate at least one of the first ribs38with at least one of second ribs40while the first link34is at one of a plurality of orientations relative to the second link36, wherein at last one of the first ribs is configured to mate with at least one of the second ribs at each of the plurality of orientations. The orientations can be out-of-plane orientations. The method can further include the step of inserting a bone fixation member through at least one of the first and second links34and36so as to attach the linkage to bone. The inserting step can be performed after the bringing step. The placing step can be performed before or after the bringing step. The method can further include the step of reducing at least first and second bone fragments, wherein the inserting step comprises attaching the linkage to each of the first and second bone fragments. The inserting step can include inserting the bone fixation member through at least one of the first and second links so as to attach the linkage to a first bone fragment of the bone. The method can further include the step of reducing a gap between the first bone fragment and a second bone fragment of the bone after the inserting step. After the reducing step, the method can include the step of inserting the bone fixation member through at least one of the first and second links so as to attach the linkage to the second bone fragment. The method can include the step of articulating the first and second links relative to each other so as to bring the first and second bone fragments toward each other. The articulating step can be performed before the ribs of the first and second links are mated with each other. Alternatively, mated ribs can be unmated to articulate the links relative to each other.

Referring now toFIGS. 3 and 9B, the first links34can each define a first end35aand a second end35bopposite the first end35aalong a central axis of elongation CA of the first link. At least one or both of the first and second ends35aand35bof at least one or more of the first links34up to all of the first links34can include at least one of the in-plane attachment end37and at least one of the out-of-plane attachment end63as described above. For instance, as illustrated inFIG. 9B, each of the first and second ends35aand35bof at least one or more of the first links34up to all of the first links34can include the in-plane attachment end37. Alternatively, as illustrated inFIG. 3, one of the first and second ends35aand35bcan include the in-plane attachment end37, and the other of the first end second ends35aand35bof at least one or more of the first links34up to all of the first links34can include the out-of-plane attachment end63. Thus, it can be said that at least one or both of the first and second ends35aand35bof at least one or more of the first links34up to all of the first links34can include at least one of the in-plane attachment end37. Alternatively still, if desired, each of the first and second ends35aand35bof at least one or more of the first links34up to all of the first links34can include the out-of-plane attachment end63. Thus, it can be said that at least one or both of the first and second ends35aand35bof at least one or more of the first links34up to all of the first links34can include the out-of-plane attachment end63.

Similarly, referring now toFIGS. 3, 5, 8, and 9A, the second links36can each define a first end41aand a second end41bopposite the first end35aalong a central axis of elongation CA2of the second link. The central axis CA2can extend through each of the first and second ends41aand41b. For instance, the central axis CA2can extend centrally through each of the first and second ends41aand41bwith respect to the lateral direction A. In one embodiment the second links36can include at least one terminal end link, such as a pair of terminal links at opposed ends of the linkage26. It should be appreciated that the bone fixation linkage26can terminate at a pair of outermost terminal links. One or both of the terminal links of the bone fixation linkage26can be defined by the second link36. Alternatively or additionally, one or both of the terminal links of the bone fixation linkage26can be defined by the first link34.

One of the first and second ends41aand41bof each terminal links can include the main body portion45, and the other of the first and second ends41aand41bcan include one of the in-plane attachment end39and the out-of-plane attachment end65. For instance, one of the first and second ends41aand41bcan define the main body portion45, and the other of the first and second ends41aand41bcan define the in-plane attachment end39as illustrated inFIG. 3. Alternatively, one of the first and second ends41aand41bcan define the main body portion45, and the other of the first and second ends41aand41bcan define the out-of-plane attachment end65as illustrated inFIG. 5. Alternatively still, as illustrated inFIGS. 8 and 9A, at least one or both of the first and second ends41aand41bof at least one or more of the second links36up to all of the second links36can include at least one of the in-plane attachment end39and at least one of the out-of-plane attachment end65as described above. For instance, as shown inFIG. 8, one of the first and second ends41aand41bcan include the in-plane attachment end39, and the other of the first and second ends41aand41bcan include the out-of-plane attachment end65. Alternatively, as illustrated inFIG. 9A, the first end41acan include the in-plane attachment end39, and the second end41bcan include the in-plane attachment end39. Alternatively still, each of the first and second ends41aand41bcan include the out-of-plane attachment end65as desired.

