Abstract:
A bone screw and a method for using same, the bone screw comprising an elongated shaft including a proximal end, a distal end, a leading portion, and intermediate portion and a trailing portion, the elongated shaft defining a longitudinal axis; a cannula bored completely through said elongated shaft extending from said distal end to said proximal end, the cannula aligned with said longitudinal axis; the leading portion having at least one thread; the intermediate portion being unthreaded; and the trailing portion comprising a threaded tapered head adapted engage a threaded hole at a selectable angle.

Description:
CLAIM OF PRIORITY 
       [0001]    This application is being filed as a non-provisional patent application under 35 U.S.C. §111(b) and 37 CFR §1.53(c). This application is a divisional of application Ser. No. 13/604,931 filed on Sep. 6, 2012, which is a continuation-in-part of application Ser. No. 13/366,886 filed on Feb. 6, 2012 which claims priority under 35 U.S.C. §111(e) to U.S. provisional patent applications Ser. No. 61/531,485 filed on Sep. 6, 2011; Ser. No. 61/536,316 filed on Sep. 19, 2011 and Ser. No. 61/595,986 filed on Feb. 7, 2012, the contents of which are incorporated herein by reference. 
     
    
     FIELD OF INVENTION 
       [0002]    The invention relates generally to the fixation of bone fractures and in particular to plates for the volar fixation of fractures of the distal radius. 
       BACKGROUND OF THE INVENTION 
       [0003]    Fracture fixation plates for the distal radius are known in the art. In particular, volar fracture fixation plates for the treatment of the Colles&#39; fracture are frequently used. While many existing volar plates are effective, in many instances they do not provide the means for: a.) good visualization of the fracture; b.) achieving good contact between the plate and the bone; c.) the need to target particular bone fragments; d.) the fixation of small volar marginal fragments and e.) accommodating for conditions such as morbidity of the patient in the form of osteoporotic diaphyseal bone. Furthermore, in a small but significant number of cases, known fracture fixation plates and/or the fasteners attached thereto can impinge upon flexor and/or extensor tendons, resulting in post-operative tendon injury or rupture. 
       SUMMARY OF THE INVENTION 
       [0004]    It is among the objects of this invention to overcome the limitations of the heretofore-known devices by providing inventive features to achieve: a.) superior fixation of the plate to osteoporotic diaphyseal bone; b.) improved visualization of the fracture line; c.) intraoperative adjustability to achieve better contact of the plate and the bone; d.) reduction of the risk of post-surgery flexor and extensor tendon rupture; e.) improved fixation of small volar marginal fragments; f.) improved targeting and fixation of particular fractured bone fragments and g.) reduction of the time required to perform a surgical procedure to install a volar plate. 
         [0005]    Although the invention is illustrated and described herein as embodied in a volar fracture fixation plate for the distal radius it is nevertheless not intended to be limited to only the details shown, since various modifications and structural changes may be made therein without departing from the spirit of the invention and within the scope and range of equivalents of the claims. 
         [0006]    The construction of the invention, however, together with additional objects and advantages thereof will be best understood from the following description of the specific disclosed embodiments when read in connection with the accompanying drawings. 
         [0007]    For purpose of the descriptions of the invention that follow, “bottom” refers to the bone contacting surface of a plate and “top” refers to the opposite surface. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]      FIG. 1  is a top view of a fracture fixation plate in accordance with the present invention. 
           [0009]      FIG. 2  is a bottom view of a fracture fixation plate in accordance with the present invention. 
           [0010]      FIG. 3  is an additional top view of the fracture fixation plate of  FIG. 1  showing additional features of the present invention. 
           [0011]      FIG. 4  is an additional bottom view of the fracture fixation plate of  FIG. 2  showing additional features of the present invention. 
           [0012]      FIG. 5  is a top orthogonal view of a fracture fixation plate in accordance with the present invention illustrating the skew axes defined by holes in the ulnar head portion of the fracture fixation plate. 
           [0013]      FIG. 6  is top orthogonal view of a fracture fixation plate in accordance with the present invention illustrating the skew axes defined by holes in the radial head portion of the fracture fixation plate. 
           [0014]      FIG. 7  is a top orthogonal view of an alternate embodiment of a fracture fixation plate in accordance with the present invention illustrating the skew axes defined by holes in the ulnar head portion of the fracture fixation plate. 
           [0015]      FIG. 8  is top orthogonal view of an alternate embodiment of a fracture fixation plate in accordance with the present invention illustrating the skew axes defined by holes in the radial head portion of the fracture fixation plate. 
           [0016]      FIG. 9A  is a top view (semi-transparent for clarity) of a fracture fixation plate in accordance with the present invention with bone fasteners and K-wires installed therein. 
           [0017]      FIG. 9B  is a longitudinal cross section of the fracture fixation plate in  FIG. 9A  showing the ulnar side of the fracture fixation plate. 
           [0018]      FIG. 9C  is a longitudinal cross section of the fracture fixation plate in  FIG. 9A  showing the radial side of the fracture fixation plate. 
