Suprapectineal quadrilateral bone plating system and methods of making and using same

The presently disclosed and claimed inventive concept(s) relates generally to the field of bone plates for the reduction and fixation of bone fractures. In particular, the presently disclosed and claimed inventive concept(s) relates to a quadrilateral surface bone plate for the fixation of acetabular fractures having at least one securing port therein and methods of making and using same.

CROSS REFERENCE TO RELATED APPLICATIONS/INCORPORATION BY REFERENCE STATEMENT

Not Applicable.

Not Applicable.

BACKGROUND

1. Field of Invention

The presently disclosed and claimed inventive concept(s) relates generally to the field of bone plates for the reduction and fixation of bone fractures. In particular, the presently disclosed and claimed inventive concept(s) relates to a suprapectineal and quadrilateral surface bone plating system for the fixation of acetabular fractures having at least one securing port therein and methods of making and using same.

2. Description of Background Technology

A pelvis consists of an ilium, an ischium, and a pubis. A big and deep fossa located in the outer lateral side of the pelvis is called the acetabulum, and both the acetabulum and a caput femoris together make up a hip joint. The acetabulum and adjacent structures can be divided into two parts, namely, the anterior column and the posterior column. The anterior column consists of the anterior part of the ilium and the superior part of the pubis, which starts from the anterior superior iliac spine, and goes through a rami ossis pubis, and ends at the symphysis ossium pubis. The posterior column is generally thick and includes the vertical part of the ischium and the posterior part of the ilium connected with the ischium starting from the greater sciatic notch, through the center of the acetabulum, ending at the sciatic tuberosity.

The anterior column and the posterior column together form an upside-down “Y” shape (thereby “holding” the acetabulum), and their inner lateral sides meet at a quadrilateral area, thereby preventing the hip joint from moving inward. The iliac tuberosity at the outer side of the ilium narrows to a columnar area, where the acetabular dome is located and the bone mass thereafter thickens, generally. The anterior and posterior column meet at an angle-generally measured at or about 60 degrees—and form the shape of an arc (i.e., the acetabular dome) which is a weight-bearing area, supporting the articular surface of the hip joint.

Acetabulum fractures are mainly caused by high energy trauma. Currently, the commonly used fracture classification is Letournel-Judet, which divides the acetabulum fractures into 5 simple types and 5 complicated types with surgical treatment requiring anatomical reduction and rigid internal fixation in order to ensure successful restoration of function. Reduction and fixation of acetabulum fractures repair the concentric circles between the acetabulum and the hip joint, thereby allowing free and unimpaired movement of the hip and femur.

The fixation of acetabular fractures involving the quadrilateral area on the inner lateral sides of the acetabulum is complicated by the anatomical structures in line with known and currently used surgical approaches to the quadrilateral area. Such complications are mainly due to: (1) plate screws invading into the joint or vessels, nerves and organs around and within the pelvis, (2) incongruity between the surface of the plates and bones such that the fractures are not reduced resulting in the potential for uneven shear force and sliding displacement between the plate and bone, (3) failure of plates due to repeated bending thereby causing focal points of internal stress causing the plates to break, (4) mismatching of the contours of the plates and bone surfaces that cause the fracture site to loosen, displace, and the resulting nonunion or malunion of the fractured bone, and (5) as the quadrilateral area of the acetabulum is adjacent to important anatomical structures (e.g., internal and external iliac arteries and veins, femoral arteries and veins, obturator nerves, obturator arteries and veins) as well as important organs (e.g., intestinal canals, uterus, and bladder), the likelihood of unintended injury during surgical repair is heightened.

In order to overcome some of these known challenges, those working in the field have developed bone plating systems for placement in the quadrilateral area. For example, U.S. Pat. No. 8,603,091. Additionally, others working in the field have developed bone plating systems comprising at least two plate structures attached to one another to form a “T” shape wherein a primarily horizontal portion conforms to the boney anatomical structure of the pelvic brim while a vertical portion extends from the horizontal portion into the quadrilateral area. See, for example, U.S. Patent Application Publication No. 2017/0181784. The horizontal and vertical portions have a plurality of holes for the placement of fixation screws that, when inserted through these holes and into the bone, bring the horizontal and vertical portions tight against the bone and, in some cases, reduce the fracture and position the broken bone fragments into alignment and in contact with one another. A disadvantage to these T shape plates is that the screw holes in the vertical portion are generally oriented 90 degrees to the surface of the vertical portion and allow limited variability of the angular approach of the bone screw to the surface of the bone. This limited angular variability is significant in the quadrilateral area as the insertion of a screw at an angle perpendicular to the surface of the vertical portion has a high rate of impingement of the acetabulum as well as other significant anatomical structures associated with the hip discussed hereinabove. Additionally, in order to insert a bone screw generally perpendicular to the quadrilateral surface and through such a vertical portion of a bone plate, the surgeon must work adroitly within the pelvis, avoiding injury to the important anatomical structures that lie within and about the pelvis and hip.

As such, it is known that the reduction and fixation of quadrilateral surface fractures are difficult and that current surgical systems, approaches, and methods can result in the impairment of the acetabulum. The center of the quadrilateral surface between the inner pelvis and the acetabulum is thin and must be buttressed in order to reduce the fracture and apply fixation-without misplacing a screw through this thin center portion and into significant anatomical structures within and surrounding the acetabulum. The known difficulties and disadvantages of existing quadrilateral fracture fixation systems are overcome by the presently disclosed and claimed inventive concept(s) relating generally to a suprapectineal and quadrilateral surface bone plating system for the fixation of acetabular fractures having at least one securing port therein and methods of making and using same.

DETAILED DESCRIPTION

Before explaining at least one embodiment of the presently disclosed and claimed inventive concept(s) (hereinafter referred to as “the present disclosure”) in detail by way of exemplary language and results, it is to be understood that the present disclosure is not limited in its application to the details of construction and the arrangement of the components set forth in the following description. The present disclosure is capable of other embodiments or of being practiced or carried out in various ways. As such, the language used herein is intended to be given the broadest possible scope and meaning; and the embodiments are meant to be exemplary—not exhaustive. Also, it is to be understood that the phraseology and terminology employed herein is for the purpose of description and should not be regarded as limiting.

Unless otherwise defined herein, scientific and technical terms used in connection with the present disclosure shall have the meanings that are commonly understood by those of ordinary skill in the art. Further, unless otherwise required by context, singular terms shall include pluralities and plural terms shall include the singular. The foregoing techniques and procedures are generally performed according to conventional methods well known in the art and as described in various general and more specific references that are cited and discussed throughout the present specification. The nomenclatures utilized in connection with, and the medical procedures and techniques of, surgery, anesthesia, wound healing, orthopedic surgery, and infectious control described herein are those well-known and commonly used in the art. Standard techniques are used for orthopedic fracture reduction, fixation, and resolution of orthopedic trauma to the body.

All of the articles, compositions, kits, and/or methods disclosed herein can be made and executed without undue experimentation in light of the present disclosure. While the articles, compositions, kits, and/or methods have been described in terms of particular embodiments, it will be apparent to those of skill in the art that variations may be applied to the articles, compositions, kits, and/or methods and in the steps or in the sequence of steps of the methods described herein without departing from the concept, spirit, and scope of the present disclosure. All such similar substitutes and modifications apparent to those skilled in the art are deemed to be within the spirit, scope, and concept of the present disclosure as defined by the appended claims.

The use of the term “a” or “an” when used in conjunction with the term “comprising” in the claims and/or the specification may mean “one,” but it is also consistent with the meaning of “one or more,” “at least one,” and “one or more than one.” As such, the terms “a,” “an,” and “the” include plural referents unless the context clearly indicates otherwise. Thus, for example, reference to “a compound” may refer to one or more compounds, two or more compounds, three or more compounds, four or more compounds, or greater numbers of compounds. The term “plurality” refers to “two or more.”

The use of the term “at least one” will be understood to include one as well as any quantity more than one, including but not limited to, 2, 3, 4, 5, 10, 15, 20, 30, 40, 50, 100, etc. The term “at least one” may extend up to 100 or 1000 or more, depending on the term to which it is attached; in addition, the quantities of 100/1000 are not to be considered limiting, as higher limits may also produce satisfactory results. In addition, the use of the term “at least one of X, Y, and Z” will be understood to include X alone, Y alone, and Z alone, as well as any combination of X, Y, and Z. The use of ordinal number terminology (i.e., “first,” “second,” “third,” “fourth,” etc.) is solely for the purpose of differentiating between two or more items and is not meant to imply any sequence or order of importance to one item over another or any order of addition, for example.

The use of the term “or” in the claims is used to mean an inclusive “and/or” unless explicitly indicated to refer to alternatives only or unless the alternatives are mutually exclusive. For example, a condition “A or B” is satisfied by any of the following: A is true (or present) and B is false (or not present), A is false (or not present) and B is true (or present), and both A and B are true (or present).

As used herein, any reference to “one embodiment,” “an embodiment,” “some embodiments,” “one example,” “for example,” or “an example” means that a particular element, feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. The appearance of the phrase “in some embodiments” or “one example” in various places in the specification is not necessarily all referring to the same embodiment, for example. Further, all references to one or more embodiments or examples are to be construed as non-limiting to the claims.

Throughout this application, the term “about” is used to indicate that a value includes the inherent variation of error for a composition/apparatus/device, the method being employed to determine the value, or the variation that exists among the study subjects. For example, but not by way of limitation, when the term “about” is utilized, the designated value may vary by plus or minus twenty percent, or fifteen percent, or twelve percent, or eleven percent, or ten percent, or nine percent, or eight percent, or seven percent, or six percent, or five percent, or four percent, or three percent, or two percent, or one percent from the specified value, as such variations are appropriate to perform the disclosed methods and as understood by persons having ordinary skill in the art.

