Patent Publication Number: US-2022211394-A1

Title: Locking trocar and method of using the same

Description:
TECHNICAL FIELD 
     The present disclosure relates to systems, kits, assemblies, and methods for the alignment and attachment of an aiming guide to a bone plate for attachment to an intramedullary nail in a medullary canal of the bone. 
     BACKGROUND 
     Intramedullary nails have long been used to treat fractures in long bones of the body such as the femur, the tibia, the humerus, and the like. To treat such fractures, the intramedullary nail is inserted into a medullary canal of the long bone such that the nail extends spans across one or more fractures in the long bone to segments of the long bone that are separated by the one or more fractures. Bone anchors are then inserted through the bone and into the intramedullary nail on opposing sides of the fracture, thereby fixing the intramedullary nail to the bone. The intramedullary nail can remain in the medullary canal at least until the fracture is fused. 
     The foregoing background discussion is intended solely to aid the reader. It is not intended to limit the innovations described herein. Thus, the foregoing discussion should not be taken to indicate that any particular element of a prior system is unsuitable for use with the innovations described herein, nor is it intended to indicate that any element is essential in implementing the innovations described herein. 
     SUMMARY 
     In conventional intramedullary nailing techniques, a surgeon needs to lock the nail to both the distal and proximal fracture fragments after inserting the nail into the bone. To complete this technique, a series of sleeves are used to expose the target screw location, drill a pilot hole along the appropriate trajectory, and provide guidance to insert the screw through the nail. The sleeves can also be used to apply pressure to the bone as a reduction force or to temporarily hold other hardware. Current methods for this technique may be adequate for drilling and inserting a screw, but lack the ability to quickly and reliably apply and release pressure. 
     The foregoing needs are met, to a great extent, by the system and method disclosed in the present application. 
     According to an aspect of the present disclosure, a guide sleeve assembly in combination with an aiming arm system is configured to apply pressure to a lateral attachment plate and/or washer (e.g. bone plate) to hold the plate to the bone during drilling and/or screwing for the nail locking elements. The guide sleeve assembly can be applied to any circumstance whereby the surgeon needs to apply lateral pressure (e.g. to the bone as a reduction force), and lock the position of the sleeve assembly relative to the plate. 
     The aiming arm system includes an aiming arm guide hole for directing the guide sleeve assembly. The geometry of the guide sleeve assembly can include a non-cylindrical outer profile formed by removing material from an outer diameter along a length of an outer sleeve guide. The aiming arm guide hole includes a crossing pin (e.g. retention element) which forms a chord in the guide hole profile. When the outer sleeve guide is inserted in an unlocked orientation, the cross pin passes freely along the sleeve guide. When the outer sleeve guide is rotated in the aiming arm guide hole relative to the crossing pin, the sleeve guide creates a cam mechanism between a full outer diameter of the sleeve guide and the cross pin. This forms an interference fit between the outer sleeve guide and the cross pin, that produces enough friction between the sleeve guide and pin to substantially prevent axial movement of the sleeve guide in the guide hole. 
     According to another aspect of the present disclosure, an aiming arm system is provided. The aiming arm system comprises an aiming arm and a guide sleeve. The aiming arm has 1) an aiming arm body and a guide hole that extends through the aiming arm body along a central guide hole axis, wherein the aiming arm is configured to be positioned such that the central guide hole axis is aligned with a target location of an anatomical implant, and 2) a retention element supported relative to the aiming arm body. The guide sleeve extends along a central guide sleeve axis that is oriented along a linear direction, and sized to be inserted through the guide hole in the linear direction. The relative rotation between the guide sleeve and the retention element transitions the aiming arm system between an unlocked configuration whereby the guide sleeve is insertable through the guide hole along the linear direction, and a locked configuration whereby the retention element applies a retention force to the guide sleeve that substantially prevents the guide sleeve from moving further along the linear direction. 
     According to another aspect of the present disclosure, a method for positioning a guide sleeve within a guide hole is disclosed. The method comprises: moving a guide sleeve within a guide hole defined by an aiming arm, wherein the guide hole extends through the aiming arm body along a central guide hole axis, wherein the aiming arm is configured to be positioned such that the central guide hole axis is aligned with a target location of an anatomical implant, the aiming arm supporting a retention element; inserting the guide sleeve into the guide hole in a linear direction, wherein the guide sleeve extends along a central guide sleeve axis that is oriented along the linear direction; and transitioning the aiming arm between an unlocked configuration whereby the guide sleeve is insertable through the guide hole along the linear direction, and a locked configuration whereby the retention element applies a retention force to the guide sleeve that substantially prevents the guide sleeve from moving along the linear direction. The transitioning step occurs by relative rotation between the guide sleeve and the retention element. 
     This summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description section. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used to limit the scope of the claimed subject matter. Furthermore, the claimed subject matter is not constrained to limitations that solve any or all disadvantages noted in any part of this disclosure. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The foregoing summary, as well as the following detailed description of illustrative embodiments of the intervertebral implant of the present application, will be better understood when read in conjunction with the appended drawings. For the purposes of illustrating the expandable intervertebral implant of the present application, there is shown in the drawings illustrative embodiments. It should be understood, however, that the application is not limited to the precise arrangements and instrumentalities shown. In the drawings: 
         FIG. 1  illustrates a perspective view of a system according to one aspect having a guide sleeve assembly supported by an aiming arm system that is attached to an intramedullary nail received in a medullary canal of a bone; 
         FIG. 2  illustrates a top perspective view of an aiming arm body, according to an aspect of this disclosure; 
         FIG. 3  illustrates a front view of the aiming arm body shown in  FIG. 2 ; 
         FIG. 4  illustrates a cross-sectional view of the aiming arm body taken along line  4 - 4  shown in  FIG. 3 ; 
         FIG. 5  illustrates a top view of the aiming arm body shown in  FIG. 2 ; 
         FIG. 6A  illustrates a close-up top view of the aiming arm body shown in box  6  of  FIG. 5 ; 
         FIG. 6B  illustrates a close-up top view of an alternative aspect of the aiming arm body shown  FIG. 6A ; 
         FIG. 7  illustrates a side view of the aiming arm body shown in  FIG. 2 ; 
         FIG. 8  illustrates a cross-sectional view of the aiming arm body taken along line  8 - 8  shown in  FIG. 7 ; 
         FIG. 9  illustrates a perspective view of a retention element, according to an aspect of this disclosure; 
         FIG. 10  illustrates a side view of the retention element shown in  FIG. 9 ; 
         FIG. 11  illustrates a top view of the retention element shown in  FIG. 9 ; 
         FIG. 12  illustrates a perspective view of a bone plate, according to an aspect of this disclosure; 
         FIG. 13  illustrates a perspective view of a guide sleeve assembly, according to an aspect of this disclosure; 
         FIG. 14  illustrates a top view of an outer guide sleeve, according to an aspect of this disclosure; 
         FIG. 15  illustrates a cross-sectional view of the outer guide sleeve taken along line  15 - 15  in  FIG. 14 ; 
         FIG. 16  illustrates a view of the guide sleeve assembly supporting the bone plate shown in  FIG. 12  against a bone, according to an aspect of this disclosure; 
         FIG. 17  illustrates a front view of the outer guide sleeve shown in  FIG. 14 ; 
         FIG. 18  illustrates a rear view of the outer guide sleeve shown in  FIG. 14 ; 
         FIG. 19  illustrates a perspective view of an inner guide sleeve, according to an aspect of this disclosure; 
         FIG. 20  illustrates a top view of the inner guide sleeve shown in  FIG. 19 ; 
         FIG. 21  illustrates a cross-sectional view of the inner guide sleeve taken along line  21 - 21  in  FIG. 20 ; 
         FIG. 22  illustrates a front view of the inner guide sleeve shown in  FIG. 19 ; 
         FIG. 23  illustrates a rear view of the outer guide sleeve shown in  FIG. 19 ; 
         FIG. 24  illustrates a top view of the aiming arm body shown in  FIG. 2  with the retention element shown in  FIG. 9  and the guide sleeve assembly shown in  FIG. 13  both positioned within the aiming arm body, according to an aspect of this disclosure; 
         FIG. 25A  illustrates a cross-sectional view of the aiming arm body, the retention element, and the guide sleeve assembly taken along line  25 - 25  shown in  FIG. 24  in an unlocked configuration; and 
         FIG. 25B  illustrates a cross-sectional view of the aiming arm body, the retention element, and the guide sleeve assembly taken along line  25 - 25  shown in  FIG. 24  in an locked configuration. 
