Abstract:
An apparatus for reducing a fracture in a bone and attaching a plate to the bone includes a first sub-assembly configured to reduce the fracture, and a second sub-assembly integrated with said first sub-assembly in a single surgical instrument. The second sub-assembly is configured to hold the plate against the bone concurrently with reduction of the fracture by the first sub-assembly.

Description:
BACKGROUND AND SUMMARY 
     This disclosure relates to a device for reducing and repairing fractures of small bones and more particularly to a device for reducing fractures of the bones of the hands and feet, for clamping plates to those bones and for guiding a drill during drilling of the plate and bone to facilitate attachment of the plate to the bone. 
     Typically, fractures of the bones of the hands (e.g., the metacarpals) and feet (e.g., the phalanges) are reduced and then a plate is secured to the bone with bone screws passing through the bone and the plate on opposite sides of the fracture to hold the bone sections in place during healing. It is often difficult for surgeons to reduce a fracture while simultaneously positioning and affixing a plate to the fractured bone. Currently, surgeons must hold a plate on the bone with either a clamp or their hands while screw holes are drilled through the plate and into the bone. These screw holes must be drilled in the precise location and orientation the surgeon desires. Since the bones of the hands and feet are relatively small, there is little margin of error to correct for misplaced screw holes. 
     Most surgeons use medical pliers or other small clamping devices to perform the aforementioned functions. However, these instruments are not designed to simultaneously reduce a fracture and secure a plate in a desired location. As a result, it is often difficult to correctly position the pliers or clamping devices and still allow enough room to drill holes and place screws. Additionally, in order to accurately drill screw holes, a second device is required. Currently a hand held drill guide or a clamp containing a point contract drill guide is used to guide the drill while drilling holes through the plate and into the bone. Thus, a minimum of two clamps are currently typically used to perform fracture reduction, clamping of a plate to the reduced bone and securing of a drill guide in a desired location to guide a drill while drilling through the plate and into the bone. 
     This invention serves as both an external plate to bone clamp and reduction device for use with fractures of the hands and feet. The proximal portion of the device contains a bone hook, which can be adapted to fit around different bone diameters. The distal section of the device contains a thumbscrew assembly, which moves the reduction device and plate fixation pin away from and towards the fracture. Additionally, the medial section of the device contains a removable dial-able drill guide and a single hand operation handle. This disclosure is for a plate to bone clamp which also serves as a reduction device and drill guide. 
     The thumbscrew assembly of this device allows the surgeon to quickly reduce a fracture and temporarily clamp a plate in the desired location for attachment to the bone while holes are drilled through the plate into the bone at the desired locations. A removable drill guide is provided that allows a surgeon to visualize the placement of the drill and precisely control the orientation of the drill during the drilling operation. Thus, the disclosed device advantageously saves operating room time and allows for more accurate and less cumbersome procedure for repair of fractures of small bones. 
     According to one aspect of the disclosure, a surgical instrument for repairing a fracture in a small bone comprises a body portion, a first and second bone-engaging member, and a plate fixation member. The body portion is configured to facilitate manipulation of the surgical instrument. The first bone-engaging member is coupled to the body and configured to engage a first side of the small bone having a fracture therein at a first location. The second bone-engaging member is coupled to the body and configured to engage upon movement relative to the first bone-engaging member the small bone having the fracture in a position relative to the first location to facilitate in cooperation with the first bone-engaging member reduction of the fracture in the small bone. The plate fixation member is coupled to the body for movement relative to the body from a first position in which a plate can be inserted between the plate fixation member and the small bone and a second position in which a plate inserted between the plate fixation member and the small bone is temporarily fixed to the small bone. 
     According to a second aspect of the disclosure, a method of repairing a fracture in a fractured small bone is disclosed. According to the method a single instrument configured to capture a fractured small bone between a first member and a second member configured to move longitudinally with respect to each other and configured to engage a plate and seat the plate against the fractured small bone upon longitudinal movement of a third member with respect to the second member is provided. The first member of the instrument is disposed on a first side of the fractured small bone. The second member is disposed on a different side of the small bone. The fracture in the small bone is reduced by moving the first member relative to the second member to capture the fractured small bone between the first and second members. A plate is placed in engagement with the fractured small bone. The plate is seated against the fractured small bone by moving the third member longitudinally relative to the second member to bring the third member into engagement with the plate. 
