Patent Publication Number: US-2021161575-A1

Title: Bone fixation system, assembly, implants, devices, alignment guides, and methods of use

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application is a divisional of U.S. application Ser. No. 15/942,040 filed on Mar. 30, 2018, which will issue as U.S. Pat. No. 10,918,431 on Feb. 16, 2021, which is a continuation of PCT Application No. PCT/US2018/025443 filed on Mar. 30, 2018, and which claims priority benefit under 35 U.S.C. § 119(e) of U.S. provisional application No. 62/478,984 filed Mar. 30, 2017, which are incorporated herein by reference in their entireties. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates generally to general, podiatric, and orthopaedic surgery related to fixation of prepared joint surfaces. More specifically, but not exclusively, the present disclosure relates to implants, guides, devices, instruments, systems and methods for fixing a joint using bone plates. 
     BACKGROUND OF THE INVENTION 
     In patients with Charcot neuroarthropathy and other deformities of the foot there may be a breakdown of the arch of the foot including the medial column resulting in pain, areas of increased pressure resulting in ulceration and instability. In order to alleviate the pain, increased pressure and instability, it is sometimes necessary to perform arthrodesis or fusion on the bones of the foot and ankle to place the foot back into a plantigrade position. New and improved bone fixation systems, assemblies, implants, alignment guides, and methods are needed to improve the stability of the patient&#39;s foot after arthrodesis or fusion. 
     SUMMARY OF THE INVENTION 
     The present disclosure is directed toward devices and methods for use in fixation of a patient&#39;s joints or for fixation of a fracture. The alignment guides provide an orientation for securement of a beaming screw and bone plates across a patient&#39;s joint or fracture. 
     In one aspect of the present disclosure provided herein, is a bone fixation system. The bone fixation system includes an alignment guide with a first end and a second end, an alignment wire rotatably coupled to the first end of the alignment guide, and a coupling member slidingly engaging a first portion of the alignment guide near the first end. 
     In another aspect of the present disclosure provided herein, is a bone plate, that includes a body with a first end and a second end, a plurality of lobes extending from the body, a plurality of screw holes extending through the body with each screw hole of the plurality of screw holes being positioned in at least one lobe of the plurality of lobes, and an alignment hole positioned along a longitudinal axis of the body. 
     In yet another aspect of the present disclosure provided herein, is a method of using a bone fixation system for fixation of at least two bones. The method includes creating an incision near the at least two bones and preparing the at least two bones for fixation. The method also includes inserting an alignment wire into one of the at least two bones and coupling an alignment guide to the alignment wire. The method further includes positioning a bone plate on the at least two bones and inserting a beaming screw into the at least two bones. Finally, the method includes securing the bone plate to the at least two bones and closing the incision. 
     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 
       The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the disclosure and together with the detailed description herein, serve to explain the principles of the disclosure. It is emphasized that, in accordance with the standard practice in the industry, various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of discussion. The drawings are only for purposes of illustrating preferred embodiments and are not to be construed as limiting the disclosure. 
         FIG. 1  is a top perspective view of one embodiment of a bone fixation system, in accordance with an aspect of the present disclosure; 
         FIG. 2  is a first side perspective view of the bone fixation system of  FIG. 1 , in accordance with an aspect of the present disclosure; 
         FIG. 3  is a second side perspective view of the bone fixation system of  FIG. 1 , in accordance with an aspect of the present disclosure; 
         FIG. 4  is a first end perspective view of the bone fixation system of  FIG. 1 , in accordance with an aspect of the present disclosure; 
         FIG. 5  is a top view of the bone fixation system of  FIG. 1 , in accordance with an aspect of the present disclosure; 
         FIG. 6  is an exploded, top perspective view of the bone fixation system of  FIG. 1  and a bone plate and fasteners, in accordance with an aspect of the present disclosure; 
         FIG. 7  is an exploded, side view of the bone fixation system and bone plate of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 8  is an exploded, bottom perspective view of the bone fixation system, bone plate and fasteners of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 9  is an exploded, top perspective view of a portion of the bone fixation system of  FIG. 1 , in accordance with an aspect of the present disclosure; 
         FIG. 10  is an exploded, bottom perspective view of a portion of the bone fixation system of  FIG. 1 , in accordance with an aspect of the present disclosure; 
         FIG. 11  is a top perspective view of the bone plate of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 12  is an end view of the bone plate of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 13  is a top view of the bone plate of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 14  is a back view of the bone plate of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 15  is a first side view of the bone plate of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 16  is a second side view of the bone plate of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 17  is a top view of another bone plate, in accordance with an aspect of the present disclosure; 
         FIG. 18  is a bottom perspective view of the bone plate of  FIG. 17 , in accordance with an aspect of the present disclosure; 
         FIG. 19  is a dorsal perspective view of a portion of the bone fixation system of  FIG. 1  positioned on a patient&#39;s foot, in accordance with an aspect of the present disclosure; 
         FIG. 20  is a dorsal perspective view of the guide wire and beaming screw of the bone fixation system of  FIG. 1  positioned in a patient&#39;s foot, in accordance with an aspect of the present disclosure; 