     
    
    
     DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS 
     The present disclosure can be understood more readily by reference to the following detailed description taken in connection with the accompanying figures and examples, which form a part of this disclosure. It is to be understood that this disclosure is not limited to the specific devices, methods, applications, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the scope of the present disclosure. Also, as used in the specification including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. 
     Certain terminology used in this description is for convenience only and is not limiting. The words “top”, “bottom”, “distal”, “proximal”, “inward”, “outward”, “inner”, “outer”, “above”, “below”, “axial”, “transverse”, “circumferential,” and “radial” designate directions in the drawings to which reference is made. The words “inner”, “internal”, and “interior” refer to directions towards the geometric center of the implant and/or implant adjustment tools, while the words “outer”, “external”, and “exterior” refer to directions away from the geometric center of the implant and/or implant adjustment tools. The words, “anterior”, “posterior”, “superior,” “inferior,” “medial,” “lateral,” and related words and/or phrases are used to designate various positions and orientations in the human body to which reference is made. The term “plurality”, as used herein, means more than one. When a range of values is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment. All ranges are inclusive and combinable. The terminology includes the above-listed words, derivatives thereof and words of similar import. 
     As used herein, the term “substantially” and derivatives thereof, and words of similar import, when used to describe a size, shape, orientation, distance, spatial relationship, or other parameter includes the stated size, shape, orientation, distance, spatial relationship, or other parameter, and can also include a range up to 10% more and up to 10% less than the stated parameter, including 5% more and 5% less, including 3% more and 3% less, including 1% more and 1% less. 
     Referring to  FIG. 1 , a system  10  is shown that is configured to position a bone plate  30  against a surface of a bone  70  as the bone plate  30  is fastened to the bone  70  and an intramedullary nail  60 . In general, the system  10  comprises an aiming arm system  100  that facilitates the alignment of the bone plate  30  with the bone  70  and the intramedullary nail  60 . The aiming arm system  100  releasably attaches to a proximal end of the intramedullary nail  60  and comprises an aiming arm body  101  that has at least one aiming guide  104  (e.g. aiming arm) and a handle  90 . The aiming arm system  100  can facilitate alignment of the bone plate  30  such that axes A S1  and A S2  of the bone plate  30  are aligned with corresponding bone-anchor apertures of the intramedullary nail  60 . For example, an axis A B1  of the bone plate  30  can be aligned with a first aperture of the bone plate  30  and a first bone-anchor opening that extends through the intramedullary nail  60 , and the axis A B2  of the bone plate  30  can be aligned with a second aperture of the bone plate  30  and a second bone-anchor opening that extends through the intramedullary nail  60 . 
     The system  10  can further comprise at least one guide sleeve assembly  300 . The aiming arm system  100  supports the guide sleeve assembly  300  so as to align the guide sleeve assembly  300  with the bone plate  30  and the intramedullary nail  60 . For example, the axis A B1  of the bone plate  30  can be aligned with a first guide sleeve assembly  300  and the axis A B2  of the bone plate  30  can be aligned with a second guide sleeve assembly  300 , as is further described below. The system  10  can further comprise at least one retention element  150  for securing each at least one guide sleeve assemblies  300  to the aiming arm system  100 , as further described herein. 
     The system  10  can further comprise one or more of the bone plates  30 , at least one bone anchor  40  such as a bone screw, the aiming arm system  100 , an intramedullary nail  60 , and one or more guide sleeve assemblies  300 . The intramedullary nail  60  is elongate generally along a superior-inferior direction SI and is sized to be received in a medullary canal of a long bone such as a femur, tibia, or humerus. 
     The intramedullary nail  60  can be implanted by driving the nail  60  into a medullary canal of the bone  70 . In so doing, the handle  90  can be attached to the nail  60 , and a medical professional such as a surgeon can hold the handle to guide the intramedullary nail  60  into the medullary canal. 
     To secure the intramedullary nail  60  to the bone  70 , the intramedullary nail  60  can define at least one bone-anchor fixation hole that extends at least partially through the intramedullary nail  60 . For example, the intramedullary nail  60  can include at least one proximal bone-anchor fixation hole at a proximal portion of the intramedullary nail  60  and at least one distal bone-anchor fixation hole at a distal portion of the intramedullary nail  60 . The intramedullary nail  60  can be secured to the bone  70  by (1) drilling, for each bone-anchor fixation hole, a hole in the bone that aligns with the bone-anchor fixation hole, and (2) inserting, for each bone-anchor fixation hole, a bone anchor  40  through the bone  70  and into the bone-anchor fixation hole such that the bone anchor  40  engages the bone  70  on at least one side, such as opposed sides, of the intramedullary nail  60 . 
     This procedure, however, can present several difficulties. For example, the proximal and distal bone-anchor fixation holes are not visible to the surgeon since the intramedullary nail  60  is disposed inside the bone  70 . Moreover, as the intramedullary nail  60  is driven into the medullary canal, the intramedullary nail  60  can bend by an undetermined amount. This bending can make it difficult to predict with accuracy the location and orientation of the bone-anchor fixation holes. Therefore, a targeting system or systems can be employed to determine the location of each bone-anchor fixation hole, and/or align a cutting instrument such as a drill bit with each bone-anchor fixation hole. Once the location of a bone-anchor fixation hole is determined and/or the cutting instrument is aligned with the bone-anchor fixation hole, a hole can be drilled into the bone to the bone-anchor fixation hole. The bone anchor  40  can subsequently be inserted through the bone and into the bone-anchor fixation hole. 
