Abstract:
An external fixator for fixating fractures provides an elongated support rod that includes proximal and distal rod sections. Fixation pins are provided for engaging the patient&#39;s bone tissue on opposite sides of a fracture. Clamps are rotatably supported upon the proximal rod section and distal rod section, each of the clamps being movable in rotational fashion both with respect to the rod and with respect to the pins. At least one of the clamps has articulating portions that rotate and angulate relative to one another so that total adjustment is provided between the rod and the pins. The articulating portion can be rigidified using one set fitting or set screw.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. Ser. No. 09/530,760, now U.S. Pat. No. 6,491,694, which is the U.S national stage entry of International Application No. PCT/US97/20258 filed on Nov. 4, 1997 and published in English as International Publication No. WO 99/22661 on May 14, 1999, the contents of which are incorporated herein by reference, which is a continuation in part of U.S. application No. 08/349,323, filed Dec. 5, 1994, now U.S. Pat. No. 5,683,389. 
    
    
     FILED OF THE INVENTION 
     The present invention relates to orthopedic surgical instrumentation, and more particularly relates to an improved fixator for use in the treatment of bone fractures such as distal radius fractures. Even more particularly, the present invention relates to an improved external fixator for the treatment of distal radius and other like bone fractures that will assist the surgeon in restoring anatomy of a fracture following an injury by allowing the surgeon to quickly manipulate the fixator to apply force to the ligaments in several directions so that the ligaments will reposition the bone fragments in their correct anatomical position and wherein the fixator includes a unique clamp arrangement that fully articulates, yet can be rigidly affixed in a selected configuration by tightening a single connector. 
     BACKGROUND OF THE INVENTION 
     One of the most common fractures that is treated in emergency rooms is a distal radius fracture sometimes classified as a Colles fracture. One of the popular methods of treating distal radius fractures is to apply an external fixator for the purpose of reducing the fracture by ligamentotaxis, which is a method of distracting the wrist to allow the ligaments to push the bone fragments back in place. 
     Simple distraction of the wrist is sufficient to restore the original length of the radius, but may not adequately restore other anatomical features such as the tilt angle of the radial head commonly referred to as the radial tilt and the volar tilt. 
     An example of a technique of multiplanar ligamentotaxis is described by Dr. John Agee in an article published in  Orthopedic Clinics of North America , Volume 24, No. 2, April 1993 and entitled “External Fixation: Technical Advances Based Upon Multiplanar Ligamentotaxis”. John Agee is the named patentee of three (3) United States patents, namely, U.S. Pat. Nos. 4,548,199; 4,611,586; and 4,922,856. The fixator developed by Dr. Agee provides a method of achieving multiplanar ligamentotaxis through gradual turning of worm screws. 
     Several fixation systems have been patented that relate to the holding of bone segments. An example is U.S. Pat. No. 4,483,334, issued to William Murray and entitled “External Fixation Device”. The &#39;334 patent discloses a device for holding bone segments in known relation to each other. The apparatus includes a pair of bone clamp assemblies each secured to bone pins extending from the bone segments. A bridge extends between the pin clamp assemblies and a specialized high friction universal assembly connects the bridge to each of the pin clamp assemblies. 
     U.S. Pat. No. 5,207,676, issued to Jose Canadell et al., relates to an external fixator with controllable damping. This external fixator disclosed in the &#39;676 patent is for the correction and reduction of bone fragments. The apparatus comprises a bar fastened to a biocompression system on which the bar and system are disposed upon supports for fastening pins inserted into bones. 
