Patent Publication Number: US-10321941-B2

Title: Intramedullary repair system for bone fractures

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation of co-pending U.S. patent application Ser. No. 12/622,309 filed 19 Nov. 2009 entitled “Intramedullary repair system for bone fractures,” which claims priority under 35 U.S.C. § 119 to U.S. provisional patent application No. 61/116,074 filed 19 Nov. 2008 entitled “Intramedullary fixation device with universal adjuster and method of using.” The disclosure of each of these applications is hereby incorporated herein by reference in its entirety. 
     The present application is also related to U.S. patent application Ser. No. 12/622,320 filed 19 Nov. 2009 entitled “Intramedullary repair system for vertebra fractures,” the disclosure of which is hereby incorporated herein by reference in its entirety. 
    
    
     TECHNICAL FIELD 
     The present invention relates to orthopedic apparatus and methods. More specifically, the present invention relates to intramedullary bone fracture repair devices and methods. 
     BACKGROUND 
     Certain types and severities of bone fractures require orthopedic surgery to properly align the fracture and to implant an artificial structure across the fracture to maintain the proper alignment and reinforce the fractured bone as the fracture heals. An example of a fracture that often demands the implantation of an artificial structure across the fracture is a fracture at the distal radius, which is one of the most common sites of bone fracture and is the most common fracture site in the upper extremity, accounting for approximately 10% of all fractures in adults. A distal radial fracture often occurs as a compression injury that is sustained while the patient experiences axial loading of the bone as a result of a fall. This type of fracture is particularly common in elderly patients due to osteoporosis and in younger, physically active patients. 
     In 2004, there were over 1.5 million distal radial fractures, and this number is expected to increase steeply as the population ages. However, despite this frequency, the methods available to repair the distal radius are limited and prone to a variety of complications that limit the clinical outcome following definitive treatment. For example, open reduction of the distal radius enables the surgeon to most confidently realign the distal radius bone fragments and restore stability to the joint. This method is required in approximately 25% of patients (˜375,000/year). Unfortunately, current practice requires the surgeon to disrupt the soft tissues over a 10 cm distance adjacent to the joint to expose the bone for placement of hardware to stabilize the fracture, such as a dorsal or volar locking plate. Thus, improved bone stability is achieved by sacrificing the integrity of an extensive tendon, ligament and neuromuscular network that is critical for proper wrist function. Also, plating techniques external to the bone can become a source of irritation to the soft tissue, including tendons and peripheral nerves. Such soft tissue irritation necessitates revision surgeries in over 30% of patients to remove the offending plates. This results in additional cost, disability and surgical risk to the patient. Furthermore, since plates are load-shielding as opposed to load-sharing, plates do not promote the bone remodeling that is necessary for better long-term strength of the bone tissue. Similar issues exist with respect to the treatment of other types of fractures (e.g., fractures in long bones, such as, for example, the proximal ulna and radius at the elbow, the distal humerus at the elbow, the proximal humerus at the shoulder, the proximal femur at the hip, the distal femur and proximal tibia at the knee, the distal tibia and other ankle and foot bones, the clavicle, and the spine, etc.) 
     There is a need in the art for devices and methods that offer improved outcomes for the treatment of bone fractures, resulting in better aligned and stronger healed fractures, reducing the likelihood of a revision being necessary, and reducing the damage to soft tissue adjacent the fracture. There is also a need in the art for devices and methods that offer a reduction in the surgical time required for the treatment of bone fractures. 
     SUMMARY 
     An intramedullary bone fixation device is disclosed herein. In one embodiment, the device includes a first longitudinally extending member, a second longitudinally extending member, and a coupling member. The first longitudinally extending member includes a connector end and a bone engagement end opposite the connector end. The second longitudinally extending member includes a connector end and a bone engagement end opposite the connector end. The coupling member is configured to engage the connector ends of the respective longitudinally extending members, thereby coupling the first longitudinally extending member to the second longitudinally extending member. The device may be provided in an kit form at least partially unassembled. The device may be delivered into a fracture and fully assembled within the fracture or adjacent bone via percutaneous or minimally invasive surgical procedures. The device, on account of its configuration and assembly, may be considered modular in some cases. 
     In another embodiment, the intramedullary bone fixation device may include a first bone engaging means for engaging a bone, a second bone engaging means for engaging a bone, and a coupling means for coupling together the first and second bone engaging means. The first and second bone engaging means may each include connector means for acting with the coupling means in coupling the together the first and second bone engaging means. Each connector means may include interdigitation means for forming an interdigitate relationship between the coupling means and the connector means. Each bone engaging means may include a free end and an anchor means at or near the free end for anchoring the free end in adjacent bone. Each bone engaging means may be extendable in length and include fixing means for fixing the length of the bone engaging means once adjusted as desired. 
     A bone fracture repair device is also disclosed herein. In one embodiment, the device includes a hub and at least two intramedullary rods radially extending from the hub. The hub may be configured such that at least one of the rods is securable at a selected radial position over a range of selectable radial positions extending over at least a portion of an edge boundary of the hub. The selectable positions may be incremental. For example, the incremental selectable positions may have increments of approximately five degrees or, in other embodiment, increments of greater or lesser than five degrees. In some embodiments, the hub may be configured such that at least one of the rods is securable at a selected extension position over a range of selectable extension positions, the selected extension position being the extent to which the at least one of the rods extends beyond an edge boundary of the hub. In some embodiments, the at least one of the rods is configured to allow an overall length of the at least one of the rods to be adjusted. The device may be configured for intramedullary implantation. The device may also be configured for percutaneous or minimally invasive surgical delivery. 
     Also disclosed herein is a bone fracture repair device. In one embodiment, the device includes a first bone engagement member, a second bone engagement member, a coupling member. The coupling member is configured to secure the first and second bone engagement members together in a variety of angular relationships to each other. For example, the angular relationship between engagement bone engagement members may be between approximately zero degrees and approximately 180 degrees. The bone engagement members and coupling member may be configured for percutaneous delivery and intramedullary implantation. In one embodiment, the coupling member is configured to secure at least one of the bone engagement members in a variety of extents to which the at least one of the bone engagement members extends from the coupling member. In one embodiment, the at least one of the bone engagement members is configured to allow an overall length of the at least one of the bone engagement member to be adjusted. In one embodiment, the bone engagement members include intramedullary rods and the coupling member includes a hub. 
     Also disclosed herein is a method of treating a bone fracture. In one embodiment, the method includes: intramedullarly implanting a first longitudinally extending member including a first bone anchor end and a first connector end opposite the first bone anchor end, wherein the first bone anchor end anchors in bone material on a first side of the bone fracture; intramedullarly implanting a second longitudinally extending member including a second bone anchor end and a second connector end opposite the second bone anchor end, wherein the second bone anchor end anchors in bone on a second side of the bone fracture opposite the first side; intramedullarly implanting a coupling member near the fracture; and connecting the first connector end to the coupling member and connecting the second connector end to the coupling member. Depending on the embodiment, the method may also include any of the following. For example, at least one of the longitudinally extending members may include an intramedullary rod. The implantation of one or more of the longitudinally extending members and/or the coupling member may be achieved via minimally invasive surgical procedures. In causing the bone anchor ends to anchor in bone material, the aspects of the bone anchor ends may be caused to expand into the bone material. The length of the longitudinally extending members may be adjusted as needed to facilitate the implantation of the longitudinally extending members and the coupling thereof to the coupler member. 
     Also disclosed herein is a bone fracture repair device, which, in one embodiment, includes a proximal hub, a distal hub, an intermediate intramedullary rod extending between the hubs, a proximal intramedullary rod extending proximally from the proximal hub, and a distal intramedullary rod extending distally from the distal hub. Such a multiple hub bone fracture repair device may be employed to repair fractures in, for example, long bones where a first fracture is at a proximal end of the bone and another fracture is at another end of the bone, the hubs being located at respective fracture locations and the intermediate intramedullary rod extending through the bone to secure the hubs together. 
     In another embodiment, a bone fracture repair device may include a hub configured to engage bone material and an intramedullary rod extending from the hub. 
     In yet another embodiment, a bone fracture repair device may include a first intramedullary rod, a second intramedullary rod, and an engagement member that is configured to allow the first and second intramedullary rods to move relative to each other along an axis in being received in the engagement member to secure the rods in a final position with respect to each other. In one embodiment, the engagement member may include a snap plate. 
     While multiple embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following Detailed Description, which shows and describes illustrative embodiments of the invention. As will be realized, the invention is capable of modifications in various aspects, all without departing from the spirit and scope of the present invention. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a top plan view of a first embodiment of the bone implant assembly in an assembled state. 
         FIG. 2  is a side elevation view of the first embodiment of the bone implant assembly as taken along section line  2 - 2  in  FIG. 1 . 
         FIG. 3  is a bottom plan view of a first embodiment of the bone implant assembly in an assembled state. 
         FIGS. 4A-4C  are side elevation views of alternative embodiments of free ends of intramedullary rods, wherein the free ends have bone interface tips with different features. 
         FIG. 4D  is an end elevation view of the embodiment depicted in  FIG. 4C  as viewed along line  4 D- 4 D in  FIG. 4C . 
         FIG. 5  is a plan view of an inner face of the lower plate. 
         FIGS. 6A-6C  are cross sections of different embodiments of the lower plate as taken along section line  6 - 6  in  FIG. 5 . 
         FIG. 7  is a plan view of an inner face of the upper plate. 
         FIG. 8  is a cross section of the upper plate as taken along section line  8 - 8  in  FIG. 7 . 
         FIGS. 9A and 9B  are, respectively, enlarged bottom and top plan views of a connector end of intramedullary rods for coupling with the hub described with respect to  FIGS. 5-8 . 
         FIGS. 9C and 9D  are, respectively, enlarged side and end elevations of the connector end depicted in  FIGS. 9A and 9B . 
         FIG. 10  is a plan view of an inner face of the lower plate of an alternative embodiment of the hub. 
         FIG. 11  is a plan view of an inner face of the lower plate of an alternative embodiment of the hub. 
         FIG. 12  is an enlarged side elevation of the connector end of intramedullary rods for coupling with the hub described with respect to  FIGS. 10 and 11 . 
         FIG. 13A  is a side elevation cross section of the free end of the rod with the anchor stowed. 
         FIGS. 13B and 13C  are the same view as  FIG. 13A , except of the anchor being progressively deployed. 
         FIG. 14A  is a side elevation cross section of the free end of the rod with the anchors stowed. 
         FIG. 14B  is the same view as  FIG. 14A , except the anchors are fully deployed. 
         FIG. 15A  is a side elevation view of a free end of the rod, wherein the rod is configured to expand. 
         FIG. 15B  is a side elevation cross section of the free end of the rod of  FIG. 15A , the rod being in a non-expanded state. 
         FIG. 15C  is the same view as  FIG. 15B , except the rod is in the expanded state. 
         FIG. 16A  is a side elevation view of another free end of the rod, wherein the rod is also configured to expand. 
         FIG. 16B  is a side elevation cross section of the free end of the rod of  FIG. 16A , the rod being in a non-expanded state. 
         FIG. 16C  is the same view as  FIG. 16B , except the rod is in the expanded state. 
         FIG. 17  is a plan view of a bone with a fracture. 
         FIG. 18  is the same view of the bone of  FIG. 17  subsequent to the creation of an access window in the bone at the fracture. 
         FIG. 19  is the same view of the bone of  FIG. 18  subsequent to the delivery of a proximal intramedullary rod into the interior of the bone via the access window. 
         FIG. 20  is generally the same view of the bone of  FIG. 19 , except the bone portions are separated and subsequent to the delivery of the distal intramedullary rods into the interior of the bone via the access window. 
         FIG. 21  is the same view of the bone of  FIG. 20  subsequent to the delivery of a bottom plate of the hub into the interior of the bone via the access window. 
         FIG. 22  is generally the same view of the bone of  FIG. 20 , except the bone portions are no longer separated and subsequent to the desired alignment of the rod connector ends relative to the bottom plate. 
         FIG. 23  is the same view of the bone of  FIG. 22  subsequent to the delivery of a top plate of the hub into the interior of the bone via the access window. 
         FIG. 24  is the same view of the bone of  FIG. 23  subsequent to the implant being secured into a rigid implant assembly and the delivery of bone paste. 
         FIG. 25  is a plan view of a proximal locking plate. 
         FIG. 26  is a plan view of a distal locking plate. 
         FIG. 27  is a side elevation view of an intramedullary rod that may be employed as part of the implant assembly. 
         FIG. 28  is the same view as  FIG. 27 , except showing the rod with an anchor deployed. 
         FIG. 29  is a side elevation view of the implant assembly in the process of having the plates slide together. 
         FIG. 30  is a side elevation view of the implant assembly in a fully assembled state. 
         FIG. 31  is a view of a bone having a fracture. 
         FIG. 32  is the same view as  FIG. 31 , except the distal and proximal bone portions are displaced from each other. 
         FIG. 33  is the same view as  FIG. 32 , except the proximal plate has been implanted. 
         FIG. 34  is the same view as  FIG. 33 , except the proximal intramedullary rods have been coupled to the proximal plate and inserted into the proximal bone portion. 
         FIG. 35  is the same view as  FIG. 34 , except the anchors have been deployed on the proximal anchors. 
         FIG. 36  is the same view as  FIG. 35 , except the distal plate has been implanted. 
         FIG. 37  is the same view as  FIG. 36 , except the distal intramedullary rods have been coupled to the distal plate and inserted into the distal bone portion. 
         FIG. 38  is the same view as  FIG. 37 , except the anchors have been deployed on the distal anchors. 
         FIG. 39  is the same view as  FIG. 38 , except the plates and their respective bone portions are being moved into place for fixation of the plates to each other. 
         FIG. 40  is the same view as  FIG. 39 , except the plates have been joined to form a rigid integral implant assembly. 
         FIG. 41  is the same view as  FIG. 40 , except bone substitute material has been deposited in the fracture. 
         FIG. 42  is a plan view of an interior face of a top plate having radially extending grooves. 
         FIG. 43  is a side elevation view of the bottom plate as taken along line  42 - 42  in  FIG. 42 . 
         FIG. 44  is a side view of a connector end of a rod, the connector end including a ringed/grooved configuration having plurality of rings and grooves defined in the shaft of the connector end. 
         FIG. 45  is a cross section elevation of a connector end extending along a groove of a top plate when the plates are assembled into a hub. 
         FIG. 46  is a plan view of the interior face of the bottom plate. 
         FIG. 47  is a side elevation cross section of the plate as taken along section line  47 - 47  in  FIG. 46 . 
         FIG. 48  is a cross section elevation of a connector end extending along a groove of a bottom plate when the plates are assembled into a hub and the bottom plate includes both the radially extending grooves and the concentric rings. 
         FIG. 49  is a plan view of an inner face of the lower plate of an alternative embodiment of the hub. 
         FIG. 50  is a plan view of an inner face of the upper plate of an alternative embodiment of the hub for use with the plate of  FIG. 49 . 
         FIG. 51A  is a view similar to  FIG. 12   
         FIG. 51B  is an end view of the connector end. 