     One method of targeting the at least one bone-anchor fixation hole includes using fluoroscopy to obtain moving X-ray images of the position of the drill bit relative to the bone-anchor fixation hole in real-time. However, the use of fluoroscopy can over expose the patient, and particularly the surgeon who performs numerous such procedures, to harmful X-rays. As an alternative to fluoroscopy, the aiming arm system  100  can be coupled to the intramedullary nail  60 , and the aiming arm system  100  can be used to target at least one of the bone-anchor fixation holes with a cutting instrument such as a drill bit. Generally, the aiming arm system  100  can include an alignment aperture that aligns with at least one bone-anchor fixation hole when the aiming arm system  100  is affixed to the intramedullary nail  60 . The cutting instrument can then be guided into the alignment aperture and through the bone to the bone-anchor fixation hole. 
     To strengthen the attachment between the bone anchor  40  and the bone  70 , the bone anchor  40  can be further secured to the bone plate  30  that is positioned against the outer surface of the bone  70  and that is further secured to the bone  70  via one or more additional bone anchors. For example, the bone plate  30  can be positioned against the bone, and a first bone anchor can be inserted into an aperture in the plate  30 , through the surface of the bone  70 , and into the intramedullary nail  60 , such that the first bone anchor attaches to the plate  30 , the bone  70 , and the intramedullary nail  60 . Further, one or more other bone anchors can be inserted into the plate  30  adjacent the first bone anchor such that the one or more other bone anchors terminate in the bone with or without passing into the intramedullary nail  60 . The one or more other bone anchors provide additional fixation to the bone that can reduce loading on the first bone anchor. 
     Aligning and supporting the bone plate  30  on the bone  70  while the bone plate is being secured to the bone  70  can present challenges. For example, the bone plate must be gripped and/or secured to the bone to maintain the position of the bone plate  30  relative to the intramedullary nail  60  while inserting a bone anchor  40  through an aperture in the plate  30 , through the bone  70 , and into an aperture in the nail  60 . If a hole is pre-drilled prior to insertion to the bone anchor  40 , the position of the plate  30  may also need to be maintained while a hole is drilled through the bone  70  and into the aperture in the nail  60 . The guide sleeve assembly  300  is configured to secure the bone plate  30  to the bone  70  during the process of securing the bone anchor  40  to the intramedullary nail  60 . 
     The aiming arm system  100  is configured to quickly couple to, and quickly decouple from, the insertion handle  90 . The insertion handle  90  is also configured to couple to the intramedullary nail  60 . The guide sleeve assembly  300  is configured to support and retain a position of the bone plate  30  against the bone  70 . The aiming arm system  100  is configured to support the guide sleeve assembly  300 . It will be understood, however, that the guide sleeve assembly  300 , the insertion handle  90 , the intramedullary nail  60 , and the guide sleeve assembly  300  can be distributed separately from one another or can be distributed in groups of two or more of the aiming arm system  100 , the insertion handle  90 , the intramedullary nail  60 , and the guide sleeve assembly  300 . Therefore, examples of the present disclosure can include as few as one of the insertion handle  90 , the intramedullary nail  60 , and the guide sleeve assembly  300 , or more than one of the aiming guide  100 , the insertion handle  90 , the intramedullary nail  60 , and the guide sleeve assembly  300 . 
     Referring to  FIGS. 2-8 , the aiming arm system  100  may include the aiming arm body  101 . The aiming arm body  101  includes a coupler  102  and at least one aiming arm  104  that extends away from the coupler  102 . The at least one aiming arm  104  defines at least one guide hole  106  therethrough. The coupler  102  is configured to couple the aiming arm system  100  to the insertion handle  90  such that the at least one guide hole  106  is positioned to guide an instrument, such as the guide sleeve assembly  300 , towards at least one bone-anchor fixation hole of the intramedullary nail  60  when the insertion handle  90  is coupled to the intramedullary nail  60 . It will be appreciated that the at least one guide hole  106  can target locations within the bone  70  external from the intramedullary nail  60  (e.g. mistarget the nail  60 ). 
     The aiming arm system  100  has an inner guide surface  108 , and an outer guide surface  110  that is opposite the inner surface  108 . The inner guide surface  108  can be positioned closer to the intramedullary nail  60  than the outer guide surface  110  when the aiming arm system  100  is coupled to the intramedullary nail  60 . The aiming arm system  100  has a leading end  105  and a trailing end  107 . The leading end  105  can be spaced from the trailing end  107  along an insertion direction I. Each guide hole  106  can extend entirely through the aiming arm body  101  from the inner guide surface  108  to the outer guide surface  110 . 
     The at least one aiming arm  104  can include a pair of aiming arms that extend away from the coupler  104  in opposite directions. Each aiming arm  104  can extend partially around a central axis A L  (see  FIG. 1 ) that extends along the insertion direction I. For example, each aiming arm  104  can extend in a circumferential direction that extends circumferentially about the intramedullary nail  60  when the aiming arm system  100  is coupled to the intramedullary nail  60 . Each aiming arm  104  can be coupled to the aiming arm body  101 , or each aiming arm  104  can be formed as a single unitary piece with the aiming arm body  101 . The aiming arms  104  can have any suitable configuration. 
     Each aiming arm  104  has at least one guide hole  106  that extends through the aiming arm  104 . Each guide hole  106  extends along a central guide hole axis A C  oriented along a first linear direction L 1 . The central guide hole axis A C  is aligned with one of the bone-anchor fixation holes of the intramedullary nail  60  when the aiming arm system  100  is coupled to the intramedullary nail  60  by the insertion handle  90 . For example, a first guide hole  106   a  can extend along a first central guide hole axis A C1  that can align with the axis A B1  of the bone plate  30 , and a second guide hole  106   b  can extend along a second central guide hole axis A C2  that can align with the axis A B2  of the bone plate  30 . The alignment of the first central guide hole axis A C1  with the axis A B1  of the bone plate  30  can align the first guide hole  106   a  with the first bone-anchor opening (e.g. a target location of an anatomical implant) of the intramedullary nail  60 . Similarly, the alignment of the second central guide hole axis A C2  with the axis A B2  of the bone plate  30  can align the second guide hole  106   b  with the second bone-anchor opening (e.g. another target location of an anatomical implant) of the intramedullary nail  60 . 