           [0019]      FIG. 10A  is a top view of a fracture fixation plate in accordance with an alternate embodiment of the present invention with bone fasteners installed therein, and superimposed on a human radius bone to illustrate its relative positioning. 
           [0020]      FIG. 10B  is a longitudinal cross section of the fracture fixation plate in  FIG. 10A  showing the ulnar side of the fracture fixation plate. 
           [0021]      FIG. 10C  is a longitudinal cross section of the fracture fixation plate in  FIG. 10A  showing the radial side of the fracture fixation plate. 
           [0022]      FIG. 11  is a bottom orthogonal view of a fracture fixation plate in accordance with the present invention illustrating various portions of the bone contacting surface of the fracture fixation plate. 
           [0023]      FIG. 12  is a bottom orthogonal view of a fracture fixation plate in accordance with the present invention illustrating the range of adjustability of the position of the radial head portion of the fracture fixation plate. 
           [0024]      FIG. 13  is a perspective view of an alternate embodiment of a fracture fixation plate in accordance with the present invention installed on the volar aspect of a human radius bone illustrating its position relative to the watershed line. 
           [0025]      FIGS. 14A and 14B  are diagrams illustrating the relative positioning between a flexor tendon in the volar side of the human radius bone and prior art single-headed fracture fixation plates. 
           [0026]      FIG. 14C  is a diagram illustrating the relative positioning between a flexor tendon in the volar side of the human radius bone and a fracture fixation plate in accordance with the present invention. 
           [0027]      FIGS. 15A and 15B  show, respectively, prior art threaded fastener and the relative positioning between an extensor tendon and the prior art threaded fastener affixed to a fracture fixation plate installed on the volar aspect of a human radius bone. 
           [0028]      FIGS. 15C and 15D  show, respectively, a threaded fastener in accordance with the present invention and the relative positioning between an extensor tendon and a threaded fastener in accordance with the present invention affixed to a fracture fixation plate installed on the volar aspect of a human radius bone. 
           [0029]      FIG. 16A  is a perspective view of a variable angle cannulated fastener in accordance with the present invention. 
           [0030]      FIG. 16B  is a longitudinal, perspective cross-section view of variable angle cannulated fastener in accordance with the present invention. 
           [0031]      FIGS. 17A-17I  illustrate the procedure for installing a variable angle cannulated fastener of  FIGS. 16A-6B   
           [0032]      FIG. 18A  is a partial top orthogonal view of an alternate embodiment of a fracture fixation plate in accordance with the present invention illustrating suture holes and a communicating channel therebetween. 
           [0033]      FIG. 18B  is a bottom orthogonal view of the fracture fixation plate in  FIG. 18A . 
           [0034]      FIGS. 19A-19E  illustrate a hook plate for use in conjunction with a fracture fixation plate in accordance with the present invention to secure a volar marginal fragment. 
           [0035]      FIGS. 19F-19I  illustrate a second embodiment of a hook plate for use in conjunction with a fracture fixation plate in accordance with the present invention to secure a volar marginal fragment. 
           [0036]      FIGS. 20A-20B  illustrate a fracture fixation plate in accordance with the present invention with pre-installed head drill guides, body drill guides, K-wire aiming guides, and K-wires. 
           [0037]      FIGS. 21A-21D  illustrate the assembly of head drill guides, body drill guides, K-wire aiming guides, and K-wires relative to a fracture fixation plate in accordance with the present invention. 
           [0038]      FIGS. 22A-22E  illustrate a head drill guide in accordance with the present invention. 
           [0039]      FIGS. 23A-23E  illustrate a K-wire aiming guide in accordance with the present invention. 
           [0040]      FIGS. 24A-24B  illustrate the assembly of alternative embodiments of a head drill guide and a K-wire aiming guide in accordance with the present invention. 
           [0041]      FIGS. 25A-25D  illustrate the alternative embodiment of a K-wire aiming guide of  FIGS. 24A-24B  in accordance with the present invention. 
           [0042]      FIGS. 25E-25H  illustrate the alternative embodiment of a head drill guide of  FIGS. 24A-24B  in accordance with the present invention. 
           [0043]      FIGS. 26A-26E  illustrate a body drill guide in accordance with the present invention. 
           [0044]      FIGS. 27A-27B  illustrate a plate bender in accordance with the present invention and the method of engagement of same with a fracture fixation plate in accordance with the present invention. 
           [0045]      FIG. 28  illustrates the use of a plate bender and a plate holder engaged in bending of a fracture fixation plate in accordance with the present invention. 