         FIG. 21  is a dorsal perspective view of a portion of the bone fixation system of  FIG. 1  and the bone plate and fasteners of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 22  is a dorsal perspective view of the bone fixation system of  FIG. 1  and the bone plate and fasteners of  FIG. 6 , in accordance with an aspect of the present disclosure; 
         FIG. 23  is a first perspective, side view of a portion of another targeting guide system with a protector member, in accordance with an aspect of the present disclosure; 
         FIG. 24  is a second perspective, side view of the portion of the targeting guide system of  FIG. 23 , in accordance with an aspect of the present disclosure; 
         FIG. 25  is a first perspective, side view of the targeting guide system of  FIG. 23  with a drill guide after removal of the protector member, in accordance with an aspect of the present disclosure; 
         FIG. 26  is a second perspective, side view of the targeting guide system of  FIG. 25 , in accordance with an aspect of the present disclosure; 
         FIG. 27  is a perspective view of the targeting guide system of  FIG. 25  with a bone plate attached, in accordance with an aspect of the present disclosure; 
         FIG. 28  is another perspective view of the targeting guide system of  FIG. 27 , in accordance with an aspect of the present disclosure; 
         FIG. 29  is an exploded perspective view of the complete targeting guide system of  FIG. 23 , in accordance with an aspect of the present disclosure; 
         FIG. 30  is another exploded, perspective view of the targeting guide system of  FIG. 29 , in accordance with an aspect of the present disclosure; 
         FIG. 31  is an exploded, first side view of the targeting guide system of  FIG. 29 , in accordance with an aspect of the present disclosure; 
         FIG. 32  is an exploded, second side view of the targeting guide system of  FIG. 29 , in accordance with an aspect of the present disclosure; 
         FIG. 33  is a dorsal view of the targeting guide system of  FIG. 23  positioned on a foot, in accordance with an aspect of the present disclosure; 
         FIG. 34  is a perspective view of the foot and targeting guide system of  FIG. 33  after a bone plate is secured to the foot with fasteners, in accordance with an aspect of the present disclosure; 
         FIG. 35  is a perspective view of the foot and targeting guide system of  FIG. 34  after removal of the protector member and insertion of the drill guide, in accordance with an aspect of the present disclosure; 
         FIG. 36  is a perspective view of the foot of  FIG. 35  after removal of the targeting guide system and insertion of a threaded member, in accordance with an aspect of the present disclosure; 
         FIG. 37  is a side view of the foot of  FIG. 36  after removal of the target pin, in accordance with an aspect of the present disclosure; 
         FIG. 38  is a top perspective view of the bone plate of  FIG. 27 , in accordance with an aspect of the present disclosure; 
         FIG. 39  is an end view of the bone plate of  FIG. 27 , in accordance with an aspect of the present disclosure; 
         FIG. 40  is a top view of the bone plate of  FIG. 27 , in accordance with an aspect of the present disclosure; 
         FIG. 41  is a bottom view of the bone plate of  FIG. 27 , in accordance with an aspect of the present disclosure; 
         FIG. 42  is a first side view of the bone plate of  FIG. 27 , in accordance with an aspect of the present disclosure; and 
         FIG. 43  is a second side view of the bone plate of  FIG. 27 , in accordance with an aspect of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION 
     Generally stated, disclosed herein are implants, guides, devices, instruments, and systems for fixing a joint using bone plates. Further, methods for using the implants, guides, devices, instruments and systems are discussed. 
     In this detailed description and the following claims, the words proximal, distal, anterior or plantar, posterior or dorsal, medial, lateral, superior and inferior are defined by their standard usage for indicating a particular part or portion of a bone or implant according to the relative disposition of the natural bone or directional terms of reference. For example, “proximal” means the portion of a device or implant nearest the torso, while “distal” indicates the portion of the device or implant farthest from the torso. As for directional terms, “anterior” is a direction towards the front side of the body, “posterior” means a direction towards the back side of the body, “medial” means towards the midline of the body, “lateral” is a direction towards the sides or away from the midline of the body, “superior” means a direction above and “inferior” means a direction below another object or structure. Further, specifically in regards to the foot, the term “dorsal” refers to the top of the foot and the term “plantar” refers the bottom of the foot. 
     Similarly, positions or directions may be used herein with reference to anatomical structures or surfaces. For example, as the current implants, devices, instrumentation and methods are described herein with reference to use with the bones of the foot, the bones of the foot, ankle and lower leg may be used to describe the surfaces, positions, directions or orientations of the implants, devices, instrumentation and methods. Further, the implants, devices, instrumentation and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to one side of the body for brevity purposes. However, as the human body is relatively symmetrical or mirrored about a line of symmetry (midline), it is hereby expressly contemplated that the implants, devices, instrumentation and methods, and the aspects, components, features and the like thereof, described and/or illustrated herein may be changed, varied, modified, reconfigured or otherwise altered for use or association with another side of the body for a same or similar purpose without departing from the spirit and scope of the disclosure. For example, the implants, devices, instrumentation and methods, and the aspects, components, features and the like thereof, described herein with respect to the right foot may be mirrored so that they likewise function with the left foot. Further, the implants, devices, instrumentation and methods, and the aspects, components, features and the like thereof, disclosed herein are described with respect to the foot for brevity purposes, but it should be understood that the implants, devices, instrumentation and methods may be used with other bones of the body having similar structures. 