As used herein, the term “substantially” means that the subsequently described event or circumstance completely occurs or that the subsequently described event or circumstance occurs to a great extent or degree. For example, when associated with a particular event or circumstance, the term “substantially” means that the subsequently described event or circumstance occurs at least 80% of the time, or at least 85% of the time, or at least 90% of the time, or at least 95% of the time. The term “substantially adjacent” may mean that two items are 100% adjacent to one another, or that the two items are within close proximity to one another but not 100% adjacent to one another, or that a portion of one of the two items is not 100% adjacent to the other item but is within close proximity to the other item.

As used herein, the phrases “associated with” and “coupled to” or “connected with/to” include both direct association/coupling of two items to one another as well as indirect association/coupling of items moieties to one another. Non-limiting examples of associations/couplings include connections in which the connected parts are fixed to each other by atomic or molecular forces. These are non-detachable connections which can only be separated by destruction of the connection. Preferably, the connections are formed monolithically. As such, a bone plating system comprising differing portions formed from a single stamped metal plate would exhibit such properties. With respect to associations/couplings they may also have plastic deformation characteristics with an elasticity that can be pre-defined by dimensioning the cross-sections of the associations/couplings.

As used herein, the term “patient” or “subject” is meant to include all organisms, whether alive or dead, including any species having soft tissues and bones. For example, a method according to the inventive concepts disclosed herein may be used to fix an acetabular fracture within a living human, horse, cow, sheep, cat, dog, and the like.

Certain non-limiting embodiments of the present disclosure are directed to a bone plating system for a patient. The bone plating system includes a first bone plate sized and shaped to conform to a first bone portion of the patient, a second bone plate sized and shaped to conform to a second bone portion of the patient, wherein the second bone plate includes at least one securing port for receiving a fastener at an angle less than about 90 degrees with respect to a surface of the second bone plate, and at least one connecting bridge member configured to attach the first bone plate to the second bone plate. It is contemplated that the first bone plate may be a suprapectineal plate with the second bone plate being a quadrilateral plate. In such an embodiment, the bone plating system may also contain at least one connecting bridge member connecting the suprapectineal plate to the quadrilateral plate. It is further contemplated that the suprapectineal plate may be sized and shaped to conform to a pelvic brim of the patient and the quadrilateral plate is sized and shaped to a quadrilateral surface of the patient.

In certain non-limiting embodiments, the first bone plate has a first edge, a second edge, a first end, and a second end with a width extending generally between the first edge and the second edge, and a length extending between the first end and the second end, with the length being greater than the width. The first end and second end of the first bone plate may be generally rounded having a convex shaped extending generally from a first bone engaging surface to a first tissue engaging surface of the first bone plate. The length of the first bone plate is generally linear. It is contemplated that the length of the first bone plate may have one or more curves or twists that conform the first bone plate to the anatomy of the patient.

In certain non-limiting embodiments, the first bone plate further includes a plurality of screw apertures. The plurality of screw apertures may further include a screw head support surface and a screw shaft clearance surface, with the screw head support surface defining a screw head receiving volume and the screw shaft clearance surface defining a screw shaft receiving volume. The first bone plate may also include a plurality of forming bridges adjacent and between the plurality of screw apertures and the plurality of forming bridges may be plastically deformable thereby providing the first bone plate with a secondary configuration. It is contemplated that the secondary configuration of the first bone plate matches an anatomy of the patient.

In certain non-limiting embodiments, the second bone plate may be generally trapezoid shaped and further includes a distal end, a proximal end, a first side, and a second side wherein the distal end and proximal are generally parallel to one another and the first side and the second side generally diverge from one another. It is contemplated that the second bone plate may include a plurality of secondary screw apertures. The plurality of secondary screw apertures may further include a screw head support surface and a screw shaft clearance surface, with the screw head support surface defining a screw head receiving volume and the screw shaft clearance surface defining a screw shaft receiving volume. It is contemplated that the second bone plate may include a plurality of internal struts defining a plurality of through-holes extending from a second bone engaging surface to a second tissue engaging surface of the second bone plate. It is further contemplated that the second bone plate may include at least one reduction engaging aperture for receiving a surgical instrument capable of applying a force to the second bone plate.

In certain non-limiting embodiments, the at least one securing port includes a bore extending from a second tissue engaging surface of the second bone plate to a second bone engaging surface of the second bone plate, the bore extending in a direction substantially oriented toward a distal end of the second bone plate and away from a proximal end of the second bone plate. The bore may further include a bore central axis extending through a center of the bore in a direction substantially oriented toward the distal end of the second bone plate and away from the proximal end of the second bone plate. The at least one securing port may further include a wall surrounding the bore, wherein the wall defines (i) a fastener support surface defining a head receiving volume adjacent the second tissue engaging surface, and (ii) a shaft clearance surface defining a generally frustoconical shaped shaft receiving volume, whereby the head receiving volume is generally spherically shaped and the shaft clearance surface is generally ellipse shaped. It is contemplated that the fastener support surface is adjacent and abuts the shaft clearance surface at a bore vertex extending generally the entire circumference of the bore.

In certain non-limiting embodiments, the at least one securing port may further include a fastener support axis generally adjacent the bore vertex, wherein the fastener support axis extends at a first angle that is less than or equal to 90 degrees relative to a bone engaging axis of the second bone plate. It is contemplated that the first angle may be from about 1 to about 15 degrees, from about 15 to about 35 degrees, from about 35 to about 60 degrees, from about 60 to about 75 degrees, and from about 75 to about 90 degrees.

Certain further non-limiting embodiments of the present disclosure are directed to a bone plating system for a patient having (a) a substantially rectangular shaped first bone plate sized and shaped to conform to a first bone portion of the patient, the first bone plate having a first bone engaging surface, a first tissue engaging surface, a first edge, and a second edge; (b) a substantially trapezoidal shaped second bone plate sized and shaped to conform to a second bone portion of the patient, the second bone plate having a second bone engaging surface, a second tissue engaging surface, a proximal end, a distal end, and an outer peripheral edge; and (c) at least one connecting bridge member having a first end and a second end, wherein the first end of the at least one connecting bridge member is connected to the second edge of the first bone plate and the second end of the at least one connecting bridge member is connected to the proximal end of the second bone plate.

In certain non-limiting embodiments, the proximal end of the second bone plate is spaced a first distance away from the second edge of the first bone plate, and the distal end of the second bone plate is spaced a second distance away from the second edge of the first bone plate, with the second distance being larger than the first distance. The second bone engaging surface of the second bone plate may have a bone engaging axis extending from the proximal end of the second bone plate to the distal end of the second bone plate, the bone engaging axis being a straight line fit to a series of data points representing the second bone engaging surface of the second bone plate. Further, the second bone plate may have at least one securing port for receiving a fastener, the at least one securing port having a bore extending from the second tissue engaging surface to the second bone engaging surface in a direction substantially oriented toward the outer peripheral edge and away from an interior portion of the second bone plate.

In certain non-limiting embodiments, the at least one securing port may have a wall surrounding the bore, the wall having a fastener support surface defining a head receiving volume of the bore adjacent to the second tissue engaging surface, and a shaft clearance surface defining a substantially frustoconical shaped shaft receiving volume of the bore adjacent to the second bone engaging surface. It is contemplated that the fastener support surface is adjacent to the shaft clearance surface such that the fastener support surface and the shaft clearance surface have a common vertex extending around at least a portion of the bore, the fastener support surface having a fastener support axis adjacent to the common vertex, the fastener support axis extending at an angle less than or equal to 90 degrees relative to the bone engaging axis. It is further contemplated, that when the first bone plate is positioned on the first bone portion, the second bone plate is positioned on the second bone portion, and a shaft of a fastener is disposed through the bore and into the second bone portion, a head of the fastener engages the fastener support surface and applies a first force vector to the second bone plate thereby drawing the second bone engaging surface against the second bone portion of the patient's bone. It is also contemplated that the bone plating system includes at least one secondary surgery instrument for implanting the bone plating system in the patient in another non-limiting embodiment.

Certain non-limiting embodiments of the present disclosure are further directed to a method of implanting a bone plating system into a patient. It is contemplated that the method includes the step of surgically accessing a pelvic cavity of the patient and implanting a bone plating system in the patient. The bone plating system in certain embodiments includes: (a) a substantially rectangular shaped first bone plate sized and shaped to conform to a first bone portion of the patient, the first bone plate having a first bone engaging surface, a first tissue engaging surface, a first edge, and a second edge; (b) a substantially trapezoidal shaped second bone plate sized and shaped to conform to a second bone portion of the patient, the second bone plate having a second bone engaging surface, a second tissue engaging surface, a proximal end, a distal end, and an outer peripheral edge; and (c) at least one connecting bridge member having a first end and a second end, wherein the first end of the at least one connecting bridge member is connected to the second edge of the first bone plate and the second end of the at least one connecting bridge member is connected to the proximal end of the second bone plate.

In certain non-limiting embodiments of the method, the proximal end of the second bone plate is spaced a first distance away from the second edge of the first bone plate, and the distal end of the second bone plate is spaced a second distance away from the second edge of the first bone plate, with the second distance being larger than the first distance. The second bone engaging surface of the second bone plate may have a bone engaging axis extending from the proximal end of the second bone plate to the distal end of the second bone plate, the bone engaging axis being a straight line fit to a series of data points representing the second bone engaging surface of the second bone plate. Further, the second bone plate may have at least one securing port for receiving a fastener, the at least one securing port having a bore extending from the second tissue engaging surface to the second bone engaging surface in a direction substantially oriented toward the outer peripheral edge and away from an interior portion of the second bone plate.