     A spinal fixator reduction frame is the subject of U.S. Pat. No. 5,219,349. A reduction frame disclosed in the &#39;349 patent is secured to shaft handles extending from the pedicle screws of a Vermont Spinal Fixator type implant. Shaft clamps secure two T-handles of the reduction frame to the shaft handles. A lower-rod assembly joins the two opposite T-frames by means of lower-rod clamps. The shaft clamps are provided with four degrees of freedom. The joint between the lower-rod assembly and T-handle is provided with five degrees of freedom. The lower-rod assembly and the T-handle are provided with power screw threads to allow for precise translational control. The shaft clamps and lower-rod clamps are provided with taper fit joints to allow for infinite rotational adjustment and fixture. An upper-rod assembly is also provided on the T-handles to produce rotation of the T-handles by providing means for changing the distance between the upper ends of the T-handles. Finger grips are provided on the upper-rod assembly to allow the surgeon to easily use one hand to either apply or monitor the force acting along the upper-rod. 
     The Hardy U.S. Pat. No. 5,429,637, discloses an external modular fixator for immobilization of a fracture. The apparatus includes elements functioning as clamps and receiving anchor pins to be fixed in a predetermined angular position on either side of a fracture. A mobilization relay body is configured to be attached to the fracture. The mobilization body has a device for locking which is used to lock the clamps. A fixator and the mobilization relay bodies are lockable in various chosen arrangements. The device is shown affixed to a patient&#39;s lower arm and wrist area. 
     The Pennig U.S. Pat. No. 5,443,465 refers to an osteosynthesis aid which is used in particular for the fixation of a pelvis and includes a central body which is formed of at least two arm or link members, each of which has an elongated slot through which a lock bolt is passed to provide a releasable clamped joint and each of which also has releasably secured ball-joint connection to an end-connecting clamp for bone-pin or bone-screw anchorage to an afflicted bone. 
     A Russian Patent SU 1491-492-A1 discloses a femur neck fracture osteosynthesis device that has a support in the form of plates with inclined slots for pins. The plates have apertures for pin locks. The pin locks are designed in the form of threaded rods with nuts and washers. The plates are in parallel plane with an offset greater than the sum of the thickness of the plates and the pin diameter. The plates are interconnected by connecting pieces. Pins are passed after passing through the aiming pin and are locked by the pin locks. This device has an advantage of simplifying the design by allowing crossing-over angle in the planes parallel with the femur axis. 
     A patent that relates generally to orienting and securing a rod in a spatially adjusted position is the subject of the Jaquet U.S. Pat. No. 3,961,854, entitled “Apparatus For Orienting And Maintaining A Rod In Any Direction”. The Jaquet patent discusses maintaining an object which one desires to place in diverse orientations as for example, a table lamp, a reflector, and also to employ the same in surgical uses. 
     SUMMARY OF THE INVENTION 
     The present invention provides an improved bone fixator that enables the orthopedic surgeon to restore the patient&#39;s anatomy at a fracture following an injury. The present invention enables a surgeon to quickly manipulate the fixator and an articulating clamp (or clamps) to apply force to the ligaments in several directions so that the ligaments will reposition the bone fragments in their correct anatomical position and wherein a single fastener is tightened to rigidify the clamp and bone parts connected thereto. 
     Multiple pin clamps are placed along a rod to secure the rod to the bone. The pin clamps allow rotation around the bar as well as rotation around the clamp to allow the pins to be placed at a wide variety of angles and in multiple planes. A double pin clamp can be used to secure pins into selected bone parts such as the metacarpals of the hand. The multiple pin clamp also allows rotation about two axes. It can be rigidified in a selected position with a single fastener. 
