Abstract:
The invention comprises an orthopedic construct comprising an active compression orthopedic plate that can in the alternative, include either compression screws or an elastic or superelastic staple which is capable of inducing compression into the associated bone, and in alternative embodiments, the plate is a compound plate or has a translating portion which receives a leg of the bone staple.

Description:
FIELD OF THE INVENTION 
       [0001]    The invention generally relates to an orthopedic construct comprising an orthopedic plate that provides for improved compression in associated bone, in particular, to achieve fusion. The plate can, in the alternative, include one or more compression screws, one or more staples, or both. The construct is capable of inducing compression into the associated bone, and in an alternative embodiment, the plate has a translating portion which is associated with at least either a screw (i.e., compression screw) or one leg of a bone staple. 
       BACKGROUND OF THE INVENTION 
       [0002]    Orthopedic plating has been practiced for some time to repair osteotomy sites, bone fractures, and other sites where bones need to be held in close proximity to facilitate bone healing, in particular bone fusion. Typically a bone plate is affixed by means of screws to two or more bone portions so as to immobilize the portions relative to each other and thereby facilitate formation of a bone bridge or callus between the two portions. In some cases a bone plate and screws are oriented and tightened to provide a fixed amount of initial compressive force between the bone portions by drawing the bone portions towards each other. In some cases, a bone screw will couple with a compression slot in a bone plate and provide initial compressive force between the bone portions by drawing the portions towards each other by a fixed distance. Generally speaking, with these approaches, the amount of compression between the bone portions diminishes over time due to one or more of loosening of the screws and plates, remodeling of the bones, applied mechanical forces, or other reasons. Since bone is a living organism, it reacts to the load applied in ways that are different than non-living materials, such as metal, plasterboard or wood. It is known that the amount of compression applied to the bone by fasteners can change or reduce over time, due to necrosis or erosion of bone. 
         [0003]    Another limitation of using plates for fixation of bone portions is that while the portions in contact with the plate may be immobilized relative to each other the portions of the bone furthest away from the plate may not be sufficiently immobilized relative to each other due to flexing of the plate, or bone, or both. This is a particular problem in load bearing situations. For example, a plate applied to the dorsal surface of a metatarsal may immobilize the bone portions adjacent to the plate yet the bone portions on the plantar side of the metatarsal may suffer significant movement relative to each other during application of force to the metatarsal by, for example, standing on the foot. 
         [0004]    In another approach, staples can be used to provide a fixed amount of initial compressive force between two or more bone portions by drawing the portions towards each other at the crown of the staple. In some staples the legs of the staples may be angled such that the ends of the legs are closer to each other than the separation of the legs at the crown. Such staples may be initially placed in an elastically deformed state and thereby also apply a compressive force that continues over time at the ends of the staple legs, for a much longer time than the initial compressive force described above for plates, particularly if the staple is comprised of a superelastic alloy, for example, Nitinol. The force so applied is below the surface of the bone portions. However, a disadvantage of using staples for fixation of bone portions is that the crown of the staple is far less resistant to bending than a plate. In load bearing applications the use of staples is insufficient to immobilize the bone portions over time. 
         [0005]    It is desirable to have an orthopedic plating construct that can immobilize bone portions in load bearing applications where the portions are initially compressed into close proximity with each other, the construct prevents motion between the portions due to applied loads, and the construct applies compressive force to immobilize the portions over the healing time. 
         [0006]    It is desirable to have an orthopedic plating construct that can achieve joint compression on the side of the bone farthest away from the plating surface (i.e., plantar compression with dorsal plating). 
         [0007]    It is desirable to have an orthopedic plating construct that can improve upon the strength and stiffness of staple-only constructs and improves compression in the presence of plate-only constructs. 
       SUMMARY OF THE INVENTION 
       [0008]    The present invention provides a system for combining a staple and plate, and has utility particularly in midfoot plating where access and plating is done dorsally (compression side of the joint) and there is concern with plantar (tension side of the joint) gapping of the joint. 
         [0009]    In one embodiment, the plate of the present invention has a proximal surface, a distal surface, and a first thickness defined from the distal surface to the proximal surface; a first screw hole, a second screw hole; and, a recessed portion connecting a first through-hole to a second through-hole, the recessed portion configured to at least partially receive a bone staple. Further this bone plate (e.g. in particular as set forth in claim  1 ), wherein the recessed portion is recessed from the proximal surface of the bone plate. The bone plate has a recessed portion disposed between the proximal and distal surface of the bone plate. The recessed portion may also be positioned between the first and second screw hole. Further, the bone plate may have a second thickness defined from the distal surface of the bone plate to the proximal surface of the recessed portion and in embodiments, the second thickness is less than the first thickness. Bone plates may further have at least one internally threaded through-hole. Further, the first through-hole and the second through-hole may be configured to receive at least a portion of a first staple leg and a second staple leg, respectively and the recessed portion is configured to at least partially receive a staple bridge. 
         [0010]    The bone plates may have at least one threaded screw hole and at least one of the screw holes may be a compression screw hole. In some embodiments, the first screw hole is a compression screw hole which has a lateral shoulder which forms an edge that sloped toward the proximal surface of the plate. 
         [0011]    Methods of conducting surgery are also disclosed including providing a bone plate including a distal surface and a proximal surface, a first screw hole, a second screw hole and a recessed portion recessed from the proximal surface of the plate, the recessed portion inter-connecting a first through-hole to a second through-hole, exposing a bone surface; positioning the bone plate on the bone surface; placing at least a first of a compression, non-locking or locking screw at least partially through the first screw hole of the bone plate; placing a staple at least partially though the bone plate, a first staple leg at least partially received within the first through hole, a second staple leg at least partially received within the second through-hole and a staple bridge positioned adjacent the recessed portion; and, placing at least a second compression, non-locking or locking screw at least partially through the second screw hole of the bone plate. 
         [0012]    The present invention also discloses a bone plate having a first surface and a second surface including a first screw hole, a second screw hole, and a recessed portion configured to receive a portion of the staple bridge, wherein the recessed portion interconnects a first through-hole and a second through-hole sized to receive the first leg and the second leg respectively therethrough and bone staple having a bridge which spans a first leg and a second leg. 