In further certain non-limiting embodiments of the method, the at least one securing port may have a wall surrounding the bore, the wall having a fastener support surface defining a head receiving volume of the bore adjacent to the second tissue engaging surface, and a shaft clearance surface defining a substantially frustoconical shaped shaft receiving volume of the bore adjacent to the second bone engaging surface. It is contemplated that the fastener support surface is adjacent to the shaft clearance surface such that the fastener support surface and the shaft clearance surface have a common vertex extending around at least a portion of the bore, the fastener support surface having a fastener support axis adjacent to the common vertex, the fastener support axis extending at an angle less than or equal to 90 degrees relative to the bone engaging axis. It is further contemplated, that when the first bone plate is positioned on the first bone portion, the second bone plate is positioned on the second bone portion, and a shaft of a fastener is disposed through the bore and into the second bone portion, a head of the fastener engages the fastener support surface and applies a first force vector to the second bone plate thereby drawing the second bone engaging surface against the second bone portion of the patient's bone.

Turning now to the drawings, FIG. A is a three-dimensional view of an exemplary human pelvis A from a perspective looking inclined downwards from the left side of the pelvis to the right side of the pelvis. In FIG. A, a pelvic brim is roughly framed with a dashed line and indicated with reference letter B, a quadrilateral surface is roughly encircled with a dashed line and indicated with reference letter C, a posterior column is roughly framed with a dashed line and indicated with reference letter D, and an acetabulum is indicated with reference letter E. Further, an exemplary fracture F is shown, which runs across the pelvis A and passes through the quadrilateral surface C. As one of ordinary skill in the art would appreciate, the fracture F is only one example of such a fracture that can occur, and other fractures are likely in which the quadrilateral surface C is comminuted such as those types of fractures outlined by Letournel-Judet mentioned hereinabove.

With regard toFIGS. 1-1D, shown therein is a bone plating system10constructed in accordance with the present disclosure. The bone plating system10includes a first bone plate100, sometimes known in the art generally as a suprapectineal plate, a second bone plate200, sometimes known in the art generally as a quadrilateral plate, and at least one connecting bridge member500(with two connecting bridge members500shown inFIG. 1). The first bone plate100is connected to the second bone plate200generally via the at least one connecting bridge member500to form generally a T-shape. The bone plating system10can be used in repairing fractures of the acetabulum E and, more particularly, in repairing fractures running through at least a portion of the quadrilateral surface C (FIG. A). Additionally, the bone plating system10can be used to repair fractures of the acetabulum E that include fractures having an anterior column D component in addition to a fracture of the quadrilateral surface C.

FIGS. 3 and 4, described in further detail hereinafter, show the bone plating system10according to the embodiment of the present disclosure according toFIG. 1being located at the implanting position within the human pelvis A of a patient15. The bone plating system10may come in one or more sizes and shapes, differentiated to account for morphological differences between subpopulations of patients (e.g. for male and female anatomy), and may be supplied in kit form with one or more additional surgical tools.

The first bone plate100is generally elongated and rectangular in shape and is sized and shaped to conform to a first bone portion20(generally, along the pelvic brim B) of the pelvis A of the patient15(as shown in FIGS. A,3, and4). As can be ascertained from the figures, the first bone plate100while being generally rectangular in shape itself may overall take on a configuration generally resembling the letters J or C when shaped and sized to fit a specific patient's anatomy and/or when supplied to the surgeon in a pre-arranged shape. The first bone plate100includes a first bone engaging surface105, a first tissue engaging surface110, a first edge115, a second edge120, a first end125, and a second end130. The first bone plate100has a length135extending from the first end125to the second end130, and a width140extending from the first edge115to the second edge120. The length135is greater than the width140. The first end125and the second end130are generally rounded in shape and are shown as having a blunt nose configuration inFIGS. 1 through 1D—i.e., the first end125and the second end130are defined by a generally convex shape extending from the first bone engaging surface105to the first tissue engaging surface110. Additionally, the first end125and the second end130can be shaped in any configuration (for example, but not by way of limitation, a “knife-edge,” a squared edge, and a rounded edge) and the shape of first end125may be different from that of second end130. One of ordinary skill in the art would appreciate, however, that the first bone plate100can be sized and shaped in various configurations to conform to the first bone portion20of the patient. For example, but not by way of limitation, the first bone plate100can be shaped with curves and twists along its length135as shown in detail inFIG. 1and in particular detail inFIGS. 1A and 1B—i.e., generally in the shape of the letters J or C as described hereinabove or in a more circular or serpentine configuration.

The first bone plate100has a plurality of screw apertures145(as shown in detail as having eleven such screw apertures145inFIG. 1-1D) for accepting bone screws, such as screw30(FIGS. 1 and 1C), extending from the first tissue engaging surface110to the first bone engaging surface105. The plurality of screw apertures145are provided along the length135of the first bone plate100in substantially equal intervals. Spaced between at least a portion of the plurality of screw apertures145, along the length135of the first bone plate100, are a series of forming bridges155that are deformable in three axes and have sufficient memory such that a surgeon or other medical practitioner can bend and twist the first bone plate100into a new configuration that conforms to the first bone portion20of the patient without deforming or otherwise encroaching upon the structural integrity and configuration of the plurality of screw apertures145themselves and/or the first bone plate100.

The deformation of the forming bridges155is preferably performed solely by hand force without further measures, such as heating of the material before bending, or the like. More preferably, the forming bridges155can also be constructed such that bending tools (not shown) are required and/or preferable for use in deforming the first bone plate100and are either separately provided or paired or included as part of a kit containing the bone plating system10. In another embodiment, the material comprising the bone plating system10generally, and the forming bridges155more specifically, can be formed from a material that requires heating in order to be deformable. It is contemplated that the bone plating system10—including the first bone plate100, the second bone plate200, and the connecting bridge members500—is provided alone or as part of a kit in an appropriately pre-bent shape from the manufacturer. In such a pre-bent configuration, the bone plating system10may or may not include deformable components that the surgeon or other medical practitioner can shape to fit the specific patient anatomy.

Each of the plurality of screw apertures145include a screw head support surface146defining a screw head receiving volume147(shown with perspective in respect to screw aperture145kinFIG. 1A) adjacent the first tissue engaging surface110, and a screw shaft clearance surface148defining a screw shaft receiving volume149adjacent the first bone engaging surface105. The screw shaft clearance surface148has a diameter less than a spherical diameter of the screw head support surface146—for example, an exemplary spherical diameter of the screw head support surface146is from about 6 to about 9 mm, while an exemplary diameter of the screw shaft clearance surface148is from about 3 to about 5.5 mm. A vertex150exists within each of the plurality of screw apertures145where the screw shaft clearance surface148meets the screw head support surface146. As such, each screw aperture145is formed as a countersunk hole. This “countersunk hole” configuration of the screw aperture145is such that the screw head support surface146is provided with a curved fillet in one embodiment or a conical chamfer in an alternative embodiment. In such a “countersunk hole” configuration of the screw aperture145, a head of the screw30is generally seated within the screw head receiving volume147and does not interact or engage substantially with tissue that may come into contact with the first tissue engaging surface110of the first bone plate100.

Each of the plurality of screw apertures145have a central axis151running through a center of the screw head receiving volume147and the screw shaft receiving volume149from the first tissue engaging surface110to the first bone engaging surface105—i.e., the central axis151of each of the screw apertures145is positioned substantially at a point where a longitudinal centerline141of the first bone plate100intersects with a latitudinal centerline142running through each of the screw apertures145from the first edge115to the second edge120of the first bone plate100.

As shown inFIG. 1, the central axis151is oriented generally at a 90-degree angle with respect to at least one of the first bone engaging surface105and the first tissue engaging surface110of the first bone plate100. Alternatively, the central axis151may be oriented at an angle of from about 45-degrees to about 90-degrees with respect to at least one of the first bone engaging surface105and the first tissue engaging surface110of the first bone plate100as depicted in the embodiment ofFIG. 5. In use, a bone fastener such as the screw30(FIGS. 1 and 1C) is inserted through the screw aperture145along the central axis151—in a direction from the first tissue engaging surface110to the first bone engaging surface105—and into at least a portion of the first bone portion20of the patient. In alternate embodiments, which will be appreciated by those of ordinary skill in the art given the present disclosure, the screw30can be inserted through the screw aperture145at an angle less than or greater than that of the central axis151. For example, but not by way of limitation, the screw30can be inserted through the screw aperture145at an angle deviating from the central axis151from about 1 degree to about 40 degrees. As such, the angle at which the screw30can be inserted through the screw aperture145can be +/−40 degrees from the central axis151as indicated by insertion vectors152,153. In preferred embodiments, the angle from which the screw30can deviate from the central axis151while being inserted through the screw apertures145is from about 1 to about 10 degrees; more preferably from about 10 to about 20 degrees; and more preferably from about 20 to about 40 degrees. The screw30may be of any width, size, or length and is generally chosen by the surgeon according to the thickness and physical characteristics of the bone into which the screw30is inserted. It is unnecessary for all of the plurality of screw apertures145to have screws30inserted therein—the choice of where to insert screws30being within the purview of the surgeon given the patient's anatomy and fracture geometry.

As can be appreciated fromFIG. 4, the placement of screws30within the screw apertures145can be at any number of insertion vectors deviating from the central axis151and between insertion vectors152,153. The choice of the placement of screws30within the screw apertures145is within the skill and judgment of the surgeon and may be dictated, generally, by the anatomy of the patient's pelvis A as well as the nature of the pattern of fracture F (FIG. A). Screws30, as shown inFIG. 4, are generally placed through the screw apertures145in a manner that joins pieces of fractured bone and/or acquires sufficient purchase within the bone to hold the first bone plate100securely to the first bone portion20of the patient. The screw30can be a cortex screw, for example but not by way of limitation.

A bridging portion160is shown inFIGS. 1 and 1Aas a generally central portion of the first bone plate100. The bridging portion160generally lacks the presence of forming bridges155as the bridging portion160retains a substantially linear configuration while in use and is not generally deformable by the surgeon although in certain embodiments, the bridging portion160may be deformable by the surgeon. The bridging portion160is generally adjacent to the connecting bridge members500. In the example shown, the bridging portion160extends across and between the two connecting bridge members500.