     In the preferred embodiment, the pins are secured to the clamp by set screws. However, other clamping methods may be used (for example, clam shell clamps). The restoration of anatomical length is achieved by sliding the pin clamps along the rod to distract the ligaments. 
     For a wrist fracture, restoration of the volar tilt is achieved by loosening the set screws on the metacarpal pin clamp and rotating the rod to allow a vertical translation of the metacarpal pin clamp. Radial tilt can be restored by translating the metacarpal pins through the clamp to shift the wrist sideways. In extreme cases, the rotation can be adjusted by tightening the metacarpal pin clamp to the rod and rotating the rod. 
     The present invention provides an improved fixator apparatus for distal radius fractures that includes an elongated support rod having proximal and distal rod sections joined by a transverse rod section that offsets the proximal and distal rod sections. A pair of bends integrally joins the proximal and distal rod sections to the transverse rod section. Radius fixation pins are provided for engaging a patient&#39;s radius bone tissue. 
     Radius support clamps are rotatably supported upon the proximal rod section for externally supporting the patient&#39;s distal radius, the support clamps including openings that support the radius fixation pins. The support clamps allow rotation relative to the rod and relative to the radius fixation pins. Metacarpal fixation pins are provided for engaging the patient&#39;s metacarpal bone tissue. 
     Hand support clamps are rotatably supported upon the distal rod section for externally supporting the patient&#39;s hand. The hand support clamps include openings for holding the metacarpal fixation pins, the hand support clamps allowing rotation relative to the rod and relative to the metacarpal fixation pins. The proximal and distal rod sections are preferably generally parallel. 
     The proximal rod section has a central longitudinal axis and the radius support clamp and rod are so configured that the distal rod section is rotatable during use about the central longitudinal axis of the proximal rod section. 
     The metacarpal support clamp is slidable along the distal rod section during use for distracting the ligaments of the patient&#39;s wrist. 
     The rod and support clamps are so configured that volar tilt is achieved by rotating the distal rod section relative to the proximal rod section when the support clamps are rotated with respect to the rod. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     For a further understanding of the nature, objects, and advantages of the present invention, reference should be had to the following detailed description, read in conjunction with the following drawings, wherein like reference numerals denote like elements and wherein: 
     FIG. 1 is a perspective view of a first embodiment of the apparatus of the present invention; 
     FIG. 2 is a partial sectional view of the first embodiment of the apparatus of the present invention; 
     FIG. 3 is a partial perspective exploded view of the first embodiment of the apparatus of the present invention; 
     FIG. 4 is a partial perspective view of the first embodiment of the apparatus of the present invention; 
     FIG. 5 is a partial side view of the first embodiment of the apparatus of the present invention; 
     FIG. 6 is a partial end view of the first embodiment of the apparatus of the present invention; 
     FIG. 7 is a perspective view of the second embodiment of the apparatus of the present invention affixed to a patient&#39;s wrist area; 
     FIG. 8 is a partial perspective exploded view of a clamp that can be used with the first and second embodiments of the apparatus of the present invention; 
     FIG. 9 is a perspective view of the second embodiment of the apparatus of the present invention shown attached to a patient&#39;s leg bone; 
     FIG. 10 is a partial perspective view of the second embodiment of the apparatus of the present invention; and 
