Patent Publication Number: US-2021177478-A1

Title: Wire tensioner tip

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application claims benefit to U.S. Provisional Application Ser. No. 62/576,872, filed Oct. 25, 2017, entitled “WIRE TENSIONER TIP,” and which is incorporated by reference herein in its entirety. 
    
    
     BACKGROUND 
     For most standard arthrodesis (i.e., circular frame) procedures, a prebuilt frame including two tibial rings and a foot plate with an extension can be utilized. A circular fixator system can be used for open or closed fracture fixation, pseudoarthrosis or nonunions of long bones, limb lengthening by epiphyseal or metaphyseal distraction, correction of bony or soft tissue deformities, or correction of segmental or nonsegmental bony or soft tissue defects. Circular Fixators have been used on long bones including: the tibia, fibula, femur, humerus, radius, and ulna. 
     Prior to insertion of wires or pins, the circular fixator is positioned around the tibia and foot. The leg is eccentrically located in the frame to accommodate the posterior musculature, and the plantar aspect of the foot extends above or below the foot plate. To maintain the tibia and foot in position, folded up towels can be placed under the calf. The surgeon inserts wires through the bones, and secures the wires to the frame. Current systems use bolts that are inserted into holes in the rings and foot plate of the frame. 
     SUMMARY 
     In various embodiments, a wire tensioner tip is disclosed. The wire tensioner tip includes a body having a first extension and a second extension spaced apart to define a ring slot, an engagement body disposed within the ring receiving slot, and a coupling element extending from the body and configured to couple the body to a wire tensioner. The engagement body includes one or more projections configured to engage an outer surface of a ring positioned within the ring receiving slot. 
     In various embodiments, a wire tensioner is disclosed. The wire tensioner includes a tensioning body comprising a handle portion and a tensioner and a tensioner tip coupled to the tensioning body. The handle portion includes a first handle and a second handle configured to actuate the tensioner. The tensioner is configured to apply a force to a wire inserted into the tensioner. The tensioner tip includes a tip body having a first extension and a second extension spaced apart to define a ring slot and an engagement body disposed within the ring receiving slot. The engagement body includes one or more projections configured to engage an outer surface of a ring positioned within the ring receiving slot. 
     In various embodiments, a system is disclosed. The system includes a circular fixator comprising at least one ring defining a slot, a wire fixation element sized and configured to be positioned within the slot of the circular fixator, and a wire tensioner. The wire tensioner includes a tensioning body comprising a handle portion and a tensioner and a tensioner tip coupled to the tensioning body. The handle portion includes a first handle and a second handle configured to actuate the tensioner. The tensioner is configured to apply a force to a wire inserted into the tensioner. The tensioner tip includes a tip body having a first extension and a second extension spaced apart to define a ring slot sized and configured to receive the at least one ring and an engagement body disposed within the ring receiving slot. The engagement body includes one or more projections configured to engage an outer surface of the at least one ring when the at least one ring is positioned within the ring slot. 
     In various embodiments, a method is disclosed. The method includes coupling a wire to a first fastener and a second fastener. The wire extends through at least a first bone. Each of the first fastener and the second fastener are coupled to a ring of a circular fixator. The first fastener is tightened to lock a first end of the wire in a fixed position and a wire tensioner is coupled to a second end of the wire. The wire tensioner includes a tensioning body including a tensioner defining a channel sized and configured to receive the wire therethrough and a tensioner tip coupled to the tensioning body. The tensioner tip includes a tip body having a first extension and a second extension spaced apart to define a ring slot sized and configured to receive the ring therein and an engagement body disposed within the ring receiving slot. The engagement body includes one or more projections configured to engage an outer surface of the ring when the ring is positioned within the ring slot. The wire is tensioned by the tensioner which is configured to apply a tensioning force to the wire. The second fastener is tightened to lock the second end of the wire in a fixed position. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
       The features and advantages of the present invention will be more fully disclosed in, or rendered obvious by the following detailed description of the preferred embodiments, which are to be considered together with the accompanying drawings wherein like numbers refer to like parts and further wherein: 
         FIG. 1A  is an isometric view of a circular fixator, in accordance with some embodiments. 
         FIG. 1B  illustrates a patient&#39;s leg fixed within the circular fixator of  FIG. 1A , in accordance with some embodiments. 
         FIG. 2  is a plan view of the circular fixator of  FIG. 1A , in accordance with some embodiments. 
         FIG. 3  is a posterior side elevation view of the circular fixator of  FIG. 1A , in accordance with some embodiments. 
         FIG. 4  is an isometric view of a fixation element configured to be coupled to the circular fixator of  FIG. 1A , in accordance with some embodiments. 
         FIG. 5  is a side elevation view of the fixation element of  FIG. 4 , in accordance with some embodiments. 
         FIG. 6  is an isometric view of a wire tensioner coupled to a wire extending from a first a fixation element to a second fixation element, in accordance with some embodiments. 
         FIG. 7A  is a plan view of a wire tensioner tip configured to be coupled to the wire tensioner of  FIG. 6 , in accordance with some embodiments. 