           [0046]      FIGS. 29A-29D  illustrate the sequence of steps for assembling a fracture fixation plate with the plate holder and the plate bender in accordance with the present invention for the purpose to applying force to the plate bender to achieve the desired adjustment. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0047]    Referring to  FIGS. 1 and 2 , a generally “Y” shaped volar fracture fixation plate  100  is shown having a bone contacting surface  101  and an opposite surface  102 , a straight or slightly curving elongated body portion  110  having a proximal end and a distal end and a plurality of independently adjustable head portions  120 ,  130 . The plurality of head portions are angled relative to the body portion  110  about ulnar lateral axis u 1  and radial lateral axis r 1  that diverge distally at an angle α not less than 20 degrees and not greater than 45 degrees. In one embodiment of the present invention, for use as a volar radius fixation plate, the plurality of head portions are embodied as an ulnar head portion  120  and a radial head portion  130 . Head portions  120  and  130  are independently connected to body portion  110 , respectively, by ulnar neck portion  125  and radial neck portion  135  which branch out angularly from the distal end of body portion  110  and are independently adjustable. Body portion  110  is intended to be anchored to the diaphysis portion of a bone while ulnar and radial head portions  120  and  130  are adapted to anchor, respectively, the ulnar and radial metaphyseal fragments of a fracture. The gap  140  formed between head portions  120  and  130  as well as between neck portions  125  and  135  allows for good visualization of the fracture line and to accommodate the passage of flexor tendons without impingement. 
         [0048]    The volar fracture fixation plate  100  of  FIGS. 1-2  corresponds to a volar plate to be installed on the volar aspect of the right human distal radius. A volar plate for installation on the volar aspect of the left human distal radius (not shown) is a mirror image of volar plate  100 , identical in all other respects and a further embodiment of the instant invention. It should also be understood that all volar plates of the instant invention referred to herein can be made for the right or the left distal radius and in different sizes to accommodate varying anatomies. 
         [0049]    Referring now to  FIGS. 1-4  radial head portion  130  of fracture fixation plate  100  includes a plurality of threaded holes  160 . In this particular embodiment, the radial head portion  130  includes three threaded holes  160 . The threaded holes  160  are arranged non-linearly, e.g.: as vertices of a triangle if three holes  160  are present. In alternate embodiments, if more than three threaded holes  160  are present, the holes are arranged as vertices of a polygon. Holes  160  are intended to receive bone fasteners (i.e.: screws or pegs, solid or cannulated) having threaded heads that are adapted to engage the threads of holes  160  in either: a.) a fixed angle relationship (i.e.: along the axis of a hole  160 ) or b.) a variable angle relationship (i.e.: along an axis selected intraoperatively by the surgeon, non-collinear with the axis of a hole  160 ). Likewise, ulnar head portion  120  includes a plurality of holes of type  160 , similarly arranged and having similar functionality to those in radial head portion  130 . 
         [0050]    Referring again to  FIGS. 1-4 , radial head portion  130  of fracture fixation plate  100  optionally includes at least one non-threaded hole  161 . Holes  161  are intended to receive complimentarily sized Kirschner wires (hereinafter “K-wires”) therethrough in a pre-defined angular relationship to the bone contacting surface  101  of head portion  130 . The K-wires (shown in  FIGS. 9A, 9B and 9C ) enter the plate through the opposite surface  102  and exit the fracture fixation plate through the bone contacting surface  101 . Likewise, ulnar head portion  120  is optionally provided with at least one non-threaded hole  161  having identical functionality to those in radial head portion  130  and may optionally be provided with interconnected holes  164  for receiving sutures as will be explained further below. 
         [0051]    As further shown in  FIGS. 1-4 , in the present embodiment, the body portion  110  includes at least one anchoring hole  162 , which is threaded and adapted to receive anchoring fasteners with complementarily threaded heads that engage the threads of anchoring holes  162  at a fixed angle relationship (i.e.: collinear to the axes of anchoring holes  162 ). The axes of threaded holes  162  may optionally be skew (heretofore defined as non-coplanar) relative to each other. Furthermore, the body portion  110  may optionally include one or more non-threaded anchoring slots  163 , for receiving compression screws permitting the temporary repositioning of the plate relative to the underlying bone during surgery. Body portion  110  may optionally include one or more holes  161  intended to receive complimentarily sized K-wires for temporary anchoring of the body portion to the bone. 
         [0052]    Referring now to  FIGS. 5-6 , therein is shown one embodiment of a fracture fixation plate  100  having axes a 1  through a 9  defined by the plurality of holes  160  and  162 . The actual number of axes a 1 , a 2  . . . aN in a particular fracture fixation plate is a function of the number of holes  160  and  162  existing in that particular embodiment of the fracture fixation plate. Axes a 1 , a 2  and a 3  in ulnar head portion  120  are skew (non-coplanar, as previously defined) relative to each other but exist in planes that are mutually parallel. Axes a 4 , a 5 , and a 6  in radial head portion  130  are also skew relative to each other and also exist in planes that are mutually parallel. However, the parallel planes where the first set of axes (a 1 , a 2 , a 3 ) exist are not parallel to the parallel planes where the second set of axes (a 4 , a 5 , a 6 ) exist but, instead, the first set of parallel planes diverges distally relative to the second set of parallel planes. This arrangement is advantageous because skew lines are inherent to the formation of surfaces that mimic the shape of the articular surface of at least one bone in a joint. Axes a 7 , a 8  and a 9  in body portion  110  may optionally be skew relative to each other. This is also advantageous since fasteners anchored along skew axes provide better anchorage of the plate to the diaphysis of osteoporotic bone than equivalent fasteners with parallel axes. 