         [0013]    Another embodiment of the present disclosure includes a bone plate assembly wherein a plate has a first surface and a second surface; a bone staple has a staple bridge, and first leg and a second leg extending from the staple bridge at an inside angle of from 45° to 135° from the staple bridge; and, wherein the first plate surface has a recess that at least partially receives the staple bridge and including a first through hole that accommodates the staple first leg and a second through hole that accommodates the staple second leg. 
         [0014]    Further, the recess may define an intermediate surface facing the direction of the first plate surface and the bridge second surface contacts the intermediate surface in use. Optionally, the plate may have a compression slot having an edge defining a shoulder that slopes toward the plate second surface. 
         [0015]    The plate may have at least one threaded, locking screw hole and in embodiments, two threaded screw holes that are separate and distinct from the first and second through-holes. The first through-hole may be partially threaded and the second through-hole may have a compression ramp with an internal shoulder that slopes downward in a direction away from the first through hole. 
         [0016]    Screws may be used with the bone plate assembly and can be non-locking, locking, compression screws and combinations thereof. In one particular embodiment, one screw may be a compression screw and another may be a locking screw. 
         [0017]    Further, bone plate assemblies may include drill means capable of drilling a tapered hole. 
         [0018]    Methods for conducting surgery are also described including the steps of providing a bone plate including a first surface and a second surface, a slot extending therethrough from the first surface to the second surface, the slot further including a first through-hole that accommodates the staple first leg and a second through-hole that accommodates the staple second leg, and a first screw hole and a second screw hole; exposing a bone surface, placing a staple therethrough the bone surface, the staple comprising a bridge having a first surface and a second surface, and first leg and a second leg extending from the bridge at an angle of from 45° to 135° from the bridge; placing the bone plate slot around the staple, on the exposed bone surface wherein the first through-hole is disposed around the first staple leg, and the second through-hole is disposed around the second staple leg; wherein after the bone plate is placed on the bone surface, and placing at least one of a compression, non-locking or locking screw therethrough the screw hole of the bone plate. 
         [0019]    In a further aspect of the present disclosure, a bone plate is disclosed having a long axis and first surface and a second surface, the bone plate first surface having a slot that accommodates a staple bridge, the slot including a first through hole that accommodates the staple first leg and a second through hole that accommodates the staple second leg and the plate including a translation member having a threaded locking screw hole wherein the translation member is configured to translate along the long axis distal to the slot. 
         [0020]    In yet another embodiment of the present disclosure, a bone plate assembly includes a plate fixed member having a first longitudinal axis, a first screw hole disposed near a plate fixed member first end portion, a first surface and a second, opposing bone facing surface, the plate first surface having a recess near a plate fixed member distal end that accommodates a staple bridge, the plate further including a first through-hole that accommodates a staple first leg and a second through-hole that accommodates a staple second leg, and a plate translation member having a second longitudinal axis and a second screw hole disposed near a translation member second end portion, wherein the plate translation member second end portion is movably coupled to the plate fixed member first end portion. The plate translation member may permit or enable the second screw hole to be translated across the second longitudinal axis. The first and second longitudinal axis may be parallel or the same axis. Further, the translation member can be moveable along at least one of the first longitudinal axis or the second longitudinal axis, relative to the fixed member. 
         [0021]    The bone plate assembly may have first and second screw holes disposed along the first longitudinal axis. Further, the second screw hole may be a threaded locking screw hole. In some embodiments, the first and second through-holes include internal threads and the second through-hole can have a compression ramp having an internal shoulder that slopes downward in a direction away from the first through-hole. 
         [0022]    The bone plate assembly may include a recess defining an intermediate surface, the surface facing the direction of the first plate surface. The bone plate assembly may also include a bone staple and the bone staple has a second bridge surface which contacts the plate intermediate surface when in use. Alternatively, the plate includes a compression slot. 
         [0023]    Methods for conducting surgeries are described herein including providing a plate including fixed member having a first longitudinal axis, a first screw hole disposed near a plate fixed member first end portion, a first surface and a second, opposing bone facing surface, the plate first surface having a recess near a plate fixed member distal end that accommodates a staple bridge, the plate further including a first through-hole that accommodates a staple first leg and a second through-hole that accommodates a staple second leg, and a plate translation member having a second longitudinal axis and a second screw hole disposed near a translation member second end portion, wherein the plate translation member second end portion is movably coupled to the plate fixed member first end portion; placing the plate on a bone surface; positioning the staple bridge thereon the recess, wherein the first and second staple legs are disposed therethrough the first and second through-holes, respectively; positioning at least one of a locking, non-locking and compression screw therethrough the plate and bone surface; and closing the exposed bone surface. 
         [0024]    Other orthopedic plate systems described herein include a locking screw, a compression screw, and a staple, and an orthopedic plate having a translation portion including a translation portion screw hole and a locking portion including a locking portion screw hole, and at least one of a slot or recessed portion disposed between the translating portion screw hole and the locking portion screw hole. The slot may extend from a first distal surface of the plate to a second proximal surface of the plate. In certain embodiments, the slot is shaped to receive at least a portion of the staple. Alternatively, the recessed portion is disposed between a first and a second through-hole. The recessed portion may also be configured to at least partially receive a portion of the staple. Further, the translation portion is moveable with respect to the locking portion. 
