Abstract:
Orthopaedic plate and spreader apparatuses and methods for distracting and compressing bones and fractured bones in a patient. A first orthopaedic plate and tab assembly has ratcheting teeth on the plate and tab for distracting two bone surfaces to a desire wedge shape. The plate may have longitudinal and diametral curvatures. A second orthopaedic plate and tab assembly has a female plate with ratcheting teeth configured to mate with a male plate with ratcheting teeth for compression and distraction of two bone surfaces. The ratcheting teeth of the first and second orthopaedic plate and tab assemblies may be one way ratcheting teeth or two way ratcheting teeth. Surgical methods for inserting the implants within the patient.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a national stage filing under section 371 of International Application No. PCT/US2012/032776 filed on Apr. 9, 2012, and published in English on May 2, 2013 as WO 2013/062621 A2 and claims priority benefit under 35 U.S.C. §119(e) to U.S. provisional patent application No. 61/473,195 filed Apr. 8, 2011 and U.S. provisional patent application No. 61/473,200 filed Apr. 8, 2011, the entire disclosure of these applications being hereby incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     This present disclosure relates generally to the field of orthopaedics related to ratcheting plates and spreaders. 
     BACKGROUND 
     Currently surgeons perform an opening wedge procedure to correct an angular deformity of a bone by making a partial cut in a first bone, for example a metatarsal, and preserving the lateral cortex of the bone. Once the surgeon creates the opening wedge, the size of the block to be inserted is determined. In order to determine the appropriate sized block, the surgeon will generally use a measuring device. The surgeon will initially select a first size block, insert the first size block into the opening, and measure the length. The surgeon may then try other sizes of blocks in the opening which result in the bone cut being repeatedly opened and then closed. With the repeated opening and closing of the bones the lateral cortex of the bone is likely to crack and compromise the hinge that the surgeon created between the two bone surfaces. This loss of the hinge between the cut bones will result in the loss of all stability between the two bones leading to distraction of the toe and malalignment. 
     SUMMARY 
     The present invention is directed toward devices, instruments, and methods for expanding and compressing the space between bones. 
     In one aspect of the present invention provided herein, the ratcheting plate and spreader devices, instruments, and methods are used for correction of the hallux valgus deformity at the base of the first metatarsal using an opening wedge procedure. The device and instrumentation enable precise and gradual correction of the deformity while minimizing the risk associated with fracture of the lateral cortex and subsequent destabilization. 
     In another aspect of the present invention provided herein, the ratcheting plate and spreader devices, instruments, and methods are used for compression of an osteotomy or fracture to create an appropriate environment for healing to occur. The device will prevent release of compression via ratcheting teeth of the female plate engaging with the ratcheting teeth of the male plate. The device and instrumentation enable precise compression, appropriate for the differing degrees of bone quality encountered during surgery. The ratcheting teeth may allow for small increments of compression, such as 0.5 mm. The teeth may be shaped and designed to allow movement in only one direction or in both directions. 
     In one aspect of the present invention provided herein, is an orthopaedic plate system for insertion into a patient&#39;s joint. The plate system has a plate and a tab. The plate has a proximal end and a distal end with a central portion extending between the proximal end and the distal end wherein the plate has a first opening in the central portion, a first pair of arms at a proximal end, and a second pair of arms at a distal end. The tab has a body with a first arm and a second arm. The tab is configured to mate with the first opening of the plate. The first opening of the plate may have a generally rectangular shape and a row of teeth on each longitudinal edge. The tab may have a row of teeth on the first and second arms which engage the teeth on the longitudinal edges of the first opening of the plate. The plate may have a longitudinal curvature along a longitudinal axis and/or a diametral curvature along a lateral axis. 
     In another embodiment of the present invention provided herein, is a surgical method for implanting the orthopaedic plate system in a patient. The method includes exposing a first bone surface and a second bone surface of the patient. The plate system is then inserted into the patient with the tab being inserted between the first and second bone surfaces. The first end of the plate system may then be attached in a first position to the first bone surface. The plurality of teeth of the first and second arms of the tab may then be ratcheted over the two rows of teeth of the plate to apply a force on the second bone surface. The force on the second bone surface may distract the second bone surface away from the first bone surface and to a final position. After the final position is achieved the second end of the plate system may be attached to the second bone surface. Finally, the tab may optionally be removed from the plate. 
     In a further aspect of the present invention provided herein, is an orthopaedic plate system which has a curved plate with a proximal end and a distal end. The curved plate has a central portion extending between the proximal end and the distal end with a first opening in the central portion, a first pair of arms at a proximal end, and a second pair of arms at a distal end. The plate system may also have a notch in the first opening that is configured to mate with a tool. The tool may have a first and second tip use with the plate to distract a first bone surface from a second bone surface. 
     In yet another aspect of the present invention provided herein, is an orthopaedic plate system which has a curved plate, an insert plate, and a tab. The curved plate has a proximal end and a distal end. The curved plate also has a central portion extending between the proximal end and distal end with a first opening, a first pair of arms at a proximal end, and a second pair of arms at a distal end. The insert plate may have teeth which engage with teeth in the first opening of the curved plate. The tab may be coupled to the plate with a fastener and is inserted between a first bone and a second bone. 
