Abstract:
A disposable single indication orthopedic trauma surgical kit has no bone plates other than a single bone plate precountoured and sized to match an anatomic shape of a portion of a bone of a patient&#39;s extremity. The single bone plate has a plurality of fastener apertures. The surgical kit also has a plurality of fasteners with heads that are dimensioned to mate with the fastener apertures. The surgical kit also has a disposable torque driver adapted to engage the fastener heads. The foregoing components are contained in a sterile sealed container.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a divisional of U.S. patent application Ser. No. 12/884,242 filed on Sep. 17, 2010, which claims the benefit of U.S. Provisional Application No. 61/243,752 filed on Sep. 18, 2009. The entire disclosure of each of the above applications is incorporated herein by reference in its entirety. 
     
    
     BACKGROUND 
       [0002]    This disclosure relates generally to surgical devices and procedures, and more particularly, to orthopaedic surgical devices and procedures for the internal fixation of fractured bones. 
         [0003]    Bone plate systems for the internal fixation of fractured bones of patients are typically provided by manufacturers in non-sterile, reusable trays to the surgical care facilities. These trays may include a number of bone plates of various types, sizes and shapes for various patient anatomies and surgical indications. The trays also may include a number of reusable instruments and a large number of bone plate fasteners of numerous sizes and types, many more than what would normally be required for any given patient and surgical indication. Prior to the surgical procedure, the surgical care facility personnel must be sure that a complete tray of these components is assembled and sterilized, such as by steam autoclave. Often a manufacturer&#39;s sales representative may be present at the facility to assist in assembling the tray of necessary components in preparation for the surgical procedure. After the procedure is completed, the tray of unused components may be sterilized and stored for a later surgical procedure. Any components missing from the tray generally are replenished and the entire tray is sterilized again prior to a surgical procedure for another patient. 
         [0004]    The overall cost of providing to the surgeon many more components in sterile condition than would normally be required for a particular patient with a specific surgical indication can be significant. This overall cost may include costs related to the necessary inventory of bone plate system components, repeated sterilization of the components, the need to make high quality, durable instruments for repeated use, the assistance of manufacturers&#39; representatives, and other factors. Such factors may also impact the availability of such bone plate systems to trauma surgeons practicing in certain areas of the world. 
     
    
     
       BRIEF DESCRIPTION OF FIGURES 
         [0005]    While this specification concludes with claims that particularly point out and distinctly claim the invention, the following description and the accompanying figures further illustrate some non-limiting examples of the claimed invention. Unless otherwise indicated, like reference numerals identify the same elements. 
           [0006]      FIG. 1  is a top perspective view of a single-use, orthopaedic surgery kit (or more simply, a single-use kit), showing a first embodiment of a container sealed inside of an outer package; 
           [0007]      FIG. 2  is a top perspective view of an alternative embodiment of a container, which includes a bottom tray and a top lid, shown with the lid closed; 
           [0008]      FIG. 3  is a top perspective view of the container of  FIG. 2 , shown with the lid opened; 
           [0009]      FIG. 4  is a top perspective view of a single-use, distal volar radius (or DVR) kit; 
           [0010]      FIG. 5  is a top perspective, detailed view of part of the DVR kit of  FIG. 4 , showing a first fastener positioned in a fastener length gage; 
           [0011]      FIG. 6  is a top perspective, detailed view of another part of the DVR kit of  FIG. 4 , showing a drill guide as it is removed from a driver and placed into a reservoir of the container; 
           [0012]      FIG. 7  is a top perspective, detailed view of another part of the DVR kit of  FIG. 4 , showing a retaining clip holding a DVR assembly in the container; 
           [0013]      FIG. 8  is a top perspective view of a single-use, DVR long kit; 
           [0014]      FIG. 9  is a top perspective view of a single-use, fibula kit; 
           [0015]      FIG. 10  is a top perspective view of a single-use, dorsal nail plate (or DNP) kit; 
           [0016]      FIG. 11  is a top perspective view of a single-use, flexible fragment fixation (or F3) kit; 
           [0017]      FIG. 12  is a top perspective view of a single-use, proximal radius kit; 
           [0018]      FIG. 13  is a top perspective view of a navicular kit; 
           [0019]      FIG. 14  is a perspective view of a first drive instrument, which has a first drive tip; 
           [0020]      FIG. 15  is a perspective view of a depth gage for measuring the length of a hole extending through an aperture of a bone plate and a coaxially drilled hole in the bone, the depth gage shown in an extended position; and 
           [0021]      FIG. 16  is a perspective view of the depth gage of  FIG. 15 , shown in a retracted position; 
           [0022]      FIG. 17  is a perspective view of a pair of wire drills; 
           [0023]      FIG. 18  is a perspective, detail view of the distal ends of the wire drills shown in  FIG. 17 ; 
           [0024]      FIG. 19  is a perspective view of a first fastener, according to a second embodiment; 
           [0025]      FIG. 20  is a perspective view of a first fastener, according to a first embodiment; 
           [0026]      FIG. 21  is a perspective view of a second fastener; 
           [0027]      FIG. 22  is a detail view of a first tapered, threaded head of the first fastener shown in  FIG. 20 ; 
           [0028]      FIG. 23  is a detail view of a crest portion of a thread of the first tapered, threaded head of  FIG. 22 ; 
           [0029]      FIG. 24  is a perspective, detail view of a double socket of the second fastener shown in  FIG. 21 ; 
           [0030]      FIG. 25  is a perspective, detail view of the first drive tip shown in  FIG. 14 ; 
           [0031]      FIG. 26  is a perspective, detail view of a second drive tip; 
           [0032]      FIG. 27  is a perspective view of a first drill guide; 
           [0033]      FIG. 28  is a perspective view of a second drill guide; 
           [0034]      FIG. 29  is a cross-sectional view of a non-locking aperture; 
           [0035]      FIG. 30  is a cross-sectional view of a bone plate showing three possible trajectories of the first fastener of  FIG. 20  inserted into the non-locking aperture of  FIG. 29 ; 
           [0036]      FIG. 31  is a cross-sectional view of a locking aperture; 
           [0037]      FIG. 32  is a cross-sectional view of a bone plate with the first fastener of  FIG. 20  inserted at a fixed angle into the locking aperture of  FIG. 31 ; 
           [0038]      FIG. 33  is a top view of a unidirectionally ramped aperture; 
           [0039]      FIG. 34  is a cross-sectional view of the unidirectionally ramped aperture of  FIG. 33 ; 
           [0040]      FIG. 35  is a cross-sectional view of the unidirectionally ramped aperture of  FIG. 34  with the first fastener of  FIG. 20  partially inserted therein; 
           [0041]      FIG. 36  is a cross-sectional view of the unidirectionally ramped aperture of  FIG. 35  with the first fastener of  FIG. 20  fully inserted therein; 
           [0042]      FIG. 37  is a top view of a bidirectionally ramped non-locking aperture; 
           [0043]      FIG. 38  is a cross-sectional view of the bidirectionally ramped non-locking aperture of  FIG. 37 ; 
           [0044]      FIG. 39  is a top view of a unidirectionally ramped slot positioned along a longitudinal axis of a plate; 
           [0045]      FIG. 40  is a cross-sectional view taken through the longitudinal axis of the plate of  FIG. 39 , showing a unidirectionally ramped slot; 
           [0046]      FIG. 41  is a cross-sectional view taken through line  41 - 41  of  FIG. 39 , showing the unidirectionally ramped slot of  FIG. 39 ; 
           [0047]      FIG. 42  is a top view of the first fastener partially inserted into the unidirectionally ramped slot of the bone plate; 
           [0048]      FIG. 43  is a top view of the first fastener fully inserted into the unidirectionally ramped slot; 
           [0049]      FIG. 44  is a cross-sectional view, taken through the longitudinal axis, of the first fastener partially inserted into the unidirectionally ramped slot as shown in  FIG. 42 ; 
           [0050]      FIG. 45  is a cross-sectional view, taken through the longitudinal axis, of the first fastener fully inserted into the unidirectionally ramped slot as shown in  FIG. 43 ; 
           [0051]      FIG. 46  is a top view of a bidirectionally ramped slot in a bone plate; 
           [0052]      FIG. 47  is a cross-sectional view, taken through the longitudinal axis, of the bidirectionally ramped slot of  FIG. 46 ; 
           [0053]      FIG. 48  is an end view of a first DVR assembly; 
           [0054]      FIG. 49  is a top view of the first DVR assembly of  FIG. 48 ; 
           [0055]      FIG. 50  is a perspective view of the first DVR assembly of  FIG. 48 ; 
           [0056]      FIG. 51  is an end view of a second DVR assembly; 
           [0057]      FIG. 52  is a top view of the second DVR assembly of  FIG. 51 ; 
           [0058]      FIG. 53  is a perspective view of the second DVR assembly of  FIG. 51 ; 
           [0059]      FIG. 54  is an end view of a third DVR assembly; 
           [0060]      FIG. 55  is a top view of the third DVR assembly of  FIG. 54 ; and 
           [0061]      FIG. 56  is a perspective view of the third DVR assembly of  FIG. 54   
       
    
    
     SUMMARY 
       [0062]    A disposable single indication orthopedic trauma surgical kit has no bone plates other than a single bone plate precountoured and sized to match an anatomic shape of a portion of a bone of a patient&#39;s extremity. The single bone plate has a plurality of fastener apertures. The kit also has a plurality of fasteners, each comprising a head and a shaft. The heads are dimensioned to mate with the fastener apertures. The kit also has a disposable torque driver adapted to engage the fastener heads. The foregoing components are contained in a sterile sealed container. 