The second bone plate200(shown with particularity inFIGS. 1, 1C, and 1D) is generally trapezoid in shape and is sized and shaped to conform to the second bone portion35of the patient (as shown in FIGS. A,3, and4) and, in particular, to the posterior column D of the pelvis A of the patient and, more particularly, to the quadrilateral surface C of the pelvis A of the patient. The second bone plate200includes a second bone engaging surface205, a second tissue engaging surface210, a proximal end215, a distal end220, a first side225, and a second side230, with the proximal end215, the distal end220, the first side225, and the second side230defining a peripheral edge235of the second bone plate200. The proximal end215is generally parallel to the distal end220while the first side225and the second side230generally diverge from the distal end220to the proximal end215, although this configuration should not be considered to be limiting to the potential range of different acceptable shapes for the second bone plate200. The second bone plate200further comprises a plurality of internal struts240connected to one another in a web-like pattern to define the general structure of the second bone plate200. Where the internal struts240intersect, a plurality of secondary screw apertures250are placed. The internal struts240are deformable in three axes (similar to the forming bridges155) and have sufficient memory such that a surgeon or other medical practitioner can bend, deform, or otherwise twist the second bone plate200into a new configuration that conforms the second bone plate200to the particular anatomical characteristics of the second bone portion35of the patient without deforming or otherwise encroaching upon the structural integrity and configuration of the plurality of secondary screw apertures250themselves and/or the second bone plate200itself.

The internal struts240further define a plurality of through holes245extending through the second bone plate200from the second tissue engaging surface210to the second bone engaging surface205. The through holes245allow a surgeon to visualize the second bone portion35while placing the second bone plate200into position and/or allow a surgeon to visualize the second bone portion35via radiographic techniques without the generally radiopaque second bone plate200interrupting the surgeon's view. Although shown as a generally trapezoid shape, one of ordinary skill in the art would appreciate that the second bone plate200can be sized and shaped in various configurations to conform to the second bone portion35of the patient15. For example, but not by way of limitation, the second bone plate200can be curved with respect to a plane defined by the second bone engaging surface205, as shown with particularity inFIGS. 1A and 1B. Further, the shape, size, and configuration of the internal struts240, as shown in the figures, is not intended to be considered as limiting and the internal struts240can be shaped, sized, and configured in any manner that provides the second bone plate200the rigidity and strength needed to reduce and fix fractures of the quadrilateral surface C of the patient15, for example. See, for example, the alternative embodiments of the bone plating system10inFIGS. 4, and 7-9, discussed hereinafter.

The plurality of secondary screw apertures250(shown in detail inFIGS. 1B and 1C) extend from the second tissue engaging surface210to the second bone engaging surface205. The secondary screw apertures250are similar in construction and operation to the screw apertures145in the first bone plate100. In particular, each of the plurality of secondary screw apertures250include a screw head support surface146adefining a screw head receiving volume147aadjacent the second tissue engaging surface210, and a screw shaft clearance surface148adefining a screw shaft receiving volume149aadjacent the second bone engaging surface205. The screw shaft clearance surface148ahas a diameter less than a spherical diameter of the screw head support surface146a—for example, an exemplary spherical diameter of the screw head support surface146ais from about 6 to about 9 mm, while an exemplary diameter of the screw shaft clearance surface148ais from about 3 to about 5.5 mm. A vertex150aexists within each of the plurality of secondary screw apertures250where the screw shaft clearance surface148ameets the screw head support surface146a. (As shown inFIG. 1C) As such, each secondary screw aperture250is formed as a countersunk hole. This “countersunk hole” configuration of the secondary screw aperture250is such that the screw head support surface146ais provided with a curved fillet in one embodiment or a conical chamfer in an alternative embodiment. In such a “countersunk hole” configuration of the secondary screw aperture250, a head of the screw40is generally seated within the screw head receiving volume147aand does not interact or engage substantially with tissue that may come into contact with the second tissue engaging surface210of the second bone plate200.

Each of the plurality of second screw apertures250have a secondary central axis251running through a center of the screw head receiving volume147aand the screw shaft receiving volume149afrom the second tissue engaging surface210to the first bone engaging surface105.

As shown inFIG. 1B, the secondary central axis251is oriented at a 90-degree angle with respect to at least one of the second bone engaging surface205and the second tissue engaging surface210of the second bone plate200. Alternatively, the secondary central axis251may be oriented at an angle of from about 45-degrees to about 90-degrees with respect to at least one of the second bone engaging surface205and the second tissue engaging surface210of the second bone plate200as depicted in the embodiment ofFIG. 5. In use, a bone fastener such as a screw40(FIG. 1B) is inserted through one or more of the secondary screw apertures250along the secondary central axis251—in a direction from the second tissue engaging surface210to the second bone engaging surface205—and into the second bone portion35of the patient. In alternate embodiments, which will be appreciated by those of ordinary skill in the art given the present disclosure, the screw40can be inserted through one or more of the secondary screw apertures250at an angle less than or greater than that of the secondary central axis251. For example, but not by way of limitation, the screw40can be inserted through the secondary screw apertures250at an angle deviating from the secondary central axis251from about 1 degree to about 40 degrees. As such, the angle at which the screw40can be inserted through the secondary screw apertures250can be +/−40 degrees from the secondary central axis251as indicated by secondary insertion vectors252,253. In preferred embodiments, the angle from which the screw40can deviate from the secondary central axis251while being inserted through the secondary screw apertures250is from about 1 to about 10 degrees; more preferably from about 10 to about 20 degrees; and more preferably from about 20 to about 40 degrees. The screw40may be of any width, size, or length and is generally chosen by the surgeon according to the thickness and physical characteristics of the bone into which the screw40is inserted. It is unnecessary for all of the plurality of secondary screw apertures250to have screws40inserted therein—the choice of where to insert screws40being within the purview of the surgeon given the patient's anatomy and fracture geometry.

As can be appreciated fromFIG. 4, the placement of screws40within the secondary screw apertures250can be at any number of insertion vectors deviating from the secondary central axis251and between insertion vectors252,253. The choice of the placement of screws40within the secondary screw apertures250is within the skill and judgment of the surgeon and may be dictated, generally, by the anatomy of the patient's pelvis A as well as the nature of the pattern of fracture F (FIG. A). Screws40, as shown in FIG. A, are generally placed through the secondary screw apertures250in a manner that joins pieces of fractured bone and/or acquires sufficient purchase within the bone to hold the second bone plate200securely to the second bone portion35of the patient. The screw40can be a cortex screw, for example but not by way of limitation.

The second bone plate200further includes at least one reduction instrument engaging aperture260for receiving a surgical instrument (such as a ball spike, not shown) capable of applying a force vector261generally at a 90 degree angle to the second tissue engaging surface210of the second bone plate200to urge or bring the second bone engaging surface205of the second bone plate200into contact with and generally adjacent to the second bone portion35(e.g., the quadrilateral surface C) of the patient. The reduction instrument engaging aperture260may also be configured to accept other reduction and fixation instrumentation such as forceps, clamps, and other such devices, which may be individual tools or provided as part of a kit with the bone plating system10.

As shown inFIG. 1, the proximal end215of the second bone plate200is spaced a first distance242away from the second edge120of the first bone plate100and the distal end220of the second bone plate200is spaced a second distance244away from the second edge120of the first bone plate100with the second distance264being larger than the first distance262. As shown inFIGS. 1B and 2, the second bone engaging surface205of the second bone plate200includes a bone engaging axis265extending from the proximal end215of second bone plate200to the distal end220of the second bone plate200. The bone engaging axis265is generally a straight line fit to a series of data points representing the second bone engaging surface205of the second bone plate200.

The second bone plate200includes at least one securing port270with one such securing port being shown inFIGS. 1-1D. The at least one securing port270of the second bone plate200is shown more particularly in cross-section inFIG. 2along a line A-A ofFIG. 1(and in close-up detail inFIG. 2A) and with respect to a fastener271(shown in dashed line inFIG. 2) and the second bone portion35, where the fastener271has a shaft273and a head274. The fastener271can be a cortex screw, for example but not by way of limitation. A fastener central axis276runs through a center of the fastener271—i.e., the fastener central axis276is a line extending longitudinally through a center of the head274and a center of the shaft273of the fastener271. The securing port270includes a bore290extending from the second tissue engaging surface210to the second bone engaging surface205in a direction substantially oriented toward the distal end220and away from the proximal end215of the second bone plate200. In alternative embodiments, the bore290may extend from the second tissue engaging surface210to the second bone engaging surface205in a direction substantially oriented toward the peripheral edge235and away from an inner portion of the second bone plate200with the inner portion being generally defined in one embodiment as a point on the second bone plate200that is equidistant from all points along the peripheral edge235. In an additional embodiment, shown more particularly inFIG. 8, for example but not by way of limitation, the bore290may extend from the second tissue engaging surface210to the second bone engaging surface in a direction substantially oriented toward the peripheral edge235and away from an offset point (not shown) of the second bone plate. The offset point is generally defined as a point that is part of the interior of the second bone plate200and is not equidistant from all points along the peripheral edge235. A bore central axis292runs through a center of the bore290—i.e., the bore central axis292is a line extending longitudinally through a center of the bore290in a direction substantially oriented toward the distal end220and away from the proximal end215of the second bone plate200. As shown inFIG. 2, when the fastener271is within the at least one securing port270in at least one configuration, the fastener central axis276is adjacent to and/or coextensive with the bore central axis292.