It is further appreciated that the first and second links34and36can define any suitable geometry as desired. For instance, as illustrated inFIG. 3, the central axis CA of at least one or more up to all of the first links34can define a straight line from the first end35ato the second end35b. The straight line can be oriented along the longitudinal direction L. The central axis CA can extend each of the first and second ends35aand35b. For instance, the central axis CA can extend centrally through each of the first and second ends35aand35bwith respect to the lateral direction A. In another example illustrated inFIG. 1, the central axis CA of at least one of the first links34′ can define a first portion and a second portion that is angularly offset in-plane with respect to the first portion. Thus, the first link34′ can define a first portion and a second portion elongated along directions angularly offset in-plane relative to each other. In one example, the central axis CA can define an in-plane elbow at an interface of the first and second portions of the central axis CA. At least one or both of first and second portions of the central axis CA can be linear. Alternatively or additionally, at least one or both of first and second portions of the central axis CA can be nonlinear or curved.

Alternatively, referring toFIG. 10, the central axis CA of at least one of the first links34can define a first portion and a second portion that is angularly offset with respect to the first portion out-of-plane. Thus, the first link34can define a first portion and a second portion elongated along directions angularly offset out-of-plane with respect to each other. In one example, the central axis CA can define an out-of-plane elbow at an interface of the first and second portions of the central axis CA. At least one or both of first and second portions of the central axis CA can be linear. Alternatively or additionally, at least one or both of first and second portions of the central axis CA can be nonlinear curved. Alternatively still, the central axis CA of at least one of the links34can define a first portion and a second portion that is angularly offset with respect to the first portion both out-of-plane and in-plane. Thus, the first link34can define a first portion and a second portion elongated along directions angularly offset both in-plane and out-of-plane with respect to each other. Accordingly, the elbow can be both an in-plane elbow and an out-of-plane elbow.

It should be appreciated that the bone fixation linkage26has been described above in accordance with one example, and that other examples of bone fixation linkage26are contemplated the offer the desired relative motion characteristic of the links. For instance, referring now toFIGS. 11-13C, the bone fixation linkage26includes a plurality of links130that are configured to be interconnected to each other. Each of the links130can define a first end135aand a second end135bopposite the first end135a. The first ends135acan each include a first out-of-plane attachment end163, and the second ends135bcan each include a second out-of-plane attachment end165. The first out-of-plane attachment ends163of each at least one or more up to all of the links130are configured to attach to the second out-of-plane attachment ends165of at least one or more up to all others of the links130. In particular, the first out-of-plane attachment ends163are configured to attach to the second-out-of-plane attachment ends165at one of a plurality of out-of-plane positions, and at a fixed in-plane position.

The first out-of-plane attachment end163can include a plurality of first locking ribs164. The second out-of-plane attachment end165can each include a plurality of second locking ribs166. At least one of the first locking ribs164is configured to mate with at least one of the second locking ribs166so as to lock respective first and second adjacent ones of the links130to each other at a plurality of out-of-plane angulated relative positions between the first and second ones of the links130. The first and second ones of the links130can be alternatingly arranged along the length of the bone fixation linkage. The first and second locking ribs164and166can be referred to as first and second out-of-plane locking ribs. Thus, at least one first locking rib164of the first out-of-plane attachment end163can mate with at least one second locking rib166of the second out-of-plane attachment end165when the first and second ones of the links130are in a first out-of-plane position relative to each other. Further, the at least one first locking rib164can mate with the at least one second locking rib166when the first and second ones of the links130are in a second out-of-plane position relative to each other that is different than the first out-of-plane position. It should be appreciated that the first and second ones of the links130are at the same in-plane position when the ribs164and166mate with each other in each of the first and second out-of-plane relative positions. One or both of the inner and outer surfaces of the first one of the links130can be out-of-plane with the respective adjacent second one of the links130when the first and second locking ribs164and166in at least one of the first and second out-of-plane positions relative to each other.

As will be appreciated from the description below, the at least one of the first locking ribs164is configured to mate with at least one of the second locking ribs166so as to lock the first one of the links130to the adjacent second one of the links130without expansion of either of the first and second ones of the links130relative to the other of the first and second ones of the links10. For instance, it can be said that the second out-of-plane attachment end165is unexpandable inside the first in-plane attachment end1631) from a first position whereby the first ribs164are spaced from each other along a first path and the second ribs166are spaced from each other along a second path that is different than the first path such that the at least one of the first ribs164is configured not to mate with the at least one second rib166, 2) to a second expanded position whereby the first and second paths are substantially complementary to each other such that the at least one first rib164is configured to mate with the at least one second rib166. Accordingly, the first and second locking ribs164and166are positioned such the at least one of the first locking ribs164is configured to mate with at least one of the second locking ribs166so as to positionally lock the first one of the links130to the adjacent second one of the links10prior to insertion of the fixation member50into or through either of the apertures182and184. Thus, the at least one of the first and second locking ribs164and166are sized to mate with each other both when 1) the first and second locking ribs164and166are offset from each other along a direction perpendicular to the transverse direction T, and 2) the second out-of-plane attachment end165is configured to be received in the first out-of-plane attachment end163.