         [0063]    The portion of the bone may be any one of the right distal volar radius, the left distal volar radius, the right fibula, the left fibula, the right proximal radius, the left proximal radius, the right navicular, the left navicular, the right distal ulna, and the left distal ulna. All of the fasteners in the surgical kit may have the same sized head, while all of the fastener apertures of the single bone plate may be dimensioned to receive the same sized head. All of the fasteners in the surgical kit may have only one of two different sized heads. Alternatively, all of the fasteners in the surgical kit may have either a first sized head or a second sized head, while all of the fastener apertures of the single bone plate may be dimensioned to receive either the first sized head or the second sized head. The surgical kit may include thirty-six or fewer fasteners, each of which may have only one of nine or fewer different shaft lengths. The fasteners may be arranged in the container in a plurality of groupings of four or fewer fasteners, each having the same shaft length. The container may include labels to indicate the shaft length of each of the plurality of groupings of fasteners. The container may include a plurality of fastener length gages to aid the user in determining the length of each of the plurality of fasteners. The surgical kit may also include a wire drill, a drill guide, and a depth gage, all contained in the sterile sealed container. In addition, the surgical kit may be resterilizable by a steam autoclave once the sterile sealed kit has been opened. 
         [0064]    A disposable single indication orthopedic trauma surgical kit includes a single bone plate adapted for a use on a bone of a patient&#39;s extremity. The bone plate has a plurality of fastener holes. The kit also has a plurality of fasteners, each comprising a head and a shaft. The heads are adapted to interface with the fastener holes. The kit also includes a disposable torque driver adapted to engage the fastener heads, one or more wire drills, one or more drill guides, and a disposable depth gage. All of the foregoing components are contained in a sterile sealed container. 
         [0065]    A system of single indication orthopedic trauma surgical kits includes a sterile sealed left DVR kit for treatment of fractures of the left distal volar radius. The left DVR kit includes a sterile sealed container, a single bone plate that is anatomically shaped and sized to match the left distal volar radius, a plurality of fasteners, a fastener driver, a wire drill, a drill guide, and a depth gage. The system also includes a sterile sealed right DVR kit for treatment of fractures of the right distal volar radius. The right DVR kit includes a sterile sealed container, a single bone plate that is anatomically shaped to match the right distal volar radius, a plurality of fasteners, a fastener driver, a wire drill, a drill guide, and a depth gage. The system also includes a sterile sealed fibula kit for treatment of fractures of the fibula. The fibula kit includes a sterile sealed container, a single bone plate that is anatomically shaped to match the right and left fibula, a plurality of fasteners, a fastener driver, a wire drill, a drill guide, and a depth gage. The system also includes a sterile sealed distal ulna kit for treatment of fractures of the distal ulna. The distal ulna kit includes a sterile sealed container, a single bone plate that is anatomically shaped to match the right and left distal ulna, a plurality of fasteners, a fastener driver, a wire drill, a drill guide, and a depth gage. 
         [0066]    Each of the sterile sealed kits of the system may be steam autoclave resterilizable after the kit has been opened. The containers of all the sterile sealed kits may have a common design that is configurable for different surgical indications. Each kit may include displayed graphics that pertain to the surgical indication and use of the kit. Each kit may have one of a number of colors, each color corresponding to one of a number of surgical indications. 
         [0067]    A bone plate system for the internal fixation of a fractured bone of a patient has a bone plate with a bone-facing bottom surface, an opposing top surface, and a thickness between the surfaces. The bone plate also has one or more threaded bone fastener apertures and one or more non-threaded bone fastener apertures. The bone plate system further has a plurality of bone fasteners, each fastener comprising a shaft and a head. The heads are dimensioned and configured to threadedly engage the threaded bone fastener apertures to provide a fixed angle locking construct. The heads are also dimensioned and configured to directly engage the nonthreaded bone fastener apertures to provide a polyaxial non-locking compressive construct. 
         [0068]    At least one of the non-threaded bone fastener apertures may be a unidirectionally ramped aperture for dynamic compression of the fractured bone in one direction. The at least one unidirectionally ramped aperture may be an elongated slot. Also, the threaded and non-threaded bone fastener apertures of the bone plate may have the same nominal size. At least some of the plurality of bone fasteners may be threaded for engagement into bone and at least some of the plurality of bone fasteners may have non-threaded, smooth shafts. The head of each bone fastener may have a tapered external screw thread that has a flat helical crest defining a frustoconical shape. The tapered external screw thread may have either one of a double lead type of thread and a triple lead type of thread. The tapered external screw thread may have a pitch distance between adjacent threads of about 0.500 to 0.600 millimeters. Furthermore, the flat helical crest may have a width in the range of about 0.120 to 0.160 millimeters and the ratio of the width of the flat helical crest to the pitch distance between threads may be about 0.200 to 0.320. The bone plate may be sized and shaped for the internal fixation of a fractured bone of a human extremity. The bone plate may also include a shaft portion having a plurality of regions, each region having one of the non-threaded bone fastener apertures and one of the threaded bone fastener apertures paired together. A surgeon may attach the bone plate to approximately the same part of the bone by selecting one of the threaded and non-threaded bone fastener apertures in any one of the regions and inserting one of the bone fasteners into the selected aperture. 
         [0069]    A bone plate system for the internal fixation of a fractured bone of a patient has a bone plate with a bone facing bottom surface, an opposing top surface, and a thickness between the surfaces. The bone plate also has a plurality of bone fastener apertures of a first size. The plurality of bone fastener apertures have one or more apertures of a first type having a tapered threaded surface and one or more apertures of a second type having a tapered smooth surface. The bone plate system also has a plurality of bone fasteners, each comprising a shaft and a head of a first size. The heads are dimensioned and configured to threadedly engage the first type of bone fastener aperture to provide a fixed angle locking construct. The heads are also dimensioned and configured to directly engage the second type of fastener aperture to provide a polyaxial non-locking compressive construct. 