     In another aspect of the present invention provided herein, is a surgical method for implanting a plate system, which has a plate with a first opening and a notch and a tool with a first tip and a second tip, into a patient. The method including exposing a first bone surface and a second bone surface of the patient. The plate system is then inserted into the patient and a first end of the plate system is attached to the first bone surface. The tool may then be inserted between the first and second bone surfaces and the first tip may mate with the notch of the plate and the second tip may mate with the second bone surface. Then a force may be applied to the tool to separate the first tip and second tip thereby applying a force on the second bone surface to distract the second bone surface from the first bone surface to a final position. When a final position is achieved a second end of the plate system may be attached to the second bone surface. 
     In a further aspect of the present invention provided herein, is a surgical method for implanting a plate system, which has an elongated plate with two rows of teeth on a longitudinal edge of the plate opening, an insert plate with a plurality of teeth configured to engage the teeth on the elongated plate, and a tab configured for attachment to the insert plate, into a patient. The method including exposing a first bone surface and a second bone surface of the patient. The plate system is then inserted into the patient with the tab being inserted between the first and second bone surfaces. The first end of the plate system is then attached to the first bone surface. The plurality of teeth of the insert plate may then be ratcheted over the teeth of the elongate plate to apply a force on the second bone surface with the tab to distract the second bone surface from the first bone surface to a final position. Then the second end of the plate system may be attached to the second bone surface in the final position. Optionally, the insert plate and tab may then be removed from the elongate plate. 
     Yet a further embodiment of the present invention provided herein, is an orthopaedic plate assembly with a male plate and a female plate. The male plate may have a base connected to a ratcheting member that has two legs separated by a slot and a plurality of teeth on the outer longitudinal edge of the two legs. The female plate may have a base with a cavity which has a plurality of teeth on at least one longitudinal edge. The teeth of the cavity may be configured to mate with the teeth of the ratcheting member. The plate assembly may be used for compression or distraction of two bone surfaces. 
     In still another embodiment of the present invention provided herein, is an orthopaedic plate assembly with a male plate and a female plate. The male plate may have a base with a plurality of teeth on at least one edge. The female plate may have a base, two end openings, and a center opening. The center opening has a plurality of teeth on at least one longitudinal edge configured to engage the plurality of teeth on the male plate. The plate assembly may be used for compression or distraction of two bone surfaces. 
     In another aspect of the present invention provided herein, is a surgical method for implanting a plate system into a patient. The plate system has a female plate with a base and an opening that has a plurality of teeth along at least one longitudinal edge and a male plate with a base that has a plurality of teeth along at least one outer edge. The teeth of the female plate being configured to engage the teeth of the male plate. The method including exposing a first bone surface and a second bone surface of the patient. The plate system is then inserted into the patient. The female plate is attached to the first bone surface and the male plate is attached to the second bone surface. A force may then be applied to the male and female plates to move the first and second bone surfaces to a final position. The force applied to the male and female plates may be done using a tool. The plate assembly may be used for compression or distraction of two bone surfaces. 
     These and other objects, features and advantages of this invention will become apparent from the following detailed description of the various aspects of the invention taken in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention and together with the detailed description herein, serve to explain the principles of the invention. It is emphasized that, in accordance with the standard practice in the industry, various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of discussion. The drawings are only for purposes of illustrating preferred embodiments and are not to be construed as limiting the invention. 
         FIG. 1  is a top view of a ratcheting plate, in accordance with an aspect of the present invention; 
         FIG. 2  is a side view of the ratcheting plate of  FIG. 1 , in accordance with an aspect of the present invention; 
         FIG. 3  is a top view of the ratcheting plate of  FIGS. 1 and 2  in a vertical orientation, in accordance with an aspect of the present invention; 
         FIG. 4  is a side view of the ratcheting plate of  FIGS. 1-3 , in accordance with an aspect of the present invention; 
         FIG. 5  is an isometric view of a ratcheting plate of  FIGS. 1-4 , in accordance with an aspect of the present invention; 
         FIG. 6  is a top view of a ratcheting tab, in accordance with an aspect of the present invention; 
         FIG. 7  is a side view of the ratcheting tab of  FIG. 6 , in accordance with an aspect of the present invention; 
         FIG. 8  is a front view of the ratcheting tab of  FIGS. 6-7 , in accordance with an aspect of the present invention; 
         FIG. 9  is a bottom view of the ratcheting tab of  FIGS. 6-8 , in accordance with an aspect of the present invention; 
         FIG. 10  is an isometric view of the ratcheting tab of  FIGS. 6-9 , in accordance with an aspect of the present invention; 
         FIG. 11  is an exploded isometric view of the ratcheting plate of  FIGS. 1-5  and the ratcheting tab of  FIGS. 6-10 , in accordance with an aspect of the present invention; 
         FIG. 12  is an isometric view of the ratcheting plate of  FIGS. 1-5  and the ratcheting tab of  FIGS. 6-10  inserted into the ratcheting plate, in accordance with an aspect of the present invention; 