         [0025]    Other methods are surgery described herein include a method of surgery to achieve active compression in at a bone interface having at least a bone and comprising the steps of: exposing the bone interface; placing an orthopedic plate on the bone and fastening it to the bone with a first fastener and a second fastener, and optionally a third fastener, where either the second or the third fastener is a compression fastener and the orthopedic plate having a translation portion having a translation portion fastener hole and a locking portion having a locking portion fastener hole, wherein a first fastener is a locking fastener and installing the first fastener in the locking portion fastener hole to form a locked relationship and installing the second fastener in the translation portion fastener hole and installing the compression fastener to drive active compression in the translation portion. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0026]      FIG. 1  is a top perspective view of the unassembled active compression plate, staple and fasteners in accordance with one embodiment of the present invention; 
           [0027]      FIG. 2  is a side view of the staple of  FIG. 1 ; 
           [0028]      FIG. 3  is a side perspective view of the staple of  FIG. 1 ; 
           [0029]      FIG. 4  is a cross-section of the active compression plate of  FIG. 1  taken along line A-A; 
           [0030]      FIG. 5  is a top view of the active compression plate and staple and locking screw assembly of  FIG. 1 ; 
           [0031]      FIG. 6  is a side view of the active compression plate and staple and locking screw assembly of  FIG. 1 ; 
           [0032]      FIG. 7  is a side perspective view of the active compression plate of  FIG. 1 ; 
           [0033]      FIG. 8  a side perspective view of the active compression plate assembly of  FIG. 1 ; 
           [0034]      FIG. 9  is top view of another embodiment of the active compression plate in accordance with the invention; 
           [0035]      FIG. 10  is a cross-section of the active compression plate of  FIG. 9  taken along line B-B; 
           [0036]      FIG. 11  is a top view of the active compression plate of  FIG. 9  with assembled locking screws and a compression screw; 
           [0037]      FIG. 12  is a top view of the active compression plate of  FIG. 9  with assembled locking screws and a staple; 
           [0038]      FIG. 13  is a side perspective view of the active compression plate assembly of  FIG. 12 ; 
           [0039]      FIG. 14  is a side perspective view of the active compression plate assembly of  FIG. 11 ; 
           [0040]      FIG. 15  is top view of yet another embodiment of the active compression plate including a translating section in accordance with the invention; 
           [0041]      FIG. 16  is a cross-section of the active compression plate of  FIG. 15  taken along line C-C; 
           [0042]      FIG. 17  is a side view of the active compression plate of  FIG. 15 ; 
           [0043]      FIG. 18  is a bottom view of the active compression plate of  FIG. 15 ; 
           [0044]      FIG. 19  is a top side perspective view of the active compression plate of  FIG. 15 ; 
           [0045]      FIG. 20  is an exploded view of the active compression plate of  FIG. 15 ; 
           [0046]      FIG. 21  is a top view of the active compression plate of  FIG. 15  with assembled locking screws and with a staple; 
           [0047]      FIG. 22  is a cross-section of the active compression plate assembly of  FIG. 21  taken along line D-D; 
           [0048]      FIG. 23  is a side view of the active compression plate assembly of  FIG. 21 ; 
           [0049]      FIG. 24  is an exploded bottom perspective view of the active compression plate of  FIG. 15 ; 
           [0050]      FIG. 25  is a bottom view of the active compression plate of  FIG. 15 ; 
           [0051]      FIG. 26  is a detail of the telescoping mechanism for the translating and locking portions of the active compression plate of  FIG. 15 ; 
           [0052]      FIG. 27  is a cross-section of the active compression plate of  FIG. 15  taken at line E-E; 
           [0053]      FIG. 28  is a top view of an alternate embodiment of the active compression plate of the present invention including an alternative locking and translating profile; 
           [0054]      FIG. 29  is a bottom view of the active compression plate of  FIG. 28  illustrating the translating portion in a first position; 
           [0055]      FIG. 30  is a bottom view of the active compression plate of  FIG. 28  illustrating the translating portion in a second position; 
           [0056]      FIG. 31  is a cross-section of the translating active compression plate of  FIG. 28  taken at line F-F; 
           [0057]      FIG. 32  is an exploded view of the translating active compression plate of  FIG. 28 ; 
           [0058]      FIG. 33  is a top view of another embodiment of the active compression plate of the present invention; 
           [0059]      FIG. 34  is a side perspective view of the active compression plate of  FIG. 33 ; 
           [0060]      FIG. 35  is a top view of the active compression plate assembly using the active compression plate of  FIG. 33  and including first and second locking screws and a staple; 
           [0061]      FIG. 36  is a cross section of the active compression plate assembly of  FIG. 33  taken at line G-G; 
           [0062]      FIG. 37  is a side perspective view of the active compression plate of  FIG. 36 ; 
           [0063]      FIG. 38  is a side view of the active compression plate of  FIG. 33  taken along lines H-H; 
           [0064]      FIG. 39  is a top view of yet another embodiment of the present invention including a compound active compression plate and in which each plate segment includes first and second locking screws and a staple; 
           [0065]      FIG. 40  is a top view of the compound active compression plate of  FIG. 39 ; 
           [0066]      FIG. 41  is a side view of the compound active compression plate of  FIG. 39 ; 
           [0067]      FIG. 42  is an anterior/lateral view of the skeleton of a foot including two active compression plate assemblies as shown in  FIG. 35-37 ; and, 
           [0068]      FIG. 43  is a dorsal view of the skeleton of the foot and active compression plate assemblies of  FIG. 39 . 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Embodiment 1—Full Thickness Slot 
       [0069]      FIG. 1  illustrates active compression plate system  1  in an unassembled configuration, comprised of bone plate  10 , bone staple  30 , and one or more fasteners  40  in accordance with a first embodiment of the invention. In one example of use plate  10  is placed against a patient&#39;s bone, one fastener  40  is inserted through fastener hole  12  of plate  10  and affixed to the bone, one staple  30  is inserted through plate slot  16  and into the patents bone, and a second fastener  40  is inserted through fastener hole  12  in plate  10  and affixed to the bone. It should be noted that the term “slot”, refers to herein specifically as a full thickness recess or full thickness opening which extends from a first proximal plate surface to a second distal plate surface. With reference to  FIGS. 1 to 8 , active compression plate system  1  will be further described below. 
         [0070]    Bone plate  10  may have a profile looking down from the top of a modified rectangle, with equivalent opposing parallel long sides  21  defining straight lateral edges  22 , and with rounded short ends  23  having circular lateral edges  24 . Bone plate  10  is comprised of a proximal surface  13  and a distal surface  14  having a first thickness  15  therebetween, at least one slotted portion  16 , one or more through holes  17  and one or more fastener holes  12 . As illustrated in  FIGS. 1-8 , slotted portion or slot extends all the way through the plate, from a first surface to a second surface of the plate. Slotted portion  16 , through holes  17  and fastener holes  12  may be generally aligned along plate longitudinal axis LA. In one embodiment plate is comprised of one slot, two through holes and two fastener holes. Fastener holes  12  may be smooth walled, threaded, for example for use with threaded fasteners, or formed as compression slots having an angled shoulder that cooperates with a screw to apply a transverse motion to the plate as the screw is tightened against a bone. Optionally bone plate  10  may be comprised of one, two, three, four, five, six, or more fastener holes (not shown) for use with various fasteners as is known in the art. 