         [0070]    The bone plate may have only bone fastener apertures of the first size and may also have one or more non-fastener apertures. 
         [0071]    A bone plate system has a bone plate with a bone facing bottom surface, an opposing top surface, and a thickness between the surfaces. The bone plate further has a plurality of bone fastener apertures of a first size and a plurality of bone fastener apertures of a second size. The first and second sized apertures each have one or more apertures of a first type having a tapered surface with internal threads and one or more apertures of a second type having a tapered smooth surface. The bone plate system also has a plurality of first bone fasteners, each comprising a shaft and a head of a first size. The heads are dimensioned and configured to threadedly engage the first type of apertures of the first size to provide a fixed angle locking construct. The heads also are dimensioned and configured to directly engage the second type apertures of the first size to provide a polyaxial non-locking compressive construct. The bone plate system also has a plurality of second bone fasteners, each comprising a shaft and a head of a second size. The heads are dimensioned and configured to threadedly engage the first type of apertures of the second size to provide a fixed angle locking construct. The heads are also dimensioned and configured to directly engage the second type of apertures of the second size to provide a polyaxial non-locking compressive construct. 
         [0072]    The bone fastener apertures of the first and second sizes of the second type may have at least one unidirectionally ramped aperture for dynamically compressing the fractured bone in one direction. The bone fastener apertures of the first and second sizes of the second type may include at least one bidirectionally ramped aperture for dynamically compressing the fracture bone in either one of two opposing directions. The head of the first bone fastener may have a first drive socket and the head of the second bone fastener may include a second drivesocket, and the first and second drive sockets may be dimensioned to receive a driver tip of a torque driver for insertion of the first and second bone fasteners into bone. Furthermore, the first drive socket may have a first configuration. The second drive socket may have a stepped recess with a distal recess having the first configuration and a coaxial, adjacent proximal recess with a second configuration. The second configuration may be larger than the first configuration as viewed along the axis. Either one or both of the distal and proximal recesses can transmit a torque from the torque driver to the head of the second bone fastener. 
       DETAILED DESCRIPTION 
       [0073]    Throughout the following description, the term “user” may refer to the surgeon or other users of the single-use kit, including surgical assistants, technicians, and so on. Also, the term “single-use”, as used herein, is interchangeable with the terms “disposable” or “disposable, single-indication”, meaning that the kit, including all the components contained therein, is intended for use for only one surgical patient. After completion of the surgical procedure, the components that are not implanted into the patient may be discarded using conventional methods. However, for some embodiments, it is also possible that the single-use kit or a portion of it can be resterilized for use in a surgical procedure for another patient. 
         [0074]    Each single-use kit is designed for transport from the manufacturer to the surgical care facility, storage, and then finally, sterile presentation to the surgeon for use during the surgical procedure. Using the appropriate single-use kit for a particular surgical procedure may reduce the need for the surgical care facility to maintain a large inventory of individual components that must be combined into a surgical tray and sterilized prior to that procedure. Furthermore, using the appropriate single-use kit may reduce the need for special assistance from the representatives of the component manufacturers, and assures the surgeon that the components are always new and in sterile condition. In addition, since the single-use kit may be designated to have a single product code, expensing the cost of the kit to the patient and/or the patient&#39;s health care provider may be simplified and result in reduced overhead costs for the surgical procedure. 
         [0075]    We envision that occasionally the surgeon may select a single-use kit containing components for a particular type of bone fracture procedure, and then determine during the surgical procedure that the single-use kit is not appropriate for that patient. In case a single-use kit is contaminated during (or prior to) a surgical procedure for a patient and then is not used for that patient, it is possible to steam autoclave the kit with the components contained therein, such that the kit may be used in a surgical procedure for a different patient. 
         [0076]    One advantage of these single-use kit embodiments is the commonality of components that is possible due to the reduction of the number of bone plate fastener types required, as compared to currently available systems for similar surgical procedures. By minimizing the variety of required fastener types for attaching a plurality of different types of bone plates, an economy is realized in the instrumentation required to perform the various surgical procedures. As a consequence, the size and cost of the single-use kit is minimized. We envision that this may increase availability of such kits to surgical care centers throughout the world, so that more trauma patients may be treated using the latest implants, instruments and techniques. In addition, we envision that the overall surgical procedure may be simplified, potentially resulting in reduced surgical procedure duration and improved clinical outcome for the patient. 
         [0077]    Referring now to the figures,  FIG. 1  is a top perspective view of a single-use kit  4 , which includes a container  8  according to a first embodiment, a plurality of components (not visible) contained therein, and an outer package  2 . (Each of the plurality of components will be later described in detail for each of the single-use kit embodiments disclosed herein.) Outer package  2  physically protects container  8  and the components contained therein, and may also serve to seal and to maintain the sterility of container  8  and the components contained therein until accessed prior to or during the surgical procedure. 
         [0078]    Outer package  2  may be formed from materials and by methods that are well known in the art for the sterile packaging of medical devices. Outer package  2  includes a pan  5  that is sized and shaped to hold container  8 . Pan  5  has a peripheral lip  3  and may be formed from a plastic material suitable for maintaining sterility. Outer package  2  may include a removably attachable, sealing membrane  6  that is adhered to peripheral lip  3  of pan  5  prior to sterilization by gamma radiation or other sterilization methods known in the art. The user peels sealing membrane  6  from pan  5  to access container  8 . Sealing membrane  6  may be formed from a suitable, transparent plastic material so that a graphic  20  displayed on container  8  is visible prior to opening outer package  2 . Graphic  20  may provide information pertaining to, for example, the manufacturer, the distributor, the surgical indications, the product code(s), the components contained therein, the overall physical characteristics (i.e., size and weight), the relevant patents, warnings, directions for opening, and so on. Alternatively, sealing membrane  6  may be formed from a suitable, solidly colored or translucent plastic material, and may include a graphic that is similar or complementary to graphic  20 . 
         [0079]    It should be understood that other embodiments of single-use kit  4  may not include outer package  2  at all or that outer package  2  may provide only non-sterile protection for container  8  and the components contained therein. For example, container  8  and the components contained therein may be first removed from outer package  2  in a non-sterile condition and then sterilized at the surgical care facility prior to the surgical procedure. 
         [0080]      FIG. 2  is a top perspective view of a container  10  in a closed configuration according to a second embodiment.  FIG. 3  is a top perspective view of container  10  in an open configuration. Container  10  includes a bottom tray  22  and a top lid  12 , each of which is formed, such as by injection molding, from any one of a number of polymers, including, for example, polysulfone, polyetherimide and polypropylene. Either one or both of tray  22  and lid  12  may be formed from a transparent polymer to allow viewing of the components contained therein without opening container  10 . 
         [0081]    Lid  12  may be formed from a polymer that is colored to indicate the surgical indication of the kit or to provide some other type of information to the user. For example, a red color may indicate that the kit is to be used for the right side of the patient&#39;s anatomy, a lime color may indicate that the kit is to be used for the left side, and a white color may indicate that the kit is to be used for either side. 
         [0082]    As shown in  FIGS. 2 and 3 , tray  22  has a rectangular shape defined by four tray sides  24 , although other shapes may be desirable depending on functional, economic, aesthetic or other reasons. Tray  22  includes a tray bottom  26  that includes a plurality of openings  28  to facility steam access and drainage during sterilization. Lid  12  has a top portion  16  and a peripheral lip  14  that is sized and shaped to fit closely around tray  22 . Top portion  16  of lid  12  includes a plurality of openings  18  to facilitate steam sterilization and drainage of container  10  and the components contained therein. Graphic  20  may be integrally molded into top portion  16  of lid  12  and/or selectively highlighted with a suitable ink or paint, such as is well known in the art. 