     The above-noted features and advantages of the present invention, as well as additional features and advantages, will be readily apparent to those skilled in the art upon reference to the following detailed description and the accompanying drawings, which include a disclosure of the best mode of making and using the invention presently contemplated. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In describing the disclosed device, reference will be made to the following figures in which: 
         FIG. 1  is a perspective view of a disclosed device for facilitating reduction and repair of fractures of small bones; 
         FIG. 2  is another perspective view of the device for facilitating reduction and repair of fractures of small bones of  FIG. 1 ; 
         FIG. 3  is a sectional view of the device for facilitating reduction and repair of fractures of small bones of  FIG. 1 ; 
         FIG. 3A  is an enlarged sectional view of the proximal section of the device for facilitating reduction and repair of fractures of small bones of  FIG. 1  (and  FIG. 3 ); and 
         FIG. 4  is a view of the device for facilitating reduction and repair of fractures of small bones of  FIG. 1  showing a bone captured between the hook arm and bone-engaging assembly and a plate temporarily affixed to the bone by the plate fixation pin. 
     
    
    
     Corresponding reference characters indicate corresponding parts throughout the several views. Like reference characters tend to indicate like parts throughout the several views. 
     DETAILED DESCRIPTION 
     For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and described in the following written specification. It is understood that no limitation to the scope of the invention is thereby intended. It is further understood that the present invention includes any alterations and modifications to the illustrated embodiments and includes further applications of the principles of the invention as would normally occur to one skilled in the art to which this invention pertains. 
     Referring to  FIGS. 1-4 , there is shown a device for facilitating reduction and repair of fractures of small bones  10 . The device or surgical instrument  10  includes a plate fixation pin  12 , a thumbscrew assembly  14 , a body  16 , a hollow shaft  18 , a handle  20 , a hook assembly  22  and a bone-engaging assembly  24 . The device  10  includes a distal section  26 , a medial section  28  and a proximal section  30 . A removable drill guide assembly  32  is configured to be removably coupled to the medial section  28  of the device  10 . 
     The hollow shaft  18  includes an outside wall  34  and an inside wall  36  defining a lumen  38  all of which are formed concentrically about a longitudinal axis  40 . The hollow shaft  18  extends longitudinally between the distal section  26  and the proximal section  30 . Adjacent the distal end of the hollow shaft  18 , the outside wall  34  is formed to include a screw thread  42  to facilitate attachment of the thumbscrew assembly  14  to the hollow shaft  18 . The thumbscrew assembly  20  located in the distal section  12  of the device is coupled to the hollow shaft  18  to control vertical movement of the hollow shaft  18  along its longitudinal axis  40  relative to the body  16  of the device. Also adjacent the distal end of the hollow shaft  18 , the inside wall  36  is formed to include a screw thread  44  to facilitate attachment of the plate fixation pin  12  to the hollow shaft  18  for longitudinal movement of the plate fixation pin  12  relative to the hollow shaft  18 . 
     The body  16  includes a cylindrical outer wall  46  extending between two annular radially outwardly extending lips  48 ,  50 , a handle  20  extending from the distal lip  50 , an attachment flange  54  extending from the proximal lip  48  and a cylindrical inner wall  56  defining a shaft-receiving bore  58 . A distal wall  60  of the proximal lip  48 , a proximal wall  62  of the distal lip  50  and the cylindrical outer wall  46  define a guide-receiving channel  64  extending circumferentially about the body  16  which is configured to receive the drill guide assembly  32  for fixation in a plurality of radial orientations relative to the body  16  in a manner described more fully below. 
     The cylindrical inner wall  56 , cylindrical outer wall  46  and lips  48 ,  50  are formed concentrically about a longitudinal axis  66  of the body  16 . The shaft-receiving bore  58  has an inside diameter  68  slightly greater than, but approximately equal to, the outside diameter  70  of the hollow shaft  18 . Thus, the shaft-receiving bore  58  is configured to receive the hollow shaft  18  therein for longitudinal movement of the hollow shaft  18  relative to the body  16 . When received in the shaft-receiving bore  58 , the longitudinal axis  40  of the hollow shaft  18  is coincident with the longitudinal axis  66  of the body  16 . The thumb screw assembly  14  cooperates with the distal lip  50  and the external threads  42  on the outer wall  34  of the hollow shaft  18  to limit the longitudinal movement of the hollow shaft  18  relative to the body  16 . 
     Illustratively, the handle  20  includes an outwardly extending attachment arm  72  and a downwardly extending grip  74 . The attachment arm  72  is coupled at a first end  76  to the distal lip  50  of the body  16  and extends radially outwardly from the body  16 . A second end  78  of the attachment arm  72  is coupled to a first end  80  of the grip  74 . The grip  74  extends downwardly from the attachment arm  72  for a distance  82  sufficient to permit a surgeon to comfortably hold the grip  74 . The attachment arm  72  extends outwardly from the body a distance  84  sufficient to permit a surgeon to comfortably grasp the grip  74  without interfering with the attachment flange  54 . The illustrated attachment arm  72  initially curves upwardly as it extends radially away from the distal lip  50  and then adjacent the second end  78  curves downwardly. The second end  86  of the grip  74  may be curved, as shown, for example, in  FIGS. 1-3  and is illustratively free from the remainder of the device  10 . In the illustrated embodiment, the grip  74  includes a straight section  88  that is substantially parallel to the longitudinal axis  66  of the body  16 . The curvature of the attachment arm  72  permits the straight section  88  of the grip  74  to be long enough to allow the surgeon to comfortably grip the instrument  10  while ensuring that the free end  86  of the grip  74  does not engage the tissue surrounding the surgical site. While described as separate components, the illustrated attachment arm  72  and grip  74  of the handle  52  are formed as monolithic unit. 
