Abstract:
A bone plate is described which is adapted for use in situ to fix a spatial relationship of at least two bone parts. The bone plate has at least one pair of the bone screw apertures that are adjoined by a relief-space contiguous with the open space of the screw apertures themselves. An adjoined aperture pair forms a complex aperture and has a center-to-center distance d of the apertures along an axis running through the centers of the apertures. The center-to-center distance d is equal to or greater than the sum of the radii (r 1 +r 2 ) of the heads of the individual bone screw used with the aperture pair.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims priority as continuation-in-part of U.S. patent application Ser. No. 12/307,451, filed on Jan. 5, 2009; which also claims priority as a 371 of international application PCT/IB2007/001895, filed on 6 Jul. 2007; which further claims the benefit of prior filed U.S. Provisional Patent Application Ser. Nos. 60/806,728 filed 7 Jul. 2006, and 60/806,730 also filed 7 Jul. 2006. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention is in the field of surgically implanted orthopedic devices, implants and prostheses used in orthopedic surgery. More specifically, the present invention relates to bone plates used to reinforce fractured bones and thus to promote healing. 
       BACKGROUND OF THE INVENTION 
       [0003]    A compressive screw system, also known as the DCS system, is a bone plate system that has been used in trauma surgery for many years. The procedures for use of this system are well documented by the AO Institute (Davos, Switzerland), an institute having as one of its goals, the promotion of new orthopedic surgical procedures. This system included a bone plate having slots communicating therethrough. A land in which the slot is wider at one end defines a stepped surface adjacent the portion of the slot that extends through the bone plate. The stepped surface is generally cut with a spherical endmill, thus creating a spherical stepped surface. 
         [0004]    In a still further development, there exists bone plates which have individual threaded and non-threaded apertures interspersed along the length of the plate. In this and other designs, the distance between holes has become a standard. Although an improvement over the inserts noted above, the locking positions are pre-defined and only available in limited locations, which also reduce surgical flexibility. In another product variation, expandable, lockable inserts enter into the slots of a standard bone plate. When the bone screw passes through one of these inserts and is torqued down, the insert expands and locks the screw in place. However, this insert is locked in a secondary operation. This is not desirable because this requires more operating room time and adds complexity to the procedure. Further, the inserts must be added in the specific location before the plate is fixed to the bone and cannot be subsequently inserted. This limits the choice of placement during surgery if the need arises. 
         [0005]    Also, the above insert designs rely on a friction lock via contact between two simple surfaces. Simple surface friction locks are not reliable and come loose more easily than threaded locked holes. The result of such a design is inferior to that of the threaded plate and screw designs discussed below. 
         [0006]    In U.S. Pat. No. 5,002,544, there is shown an osteosynthetic pressure plate having a cross-section transverse to the longitudinal axis of the plate at least at one point being wider toward the upper surface than toward the lower surface and the plate having recesses in the lower surface so that upon application to a bone there is space between the bone and the plate. The cross-section between the screw holes is reduced, preferably to the extent that the resistance of the plate to bending in this area is less than in the area of the holes. Because of the reduced bend resistance between the holes, the plate can more easily be adapted to conform to the anatomy of the bone. Furthermore, this can be done without deformation of the holes, thus minimizing the resulting loss of fatigue strength and minimizing the misfit of the screw heads. 
         [0007]    Further, U.S. Pat. No. 5,709,686 describes a bone plate that has recesses or reduced thickness portions on its sides, between threaded apertures. Although the purpose is not specifically described, these recesses appear to function to avoid warpage of the threaded portions when the bone plate is bent. However, when such a bone plate is fixed to a bone, these discontinuous recesses are exposed and may potentially come into contact with and potentially aggravate muscle tissue. 
