Intramedullary rod for fracture fixation of femoral shaft independent of ipsilateral femoral neck fracture fixation

A femoral intramedullary rod has a thin or reduced proximal segment so as to provide room for the use of femoral hip screws. Use of the rod for femoral shaft fixation permits subsequent independent treatment of an ipsilateral femoral hip fracture as an isolated injury, regardless of whether initially detected. Different rod embodiments are formed by the omission of different proximal portions of the rod. It is in such portions that the femoral screws may be placed to set hip fractures. The rod is cannulated for installation over a guide wire. Internal rod threads, below the thin proximal segment in some embodiments, are used for initial installation of the rod with a driving member screwed into such threads. Without driving forces on the thin proximal segment, such segment can be made even thinner. Once the rod is seated, hip screws may be installed if there is a detected hip fracture. Subsequent to healing, the femoral screws and interlocking screws (if any) may be removed. A hollow reamer sized for clearance over the intramedullary rod may be placed down over the top of the rod to cut away any bony tissue ingrown into the proximal end. Thereafter, the rod is extracted with a suitable extraction device.

BACKGROUND OF THE INVENTION 
The present invention relates in general to improved treatment for 
fractures of the femur and in particular concerns apparatus and 
methodology for the efficacious treatment of the highly problematic 
combination of a femoral shaft fracture with an ipsilateral femoral neck 
fracture (i.e., femoral hip region fracture). 
The femur or thigh bone is the largest and longest bone in the human 
skeleton. In general, it comprises two extremities connected by an 
elongated fairly cylindrical shaft. The upper or proximal extremity may be 
broadly regarded as constituting the hip region. 
Generally speaking, fracture injuries to the femoral shaft have been 
primarily treated (per current acceptable methods) with various 
intramedullary rods or nails. An intramedullary rod is an elongated member 
which is introduced to and resides in the marrow of the femur for the 
purpose of stabilizing the fractured femoral shaft. It is desired that 
stabilization take place in conjunction with anatomic reduction (i.e., 
proper reorientation of fractured elements to their original position, 
both relative to one another and relative to other adjacent anatomical 
features). As well known to those of ordinary skill in the art, 
installation of intramedullary rods often involves passage through the 
upper extremity or hip region, and in fact results in the proximal end of 
the rod occupying a significant portion of the hip portion of the femur. 
It is possible to sustain fracture injuries not only to the femoral shaft, 
but also to one or both of the femoral extremities. Of particular present 
concern is the occurrence of a fracture to the upper extremity, 
particularly to the head or neck regions of the femur. The primary problem 
addressed by this invention occurs whenever a femoral neck fracture (or 
any femoral hip region fracture generally) occurs at the same time and in 
the same femur (ipsilateral fractures) as a femoral shaft fracture. A 
straightforward problem arises from the fact that the standard presently 
acceptable treatment for femoral neck fractures primarily involves the use 
of bone screws which are introduced (at various angles and locations) to 
the femoral hip region. Thus, there exists literally a physical 
interference between the standard intramedullary rod provided for treating 
a femoral shaft fracture and the standard bone screws provided for 
treating a femoral hip region injury. Less apparent but just as serious 
problems and complications also arise due to the practicalities of 
installation procedures accompanying the use of such two standard 
techniques. 
Therefore, a major problem exists in instances of ipsilateral femoral shaft 
and hip fractures in that the standard acceptable treatments for 
respective femoral shaft and hip fractures are substantially mutually 
exclusive. At present, there is no standard accepted treatment method for 
ipsilateral femoral shaft and hip fractures, despite the availability of 
numerous different approaches. In some instances, the treating doctors 
even choose to forgo treatment of the shaft fracture until at least 
partial recuperation of the hip fracture, since highly precise fracture 
reduction is not as critical in the femoral shaft as it is in the hip. In 
other words, if the doctor thinks in a given situation that he cannot 
"fix" both problems in an ipsilateral fracture case, he or she may risk 
potential negative consequences of poor shaft fracture healing (e.g., limp 
or discomfort from shortened leg or misalignment) versus potential 
negative consequences of poor hip fracture healing (e.g., artificial hip 
replacement surgery). 
The difficulties of the central problem may be better comprehended with a 
more detailed understanding of the anatomical considerations and of 
exemplary prior treatment approaches and drawbacks. The following very 
briefly outlines pertinent anatomical terminology with reference to 
present FIG. 1. FIG. 1 illustrates a generally anterior (front) surface 
view of a right human femur generally 20. Femur 20 is comprised of an 
inferior or distal extremity generally 22, a superior or proximal 
extremity generally 24, and an elongated generally cylindrical shaft 26 
connecting the two opposing extremities. In the anterior view of present 
FIG. 1, the medial side of femur 20 is generally the right-hand 
illustrated side while the lateral side thereof is generally the left-hand 
illustrated side in the view. 
The superior extremity generally 24 includes a number of separately 
recognizable features of present interest, including a head generally 28, 
a neck region generally 30, and greater and lesser trochanters generally 
32 and 34, respectively. The greater trochanter is a relatively large and 
somewhat irregular eminence located above the top of the shaft and towards 
the lateral side of the neck, while the lesser trochanter constitutes a 
somewhat smaller (but of variable size in different patients) projection 
from the relatively lower and posterior (back) side of the femoral neck. 
Generally speaking, the "hip" may be regarded as comprising the features 
proximal to (i.e., above) the lesser trochanter 34. 
Though not shown in detail in the illustration of present FIG. 1, a slight 
surface crest extends anteriorly and posteriorly between the trochanters 
32 and 34. Also, an imaginary line or plane extending between the greater 
and lesser trochanters is referred to as the intertrochanteric line. 
Fractures can occur in may varieties in the hip. Generally speaking, 
fractures occurring between the intertrochanteric line and the head 28 are 
referred to as neck fractures. An intertrochanteric fracture is one 
generally in alignment with the intertrochanteric line, while a 
pertrochanteric fracture is one which resides at least in part in the neck 
region but which crosses the intertrochanteric line. A subtrochanteric 
fracture is still in the hip but at least partly below the 
intertrochanteric line. 
Fracture patterns are the subject of much study and analysis. For example, 
one classification system referred to as Pauwels' classification grades 
femoral neck fractures into three types, depending on the angle the 
fracture forms with an imaginary horizontal plane resting across the 
extreme proximal end of the femur. Determination of such classification in 
a given instance (such as from x-rays or the like) helps the treating 
physician determine the desired positioning of femoral neck screws for 
treatment of the fracture. Generally speaking, greater strength is 
established whenever the screws normally address (i.e., are perpendicular 
to) the fracture line. Hence, the nature of the hip fracture can dictate 
the desired (or required) positioning of screws in the hip region, which 
indicated positions can be in conflict with the needed placement or 
effective space requirements of a standard intramedullary rod for treating 
an accompanying shaft fracture. 
Also, a lateral view x-ray is virtually required to insure satisfactory 
anatomical reduction of a femoral neck fracture. However, many of the 
currently available shaft nail systems incorporate structures, such as a 
lateral fixation plate or similar, which literally would block the 
necessary x-ray view. See, for example, U.S. Pat. No. 4,506,662 issued to 
Anapliotis, and illustrating an exemplary attachment plate 40 in FIG. 4 
thereof. FIG. 2b of such '662 patent also illustrates a technique referred 
to as "bundle" nailing, which can literally block out (or fill) an entire 
hip region to the exclusion of femoral screws needed for treatment of a 
femoral hip fracture. 
Femoral shaft fractures are likewise the subject of much study and 
analysis, and can be variously classified. One accepted system is referred 
to as the Winquist-Hansen Comminution Scale, which focuses attention on 
the cortical damage to the femur. The femur is comprised of cortical bone, 
which is the dense rim of bone forming portions such as the annular 
portion of the shaft, and of marrow, which is the soft bone tissue 
received in the internal cavity defined by the cortical bone. On the 
Winquist-Hansen scale, a first type injury involves a fracture (i.e., 
break) to cortical bone in the shaft. The next higher level injury 
involves some loss (through absence, crushing, pulverizing, or other 
destructive effects) of the cortical bone, but less than fifty percent 
loss in a given region. The next higher type of fracture involves the same 
damage characteristics as above, but with greater than fifty percent 
cortical bone loss in a given region. The next higher type of injury 
involves trauma to such an extent that there is no remaining cortical bone 
contact in a given region. The highest type of injury on the communition 
scale involves actual segmental bone loss. 
The importance in understanding the above-described progressive degrees of 
injury which can result from trauma to the femur arises from understanding 
the corresponding conventional treatments thereof. Generally speaking, the 
goal of any fracture treatment is to provide a stable and complete 
anatomic reduction (i.e., "setting") of the fracture. 
As the nature of a fracture is progressively more severe, as described 
above, the treatment approaches become more complex and more difficult to 
administer. For example, one of the more simple approaches to treatment of 
femoral shaft injuries involves the use of relatively smaller diameter, or 
in some instances, even flexible, intramedullary rods. A smaller diameter 
rod is typically less strong but may avoid the need to literally ream 
(i.e., cut) out a channel inside the femur for insertion of the rod. 
Sometimes, an anatomic reduction of adequate mechanical stability can be 
achieved through the introduction of a guide wire or similar in the top of 
the shaft and down through the bone marrow, followed by introduction of a 
cannulated (i.e., hollow) femoral nail or rod over the top of the guide 
wire. However, an inadequate biomechanically stable fixation pattern can 
result in various complications, such as non-union or malunion, or even 
shortening and malrotation. In worst case complications, there can be 
osteonecrosis (tissue death). Even in younger patients, such events can 
lead to the need for hip replacement surgery (highly undesirable for any 
patient, but regarded especially as potentially devastating to younger 
patients). 