In alternate embodiments, which will be appreciated by those of ordinary skill in the art given the present disclosure, the fastener271can be inserted into the bore290of the at least one securing port270at an angle less than or greater than that of the bore central axis292. For example, but not by way of limitation, the fastener271can be inserted through the bore290at an angle deviating from the bore central axis292from about 1 degree to about 75 degrees. As such, the angle at which the fastener271can be inserted through the bore290can be +/−75 degrees from the bore central axis292as indicated generally by fastener insertion vectors294,296. In preferred embodiments, the angle from which the fastener271can deviate from the bore central axis292while being inserted through the bore290is from about 1 to about 10 degrees; from about 10 to about 20 degrees; from about 20 to about 35 degrees; from about 35 to about 50 degrees; from about 50 to about 65 degrees; and from about 60 to about 75 degrees. In particular, it is contemplated that insertion of the fastener271can deviate from the bore central axis292in an amount ranging from where insertion vector296is at an angle of about 10 degrees measured from the bone engaging axis265and insertion vector294is at an angle of about 90 degrees measured from the bone engaging axis265. In an alternate embodiment, insertion of fastener271can deviate from the bore central axis292in an amount ranging from where insertion vector296is at an angle of about 15 degrees measured from the bone engaging axis265and insertion vector294is at an angle of about 33 degrees measured from the bone engaging axis265.

In further detail, the securing port270has a wall295surrounding the bore290. The wall295has an exterior surface298. The wall295defines a fastener head support surface300opposite to the exterior surface298of the wall295. The fastener head support surface300defines a fastener head receiving volume305of the bore290adjacent to the second tissue engaging surface210. In the embodiment ofFIG. 2(and as shown in further detail inFIG. 2A), the exterior surface298is spaced from the fastener head support surface300by a lip portion301of the wall295. The fastener head support surface300defines a fastener head receiving volume305of the bore290adjacent to the second tissue engaging surface210. The wall295also defines a fastener shaft clearance surface310defining a generally frustoconical shaped fastener shaft receiving volume315of the bore290adjacent to the second bone engaging surface205. In use, when the fastener271is placed within the bore290, the head274of the fastener271is in a “shrouded” configuration—i.e., the head274of the fastener271is nested within the fastener head receiving volume305and does not extend (or does not substantially extend depending upon the embodiment and/or configuration of the fastener271) into tissue adjacent the second tissue engaging surface210of the second bone plate200. In one embodiment, a spherical diameter of the fastener head support surface300is from about 6 mm to about 9 mm. The fastener shaft clearance surface310is generally shaped as an ellipse and has a length along a major radius of from about 3 mm to about 9 mm and a length along a minor radius of from about 3 mm to about 6 mm at an upper edge of the fastener shaft clearance surface310near the second tissue engaging surface310and a length along a major radius of from about 3 mm to about 23 mm and a length along a minor radius of from about 3 mm to about 6 mm at a lower edge of the fastener shaft clearance surface310near the second bone engaging surface305. As at least one of the length along the major radius and the length along the minor radius found at the upper edge of the fastener shaft clearance surface310are smaller than at least one of the length along the major radius and the length along the minor radius found at the lower edge of the fastener shaft clearance surface310, the frustoconical shape of the fastener shaft clearance surface310can be appreciated. Further, the lengths along the major and minor radii found at the upper edge of the fastener shaft clearance surface310may be identical to the lengths along the major and minor radii of the lower edge of the fastener shaft clearance surface310. In this manner, the fastener head receiving volume305is formed as a countersunk hole. This “countersunk hole” configuration is such that the fastener head support surface300is provided with a curved fillet in one embodiment or a conical chamfer in an alternative embodiment. In such a “countersunk hole” configuration of the fastener head receiving volume305, the head274of the fastener271is generally seated within the fastener head receiving volume305and does not interact or engage substantially with tissue that may come into contact with the second tissue engaging surface210of the second bone plate200. As shown in the configuration ofFIG. 1, the bore central axis292is a line extending longitudinally through a center of the fastener head receiving volume305and a center of the fastener shaft receiving volume315of the bore290.

The fastener head support surface300is adjacent to the fastener shaft clearance surface310such that the fastener head support surface300and the fastener shaft clearance surface310have a bore vertex320extending around at least a portion of the bore290. The fastener head support surface300has a fastener support axis325adjacent to the bore vertex320. The fastener support axis325extends at a first angle330that is less than or equal to 90 degrees relative to the bone engaging axis265. In one embodiment, the first angle330can be between 1 and 15 degrees. In other embodiments, the first angle330can be between 15 and 35 degrees, 35 and 60 degrees, 60 and 75 degrees, and 75 and 90 degrees. In a preferred embodiment, the first angle330is between 45 and 80 degrees, preferentially being between 55 and 75 degrees.

The generally frustoconical shape of the fastener shaft receiving volume315can be appreciated from the view of the bore290ofFIG. 2wherein a first distance345measured from the bore central axis292to a first portion347of the fastener shaft clearance surface310near the proximal end215of the second bone plate200is less than a second distance350measured from the bore central axis292to a second portion352of the fastener shaft clearance surface310near the distal end220of the second bone plate200. As one of ordinary skill in the art would appreciate from the present disclosure, the first distance345and the second distance350can vary depending on the angle at which the fastener271is placed within the bore290and there may be a configuration wherein the first distance345and the second distance350are identical yet the fastener shaft receiving volume315retains its generally frustoconical shape as defined by the fastener shaft clearance surface315extending from the bore vertex320to the second bone engaging surface205of the second bone plate200. The frustoconical shape of the fastener shaft receiving volume315allows the fastener271to approach the second bone portion35at an angle that deviates from the bore central axis292by +/−40 degrees.

Shown inFIG. 2Bis a securing port270′ that is constructed identical to the securing port270, except as discussed below. For purposes of brevity, the securing port270′ will use similar reference numerals to the securing port270, but such reference numerals will include a “′” suffix. Also, for purposes of clarity, common elements between the securing port270and the securing port270′ will not be described, but such are incorporated herein by reference. The securing port270is provided with a wall295′ surrounding a bore290′. The wall295′ has an exterior surface298′. The wall295′ also defines a fastener head support surface300′ intersecting the exterior surface298′ of the wall295′. Because the fastener head support surface300′ intersects the exterior surface298′ (i.e., being devoid of the lip portion301), the securing port270′ can be fabricated from thinner material making the securing port270′ less costly to manufacture. The exterior surface298′ may have a planar configuration as depicted inFIG. 2B.

The second bone plate200in certain embodiments further includes one or more tertiary fastening members400with two such tertiary fastening members400being shown in the embodiment of the bone plating system10ofFIGS. 1-1D. As shown inFIG. 1, the tertiary fastening members400are coextensive with the peripheral edge235of the second bone plate200near the proximal end215thereof. Although in other contemplated embodiments the tertiary fastening members400may be coextensive with the peripheral edge235near the distal end220or coextensive with the peripheral edge235near both the distal and proximal ends220,215, respectively, of the second bone plate200. In particular, the tertiary fastening members400are connected to the second bone plate200via external struts402extending from the first side225and second side230of the second bone plate200and connecting with the tertiary fastening members400. Like the forming bridges155and the internal struts240, the external struts402are deformable by the surgeon in at least two axes (and in certain embodiments, three axes) thereby allowing the tertiary fastening members400to be placed into a configuration such that a bone contacting surface404(shown in detail inFIG. 1A) of the tertiary fastening members400is in contact with the second bone portion35. The tertiary fastening members400include at least one tertiary screw aperture406constructed in a similar manner as the screw apertures145and the secondary screw apertures250thereby allowing the placement of a bone screw50(as shown inFIG. 1B) through the tertiary screw apertures400and into the second bone portion35. The bone screw50may be a polyaxial bone screw.

In certain further embodiments shown inFIGS. 5A-5D and 8, the second bone plate200particularly includes two securing ports270a,270b. Although it is shown inFIGS. 5A-5D and 8that the two securing ports270a,270bare adjacent to one another at the distal end220of the second bone plate200, one of ordinary skill in the art will appreciate that the two securing ports270a,270bcan be placed at any location within the second bone plate200either together, adjacent, or separately and that the two securing ports270a,270bneed not be placed in a parallel configuration with respect to one another. In particular, the two securing ports270a,270bmay be placed at an angle to one another such that the two securing ports270a,270bconverge and or diverge from one another depending on the angular positioning of each to the other as shown inFIG. 8, for example but not by way of limitation. Furthermore, the second bone plate200may include three, four, five, six, or any number of securing ports with the number of such securing ports only being limited by the size and configuration of the second bone plate200. The two securing ports270a,270bare generally identical to the at least one securing port270. With respect to the views of the two securing ports270a,270bshown inFIGS. 5A-5Dit should be readily apparent that the wall295aof the securing port270ahas a height that is greater than a height of the wall295bof the securing port270b. Furthermore, each of securing ports270a,270bofFIGS. 5A-5D and 8have a concomitant fastener central axis276generally adjacent bore vertex320. The first angle330residing between the fastener support axis325and the bone engaging axis265of the second bone plate200may be identical in the securing ports270a,270b, or the first angle330may be different in each of securing ports270a,270b. In this manner, the second bone plate is provided with two securing ports270a,270bthat each may have fastener support axes325that intersect with the bone engaging axis265of the second bone plate200at first angles330that are identical or different than one another.

The at least one connecting bridge member500, with two connecting bridge members500shown inFIGS. 1-1D, comprise a proximal end505, a distal end510, a first side515, and a second side520with the proximal end505, the distal end510, the first side515, and the second side520defining an outer peripheral edge525. The connecting bridge members500are capable of being deformed in three axes, with deformation in two axes being generally preferred, and have sufficient memory such that a surgeon or other medical practitioner can bend and twist the connecting bridge members500such that the first bone plate100and the second bone plate200are placed into a new configuration with respect to one another that conforms the bone plating system10to the anatomy of the pelvis A of the patient15. The connecting bridge members500are shown as being substantially rectangular in shape with the proximal end505and the distal end510being spaced a distance away from and generally parallel to one another, while the first side515and the second side520being spaced a distance away from and generally parallel to one another. The proximal end505of the connecting bridge member500is adjacent to, in contact with, or connected to the second edge120along the bridging portion160of the first bone plate100.