         [0008]    Still further, U.S. Pat. No. 5,733,287 shows, in FIG. 4, a plate that has transverse cuts 13 and a longitudinal cut 14 on the lower surface 7 to reduce contact between the plate and bone. Due to the transverse undercuts 13, the cross-section 15 between the holes is already significantly reduced and therefore is not further decreased by an additional groove 10 on the upper surface 6 as in the embodiment according to FIG. 3. To avoid a cross-section that is too thin, the groove 10 on the upper surface 6 is made discontinuous in short segmental grooves 16 providing a smooth transition into and out of the holes 8. 
         [0009]    In yet another solution, PCT application no. WO01/54601 combines the features of the DCS system discussed above with a locking screw. Such a system is known as the combi-slot. In this design, the stepped surface of the slot is generally ramped or tapered so as to be deeper at one end than at another. This enables the positioning and selective fixing of the bone plate for compressing two bone fragments together with a preload created by wedging action. In this manner, the bones are placed in a position that the surgeon believes would best promote healing. 
         [0010]    Further, this combi-hole includes two distinct overlapping portions in a single slot. One portion of the slot is suited to receive a standard bone screw, while the other portion of the slot is suited to receive a threaded peg oriented perpendicular to the top surface of the bone plate. Also, the combi-holes are generally oriented with the threaded portions being on the innermost end of the combination and the unthreaded portions oriented toward the ends of the bone plate. This improvement increased the flexibility of choice available to orthopedic surgeons using the device in that it was more likely that a hole would be present at a suitable anchoring point in the bone plate. Nevertheless, there are often trauma situations that are best served by the threaded portion being at the extreme ends of the bone plate and/or at various positions throughout the plate. In addition, sometimes there is no specific center of the facture—in such a situation; use of the combi-hole design is limited. The combi-hole if further limited in that it allows the fixing of a screw in either the slotted portion or the threaded portion, but not both. 
         [0011]    While patent application no. WO01/54601 has proven advantageous because screws can be locked to the plate; the presence of an unthreaded slot limits the user&#39;s ability to have multiple orientations for the screw. 
         [0012]    In a further development, the AO Institute has studied and proposed the use of endpegs which are rigidly fixed in the extreme ends of the bone plate. Such an arrangement has been shown to better resist the flexing of the bone than use of a bone screw alone. Flexing can otherwise loosen the connection between the bone plate and bone in other bone plate systems. 
         [0013]    U.S. Pat. No. 5,324,290 shows a complex bone plate having slots with countersunk circular recessed cuts at intervals along the slot (a similar arrangement is shown in U.S. Pat. No. 4,696,290). It further shows the bone plate torqued against the bone so as to at least marginally, conform to the shape of the bone (see FIG. 2). Other patents of interest include U.S. Pat. Nos. 3,716,050; 3,659,595; 5,681,311; 5,261,910, and 5,364,399, as well as German Patent application DE4341980A1, all showing combinations of conventional slots and recesses which do not fully accommodate a bone screw having a threaded head. In comparison with the combi-hole design and the friction locking design described above, what is needed is a bone plate that provides greater flexibility of choice to the surgeon. More specifically, what is needed is a bone plate that provides this choice of plate placement while reliably and permanently fixing the bone plate to the bone fragments, in any hole position. 
         [0014]    What is needed is a bone plate that provides greater flexibility of choice to the surgeon, in a bone plate that has multiple orientations for the locking screw and thus, plate placement, while reliably and permanently fixing the bone plate to the bone fragments, in any hole position. 
         [0015]    In addition, what is needed is a versatile bone plate having recesses which determine where the bone plate will bend, in order to avoid the threads in any holes to be bent or warped, while maintaining a smooth external surface. 
         [0016]    Finally, what is needed is a bone plate with holes that create bi-directional compression. 