         FIG. 51C  is a transverse cross section of the connector end as taken along section line  51 C- 51 C in  FIG. 51A . 
         FIG. 52A  a view similar to  FIG. 11  and depicting the hole spacing. 
         FIG. 52B  is a view of the rod connector ends being pinned at different positions along the pair hole array of  FIG. 52A . 
         FIG. 52C  is a view of a rod connector end having a notch spacing. 
         FIG. 53  is a plan view of an interior face of a plate, the interior face being textured. 
         FIG. 54  is a side view of a rod connector end, the connector end being textured. 
         FIG. 55A  is a plan view of the implant assembly employing the plates and connector ends of  FIGS. 53 and 54 . 
         FIG. 55B  is a side cross section view of the implant assembly as taken along section line  55 B- 55 B in  FIG. 55A . 
         FIG. 56  is a side view of a rod connector end having the ball end connection arrangement. 
         FIG. 57  is the same view as  FIG. 56 , except a securing force is being applied to the ball connection arrangement. 
         FIGS. 58A-58F  depict different views and elements of another version of the ball connection arrangement of  FIGS. 56 and 57 . 
         FIG. 59A  is a plan view of a bottom plate with a wedged attachment point mounted thereon. 
         FIG. 59B  is a plan view of a wedged attachment point  565 . 
         FIG. 59C  is a side elevation of the bottom plate and the wedged attachment point of  FIG. 59A , wherein the bottom plate and wedged attachment point are parallel. 
         FIG. 59D  is the same view as  FIG. 59C , except the bottom plate and wedged attachment point are not parallel. 
         FIG. 60  is a longitudinal cross section of an intramedullary rod having a telescopic configuration and a clip or pin securing arrangement. 
         FIG. 61  is the same view as  FIG. 60 , except of an embodiment employing a crimp securing arrangement. 
         FIGS. 62A and 62B  are transverse cross sections as taken along section line  62 - 62  of  FIG. 61 . 
         FIG. 63  is a longitudinal side view of the inner shaft. 
         FIG. 64  is a transverse cross section as taken along section line  64 - 64  of  FIG. 63 . 
         FIG. 65  is a longitudinal side view of the inner shaft wherein a spring clip is employed as part of the securing arrangement and the clip is not engaged with the notches. 
         FIG. 66  is a transverse cross section as taken along section line  66 - 66  of  FIG. 65 . 
         FIG. 67  is a longitudinal side view of the inner shaft wherein a spring clip is employed as part of the securing arrangement and the clip is engaged with the notches. 
         FIG. 68  is a transverse cross section as taken along section line  68 - 68  of  FIG. 67 . 
         FIG. 69  is a longitudinal cross section of the sliding lock on the inner shaft  705 . 
         FIGS. 70A and 70B  are transverse cross sections of the intramedullary rods, wherein the embodiment depicted therein shows a rotation to lock the rods. 
         FIGS. 71A-71D  are transverse cross sections of the outer and inner shafts individually and combined into a intramedullary rod, wherein rotation may expand and/or lock the rods. 
         FIG. 72  is a cross section of the shafts locked together via inserted pins. 
         FIGS. 73A and 73B  are longitudinal cross sections of portions of the rod, wherein a portion of the rod may be deformable. 
         FIGS. 74A and 74B  are views respectively similar to  FIGS. 13A and 13C , except of another embodiment. 
         FIGS. 75A and 75B  are similar respective views to  FIGS. 74A and 74B , except of another embodiment. 
         FIGS. 76A and 76B  are similar respective views to  FIGS. 75A and 75B , except of another embodiment. 
         FIGS. 76C and 76D  are similar respective views to  FIGS. 76A and 76B , except of another embodiment. 
         FIG. 77  is a plan view of a kit including the disassembled implant assembly and implantation instructions. 
         FIG. 78  is a plan view of the implant assembly implanted at a bone fracture, wherein the implant assembly employs a hub that engages the bone material. 
         FIG. 79  is a plan view of the implant assembly implanted at a bone fracture, wherein the implant assembly employs a hub that engages the bone material. 
         FIG. 80  is a plan view of a multiple hub embodiment of the implant assembly. 
         FIGS. 81A-81C  are plan views of a plate having an alternative radiating groove or ridge pattern, wherein the radiating pattern and rods, when coupled to the radiating pattern, do not extend from the center of the plate. 
         FIG. 82  is a plan view of a rods coupled to a plate, wherein rods may be coupled to rods. 
         FIGS. 83A and 83B  are side views of a fractured bone in which a snap plate equipped implant assembly is being deployed, wherein the snap plate may include two members that can move relative to each other along an axis and can be snapped into a final position and engagement with each other to provide fixation. 
     
    
    
     DETAILED DESCRIPTION 
     A universal assembly  10  of modular, telescopic, micro-adjustable bone implants for intramedullary fixation is disclosed herein that can be delivered minimally invasively and assembled by the surgeon partially, or entirely, at, or within, a fracture to restore the bone, including the shape of articulating surfaces impacted by the fracture. As the implant assembly  10  may be delivered to the fracture and assembled within the fracture via minimally invasive techniques, patient discomfort and soft tissue damage is minimized. As the implant assembly  10  is intramedullary, it is a load-sharing, not a load-shielding device, thereby promoting the remodeling performance of the bone after the fracture heals and leading to better long-term strength of the bone tissue. Also, as the implant assembly  10  is intramedullary, the assembly  10  does not result in irritation to the soft tissue, and revision surgeries are less likely to be needed. Due in part to its modular, telescopic, micro-adjustable characteristics, the implant assembly  10  is highly adaptable to a wide variety of fractures with respect to location, bone and severity. For example, while the method of implanting the implant assembly is given below in the context of a radial fracture, the implant assembly  10  is readily employable for any type of fracture in any type of bone. For example, the implant assembly  10  may be employed for fractures of long bones (e.g., humerus, ulna, radius, femur, tibia, etc.) anywhere along the long bone shaft or near a long bone joint (e.g., shoulder, elbow, wrist, hip, knee, ankle, etc.). The implant assembly  10  may also be employed for other bone fractures (e.g., fingers, toes, ribs, vertebra, pelvis, etc.) in the body of such bones or near any joint of such bones. The modular and minimally invasive characteristics of the implant assembly  10  may reduce by approximately 50% the number of surgical steps needed to repair a fracture as compared to repairing the same fracture with plates or intramedullary rods known in the art, saving surgical time, costs and risks to the patient from lengthened procedure times. 
     For a detailed discussion of an embodiment of the bone implant assembly  10  disclosed herein, reference is made to  FIGS. 1-3 .  FIGS. 1 and 3  are, respectively, top and bottom plan views of the first embodiment of the bone implant assembly  10  in an assembled state.  FIG. 2  is a side elevation view of the first embodiment of the bone implant assembly  10  as taken along section line  2 - 2  in  FIG. 1 . 
     As can be understood from  FIGS. 1 and 3 , the bone implant assembly  10  in an assembled state includes multiple intramedullary members or rods  15 ,  16  radiating from a central locking member or hub  20 . Depending on the needs of the fracture to be secured via the bone implant assembly  10 , there may be at least two, three or more rods  15 ,  16  radiating from the hub  20 . As will be discussed in greater detail below, at least one of the rods  15  will extend from the hub  20  to one side of the fracture (e.g., a distal side of the fracture), and at least another of the rods  16  will extend from the hub  20  to the other side of the fracture (e.g., a proximal side of the fracture). In other embodiments, as discussed below with respect to  FIGS. 78 and 79 , the bone implant assembly  10  may include one, two, three or more rods  15 ,  16  extending from the hub  20 . For example, in one embodiment, one to five rods  15 ,  16  may extend from a single hub  20 . 
     As discussed below with respect to  FIG. 80 , the implant assembly  10  may include two or more hubs  20  joined together by one or more rods  15 ,  16  and, in some embodiments, further including one, two, three, four or more rods  15 ,  16  further extending from the hubs  20 . For example, in one embodiment, two to nine rods  15 ,  16  may extend from two hubs  20 . 
     In some embodiments, the rods  15 ,  16  may have a fixed length and, in other embodiments, the rods  15 ,  16  may have an adjustable length. In some embodiments, the implant assembly  10  may employ only fixed length rods, only adjustable length rods, or a combination of fixed length and adjustable length rods. 
     As indicated in  FIGS. 1-3 , each rod  15 ,  16  includes a connector end  25  and a free end  30 . When the assembly  10  is in an assembled state, the connector ends  25  are received in an engaged or coupled fashion in the hub  20 , and the free ends  30  radiate away from the hub  20  such that the free ends  30  may be engaged to bone tissue. 
     In one embodiment as shown in  FIGS. 1-3 , the hub  20  includes an upper member or plate  35  and a bottom member or plate  36 . While plate  35  and plate  36  are respectively referred to herein as the upper plate and lower plate, the positions of the plates may be reversed relative to each by design or in practice, depending on the embodiment. A securing member  40  (e.g. a screw, bolt, tab, etc.) extends between and through or into the plates  35 ,  36  to secure the plates  35 ,  36  to each other in an opposed fashion, defining a void or region  45  between the plates  35 ,  36  in which the connector ends  25  of the rods  15 ,  16  are received. In some embodiments, one, two or more securing members  40  may be employed to join together the plates  35 ,  36  of the hub  20 . As each plate  35 ,  36  includes a respective outer face  50 ,  51  and respective inner face  55 ,  56 , and the outer faces  50 ,  51  face away from each other and the inner faces  55 ,  56  face each other in an opposed fashion when the plates  35 ,  36  are secured together in an assembled fashion via the screw  40 , the opposed inner faces  55 ,  56  define the void or region  45  in which the connector ends  25  of the intramedullary rods  15 ,  16  are received. 
     In one embodiment, the plates  35 ,  36  of the hub  20  and the connector ends  25  of the rods  15 ,  16  are configured to create an interlocking or interdigitation of the rods  15 ,  16  and the plates  35 ,  36 . Described below are various embodiments for achieving this interlocking or interdigitation. For example, in some embodiments, the interdigitation or interlocking may be a notched interlocking of the connector ends  25  to the hub  20 , the notched interlocking in some cases even being of a ratcheting arrangement. To begin a discussion of such an embodiment, reference is first made to  FIGS. 5-6C , wherein  FIG. 5  is a plan view of an inner face  56  of the lower plate  36  and  FIGS. 6A-6C  are cross sections of different embodiments of the lower plate  36  as taken along section line  6 - 6  in  FIG. 5 . 
     As shown in  FIG. 5 , the bottom plate  36  includes an outer edge or circumference  57  and a central hole  58  for receiving therein the screw  40 . The inner face  56  of the lower plate  36  may have a plurality of concentric rings  60  defined in the inner face  56 . As indicated in  FIG. 6A , the rings  60  may have a square toothed cross section. Alternatively, as shown in  FIG. 6B , the rings  60  may each have a saw toothed cross section, wherein each saw tooth profile is arranged to hold the rods in place and not allow them to move radially outward once fastened to the bottom plate  36 . In one embodiment, each saw tooth profile of the rings has a triangular cross section. In one embodiment, the triangular cross section may be a right triangle cross section, the right angle of each ring cross section facing the direction of the central hole  58  and the slope of each ring cross section facing the direction of the outer edge  57 . The ring cross section configurations of  FIGS. 6A and 6B  have features that transfer a pull load directly to the plates without relying on compressive loads from the plates, resulting in a desirable interdigitation or interlocking of the rods to the plates. 
     In another alternative, as shown in  FIG. 6C , the triangular cross section of the rings  60  may be in the form of an isosceles, equal lateral or other type of triangle cross section, the slope of each triangle cross section facing the direction of the central hole  58  being generally equal to the slope of each triangle cross section facing the direction of the outer edge  57 . Such a triangular cross section as depicted in  FIG. 6C  may be such that the plates  35 ,  36  be fastened together to produce a compressive force to fix the rods in place within the hub. Thus, such a configuration may rely less on interdigitation or interlocking and more on a friction fit aided by compressive force of the clamping plates. 
     In one embodiment, the lower plate  36  is machined, molded, formed or otherwise manufactured from a biocompatible metal, such as, for example, stainless steel, Titanium, Zirconium, Niobium, Cobalt Chrome, or NITINOL® or a biocompatible polymer, such as, for example, PEEK®, TEFLON®, TYROSINE®, POLYSULFONE®, polyethylene, polyurethane, polymethylmethacrylate, DELRIN®, or polyphenylsulfone or a biocompatible ceramic, such as, for example, alumina, zirconia, calcium phosphate, or pyrolitic carbon. The lower plate  36  may have a diameter of between approximately 0.05″ and approximately 3″, an overall thickness of between approximately 0.02″ and approximately 0.5″, and the concentric rings  60  may have a height of between approximately 0.01″ and 0.1″. The lower plate  36  may have between approximately 2″ and approximately 100 concentric rings  60 . Concentric rings  60  can be evenly spaced, grouped in sections, or unevenly spaced on the plate surface  56 . In some embodiments, the upper and lower plates  35 ,  36  may have generally the same diameters. However, in other embodiments, the upper and lower plates  35 ,  36  may have different diameters such that the edge of one of the plates may extend past the edge of the other plate. 
     As shown in  FIGS. 7 and 8 , wherein  FIG. 7  is a plan view of an inner face  55  of the upper plate  35  and  FIG. 8  is a cross section of the upper plate  35  as taken along section line  8 - 8  in  FIG. 7 , the upper plate  35  includes an outer edge or circumference  65  and a central hole  66  for receiving therein the screw  40 . The inner face  55  of the upper plate  35  may have a plurality of radially oriented ridges  70  defined in the inner face  55 . The ridges  70  radiate outwardly from a point near the central hole  66  towards the outer edge  65 , and the ridges  70  may have rectangular cross sections. 
     In one embodiment, the upper plate  35  is machined, molded, formed or otherwise manufactured from a biocompatible metal, such as, for example, stainless steel, Titanium, Zirconium, Niobium, Cobalt Chrome, or NITINOL® or a biocompatible polymer, such as, for example, PEEK®, TEFLON®, TYROSINE®, POLYSULFONE®, polyethylene, polyurethane, polymethylmethacrylate, DELRIN®, or polyphenylsulfone or a biocompatible ceramic, such as, for example, alumina, zirconia, calcium phosphate, or pyrolitic carbon. The upper plate  35  may have a diameter of between approximately 0.05″ and approximately 3″, an overall thickness of between approximately 0.02″ and approximately 0.5″, and the radiating ridges  70  may have a height of between approximately 0.01″ and 1″. The upper plate  35  may have between approximately 2 and approximately 360 radiating ridges  70 . Ridges  70  can be evenly spaced, grouped in sections, or unevenly spaced on the plates surface  55 . 
     For a discussion of the features of a connector end  25  of an intramedullary rod  15 ,  16  to be received by and connected to the embodiment of the hub  20  discussed above with respect to  FIGS. 5-8 , reference is made to  FIGS. 9A-9D .  FIGS. 9A and 9B  are, respectively, enlarged bottom and top plan views of a connector end  25  of intramedullary rods  15 ,  16 .  FIGS. 9C and 9D  are, respectively, enlarged side and end elevations of the connector end  25  depicted in  FIGS. 9A and 9B . 