     The aiming arm body  101  can include one or more additional aiming arms  112 . For example, each aiming arm  104  can include an aiming arm  112  extending therefrom. In an aspect, each additional aiming arm  112  extends from a respective aiming arm  104  in the insertion direction I. Each additional aiming arm  112  can include an alignment aperture  114  extending therethrough from the inner guide surface  108  to the outer guide surface  110 . Each alignment aperture  114  can align with a corresponding aperture in the bone plate  30  and/or a corresponding bone-anchor aperture in the intramedullary nail  60 . Each additional aiming arm  112  can be coupled to the aiming arm  104 , or each additional aiming arm  112  can be formed as a single unitary piece with the aiming arm body  101 . 
     The first guide hole  106   a  and the second guide hole  106   b  are defined by a first guide hole surface  116   a  and a second guide hole surface  116   b , respectively. Each guide hole surface can be configured substantially similarly and aspects described in regard to the first guide hole  106   a  can also apply to aspects of the second guide hole  106   b . The first guide hole surface  116   a  can extend circumferentially about the first central guide hole axis A C1  forming a substantially cylindrical first guide hole  106   a . The first guide hole  106   a  extends through the aiming arm body  101  from a first opening  118   a  defined by the outer guide surface  110  to a second opening  120   a  defined by the inner guide surface  108 . The first guide hole  106   a  is sized to receive the guide sleeve assembly  300  at least partially within. 
     The aiming arm body  101  further has at least one retention hole  130  that extends at least partially through the aiming arm body  104 . Each retention hole  130  can extend from an opening  132  defined by an upper surface  134  of the aiming arm body  101  to a location  137  within the aiming arm body  101 . The upper surface  134  extends between the inner guide surface  108  and the outer guide surface  110 . Alternatively, each retention hole  130  can extend through the aiming arm body  101  from the upper surface  134  to either one of the inner guide surface  108  and the outer guide surface  110 . 
     Each retention hole  130  extends along a central retention axis A R  that is oriented along a second linear direction L 2 . For example, a first retention hole  130   a  can extend along a first retention hole axis A H1  oriented along a second linear direction L 2 , and a second retention hole  130   b  can extend along a second retention hole axis A H2  oriented along a second linear direction L 2 . The second linear direction L 2  can be angularly offset from the first linear direction L 1 . In an aspect, the second linear direction L 2  is substantially perpendicular to the first linear direction L 1 . 
     Referring to  FIGS. 4 and 6A , the first retention hole  130   a  and the second retention hole  130   b  are defined by a first retention hole surface  136   a  and a second retention hole surface  136   b , respectively. Each retention hole surface  136   a  and  136   b  can be configured substantially similarly and aspects described in regard to the first retention hole  106   a  can also apply to aspects of the second retention hole  136   b . The first retention hole surface  136   a  can extend circumferentially about the first retention hole axis A H1  forming a substantially cylindrical first retention hole  136   a . The first retention hole  136   a  is sized to receive a first retention element  150   a  at least partially within. 
       FIG. 6B  illustrates an alternative aspect of the first and second retention holes  130   a  and  130   b . The first retention hole surface  136   a  can include a flat portion  138   a  and a curved portion  140   a . The flat portion  138   a  and the curved portion  140   a  can extend along a length of the first retention hole surface  136   a  from a first opening  132   a  to a location  137   a  within the aiming arm body  101 . The curved portion  140   a  can extend at least partially about the first retention hole axis A H1  from a first end of the flat portion  138   a  to a second end of the flat portion  138   b . In an aspect, the curved portion  140   a  can form a spherical shape or partial spherical shape about the first retention hole axis A H1  when viewed along the second linear direction L 2 . The first retention element  150   a  can include an outer surface that defines a shape that corresponds to the shape of the first retention hole  130   a  when viewed along the second linear direction L 2 . It will be appreciated that each retention hole  130  can include other alternative sizes and shapes configured to receive the retention element  150  within, as further described herein. 
     Referring to  FIG. 8 , each of the first and second retention holes  130   a  and  130   b  can intersect with a corresponding first and second guide hole  106   a  and  106   b  within the aiming arm body  101 . For example, the first retention hole axis A H1  of the first retention hole  130   a  can be positioned relative to the first central guide hole axis A C1  of the first guide hole  106   a  such that a first intersection opening  142   a  is defined between the first retention hole surface  136   a  and the first guide hole surface  116   a . The opening  142   a  can be positioned between the first opening  118   a  of the first guide hole  106   a  and the second opening  120   a  of the first guide hole  106   a  along the first linear direction L 1 . In an aspect, the opening  142   a  can be positioned in a center of the first guide hole  106   a  along the first linear direction L 1 . The opening  142   a  can also be positioned between the first opening  132   a  of the first retention hole surface  136   a  and the location  137   a  within the aiming arm body  101  along the second linear direction L 2 . 
     Turning now to  FIGS. 9-11 , the aiming arm system  100  can further include the at least one retention element  150 , such as the first retention element  150   a  and a second retention element  150   b . The first retention element  150   a  includes a retention body  151   a  that has an outer retention surface  152   a . Although the first retention element  150   a  is illustrated and described herein, it will be appreciated that a second retention element  150   b  or other retention elements  150  can be included in the aiming arm system  100  and configured substantially similarly as the first retention element  150   a . Additionally, or alternatively, each retention element  150  can include different configurations consistent with the alternative aspects described herein. 
     The outer retention surface  152   a  extends about a central retention axis A R1  from a first end  154  to a second end  156 . The central retention axis A R1  is oriented along the second linear direction L 2  when the first retention element  150   a  is positioned within the first retention hole  130   a  such that the first retention axis A R1  is substantially parallel to the first retention hole axis A H1  of the first retention hole  130   a . The outer retention surface  152   a  defines a first protrusion  158  and a second protrusion  160  spaced from the first protrusion  158  in the second linear direction L 2 . Each of the first and second protrusions  158  and  160  can extend at least partially radially outward from the first retention axis A R1 . The outer retention surface  152   a  further defines a recessed portion  162  that extends between the first and second protrusions  158  and  160  in the second linear direction L 2 . The first and second protrusions  158  and  160  are spaced radially outward from the recessed portion  162  relative to the central retention axis A R1 . 
     The first outer retention surface  152   a  further includes a contact portion  164  and a curved portion  166 . The contact portion  164  and the curved portion  166  can extend along a length of the first retention body  151   a  from the first end  154  to the second end  156 . The contact portion  164  can include a substantially planar surface that extends substantially parallel to the central retention axis A R1  from the first end  154  to the second end  156  of the retention body  101 . Alternatively, the contact portion  164  can be curved or include any suitable alternatively shaped surface as desired. With reference to  FIG. 11 , the curved portion  166  can extend circumferentially about the central retention axis A R1  from a first end  168  of the contact portion  164  to a second end  170  of the contact portion  164 . The curved portion  166  can define a spherical shape or partial spherical shape about the first retention axis A R1  when viewed along the second linear direction L 2 . 