       SUMMARY OF THE INVENTION 
       [0017]    The present invention relates to bone plates of complex form for use with bone screws having a head radius r. The bone plates have a main longitudinal axis, a bone-contacting bottom side and a top side with a plurality of bone screw apertures. At least one pair of the bone screw apertures forms an adjoined aperture pair. An adjoined aperture pair is defined in the figures and includes an additional relief-space contiguous to the open space of the apertures themselves. An adjoined aperture pair has a center-to-center distance d of the apertures along an axis running through the centers of the apertures. The center-to-center distance d is equal to or greater than the sum of the radii (r 1 +r 2 ) of the individual bone screw heads used with the aperture pair. The adjoined pair of screw apertures is further defined by the above noted relief-space (or bar-space feature) disposed between and joining them, to provide a complex aperture the opening—which gives a portion of the complex aperture a “bar-bell” like configuration. Preferably, the additional relief-space feature is configured as either a straight slot, or as a constricted or “waisted” slot centered on, about or along the axis joining the opening of the screw apertures. When applied to a bone, two different adjoined aperture pairs are located so as to lie on opposite sides of an osteotomy site. The installation configuration of bone screws in the complex bone plate is selectable, depending on the physiology of the bone being repaired. 
         [0018]    An object of the invention is to provide a surgeon with the option of placing two bone screws in adjacent positions so that the heads of the adjacent bone screws can abut without overlapping. Another object of the invention is to provide an orthopedic surgeon greater flexibility of choice in that a threaded peg or screw providing secure fixing can be positioned at any interval along the bone plate, including at its extreme ends or on its elbow. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0019]      FIGS. 1A and 1B  respectively are top views of a bone plate of the invention incorporating one type of relief-space, and a close-up view of the first end of the bone plate. 
           [0020]      FIGS. 2A and 2B  respectively are top views of a bone plate of the invention incorporating an alternative type of relief-space, and a close-up view of the first end of the bone plate. 
           [0021]      FIGS. 3A and 3B  are cross-sectional side views of a section of the bone plate of  FIGS. 1A and 2A  taken along line  3 - 3 , and illustrating locations for the relief-space. 
           [0022]      FIG. 4  is a side view of an exemplary assembly of the screws and bone plate of the present invention. 
           [0023]      FIG. 5  is a schematic illustration of the present bone plate fixed to a bone. 
           [0024]      FIGS. 6A and 6B  are top-side perspectives views of an alternative embodiment of the present bone plate showing (A) the full plate and (B) a detailed partial view. 
           [0025]      FIGS. 6C and 6D  respectively are top-side and bottom-side plan views detaining respective portions of the present bone plate. 
           [0026]      FIG. 6E  is a top-side perspective view of a portion of the present bone plate with bone screws inserted into two of the complex apertures. 
           [0027]      FIG. 7  is a top view of a kit of the present invention. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0028]    Referring now to the drawings, the details of preferred embodiments of the present invention are graphically and schematically illustrated. Like elements in the drawings are represented by like numbers, and any similar elements are represented by like numbers with a different lower case letter suffix. 
         [0029]    As exemplified in  FIGS. 1A and 2A , the present bone plate  10  has a main longitudinal axis  12 , a bone-contacting bottom side  16  (see  FIG. 4 ), a top side  14  and opposite first  20  and second  22  plate ends. The bone plate  10  also has a thickness  200  (see  FIG. 4 ) that is defined between the top side  14  and the bone-contacting bottom side  16 . A series of screw apertures  24  extending from the top side  14  of the plate  10  through the thickness  200  to its bottom side  16  are formed along or contacting the plate axis  12 . The screw apertures  24  serve as bone screw guides through which points bone screws  28  are inserted into underlying bone to anchor the bone plate  10  to different parts or fragments  80  of a bone to be reinforced by the bone plate  10  (see  FIG. 5 ). 
         [0030]    Bone screws  28  include a conventional locking bone screw  28   a  and a conventional compression bone screw  28   b  which are illustrated at  FIGS. 3B and 7 . Each bone screw has a head area  280  with a surface that allows a tool to be interconnected to the head area to apply the desired torque to the screw to allow the bone screw enter a bone; a bone insertion area  284 ; and a bone plate area  282 . The bone plate area  282  is positioned between the head  280  and the bone thread area&#39;s crest  286 . The bone plate area  282  can be entirely threaded (element  28   a  in  FIG. 3B ), partially threaded (element  28   a  in  FIG. 6E ) or unthreaded (element  28   b  in  FIGS. 3B ,  5 , and  6 E). 
