# Patent

## Title
Guides for fracture system

## Abstract

A height measuring tool may include a body member configured to releasably couple to an implant component. A slidable member having a distal end surface may be coupled to the body member. A height reference member may also be coupled to the body member. Movement of the sliding member in a distal direction in relation to the body member may cause corresponding movement of the height reference member in the distal direction when the sliding member is engaged to the height reference member and the height reference member is in an unlocked state. Generally, when an implant component is attached to the height measuring tool, a user may insert the implant component at least partially into a bone, with the slidable member and the height reference member used in conjunction to objectively mark off a height of the implant component relative to the bone.

## Background
FIELD OF THE INVENTION
The present invention relates to guides for determining a desired position and orientation of an implant in a fracture setting, and in particular relates to a first guide for gauging the height and a second guide for orienting the version of an implant with respect to at least one bone fragment.
BACKGROUND OF THE INVENTION
A joint replacement procedure is sometimes necessary to repair a joint having a diseased or damaged articulating surface. Such a procedure may involve removal of the diseased or damaged portions of the joint and replacing them with a prosthetic implant. This is often a desirable procedure for ball-and-socket type joints, particularly the shoulder and hip joints. A shoulder joint replacement procedure, for example, often involves removal of the humeral head and replacement thereof with an implant including a stem and a head. It is important that the implant be positioned correctly within the joint in order to ensure that appropriate joint kinematics, including range of motion, are preserved so as to replicate, as closely as possible, those of the original joint.
The structure of prosthetic joint components has been developed to be suited for permanent implantation into the joint and includes features that may promote bony ingrowth, adhesion using cement, press-fit or a combination thereof. Particularly, in the case of implants including a stem, such as those used in shoulder arthroplasty, these features are generally included on the outside surface of the stem. Such features may not be well-suited for use during the assessment of joint kinematics. Accordingly, instruments such as trials have been developed to be used in this part of the procedure. Generally, trials are affixed to the bone during joint kinematic evaluation and removed therefrom after a proper position for the implant has been determined.
Typically, trials are designed to correspond to an implant in size and shape. In a shoulder arthroplasty procedure, for example, a trial may be designed to be temporarily inserted into a prepared medullary canal of the humerus in a manner similar to that of an implant. Known trials may take many forms. For example, an expanding trial stem, such as that described in U.S. Pat. No. 8,216,320, the entire contents of which are hereby incorporated by reference herein, includes a stem that may be expanded after insertion into the medullary canal. When using such trial stems, particularly in shoulder replacements, it may be difficult to establish the proper position and orientation for the implant in the humerus. It would thus be desirable to have guides that simplify the determination of proper positioning of the implant during use of a trial stem.
BRIEF SUMMARY OF THE INVENTION
In one embodiment, a height measuring tool includes a body member configured to releasably couple to an implant component, a slidable member having a distal end surface, the slidable member coupled to the body member, and a height reference member coupled to the body member. Movement of the sliding member in a distal direction in relation to the body member causes corresponding movement of the height reference member in the distal direction when the sliding member is engaged to the height reference member and the height reference member is in an unlocked state.
The body member may include a track and the slidable member and the height reference member may each be coupled to the track. The slidable member and the height reference member may be configured to slide in proximal and distal directions in relation to the body member. The height reference member and slidable member may have corresponding mating surfaces. The slidable member may include a bone position indicator in the form of an elongated rod extending distally therefrom, the bone position indicator terminating at the distal end surface of the slidable member. The bone position indicator may be configured to extend through an aperture in the height reference member. The height reference member may include at least one knob configured to increase or decrease frictional engagement between the height reference member and the body member. Movement of the sliding member in the distal direction in relation to the body member may not cause corresponding movement of the height reference member in the distal direction when the sliding member is engaged to the height reference member and the height reference member is in a locked state. The body member may include a handle portion having a first position and a second position and wherein the body member is operatively coupled to the implant component when the handle portion is in the first position. The height reference member may include a magnet therein.