         [0071]    In use slot  16  accommodates one or more staple crowns as will be described below. Slot may extend over the full thickness of plate as shown in  FIGS. 1 and 7  and have the characteristics of an opened bottom slot. Slot terminates at through openings  17  that accommodate the legs of the staple when it is assembled with the plate. Slot  16  is intermediate or disposed between the screw holes  12 . Slot is sized to accommodate staple bridge. It should be understood that the term staple “bridge” as used herein defines the portion of the staple that connects or is disposed between the two staple legs. Slot dimensions are larger than staple bridge dimensions such that bridge can pass through slot in a sliding fit or a less snug fit. In an alternative embodiment slot is sized to interact with staple bridge as an interference fit. 
         [0072]    It should be noted that in certain embodiments described herein, the slot or slotted portion, extending the full thickness of the plate may be interchanged with a recess or recessed portion, having a partial thickness of the plate. 
         [0073]    Bone plate  10  can be curved along longitudinal axis LA or normal to axis LA, or both. In one embodiment plate  10  is curved or contoured to mimic the typical shape of bone surfaces at the intended implantation location. In another embodiment plate  10  is curved or contoured to mimic the shape of the specific bone surface onto which the plate will be affixed. 
         [0074]    Bone plate  10  may comprise of titanium, stainless steel, Nitinol, or other metals; Poly Ether Ether Ketone (PEEK) or other polymers; alumina or other ceramics, bioabsorbable materials including metal, ceramic, or polymer, in whole or in part, or combinations thereof, or other materials. 
         [0075]    Bone staple  30  is comprised of two or more legs  31  joined by bridge  32 . An included angle α between leg  31  and bridge  32  (see  FIG. 2 ) falls between 45° and 135°. During insertion of staple  30  into the patient&#39;s bone angle α is held at 90°+/−10°, and preferably +/−5°, and more preferably +/−3°) in order to facilitate insertion of the staple into the bone, and once implanted tends to return to a pre-programmed second configuration as shown in  FIG. 3  in which the legs angle inward toward each other by 5-20° from the insertion position. Legs and bridge may be generally straight (as illustrated) or curved. Staple  30  may be comprised of barbs or other gripping structure  33 , which, in certain embodiments, may be disposed only on the staple legs to facilitate secure locking of staple  30  to a patient&#39;s bone. 
         [0076]    Bone staple  30  may be comprised of a wire like structure that has been formed into a shape similar to that of the English language letter U. Bone staple  30  may comprise of titanium, stainless steel, Nitinol, or other metals; polyetheretherketone (PEEK) or other polymers; alumina or other ceramics, bioabsorbable materials including metal, ceramic, or polymer, in whole or in part, or other materials. Superelastic Nitinol is a preferred material of construction for staples used in the active compression plate system  1  due to the large amount of elastic strain (up to 9%) that superelastic nitinol can reversibly sustain. 
         [0077]    Fastener  40  may be comprised of a non-locking bone screw, a locking bone screw, a compression bone screw, a peg, or other fasteners. In general, bone screws are preferred. When more than one fastener is used in active compression plate system  1  the fasteners used can be any combination of non-locking bone screws, locking bone screws, compression bone screws, pegs, or other fasteners. 
         [0078]    Fastener  40  may be comprised of titanium, stainless steel, Nitinol, or other metals; Poly Ether Ether Ketone (PEEK) or other polymers; alumina or other ceramics, bioabsorbable materials including metal, ceramic, or polymer, in whole or in part, or other materials. 
         [0079]    In an exemplar method of use of active compression plate system  1 , a patient is prepared for surgery and surgical access to one or more bones is achieved. Access may be accomplished by open surgery, small incision surgery, or percutaneously. 
         [0080]    The surgical procedure chosen, planned, or performed will be for repair of bone fracture, repair of osteotomy, bone fusion, or other procedures in which two or more bones or bone portions must be held in close proximity to each other to facilitate bone healing, and in particular to facilitate bone fusion. 
         [0081]    The patient&#39;s bone or bone portions are exposed and reduced to the desired positions. 
         [0082]    Bone staple  30  is placed into the bone or bone portions and the staple is allowed to hold the bone or bone portions at the desired positions relative to each other. 
         [0083]    Slot  16  of plate  10  is passed over bridge of staple  30  and plate  10  is brought into contact with the patient&#39;s bone. 
         [0084]    Optionally a drill guide is inserted into at least one fastener hole  12  and a hole is drilled into the patient&#39;s bone. 
         [0085]    Plate  10  is affixed to at least one bone or bone portion by means of inserting at least one fastener  40  such as a bone screw into fastener hole  12  and into the drilled hole (if any) then advancing the fastener into the patient&#39;s bone. In a preferred embodiment plate  10  is affixed to at least two bones or bone portions by means of at least two bone screws. 
         [0086]    In one particular embodiment, a method of conducting a surgery includes providing a bone plate including a first surface and a second surface, a slot extending therethrough from the first surface to the second surface, the slot further including a first through-hole that accommodates the staple first leg and a second through-hole that accommodates the staple second leg, and a first screw hole and a second screw hole; exposing a bone surface; placing a staple therethrough the bone surface, the staple comprising a bridge having a first surface and a second surface, and first leg and a second leg extending from the bridge at an angle of from 45° to 135° from the bridge; placing the bone plate slot around the staple, on the exposed bone surface wherein the first through-hole is disposed around the first staple leg, and the second through-hole is disposed around the second staple leg; wherein after the bone plate is placed on the bone surface, and placing at least one of a compression, non-locking or locking screw therethrough the screw hole of the bone plate. 
       Embodiment 2—Compression Slot 
       [0087]      FIGS. 9 to 14  illustrate active compression plate system second embodiment 1′, comprised of bone plate  10 ′, bone staple  30 ′, and one or more fasteners  40 ′. In this second embodiment a plate slot can be coupled with either a staple or with screws, as further described below. 