As one of ordinary skill in the art will appreciate, the connecting bridge member500, while shown as generally rectangular in shape inFIGS. 1-1D, could be any shape or configuration—e.g., trapezoid, triangle, square, frustoconical, conical, circular, or fanciful-so long as the connecting bridge member500is capable of connecting the first bone plate100to the second bone plate200in a manner that allows the first and second bone plates100,200, respectively, to be configured with respect to one another so as to fit the anatomy of the pelvis A of the patient15, for example. Additionally, it can be appreciated fromFIGS. 1B and 1Cthat connecting bridge member500can be curved or in a configuration having an arc running a length of the connecting bridge member500from the distal end510to the proximal end505thereby allowing the first bone plate100to be generally adjacent the first bone portion20(e.g., the pelvic brim B of FIG. A) while the second bone plate200is generally adjacent the second bone portion35(e.g., the quadrilateral surface C of FIG. A) within the patient15.

The first bone plate100, second bone plate200, and the connecting bridge members500are preferably monolithically formed of titanium, implant grade stainless steel, or composites and alloys of same. In one embodiment, the first bone plate100, the second bone plate200, and the connecting bridge members500are formed of annealed stainless steel. As mentioned herein, the forming bridges155, internal struts240, external struts402, and connecting bridge members500are capable of being bent, twisted, and otherwise deformed by a surgeon in order to change the configuration of the bone plating system10to a new configuration more closely approximating the patient's specific anatomy. It should be understood by one of ordinary skill in the art that while the forming bridges155, internal struts240, external struts402, and connecting bridge members500have some elasticity, the remaining structure of the bone plating system10should be rigid enough for appropriately fulfilling its fracture reduction and bone support functions, i.e., that the bone plating system10is rigid enough to sufficiently stabilize the first and second bone portions20,35, respectively, and thereby reduce and stabilize the fracture F running through the first and second bone portions20,35, of the patient15respectively.

Alternative embodiments of the bone plating system10are shown inFIGS. 6-7and indicated via reference numerals10aand10b, respectively. The bone plating systems10aand10bare generally the same as bone plating system10with several of the individual components being found in greater or lesser numbers. Additionally, the shape and configuration of the first and second bone plates100a,200arespectively are sized and shaped differently than the first and second bone plates100,200.

The bone plating system10ashown inFIG. 6includes a first bone plate100a, a second bone plate200a, a tertiary fastening member400, and three connecting bridge members500. The first bone plate100aincludes a first bone engaging surface105, a tissue engaging surface110, a first edge115, a second edge120, a first end125, and a second end130. A length135extends from the first end125to the second end130of the first bone plate100a. Spaced equally along a longitudinal axis running along the length135of the first bone plate100aare a plurality of screw apertures600and forming bridges605generally placed between the screw apertures600. In the embodiment ofFIG. 6, the first bone plate100acomprises ten screw apertures600and five forming bridges605. The screw apertures600are identical to the screw apertures145, and the forming bridges605are identical to the forming bridges155in shape, function, structure, and positioning considering the differences in the number of each.

The first bone plate100aincludes at least one securing channel610with two such securing channels610being shown in the embodiment ofFIG. 6. The securing channels610are positioned generally on the first end125and the second end130of the first bone plate100aand define a channel through the first bone plate100aextending from the first tissue engaging surface110to the first bone engaging surface105. The securing channels610allow the placement of a stabilizing tool (not shown), such as a K-wire, probe, or other surgical instrument, to be placed through the first bone plate100aand into the first bone portion20thereby positioning and holding/locking the first bone plate100aadjacent the first bone portion20.

The second bone plate200aincludes a second bone engaging surface205, a second tissue engaging surface210, a proximal end215, and a distal end220. The second bone plate200afurther includes internal struts240a, through holes245a, and secondary screw apertures250. The internal struts240aare generally identical to internal struts240albeit the internal struts240aare arranged in a different web-like pattern than internal struts240. Likewise, the through holes245aare generally identical to through holes245albeit the through holes245aare shaped and sized differently than the through holes245. The second bone plate200aalso includes at least one securing port270and at least one tertiary fastening member400connected to the second bone plate200avia an external strut402. Further, the bone plating system10aincludes a plurality of connecting bridge members500connecting the first bone plate100ato the second bone plate200awith three such connecting bridge members500shown in the embodiment of the bone plating system10ashown inFIG. 6. In use, the bone plating system10ais placed within the pelvis A of a patient in the same manner using the same tools and screws30,40,50and fastener271as bone plating system10with the one difference that a stabilizing tool (such as a K-wire, not shown) can be inserted within the securing channels610through the first bone plate100aand into the first bone portion20to hold the first bone plate100ain position against the first bone portion20during the surgical procedure.

The bone plating system10bshown inFIG. 7includes a first bone plate100b, a second bone plate200b, a tertiary fastening member400, and three connecting bridge members500. The first bone plate100bincludes a first bone engaging surface105, a tissue engaging surface110, a first edge115, a second edge120, a first end125, and a second end130. A length135extends from the first end125to the second end130of the first bone plate100b. Spaced equally along a longitudinal axis running along the length135of the first bone plate100bare a plurality of screw apertures600and forming bridges605generally placed between the screw apertures600. In the embodiment ofFIG. 7, the first bone plate comprises twelve screw apertures600and seven forming bridges605. In general and with respect to all embodiments of the first bone plate (for example, first bone plate100,100a, or100b, but not by way of limitation) shown and described herein, the number of screw apertures145and/or600may range from 1 to 15, although the number of such screw apertures145and/or600should not be considered as limiting with respect to the intended scope of the present disclosure. The screw apertures600are identical to the screw apertures145and the forming bridges605are identical to the forming bridges155in shape, function, structure, and positioning considering the differences in the number of each.

The first bone plate100bincludes at least one securing channel610with two such securing channels610being shown in the embodiment ofFIG. 7. The securing channels610are positioned generally on the first end125and the second end130of the first bone plate100band define a channel through the first bone plate100bextending from the first tissue engaging surface110to the first bone engaging surface105. The securing channels610allow the placement of a stabilizing tool (not shown), such as a K-wire, probe, or other surgical instrument, to be placed through the first bone plate100band into the first bone portion20thereby positioning and holding/locking the first bone plate100badjacent the first bone portion20.

The second bone plate200bincludes a second bone engaging surface205, a second tissue engaging surface210, a proximal end, and a distal end220. The second bone plate200bfurther includes internal struts240b, through holes245b, and secondary screw apertures250. The internal struts240bare generally identical to internal struts240albeit the internal struts240bare arranged in a different web-like pattern than internal struts240. Likewise, the through holes245bare generally identical to through holes245albeit the through holes245bare shaped and sized differently than the through holes245. The second bone plate200balso includes at least one securing port270and at least one tertiary fastening member400connected to the second bone plate200avia an external strut402. Further, the bone plating system10bincludes a plurality of connecting bridge members500connecting the first bone plate100ato the second bone plate200awith three such connecting bridge members500shown in the embodiment of the bone plating system10bshown inFIG. 7. In use, the bone plating system10bis placed within the pelvis A of a patient in the same manner using the same tools and screws30,40,50and fastener271as bone plating system10with the one difference that a stabilizing tool (not shown) can be inserted within the securing channels610through the first bone plate100band into the first bone portion20to hold the first bone plate100bin position against the first bone portion20during the surgical procedure.

The bone plating system10cshown inFIGS. 9A-9Cincludes a first bone plate100c, a second bone plate200c, two tertiary fastening members designated400aand400b, and two connecting bridge members500. The first bone plate100cincludes a first bone engaging surface105, a tissue engaging surface110, a first edge115, a second edge120, a first end125, and a second end130. A length135extends from the first end125to the second end130of the first bone plate100c. Spaced equally along a longitudinal axis running along the length135of the first bone plate100care a plurality of screw apertures600and forming bridges605generally placed between the screw apertures600. In the embodiment ofFIGS. 9A-9C, the first bone plate100ccomprises eleven screw apertures600and seven forming bridges605. The screw apertures600are identical to the screw apertures145, and the forming bridges605are identical to the forming bridges155in shape, function, structure, and positioning considering the differences in the number of each.

The second bone plate200cincludes a second bone engaging surface205, a second tissue engaging surface210, a proximal end215, and a distal end220. The second bone plate200cfurther includes internal struts240c, through holes245c, and secondary screw apertures250. The internal struts240care generally identical to internal struts240albeit the internal struts240care arranged in a different web-like pattern than internal struts240. Likewise, the through holes245care generally identical to through holes245albeit the through holes245care shaped and sized differently than the through holes245. The second bone plate200calso includes at least one securing port270cand at least one tertiary fastening member400connected to the second bone plate200cvia an external strut402. Further, the bone plating system10cincludes a plurality of connecting bridge members500connecting the first bone plate100cto the second bone plate200cwith two such connecting bridge members500shown in the embodiment of the bone plating system10cshown inFIGS. 9A-9C. In use, the bone plating system10cis placed within the pelvis A of a patient15in the same manner using the same tools and screws30,40,50and fastener271as bone plating system10with the one difference being the structure of the at least one securing port270c.

The at least one securing port270cof the second bone plate200cincludes a bore290cextending from the second tissue engaging surface210generally towards the second bone engaging surface205. A bore central axis292cruns through a center of the bore290c—i.e., the bore central axis292cis a line extending longitudinally through a center of the bore290cin a direction substantially oriented toward the distal end220and away from the proximal end215of the second bone plate200c. As shown inFIG. 9C, when the fastener271is within the at least one securing port270cin at least one configuration, the fastener central axis276is adjacent to and/or coextensive with the bore central axis292c. In some embodiments, the bore290cmay not be a perfect circle and have, rather, a slightly elongated oval or ellipse shape. For example, when the bore290chas an ellipse shape a length along the major radius may be from about 3 mm to about 9 mm with a length along the minor radius of from about 3 mm to about 6 mm.