     Referring to the drawings, wherein like reference numerals are used to indicate like or analogous components throughout the several views, and with particular reference to  FIGS. 1-10 , there is illustrated an exemplary embodiment of a bone fixation system  100  including a targeting guide assembly and a bone plate  200 ,  250 . The bone fixation system  100  includes an arm or alignment guide  110 , a plate attachment member  130 , a set screw or plate attachment member  140 , a guide wire or sphere wire  150 , a guide wire or k-wire  170 , a guide wire sleeve  180 , and a screw  190 . 
     As shown in  FIGS. 6-10 , the alignment guide  110  includes a first end  112  and a second end  114 . The first end  112  includes a first portion or base  116  and the second end  114  includes a second portion  118 . The second portion  118  may have a width, for example, greater than the first portion  116  or the same width across its entire length. The alignment guide  110  may taper from the second portion  118  to the first portion  116 . The first portion  116  may also include a pivoting head member  120  at the first end  112 . The pivoting member  120  may include a channel  122  forming an opening in the pivoting head member  120 . The channel or opening  122  may allow for the pivoting member  120  to deform or deflect for insertion of the sphere wire  150 . The channel or opening  122  may also provide a recess for the first end  152  of the sphere wire  150  while the pivoting member  120  is pivoting on the pivot protrusion  158  of the sphere wire  150 . The channel  122  may include two retaining members or recesses  124  on an interior surface of the pivoting member  120 . Alternatively, the channel  122  may include a plurality of deformable retaining members (not shown) separated by a plurality of recesses that surround the channel  122  and are sized and shaped to receive the pivot protrusion  152 . The second portion  118  may include an opening or through hole  126  extending through the second end  114  of the alignment guide  110 . The alignment guide  110  may also include length or measurement indicator lines  128  positioned along the region between the first and second portions  116 ,  118  and along the second portion  118 . 
     The plate attachment or coupling member  130  may include a channel  132  extending through the coupling member  130 , as shown in  FIGS. 6-10 . The channel  132  may be, for example, sized and shaped to slide over the first portion  116  of the alignment guide  110 . The coupling member  130  may also include a leg or extension member  134  extending out at a bottom of the coupling member  130 . In addition, the coupling member  130  may include an opening  136  extending through the coupling member  130  along a longitudinal axis. The extension member  134  may include an alignment protrusion  138  extending from a bottom of the extension member  134 , as shown in  FIGS. 2, 5, 8 and 10 . The alignment protrusion  138  may be sized and shaped to engage a bone plate, for example, bone plate  200 . 
     With continued reference to  FIGS. 6-10 , the set screw or plate attachment member  140  includes a body  142  with a first end and a second end. The set screw  140  may also include a head portion  144  at the first end and a threaded portion  146  at the second end. The head portion  144  may have a diameter larger than a diameter of the body  142 . The diameter of the head portion  144  may also be larger than the diameter of the opening  136  in the coupling member  130 . The threaded portion  146  of the set screw  140  may include a thread that corresponds to the threading in an opening or screw hole of the bone plate  200 . 
     The sphere wire  150  may include a first end  152  and a second end  154 , as shown in  FIGS. 1-10 . The terms “sphere wire,” “pivoting member,” “grip wire,” and “alignment wire” may be used interchangeably herein as the each essentially refer to a wire including a protrusion. The sphere wire  150  may also include a wire portion  156  extending from the first end  152  to a pivot protrusion or spherical member  158 . The pivot protrusion  158  may be, for example, spherical or may have a circular or round cross-section and be sized and shaped to match the retaining member or recesses  124  in the pivoting head member  120  at the first end  112  of the alignment arm  110 . The pivot protrusion  158  may rotate within the retaining member  124  in the pivoting head  120 . The pivoting member  150  may also include a threaded insertion end  160  and a tapered region  162  extending between the pivot protrusion  158  and the insertion end  154 . The insertion end  154  may have a pointed tip for insertion into the patient&#39;s foot. 
     The alignment guide system  100  may also include a guide wire or k-wire  170 , as shown in  FIGS. 1-8 . The guide wire  170  may include a first end  172  and a second end or insertion end  174 , as shown in  FIGS. 6-8 . 
     As shown in  FIGS. 6-10 , the guide wire sleeve  180  of the alignment guide system  100  may include a body  182  with a first end  184  and a second end  186 . The first end  184  may include a head portion or handle member. The second end  186  may have a tapered end terminating with a bone contacting surface that may be, for example, serrated or smooth. The guide wire sleeve  180  may also include a through hole or cannulation  188  extending through the body  182  from the first end  184  to the second end  186 . The cannulation  188  may be, for example, sized and shaped to receive the guide wire  170 . 
     The screw, beaming screw, solid screw or compression screw  190  may include a first end  192  and a second end  194 , as shown in  FIGS. 6-8 . The head portion of the screw  190  positioned at the first end  192  may be, for example, tapered from the first end  192  to the threaded shaft portion  196 . The beaming screw  190  may include threads  196  along at least a portion of the length. In addition, the beaming screw  190  may include a through hole or cannulation  198  extending from the first end  192  to the second end  194 . The cannulation  198  may be sized and shaped to receive the guide wire  170  to allow for the beaming screw  190  to optionally be inserted over the guide wire  170 . A drill (not shown) may optionally be inserted over the guide wire  170  to create a path for the screw  190  prior to inserting the screw  190  over the guide wire  170 . Alternatively, the beaming screw  190  may be solid. 