     FIG. 11 is a partial exploded perspective view of the second embodiment of the apparatus of the present invention. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     FIGS. 1-4 show generally the first embodiment of the apparatus of the present invention designated generally by the numeral  10  in FIG.  1 . Fixator  10 A is shown in FIG. 1 can be attached to a patient&#39;s fractured bone such as the distal radius  11 , wrist  12  and hand  13  at metacarpals  14 . 
     An elongated rod  15  includes a proximal rod section  16  and a distal rod section  17 . Rod sections  16  and  17  are preferably joined by a transverse rod section  18  and a pair of bends  19 ,  20 . The rod  15  is preferably integrally formed as shown, including proximal and distal rod sections  16 ,  17 , transverse rod section  18 , and bends  19 ,  20 . The rod ends  21 ,  22  can be provided with protective plastic end caps (not shown) to contain the pin clamps on the rod when the clamps are loosened. 
     One or more clamps  25  can be attached to proximal rod section  16 . In FIG. 1, a single radius pin clamp  25  is shown in the illustration. Each of the radius pin clamps  25  affixes to the radius bone pins  26 ,  27  as shown. The construction of pin clamps  25  is shown more particular in the parent patent application U.S. Ser. No. 08/349,323, filed Dec. 5, 1994, now U.S. Pat. No. 5,683,389 which is incorporated herein by reference. Each radius pin  26 ,  27  is surgically connected to the fractured radius  11  as shown. 
     Fixator  10 A also provides a distraction mechanism that can be used in combination with an improved, easily adjustable articulating clamp  23  as shown at the distal rod section  17  in FIG.  1 . Distraction clamp mechanism  24  clamps to proximal rod section  17  nearer to transverse rod section  18  Articulating clamp  23  is positioned in between distraction clamp  24  and rod end  22 . In FIGS.  1  and  3 - 6 , distraction clamp  24  includes a pair of clamp members  28 ,  29  that are hingedly connected together at hinge  30 . A cylindrically shaped recess  31  is defined upon a closure of distraction clamp  24  as shown in FIG.  3 . Each clamp member  28 ,  29  provides a respective half cylinder shaped slot  32 ,  33  that together define the cylindrical recess  34  upon closure. 
     Hinge  30  includes aligned openings in each clamp member  28 ,  29  that align and mount to bushing  34 . Each of the clamp members  28 ,  29  has an opening  35 ,  36  respectively that fits over bushing  34 . Each clamp member  28 ,  29  opening  35 ,  36  is cylindrically shaped and sized to closely fit the external surface and diameter of bushing  34 . Pin  37  fits through opening  38  in bushing  34  and then through bolt  40  at opening  39 . Countersunk distraction clamp bolt  40  extends through bushing  34  and engages articulating clamp  23  at internally threaded cylindrical opening  41 . Clamp  23  includes a pair of spaced apart flanges  42 ,  43 . Each flange  42 ,  43  provides an opening  44 ,  45 , respectively for accommodating bolt  46 . The clamp  23  includes a generally cylindrically shaped slot  47  that is generally parallel to threaded opening  41  and bolt  40  as shown in FIG.  3 . Slot  47  engages distal section  17  of rod  15  during use. 
     Pin block  48  attaches to clamp  23  at hemispherical recess  49 . Pin block  48  provides a correspondingly shaped hemispherical projection  50  that engages recess  49  as shown in FIG. 3. A cylindrically shaped opening  51  receives pin  52 . Pin  52  has internally threaded opening  53  for receiving the threaded shaft  54  of machine screw  46 . 
     Hemispherical projection  50  has an arcuate slot  55  that allows threaded shaft  54  of screw  46  to pass therethrough. This allows the projection  50  to articulate with respect to recess  49  and clamp flanges  42 ,  43 . Pin block  48  includes a plurality of openings  56 - 58  that accommodate a plurality of bone pins such as the pins  59 - 61 . Pins  59 - 61  are surgically affixed to the patient&#39;s bone tissue as seen in FIG.  1 . Set screws  62 - 64  are used to affix each pin  59 - 61  to pin block  48 . Each set screw  62 - 64  travels in a threaded opening  65 - 67  respectively of pin block  48 . 