     The attachment flange  54  includes a radially extending offset arm  90  and a longitudinally extending attachment arm  92 . The first end  94  of the offset arm  90  is coupled to the proximal lip  48  of the body  16  at a position below the attachment location of the handle  52 . The offset arm  90  extends radially outwardly from the body  16  in the same radial direction as the attachment arm  72  of the handle  52 . The second end  96  of the offset arm  90  is displaced from the first end  94  by length  98 . Length  98  is selected to displace the attachment arm  92  a sufficient distance away from the hollow shaft  18  so as not to interfere with movement of the shaft  18  relative to the body  16 , to not interfere with the bone-engaging assembly  24 , to not interfere with the ability of the surgeon to grasp the handle  52  and to allow the hook assembly  22  to engage the opposite side of the bone from the side the bone-engaging assembly  24  engages. 
     The first end  100  of the attachment arm  92  is coupled to the second end  96  of the offset arm  92 . The attachment arm  92  is substantially straight and extends downwardly substantially parallel to the longitudinal axis  66  of the body  16 . The second or free end  102  of the attachment arm  92  is displaced from the first end  100  by a displacement  104 . The displacement  104  is selected to allow the hook assembly  22  to slide longitudinally relative to the attachment arm  92  to facilitate adjustment of the hook assembly  22  based on the diameter of the bone being reduced and clamped. In the illustrated embodiment, the attachment arm  92  is formed symmetrically about a longitudinal axis  106  and has a cross-sectional shape conforming to a cross-sectional shape of a cavity  168  in an attachment housing  150  of the hook assembly  22 . Illustratively, the attachment arm  92  has a rectangular cross-sectional shape as the cross-sectional shape of a cavity  168  in an attachment housing  150  of the hook assembly  22  is rectangular. The outside dimensions of the attachment arm  92  are sized to be slightly less than, but substantially equal to, the inside dimensions of the cavity  168  in the attachment housing  150  of the hook assembly  22 . 
     The bone-engaging assembly  24  is attached to the proximal end of the hollow shaft  18 . The bone-engaging assembly  24  includes attachment fasteners  108 , a first frame member  110 , a second frame member  112 , a first foot  114 , a second foot  116 , a first fastener  118  and a second fastener  120 . In the illustrated embodiment, the first and second frame members  110 ,  112  are bars that are attached at their centers on opposite sides of the outside wall  34  of the proximal end of the hollow shaft  18 . Each frame member  110 ,  112  is illustratively attached to the hollow shaft  18  utilizing an attachment fastener  108  that extends into the outer wall  34  of the hollow shaft  18  but do not extend into the lumen  38  so as not to interfere with reciprocal longitudinal movement of the plate fixation pin  12  within the lumen  38  relative to the shaft  18 . 
     The first frame member  110  is formed symmetrically about a longitudinal axis  122  and includes a first end  124  and a second end  126 . The first frame member  110  is formed to include a first foot attachment hole  128  extending through the bar perpendicular to the longitudinal axis  122  at a location between the center and the first end  124 . The first frame member  110  is also formed to include a second foot attachment hole  130  extending through the bar perpendicular to the longitudinal axis  122  at a location between the center and the second end  126 . The second frame member  112  is formed symmetrically about a longitudinal axis  132  and includes a first end  134  and a second end  136 . The second frame member  112  is formed to include a first foot attachment hole  138  extending through the bar perpendicular to the longitudinal axis  132  at a location between the center and the first end  134 . The second frame member  112  is also formed to include a second foot attachment hole  140  extending through the bar perpendicular to the longitudinal axis  132  at a location between the center and the second end  136 . 