When the at least one first rib164is mated with the at least one second rib166, the first ribs164are spaced from each other along a plane and the second ribs166are spaced from each other along the plane. The ribs164and166interfere with each other so as to prevent the first and second ones of the links130from rotating with respect to each other about an axis of rotation that is normal to the plane. For instance, the plane can include the transverse direction T. Thus, the plane can be substantially orthogonal to the inner end of the first and second ones of the links130. Thus, the out-of-plane angulation can be along a plane that is partially defined by the transverse direction T. The plane can be further defined by the longitudinal direction L defined as the direction of elongation of the first one of the links130, or at least a portion of the first one of the links130that includes the out-of-plane attachment end. The axis of rotation for out-of-plane angulation can be oriented along a direction perpendicular to the transverse direction T. For instance, the axis of rotation for out-of-plane angulation can be oriented along the lateral direction A.

The first ones of the ribs164can be spaced from each other along an arcuate path. Similarly, the second ones of the ribs166can be spaced from each other along a complementary arcuate path. One of the arcuate paths can be concave, while the other of the arcuate paths can be convex. The concave arcuate path can be concave with respect to the inner end22a, while the convex arcuate path can be convex with respect to the outer end22b. For instance, the arcuate paths can be a substantially cylindrical path. In one example, all of the first ribs164are aligned with each other along the respective substantially cylindrical path. Similarly, all of the second ribs166can be aligned with each other along the respective substantially cylindrical path. The substantially cylindrical paths can be defined by a cylinder having a central axis oriented along a direction angularly offset with respect to the transverse direction T. For instance, the direction can be oriented substantially along the lateral direction A. In the illustrated example, the arcuate path defined by the first ribs164can be concave, and the arcuate path defined by the second ribs166can be convex. Thus, the first out-of-plane attachment ends163can define plugs170, and the second out-of-plane attachment ends165can define receptacles168sized and shaped to receive the plugs170of the first out-of-plane attachment ends163. The plugs170can carry the first ribs164, and the receptacles168can carry the second ribs166.

In particular, the first ribs164can project out from the plugs170to respective distal tips. The first ribs164can extend outwardly. The distal tips of the first ribs164can be elongate along respective straight lines. The straight lines can be oriented parallel to each other. For instance, the distal tips of the first ribs164can be elongate substantially along the lateral direction A. It should be appreciated, of course, that the distal tips can be alternatively shaped as desired. The second ribs166can project out from at least one inner surface that defines the receptacle168. Thus, the second ribs166can project inwardly. In particular, the second ribs166can project inwardly to respective distal tips. The distal tips of the second ribs166can be elongate along respective straight lines. The straight lines can be oriented parallel to each other. For instance, the distal tips of the second ribs166can be elongate substantially along the lateral direction A. It should be appreciated, of course, that the distal tips can be alternatively shaped as desired.

With continuing reference toFIGS. 11-13B, the outer surface of the first out-of-plane attachment end163can be recessed with respect to the outer end of the second out-of-plane attachment end in the inward direction. Accordingly, the linkage can maintain a low profile when the at least one inner surface of the second one of the links130that defines the receptacle168rests on the plug170of the first one of the links130so as to cause the respective at least one of the ribs164and166to mate with each other. In one example, the first and second ones of the plurality of links130can be identical to each other. Alternatively or additionally, as will be described in more detail below, at least one of the links130can geometrically differ from at least one other of the links130.

The links130can define a link body180, and the first out-of-plane attachment end163can define a first fixation aperture182that extends at least into the first link body80along a first aperture axis. The first aperture axis can be oriented along the transverse direction T. In one example, the he fixation aperture182can extend through the first link body80from the inner surface to the outer surface. The links130can further define a second fixation aperture184that extends through the second out-of-plane attachment end163from the outer surface to the inner surface. The first fixation aperture182of the first one of the links130is configured to align with the second fixation aperture184of the second one of the links130when the ribs164and166are mated with each other.