         [0053]    Referring now to  FIGS. 7-8 , therein is shown an alternate embodiment of a fracture fixation plate  200  having axes b 1  through b 10  defined by the plurality of threaded holes  260  and  262 . In this particular embodiment the ulnar head portion  220  defines four threaded holes  260  arranged as vertices of a four-sided polygon. Axes b 1 , b 2 , b 3  and b 4  of the threaded holes  260  in ulnar head portion  220  are skew relative to each other but exist in planes that are parallel. Axes b 5 , b 6  and b 7  of the threaded holes  260  in radial head portion  230  are also skew relative to each other and also exist in planes that are parallel. As in the case of fracture fixation plate  100 , the parallel planes where the first set of axes (b 1 , b 2 , b 3  and b 4 ) exist are not parallel to the parallel planes where the second set of axes (b 5 , b 6  and b 7 ) exist but, instead, the first set of parallel planes diverges distally relative to the second set. As previously described in reference to body portion  110 , Axes b 8 , b 9  and b 10  of threaded holes  262  in body portion  210  are optionally skew relative to each other. 
         [0054]    Referring now to  FIG. 9A , therein is shown a plan view of fracture fixation plate  100  (transparent, for clarity) indicating the alignment of axes a 1 , a 2 , a 3  of ulnar head portion  120  and a 4 , a 5  and a 6  of radial head portion  130  in an example of one embodiment of the present invention.  FIGS. 9B and 9C , respectively, show longitudinal cross sections of fracture fixation plate  100 .  FIG. 9B  shows the ulnar side cross section view of the alignment of axes a 1 , a 2  and a 3  of the ulnar head  120 .  FIG. 9C  shows the radial side cross section view of the alignment of axes a 4 , a 5  and a 6  on radial head  130 . As indicated in  FIG. 9B , ulnar head portion  120  and is inclined upwards at an angle β (i.e.: away from the bone contacting surface) not less than 10 degrees and not greater than 30 degrees relative to a plane defined by the peripheral edges of the bone contacting surface of longitudinal body portion  110 . Radial head portion  130  is similarly inclined. 
         [0055]    Referring now to  FIG. 10A  therein is shown a perspective view of the distal volar side of a right radius bone  300 , transparent for clarity, with an alternate embodiment  200  of the fracture fixation plate of the instant invention superimposed in the correct position on the bone  300  and indicating the alignment of axes b 1 , b 2 , b 3  and b 4  of the threaded holes and the corresponding fasteners of the ulnar head portion  220  and axes b 5 , b 6  and b 7  of the threaded holes and the corresponding fasteners of the radial head portion  230 .  FIGS. 10B and 10C  are, respectively, longitudinal cross sections of fracture fixation plate  200 .  FIG. 10B  shows the alignment of axes b 1 , b 2 , b 3  and b 4  of the threaded holes and the corresponding fasteners of ulnar head portion  220 .  FIG. 10C  shows the alignment of axes b 5 , b 6  and b 7  of the threaded holes and the corresponding fasteners of radial head portion  230 . The alignment of the axes of threaded holes  260  on each of the head portions and, correspondingly, the axes of the bone fasteners installed thereupon, are skew relative to each other to advantageously provide subchondral support of the articular surface at the lunate fossa and scaphoid fossa. As indicated in  FIG. 10B , ulnar head portion  220  and is inclined upwards (i.e.: away from the bone contacting surface) at an angle β not less than 10 degrees and not greater than 30 degrees relative to a plane defined by the peripheral edges of the bone contacting surface of longitudinal body portion  210 . Radial head portion  230  is similarly inclined. 
         [0056]    Referring now to  FIG. 11  therein is shown a perspective view of particular portions of the bone contacting surface  101  of one embodiment  100  of the fracture fixation plate of the instant invention. In the ulnar head portion  120  the bone contacting surface  170  is spherically concave. In the radial head portion  130  the bone contacting surface  171  is substantially flat. In the body portion  110  the bone contacting surface  172  is cylindrically concave in relation to the longitudinal axis of the body portion  110 . Alternate fracture fixation plate embodiments optionally may include similar geometrical characteristics of the corresponding surfaces. 
         [0057]    Referring now to  FIG. 12 , therein is indicated the range of adjustability of the position of radial head portion  130  of fracture fixation plate  100 :  1 .) separation S between head portions  130  and  120 ;  2 .) elevation E of the head portion  130  relative to the bone surface and  3 .) rotation R of the head portion  130  around the longitudinal axis r 1  of radial neck portion  135 . The range of adjustability is illustrated by way of example and is not intended to be limiting. The adjustments may be accomplished by the use of plate bending tools, as described further below, to apply appropriate bending and/or torqueing force to radial neck portion  135 . The adjustments are advantageous because they facilitate achieving the best contact possible between the bone contacting surfaces of the plate  100  and the underlying bone and bone fragments. Although indicated in  FIG. 12  as referring to radial head portion  130 , similar positional adjustment can be accomplished on ulnar head portion  120 . Alternate embodiments of the fracture fixation plate optionally may include similar positional adjustment features. 
