Abstract:
Devices and systems for repairing bone fractures and more specifically a fracture repair plate that provides for fixation of a metaphysis to the diaphysis of a long bone, for instance a fracture between the proximal humerus and the diaphysis of the humerus. The fracture repair system includes an implantable repair fracture repair plate and a bone anchor for fixing the fracture repair plate to a bone. In one embodiment, the fracture repair plate may also be adapted to serve as an anchor for a suture. The fracture repair system may also include a fracture reduction mechanism attachable to the fracture repair plate for imparting a controlled translational movement between two bone segments along a plane that lies substantially parallel to the surface of the bone to which the fracture repair plate is attached and substantially parallel to the longitudinal axis of the bone shaft.

Description:
RELATED APPLICATIONS 
     This application is a continuation of application Ser. No. 13/041,350 entitled Proximal Humerus Fracture Repair Plate and System. Filed Mar. 4, 2011, which claims the benefit of the filing date of a prior-filed Provisional Application Ser. No. 61/312,201 entitled Long Bone Head Fracture Repair Plate, filed Mar. 9, 2010, each of which is incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to a device and system for repairing a fracture of a long bone and more specifically to a fracture repair plate and system that provides for reduction and fixation of a fracture of the humerus bone, for instance a fracture at the surgical neck of the humerus. 
     BACKGROUND 
     A fracture repair plate is fastenable to the surface of a bone at the site of a fracture to aid in a repair of the fracture by stabilizing the fracture. Attaching a fracture repair plate for such a purpose with threaded bone screws is well known in the art. As the proximal humerus bone breaks, the fracture lines usually propagate in predictable planes. Based on this, a fracture classification system has been described (the Neer classification system). There are up to 4 large bony fragments that typically result when a proximal humerus bone is fractured. These include: 1) the humeral head, 2) the greater tuberosity, 3) the lesser tuberosity, and 4) the diaphysis or shaft. The rotator cuff tendons attach to the greater and lesser tuberosities. It is usually possible to achieve robust purchase of a screw in the humeral diaphysis and humeral head. However, the greater and lesser tuberosities are often not amenable to screw fixation due to the frailty of these bony fragments. Fortunately, it is still often possible to reduce these fracture fragments to an anatomical position and to achieve acceptable fixation by placing sutures through the rotator cuff tendons at the tendon-bone interface, and then tying those sutures to a plate. 
     Fractures at the juncture of the metaphysis and diaphysis of a long bone are relatively common, for instance fractures at the surgical neck of the humerus bone. In those instances where such a fracture is complete, it may be beneficial to provide a force substantially along the axis of the diaphysis of the bone to provide a translational force between the bone segments in order to compress or distract the segments in order to reduce the fracture. 
     A variety of screws and anchoring devices are used in connection with fixing fracture repair plates to bone. Screws employed in conventional means and with known fracture repair devices for the repair of a fracture at the head of a long bone have been seen to back out on occasion. In addition, screws tips may cut through the bone, leading to failure of fracture fixation. Additionally, in the case of comminuted fractures the smaller fragments and their soft tissue connections are not amenable to fixation with screws, but may be more effectively repaired using sutures. 
     A need exists to provide a fracture repair plate for repairing a fracture of a long bone and more specifically to a fracture repair plate that provides for fixation of a fracture at the surgical neck of the humerus bone. Additionally, a need exists to provide a fracture repair plate that provides for fixation of a proximal humerus to the diaphysis of a long bone. There is also a need for a fracture repair plate for repairing a fracture at the surgical neck of the humerus bone specifically designed to account for the anatomy of the rotator cuff, proximal humeral bony anatomy and contour, and vascular supply of the proximal humerus. Additionally, a need exists for a fracture fixation plate that is optimized to allow the surgeon to use sutures to augment the repair of smaller bony fragments. 
     Additionally, there is a need for a fracture fixation plate that cooperates with means for providing a translational force between the bone segments in order to compress or distract the segments in order to reduce the fracture. More particularly there is a need for a fracture fixation plate that provides a means for applying a translational force between bone segments capable of imparting a force sufficient to create an impacted interface at the site of the fracture. In addition there is a need to provide means for imparting a translational force between bone segments that capable of being adapted for use with an anatomic right or left fracture repair plate. While the prior art includes translational devices, in each case these devices apply the translational force in a plane defined generally by the upper surface of a fracture repair plate, a plane defined generally by the surface of the diaphysis or in some cases along a plane that lies above both of these. 