     The bone fixation system  100  may also include a bone plate  200 , as shown in  FIGS. 6-8 and 11-16 . The bone plate  200  may include a body  202  with a first end  204  and a second end  206 . The body  202  may also include a plurality of lobes  208  extending away from the body  202 , as shown in  FIGS. 11 and 13-16 . The body  202  may also include a plurality of screw holes or openings  210 . Each of the plurality of screw holes  210  may be positioned in one of the plurality of lobes  208 . The screw holes  210  are positioned to allow for bone fastener trajectories that form a longitudinal opening or space between the bone fasteners  230  inserted through the screw holes  210 . The longitudinal opening or space is generally parallel to the body  202  of the bone plate  200 . The bone fastener trajectories of the screw holes  210  are selected to provide the longitudinal opening for receiving a beaming screw  190  or to avoid interference or intersection with an already inserted beaming screw  190 . The longitudinal opening may extend through, for example, at least one of the patient&#39;s joints. At least one of the plurality of screw holes  210  may be sized and shaped to receive the threaded portion  146  of the plate attachment member or set screw  140  to secure the plate  200  to the coupling member  130  of the alignment guide  110 , as shown in  FIGS. 21 and 22 . 
     As shown in  FIGS. 11, 13 and 14 , the bone plate  200  may also include a first opening  214 , a second opening  216 , and a third opening  218  positioned along the longitudinal axis of the plate  200 . The openings  214 ,  216 ,  218  may be, for example, sized and shaped to allow for visualization of the bones. The body  202  may also include an alignment hole  220  for receiving the alignment protrusion  138  of the coupling member  130 . The alignment hole  220  may be positioned generally centered on the body  202 . As shown, the alignment hole  220  may also be positioned between the first opening  214  and second opening  216  near a midpoint of the plate  200 . Although not shown, the alignment hole  220  may alternatively be positioned anywhere along the plate to provide for coupling to the plate  200  with adequate visualization for the procedure. For example, the alignment hole  220  may be positioned between the opening  214  and the first end  204 , between the openings  216 ,  218 , or between the opening  218  and the second end  206 . The third opening  218  may be positioned between the second opening  216  and the second end  206 , as shown in  FIGS. 11, 13 and 14 . As shown in  FIG. 12 , the body  202  may be curved to match the curvature of the bones. The bone plate  200  may also include slots, as shown and described in greater detail below with reference to bone plate  500 , positioned in the body  202  to allow for temporary fixation and compression of the bones being coupled to the plate  200 . 
     Referring now to  FIGS. 17 and 18 , another embodiment of a bone plate  250  is shown. The bone plate  250  may include a body  252  with a first end  254  and a second end  256 . The body  252  may also include a plurality of lobes  258  extending away from the body  252 , as shown in  FIGS. 17-18 . The body  252  may also include a plurality of screw holes or openings  260 . Each of the plurality of screw holes  260  may be positioned in one of the plurality of lobes  258 . At least one of the plurality of screw holes  260  may be sized and shaped to receive the threaded portion  146  of the plate attachment member or set screw  140  to secure the plate  250  to the coupling member  130  of the alignment guide  110 . 
     With continued reference to  FIGS. 17 and 18 , the plate  250  also includes at least one alignment opening  262 ,  264  for receiving the alignment protrusion  138  of the coupling member  130 . In the depicted embodiment, the plate  250  includes a first alignment opening  262  and a second alignment opening  264 . The alignment opening  262 ,  264  may be positioned, for example, anywhere along the length of the plate  250 . In addition, the plate  250  includes a first opening  266  and a second opening  268  for visualization of the bones during insertion. 
     The surgical method for using the bone fusion system  100  on a patient&#39;s foot  300  is shown in  FIGS. 19-22 . The method may use the bone fixation system  100  during an arthrodesis procedure, for example, for fusion of at least the first metatarsal  302  and the medial cuneiform  304  at the first tarsometatarsal joint  312 . The bone fixation system  100  may also be used for fusion of, for example, the first tarsometatarsal joint  312  and naviculaocuneiform joint  314  to fuse the first metatarsal  302 , the medial cuneiform  304  and the navicular  306  bones. It is also contemplated that the bone fixation system  100  may be used for fusion of, for example, the first metatarsal  302 , the medial cuneiform  304 , the navicular  306 , and the talus  308  bones at the first tarsometatarsal joint  312 , the naviculocuneiform joint  314  and the talonavicular joint  316 , respectively. The bone fixation system  100  may also be used for treatment of Charcot neuroarthropathy where the breakdown of the medial column of the foot has occurred and restoration of the medial foot is necessary. 
     For example, the method may include making a skin incision to expose the first tarsometatarsal joint  312 , the naviculocuneiform joint  314 , the talonavicular joint  316 , and the first metatarsophalangeal joint  310 . Next, preparation of the joints  312 ,  314 ,  316  is performed by, for example, removing cartilage or performing osteotomies of the medial column joints  312 ,  314 ,  316 . The joints may be prepared, for example, to obtain a plantigrade foot. After the joints are prepared, a guide wire  150 , for example, a sphere wire may be placed into the talus  308 . In procedures where fusion of the talonavicular joint  316  is not necessary, the sphere wire  150  may be placed in a more distal bone. The sphere wire  150  may be placed to position the tip  154  of the wire  150  or the threaded portion  160  of the wire  150  along the axis of the trajectory where a screw or beaming screw  190  will be inserted. 