     Referring to  FIGS. 10 and 11 , the recessed portion  162  of the first outer retention surface  152   a  can extend substantially linearly along the second linear direction L 2  thereby defining a second flat portion of the first retention body  151   a . The first outer retention surface  152   a  further includes a first neck portion  172  that extends from the recessed portion  162  at least partially radially outward to the first protrusion  158 . The first outer retention surface  152   a  further includes a second neck portion  174  that extends from the recessed portion  162  at least partially radially outward to the second protrusion  160 . The first and second neck portions  172  and  174  can include a curved configuration, a linear configuration, combinations of curved and linear portions, or another shape. The configurations of the first and second protrusions  158  and  160 , the first and second neck portions  172  and  174 , and the recessed portion  162  are to facilitate flexing and/or bending (e.g. a deflection) of the recessed portion  162  radially outward from the central retention axis A R1 , as further described below. 
     The first outer retention surface  152   a  of the first retention body  151   a  further includes a first beveled edge  176  and a second beveled edge  178 . The first beveled edge  176  extends from the first end  154  toward the first protrusion  158  at least partially in the second linear direction L 2 . The second beveled edge  178  extends from the second end  156  toward the second protrusion  160  at least partially in a direction opposing the second linear direction L 2 . The first and/or second beveled edge  176  and  178  can facilitate insertion of the first retention element  150   a  into the first retention hole  130   a  along the first retention hole axis A H1 . In an aspect, the first retention element  150   a  can be substantially symmetric about a center of the first retention element  150   a . The center of the first retention element  150   a  being between the first end  154  and the second end  156  of the first retention body  151   a . The symmetry of the first retention element  150   a  allows either the first end  154  to be inserted through the first opening  132   a  of the first retention hole  130   a  followed by the second end  156 , or the second end  156  to be inserted through the first opening  132   a  of the first retention hole  130   a  followed by the first end  154 . 
     Turning now to  FIG. 12 , the bone plate  30  includes a bone-facing surface  202  and an outer surface  204  opposite the bone-facing surface  202 . The bone plate  30  can have a first transverse side  206  and a second transverse side  208  opposite from one another. The first and second transverse sides  206  and  208  can extend from the bone-plate facing surface  202  to the outer surface  204 . The bone plate  30  can additionally or alternatively have a first lateral side  210  and a second lateral side  212  opposite from one another. The first and second lateral sides  210  and  212  can extend from the bone-plate facing surface  202  to the outer surface  204 . The first and second lateral sides  210  and  212  can extend from the first transverse side  206  to the second transverse side  208 . It will be understood that embodiments of the disclosure are not limited to the specific bone plate shown in  FIG. 9 , and that alternative bone plates are contemplated. 
     The bone plate  30  defines at least one bone-anchor aperture  218 , such as a plurality of bone-anchor apertures  218 . One or more of the bone-anchor apertures  218  are configured to extend along the axis A B1 . For example, a first bone-anchor aperture  218   a  can extend along the axis A B1 , and a second bone anchor aperture  218   b  can extend along the axis A B2 . The bone plate  30  can be positioned on the bone  70  such that each axes A S1  and A S2  can align with a corresponding target location (e.g. bone-anchor hole) in the intramedullary nail  60 . The at least one bone-anchor aperture  218  extends through the bone plate  30  from the outer surface  204  to the bone-facing surface  202 . At least one of the bone-anchor apertures  218  can be threaded to receive a threaded head of a bone anchor. Further, each bone-anchor aperture  218  can define variable-angle threading that permits a bone anchor to be inserted into the bone-anchor aperture  218  at varying angles. Alternatively, each additional bone-anchor aperture  218  can be unthreaded. 
     The first bone-anchor aperture  218   a  is spaced from the second bone-anchor aperture  218   b  such that the axis A B1  of the first bone-anchor aperture  218   a  is offset from (i.e., not aligned with) the axis A B2  of the second bone-anchor aperture  218   b  when the bone plate  30  is fastened to the intramedullary nail  60 . 
     The bone plate  30  can also define additional bone-anchor apertures  214  and  216 . The bone-anchor apertures  214  and  216  can be configured to receive a bone-plate placement tool, alignment tool, support tool, or other tool to releasable fasten the tool to the bone plate  30  to facilitate alignment and/or support of the bone plate  30  while the bone plate  30  is secured to the intramedullary nail  60 . Thus, a shaft of a tool extend at least partially through the additional bone-anchor apertures  214  and  216  when the bone plate  30  is fastened to the nail  60 . Further, the additional bone-anchor apertures  214  and  216  can be positioned and/or angled over a full range of angles to minimize impeding with a path of a bone anchor or drill bit. The additional bone-anchor apertures  214  and  216  can extend through the bone plate  30  from the outer surface  204  to the bone-facing surface  202 . The additional bone-anchor apertures  214  and  216  can be configured to receive a bone anchor so as to further attach the bone plate  30  to the bone  70 . The additional bone-anchor apertures  214  and  216  can be threaded to receive a threaded head of a bone anchor. Further, the additional bone-anchor apertures  214  and  216  can define variable-angle threading that permits a bone anchor to be inserted into the additional bone-anchor apertures  214  and  216  at varying angles. Alternatively, the bone-anchor apertures  214  and  216  can be unthreaded. 
     Turning now to  FIG. 13 , the guide sleeve assembly  300  includes an outer guide sleeve  302  and an inner guide sleeve  304 . The inner guide sleeve  304  is insertable through the outer guide sleeve  302 . The inner guide sleeve  304  can be coupled to the outer guide sleeve  302  to substantially prevent movement between the inner and outer guide sleeves  302  and  304 . The guide sleeve assembly  300  is configured to be inserted through the at least one guide hole  106  of the aiming arm system  100  to align with the bone plate  30  and the intramedullary nail  60 . The alignment of the guide sleeve assembly  300  with the bone plate  30  and the intramedullary nail  60  enables a bone anchor and/or a drill be to be inserted through the guide sleeve assembly  300  and into and/or through the bone plate  30 , the bone  70 , and the nail  60 . 
     Referring to  FIGS. 14-18 , the outer guide sleeve  302  includes an outer guide body  303  and an outer sleeve handle  306 . The outer sleeve handle  306  is configured to be gripped and/or controlled by a surgeon during a medical procedure to align the outer guide sleeve  302  relative to the inner guide sleeve  304  and/or align the outer guide sleeve  302  relative to the aiming arm system  100 . The outer guide body  303  extends along a central outer guide sleeve axis A S1 , that can align with the first central guide hole axis A C1  of the first guide hole  106   a  when the guide sleeve assembly  300  is inserted into the first guide hole  106   a . It will be appreciated that the central outer guide sleeve axis A S1  can align with other central guide hole axes A C  of guide holes  106  defined by the aiming arm  104 . For example, the central outer guide sleeve axis A S1  can align with the second central guide hole axis A C2  of the second guide hole  106   b  when the guide sleeve assembly  300  is inserted into the second guide hole  106   b . The outer guide sleeve  302  is configured and sized to be inserted into and extend through a corresponding guide hole  106  in the first linear direction L 1 , thereby orienting the central outer guide sleeve axis A S1  along the first linear direction L 1 . 