     A need also exists to provide an anchor, and an anchoring system for fixation of fracture repair plates to bone, improving on the devices and systems currently employed for affixing fracture repair plates to the bone. Finally, a need also exists to provide an anchor, and an anchoring system for fixation and anchoring of a proximal humerus to the diaphysis of a long bone, for instance in the case of a fracture at the surgical neck of the humerus bone using a fracture repair plate. 
     Therefore an object of the present invention is to provide a fracture repair plate for repairing a fracture at the head of a long bone and more specifically to a fracture repair plate that provides for fixation of a proximal end to the diaphysis of a long bone. Another object of the present invention is to provide fracture repair plate for repairing a fracture at the head of a long bone and more specifically to a fracture repair plate that also provides for fixation of a proximal end to the diaphysis of a long bone and for tendon-to-bone repair that may accompany the fracture between the proximal end to the diaphysis of a long bone. Yet another object of the present invention is to provide a fracture repair plate for repairing a fracture at the head of a long bone specifically designed to account for the anatomy of the rotator cuff, proximal humeral bony anatomy and contour, and vascular supply of the proximal humerus. Another object of the present invention is to provide a fracture repair plate that is optimized to facilitate the use of sutures for augmenting the repair of smaller bony fragments and their soft tissue connections. Another object of the present invention is to improve the devices and systems currently employed for affixing fracture repair plates to the bone. 
     Another object of the present invention is to provide a fracture fixation plate that cooperates with means for providing a translational force between the bone segments in order to compress or distract the segments in aid of reducing the fracture. An additional objective of the present invention is to provide a fracture fixation plate that cooperates with means for providing a translational force between bone segments capable of imparting a force sufficient to create an impacted interface at the site of the fracture. An additional objective of the present invention is to provide means for imparting a translational force between bone segments that capable of being adapted for use with anatomic right and left fracture repair plates. An additional objective of the present invention is to provide means for imparting a translational force between bone segments configured such that the translational force is applied along a plane that intersects the diaphysis and preferably along a plane that lies parallel to and substantially along a longitudinal axis of the diaphysis. An additional objective of the present invention is to provide a device and system for reducing a fracture at the surgical neck of the humerus bone using a fracture repair plate that cooperates with means for providing a translational force between bone segments capable of imparting a force sufficient to create an impacted interface at the site of the fracture. Another object of the present invention is to provide a fracture fixation plate that cooperates with means for providing a translational force between bone segments capable of being adapted for use with an anatomic right or left fracture repair plate. 
     An additional objective of the invention is to provide an anchor, and an anchoring system for providing fixation of a fracture repair plate to a bone. 
     SUMMARY OF THE INVENTION 
     The present invention is directed to devices and systems for repairing a fracture of a long bone. In the preferred embodiment of the invention, the fracture repair plate provides for fixation of a fracture located between a proximal end and the diaphysis of a long bone, for instance the proximal humerus to the diaphysis of the humerus bone. The present invention also includes systems for repairing a fracture of a long bone that include means for imparting a translational force between bone segments to compress or distract the segments in order to reduce the fracture. In a preferred embodiment of the system, the means for imparting a translational force between bone segments is capable of being adapted for use with an anatomic right or left fracture repair plate. In a preferred embodiment of the system, the means for imparting a translational force between bone segments is configured such that the translational force is applied along a plane that lies substantially parallel to and substantially coplanar with a longitudinal axis of the diaphysis. 
     In a preferred embodiment, the contour of the inner face of the fracture repair plate approximates the contour of a long bone against which the fracture repair plate is intended for use in repairing. In a preferred embodiment, while the contour of the inner face of the fracture repair plate approximates the contour of a long bone against which the fracture repair plate is to be used, the inner face is configured such as to minimize the actual surface area of contact of the inner face of the fracture repair plate and the surface of the bone. For example, a fracture repair plate according to the present invention used in the repair of a fracture involving the proximal humerus would include a shaft attachment segment and a head segment each attached and extending from a transitional neck segment. An inner face contour of the fracture repair plate is configured such that the inner face contour of shaft attachment segment approximates a contour of a proximal lateral surface of the humeral shaft including a part of the crest of the lesser tuberosity, the inner face contour of the transitional neck segment would approximate a contour of a proximal lateral aspect of the surgical neck of the humerus including a lateral portion of the crest of the lesser tuberosity. Similarly, an inner face contour of the head segment would approximate a contour of a proximal lateral aspect of the humerus as defined by the greater tuberosity and the lateral metaphysis. 