     As indicated in  FIGS. 9A and 9C , the bottom side of the connector end  25  (i.e., the side of the connector end  25  that faces the concentric rings  60  of the bottom plate  36  when the connector end  25  is received in the void  45  of the hub  20 ) includes a plurality of transverse grooves or teeth  75  defined therein. The grooves or teeth  75  may have a curvature that matches the curvature of the rings  60  of the plate  36 . Each of the teeth  75  may have a saw toothed cross section, wherein each tooth  75  has a right triangle cross section, the right angle of each tooth cross section facing the direction of the free end  30  and the slope of each tooth cross section facing in a direction opposite the direction of the free end  30  (i.e., in the direction of the extreme end  80  of the connector end  25 ). The toothed region formed by the teeth  75  may extend along a length of the rod  15 ,  16  from a location near the extreme end  80  towards the free end  30  for a distance of between approximately 0.1″ and approximately 1.5″. While the interdigitation or interlocking features are depicted as being at the connector ends  25  of the various rods  15 ,  16 , in some embodiments, the interdigitation or interlocking features may be in a single region of the rods, in multiple regions of the rods, or the generally the entire surface of the rods. The interdigitation or interlocking features can also be on one or more sides of the rods or extend circumferentially around the entire surface of the rods. 
     As indicated in  FIGS. 9C and 9D , the tooth arrangement may have an elastic or deformable member (e.g. a spring  525 ) that extends from the rod connector end  25 . The spring and teeth, along with the concentric rings of the plate, may combine to form a spring loaded ratchet mechanism. 
     As shown in  FIGS. 9A-9D , the upper side of the connector end  25  (i.e., the side of the connector end  25  that faces the radiating ridges  70  of the top plate  35  when the connector end  25  is received in the void  45  of the hub  20 ) includes a longitudinally extending slot  85  that extends from the extreme end  80  towards the free end  30  parallel to the longitudinal axis of the rod  15 ,  16 . The length of the slot  85  may be between approximately 0.05″ and approximately 1.5″. 
     In one embodiment, the rods  15 ,  16  are machined, molded, formed or otherwise manufactured from a biocompatible metal, such as, for example, stainless steel, Titanium, Zirconium, Niobium, Cobalt Chrome, or NITINOL® or a biocompatible polymer, such as, for example, PEEK®, TEFLON®, TYROSINE®, POLYSULFONE®, polyethylene, polyurethane, polymethylmethacrylate, DELRIN®, or polyphenylsulfone or a biocompatible ceramic, such as, for example, alumina, zirconia, calcium phosphate, or pyrolitic carbon. In one embodiment, the rod connector end  25  and/or the concentric rings  60  of the bottom plate  36  are formed of a material that deforms or crimps to facilitate a more secure connection between the rod connector end  25  and the hub  20 . Each rod  15 ,  16  may have a diameter of between approximately 0.01″ and approximately 1.5″ and an overall length of between approximately 0.1″ and approximately 30″. Each tooth  75  may have a height of between approximately 0.05″ and approximately 0.25″. Each rod  15 ,  16  may have between approximately 2 and approximately 150 teeth  75 . Each slot  85  may have a width of between approximately 0.005″ and approximately 0.1″ and a depth of between approximately 0.005″ and approximately 0.1″. 
     As can be understood from  FIGS. 5-9D , when the connector ends  25  of the intramedullary rods  15 ,  16  are received in the void  45  between the plates  35 ,  36  of the hub  20 , as depicted in  FIGS. 1-3 , the slot  85  of a specific rod  15 ,  16  may be caused to receive therein a specific radiating guide ridge  70  such that the specific rod  15 ,  16  may displace along the specific radiating guide ridge  70  towards the center hole  66  of the upper plate  35 . As a result, the connector end  25  of the specific rod  15 ,  16  may be caused to be received within the hub  20  to a greater or lesser extent, depending on how far radially inward the specific slot  85  extends along the specific radiating guide ridge  70 . The more fully the specific guide ridge  70  is received in the specific slot  85 , the more fully the connector end  25  is received in the hub  20  and the closer the free end  30  of the specific rod  15 ,  16  is to the outer edge  65  of the upper plate  35 . Thus, the distance between the free end  30  and the outer edge  65  can be telescopically adjusted relative to the hub  20  on account of the sliding engagement between the slot  85  and the ridge  70  received therein. Also, as can be understood from  FIGS. 1 and 3  and, more specifically from the slot/ridge engagement indicated by arrow A in  FIG. 2 , the radial orientation of the specific rod  15 ,  16  about the edge  65  of the upper plate  35  may be selected and maintained according which of the ridge  70  is received by the slot  85 . In summary, the engagement between a slot  85  and a specific ridge  70 , and the extent of such an engagement, may be used to position the free end  30  of a rod  15 ,  16  with respect to both the free end&#39;s radial position about the hub  20  and the linear distance between the free end and the hub&#39;s outer edge. 
     For example, the concentric rings  60  in the bottom plate  36  allow the connector ends  25  of the intramedullary rods  15 ,  16  to be positioned at any radial angle relative to the bottom plate  36 . The length of the rods is also telescopically adjustable relative to the hub  20  by fixed increments, depending on which rings  60  in the bottom plate are engaged by the ridges, grooves or teeth  75  of the connector ends  25  of the rods  15 ,  16 . The radially oriented guides  70  on the top plate  35  provide lateral stability to the rod connector ends  25  of the rods  15 ,  16 . The two plates are assembled such that the concentric and radial features  60 ,  70  orient the rods  15 ,  16  and maintain the orientation. 
     As can be understood from  FIGS. 5-9D , the configuration of the teeth  75  and the spring  525  of a connector end  25  of an intramedullary rod  15 ,  16  results in a ratchet arrangement with the corresponding concentric rings  60  of the lower plate  36  of the hub  20  when the screw  40  couples the plates  35 ,  36  together but is not completely screwed tight to make the hub  20  tightly grip the rod connector ends  25  and to make the implant assembly  10  substantially rigid, as described later in this Detailed Description. Specifically, when the plates  35 ,  36  are generally loosely joined together via a screw  40  that is not tightened down, because of the flexible spring  525  and/or the slopes of the triangular cross sections of the rod teeth  75  face towards the extreme end  80  of the rod  15 ,  16 , and the right angles of the triangular cross sections of the rod teeth  75  face towards the rod free end  30 , the ratchet arrangement formed between the rod teeth  75  and the lower plate concentric rings  60  allows the rod connector end  25  to increasingly travel into the void  45  as the ridge  70  is increasingly received in the slot  85 . However, the ratchet arrangement prevents the rod connector end  25  from withdrawing from the void  45 . Thus, the ratchet arrangement between the rod connector end  25  and the concentric rings  60  allows the rod connector end  25  to be inserted into the void  45  of the hub  20  to the greatest extent made possible via the interaction between the slot  85  and ridge  70  received therein; however, the ratchet arrangement prevents the rod connector end  25  from withdrawing from the void  45 , thereby maintaining the rod connector end  25  within the void  45  to the greatest extent the rod connector end  25  has yet to be received in the hub  20 . Once the rod connector end  25  is received in the hub  20  to the extent desired, the screw  40  may be fully tightened, causing the hub  20  to rigidly grasp the connector end  25  between the plates  35 ,  36 , preventing any further ratcheting and displacement of the connector end  25  within the hub  20 . 
     In one embodiment, the radially extending ridges  70  of the upper plate  35  discussed with respect to  FIGS. 7 and 8  may instead be radially extending grooves  500 . For a discussion of such an embodiment, reference is made to  FIGS. 42 and 43 .  FIG. 42  is a plan view of the top plate  35 .  FIG. 43  is a side elevation view of the bottom plate  35  as taken along line  42 - 42  in  FIG. 42 . As shown in  FIG. 42 , the grooves  500  radially extend from the center hole  66  to the outer circumferential edge  65  and are defined in the inner face  55  of the upper plate  35 . As shown in  FIG. 43 , the grooves  500  may have a V-shaped cross section or other cross section, such as, for example, U-shaped, semi-circular, rectangular, etc. 
     As shown in  FIG. 44 , which is a side view of a connector end  25  of a rod  15 ,  16 , the connector end may include a ringed/grooved configuration having plurality of rings  505  and grooves  510  defined in the shaft of the connector end  25 . As can be understood from  FIG. 45 , which is a cross section elevation of a connector end  25  extending along a groove  500  of a top plate  35  when the plates  35 ,  36  are assembled into a hub  20 , a concentric ring  60  of the bottom plate  36  is received in a groove  510  of the connector end  25  defined between adjacent rings  505  of the connector end  25 . Thus, the groove  500  of the top plate  35  maintains the radial orientation of the connector end  25  and the meshing of the ring/groove arrangement  505 ,  510  of the connector end  25  with the ring arrangement  60  of the bottom plate  36  secures the connector end  25  in position along the groove  500  of the top plate. 
     In one embodiment, the radial grooves  500  and concentric rings  60  can be combined on the interior face of a single plate  35 ,  36 . For a discussion of such and embodiment, reference is made to  FIGS. 46 and 47 .  FIG. 46  is a plan view of the interior face  56  of the bottom plate  36 .  FIG. 47  is a side elevation cross section of the plate  36  as taken along section line  47 - 47  in  FIG. 46 . As shown in  FIG. 46 , the grooves  500  radially extend from the center hole  66  to the outer circumferential edge  65  and are defined in the inner face  55  of the upper plate  35  and the concentric rings  60  of the inner face  55 . As shown in  FIG. 47 , the grooves  500  may have a V-shaped cross section or other cross section, such as, for example, U-shaped, semi-circular, rectangular, etc. The grooves  500  may be defined only through the concentric rings  60  or additionally through other portions of the bottom plate  36 . 
     As can be understood from  FIG. 48 , which is a cross section elevation of a connector end  25  extending along a groove  500  of a bottom plate  36  when the plates  35 ,  36  are assembled into a hub  20 , a concentric ring  60  of the bottom plate  36  is received in a groove  510  of the connector end  25  defined between adjacent rings  505  of the connector end  25 . Thus, the groove  500  of the bottom plate  35  maintains the radial orientation of the connector end  25  and the meshing of the ring/groove arrangement  505 ,  510  of the connector end  25  with the ring arrangement  60  of the bottom plate  36  secures the connector end  25  in position along the groove  500  of the bottom plate  36 . In such an embodiment, the top plate  35  inner face  55  may be generally free of any feature, simply acting as a cap to maintain the connector end  25  of the rod  15 ,  16  received in the radial groove  500  and meshed with the concentric rings  60 . 
     As can be understood from  FIGS. 42 and 46 , in one embodiment, the radially extending grooves  500  may have generally parallel sides such that the grooves  500  have the same width near the center opening  58  and at the circumferential edge  57 . In other embodiments, the radially extending grooves  500  may have sides that diverge from each other such that the grooves are generally pie shaped, having a width at the circumferential edge  57  that is greater than the width at the center opening  58 . As a result of the pie shaped configuration of the grooves  500 , the grooves  500  may allow a slight radial adjustment of the connector end  25  of the rods  15 ,  16 , allowing the free ends  30  of the rods  15 ,  16  to be radially positionally varied a small amount despite being secured within the groove  500 . In one embodiment, the pie shaped grooves  500  may also be wedge shaped (i.e., the depth of the groove  500  into the plate  35 ,  36  increases moving from the center hole  58 ,  66  towards the outer circumferential edge  56 ,  65 . Such a wedge configuration may allow the rods  15 ,  16  to be attached out of plane from the adjacent locking plate at a pre-determined angle. 
     While the embodiments depicted in  FIGS. 7, 42 and 46  depict ridges  70  or grooves  500  that extend radially outward from the center hole  66  of the plate or, in other words, the ridges  70  or grooves  500  are in line with the center hole  66  of the plate  35 , in other embodiments, the ridges or grooves may have different arrangements. For example, as depicted in  FIGS. 81A-81C , which are plan views, respectively, of a plate and plates coupled with rods, a plate  35  may have a radiating pattern of ridges  70  or grooves  500  that radiate outwardly, but are not aligned with the center hole  66  of the plate  35  (see  FIG. 81A ). Thus, as indicated in  FIGS. 81B and 81C , the rods  15 ,  16  may be coupled to the plate  35  such that they radiate outwardly from the plate, but do not align or extend in the direction of the center hole of the plate. In other words, the line along which the rods extend is offset from the center of the plate. 
     In one embodiment, the collar  20  may further includes an adjustable collar located between the two plates  35 ,  36 . The collar may be used to set the angle between rods  15 ,  16  and the plates  35 ,  36  prior to the plates  35 ,  36  being tightened together. Once the plates and rods are positioned as desired, the collar acting to temporarily secure the rods as desired, the plates may be tightened together to form the generally rigid hub. 
     In one embodiment, one or more of the plates  35 ,  36  may be in the form of a simple plate having multiple slots and/or holes through the surface. These slots and/or holes mate with simple rods  15 ,  16  having tapped holes that are perpendicular to the longitudinal axis of the rods. Screws or other fasteners are placed through a hole/slot in a plate and into the rod, securing the rod to the plate. In an alternative embodiment, the tapped holes are in the plate and a clean hole in the rod, the screw extending through the rod and into the tapped hole in the plate. 
     In one embodiment, one or more of the plates  35 ,  36  are deflectable by being formed of a material that allows the one or more plates to be deformed around the rods  15 ,  16  when the plates  35 ,  36  are secured together by, for example, tightening screws to bring the two plates together. 
     While the plates  35 ,  36  and hub  20  are depicted as being generally circular in shape, in some embodiments, the plates and hub may have other shapes, such as, for example, rectangular, square, triangular, hexagonal, semi-circular, elliptical, pie slice shaped, etc. 
     In one embodiment, the plates  35 ,  36  of the hub  20  and the connector ends  25  of the rods  15 ,  16  are configured to create a hole or setscrew interlocking of the connector ends  25  to the hub  20 , the hole or setscrew interlocking in some cases even being fractionally adjustable in a manner resembling a Vernier scale. To begin a discussion of such an embodiment, reference is first made to  FIG. 10 , which is a plan view of an inner face  56  of the lower plate  36 . 
     As shown in  FIG. 10 , the bottom plate  36  includes an outer edge or circumference  57  and a central hole  58  for receiving therein the screw  40 . The inner face  56  of the lower plate  36  may have a plurality of holes  90  arranged in a spiral array extending between the central hole  58  and the outer edge  57 . As indicated in  FIG. 10 , the holes  90  may be arranged in the spiral array such that at least two holes  90  form each radial line  95  of holes  90  extending from the center hole  58  to the outer edge  57 . In one embodiment, each of the radial lines  95  of holes  90  may be radially spaced at approximately five degree increments. In one embodiment, each of the radial lines  95  of holes  90  may be radially spaced at approximately 15 degree increments. In other embodiments, the radial spacing between adjacent radial lines  95  of holes  90  may be greater or lesser than five degrees or greater or lesser than 15 degrees. 