         [0088]    In active compression plate system second embodiment 1′, bone plate  10 ′, bone staple  30 ′, and fasteners  40 ′ have a similar structure and are made of the same materials as bone plate  10 , bone staple  30 , and fasteners  40  of active compression plate system  1 , discussed above, except as noted below. 
         [0089]    In active compression plate system second embodiment 1′, slotted portion  16 ′ of plate  10 ′ terminates at one end in a threaded through-hole  17   a  which can accommodate fastener  40 ′, in one embodiment a threaded locking screw and at the other end terminates in a second through-hole which is a ramped compression slot  17   b , accommodating fastener  40 ′, in one embodiment a non-locking screw, to cause active compression by means of bone screws instead of by means of a bone staple. In other embodiments, as illustrated in  FIG. 13 , the first through-hole  17   a  and second through-hole  17   b  are shaped to at least partially receive a staple  30 ′, and in particular a first staple leg and a second staple leg. 
         [0090]    In an exemplar method of use of active compression plate system  1 ′, a patient is prepared for surgery and surgical access to one or more bones is achieved. Access may be accomplished by open surgery, small incision surgery, or percutaneously. 
         [0091]    The surgical procedure chosen, planned, or performed will be for repair of bone fracture, repair of osteotomy, bone fusion, or other procedures in which two or more bones or bone portions must be held in close proximity to each other to facilitate bone healing, and in particular to facilitate bone fusion. 
         [0092]    The patient&#39;s bone or bone portions are exposed and reduced to the desired positions. 
         [0093]    The surgeon considers whether the appropriate form of treatment will be to insert staple  30 ′ into the bone or bone portions, followed by use of plate  10 ′, or to use fasteners  40 ′ as an alternative to staple  30 ′. 
         [0094]    In the case where the surgeon decides to insert staple  30 ′ into the bone or bone portions the method of use from this decision onwards adheres to the method described in connection with active compression plate system  1 . 
         [0095]    In the case where the surgeon decides to insert fasteners  40 ′ into the bone or bone portions, optionally a drill guide is inserted into at least fastener hole  17   a  and a hole is drilled into the patient&#39;s bone. 
         [0096]    Plate  10 ′ is positioned such that slot  16 ′ straddles a gap between two adjacent bones or bone portions. 
         [0097]    Plate  10 ′ is affixed to at least one bone or bone portion by means of inserting at least one fastener  40 ′ such as a bone screw into through hole  17   a , into the drilled hole (if any) and then advancing the fastener into the patient&#39;s bone. 
         [0098]    Plate  10 ′ is further affixed to at least one bone or a second bone portion by means of inserting at least one fastener  40 ′ such as a bone screw into ramped compression slot  17   b  then advancing the fastener into the patient&#39;s bone thereby causing bone portions to move towards each other and closing any gap between the portions. 
         [0099]    Optionally a drill guide is inserted into at least one fastener hole  12 ′ and a hole is drilled into the patient&#39;s bone. 
         [0100]    Plate  10 ′ is further affixed to at least one bone or bone portion by means of inserting at least one additional fastener  40 ′ such as a bone screw into fastener hole  12 ′ and into the drilled hole (if any) then advancing the fastener into the patient&#39;s bone. In a preferred embodiment plate  10 ′ is affixed to at least two bones or bone portions by means of at least three, and preferably four, bone screws. 
       Embodiment 5—Bent Plate, Partial Thickness Recess 
       [0101]      FIGS. 33 to 38 and 42  illustrate active compression plate system fifth embodiment 1″, comprised of bone plate  10 ″, bone staple  30 ″, and one or more fasteners  40 ″. In this fifth embodiment plate  10 ″ has a narrowed central width and is bent out of plane, as further described below. 
         [0102]    In active compression plate system fifth embodiment 1″, bone plate  10 ″, bone staple  30 ″, and fasteners  40 ″ have the same structure and are made of the same materials as bone plate  10 , bone staple  30 , and fasteners  40  of active compression plate system  1 , discussed above, except as noted below. 
         [0103]    Bone plate  10 ″ is comprised of a taper inward or centrally from the ends of the plate as it progresses toward the transverse middle portion of the plate as is apparent from  FIG. 35 . 
         [0104]    Bone plate  10 ″ is also comprised of an angled or bent portion in the intermediate portion nearer to one end than the other, and in one embodiment is designed for a dorsal fusion in the mid-foot. With reference to  FIG. 36 , one end of plate  10 ″ aligns longitudinally with first medial axis  25  and the other end of plate  10 ″ aligns longitudinally with second medial axis  26 . Medial axes  25  and  26  intersect at angled or bent portion  28  such that the included angle between axes  25  and  26  is acute at the distal surface  14 ″ of plate  10 ″. 
         [0105]    Bone plate  10 ″ is also comprised of recess  16 ″ that may extend over a partial thickness of the plate as shown in  FIGS. 34 and 36 , having a proximally facing surface  18 , a second thickness  19 , and web  20  spanning the portion of the plate distal to the recess. In particular, recess  16 ″ is recessed from proximal surface of the plate as can be best seen in  FIGS. 36 and 38 . Further, recess, is disposed between first and second screw holes. Recessed surface may also be angled similarly as described above with regards to medial axes  25  and  26 . It should be noted that second thickness  19  is less than full thickness of the bone plate t 1 . 
         [0106]    It should be noted that in embodiments described herein, the slot or slotted portion, extending the full thickness of the plate may be interchanged with a recess or recessed portion, having a partial thickness of the plate. 
         [0107]    In an exemplar method of use of active compression plate system  1 ″, a patient is prepared for surgery and surgical access to one or more bones is achieved. Access may be accomplished by open surgery, small incision surgery, or percutaneously. 
         [0108]    The surgical procedure chosen, planned, or performed will be for repair of bone fracture, repair of osteotomy, bone fusion, or other procedures in which two or more bones or bone portions must be held in close proximity to each other to facilitate bone healing, and in particular to facilitate bone fusion. 
         [0109]    The patient&#39;s bone or bone portions are exposed and reduced to the desired positions. 
         [0110]    Plate  10 ″ is positioned such that recess  16 ″ straddles a gap between two adjacent bones or bone portions. 