     The outer sleeve handle  306  extends along the central outer guide sleeve axis A S1  from the outer sleeve body  303  to a first end  308  of the outer sleeve guide  302 . The outer guide body  303  extends along the central outer guide sleeve axis A S1  from the outer sleeve handle  306  to a second end  310 . The outer guide body  303  includes an outer sleeve surface  312  that extends about the central outer guide sleeve axis A S1  between the outer sleeve handle  306  and the second end  310 . The outer sleeve surface  312  comprises a reduced cross-sectional dimension portion  314  and a curved portion  316 . The curved portion  316  extends about the central outer guide sleeve axis A S1  from a first end  318  of the reduced portion  314  to a second end  320  of the reduced portion  314 . The curved portion  316  can extend along a length of the outer sleeve surface  312  from the handle  306  to the second end  310 . Alternatively, the curved portion  316  can extend along a part of the outer sleeve surface  312  between the handle  306  and the second end  310 . For example, the curved portion  316  could extend from the second end  310  to a location on the outer sleeve surface  312  between the handle  306  and the second end  310 . 
     The curved portion  316  is spaced from the central outer guide sleeve axis A S1  by a first dimension R 1 . The first dimension R 1  extends substantially perpendicular to the central outer guide sleeve axis A S1 . The curved portion  316  can have a substantially constant first dimension R 1  along the length of the outer sleeve surface  312  from the handle  306  to the second end  310 . Alternatively, the curved portion  316  can vary in size and or dimension along the length of the outer sleeve surface  312 . For example, the curved portion  316  can have a first dimension R 1  along a length of the outer sleeve surface  312  between the handle  306  and a location  315  between the handle  306  and the second end  310 , and the curved portion  316  can have a first dimension R′ 1  between the location and the second end  310 , whereby the first dimension R′ 1  is less than the first dimension R 1 . The reduced first dimension R′ 1  can facilitate insertion of the outer sleeve guide  302  into the corresponding guide hole  106 . Additionally, the second end  310  of the outer sleeve guide  302  can include a beveled edge to further facilitate insertion of the outer sleeve guide  302 . 
     The reduced portion  314  can extend along a length of the outer sleeve surface  312  from the handle  306  to the second end  310 . Alternatively, the reduced portion  314  can extend along a part of the outer sleeve surface  312  between the handle  306  and the second end  310 . For example, the reduced portion  314  can extend from a first location  326  on the outer sleeve surface  312  positioned between the handle  306  and the second end  310  to a second location  328  on the outer surface  312  positioned between the handle  306  and the second end  310 . 
     The reduced portion  314  is spaced from the central outer guide sleeve axis A S1  by a second dimension R 2 . The second dimension R 2  extends substantially perpendicular to the central outer guide sleeve axis A S1 . The second dimension R 2  of the reduced portion  314  can vary along a width of the reduced portion  314  between the first end  318  and the second end  320  of the reduced portion  314 . For example, the second dimension R 2  at the first end  318  and the second end  320  can be greater than the second dimension R 2  between the first and second ends  318  and  320  of the reduced portion  314 . The second dimension R 2  of the reduced portion  314  is less than the first dimension R 1  of the curved portion  316  that extends from the first end  318  to the second end  320  of the reduced portion  314 . The size of the second dimension R 2  of the reduced portion  314  relative to the size of the first dimension R 1  of the curved portion  316  enables movement of the guide sleeve assembly  300  within the guide hole  106  when the aiming arm system  100  is in an unlocked configuration, as further described below. 
     In an aspect, the reduced portion  314  can define a substantially flat planar surface. In an alternative aspect, the reduced portion  314  can be curved or partially curved about the central outer guide sleeve axis A S1  from the first end  318  to the second end  320  of the reduced portion  314 . For example, the reduced portion  314  can have a substantially constant second dimension R 2  along a circumferential width of the outer sleeve surface  312  from first end  318  to the second  320  of the reduced portion  314 , and along a length of the outer sleeve surface  312  from the first location  326  to the second location  328  on the outer sleeve surface  312 . 
     The outer guide sleeve  302  further includes an inner guide surface  330  that defines an outer guide aperture  331  that extends through the outer guide sleeve  302  about the central outer guide sleeve axis A S1  from the first end  308  to the second end  310  of the outer guide sleeve  302 . The inner guide surface  330  includes a first coupler  332 . The first coupler  332  can include a threaded portion, a snap-fit element, a recess, a protrusion, or other coupling element configured to couple the outer guide sleeve  302  to the inner guide sleeve  304  when the inner guide sleeve  304  is inserted and positioned within the outer guide aperture  331 . The first coupler  332  can be positioned along the inner guide surface  330  between the first and second ends  308  and  310  of the outer guide sleeve  302 . In an aspect, the first coupler  332  is positioned on a portion the inner guide surface  330  within the handle  306 . 
     Referring to  FIGS. 19-23 , the inner guide sleeve  304  includes an inner guide body  350  and an inner sleeve handle  352 . The inner sleeve handle  352  is configured to be gripped and/or controlled by a surgeon before or during a medical procedure to align the inner guide sleeve  304  relative to the outer guide sleeve  302  and/or align and couple the inner guide sleeve  304  to the bone plate  30 . The inner guide body  350  extends along a central inner guide sleeve axis A S2 , that can align with the central guide hole axis A C  of the guide hole  106  when the guide sleeve assembly  300  is inserted into the guide hole  106 . The inner guide sleeve  302  is configured and sized to be inserted into and extend through the outer guide aperture  331  of the outer guide sleeve  302  in the first linear direction L 1 , thereby orienting the central inner guide sleeve axis A S2  along the first linear direction L 1 . 
     The inner sleeve handle  352  extends along the central inner guide sleeve axis A S2  from the inner guide body  350  to a first end  358  (e.g. a proximal end) of the inner sleeve guide  304 . The inner guide body  350  extends along the central inner guide sleeve axis A S2  from the inner sleeve handle  352  to a second end  360  (e.g. a distal end) of the inner sleeve guide  304 . The inner guide body  350  includes an outer sleeve surface  362  that extends about the central inner guide sleeve axis A S2  between the inner sleeve handle  352  and the second end  360  of the inner sleeve guide  304 . The outer sleeve surface  362  of the inner sleeve guide  304  includes a second coupler  364 . The second coupler  364  can include a threaded portion, a snap-fit element, a recess, a protrusion, or other coupling element configured to couple to the first coupler  332  of the outer guide sleeve  302  when the inner guide sleeve  304  is inserted and positioned within the outer guide aperture  331 . The second coupler  364  is configured to couple to the first coupler  332  such that the inner guide sleeve  304  is substantially prevented from moving along the first linear direction L 1  within the outer guide aperture  331  of the outer guide sleeve  302 . 