     Next, an alignment guide  110  may be selected and coupled to the sphere wire  150 . The pivot protrusion  158  of the sphere wire  150  may be, for example, inserted through the channel  122  and into engagement with the retaining member  124  inside of the pivoting head  120  of the alignment guide  110  to couple the sphere wire  150  to the alignment guide  110 . The alignment guide  110  may be positioned to align the sleeve opening  126  with the central aspect of the first metatarsophalangeal joint  310 . Then, a guide wire sleeve  180  may be inserted through the opening  126  in the distal end of the alignment guide  110 . After the guide wire sleeve  180  is positioned, a guide wire  170  may be driven through the central aspect of the head of the first metatarsal  302 , as shown in  FIG. 19 . The guide wire  170  may be driven proximally through the first metatarsal  302  and across, for example, the first tarsometatarsal joint  312 , the naviculocuneiform joint  314  and the talonavicular joint  316 . Once the guide wire  170  is inserted through the joints  312 ,  314 ,  316 , the position of the guide wire  170  may be confirmed using fluoroscopy. If the guide wire  170  is in the desired position, the alignment guide  110  and the sphere wire  150  may be removed, for example, if only a beaming screw  190  is being inserted into the patient&#39;s foot  300 . 
     The beaming screw  190  may be inserted, as shown in  FIG. 20 , by drilling over the guide wire  170 . After the drilling is complete, a cannulated screw, solid screw, or beaming screw  190  may be inserted into the first metatarsal  302  and across, for example, the first tarsometatarsal joint  312 , the naviculocuneiform joint  314  and the talonavicular joint  316 , if fusion of all three joints is desired. The screw  190  may be, for example, inserted over the guide wire  170  if the screw  190  is cannulated. Alternatively, if the screw  190  is solid, the guide wire  170  may be removed and then the screw  190  may be inserted through the opening in the patient&#39;s bones  302 ,  304 ,  306 ,  308 . The screw  190  may be, for example, a headed or headless screw and a partially or fully threaded screw. The screw  190  may also have, for example, a tapered head portion with or without threads on the exterior surface. 
     In one embodiment, a bone plate  200  may be secured to the bones  302 ,  304 ,  306 ,  308 , as shown in  FIG. 22 , for additional fixation, after the beaming screw  190  is inserted. Alternatively, the bone plate  200  may be secured to the bones after the guide wire  170  is placed but prior to beaming screw  190  placement. The plate  200  may be coupled to the coupling member  130  of the alignment guide  110  by aligning the opening  136  of the coupling member  130  with a screw hole  210  of the plate  200 . The alignment protrusion  138  may be inserted into the alignment hole  220  in the plate  200  to assist with aligning the opening  136  with a screw hole  210 . Next, a plate attachment member or set screw  140  may be inserted through the opening  136  and the threaded portion  146  may be screwed into a screw hole  210  of the plate  200 . The channel  132  of the coupling member  130  may then be inserted over the first portion  116  of the alignment guide  110 . Once the coupling member  130  is positioned on the first portion  116  of the alignment guide  110 , the coupled plate  200  may be positioned on the patient&#39;s foot  300 . The coupling member  130  enables translation along the alignment guide  110  to move the plate in a proximal-distal direction until a desired positioning is achieved on the patient&#39;s foot  300 . The bone fixation system  100  also allows for rotation of the plate  200  in a frontal plane to allow for plate  200  fixation on a slightly more dorsal or plantar position depending on the patient&#39;s anatomy and desired correction. The coupled alignment guide  110  and plate  200  may rotate about the pivot protrusion  158  of the sphere wire  150 . The translation and rotation of the plate  200  with respect to the patient&#39;s foot  300  allows for variations in the plate  200  positioning and for on-axis placement of the plate  200 . Once the position of the plate is selected, bone plate screws  230  may be inserted through the screw holes  210  and the screw holes  210  may have trajectories to avoid contacting or interference with the beaming screw  190 . In addition, the translation and rotation of the plate  200  allows for variations to the placement of the plate  200  before insertion of the bone plate screws  230  while still ensuring there is no contact or interference with the beaming screw  190 . 
     In another embodiment, as shown in  FIG. 21 , after placement of the guide wire  170 , the plate  200  may be positioned on the patient&#39;s foot, as described in greater detail above, which will not be described again here for brevity sake. Next, the plate  200  may be secured to the patient&#39;s bones  302 ,  304 ,  306 ,  308  by inserting bone fasteners  230  through the plurality of openings or screw holes  210  in the plate  200 . The plate  200  may be secured to the patient&#39;s foot  300  prior to insertion of the beaming screw  190 . The plurality of screw holes  210  may include insertion trajectories forming an opening or space between the plurality of bone fasteners  230  for insertion of the beaming screw  190 . Once the plate  200  is attached to the patient&#39;s foot  300 , then the guide wire sleeve  180  may be removed and a drill may be inserted over the guide wire  170  to drill an opening for a beaming screw  190 . Next, a screw  190  may be inserted into the patient&#39;s foot  300 . As the screw  190  is inserted, the screw  190  will avoid interference and/or intersection with the bone fasteners  230  and trajectory thereof. Once the screw  190  is positioned in the bones  302 ,  304 ,  306 ,  308 , then the guide wire  170 , spherical wire  150 , and alignment guide  110  may be removed from the patient. 
     Finally, once the beaming screw  190  and/or plate  200  are secured to the patient&#39;s bones  302 ,  304 ,  306 ,  308 , the arthrodesis procedure may be completed and the incision may be closed. 