         [0111]    Optionally a drill guide is inserted into at least one fastener hole  12 ″ and a hole is drilled into the patient&#39;s bone 
         [0112]    Plate  10 ″ is affixed to at least one bone or bone portion by means of inserting at least one fastener  40 ″ such as a bone screw into fastener hole  12 ″ and into the drilled hole (if any) then advancing the fastener into the patient&#39;s bone. 
         [0113]    Bone staple  30 ″ is placed through recess  16 ″, through holes  17 ″, and into the bone or bone portions and the staple is allowed to hold the bone or bone portions at the desired positions relative to each other. 
         [0114]    Plate  10 ″ is affixed to at least one bone or bone portion by means of inserting a second fastener  40 ″ such as a bone screw into hole  12 ″, into a drilled hole (if any) and then advancing the fastener into the patient&#39;s bone. 
         [0115]    Active compression plate system  1 ″ implanted on a patient&#39;s mid-foot F in a dorsal fusion procedure is represented in  FIG. 42 . 
         [0116]    In another particular method of surgery, a bone plate  10 ″ is provided including a distal surface and a proximal surface, a first screw hole, a second screw hole and a recessed portion  16 ″ recessed from the proximal surface of the plate, the recessed portion  16 ″ inter-connecting a first through-hole  17 ″ to a second through-hole  17 ″, exposing a bone surface; and positioning the bone plate  10 ″ on the bone surface. Next, at least a first compression, non-locking or locking screw is at least partially inserted through the first screw hole of the bone plate. Then, the staple is at least partially received though the bone plate wherein a first staple leg at least partially received within the first through hole, a second staple leg at least partially received within the second through-hole and a staple bridge positioned adjacent the recessed portion. In particular, the staple bridge includes a first proximal surface (not labeled) and second distal surface (not labeled) and the second distal surface of the staple bridge is positioned adjacent the recessed portion proximal surface  18 . Lastly, a second compression, non-locking or locking screw is positioned at least partially through the second screw hole of the bone plate. 
       Embodiment 6—Compound Plate 
       [0117]      FIGS. 39 to 41 and 43  illustrate active compression plate system sixth embodiment  100 , comprised of staples  30 , fasteners  40 , and two or more of active compression plate systems  1 ,  1 ′,  1 ″ joined together by means of linking sections  155 . It is contemplated that in other embodiments 3, 4, or 5 of systems  1 ,  1 ′,  1 ″ can be joined together by linking sections  155 . In compounded plate system  100  compound bone plate  110  is implanted to promote fusion between multiple adjacent bones and/or bone portions. In one embodiment, system  100  is implanted to promote dorsal midfoot bone fusion as shown in  FIG. 43 . Other embodiments are particularly well suited for midfoot procedures involving adjacent bones of the foot (i.e., for adjacent rays). 
         [0118]    In compound plate  110 , individual plates  10 ′″ are linked together such that the longitudinal axes of the plates are not parallel, and so, while the recessed portions  16  and holes  12  are at least roughly aligned along the long axes of the individual plates  10 ′″, the rows of holes in adjacent plates  10 ′″ are not parallel. In another embodiment the rows of holes in adjacent plates  10 ′″ can be parallel or disposed along longitudinal axes which may be parallel to one another. 
         [0119]    In compound plate  110  linking sections  155  are comprised of multiple elongate tape-shaped sections of plate that are oriented generally transverse to plate  10 ′″ longitudinal axes. In one embodiment, linking sections  155  have similar structure to bone plates  10 ,  10 ′,  10 ″ and are made of the same materials as bone plates  10 ,  10 ′,  10 ″. In alternate embodiments, linking sections may be comprised of a biodegradable material which can preferentially degrade the linking sections  155 , leaving the individual bone plates intact. In yet alternate embodiments, the compound plate may comprise degradable materials wherein the linking sections or the bone plates may have different degradation rates including mass loss and strength loss, each of which can be tailored or designed depending on the patient and surgical application. 
         [0120]    In compounded plate system  100 , bone plate  110  is comprised of two or more of bone plates  10 ′″. Bone plates  10 ′″ have the same structure and are made of the same materials as bone plates  10 ,  10 ′,  10 ″ of active compression plate systems  1 ,  1 ′,  1 ″, discussed above, except as noted below. It is understood that bone plate  10 ′″ may be comprised of an angled or bent portion in the intermediate portion, similar to bone plate  10 ″. Bone staples  30 , fasteners  40 , and fastener holes  12  have the same structure and are made of the same materials as bone staples  30 ,  30 ′,  30 ″, fasteners  40 ,  40 ′,  40 ″, and fastener holes  12 ,  12 ′,  12 ″ of active compression plate systems  1 ,  1 ′,  1 ″, discussed above, except as noted below. Recessed portions  160  and through-holes  170  have the same structure and are made of the same materials as recessed/slotted portions  16 ,  16 ′,  16 ″ and through-holes  17 ,  17 ″,  17   a ,  17   b  of active compression plate systems  1 ,  1 ′,  1 ″, discussed above, except as noted below. It is understood that plates  10 ′″ can be comprised of full thickness slots or partial thickness recesses. 
         [0121]    Plate  10 ′″, as illustrated in  FIGS. 39 to 41 and 43 , varies somewhat from the illustrated structures of plates  10 ,  10 ′ and  10 ″. Specifically, three fastener holes  12  are provided in the plate, and the central hole  12  is configured as a compression slot. Additionally, recess  160  has through hole  170  configured as a threaded hole similar to hole  17   a    
         [0122]    In an exemplar method of use of active compression plate system  100 , a patient is prepared for surgery and surgical access to one or more bones is achieved. Access may be accomplished by open surgery, small incision surgery, or percutaneously. 
         [0123]    The surgical procedure chosen, planned, or performed will be for repair of bone fracture, repair of osteotomy, bone fusion, or other procedures in which two or more bones or bone portions must be held in close proximity to each other to facilitate bone healing, and in particular to facilitate bone fusion. 
         [0124]    The patient&#39;s bone or bone portions are exposed and reduced to the desired positions. 
         [0125]    A. Plate  100  is positioned such that recess  160  of first plate  10 ′″ straddles a gap between two adjacent bones or bone portions AND second plate  10 ′″ is positioned over adjacent bones and/or bone portions such that they also can be immobilized in the desired positions by the cooperation of first and second bone plates  10 ′″. 