     In one embodiment, as can be understood from  FIG. 10  and from discussion below, the plate  36  may be rotated to determine the set of holes  90  that align with the corresponding notches  110 ,  111  on the connector end of the intramedullary rod  15 ,  16  when the rods  15 ,  16  are implanted with their respective free ends  30  located as desired. Thus, because of the spiral array of holes  90 , rotation of the array allows the rods  15 ,  16  to be telescopically positioned relative to the hub  20  as desired, the rotated array of holes  90  enabling fine adjustment to the distance the rods  15 ,  16  extend (telescope) away from the hub  20 . 
     In one embodiment, the spiral array equipped plate  36  of  FIG. 10  may be employed by itself to form the hub  20  of the implant assembly  10 . Specifically, plate  36  may be positioned proximally/distally and rotationally within the bone such that the spiral array of holes  90  may be used to secure the rods  15 ,  16  to the plate  36  as desired with respect to the extent to which the rods radially extend from the plate and the direction of projection from the plate. 
     In other embodiments, the spiral array equipped plate  36  may be configured to be used with another plate  35  to form the hub  20  of the implant assembly  10 . For example, as indicated in  FIG. 49 , which is the same view as  FIG. 10 , except of another embodiment, the spiral array holes  90  discussed with respect to  FIG. 10  may further include alignment holes  91  near the outer circumferential edge  57  of the plate  36 . In one embodiment, one of the alignment holes  91  is located adjacent the last and most outward hole  90  of the spiral array. Another alignment hole  91  may be located directly across the plate  36  near the opposite side of the outer circumferential edge  57 . The alignment holes  91  may be employed for positionally securing the plate  36  rotationally relative to an accompanying plate  35 , which may have a plurality of interlocking holes  93  adjacent the outer circumference of the plate  35 , as indicated in  FIG. 50 . In other words, once the plate  36  is rotationally positioned as desired to position the spiral holes  90  as needed, then a pin or setscrew can extend through the alignment holes  91  in the plate  36  and into the locking holes  93  of the plate  35 , preventing further rotational displacement between the plates  35 ,  36 , which in combination may form the hub  20  of the implant assembly  10 . 
     In one embodiment, such a lower plate  36  is machined, molded, formed or otherwise manufactured from a biocompatible metal, such as, for example, stainless steel, Titanium, Zirconium, Niobium, Cobalt Chrome, or NITINOL® or a biocompatible polymer, such as, for example, PEEK®, TEFLON®, TYROSINE®, POLYSULFONE®, polyethylene, polyurethane, polymethylmethacrylate, DELRIN®, or polyphenylsulfone or a biocompatible ceramic, such as, for example, alumina, zirconia, calcium phosphate, or pyrolitic carbon. The lower plate  36  may have a diameter of between approximately 0.05″ and approximately 3″, an overall thickness of between approximately 0.02″ and approximately 0.5″, and the holes  90  may have a diameter of between approximately 0.01″ and 0.1″. The lower plate  36  may have between approximately 1 and approximately 500 holes  90 . 
     As shown in  FIG. 11 , which is a plan view of an inner face  56  of the lower plate  36 , the lower plate  36  includes an outer edge or circumference  57  and a central hole  58  for receiving therein the screw  40 . The inner face  56  of the lower plate  36  may have a plurality of radially oriented paired lines  100  of holes  105  in the inner face  56 . The paired lines  100  of holes  105  radiate outwardly from a point near the central hole  58  towards the outer edge  57 . In one embodiment, the paired lines  100  of holes  105  may be radially spaced from adjacent paired lines  100  of holes  105  at 30 degree increments. In other embodiments, the radial spacing between adjacent paired lines  100  of holes  105  may be greater or lesser than 30 degrees. 
     In one embodiment, such a lower plate  36  is machined, molded, formed or otherwise manufactured from a biocompatible metal, such as, for example, stainless steel, Titanium, Zirconium, Niobium, Cobalt Chrome, or NITINOL® or a biocompatible polymer, such as, for example, PEEK®, TEFLON®, TYROSINE®, POLYSULFONE®, polyethylene, polyurethane, polymethylmethacrylate, DELRIN®, or polyphenylsulfone or a biocompatible ceramic, such as, for example, alumina, zirconia, calcium phosphate, or pyrolitic carbon. The upper plate  35  may have a diameter of between approximately 0.05″ and approximately 3″, an overall thickness of between approximately 0.02″ and approximately 0.5″, and the holes  105  may have a diameter of between approximately 0.01″ and 0.1″. The upper plate  35  may have between approximately 1 and approximately 500 holes  105 , between approximately 2 and approximately 75 paired lines  100  of holes with between approximately 2 and approximately 50 holes  105  in each line of a paired line  100  of holes  105 . The holes  105  extending along a paired line  100  may be spaced or offset from each other at generally even intervals of between approximately 0.02″ and approximately 0.1″. 
     In one embodiment, the connector ends of the intramedullary rods  15 ,  16  may be connected to the paired lines  100  of holes  105  via pins, screws or other members. The extent to which a rod  15 ,  16  extends from the plate  36  of  FIG. 11  will depend where along the paired lines  100  the rod  15 ,  16  is coupled to the holes  105 . Thus, the paired lines  100  of holes  105  may be employed to allow a rod connector end  25  to be coupled to the plate  36  such that the rod  15 ,  16  extends from the plate  36  a greater or lesser extent. In one embodiment, the plate  36  of  FIG. 11  may be rotationally coupled to the plate  35  of  FIG. 50  such that the lines  100  of holes  105  may be rotationally positioned about the center holes  58 ,  66  as desired to allow the rods  15 ,  16  to extend in a desired direction from the plates of the hub. Once positioned as desired, one or more holes in the plate  36  of  FIG. 11  may be pinned, screwed or otherwise connected to the holes  93  adjacent the outer circumference of the plate  35  of  FIG. 50 , preventing further rotational displacement between the plates of  FIGS. 11 and 50 . 
     In other embodiments, the various versions of the plates  35 ,  36  depicted in  FIGS. 10, 11, 49, 50 and 52A  may be combined as already discussed above or in other combinations. For example, in some embodiments, the plate of  FIG. 10 or 49  may be employed with the plate  35  of  FIG. 50 . Alternatively, for example, in some embodiments, the plate of  FIG. 11 or 52A  may be employed with the plate of  FIG. 50 . Alternatively, for example, in some embodiments where three or more plates are employed, one of the plates may be as depicted in  FIGS. 10 and 49  and have rods  15 ,  16  coupled thereto, another of the plates may be as depicted in  FIGS. 11 and 52A  and have other rods  15 ,  16  coupled thereto, and another plate as depicted in  FIG. 50  may be used to prevent the three plates from rotating relative to each other once the rods  15 ,  16  and plates are coupled together and positioned as desired. Alternatively, for example, in some embodiments where three or more plates are employed, two of the plates may be as depicted in  FIGS. 10 and 49 , each those two spiral array plates having rods  15 ,  16  coupled thereto, the third plate being as depicted in  FIG. 50  and being used to prevent the three plates from rotating relative to each other once the rods  15 ,  16  and plates are coupled together and positioned as desired. Alternatively, for example, in some embodiments where three or more plates are employed, two of the plates may be as depicted in  FIGS. 11 and 52A , each those two pair line array plates having rods  15 ,  16  coupled thereto, the third plate being as depicted in  FIG. 50  and being used to prevent the three plates from rotating relative to each other once the rods  15 ,  16  and plates are coupled together and positioned as desired. 
     While the various plates  35 ,  36  are referred to herein as upper and lower plates, or similar terms, any of the plates  35 ,  36  described herein may be positioned to be an upper or lower plate or vice versa. Also, any of the different plate embodiments may be combined with any other plate embodiment (e.g., plates described as an upper plate  35  may be combined with another plate described as an upper plate, and plates described as a lower plate  36  may be combined with another plate described as a lower plate) in forming a hub  20 . Also, features of the various plates may be combined into a single plate. A hub  20  may be formed of a single plate, two plates, three plates, four plates or more, and each plate of a hub may couple with one or more of the same rods  15 ,  16  or a specific rod may have a dedicated connection to a single plate of the hub. 
     For a discussion of the features of a connector end  25  of an intramedullary rod  15 ,  16  to be received by and connected to the various embodiments of the hub  20  discussed above with respect to  FIGS. 10-11, 49, 50 and 52A , reference is made to  FIG. 12 , which is an enlarged side elevation of the connector end  25  of intramedullary rods  15 ,  16 . 
     As indicated in  FIG. 12 , the side of the connector end  25  includes a plurality of notches  110  defined therein. Each of the notches  110  may have a semicircular cross section. The notched region formed by the notches  110  may extend along a length of the rod  15 ,  16  from a location near the extreme end  80  towards the free end  30  for a distance of between approximately 0.1″ and approximately 1.5″. 
     As shown in  FIG. 12 , the other side of the connector end  25  includes a plurality of notches  111  defined therein. Each of the notches  111  may have a semicircular cross section. The notched region formed by the notches  111  may extend along a length of the rod  15 ,  16  from a location near the extreme end  80  towards the free end  30  for a distance of between approximately 0.1″ and approximately 1.5″. 
     As shown in  FIG. 51A , which is a view similar to  FIG. 12 , the connector end  25  of the rod  15 ,  16  may include notch spacings on each side that are generally equal and positioned the same as each other. As shown in  FIG. 51B , which is an end view of the connector end  25 , the connector end  25  may have a flat face  520  that may abut against the interior face  55 ,  56  of a plate  35 ,  36 . As can be understood from  FIG. 510 , which is a transverse cross section of the connector end  25  as taken along section line  510 - 510  in  FIG. 51A , the notches  110 ,  111  are defined in the sides of the connector end  25  that are lateral of the flat face  520 . 
     In one embodiment, the rods  15 ,  16  are machined, molded, formed or otherwise manufactured from a biocompatible metal, such as, for example, stainless steel, Titanium, Zirconium, Niobium, Cobalt Chrome, or NITINOL® or a biocompatible polymer, such as, for example, PEEK®, TEFLON®, TYROSINE®, POLYSULFONE®, polyethylene, polyurethane, polymethylmethacrylate, DELRIN®, or polyphenylsulfone or a biocompatible ceramic, such as, for example, alumina, zirconia, calcium phosphate, or pyrolitic carbon. Each rod  15 ,  16  may have a diameter of between approximately 0.01″ and approximately 1.5″ and an overall length of between approximately 0.1″ and approximately 30″. Each notch  110 ,  111  may have a depth of between approximately 0.005″ and approximately 0.1″ and a length or mating surface area of between approximately 0.01″ and approximately 0.25″. Each rod  15 ,  16  may have between approximately 2 and approximately 150 notches  110  on one side and between approximately 2 and approximately 150 notches  111  on the other side. In one embodiment, as indicated in  FIG. 12 , the notches  110  on the one side may be spaced or offset from each other at generally even intervals of between approximately 0.01″ and approximately 0.25″. The notches  111  on the other side may be spaced or offset from each other at generally even intervals of between approximately 0.01″ and approximately 0.25″. Thus, in one embodiment, as indicated in  FIG. 12 , the notches  110  on one side may have a spacing that is different from the notches  111  on the other side. However, as indicated in  FIG. 51A , the spacing of the notches  110 ,  111  on each side may be generally equal, and the notches  110 ,  111  on each side may not be offset from each other. 
     As can be understood from  FIGS. 10 and 12 or 49 and 12 , when the connector ends  25  of the intramedullary rods  15 ,  16  are received in the void  45  between the plates  35 ,  36  of the hub  20  in a manner similar to that depicted in  FIGS. 1-3 , the spiral array of holes  90  in the bottom plate  36  is employed to allow for a variety of lengths for the intramedullary rods to extend from the hub  20 . In other words, the spiral array of holes  90  may be employed to adjust the length of distance between the rod free end  30  and the edge of the hub  20 . Once positioned with respect to the extent the rods extend form the plate  36 , the plate may be rotated as needed to position the rods as needed with respect to radial direction. The plate  35  of  FIG. 50  may then be secured to the spiral plate  36  of  FIG. 10 or 49  as described above to prevent the plates  35 ,  36  from rotationally displacing relative to each other. 
     As can be understood from  FIGS. 10, 12, 49, 50 and 51A , in one embodiment, pins or setscrews  115  may be employed in the holes  90  of the spiral array to engage corresponding notches  110 ,  111  to secure the rod connector end  25  within the hub  20 . The plates  35 ,  36  may be placed together to sandwich the rod connector ends  25  within the resulting hub  20  as depicted in  FIG. 2 , and the holes  91 ,  93  in the plates  35 ,  36  may be pinned together to prevent the plates from rotationally displacing relative to each other. The central setscrew  40  can then be fully tightened down to cause the hub  20  and rods  15 ,  16  extending from the hub  20  to form a generally rigid assembly  10 . 
     As can be understood from  FIGS. 11 and 52A-52C , the paired line array may be employed to both position the rods  15 ,  16  with respect to radial position about the hub and telescopic extension from the hub. For example, the paired line array may have radially extending paired lines of holes  105 . For each set of paired lines, one line of holes  105  will have a hole spacing that is offset from the hole spacing of the other line of holes  105 . As indicated by arrow R in  FIG. 52A , the offset R between the lines of holes may be between approximately 0.02″ and approximately 0.1″. In one embodiment, the offset R may be approximately ½ of the pitch between the holes. As indicated by arrows T and T′ respectively in  FIGS. 52A and 52C , the spacing T′ between adjacent notches  110 ,  111  on the connector end  25  may be between approximately 0.1″ and approximately 0.4″, and this spacing T′ may correspond to a spacing T between holes  105  in the plate  35 ,  36  (e.g., spacing T may be the distance across four adjacent holes  105 ). 
     In one embodiment, Twill be approximately the centerline distance of two holes and the space between them. Hole size may be from approximately 0.02″ to approximately 0.08″. Such holes may be threaded or not threaded. The pitch between holes on the same side of the rod may be approximately 0.1″ to 0.4″ with hole size of 0.02″ to 0.08″. As can be understood from  FIG. 52C , groove spacing on one side of the a rod may be in line with the groove spacing on the other side of the rod, and, as can be understood from  FIGS. 52A and 52B , the offset spacing of the holes in the plate indexing the rod. Offset spacing R of the holes  105  in the plate labeled may be ½ of the 0.1″ to 0.4″ pitch range of the grooves in the rod. 
     As can be understood from  FIG. 52B  at arrow Z, the rod connector end  25  may be positioned on the plate  35 ,  36  such that certain notches  111  align with certain holes  105  of a first line of holes  105 . Pins or screws  115  may be used to secure the rod connector end  25  in the position indicated by arrow Z. The rod  15 ,  16  may need to project or telescope further than is allowed by the pin positioning arrangement at arrow Z. As indicated by arrow X, the rod  15 ,  16  may be moved along the paired line of holes  105  such that the notches  110  on the other side of the rod connector end  25  are mated with holes  105  in the other of the paired lines of holes  105 , the free end  30  of the rod  15 ,  16  projecting further at arrow Y than it did at arrow Z by a movement increment amount of W. Thus, it can be understood that the hole/notch arrangement may be employed to incrementally telescope the rod relative to the hub. 