In alternative embodiments, the fastener271can be inserted into the bore290cof the at least one securing port270cat an angle less than or greater than that of the bore central axis292c—i.e., at an angle from about 1 degree to about 75 degrees. As such, the angle at which the fastener271can be inserted through the bore290ccan be +/−75 degrees from the bore central axis292cas indicated generally by fastener insertion vectors294c,296c. The degree by which the fastener271can deviate from the bore central axis292cis identical to the degree by which the fastener can deviate from the bore central axis292. In particular, it is contemplated that insertion of the fastener271can deviate from the bore central axis292cin an amount ranging from where insertion vector296cis at an angle of about 10 degrees measured from the bone engaging axis265and insertion vector294cis at an angle of about 90 degrees measured from the bone engaging axis265. In an alternate embodiment, insertion of fastener271can deviate from the bore central axis292cin an amount ranging from where insertion vector296cis at an angle of about 15 degrees measured from the bone engaging axis265and insertion vector294cis at an angle of about 33 degrees measured from the bone engaging axis265.

In further detail, the at least one securing port270chas a wall295csurrounding at least a portion of the bore290cwith the wall295chaving an upper surface700and a lower surface705. The wall295cdefines a fastener head support surface300cdefining a fastener head receiving volume305cof the bore290cdisposed a predetermined distance above the second tissue engaging surface210as shown inFIG. 9C. The at least one securing port270cfurther including a port through passage710shown in particular inFIG. 9Bwherein the port through passage710has a first width715adjacent the lower surface705of the wall295cthat tapers toward a point720adjacent the distal end220of the second bone plate200c. As shown inFIG. 9B, the port through passage710has a generally wish-bone configuration. One of ordinary skill in the art would appreciate, however, that the port through passage710could have any shape desired by the surgeon that allows the fastener271to move through the bore290c, through the second bone plate200c, and into the second bone portion35of the patient15at an angle measured from the bone engaging axis as described hereinabove. In use, when the fastener271is placed within the bore290c, the head274of the fastener271is in a shrouded configuration—i.e., the head274of the fastener271is at least partially nested within the fastener head receiving volume305cand at least a portion of the head274does not extend into tissue adjacent the second tissue engaging surface210of the second bone plate200c. In this manner, the fastener head receiving volume305cis formed as a countersunk hole. This “countersunk hole” configuration is such that the fastener head support surface300cis provided with a curved fillet in one embodiment or a conical chamfer in an alternative embodiment—i.e., the fastener head support surface300ccan be of any shape that corresponds to the underside of the head274of the fastener271. In such a “countersunk hole” configuration of the fastener head receiving volume305c, the head274of the fastener271is generally seated within the fastener head receiving volume305cand does not interact or engage substantially with tissue that may come into contact with the second tissue engaging surface210of the second bone plate200c.

The fastener head support surface300cis adjacent to the lower surface705of the at least one securing port270csuch that the fastener head support surface300cand the lower surface705have a bore vertex320cextending around at least a portion of the bore290c. The fastener head support surface300chas a fastener support axis325cadjacent to the bore vertex320c. The fastener support axis325cextends at a first angle330cthat is less than or equal to 90 degrees relative to the bone engaging axis265. In one embodiment, the first angle330ccan be between 1 and 15 degrees. In other embodiments, the first angle330ccan be between 15 and 35 degrees, 35 and 60 degrees, 60 and 75 degrees, and 75 and 90 degrees. In a preferred embodiment, the first angle330cis between 45 and 80 degrees, preferentially being between 55 and 75 degrees. The fastener head support surface300chas a spherical diameter from about 6 mm to about 9 mm.

In use, and as more particularly shown inFIGS. 3, 4, and 5E, the surgeon configures the bone plating system10to generally conform to the patient's anatomy. In particular, after achieving initial reduction of the fracture intra-operatively the surgeon can insert a bending template (not shown) into the portion of the pelvis A where placement of the bone plating system10is intended. A bending template is typically thin and easy to shape to the configuration of the bones in the pelvis A. Oftentimes such bending templates are made from a very ductile aluminum alloy less than a millimeter in thickness. Alternatively, the surgeon may place the bone plating system10generally into position within the pelvis A-fitting the bone plating system10visually and by feel—with the first bone plate100adjacent the first bone portion20(e.g., the pelvic brim B as shown in FIGS. A,3,4, and5E), the second bone plate200adjacent the second bone portion35(e.g., the quadrilateral surface C as shown in FIGS. A,3,4, and5E), and with the connecting bridge members500connecting the first bone plate100to the second bone plate200. In this placement, the first bone engaging surface105of the first bone plate100is in at least partial contact with the surface of the pelvic brim B and the second bone engaging surface205of the second bone plate200is in at least partial contact with the quadrilateral surface C. The bone plating system10is either bent into shape in conformity with the bending template or according to trial and error intra-operatively against the actual anatomical structures of the patient.

In alternate embodiments, the bone plating system10will be provided to the surgeon as a kit comprising one or more “sizing trials” of the bone plating system10. Such sizing trials of the bone plating system10are generally identical to the bone plating system10albeit having different sizes and/or three-dimensional configurations to fit the differing size and shape of the patient's anatomy. The sizing trials are generally more rigid, less detailed, and non-implantable versions of the bone plating system10. In use, a surgeon would select a sizing trial of the bone plating system10from a kit containing a plurality of sizing trials that appears to match most closely to the patient's size and anatomy. The surgeon thereafter places the chosen sizing trial adjacent the patient's anatomy to gauge the appropriateness (or lack thereof) of the fit of the sizing trial to the patient's anatomy and/or the pattern of fracture F (FIG. A). Once a sizing trial is found to most closely approximate the patient's anatomy, a bone plating system10that best approximates the size and shape of the sizing trial is selected for implantation within the patient adjacent the first bone portion20and the second bone portion35.

At least one of the plurality of screw apertures145of the first bone plate100—for example, but not by way of limitation, the screw aperture145k(FIG. 1A)—can be chosen by the surgeon to place a first screw30for securing the first bone plate100to the first bone portion20. Although this embodiment contemplates the insertion of the screw30through at least one of the screw apertures145, alternative embodiments contemplate that the surgeon may elect to forego inserting the screw30in any of the secondary screw apertures145. In particular, the surgeon places the screw30into screw aperture145kgenerally along its central axis151such that a tip of a shaft of screw30enters and moves through the screw head receiving volume147, through the screw shaft receiving volume149, and into contact with the first bone portion20. The surgeon continues to move the screw30along the central axis151such that the shaft of the screw30enters the first bone portion20. The screw30is further tightened by the surgeon such that threads of the screw30further enter the first bone portion20, thereby pulling the first bone engaging surface105adjacent the screw aperture145kinto intimate and engaging contact with the first bone portion20.

When the first bone engaging surface105adjacent the screw aperture145kis in such intimate and engaging contact with the first bone portion20, an outer surface of a head of the screw30is tightly disposed against the screw head support surface146of the screw aperture145k. As the screw apertures145have a variety of angles of approach for screw30to enter into the first bone portion20(i.e., between insertion vectors152,153), the surgeon can select an angle of approach to the first bone portion20for placing the screw30through screw aperture145kand into the first bone portion20that is appropriate for the patient's anatomy (e.g., that best matches the access to the surgical site offered by the approach chosen by the surgeon), best reduces the fracture F of the patient, achieves the greatest purchase of bone across the length the screw30, and/or is a best compromise factoring all of the above-noted considerations.

For example, the surgeon can select an angle of approach of the screw30through the screw aperture145kto the first bone portion20between insertion vectors152,153that allows the screw30to bridge two sides of a fracture line (such as fracture F) and thereby reduce the fracture by pulling portions of bone adjacent the fracture toward one another. Additionally, the screw30can be of any size, shape, or material suitable for the use in attaching the first bone plate100to the first bone portion20and, in some cases, reducing the fracture F within the acetabulum E of the pelvis A. The surgeon can thereafter insert additional screws30within screw apertures145a-145jin a sequential or other ordered manner such that the first bone plate100is secured to the first bone portion20(e.g., the pelvic brim B, FIG. A) of the patient. It will be understood by those of ordinary skill in the art that not all screw apertures145a-145kneed have screws30inserted therein.

As shown inFIGS. 4, and 5E, the screws30are shown inserted through the plurality of screw apertures145in the first bone plate100and into the first bone portion20. As can be appreciated in particular fromFIGS. 4 and 5E, the placement of screws30within the screw apertures145can be at any number of insertion vectors deviating from the central axis151and between insertion vectors152,153. The choice of the placement of screws30within the screw apertures145is within the skill and judgment of the surgeon and may be dictated, generally, by the anatomy of the patient's pelvis A (FIG. A) in that the screws30are generally placed through the screw apertures145in a manner to join pieces of fractured bone and/or gain sufficient purchase in the bone along the length of the screws30to hold the first bone plate100securely to the first bone portion20of the patient.

At least one of the secondary screw apertures250of the second bone plate200—for example, but by way of limitation, the secondary screw aperture250a(shown inFIG. 1B)—can be chosen by the surgeon to place a screw40for securing the second bone plate200to the second bone portion35. Although this embodiment contemplates the insertion of the screw40through at least one of the secondary apertures250, alternative embodiments contemplate that the surgeon may elect to forego inserting the screw40in any of the secondary screw apertures250. In particular, the surgeon places the screw40into secondary screw aperture250agenerally along its secondary central axis251such that a tip of a shaft of screw40enters and moves through the screw head receiving volume147a, through the screw shaft receiving volume149a, and into contact with the second bone portion35. The surgeon continues to move the screw40along the secondary central axis251such that the shaft of the screw40enters the second bone portion35. The screw40is further tightened by the surgeon such that threads of the screw40further enter the second bone portion35, thereby pulling the second bone engaging surface205adjacent the secondary screw aperture250ainto intimate and engaging contact with the second bone portion35.

When the second bone engaging surface205adjacent the secondary screw aperture250ais in such intimate and engaging contact with the second bone portion35, an outer surface of a head of the screw40is tightly disposed against the screw head support surface146aof the secondary screw aperture250a. As the secondary screw apertures250have a variety of angles of approach for screw40to enter the second bone portion35(i.e., between secondary insertion vectors252,253), the surgeon can select an angle of approach to the second bone portion35for placing the screw40through secondary screw aperture250aand into the second bone portion35that is appropriate for the patient's anatomy (e.g., that best matches the access to the surgical site offered by the approach chosen by the surgeon), best reduces the fracture F of the patient, achieves the greatest purchase of bone across the length the screw40, and/or is a best compromise factoring all of the above-noted considerations.