     While the contour of the fracture repair plate approximates the contour of the lateral aspect of the proximal humerus, the fracture repair plate is configured having a bearing surface configured to minimize plate-to-bone contact upon which the fracture repair plate rests against the bone, thereby substantially reducing the surface area of contact of the inner face of the fracture repair plate and the surface of the bone. 
     It is believed that bone health is improved by avoiding compression of the periosteal tissue by minimizing actual surface area of contact of the inner face of the fracture repair plate and the surface of the bone. This is achieved by purposefully mismatching the radius of curvature of the concave surface of the plate relative to the radius of curvature of the bone. 
     The generally “D” shaped peripheral configuration of the head segment of the fracture repair plate is designed to follow the contour of the intertubercular groove and the lateral portion of the proximal humerus. More particularly, the generally “D” shaped peripheral configuration of the head segment is configured to accommodate the arcuate artery that branches from the anterior humeral circumflex artery and runs superiorly just lateral to the intertubercular groove. A fracture repair plate according to the present invention for use in the repair of a fracture involving the proximal humerus and diaphysis of the right arm would be the mirror image of a fracture repair plate for use in the repair of a fracture involving the proximal humerus and diaphysis of the left arm. 
     Apertures formed through the cross-section of the fracture repair plate may include a variety of configurations adapted for a variety or purposes including threaded and un-threaded apertures adapted to accept locking or non-locking screws as well as apertures of various configurations including oblong or slotted aperture adapted to accept non-locking screws. 
     The present invention is also directed to an anchor and an anchoring system for anchoring a fracture repair plate against a long bone. The preferred anchor includes a shaft portion having a plurality of annular grooves formed about a periphery of the shaft and one or more longitudinal grooves that are formed parallel to a primary axis of the shaft. The anchor also includes a head having an external thread adapted to cooperate with the interior thread formed in an anchor aperture. The anchor is pressed into a hole drilled into the bone such that a “press” or “interference” fit exists between the anchor and the drilled hole. The external thread of the head engages the threads of the anchor aperture and the anchor is tightened and locked to the plate. The annular grooves formed about a periphery of the shaft of the anchor and the longitudinal grooves provide several advantages. First when inserting or withdrawing the anchor from a freshly drilled hole, the longitudinal grooves in particular provide venting for fluid captured in the hole. Additionally as the fracture and the site of insertion of the anchors heal growth of new bone will form in the annular and longitudinal grooves resisting and reducing the possibility of both rotation and pullout of the anchors. 
     An additional advantage of the anchor of the present invention is found in its blunt tip. It is known that stress risers form in materials including bone at the site of angular transitions and the more acute the transition the greater the propensity for that site being the locus of crack propagation and failure. 
     In the preferred embodiment, the axis of each screw diverges from a plane perpendicular to an outer face of the fracture repair plate, as well as diverging from the axis of each of the remaining screws. Similarly, the axis of each bone anchor diverges from the axis of each of the remaining bone anchors. 
     The present invention is also directed to a fracture repair plate that is further configured having a plurality of suture apertures that provide anchoring for sutures that may be employed in a procedure to reduce a fracture of the head of a long bone. An upper peripheral edge of fracture repair plate is configured having an undercut land. One or more suture apertures are formed along an upper peripheral edge of the fracture repair plate through the undercut land. In one embodiment, the suture apertures exhibit an elongated configuration. The undercut peripheral edge of the fracture repair plate contributes to the ease and accommodation of passing a needle and suture through the plate. 