         [0031]    Each screw aperture  24  has a screw axis  26  through its center  27  (the general path that a screw takes when inserted through the aperture). The screw axis  26  (see  FIGS. 1B ,  2 B and  4 ) is either perpendicular  26   b  or angled  26   a  relative to the plane of the bone plate  10 . The position of the screw axis depends on the need of a particular application or surgical protocol. 
       Complex Aperture 
       [0032]    Additionally, the bone plate  10  of the present invention has one or more complex apertures  40 . Each complex aperture comprises a pair of closely spaced apart screw apertures  24  (identified in the FIGs as  24   b  and  24   c ) adjoined by a “relief”-space feature  60 . The relief-space feature  60  is disposed between and joins the openings of the two pair of closely spaced apart screw apertures  24   b  and  24   c ). The relief space feature also provides a complex aperture having a single opening to form, at least within portions of the thickness  200  and the bone contacting bottom side  16 , a “dumb-bell” or “bar-bell” like configuration. Preferably, the relief-space  60  has a portion thereof that is configured as either a straight slot  60   a  (see  FIG. 2B ) or a constricted or “waisted” slot  60   b  (see  FIG. 1B ). 
       Relief Space Embodiments 
       [0033]    In a preferred embodiment illustrated at  FIGS. 1A and 1B , the relief-space  60  has the constricted or “waisted” slot  60   b . Referring to  FIGS. 1B and 6C , the constricted or waisted slot  60   b  is defined between (a) the pair of closely spaced apart screw apertures  24   b  and  24   c  and (b) two facing arcuate walls—a first walled surface  202  and a second walled surface  204 —which have their cord parallel to the radial axis  42  of the closely spaced apertures  24   b  and  24   c.    
         [0034]    In an alternative preferred embodiment shown in  FIGS. 2A and 2B , the relief space  60  has the straight-slot relief  60   a . The straight-slot relief is defined between (a) the pair of closely spaced apart screw apertures  24   b  and  24   c  and (b) two facing parallel walls—the first walled surface  202  and the second walled surface  204 . 
         [0035]    Despite those differences, the straight slot  60   a  and the “waisted” slot  60   b  have some similarities. One of the similarities is that each slot of the relief-space  60  is defined by
       (a) the first screw aperture  24   b , wherein the first screw aperture has a first radius (r 1 ). The first radius (r 1 ) is measured from the first screw aperture&#39;s center  27   b  in its seat area  207   b  (defined in greater detail later) to the walled surface (and if the walled surface is threaded then to the root of the threaded surface) in the first screw aperture&#39;s seat area  207   b  as illustrated in  FIGS. 3A ,  3 B,  6 A, and  6 B. The seat area  207   b  can be a threaded surface, a ringed surface, or an unthreaded surface—it depends on the need of a particular application or surgical protocol that the bone plate is to be used;   (b) the second screw aperture  24   c , wherein the second aperture has a second radius (r 2 ). The second radius (r 2 ) is measured from the second screw aperture&#39;s center  27   c  in its seat area  207   c  to the walled surface (and if the walled surface is threaded then to the root of the threaded surface) in the second screw aperture&#39;s seat area  207   c  as illustrated in  FIGS. 3A ,  3 B,  6 A, and  6 B. The seat area  207   c  can also be a threaded surface, a ringed surface, or an unthreaded surface—it depends on the need of a particular application or surgical protocol that the bone plate is to be used;   (c) the first walled surface  202 , and   (d) the second walled surface  204 .
 
The first walled surface  202  and the second walled surface  204  are spaced apart a distance (s) which is less than twice the distance of (i) the first radius (r 1 ) and (ii) the second radius (r 2 ), as illustrated at  FIG. 6C , and do not contact each other in the straight slot embodiment  60   a.  
       
 
         [0040]    The relief-space is also preferably centered on a radial axis  42  (in relation to the centers  27  of the respective apertures  24   b  and  24   c ) joining the opening of the screw apertures  24   b  and  24   c , as illustrated at  FIGS. 1B ,  2 B,  6 C. 
       Complex Aperture 
       [0041]    As noted above, the bone plate  10  has at least one complex screw aperture  40  made up of two screw apertures  24   b  and  24   c  joined by a relief-space  60 . Each screw aperture  24   b  and  24   c  in the complex screw aperture has a bevel surface section  41  and its respective seat area  207   b,c . Each seat area extends from the bottom of the bevel surface  41  to the bottom surface  16 , as illustrated in  FIGS. 3A ,  3 B,  6 A,  6 B. Whichever seat area  207   b,c  embodiment is selected or used, the screw apertures  24   b  and  24   c  are joined by a relief-space  60 . 
         [0042]    Likewise, each relief space  60  is defined by the respective slot embodiment and extending from the first walled surface  202  and the second walled surface  204  toward the top surface  14  is the bevel surface  41 . 
         [0043]    However, multiplex screw apertures  40  (not shown) made up of more than two screw apertures  24  are considered a possible alternative embodiment of the current description of the complex screw aperture. In the possible alternative multiplex-complex screw aperture there is at least one pair of the of the screw apertures  24   b  and  24   c  is separated by a relief-space  60 . 
         [0044]    The complex aperture  40  has a top surface opening  206 . The top surface opening  206  is positioned on the top surface  14 , has a perimeter greater than the perimeter of the complex aperture&#39;s (a) first screw aperture&#39;s seat area  207   b , (b) second screw aperture&#39;s seat area  207   c  and (c) relief slot area (defined by the first walled surface  202  and the second walled surface  204  and the seat areas  207   b,c ). In addition, the top surface opening  206  initiates the bevel surface section  41 . 
         [0045]    The bevel surface section  41  is divided into at least four areas—a first compression ramp area  212   b , a second compression ramp area  212   c , a third compression ramp area  212   g , and a fourth compression ramp area  212   h . The first compression ramp area  212   b  extends from the top surface opening  206  downwardly and inwardly at least part way through the plate&#39;s thickness  200  to the first screw aperture&#39;s seat area  207   b . Likewise, the second compression ramp area  212   c  extends from the top surface opening  206  downwardly and inwardly at least part way through the plate&#39;s thickness  200  to the second screw aperture&#39;s seat area  207   c . The third compression ramp area  212   g  extends from the top surface opening  206  downwardly and inwardly at least part way through the plate&#39;s thickness  200  to the relief space&#39;s first walled surface  202 . The fourth compression ramp area  212   h  extends from the top surface opening  206  downwardly and inwardly at least part way through the plate&#39;s thickness  200  to the relief space&#39;s second walled surface  204 . In a preferred embodiment, the first walled surface  202  and second walled surface  204  are unthreaded from the respective compression ramp area  212   g,h  to the bottom surface  16 . 
         [0046]    The first and second compression ramp areas  212   b ,  212   c  can have the same or different ramp angles; likewise the third and fourth compression ramp areas can have the same or different ramp angles. The ramp angles are dependent on the distance from the perimeter of the top surface opening  206  to the respective seat area and relief space&#39;s respective walled surface. In view of the different ramp angles, it is evident that there is a transition compression ramp area  212   f  between (a) the first compression ramp area and the third compression ramp area and (b) the first compression ramp area and the fourth compression ramp area, (c) the second compression ramp area and the third compression ramp area and (d) the second compression ramp area and the fourth compression ramp area. 
         [0047]    In a preferred embodiment, the angle of each compression ramp is designed to (1) optimize the desired force (a) from the bone screw  28  into the bone  80 , (b) from the bone plate  10  onto the bone, and (2) secure the bone plate  10  against the bone&#39;s exterior surface. Each compression ramp can be a mono-faceted surface as illustrated in  FIG. 6B  or a multifaceted surface as illustrated in  FIG. 6E . 
         [0048]    Each compression ramp is also designed to align the bone screw into the proper location. For example, compression ramp  212   b  guides the bone screw into the seat area  207   b  of first aperture  24   b  so the bone insertion area  284  aligns with the screw aperture&#39;s  24   b  center  27   b  to obtain the desired axis  26  into the bone  80 . Likewise, compression ramp  212   c  guides the bone screw into the seat area  207   c  of first aperture  24   c  so the bone insertion area  284  aligns with the screw aperture&#39;s  24   c  center  27   c  to obtain the desired axis  26  into the bone  80 . When (a) a screw bone is inserted into (i) the first screw aperture  24   b  or (ii) the second screw aperture  24   c  or (b) a first screw bone is inserted into the first screw aperture  24   b  of a first complex aperture and a second screw bone is inserted into the second screw aperture  24   c  of the first complex aperture so the first screw bone and the second screw bone do not overlap each other and may even contact each other as illustrated in  FIGS. 3B and 5 , then the screw bone(s) anchors and therefore locks the bone plate  10  to the bone  80 . 
         [0049]    The compression ramps  212   g  and  h  also align the bone screw into the proper location. Instead of having the bone screw positioned in the respective seat area  207  of the first or second aperture  24   b,c ; the bone screw is positioned in the relief slot  60   a  or  60   b . When the bone screw passes through the relief space  60  and is torqued down, the relief slot  60   a,b  expands and locks the screw  28   b  in place as illustrated at  FIG. 5 . In this embodiment, only one bone screw can be used in the complex aperture  40 . 
         [0050]    Additionally, the present bone plate  10  includes angled screw apertures  24   a . Referring now to  FIGS. 1B and 2B , two angled apertures  24   a  (preferably positioned proximate at least one of the plate ends  20 ,  22  of the bone plate  10 ) have screw axes  26   a  that are angled from the perpendicular relative to the plane of the bottom side  16  of the bone plate  10 , and preferably in opposing orientations. The orientation is selectable by one of skill in the field to provide an optimal utility for a variety of operative procedures. In this particular embodiment, the angled holes  24   a  in the plate ends  20 ,  22  are inclined at an angle of approximately forty-five degrees relative to the plane of the bottom side  16  of the bone plate  10 . The angled apertures  24   a  are disposed relative to each other to accept and to guide a bone screw  28  at opposing angles in order to securely anchor the bone plate  10  to the bone fragment  80  (see  FIG. 5 ). 
         [0051]    It should be noted that screw apertures  24  ( 24   a, b, c ) can be configured to be complementary to bone screws  28  having a number of configurations screw head areas  280 , bone plate areas  282  and bone insertion areas  284 . For example, as exemplified in  FIGS. 3A and 3B  a bone screw  28  can have a threaded-bone plate area  282  or an unthreaded-bone plate area  282 . Additionally, a bone screw  28  with a threaded-bone plate area  282  can have a threaded-bone insertion area  284  or an unthreaded-bone insertion area  284  (see  FIG. 7 ). Correspondingly, the screw apertures  24  can have the seat area  207   b,c  threaded or unthreaded as previously described to receive the desired and corresponding bone screw  28 . The bone plate  10  may optionally use a locking bone peg  50 , i.e., a bone screw  28  with a threaded-bone plate area  282  and unthreaded-bone insertion area  284  (see  FIG. 7 ). Preferably, the threads cut in the head of the bone pegs  50  are designed so as to lock with the threaded apertures in a threaded seat area  207   b,c  in order to better ensure rigid fixing of a fracture. The locking feature used can be any of the known methods of locking threads by mechanical means. 
         [0052]    Referring now to  FIGS. 3B and 6C , the center-to-center distance d of the two screw apertures  24   b,c  as measured from the respective seat areas  207   b,c  of the complex-aperture  40  corresponds substantially to the sum of the radii of the of the two screw apertures  24   b,c , i.e., r 1 +r 2 =d. This configuration enables installation of bone screws  28  through the elongated plate  11  so that the head areas  280  of the bone screws  28  can be positioned as close together as possible, and even to be touching. 
         [0053]    In the embodiment illustrated in  FIG. 4 , a pair of angled screw apertures  24   a  is shown at the first plate end  20  of a bone plate  10  with bone screws  28  installed through them. In this embodiment, the screw axes  26   a  of the angled screw apertures  24   a  at the first plate end  20  slant toward the second plate end  22 . The general triangular configuration formed by the bone screw axes  26   a ,  26   b  with the axis  12  of the elongated plate  11  creates a triangular truss-like structure that is able to resist a wide range of forces which could otherwise tend to loosen an installed bone plate  10 . Consequently, this configuration resists pull-out forces coming from a wider range of directions. Although  FIG. 4  shows the screw axes  26  of the angled screw apertures  24   a  at the first plate end  20  slant toward the second plate end  22 , they can slant in the opposite direction as shown in  FIGS. 1B and 2B . Additionally, the screw apertures  24  proximate the plate ends  20 ,  22  are independent of screw apertures  24  located in the mid-section of the bone plate  10 . It should be noted that in other preferred embodiments, a pair of angled screw apertures  24   a  can be disposed at both first and second plate ends  20 ,  22  of a bone plate  10  (see  FIGS. 1A &amp; 2A ), or at any other location on the elongated plate  11 . 
         [0054]    Referring now to  FIG. 5 , in another embodiment, the bone plate  10  is particularly suited for femoral osteotomies  44 , correcting medial patellar luxations, and/or other corrective osteotomies of the femur. The bone plate  10  has a main longitudinal axis  12 , a bone contacting bottom side  16  and a top side  14  with one or more complex apertures  40  having a pair of closely adjacent screw apertures  24   b,c , which communicate through the plate  11  from the top side  14  to the bottom side  16 . The closely adjacent pairs of screw apertures  24   b,c  have a multifaceted screw head areas  280  and bone plate areas  282 . Preferably, when the elongated plate  11  is applied to a bone  80 , two complex apertures  40  are disposed to lie on opposite sides  51  of an osteotomy site  44 . In the figure shown, the bone plate  10  also has two pairs of angled apertures  24   a —one pair on or near the first plate end  20  and the other pair on or near the second plate end  22 . The pairs of screw apertures  24  can act together as compression fittings. When applied to a bone part  80 , each pair of screw apertures  24   b,c  can be disposed to lie on opposite sides  51  of an osteotomy site  44 . 
         [0055]    An alternative embodiment of the present bone plate  10  is illustrated in  FIGS. 6A to 6E . In this embodiment the complex apertures  40  are similar to the complex apertures described above, but differ in that they have a relief notch  84  disposed in the screw head seat  207   b,c    34  portion of one or both screw apertures  24   b,c . The relief notch  84  provides desirable advantages that are not similarly accomplished in their absence. For example, as shown in  FIG. 6C , a self-locking insert  92  can be disposed in the notch  84  to provide increased friction for setting a threaded bone plate area  282  set in a threaded seat area  207   b,c . As also illustrated in  FIG. 6C , it is intended that a screw aperture  24  may have more than one relief notch  84   a . A further example of an advantage of the present notch feature is illustrated in  FIG. 6E , which illustrates that a tensioning wire  88  may be looped around a first bone screw  28   d , passed along the bottom side  16  of the elongated plate  11  and the ends of the wire drawn up to the top side  14  of the elongated plate  11  through the recess notch  84   b  in an adjacent second bone screw  28   e . In the embodiment illustrated in  FIG. 6D , the bottom-side  16  of the elongated plate  11  is provided with a clearance channel  94 ,  94   a  recessed into the surface of the bottom-side of the plate  11 . The clearance channel communicates with the relief notch  84  to provide a path for the tensioning wire  88  to be easily removed through the relief notch  84  after the bone screws  28  have been set against the bone plate  10 . 