As described above, the first ribs164can be spaced from each other along a respective arcuate path, and the second ribs166can be spaced from each other along a respective complementary arcuate path. The arcuate path defined by the first ribs164can be defined by a plane that includes the transverse direction T. In one example, the first ribs164can include at least one group of first ribs164that are spaced from each other along a respective plane that includes the transverse direction T, and aligned with each other along the plane that includes the transverse direction T. In another example, all of the first ribs164of each group of first ribs164can be spaced from each other and aligned with each other along a respective plane that is parallel to the central axis of the fixation aperture82of the first link34. The plane of the arcuate path of the first ribs164can also include the longitudinal direction L. Similarly, the second ribs166of each group of second ribs166can be spaced from each other along a respective arcuate path. The respective arcuate path can be defined by a plane that includes the transverse direction T. In one example, all of the second ribs166of each group of second ribs166are spaced from each other along the respective plane that includes the transverse direction T, and aligned with each other along the plane that includes the transverse direction T. In another example, all of the second ribs166of the group of second ribs166can be spaced from each other and aligned with each other along a plane that is oriented parallel to the central axis of the second fixation aperture184. The plane of the arcuate path of the second ribs66can also include the longitudinal direction L.

The first fixation aperture182can be is encircled by the link body180at the first out-of-plane attachment end163along a plane that passes through the first fixation aperture182and is normal to the central axis of the first fixation aperture182. For instance, the first fixation aperture182can have a circular cross-section. It should be appreciated, of course, that the first fixation aperture182can define any suitably shaped cross-section as desired. In one example, the first ribs164can be arranged in first and second groups of first ribs164that are disposed on opposite sides of the first fixation aperture182. For instance, the first and second groups of first ribs164can be disposed on opposite sides of the receptacle42along the lateral direction A. The ribs164of the first group of first ribs164can be aligned with respective ones of the ribs164of the second group of first ribs164.

The second fixation aperture184can be open to an external perimeter of the second one of the links130along a plane that passes through the second fixation aperture184and is oriented substantially normal to the central axis of the second aperture184. For instance, the second fixation aperture can be open to the external perimeter of the second one of the links130along the longitudinal direction L. Thus, the second out-of-plane attachment end165can be forked. In particular, the second out-of-plane attachment end165can define first and second tines167that project out from the link body180along the longitudinal direction L and are spaced from each other along the lateral direction A. The second fixation aperture184can be defined between the tines167. Alternatively, the second fixation aperture184can be enclosed by the link body180along the plane that passes through the second fixation aperture184and is oriented substantially normal to the central axis of the second aperture184. In particular, the second fixation aperture184can be oval shaped having its major axis oriented along the longitudinal direction L. Accordingly, the second out-of-plane attachment end165can have clearance with respect to a received fixation member as the second one of the links130is disposed at one of a range of different out-of-plane positions relative to the first one of the links130.

The first and second ones of the links134136are configured to receive a fixation member50that extends through the second fixation aperture184and at least into the first fixation aperture182in the inward direction. In particular, the fixation member50can be configured to secure the first and second links together, for instance at the first out-of-plane attachment end163and the second out-of-plane attachment end165, respectively, such that the at least one of the first ribs164is mated with the at least one of the second ribs166. In one example, the head52can bear against the outer surface of the second one of the links130. In particular, the head52can bear against the tines167, and the shaft54can purchase in the underlying anatomical structure, thereby capturing the second one of the links130between the head52and the first one of the links130, and capturing the first one of the links130between the underlying anatomical structure and the second one of the links130. Alternatively, the first fixation aperture182can be threaded. The fixation member50can also be threaded and configured to purchase with the first one of the links130in the first fixation aperture182. Accordingly, the second one of the links130can be captured between the head52and the first one of the links130. In one example, the fixation member can have a threaded neck60disposed between the head52and the shaft54. The threaded neck60can be configured to threadedly mate with the first one of the links130in the first fixation aperture182. Alternatively or additionally, the shaft54can be threaded, and can have a length sufficient to purchase in the underlying anatomical structure. Thus, the fixation member50can be configured to secure the first and second ones of the links130to each other, and can be further configured as a bone fixation member28.