In another embodiment, a method of determining a height of a first implant component relative to a bone in which the first implant component is positioned may include coupling a body member of a height measuring tool to the first implant component. The method may further include inserting the first implant component at least partially into the bone, and moving a slidable member coupled to the body member in a first direction from an initial position to a second position in which a distal surface of a bone position indicator coupled to the slidable member contacts a surface of the bone. A height reference member may be coupled to the body member and, when the height reference member is in an unlocked state, movement of the sliding member causes corresponding movement of the height reference member. The method may also include the step of locking the height reference member after the bone position indicator contacts the surface of the bone, wherein, when in the locked state, movement of the sliding member does not cause corresponding movement of the height reference member. The step of locking the height reference member may include increasing frictional engagement between the height reference member and the body of the handle portion.
The method may further include the step of moving the slidable member in a second direction opposite the first direction while the height reference member remains stationary with respect to the body member. The method may additionally include the step of detaching the first implant component from the body member of the height measuring tool and coupling a second implant component to the body member of the height measuring tool. Even further, the method may include the step of inserting the second implant component at least partially into the bone. An additional step may include moving the slidable member in the first direction until the slidable member contacts the height reference member. Another step may include confirming a desired height of the second implant component with respect to the bone. Yet another step may include detaching the second implant component from the body member of the height measuring tool.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a schematic view of an exemplary proximal humerus broken into a plurality of bone fragments.
FIG. 2 is a cross-sectional view of one embodiment of a trial stem for use during a shoulder replacement procedure.
FIG. 3A is a perspective view of one embodiment of a height measuring gauge according to aspects of the disclosure.
FIG. 3B is a perspective view of the height measuring gauge of FIG. 3A shown in partial transparency.
FIG. 3C is an isolated perspective view of a slider member of the height measuring gauge of FIG. 3A.
FIG. 3D is an isolated perspective view of a support member or pointer of the height measuring gauge of FIG. 3A.
FIG. 3E is a cross-sectional view of the pointer taken along line 3E-3E in FIG. 3D.
FIG. 4A is a perspective view of the trial stem of FIG. 2 attached to the height measuring gauge of FIG. 3 in a locked configuration with the pointer and slider in a neutral or first position.
FIG. 4B is a perspective view of the trial stem of FIG. 2 attached to the height measuring gauge of FIG. 3 in a locked configuration with the pointer and slider in an active or second position.
FIG. 4C is a perspective view of the trial stem of FIG. 2 attached to the height measuring gauge of FIG. 3 in a locked configuration with the pointer in the second position and the slider in the first position.
FIG. 4D is a perspective view of the height measuring gauge of FIG. 3 in an unlocked configuration with the pointer in the second position and the slider in the first position.
FIG. 5A is a perspective view of one embodiment of a stem implant according to aspects of the disclosure.
FIG. 5B is a perspective view of a proximal portion of the stem implant of FIG. 5A.
FIG. 5C is a top view of the stem implant of FIG. 5A.
FIG. 5D is a side view of a proximal portion of the stem implant of FIG. 5A.
FIG. 6A is a perspective view of the stem implant of FIG. 5A attached to the height measuring gauge of FIG. 3 in a locked configuration with the pointer and slider in a second position.
FIG. 6B is a perspective view of the stem implant of FIG. 5A attached to the height measuring gauge of FIG. 3 in a locked configuration with the pointer and slider in a first position.
FIG. 7A is a perspective view of one embodiment of a version block according to an aspect of the disclosure.
FIG. 7B is a cross-sectional view of the version block of FIG. 7A.
FIG. 7C is an isolated perspective view of a catch member of the version block of FIG. 7A.
FIG. 7D is an isolated perspective view of a lever of the version block of FIG. 7A.
FIG. 7E is a cross-sectional view of the version block of FIG. 7A attached to the stem implant of FIG. 5A in an unlocked configuration.
FIG. 7F is a cross-sectional view of the version block of FIG. 7A attached to the stem implant of FIG. 5A in a locked configuration.
FIG. 8A is a side view of a height measurement gauge according to another aspect of the disclosure.
FIG. 8B is a cross-sectional view of the height measurement gauge of FIG. 8A.
FIG. 9A is a perspective view of a height measuring gauge according to another aspect of the disclosure in partial transparency in an unlocked configuration.
FIG. 9B is a perspective view of the height measurement gauge of FIG. 9A in partial transparency in a locked configuration.
FIG. 9C is a side view of a deformable plate and locking status indicator of the height measurement gauge of FIG. 9A.