         [0058]    As previously described above, the instant invention provides a fracture fixation plate with a plurality of head portions. This is particularly advantageous for minimizing the risk of post-operative flexor tendon rupture. Referring to  FIG. 13  therein is shown a fracture fixation plate  200  correctly installed on the volar side of a distal radius bone  300  just proximal of the watershed line  310 , a theoretical line marking the most volar aspect of the volar margin of the distal radius. Referring now to  FIG. 14A  therein is shown a diagrammatic view of the articular surface of the distal radius, with the volar aspect on the upper side of the diagram, wherein is indicated the scaphoid fossa  320 , the lunate fossa  330  and the inter-fossae sulcus  340  and the edge of the watershed line  310 . Also shown diagrammatically is a flexor tendon  350  (for example: the Flexor Pollicis Longus). In some patients, the inter-fossae sulcus  340  is relatively shallow at the watershed line  310  and this allows for the correct installation of a prior-art single headed fracture fixation plate  360  (shown dotted) just beyond of the watershed line  310  without post-operative impingement with a flexor tendon  350 . However, as shown in  FIG. 14B , in other patients, the inter-fossae sulcus  340  is much deeper at the watershed line  310 . The installation of a prior-art single headed plate (shown dotted), even if correctly installed proximal of the watershed line  310 , can lead to post-operative impingement of said plate and a flexor tendon  350  resulting in tenosynovitis or rupture of the tendon. Referring now to  FIG. 14C  therein is shown, diagrammatically in dotted line, the installed position of a double headed fracture fixation plate of the instant invention wherein the gap between the radial head portion  230  and the ulnar head portion  220  of the plate allows for the movement of the flexor tendon  350  free of impingement with either of said heads. 
         [0059]    In a further advantageous aspect of the instant invention, a threaded fastener is provided for the purpose of minimizing the risk of post-surgical extensor tendon rupture. Referring now to  FIGS. 15A-15D  and in particular,  FIG. 15A  therein is shown a prior art threaded fastener  400  having a threaded head  401  for engaging a threaded hole  160  of fracture fixation plate  100  and an opposite bone engaging threaded sharp end  402 . If, as can frequently occur and shown in  FIG. 15B , the sharp end  402  of the threaded fastener  400  should protrude even minimally through the dorsal aspect of a distal radius bone  300 , the sharp end  402  can injure, and even cause rupture, of extensor tendon  420 . As shown in  FIG. 15C  the instant invention provides a threaded fastener  450  having a threaded head  451  for engaging a threaded hole  160  of fracture fixation plate  100  and an opposite, bone engaging, rounded end  452  that is atraumatic. As shown in  FIG. 15D , should the threaded fastener  450  protrude as much as 2 mm through the dorsal aspect of the radius, the rounded end  452  of the fastener will not injure or rupture the extensor tendon  420 . 
         [0060]    As previously discussed, threaded holes  160 ,  260  of a volar fracture fixation plate  100 ,  200  are intended to receive fasteners (i.e.: solid pegs or screws) with threaded heads adapted to engage the threads in holes  160 ,  260 . These fasteners can be received at fixed angles, that is, collinearly with the axes of the corresponding hole  160 ,  260 . However, it is one object of the instant invention to provide improved targeting and fixing of particular fractured bone fragments and in many instances this is difficult to accomplish by fixed angle fasteners. Accordingly, to accomplish this purpose, alternative embodiments of the present invention may employ cannulated, variable angle fasteners. 
         [0061]    Referring now to  FIGS. 16A-16B  therein is shown one embodiment of a cannulated variable angle fastener  500  adaptable for use with the present invention.  FIG. 16A  shows a perspective view of a variable angle cannulated fastener  500 , in this instance a screw, having a tapered threaded head  501  adapted to engage a threaded hole  160 ,  260  at an angle selected by the surgeon. Variable angle cannulated fastener  500  may optionally have a threaded portion  502  adapted to engaging a bone fragment. 
         [0062]      FIG. 16B  shows a longitudinal, perspective cross-section view of variable angle fastener  500  with longitudinal cannula  503  extending through the entire length of variable angle fastener  500  and open at both ends. The cannula  503  of variable angle fastener  500  is adapted to be inserted over an appropriately sized K-wire. 