     The first and second frame members  110 ,  112  are attached to the proximal end of the hollow shaft  118  so that their respective longitudinal axes  122 ,  132  are substantially perpendicular to the longitudinal axis  40  of the hollow shaft  18 , substantially parallel to the radius along the direction in which both the attachment arm  72  of the handle  52  and the offset arm  90  of the attachment flange  54  extend away from the body  16 , and substantially perpendicular to the attachment arm  92  of the attachment flange  54 . When the first and second frame members  110 ,  112  are attached at their centers, the first attachment holes  128 ,  138  and the second attachment holes  130 ,  140  align. As a result of this alignment, the first fastener  118  can be inserted through the first attachment hole  128  of the first frame member  110  and the first attachment hole  138  of the second frame member  112  and an attachment hole  142  in the first foot  114  to secure the first foot  114  between both frame members  110 ,  112 . Similarly, as a result of this alignment, the second fastener  120  can be inserted through the second attachment hole  130  of the first frame member  110  and the second attachment hole  140  of the second frame member  112  and an attachment hole  144  in the second foot  116  to secure the second foot  116  between both frame members  110 ,  112 . When so attached the first and second feet  114 ,  116  are on opposite sides of the hollow shaft and the bone-engaging end  146  of the first foot  114  and the bone engaging-end  148  of the second foot  116  extend longitudinally beyond the proximal end of the hollow shaft  18 . 
     The hook assembly  22  includes an attachment housing  150 , a position locking screw  152  and a bone-engaging hook arm  156 . The attachment housing  150  is includes a body  158  having an outer wall  160 , an upper wall  162 , a lower wall  164  and an inner wall  166 . The inner wall  166  defines a cavity  168  extending longitudinally through the body  158  between the upper wall  162  and lower wall  164 . A threaded screw hole  170  is formed through the body  158  and extends between the outer wall  160  and the inner wall  162 . The threaded screw hole  170  is sized and threaded to receive and cooperate with the threaded shaft  172  of the position locking screw  152  to allow the screw  152  to be tightened in the screw hole  170  so that the end  174  of the shaft  172  engages the attachment arm  92  of the attachment flange  54  to lock the attachment housing  150  in a position relative to the attachment flange  54  when the head  176  of the locking screw  152  is turned. Since the attachment arm  92  in the illustrated embodiment has a rectangular cross-sectional shape the cavity  168  in the attachment housing  150  of the hook assembly  22  also has a rectangular cross-sectional shape. The outside dimensions of the attachment arm  92  are sized to be slightly less than, but substantially equal to, the inside dimensions of the cavity  168  in the attachment housing  150  of the hook assembly  22  to allow the attachment housing  150  to move longitudinally relative to the attachment arm  92  when the attachment arm  92  is received in the cavity  168 . Illustratively, the attachment housing  150  is sized to be received between the frame members  110 ,  112  of the bone-engaging assembly  24 . 
     The bone-engaging hook arm  156  includes a first end  178  and a second or free end  180 . Illustratively, the bone-engaging hook arm  156  is fabricated from curved bar stock material having an inner surface  182  facing toward the hollow shaft  18  and an oppositely facing outer surface  184 . Side walls  186  and  188  extend between and couple the inner and outer surfaces  182 ,  184 . The first end  178  is coupled to the bottom wall  164  of the body  158  of the attachment housing  150 . The hook arm  156  extends downwardly and curves inwardly toward the free end  180  to form a hook or cradle for engaging the opposite side of the bone from the bone-engaging feet of the assembly  22 . In the illustrated embodiment, the inner surface  182  adjacent the free end  180  is displaced from the first end  178  by a displacement  190 . The displacement  190  is selected based upon the size of bone within which a fracture is to be reduced. While only a single bone-engaging hook arm  22  is illustrated, it is envisioned that a plurality of bone engaging hook arms will be provided having different displacements  190  so that a surgeon can select the hook arm best suited for the size of the bone in which a fracture is to be reduced. 
     The plate fixation pin  12  includes a head  192  and a shaft  194  having an outer cylindrical wall  196  formed concentrically about a longitudinal axis  198 , a first end  200  and a second, free or plate-engaging end  202 . The first end  200  of the shaft  194  is coupled to the head  192  of the plate fixation pin  12 . The outer cylindrical wall  196  has a diameter  204  that is approximately equal to but slightly less than the inside diameter of the lumen  38  of the hollow shaft  18 . Thus when the shaft  194  of plate fixation pin  12  is received in the lumen  38  of the hollow shaft  18 , the plate fixation pin  12  may reciprocate longitudinally along the longitudinal axis  198 , which coincides with the longitudinal axis  40  of the hollow shaft  18 , relative to the hollow shaft  18 . 
     Adjacent the first end  200 , the outer wall  196  is formed to include an external thread  206  configured to mate and cooperate with the internal thread  44  formed adjacent the distal end of the inside wall  36  of the hollow shaft  18 . Thus by grasping the head  192  and rotating it in one direction or the other, the relative longitudinal position of the fixation pin  12  relative to the hollow shaft  18  can be controlled. The head  192  may be knurled to facilitate this rotation. The shaft  194  has a length  208  greater than the length  52  of the hollow shaft  18  by an amount sufficient to allow translation of the shaft  194  sufficiently to bring the free end  202  into contact with a plate  400  secured against the bone  402  to be repaired. The external thread  206  on the shaft  194  and the internal thread  44  are formed to allow the free end  202  of the shaft  194  to be moved relative to the proximal end of the hollow shaft  18  to clamp a plate  400  against a bone  402  held between the bone-engaging ends  146 ,  148  of the feet  114 ,  116  and the inner surface  182  of the bone-engaging hook arm  156 . 