     In some embodiments, as can be understood from  FIGS. 11 and 52A , in one embodiment, the radially extending paired lines of holes  105  may have parallel lines of holes  105  such that the adjacent lines of holes  105  have the same width of space between the lines of holes  105  near the center opening  58  and at the circumferential edge  57 . In other embodiments, the radially extending paired lines of holes  105  may diverge from each other such that the lines of holes  105  define an area between the lines of holes that is generally pie shaped, having a width at the circumferential edge  57  that is greater than the width at the center opening  58 . As a result of the pie shaped configuration of the lines of holes  105 , the lines of holes  105  may allow a slight radial adjustment of the connector end  25  of the rods  15 ,  16 , allowing the free ends  30  of the rods  15 ,  16  to be radially positionally varied a small amount despite being secured with the holes  105 . 
     As explained above, in some embodiments, the spiral and paired line arrays depicted respectively in  FIGS. 10 and 11  may each be employed respectively on a bottom plate or top plate with the plate of  FIG. 50 , the plates of  FIG. 10 or 11  being employed to position the rods with respect to the hub  20  and the plate of  FIG. 50  being employed to complete the hub  20 . However, in other embodiments, the hub  20  may only employ the one of the positioning plates depicted in  FIG. 10 or 11 , and will not be a multi-plate hub  20  (e.g. the hub  20  will not also employ the securing plate of  FIG. 50 . In some embodiments, the hole arrangements depicted in  FIGS. 10 and 11  may be combined or both such plates may be employed in the same hub  20  to act in common to secure and position the same rods  15 ,  16 . In some embodiments, the concentric rings/grooves and/or the radially extending rings/grooves discussed above with respect to  FIGS. 5-8 and 42-48 , along with the corresponding features of the connector rods  25  configured to work with the concentric and radially extending rings/grooves, may be employed, to a greater or lesser extent, with the notch/hole configurations discussed above with respect to  FIGS. 10-12 and 49-52C . 
     In one embodiment, the plates  35  and  36  respectively depicted in  FIGS. 50 and 10  are employed together as a single plate assembly. Specifically, the plate  36  of  FIG. 10  is pivotally coupled to the plate  35  of  FIG. 50  via a bolt or other fastening member extending through the plates&#39; respective center holes  58 . As the plate  36  of  FIG. 10  is rotated clockwise, the spiral line of holes  90  will pull the holes  90  on a fixed radial line  95  inwards towards the center of the plate  36 . Once the spiral line of holes  90  is rotated to present the combination of holes and location needed to result in the desired notch engagement position for the corresponding rod connector ends  25 , the plate  36  of  FIG. 10  may be locked rotationally in place relative to the plate  35  if  FIG. 50  by extending a fastening member between a hole  90  of the plate  35  into a hole  93  of the plate  36 . In some such embodiments, the hub  20  may employ multiple plates  36  of the type depicted in  FIG. 10 , each such plate  36  being dedicated to positioning a single rod  15 ,  16 . 
     In some embodiments, the rod connector ends  25  may be configured to provide a textured or friction connection within the hub  20 . For example, as shown in  FIG. 53 , which is a plan view of an interior face  55 ,  56  of a plate  35 ,  36 , the interior face  55 ,  56  may be textured (e.g., knurled or otherwise finished) to have a rough, high coefficient of friction surface. As indicated in  FIG. 54 , which is a side view of a rod connector end  25 , the connector end  25  may be similarly textured (e.g., knurled or otherwise finished) to have a rough, high coefficient of friction surface. As indicated in  FIG. 55A , which is a plan view of the implant assembly  10 , the textured connector ends  25  of the various rods  15 ,  16  are fixed within the hub  20 . As shown in  FIG. 55B , which is a side cross section view of the implant assembly  10  as taken along section line  55 B- 55 B in  FIG. 55A , the textured interior surfaces  55 ,  56  engage the textured rod connector end  25  such the rod connector end  25  is securing held in place by the plates  35 ,  36  being secured together via the screw  40  to form the hub  20  and the overall implant assembly  10 . By employing such an embodiment of textured plates and rod connector ends, the positioning options for the rods in the hub with respect to both radial and telescopic position is virtually limitless. 
     In one embodiment, the plates  35 ,  36  may be in sections (e.g., a plate may have two semi-circular section, quarter section, etc.). The sections may be individually tightened such that one plate section may be tightened independently from the rest of the plate sections. As a result, one or more rods may be placed and secured in a section of a plate (e.g., the plate section is fully tightened about the one or more rods located within the plate section) after which other rods are placed and secured in other sections of the plate. 
     In one embodiment, the rod connector ends  25  and the plates  35 ,  36 , or portions thereof, may be configured a ball end connection arrangement. For example, in  FIG. 56 , which is a side view of a rod connector end  25  having the ball end connection arrangement, the arrangement may include a ball  530  having a hole  535  through which the rod connector end  25  may extend in a telescopic fashion, as indicated by arrow N. The ball  530  may be in the form of two halves  530 ′,  530 ″ or otherwise configured such that the ball  530  can be caused to constrict about the rod connector end  25 . The ball  530  may be received in a spherical nest or pot  540  defined via an upper spherical portion  540 ′ in the upper plate  35  and a lower spherical portion  540 : in the lower plate  36 . On account of the ball end connection, the rod  15 ,  16  may be both telescopically and radially positioned until the plates  35 ,  36  are secured together, causing the plates to exert a squeezing force (arrows K in  FIG. 57 , which is the same view as  FIG. 56 , except with the squeezing force applied) that causes the spherical nest portions  540 ′,  540 ″ to grip and hold the spherical ball portions  530 ′,  530 ″ in place. Such gripping and holding results in the rod  15 ,  16  being locked in the desired radial and telescopic position for the free end  30 . 
     As shown in  FIG. 58A , which is a side view of the hub  20 , the spherical nest  540  may be formed directly into the interior surfaces  55 ,  56  of the plates  35 ,  36 . As can be understood from  FIGS. 58B and 58C , which are, respectively, a side view of a rod having a connector end  25  with a ball end  550  and a view of the hub and connector end coupled together, the ball end  550  may be secured in the nest  540 . As shown in  FIG. 58D , which is the same view as  FIG. 580 , the ball arrangement allows the rod  15 ,  16  to pivot about the ball  550  and as indicated by arrow Q until the plates are clamped together, as indicated in  FIG. 580 . As shown in  FIG. 58E , which is the same view as  FIG. 58B , the ball end  550  may include a hole  555  that may receive a fastener there through. Thus, as shown in  FIG. 58F , which is a plan view of the implant assembly  10  employing the ball configuration depicted in  FIGS. 58A-58E , the fasteners  560  may extend through the hole  555  to limit the movement to a plane generally parallel to the interior surfaces of the plates, as indicated by arrow G. The fastening of the ball end  550  within the nest  540  may be facilitated by a combination of the plates  35 ,  36  being tightened together and the fastener  560 . 
     In one embodiment, as shown in  FIGS. 59A and 59B , which are, respectively, plan views of a bottom plate  36  and a wedged attachment point  565 , a wedged attachment point  565  may be adjustably mounted on an interior face  56  of the bottom plate  36 . As indicated in  FIG. 59B , the wedged attachment point  565  may have a narrow end  566 , a wide end  567  and an opening  568  between the ends that may be slightly arcuate. As depicted in  FIG. 59A , the wedged attachment point  565  may be mounted on the interior face  56  such that the narrow end  566  is near the central opening  58  and the wide end  567  is near the outer circumferential edge  57 . A fastener  569  may extend from the interior face  56  through the opening or slot  568 . 
     In one embodiment, as indicated in  FIGS. 59C and 59D , which are side elevations of the bottom plate  36  and the wedged attachment point  565  mounted thereon, a rod connector end  25  may be coupled to the wedged attachment point  565 . The wedged attachment point  565  may be supported off of the bottom plate  36  via interfaced wedged plates  600 ,  601 . Each wedged plate  600 ,  601  has a wedged thickness. As shown in  FIG. 590 , when the wedged plates  600 ,  601  are rotated relative to each other in one way, the wedged thicknesses cancel each other out such that the wedged attachment point  565  is generally parallel to the bottom plate  36 . However, as illustrated in  FIG. 59D , when the wedged plates  600 ,  601  are rotated relative to each other in another way, the wedged thicknesses complement each other such that the wedged attachment point  565  is sloped relative to the bottom plate  36 . Thus, in the embodiments depicted in  FIGS. 59A-59D , it can be understood that the wedged attachment member  565  facilitates the rod  15 ,  16  being varied radially in a plane parallel to the bottom plate  36 , and the wedged plates  600 ,  601  facilitates the rod  15 ,  16  being varied radially in a plane perpendicular to the bottom plate  36 . Depending on the embodiment, the rods may extend both ways up and down the pie plate  565  shown in  FIG. 59D . In other embodiments, the rod will extend down the pie plate  565  in  FIG. 59D , not up the pie plate. 
     In one embodiment, certain intramedullary rods  15  have free ends  30  configured to interface with cortical bone (or other bone materials, which depending on the context, may include cortical bone, cancellous bone, and/or bone marrow) that is between the fracture location and a joint surface. For example, in the context of a distal radial fracture, the free ends  30  of certain intramedullary rods  15  will be configured to interface with cortical bone distal the fracture. In the context of a femoral neck fracture, the free ends  30  of certain intramedullary rods  15  will be configured to interface with cortical bone proximal the fracture. For a discussion of the features of free ends  30  for such intramedullary rods  15 , reference is made to  FIGS. 4A-4D .  FIGS. 4A-4C  are side elevation views of alternative embodiments of free ends of intramedullary rods, wherein the free ends have bone interface tips with different features.  FIG. 4D  is an end elevation view of the embodiment depicted in  FIG. 40  as viewed along line  4 D- 4 D in  FIG. 4C . 
     As indicated in  FIGS. 4A-4C , each embodiment of the free end  30  of the rod  15  has an interface tip  120  for penetrating or otherwise interfacing in an attaching manner cortical bone. More specifically, each free end of an intramedullary rod  15  has a penetration tip  120  for penetrating cortical bone and, thereby causing the free end  30  to connect to the cortical bone. In one embodiment, the tip  120  is pointed and may be threaded such that the tip  120  may be screwed into the cortical bone. In other embodiments, the tip is not threaded and may be pointed or blunt. In one embodiment, the length of the pointed and threaded tip  120  may be between approximately 0.5 millimeters and approximately 15 millimeters. 
     In some embodiments, a physical impediment  125  may be found on the free end  30  immediately adjacent to the widest end of the pointed and threaded tip  120 . For example, as shown in  FIG. 4B , the physical impediment  125  may be in the form of a spherical backstop  125  having a diameter that exceeds the diameter of the intramedullary rod  15  by approximately 5 percent to approximately 75 percent. In another embodiment, as shown in  FIGS. 4C and 4D , the physical impediment  125  may be in the form of a collar, rim, lip or other step-like transition  125  in the diameter of the intramedullary rod  15  at the transition between the widest end of the pointed and threaded tip  120  and the rest of the rod  15 . Regardless of the shape of the physical impediment  125 , the physical impediment  125  improves the surgeons&#39; ability to feel that the tips  120  are sufficiently penetrated into the cortical bone while helping to prevent the surgeon from causing the tips  120  to over penetrate. In other words, the physical impediment  125  may prevent the tip  120  from penetrating into the cortical bone more than the length of the threaded tip  120 , thereby preventing articular protrusion of the tip  120 . 
     As illustrated in  FIGS. 4C and 4D , in one embodiment, the rod  15  also include grooves  130  that extend into the rod  15  and extend towards the connector end  25  from the widest end of the pointed and threaded tip  120 . These grooves  130  may be cut into the rod beginning at the edge of the collar  125  to facilitate the movement of material away from the tip  120 . These grooves  130  will also help to distribute bone chips surrounding the rod  15  and improve the fixation of the rod  15  to the surrounding cortical bone. 
     In some embodiments, the rod free end  30  may not have an interface tip  120 , but instead have a blunt end that is not configured to penetrate bone material. 
     In some embodiments, the intramedullary rod  15  may further include an anchor  135  to prevent the tip  120  from being pulled out of the cortical bone once tip  120  is fixed into the cortical bone. For a discussion of such an anchor  135 , reference is made to  FIGS. 13A-13C , wherein  FIG. 13A  is a side elevation cross section of the free end  30  of the rod  15  with the anchor  135  stowed and  FIGS. 13B and 13C  are the same view, except of the anchor being progressively deployed. As can be understood from  FIG. 13A , the anchor  135  is stored inside the intramedullary rod  15  until the tip  120  is imbedded in the bone (e.g., the tip  120  has fully penetrated cortical bone  133 ). In one embodiment, the rod  15  includes a lumen  140  that extends through the length of the rod  15 . The anchor  135  extends through the lumen  140  and may be in the form of a wire or strip  135  that is biased to assume a curved shape, the bias being such that the anchor  135  may be considered to be spring loaded within the lumen  140  until deployed. When the anchor  135  is stowed as depicted in  FIG. 13A , the anchor tip  145  is biased against or towards the inner circumferential surface  150  of a lumen  140  and away from an exit opening  155  leading form the lumen  140  to outside the rod  15 . 
     An end  160  of the anchor  135  opposite the anchor tip  145  may be coupled to an anchor actuator  165  that allows the surgeon to manipulate and deploy the anchor  135 . For example, in one embodiment, the anchor actuator  165  may be a member or cylinder  165  mounted in the rod  15  that may be both rotated about the rod  15  and axially displaced along the rod  15 . Thus, as can be understood from  FIG. 13B , by rotating the member  165  about the rod  15  as indicated by arrow B, the anchor  135  is caused to rotate (e.g., 180 degrees) within the lumen  140  such that the anchor tip  145  ends up being located near the exit opening  155 . As can be understood from  FIG. 130 , by displacing the member  165  axially along the rod  15  as indicated by arrow C, the anchor  135  is caused to axially displace within the lumen  140  such that the anchor tip  145  ends up extending through the exit opening  155  and into a region in the bone  133  near the tip  120 . For example, the region in the bone  133  may be cancellous bone and the tip  120  may penetrate cortical bone  133 . The anchor tip&#39;s passage through the exit hole  155  may be facilitated via the curvature of the anchor  135  and a guide  170  near the exit opening  155 . 
     The anchor actuator  165  may be located at or form the extreme end  80  of the connector end  25  of the rod  15 . Alternatively, the anchor actuator  165  may be located on the rod  15  anywhere between the connector end  25  and the free end  30 . In other embodiments, the anchor actuator may simply be the end  160  of the anchor  135 , the end  160  protruding from an opening in the extreme end  80  and being capable of being grasped and manipulated to bring about the deployment of the anchor tip as shown in  FIGS. 13A-13C . The anchor or its actuator may be configured such that either or both lock in place once the anchor is fully deployed. For example, a locking mechanism  175  in the form of a notch  175  on the anchor  135  may ratchet past the guide or backstop  170  such that the anchor  135  cannot be retracted once fully deployed. In some embodiments, there may be more than one notch on the anchor to allow multiple anchoring positions. 