         FIG. 13  is an isometric view of a first tool used to actuate a ratcheting plate and tab assembly, in accordance with an aspect of the present invention; 
         FIG. 14  is a side view of the tool of  FIG. 13 , in accordance with an aspect of the present invention; 
         FIG. 15  is an isometric view of the tool of  FIGS. 13-14  in a partially extended position, in accordance with an aspect of the present invention; 
         FIG. 16A  is an exploded left isometric view of the tool of  FIGS. 13-15 , in accordance with an aspect of the present invention; 
         FIG. 16B  is an exploded left isometric view of the tool of  FIGS. 13-15 , in accordance with an aspect of the present invention; 
         FIG. 17  is an isometric view of the tool of  FIGS. 13-16B  and the plate and tab assembly of  FIG. 11-12  in a retracted position, in accordance with an aspect of the present invention; 
         FIG. 18  is a side view of the tool and plate and tab assembly of  FIG. 17 , in accordance with an aspect of the present invention; 
         FIG. 19  is a partially exploded isometric view of the tool and plate and tab assembly of  FIGS. 17-18 , in accordance with an aspect of the present invention; 
         FIG. 20  is a top view of the ratcheting plate and tab assembly of  FIGS. 11 and 12  and two bone segments, in accordance with an aspect of the present invention; 
         FIG. 21  is a top view of the ratcheting plate and tab assembly and two bone segments of  FIG. 20 , wherein the ratcheting tab is inserted between the two bone segments and the ratcheting plate is attached to a first bone segment in an initial position, in accordance with an aspect of the present invention; 
         FIG. 22  is a top view of a ratcheting plate and tab assembly and two bone segments of  FIGS. 20-21  attached to the first and second bone segments in an actuated position, in accordance with an aspect of the present invention; 
         FIG. 23  is a top view of a second embodiment of a ratcheting tab, in accordance with an aspect of the present invention; 
         FIG. 24  is a side view of the ratcheting tab of  FIG. 23 , in accordance with an aspect of the present invention; 
         FIG. 25  is a front view of the ratcheting tab of  FIGS. 23 and 24 , in accordance with an aspect of the present invention; 
         FIG. 26  is a bottom view of the ratcheting tab of  FIGS. 23-25 , in accordance with an aspect of the present invention; 
         FIG. 27  is an isometric view of the ratcheting tab of  FIGS. 23-26 , in accordance with an aspect of the present invention; 
         FIG. 28  is an exploded isometric view of a second embodiment of a ratcheting plate and the ratcheting tab of  FIGS. 23-27 , in accordance with an aspect of the present invention; 
         FIG. 29  is an isometric view of the second embodiment ratcheting plate and the ratcheting tab of  FIGS. 23-27  inserted into the second embodiment ratcheting plate, in accordance with an aspect of the present invention; 
         FIG. 30  is an exploded isometric view of a third embodiment of the ratcheting plate and tab assembly, in accordance with an aspect of the present invention; 
         FIG. 31  is an isometric view of the ratcheting plate and tab assembly of  FIG. 30 , in accordance with an aspect of the present invention; 
         FIG. 32  is an isometric view of a second tool used to actuate a ratcheting plate and tab assembly, in accordance with an aspect of the present invention; 
         FIG. 33  is an isometric view of the tool of  FIG. 32  inserted into the ratcheting plate and tab assembly of  FIGS. 28-29 , in accordance with an aspect of the present invention; 
         FIG. 34  is an isometric view of a third tool used to actuate a ratcheting plate and tab assembly, in accordance with an aspect of the present invention; 
         FIG. 35  is an isometric view of the tool of  FIG. 34  inserted into a ratcheting plate, in accordance with an aspect of the present invention; 
         FIG. 36  is an exploded isometric view of a first embodiment of a plate assembly, in accordance with an aspect of the present invention; 
         FIG. 37  is an isometric view of the plate assembly of  FIG. 36 , in accordance with an aspect of the present invention; 
         FIG. 38  is an exploded isometric view of a second embodiment of a plate assembly, in accordance with an aspect of the present invention; 
         FIG. 39  is an isometric view of the plate assembly of  FIG. 38 , in accordance with an aspect of the present invention; 
         FIG. 40  is a front view of two bones and the plate assembly of  FIGS. 38-39 , in accordance with an aspect of the present invention; 
         FIG. 41  is a front view of the two bones and the plate assembly of  FIG. 40  in the initial mounted position, in accordance with an aspect of the present invention; 
         FIG. 42  is a front view of two bones and the plate assembly of  FIG. 40  in the actuated position wherein the bones are compressed, in accordance with an aspect of the present invention; 
         FIG. 43  is an isometric view of one embodiment of a hand tool that is used to actuate the plate of  FIGS. 38-39 , in accordance with an aspect of the present invention; and 
         FIG. 44  is an isometric view of the tool of  FIG. 43  engaging the plate of  FIGS. 38-39 , in accordance with an aspect of the present invention. 
     
    
    
     DETAILED DESCRIPTION 
     In this application, the words proximal, distal, anterior or plantar, posterior or dorsal, medial and lateral are defined by their standard usage for indicating a particular part or portion of a bone or prosthesis coupled thereto, or directional terms of reference, according to the relative disposition of the natural bone. For example, “proximal” means the portion of a bone or prosthesis nearest the torso, while “distal” indicates the portion of the bone or prosthesis farthest from the torso. As an example of directional usage of the terms, “anterior” refers to a direction towards the front side of the body, “posterior” refers to a direction towards the back side of the body, “medial” refers to a direction towards the midline of the body and “lateral” refers to a direction towards the sides or away from the midline of the body. Further, specifically in regards to the foot, the term “dorsal” refers to the top of the foot and the term “plantar” refers the bottom of the foot. 