         [0083]    A pair of spaced apart, lid hinge elements  32  is integrally formed on lid  12  for attachment to a pair of spaced apart, tray hinge elements  33  integrally formed on tray  22 . Lid  12  may be removably attachable to tray  22  to facilitate access to the components in tray  22  during the surgical procedure, while conserving available space on the surgical stand. 
         [0084]    Similarly, a pair of spaced apart, lid latch elements  30 , positioned on the opposite side from lid hinge elements  32  of container  10 , is integrally formed on lid  12  for attachment to a pair of spaced apart, tray latch elements  31  formed on tray  22 . As is well known in the art, many types of lid hinge elements  32 , lid latch elements  30 , tray hinge elements  33  and tray latch elements  31  are possible. 
         [0085]    As shown in  FIG. 4 , tray  22  is compartmentalized by several, integrally formed partitions  34  extending from the inside of tray bottom  26  and the inside of tray sides  24 . Tray  22  also includes a shelf  36  that serves as an easily accessible, “screw caddy” for holding a plurality of implantable fasteners, including, for example, a plurality of first fasteners  401  and a plurality of second fasteners  451  (as shown, for example, in  FIG. 8 ). Shelf  36  and partitions  34  are configured to organize and retain the various combinations of all the required components for at least each of the embodiments, as will be described, of the single-use kit embodiments shown herein. 
         [0086]    Container  10 , due to its versatility in design, may be used to contain many different combinations of components, depending on the surgical indication, for at least each of the single-use kit embodiments described herein.  FIGS. 4 ,  8 ,  9 ,  10 ,  11 ,  12  and  13  show a few of the possible, single-use kit embodiments and may be referenced in combination. Each of these single-use kits is configured for a surgical procedure for the internal fixation of a particular bone of the arm, leg, hand or foot.  FIG. 4  shows a distal volar radius kit  100  (or DVR kit  100 ) for a fracture of the distal radius of the forearm;  FIG. 8  shows a single use, DVR Long kit, also for a fracture of the distal radius of the forearm;  FIG. 9  shows a single-use, fibula kit for a fracture of the fibula of the lower leg;  FIG. 10  shows a single-use, dorsal nail plate kit  210  (or DNP kit  210 ) for a fracture of the distal radius of the forearm;  FIG. 11  shows a single-use, flexible fracture fixation kit  220  (or F3 kit  220 ) for a fracture of a small bone, such as of the hand or foot;  FIG. 12  shows a single-use, proximal radius kit  240  for a fracture of the proximal radius bone at the elbow;  FIG. 13  shows a single-use, navicular kit  230  for a fracture of the navicular bone of the foot. 
         [0087]    As shown in  FIG. 4  and also in the detailed view of  FIG. 5 , shelf  36  includes a plurality of first receptacles  38  and a plurality of second receptacles  40 . Each of first receptacles  38  is sized and shaped to loosely retain first fastener  401 , which has a nominal size, for example, of 2.7 mm, and each of second receptacles  40  is sized and shaped to loosely retain second fastener  451 , which has a larger nominal size, for example, of 3.5 mm. First receptacles  38  is integrally formed in lid  12 , wherein each pair of first receptacles  38  is connected by a bridge slot  39  to facilitate injection molding. Lid  12  includes a plurality of ribs  50  integrally formed into top portion  16 , such that when lid  12  is in a closed position as shown in  FIG. 2 , each of ribs  50  abuts the exposed end of one of first fasteners  401  and second fasteners  451 , such that all of the fasteners are securely retained in container  10 . 
         [0088]    First fastener receptacles  38  and second fastener receptacles  40  may be arranged such that plurality of first fasteners  401  and plurality of second fasteners  451  may be arranged in tray  22  in a plurality of groupings of eight or fewer fasteners. Each grouping corresponds to a particular one of a number of distinct fastener lengths. As shown in the present example, receptacles  38  and receptacles  40  are arranged in groupings, such that each grouping may contain up to eight fasteners (four of first fasteners  401  and four of second fastener  451 ) of the same shaft length. The number of receptacles within each groupings may vary in other embodiments. For example, each grouping may include two, four or six receptacles for containing fasteners. 
         [0089]    When lid  12  is opened, the user may easily grasp the exposed end of each fastener and remove it from shelf  36 . Alternately, the user may pick each fastener from shelf  36  using the drive instrument to be described. Since each single-use kit may include only the number of first fasteners  401  and second fasteners  451  required for the particular surgical indication, with a few extra, a number of first receptacles  38  and second receptacles  40  may be empty. 
         [0090]    Also as shown in  FIGS. 4 and 5 , shelf  36  includes a plurality of fastener length gages  42 , each of which is configured and labeled by a size label  44  for measuring incremental lengths of first fasteners  401  and second fasteners  451 . The incremental lengths may range, for example, between 8 mm and 24 mm by 2 mm increments. Each of length gages  42  has a seat  62 , a channel  64  and a stop  66 . As shown in  FIG. 5 , when first fastener  401  of a particular, incremental length is mated into the appropriate one of gages  42 , first fastener  401  fully fills that particular length gage without extending beyond seat  62 . Using length gages  42 , the surgeon may quickly confirm the length of a selected fastener prior to implantation of the fastener into the patient, thus ensuring that the fastener is of sufficient length to properly engage bone, but not so long as to protrude too far from the bone and into soft tissue. 
         [0091]    Still referring to  FIG. 4 , DVR kit  100  includes container  10  and a plurality of components that include a first DVR assembly  102 , a plurality of first fasteners  401 , and a first drive instrument  70 . The surgeon may use first driver instrument  70  to transmit a torque and drive each of first fasteners  401  into bone. The plurality of components of DVR kit  100  includes a depth gage  380  and at least one drill wire  370 . Each of the single-use kit embodiments disclosed herein contains a vertically stacked, plurality of wire drills  370  that are retained between one of tray sides  24  and one of partitions  34  of tray  22 , such that the tips of wire drills  370  are shielded from the other components and the user&#39;s hands. 
         [0092]    As shown in  FIG. 4 , DVR kit  100  includes twenty-four of first fasteners  401 , although the quantity may vary. An appropriate quantity of first fasteners  401  of various lengths may be based on historical data for similar, distal volar radius fracture procedures, with a few more fasteners provide to allow for special circumstances (dropped or damaged fasteners, unusual fractures, etc.). 
         [0093]    First DVR assembly  102  includes a first DVR bone plate  104  preassembled with a plurality of first drill guides  330 . The surgeon may use such preassembled drill guides to guide a wire drill when drilling holes into the fractured bone, so that the drilled holes are properly aligned with the apertures of the bone plate, and while also protecting the internal threads of the apertures. Such preassembled drill guides may also be useful for reshaping the bone plate using special bending instruments that fit over the drill guides. After drilling each hole, the surgeon may insert a drive end  80  of drive instrument  70  into drill guide  330  and remove drill guide  130  from plate  104 . 
         [0094]    As shown in  FIG. 6 , each of a reservoir  46  and a stripping slot  47  is integrally formed into container  10 . The surgeon may use stripping slot  47  to remove drill guide  330  from drive instrument  70 , such that drill guide  330  falls into reservoir  46 . In the embodiment shown, the user may collect a plurality of drill guides in a easily visible, linear arrangement, such that the user can quickly account for the number of drill guides  330  that have been removed from plate  104 . An instructive label  48  (the letters “FG” stand for Fast Guide™) aids the “first-time” user in understanding where to discard drill guides  330 . 
         [0095]      FIG. 7  is a top perspective, detailed view of part of DVR kit  100 , showing a retaining clip  52  holding DVR assembly  100  between partitions  34  of container  10 . First slots  54  and second slots  56  are formed into container  10 , and clip  52  is configured, such that clip  52  may removably lock into one of first slots  54  and its opposing one of second slots  56 . Clip  52  straddles over and retains DVR assembly  100 , and is easily removable so that DVR assembly  100  may be lifted out of container  10 . When container  10  is in the closed configuration, lid  12  abuts and holds clip  52  in place. In this embodiment of container  10 , three pairs of slots  54  and  56  are provided to allow placement of clip  52  in three different positions. This allows container  10  to have the versatility to contain different types of bone plate assemblies. 