         [0126]    B. Optionally a drill guide is inserted into at least one fastener hole  12  and a hole is drilled into the patient&#39;s bone 
         [0127]    C. First plate  10 ′″ is affixed to at least one bone or bone portion by means of inserting at least one fastener  40  such as a bone screw into the fastener hole  12  not adjacent to compression slot  12  and into the drilled hole (if any) then advancing the fastener into the patient&#39;s bone. 
         [0128]    D. A second fastener  40  such as a bone screw is inserted into hole  12  of first plate  10 ′″ that is configured as a compression slot, into a drilled hole (if any) and then advancing the fastener into the patient&#39;s bone causing the bone portions or bones to be drawn together thereby reducing the gap between bones. 
         [0129]    E. Bone staple  30  is placed through recess  160  and through hole  170 , then into the bone or bone portions and the staple is allowed to hold the bone or bone portions at the desired positions relative to each other. 
         [0130]    F. A third fastener  40  such as a bone screw is inserted into remaining hole  12  of first plate  10 ′″, into a drilled hole (if any) and then advancing the fastener into the patient&#39;s bone causing the bone portions or bones to be further locked together in an active compressed state. 
         [0131]    G. First plate  10 ′″ is affixed to at least one bone or bone portion by means of inserting a third fastener  40  such as a bone screw into the remaining hole  12  in first plate  10 ′″, into a drilled hole (if any) and then advancing the fastener into the patient&#39;s bone. 
         [0132]    Method steps A through G are repeated for second plate  10 ′″. 
         [0133]    In an alternate method, the staples  30  are placed in the bone followed by placement of the bone plate  100  and fasteners. 
       Embodiment 4—Translating Screw Hole 
       [0134]      FIGS. 28 to 32  illustrate active compression plate system fourth embodiment  200 , comprised of translating bone plate  210 , bone staple  30  (not shown), fasteners  40  (not shown), recessed portion  260 , and fastener holes  12 . Bone staple  30 , fasteners  40 , and fastener holes  12  have the same structure and are made of the same materials as bone staples  30 ,  30 ′,  30 ″, fasteners  40 ,  40 ′,  40 ″, and fastener holes  12 ,  12 ′,  12 ″ of active compression plate systems  1 ,  1 ′,  1 ″, discussed above, except as noted below. Slotted portion  260  is comprised of through holes  270  and has the same structure and is made of the same materials as recessed/slotted portions  16 ,  16 ′,  16 ″ and through holes  17 ,  17 ″,  17   a ,  17   b  of active compression plate systems  1 ,  1 ′,  1 ″, discussed above, except as noted below. It is understood that plate  210  can be comprised of full thickness slot or partial thickness recess  260  and that the two may be interchangeable depending on the bone quality, patient anatomy or surgeon preference. 
         [0135]    Translating bone plate  210  has longitudinal axis LA and is further comprised of locking portion  280  and translating portion  290 . Locking portion  280  and translating portion  290  have the same structure and are made of the same materials as bone plates  10 ,  10 ′,  10 ″ of active compression plate systems  1 ,  1 ′,  1 ″, discussed above, except as noted below. It is understood that locking portion  280  may be comprised of an angled or bent portion in the intermediate portion, similar to bone plate  10 ″. 
         [0136]    Locking portion  280  is comprised of elongated plate through-hole  282  having plate hole counterbore  284  formed into and below the proximal surface of plate portion  280 , and one or more plate hole pocket  286  formed into the inner wall  288  of plate portion  280 . Translating portion  290  is comprised of retaining flange  292  formed adjacent to proximal surface of plate portion  290  and one or more snap tabs  296  each having barb  298  at the tab distal end and a clearance relief  299  on the side of the tab opposite the barb. 
         [0137]    Locking portion  280  and translating portion  290  are assembled by inserting distal end of translating portion into locking portion plate hole counterbore  284  then into plate through hole  282  so as to reversibly deflect snap tab(s) into clearance relief(s)  299  of plate translating portion. Further insertion causes plate translating portion retaining flange  292  to enter locking portion plate hole counterbore  284  and causes snap tab(s) to deflect outward and into plate hole pocket  286  of plate locking portion. Translating portion  290  is thereby prevented from exiting locking portion  280  by means of retaining flange  292  cooperating with counterbore  284  in combination with barb(s)  298  cooperating with pocket(s)  286 . However translating portion  290  is allowed to translate along longitudinal axis LA of locking portion due to designed clearances along longitudinal axis LA between the lengths of plate hole  282 , counterbore  284  and flange  292  and between the lengths of barb(s)  298  and pockets  286 . 
         [0138]    In an exemplary method of use of active compression plate system  200 , a patient is prepared for surgery and surgical access to one or more bones is achieved. Access may be accomplished by open surgery, small incision surgery, or percutaneously. 
         [0139]    The surgical procedure chosen, planned, or performed will be for repair of bone fracture, repair of osteotomy, bone fusion, or other procedures in which two or more bones or bone portions must be held in close proximity to each other to facilitate bone healing, and in particular to facilitate bone fusion. 
         [0140]    The patient&#39;s bone or bone portions are exposed and reduced to the desired positions. 
         [0141]    Plate  200  is positioned such that recess  260  straddles a gap between two adjacent bones or bone portions. 
         [0142]    Optionally a drill guide is inserted into at least one fastener hole  12  of translating portion  290  and a hole is drilled into the patient&#39;s bone 
         [0143]    Translating portion  290  is loosely affixed to at least one bone or bone portion by means of inserting at least one fastener  40  such as a bone screw into the fastener hole  12  of translating portion  290  and into the drilled hole (if any) then advancing the fastener into the patient&#39;s bone. 
         [0144]    Any gap between the bone or bone portions immediately underlying plate  200  is reduced and a second fastener  40  such as a bone screw is inserted into hole  12  of locking portion  280 , into a drilled hole (if any) and then advanced into the patient&#39;s bone causing the bone portions or bones to be locked together in a reduced configuration. 