         [0063]    As shown in  FIGS. 17A-17I  a cannulated variable angle fastener  500  may be used where the fixed angle axis of a threaded hole  160 ,  260  in a volar plate  100  or  200  would lead to an undesired result.  FIG. 17A, 17B  show a fracture fixation plate  200  having been correctly installed on the volar side of a distal radius bone  300  with threaded head fastener  520  coaxial with the axis of threaded hole b 5 . In particular, as shown in  FIG. 17B , with the radius bone  300  shown transparent for clarity, axis b 5  of the most lateral threaded hole  260  determines that fixed angle fastener  520  inserted therethrough will be anchored into the proper position within the radius bone  300 . However, on a smaller radius bone  300 ′ of a different patient, as shown on  FIGS. 17C and 17D , a fixed angle fastener  520  inserted following axis b 5  would protrude from the bone, possibly causing injury to the surrounding soft tissue. In this situation the surgeon may prefer to select an alternate axis, such as b 5 ′ in  FIG. 17C , not coaxial with axis b 5  of threaded hole  260 , through which to insert a fastener. 
         [0064]    To accomplish this, as shown on  FIG. 17E , a K-wire  530  is directed through the threaded hole  260  and drilled into the bone or bone fragment along the surgeon selected axis b 5 ′. Using a cannulated drill, (not shown) the surgeon drills over the K-wire  530  to create a cavity aligned with the desired axis b 5 ′. As further shown in  FIGS. 17F-17G , after the cannulated drill is removed, the variable angle cannulated fastener  500  is inserted over the K-wire  530  and torqued with a cannulated driver (not shown) to engage the bone fragment resulting in the correct positioning of the variable angle fastener  500  shown in  FIG. 17G . Thereafter, as shown in  FIG. 17H , with the radius bone  300 ′ shown transparent for clarity, the K-wire  530  is removed, resulting in the correct installation of variable angle fastener  500  and, consequentially, fracture fixation plate  200  as shown on  FIG. 17I . 
         [0065]    Since the alternate axis b 5 ′ selected by the surgeon is not coaxial with the axis b 5  of threaded hole  260  of fracture fixation plate  200 , the tapered thread  501  of the head portion of variable angle fastener  500  must be able to fixedly cross-thread into the thread of hole  260 . To accomplish this, variable angle fastener  500  can be made of a harder material than plate  200 . For example, variable angle fasteners  500  may be made of cobalt chromium while the plate  200  is made of titanium. 
         [0066]    As previously indicated above, ulnar head portion  120  of fracture fixation plate  100  may optionally include suture holes  164 . Suture holes  164  are non-threaded and mutually communicating and are intended to receive sutures for tension binding small volar marginal fragments of bone.  FIGS. 18A and 18B  show in greater detail suture holes  164  in ulnar head portion  120  of volar fracture fixation plate  100  and their communicating channel  165  adapted to accommodate the suture knot. If desired suture holes  164  may optionally be provided in radial head portion  130  (not shown). Similar suture holes  164  may optionally be provided in alternate embodiments, for example  200 , of the fracture fixation plate of the instant invention. 
         [0067]    In addition to, or in substitution of the suture holes  164 , the instant invention optionally provides a hook plate for securing and reducing a volar marginal fragment. Referring now to  FIGS. 19A-19C  therein is shown hook plate  600 , intended to be affixed to ulnar head portion  220  of fracture fixation plate  200  to secure a volar marginal fragment. As shown in  FIG. 19B , hook plate  600  has a plurality of hook ends  601 , a slot  602 , a tensioning break-off tab  603  breakable at break-away isthmus  607  and indicia  608  for post-operative detection of hook plate creep. Once a volar marginal fragment is temporarily reduced by the surgeon with a tool (not shown) to the stable portion of the radius bone, the hook plate  600  is superimposed onto the ulnar head portion  220  of a properly installed fracture fixation plate  200  and a retaining screw  605  is inserted through slot  602  and loosely threaded into threaded hole  604  of ulnar head portion  220 . The surgeon then engages hook ends  601  into the volar marginal fragment and, applies tension to the hook plate  600  by pulling on tensioning break-off tab  603  until the desired reduction of the volar marginal fragment is achieved. Retaining screw  605  is then tightened into threaded hole  604  and the break-off tab  603  is removed by bending at break-away isthmus  607  and discarded as shown in  FIG. 19D . The position of indicia  608  is then recorded for future reference to identify any post-operative creep.  FIG. 19E  shows the finished construct of hook plate  600  having reduced volar marginal fragment  620  to stable radius bone  300  while securely affixed to the properly installed fracture fixation plate  200 . 
         [0068]      FIGS. 19F-19I  show an alternative embodiment of the hook plate  600 ′ wherein the tensioning break-off tab  603  of hook plate  600  is substituted by a tensioning port  603 ′. After engaging the hook ends  601 ′ into volar marginal fragment  620 ′ the surgeon applies tension by pulling on the tensioning port  603 ′ with a tool (not shown) until the desired reduction is achieved. Retaining screw  605 ′ is then tightened into threaded hole  604  to affix the hook plate  605 ′ to the fracture fixation plate  200  thereby obtaining stable reduction of volar fragment  620 ′ as shown in  FIG. 19I . 