     The second coupler  364  can be positioned along the outer guide surface  364  of the inner guide sleeve  304  between the first and second ends  358  and  360  of the inner guide sleeve  304 . The position of the second coupler  364  can correspond to a position of the first coupler  332  on the inner guide surface  330 . For example, the second coupler  364  can be positioned relative to the first coupler  332  such that when the first and second couplers  332  and  364  are coupled to one another (e.g. a coupled position), the inner guide sleeve  304  extends through an opening  311  defined by the second end  310  of the outer guide sleeve  302 , and the second end  360  of the inner guide sleeve  304  is located exterior to the outer guide sleeve  302 . When the first and second couplers  332  are de-coupled (e.g. a de-coupled position), the inner guide sleeve  304  can be retracted in a direction opposite to the first linear direction L 1  within the outer guide sleeve  302 . In an aspect, when the inner guide sleeve  304  and the outer guide sleeve  302  are in the de-coupled position, the second end  360  of the inner guide sleeve  304  can be positioned within the guide aperture  331  of the outer guide sleeve  302   
     The inner guide sleeve  304  further includes an inner guide surface  370  that defines an inner guide aperture  371  that extends through the inner guide sleeve  304  about the central inner guide sleeve axis A S2  from the first end  358  to the second end  360  of the inner guide sleeve  304 . The inner guide aperture  371  of the inner guide sleeve  304  can have a substantially cylindrical shape such that a cross-sectional dimension (e.g. a diameter) of the inner guide aperture  371  is substantially the same along the length of the inner guide sleeve  304  from the first end  358  to the second end  360 . Alternatively, the inner guide aperture  371  can include other shapes, for example, a conical shape, a reduced diameter portion, combinations thereof, or another shape or shapes to facilitate alignment and positioning of a bone anchor and/or a drill bit along the plate axis A B  of the bone plate  30 . 
     The outer guide surface  362  of the inner guide sleeve  304  further defines a beveled edge  374 . The beveled edge  374  extends from the second end  360  of the inner guide sleeve  304  toward the first end  358  of the inner guide sleeve  304 . The beveled edge  274  having a minimum cross-sectional dimension (e.g. a diameter) at the second end  358 , and a maximum diameter spaced from the second end  358  toward the first end  358 . The beveled edge  358  is configured to be positioned at least partially within the bone-anchor aperture  218  of the bone plate  30  to provide a temporary connection between the bone plate  30  and the guide sleeve assembly  300  to support the plate  30  while a hole is drilled into the bone  70  and/or a bone anchor is being positioned within one or more bone-anchor apertures of the bone plate  30 . In an aspect, the beveled edge  374  can correspond to a beveled edge of the bone-anchor aperture  218  to enhance the connection between the guide sleeve assembly  300  and the plate  30 . 
     Turning now to  FIGS. 24, 25A, and 25B , the guide sleeve assembly  300  is positioned within the first guide hole  106   a  and another guide sleeve assembly  300  is positioned within the second guide aperture  106   b . The guide sleeve assembly  300  is inserted within the guide hole  106  in the first linear direction L 1 , such that the central outer guide sleeve axis A S1  of the outer guide sleeve  302  and central inner guide sleeve axis A S2  of the inner guide sleeve  304  are substantially parallel to the central guide hole axis A C . 
     The first and second retention elements  150   a  and  150   b  can be inserted into the retention holes  130   a  and  130   b  in the second linear direction L 2  such that the first and second retention axes A R1  and A R2  are substantially parallel to the first and second first retention hole axes A H1  and A H2 , respectively. The first and second retention elements  150   a  and  150   b  can be inserted into the respective retention holes  130   a  and  130   b  either before or after the guide sleeve assembly  300  is inserted into the guide hole  106 . 
     After the retention element  150  has been inserted into respective retention holes  130 , the aiming arm system  100  can be transitioned between an unlocked configuration whereby the guide sleeve assembly  300  is insertable through the guide hole  106  along the first linear direction L 1 , and a locked configuration whereby the retention element  150  applies a retention force FR to the outer guide sleeve  304  that substantially prevents the guide sleeve from moving further along the first linear direction L 1 . The outer guide sleeve  304  is configured to rotate within the guide hole  106  about the central guide hole axis A C  between an unlocked position (e.g.  FIG. 25A ) in which the aiming arm system  100  is in the unlocked configuration, and a locked position (e.g.  FIG. 25B ) in which the aiming arm system  100  is in the locked configuration. In an aspect, the retention element  150  is configured to rotate about the retention hole axis A H  relative to the outer guide sleeve  304  between an unlocked position and a locked position. 
     In the unlocked position of the outer guide sleeve  304 , a surgeon can move the guide sleeve assembly  300  to a desired location, such as adjacent to the bone-anchor aperture  218  of the bone plate  30 , and lock the guide sleeve assembly  300  in position by rotating the outer guide sleeve  304 . 
     In a first rotational position of the guide sleeve  302 , the outer sleeve surface  312  defines a first outer dimension D 1  that extends through the central guide sleeve axis A S1  in a first transverse direction T 1 . Of a transverse direction T that includes the first transverse direction T 1  and a second transverse direction T 2  that is opposite the first transverse direction T 1 . The transverse direction T, and thus each of the first transverse direction T 1  and the second transverse direction T 2 , is oriented perpendicular to each of the first and second linear directions L 1  and L 2 . The first outer dimension D 1  can be defined by first and second points of the outer sleeve surface  312  that are opposite each other and aligned with each other along the transverse direction T. In particular, the first outer dimension D 1  extends from the first point to the second point along the transverse direction T. Further, the first and second points are aligned with the respective first or second retention element  150   a  or  150   b  along the transverse direction T. It should be appreciated that the first and second points can be selected at any select location along the length of the outer guide sleeve in the first linear direction L 1  (see  FIG. 13 ) that is aligned with the respective retention element along the transverse direction T. In the first rotational position, the contact portion  164  of the retention element  150  faces the reduced portion  314  of the outer sleeve surface  312  in the first transverse direction T 1 . Further, one of the first and second points is located on the reduced portion  314 , and the other of the first and second points is located on the curved portion  316 . 