A method for fixing the bone fixation system including the linkage20having the links130to an underlying anatomical structure is also contemplated. The method can include the step of mating the at least one of the second ribs166with the at least one of the first ribs164, and driving the fixation member50through each of the first and second ones of the links130so as to secure the at least one second rib166to the at least one first rib164. For instance, the driving step can include threadly mating the fixation member50to the first one of the links130. The method can include the step of placing the first one of the links130against an anatomical structure before the mating step. The mating step can include the step of placing the second one of the links against the anatomical structure after the first one of the links130has been placed against the anatomical structure. The method can include the step of placing the first one of the links130against the anatomical structure after the mating step. The step of placing the first one of the links130against the anatomical structure can include the step of placing the second one of the links130against the anatomical structure. The method can include the step of attaching first and second ones of the links130to respective first and second bone fragments. The method can further include the step of reducing a gap between the first and second bone fragments before or after the attaching step. The reducing step can include the step of changing a relative orientation of the first and second links, and mating the first and second ribs. For instance, the mated ribs can be unmated prior to changing the relative orientation of respective ones of the links of the linkage.

As described above, each of the links130can define a first end135aand a second end135bopposite the first end135aalong a central axis of elongation CA of the first link. As described above, the first end135acan include the first out-of-plane attachment member163, and the second end135bcan include the second out-of-plane attachment member. Alternatively, both the first and second ends135aand135bat least a first one of the links130including a first plurality of the links130can include the first out-of-plane attachment end163. Conversely, both the first and second ends135aand135bat least a second one of the links130including a second plurality of the links130can include the second out-of-plane attachment end165. The first out-of-plane attachment ends163of the at least first one of the links130can attach to the second out-of-plane attachment ends165of an adjacent second one of the links130. Further, one or both of the first and second ones of the links130can define at least one link having a terminal end that is not configured to attach to an adjacent one of the links130. The links130having the terminal end can define opposed terminal ends of the bone fixation linkage.

Further, as shown inFIG. 12, the first and second ends135aand135bof at least one of the links130up to all of the links can be opposite each other along the longitudinal direction L. Thus, the links130can be elongate along a central axis CA3that is oriented along the longitudinal direction L and extends through each of the first and second ends135aand135b. For instance, the central axis CA3can extend centrally through each of the first and second ends135aand135bwith respect to the lateral direction A. The central axis CA3can extend along a straight linear path from the first end135ato the second end135b. In another example, as illustrated inFIG. 14A, the central axis CA3of at least one of the links130can define a first portion and a second portion that is angularly offset in-plane with respect to the first portion. Thus, the at least one of the links130can define a first portion and a second portion elongated along directions angularly offset in-plane relative to each other. In one example, the central axis CA3can define an in-plane elbow at an interface of the first and second portions of the central axis CA3. At least one or both of first and second portions of the central axis CA3can be linear. Alternatively or additionally, at least one or both of first and second portions of the central axis CA can be nonlinear or curved. It should be appreciated, of course, that the at least one of the links130can define any suitable pre-formed shape as desired between the first and second ends135aand135b.

Alternatively, referring toFIG. 14B, the central axis CA3of at least one of the links34can define a first portion and a second portion that is angularly offset with respect to the first portion out-of-plane. Thus, at least one of the links130can define a first portion and a second portion elongated along directions angularly offset out-of-plane with respect to each other. In one example, the central axis CA3can define an out-of-plane elbow at an interface of the first and second portions of the central axis CA3. At least one or both of first and second portions of the central axis CA3can be linear. Alternatively or additionally, at least one or both of first and second portions of the central axis CA3can be nonlinear. Alternatively still, the central axis CA3of at least one of the links130can define a first portion and a second portion that is angularly offset with respect to the first portion both out-of-plane and in-plane. Thus, the at least one of the links130can define a first portion and a second portion elongated along directions angularly offset both in-plane and out-of-plane with respect to each other. Accordingly, the elbow can be both an in-plane elbow and an out-of-plane elbow.

Referring now toFIG. 14C, while the links130have been described as including first and second ends135aand135b, at least one of the links130can further include a third end135c. Thus, the links130can be substantially “Y” shaped. Any one or more of the first, second, and third ends135a,135b, and135ccan include the first out-of-plane attachment end163. Alternatively or additionally, any one or more of the of the first, second, and third ends135a,135b, and135ccan include the second out-of-plane attachment end165. Thus, each of the first, second, and third ends135a,135b, and135ccan be configured to attach to another one of the links130.

The embodiments described in connection with the illustrated embodiments have been presented by way of illustration, and the present invention is therefore not intended to be limited to the disclosed embodiments. Accordingly, those skilled in the art will realize that the invention is intended to encompass all modifications and alternative arrangements included within the spirit and scope of the invention, as set forth by the appended claims.