     The thumb screw assembly  14  is coupled to the top wall of the body  16  and is configured to control the relative position of the hollow shaft  18  relative to the body  16 . The thumb screw assembly  14  includes a housing  210  and a thumb screw  212 . The housing  210  includes an outer wall  214 , a proximal end wall  216 , a distal end wall  218 , an inner cavity wall  220  and a longitudinal axis  222 . The outer wall  214  and inner cavity wall  220  are formed concentrically about the longitudinal axis  222 . The inner cavity wall  220  defines a shaft-receiving cavity  224  extending through the housing  210  between a proximal opening  226  in the proximal wall  216  and a distal opening  228  in the distal wall  218  of the housing  210 . Illustratively, the shaft-receiving cavity  224  has an inside diameter  230  that is slightly larger than, but approximately equal to the outside diameter  35  of the hollow shaft  18 . The shaft-receiving cavity  224  communicates with the shaft-receiving bore  58  formed in the body  16  so that the hollow shaft  18  can be received through the cavity  224  and bore  58  for longitudinal movement relative to the thumb screw assembly  14  and body  16 . The housing  210  is formed to include an annular channel  232  for receipt of an attachment flange  242  of the thumb screw  212  to facilitate rotational movement of the thumb screw  212  about its longitudinal axis  244  relative to the housing  210 . 
     The thumb screw  212  includes a proximal wall  234 , a distal wall  236 , an outer wall  238 , an inner wall  240 , a proximal attachment flange  242  and a longitudinal axis  244 . The attachment flange  242  extends from the proximal wall  234  and is configured to cooperate with the channel  232  in the housing  210  to mount the thumb screw  212  to the housing  210  in a manner facilitating rotation of the thumb  212  screw about its longitudinal axis  244 , which coincides with the longitudinal axis  222  of the housing  210 , relative to the housing  210 . The inner wall  240  of the thumb screw  212  includes a thread  246  configured to cooperate with the external thread  42  adjacent the distal end of the hollow shaft  18  to control the longitudinal movement of the hollow shaft  18  relative to the thumb screw assembly  14  and the body  16  upon rotation of the thumb screw  212 . The outer wall  238  of the thumb screw  212  may be knurled to facilitate rotation of the thumb screw. 
     The removable drill guide assembly  32  includes an attachment device  250 , a drill guide sleeve  252  and a drill guide  254 . The attachment device  250  includes clamp  256 , a drill guide arm  258  and a ball end  260 . In the illustrated attachment device, the clamp  256  includes a semi-cylindrical curved plate  262  having a width  264  and a radius of curvature  266  sized to be received in the guide-receiving channel  64  of the body  16 . A set screw  268  extends through a threaded hole  270  adjacent one end of the curved plate  262  which, upon tightening, secures the clamp  256  to the body  16 . Clamp  256  permits the removable drill guide assembly  32  to be secured in substantially any desired radial position relative to the body  16 . Loosening of the set screw  268  permits the clamp  256  to be rotated within the channel  64  about the longitudinal axis  66  of the body  16  or to be removed from the body  16  when so desired. 
     In the illustrated attachment device  250  the drill guide arm  258  extends radially outwardly and downwardly from a central portion  272  of the convex surface  274  of the curved plate  262 . The drill guide arm  258  includes a first straight portion  276  adjacent a first end  278  and a second straight portion  280  extending at an angle  282  relative to the first straight portion  276  adjacent a second end  284 . The drill guide arm  258  is attached at the first end  278  to the curved plate  262  of the clamp  256  and is attached at the second end  284  to the ball end  260 . The ball end  260  has a diameter sized to be received in a reticulation cavity  288  of a socket  290  of the drill guide sleeve  252 . 
     The drill guide sleeve  252  includes the socket  290  and a housing. In the illustrated embodiment, the housing includes an outside wall, a distal end wall, a proximal end wall an inside guide cavity wall and a longitudinal axis. The outside wall and inside guide cavity wall are formed generally concentrically about the longitudinal axis. The inside guide cavity wall defines a guide cavity extending between a proximal opening in the proximal end wall and a distal opening in the distal end wall. The guide cavity has an inside diameter sized to permit the drill guide  254  to be received therein. 