     In one embodiment wherein the rod  15  has an exterior shaft and interior shaft telescopically arranged relative to each other, the anchor  135  may be deployed by moving the anchor  135  forward relative to the exterior shaft such that the anchor  135  protrudes out through the opening  155  in the rod  15 . This motion can be achieved by pushing the interior shaft forward, by pulling the outer shaft back or some combination of these two motions. The opening  155  in the distal end of the rod  15  may be pre-shaped to facilitate the deployment of the anchor  135 . There may be one, two or more such anchors  135  for a single rod  15 , providing, respectively, one, two or more anchor points. 
     As can be understood from  FIGS. 74A and 74B , which are views respectively similar to  FIGS. 13A and 13C , the anchor  135  may be locked in place via a locking mechanism once the anchor  13  is fully extended, as shown in  FIG. 74B . The locking mechanism may include a notch  700  on the anchor wire  135  that ratchets past a locking bump or pin  705  defined in the inner circumferential surface  150  of a lumen  140  near an exit opening  155  leading form the lumen  140  to outside the rod  15 . There may be more than one notch  700  on the anchor wire  135  to allow multiple anchoring positions. In some embodiments, the locking bump or pin  705  may be formed in the inner circumferential surface  150  by crimping, dimpling or otherwise inwardly deforming the wall of the rod  15  to form the feature  705 . 
     As can be understood from  FIGS. 13A-14B, 74A and 74B , the rods  15 ,  16  may employ one, two, three, four or more anchors  135 . 
     Other methods of locking the anchor  135  may be used, for example, by crushing the outer tube of the intramedullary rod  15  into the grooves  700  in the inner anchor wire  135  with a locking pin or clamp, or by crimping the rod  15  to create a press-fit between the shaft of the intramedullary rod  15  and the interior anchor wire  135 . In these methods the crimp/crush location on the intramedullary rod  15  may be outside connector end  25  of the intramedullary rod  15  to be incorporated into the central lock hub  20 . 
     The anchor  135  may be made from Nitinol or another spring tempered material that enables the anchor  135  to follow a pre-determined curvature once deployed. 
     In one embodiment, certain intramedullary rods  16  have free ends  30  configured to interface with bone that is between the fracture location and a shaft of the bone or a portion of the bone that is opposite the fracture from a joint surface. For example, in the context of a distal radial fracture, the free ends  30  of certain intramedullary rods  16  will be configured to interface with bone proximal the fracture. In the context of a femoral neck fracture, the free ends  30  of certain intramedullary rods  16  will be configured to interface with bone distal the fracture. For a discussion of the features of free ends  30  for such intramedullary rods  16 , reference is made to  FIGS. 14A-14B .  FIG. 14A  is a side elevation cross section of the free end  30  of the rod  16  with the anchors  135  stowed.  FIG. 14B  is the same view, except the anchors  135  are fully deployed. 
     As can be understood from  FIGS. 14A-14B , each embodiment of the free end  30  of the rod  16  has an interface tip  120  for penetrating or otherwise interfacing in an attaching manner bone. More specifically, each free end of an intramedullary rod  15  has a penetration tip  120  for penetrating bone and, thereby causing the free end  30  to connect to the bone. In one embodiment, the tip  120  is pointed and may be threaded such that the tip  120  may be screwed into the bone. In one embodiment, the length of the pointed and threaded tip  120  may be between approximately 0.5 millimeters and approximately 15 millimeters. 
     In some embodiments, the tip  120  may include any of the physical impediments  125  and/or the grooves  130  discussed above with respect to  FIGS. 4A-4C . 
     As shown in  FIGS. 14A and 14B , the rod  16  may be equipped with multiple anchors  135  similar to the anchor  135  discussed above with respect to  FIGS. 13A-13C  and  FIGS. 74A-74B . Specifically, the anchors  135  may be axially displaced within the rod lumen  140  to exit from respective exit openings  155 . Each anchor  135  may be equipped with a locking mechanism  175  similar to that described with respect to  FIGS. 13A-13C  and  FIGS. 74A-74B . Full deployment of the anchors  135  allows the rod tip  120  to be anchored in the bone material or, more specifically, in the shaft of the bone. Thus, the multiple anchors  135  (e.g., three, four or more anchors) enables the free end  30  of the rod  16  to contact the interior of the shaft of a long bone, such as, for example, a radius, femur or tibia in at least two or three positions to increase the torsional and rotational stability of the fracture. The multiple anchors  135  depicted in  FIGS. 14A and 14B  may be deployed via any of the mechanisms discussed with respect to  FIGS. 13A-13C  and  FIGS. 74A-74B . 
     In other embodiments of the rod  16 , the outer wall of the rod  16  near the tip  120  may be caused to expand to cause the tip  120  to secure itself within the bone shaft. For example, as depicted in  FIG. 15A , which is a side elevation view of a free end  30  of the rod  16 , the rod outer wall or surface  180  may be sectioned immediately adjacent the rod tip  120  via cuts or scores  185 . As shown in  FIG. 15B , which is a side elevation cross section of the free end  120  of the rod  16 , a shaft  190  extends through the axial center of the rod  16 , one end  195  of the shaft  190  being connected to the tip  120  and the other end  200  being configured such that it may be acted upon by the surgeon. 
     As shown in  FIG. 15C , the shaft  190  may be displaced away from the tip  120  within the rod  16  as indicated by arrow D such that the tip  120  acts against the sectioned wall  180  so as to cause the wall  180  to fold (e.g., like a paper lantern). Thus, displacing the shaft  190  within the rod  16  as indicated by arrow D will cause the wall to form a substantially radially expanded portion  205 , which can be used to secure the tip  120  within the bone shaft once the tip  120  is properly positioned within the bone shaft. Depending on the embodiment, the surgeon may cause the displacement between shaft  190  and rod  16  by pulling the shaft  190  back relative to the rod  16  or causing rod  16  to move forward relative to the shaft  190 . The shaft  190  may have a notch  175  that engages a feature  170  on the rod  16  that locks the rod and shaft in place once the radially expanded portion  205  makes contact with the cortical bone within the bone shaft. This contact will limit displacements of the free end  30  of the rod  16 . The locking of the rod and shaft relative to each other via features  170 ,  172  will prevent the radially expanded portion  205  from unfolding. The locking of the rod and shaft relative to each other may be accomplished via other configurations, for example, by pins, screws or other members extending between the rod and shaft. Alternatively, the rod may be crimped about the shaft to secure the rod and shaft relative to each other. 
     In another embodiment of the rod  16 , the outer wall of the rod  16  near the tip  120  may also be caused to expand to cause the tip  120  to secure itself within the bone shaft. For example, as depicted in  FIG. 16A , which is a side elevation view of a free end  30  of the rod  16 , the rod outer wall or surface  180  may be sectioned immediately adjacent the rod tip  120  via cuts or scores  185 . As illustrated in  FIG. 16B , which is a side elevation cross section of the free end  120  of the rod  16 , the rod outer wall  180  may have a thickened portion  220  immediately adjacent the rod tip  120 . In other words, the interior of the rod  16  may constrict in diameter moving towards the free end  30  such that the wedge shape  225  may interact with the interior constricted surfaces of the rod  16 . As shown in  FIG. 16B , a shaft  190  may be extended through the axial center of the rod  16 , one end  195  of the shaft  190  having a wedge shape  225  and the other end  200  being configured such that it may be acted upon by the surgeon. The free tip  120  may be connected to the rest of the rod  15  via narrow longitudinally extending wall strips extending through the region of the cuts  185 . These narrow longitudinally extending strips may have a constant wall thickness similar to the wall thickness used throughout the rest of the rod  15 , with the exception of the thickened wall portions  220 . 
     As shown in  FIG. 16C , the shaft  190  may be displaced towards the tip  120  within the rod  16  as indicated by arrow E such that the wedge tip  225  acts against the thickened wall portion  220  so as to cause the thickened wall portion  220  to bulge outward near the interface between the wall  180  and the tip  120 . Thus, displacing the shaft  190  within the rod  16  as indicated by arrow E will cause the wall to form a substantially radially expanded portion  205 , which can be used to secure the tip  120  within the bone shaft once the tip  120  is properly positioned within the bone shaft. The wedge tip  225  may be received within the rod tip  120  as indicated in  FIG. 160 . Depending on the embodiment, the surgeon may cause the displacement between shaft  190  and rod  16  by pushing the shaft  190  forward relative to the rod  16  or causing rod  16  to move backward relative to the shaft  190 . The shaft  190  may have a notch  175  that engages a feature  170  on the rod  16  that locks the rod and shaft in place once the radially expanded portion  205  makes contact with the cortical bone within the bone shaft. This contact will limit displacements of the free end  30  of the rod  16 . The locking of the rod and shaft relative to each other via features  170 ,  172  will prevent the radially expanded portion  205  from returning to a non-bulged state. 
     As can be understood from  FIGS. 75A and 75B , which are similar respective views to  FIGS. 74A and 74B , in one embodiment, the inner shaft  190  may form the tip  120  of the free end  30  of the overall rod  15 , and the tip  120  may have a screw, round, tapered, flat or other type of shape. The tip  120  of the inner shaft  190  may project out of the outer shaft  180  at the free end  30 , the diameter of the outer shaft  180  at the free end  30  being smaller than a diameter of the tip  120  at the free end  30 . The portion of the tip  120  adjacent the interface between the tip  120  and the outer shaft  180  at the free end  30  may be tapered, round, tapered or other shapes. 
     As can be understood from  FIG. 75B , by displacing the inner shaft  190  relative to the outer shaft  180  in the direction of the connector end  25 , as indicated by arrow L, the oversized diameter of the tip  120  of the inner shaft  190  causes the outer shaft  180  at the free end  30  to expand radially outward, fixing the free end  30  inside the a region in the bone  133 . For example, the expansion may be into the cancellous bone, the tip  120  penetrating into the cortical bone  133 . To facilitate the expansion of the outer shaft  180  to create the radially expanded shaft anchoring members  180 A, the outer shaft may have reliefs cut therein. 
     As shown in  FIGS. 76A and 76B , which are similar respective views to  FIGS. 75A and 75B , in one embodiment, the inner shaft  190  will have features  190 X that expand and engage with features  180 X of the outer shaft  180  when the inner shaft  190  is displaced relative to the outer shaft  180  such that the tip  120  has expanded the outer shaft  180  to form the shaft anchoring members  180 A. Thus, the engagement of the features  180 X,  190 X can hold the shafts  180 ,  190  in a position relative to each other that maintains the tip  120  in a position to cause the anchoring members  180 A to remain in an expanded, anchoring state, as shown in  FIG. 76B . In some embodiments, the features  180 X may be created in the inner circumference of the outer shaft  180  by forming dimples or radial crimp lines in the outside diameter of the outer shaft  180 . 
     As can be understood from  FIGS. 76C and 76D , which are similar respective views to  FIGS. 76A and 76B , in some embodiments, the inner shaft  190  and the outer shaft  180  may have opposed interlocking features  180 X,  190 X defined along their respective lengths in the form of radial grooves  180 X,  190 X formed via dimpling or crimping. 
     In some embodiments, the intramedullary rods  15 ,  16  may be configured to be telescopic such that the actual overall length of the rods  15 ,  16  may be varied. Thus, in embodiments of the implant assembly  10  employing such length adjustable rods  15 ,  16 , the rods  15 ,  16  may be both telescopic from the hub  20 , on account of the attachment arrangement between the rod connector ends  25  and the hub  20 , and telescopic along the length of the rods  15 ,  16 , on account of the telescopic configuration of the shaft of the rods  15 ,  16 . For a discussion of a telescopic rod configuration, reference is made to  FIG. 60 , which is a longitudinal cross section of such a rod  15 ,  16 . 
     As shown in  FIG. 60 , the rods  15 ,  16  may include an outer shaft  700  and an inner shaft  705  telescopically located within the outer shaft  700 . In one embodiment, the inner shaft  705  includes a series of transverse grooves, ridges, holes, notches, depressions, bumps or other engagement features  710  at generally even intervals along the length of the inner shaft  705 . The outer shaft  700  includes radially inward engagement feature  715  that projects radially inward such that it can engage an engagement feature  710  on the inner shaft  705 . Engagement of the radially inward engagement feature  710  with an engagement feature  710  on the inner shaft  705  can lock the inner shaft  705  in the outer shaft  700  at a desired telescopic point. Depending on the embodiment, the radially inward engagement feature  715  of the outer shaft  700  may be a spring clip formed of the outer shaft, a pawl tooth, a tab, or any other engagement feature that allows the engagement features  710 ,  715  to be engaged to lock the outer and inner shafts  700 ,  705  relative to each other after the length of the rods  15 ,  16  has been adjusted as desired. In some embodiments, the radially inward engagement feature  715  is configured to establish a ratchet arrangement with the engagement features  710  of the inner shaft  705 . In some embodiments, the radially inward engagement feature  715  is non-releasable. In other embodiments, the radially inward engagement feature  715  is releasable such as, for example, in the case of a pawl tooth with a release lever or a inwardly biased tab engaged with a through hole in the inner shaft  705 . 
     In some embodiments, the engagement arrangement between the outer and inner shafts  700 ,  705  may be accomplished via a crimp configuration. For example, as shown in  FIG. 61  is the same view as  FIG. 60 , except of a crimp configuration, the inner shaft  705  may have the same engagement features  710  as described above with respect to  FIG. 60 . However, the outer shaft  700  is generally free of any engagement feature. Instead, as can be understood from  FIGS. 62A and 62B , which are transverse cross sections of the rod  15 ,  16  as taken along section line  62 - 62  in  FIG. 61 , the outer shaft  700  does not engage the engagement features  710  of the inner shaft  705  in a non-crimped state ( FIG. 62A ), but does engage the engagement features  710  of the inner shaft  705  when crimped at arrows N ( FIG. 62B ), locking the shafts  700 ,  705  together. 
     In one embodiment, the engagement feature  715  of the outer shaft  700  may be in the form of a clip  715 . In such an embodiment, as depicted in  FIGS. 63 and 64 , which are, respectively, a longitudinal side view of the inner shaft  705  and a transverse cross section as taken along section line  64 - 64  of  FIG. 63 , the shaft includes engagement features  710  similar to those described above with respect to  FIG. 60 . The outer shaft  700  is equipped with an engagement feature  715  in the form of a clip  715  biased radially inward. As can be understood from  FIGS. 65 and 66 , which are, respectively, a longitudinal side view of the inner shaft  705  and a transverse cross section as taken along section line  66 - 66  of  FIG. 65 , the inner shaft  705  is longitudinally displaceable relative to the clip  715  as indicated by arrow R when the inner shaft  705  is rotated such that the engagement features  710  of the inner shaft  705  are oriented away from engagement with the legs  715   a ,  715   b  of the clip  715 . As can be understood from  FIGS. 67 and 68 , which are, respectively, a longitudinal side view of the inner shaft  705  and a transverse cross section as taken along section line  68 - 68  of  FIG. 67 , the inner shaft  705  is longitudinally fixed relative to the clip  715  when the inner shaft  705  is rotated such that the engagement features  710  of the inner shaft  705  are oriented into engagement with the legs  715   a ,  715   b  of the clip  715 . 