     Similarly, positions or directions may be used herein with reference to anatomical structures or surfaces. For example, as the current devices, instrumentation and methods are described herein with reference to use with the bones of the foot, the bones of the foot, ankle and lower leg may be used to describe the surfaces, positions, directions or orientations of the devices, instrumentation and methods. Further, the devices, instrumentation and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to one side of the body for brevity purposes. However, as the human body is relatively symmetrical or mirrored about a line of symmetry (midline), it is hereby expressly contemplated that the devices, instrumentation and methods, and the aspects, components, features and the like thereof, described and/or illustrated herein may be changed, varied, modified, reconfigured or otherwise altered for use or association with another side of the body for a same or similar purpose without departing from the spirit and scope of the invention. For example, the devices, instrumentation and methods, and the aspects, components, features and the like thereof, described herein with respect to the right foot may be mirrored so that they likewise function with the left foot. Further, the devices, instrumentation and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to the foot for brevity purposes, but it should be understood that the devices, instrumentation, and methods may be used with other bones of the body having similar structures, for example the upper extremity, and more specifically, with the bones of the wrist, hand, and arm. 
     Referring to the drawings, wherein like reference numerals are used to indicate like or analogous components throughout the several views, and with particular reference to  FIGS. 1-5 , there is illustrated an exemplary embodiment plate  10 . Referring now to  FIGS. 1 ,  3 , and  5 , the plate  10  has a body  12  with one or more screw holes  14  and an opening  16 . For example purposes, the plate  10  is shown as being a generally I-shaped with a generally rectangular shaped body  12  and has two pairs of rounded arms forming the top and bottom lines of the I-shape. It is also contemplated that the plate  10  may be generally H-shaped. However, other plate shapes may be used to address certain clinical situations. The first pair of rounded arms of body  12  may have a first arm  20 , which is offset from a second arm  22  and the second pair of rounded arms of body  12  may have two parallel second arms  22 . As depicted in  FIGS. 1-5 , the one or more screw holes  14  may be located in the arms  20 ,  22  of the body  12  wherein there are preferably four screw holes  14 . The one or more screw holes  14  may be threaded or non-threaded holes. The opening  16  may be centered in the body  12  along the longitudinal axis of the plate  10 . The opening  16  may also have two parallel rows of teeth  18  along the outer edges of the opening  16 . As best seen in  FIG. 2 , the plate  10  may have a longitudinal curvature for conforming to the angle of the bone or bones it is attached to for distraction. Referring now to  FIG. 4 , the plate  10  may have a diametral curvature for conforming to the surface of the outer diameter of the bone or bones which the plate  10  is attached to for distraction. 
     The opening  16  of the plate  10  is configured to mate with a tab  30 , illustrated in  FIGS. 6-10 . The tab  30  may have a central slot  32  with two arms  34  on either side of the opening  36  of the central slot  32 . The arms  34  have a proximal surface for receiving a tool for actuation of the tab  30 . The central slot  32  may have an opening down the center of the tab  30  and an opening along the bottom surface of the tab  30 , more preferably the central slot  32  may have an opening down the center of the tab  30  and a semi-circular curve  24  along the bottom surface of the tab  30 , as depicted in  FIGS. 8 and 10 . The ratcheting tab  30  may also have teeth  38  on the top along the outside of the two arms  34  for mating with the teeth  18  of plate  10 . The two arms  34  may also have indents  40  above the teeth  38 . The indents  40  may enable a tool (Not Shown), to engage the top of the tab  30  if the tab  30  is actuated too far by the surgeon and reverse the tab back towards the proximal end of the plate  10 . When squeezed, the central slot  32  allows for deflection of the sides of tab  30  enabling engagement and disengagement of the teeth  38  from the teeth of the plate  10 . The bottom of the teeth  38  may have a 45 degree angle to allow insertion during a compressed state. The teeth  38  may also have a first chamfered edge on the distal end of the first arm and a second chamfered edge on the proximal end of the second arm enabling the tab  30  to be inserted into plate  10  parallel to teeth  18  and then rotated 90 degrees to engage teeth  38  of the tab  30  with teeth  18  of the plate  10 . The indents  40  may be used to squeeze the central slot  32  during insertion of the tab  30  from the plate  10  and when the tab  30  has been actuated to far during a procedure to reverse the tab  30  towards the initial position at the proximal end of the plate  10 . Alternatively, the tab  30  may be inserted into the plate  10  at the distal end of the opening  16  where there are no teeth  18  along the longitudinal sides of the opening  16 . Then the teeth  38  of the tab  30  may be aligned with the teeth  18  of the plate  10  and the tab  30  may be forced to the proximal end of the opening  16 . The ratcheting tab  30  may also have protrusions  42  on either side of the central slot  32 . The protrusions  42  may engage the under surface of the bone being distracted. The tab  30  may also have a tapered end  44  for facilitating the insertion of the tab  30  between two bone surfaces. 
     As best seen in  FIGS. 11 and 12 , a plate and tab assembly  46  are shown. The tab  30  may be inserted into the plate  10  by squeezing the indents  40  and sliding tab  30  into place within the opening  16  of the plate  10 . Alternatively, the tab  30  may be inserted into the plate  10  by rotating the tab  30  ninety degrees, inserting the tab  30  into opening  16 , and then again turning the tab  30  ninety degrees to engage the teeth of the longitudinal rails  18  of the plate  10 . As the indents  40  are squeezed the central slot  32  allows for deflection of the arms  34  thereby decreasing the width of the tab  30 . When the teeth  38  of the tab  30  are aligned with the teeth  18  of the plate  10  the indents  40  may then be released and the teeth  38  interlock with teeth  18 . Once the desired distraction has been achieved and the plate  10  is secured to the bone surfaces, bone may be inserted around the tab prior to closing the incision in the patient. It is also contemplated that the tab  30  may be removed from the plate  10  before the patient is closed. The tab  30  may be removed from plate  10  by rotating the tab  30  ninety degrees to release the teeth  38  from teeth  18  and removing the tab  30  from the plate  10 . Alternatively, the tab  30  may be removed from plate  10  by moving the tab into a gap  48  where there are no teeth  18  along the opening  16  of the plate  10 . The method of distraction using the plate  10  and tab  30  will be discussed in greater detail below with reference to  FIGS. 20-22 . 
     Referring now to  FIGS. 13-16B , a first embodiment of tool  180  is shown. The tool  180  has a first arm  182  and a second arm  184 . The first arm  182  may have a first tab  190  secured in a first cavity  194  with a fastener  196  and the second arm  184  may have a second tab  198  secured in a second cavity  200  with a fastener  196 . The tool  180  also has a knob  186  which passes through an opening  216  in the first arm  182  and an opening  218  in the second arm  184 . The first arm  182  and second arm  184  are secured onto the knob  186  by a retaining ring  202 . The knob  186  also has a first end  204  which mates with the opening  216  in the first arm  182  and a second end  206  which mates with the opening  218  in the second arm  184 . In the preferred depicted embodiment, the first end  204  may be threaded and the second end  206  may be smooth. In addition, the first end  204  may have a larger diameter than the second end  206 . Likewise, the opening  216  may be threaded and may have a larger diameter than the opening  218 . The tool  180  may also have an alignment bar  188 . The alignment bar  188  is removably fitted in a second cavity  208  on the first arm  182  and slidably inserted into a third cavity  210  on the second arm  184 . The alignment bar  188  has indicator lines  212 . The indicator lines  212  on the alignment bar  188  align with the indicator lines  214  on the second arm  184  to enable the user to measure how far the second tab  198  has been moved from the first tab  190  by turning knob  186 . The indicator lines  212  may be set at a certain distance, such as 0.1 mm to 1 mm, more preferably at 0.5 mm, and most preferably at 1.0 mm, apart allowing the surgeon to see how far the tab  30  has been moved along the opening  16  of plate  10 . 
     Illustrated in  FIGS. 17-19  is how the tool  180 , the plate  10 , and the tab  30  function together. The first tab  190  and second tab  198  in a retracted position are inserted into an opening  130  between the plate  10  and the tab  30 . The first tab  190  mates with the plate  10  and the second tab  198  mates with the tab  30 . When the knob  186  is turned, the second arm  184  is forced away from the first arm  182  moving the tab  30  along the teeth  18  of plate  10 . As the first tab  190  and second tab  198  displace the first arm  182 , the second arm  184  will also be displaced. The alignment bar  188  which is fixed in the first arm  182  slides along the third cavity  210  as the first arm  182  and second arm  184  are displaced. As the alignment bar  188  slides along the third cavity  210 , the indicator lines  212  show the surgeon how far the second arm  184  has separated from the first arm  182  thereby providing the distance the two bones contacting the first tab  190  and second tab  198  have moved relative to each other. 
     Referring now to  FIGS. 20-22 , the tab  30  in the plate  10  and a first bone surface  120  and a second bone surface  122  are shown. The plate  10  has tab  30  in a center position in  FIG. 20 . The first bone surface  120  and second bone surface  122  may be two separate bones or one bone that has been osteotomized or fractured. During surgery the surgeon will make an incision in the patient and perform an osteotomy on the bone or bones requiring correction. During the osteotomy the first bone  120  may be cut leaving the first bone  120  connected by a second portion of bone  124  which acts as a hinge. For example, with reference to the foot bones the hinge would be intact lateral cortex, but may also be opposite cortex from other bones. The plate  10  with the tab  30  may then be inserted by being slid into place between the bone or bones created by the osteotomy. After the plate  10  and tab  30  are positioned in a desired position over the first bone  120  and second bone  122  and within the osteotomy, the plate  10  may be fastened at the proximal end to the bone using fasteners. The plate  10  and tab  30  may be attached with two fasteners  126  to the second bone  122 . The fasteners  126  may be screws, nails, pins, staples, or the like. When the plate  10  is attached to the second bone  122 , the tab  30  is between the first bone  120  and second bone  122  in an initial position at the proximal end of the plate  10 . The first bone  120  will also generally be in an initial position when the plate  10  and tab  30  are inserted. Although not shown, the tool  180  may then be inserted into the opening  130  to advance the tab  30  toward the distal end of the plate  10  thereby displacing the first bone  120  from the second bone  122  at a desired distance. As the tab  30  is advanced towards the distal end of the plate  10 , the teeth  38  of the tab  30  ratchet over the teeth  18  of the plate  10 . The teeth  38  of the tab  30  and teeth  18  of the plate  10  may prevent the tab  30  from being forced back towards the opening  130  by the force of the bones being distracted. As the teeth  38  of tab  30  ratchets over the teeth  18  of the plate  10  the protrusions  42  engage underneath the cortex of the first bone  120  and a force is applied to the first bone  120 . As the teeth  38  continue to ratchet over the teeth  18  of plate  10  the first bone  120  is separated farther from the second bone  122  until a desired separation is reached. 
     Referring now to  FIG. 22 , the first bone  120  and second bone  122  are in a distracted position where the tab  30  has been advanced along the teeth  18  of plate  10  to a desired distance. Once the first bone  120  and second bone  122  are distracted a desired distance, two fasteners  128  may then be inserted through the openings  14  into the first bone  120  to secure the plate  10  in place on the first bone  120  and second bone  122  at the desired distraction. The fasteners  128  may be screws, nails, pins, or the like. Bone may also be inserted into the opening around the plate  10  and tab  30 . The surgeon may then close the incision. Optionally, the tab  30  may be removed prior to the surgeon closing the incision. 
     Referring now to  FIGS. 23-27 , a second embodiment of a ratcheting tab  50  is shown. The ratcheting tab  50  has a cutout  52  for receiving a tool for actuation. The cutout  52  is illustrated as a semi-circular cutout although other shapes, such as squares, rectangles, ovals, and the like, are also contemplated. The top of the tab  50  also has two arms  66  which have indicator lines  54  for showing the position of the tab  50  relative to the plate  10 . The two arms  66  of the tab  50  may also have inset ratcheting teeth  56  for mating with a plate  70  as best seen in  FIGS. 28-29  and described in greater detail hereinafter. The tab  50  may also have protrusions  58  on either side of a central slot  62 . The protrusions  58  may engage the bone during distraction and may more preferably engage the bottom surface of the cortical bone. The tab  50  may also have indents  64  on the top of the tab  50 . The indents  64  enable a tool, (Not Shown), to engage the top of the tab  50  and when squeezed the central slot  62  allows for deflection of the sides of tab  50  enabling the teeth  56  to disengage from the teeth  78  of a plate  70  and the tab  50  to be released. The tab  50  may also have a tapered end  60  for assisting in the insertion of the tab  50  between two bone surfaces. 
     The second embodiment of a ratcheting plate  70  and the tab  50  are depicted in  FIGS. 28-29 . The ratcheting plate  70  has a body  72  with one or more screw holes  74  and an opening  76 . The plate  70  may be generally I-shaped with a generally rectangular shaped body  72  and has two sets of rounded arms forming the top and bottom lines of the I-shape. Other shaped plates  70  are also contemplated including but not limited to generally H-shape plates. The first pair of rounded arms of the body  72  may have a first arm  80 , which is offset from a second arm  82  and the second pair of rounded arms of the body  12  may have two parallel second arms  82 . The one or more screw holes  74  may be located in the arms  80 ,  82  of the body  72 , wherein there are preferably four screw holes  74 . The one or more screw holes  74  may be threaded or non-threaded holes. The opening  76  may be centered in the body  72  along the longitudinal axis of the plate  70 . The opening  76  may also have two parallel rows of teeth  78  along the outer edges of the longitudinal side of the opening  76 . The plate  70  may also have indicator lines  84  which correspond to the position of the teeth  78 . The plate  70  may have a longitudinal curvature for conforming to the angle of the bone or bones it is attached to for distraction. In addition, the plate  70  may have a diametral curvature for conforming to the surface of the outer diameter of the bone or bones which the plate  70  is attached to for distraction. 
     As shown in  FIG. 28 , the ratcheting tab  50  may be inserted into the plate  70  by inserting the tab  50  into a gap  86  where there are no teeth  78  along the opening  76  of the plate  70 . After the tab  50  is inserted into the gap  86  the indents  64  may be squeezed allowing the central slot  62  to deflect so the teeth  56  may interlock with the teeth  78 . When the teeth  56  of the tab  50  are aligned with the teeth  78  of the plate  70  at the desired position the indents  64  may then be released allowing the teeth  56  to interlock with teeth  78 . When the teeth  56  are interlocked with the teeth  78  the indicator lines  54  of the tab  50  are aligned with an indicator line  84  on each side of the plate  70 . The indicator lines  84  may also be set at a certain distance, such as 0.5 mm, apart allowing the surgeon to see how far the tab  50  has been moved along the opening  76 . Once the desired distraction has been achieved and the plate  70  is secured to the bone surfaces. Optionally, the tab  50  may be removed from the plate  70  prior to the surgeon closing the incision. The tab  50  may be removed from plate  70  by rotating the tab  50  ninety degrees to release the teeth  56  from teeth  78  and removing the tab  50  from the plate  70 . Alternatively, the tab  50  may be removed from plate  70  by moving the tab into a gap  86  where there are no teeth  78  along the opening  76  of the plate  70 .  FIG. 29  depicts the assembled plate  70  and tab  50  with the tab  50  in a central position. 
     A third embodiment plate  90  and tab  100  has a locking plate  102  and fastener  104  is best illustrated in  FIGS. 30 and 31 . The plate  90  is attached to the bones at a predetermined position which is set in advance of inserting the tab  100  and locking plate  102  into the opening  106  of the plate  90 . The plate  90  has a body  94  with one or more screw holes  96  and an opening  106 . The plate  90  may be generally I-shaped with a generally rectangular shaped body  94  and has rounded tabs forming the top and bottom lines of the I-shape. Although other shapes are contemplated for plate  90 . The rounded tabs of body  94  may have at least one tab  96 . The one or more screw holes  98  may be located in the tabs  96  of the body  94 , wherein there are preferably four screw holes  98 . The one or more screw holes  98  may be threaded or non-threaded holes. The opening  106  may be centered in the body  94  along the longitudinal axis of the plate  90 . The opening  106  may also have two parallel rows of teeth  92  along the outer edges of the longitudinal side of the opening  106 . The plate  90  may have a longitudinal curvature for conforming to the angle of the bone or bones it is attached to for distraction. In addition, the plate  90  may have a diametral curvature for conforming to the surface of the outer diameter of the bone or bones which the plate  90  is attached to for distraction. The tab  100  has a tapered end  108  and an opening  110 . The locking plate  102  may have an opening  112  and two parallel sides have teeth  114  for mating with the teeth  92  of the plate  90 . 
     Tab  100  and locking plate  102  are inserted into the plate  90  and the tab  100  is secured to the locking plate  102  with the fastener  104 . As illustrated in  FIG. 31 , the tab  100  is in a central position in the plate  102 . When using the plate  90 , the surgeon should first position the bone surfaces in the desired position and then the plate  90  may be secured to the bone surfaces at the one or more screw holes  98  using fasteners, such as screws, pins, nails, or the like. In addition when the desired position is obtained the fastener  104  may be inserted to secure the tab  100  and locking plate  102  in the desired position. 
     Referring now to  FIGS. 32-33 , a second embodiment of tool  140  is shown. The tool  140  has two opposing handles  142  that pivot with respect to each other and a spring  144  which maintains the handles  142  at a desired position. In addition, the tool  140  may have tips  146  that are designed to engage a tab of a plate, such as the tab  30  of plate  10  or the tab  50  of plate  70 . The tips  146  may be held in place with plates  148  and fasteners  150 . The tips  146  may also be interchangeable to engage various size and shape tabs. The fasteners  150  may be screws, nails, pins, or the like. As best seen in  FIG. 33 , the tool  140  engages the plate  70  and tab  50  within opening  76  at cutout  52  of the tab  50 . The surgeon may then apply force to the handles  142  of the tool  140  to move the tab  50  with respect to plate  70  and along the teeth  78  of plate  70 . As the handles  142  are squeezed, the tips  146  separate and force the tab  30  away from the proximal end of the plate  10  thereby separating the two bone surfaces. 
     A third embodiment of tool  160  is depicted in  FIGS. 34-35 . The tool  160  has two opposing handles  162  that pivot with respect to each other and a ratcheting mechanism  164  which maintains the desired position of the handles  162 . The ratcheting mechanism  164  has a plurality of teeth  172  to lock the handles  162  in a desired position. The ratcheting mechanism  164  may also be released after a plate  174  is secured in its desired position by applying force to the handles  162  to disengage the teeth  172 . The plate  174  has a similar shape to plate  10  and plate  70  discussed above, however plate  174  lacks the teeth of the prior plates in the opening  176 . In addition, the tool  160  may have tips  166  that are designed to engage the plate  174  on one side and the bone, not shown, on the opposite side. The tips  166  may be held in place with plates  168  and fasteners  170 . The tips  166  may also be interchangeable to provide various sizes and shapes for directly engaging a bone. The fasteners  170  may be screws, nails, pins, or the like. Depicted in  FIG. 35  is one of the tips  166  of the tool  160  engaging the plate  174  and the second of the tips  166  engaging a bone surface (Not Shown). In this embodiment, as the handles  162  are squeezed the tips  166  separate, thereby moving the bone away from the proximal end of the plate  174  without the need for a tab. 
     Referring now to  FIGS. 36-37 , a plate assembly  200  is shown. The plate assembly  200  has a male plate  202  and a female plate  204 . The male plate  202  has an attachment end  206  and a ratcheting end  208 . The attachment end  206  has an opening  210  for securing the male plate  202  to a bone. The ratcheting end  208  has two legs  212  and a row of teeth  222  on the outer surface of the longitudinal sides of each of the two legs  208 . The teeth  222  may be one way ratcheting teeth. As depicted in the present embodiment, the teeth  220  and  222  are one way ratcheting teeth for compression. The teeth  220  and  222  are one way ratcheting teeth which may also be aligned for distraction. Alternatively, the teeth  220  and  222  may be two way ratcheting teeth. The female plate  204  has a body  214  with a cavity  216  and an opening  218 . The cavity  216  has a generally rectangular shape and two rows of teeth  220  on the inner edges of the longitudinal sides of the cavity  216 . The teeth  222  of the male plate  202  mate with the teeth  220  of the female plate  204  and ratchet over each other as a force is applied to the male plate  202 . The ratcheting end  208  also has a gap  224  between the two legs  212  which allows for deflection as the ratcheting teeth index. The two legs  212  may also have a recess  226  which enables a tool to be inserted into the ratcheting end  208  to pinch the legs  212  together to release the compression on the legs  212 . In addition, the ratcheting end  208  may have a notch  228  and the female plate  204  may have a notch  230 . The notches  228  and  230  are opposing and allow for a tool to engage them. When a force is applied to the tool, the male plate  202  and female plate  204  may be forced apart. The male plate  202  and female plate  204  may alternatively have notches for inserting a tool and pulling the male plate  202  and female plate  204  together. As best seen in  FIG. 37 , the male plate  202  is inserted into the female plate  204  and is partially open. 