     The socket  290  is attached to the outside wall of the housing. The socket  290  includes an outer wall, an end wall, a cylindrical cavity wall and a circular bottom wall that define the reticulation cavity  288 . The cylindrical cavity wall extends from an opening formed in the end wall to the circular bottom wall. The opening and reticulation cavity  288  both have a diameter slightly greater than but approximately equal to the diameter of the ball end  260 . In the illustrated embodiment, the reticulation cavity  288  has a depth greater than the radius, i.e. half the diameter of the ball end  260 . Thus the ball end  260  can be inserted through the opening and be received at least partially within the reticulation cavity  288  to couple the guide sleeve  252  to the attachment  250 . When the end ball  260  is received in the reticulation cavity  288 , the guide sleeve  252  can be positioned in the desired orientation to facilitate guided drilling through a plate into the bone to be repaired in the desired location. An orientation locking screw can be tightened to lock the guide sleeve  252  in the desired orientation. 
     A threaded screw hole extends through the socket  290  between the outer wall and the cylindrical cavity wall. The threaded screw hole is sized and threaded to receive the threaded shaft of the orientation locking set screw therethrough. The orientation locking screw includes a head coupled to one end of the threaded shaft. The head that may be knurled on its outer wall to facilitate turning the orientation locking screw. When turning the orientation locking screw in a first direction, the free end of the shaft is urged into frictional engagement with the outer surface of the end ball  260  and urges the opposite side of the end ball  260  into frictional engagement with the cylindrical side wall of the reticulation cavity  288 . This frictional engagement between the end ball  260  and the free end of the orientation locking screw and the cylindrical cavity wall of the reticulation cavity  288  locks the guide sleeve  252  in the desired orientation. Turning the locking screw in the opposite direction urges the free end of the shaft of the locking screw away from the outer surface of the end ball  260  allowing the guide sleeve  252  to be reoriented if desired. Alternatively, the guide sleeve  252  can be decoupled from the attachment device  250 . 
     Drill guide  254  includes a top flange, a grip, a housing, an orientation pin, a cylindrical guide wall and a longitudinal axis. The housing is formed to include a first end, a second end wall, and an outer cylindrical wall. The outer cylindrical wall has an outside diameter slightly less than but approximately equal to the inside diameter of the cavity in the guide sleeve  252 . The flange includes a top wall, a bottom wall and an outer cylindrical wall. The outer cylindrical wall has an outside diameter greater than the inside diameter of the cavity in the guide sleeve  252 . Thus, the drill guide  254  is configured to have the housing be received in the cavity of the sleeve guide  252  with the bottom wall of the flange resting on the proximal end wall of the housing of the sleeve guide  252 . 
     The grip extends outwardly and downwardly from the outer wall of the flange. The grip is provided to facilitate single handed manipulation of the device  10 . 
     In the assembled device  10 , the plate fixation pin  12  is received in the lumen  38  of the hollow shaft  18 , the hollow shaft  18  is received through the cavity  224  of the thumb screw assembly  14  and the shaft-receiving bore  58  of the body  16 , the desired hook assembly  22  is coupled to the attachment flange  54  of the body  16  and positioned below (proximally) the bone-engaging assembly  24  which is attached to the proximal end of the hollow shaft  18 . In the fully assembled device  10 , the removable drill guide assembly  32  is coupled to the body  16 . 
     In use the thumb screw  14  is utilized to control the longitudinal movement of the hollow shaft  18  relative to the body  16  and the hook assembly  22  to urge the bone-engaging assembly  24  toward and away from the hook assembly  22 . The two feet  114 ,  116  of the bone-engaging assembly  24  extend proximally beyond the proximal end of the hollow shaft  18 . The feet  114 ,  116  are constrained to move in the vertical direction only. The feet  114 ,  116  in conjunction with the bone-engaging arm  156  of the hook assembly  22  facilitate reduction of a fracture in a bone received therebetween. As previously mentioned, a plurality of hook assemblies  22  may be provided having differing dimensions and configurations to permit the surgeon to select the optimal hook assembly  22  for the bone on which the reduction procedure is being performed. Each of the plurality of hook assemblies  22  includes an attachment housing  150  configured to receive the attachment flange  54  therein for mounting the hook assembly  22  to the body  16 . 
     The plate fixation pin  12  has its shaft  194  received in the lumen  38  in the hollow shaft  18  and its external thread  206  in engagement with the internal thread  44  adjacent the distal end of the lumen  38  of the hollow shaft  18 . The external thread  206  and internal thread  44  cooperate to control longitudinal movement of the plate fixation pin  12  relative to the hollow shaft  18 . Initially, upon engagement of the external thread  206  and the internal thread  44 , the proximal end of the shaft  194  of the plate fixation pin  12 , the plate-engaging end  202  is disposed adjacent the proximal end of the shaft  18 . In this position the plate-engaging end  202  is displaced distally from the bone-engaging ends  146 ,  148  of the feet  114 ,  116 . The plate fixation pin  12  moves longitudinally with respect to the shaft  18  as a result of rotation of the pin  12 . Upon cessation of rotation of the pin  12 , the external thread  206  and internal thread  44  cooperate to fix the position of the plate fixation pin  12  relative to the hollow shaft  18 . Thus, the plate fixation pin  12  can be locked in any desired position relative to the shaft  18 . 