         [0096]      FIG. 8  is a top perspective view of the single-use, DVR long  490  kit, which includes container  10  and a plurality of components, including a DVR long plate assembly  492 , a plurality of first fasteners  401 , a plurality of second fasteners  451 , a plurality of wire drills  370 , a second driver  90  and a depth gage  380 . DVR long plate assembly  492  includes a plurality of first drill guides  330  preassembled to a DVR long plate  494 . DVR long plate  494  includes a plurality of apertures of different types to be described, such that the user may attach DVR long plate  494  to the fractured bone using at least a portion of each of the plurality of first fasteners  401  and the plurality of second fasteners  451 . (All bone plate apertures described herein should be understood to be fastener apertures, as opposed to K-wire apertures, suturing apertures, etc.) 
         [0097]      FIG. 9  is a top perspective view of the single-use, fibula kit  200 , which includes container  10  and a plurality of components, including a fibula plate assembly  202 , plurality of first fasteners  401 , plurality of second fasteners  451 , plurality of wire drills  370 , second driver  90  and depth gage  380 . Fibula plate assembly  202  includes a plurality of second drill guides  340  preassembled to a fibula plate  204 . Fibula plate  202  includes a plurality of apertures of different types to be described, such that the user may attach fibula plate  204  to the fractured bone using at least a portion of each of the plurality of first fasteners  401  and the plurality of second fasteners  451 . 
         [0098]      FIG. 10  is a top perspective view of the single-use, dorsal nail plate  210  (or DNP) kit, which includes container  10  and a plurality of components, including a DNP plate assembly  212 , a plurality of first fasteners  401 , a plurality of wire drills  370 , first driver  70  and depth gage  380 . Nail plate assembly  212  includes a DNP plate  494  removably attached to a DNP handle  216 . DNP plate  494  includes a plurality of apertures to be described, such that the user may attach DNP plate  494  to the fractured bone using at least a portion of each of the plurality of first fasteners  401 . 
         [0099]      FIG. 11  is a top perspective view of the single-use, flexible fragment fixation (or F3) kit  220 , which includes container  10  and a plurality of components, including a F3 plate assembly  222 , plurality of first fasteners  401 , plurality of wire drills  370 , first driver  70  and depth gage  380 . F3 plate assembly  222  includes a F3 plate  224  having a plurality of apertures to be described, such that the user may attach F3 plate  224  to the fractured bone using at least a portion of each of the plurality of first fasteners  401 . F3 kit  220  is particularly suitable for the internal fixation of a fractured, distal ulna bone, and therefore may also be referred to as a distal ulna kit. 
         [0100]      FIG. 12  is a top perspective view of the single-use, proximal radius kit  240 , which includes container  10  and a plurality of components, including a proximal radius plate assembly  242 , a plurality of first fasteners  401 , a plurality of wire drills  370 , first driver  70  and depth gage  380 . Proximal radius plate assembly  242  includes a proximal radius plate  244  having a plurality of apertures to be described, such that the user may attach proximal radius plate  244  to the fractured bone using at least a portion of each of the plurality of first fasteners  401 . 
         [0101]      FIG. 13  is a top perspective view of the navicular kit  230 , which includes container  10  and a plurality of components, including a navicular plate assembly  230 , a plurality of second fasteners  451 , a plurality of wire drills  370 , second driver  90  and depth gage  380 . Navicular plate assembly  230  includes a plurality of second drill guides  340  preassembled with a navicular plate  236  having a plurality of apertures to be described, such that the user may attach navicular plate  244  to the fractured bone using at least a portion of each of the plurality of first fasteners  401 . Navicular plate assembly  232  is removably retained upon a board insert  234  that, in turn, is retained within container  10  by a pair of T-rails  68  integrally formed into container  10 . 
         [0102]      FIG. 14  is a perspective view of first drive instrument  70 , which has a handle  72  connected by an attachment  76  to a shaft  74  that defines a longitudinal axis  81 . At the distal end of shaft  74  is a first drive end  80  that includes a first drive tip  84 . Handle  72  may be formed from a rigid, high strength polymer. Shaft  74  may be formed from a stainless steel and has a proximal end (not visible in the figures) that is configured to be retainably insert-molded into handle  72  at attachment  76 . As will be further described in conjunction with  FIG. 25 , first drive tip  84  is configured for use with first fastener  401 . 
         [0103]      FIG. 15  is a perspective view of depth gage  380  for measuring the length of a hole extending through an aperture of a bone plate and a coaxially drilled hole in the bone, shown in an extended position.  FIG. 16  is a perspective view of depth gage  380 , shown in a retracted position. Depth gage  380  includes a body component  382  that frictionally fits over a slide component  384  having a distal and proximal end defining a longitudinal axis  390  therebetween. Body component  382  is adjustably movable along slide component  384  along longitudinal axis  390 . Each of body component  382  and slide component  384  may be injection molded from a rigid polymer. A feeler wire  386 , which may be formed from stainless steel, is attached to body component  382  and extends distally along longitudinal axis  390  from the distal end of slide component  384 . Feeler wire  386  includes a hook tip  387 . A ring  388  is connected to the proximal end of slide component  384  and is sized and shaped for a thumb of the user. A spool portion  389  of body component  382  is sized and shaped for placement between, for example, the fore and middle fingers of the user. The slide component  384  includes indicia  385  that corresponds to the length of feeler wire  386  extending distally from the distal end of slide component  384 . The position of body component  382  is adjustable between a first stop  381  and a second stop  383  on slide component  384 . The frictional fit between slide component  384  and body component  382  is sufficient to maintain this position when the user releases depth gage  380 . 
         [0104]    The user may measure the length of the aperture through the plate and bone, and thereby determine the length of the fastener needed, by first fully extending feeler wire  386 , then catching hook tip  387  on the edge of the aperture on the far side of the bone. Then the user adjusts spool portion  389  and ring  388  towards each other until the distal end of slide component  384  abuts the top surface of the bone plate. The user may read the indicia  385  that aligns with the proximal end of body component  382  and corresponds to the length of the aperture. Depth gage  42  may also be used through a drill guide preassembled to the plate, in which case, the user may read the indicia  385  that aligns with the proximal end of second stop  383 . 
         [0105]      FIG. 17  is a perspective view of wire drill  370  and an alternate wire drill  360 .  FIG. 18  is a perspective, detail view of the distal ends of wire drill  370  and alternate wire drill  360 . Each of wire drill  370  and alternate wire drill  360  may be formed from a stainless steel and are well known in the art for drilling holes in bone, for the provisional fixation of fractured bones, for provisional attachment of bone plates to bone, and for other uses. Wire drill  370  has a proximal end  372 , a distal end  373 , a longitudinal axis  371  extending therebetween, and a fluted tip  376 . Wire drill  360  has a proximal end  362 , a distal end  364 , a longitudinal axis  361  extending therebetween, and a spade tip  366 . Each of the single-use kits disclosed herein may contain at least one of alternate wire drill  360  and/or at least one of wire drill  370 . In general, wire drill  370  may be used to prepare a pilot hole in bone for one of first fastener  401  and second fastener  451 , so the diameter of wire drill  370  is appropriately sized accordingly. One version of wire drill  360  may be what is known in the art as a K-wire, which is primarily used for provisional fixation, and may be provided, for example, with a diameter of about 1.6 mm. The surgeon may insert the K-wire through any one of the aforementioned apertures of the bone plates described herein, but it is well-known in the art that these plates may also include one or more smaller holes specifically for receiving K-wires and/or for attaching sutures thereto. 