     Referring now to  FIGS. 23-43 , another bone fixation system is shown. The bone fixation system may include a targeting guide assembly  400  and a bone plate  500 . The targeting guide assembly  400  includes a guide arm  410 , a target member  430 , an implant holder  460 , and a guide pin  490 . The target member  430  is received within a first end of the guide arm  410 . The implant holder  460  moveably engages the guide arm  410  and may, for example, slide along a top surface of a body  412  of the guide arm  410  to allow for location adjustability of a bone plate  500 , as shown in  FIGS. 34 and 35 . The guide pin  490  rotatably couples to the second end of the guide arm  410 . The implant holder  460  couples to a bone plate  500 . 
     As shown in  FIGS. 23-32 , the guide arm  410  includes a body  412  connecting a first end  414  and a second end  416  of the guide arm  410 . The first end  414  may, for example, include a wider portion  420  that includes arcuate sides that may attach the wider portion  420  in a generally perpendicular direction relative to the body  412 . The wider portion  420  may also include a through hole  422  that is sized and shaped to receive the target member  430 . The through hole  422  may be, for example, larger or smaller than as shown in  FIGS. 23-32 . The through hole  422  may extend through the wider portion  420  parallel to the body  412  allowing the target member  430  to extend parallel to the body  412  of the guide arm  410 . The second end  416  may, for example, include an angled portion  418 . The angled portion  418  extends in a downward angled direction from the body  412  to the second end  416 . A housing element  424  may be positioned at the second end  416  and be configured or sized and shaped to receive the guide pin  490 . The housing element  424  may include a top opening  426  and a bottom opening  428  forming an inner surface or cavity extending between the top opening  426  and the bottom opening  428 . The housing element  424  may also include a channel extending from an exterior surface of the housing element  424  into the inner surface. The inner surface may be, for example, configured or sized and shaped to allow the guide pin  490  to pivot, rotate, or move in multiple planes. The top opening  426  may be sized to allow for insertion of a sphere  494  of the guide pin  490  into the housing element  424 . The bottom opening  428  may be, for example, slightly smaller than the top opening  426  to capture or retain the guide pin  490  within the inner cavity of the housing element  424 . 
     The target member  430  is shown in  FIGS. 29-32  and includes a target pin  432 , a protector member  434 , a drill guide  440 , and a threaded member or implant  450 . The target pin  432  may be, for example, a guide wire, k-wire, pin, or the like elongated pin like structure or member for insertion through a joint. In the depicted embodiment the target pin  432  has a smooth outer surface with a point or sharped portion at one end. 
     The target pin  432  may be, for example, inserted from a distal to proximal direction through the cannulated opening of the protector member or guide wire targeting guide  434  when inserted into a bone pathway to secure the targeting guide in the surgical site and allow for the establishment of a target location proximally. The protector member  434  may include a knob  436  at a first end of a cylindrical portion  438 . The protector member  434  may also include a through hole or cannulated opening extending through the protector member  434  along a longitudinal axis of the protector member  434 . The protector member  434  may, for example, protect the surrounding soft tissue when the target pin  432  is inserted through the protector member  434  and into a patient&#39;s bones. The drill guide  440  may include a cylindrical portion  442  and a knob  444  positioned at a first end of the cylindrical portion  442 . The cylindrical portion  442  of the drill guide  440  may have, for example, a larger diameter than the cylindrical portion  438  of the protector member  434 . The drill guide  440  may also include a through hole or cannulated opening  446  extending along a longitudinal axis of the drill guide  440 . The cannulated opening  446  of the drill guide  440  may be, for example, sized to receive the protector member  434 . The drill guide  440  may, for example, protect the surrounding soft tissue when a drill is inserted through the cannulated opening  446  to drill an opening for inserting the threaded member  450 . In one embodiment, the drill guide  440  may be inserted into the through hole  422  of the guide arm  410 , the protector member  434  may be inserted into the cannulated opening  446 , and the target pin  432  may be inserted through the protector member  434 . In an alternative embodiment, the protector member  434  may be inserted into the through hole  422  of the guide arm  410 , the target pin  432  may be inserted through the protector member  434 , and then, the protector member  434  may be removed and the drill guide  440  inserted into the through hole  422  of the guide arm  410  over the target pin  432 . The threaded member or implant  450  may include a head portion  452  at a first end of the threaded member  450  and cutting flutes  454  at a second end of the threaded member  450 . The cutting flutes  454  may facilitate the insertion of the threaded member  450  into bones. In addition, the threaded member  450  may include a through hole or cannulated opening  456  extending through the threaded member  450  along a longitudinal axis. The through hole  456  may be configured or sized and shaped to receive the target pin  432 . Alternatively, the threaded member  450  may be, for example, solid without a longitudinal opening. As shown, the threaded member  450  is threaded along the entire length, however, it is also contemplated that the threaded member  450  may be threaded along only a portion, for example, having partially or segmentally divided threads along the length. 