     In order to articulate pin block  48  relative to flanges  42 ,  43  the user simply loosens machine screw  46 . This allows articulation of block  48  in multiple directions and into multiple angular positions with reference to flanges  42 ,  43  and distal rod  17 . Pin block  48  is free to rotate and pivot with reference to rod  17  when machine screw  46  is loosened. Clamp  23  can be attached to rod  17  as shown in FIG.  1 . Clamp  23  can also travel longitudinally along rod or rotate about rod section  17  for adjustment. 
     Distraction can be achieved by fixedly clamping distraction clamp  28  to rod section  17  by tightening set screw  68 . A loosening of screw  68  allows clamp  28  to be adjusted into desired positions on rod distal end section  17 . Once set screw  68  is tightened, the user can then move clamp  23 , the attached pins  59 - 61  and the surgically pinned metacarpals  14  relative to clamp  24  by rotating screw  40  thereby accomplishing the desired distraction. 
     FIGS. 7-12 show a second embodiment of the apparatus of the present invention, designated generally by the numeral  10 B in FIG.  7 . Fixator apparatus  10 B utilizes rod  70  having proximal  71  and distal  72  end portions and a generally straight, linear central longitudinal axis. The embodiment of FIG. 7 can use multiple clamps such as the clamp  23  of FIGS. 1-3 and  8  or the clamp assemblies  73 - 74  of FIGS. 9-12. In FIG. 7, the fixator apparatus is shown with two articulating clamp assemblies  73  (see also FIG.  10 ),  74  (see also FIG. 11) on a patient&#39;s distal radius  11  and wrist  12 . 
     In FIG. 8, the clamp  23 A shown is similar to the clamp  23  of FIG. 3, but without the distraction mechanism that is a part of the clamp  23  in FIG.  3 . In FIG. 8, the clamp  23 A has a clamp body  23 B that is comprised of a pair of flanges  42 A,  43 A having a gap therebetween. Cylindrically-shaped opening  47 A conforms to the outer surface of rod  70 . The pin block  48  is the same construction as that shown in FIG. 3, including openings  56 A- 58  for accepting pins  59 - 61  and set screws  63 - 64 . Opening  65 - 67  receive the set screws  62 - 64 . Nut  52  connects with bolt  46 . The threads  54  of bolt  46  engage the internal threads  53  of nut  52  as with the embodiment of FIG.  3 . 
     The construction of clamps  73  and  74  is shown more particularly in FIGS. 10 and 11 respectively. FIG. 9 shows the second embodiment of the apparatus of the present invention connected to a patient&#39;s leg bone  75 . In FIG. 9, the leg bone  75  is shown as a fractured leg bone. The fracture site  76  has broken the bone  75  into a proximal bone segment  77  and a distal bone segment  78 . Proximal bone pins  79  are affixed to the proximal bone segment  75 . Similarly, distal bone pins  80  are affixed to the distal bone segment  78  as shown in FIG.  9 . In FIG. 10, the clamp assembly  73  includes a clamp body  81  having a pair of flanges  82 ,  83  with gap  84  therebetween. A cylindrical recess  85  enables the clamp body  81  to be attached to rod  70  as shown in FIG.  10 . Hemispherical recess  86  on clamp body  81  accepts projecting portion  97  of block  93 . Flange  83  has a countersunk recess  87  that receives the conical head  88  of set screw  89 . Each of the flanges  82 ,  83  has an opening so that the set screw  89  can pass through the flanges  82 ,  83  and form a connection with nut  90  when the external threads  92  of set screw  89  engage the internally threaded opening  91  of nut  90 . This occurs when the nut  90  occupies cylindrical bore  94  of block  93 . An arcuate slot  95  enables the block  93  to angulate relative to set screw  89  and clamp body  81  when the set screw  89  is loosened slightly. The set screw  89  can also be loosened so that the block  93  rotates with respect to clamp body  81 . This combination of angulation and rotation of block  93  relative to clamp body  81  provides an almost universal articulating connection between the primary rod section  70  and secondary rod section  98 . The rod section  98  occupies cylindrical bore  99  of block  93 . The block  93  can slide along rod  98  and be affixed thereto at a selected position using set screw  109  that threadably engages the internally threaded opening  96  in block  93 . The internally threaded opening  96  communicates with bore  99  so that when the user tightens the set screw  109  it engages the outer surface of rod  98 . 