         [0106]      FIGS. 19 ,  20  and  21  are perspective views of the same scale showing the fasteners that may be included in the single-use kits described herein.  FIG. 20  is a perspective view of first fastener  401 .  FIG. 19  is a perspective view of an alternate embodiment of first fastener  401 , also referred to as a first fastener peg  431 .  FIG. 21  is a perspective view of second fastener  451 . Each of first fastener  401 , first fastener peg  431  and second fastener  451  may be formed from a metal such as a titanium alloy such as Ti-6Al-4V that is anodized for anti-galling and abrasion resistance. First fastener  401  and first fastener peg  431  may have a nominal size of 2.7 mm and second fastener  451  may have a nominal size of 3.5 mm. 
         [0107]    First fastener  401  has a head  404  and a shaft  408  that defines a longitudinal axis  420 . Shaft  408  may be provided in a number of incremental lengths, ranging from 8 mm to 24 mm by increments of 2 mm, for example. Head  404  includes a plurality of external threads  405  and a drive socket  412  that has an approximately square configuration. Shaft  408  has a plurality of threads  409  and a tip  418  and is configured for self-tapping into a properly sized, drilled hole in the bone. 
         [0108]      FIG. 22  is a detail view of head  404  of first fastener  401  shown in  FIG. 20 . Threads  405  are conically tapered and define a taper angle  406  of about 12 degrees, centered on longitudinal axis  420 . Threads  405  may have a double-lead type of thread as shown in  FIG. 22 . Head  404  is adapted for locking at a fixed angle into a tapered, threaded (locking) aperture of a bone plate, as is known in the art. But as will be described herein, head  404  is also adapted for use in particular non-threaded (non-locking) apertures. This is primarily due to the inclusion on threads  405  of crest portions  402  that have a crest width  414  ( FIG. 23 ). 
         [0109]    Crest width  414 , as shown in  FIG. 22 , is 0.141 millimeters, but may be approximately in the range of 0.120 to 0.160 millimeters. A pitch distance between adjacent crest portions  402 , as shown in  FIG. 22 , is 0.559, but may be approximately in the range of 0.500 to 0.600 millimeters. Therefore, a ratio of crest width  414  to pitch distance, as shown in  FIG. 22 , is 0.252, but may be approximately in the range of 0.200 to 0.320. Since crest portions  414  are relatively wide as compared to tapered, threaded heads of some currently available bone fasteners, first fastener  401  may be driven with high compressive force into a smooth (non-threaded) aperture in various trajectories, such that threads  405  are not “rolled over” or otherwise damaged during insertion. Without widened, crest portion  414  on threads  405 , it may be more likely that head  404  would “pull through” the aperture of the plate under high compressive load. 
         [0110]    First fastener peg  431 , shown in  FIG. 19 , includes a head  434  having a drive socket  442  and may be identical to head  404  of first fastener  401 . First fastener peg  431  also includes a smooth shaft  438 , a rounded tip  448  and a longitudinal axis  450 . Like shaft  408  of first fastener  401 , shaft  438  may be provided in a number of incremental lengths, ranging from 8 mm to 24 mm by increments of 2 mm, for example. First fastener peg  431  is primarily used in locking (threaded) apertures. 
         [0111]    As shown in  FIG. 21 , second fastener  451  includes a head  454 , a shaft  458  and a longitudinal axis  470 . Head  454  includes tapered threads  455  that may be a triple-lead type thread and include crest portions  456  that provide the same advantages as described for threads  405  of first fastener  401 . As shown in  FIG. 21 , tapered threads  455  may have similar dimensions for crest width and pitch distance, as compared to first fastener  401  of  FIG. 22 . Shaft  458  has threads  459  and a tip  468  that may be conventionally designed for self-tapping into a drilled hole in the bone. Second fastener  451  may also be provided, for example, in the single-use kits described herein with lengths in the range of approximately 8 mm to 24 mm in 2 mm increments. 
         [0112]      FIG. 24  is a perspective, detail view of head  454  and a portion of shaft  458  of second fastener  451  shown in  FIG. 21 . Head  454  includes a double-socket  462  that is sized and shaped for optimal use with second drive instrument  90  (to be described next for  FIG. 26 ), although it may also be used with first drive instrument  70 . Double-socket  462  includes a distal recess  463  that is adjacent and coaxial to a proximal recess  464  on longitudinal axis  470 . Each of proximal recess  464  and distal recess  463  may have an approximately square configuration with each pair of opposing sides on proximal recess  464  parallel to a corresponding pair of opposing sides on distal recess  463 . The height of distal recess  463  may be greater than the height of proximal recess  464 . Proximal recess  464  is wider than distal recess  463 , thereby forming a ledge  465  and fitting easily within the tapered shape of head  454  without weakening threads  455 . 
         [0113]      FIG. 25  is a perspective view of first drive end  80  of first drive instrument  70 .  FIG. 26  is a perspective view of second drive end  92  of second drive instrument  90 . Each of first drive instrument  70  and second drive instrument  90 , also referred to as torque drivers, may be use to drive each of first fastener  401  (including first fastener peg  431 ) and the larger, second fastener  451 . However, second drive instrument  90  may be used to transmit more torque to second fastener  451  than what is possible using first drive instrument  70 . 
         [0114]    As shown in  FIG. 25 , drive end  80  includes a conical portion  88  that transitions distally, in the direction of axis  81 , shaft  74  to a square taper portion  86 , which in turn transitions to a square drive tip  84 . When drive tip  84  is fully inserted into either one of drive socket  412  of first fastener  401  or double-socket  462  of second fastener  451 , a portion of square taper  86  wedges into the non-tapered sidewalls of either drive socket  412  or double-socket  462 , respectively. This feature causes either one of first fastener  401  or second fastener  451  to “stick” to the drive end of either one of first drive instrument  70  or second drive instrument  451 , to facilitate removal of each fastener from container  10  and to position the fastener into one of the apertures of the bone plate and partially into the drilled hole in the bone prior to transmitting torque to drive the fastener into the bone. 
         [0115]    As shown in  FIG. 26 , drive end  92  includes a first tapered square portion  95  that transitions distally, in the direction of axis  91 , shaft  94  to a first square drive portion  96 . A second tapered portion  97  extends distally along axis  91  to a second square drive portion  98  that is smaller than first square drive portion  96 . When drive tip  92  is fully inserted into either one of drive socket  412  of first fastener  401  or double-socket  462  of second fastener  451 , a portion of second square taper portion  97  wedges into the non-tapered sidewalls of either of drive socket  412  or double-socket  462 , respectively. When drive end  92  is fully inserted into double-socket  462  of second fastener  451 , at least one of first tapered portion  95  or second tapered portion  97  stick into double-socket  462 . This also serves to aid the surgeon in the pick-up and placement of the fasteners. For obvious reasons, when a limited number of fasteners are readily available, it is highly desirable to avoid dropping fasteners into the wound site of the patient or onto a nonsterile surface in the operating room. 
         [0116]      FIG. 27  is a perspective view of a first drill guide  330  for use with one of the appropriately sized, wire drills  370 , to drill a hole into bone for receiving first fastener  401 . A plurality of first drill guides  330  may be preassembled with bone plates as previously shown in  FIGS. 4 ,  8 ,  11  and  12 . First drill guide  330  includes a body  336  having a distal end  332 , a proximal end  334 , and a bore  338  sized and shaped to guide the appropriately sized wire drill  370  and defining a longitudinal axis  331 . Distal end  332  includes threads  333  for removable attachment to a threaded aperture of a bone plate. Proximal end  334  includes four indentations  339  spaced evenly apart on the periphery of bore  338  for receiving square drive tip  84  of first drive instrument  70  and second drive portion  98  of second drive instrument  90 . 