     The implant holder  460  may include a housing  462 , a knob  474  and a locking member  480 . The housing  462  may include an attachment arm  464  extending from and parallel to the housing  462  to form, for example, a U-shaped or hook like structure. The attachment arm  464  hooks under the bottom of the body  412  of the guide arm  410  to permit the sliding movement along the longitudinal axis of the body  412 . A channel  466  is formed between the attachment arm  464  and the housing  462 . The attachment arm  464  may also include at least one hole  468  extending through the attachment arm  464  from an exterior surface into the channel  466 . The at least one hole  468  may be, for example, three holes. The implant holder  460  may also include an alignment post  470  extending away from a bottom surface of housing  462 . The implant holder  460  may further include a through hole  472  extending through the housing  462  from a top surface to a bottom surface adjacent to the alignment post  470 . The knob  474  may include an engagement protrusion  476  extending away from a back surface of the knob  474 . The engagement protrusion  476  may be, for example, threaded to engage the at least one hole  468  to secure the implant holder  460  to the body  412  of the guide arm  410  at the desired position. The locking member  480  may include a shaft  482  with a knob  484  at a first end and a threaded portion  486  at a second end. The shaft  482  may be inserted through the through hole  472  of the housing  462  until the knob  484  contacts a top surface of the housing  462  and the threaded portion  486  extends past the bottom surface of the housing  462 . The threaded portion  486  may engage a bone plate, such as bone plate  500 , as described in greater detail below. The knob  474  may be rotated to insert the threaded portion  486  into the bone plate  500  and to remove the threaded portion  486  from the bone plate  500 . 
     As shown in  FIGS. 23-32 , the guide pin  490  includes a shaft  492 , a sphere  494 , a tip  496 , and a cylindrical protrusion  498 . The sphere or spherical member  494  may be positioned between a first end and the tip  496 . The tip  496  is threaded, however, it is also contemplated that the tip  496  may also have a smooth outer surface to facilitate insertion. The tip  496  is configured or sized and shaped to allow for the user to insert the guide pin  490  into a target bone either directly or through the skin. Once inserted into the target bone, the guide pin  490  may be secured to establish the target location for the threaded member  450 . The sphere  494  is sized and shaped or configured to be inserted into the housing element  424  to allow for a full range of pivoting motions, as shown in  FIGS. 23-28 and 33-35 . The cylindrical protrusion  498  may be positioned adjacent to the sphere  494  between the sphere  494  and the tip  496 . 
     The targeting guide assembly  400  may be assembled by inserting the guide pin  490  into the housing element  424  of the guide arm  410 . The protector member  434  may be inserted into the through hole  422  of the guide arm  410  to receive the target pin  432 . In addition, the implant holder  460  may be aligned with the body  412  of the guide arm  410  and be secured in the desired position by engaging the engagement protrusion  476  with the body  412 . The locking member  480  may be inserted into the opening  472  of the housing  462 . Then, the alignment post  470  may be aligned with a corresponding alignment opening  518  in the bone plate  500 , as shown in  FIGS. 38, 40 and 41 , and the threaded portion  486  of the locking member  480  may engage a corresponding screw hole  510  positioned adjacent to the alignment opening  518  in the bone plate  500 . In addition, the protector member  434  may be removed and the drill guide  440  may be inserted into the through hole  422  of the guide arm  410  over the target pin  432 . 
     As shown in  FIGS. 38-43 , the bone plate  500  may further include a body  502  with a first end  504  and a second end  506 . The plate  500  may also include a plurality of lobes  508  positioned along the length of the plate  500 . Each of the lobes  508  may include, for example, a screw hole or opening  510  for receiving a bone fastener, such as bone fasteners  540 , as shown in  FIGS. 34-37 . The plate  500  may also include a groove  512  extending, for example, perpendicular to the longitudinal axis of the plate  500 , as shown in  FIGS. 38, 40, 42, and 43 . The groove  512  may be positioned, for example, between two lobes  508  and two screw holes  510  on each side of the plate  500 . The plate  500  may further include a first opening  514  and a second opening  516  positioned along the longitudinal axis of the plate  500 . The openings  514 ,  516  may be, for example, sized and shaped to allow for visualization of the bones. The body  5020  may also include an alignment hole  518  for receiving the alignment post  470  of the implant holder  260 . The alignment hole  518  may be, for example, positioned generally centered on the body  502  and between the first end  504  and the first opening  514 . It is also contemplated that the alignment hole  518  may be, for example, positioned at alternative locations along the longitudinal axis of the plate  500  that allow for adequate visualization to perform the surgical procedure. In addition, the plate  500  may include a first pair of channels or slots  520  and a second pair of channels or slots  526 . The first pair of channels  520  may include a first channel or slot  522  and a second channel or slot  524  positioned spaced apart from and adjacent to the first channel  522 . The first pair of channels  520  may be, for example, positioned between the first opening  514  and the second opening  516 . The second pair of channels  526  may include a third channel or slot  528  and a fourth channel or slot  530  positioned spaced apart from and adjacent to the third channel  528 . The second pair of channels  526  may be, for example, positioned between the second opening  516  and the second end  506  of the plate  500 . The channels or slots  522 ,  524 ,  528 ,  530  may, for example, allow for temporary fixation and compression of the bones being coupled to the plate  500 . As shown in  FIG. 39 , the body  502  may be curved to match the curvature of the bones. 