         [0056]    The notch feature  84  can be a part of the screw aperture  24   a,b,c  having threaded seat  207   a,b,c  with the bevel area  41  between the threaded seat area and the top surface  14 . The notch feature  84  is not, however, a part of the measurement for the first radius (r 1 ) or the second radius (r 2 ) as confirmed in  FIG. 6C . 
         [0057]    Referring now to  FIG. 7 , in another embodiment, includes an orthopedic bone plate kit  100  which includes a compartmented container  102 , preferably having shaped compartment spaces  104  corresponding to the shape of the kit item  106  to be received in the shaped compartment space  104 . Kit items  106  contained in the kit  100  include one or more bone plates  10  having the same or similar elongated plate features  11   a  &amp;  11   b , and a plurality of bone screws  28 . Note that the bone screws  28  may be of a variety of somewhat different configurations practicable with the screw apertures  24  of the present invention. As examples, included in the kit  100  shown are: threaded-head bone screws, unthreaded-head bone screws (both with threaded shanks) and threaded-head pegs—(i.e., an unthreaded shank), all can be of various lengths. Additionally shown in the kit  100  is a drill guide  110 . The drill guide  110  has a threaded end  112  that can screw into the threaded-seat  207   b  and  c  on a screw aperture  24 . The drill guide has a hollow bore  114  that serves as a guide for a drill bit (not shown) for use to drill a pilot hole in the bone for the bone screw  28  that is to be inserted into the bone through the screw aperture  24 . 
         [0058]    In an advantage, unlike the case with overlapping threaded screw apertures (i.e., their center-to-center distance being less than d), a surgeon is able to place two bone screws  28  side by side, in a very close proximate position wherein the bone screws&#39; heads can abut one another. 
         [0059]    In another advantage, the invention enables the spacing between bone screws that is so close that the surgeon is able to maintain a standard spacing such as that purveyed by the AO Institute, founded by Synthes S.A. 
         [0060]    In another advantage, where a fracture runs between screw apertures  24 , a surgeon is able to place two bone screws  28  on opposite sides of the fracture, thereby better fixing the broken bone parts  80  together for optimal healing. 
         [0061]    In an advantage of the invention, the bone plate  10  provides greater flexibility of choice to the surgeon in that a threaded-head peg  50  providing secure fixing can be positioned at any interval along the elongated plate  11 , including at its extreme ends. 
         [0062]    In another advantage, the bone plate  10  provides greater flexibility of choice by providing multiple complex apertures  40  oriented either along the longitudinal axis  12  of the elongated plate  11 , oriented at an angle to the longitudinal axis  12 , and staggered along the axis  12 . 
         [0063]    In still another advantage, the threaded head apertures  34   a  of the elongated plate  11  are provided with threads cut for a screw axis  26  perpendicular to the top side  14  of the elongated plate  11 , as well as for a screw axis  26  at a non-perpendicular angle to the top side  14  of the elongated plate  11 . 
         [0064]    The configuration of this complex bone plate  10  may vary, depending on the physiology of the patient. An illustration of the flexibility of application of the plate  80  is its flexible use in osteotomy. 
         [0065]    Multiple variations and modifications are possible in the embodiments of the invention described here. Although certain illustrative embodiments of the invention have been shown and described here, a wide range of modifications, changes, and substitutions is contemplated in the foregoing disclosure. In some instances, some features of the present invention may be employed without a corresponding use of the other features. Accordingly, it is appropriate that the foregoing description be construed broadly and understood as being given by way of illustration and example only, the spirit and scope of the invention being limited only by the appended claims.