For example, the surgeon can select an angle of approach of the screw40through the secondary screw aperture250ato the second bone portion35between secondary insertion vectors252,253that allows the screw40to bridge two sides of a fracture line (such as fracture F, FIG. A) and thereby reduce the fracture by pulling portions of bone adjacent the fracture toward one another. Additionally, the screw40can be of any size, shape, or material suitable for use in attaching the second bone plate200to the second bone portion35and, in some cases, reducing the fracture F within the acetabulum E of the pelvis A (FIG. A). The surgeon can thereafter insert additional screws40within secondary screw apertures250b-250din a sequential or other ordered manner such that the second bone plate200is secured to the second bone portion35(e.g., the acetabular surface C, FIG. A) of the patient. It will be understood by those of ordinary skill in the art that not all second screw apertures250b-250dneed have screws40inserted therein.

As shown inFIGS. 4 and 5E, the screws40are shown inserted through the plurality of secondary screw apertures250in the second bone plate200and into the second bone portion35. As can be appreciated in particular fromFIGS. 4 and 5E, the placement of screws40within the secondary screw apertures250can be at any number of insertion vectors deviating from the secondary central axis251and between insertion vectors252,253. The choice of the placement of screws40within the secondary screw apertures250is within the skill and judgment of the surgeon and may be dictated, generally, by the anatomy of the patient's pelvis A (FIG. A) in that the screws40are generally placed through the secondary screw apertures250in a manner to join pieces of fractured bone and/or gain sufficient purchase in the bone along the length of the screw40to hold the second bone plate200securely to the second bone portion35of the patient.

At least one of the tertiary fastening members400of the second bone plate200, as shown inFIGS. 4 and 5E, can be chosen by the surgeon to place a screw50for further securing the second bone plate200to the second bone portion35. Although this embodiment contemplates the insertion of the screw50through at least one of the tertiary screw apertures406, alternative embodiments contemplate that the surgeon may elect to forego inserting the screw50in any of the tertiary screw apertures406. In particular, the surgeon places the screw50in the tertiary screw aperture406generally along its tertiary central axis405such that a tip of a shaft of the screw50enters and moves through the screw head receiving volume147b, through the screw shaft receiving volume149a, and into contact with the second bone portion35. The surgeon continues to move the screw50along the tertiary central axis405such that the shaft of the screw50enters the second bone portion35. The screw50is further tightened by the surgeon such that threads of the screw50further enter the second bone portion35, thereby pulling the bone contact surface404adjacent the tertiary screw aperture406of the tertiary fastening member400into intimate and engaging contact with the second bone portion35.

When the bone contact surface404adjacent the tertiary screw aperture406is in such intimate and engaging contact with the second bone portion35, an outer surface of a head of the screw50is tightly disposed against the screw head support surface146bof the tertiary screw aperture406. As the tertiary screw aperture406have a variety of angles of approach for screw50to enter the second bone portion35(i.e., between tertiary insertion vectors407,409), the surgeon can select an angle of approach to the second bone portion35for placing the screw50through the tertiary screw apertures406and into the second bone portion35that is appropriate for the patient's anatomy (e.g., that best matches the access to the surgical site offered by the approach chosen by the surgeon), best reduces the fracture F of the patient, achieves the greatest purchase of bone across the length the screw40, and/or is a best compromise factoring all of the above-noted considerations.

For example, the surgeon can select an angle of approach of the screw50through the tertiary screw aperture406to the second bone portion35between tertiary insertion vectors407,409that allows the screw50to bridge two sides of a fracture line (such as fracture F) and thereby reduce the fracture by pulling portions of bone adjacent the fracture F toward one another. Additionally, the screw50can be of any size, shape, or material suitable for use in further attaching the second bone plate200to the second bone portion35and, in some cases, further reducing the fracture F within the acetabulum E of the pelvis A (FIG. A). The surgeon can thereafter insert additional screws50within other tertiary screw apertures406associated with the second bone plate200in a sequential or other ordered manner such that the second bone plate200is further secured to the second bone portion35(e.g., the acetabular surface C or other bone surfaces or prominences of the pelvis A, for example) of the patient. It will be understood by those of ordinary skill in the art that not all tertiary screw apertures406need have screws inserted therein as is shown specifically inFIG. 4. Again, it should be understood that a surgeon may choose to not insert screws through any of the screw apertures145, the secondary screw apertures250, and/or the tertiary screw apertures406.

Although the use of the bone plating system10hereinabove has been described with respect to insertion of screws30through the first bone plate100and, once complete, thereafter inserting screws40and the screws50through the second bone plate200, one of ordinary skill in the art would appreciate that a surgeon can take a step-wise approach of inserting screws30,40,50into the first bone plate100and the second bone plate200, respectively. For example, the surgeon can elect to insert the screws30,40,50in an alternating fashion of30-40-50-30-40-50until all the screw apertures145, secondary screw apertures250, and tertiary screw apertures406have screws30,40,50respectively inserted therethrough. Additionally, the surgeon can elect to insert screws30,40,50in any other pattern—for example, but not by way of limitation,30-40-40-50-30-30-30-40-50—in the surgeon's discretion. The surgeon may even elect to insert screws40or screws50prior to insertion of screws30. All of the foregoing is to illustrate that the manner and order in which screws30,40,50are inserted into the screw apertures145, the secondary screw apertures250, and tertiary screw apertures406should not be considered as limiting to the present disclosure. In particular and with reference toFIGS. 1A and 8, a preferred particular sequence for inserting screws30,40,50into the screw apertures145, the secondary screw apertures,250, the tertiary screw apertures406, and the securing port270would be as follows: (1)145k; (2)145a; (3)145b; (4)145i; (5)145j; (6)270a(and/or270b); and (7)400a. Once again with respect toFIG. 8, an alternative preferred particular sequence for inserting screws30,40,50into the screw apertures145, the secondary screw apertures,250, the tertiary screw apertures406, and the securing port270would be as follows: (1)145k; (2)400a; (3)145j; (4)145i; (5)145d; (6)145a; and (7)270a(and/or270b).

Once the surgeon has inserted a desired number of screws30,40, and50(which may be some number less than all of screws30,40, and50) or at some intermediate point during the insertion of screws30,40and50, a fastener271can be placed within the at least one securing port270and into the second bone portion35. An exemplary method for insertion of fastener271follows but the example should not be considered as limiting as to the order or sequence of steps. As an example, when (a) the first bone plate100is positioned adjacent to, in contact with, or along the first bone portion20of the patient with at least one screw30disposed through at least one of the screw apertures145, and (b) the second bone plate200is positioned adjacent to, in contact with, or along the second bone portion35of the patient with at least one screw40disposed through at least one of the secondary screw apertures250, a fastener271can be disposed through the bore290of the at least one securing port270and into at least a portion of the second bone portion35. When the fastener271is disposed through the bore290and into at least a portion of the second bone portion35, the head274of the fastener271engages the fastener head support surface300and applies a first force vector700(FIG. 2) generally along the fastener central axis276to the second bone plate200. In this manner, the first force vector700draws the second bone plate200further against the second bone portion35of the patient (and/or draws the first bone plate100against or further against the first bone portion20, and/or compresses fragments of the first or second bone portions20,35together) thereby further reducing the second bone portion35—in particular, the quadrilateral surface C—in a substantially fixed and surgically treated configuration.

The fastener271is generally disposed through the bore290of the at least one securing port270along the bore central axis292and into at least a portion of the second bone portion35. As the at least one securing port270has a variety of angles of approach for fastener271to enter and pass through the bore290and into at least a portion of the second bone portion35(i.e., between fastener insertion vectors294,296), the surgeon can select an angle of approach to the second bone portion35for placing the fastener271through the at least one securing port270and into the second bone portion35that is appropriate for the patient's anatomy (e.g., that best matches the access to the surgical site offered by the approach chosen by the surgeon), best reduces the fracture F of the patient, achieves the greatest purchase of bone across the length of the fastener271, and/or is a best compromise factoring all of the above-noted considerations.

For example, the surgeon can select an angle of approach of the fastener271through the bore290of the at least one securing port270to the second bone portion35between fastener insertion vectors294,296that allows the fastener271to bridge two sides of a fracture line (such as fracture F) and thereby reduce the fracture by pulling portions of the bone adjacent the fracture toward one another.

Additionally, the angle of approach of the fastener271through the bore290of the at least one securing port270can also be selected by the surgeon to gain as much purchase through the second bone portion35as possible and thereby provide additional stability and post-operative strength to the bone plating system10as shown inFIGS. 4 and 5E. Additionally, the fastener271can be of any size, shape, and material suitable for use in further attaching the second bone plate200to the second bone portion35and, in some cases, further reducing the fracture F within the acetabulum E of the pelvis A of the patient15. Further, although the fastener271is generally disclosed as being inserted through the bore290of the at least one securing port270after screws30,40,50have been inserted into the first bone portion20and the second bone portion35, respectively, the surgeon can decide to insert the fastener271through the bore290of the at least one securing port270at any point in time of the surgical procedure—i.e., before, after, or during the insertion of any of the screws30,40, and50. It is also contemplated that the surgeon may elect to forego inserting the fastener271altogether and/or elect to insert the fastener271before or after any of the insertion of screws30,40, and/or50.

While the invention(s) of the present disclosure has been illustrated and described in detail in the drawings and foregoing description, such illustration and description are to be considered illustrative or exemplary and not restrictive and it is not intended to limit the invention(s) of the present disclosure to the disclosed embodiments. The mere fact that certain measures are recited in mutually different dependent claims does not indicate that a combination of these measures cannot be used advantageously.