    
    
     
       DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a representative perspective view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention; 
         FIG. 2  is a representative perspective view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention; 
         FIG. 3  is a representative perspective view of a fracture repair plate according to the present invention; 
         FIG. 4  is a representative perspective view of a fracture repair plate according to the present invention; 
         FIG. 5  is a representative front view of a non-locking cortical screw according to the present invention; 
         FIG. 6  is a representative front view of a locking bone anchor according to the present invention; 
         FIG. 7  is a representative front view of a locking cortical screw according to the present invention; 
         FIG. 8  is a representative perspective exploded view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention; 
         FIG. 9  is a representative perspective exploded view of a reduction mechanism according to the present invention; 
         FIG. 10  is a representative medial side view of a proximal humerus head fracture repair system including a fracture repair plate according to the present invention; 
         FIG. 11  is a representative medial side view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention; and 
         FIG. 12  is a representative proximal view of a proximal humerus fracture repair system including a fracture repair plate according to the present invention. 
     
    
    
     DETAILED DESCRIPTION 
     Referring to  FIG. 1 , proximal humerus fracture repair system  10  is shown including fracture repair plate  20 A attached to a right humerus bone RH including diaphysis D and proximal humerus PH. Proximal humerus PH is shown including humeral head HH and greater turbercle G. Fracture F is a fracture at the surgical neck of the humerus.  FIG. 1  shows proximal humerus fracture repair system  10  including first and second right drill guide plates  30 A and  40 A respectively fixed to outer face  21  of fracture repair plate  20 A. Fracture repair plate  20 A is specifically adapted for reduction and fixation of a fracture of the right humerus bone RH as seen in  FIG. 1 .  FIG. 2  shows proximal humerus fracture repair system  10  including first and second left drill guide plates  30 B and  40 B respectively fixed to outer face  21  of fracture repair plate  20 B. Reduction mechanism  50  is configured so that it may be adapted for attachment to first right drill guide plate  30 A for reduction and fixation of a fracture of the right humerus bone RH as shown in  FIG. 1 , or in the alternative reduction mechanism  50  may be adapted for attachment to left drill guide plate  30 B for reduction and fixation of a fracture of the left humerus bone LH as shown in  FIG. 2 . 
     Referring to  FIGS. 3 and 4  fracture repair plate  20 A is shown specifically adapted for reduction and fixation of a fracture of the right humerus bone. Fracture repair plate  20 A includes longitudinal axis LAP, outer face  21  as seen in  FIG. 3  and a contoured inner face  22  seen in  FIG. 4 . Preferably, inner face  22  of fracture repair plate  20 A is formed having a contour that approximates a contour of the lateral aspect of the proximal humerus to which fracture repair plate  20 A is to be attached for a fixation. While the contour of inner face  22  approximates the contour of the lateral aspect of the proximal humerus and diaphysis, fracture repair plate  20 A is configured having bearing surface  29  upon which fracture repair plate  20 A rests against humerus bone HB. Bearing surface  29  is configured to minimize plate to bone contact substantially reducing the surface area of contact of the inner face of the fracture repair plate and the surface of the bone. 
     Fracture repair plate  20 A is also configured having a plurality of anchor apertures typified by locking bone anchor aperture  23 , a plurality of threaded screw apertures typified by locking screw aperture  24  and a pair of slotted screw apertures typified by slotted screw aperture  25 . Fracture repair plate  20 A also includes a plurality of suture apertures typified by suture aperture  26  formed about upper peripheral edge  27 . Referring to  FIG. 4  it can be seen that fracture repair plate  20 A is formed such that upper peripheral edge  27  includes an undercut land  28  that provides clearance for passage of a suture once fracture repair plate  20 A is fastened against the bone. 
     A variety of fasteners are use to secure the fracture repair plate of the present invention.  FIG. 5  shows non-locking cortical screw  60  including head  61  adapted to accept a polygonal head type driver for instance a hex-headed driver. Non-locking cortical screw  60  also includes threads  62  and self tapping tip  63 . 