         [0069]    In addition to being adapted to receive the retaining screw  605 ,  605 ′, the threaded hole  604  of ulnar head portion  220  can optionally be adapted to receive a K-wire therethrough in a pre-defined orientation for temporary fixation to a portion of the radial bone. As shown in  FIGS. 19A and 19F  the pre-defined orientation of the axis Φ of threaded hole  604  can be, for example, the orientation that will result in the received K-wire being substantially parallel to a chord drawn, volar to dorsal, between the edges of the anatomical articular surface of the distal radius. Such orientation is at an angle of 98 to 104 degrees distally in reference to a plane defined by the bone contacting surface of the body portion of fracture fixation plate  200 . 
         [0070]    Although described in reference to fracture fixation plate  200  the hook plates  600 ,  600 ′, retaining screws  605 ,  605 ′ and threaded hole  604  can optionally be provided in fracture fixation plate  100  and any other embodiment of the instant invention. 
         [0071]    The fracture fixation plates, system and methods of the instant invention include, in their alternative embodiments, accessories that can be useful to reduce the time needed by the surgeon to complete a surgical procedure. Specifically, disclosed herein are drill guides and K-wire aiming guides that can optionally be provided pre-installed on the respective plates  100 ,  200 , thereby obviating the necessity of performing a time consuming installation thereof during surgery. The disclosure of said accessories of the instant invention are shown in  FIGS. 20A-26E . 
         [0072]    Referring now to  FIG. 20A-21D  therein are shown a fracture fixation plate  200  with a plurality of pre-installed head drill guides  700 , body drill guides  800  and K-wire aiming guides  900 . Although described in reference to fracture fixation plate  200  the head drill guides  700 , body drill guides  800  and K-wire aiming guides  900  can also be provided or pre-installed in fracture fixation plate  100  and any other embodiment of the fracture fixation plate of the instant invention. 
         [0073]    Referring now to  FIGS. 22A-22E  therein are shown a head drill guide  700  having a proximal end [ FIGS. 22A ,D], a cylindrical body portion [ FIG. 22B ] and a distal end [ FIGS. 22C ,E]. The distal end of head drill guide  700  is provided with an external thread  710  adapted to engage into any threaded hole  260  in any of the head portions of a fracture fixation plate  200  along the axis determined by the thread of said hole  260 . The body portion of head drill guide  700  is internally bored, said bore  720  adapted to closely receive and stabilize a drill bit (not shown) inserted therethrough. The proximal end of a head drill guide  700  is provided with an internal thread  730  adapted to engage the threaded central portion of a K-wire aiming guide  900  as further described below and said proximal end is further provided with an internal recess  740  adapted to receive a torque transmitting tool (for example, a hexagonal “Allen” torque transmitting tool—not shown). 
         [0074]    Referring again to  FIGS. 21A-21C  and in greater detail in  FIGS. 23A-23E  therein are shown K-wire aiming guides  900 . Referring now to  FIG. 23B  K-wire aiming guides  900  are provided with a distal elongated body portion  910 , a threaded central portion  920  and a proximal head portion  930 . The distal elongated body portion  910  of K-wire aiming guide  900  is adapted to be received inside the bore portion  720  of a head drill guide  700 . The externally threaded central portion  920  of K-wire aiming guide  900  is adapted to engage the internal thread  730  of the proximal end of a head drill guide  700 . K-wire aiming guide  900  is bored throughout the distal elongated body portion  910 , the threaded central portion  920  and the proximal head portion  930 , said bore  940  adapted to closely receive and stabilize a K-wire inserted therethrough. As shown in  FIGS. 23A and 23D , proximal head portion  930  is provided with an internal recess  950  adapted to receive torque from a torque transmitting tool (for example, a square driver—not shown). 
         [0075]    Referring now to  FIGS. 24A-25H  therein is shown an alternative embodiment of head drill guide  700 ′ and aiming guide  900 ′ wherein are shown external thread  920 ′ and corresponding internal thread  920 ″ for positively engaging aiming guide  900 ′ in head drill guide  700 ′ and thread  710 ′ for coupling head drill guide  700 ′ to a plate  100  or  200  (not shown). During surgery, the aiming guides  900 ′ are removed from the head drill guides  700 ′ after the K-wires they are adapted to guide through bore  940 ′ have been drilled, leaving in place the head drill guide  700 ′ for the further receiving a drill bit (not shown) through bore  720 ′ for drilling pilot holes for the fasteners. In order to assure that, upon removal of the aiming guides  900 ′, the head drill guides  700 ′ remain in place, it is advantageous to provide aiming guide  900 ′ with an external thread  920 ′ that requires less resistance to torque to obtain release than the external threads  710 ′ that couple head drill guides  700 ′ to plates  100 ,  200 . In one particular embodiment of the instant invention this is accomplished by providing a threads  920 ′,  920 ″ with a higher thread angle than external thread  710 ′. Given the same torque applied to recess  950 ′ of the assembled aiming guides  900 ′ and head drill guide  700 ′, the thread with the higher thread angle will release first. Exemplarily, and not intending to be limiting, threads  920 ′,  920 ″ can be implemented as double lead 2-56 threads while threads  710 ′ can be implemented as 5-44 single lead threads. 