         [0117]      FIG. 28  is a perspective view of a second drill guide  340  for use with one of the appropriately sized, wire drills  370 , to drill a hole into bone for receiving second fastener  451 . A plurality of second drill guides  340  may be preassembled with bone plates as previously shown in  FIGS. 9 and 13 . Second drill guide  340  includes a body  346  having a distal end  342 , a proximal end  344 , and a bore  348  sized and shaped to guide the appropriately sized wire drill  370  and defining a longitudinal axis  341 . Distal end  342  includes threads  343  for removable attachment to a threaded aperture of a bone plate. Proximal end  344  includes four indentations  349  spaced evenly apart on the periphery of bore  348  for receiving square drive tip  84  of first drive instrument  70  and second drive portion  98  of second drive instrument  90 . 
         [0118]      FIG. 29  is a cross-sectional view of a non-locking aperture  270  that may be sized to receive first fastener  401 . (The term “aperture”, as used herein, is interchangeable with the term “hole”.) Similarly, although not shown in detail views in the figures, non-locking aperture  270  may also be sized to receive second fastener  451 .  FIG. 30  is a cross-sectional view of a portion of a bone plate  271  (for no particular surgical indication, but shown for description purposes), showing three possible trajectories of first fastener  401  of  FIG. 20  inserted into nonlocking aperture  270  of  FIG. 29 . Non-locking aperture  270  extends between a top surface  286  and a bottom surface  284  of a plate  271  and defines an axis  272 . Non-locking aperture  270  has a conical upper portion  274  and tapers from top surface  286  towards the middle of plate  271 . A conical lower portion  278  is coaxial with conical upper portion  274  and tapers from bottom surface  284  towards the middle of plate  271  to form a waist  282  with conical upper portion  274 . The position and orientation of waist  282  relative to top surface  286  may vary, but as shown in  FIG. 29 , is deep enough to receive head  404  of first fastener  401 , such that head  404  is not proud to top surface  286 . As shown in  FIG. 30 , first fastener  401  may be inserted through plate  271  in any desired trajectory within a range defined by a conical angle  422 , wherein axes  401 ′,  401 ″ and  401 ′″ define three possible trajectories of first fastener  401  within that range. This multidirectional ability allows the surgeon to form a polyaxial non-locking compressive construct. 
         [0119]      FIG. 31  is a cross-sectional view of a locking aperture  250 , which is very similar to other locking apertures of bone plates that are well-known in the art.  FIG. 32  is a cross sectional view of bone plate  271  with first fastener  401  of  FIG. 20  inserted at a fixed angle into locking aperture  250 . Similarly, although not shown in detailed views in the figures, locking aperture  250  may be sized to receive second fastener  451 . Locking aperture  250  includes a tapered, threaded bore  254  for receiving head  404  of first fastener  401 . Bore  254  extends between top surface  286  and bottom surface  284  of plate  271  and defines an axis  252 . As shown in  FIG. 32 , when first fastener  401  is fully inserted into plate  271 , axis  420  of first fastener  401  is coaxial with axis  252  of locking aperture  250 . This arrangement allows the surgeon to form a fixed-angle locking construct. 
         [0120]      FIG. 33  is a top view of a unidirectionally ramped (or UR) aperture  290 .  FIG. 34  is a cross-sectional view of UR aperture  290 .  FIG. 35  is a cross-sectional view of UR aperture  290  with first fastener  401  partially inserted therein.  FIG. 36  is a cross-sectional view of UR aperture  290  with first fastener  401  fully inserted therein. UR aperture  290  may also be sized, although not shown in detail views in the figures, to receive second fastener  451 . UR aperture  290  is a non-locking type of aperture for compressively attaching the bone plate against the bone. The surgeon may also use UR aperture  290  to aid in reduction of the bone fragments, i.e., the compression of bone fragments along the longitudinal axis of the bone plate, often referred to in the art as dynamic compression. As shown in  FIGS. 35 and 36 , proper insertion of first fastener  401  into UR aperture  290  causes plate  271  to shift in a direction depending on the orientation of UR aperture  290 . As shown in  FIGS. 33 and 34 , UR aperture  290  has an upper conical portion  294  intersecting with a coaxially opposing, lower conical portion  298  to form a waist  282  about an axis  292 , in an arrangement similar to non-locking aperture  270  of  FIG. 29 . UR aperture  290  further includes a circular bore portion  306  defining an axis  307  that is parallel and offset from axis  308 . Circular bore portion  306  is sized to receive shaft  408  of first fastener  401 , but is too small to receive head  404 . The surgeon may drill a hole into bone that is approximately coaxial with axis  307  and then insert first fastener  401  as shown in  FIGS. 35 and 36 , such that head  404  tends to seat into upper conical portion  294 , and “ramp” in a translation direction along plate axis  272 . The translation distance possible is determined by an offset distance  308  between axis  292  and  307 . 
         [0121]      FIG. 37  is a top view and  FIG. 38  is a cross-sectional view of a bidirectionally ramped (BR) aperture  501 , which is similar to UR aperture  290  of  FIG. 34 . BR aperture  501  may be sized to receive first fastener  401  or second fastener  451 . The surgeon may use BR aperture  501  to compressively attach bone plate  271  against the bone, and also to dynamically compress the bone fragments along the longitudinal axis of plate  271  in either of opposing directions. This bidirectional feature allows the surgeon to reduce fragments on either side of BR aperture  501 . BR aperture  501  includes an upper conical portion  504  defining an axis  502 , a coaxial, lower conical portion  508 , a waist  512 , a first circular bore portion  516  defining an axis  517 , and an opposing second circular bore portion  518  defining an axis  519 . The surgeon may use BR aperture  501  with first fastener  401  to translate plate  271  an offset distance  521  in a first direction along axis  272  of plate  271 , or an offset distance  522  in a second, opposing direction along axis  272 . 
         [0122]      FIG. 39  is a top view of a unidirectionally ramped (UR) slot  310  positioned along axis  272  of plate  271 .  FIG. 40  is a cross-sectional view of UR slot  310 , taken through axis  272 ;  FIG. 41  is a cross-sectional view of UR slot  310 , taken through line  41 - 41  of  FIG. 39 ;  FIG. 42  is a top view of first fastener  401  partially inserted into UR slot  310 ;  FIG. 43  is a top view of first fastener  401  fully inserted into the UR slot  310 ;  FIG. 44  is a cross-sectional view, taken through axis  272 , of first fastener  401  partially inserted into UR slot  310 ;  FIG. 45  is a cross-sectional view, taken through axis  272 , of first fastener  401  fully inserted into the UR slot  310 . UR slot  310  is more elongated than UR aperture  290 , and also may be used to dynamically compress bone fragments as first fastener  401  is inserted into bone. The use of slotted apertures similar to UR slot  310  in bone plates is well-known in the art for reducing bone fragments as the surgeon attaches the plate to the bone. UR slot  310  has an elongated, tapered portion  314  that defines a slot axis  315  and tapers from top surface  286  to bottom surface  284  of plate  271 . A circular bore portion  312  is formed into one end of tapered portion  314  and is sized to receive shaft  408  of first fastener  401 , but not head  404 . As the surgeon inserts first fastener  401  into bone as shown in  FIGS. 44 and 45 , head  404  tends to seat into tapered portion  310  and move plate  271  in a direction along axis  272  a distance  317  ( FIG. 45 ). 
         [0123]      FIGS. 46 and 47  shown a bidirectionally ramped (BR) slot  320  that is similar to UR slot  310 , except the surgeon may use BR slot  320  to dynamically compress bone fragments in either of opposing directions along axis  292  of plate  271 . BR slot  320  includes an elongated, tapered portion  325  that tapers from top surface  286  to bottom surface  284  of plate  271 . A first circular bore portion  322  and a second circular bore portion  325  are formed into opposing ends of tapered portion  325 . 