     In one embodiment, the outer and inner shafts  700 ,  705  are capable of being fixed relative to each other via a sliding lock  725  as depicted in  FIG. 69 , which is a longitudinal cross section of the sliding lock  725  on the inner shaft  705 . As can be understood from  FIG. 69 , in one embodiment, a holder  730  is supported off of the outer shaft  700  and includes housing  732  with a sloped inner face  735 , balls  740 , a plunger  745  and a helical spring  750 . The balls  740  are located adjacent the outer surface of the inner shaft  705 . The spring  750  extends about the inner shaft  705 . The plunger  745  extends about the inner shaft  705  between the balls  740  and the spring  750 . The spring  750  acts between the housing  732  and the plunger  745 . The housing extends from the outer shaft  700  and about the inner shaft  705 . The outer shaft  700  and housing  732  can be displaced freely in the direction of arrow S such that the spring  750  and plunger  745  causes the balls  740  to travel in the same direction along the inner shaft  700 . Once a desired telescopic relationship between the outer and inner shafts  700 ,  705  is reached, displacement in a direction opposite arrow S is prevented by the wedging action of the sloped inner face  735  acting with the balls  740  against the inner shaft  705 . Depending on the embodiment, the holder  730  can be supported off of the inner shaft  700 , as opposed to the outer shaft  700 . Also, the holder  730  can be configured to travel and lock in both directions, as opposed to a single direction. 
     In one embodiment, the shafts  700 ,  705  may be configured such that rotation of the shafts  700 ,  705  relative to each other causes the shafts  700 ,  705  to lock with respect to longitudinal displacement relative to each other. For example, as indicated in  FIGS. 70A and 70B , which are transverse cross sections of the rods  15 ,  16 , one or more balls  740  may be located between the inner circumferential surface  760  of the outer shaft  700  and the outer circumferential surface  765  of the inner shaft  705 . As indicated in  FIG. 70A , a feature  770  may extend from one of the surfaces  760 ,  765  that can be used to move the ball  740  along the surfaces  760 ,  765  as the shafts  700 ,  705  are rotated relative to each other as indicated by arrow H′ and H″. As shown in  FIG. 70B , at after a certain amount of rotation, the ball  740  will wedge between the circumferential surfaces  760 ,  765 , causing the shafts  700 ,  705  to lock together to prevent longitudinal displacement of the shafts  700 ,  705  relative to each other. 
     In some embodiments, the configuration of the shafts  700 ,  705  themselves results in locking of the shafts together with respect to preventing longitudinal displacement of the shafts relative to each other and/or may be employed to expand the shaft to allow the shaft to anchor in surrounding bone material. For example, as indicated in  FIGS. 71A-71D , which are transverse cross sections of the shafts  700 ,  705 , the rotation of the inner shaft  705  relative to the outer shaft  700  causes the outer shaft  700  to expand. This feature may be employed to lock the shafts  700 ,  705  relative to each to prevent longitudinal displacement of the shafts relative to each other. Additionally or alternatively, this feature may be used to expand the outer shaft  700  to anchor the shaft in surrounding bone material. In one embodiment, as shown in  FIG. 71A , the inner shaft  705  may have a non-circular cross section, for example, an oval cross section. As shown in  FIG. 71B , the outer shaft  700  may be sectioned into two halves  700 ′,  700 ″ and its interior space  770  may have a cross section that corresponds to the cross section of the inner shaft  705 , for example, an oval cross section also. The oval cross section of the interior space  770  may have arcuate recesses  775  defined in the inner surface  780  of the interior space  770  that are located generally transverse to the major axis of the oval interior space  770 . 
     As illustrated in  FIG. 71C , when the inner shaft  705  is positioned in the interior space  770  of the outer shaft  700  such that the major axis of the inner shaft oval cross section aligns with the major axis of the interior space cross section, the halves  700 ′,  700 ″ remain in contact or in an otherwise non-expanded state. As depicted in  FIG. 71D , when the inner shaft  705  is positioned in the interior space  770  of the outer shaft  700  such that the major axis of the inner shaft oval cross section is transverse with the major axis of the interior space cross section, the narrow oval ends of the inner shaft cross section are received in the recesses  775  and the halves  700 ′,  700 ″ are expanded away from each other. The interaction of the narrow oval ends of the inner shaft cross section with the recesses  775  creates a resting point to maintain the outer shaft in the expanded state. Such an expanded condition of the outer shaft  700  creates sufficient frictional interaction between the outer and inner shafts  700 ,  705  to lock the shafts together to prevent longitudinal displacement of the shafts relative to each other. 
     In one embodiment, the pins  800  or other members  800  are inserted between the outer and inner shafts  700 ,  705  to lock the shafts together with respect to preventing longitudinal displacement of the shafts relative to each other. For example, as indicated in  FIG. 72 , which is a cross section of the shafts  700 ,  705 , pins  800  may be inserted into the space between the outer surface of the inner shaft  705  and the inner surface of the outer shaft  700 . The pins  800  may be so inserted once the shafts are longitudinally positioned relative to each other as desired. In one embodiment, the inner shaft outer surface may have multiple ridges  805  and troughs  810 . The ridges  805  contact the inner surface of the outer shaft  700 , and the pins  800  are received in the space between the inner surface of the outer shaft and the outer surface of the inner shaft as provided by the troughs  810 . In one embodiment, the pins  800  have a tapered cross section such that the narrow ends of the pins  800  are the leading ends of the pins  800  when inserted into the troughs  810 . As the tapered pins  800  are increasingly inserted into the troughs  810 , the increasing width of the pins creates a bind between the pins, the inner shaft and the outer shaft, the bind being sufficient to lock the shafts in place relative to each other. 
     In one embodiment, a portion of the rod  15 ,  16  may deform to cause a locking condition between the outer and inner shafts  700 ,  710  and/or cause the outer sleeve to anchor into surrounding bone material. For example, as can be understood from  FIGS. 73A and 73B , which are longitudinal cross sections of portions of the rod  15 ,  16 , a portion of the rod  15 ,  16  may be equipped with a collapsible or otherwise deformable sleeve  820 . For example, as depicted in  FIG. 72A , the sleeve  820  may be located between the outer and inner shafts  700 ,  705 . Applying a force against the sleeve  820  via either of the shafts  700 ,  705  causes the sleeve  820  to deform ( FIG. 72B ), causing expansion of the sleeve  820  and binding of the sleeve and shafts together and preventing longitudinal displacement of the shafts relative to each other. In another embodiment, either the outer or inner shaft  700 ,  705  may be caused to deform as described with respect to the sleeve  820 , causing the shafts  700 ,  705  to bind together. Additionally or alternatively, the expanding of the sleeve may result in anchoring into the surrounding bone material. 
     As stated above, the intramedullary rods  15 ,  16  may have an outer shaft  700  and an inner shaft  705  telescopically located within the outer shaft  700 . Such a telescopic arrangement allows the rods  15 ,  16  to be lengthened or shortened to provide a desired overall length for the rods  15 ,  16 . Thus, the telescopic nature of such rods  15 ,  16  may be employed to position a rod free end  30  a desired distance from the edge of the hub  20 . As can be understood from the preceding discussion regarding  FIGS. 60-72 , once the shafts  700 ,  705  are longitudinally positioned relative to each other to provide a rod  15 ,  16  having a desired length, the shafts  700 ,  705  may be locked together employing the above-described engagement mechanisms. 
     As can be understood from  FIG. 82 , which is a plan view of an alternative embodiment of the rods, the rods  15 ,  16  may be configured such that additional rods  18  may extend from rods  15 ,  16  extending from the plate  35  used to form the hub  20 . The additional rod  19  may be coupled a rod  15 ,  16  via a pin, screw or other joining member or arrangement. Generally, the additional rod  19  may be configured as any of the other rods  15 ,  16  disclosed herein, except such rod  19  is configured to be coupled to and supported off of the rods  15 ,  16 . 
     For a discussion of a method of employing the implant assembly  10  described above with respect to  FIGS. 1-16C  to treat a bone fracture, reference is now made to  FIGS. 17-24 , which illustrate the implant assembly  10  being assembled in a bone fracture over a series of steps. As shown in  FIG. 17 , a fracture  290  has occurred in a bone  300  near a joint region  305  of the bone  300  resulting in a proximal bone portion  300   a  and a distal bone portion  300   b . While the fracture illustrated in  FIG. 17  is that of a distal radial fracture  290 , the method and implant assembly  10  depicted in  FIGS. 17-24  is readily applicable to other types of fractures (e.g., fractures near or away from a joint region of a bone, multi-bone fragment fractures, spiral fractures, etc.) in other types of bones (e.g., femurs, tibia, humerus, ulna, ribs, collar bone, pelvis, finger, toes, vertebra, etc.). 
     As shown in  FIG. 18 , a small access window  310  may be created in the bone  300  across the fracture  290 . The access window  310  may be formed in the dorsal or volar surface the bone or another surface of the bone. The access window  310  may have a diameter of between approximately 0.05″ and approximately 3″. The access window  310  may be formed via a minimally invasive or percutaneous access in the patient&#39;s soft tissue extending over the fracture  290 . In some embodiments and/or some types of fractures, the creation of an access window  310  may not be necessary, as the implant may simply be delivered into the bone via the fracture itself. In some embodiments, as described below, the implant assembly  10  is assembled within the fracture and inside the bone. In other embodiments, the implant assembly  10  may be assembled on the fracture and on the outside of the bone. 
     As explained above with respect to  FIGS. 14A-16C , certain intramedullary rods  16  have free ends  30  configured to interface with bone that is between the fracture location and a shaft of the bone or a portion of the bone that is opposite the fracture from a joint surface. In the context of a distal radial fracture, such an intramedullary rod  16  may be considered a proximal intramedullary rod  16  that extends proximally from the fracture  290 . As illustrated in  FIG. 19 , the access window  310  is used to insert the proximal rod  16  into the interior of the proximal bone portion  300   a  such that the free end  30  resides deep within interior of the proximal bone portion  300   a  and the connector end  25  is located within the access window  310  and terminates near the fracture  290 . The free end  30  of the proximal rod  16  may have any of the tip and anchor features described above with respect to  FIGS. 4A-4C and 14A-16C . Therefore, once the free end  30  and, more specifically, the entire proximal rod  16  is positioned as desired within the interior of the proximal bone portion  300   a , the anchoring features  135 ,  205  described with respect to  FIGS. 14A-16C  may be deployed to fix the free end  30  in place within the bone interior. It should be noted that while a single proximal rod  16  is shown as being inserted proximal of the fracture  290 , in some embodiments of the implant assembly  10  and/or for some types of fractures, there may be two, three or more such proximal rods  16  delivered to the interior of the proximal bone portion  300   a.    
     As can be understood from  FIG. 20 , the distal bone portion  300   b  and the proximal bone portion  300   a  may be displaced relative to each other (e.g., tilted, spread apart, etc.) to facilitate of rods  15 ,  16  through the access window  310  or the fracture  290  itself. In some cases, such displacement of the bones portions  300   a ,  300   b  relative to each other may not be necessary to facilitate the delivery of the rods  15 ,  16 . 
     As explained above with respect to  FIGS. 4A-4C and 13A-13C , certain intramedullary rods  15  have free ends  30  configured to interface with bone that is between the fracture location and a joint surface. In the context of a distal radial fracture, such an intramedullary rod  15  may be considered a distal intramedullary rod  15  that extends distally from the fracture  290 . As illustrated in  FIG. 20 , the access window  310  is used to insert the distal rods  15  into the interior of the distal bone portion  300   b  such that the free ends  30  reside deep within interior of the distal bone portion  300   b  and the connector ends  25  are located within the access window  310  and terminate near the fracture  290 . The free ends  30  of the distal rod  16  may have any of the tip and anchor features described above with respect to  FIGS. 4A-4C and 13A-13C . Therefore, once the free ends  30  and, more specifically, the entire distal rods  15  are positioned as desired within the interior of the distal bone portion  300   b , the anchoring features  135  described with respect to  FIGS. 13A-13C  may be deployed to fix the free ends  30  in place within the bone interior. It should be noted that while two distal rods  15  are shown as being inserted distal of the fracture  290 , in some embodiments of the implant assembly  10  and/or for some types of fractures, there may be one, three or more such distal rods  15  delivered to the interior of the distal bone portion  300   b.    
     As shown in  FIG. 21 , a bottom plate  36  having the features described with respect to  FIGS. 5-6C  or  FIG. 10  may be delivered to the access window  310  with the interior surface  56  of the bottom plate  36  facing upward. While  FIG. 21  shows the bottom plate  36  as being delivered subsequent to the delivery of the rods  15 ,  16 , the bottom plate  36  may be delivered prior to the delivery of the rods  15 ,  16  or between the delivery of the various rods  15 ,  16 . 
     As indicated in  FIG. 22 , the bottom plate  36 , the connector ends  25  of the various rods  15 ,  16 , and the bone portions  300   a ,  300   b  may be positioned relative to each other as desired to bring about the arrangement of the bone portions  300   a ,  300   b  that will restore the bone  300  to its pre-fractured alignment and configuration. As illustrated in  FIG. 23 , the upper plate  35  may then be placed over the bottom plate  36  and junction of the various rod connector ends  25  with the interior surface  55  of the upper plate  35  facing downward. In doing so, the various features (e.g.,  75 ,  85  in  FIGS. 9A-9C or 110, 111, 115  in  FIG. 12 ) of the rod connector ends  25  are caused to interface as discussed above with the respective corresponding features (e.g.,  60 ,  70  in  FIG. 5-8 or 90, 105  in  FIGS. 10-11 ) of the upper and lower plates  35 ,  36  of the hub  20 . 
     As depicted in  FIG. 24 , the setscrew  40  is then inserted into the center hole of the hub  20  to join the plates  35 ,  36  of the hub  20  together about the connector ends  25  of the various rods  15 ,  16 . Tightening the setscrew  40  down via a screwdriver  350  results in a rigid implant assembly like discussed above with respect to  FIGS. 1-3  (in the context of plate and rod connector end embodiments discussed with respect to  FIGS. 5-9C ) or similar thereto (in the context of plate and rod connector end embodiments discussed with respect to  FIGS. 10-12 ). The rigid implant assembly  10  secures the proximal bone portion  300   a  to the distal bone portion  300   b  in a desired relationship that is believed to lead to the bone  300  healing in its pre-fractured alignment and configuration. As indicated by the arrows leading from the syringe  355 , bone paste, bone substitute or bone growth inducing material may be delivered to the fracture  290  and about the implant hub  20  to facilitate healing of the fracture and the securing of the implant assembly  10  at its implanted location. 
     All of the above mentioned steps, including the delivery of components of the implant assembly  10  and the assembly of the implant assembly  10  within the bone fracture  290  and interior of the bone  300 , may be accomplished via a percutaneous or minimally invasive opening in the soft tissue neighboring the fracture  290  via minimally invasive surgical procedures and tools. 