     Secondary rod  98  carries a pair of clamps  100 A,  100 B. The clamp  100 A has a pair of flanges  101 ,  102  with a gap  103  therebetween. Set screw  104  extends through openings in flanges  101 ,  102  and engages internally threaded sleeve  108 A at the cylindrically shaped internally threaded bore  111  thereof. Cylindrical opening  110  through sleeve  108 A receives a distal bone pin  80 . Set screw  109  also engages internally threaded bore  111  to form a clamped connection with pin  80  holding it in a selected position. 
     Clamp  100 B includes a pair of flanges  101 ,  102  with a gap  103  therebetween. Opening  106  receives set screw  104 . The set screw  104  is externally threaded to engage the internally threaded bore  111  of sleeve  108 B. Opening  110  in sleeve  108 B receives bone pin  80 . Set screw  109  engages internally threaded bore  111  of sleeve  108 B to clamp bone pin  80  in a selected position. Openings  107  in the clamps  100 A,  100 B enable the clamps  100 A,  100 B to be mounted on rod secondary rod section  98 . Each of the clamps  100 A,  100 B can have a countersunk recess  105  at flange  100  for cooperating with a correspondingly shaped head portion of set screw  104 . 
     In FIG. 11, clamp  74  is shown. Clamp  74  is similar in construction to the clamp  73  of FIG. 10 but with an added distraction feature. The clamp  74  includes secondary rod  98 , block  93 , and clamps  100 A,  100 B. However, a distraction clamp body  115  mounts to primary rod  70  at cylindrical bore  122 . Clamp body  115  includes a pair of flanges  116 ,  117  with a gap  118  therebetween. Hemispherically-shaped recess  119  receives the projecting portion  97  of block  93 . Set screw  120  cooperates with a countersunk opening  121  portion of flange  117 . An opening in each of the flanges  116 ,  117  allows set screw  120  to pass through flanges  116 ,  117  in order to engage nut  90  at its internally threaded opening  91 . As with the clamp  73  of FIG. 10, slot  95  allows angulation between block  93  and clamp body  115 . Clamp body  115  provides a cylindrically-shaped opening  122  that is sized and shaped to fit the outside surface of rod  70 . Set screw  123  engages a correspondingly shaped internally threaded opening that extends through clamp body  115  to communicate with bore  122 . In this fashion, a user simply tightens the set screw  123  to affix the rod  70  with respect to the clamp body  115  in a desired position. 
     Internally threaded opening  124  receives threaded shaft  135  of bolt  128 . Clamp body  125  carries bolt  128 . The clamp body  125  is comprised of a pair of clamped members  126 ,  127  that are hingedly connected together at hinge  129 . A cylindrically-shaped recess  130  enables rod  70  to extend through clamp body  125 . Set screw  131  engages internally threaded openings  132 ,  133  and the clamp members  126 ,  127 . This enables the set screw  131  to be tightened, closing the gap  134  and clamping the clamp body  125  to rod  70 . 
     During use, a very universal articulating connection can thus be formed between either of the clamps  73  or  74  and rod  70  relative to bone parts  77 ,  78  or a patient&#39;s radius  11  and wrist  12 . This is accomplished by the ability to rotate the clamp body  81  relative to rod  70 , or the clamp body  115  relative to the rod  70 . Further, the block  93  of either clamp  73  or  74  can articulate and rotate relative to the clamp body  81  or  115 . Additionally, the connection between rod  98  and block  93  is a sliding and rotating connection. Further, each block  93  can angulate relative to its associate clamp body  81  or  115 . The clamps  100 A,  100 B can slide along secondary rod  98  or rotate with respect thereof. Further, the bone pins  79  and  80  can rotate with respect to the clamps  100 A,  100 B. Additionally, the bone pins  79  and  80  can slide in their respective sleeves  100 A,  100 B. 
     The following table lists the parts numbers and parts descriptions as used herein and in the drawings attached hereto. 
     