     Referring now to  FIGS. 33-37 , a method for using the targeting guide assembly  400  to correct bone deformities is shown. The method may include, for example, performing an arthrodesis across at least one joint. The at least two bones of the at least one joint may be positioned in a desired final position and may be temporarily fixed. As shown in  FIG. 33 , the method may also include inserting a guide pin  490  into a first bone  550  to set the trajectory for the target pin  432  and the threaded member  450 . Next, the housing element  424  of the guide arm  410  may be coupled to the sphere  494  of the guide pin  490 . The guide arm  410  may be rotated about the sphere  494  to position the first end  414  of the guide arm  410  with respect to a second bone  552 . Next, the protector member  434  may be inserted into the through hole  422  and a target pin  432  may be inserted through the protector member  434  and into at least one bone  552 ,  554 ,  556 ,  550 . Alternatively, the drill guide  440  may be inserted into the through hole  422 , the protector member  434  may be inserted into the cannulated opening  446  of the drill guide  400 , and then the target pin  432  may be inserted through the protector member  434  and into at least one bone  552 ,  554 ,  556 ,  550 . The trajectory of the target pin  432  will overlap or engage the guide pin  490 . In one embodiment, the implant holder  460  may be coupled to the guide arm  410  before the guide arm  410  is coupled to the guide pin  490 . Alternatively, the implant holder  460  may be coupled to the guide arm  410  after the target pin  432  is inserted into the bones  552 ,  554 ,  556 ,  550 . The bone plate  500  may then be coupled to the implant holder  460  and aligned on the bones  552 ,  554 ,  556 ,  550 , as shown in  FIG. 34 . It is also contemplated that the bone plate  500  may be coupled to the implant holder  460  prior to the guide arm  410  being coupled to the guide pin  490 . Once the bone plate  500  is coupled to the implant holder  460 , the position of the implant  500  may be adjusted along the length of the guide arm  410  to allow for implant positioning in a first plane, for example, the sagittal plane. The guide arm  410  may alternatively or in addition to adjustment along the length be rotated around the guide pin  490  to rotate the bone plate  500  in a second plane, for example, the frontal plane. Movement of the bone plate  500  in the two planes allows for fixation devices or bone screws  540  to be inserted with a trajectory to avoid contacting the target pin  432  and/or threaded member  450 . The bone plate  500  may be secured to the bones  552 ,  554 ,  556 ,  550  with bone fasteners  540  inserted to avoid contacting the target pin  432  and the threaded member  450  when inserted. The bone fasteners or fixation devices  540  may be, for example, locking or non-locking fasteners. The method may then include removing the protector member  434  by sliding the protector member  434  out of the through hole  422  of the guide arm  410  over the target pin  432 . As shown in  FIG. 35 , the drill guide  440  may then be inserted through the through hole  422  over the target pin  432  and positioned onto a bone  552 . A cannulated drill may be used to drill over the target pin  432 . The cannulated drill and drill guide  440  may then be removed from the guide arm  410  and the threaded member  450  may be inserted over the target pin  432  and into the bones  552 ,  554 ,  556 ,  550 , as shown in  FIG. 36 . Although not shown, it is also contemplated that the bone plate  500  may be coupled to the bones  552 ,  554 ,  556 ,  550  after the threaded member  450  is inserted into the bones  552 ,  554 ,  556 ,  550 . As also shown in  FIG. 36 , the guide arm  410  and guide pin  490  may be removed from the bones  552 ,  554 ,  556 ,  550 . Finally, as shown in  FIG. 37 , the target pin  432  may be removed from the bones  552 ,  554 ,  556 ,  550  and the threaded member  450 . 
     As may be recognized by those of ordinary skill in the art based on the teachings herein, numerous changes and modifications may be made to the above-described and other embodiments of the present disclosure without departing from the scope of the disclosure. The components of the instruments, guides, implants, plates, and/or systems as disclosed in the specification, including the accompanying abstract and drawings, may be replaced by alternative component(s) or feature(s), such as those disclosed in another embodiment, which serve the same, equivalent or similar purpose as known by those skilled in the art to achieve the same, equivalent or similar results by such alternative component(s) or feature(s) to provide a similar function for the intended purpose. In addition, the instruments, guides, implants, plates, and/or systems may include more or fewer components or features than the embodiments as described and illustrated herein. For example, the components and features of  FIGS. 1-10  and  FIGS. 23-32  may be used interchangeably and in alternative combinations as would be modified or altered by one of skill in the art. In addition, the components and features of  FIGS. 11-16 ,  FIGS. 17-18 , and  FIGS. 38-43  may be used interchangeably and in alternative combinations as would be modified or altered by one of skill in the art. Further, the steps of the surgical methods associated with  FIGS. 19-20 ,  FIGS. 21-22 , and  FIGS. 33-37  may be used interchangeably and in alternative combinations as would be modified or altered by one of skill in the art. Accordingly, this detailed description of the currently-described embodiments is to be taken in an illustrative, as opposed to limiting of the disclosure. 
     The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the disclosure. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has”, and “having”), “include” (and any form of include, such as “includes” and “including”), and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a method or device that “comprises,” “has,” “includes,” or “contains” one or more steps or elements possesses those one or more steps or elements, but is not limited to possessing only those one or more steps or elements. Likewise, a step of a method or an element of a device that “comprises,” “has,” “includes,” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features. Furthermore, a device or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways that are not listed. 
     The invention has been described with reference to the preferred embodiments. It will be understood that the architectural and operational embodiments described herein are exemplary of a plurality of possible arrangements to provide the same general features, characteristics, and general system operation. Modifications and alterations will occur to others upon a reading and understanding of the preceding detailed description. It is intended that the disclosure be construed as including all such modifications and alterations.