         [0076]    Referring again to  FIGS. 21A and 21D  and in greater detail in  FIGS. 26A-26E  therein are shown body drill guides  800 . Body drill guides  800  have a proximal end [ FIGS 26A and 26D ], an externally cylindrical body portion [FIG.  26 B] and a distal end [ FIGS. 26C and 26E ]. The distal end of a body drill guide  800  is provided with an external thread  810  adapted to engage any threaded hole  262  in the body portion  210  of fracture fixation plate  200  along the axis determined by the thread of said hole  262 . The body portion of body drill guide  800  is bored throughout, said bore  830  having a non-circular (for example but without limitation, hexalobular) cross section perpendicular to the axis of the bore with at least three flat portions  835 , said flat portions adapted to closely receive and stabilize a drill bit inserted therethrough and said non-circular cross-section further capable of accepting torque from a torque transmitting tool (not shown). The proximal end of a body drill guide  800  is additionally provided with an internal recess  840  adapted to receive torque from a different torque transmitting tool (for example, a hexagonal Allen driver—not shown) to permit removal of a body drill guide  800  when its drill guiding purpose has been accomplished. 
         [0077]    As referred to above, head drill guides  700 ,  700 ′ K-wire aiming guides  900 ,  900 ′ and body drill guides  800  are optionally pre-installed on the fracture fixation plate  100 ,  200  prior to surgery being performed. Since the installation of K-wires for temporary fixation and the drilling of pilot holes for the installation of bone fasteners require, in many prior-art plates, that the surgeon be provided with and install the appropriate guides during surgery, providing pre-installed guides advantageously leads to a reduction of the time required for completing the surgery. 
         [0078]    As previously described above in reference to  FIG. 12 , plate bending tools may be provided to apply appropriate force to radial neck portion  135 ,  235  and/or ulnar neck portion  125 ,  225  of fracture fixation plate  100 ,  200  to adjust the position of radial head portion  130 ,  230  and/or ulnar head portion  120 ,  220  to obtain the best contact possible between the bone contacting surfaces of the plate  100 ,  200  and the underlying bone and/or bone fragments. Referring now to  FIG. 27A  therein is shown a plate bender  1000  provided with a plurality of notches  1010 ,  1020  adapted to engage the radial or ulnar head portions of a fracture fixation plate  100 ,  200  over the head drill guides  700 ,  700 ′ and a narrower notch  1030  adapted to engage the radial or ulnar head portions when the head drill guides  700 ,  700 ′ are not present or have been removed.  FIG. 27B  shows a plate bender  1000  wherein notch  1020  engages the radial head portion  230  of a fracture fixation plate  200 . 
         [0079]    Referring now to  FIG. 28 , therein is shown a plate bender  1000  and a complementary plate holder  1050 . Plate holder  1050  is provided and adapted to immobilize a fracture fixation plate  100 ,  200  after said fixation plate has been inserted into retaining notch  1051  on either end of plate holder  1050 , while force is applied to plate bender  1000 . When said force is applied to plate bender  1000  in a proximal to distal direction, shown as dotted arrow E, the radial neck portion  135 ,  235  is deformed, resulting in an adjustment of the elevation of radial head portion  130 ,  230  relative the future underlying bone surface. Conversely, when force is applied to plate bender  1000  in a lateral direction, shown as dashed arrow R the radial neck portion  135 ,  235  is deformed, resulting in an adjustment of the rotation of radial head portion  130 ,  230  relative to the future underlying bone surface. 
         [0080]      FIGS. 29A-29D  illustrate the steps for assembling a fracture fixation plate  100 ,  200  ( 200  shown) with the plate holder  1050  and plate bender  1000  for the purpose of applying force to plate bender  1000  to achieve the desired adjustment. Referring now to  FIG. 29A , the body portion of plate  100 ,  200  with body drill guides  800  pre-installed is inserted in the direction of arrow Δ into retaining notch  1051  of plate holder  1050 . Once held securely in place by the plate holder  1050  as shown in  FIG. 29B  the plate bender  1000  is inserted over a head portion of the plate  100 ,  200  (with head drill guides  700 ,  700 ′ pre-installed) in the direction of arrow Δ′. Force can then be applied indistinctly in a proximal to distal direction E (shown in  FIG. 29C ) or a lateral direction to accomplish the desired deformation of the corresponding neck portion  135 ,  235  of plate  100 ,  200 . 
         [0081]    Although described above in connection with a volar fracture fixation plate, accessories, system and method for volar fixation of fractures of the distal radius, these descriptions are not intended to be limiting, as other plates can be made in accordance with the description herein, but of different size or scale, so as to treat other fractures, as needed. As such, although the invention is illustrated and described herein, various modifications and structural changes may be made therein without departing from the spirit of the invention and within the scope and range of equivalents of the claims.