     The handle  20  facilitates single handed operation of the device  10 . While not illustrated, it is within the scope of the disclosure to couple the handle  20  to the body  16  in a manner that facilitates rotation of the handle  20  about the longitudinal axis  66  of the body  16  through 360 degrees. Once positioned in the desired position, the handle  20  may be locked in that position relative to the body  16  to reduce interference with the surgical procedure. 
     As previously mentioned the modular removable drill guide assembly  32  may be coupled to or decoupled from the medial portion  28  of the device  10 . Illustratively, the drill guide assembly  32  is coupled in the channel  64  below the attachment location of the handle  20 . 
     A plurality of drill guides  254 , each configured to have their housings be received in the cavity of the drill guide sleeve  252  may be provided within the scope of the disclosure. The plurality of drill guides  254  may include differently sized cylindrical guide walls to facilitate different sizes of drills and different overall lengths. The surgeon can thus select the optimal drill guide  254  from the plurality of drill guides  254  for the operation being performed. The drill guide  254  can be changed to accommodate various sizes of screws and plates  400  to be used in the surgical procedure. 
     As mentioned above the removable drill guide assembly  32  can be placed in any radial position relative to the device  10  and the guide sleeve  252  and drill guide  254  received therein can be oriented in the desired position for optimal guided drilling results. 
     This device  10  is intended to be placed around fractures of the bones of the hands or feet. The handle  20  may be utilized to position the device  10  around a fractured region of bone  402  using a single hand operation procedure. The handle  20  is utilized to guide the device  10  relative to the fractured bone  400  so that the bone  400  is placed between the feet  114 ,  116  of the bone-engaging assembly  24  and the hook assembly  22 . Once positioned around the fractured bone  400 , the thumb screw of the thumb screw assembly  14  is turned causing the hollow shaft  18  and the bone-engaging assembly  24  attached thereto to move longitudinally relative to the body  16  toward the hook assembly  22 . Since the attachment flange  54  and attachment housing  150  are captured between the frame members  110 ,  112  of the bone-engaging assembly  24  and the bone-engaging assembly  24  is rigidly affixed to the hollow shaft  18 , the hollow shaft  18  and bone-engaging assembly  24  are constrained to move longitudinally without rotating. 
     The thumbscrew  14  is rotated in the appropriate direction until both the hook assembly  22  and the bone-engaging ends  146 ,  148  of the feet  114 ,  116  of the bone-engaging assembly  24  strike the bone and cooperate to reduce the fracture. Since the hollow shaft  18  and bone-engaging assembly  24  are constrained against rotational movement, the feet  114 ,  116  cannot rotate during the longitudinal movement and thus cannot misalign the fracture. As mentioned above, the surgeon can select from a plurality of differently sized and configured hook assemblies  22  so that the optimal hook assembly  22  is attached to the attachment flange  54  for the size of bone and procedure being performed. 
     Once the hook assembly  22  and the feet  114 ,  116  of the bone-engaging assembly  24  have cooperated to reduce the fracture, as shown, for example, in  FIG. 4 , the plate fixation pin  12  is utilized to provide temporary plate  400  to bone  402  fixation. The plate fixation pin  12  is moved longitudinally relative to the hollow shaft  18  so that the free end  202  of the shaft  194  of the plate fixation pin  12  is displaced sufficiently from the bone  402  to allow a plate  400  with a fixation hole  404  formed therein to be slid on the bone  402  between the feet  114 ,  116  of the bone engaging assembly  24 . The fixation pin  12  is then moved longitudinally in the proximal direction relative to the hollow shaft  18  until the pin-shaped free end  202  of the plate fixation pin  12  passes through the fixation hole  404  of the plate  400  and into contact with the bone  402 . The length of the pin shaped free end  202  is such that when the free end of the fixation pin  12  contacts the bone  400 , the ring wall  406  formed between the shaft  194  and the free end  202  of the fixation pin  12  engages the distal surface of the plate  400 . Once in contact with the bone  402 , the external threads  206  adjacent the distal end of the shaft  194  of the plate fixation pin  12  and the internal threads  44  adjacent the distal end of the lumen  38  of the hollow tube  18  cooperate to lock the plate fixation pin  12  in the desired location temporarily affixing the plate  400  to the bone  402 . 