     While the embodiment depicted in  FIG. 24  illustrates the distal bone  300   b  and proximal bone portion  300   a  are held together via an implant assembly  10  having a hub  20  with distal rods  15  and proximal rods  16  respectively anchored in the distal and proximal bone portions, in other embodiments, the implant  10  may only employ proximal or distal rods, the hub  20  instead being adapted to engage bone material. For example, as shown in  FIG. 78 , which is a plan view of the implant assembly  10  implanted at a bone fracture  290 , the hub  20  is configured to anchor to or engage with bone material on one side of the fracture  290  (e.g., on the distal bone portion  300   b  in the embodiment depicted in  FIG. 78 ), and rods  16  extend into the bone portion  300   a  on the other side of the fracture  290 . The hub  20  may be configured to receive anchoring members  1100 , for example, bone screws  1100  that extend from the hub  20  into adjacent bone material of the distal bone portion  300   b , securing the hub  20  to the distal bone portion  300   b . Rods  16  proximally extend from the hub  20  in a manner as described above to anchor in bone material of the proximal portion  300   a . The implant assembly  10  may then be employed to treat the fracture  290 . While the embodiment discussed with respect to  FIG. 78  is discussed with respect to the hub  20  being engaged with the distal portion  300   b  and the rods  16  being engaged with the proximal portion  300   a , in other embodiments and types of fractures, the opposite with be true. Depending on the embodiment and the type of fracture, bone cement may be employed in place of or in addition to the screws  1100 . 
     While the embodiment depicted in  FIG. 24  illustrates an implant assembly  10  including a single hub  20  and treating a single fracture  290 , in other embodiments, the implant assembly  10  may include two or more hubs  20  joined together via one or more intermediate rods  17 . For example, as shown in  FIG. 80 , which is a plan view of such a multiple hub embodiment, the implant assembly  10  includes first and second hubs  20  on generally opposite ends of the implant assembly  10 , the first and second hubs  20  being joined together via one or more intermediate rods  17  using rod/hub coupling arrangements similar to any of those described above. Proximal rods  16  extend from one of the hubs  20  to engage bone material at a first fracture, and distal rods  15  extend from the other of the hubs  20  to engage bone material at a second fracture. Thus, for example, in a dual fracture of a long bone such as a femur, where a first fracture is at the femoral head and the second fracture is at the femoral condyles, one hub  20  may be located at the first fracture, the proximal rods  16  extending across the first fracture and into the femoral head region. The second hub  20  may be located at the second fracture, the distal rods  15  extending across the second fracture and into the femoral condyles. The hubs  20  are joined together via the intermediate rod  17 , which extends through the length of the femur. The intermediate rod  17  may couple to the hubs  20  via any of the above described rod/hub coupling arrangements, and the intermediate rod  17  may have a fixed length or an adjustable length as described above with respect to the other rods  15 ,  16 . In some embodiments, one or both of the hubs  20  may be configured for direct engagement with bone material, as described above with respect to  FIG. 78 . 
     For a discussion of another embodiment of an intramedullary implant assembly  10 , reference is made to  FIG. 25 , which is a plan view of a proximal locking plate  36 . As shown in  FIG. 25 , the proximal locking plate  36  includes holes  400  for receiving therein and coupling to connector ends  25  of proximal intramedullary rods  16 . The proximal locking plate  36  also includes a center hole  405  and a slot  410  leading thereto. The holes  400  are evenly radially distributed about the center hole  405  near the outer circumferential edge  415  of the plate  36 . The slot  410  extends from the center hole  405  and the outer edge  415 . The slot  410  and center hole  405  are used to couple the proximal plate  36  to a distal plate  35  as described below. 
     As shown in  FIG. 26 , which is a plan view of a distal locking plate  35 , the distal locking plate  35  includes holes  400  for receiving therein and coupling to connector ends  25  of distal intramedullary rods  15 . The distal locking plate  35  also includes a center locking pin  420 . The holes  400  are evenly radially distributed about the center locking pin  420  near the outer circumferential edge  415  of the plate  35 . The center locking pin  420  is configured to be slid via the slot  410  into the center hole  405 . The center locking pin  420  and center hole  405  interlock to couple the proximal plate  36  to a distal plate  35  as described below. 
     As can be understood from  FIGS. 27 and 28 , which are side elevation views of intramedullary rods  15 ,  16  that may be employed as part of the implant assembly  10 , the rods  15 ,  16  have a connector end  25  and a free end  30 . The connector end  25  is configured to be securely connected to any of the holes  400  in either of the plates  35 ,  36 . The connector ends  25  and holes  400  may have a mechanical engagement arrangement such as, for example, a bayonet lock, threads, interference fit, setscrew, ball joints (e.g., as depicted in  FIGS. 56 and 57 ), ball and cup connection (e.g., as depicted in  FIGS. 58A-58E ), etc. to fixedly connect a connector end  25  to a hole  400 . The tips  120  of the rods  15 ,  16  may have any one or more of the features described above with respect to  FIGS. 4A-4C . As can be understood from  FIG. 28 , the tips  120  may be equipped with anchor systems  135  that may be configured and deployed as discussed above with respect to  FIGS. 13A-16C . 
     As can be understood from  FIGS. 29 and 30 , which are side elevation views of the implant assembly  10  being assembled, the distal and proximal rods  15 ,  16  are respectively coupled to the distal and proximal plates  35 ,  36  via the rod connector ends  25  being mechanically connected in the holes  400 . The faces of the plates  35 ,  36  are abutted together, and the center pin  420  is received in the slot  410  and slid in the direction of the center hole  405  as indicated by arrow F in  FIG. 29 . As shown in  FIG. 30 , once the center pin  420  is fully received in the center hole  405 , a mechanical locking feature  425  (e.g., detent, interference fit, etc.) may cause the center pin  420  to be locked in the center hole  405 . The result is a rigidly and securely assembled implant assembly  10  assembled from the plates  35 ,  36  and rods  15 ,  16 . 
     For a discussion of a method of repairing a fracture employing the implant assembly  10  described with respect to  FIGS. 25-30 , reference is made to  FIGS. 31-41 , which are the same view of a bone with a fracture as the implant assembly  10  is being assembled in the fracture via percutaneous or minimally invasive delivery and assembly methods. As shown in  FIG. 31 , the bone  300 , which in this example, is a distal radius, has suffered a Colles&#39; fracture  290 , resulting in a proximal bone portion  300   a  and a distal bone portion  300   b . Of course, the implant assembly  10  and method provided below is applicable to a wide variety of bones and fractures and should not be limited to the following discussion. 
     As illustrated in  FIG. 32 , the distal bone portion  300   b  may be displaced to expose the fracture surface of the proximal bone portion  300   a . As indicated in  FIG. 33 , the proximal locking plate  36  may be press fit into the trabecular bone such that the plate  36  extends generally transverse to the axis of the bone  300  and a face of the plate  36  faces towards the fracture surface of the proximal bone portion  300   a . In one embodiment, the plate  36  may be positioned to be parallel to the fracture. The plate  36  serves as a template for the proximal rods  16 . The angle of the plate  36  relative to the fracture surface of the proximal bone portion  300   a  may require preoperative surgical planning. 
     As shown in  FIG. 34 , the connector ends  25  of the proximal intramedullary rods  16  are coupled to the holes  400  of the proximal plate  36  as shown in  FIG. 29 . The rods  16  may be passed through the holes  400  and driven into the trabecular bone, the rods  16  telescoping from the plate  36  until the free ends  30  interface with the cortical bone. As discussed above, the shape of the free ends  30  may be configured to indicate to the surgeon when the free ends  30  have fully interfaced with the cortical bone and configured to prevent over penetration. As depicted in  FIG. 35  and previously described with respect to  FIG. 28 , the anchors  135  may then be deployed to prevent the rod  16  from pulling out. The anchors  135  may be spring loaded and configured as described above. 
     As shown in  FIG. 36 , the distal locking plate  35  may be press fit into the trabecular bone such that the plate  35  extends generally transverse to the axis of the bone  300  and a face of the plate  35  faces towards the fracture surface of the distal bone portion  300   b . The plate  35  serves as a template for the distal rods  15 . The angle of the plate  35  relative to the fracture surface of the distal bone portion  300   b  may require preoperative surgical planning. 
     As shown in  FIG. 37 , the connector ends  25  of the distal intramedullary rods  15  are coupled to the holes  400  of the distal plate  35  as shown in  FIG. 29 . The rods  15  may be passed through the holes  400  and driven into the trabecular bone, the rods  15  telescoping from the plate  35  until the free ends  30  interface with the cortical bone. As discussed above, the shape of the free ends  30  may be configured to indicate to the surgeon when the free ends  30  have fully interfaced with the cortical bone and configured to prevent over penetration. As depicted in  FIG. 38  and previously described with respect to  FIG. 28 , the anchors  135  may then be deployed to prevent the rod  15  from pulling out. The anchors  135  may be spring loaded and configured as described above. 
     As shown in  FIG. 39 , the plates  35 ,  36  are placed face-to-face to cause the pin  420  to enter the slot  410  as depicted in  FIG. 29 . As depicted in  FIG. 40 , the plates  35 ,  36  are locked together when the pin  420  is received in the center hole  405  as illustrated in  FIG. 30 . The implant assembly  10  is now fully assembled into a rigid integral device that maintains the distal and proximal bone portions  300   a ,  300   b  in the desired positional relationship to each other via its distal and proximal rods  15 ,  16  that are coupled together via the distal and proximal plates  35 ,  36 . Finally, as shown in  FIG. 41 , bone substitute may be added between the locking plates  35 ,  36  and the fracture surfaces to fill the void and improve stability. The bone substitute material will be remodeled as the bone heals. 
     All of the above mentioned steps, including the delivery of components of the implant assembly  10  and the assembly of the implant assembly  10  within the bone fracture  290  and interior of the bone  300 , may be accomplished via a percutaneous or minimally invasive opening in the soft tissue neighboring the fracture  290  via minimally invasive surgical procedures and tools. 
     While the embodiment depicted in  FIGS. 30 and 40  illustrate the distal bone  300   b  and proximal bone portion  300   a  are held together via an implant assembly  10  having a hub  20  with distal rods  15  and proximal rods  16  respectively anchored in the distal and proximal bone portions, in other embodiments, the implant  10  may only employ proximal or distal rods, the hub  20  instead being adapted to engage bone material. For example, as shown in  FIG. 79 , which is a plan view of the implant assembly  10  implanted at a bone fracture  290 , the hub  20  is configured to anchor to or engage with bone material on one side of the fracture  290  (e.g., on the distal bone portion  300   b  in the embodiment depicted in  FIG. 79 ), and rods  16  extend into the bone portion  300   a  on the other side of the fracture  290 . The hub  20  may be configured to be fit in a pocket in the proximal bone portion  300   b  by being placed generally transverse to the bone and/or generally parallel to the fracture  290 . Alternatively or additionally, the hub  20  may be configured to receive anchoring members  1100 , for example, bone screws  1100  that extend from the hub  20  into adjacent bone material of the distal bone portion  300   b , securing the hub  20  to the distal bone portion  300   b . Rods  16  proximally extend from the hub  20  in a manner as described above to anchor in bone material of the proximal portion  300   a . The implant assembly  10  may then be employed to treat the fracture  290 . While the embodiment discussed with respect to  FIG. 79  is discussed with respect to the hub  20  being engaged with the distal portion  300   b  and the rods  16  being engaged with the proximal portion  300   a , in other embodiments and types of fractures, the opposite will be true. Depending on the embodiment and the type of fracture, bone cement may be employed in place of or in addition to the screws  1100 . 
     Depending on the materials forming the hub  20  and rods  15 , the embodiments of the hub  20  and rods  15  employed, and the degree to which the rods  15  are gripped or otherwise attached to the hub  20 , the assembled implant assembly  10  and various portions thereof may be generally rigid or fixed, semi-rigid or fixed, or generally flexible with respect to the implant assembly  10 , the hub  20 , the rods  15 , elements of the hub  20  or rods  15 , or connections between the various elements of the implant assembly  10 . 
     In some embodiments, the implant assembly  10  may be assembled (partially or completely) within the bone and implanted within the bone (e.g., sub bone surface). In such embodiments, the implant assembly  10  may be said to function from the interior of the bone to the exterior of the bone. Depending on the bone and the way the implant assembly is implanted, in such embodiments, the implant assembly  10  may be said to act and/or extend along the axis of the bone in which it is implanted. 
     In other embodiments, the implant assembly  10  may be implanted so as to be partially within and outside the bone (e.g., partially sub bone surface and partially on the exterior of the bone). In yet other embodiments, the implant assembly  10  may be implanted so as to be generally completely on the outside of the bone (e.g., on the exterior of the bone). 
     In some embodiments, as can be understood from  FIG. 77 , the implant assembly  10  may be provided in the form of a kit  1000 . For example, the implant assembly components (e.g., the rods  15 ,  16 , the plates  35 ,  36 , and the screw  40  for joining the plates  35 ,  36 ) may be provided in a sterilized packaging  1005  along with instructions  1010  that explain the method of implantation as described above. Alternatively, the instructions  1010  may be provided via other methods, such as, for example, via the internet. The above mentioned implant assembly components may be provided in the kit  1000  in a fully assembled state (i.e., the implant assembly  10  is fully assembled), in a partially assembled state, or a fully disassembled state. The kit  1000  may include rods  15 ,  16  of a variety of fixed lengths or rods  15 ,  16  that are adjustable over a variety of possible lengths, thereby allowing the physician to select the length of rod needed for assembling the bone fracture via the implant assembly  10 . 
     As indicated in  FIG. 83A , which is a side view of a fractured bone, the implant assembly  10  may employ a snap plate  1040 . One or more rods  15  may extend distally from the snap plate  1040  and be pivotally coupled thereto. One or more rods  16  may extend proximally from the snap plate  1040  and be fixedly coupled thereto. The implant assembly  10  may be delivered in pieces and assembled in the fracture  290  or delivered into the fracture essentially assembled. For example, as indicated in  FIG. 83A , the bone portions  300   a ,  300   b  may be placed out of plane relative to each other and the pieces of the implant  10  may be placed in the bone portions. For example, the proximal rod  15  may be placed in the proximal bone portion  300   b , the distal rod  16  may be placed in the distal bone portion  300   b  with the snap plate  1040  already coupled thereto or added in a subsequent step. Once the implant assembly  10  is fully located within the fracture  290  such that the proximal and distal rods  16 ,  15  are respectively coupled to the distal and bone portions  300   b ,  300   a  as shown in  FIG. 83A , the connector end  25  of the proximal rod  15  may be received in the snap plate  1040  to couple the implant assembly  10  together as depicted in  FIG. 83B . As can be understood from  FIGS. 83 a    and  83 B, the snap plate  1040  may be configured to allow the rods  15 ,  16  coupled thereto to move relative to each other along an axis to allow the rods  15 ,  16  to be snapped or otherwise received into the snap plate or each other, securing the rods in a final position with each other to provide fixation. 
     Although the present invention has been described with reference to preferred embodiments, persons skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention.