Patent Publication Number: US-2021186562-A1

Title: Adjustable rail apparatus for external fixation systems

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority benefit from International Application No. PCT/US2019/049828 filed on Sep. 5, 2019, which claimed priority from U.S. Provisional Application No. 62/727,116 filed Sep. 5, 2018, each of which is incorporated herein by reference in its entirety. 
    
    
     FIELD OF THE INVENTION 
     The present disclosure is generally directed to rails for external bone fixation systems and related methods. More particularly, the present disclosure is directed to adjustable rails for external bone fixation systems and related methods that allow adjustability between the orientation between two or more rail portions. 
     BACKGROUND OF THE INVENTION 
     External fixation devices have been used to treat bone and tissue conditions by positioning bone or tissue segments in desired relative positions based on particular clinical needs. One form of external fixation devices is a unilateral or mono-lateral rail based fixation device. These devices are typically comprised of a rail or beam element serving as the structural backbone of the device, along which are slidably attached clamp assemblies that can accept fixation elements such as bone fixation pins or wires. In some embodiments, these clamp assemblies have the ability to be statically locked to the rail, or be dynamically driven or translated axially along the rail. In some embodiments, the clamp assemblies can be rotated about the rail and/or angulated relative to the axis of the rail. 
     When configured as bone or tissue fixation systems, some external fixation systems typically include a multitude of clamp assemblies. In the most basic configurations, there is one static clamp assembly and one drivable clamp assembly coupled to the beam element. In some embodiments, the beam element and the clamp assemblies arranged in this way can be connected to a second beam and clamp assembly through the use of a joint element having one or more degrees of freedom, such as a hinge having one degree of freedom to a spherical or cardan joint having three degrees of freedom. However, the beam element itself is typically linear and static (i.e., is not adjustable out of the linear shape or pathway). The relative positioning and orientation between two or more clamps coupled to the rail is thereby limited by the linear nature of the rail. Further, adding or removing parts of the clamp assemblies and/or additional segments or extensions to the rail to suit a particular anatomical or fixation arrangement can be cumbersome and/or time consuming. 
     External bone fixation rails and external bone fixation systems with rails that provide with two or more rail segments and a joint that can be selectively adjusted to adjust the orientation between the rail segments to facilitate optimal fixation of bone elements via clamps coupled to the rail segments (and thereby corresponding bones or bone segments) is therefore desirable. 
     SUMMARY OF THE INVENTION 
     In one aspect, the present disclosure provides external fixation systems comprised of a longitudinal rail or beam apparatus that accepts and guides a multitude of clamp assemblies (of the same or differing configuration) positionable in differing positions and/or orientations relative to the rail. The rail apparatus may include a plurality of rail segments with an adjustable joint coupling and extending between adjacent segments. The rail segments may include an axial engagement feature, such as a threaded or ribbed track, that extends along the length or axis of the rail segments that serves as a point of driving engagement for each of the clamp assemblies. The engagement feature is configured to allow the clamp assemblies to be locked in place along the axis or length of the respective rail segments, and to be selectively driven or translated along the respective rail segments. Each rail segment may also include an axially extending alignment groove, and a central bore of the least one drivable fixation clamp assembly includes an anti-rotation member that extends into the alignment groove to rotationally fix the least one drivable fixation clamp assembly and a beam segment/element about the axis of the beam segment. 
     In another aspect, the present disclosure provides a joint apparatus for coupling and selectively adjusting the relative angular and rotational arrangement of first and second external fixation beam elements. The apparatus comprises a first beam end housing comprising a sleeve portion configured to rotationally fix to the first external fixation beam element and a post portion; a first screw configured to axially fix the first beam end housing to the first external fixation beam element; a first clamp member axially and rotationally fixed to the post portion of the first external fixation beam element; and a first rotation end housing comprising a rotation portion and a post portion coupled with the first clamp member, the first rotation end housing being selectively rotatably adjusted with respect to the first clamp member within a fixed range of rotation. The apparatus further comprises a second beam end housing comprising a sleeve portion configured to rotationally fix to the second external fixation beam element and a post portion; a second screw configured to axially fix the second beam end housing to the second external fixation beam element; a second clamp member axially and rotationally fixed to the post portion of the second external fixation beam element; and a second rotation end housing comprising a rotation portion and a post portion coupled with the second clamp member, the second rotation end housing being selectively rotatably adjusted with respect to the second clamp member within a fixed range of rotation. The rotation portions of the first and second rotation end housings are rotationally coupled about an axis of rotation. The first clamp member comprises a compression screw configured to selectively apply a compressive force to selectively rotatably fix the first rotation end housing to the first clamp member, and the second clamp member comprises a compression screw configured to selectively apply a compressive force to selectively rotatably fix the second rotation end housing to the second clamp member. 
     In some embodiments, the first beam end housing, the first clamp member and the first rotation end housing comprise apertures that form a passageway extending from the rotation portion of the first rotation end housing to the first screw. In some embodiments, the first beam end housing, the first clamp member, the first rotation end housing and the second rotation end housing comprise apertures that form a passageway extending from the rotation portion of the first rotation end housing to the second screw in a first relative orientation of the first and second rotation end housings about the axis of rotation. In some embodiments, the axis of rotation intersects axes of the first and second screws. In some embodiments, the axis of rotation is oriented perpendicular to axes of the first and second screws. 
     In another aspect, the present disclosure provides an adjustable rail apparatus comprising a first elongate external fixation element defining a first axis and comprising a first axially extending threaded track portion; a second elongate external fixation element defining a second axis and comprising a second axially extending threaded track portion; and a joint apparatus disclosed herein coupling the first and second elongate external fixation beam elements. 
     In some embodiments, the axis of rotation intersects axes of the first and second elongate external fixation elements. In some embodiments, the axis of rotation is oriented perpendicular to axes of the first and second elongate external fixation elements. 
     In another aspect, the present disclosure provides an external bone and/or tissue fixation system, comprising an adjustable rail apparatus disclosed herein; and at least one drivable fixation clamp assembly coupled to one of the first and second elongate external fixation beam elements. 
     In another aspect, the present disclosure provides an adjustable rail apparatus. The adjustable rail apparatus comprises an elongate first external fixation beam element comprising a first axis and an external surface with an alignment groove, an elongate external fixation beam element comprising a second axis, an external surface with an alignment groove, and a joint coupling the first and second beam elements and configured to selectively adjust the relative angular and rotational arrangement of the first and second beam elements. The joint comprises a first beam end housing comprising a post portion and sleeve portion rotationally fixed to the first external fixation beam element, a first screw axially fixing the first beam end housing to the first external fixation beam element, a first clamp member axially and rotationally fixed to the post portion of the first beam end housing, and a first rotation end housing comprising a rotation portion and a post portion coupled with the first clamp member, the first rotation end housing being selectively rotatably adjusted with respect to the first clamp member within a fixed range of rotation. The joint also comprises a second beam end housing comprising a post portion and sleeve portion rotationally fixed to the second external fixation beam element, a second screw axially fixing the second beam end housing to the second external fixation beam element, a second clamp member axially and rotationally fixed to the post portion of the second beam end housing, and a second rotation end housing comprising a rotation portion and a post portion coupled with the second clamp member, the second rotation end housing being selectively rotatably adjusted with respect to the second clamp member within a fixed range of rotation. The rotation portions of the first and second rotation end housings are rotationally fixed and pivotably angularly coupled about a third axis that is angled with respect to the first and second axes of the first and second external fixation beam elements, respectively. The first clamp member comprises a first compression screw configured to selectively apply a compressive force to the post portion of the first rotation end housing to selectively rotatably and axially fix the first clamp member and the first rotation end housing. The second clamp member comprises a second compression screw configured to selectively apply a compressive force to the post portion of the second rotation end housing to selectively rotatably and axially fix the second clamp member and the second rotation end housing. 
     In some embodiments, the first beam end housing, the first clamp member and the first rotation end housing comprise first apertures that form a first passageway extending from the rotation portion of the first rotation end housing to the first screw. In some embodiments, the first beam end housing, the first clamp member, the first rotation end housing and the second rotation end housing comprise second apertures that form a second passageway extending from the rotation portion of the first rotation end housing to the second screw in a first relative orientation of the first and second rotation end housings about the axis of rotation. 
     In some embodiments, the third axis intersects the first and second axes. In some embodiments, the third axis is oriented perpendicular to the first and second axes. 
     In some embodiments, a first end portion of the first external fixation beam element is positioned within an opening of the sleeve portion of the first beam end housing, and the joint further comprises a first pin member coupled to the sleeve portion and including a portion extending within the opening of the sleeve portion and along a portion of the alignment groove of the first external fixation beam element to rotationally fix to the first beam end housing and the first external fixation beam element. In some such embodiments, the first end portion of the first beam element includes an internally threaded axial aperture, the first beam end housing includes an axial aperture extending through the post portion thereof to the opening of the sleeve portion thereof, and the first screw comprises an externally threaded shaft portion that is threadably coupled within the internally threaded axial aperture of the first end portion of the first beam element. In some such embodiments, the first screw further comprises a head portion that defines a cross-sectional size that is larger than that of a portion of the axial aperture of the first beam end housing such that the head portion is prevented from axially passing therethrough to axially fix the first beam end housing and the first external fixation beam element. 
     In some embodiments, the first clamp member comprises an internally threaded bore comprising a first end portion that is threadably coupled with the post portion of the first beam end housing and includes a first slot comprising a width that corresponds to a width of the first pin member, and the first pin member further includes a portion extending axially along an outer side of the post portion of the first beam end housing and within the first slot of the threaded bore of the first clamp member to rotationally and axially fix the first clamp member and the first beam end housing. In some such embodiments, the internally threaded bore of the first clamp member further comprises a second end portion that is threadably coupled with the post portion of the first rotation end housing and includes a first non-threaded recessed portion comprising a width that is wider than a width of a second pin member that is coupled to the first rotation end housing, and the second pin member includes a portion extending axially along an outer side of the post portion of the first rotation end housing and within the first non-threaded recessed portion of the threaded bore of the first clamp member to selectively allow a limited range of relative rotation between the first clamp member and the first rotation end housing. In some such embodiments, the first clamp member comprises a compression slot that extends from an outer side thereon to the internally threaded bore along an entire axial length of the first clamp member and a pair of first clamping portions with substantially aligned clamping apertures on opposing sides of the compression slot, and the joint further comprises a first compression screw that extends within the clamping apertures of the first clamping portions and is threadably coupled with at least one of the clamping apertures of the first clamping portions such that rotation of the first clamping screw about an axis thereof in a first direction draws the first clamping portions towards each other and deforms the internally threaded bore of the first clamp member inwardly such that the first clamp member exerts a compressive force on the post portion of the first rotation end housing to selectively rotatably fix the first clamp member and the first rotation end housing, and rotation of the first clamping screw about the axis thereof in a second direction that opposes the first direction allows the internally threaded bore of the first clamp member to deform outwardly such that the first clamp member exerts less compressive force or no compressive force on the post portion of the first rotation end housing to selectively allow the limited range of relative rotation between the first clamp member and the first rotation end housing. In some such embodiments, the rotation portions of the first and second rotation end housings are pivotably coupled via a joint pin that defines the third axis. In some such embodiments, the first and second rotation end housings comprise a split flange yoke and a shaft portion that are pivotably coupled via the joint pin, the shaft portion being positioned within the split flange yoke. 
     In some embodiments, the rotation portions of the first and second rotation end housings are pivotably coupled via a joint pin that defines the third axis. In some such embodiments, the rotation portions of the first and second rotation end housings comprise a split flange yoke and a shaft portion that are pivotably coupled via the joint pin, the shaft portion being positioned within the split flange yoke. 
     In some embodiments, a second end portion of the second external fixation beam element is positioned within an opening of the sleeve portion of the second beam end housing, and the joint further comprises a third pin member coupled to the sleeve portion and including a portion extending within the opening of the sleeve portion and along a portion of the alignment groove of the second external fixation beam element to rotationally fix to the second beam end housing and the second external fixation beam element. In some such embodiments, the second end portion of the second beam element includes an internally threaded axial aperture, the second beam end housing includes an axial aperture extending through the post portion thereof to the opening of the sleeve portion thereof, and the second screw comprises an externally threaded shaft portion that is threadably coupled within the internally threaded axial aperture of the second end portion of the second beam element. In some such embodiments, the second screw further comprises a head portion that defines a cross-sectional size that is larger than that of a portion of the axial aperture of the second beam end housing such that the head portion is prevented from axially passing therethrough to axially fix the second beam end housing and the second external fixation beam element. In some such embodiments, the second clamp member comprises an internally threaded bore comprising a first end portion that is threadably coupled with the post portion of the second beam end housing and includes a second slot comprising a width that corresponds to a width of the third pin member, and the third pin member further includes a portion extending axially along an outer side of the post portion of the second beam end housing and within the first slot of the threaded bore of the second clamp member to rotationally and axially fix the second clamp member and the second beam end housing. In some such embodiments, the internally threaded bore of the second clamp member further comprises a second end portion that is threadably coupled with the post portion of the second rotation end housing and includes a second non-threaded recessed portion comprising a width that is wider than a width of a fourth pin member that is coupled to the second rotation end housing, and the fourth pin member includes a portion extending axially along an outer side of the post portion of the second rotation end housing and within the second non-threaded recessed portion of the threaded bore of the second clamp member to selectively allow a limited range of relative rotation between the second clamp member and the second rotation end housing. In some such embodiments, the second clamp member comprises a compression slot that extends from an outer side thereon to the internally threaded bore along an entire axial length of the second clamp member and a pair of second clamping portions with substantially aligned clamping apertures on opposing sides of the compression slot, and the joint further comprises a second compression screw that extends within the clamping apertures of the second clamping portions and is threadably coupled with at least one of the clamping apertures of the second clamping portions such that rotation of the second clamping screw about an axis thereof in a first direction draws the second clamping portions towards each other and deforms the internally threaded bore of the second clamp member inwardly such that the second clamp member exerts a compressive force on the post portion of the second rotation end housing to selectively rotatably fix the second clamp member and the second rotation end housing, and rotation of the second clamping screw about the axis thereof in a second direction that opposes the first direction allows the internally threaded bore of the second clamp member to deform outwardly such that the second clamp member exerts less compressive force or no compressive force on the post portion of the second rotation end housing to selectively allow the limited range of relative rotation between the second clamp member and the second rotation end housing. In some such embodiments, the first clamp member comprises an internally threaded bore comprising a first end portion that is threadably coupled with the post portion of the first beam end housing and includes a first slot comprising a width that corresponds to a width of the first pin member, and the first pin member further includes a portion extending axially along an outer side of the post portion of the first beam end housing and within the first slot of the threaded bore of the first clamp member to rotationally and axially fix the first clamp member and the first beam end housing. In some such embodiments, the internally threaded bore of the first clamp member further comprises a second end portion that is threadably coupled with the post portion of the first rotation end housing and includes a first non-threaded recessed portion comprising a width that is wider than a width of a second pin member that is coupled to the first rotation end housing, and the second pin member includes a portion extending axially along an outer side of the post portion of the first rotation end housing and within the first non-threaded recessed portion of the threaded bore of the first clamp member to selectively allow a limited range of relative rotation between the first clamp member and the first rotation end housing. In some such embodiments, the first clamp member comprises a compression slot that extends from an outer side thereon to the internally threaded bore along an entire axial length of the first clamp member and a pair of first clamping portions with substantially aligned clamping apertures on opposing sides of the compression slot, and the joint further comprises a first compression screw that extends within the clamping apertures of the first clamping portions and is threadably coupled with at least one of the clamping apertures of the first clamping portions such that rotation of the first clamping screw about an axis thereof in a first direction draws the first clamping portions towards each other and deforms the internally threaded bore of the first clamp member inwardly such that the first clamp member exerts a compressive force on the post portion of the first rotation end housing to selectively rotatably fix the first clamp member and the first rotation end housing, and rotation of the first clamping screw about the axis thereof in a second direction that opposes the first direction allows the internally threaded bore of the first clamp member to deform outwardly such that the first clamp member exerts less compressive force or no compressive force on the post portion of the first rotation end housing to selectively allow the limited range of relative rotation between the first clamp member and the first rotation end housing. 
     In another aspect, the present disclosure provides an external bone and/or tissue fixation system. The fixation system comprise an adjustable rail apparatus as described above, and at least one drivable fixation clamp assembly coupled to one of the first and second first external fixation beam element. 
     In some embodiments, the at least one drivable fixation clamp assembly is configured to axially translate along the one of the first and second first external fixation beam elements via an axial-extending track portion of the exterior surface thereof. In some such embodiments, the axial-extending track portion comprises an externally threaded or patterned engagement track. In some embodiments, the at least one drivable fixation clamp assembly is rotationally fixed to the one of the first and second first external fixation beam elements via the alignment groove thereof. 
     These and other objects, features and advantages of this disclosure will become apparent from the following detailed description of the various aspects of the disclosure taken in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       For the purposes of illustrating the adjustable rails, external bone and/or tissue fixation systems and related fixation methods described herein, illustrative embodiments are provided. These illustrative embodiments are in no way limiting in terms of the precise configuration, arrangement and operation of the disclosed adjustable rails, external bone and/or tissue fixation systems and related fixation methods, and other similar embodiments are envisioned. 
         FIG. 1  illustrates a perspective view of an exemplary beam element of an external fixation system, in accordance with the present disclosure; 
         FIG. 2  illustrates an end view of the exemplary beam element of  FIG. 1 , in accordance with the present disclosure; 
         FIG. 3  illustrates a side view of the exemplary beam element of  FIG. 1 , in accordance with the present disclosure; 
         FIG. 4  illustrates a cross-sectional side view of the exemplary beam element of  FIG. 1 , along Line  4 - 4  of  FIG. 3 , in accordance with the present disclosure; 
         FIG. 5  illustrates an enlarged cross-sectional view of a portion of the exemplary beam element of  FIG. 1  as indicted in  FIG. 4 , in accordance with the present disclosure; 
         FIG. 6  illustrates an elevational perspective view of an adjustable rail apparatus for an external fixation system including a pair of the exemplary beam elements of  FIGS. 1-5  coupled via an exemplary adjustable hinge in a linear arrangement, in accordance with the present disclosure; 
         FIG. 7  illustrates a side elevational view of the exemplary adjustable rail apparatus of  FIG. 6  in a linear arrangement, in accordance with the present disclosure; 
         FIG. 8  illustrates an elevational perspective view of the exemplary adjustable rail apparatus of  FIG. 6  in a non-linear arrangement, in accordance with the present disclosure; 
         FIG. 9  illustrates a bottom perspective view of the exemplary adjustable rail apparatus of  FIG. 6  in a non-linear arrangement, in accordance with the present disclosure; 
         FIG. 10  illustrates another side elevational view of the exemplary adjustable rail apparatus of  FIG. 6  in a linear arrangement, in accordance with the present disclosure; 
         FIG. 11  illustrates a top view of the exemplary adjustable rail apparatus of  FIG. 6  in a linear arrangement, in accordance with the present disclosure; 
         FIG. 12  illustrates a side cross-sectional view of the exemplary adjustable rail apparatus of  FIG. 6  in a linear arrangement along Line  12 - 12  of  FIG. 11 , in accordance with the present disclosure; 
         FIG. 13  illustrates an elevational perspective view of the exemplary adjustable hinge of the adjustable rail apparatus of  FIG. 6  in a linear arrangement, in accordance with the present disclosure; 
         FIG. 14  illustrates a top view of the exemplary adjustable hinge of  FIG. 13  in a linear arrangement, in accordance with the present disclosure; 
         FIG. 15  illustrates an end view of the exemplary adjustable hinge of  FIG. 13  in a linear arrangement, in accordance with the present disclosure; 
         FIG. 16  illustrates an exploded side view of a portion of the exemplary adjustable rail apparatus of  FIG. 6  including the exemplary adjustable hinge thereof, in accordance with the present disclosure; 
         FIG. 17  illustrates an exploded elevational perspective view of a portion of the exemplary adjustable rail apparatus of  FIG. 6  including the exemplary adjustable hinge thereof, in accordance with the present disclosure; 
         FIG. 18  illustrates an exploded elevational perspective view of a portion of the exemplary adjustable hinge of the exemplary adjustable rail apparatus of  FIG. 6 , in accordance with the present disclosure; 
         FIG. 19  illustrates an exploded elevational perspective view of another portion of the exemplary adjustable hinge of the exemplary adjustable rail apparatus of  FIG. 6 , in accordance with the present disclosure; 
         FIG. 20  illustrates an exploded side view of a portion of the exemplary adjustable hinge of the exemplary adjustable rail apparatus of  FIG. 6 , in accordance with the present disclosure; 
         FIG. 21  illustrates an exploded perspective view of the portion of the exemplary adjustable hinge of the exemplary adjustable rail apparatus of  FIG. 20 , in accordance with the present disclosure; 
         FIG. 22  illustrates an exploded elevational perspective view of the portion of the exemplary adjustable hinge of the exemplary adjustable rail apparatus of  FIG. 20 , in accordance with the present disclosure; 
         FIG. 23  illustrates a perspective view of the exemplary adjustable rail apparatus of  FIG. 6  in a non-linear arrangement, in accordance with the present disclosure; 
         FIG. 24  illustrates an enlarged elevational perspective view of a portion of the exemplary adjustable rail apparatus of  FIG. 6  including the exemplary hinge thereof in a non-linear arrangement, in accordance with the present disclosure; 
         FIG. 25  illustrates an enlarged top view of a portion of the exemplary adjustable rail apparatus of  FIG. 6  including the exemplary hinge thereof in a non-linear arrangement, in accordance with the present disclosure; and 
         FIG. 26  illustrates an enlarged top view of another portion of the exemplary adjustable rail apparatus of  FIG. 6  including the exemplary hinge thereof in a non-linear arrangement, in accordance with the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     When introducing elements of various embodiments of the present disclosure, the articles “a,” “an,” “the,” and “said” are intended to mean that there are one or more of the elements. The terms “comprising,” “including,” and “having” are intended to be inclusive and mean that there may be additional elements other than the listed elements. Any examples of parameters are not exclusive of other parameters of the disclosed embodiments. Components, aspects, features, configurations, arrangements, uses and the like described, illustrated or otherwise disclosed herein with respect to any particular embodiment may similarly be applied to any other embodiment disclosed herein. 
     The present disclosure provides for external bone or tissue fixation systems and related fixation methods  100 , as shown in  FIGS. 6-26 . The fixation systems and methods  100  include one or more independently drivable clamp assembly (not shown) (which may provide at least  3 DOF) that are each translatable or drivable along rail segments  132 A,  132 B . . .  132 N of a rail apparatus  130 . In some other embodiments (not shown), the fixation systems and methods  100  may include at least one fixed rotatable end clamp assembly (which may provide at least 2DOF) positioned at a free end of one of the rail segments  132 A,  132 B . . .  132 N. The fixation systems and methods  100  of  FIGS. 6-26  may be configured or particularly advantageous for use with relatively small bones, such as bones of a hand or foot. For example, the fixation systems and methods  100  of  FIGS. 6-26  may be configured or particularly advantageous to fix two or more small bones or bone segments of one or more relatively small bone with respect to each other, such one or more bones or bone segments of a hand or foot. In some embodiments, the fixation systems and related fixation methods  100 , as shown in  FIGS. 6-26 , may be configured or particularly advantageous for the repair of fractures or deformities of one or more bone, such as fractures of or deformities in one or more relatively small bone in a hand or foot. However, the fixation systems and related fixation methods  100  may also be configured or particularly advantageous to fix two or more relatively long bones or bone segments of one or more relatively long bone with respect to each other, such one or more bones or bone segments of an arm or leg. 
     The present application thereby provides external bone fixation systems that provide for relative movement of two or more bones or bone segments with respect to each other. The systems may include movable and drivable clamp assemblies located along the axial length of rail elements  130  (with provisions to allow for the attachment of at least one non-traveling clamp assemblies  120 ), and the relative orientation between rail elements  130  may be adjustable or movable with respect to each other through the use of a joint mechanism  127 , such as but not limited to a joint that provides for adjustment of the angle between the axes of the rail elements  130  and/or the orientation of the rail elements  130  about their axes, as shown in  FIGS. 1-12 . 
     As shown in  FIGS. 1-12 , the beam segments or elements  130  (to which at least one drivable clamp assemblies and/or at least one fixed clamp assembly can be coupled) may comprise axially-extended or axially elongate beams  130  that each define an axis or linear length along a first direction. At least one drivable clamp assembly may be translatably or drivably coupled to the exterior of each beam element  130 , such as a plurality of drivable clamp assemblies  110  translatably coupled to the exterior of the beam elements  130  spaced along the axis or axial length of the beam elements  130 . For example, an exemplary fixation system and method including at least a pair of beam elements  130  may be positioned into a first configuration with the main axes of the beam elements  130  (and thereby clamp assemblies coupled thereon) being aligned (e.g., co-linear and/or commonly oriented about their axes). From such a first configuration, the joint between the beam elements  130  may be adjusted such that pair of beam elements  130  are re-positioned into a second configuration with the main axes of the beam elements  130  (and thereby clamp assemblies coupled thereon) being offset for each other (e.g., the axes being angled with respect to each other and/or oriented differently about their axes). 
     As noted above, in some embodiments at least one drivable clamp assembly may pass over the beam elements  130 . Stated differently, in some embodiments the beam elements  130  may extend through at least one drivable clamp assembly, and the at least one drivable clamp assembly may be configured to translate along or over the exterior surface of at least the respective beam element  130 . 
     As shown in  FIGS. 1-12 , the beam elements  130  may be at least generally cylindrical and define an exterior surface that extends about the axis and between substantially opposing free ends (e.g., a generally cylindrical exterior surface with opposing bases or free ends). At least one end of the beam element  130  may include an aperture or hole  132  extending at least substantially axially into the beam element  130  from the end surface, as shown in  FIGS. 1-12 . The axially-extending aperture  132  may extend along the axial length of the beam element  130  at least partially into the interior or medial portion of the beam element  130  (along the axial direction). The at least one end aperture  132  of the beam element  130  may include internal threads such that the at least one end aperture  132  comprises a tapped hole  132 . As shown in  FIGS. 1-12 , the at least one end aperture  132  may thereby be configured to threadably couple or mate with external threads of a bolt portion of an end clamp assembly. Similarly, the at least one end aperture  132  may thereby be configured to threadably couple or mate with external threads of another beam element  130  or hinge or connection mechanism (e.g., a dual threaded hinge or connection mechanism) to removably couple the ends of a pair of beam elements  130 . The beam apparatus  100  may thereby be effectively axially lengthened via the additional beam element. In other embodiments, the beam element  130  and/or the at least one end aperture  132  of the beam element  130  may be non-threaded or include another configuration or mechanism besides internal threads for mating with a rotatable end clamp assembly  120  and/or an additional beam element. 
     As shown in  FIGS. 1-12 , the exterior surface of the beam elements  130  may be generally cylindrical and include an externally threaded or patterned engagement track  131  and an alignment groove or slot  133 . The externally threaded or patterned engagement track  131  and/or the alignment groove  133  may extend along the axial length of the exterior surface of the beam element  130  for the entire length of the beam element  130  or partially along the length of the beam element  130 . As shown in  FIGS. 1-12 , the engagement track  131  may be indented or recessed into the beam element  130 . In this way, the track  131  may form a groove extending radially into or within the beam element  130 . The engagement track  131  may form a portion of the exterior surface of the beam element  130 . In some embodiments, as shown in  FIGS. 4-8 , the engagement track  131  may be a groove defined by a radius. As shown in  FIGS. 4-8 , the track  131  may include external threads (or internal threads, depending upon perspective) or other surface features extending along the axial length of the track  131 . The threads of the engagement track  131  may mate with threads of a driving member of a drivable clamp assembly to allow the drivable clamp assembly to be axially translated or driven along the length of the beam element  130  via a driving member. As such, the pitch of the threads of the engagement track  131  and the threads of the driving member of a drivable clamp assembly may have compatible pitches and/or other configurations. In some embodiments, the engagement track  131  may be a hemispherical threaded groove extending into the beam element  130 . It is noted that such a radial or hemispherical grooved threaded engagement track  131  may be machined relatively easily. For example, the hemispherical grooved threaded engagement track  131  may be machined via ball end-mill which alleviates difficulties associated with tap a relatively long partial bore, such as opposed to a standard  60  thread or a trapezoidal thread for example. However, the engagement track  131  may include any thread design and/or other surface feature to allow a clam assembly to lock or fix to the beam element  130  and/or axially drive along the beam element  130 . 
     As also shown in  FIGS. 1-12 , similar to the engagement track  131 , the alignment groove  133  may be indented or recessed into the beam element  130 . In this way, the alignment groove  133  may form a groove extending radially into or within the beam element  130 . The alignment groove  133  may form a portion of the exterior surface of the beam element  130 . In some embodiments, as shown in  FIGS. 1-12 , the alignment groove  133  may be defined by a radius, such as a hemispheric-al groove. In other embodiments, the alignment groove  133  may be any other shape or configuration. The alignment groove  133  may couple with an alignment member (such as a pin or ball bearing) of a drivable clamp assembly to allow the drivable clamp assembly  110  to be axially translated or driven along the length of the beam element  130  (via the driving member and engagement track  131 ) while being aligned or positioned in a particular orientation about the axis of the beam element  130 , as explained further below. The alignment groove  133  may thereby serve as a linear, partially cylindrical groove that serves to provide anti-rotation of a drivable clamp assembly about the beam element  130 , as explained further below. The alignment groove  133  and the drivable clamp assembly may mate via the alignment member only in a particular relative orientation between the drivable clamp assembly and the beam element  130 , and may prevent the drivable clamp assembly from rotating about the beam element  130  from such an orientation (but allow the drivable clamp assembly to translate or slide axially along the alignment groove  133  when being axially driven via the driving member thereof. 
     In some embodiments, the beam element  130  may include intermediate exterior surface portions  134  extending between the alignment groove  133  and the engagement track  131  portions of the beam element  130 , as shown in  FIGS. 1-12 . In some embodiments, the alignment groove  133  and the engagement track  131  portions of the beam element  130  may substantially oppose each other about the axis of the beam element  130 , and thereby two substantially similar intermediate exterior surface portions  134  may extend therebetween. In other embodiments, the alignment groove  133  and the engagement track  131  portions of the beam element  130  may be offset about the axis of the beam element  131 . As shown in  FIGS. 1-12 , the intermediate exterior surface portions  134  may be substantially smooth surfaces (e.g., non-threaded surfaces), and may be curved or arcuate. In some embodiments, the intermediate exterior surface portions  134  may be cylindrical surface portions extending about the axis of the beam element  130  (e.g., convex surfaces defined by a single radius) and/or along the axial length of the beam element  130 . 
     As shown in the linear and aligned first configuration of the beam elements  130  of the adjustable beam apparatus  125  as shown in  FIGS. 6 and 7  as compared to the non-linear/angled and rotated second configuration of the beam elements  130  of the adjustable beam apparatus  125  of  FIGS. 3 and 4  as shown in  FIGS. 8 and 9 , the hinge mechanism  127  allows a user to adjust or configure the angle of the axes of the beam elements  130  with respect to each other and/or the relative orientations of the beam elements  130  about their axes (with respect to each other). 
     As shown in  FIGS. 6-26 , the hinge mechanism  127  may include beam end housings  152  that axially fix or couple to an end portion  132  of the beam element  130 . For example, the beam end housings  152  may include a through aperture that is configured to allow a threaded post portion of a cap screw  154  to extend therethrough and threadably couple with a threaded internal aperture  132  extending into the end of a respective beam element  130 , as shown in  FIGS. 4, 5, 12-22, 25 and 26 . The through aperture of the beam end housings  152  may also be configured to prevent a head portion of the cap screws  154  to travel/translate (axially) therethrough. The head portion of the cap screws  154  may also include a rotation depression, aperture, projection or other feature that allows the cap screws  154  to be engaged and be rotated or torqued (about an axis thereof) to screw the threaded post portions extending through/past the aperture of the beam end housings  152  into the internal aperture  132  of a respective beam element  130 . 
     As shown in  FIGS. 6-26 , the hinge mechanism  127  may be configured or provided such that the cap screws  154  are trapped or housed within the beam end housings  152 , and the rotation feature thereof is accessible (e.g., along the rotation axis of the cap screws  154  via one or more through apertures) via access apertures  199 A,  199 B in at least one relative configuration or arrangement of the hinge mechanism  127 , as shown in  FIGS. 23-26 , so that the hinge mechanism  127  can be coupled between/to the ends portions  132  of a pair of the beam elements  130 , as described further below. In this way, the hinge mechanism  127  may initially be provided separately/individually or de-coupled from the pair of the beam elements  130 , and subsequently coupled thereto via threading the cap screws  154  (via rotation) into the internal apertures  132  of the beam element  130 . 
     As shown in  FIGS. 6-26 , the beam end housings  152  may include a sleeve portion  156  that extends at least partially about the exterior surface of the end portion  132  of a beam element  130  (e.g., when the adjustment hinge  127  is coupled thereto via the cap screws  154 ). As shown in  FIGS. 12, 13 and 16-22 , the sleeve portion  156  of the beam end housings  152  may include a projection or pin  158  that engages within the groove  133  of a beam element  130  (e.g., when the adjustment hinge  127  is coupled thereto via the cap screws  154 ) to rotationally lock the beam end housings  152  and the beam elements  130  together (i.e., prevent the beam end housings  152  from rotating about the axis of the respective beam elements  130 ). As shown in  FIGS. 12, 13 and 16-22 , in one exemplary embodiment the projection  158  may comprise a pin or like member that is positioned or captured within, and extends from, an aperture or slot within an interior surface of the sleeve portion  156  of the beam end housings  152 . 
     The sleeve portion  156  of the beam end housings  152  and the projections  158  may be configured to be axially translated onto an end portion  132  of the beam elements  130  via rotation of the cap screws  154  (i.e., threadably coupled with the internally threaded axial aperture of the end portion  132  of the beam elements  130 ) such that the end portion  132  of the beam element  130  is received/positioned within the sleeve portion  156  and the projection  158  is seated within the recess  133  of the beam element  130 . The beam end housings  152  may thereby be axially and rotationally fixed with respect to a respective beam element  130 . 
     As shown in  FIGS. 6-26 , the adjustment hinge  127  may also include a pair of split clamp collars  160 . Each split clamp collar  160  includes an internally threaded axial internal bore  162  configured to threadably mate with an externally threaded post portion  164  of a respective beam end housing  152  and an externally threaded post portion  182  of a respective rotation end housing  180 A,  180 B to axially fix each clamp collar  160  with a respective beam end housing  152 , a respective rotation end housing  180 A,  180 B and a respective beam element  130  (via a respective cap screw  154 ), as shown in  FIGS. 12 and 16-22 . The threaded post portion  164  of the beam end housing  152  is provided/positioned at one axial end of the beam end housing  152 , and the sleeve portion  156  thereof is provided/positioned the other axial end of the beam end housing  152 , as shown in  FIGS. 12 and 16-22 . 
     A distal axial side of the threaded internal bore  162  of each clamp collar  160  may include a recess or non-threaded portion  166  that mates with the projection or pin  158  mounted on/associated with the respective beam end housing  152  (when the externally threaded post portion  164  of the respective beam end housing  152  is threadably coupled with the distal axial side of the threaded internal bore  162 ), as shown in  FIGS. 12, 17-19, 21 and 22 . For example, each beam end housing  152  may be configured with an aperture and/or slot that houses the projection or pin  158  that extends, partially, on the inner/interior side of the sleeve portion  156  and the outer/exterior side of the post portion  164 , as shown in  FIGS. 12, 17-19, 21 and 22 . The recess or non-threaded portion  166  of the threaded internal bore  162  of the clamp collar  160  and the portion of the projection or pin  158  mounted on/associated with the outer side of the threaded post portion  164  of the beam end housing  152  are configured such that when the projection  158  is seated within the recess  166 , the clamp collar  160  and the beam end housing  152  are rotationally fixed (about the axis of the beam elements  130 ), as shown in  FIGS. 12, 17-19, 21 and 22 . For example, the width of the recess or non-threaded portion  166  of the threaded internal bore  162  of the clamp collar  160  may match or substantially correspond to that of the projection or pin  158  mounted on/associated with the outer side of the threaded post portion  164  of the beam end housing  152 . 
     Similarly, a proximal axial side of the threaded internal bore  162  of each clamp collar  160  may include a recess or non-threaded portion  168  that mates with a projection or pin  196  mounted on/associated with a threaded post portion  182  of a respective rotation end housing  180 A,  180 B (when the externally threaded post portion  182  of the respective rotation end housing  180 A,  180 B is threadably coupled with the proximal axial side of the threaded internal bore  162 ), as shown in  FIGS. 12, 16-19, 21 and 22 . For example, the threaded post portion  182  of each rotation end housing  180 A,  180 B may be configured with an aperture and/or slot that houses the projection or pin  196  that partially extends on the outer/exterior side of the post portion  182 , as shown in  FIGS. 12, 16-19, 21 and 22 . The recess or non-threaded portion  168  of the threaded internal bore  162  of the clamp collar  160  and the portion of the projection or pin  196  mounted on/associated with the outer side of the threaded post portion  182  of the rotation end housing  180 A,  180 B are configured such that when the projection or pin  196  is seated within the recess or non-threaded portion  168 , only a limited about of relative rotation of the respective rotation end housing  180 A,  180 B within the internal bore  162  of the clamp collar  160  (and thereby about the axis of the beam elements  130 ) is provided, as shown in  FIGS. 12, 16-19, 21 and 22 . For example, the width of the recess or non-threaded portion  168  of the threaded internal bore  162  of the clamp collar  160  may be substantially larger or longer than that of the projection or pin  196  mounted on/associated with the outer side of the threaded post portion  182  of the respective rotation end housing  180 A,  180 B, as shown in  FIGS. 17, 18, 21 and 22 . In this way, the relative rotational arrangement or orientation of an associated beam element  130  with respect to a respective rotation end housing  180 A,  180 B (and thereby the pivot or rotation point or axis, as explained further below) can be adjusted or chosen within the range provided for/by the recess  168  via relative rotation of the respective clamp member  160 , beam end housing  156  and beam element  130  (e.g., about the axes thereof). 
     When a particular relative rotational arrangement or orientation of a beam element  130  and a respective rotation end housing  180 A,  180 B, such as with respect to the joint  127  generally (e.g., the pivot or rotation point or axis of the joint  127 , as explained further below) and/or the respective clamp collar  160  is selected or achieved, the respective split clamp collar  160  can utilized to selectively lock the particular rotational arrangement. As shown in  FIGS. 6-26 , the split clamp collars  160  include clamping portions  170  that are separated by a gap or split that passes from the exterior of the clamp collars  160  to the central bore  162  along the entirety of the axial length thereof. The clamping portions  170  may include substantially aligned through apertures with axes that extend across the gap between the clamping portions  170 , as shown in  FIGS. 6-26 . At least one of the through apertures of the clamping portions  170  may be threaded, and the through apertures may be configured to mate with a clamping or compression screw  172 , as shown in  FIGS. 6-26 . The clamp collars  160  and the clamping screws  172  may be configured such that when a clamping screw  172  is rotated or axially advanced into/through the aperture of the clamping portions  170  and across the gap of a clamp collar  160 , the clamping portions  170  are drawn together and the central bore  162  is compressed (i.e., the diameter or width of the central bore  162  thereof is made smaller) such that the clamp collar  160  applies a compressive force to the associated threaded post portion  164  of a respective rotation end housing  180 A,  180 B to rotationally fix (e.g., about the axis of the associated beam element  130 ) the associated threaded post portion  164  of the respective rotation end housing  180 A,  180 B and the respective clamp collar  160 . 
     In this way, the relative rotational arrangement or orientation of a respective beam element  130  with respect to a respective rotation end housing  180 A,  180 B (and thereby the pivot or rotation point or axis of the joint  127 , as explained further below) can be selectively fixed via the clamping or compression force applied to the threaded post portion  164  of the respective rotation end housing  180 A,  180 B via the clamp collar  160  as the clamp collar  160  is rotationally fixed to a respective beam end housing  156  and a beam element  130  associated therewith, as described above. Conversely, the relative rotational arrangement or orientation of a respective beam element  130  with respect to a respective rotation end housing  180 A,  180 B (and thereby the pivot or rotation point or axis of the joint  127 , as explained further below) can be selectively provided or adjusted via reducing (or eliminating) the clamping or compression force applied to the threaded post portion  164  of the respective rotation end housing  180 A,  180 B via the clamp collar  160  (via rotation of the clamping screw  172 ), and rotating the respective beam element  130  (and the associated clamp collar  160  and beam end housing  152  rotationally fixed thereto) about its axis with respect to the respective rotation end housing  180 A,  180 B (and thereby the pivot or rotation point or axis of the joint  127 , as explained further below). 
     In some embodiments, the split clamp collars  160  may be deformed via rotation of the clamping screw  172  such that the clamping portions  170  are moved closer toward each other (i.e., the gap is decreased) and, thereby, the diameter or other size of the central bore  162  is decreased to apply the compressive force to the threaded post portion  164  of a respective beam end housing  152  and a threaded post portion  164  of a respective rotation end housing  180 A,  180 B (to rotationally fix the components). 
     As shown in  FIGS. 12-14 and 16-22 , the rotation end housings  180 A,  180 B each include a joint or rotation portion  186  that are rotationally or pivotably coupled or mated via at least one joint pin  192  extending through aligned apertures  188  thereof. As shown in  FIGS. 12-14 and 16-22 , the rotation portions  186  of the rotation end housings  180 A,  180 B and the at least one joint pin  192  may form a U-joint such that the second rotation end housing  180 B comprises a “U” or split flange yoke and the first rotation end housing  180 A forms a shaft portion that fits and rotates within the rotation end housing  180 B (or vice versa). The at least one joint pin  192  (e.g., at least one stepped pin) may extend through the apertures  188  of the rotation portion  186  of the second rotation end housing  180 B and at least partially through the aperture(s)  188  of the rotation portion  186  of the first rotation end housing  180 A. The at least one pin  192  may rotationally fix the rotation portions  186  of the first and second rotation end housings  180 A,  180 B together, but allow for pivoting or angular rotation therebetween along an axis that is angled with respect to the axes of the beam elements  130 . For example, the at least one joint pin  192  may fix the rotation portions  186  of the first and second rotation end housings  180 A,  180 B together (and thereby the associated beam elements  130  together) along the axes of the associated beam elements  130 , but allow angular/pivoting movement therebetween (and thereby between the associated beam elements  130 ) about the axis of the at least one joint pin  192 , as shown by the arrangement of the joint  127  in  FIGS. 6 and 7  as compared to  FIGS. 8 and 9 . 
     The axis of the angular movement or rotation between the rotation portions  186  of the first and second rotation end housings  180 A,  180 B, and thereby the associated beam elements  130 , provided by the at least one joint pin  192  (i.e., the axis of the at least one joint pin  192 ) is thereby angled with respect to the axis of the associated beam elements  130 . In some embodiments, the axis of the angular movement or rotation between the first and second rotation end housings  180 A,  180 B (i.e., the axis of the at least one joint pin  192 ) (and thereby between the associated beam elements  130 ) intersects the axes of the associated beam elements  130 . In some embodiments, the axis of the angular movement or rotation between the first and second rotation end housings  180 A,  180 B (i.e., the axis of the at least one joint pin  192 ) (and thereby between the associated beam elements  130 ) is oriented normal or perpendicular to the axes of the associated beam elements  130 . 
     As also shown in  FIGS. 6-26 , the first rotation end housing  180 A may include first and second coupling apertures  199 A,  199 B extending therethrough from the rotation portion  186 . The first coupling aperture  199 A of the first rotation end housing  180 A may be at least partially aligned with the axis of the coupling cap screw  154  captured within the associated beam end housing  152 . Similarly, the associated beam end housing  152  may also include a first coupling aperture  199 A that is at least partially aligned with the first coupling aperture  199 A of the first rotation end housing  180 A and the axis of the coupling cap screw  154  captured therein. In this way, when the hinge mechanism  127  is configured/arranged (e.g., the angular orientation of the beam elements  130  is configured/arranged) such that the first coupling aperture  199 A at the rotation portion  186  of the first rotation end housing  180 A is exposed or accessible, as shown in  FIGS. 23-25 , a tool may be inserted through the first coupling apertures  199 A and into engagement with the coupling cap screw  154  to apply a torque thereto and, ultimately, threadably couple or de-couple the cap screw  154  (and thereby the first rotation end housing  180 A and the hinge mechanism  127  as a whole) with the end aperture  132  of a first beam element  130 . 
     Similarly, the second coupling aperture  199 B of the first rotation end housing  180 A may be at least partially aligned with the axis of the coupling cap screw  154  captured within the beam end housing  152  associated with the second rotation end housing  180 B in a particular arrangement or rotational arrangement of the first and second rotation end housings  180 A,  180 B about the axis of rotation (and thereby a particular angular orientation of the beam elements  130 , as shown in  FIGS. 23, 24 and 26 . The second rotation end housing  180 B and the associated beam end housing  152  may also include a second coupling aperture  199 B that is at least partially aligned with the axis of the coupling cap screw  154  captured therein and the second coupling aperture  199 A of the first rotation end housing  180 A when in the particular arrangement, as shown in  FIGS. 23, 24 and 26 . In this way, when the hinge mechanism  127  is configured/arranged (e.g., the angular orientation of the beam elements  130  is configured/arranged) such that the second coupling aperture  199 B at the rotation portion  186  of the first rotation end housing  180 A is at least partially aligned with the coupling cap screw  154  associated with the second rotation end housing  180 A,  FIGS. 23, 24 and 26 , a tool may be inserted through the second coupling apertures  199 B of the first and second rotation end housings  180 A,  180 B and the associated beam end housing  152  and into engagement with the coupling cap screw  154  to apply a torque thereto and, ultimately, threadably couple or de-couple the cap screw  154  (and thereby the second rotation end housing  180 B and the hinge mechanism  127  as a whole) with the end aperture  132  of a second beam element  130 . 
     It is to be understood that the above description is intended to be illustrative, and not restrictive. Numerous changes and modifications may be made herein by one of ordinary skill in the art without departing from the general spirit and scope of the disclosure as defined by the following claims and the equivalents thereof. For example, the above-described embodiments (and/or aspects thereof) may be used in combination with each other. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the various embodiments without departing from their scope. While the dimensions and types of materials described herein are intended to define the parameters of the various embodiments, they are by no means limiting and are merely exemplary. Many other embodiments will be apparent to those of skill in the art upon reviewing the above description. The scope of the various embodiments should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. In the appended claims, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects. Also, the term “operably connected” is used herein to refer to both connections resulting from separate, distinct components being directly or indirectly coupled and components being integrally formed (i.e., monolithic). Further, the limitations of the following claims are not written in means-plus-function format and are not intended to be interpreted based on 35 U.S.C. § 112, sixth paragraph, unless and until such claim limitations expressly use the phrase “means for” followed by a statement of function void of further structure. It is to be understood that not necessarily all such objects or advantages described above may be achieved in accordance with any particular embodiment. Thus, for example, those skilled in the art will recognize that the systems and techniques described herein may be embodied or carried out in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other objects or advantages as may be taught or suggested herein. 
     While the disclosure has been described in detail in connection with only a limited number of embodiments, it should be readily understood that the disclosure is not limited to such disclosed embodiments. Rather, the disclosure can be modified to incorporate any number of variations, alterations, substitutions or equivalent arrangements not heretofore described, but which are commensurate with the spirit and scope of the disclosure. Additionally, while various embodiments of the disclosure have been described, it is to be understood that aspects of the disclosure may include only some of the described embodiments. Accordingly, the disclosure is not to be seen as limited by the foregoing description, but is only limited by the scope of the appended claims. 
     This written description uses examples to disclose the disclosure, including the best mode, and also to enable any person skilled in the art to practice the disclosure, including making and using any devices or systems and performing any incorporated methods. The patentable scope of the disclosure is defined by the claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the claims if they have structural elements that do not differ from the literal language of the claims, or if they include equivalent structural elements with insubstantial differences from the literal language of the claims.