     Since the disclosed handle  20  is able to spin 360 degrees about the longitudinal axis  66  of the body  16 , the handle  20  can then be positioned so that it does not interfere with the remainder of the procedure. If the removable drill guide assembly  32  has not been previously affixed to the body  16 , the semi-cylindrical plate  262  of the clamp  256  is received in the channel  64  of the body  16  and clamped in a desired radial location by tightening the set screw  268  to secure the drill guide arm  258  to the body  16 . A plurality of drill guide arms  258  configured as described above but having arms of differing length may be provided so that the surgeon can select the optimal drill guide arm  258  for the procedure being performed and the length of the plate  400  required for such procedure. 
     Once the optimal drill guide arm  258  is selected and attached to the body  16  of the device  10 , the drill guide sleeve  252  is attached to the drill guide arm  258  by capturing the ball end  260  of the drill guide arm  258  in the reticulation cavity  288  of the socket  290  of the drill guide sleeve  252 . With the ball end  260  received in the reticulation cavity  288 , the drill guide sleeve  252  may be oriented in an anticipated desired orientation for the screw hole to be drilled. The drill guide sleeve  252  may then be locked in the anticipated desired orientation by tightening the orientation screw until the ball end  260  is brought into frictional engagement with the free end of the screw and the inside cavity wall radially opposite the screw hole extending through the socket  290 . The housing of the desired drill guide  254  for the size of drill to be used in the procedure is inserted into the drill guide cavity in the drill guide sleeve  252  until bottom wall of the flange engages the distal wall of the sleeve  252 . 
     The orientation pin of the drill guide  254  provides a visual cue for the alignment of the hole to be drilled. After insertion of the drill guide  254  into the drill guide sleeve  252 , the surgeon may loosen the set screw and reorient the drill guide sleeve  252  if the orientation pin indicates that the anticipated desired orientation was incorrect. When the drill guide  254  received in the drill guide sleeve  252  is oriented in the desired position, the set screw is tightened to lock the drill guide  254  and sleeve  252  in the desired orientation. 
     The appropriately sized drill for the procedure and for the selected drill guide  254  is then inserted through the cavity defined by the cylindrical guide wall of the drill guide  254  and utilized to drill attachment holes through the plate  400  and the bone  402 . Fasteners (not shown) are then inserted through the drilled attachment holes through the plate  400  and into the bone  402  to secure the plate  400  to the bone  402 . Bone screws are typically used as fasteners with the bone screws being screwed into the attachment holes to secure the plate  400  to the fractured bone  402 . The drill guide  254  may then be repositioned and oriented to drill any additional attachment holes required by the procedure being performed. Once the desired number of screws or other fasteners is inserted through the drilled attachment holes, the thumb screw  14  is rotated in the opposite direction to move the free end  202  and ring wall  406  of the plate fixation pin  12  out of engagement with the bone  402  and plate  400 , respectively, and to disengage the hook assembly  22  and the bone-engaging assembly  24  from the bone  402 . 
     The disclosed device advantageously allows a surgeon to perform multiple tasks utilizing a single instrument  10 . The surgeon is able to reduce the fracture in the bone  402  utilizing the disclosed instrument  10 . The surgeon is also able to temporarily affix a bone plate  400  in a desired position to the bone  402  containing the reduced fracture. While the plate  400  is affixed to the bone  402 , appropriate attachment holes may be drilled through the plate  400  into the reduced bone  402  so that bone screws or other fasteners can be utilized to more permanently affix the plate  400  to the bone  402 . Utilizing the disclosed removable drill guide assembly  32 , these attachment holes can be drilled in a guided manner. The disclosed instrument  10  saves the surgeon time in performing the repair of the fracture by reducing the number of clamps that must be used. Also the accuracy of the drilling of the attachment holes is increased when the removable drill guide assembly  32  is utilized. The orientation guide  346  on the drill guide  254  provides a visual reference for the location and orientation of the attachment hole to be drilled. 
     Although specific embodiments of the invention have been described herein, other embodiments may be perceived by those skilled in the art without departing from the scope of the invention as defined by the following claims. For example, although the invention has been described in terms of reduction and repair of fractures in the bones of the hand and foot, but may be utilized in reduction and repair of other bones, particularly other small bones such as ribs and bones in young patients. Additionally, it is noted that to facilitate avoidance of various tendons or other soft tissues in alternative embodiments the arm of the hook assembly  22  may be replaced with an arm of greater or lesser curvature or another geometry differing from the exemplary embodiment, may be laterally wider or thinner than the exemplary embodiment, may be replaced with a plurality of forklift-like spaced apart arms, or may be implemented in any other suitable alternative configuration. The lateral spacing between forklift-like arms may be adjustable. Further, in alternative embodiments the first foot  114  and the second foot  116  may be individually vertically adjustable and the drill guide assembly  32  may be replaced with any of a number of suitable alternative guide assemblies for aligning different drills, bone saws, or other surgical tools.