To satisfy reduction and stability needs, femoral shaft injuries, 
particularly those of greater severity, often entail treatment with larger 
diameter or more stiff femoral nails, which can involve reaming techniques 
for placement of the nail. Such techniques literally involve reaming out 
part of the femur interior to be followed by installation of the nail. In 
many instances, so-called second generation or reconstruction nails 
("recon" nails) are utilized, which typically involves interlocking steps 
of inserting screws through the leg and femur into holes in the nail to 
secure the position of both the femur and the nail. Special targeting 
devices, assistants, and experience can be required for blindly seating 
interlocking screws inside of a femur. 
In some patients, the use of intramedullary nails in an unreamed femur may 
be adequate for the treatment of inherently stable fractures, but the use 
of intramedullary nails in a reamed femur and/or the use of interlocking 
femoral nails are standard treatments for more severe injuries. A readily 
apparent drawback of such technique, however, relates to the installation 
process, being both costly in terms of the required special instruments, 
and for the personnel who must have special surgical training, and 
additional assistants. Since worser or worst case traumas typically occur 
less frequently, doctors tend to have (and can expect to have) generally 
less experience with the more severe situations. Such fact only compounds 
the difficulty of, for example, night time emergency room treatment of 
ipsilateral femoral fractures. 
It has been reported that as many as 2.5 percent to 5 percent of femoral 
shaft fractures occur in combination with (i.e., ipsilaterally) with 
femoral hip fractures. Moreover, such combination fractures most often 
occur as a result of high energy trauma. The above description of standard 
treatments of more progressive fracture types (i.e., most likely occurring 
due to relatively higher energy trauma) provides a background for 
understanding the considerable difficulty of treating ipsilateral 
fractures. High energy trauma to the thigh region can occur in a variety 
of ways, such as due to high speed motorcycle accidents, car accidents, or 
falls from a relative height. 
One exemplary analysis of high energy trauma leading to ipsilateral femoral 
fractures is as follows. The energy or force from a given traumatic impact 
must be dissipated somewhere or somehow. Very frequently, such dissipation 
takes the form of a fracture (i.e., break) in the femoral shaft, typically 
medial or distal thereto. If excess energy exists after partial 
dissipation through a femoral shaft fracture, then further energy 
dissipation must take place. 
The femur or thigh is in an adducted position whenever the legs are close 
together and generally aligned with the trunk of the body. The femoral 
head resides in and articulates in the acetabulum. Whenever the femur is 
in such adducted position, excess energy dissipation often results in the 
hip being dislocated by escaping from the acetabulum. However, if the 
femur is in an abducted position (i.e., with the leg turned out or open, 
such as a rider on a motorcycle), the hip region of the femur cannot 
escape from the acetabulum and therefore must absorb the excess energy to 
be dissipated. Such events can result in one of the various hip fractures 
as described above, such as a neck fracture, intertrochanteric fracture, 
or other. 
Other traumatic events can cause ipsilateral fractures "in reverse," (i e 
with the femoral hip fracturing before the femoral shaft. Resulting 
treatment complications are roughly the same, regardless of the 
originating trauma. 
A generally accepted treatment for stabilizing femoral neck fractures is 
the use of multiple lag screws, such as in a triangular or some other 
deliberate pattern designed to gain needed fixation stability. However, 
reports indicate that as many as one third of the femoral neck fractures 
may be missed from an initial diagnosis. This means that a standard 
intramedullary nail may have already been used to fix a femoral shaft 
fracture, and therefore occupies the space in the hip within which the 
multiple lag screws should be inserted. Such an occurrence results in 
attempted placement around the prepositioned nail, but such approach can 
lead to inadequate mechanical stability for the femoral neck fracture. If, 
for example, Ender nails are utilized (nails which are placed upwardly 
through the distal end of the femur; see, for example, U.S. Pat. No. 
4,055,172 issued to Ender et al.), there may be an inadequate and unstable 
anatomic reduction of the femoral shaft fracture. Therefore, no 
satisfactory standard treatment exists for treatment of the ipsilateral 
shaft and hip fractures as described above. 
Traumatic injury of sufficiently high energy to cause ipsilateral femoral 
shaft and hip injuries may well result in multiple injuries or compound 
trauma to the patient. Significantly, pertinent literature analyzing and 
advocating various treatments of trauma patients has revealed handling of 
femoral fractures (i.e., stabilization thereof) to be an integral part of 
the overall resuscitation of such a trauma victim. Early stabilization of 
femoral fracture conditions has been shown to decrease the incidences of 
acute respiratory distress syndrome and death. Hence, there is potentially 
a great deal at stake whenever treatment standards have heretofore been 
generally unable to address particular fracture patterns (i.e.., 
ipsilateral femoral shaft and hip fractures) occurring most typically in 
trauma victims of the type most likely to also have other trauma related 
complications (i.e., multiple or compound injuries). Given such facts, it 
should be all the more apparent that treatments which involve time 
consuming, complex, or unfamiliar skill specific procedures are all the 
more contraindicated. 
The patent literature describes different attempts at treating various 
femoral fractures, and thus provides additional background in this area. 
Further examples of such patents are: 
______________________________________ 
U.S. Pat. No. 
INVENTOR ISSUE DATE 
______________________________________ 
2,761,444 Luck September 4, 1956 
4,705,027 Klaue November 10, 1987 
4,817,591 Klaue April 4, 1989 
4,846,162 Meohring July 11, 1989 
4,865,025 Buzzi et al. September 12, 1989 
4,877,019 Vives October 31, 1989 
4,988,350 Herzberg January 29, 1991 
______________________________________ 
The disclosures of all the above-listed and above-referenced U.S. Patents 
are fully incorporated herein by reference. 
SUMMARY OF THE INVENTION 
The present invention recognizes and addresses various of the foregoing 
drawbacks and shortcomings, and others, concerning treatment of femoral 
fractures, particularly ipsilateral femoral shaft and hip fractures. Thus, 
broadly speaking, a principal object of this invention is improved 
treatment of ipsilateral femoral hip and shaft fractures. More 
particularly, a main concern is providing an efficacious treatment for 
such ipsilateral femoral fractures, adequate to provide a standard method 
of treatment for such difficult fracture patterns, which technology is 
presently generally lacking. 
It is another more particular object of the present invention to provide a 
standard method of treatment for ipsilateral fracture patterns which is 
not overly technically demanding on the treating physician, thereby 
improving the quality of practice and broadening the availability of the 
treatment. 
Still a further more particular object is to provide methodology and 
apparatus for a successful and an acceptable treatment approach for the 
above-described ipsilateral fracture patterns. More specifically, an 
object is to provide for adequate biomechanically stable hip and shaft 
fracture fixation, even whenever accompanied by significant femoral shaft 
comminution. 
It is another more general object of the subject invention to provide an 
apparatus in the form of a new intramedullary rod design which results in 
adequate apparatus and corresponding methodology for the treatment of 
ipsilateral femoral hip and shaft fractures while addressing the foregoing 
various concerns and others of inadequate or inferior performance of 
currently available fracture treatments and techniques. More specifically, 
it is desired to provide a femoral intramedullary rod which has a 
specialized proximal segment of unique design such that, when installed in 
the femur, adequate space is still afforded for the use and presence of 
multiple bone screws. Such advantageous approach in accordance with 
practice of the subject invention, treatment of a femoral hip or neck 
fracture is rendered completely independent from the treatment of a shaft 
fracture, resulting in an idealized treatment approach for the physician. 
Further, it is an object to make use of a new intramedullary rod design in 
accordance with this invention having such capabilities as to permit a 
treating physician or surgeon to utilize or rely on otherwise familiar 
techniques (generally speaking) for installation of such rod for femoral 
shaft fixation, while subsequently independently treating the femoral neck 
fracture by the use of multiple hip screws as if it were an isolated or 
separate injury. With such apparatus and through such treatment 
methodology, it is an object to permit later treatment of any femoral neck 
or otherwise hip located fracture which may be missed or otherwise omitted 
during initial assessment. 
It is another present object to provide an improved intramedullary rod 
having a variously notched proximal segment to receive hip screws in such 
notched portions thereof for improved biomechanically stable fixation 
patterns for a femoral hip fracture while the seated rod addresses an 
existing ipsilateral femoral shaft fracture. It is a more particular 
object to provide such improved rod in specific embodiments for use with 
interlocking screws and without. 
Still further objects of the present invention relate to providing 
accompanying installation and subsequent withdrawal apparatus and 
methodology for use with an intramedullary rod of the new design disclosed 
herewith. 
Additional objects and advantages of the invention are set forth in, or 
will be apparent to those of ordinary skill in the art from, the detailed 
description which follows. Also, it should be further appreciated that 
modifications and variations to the specifically illustrated and discussed 
features, materials, and steps hereof may be practiced in various 
embodiments and uses of this invention without departing from the spirit 
and scope thereof, by virtue of present reference thereto. Such variations 
may include, but are not limited to, substitution of equivalent means and 
features, materials, or steps for those shown or discussed, and the 
functional or positional reversal of various parts, features, steps, or 
the like. 
Still further, it is to be understood that different embodiments, as well 
as different presently preferred embodiments, of this invention may 
include various combinations or configurations of presently disclosed 
features, elements, steps, or their equivalents (including combinations of 
features or steps or configurations thereof not expressly shown in the 
figures or stated in the detailed description). One exemplary such 
embodiment of the present invention relates to a femoral intramedullary 
rod for the biomechanically stable anatomic reduction of a femoral shaft 
fracture while facilitating the independent treatment of an ipsilateral 
femoral hip fracture. 
Such foregoing intramedullary rod preferably comprises an elongated 
cannulated shaft and a relatively short proximal cannulated shaft segment. 
More specifically, the shaft has a tip end for being seated in a femoral 
shaft with the tip end introduced in a relatively distal direction through 
the proximal extremity of a receiving fractured femur. The shaft segment 
is associated in axial alignment with the elongated rod shaft proximal 
thereto and opposite to the shaft tip end, for residing generally in a 
femoral hip region whenever the rod shaft is situated in a receiving 
femoral shaft. Such proximal shaft segment further preferably includes 
connection means for selectively interconnecting with drive components and 
extraction components for alternate installation and withdrawal, 
respectively, of the rod relative to a receiving femur, and the proximal 
shaft segment still further includes a relatively reduced cross-sectional 
area region forming a femoral hip screw passageway therethrough, so that 
femoral hip screws may be independently introduced into a femoral hip 
region for the treatment of fractures therein. 
Another present exemplary embodiment concerns an intramedullary rod for the 
treatment of ipsilateral femoral hip and shaft fractures, comprising an 
elongated shaft with a relatively thin proximal segment for receipt of 
such segment in a femoral hip region with the shaft distal thereto so that 
space is provided for the independent introduction of at least one femoral 
hip screw relatively adjacent such segment. 
Yet another construction comprising a present exemplary embodiment includes 
a treatment system for ipsilateral fracture patterns of the femoral hip 
and shaft, such system including a cannulated femoral intramedullary rod, 
driving means, a plurality of interlocking screws, interlocking screw 
guide means, and at least one femoral hip screw. In the foregoing 
exemplary system embodiment, the intramedullary rod preferably has a 
tapered distal end, an intermediate elongated shaft, a reduced 
cross-sectional area proximal end defining a passageway therethrough for 
femoral hip screws, at least one relatively distal interlocking screw 
hole, at least one relatively proximal interlocking screw hole, internal 
diameter proximal end connection thread means for the attachment of 
further components thereto, and registration means formed in such proximal 
end for guiding the positioning of further components relative to said 
rod; 
The foregoing exemplary driving means may be removably operatively 
associated with the rod proximal end connection thread means, for 
selectively driving the intramedullary rod to a desired predetermined 
depth into a receiving fractured femur, with the rod proximal end received 
in the femoral hip region with the rod shaft distal thereto. 
The plurality of interlocking screws are for receipt thereof in the 
interlocking screw holes. The interlocking screw guide means may be 
removably operatively associated with the rod proximal end connection 
thread means and the rod proximal end registration means, for aligning at 
least one of such interlocking screws for seating thereof in the at least 
one relatively proximal interlocking screw hole. The at least one femoral 
hip screw is provided for selected seating thereof through the rod 
proximal end passageway into the hip region of the receiving femur for 
stable anatomic reduction of a femoral hip fracture therein. 
Various present embodiments also relate to corresponding treatment methods 
involving the present apparatuses. One exemplary such method relates to a 
method of treatment for ipsilateral femoral hip and shaft fractures, 
comprising providing an intramedullary rod having an elongated shaft with 
a relatively thin proximal segment; and seating such intramedullary rod in 
a fractured femur with the elongated shaft situated in the femoral shaft 
for treatment of a fracture therein, and with the relatively thin proximal 
segment situated in the femoral hip region. With such arrangement, space 
is provided for the subsequent independent introduction of at least one 
femoral hip screw relatively adjacent the rod proximal segment. 
A further exemplary method of the invention is as set forth in the 
foregoing method, and further including the step of independently 
introducing at least one femoral hip screw relatively adjacent the rod 
proximal segment for treatment of a fracture in the femoral hip region. 
Another exemplary present method concerns a treatment method for 
ipsilateral fracture patterns of the femoral hip and shaft, such method 
including the steps of providing a cannulated femoral intramedullary rod, 
having a tapered distal end, an intermediate elongated shaft, a reduced 
cross-sectional area proximal end defining a passageway therethrough for 
femoral hip screws, at least one relatively distal interlocking screw 
hole, at least one relatively proximal interlocking screw hole, internal 
diameter proximal end connection thread means for the attachment of 
further components thereto, and registration means formed in the proximal 
end for guiding the positioning of further components relative to such 
rod; providing rod driving means and removably operatively associating 
such driving means with the rod proximal end connection thread means; 
using the driving means for selectively driving the intramedullary rod to 
a desired predetermined depth into a receiving fractured femur, with such 
rod proximal end received in the femoral hip region with the rod shaft 
distal thereto for stable anatomic reduction of a femoral shaft fracture 
in the receiving femur; providing a plurality of interlocking screws for 
receipt thereof in the interlocking screw holes; providing interlocking 
screw guide means and removably operatively associating such guide means 
with the rod proximal end connection thread means and the rod proximal end 
registration means; using the guide means for aligning at least one of the 
interlocking screws for seating thereof in said at least one relatively 
proximal interlocking screw hole, and seating such screw in such proximal 
screw hole to further stabilize a femoral shaft fracture of the receiving 
femur; and providing at least one femoral hip screw and selectively 
seating such hip screw through the rod proximal end passageway into the 
hip region of the receiving femur for stable anatomic reduction of a 
femoral hip fracture therein. 
Still further present embodiments concern additional improved devices for 
supporting use of present femoral intramedullary rods (as well as other 
forms of intramedullary rods). One such exemplary embodiment concerns an 
interlocking screw hole targeting apparatus for use with a femoral 
intramedullary rod of the type having a central longitudinal axis, 
proximal end connection means for securement of a further device thereto, 
proximal end registration means for alignment of a further device relative 
thereto, and at least one relatively proximal interlocking screw hole 
situated at a predetermined distance distal to the registration means, 
such targeting apparatus comprising rotational position control arm means, 
securement means, selectively operable clamping means, and targeting arm 
means. 
The foregoing control arm means may be removably operatively associated 
with the rod proximal end registration means and operative for extending 
generally laterally therefrom in rotational alignment with the rod 
relatively proximal interlocking screw hole. The securement means are for 
removably securing such control arm means to the proximal end connection 
means of the intramedullary rod. 
The foregoing exemplary selectively operable clamping means are movably 
supported on the lateral extension of the rotational position control arm 
means, for selectively clamping thereon at a selected distance radially 
outward from the central longitudinal axis of the intramedullary rod. The 
targeting arm means are secured to such clamping means for movement 
therewith and extending therebelow for parallel alignment thereby with the 
central longitudinal axis of the intramedullary rod, such targeting arm 
means having at least one interlocking screw target hole located a 
predetermined distance distal to the clamping means such as to align with 
the intramedullary rod screw hole. With practice of the foregoing 
arrangement, the intramedullary rod screw hole may be targeted for 
drilling through the femur and securing an interlocking screw in such 
intramedullary rod screw hole. 
Those of ordinary skill in the art will better appreciate the features and 
aspects of such embodiments, methods, and others, upon review of the 
remainder of the specification.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
The following description sets forth numerous details both as to structural 
embodiments in accordance with the subject invention and present 
methodology. However, those of ordinary skill in the art will appreciate 
various broader aspects to the subject invention, taken from the following 
detailed description thereof, and which aspects are not expressly limited 
to the precise embodiments illustrated herewith or discussed herein. The 
present invention is intended to encompass all such variations, 
modifications, and the like as would be understood by those of ordinary 
skill in the art from the following. 
Broadly speaking, present FIGS. 1-4 (including FIGS. 4A-4G) illustrate a 
first exemplary embodiment of an intramedullary rod in accordance with the 
subject invention. More specifically, FIGS. 1-3 illustrate one preferred 
installation of such rod in the femur generally 20 of a given patient. The 
anatomy of femur 20 is discussed in some detail in the Background portion 
of this specification, and familiarity with such discussion will be 
hereafter presumed. 
FIG. 1 is a generally anterior somewhat isometric view of a right femur 20 
of the human skeleton, with an exemplary first embodiment of an 
intramedullary rod generally 36 in accordance with the subject invention 
illustrated in dotted line therein (FIGS. 1 and 3). FIG. 2 is a top view 
of the FIG. 1 illustration, as seen from the view line 2--2 indicated 
therein. FIG. 3 is a fully anterior view of the illustration of FIG. 1, as 
seen from the view line 3--3 indicated therein. 
FIGS. 4A, 4B, and 4C, illustrate respectively a side view (looking in the 
medial direction of the human skeleton right femur), an anterior view, and 
a posterior view of the first embodiment generally 36 of an exemplary 
intramedullary rod in accordance with the subject invention. As shown, rod 
36 primarily comprises an elongated shaft 38 having a relatively thin 
proximal segment generally 40, which segment 40 is situated so as to be 
received in a femoral hip region with the shaft 38 distal thereto. As a 
result, space is provided in the femoral hip region for the independent 
introduction of femoral hip screws, such as exemplary screws 42, 44, and 
46. Such hip screws are well known to those of ordinary skill in the art, 
without additional detailed description. In addition, particular details 
of such screws form no particular aspects of the subject invention, other 
than their useful combination with present embodiments of intramedullary 
rods and present methodology incorporating same and such femoral hip 
screws. Also, implantation rods, screws, and the like are typically formed 
of stainless steel or similar, all of which is well known to those of 
ordinary skill without further discussion. 
FIGS. 1 through 3 very clearly illustrate the considerable advantage of the 
present invention, which is to permit the independent use of femoral hip 
screws for treatment of an ipsilateral femoral hip (or neck) fracture in 
combination with use of an intramedullary rod for treatment of a femoral 
shaft fracture. FIGS. 1 and 3 illustrate in dotted line and in partial 
cutaway (FIG. 1) the placement of rod 36 into femur 20 via an enlarged 
opening such as 48 formed in the proximal end 24 of such femur. For the 
sake of clarity, exemplary fracture patterns are primarily discussed in 
the Background of the subject specification, rather than illustrated 
throughout the figures. However, representative fracture line 50 of 
present FIG. 3 illustrates a femoral shaft fracture in an approximately 
medial shaft position, while representative fracture line 52 (FIGS. 1 and 
2) illustrates an exemplary femoral hip region fracture. More 
specifically, hip fracture 52 is generally transverse across the neck 
region 30. 
FIGS. 1 through 3 provide a very clear illustration of utilizating present 
exemplary femoral intramedullary rod 36 for the biomechanically stable 
anatomic reduction of the femoral shaft fracture 50 while facilitating the 
independent treatment of the ipsilateral femoral hip fracture 52 (through 
the use of hip screws 42, 44, and 46). Various hip screw patterns may be 
practiced in accordance with the subject invention. The representative 
triangular pattern of three screws at different placements and angles is 
one example of a particularly strong and stable arrangement. Other known 
arrangements of multiple lag screws or the like may be practiced in 
conjunction with the subject invention. 
FIG. 2 in particular illustrates the femoral hip screw passageway 
advantageously provided in the proximal shaft segment generally 40 by the 
use of a relatively reduced cross-sectional area region 54. As best seen 
in FIGS. 1, 5a, and 5b in a preferred embodiment the passageway is defined 
through at least a 180 degrees of the circumference of the proximal shaft 
segment at least up to the longitudinal centerline of the shaft segment 
and elongated in the longitudinal direction which allows for independent 
and variable positioning of the hip screws through an angular range 
defined by the elongated passageway. In the illustrated example of present 
FIGS. 1 through 4, such region is situated in a relatively posterior 
position relative to the receiving femur 20, which means that the femoral 
hip screw passageway established thereby resides in a generally anterior 
position relative to such femur. Further embodiments of the subject 
invention as discussed disclose the structural arrangements for 
accommodating still further femoral hip screw placements. 
As discussed in the Background of the specification, the location and 
nature of the hip fracture to be treated can substantially dictate the 
desired location or placement for hip pins, as well as the number of hip 
pins or screws to be used. The anterior position of the hip pins 
illustrated in present FIGS. 1 through 3 is one very typical (i.e., 
frequently encountered) placement. However, such placement would 
completely interfere with a conventional intramedullary rod having a 
substantially larger or solid proximal region with no femoral hip screw 
passageway formed therethrough. The passageway established through 
practice of the subject invention is entirely different from interlocking 
screw holes as utilized in some reconstructive type intramedullary rods, 
which holes have a preset location and angle (such as towards the hip), 
and which rods have the difficulty of targeting and penetrating the holes 
with the hip screws, while also properly seating the screws in relation to 
the hip fracture. 
Present FIGS. 1 through 4 illustrate additional exemplary aspects of the 
subject invention aside from the femoral hip screw passageway provided 
thereby. For example, the full length of rod 36 may be cannulated (i.e., 
hollow), so as to define an inside diameter 56 along its length. With such 
arrangement, intramedullary rod 36 is useful with a guide wire, well known 
to those of ordinary skill in the art for establishing an initial pathway 
for either insertion of an intramedullary rod or a reaming device to 
further prepare for insertion of a rod. Reaming techniques are likewise 
known to those of ordinary skill in the art, without discussion of 
additional details herewith. 
Another feature which may be practiced is the use of a tapered tip end 
generally 58 by which rod 36 is further aided in penetration of the 
medullary canal generally 60 of femur 20. The use of larger or stiffer 
nails, particularly when involving reaming operations, can include some 
degree of reaming of cortical bone 62 (the generally harder or dense rim 
of bone annularly along the length of femur shaft 26). 
FIGS. 1 through 4 further illustrate optional use of interlocking screw 
holes, by which an intramedullary rod may further anatomically reduce 
and/or stabilize a fractured femur. While different numbers and placements 
of such interlocking screw holes may be practiced in various embodiments, 
the present exemplary embodiment 36 illustrates a pair of relatively 
proximal interlocking screw holes 64 and 66 located respective 
predetermined distal distances from proximal end 68 of rod 36. Devices in 
accordance with the subject invention for targeting such relatively 
proximal interlocking screw holes 64 and 66 are discussed in greater 
detail below, such as with reference to present FIGS. 13 through 15. 
Similarly, relatively distal interlocking screw holes represented by holes 
70 and 72 may be provided, likewise at known or predetermined distal 
distances from proximal end 68 of rod 36. Present FIG. 3 also represents 
practice of the present invention without use of interlocking screw holes. 
FIGS. 1 through 4 represent another feature which may be optionally 
practiced, which is that the proximal region generally 40 of rod 36 may 
have a relatively larger outside diameter than the remainder of the rod, 
particularly the elongated shaft 38 thereof. In larger rods, such as 12 to 
13 millimeters outside diameter or larger, a single outside diameter may 
be practiced. However, with smaller outside diameters for the elongated 
shaft, the slightly larger outside diameter proximal shaft segment 40 
helps to accommodate additional features of the subject invention 
preferably being practiced herewith. 
FIGS. 4D and 4E particularly illustrate some of the above-referenced 
attributes of the subject invention in the area of proximal shaft segment 
generally 40 thereof. Generally speaking, by way of clarification, such 
proximal shaft segment 40 comprises all portions of rod 36 proximal to the 
enlarged diameter point approximately 74. The elongated shaft 38 comprises 
all portions of rod 36 distal to such outside diameter change point 74. 
The same approximate location in other embodiments constitutes the break 
point between the elongated shaft and the proximal shaft segment, 
regardless of whether any change in outside diameter takes place. 
More specifically, FIGS. 4D and 4E respectively illustrate (in enlargement) 
the proximal end region 40 of an anterior view and a side view (looking in 
the medial direction of the human skeletal right femur) of the first 
exemplary embodiment 36 of present FIGS. 1 through 4. 
While the drawings are not intended as being precisely drawn to scale, they 
do reflect preferred relative relationships and dimensions among the 
variously illustrated exemplary components. For example, in an exemplary 
rod 36, the overall length thereof from distal tip end 58 to proximal end 
68 thereof may be about 400 millimeters. In such embodiment, the distance 
from the most proximal interlocking screw hole 64 to the proximal end 68 
may be about 70 millimeters in one preferred embodiment. As represented 
particularly in present FIG. 3, such an arrangement (and proper seating 
thereof) results in proximal shaft segment 40 covering (i.e., occupying) 
substantially all of the femoral hip region (i.e., all portions of the 
femur even with and proximal to the lesser trochanter generally 34). With 
such an arrangement, a considerable femoral hip screw passageway generally 
76 (see FIG. 4E) is provided. Those of ordinary skill in the art will 
appreciate and understand that even embodiments of rod 36 may have 
different specific dimensional characteristics. For example, the overall 
length of rod 36 may generally fall in a range of from about 300 
millimeters to about 500 millimeters, and even fall outside such range for 
specific embodiments (if necessary to meet a given patient's needs). 
Enlarged views of present FIGS. 4D and 4E represent still further present 
features which may be practiced in accordance with given embodiments of 
the subject invention. For example, FIG. 4D provides a partial cutaway 
view adjacent proximal end 68, which represents connection means generally 
78 for selectively interconnecting rod 36 with drive components and 
extraction components for alternate installation and withdrawal, 
respectively, of rod 36 relative to a receiving femur 20. More 
particularly, such connection means 78 may comprise internal diameter 
threads generally 80 formed in at least a portion of the proximal 
cannulated shaft segment 40. As represented in present FIG. 4D, such 
threads are formed on the proximal side of the relatively reduced region 
54 of rod 36. In such an arrangement, whenever a driving means is coupled 
with connection means 78, axial rod installation forces may be transmitted 
through the relatively reduced cross-sectional area region 54. Likewise, 
axial withdrawal of rod 36 may be obtained through connection of a 
withdrawal device with connection means 78. 
FIG. 4E more particularly illustrates registration means generally 82 which 
may be associated with proximal end 68 of rod 36, and by which the 
rotational alignment of rod 36, and hence of the interlocking screw holes 
64, 66, 70, and 72 thereof, may be determined, with use of proper 
instrumentation (such as that presently disclosed herewith in accordance 
with the subject invention). More specifically, a transverse notch 84 may 
be provided in proximal end 68, and have a predetermined rotational 
relationship with reference to the interlocking screw holes, so that 
location of notch 84 determines (in part) the location of such screw 
holes. The remaining information necessary to determine the location of 
such screw holes may be provided in the form of respective predetermined 
distal distances of such screw holes from proximal end 68, as referenced 
above. 
FIG. 4F illustrates a top view of the exemplary embodiment of present FIG. 
4E, as seen from the view line 4F--4F indicated therein. Hence, such top 
view FIG. 4F more fully illustrates both the annular nature of an 
exemplary cannulated rod and the substantially two part nature of slot 84 
across proximal end 68. Utilizing solid line and dotted line 
illustrations, various outside and inside diameters of the first exemplary 
embodiment of rod 36 are represented. Generally speaking, the outside 
diameter 86 of proximal shaft segment generally 40 may fall generally in a 
range of from about 10 millimeters to about 16 millimeters, and in the 
lower aspects of such range generally has a slightly larger outside 
diameter than that of the elongated shaft 38. The slightly smaller outside 
diameter of such shaft 38 is represented by the dotted line circle 88. 
Dotted line 90 represents the inside diameter of the elongated shaft 38. 
See also FIGS. 4D and 4E. As represented in such FIGS. 4D and 4E, the 
inside diameter 92 throughout much of the proximal shaft segment 40 is the 
smallest inside diameter in rod 36. As a result, a relative shoulder 94 is 
formed at the intersection with threaded proximal inside diameter 96. Such 
shoulder 94 further aids in providing suitable connection means 78 for 
receipt of axial installation forces. 
In one exemplary embodiment having, for example, an outside proximal 
segment diameter 86 of 14 millimeters, the inside diameter 92 may be about 
5 millimeters, while the threaded portion inside diameter 96 is centered 
on 10 millimeters. In such embodiment, the inside diameter 90 of elongated 
shaft 38 may be enlarged from diameter 92 to about 9 millimeters, while 
the outside diameter of elongated shaft 38 may be about 12 millimeters. 
Other specific dimensions may be practiced, as well as other relative 
relationships between the respective diameters. 
The figures, particularly FIGS. 4D and 4E, further represent that, in a 
cannulated embodiment, the relatively reduced cross-sectional area 54 is 
generally constant throughout its designated region. Also, due to the 
cannulation, an annular region is defined, with the cross-sectional area 
54 occupying a predetermined angular portion thereof. As shown by FIGS. 4D 
and 4E, with such annular region being generally coaxial with the outside 
diameter 86 of the proximal shaft segment 40, the angular portion of such 
exemplary embodiment preferably occupies generally about 180 degrees of 
the annular region. With such an arrangement, the strength of the 
relatively thin proximal segment or relatively reduced cross-sectional 
area region 54, is adequate to transmit axial drive forces therethrough to 
elongated shaft 38. In various embodiments of the subject invention, such 
angular portion may fall more generally in a range of from about 120 
degrees to about 240 degrees of the overall annular region. As the angular 
portion becomes smaller, particularly as it nears 120 degrees, other 
connection means are preferred, primarily so as to provide for the 
transmission of axial drive forces to elongated shaft 38, without 
requiring axial load bearing on the relatively thin proximal segment. 
FIG. 4G illustrates still further several different alternative aspects of 
several specific features for practice in accordance with the subject 
invention. More specifically, FIG. 4G illustrates a cross-sectional view 
of the intramedullary rod shaft 38 of the exemplary embodiment of present 
FIG. 4A, taken along the sectional line 4G--4G indicated therein. 
Respective outside and inside diameters 88 and 90 of such rod portion are 
represented. In addition, a lengthwise slot generally 98 is represented, 
and may be provided along most of the length of elongated shaft 38 for the 
purpose of relatively increasing flexibility thereof. Such slotted shaft 
98 is entirely an optional feature. Shaft 38 is otherwise a generally 
cylindrical shaft, as represented by dotted lines 99 in FIG. 4G. Other 
exemplary cross-sectional shapes may be practiced in accordance with this 
invention, as discussed in greater detail below. 
FIG. 5A illustrates a side view (looking in the medial direction of the 
human skeletal right femur) of a second exemplary embodiment generally 100 
of an intramedullary rod in accordance with the subject invention. Such 
rod 100 may again have primarily an elongated shaft 38, a cannulated 
inside diameter 56 throughout its length, and optional interlocking screw 
holes 64, 66, 70, and 72. However, present FIG. 5A represents several 
alternative features different from those illustrated in present FIGS. 1 
through 4. 
First, a substantially straight line 102 (an imaginary line) is shown as a 
point of reference to illustrate that rod 100 may be generally provided 
with a radius of curvature, primarily in the elongated shaft 38 thereof. 
Such radius of curvature may generally fall in a range of from about 1 
meter to about 3 meters, and more preferably from about 1.1 to about 1.5 
meters, so as to match the known natural curvature of a patient's femur. 
In addition, for those embodiments which make use of a rod radius of 
curvature, an intended rotational relationship is established relative to 
the femur, thereby establishing the intended relative position (for 
example, posterior, anterior, or the like) of the relatively thin proximal 
segment provided. Present FIGS. 1 through 4 represent no particular radius 
of curvature, but such may be practiced so that the resulting relatively 
reduced cross-sectional area region 54 is always intended to be in a 
relatively posterior location to provide a relatively anterior passageway 
for femoral hip screws 42, 44, and 46. 
Present FIG. 5A is similar to present FIGS. 1 through 4 in that it shows a 
relatively intended posterior location of a relatively reduced 
cross-sectional area region or thin proximal segment 104 thereof. Such 
relatively thin proximal segment 104 results in the creation of a 
complementary femoral hip screw passageway 106. In other words, present 
FIG. 5B illustrates a cross-sectional view in the proximal region of the 
exemplary embodiment 100 of present FIG. 5A, taken along the sectional 
line 5B--5B indicated therein, and representing an angular portion 104 of 
only approximately 120 degrees of the complete annular region defined 
between cannulated inner diameter 56 and proximal shaft segment outside 
diameter 86. As shown, such arrangement creates a substantial 
complementary passageway 106 covering an angular portion of approximately 
240 degrees of the total available annular region. 
As a result, it is preferred for embodiments such as FIG. 5A that the 
connection means generally 78 include internal diameter threads formed in 
both a proximal side 108 relative thin proximal segment 104 and a relative 
distal side 110 thereof. With such an arrangement, a threaded driving 
means may be connected down through proximal region 108, passageway 106, 
and threadably seated into the relative distal side threads 110. With such 
a resulting arrangement, axial rod installation forces (in the direction 
of arrow 112) are not transmitted through the relatively reduced 
cross-sectional area region or thin proximal segment 104. Instead, forces 
are more directly applied to rod shaft 38. By providing such a form of 
connection means generally 78, the relatively thin proximal segment 104 is 
able to be made even relatively thinner in relation to the full outside 
diameter 86 in such proximal shaft segment. 
Those of ordinary skill in the art should understand and appreciate that 
further embodiments of the subject invention may provide the relatively 
thin proximal segment 104 in a relatively anterior location, given the 
intended orientation of the intramedullary rod relative to a receiving 
femur, so that femoral hip screws may be received in a relatively 
posterior position. The same alternative positioning arrangement may be 
practiced, for example, in conjunction with the exemplary embodiment of 
rod 36 of present FIGS. 1 through 4, and is in fact so represented in 
present FIGS. 6A and 6B. 
More specifically, present FIGS. 6A and 6B respectively illustrate (in 
enlargement) the proximal shaft segment 40 of an anterior view and a side 
view (looking in the medial direction of a human skeletal right femur) of 
a third exemplary embodiment generally 114 of an intramedullary rod in 
accordance with the subject invention. Those of ordinary skill in the art 
will readily appreciate that FIGS. 6A and 6B constitute in essence the 
reverse image of present FIGS. 4D and 4E, and vice versa. Hence, like 
reference characters are utilized so as to eliminate the need for lengthy 
detailed discussion. Rather, an anterior position for relatively thin 
proximal segment generally 116 is illustrated in place of the relatively 
thin proximal segment 54 of present FIGS. 4D and 4E. Likewise, present 
FIG. 6B illustrates a relatively posterior location for a femoral hip 
screw passageway 118 of exemplary embodiment 114, in place of the 
generally anterior passageway 76 of present FIG. 4E. Remaining present 
features of FIGS. 6A and 6B correspond with previously discussed features 
of present FIGS. 4D and 4E, and are marked with reference characters 
accordingly. 
Present FIG. 7A illustrates a side view (in the medial direction of a human 
skeletal right femur) of yet a fourth exemplary embodiment of an 
intramedullary rod generally 120 in accordance with the subject invention. 
The distinctive feature primarily represented by such figure relates to 
yet a further exemplary embodiment of a relatively thin proximal segment 
or relatively reduced cross-sectional region generally 122 thereof. The 
arrangement is further illustrated by FIG. 7B, representing a 
cross-sectional view in the proximal region of the exemplary embodiment 
120 of present FIG. 7A, taken along the sectional line 7B--7B indicated 
therein. 
As shown by FIG. 7B, the relatively reduced cross-sectional area actually 
occupies what may be described as a partially annular position, i.e., two 
distinct angular portions 124 and 126 of the full annular region defined 
between proximal shaft segment diameter 86 and inside diameter 56 thereof. 
Similar to the construction of present FIG. 5A, respective threaded regions 
108 and 110 are provided proximally and distally to the relatively thin 
proximal segment 122 so as to comprise threaded connection means for rod 
120. At the same time, it will be further apparent to those of ordinary 
skill in the art from viewing both present FIGS. 7A and 7B that a 
substantial femoral hip screw passageway generally 128 is formed between 
the opposing annular segments 124 and 126. In general, each such annular 
segment 124 and 126 comprise about 120 degrees angular coverage of the 
full annular region available between proximal shaft segment outside 
diameter 86 and cannulation inside diameter 56 thereof. The segments 124 
and 126 may fall in more of a range generally comprising from about 1/4 to 
about 1/3 each of the full annular region. 
FIG. 8A illustrates (in enlargement) a side view of a proximal end portion 
of yet a further exemplary embodiment of an intramedullary rod generally 
130 in accordance with the subject invention. Primarily, the rod 130 
differs from previously illustrated embodiments in that the relatively 
reduced cross-sectional area or relatively thin proximal segment thereof 
generally 132 occupies a central or center post position. In a cannulated 
embodiment, such center post arrangement 132 includes respective outside 
and inside diameters 134 and 136. FIG. 8B illustrates a cross-sectional 
view in the proximal region of such exemplary embodiment generally 130 of 
present FIG. 8A, taken along the sectional line 8B--8B indicated therein. 
A still further embodiment of exemplary connection means generally 78 is 
shown by the specific configuration of proximal end inside diameter 
threads generally 138 formed in a portion of the rod adjacent to proximal 
end 68 thereof. As shown, such threads 138 have a substantially larger 
inside diameter than the cannulation inside diameter generally 140 in the 
relatively thin proximal segment 132, resulting in a substantial interior 
shoulder 142 between such respective inside diameters. Other present 
features may be practiced, such as registration or alignment proximal end 
slot 84 (as represented), or a given radius of curvature for rod 38 
(represented generally by present FIG. 5A), or the use of interlocking 
screw holes along the rod, as represented by present FIG. 4A. Certain 
features may be utilized in still further capacities and locations, such 
as the relatively moved exemplary illustration of alignment slot 84 shown 
in the cross-sectional view of present FIG. 8B. All such variations and 
different combinations, as would be understood by those of ordinary skill 
in the art, are intended to come within the spirit and scope of the 
present invention by virtue of present reference thereto. 
FIG. 9A illustrates a side view (in the medial direction of a human 
skeletal right femur) of a general illustration of an exemplary 
intramedullary rod generally 144 in accordance with the subject invention, 
and representative of present optionally used variations in the shaft 
section thereof. With the exception primarily of the specific shape of the 
shaft cross-sectional area thereof, the features of exemplary rod 144 are 
generally about the same as those of exemplary rod 36 of present FIG. 4A. 
FIG. 9B more fully illustrates the differences between embodiments 36 and 
144, by representing a cross-sectional view of the shaft 146 which has an 
outside diameter 148 which may broadly be referred to as being fluted. Two 
opposing flutes or depressions generally 150 and 152 are represented, and 
contrast with a generally cylindrical inside diameter 154. However, in 
some embodiments, it may be practiced that the inside diameter 154 is 
formed, such as with cold rolling, or the like so that the inside diameter 
154 actually matches the shape of the outside diameter 148. 
In addition to the cylindrical, slotted, and fluted embodiments discussed 
above, still further cross-sectional shaft shapes may be practiced. For 
example, present FIGS. 9C and 9D illustrate respective alternative 
cross-sectional rod shaft embodiments 156 and 158 which may be practiced 
in place of the exemplary embodiment of present FIG. 9B. Moreover, such 
features may be utilized in combination with other present exemplary 
proximal end portions and other features of the exemplary intramedullary 
rods disclosed herewith. 
More specifically, FIG. 9C represents an outside diameter 160 which is 
fluted (including three flutes generally 162, 164, and 166), and a 
generally circular inside diameter 168. Again, inside diameter 168 may 
alternatively be formed in the same shape as outside diameter 160. 
The FIG. 9D embodiment illustrates an outside diameter generally 170 having 
fluting comprising a total of four separate flutes generally 172, 174, 
176, and 178. A relatively cylindrical inside diameter 180 may be 
practiced, or other shapes may be utilized, particularly those matching 
the outside diameter generally 170. 
In the embodiments discussed above, the proximal shaft segment of each 
respective embodiment is preferably integrally formed with its 
corresponding elongated shaft, in axial alignment therewith. Present FIGS. 
10A, 10B, and 10C illustrate a sixth rod embodiment generally 182 in which 
the proximal shaft segment generally 184 and the elongated shaft generally 
186 comprise respective, axially matably members which may be joined 
together with joining means generally 188 in accordance with the present 
invention. 
More specifically, FIG. 10A illustrates a partial side view (in the medial 
direction of a human skeletal right femur) of the exemplary rod 182, 
particularly having interchangeable features for the proximal end portion 
184 thereof. FIG. 10B illustrates an enlarged cross-sectional view of such 
proximal end portion generally 184 of the embodiment of FIG. 10A. FIG. 10C 
specifically represents a cross-sectional view of an exemplary joining 
means feature (for example, a locking bolt) as used in the exemplary 
embodiment of present FIG. 10B, taken along the sectional line 10C--10C 
indicated therein. 
The enlarged view of present FIG. 10B illustrates how the joining means 
generally 188 may axially join the respective proximal shaft segment 
generally 184 and the elongated shaft 186 in mated axial arrangement. As 
shown by alternately directed diagonal lines, the respective members 184 
and 186 are preferably telescopically related to one another and held 
together, for example by such as a plurality of locking bolts 190. FIGS. 
10B and 10C are representative of preferred exemplary set screws, such as 
so-called "prevailing-torque" locking fasteners. As shown in FIG. 10C, the 
threaded shaft 192 may have deformed threads or otherwise contoured thread 
profiles so as to, in essence, jam into place for a very secure fit. Other 
forms of locking fasteners, set screws, lock nuts, pins, or other forms of 
joining means may be practiced. For example, the members 184 and 186 may 
be threadably joined together or brought together with matably aligned 
splines, or other forms of actual joining, so long as a connection of 
adequate strength is provided. 
Those of ordinary skill in the art will appreciate that the purpose of an 
embodiment such as FIGS. 10A, 10B, and 10C is to permit the use of a 
particular proximal shaft segment with a predetermined selected shape for 
the relatively reduced cross-sectional area region thereof, so as to 
provide a treating physician with a selected location for the femoral hip 
screw passageway customized for the femoral neck or hip fracture treatment 
of a given patient. The illustration of present FIG. 10A represents use of 
a cannulated embodiment having a cannulation inside diameter 194, 
relatively proximal interlocking screw holes 196 and 198, and a generally 
posteriorly located relatively thin proximal segment 200. From the 
foregoing discussion, it will be understood that such arrangement results 
in a generally anterior femoral hip screw passageway 202. It will be 
apparent that the predetermined selected shape and location of such 
passageway may be selected by providing a relatively reduced 
cross-sectional area of predetermined shape as occupying one of a 
posterior, anterior, central, or partially annular position, as discussed 
in the embodiments of FIGS. 1 through 9. 
Still further, other alternative arrangements may be practiced, including 
configurations different from those expressly illustrated. For example, 
different angular portions of the annular region for relatively thin 
proximal segment 200 may be practiced, as in the above embodiments. Also, 
different rotational alignments may be practiced. For example, in FIG. 7A, 
the femoral hip screw passageway 128 is aligned with the direction of 
interlocking screw holes 64, 66, 70, and 72. The annular segments 124 and 
126 could be in positions rotated therefrom, such as by 90 degrees, so 
that the passageway 128 is instead transverse to the interlocking screw 
holes. Other relatively axially rotated arrangements could be practiced, 
either in the modular embodiment of present FIGS. 10A through 10C, or in 
an integral embodiment, and all such modifications and variations are 
intended to be covered by the present invention. 
FIGS. 11A through 11E represent a still further aspect of certain "modular" 
features which may be practiced in accordance with the subject invention. 
More specifically, FIG. 11A illustrates (in enlargement of a proximal 
portion generally 204) a side view (in the medial direction of a human 
skeletal right femur) of a seventh exemplary embodiment of an 
intramedullary rod generally 206 in accordance with the subject invention, 
particularly having modular components, with the selected addition of 
which converts the intramedullary rod 206 from one type proximal end to 
another type proximal end. FIGS. 11B, 11C, and 11D illustrate respectively 
a side view (in the medial direction of a human skeletal right femur), an 
anterior view, and a bottom view of a modular component generally 208 in 
accordance with this aspect of the subject invention. 
FIG. 11A represents a generally posterior relatively thin proximal segment 
generally 210, similar to the exemplary constructions of present FIGS. 1, 
4E, 9A, and 10A. As illustrated, the modular element 208 has a contour 
which is complementary to that of the femoral hip screw passageway defined 
by relatively thin proximal segment 210. So configured, modular element 
208 fills in the femoral hip screw passageway whenever attached to such 
proximal shaft segment 204. 
FIG. 11E illustrates a cross-sectional view of an exemplary locking bolt 
(i.e., modular element attachment means) such as may be used in the 
exemplary embodiment of present FIG. 11A, taken the sectional line 
11E--11E indicated therein, for attaching modular element 208 to the 
proximal shaft segment 204. The locking bolt 212 may include threaded 
shaft segment 214 of a prevailing torque type (see FIG. 10C and related 
discussion) which deforms or jams in the attachment screw holes 214. Those 
of ordinary skill in the art will understand that such attachment is done 
prior to implantation of intramedullary rod 206, which may further have 
cannulation inside diameter 216, threaded connection means 218, a 
registration slot 220, an interlocking screw hole 222, and other features 
of other embodiments herewith. Various such combinations may be practiced 
in conjunction with use of a modular component 208, and such component may 
take on different shapes so as to fill differently shaped femoral hip 
screw passageways. 
In addition to the attachment means screw holes 224 formed in modular 
element 208, partial screw hole openings 226 may be formed therein, as 
follows. Certain standard "recon" intramedullary rods or nails include 
femoral hip screw holes placed at specific angles therein, for the 
upwardly angled seating of hip screws, similar to the seating of hip 
screws represented in present FIGS. 1 through 3. Therein, such screws 42, 
44, and 46 enter from a generally lateral side and proceed at 
approximately a 45 degree angle from the proximal direction, upwardly 
through the femoral neck and into the femoral head. The exemplary 
embodiment of present FIGS. 11A through 11E represent such "recon" type 
holes formed by respective hole components 226 of the modular component 
208 and hole portions 228 formed in relatively thin proximal segment 210. 
Those of ordinary skill in the art will understand that other combinations 
and placements of such openings may be provided in accordance with such 
modular component embodiment of the subject invention, and others. 
Likewise, various features such as countersunk screw heads and the like, 
as would be apparent to those of ordinary skill in the art, may be 
practiced with the foregoing embodiment. 
The foregoing description relates primarily to specific examples and 
variations of intramedullary rods which may be practiced in accordance 
with the subject invention. The remainder of this description primarily 
relates to various devices for use with the subject intramedullary rods, 
resulting in various treatment systems and methods in accordance with this 
invention, including installation and withdrawal devices and methodology. 
For example, one treatment system in accordance with the subject invention 
for the treatment of ipsilateral fracture patterns of the femoral hip and 
shaft may include a femoral intramedullary rod (such as one of the 
above-described embodiments), driving means for installation of such rod 
in a receiving femur, a plurality of interlocking screws for securing the 
rod, interlocking screw guide means for alignment of such interlocking 
screws during seating thereof, and at least one femoral hip screw for 
seating in the passageway defined therefor with the intramedullary rod in 
accordance with this invention. The following discussion with reference to 
present FIGS. 12-19 discusses such arrangement, and others, as well as 
present methodology. 
More specifically, FIG. 12 illustrates various alternative driving 
arrangements for installing an intramedullary rod in accordance with the 
present invention, while FIG. 13 illustrates exemplary interlocking screw 
guide means of the present invention. FIG. 14 shows a cross-sectional 
detail of a portion of such interlocking screw guide means, while FIG. 15 
shows an exploded representation of the entire guide means. FIG. 16 
represents an exemplary 90 degree drive for use in practicing the present 
invention, while FIG. 17 illustrates one alternative embodiment of a 
portion of the FIG. 13 device. FIG. 18 illustrates yet another alternative 
to portions of the features of FIG. 13, so as to provide an alignment 
guide for seating of the femoral hip screws, while FIG. 19 represents 
various features and methodology for the ultimate withdrawal of an 
intramedullary rod from a healed femur. 
Those of ordinary skill in the art will appreciate that the following 
devices and methodology may be practiced with any of the foregoing, and 
other, embodiments of the present intramedullary rod. For purposes of 
example only, an intramedullary rod proximal shaft segment generally 230 
is shown in FIG. 12, similar to the embodiment of present FIGS. 1 and 4A. 
Briefly, such proximal shaft segment 230 has a relatively thin proximal 
segment 232 which includes connection means generally 234 comprising 
cannulation inside diameter threads 236, and which shaft segment 230 is 
connected with an elongated shaft 238 distally therefrom (partially 
shown), and which further includes a single representative interlocking 
screw hole 240. 
A further threaded element 242 may be provided for axially connecting with 
rod connection means threads 236 via threads 244. Member 242 comprises, in 
essence, a modular component for the additional connection thereto of 
other removably operative devices, which may variously connect to threads 
246 thereof (having a relatively larger outside diameter) or proximal 
threads 248 thereof (having a relatively smaller outside diameter and also 
having a stop hex coupling 250 or similar integrally formed at the base 
thereof). 
As further shown by FIG. 12, various alternative driving means generally 
252 and 254 may be removably operatively associated with the rod proximal 
end connection thread means 236 (such as via member 242) for selectively 
driving the intramedullary rod shaft 238 to a desired predetermined depth 
into a receiving fractured femur, with the result that the rod proximal 
shaft segment 230 is received in the femoral hip region. In one 
embodiment, the driving means 252 may comprise a threaded hammer block 255 
for use with a free-hand hammer (not shown). Such hammer block 255 has a 
cannulation passageway 256, which mates with a similar cannulation 
passageway 258 of extension member 242. An internal diameter thread 
connection 260 (or some other equivalent means) may be provided for 
connecting hammer block 255 to the extension member 242. In such position, 
a fully cannulated device is provided so that the intramedullary rod may 
be seated over a guide wire, in accordance with general installation 
procedures with which those of ordinary skill in the art are familiar, 
without additional detailed discussion thereof. 
The alternative embodiment of present driving means 254 represents a 
threaded slide hammer means generally 262 and attached handle generally 
264. Such arrangement also makes use of a cannulation passageway generally 
266 along its full length so that the rod may be driven over the guide 
wire, or possibly over reaming guides, or other similar devices. The 
threaded slide hammer means includes a mass 268 which may be manipulated 
for alternate travel along the axial direction of double-headed arrow 270. 
The threaded slide hammer means 262 further includes a drive type member 
272, relatively similar to hammer block 255, and against which mass 268 is 
axially moved for striking the intramedullary rod shaft 238 in a distal 
direction. 
Those of ordinary skill in the art will appreciate from the illustration of 
present FIG. 12 the various threaded couplings which may be practiced, 
including the coupling between members 272 and axial support shaft 274, as 
well as the locking nut coupling 276 which may be used in conjunction with 
handle 264. An upper stop member 278 may be formed in a fixed position 
along shaft 274. Use of handle 264 facilitates driving of the rod shaft 
238, while also permitting to a certain extent the rotational manipulation 
thereof. Variations to these arrangements may be practiced, as will be 
understood by those of ordinary skill in the art. 
Those of ordinary skill in the art are already familiar with various guide 
wire and reaming techniques which may be practiced as part of installation 
procedures for conventional intramedullary rods. One advantage of the 
present intramedullary rod is that it may be utilized with such procedures 
already familiar to many practicing orthopedic physicians. Another present 
advantage is the additional use of equipment disclosed herewith, such as 
the interlocking screw guide means of present FIG. 13, which further 
simplifies operations, as discussed hereinafter. 
In general, once an intramedullary rod is seated, interlocking screws (if 
used) are put in place. Present FIGS. 13 through 15 illustrate 
interlocking screw guide means generally 280 in accordance with the 
subject invention, for the targeting and alignment of relatively proximal 
interlocking screw holes 240 and 282. FIG. 13 illustrates an isometric 
view of an assembled proximal screw hole targeting apparatus generally 280 
in accordance with the subject invention, particularly adapted for use 
with present intramedullary rods, while FIG. 15 illustrates an isometric 
exploded view of such exemplary apparatus 280. 
In general, interlocking screw holes 240 and 282 are situated a 
predetermined or known distal distance (respectively) from proximal end 
284 (FIG. 15) of the intramedullary rod. In addition, as discussed above 
with reference to various of the figures, a registration means slot 286 or 
other form of alignment may be utilized for indicating the relative 
rotational position of screw holes 240 and 282. Those of ordinary skill in 
the art will understand (such as from exemplary FIGS. 1 and 3) that the 
proximal end 284 of the intramedullary rod remains close to the outer 
surface of the femur, so that access may be had to registration slot 286. 
The dotted continuation line 288 shown throughout FIG. 15 represents 
desired interconnection of the elements comprising interlocking screw 
guide means 280, as discussed in detail hereinafter. 
Such interlocking screw guide means 280 may variously comprise a 
combination of different respective devices and elements, such as 
rotational position control arm means generally 290, securement means 
generally 292, selectively operable clamping means generally 294, and 
targeting arm means generally 296. 
More specifically, the rotational position control arm means generally 290 
may in one exemplary embodiment comprise a member which is removably 
operatively associated with the rod proximal end registration means 286 
and which extends generally laterally therefrom via a lateral extension 
arm 298. When so extended, arm 298 is in rotational alignment with the rod 
relatively proximal interlocking screw hole or holes 240 and 282. A pair 
of tabs 300 or other correspondingly mating elements, may be provided for 
use in conjunction with registration slot 286. As shown, an annular member 
302 may be telescopically seated onto proximal end 284, with the tabs 300 
received in the corresponding slot arrangements 286. A cannulation inside 
diameter 304 is again provided in means 290, particularly shown by the 
inside diameter of annular member 302. 
As shown by FIGS. 13 and 15, the securement means 292 may comprise a 
locking nut 306, which also has a cannulation inside diameter 308. It is 
with such locking nut 306 that the control arm means 290 are removably 
secured to the intramedullary rod proximal end connection thread means 
236. It will be understood by those of ordinary skill in the art that the 
extension member 242, in essence, forms part of such rod proximal 
structure to and with which mounting of the various further devices in 
accordance with the subject invention may be practiced. The threads along 
inside diameter 308 of locking nut 306 are in fact received about the 
threaded portion 246 of such extension member 242, as clearly represented 
in present FIGS. 13 and 15. Annular member 302 of control arm means 290 in 
fact is received about the relatively smooth outside diameter portion 310 
of such extension member 242. 
Still further, the interlocking screw guide means 280 may include 
selectively operable clamping means generally 294, which are movably 
supported (preferably slidably) on the lateral extension or extension arm 
298 of control arm means 290. See FIGS. 13 and 15. FIG. 14 is in fact an 
enlarged cross-sectional view of specific clamping means features in 
accordance with the exemplary embodiment of present FIG. 13, taken along 
the sectional line 14--14 indicated therein. With such an arrangement, the 
clamping means 294 may be selectively clamped on lateral arm 298 at a 
selected distance radially outward from the central longitudinal axis 312 
of the intramedullary rod. Operatively, the purpose of such arrangement is 
to permit the position of targeting arm means generally 296 to be moved so 
as to match the size of a patient's leg into which the intramedullary rod 
is associated with the receiving femur. 
Still further, such targeting arm means generally 296 may be variously 
secured to the clamping means 294 for movement therewith and extending 
therebelow for parallel alignment thereby with the central longitudinal 
axis 312 of the intramedullary rod. Such targeting arm means has at least 
one relatively proximal interlocking screw target hole 314 located a 
predetermined distance distal to clamping means 294. Such target hole 314 
becomes aligned with the intramedullary rod relatively proximal 
interlocking screw hole 240 by virtue of the present arrangement, so that 
such hole 240 may be targeted for drilling through the femur and 
subsequently securing an interlocking screw in such hole 240. The same 
alignment approach permits additional target hole 316 to become aligned 
with corresponding additional interlocking screw hole 282 of the 
intramedullary rod. 
More particularly, the control arm means lateral extension arm 298 has a 
predetermined cross-sectional shape (see FIG. 14) defined at least in part 
by at least one guide surface. The clamping means generally 294 includes 
one clamping surface to be selectively and correspondingly matched with 
such extension arm guide surface, and being movable relative to such 
matched guide surface so that the clamping means can be selectively 
engaged in a given position slidably along the extension arm (along the 
direction of double-headed arrow 318 of present FIG. 13). As stated, it is 
such arrangement which permits the overall targeting apparatus to be 
custom fitted to the leg size of a given patient. 
The targeting arm means 296 may be integrally associated with the clamping 
means 294 (as represented by present FIG. 14), or may otherwise be 
attached thereto. Looking to all FIGS. 13 through 15, clamping means 294 
may be provided in the form of a clamp plate housing generally 320 which 
is slidably and removably received about the lateral extension arm 298, 
and which may be integrally associated with the targeting arm means 296. 
Further, a clamp plate 322 may be provided movably residing between the 
lateral extension arm 298 and an inside surface 324 of clamp plate housing 
320. A clamp plate bolt 326 with capture member 328 may be threadably 
received through the clamp plate housing 320 and positioned so as to 
selectively drive the clamp plate 322 into clamping engagement with the 
lateral extension arm 298. 
By way of specific example, the lateral extension arm 298 is shown to have 
a cross-sectional shape utilizing six different guide surfaces comprising 
substantially a rectangle (in this example) with two bevelled edges 330 
and 332 respectively connecting a first guide surface 334 of such 
rectangle to the two adjacent guide surfaces 336 and 338 thereof. A lower 
surface 340 completes the rectangle, all of which surfaces are surrounded 
and enclosed by clamp plate housing 320. While clamping surfaces may be 
provided for correspondingly matching with such six guide surfaces, not 
all such surfaces may actually need to be brought into engagement or 
contact in order for clamping to be effected. For example, as shown in 
present FIG. 14, the clamp plate housing 320 provides three internal 
surfaces (unreferenced) for contacting guide surfaces 336, 338, and 340, 
respectively. At the same time, the clamp plate provides surfaces 
(unreferenced) for respective contact with guide surfaces 330 and 332, 
though a gap is preferably maintained between guide surface 334 and the 
clamp plate in order to accommodate the end of clamp screw 326 and its 
securement ring or element 328. Those of ordinary skill in the art will 
appreciate that different embodiments of such clamping arrangements may be 
practiced in accordance with the subject invention, in keeping with the 
broader teachings herewith. 
Those of ordinary skill in the art will appreciate that the interlocking 
screw guide means generally 280 discussed above, as well as the different 
embodiments of present exemplary driving means 252 and 254, may be 
removably associated with intramedullary rod embodiments in accordance 
with this invention. Such operative connection and subsequent removal 
thereof permits overall alternative accompanying devices to be utilized. 
For example, FIG. 16 illustrates a side elevational view, with partial 
cutaway, of a further example of a present rotational positional control 
arm generally 342, in accordance with the subject invention and providing 
a 90 degree drive feature. 
More specifically, a threaded coupling 344 may be provided for mating with 
internal diameter threads 236 of a given intramedullary rod, while 
projecting tabs 346 and 348 may interface with registration slots 286 of 
the intramedullary rod. The purpose of such registration coupling is to 
ensure a fixed position of coupling element 350 so that torque may be 
applied to member 344 via 90 degree bevelled drive gear arrangement 
generally 352 and elongated drive coupling 354. In other words, as is well 
understood by those of ordinary skill in the art, drive power or 
rotational force applied to drive connection 356 will be translated into 
drive force about the longitudinal axis of coupling 344. A hex drive of 
356 or similar may be utilized. 
Again, a cannulation inside diameter 358 may be provided throughout the 
device for use with a nail insertion guide rod. In other words, 
cannulation inside diameter 358 extends throughout device 352 from the top 
side 360 thereof to the distal most portion 362 thereof. 
In addition, a portion of the cannulation inside diameter 358 may include 
thread connections 363 for receiving a slide hammer driving means such as 
means 254, or a hammer block connection 252, preferably coupled through or 
with an element such as extension member 242. With the foregoing 
arrangement, rotational alignment of the intramedullary rod may be 
practiced with mechanical advantage, during the driving phase. Those of 
ordinary skill in the art will appreciate that such device 342 may be 
utilized and then removed from the intramedullary rod, so as to permit 
additional or alternative devices to be applied thereto. 
FIG. 17 represents still further alternative devices in accordance with the 
subject invention, illustrating an isometric exploded view of an 
alternative embodiment of a laterally extending clamp plate support 
generally 364 for use in place of means 290 of FIGS. 13 and 15. With such 
device, a different extension member 366 is provided with only one set of 
proximal screw threads 368 and distal threads 370, which may couple with 
threads (not shown) within the intramedullary rod proximal end 284 
thereof. Other connection means may be practiced in given embodiments. 
Hence, as representatively shown in FIG. 17, the proximal end inside 
diameter 372 of the intramedullary rod may be alternatively made smooth 
bored rather than threaded. 
The annular member generally 374 may include projecting tabs 376 and 378 
for registration and coupling with slots 286, in the fashion as discussed 
above in conjunction with other embodiments of the subject invention. 
Similarly, a locking nut 380 may be provided for securing device 364 to 
the intramedullary rod, and cannulation inside diameters 382 may be 
provided throughout the arrangement, as before with other devices. 
In addition, a further threaded connection 384 may be provided for receipt 
of driving means generally 386 direct therewith, and at an angle offset 
from the central axis 386 of the intramedullary rod. Lateral extension arm 
388 may again be utilized with a clamping means 294 (not shown) in the 
same fashion as described above with reference to present FIGS. 13 through 
15. 
The arrangement of present FIGS. 13 through 15 may be utilized with still 
further alternative features in accordance with the subject invention. For 
example, FIG. 18 illustrates an isometric view of a further exemplary 
embodiment in accordance with this invention, illustrating features 
alternative to some of those of present FIG. 13, and particularly 
representing a neck or hip screw placement guide arm generally 390 for use 
with intramedullary rods in accordance with the subject invention. 
The intramedullary rod arrangement of FIG. 13 is substantially reiterated 
in FIG. 18, and represents that an imaginary plane 392 may be shown in 
relation to relatively thin proximal segment 232 of the intramedullary 
rod. Such imaginary plane 392 represents the dividing plane between such 
relatively thin proximal segment 232 and the complementary femoral hip 
screw passageway provided thereby. While certain features discussed above 
may be utilized for targeting interlocking screw holes 240 and 282, the 
features of present FIG. 18 may be utilized for targeting or guiding 
femoral hip screws into the passageway formed therefor with the subject 
invention. 
More particularly, the femoral hip screw placement guide means 390 in 
accordance with the subject invention may include an arm 394 which is 
integrally formed with or operatively associated with clamping means 294, 
similar to the fashion in which depending arm 296 was so associated. 
However, rather than providing target holes 314 and 316 as in FIGS. 13 and 
15, arm 394 has a relatively reduced size (i.e., width) and is 
specifically positioned relative clamping means 294 so as to provide a 
guide surface 396 which is coplanar to imaginary plane 392. 
Therefore, a treating physician utilizing the arrangement of FIG. 18, may 
utilize clamp bolt 326 for sliding clamping means 294 inwardly along arrow 
318 towards the central axis 312 of the intramedullary rod, until the 
surface 398 of guide arm 394 is brought into contact with or proximity 
with the outside of a patient's leg. Thereafter, the treating physician 
may drill along and adjacent to the side 396 of arm 394, thereby drilling 
on the passageway-side of imaginary plane 392 so as to seat femoral hip 
screws in the passageway defined therefor by relatively thin proximal 
segment 232. 
It will be further understood by those of ordinary skill in the art that, 
if desired, various indicia or markings may be applied to surface 400 of 
guide arm 394, so that axial depth along central axis 312 may be indicated 
in addition to indication of the imaginary plane 392. However, even 
without such indicia, the treating orthopedic physician will be very 
familiar with the axial position of the femur as to where the screws (such 
as exemplary screws 42, 44, and 46 of present FIGS. 1 through 3) are to be 
seated. It is only the planar guidance which would be otherwise missing 
without practice of the present FIG. 18 features and methodology in 
accordance with the subject invention. 
Lastly, FIG. 19 illustrates an isometric exploded view of a proximal end 
over-reamer generally 402 which may be practiced during extraction or 
withdrawal of intramedullary rods in accordance with the present 
invention, and further illustrates elongated slide hammer removal features 
generally 404 which may also be practiced in accordance with the subject 
invention during extraction. 
The extraction over-reamer means generally 402 of present FIG. 19 is 
provided for cutting bony growth from around the intramedullary rod 
reduced cross-sectional area 232 for removal of the intramedullary rod 
from a patient's healed femur. Such extraction over-reamer means generally 
402 may comprise a generally cylindrical annular cutting member 406, shown 
in broken illustration in present FIG. 19. Such annular cutting member is 
sized to fit over the intramedullary rod proximal end 284 and to slide 
therealong over proximal shaft segment 230. Distally located saw teeth 408 
are provided for cutting into the bones, while a proximally located drive 
coupling 410 permits rotational driving of the saw teeth. The hexdrive 
arrangement 410 may be power driven or mechanically coupled to a manual 
arrangement. 
In terms of withdrawal methodology in accordance with the subject 
invention, once any sort of interlocking screws or femoral hip screws are 
removed, the extraction over-reamer means generally 402 may be utilized to 
cut the proximal shaft segment 230 free from any bony growth around 
relatively proximal segment 232. Thereafter, rod removal means generally 
412 may be utilized, such as including a slide hammer device 404 and hook 
414 and eye 416 connection operatively associated with a threadable member 
418 for direct attachment via threads 420 and 236 to the intramedullary 
rod proximal end 284. Of course, different connection means 234 for such 
rod may be practiced, and connection element 418 would be modified 
accordingly. A hex coupling 422 may be provided to facilitate driving 
connection of member 418, as will be well understood by those or ordinary 
skill in the art. 
Once member 418 is seated, hook 414 may be secured thereto, and slide 
hammer element 424 may be axially moved along the direction of 
double-headed arrow 426 for axial extraction of the intramedullary rod. As 
will be understood by those of ordinary skill in the art, a handle device 
generally 426 may be provided as well as a fixed element 428 against which 
slide hammer 424 may strike. A shaft 430 is provided for movement of such 
slide hammer element 424, and may be threadably coupled via threads 432 
and 434 to the hook connection member 414. It will be further understood 
by those of ordinary skill in the art that alternatives may be practiced. 
For example, the hook portion 414 may be associated with the member 418, 
and the eye portion 416 associated with the threadable coupling 434. 
Those of ordinary skill in the art will further understand and appreciate 
from the totality of the foregoing disclosure, that the various 
alternative features and components shown and discussed in conjunction 
with FIGS. 12 through 19, may be practiced in accordance with various 
installation and withdrawal metholodologies, all of which combinations are 
intended to come within the spirit and the scope of the present, without 
rediscussion thereof. Such alternative methodologies are intended to 
include the use of different intramedullary rod embodiments practiced in 
accordance with the invention. 
In addition to the foregoing, different embodiments such as including 
different numbers and placements of interlocking screws, or use of 
different femoral hip screws and neck screws, may be practiced. Likewise, 
it is to be fully understood by those of ordinary skill in the art that 
the foregoing structures and methodologies may be practiced for the 
treatment of various types and degrees of combination shaft and hip (or 
neck) ipsilateral fractures, without further detailed discussion of such 
different fracture types and degrees, as alluded to above in the 
Background and Summary portions of the subject specification. 
It should be further understood by those of ordinary skill in the art that 
the foregoing presently preferred embodiments are exemplary only, and that 
the attendant description thereof is likewise by way of words of example 
rather than words of limitation, and their use does not preclude inclusion 
of such modifications, variations, and/or additions to the present 
invention (either apparatus or methodology) as would be readily apparent 
to one of ordinary skill in the art, the scope of the present invention 
being set forth in the appended claims.