       FIG. 6  shows locking bone anchor  65  including head  66  also adapted to accept a polygonal head type driver for instance a hex-headed driver. Locking bone anchor  65  is configured having threaded head  66  adapted to cooperate with a thread formed in each of the anchor apertures typified by locking bone anchor aperture  23 , (shown in  FIGS. 2 and 3 ). Locking bone anchor  65  includes shaft  67  having blunt tip  64 , a plurality of annular grooves  68  formed about shaft  67  and a plurality of longitudinal grooves  69  formed parallel to a primary axis of shaft  67 . Locking bone anchor  65  is pressed into a hole drilled into the bone such that a “press” or “interference” fit exists between shaft  67  and the drilled hole. Threaded head  66  of engages the threads of the threaded anchor aperture and the anchor is tightened and locked. As a fracture and the site of insertion of the locking bone anchors  65  heal, growth of new bone will form in annular grooves  68  and longitudinal grooves  69  resisting and preventing both rotation and pullout of locking bone anchor  65 . 
       FIG. 7  shows locking diaphyseal screw  70  including threaded head  71  also adapted to accept a polygonal head type driver for instance a hex-headed driver. Locking diaphyseal screw  70  also includes threads  73  formed on shaft  72  and self tapping tip  74 . In the preferred embodiment threaded head  71  includes a thread formed at a first thread pitch P 1  and threads  73  formed on shaft  72  includes a thread formed at a second thread pitch P 2 . This feature reduces the tendency of locking diaphyseal screw  70  to back out over time. 
     Referring to  FIG. 8 , right humerus bone RH is shown including diaphysis D and proximal humerus PH that includes humeral head HH and greater tuberosity G. Fracture F is a commonly seen surgical neck fracture. Right humerus bone RH is shown positioned in a routinely implemented “beach chair position” for reduction and fixation to demonstrate the advantageous positioning of reduction mechanism  50  during a procedure. Proximal humerus fracture repair system  10  is shown with fracture repair plate  20 A partially attached to a generally lateral surface of right humerus bone RH with upper peripheral edge  27  fracture repair plate  20 A extending over a proximal lateral aspect of the proximal humerus defined in part by the greater tuberosity G. Fracture repair plate  20 A includes a plurality of anchor apertures typified by locking bone anchor aperture  23 , through which a plurality of locking bone anchors  65  are set. As shown, fracture repair plate  20 A includes a pair of slotted screw apertures typified by slotted screw aperture  25 . Non-locking cortical screw  60  is shown engaging left humerus LH through slotted screw aperture  25 . Fracture repair plate  20 A also includes a plurality of threaded screw apertures typified by locking screw aperture  24 . A plurality of suture apertures typified by suture aperture  26 , are formed through upper peripheral edge  27  of fracture repair plate  20 A. 
     Proximal humerus fracture repair system  10  also includes first right drill guide plate  30 A having a plurality of locking screw guide apertures typified by locking screw guide aperture  32  and a plurality of slotted screw guide apertures typified by slotted screw guide aperture  33 . As shown first right drill guide plate  30 A may be located against outer face  21  of fracture repair plate  20 A by inserting a pair of locator pins typified by first drill guide plate locator pin  31  into a pair of corresponding locator pin apertures typified by first drill guide plate locator pin aperture  37 . First right drill guide plate  30 A may be secured to fracture repair plate  20 A by inserting first drill guide  36  through one of several locking screw guide apertures typified by locking screw guide apertures  32  and threadedly engaging the end of first drill guide  36  with one of the plurality of threaded screw apertures typified by locking screw aperture  24 . 
     Proximal humerus fracture repair system  10  also includes second drill guide plate  40 A having a plurality of bone anchor apertures typified by bone anchor aperture  42 . Second drill guide plate  40 A may be located against fracture repair plate  20 A by inserting second drill guide plate locator pin  41  into a corresponding suture aperture  26  which serves as a locator pin aperture. Second drill guide plate  40 A is secured to fracture repair plate  20 A by inserting second drill guide  43  through one of several threaded bone anchor apertures typified by bone anchor aperture  42  and threadedly engaging the end of second drill guide  43  with one of the plurality of locking bone anchor apertures typified by locking bone anchor aperture  23 . Both first right drill guide plate  30 A and second drill guide plate  40 A are adapted to guide a drill at a pre-selected angle. 
     With continued reference to  FIG. 8 , proximal humerus fracture repair system  10  also includes reduction mechanism  50 . Reduction mechanism  50  includes reduction mechanism body  51  that may be located against upper edge  38  of first right drill guide plate  30 A by inserting a pair of reduction mechanism locator pins typified by reduction mechanism locator pin  52  into a corresponding pair of reduction mechanism locator pin apertures typified by reduction mechanism locator pin aperture  34  located on upper edge  38  of first right drill guide plate  30 A. Reduction mechanism body  51  is secured against upper side  38  of first right drill guide plate  30 A by threadedly engaging a pair of captured screws typified by captured screw  53  with the corresponding threaded aperture located on upper side  38  of first right drill guide plate  30 A. 
     With reduction mechanism body  51  is secured against upper side  38  of first right drill guide plate  30 A, dovetail  58  of traction arm  57  is slideably engaged with right dovetail groove  56 A of reduction mechanism body  51  with right side rack gear  59 A of traction arm  57  engaging right pinion  54 A of reduction mechanism body  51 . Traction arm  57  is positioned with respect to reduction mechanism body  51  so that as right pinion  54 A is rotated against right side rack gear  59 A, traction arm  57  moves towards the proximal humerus PH of right humerus RH. Once traction arm  57  is positioned as desired, non-locking screw  80  is inserted through bushing  44  and traction arm aperture  45  and is subsequently driven into diaphysis D of right humerus RH along a traction plane T that lies substantially parallel to surface plane SP said traction plane T passing through a longitudinal axis of diaphysis LAS. Spring biased pawl  55  assures that the position of traction arm  57  may be accurately maintained with respect to reduction mechanism body  51  throughout a procedure. 
       FIG. 9  shows reduction mechanism  50  adapted for attachment to first left drill guide plate  30 B, (as shown in  FIG. 2 ), for reduction and fixation of a fracture of the left humerus bone LH, (as shown in  FIG. 2 ). For use in the reduction and fixation of a fracture of the left humerus bone, reduction mechanism body  51  is rotated one-hundred and eighty degrees about dovetail groove axis GA and traction arm  57  is rotated one-hundred and eighty degrees about traction arm axis TA that is perpendicular to dovetail  58  of traction arm  57 . Dovetail  58  of traction arm  57  then slideably engages with left dovetail groove  56 B with left side rack gear  59 B of traction arm  57  engaging left side pinion  54 B of reduction mechanism body  51 . Once traction arm  57  is positioned as desired, non-locking screw  80  may be inserted through bushing  44  and traction arm aperture  45  in preparation to driving into diaphysis D of left humerus LH, (as shown in  FIG. 2 ). Spring biased pawl  55  assures that the position of traction arm  57  may be accurately maintained with respect to reduction mechanism body  51  throughout a procedure. 
       FIG. 10  shows left humerus bone LH having fracture F located between diaphysis D and proximal humerus PH. Proximal humerus fracture repair system  10  is shown with fracture repair plate  20 B partially attached to a generally lateral surface of left humerus bone LH. In use, once secondary or tertiary fractures if any of proximal humerus PH have been stabilized, fracture repair plate  20 B is positioned against diaphysis D of left humerus bone LH with upper peripheral edge  27  fracture repair plate  20 B extending over a proximal lateral aspect of proximal humerus PH defined in part by the greater tuberosity G. A pair of pilot holes are drilled into diaphysis D, one each at location corresponding to the pair of slotted apertures typified by slotted aperture  25 , (shown in  FIG. 8 ). A pair of non-locking cortical screws  60  are set into each of the pair of drilled pilot holes and fracture repair plate  20 B is adjusted lengthwise on diaphysis D along an axis of the slotted apertures to a desired position relative to the bone and non-locking cortical screws  60  are tightened. 
     Next, first left drill guide plate  30 B and second left drill guide plate  40 B are attached to outer face  21  of fracture repair plate  20 B and a plurality of bone anchor holes typified by bone anchor hole  75  are drilled employing second left drill guide plate  40 B. A pattern of bone anchor holes are drilled into proximal humerus PH or bone fragments thereof. According to the preferred embodiment of the invention each bone anchor hole drilled for one of the plurality of bone anchors is drilled at a specified angle so that an axis of each hole differs and diverges from the angle of the axes of each of the remaining holes. As the bone anchor holes  75  are drilled bone anchors  65  are set. Preferably a fit between each locking bone anchor  65  and its respective bone anchor hole  75  is characterized as a “press” or “interference” fit. 
     Once proximal humerus PH is anchored against fracture repair plate  20 B, reduction mechanism body  51  of reduction mechanism  50  is secured against upper side  39  of first left drill guide plate  30 B by a pair of captured screws typified by captured screw  53 . Traction arm  57  slideably engages reduction mechanism body  51  and traction arm  57  is positioned so that adequate forward travel of traction arm  57  may be achieved. Once so positioned, traction are  57  is secured to diaphysis D of left humerus bone LH by non-locking screw  60 . As seen in  FIG. 10  another unique aspect of the present invention lies in the fact that diaphysis D and proximal humerus PH of left humerus bone LH are each capable only of a single degree of movement with respect to one another, that being movement along a line defined by longitudinal axis of the diaphysis LAD, while secured by the placement of locking bone anchors  65 , the two non-locking cortical screws  60  placed through fracture repair plate  20 B and non-locking cortical screw  80  set through traction arm  57  of reduction mechanism  50 . 
     Once reduction mechanism  50  is secured against first left drill guide plate  30 B, non-locking screws  60  are loosened so that diaphysis D of left humerus bone LH is free to move with the advance of traction arm  57 . Left pinion  54 B is rotated against left side rack gear  59 B such that controlled movement of traction arm  57  and therefore the attached diaphysis D towards proximal humerus PH is achieved. Spring biased pawl  55  assures that the position of traction arm  57  is accurately maintained as a translational force TF is applied substantially along a longitudinal axis of the diaphysis LAD of left humerus bone LH. Translational force TF between diaphysis D and proximal humerus PH is sufficient to create an impacted interface or impacted zone at the site of the fracture. Once diaphysis D is positioned as desired with respect to proximal humerus PH, non-locking screws  60  are once again tightened so that diaphysis D will maintain the desired position with respect to proximal humerus PH. 
     Referring to  FIGS. 11 and 12 , show fracture repair plate  20 B attached to a generally lateral surface of left humerus bone LH against diaphysis D with upper peripheral edge  27  fracture repair plate  20 B extending over a proximal lateral aspect of proximal humerus PH defined in part by the greater tuberosity G. Referring to  FIG. 11 , once an impacted zone IZ has been established as described above, locking diaphyseal screws  70 A- 70 C may be set. Pilot holes are drilled for locking diaphyseal screws  70 A- 70 C using drill guide  36  to assure that the screw are set at the determined angles. Each pilot hole for locking diaphyseal screws  70 A- 70 C is drilled on a screw axis SA that is divergent from the longitudinal axis of the diaphysis LAD, that angle also being divergent from a screw axis SA of each of the remaining locking diaphyseal screws  70 A- 70 C. As shown in  FIG. 11 , an angle of screw axis SA for each locking diaphyseal screw  70 A- 70 C and correspondingly an angle of an axis at which each of the locking screw apertures  24  are formed relative to outer face  21  and surface plane SP, defined generally as the surface of the lateral aspect of left humerus bone LH increases progressively as the location of the diaphyseal screws  70 A- 70 C move further distally down diaphysis D and fracture repair plate  20 B. More particularly, in the preferred embodiment, screw axis SA for first diaphyseal screw  70 A measures ninety degrees, the screw axis SA for second diaphyseal screw  70 B measures one-hundred, and the screw axis SA for third diaphyseal screw  70 B measures one-hundred and ten degrees. This configuration provides an increased resistance to pullout of the screws which in turn would lead to a failure of the repair. 
       FIGS. 11 and 12  also show the divergence of anchor axes A of locking bone anchors  65 . As seen in the referenced figures, each of the plurality of locking bone anchors  65  is pressed into a hole drilled on anchor axis AA that is divergent from the longitudinal axis of the diaphysis LAD and surface plane SP, (Shown in  FIG. 11 ), that angle also being divergent from an anchor axis AA of each of the remaining locking bone anchors  65 . Correspondingly each of the bone anchor apertures  23 , shown in  FIG. 8 , diverge from an anchor axis AA of each of the remaining bone anchor apertures  23 . 
     While this invention has been described with reference to the described embodiments, this is not meant to be construed in a limiting sense. Various modifications to the described embodiments, as well as additional embodiments of the invention, will be apparent to persons skilled in the art upon reference to this description. It is therefore contemplated that the appended claims will cover any such modifications or embodiments as fall within the true scope of the invention.