DETAILED DESCRIPTION
In describing preferred embodiments of the disclosure, reference will be made to the directional nomenclature used in describing the human body. It is noted that this nomenclature is used only for convenience and that it is not intended to be limiting with respect to the scope of the invention. When referring to specific directions in relation to a device, the device is understood to be described only with respect to its orientation and position during an exemplary application to the human body. As used herein when referring to bones or other parts of the body, the term “proximal” means closer to the heart and the term “distal” means more distant from the heart. The term “inferior” means toward the feet and the term “superior” means toward the head. The term “anterior” means toward the front part or the face and the term “posterior” means toward the back of the body. The term “medial” means toward the midline of the body and the term “lateral” means away from the midline of the body. Further, although the devices and methods described herein are generally described in relation to human shoulder replacements, it should be understood that the devices and methods are not intended to be so limited and could be used with other joints, such as other ball and socket joints, including the hip, for example.
Generally, the replacement of a humeral head with a prosthetic implant during shoulder arthroplasty involves gaining access to the shoulder joint through a retracted incision and removing the damaged humeral head. An exemplary damaged proximal humerus 10 is illustrated in FIG. 1. Although such breaks giving rise to a plurality of bone fragments may occur in any number of ways, this particular humerus 10 is broken such that a first segment 20, a second segment 30, and a third segment 40 including a substantial portion of the humeral head are each detached from the proximal end 12 of the humerus. After removal of the humeral head 40, the proximal end of the humeral medullary canal may be shaped in order to accept an implant according to known methods. In one exemplary method, a hand reamer, for example, may be used at a proximal humeral bearing surface 14 to remove bone material until an appropriately-shaped opening is formed in the proximal end 12 of humerus 10 for receiving an implant. Typically, successive reamers of increasing size are used in order to form an opening of the desired size. In many cases, bearing surface 14 may not be as flat as shown. Most surfaces at a fracture site are irregularly shaped unless there is a clean break between adjacent fragments. Such a surface may be resected into a generally flat shape to receive a corresponding bearing surface of a trial and/or implant stem as shown in FIG. 1.
Once an appropriate bearing surface 14 and opening is formed for receiving an implant, trialing is conducted to determine the proper size and location for the implant prior to implantation thereof. According to one example of the present disclosure, trialing includes inserting a trial stem 100, as illustrated in FIG. 2, into the opening in the proximal end 12 of humerus 10. Trial stem 100 may include a proximal portion 110 connected to a distal portion 120, for example by welding, with an expansion bolt 130 positioned within the trial stem. Generally, proximal portion 110 is adapted for insertion into the proximal end 12 of a prepared humerus 10. Proximal portion 110 may include a catch aperture 112, a trial recess 114, two locking pin apertures (not visible in FIG. 2), and a driver recess 118. Catch aperture 112 and the locking pin apertures may be configured to mate with corresponding features on a height measuring gauge 200, for example, as described in greater detail below with respect to FIG. 3A. Trial recess 114 may be shaped to receive a corresponding portion of a trial humeral head (not shown) or a reverse cup humeral trial, such as that described in U.S. Pat. No. 8,545,511, the entire contents of which are hereby incorporated by reference herein. Trial recess 114 may have a longitudinal axis that is angled with respect to a longitudinal axis of distal portion 120 so as to substantially replicate the typical geometry of a shaft and neck of the native bone prior to a fracture situation as shown in FIG. 1.
The distal portion 120 of trial stem 100 may be structured to fit within a prepared bone canal, preferably the medullary canal of the humerus 10. Distal portion 120 projects along a longitudinal axis thereof from proximal portion 110 generally in the proximal-to-distal direction. Distal portion 120 may include a first arm 122 and a second arm 124 configured to move away from each other in cooperation with expansion bolt 130, such as that described in U.S. Pat. No. 8,216,320, the entire contents of which are hereby incorporated by reference herein. Distal portion 120, or a portion thereof, may define a cavity or configured to accept expansion bolt 130, the cavity including a mating surface such as threads.
Expansion bolt 130 may generally include a shaft 132 with a pointed distal tip 134. A proximal end of expansion bolt 130 may include a head 136, which may include a recess, such as a hex recess, to cooperate with a correspondingly shaped driving tool (not shown). A proximal end of shaft 132 may include a mating surface, such as threads 138, configured to mate with a corresponding surface in the cavity of distal portion 120. Although proximal portion 110, distal portion 120, and expansion bolt 130 may each be separate pieces prior to assembly, trial stem 100 is preferably provided to the end user as a single piece with the proximal and distal portions permanently connected, for example by welding, with the expansion bolt contained therein.
After trial stem 100, which may be one chosen from a set of differently sized trial stems, is inserted into the opening in the proximal end 12 of humerus 10, the trial stem may be temporarily secured into place by expanding the distal portion 120. To expand the distal portion 120, a user may insert a driving tool (not shown) through driver recess 118 in the proximal portion 110 of the trial stem until the driving tool mates with the corresponding surface of the head 136 of expansion bolt 130. Rotating the driving tool may engage the threads 138 of expansion bolt 130 with corresponding threading in distal portion 120, driving the expansion bolt distally and causing first arm 122 to be separated from second arm 124, thus causing expansion of the distal end of distal portion 120. This expansion may result in a tighter fit of trial stem 100 in humerus 10. Geometrical stops may be included in one or both of expansion bolt 130 and distal portion 120 to limit the distance which the expansion bolt my travel in the proximal-to-distal direction. For example, the size of head 136 or a portion of the proximal shaft of expansion bolt 130 may be larger than certain portions of the cavity in the distal portion 120 of trial stem 100, such that advancement of the expansion bolt is limited to a particular range of movement.
According to known methods, a height of trial stem 100 with respect to the medullary canal of the humerus 10 in which the trial stem is positioned may be noted by a user by, for example, observing indicia printed or otherwise marked on the trial stem with respect to bearing surface 14, for example. This height would be noted to ensure proper placement of a corresponding humeral stem implant. However, in another embodiment according to the present disclosure, a height measuring gauge 200, as illustrated in FIGS. 3A-B, may be connected to trial stem 100 prior to insertion into the medullary canal, and then used to insert trial stem into the medullary canal and to objectively mark the height of the trial stem with respect to a location or surface of the intact humerus, such as bearing surface 14, for example. Height measuring gauge 200 may include a handle portion 210 which may have a flexure spring assembly similar to the broach handle described in U.S. Pat. No. 8,449,548 (“the '548 patent”), the entire contents of which are hereby incorporated by reference. Handle portion 210 may generally include a handle body 212, a deformable plate 214 positioned at least partially within handle body 212, and a loading member 216 configured to interact with the deformable plate. A distal end of deformable plate 214 may include a catch element 218 extending therefrom, and a distal end of handle body 212 may include a pair of locking pins 220 extending therefrom. Briefly, as a user actuates loading member 216 by rotating the loading member clockwise (transition illustrated from FIG. 3A to FIG. 3B), a cam on the loading member interacts with deformable plate 214, generally pushing the plate proximally. If handle portion 210 is not attached to any device, such actuation will not deform deformable plate 214. However, when catch element 218 is positioned inside catch aperture 112 of trial stem 100 and locking pins 220 are positioned inside the locking pin apertures of the trial stem, actuating loading member 216 causes the deformable plate 214 to deform, locking the trial stem to the handle portion 210 of height measuring gauge 200. This mechanism is described in greater detail in the '548 patent.
It should be noted that a stabilizing mechanism, such as a pin 222 extending from a proximal portion of deformable plate 214 and fixed within a corresponding cavity defined by handle body 212, for example by welding, may be provided to apply a downward force on deformable plate 214. Pin 222 may be fixed to body 212 while deformable plate 214 is under some amount of compression. This configuration of pin 222 and deformable plate 214 may, for example, stabilize deformable plate 214 so that it does not move or “rattle” around within body 212 when loading member 216 is placing little or no force on deformable plate 214. It should further be noted that handle body 212 may include a driver aperture 224 extending the length of the body and configured to align with driver recess 118 of trial stem 100, such that when handle portion 210 is attached to the trial stem, a driving tool may be passed through the handle body, through the proximal portion 110 of the trial stem, and into the head 136 of expansion bolt 130 to allow driving of the expansion bolt.
Height measuring gauge 200 may also include a height measurement system 230. Height measurement system 230 may generally include a slider 240 and a height reference member in the form of pointer 250. Slider 240, illustrated alone in FIG. 3C, may generally include a main body 242, flanges 244, one or more ball plungers 246, and a bone position indicator 248 extending distally from the main body. The bone position indicator 248 may take the general form of an elongated slender cylindrical rod and may be integral or monolithic with slider 240. Main body 242 may include a relatively large portion configured to fit within a track defined by handle body 212, and a relatively small portion configured to extend through the track to the outside of the handle body. This configuration is illustrated as generally rectangular members fitting within rectangular grooves, but may take other forms, such as a dovetail configuration. This configuration provides main body 242 the ability to slide proximally or distally down the track in handle body 212 while being securely maintained therein. At least one flange 244, and preferably two, may extend from main body 242 and be configured to wrap around an outer portion of handle body 212. Flanges 244 may include texturing, such as ridges, to provide a gripping surface for a user. One or more ball plungers 246 may be imbedded in main body 242. In the illustrated configuration, a first pair of ball plungers 246 is positioned on a proximal end of main body 242 (only one visible in FIG. 3C) and another pair of ball plungers 246 is positioned on a distal end of the main body (only one visible in FIG. 3C). Generally, each ball plunger 246 may be spherical and biased away from main body 242 by a spring or spring-like member, although such biasing is not required. The ball plungers 246 may contact a wall of the track in handle body 242, providing frictional engagement therewith. A user may grip one or more flanges 244 to slide the slider 240 proximally or distally along the track, with ball plungers 246 facilitating such sliding motion while also providing friction to keep main body 242 generally in place when a sliding force is not being provided by a user. In other words, ball plungers 246 help prevent free sliding of slider 240 when no force is being applied to the slider. As will be explained in greater detail below, sliding main body 242 also slides bone position indicator 248, which may be used to determine a position of the humerus 10, and in particular the bearing surface 14 of the proximal portion 12 of the humerus.