         [0124]    Each of UR slot  310  and BR slot  320  may be sized to receive either first fastener  401  or second fastener  451 . 
         [0125]      FIG. 48  is an end view,  FIG. 49  is a top view, and  FIG. 50  is a perspective view of a first DVR assembly  102  that was earlier described for  FIG. 4 . First DVR assembly  102  includes a first DVR plate  114  that has a head  106 , a neck  108  and a shaft  110  that extends along a longitudinal axis  101 . 
         [0126]    Head  106  includes a plurality of locking apertures  250 , each of which is assembled with a first drill guide  330 . Each of locking apertures  250  of head  106  defines a desired, fixed trajectory, such that insertion of first fastener  401  into each locking aperture  250  of head  106  provides subchondral support of the articulation surface of the wrist joint of the distal radius. 
         [0127]    Shaft  110  includes a plurality of locking apertures  250 , a plurality of non-locking apertures  270 , and one UR slot  310 , wherein the respective axis of each aperture is generally directed inwardly towards the center of the underlying bone. Each of locking apertures  250  is assembled with one of first drill guides  330 . Each of locking apertures  250 , non-locking apertures  270 , and UR slot  310  is sized for receiving first fastener  401 . Each locking aperture  250  of shaft  110  is paired closely together with one of the non-locking apertures  270  to form four, spaced-apart, groupings or clusters, including a first grouping  120 , a second grouping  130 , a third grouping  140  and a fourth grouping  146 , and corresponding to a first region  121 , a second region  131 , a third region  141 , and a fourth region  147  on shaft  110 . First grouping  120  opposes second grouping  130  about longitudinal axis  111  of plate  104 , such that aperture axes  123  and  125  of first grouping  120  cross-over aperture axes  133  and  135  of second grouping  130 . Similarly, third grouping  140  opposes fourth grouping  146 . 
         [0128]    During the surgical procedure, the surgeon may insert one of first fasteners  401  into each of regions  121 ,  131 ,  141 , and  147 . The surgeon may choose whether to select one of locking apertures  250  or one of non-locking apertures  270  for each region. In general, surgeons may choose to use locking apertures  250  if the underlying bone is not in condition to provide optimal engagement with the threads of shaft  110  of first fastener  401 . 
         [0129]    It should be appreciated that first DVR assembly  102  may be attached to the distal radius of a patient using only one type of bone fastener, i.e., a plurality of first fasteners  401  of varying lengths. In many current bone plate systems for fixation of the distal radius, a number of different types of fasteners are required. By using only one type, it is possible to reduce the number of instruments required in DVR kit  100 , thereby reducing the size of container  10  ( FIG. 4 ) and potentially lowering the overall cost of DVR kit  100 . Using only one type of fastener also may help surgeons, especially those who are not greatly experienced doing the procedure, to perform the surgical procedure more quickly and without using the fasteners inappropriately. 
         [0130]      FIG. 51  is an end view,  FIG. 52  is a top view, and  FIG. 53  is a perspective view of a second DVR assembly  152 , which includes a second DVR plate  154  assembled with a plurality of first drill guides  330 , and a plurality of second drill guides  340 . Second DVR plate has a head  156 , a neck  158  and a shaft  160  that extends along a longitudinal axis  161 . 
         [0131]    Head  156  includes a plurality of locking apertures  250 , each of which is assembled with one of first drill guides  330  and is sized for receiving one of first fasteners  401 . Each of locking apertures  250  of head  156  defines a desired, fixed trajectory, such that insertion of first fastener  401  into each locking aperture  250  of head  156  provides subchondral support of the articulation surface of the wrist joint of the distal radius. 
         [0132]    Shaft  154  includes two of locking apertures  250 , each of which is assembled with one of second drill guides  340  and is sized to receive one of second fasteners  451 . Each of locking apertures  250  in shaft  154  is paired closely together with one of UR apertures  290 , each of which is sized to receive one of second fasteners  451 , to form a first grouping  170  that is spaced apart from a second grouping  180  along axis  161 . First grouping  170  corresponds to a first region  171  and second grouping  180  corresponds to a second region  181  of plate  154 . As for first DVR assembly  102 , the axes  173 ,  175 ,  183  and  185  of the apertures of shaft  160  of second DVR assembly  152  are generally directed towards the center of the bone. Shaft  154  also includes BR slot  320  positioned approximately midway along axis  161 . 
         [0133]    Second DVR assembly  152  requires two types of fasteners, i.e., first fasteners  401  and second fasteners  451  of varying lengths. However, we envision that using two of second fasteners  451  in shaft  160  precludes the need to use four of first fasteners  401  in shaft  110  of first DVR assembly  102 . This facilitates a quicker surgical procedure and eliminates the cost of the additional two fasteners. 
         [0134]    Another feature of second DVR assembly  152  is the enhanced ability to draw the fractured bone fragments together axially as the fasteners are inserted. That is because, the dynamic compression that is achievable using UR apertures  290 , if done in proper sequence, may be additive to the dynamic compression that is achievable using UR slot  310 . 
         [0135]      FIG. 54  is an end view,  FIG. 55  is a top view, and  FIG. 56  is a perspective view of a third DVR assembly  552 , which includes a third DVR plate  554  assembled with a plurality of first drill guides  330 , and a plurality of second drill guides  340 . Third DVR plate  554  has a head  556 , a neck  558  and a shaft  560  that extends along a longitudinal axis  561 . 
         [0136]    Head  556  includes a plurality of locking apertures  250 , each of which is assembled with one of first drill guides  330  and is sized for receiving one of first fasteners  401 . Each of locking apertures  250  of head  556  defines a desired, fixed trajectory, such that insertion of first fastener  401  into each locking aperture  250  of head  556  provides subchondral support of the articulation surface of the wrist joint of the distal radius. 
         [0137]    Shaft  554  includes two of locking apertures  250 , each of which is assembled with one of second drill guides  340  and is sized to receive one of second fasteners  451 . Each of locking apertures  250  in shaft  554  is paired closely together with one of BR apertures  320 , each of which is sized to receive one of second fasteners  451 , to form a first grouping  570  that is spaced apart from a second grouping  580  along axis  561 . First grouping  570  corresponds to a first region  571  and second grouping  180  corresponds to a second region  581  of plate  554 . As for the previously described DVR assemblies  102  and  152 , the axes of the apertures of shaft  560  of third DVR assembly  552  are generally directed towards the center of the bone. Shaft  554  also includes BR slot  320  positioned approximately midway along axis  561 . 
         [0138]    Third DVR assembly  552  requires two types of fasteners, i.e., first fasteners  401  and second fasteners  451  of varying lengths. However, as for second DVR assembly  152 , we envision that using two of second fasteners  551  in shaft  560  precludes the need to use four of first fasteners  401  in shaft  110  of first DVR assembly  102 . This facilitates a quicker surgical procedure and eliminates the cost of the additional two fasteners. 
         [0139]    Again as with second DVR assembly  152 , third DVR assembly  552  has the enhanced ability to draw the fractured bone fragments together axially as the fasteners are inserted since the dynamic compression that is achievable using BR apertures  501 , if done in proper sequence, may be additive to the dynamic compression that is achievable using BR slot  320 . However, third DVR assembly  552  has the additional ability to provide dynamic compression in either direction along axis  561  of plate  554 . 
         [0140]    We have shown and described various embodiments and examples. However, a person having ordinary skill in the art may modify the methods and devices described herein without departing from the overall concept. For instance, the specific materials, dimensions and the scale of drawings should be understood to be non-limiting examples. Accordingly, we do not intend the scope of the following claims to be understood as limited to the details of structure, materials or acts shown and described in the specification and drawings