         [0145]    The bone or bone portions are further advanced towards each other to reduce any gap therebetween. This is allowed by system  200  due to the allowable longitudinal motion between translating portion and fixed portion. Fastener  40  on translating portion is immediately advanced to lock translating portion and adjacent locking portion of plate to the bone or bone portions. 
         [0146]    Bone staple  30  is placed through recess  260  and through hole(s)  270 , then into the bone or bone portions and the staple is allowed to hold the bone or bone portions at the desired positions relative to each other. The staple ends apply active compression forces against the bone at a distance below the bone plate distal surface. 
         [0147]    In an alternate method staple  30  can be placed into the bone followed by placement of bone plate  210  and use of the translating aspect of system  200 . 
       Embodiment 3—Translating Plate Portion 
       [0148]      FIGS. 15 to 27  illustrate active compression plate system third embodiment  300 , comprised of translating bone plate  310 , bone staple  30 , fasteners  40 , slotted portion  360 , and fastener holes  12 . Bone staple  30 , fasteners  40 , and fastener holes  12  have the same structure and are made of the same materials as bone staples  30 ,  30 ′,  30 ″, fasteners  40 ,  40 ′,  40 ″, and fastener holes  12 ,  12 ′,  12 ″ of active compression plate systems  1 ,  1 ′,  1 ″, discussed above, except as noted below. Slotted portion  360  is comprised of through-holes  370  and has the same structure and are made of the same materials as recessed/slotted portions  16 ,  16 ′,  16 ″ and through holes  17 ,  17 ″,  17   a ,  17   b  of active compression plate systems  1 ,  1 ′,  1 ″, discussed above, except as noted below. It is understood that plate  310  can be comprised of full thickness slot ( 360 ) or partial thickness recess  360  (not shown). 
         [0149]    Translating bone plate  310  has longitudinal axis LA and is further comprised of locking portion  380  and translating portion  390 . Locking portion  380  and translating portion  390  have the same structure and are made of the same materials as bone plates  10 ,  10 ′,  10 ″ of active compression plate systems  1 ,  1 ′,  1 ″, discussed above, except as noted below. It is understood that locking portion  380  may be comprised of an angled or bent portion in the intermediate portion, similar to bone plate  10 ″, as illustrated in the figures. 
         [0150]    Translating and locking portions cooperate in a telescoping manner. Locking portion  380  is comprised of one or more elongated tab  383 , one or more elongated slot  381  and one or more plate pocket(s)  386  formed into the inner wall  388  of plate portion  380 . Translating portion  390  is comprised of retaining flange  392 , one or more plate elongated slot  393 , one or more elongated tab  391 , and one or more snap tabs  396  each having barb  398  at the tab distal end and a clearance relief  399  on the side of the tab opposite the barb. 
         [0151]    Locking portion  380  and translating portion  390  are assembled by inserting elongated tab  391  of translating portion into elongated slot  381  of locking portion so as to reversibly deflect snap tab(s) into clearance relief(s)  399  of plate translating portion. Further insertion causes plate translating portion retaining flange  392  to contact locking portion plate proximal surface and causes snap tab(s) to deflect outward and into plate hole pocket  386  of plate locking portion. Translating portion  390  is thereby prevented from exiting locking portion  380  by means of retaining flange  392  cooperating with plate  380  proximal surface in combination with barb(s)  398  cooperating with pocket(s)  386 . However translating portion  390  is allowed to translate along longitudinal axis LA of locking portion due to designed clearances along longitudinal axis LA between the lengths of plate tabs  381 ,  391  and plate slots  383 ,  393  and between the lengths of barb(s)  398  and pockets  386 . 
         [0152]    In an exemplary method of use of active compression plate system  300 , a patient is prepared for surgery and surgical access to one or more bones is achieved. Access may be accomplished by open surgery, small incision surgery, or percutaneously. 
         [0153]    The surgical procedure chosen, planned, or performed will be for repair of bone fracture, repair of osteotomy, bone fusion, or other procedures in which two or more bones or bone portions must be held in close proximity to each other to facilitate bone healing, and in particular to facilitate bone fusion. 
         [0154]    The patient&#39;s bone or bone portions are exposed and reduced to the desired positions. 
         [0155]    Plate  300  is positioned such that recess  360  straddles a gap between two adjacent bones or bone portions. 
         [0156]    Optionally a drill guide is inserted into fastener hole  12  of translating portion  390  and a hole is drilled into the patient&#39;s bone 
         [0157]    Translating portion  390  is loosely affixed to at least one bone or bone portion by means of inserting at least one fastener  40  such as a bone screw into the fastener hole  12  of translating portion  390  and into the drilled hole (if any) then advancing the fastener into the patient&#39;s bone. 
         [0158]    Any gap between the bone or bone portions immediately underlying plate  300  is reduced and a second fastener  40  such as a bone screw is inserted into hole  12  of locking portion  380 , into a drilled hole (if any) and then advanced into the patient&#39;s bone causing the bone portions or bones to be locked together in a reduced configuration. 
         [0159]    The bone or bone portions are further advanced towards each other to reduce any gap therebetween. This is allowed by system  300  due to the allowable longitudinal motion between translating portion and fixed portion. Fastener  40  on translating portion is immediately advanced to lock translating portion and adjacent locking portion of plate to the bone or bone portions. 
         [0160]    Bone staple  30  is placed through recess  360  and through hole(s)  370 , then into the bone or bone portions and the staple is allowed to hold the bone or bone portions at the desired positions relative to each other. The staple ends apply active compression forces against the bone at a distance below the bone plate distal surface. 
         [0161]    In an alternate method staple  30  can be placed into the bone followed by placement of bone plate  310  and use of the translating aspect of system  300 . 
         [0162]    In another method of surgery, active compression is achieved by first, exposing the bone surface. Next, an orthopedic plate  310  having a translation portion  390  having a translation portion fastener hole and a locking portion having a locking portion fastener hole is placed on the bone, and fastened to the bone with a first fastener and a second fastener, and optionally a third fastener. It should be noted, that either the second or the third fastener is a compression fastener and the first fastener is a locking fastener. Then, the first fastener is locked in the locking portion fastener hole to form a locked relationship and a second fastener is placed in the translation portion fastener hole and the compression fastener drives active compression in the translation portion  360 .