     The retention element  150  defines a third dimension D 3  that extends from a first point on a surface of the contact portion  164  of the retention element  150  to a second point on the inner guide surface  116  of the guide hole  106  that is opposite the contact portion  164  along the transverse direction T. The third dimension D 3  is greater than the first dimension D 1  when the guide sleeve  302  is in the first rotational position, thereby spacing the retention element  150  from the outer guide sleeve  302  along the transverse direction T. Because the third dimension D 3  is greater than the first dimension D 1 , the retention element  150  and the guide sleeve  302  are movable with respect to each other along the first linear dimension L 1  (see  FIG. 13 ). Otherwise stated, the retention element does not interfere with movement of the guide sleeve  302  relative to the retention element  150 , and thus relative to the aiming guide  104 , along the first linear dimension L 1 . Thus, the first rotational position of the guide sleeve can be referred to as an unlocked position of the outer guide sleeve  302 . 
     The guide sleeve  302  can be rotated about its central outer guide sleeve axis A S1  from the first rotational position to a second rotational position. As will be appreciated from the description below, the second rotational position of the guide sleeve  302  can be referred to as a locked position. In the second rotational position of the guide sleeve  302 , the outer sleeve surface  312  defines a second dimension D 2  that extends through the central guide sleeve axis A S1  along the transverse direction T. The second dimension D 2  can be defined by third and fourth points on opposed sides of the outer sleeve surface  312  that are opposite each other and aligned with each other along the transverse direction T. In particular, the second dimension D 2  extends from the third point to the fourth point along the transverse direction T. Further, the third and fourth points can be disposed at the select location along the length of the guide sleeve  302  that is aligned with the retention element  150  along the transverse direction T. The second dimension D 2  is greater than the first dimension D 1 . Accordingly, the outer sleeve surface  312  of the outer guide sleeve  302  to contact the retention element  150  in the locked position. In particular, the outer sleeve surface  312  contacts the surface of the contact portion  164  of the retention element  150 . The outer sleeve surface  312  can thus urge the contact portion  164  of the retention element  150  to compress along the transverse direction T when the guide sleeve  302  is rotated from the first rotational position to the second rotational position. For instance, recessed portion  162  of the retention element  150  defines a region of reduced thickness of the retention element  150  that allows the retention element  150  to flex in the transverse direction away from the guide sleeve  302 . Alternatively or additionally, a compressible material can define the outer surface of the guide sleeve  302  that compresses along the transverse direction T when the guide sleeve  302  is rotated from the first rotational position to the second rotational position. The retention element  150  can be positioned within the retention hole  130  such that the outer sleeve surface  312  contacts the contact portion  164  of the outer retention surface  152  of the retention element  150 . The contact portion  164  can be disposed opposite the recessed portion  162  along the transverse direction T. The recessed portion  162  can deflect away from (e.g. radially outward) the central guide hole axis A C  of the guide hole  106 , thereby allowing the contact portion  164  of the retention element  150  to compresses in the manner described above. In the locked position of the outer guide sleeve  302 , the recessed portion  162  of the retention element  150  can be positioned a greater distance away from the central guide hole axis A C  than a distance that the retention element  150  is positioned away from the central guide hole axis Ac. 
     In the locked position, the third dimension D 3  defined by the retention element  150  is naturally less than the second dimension D 2 , causing the retention element  150  to contact and provide the retention force F′ R1  to the outer guide sleeve  302  in the first transverse direction T 1 . It will be appreciated that an opposing retention force F′ R1  can also be applied by the inner guide surface  116  of the guide hole  106  in a second transverse direction T 2  to the outer guide sleeve  302 . The second transverse direction T 2  is oriented perpendicular to each of the first and second linear directions L 1  and L 2 . Further, the second transverse direction T 2  is opposite the first transverse direction T 1 . The contact between the retention element  150  and the outer guide sleeve  302  can form an interference fit connection, whereby the retention force FRI comprises a friction force applied to the outer guide sleeve  302  by the retention element  150  in a direction opposing a direction of movement of the outer guide sleeve  302  within the guide hole  106 . 
     In an alternative example, the retention element  150  can be configured to rotate within the retention hole  130  between an unlocked position in which the aiming arm system  100  is in the unlocked configuration, and a locked position in which the aiming arm system  100  is in the locked configuration. For example, the outer sleeve surface  312  of the outer guide sleeve  302  can be substantially cylindrical along a length of the outer guide body  303 . The retention element can be transitioned between an unlocked position and a locked position. In the unlocked position, the retention element  150  is spaced from the outer sleeve surface  312 . In the locked position, the retention element  150  contacts the outer sleeve surface  312  of the outer guide body  302 , whereby the contact on the outer retention surface  152  of the retention element  150  is at a location on the outer retention surface  152  that opposes the recessed portion  162 . The contact between the outer retention surface  152  and the outer sleeve surface  312  deflects the recessed portion  162  away from the outer sleeve surface  312  as the retention element  150  provides the retention force F R1  to the outer sleeve guide  302 . 
     The retention element  150  can be positioned externally from the aiming arm body  101 . For example, the retention element  150  can be separate from the aiming arm bod  101  and coupled to the aiming arm body  101 . For instance, the retention element  150  can be coupled to the inner guide surface  108  or the outer guide surface  110 , or other surface of the aiming arm body  101 . The retention element  150  can be coupled to a surface of the aiming arm body  101  such that the third dimension D 3  is defined between two surfaces of the retention element  150 . The two surfaces can oppose each other in the first transverse direction T 1 , and can compose a portion of the guide hole  106 . The third dimension D 3  defined between the two surfaces of the retention element  150  is less than the first dimension D 1  defined by the two points on opposing sides of the outer sleeve surface  312 , causing the retention element  150  to contact and provide the retention force F R1  to the outer guide sleeve  302  in the first transverse direction T 1 , and also provide the opposing retention force FRI to the outer guide sleeve  302  in the second transverse direction T 2 , when the outer guide sleeve  302  is rotated to the locked position. Alternatively, the retention element  150  can be monolithic with the aiming arm bod  101 . 
     During use of the system  10 , after the central guide hole axis A C  has been aligned with the target location of the intramedullary nail  60  and the aiming arm system  100  has been transitioned to locked configuration, posterior bone-anchor screws and/or a drill bit can be inserted through the inner guide aperture  371  of the inner guide sleeve  304  and through the bone plate  30 , the bone  70  and/or the intramedullary nail  60 . After the bone-anchors have been inserted, the aiming arm system  100  can be transitioned to the unlocked configuration and the guide sleeve assembly  300  can be removed from the guide hole  106 . 
     Although the disclosure has been described in detail, it should be understood that various changes, substitutions, and alterations can be made herein without departing from the spirit and scope of the invention as defined by the appended claims. Additionally, any of the embodiments disclosed herein can incorporate features disclosed with respect to any of the other embodiments disclosed herein. Moreover, the scope of the present disclosure is not intended to be limited to the particular embodiments described in the specification. As one of ordinary skill in the art will readily appreciate from that processes, machines, manufacture, composition of matter, means, methods, or steps, presently existing or later to be developed that perform substantially the same function or achieve substantially the same result as the corresponding embodiments described herein may be utilized according to the present disclosure.