The pointer 250 of height measurement system 230, illustrated alone in FIG. 3D, may generally include a main body 252, flanges 254, and one or more knobs 256. Main body 252 may be of a similar shape to the main body 242 of slider 240, with a relatively large portion configured to fit within a track defined by handle body 212, and a relatively small portion configured to extend through the track to the outside of the handle body. Main body 252 may also include an aperture 253 extending the length of the main body in a proximal-to-distal direction, the aperture being sized and configured to accept the bone position indicator 248 of slider 240 therethrough. At least one flange 254, and preferably two, may extend from main body 252 and be configured to wrap around an outer portion of handle body 212. Each flange 254 may include a knob 256. Knobs 256 may include threaded screws such that rotating the knobs in one direction drives the screws toward the center of pointer 250. When pointer 250 is connected to handle portion 210 such that main body 252 is positioned inside the track defined by handle body 212 and flanges 254 are on the outside of the handle portion, rotating the knobs 256 may cause the threaded screws to drive into frictional engagement with the handle body, causing the pointer to lock in its current position.
FIG. 3E illustrates a cross sectional view of pointer 250 taken along the line 3E-3E of FIG. 3D. A portion of main body 252 adjacent aperture 253 may define a cavity 257. Cavity 257 may include a magnet 258 and a cap 259, the cap acting to keep the magnet within the cavity. Magnet 258 is configured to cause engagement between a distal facing surface of the main body 242 of slider 240 and a proximal facing surface of pointer 250, such that during sliding motion of the slider, the pointer will slide along with the slider as long as the pointer is in an unlocked configuration. The coupled movement of the slider 240 with respect to the pointer 250 may be referred to as a first mode of operation. When slider 240 is at a desired location, as will be explained in greater detail below, pointer 250 will be at a corresponding desired location. At this point, the one or more knobs 256 may be rotated or tightened to keep pointer 250 in the desired location, with slider 240 removed. The frictional force of knobs 256 with handle body 212 is preferably greater than the attractive force between magnet 258 and the distal portion of the main body 242 of slider 240, such that removing the slider 242 does not cause pointer 250 to change positions once the pointer is in the locked configuration. The decoupled movement of the slider 240 with respect to the pointer 250 may be referred to as a second mode of operation.
As noted above, in an embodiment according to the present disclosure, height measurement gauge 200 may be connected to trial stem 100 prior to insertion into the medullary canal, and then used to insert the trial stem into the medullary canal and to objectively mark the height of the trial stem. Once height measuring gauge 200 is locked onto trial stem 100, as described above and illustrated in FIG. 4A, the trial stem is inserted into the previously formed opening to the medullary canal in the proximal portion 12 of humerus 10. If the user determines that a different sized trial stem 100 is desirable at this point, the user may remove the height measuring gauge 200 and trial stem 100, disconnect the original trial stem, and attach a differently sized trial stem to the height measuring gauge. If the trial stem 100 is an appropriate size, the user may continue. At this point, slider 240 and pointer 250 are in a first or initial proximal position, with the pointer attached to the slider via magnet 258 as described above. Pointer 250 is also in an unlocked configuration. To facilitate the initial choice of an appropriately sized trial stem 100, handle 210 may include a plurality of indicia, such as gradations 211 (only illustrated in FIG. 4A) that may referenced in concert with a contralateral X-ray template of the healthy bone. The contralateral X-ray template may include corresponding markings as handle 210 to facilitate the choice of an appropriately sized stem 100.
Once trial stem 100 is inserted into humerus 10 to a desirable depth as determined by the user, a driving tool may be inserted through the driver aperture 224 in handle portion 210, through driver recess 118 of the proximal portion 110 of trial stem 100, and finally mate the driving tool with the head 136 of expansion bolt 130. The driving tool may be rotated, torqued, or otherwise used to drive expansion bolt 130, causing expansion of the first and second arms 122, 124 of the distal portion 120 of trial stem 100, causing the trial stem to have a snug fit within the proximal portion 12 of humerus 10.
Before or after causing such expansion, the user may grip slider 240 and slide it distally until a distal end surface 249 of bone position indicator 248 makes contact with a bearing surface 14 of the humerus, the position of slider 240 and pointer 250 being shown in FIG. 4B. At this stage, knobs 256 may be tightened to frictionally engage handle body 212. Pointer 250 may now serve as an objective reference to a height of trial stem 100 with respect to humerus 10 for later reference. Because pointer 250 is frictionally locked, slider 240 may be slid proximally while the pointer remains in place, the magnetic interaction between magnet 258 and the main body 242 of the slider not affecting the position of the pointer, as illustrated in FIG. 4C. Once pointer 250 is locked into the desired position and slider 240 is back at an original proximal position, handle portion 210 may be shifted to the unlocked configuration by actuating loading member 216 as described above. This allows a user to remove height measuring gauge 200, as shown in FIG. 4D, while leaving trial stem 100 expanded in place.
With trial stem 100 secure in place, any one of a number of additional trial components may be attached to trial stem 100 via trial recess 114, such as a trial humeral head or a reverse cup humeral trial (not shown). One benefit of the trial stem 100 illustrated herein is that the trial recess 114 may provide compatibility with a greater number of other trial components compared to known expandable trial stems that have a protruding peg or similar protruding structure onto which other trial components fit. The position of trial recess 114 is possible at least partly due to the location of expandable bolt 130. In certain known expandable trial stems, an expansion bolt extended close to the proximal end of the known trial stem, making such a trial recess incompatible as any component inserted into a recess made in the known trial would make contact with a proximal end of the expansion bolt. However, the relatively distal position of expansion bolt 130 and its total encapsulation within trial stem 100, as disclosed herein, facilitates the ability of using trial recess 114 which, as noted above, may accept a number of different types of trial components. Once the desired trial component is connected to trial stem 100, the user may conduct trialing to confirm the size and placement of trial stem 100 as well as any other trial components being used.
After the user is satisfied with the results of trialing, any trial components still connected to trial stem 100 may be removed. Trial stem 100 may then be removed, with or without the use of height measuring gauge 200. Based on the results of trialing, a particular sized stem implant 300 is chosen. An exemplary embodiment of stem implant 300 is illustrated in FIG. 5A and may be structurally similar to trial stem 100 in certain respects. Stem implant 300 may be monolithic with a proximal portion 310 and a distal portion 320. Proximal portion 310 of stem implant 300, shown in greater detail in FIGS. 5B-D, may include a catch aperture 312, an implant recess 314, and two locking pin apertures 316. The apertures 312, 316, similar to corresponding features on trial stem 100, facilitate the connection between handle portion 210 of height measuring gauge 200 with stem implant 300. Implant recess 314 may be configured to accept a humeral head implant, reverse cup humeral implant, or other compatible implant. Proximal portion 310 may also include a number of features to facilitate securing portions of humerus 10, such as first segment 20 and second segment 30, to stem implant 300. For example, a first pair of suture holes 317a may be formed on a lateral-anterior side of proximal portion 310 and a second pair of suture holes 317b may be formed on a lateral-posterior side of the proximal portion. A third pair of suture holes 317c may be formed on a medial side of proximal portion 310. The suture holes 317a-c may facilitate securing one or more bone fragments to stem implant 300 via sutures (not illustrated). One suture pocket 319a may be formed on the lateral-anterior side of proximal portion 310, and may be connected to suture holes 317a. Another suture pocket (not visible in FIGS. 5A-D) may be formed on the lateral-posterior side of proximal portion 310, and may be connected to suture holes 317b. The suture pockets may, for example, facilitate the insertion of a suture needle.
After the desired stem implant 300 is chosen, the user may connect the stem implant to height measuring gauge 200 and lock the stem implant using loading member 216, as described above. Once locked into place, a user may insert stem implant 300 into the prepared hole in humerus 10 using height measuring gauge 200. At this stage, pointer 250 is still locked into the position determined during insertion of trial stem 100, described above in relation to FIGS. 4A-C. The user may slide slider 240 distally until it contacts pointer 250, as illustrated in FIG. 6A. The user may confirm that the distal end of bone position indicator 248 is in contact with bearing surface 14 of the proximal portion 12 of humerus 10. This confirms that the height of stem implant 300 with respect to humerus 10 corresponds to the desired height determined using trial stem 100, reducing or eliminating the requirement for the user to subjectively assess the respective heights.
The user may assess and confirm a correct rotational position of stem implant 300 at this point using one or more of threaded apertures 260, 270, and 280, as shown in FIG. 4B. Each threaded aperture 260, 270, and 280 is a threaded aperture at varying angles. For example, one of the threaded apertures may be angled at approximately 20 degrees, another may be angled at approximately 30 degrees, and the third may be angled at approximately 40 degrees. A version rod taking the form of a straight rod with a threaded end may be threaded into any one of the threaded apertures 260, 270, or 280. The version rod may be used to provide a line of reference for comparison, for example, with the position of the forearm relative to the shoulder. When the version rod aligns with the desired anatomical landmark(s), the angle will be known or estimated based on which threaded aperture 260, 270, or 280 the version rod extends from. More or fewer than three threaded apertures may be provided, and the particular angles are not limited to 20, 30, and 40 degrees. Further, threaded apertures may be provided on one or both sides of handle 210. This procedure is essentially the same whether measurements are being taken in relation to trial stem 100 or stem implant 300.
Once version has been confirmed, the user may then unscrew the knobs 246 of pointer 250, causing the pointer to transition into an unlocked configuration. Then, slider 240 may be slid proximally, causing pointer 250 to slide proximally due to the magnetic connection between the pointer and slider, as illustrated in FIG. 6B. Finally, the user may rotate loading member 246 to unlock handle portion 210 of height measuring gauge 200 from stem implant 300. At this point, the user may attach a humeral head or other implant component to stem implant 300, and complete the particular implant procedure desired.
As noted above, during the procedure, it may be desirable to assess and confirm a correct rotational position of trial stem 100 and/or stem implant 300. One method of assessing and/or confirming version was described above in relation to threaded apertures 260, 270, and 280 of handle 210. A version block 400, as illustrated in FIG. 7A, may be used in conjunction with a version rod (not illustrated) to determine the rotational position of stem implant 300 or trial stem 100 if a user does not wish to use threaded apertures 260, 270, and 280 of handle 210. Generally, version block 400 is a monolithic structure with a number of components that facilitate locking of the version block to stem implant 300. In particular, version block 400 may include a pair of locking pins 420 configured to mate with locking pin apertures 316 of stem implant 300. Version block 400 may also include a catch member 418 configured to mate with catch aperture 312 of stem implant 300. As illustrated in FIG. 7B, version block 400 may also include a driver recess 419 configured to allow passage of a driving tool through the version block and into trial stem 100 when the version block is attached to the trial stem.
Still referring to FIG. 7B, the locking mechanism of version block may generally include catch member 418, spring cap 450, spring 460, lever 470, and actuator 480. Catch member 418, which is also illustrated in FIG. 7C, may be a generally cylindrical member with a flange that cooperates with spring 460, the spring contacting the flange of the catch member on a first end and spring cap 450 on a second end opposite the first end. This configuration provides for a force that biases catch member 418 beyond a distal end of version block 400. A distal end of the flange of catch member 418 may be configured to contact a proximal face of lever 470, with a cylindrical portion of the catch member extending through a slot 472 in the lever. Lever 470, which is also illustrated in FIG. 7D, is configured to pivot about pin 490, the pin connecting the lever to version block 400 through a pin aperture 474 in the lever. The flange of catch member 418 does not fit through slot 472 in lever 470, so the biasing force provided by spring 460 on the catch member is transmitted to the lever, causing the lever to be biased in a counterclockwise direction in the view of FIG. 7B. One end of lever 470 is configured to contact a distal end of actuator 480. Actuator 480 may generally comprise a cylindrical pin with an enlarged head 482 and a slot 484. Actuator 480 is connected to version block 400 by another pin 490 extending through slot 484 of the actuator. Actuator 480 may slide into or out of version block 400, the sliding motion being limited by enlarged head 482 and the cooperation of pin 490 with slot 484. As should be understood from the description of the components above, actuator 480 is biased in a proximal direction resulting from the transmission of force from spring 460 to catch member 418 to lever 470 and finally to the actuator. Thus, a user may press distally on the enlarged head 482 of actuator 480 to cause catch member 418 to retract within the body of version block 400. Similarly, a user may stop the application of force on the enlarged head 482 of actuator 480 to cause the spring 460 to push catch member 418 partially out of version block 400.
To lock version block 400 to stem implant 300, a user depresses actuator 480 to retract catch member 418 inside the version block. Locking pins 420 are inserted into corresponding locking pin apertures 316 of stem implant 300, as illustrated in FIG. 7E. The user then aligns catch member 418 with catch aperture 312 and releases actuator 480, causing the bias force provided by spring 460 to push the catch member distally out of version block 400 and into corresponding catch aperture 312 of stem implant 300, as illustrated in FIG. 7F. Once in the locked configuration, a version rod (not illustrated) may be inserted into any one of a number of version rod apertures 495 in version block 400, as illustrated in FIG. 7A. The version rod may be generally “L” shaped or straight, as noted above, with one end of the rod extending to provide a line of reference for comparison, for example, with the position of the forearm relative to the shoulder. As noted above, version block 400 may be used with trial stem 100 or stem implant 300 to assess the rotational position of the trial stem or stem implant in relation to the anatomy during trialing or assessment of implant position. Because version rods are generally known in the art, they are not described in greater detail herein.
An alternate embodiment of height measurement gauge 200′ is illustrated in FIGS. 8A-8B. Height measurement gauge 200′ is similar to height measurement gauge 200 in nearly all respects, with the exception of the following. The height measurement system only includes a sliding member 240′, without a pointer as provided with height measurement gauge 200. Sliding member 240′ may include a marking, such as an arrow or a notch, to reference corresponding indicia 211′ on the handle body 210′ of height measurement gauge 200′. During insertion of trial stem 100, slider 240′ is slid distally until a distal end surface 249′ of bone position indicator 248′ makes contact with a bearing surface 14 of the humerus, much in the same way as described in connection with height measurement gauge 200. In this embodiment, the user may take note of the position of the arrow or other indicator on sliding member 240′ with respect to indicia 211′ on the body of handle 210′. This provides an objective indication of the position of bone position indicator 248′ when trial stem 100 is properly inserted into the bone. When inserting stem implant 300 using height measurement gauge 200′, sliding member 240′ may be positioned so that the arrow or other indicator aligns with the corresponding indicia 211′ as determined while using trial stem 100. In addition, sliding member 240′ may include teeth, screws, or other members to lock the sliding member 240′ in a particular position with respect to the body of handle 210′. For example, a structure similar to knobs 256 of pointer 250 may be used with sliding member 240′ to achieve such locking.
Another embodiment of height measuring gauge 200′′ is illustrated in FIGS. 9A-B. Height measuring gauge 200′′ is nearly identical to height measuring gauge 200, with the exception that height measuring gauge 200′′ includes a locking status indicator mechanism, for example locking status pin 290′′. Pin 290′′ extends from a proximal portion of deformable plate 214′′ and is positioned within a corresponding cavity defined by handle body 212′′. Pin 290′′ may be welded or otherwise fixed to deformable plate 214′′ but free to slide within the corresponding cavity defined by handle body 212′′. Pin 290′′ may help indicate to the user whether loading member 216′′ is in a locked or unlocked configuration. For example, when in an unlocked configuration, as shown in FIG. 9B, pin 290′′ may be generally flush with a proximal end of handle body 212′′. After a transition to a locked configuration, as shown in FIG. 9B, pin 290′′ may be pushed proximally so as to extend beyond the proximal end of handle body 212′′, providing a user with a visual indication that loading member 216′′ is in a locked configuration. The length and position of pin 290′′ may be altered to vary the exact position of the pin that indicates the locked or unlocked configuration. Deformable plate 214′′ and pin 290′′ are illustrated without handle body 212′′ in FIG. 9C.
Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.

## Claims

1. A height measuring system comprising:
a prosthetic humeral stem trial implant;
a prosthetic humeral stem implant component; and
a height measuring tool including:
a body member configured to releasably couple to the prosthetic humeral stem trial implant and the prosthetic humeral stem implant component;
a slidable member having a distal end surface, the slidable member coupled to the body member; and
a height reference member coupled to the body member,


wherein movement of the sliding member in a distal direction in relation to the body member causes corresponding movement of the height reference member in the distal direction when the sliding member is engaged to the height reference member and the height reference member is in an unlocked state,
wherein the height reference member includes at least one knob configured to increase or decrease frictional engagement between the height reference member and the body member,
wherein movement of the sliding member in the distal direction in relation to the body member does not cause corresponding movement of the height reference member in the distal direction when the sliding member is engaged to the height reference member and the height reference member is in a locked state.

2. The height measuring system of claim 1, wherein the body member includes a track and the slidable member and the height reference member are each coupled to the track.

3. The height measuring system of claim 1, wherein the slidable member and the height reference member are configured to slide in proximal and distal directions in relation to the body member.

4. The height measuring system of claim 1, wherein the height reference member and slidable member have corresponding mating surfaces.

5. The height measurement system of claim 4, wherein the slidable member includes a slider portion and a bone position indicator in the form of an elongated rod extending distally from the slider portion, the bone position indicator terminating at the distal end surface of the slidable member.

6. The height measurement system of claim 5, wherein the bone position indicator is configured to extend through an aperture in the height reference member.

7. The height measuring system of claim 1, wherein the body member includes a handle portion having a first position and a second position and wherein the body member is configured to be operatively coupled to the prosthetic humeral stem trial implant or the prosthetic humeral stem implant component when the handle portion is in the first position.

8. The height measuring system of claim 1, wherein the height reference member includes a magnet therein.