       
         
               
             
               
               
             
           
               
                   
               
               
                 PARTS LIST 
               
             
          
           
               
                 Part Number 
                 Description 
               
               
                   
               
               
                  10A 
                 fixator apparatus 
               
               
                  10B 
                 fixator apparatus 
               
               
                 11 
                 distal radius 
               
               
                 12 
                 wrist 
               
               
                 13 
                 hand 
               
               
                 14 
                 metacarpals 
               
               
                 15 
                 rod 
               
               
                 16 
                 proximal rod section 
               
               
                 17 
                 distal rod section 
               
               
                 18 
                 transverse rod section 
               
               
                 19 
                 bend 
               
               
                 20 
                 bend 
               
               
                 21 
                 rod end 
               
               
                 22 
                 rod end 
               
               
                 23 
                 clamp 
               
               
                  23A 
                 clamp 
               
               
                  23B 
                 clamp body 
               
               
                 24 
                 distraction clamp mechanism 
               
               
                 25 
                 radius pin clamp 
               
               
                 26 
                 radius pin 
               
               
                 27 
                 radius pin 
               
               
                 28 
                 clamp member 
               
               
                 29 
                 clamp member 
               
               
                 30 
                 hinge 
               
               
                 31 
                 recess 
               
               
                 32 
                 slot 
               
               
                 33 
                 slot 
               
               
                 34 
                 bushing 
               
               
                 35 
                 opening 
               
               
                 36 
                 opening 
               
               
                 37 
                 pin 
               
               
                 38 
                 opening 
               
               
                 39 
                 opening 
               
               
                 40 
                 bolt 
               
               
                 41 
                 opening 
               
               
                 42 
                 flange 
               
               
                  42A 
                 flange 
               
               
                 43 
                 flange 
               
               
                  43A 
                 flange 
               
               
                 44 
                 opening 
               
               
                 45 
                 opening 
               
               
                 46 
                 bolt 
               
               
                 47 
                 opening 
               
               
                  47A 
                 opening 
               
               
                 48 
                 pin block 
               
               
                 49 
                 recess 
               
               
                  49A 
                 recess 
               
               
                 50 
                 hemispherical projection 
               
               
                 51 
                 opening 
               
               
                 52 
                 nut 
               
               
                 53 
                 internally threaded opening 
               
               
                 54 
                 threaded shaft 
               
               
                 55 
                 slot 
               
               
                 56 
                 opening 
               
               
                 57 
                 opening 
               
               
                 58 
                 opening 
               
               
                 59 
                 pin 
               
               
                 60 
                 pin 
               
               
                 61 
                 pin 
               
               
                 62 
                 set screw 
               
               
                 63 
                 set screw 
               
               
                 64 
                 set screw 
               
               
                 65 
                 threaded opening 
               
               
                 66 
                 threaded opening 
               
               
                 67 
                 threaded opening 
               
               
                 68 
                 set screw 
               
               
                 69 
               
               
                 70 
                 rod 
               
               
                 71 
                 proximal end 
               
               
                 72 
                 distal end 
               
               
                 73 
                 clamp assembly 
               
               
                 74 
                 clamp assembly 
               
               
                 75 
                 leg bone 
               
               
                 76 
                 fracture site 
               
               
                 77 
                 proximal bone segment 
               
               
                 78 
                 distal bone segment 
               
               
                 79 
                 bone pin, proximal 
               
               
                 80 
                 bone pin, distal 
               
               
                 81 
                 clamp body 
               
               
                 82 
                 flange 
               
               
                 83 
                 flange 
               
               
                 84 
                 gap 
               
               
                 85 
                 cylindrical recess 
               
               
                 86 
                 hemispherical recess 
               
               
                 87 
                 countersunk recess 
               
               
                 88 
                 conical head 
               
               
                 89 
                 set screw 
               
               
                 90 
                 nut 
               
               
                 91 
                 internally threaded opening 
               
               
                 92 
                 external threads 
               
               
                 93 
                 block 
               
               
                 94 
                 cylindrical bore 
               
               
                 95 
                 arcuate slot 
               
               
                 96 
                 internal threaded opening 
               
               
                 97 
                 projecting portion 
               
               
                 98 
                 rod 
               
               
                 99 
                 cylindrical bore 
               
               
                  100A 
                 clamp 
               
               
                  100B 
                 clamp 
               
               
                 101 
                 flange 
               
               
                 102 
                 flange 
               
               
                 103 
                 gap 
               
               
                 104 
                 set screw 
               
               
                 105 
                 countersunk recess 
               
               
                 106 
                 internally threaded opening 
               
               
                 107 
                 cylindrical bore 
               
               
                  108A 
                 internally threaded sleeve 
               
               
                  108B 
                 internally threaded sleeve 
               
               
                 109 
                 set screw 
               
               
                 110 
                 cylindrical opening 
               
               
                 111 
                 internally threaded bore 
               
               
                 115 
                 distraction clamp body 
               
               
                 116 
                 flange 
               
               
                 117 
                 flange 
               
               
                 118 
                 gap 
               
               
                 119 
                 hemispherically-shaped recess 
               
               
                 120 
                 set screw 
               
               
                 121 
                 countersunk opening 
               
               
                 122 
                 cylindrical bore 
               
               
                 123 
                 set screw 
               
               
                 124 
                 internally threaded opening 
               
               
                 125 
                 clamp body 
               
               
                 126 
                 clamp member 
               
               
                 127 
                 clamp member 
               
               
                 128 
                 bolt 
               
               
                 129 
                 hinge 
               
               
                 130 
                 cylindrically-shaped recess 
               
               
                 131 
                 set screw 
               
               
                 132 
                 countersunk opening 
               
               
                 133 
                 internally threaded bore 
               
               
                 134 
                 gap 
               
               
                 135 
                 threaded shaft 
               
               
                   
               
             
          
         
       
     
     The foregoing embodiments are presented by way of example only; the scope of the present invention is to be limited only by the following claims.