     In use, a surgeon would make an incision in the patient and expose the bone or bones for attachment of the plate assembly  200 . Once the bone or bones are exposed, the female plate  204  would be attached to a first bone (Not Shown), and the male plate  202  would be attached to a second bone (Not Shown). The male plate  202  and female plate  204  would be attached with fasteners, such as screws, pins, nails, or the like. The male plate  202  and female plate  204  attached in an initial position with respect to each other and then the male plate  202  and female plate  204  would be ratcheted together for compression or ratcheted apart for distraction. The ratcheting of the male plate  202  and female plate  204  may be done manually, or optionally, a hand tool may be used to assist with the ratcheting. 
     A second plate assembly  250  is illustrated in  FIGS. 38-39 . The plate assembly  250  has a female plate  252  and a male plate  254 . The female plate  252  has a body  256  with a first opening  258 , a second opening  260 , a third opening  262 , two notches  264 , and at least one elongated slot  266 . The third opening  262  has two rows of teeth  268  along the inner edges of the longitudinal sides. The two notches  264  may be used to release the teeth  274  of the male plate  254  from the teeth  268  of the female plate  252 . The male plate  254  has a body  270  with an opening  272 , two rows of teeth  274  on the outer edges of the longitudinal sides of the body  270 , and a notch  276  for ratcheting the male plate  254  within the female plate  252 . As best seen in  FIG. 39 , the male plate  254  is inserted into the female plate  252  in an initial position. 
     In use, a surgeon would make an incision in the patient and expose the bone or bones for attachment of the plate assembly  250 . Once the bone or bones are exposed, the female plate  252  would be attached to a first bone by inserting a fastener in opening  258 . The fastener may be a screw, pin, nail, or the like. Then a surgeon may optionally insert a temporary alignment wire (Not Shown), through the opening  260  and into a bone to maintain the position of the female plate  252  while the male plate  254  is inserted into the third opening  262  and secured with a fastener. The fastener may be a screw, pin, nail, or the like. The male plate  254  may then be ratcheted to a desired position. While the male plate  254  is ratcheted, the elongated slots  266  on the female plate  252  allow for the female plate  252  to deflect as the teeth  274  of the male plate  254  ratchet over the teeth  268  of the female plate  252 . The male plate  254  and female plate  252  may be ratcheted together for compression or ratcheted apart for distraction. Once a desired position is reached, the ratcheting tool may be removed and the surgeon may close the patient incision. 
     Depicted in  FIGS. 40-42  is the plate assembly  250 , a first bone  280 , and a second bone  282 . The plate assembly  250  is attached at the first bone  280  through opening  258  with a fastener  284 . As seen in  FIG. 41 , the male plate  254  is attached to the second bone  282  through opening  272  with a fastener  284  in an initial position. The fastener  284  may be a screw, pin, nail, or the like. In the depicted embodiment, the first bone  280  and second bone  282  are separated by a gap and the plate assembly  250  is assembled for compression. As seen in  FIG. 42 , the male plate  254  has been ratcheted to a second position where the first bone  280  and second bone  282  have been compressed to close the gap between the first bone  280  and the second bone  282 . 
     Referring now to  FIGS. 43-44 , a tool  300  is shown. The tool  300  has two opposing handles  302  that pivot with respect to each other and a spring  304  which maintains the handles  302  at a desired position. In addition, the tool  300  may have tips  306  that are designed to engage a plate, such as the plate  254 . The tips  306  may be held in place with plates  308  and fasteners  310 . The tips  306  may also be interchangeable to engage various size and shape plates. The fasteners  310  may be screws, nuts, pins, or the like. As best seen in  FIG. 44 , the tool  300  engages the plate  254  within notch  276  and the plate  252  in the opening  262 . The surgeon may apply a force to the handles  302  of the tool  300  to move the male plate  254  with respect to the female plate  252 . As the handles  302  are squeezed, the tips  306  separate and force the male plate  254  down the opening  262  of the female plate  252 , thereby compressing the two bones. The tool  300  and plate assembly  250  may be used for compression or distraction of two bones or two bone segments. 
     The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has”, and “having”), “include” (and any form of include, such as “includes” and “including”), and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a method of device that “comprises,” “has,” “includes,” or “contains” one or more steps or elements possesses those one or more steps or elements, but is not limited to possessing only those one or more steps or elements. Likewise, a step of a method or an element of a device that “comprises,” “has,” “includes,” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features. Furthermore, a device or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways that are not listed. 
     The invention has been described with reference to the preferred embodiments. It will be understood that the architectural and operational embodiments described herein are exemplary of a plurality of possible arrangements to provide the same general features, characteristics, and general system operation. Modifications and alterations will occur to others upon a reading and understanding of the preceding detailed description. It is intended that the invention be construed as including all such modifications and alterations.