         FIG. 7B  is a posterior view of the wire tensioner tip of  FIG. 7A , in accordance with some embodiments. 
         FIG. 7C  is a side elevation view of the wire tensioner tip of  FIG. 7A , in accordance with some embodiments. 
         FIG. 7D  is a front isometric view of the wire tensioner tip of  FIG. 7A , in accordance with some embodiments. 
         FIG. 7E  is a front elevation view of the wire tensioner tip of  FIG. 7A , in accordance with some embodiments. 
         FIG. 7F  is a cross-section of the wire tensioner tip taken along line F-F in  FIG. 7E , in accordance with some embodiments. 
         FIG. 7G  is an enlarged view of area ‘A’ illustrated in  FIG. 7F , in accordance with some embodiments. 
         FIG. 8  is an isometric view of the wire tensioner tip of  FIG. 7A  coupled to a ring of a circular fixator in a straight engagement, in accordance with some embodiments. 
         FIG. 9  is a side elevation view of the wire tensioner tip and ring of  FIG. 8 , in accordance with some embodiments. 
         FIG. 10A  is a cross-section of the wire tensioner tip and ring taken along line  10 - 10  in  FIG. 9 , in accordance with some embodiments. 
         FIG. 10B  is an expanded view of the area B of  FIG. 10A , in accordance with some embodiments. 
         FIG. 11  is a plan view of the wire tensioner tip of  FIG. 7A  coupled to a ring of a circular fixator in an angled engagement, in accordance with some embodiments. 
         FIG. 12  is a side elevation view of the wire tensioner tip and ring of  FIG. 11 , in accordance with some embodiments. 
         FIG. 13A  is a cross-section of the wire tensioner tip and ring taken along line  13 - 13  in  FIG. 12 , in accordance with some embodiments. 
         FIG. 13B  is an expanded view of the area B of  FIG. 13A , in accordance with some embodiments. 
         FIG. 14A  is a plan view of a wire tensioner tip configured to be coupled to the wire tensioner of  FIG. 6 , in accordance with some embodiments. 
         FIG. 14B  is a posterior view of the wire tensioner tip of  FIG. 14A , in accordance with some embodiments. 
         FIG. 14C  is a side elevation view of the wire tensioner tip of  FIG. 14A , in accordance with some embodiments. 
         FIG. 14D  is a bottom plan view of the wire tensioner tip of  FIG. 14A , in accordance with some embodiments. 
         FIG. 14E  is a front isometric view of the wire tensioner tip of  FIG. 14A , in accordance with some embodiments. 
         FIG. 14F  is a cross-section of the wire tensioner tip taken along line F-F in  FIG. 14C , in accordance with some embodiments. 
         FIG. 14G  is a cross-section of the wire tensioner tip taken along line G-G in  FIG. 14B , in accordance with some embodiments. 
         FIG. 15  is a side elevation view of the wire tensioner tip of  FIG. 14A  coupled to a ring of a circular fixator in a straight engagement, in accordance with some embodiments. 
         FIG. 16A  is a cross-section of the wire tensioner tip and ring taken along line  16 - 16  in  FIG. 15 , in accordance with some embodiments. 
         FIG. 16B  is an expanded view of area B of  FIG. 16A , in accordance with some embodiments. 
         FIG. 17  is a side elevation view of the wire tensioner tip of  FIG. 14A  coupled to a ring of a circular fixator in an angled engagement, in accordance with some embodiments. 
         FIG. 18A  is a cross-section of the wire tensioner tip and the ring taken along line  18 - 18  in  FIG. 17 , in accordance with some embodiments. 
         FIG. 18B  is an expanded view of area B of  FIG. 18A , in accordance with some embodiments. 
         FIG. 19A  is a plan view of a wire tensioner tip configured to be coupled to the wire tensioner of  FIG. 6 , in accordance with some embodiments. 
         FIG. 19B  is a posterior view of the wire tensioner tip of  FIG. 19A , in accordance with some embodiments. 
         FIG. 19C  is a side elevation view of the wire tensioner tip of  FIG. 19A , in accordance with some embodiments. 
         FIG. 19D  is a cross-section of the wire tensioner tip taken along line D-D in  FIG. 19C , in accordance with some embodiments. 
         FIG. 19E  is a cross-section of the wire tensioner tip taken along line E-E in  FIG. 19B , in accordance with some embodiments. 
         FIG. 20  is a side elevation view of the wire tensioner tip of  FIG. 19A  coupled to a ring of a circular fixator in a straight engagement, in accordance with some embodiments. 
         FIG. 21A  is a cross-section of the wire tensioner tip and the ring taken along line  21 - 21  of  FIG. 20 , in accordance with some embodiments. 
         FIG. 21B  is an expanded view of area B of  FIG. 21A , in accordance with some embodiments. 
         FIG. 22  is a side elevation view of the wire tensioner tip of  FIG. 19A  coupled to a ring of a circular fixator in an angled engagement, in accordance with some embodiments. 
         FIG. 23A  is a cross-section of the wire tensioner tip and the ring taken along line  23 - 23  in  FIG. 22 , in accordance with some embodiments. 
         FIG. 23B  is an expanded view of area B of  FIG. 23A , in accordance with some embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     This description of the exemplary embodiments is intended to be read in connection with the accompanying drawings, which are to be considered part of the entire written description. In the description, relative terms such as “lower,” “upper,” “horizontal,” “vertical,”, “above,” “below,” “up,” “down,” “top,” “bottom,” “proximal,” “distal,” “superior,” “inferior,” “medial,” and “lateral” as well as derivative thereof (e.g., “horizontally,” “downwardly,” “upwardly,” etc.) should be construed to refer to the orientation as then described or as shown in the drawing under discussion. These relative terms are for convenience of description and do not require that the apparatus be constructed or operated in a particular orientation. Terms concerning attachments, coupling and the like, such as “connected,” refer to a relationship wherein structures are secured or attached to one another either directly or indirectly through intervening structures, as well as both movable or rigid attachments or relationships, unless expressly described otherwise. Like elements have been given like numerical designations to facilitate an understanding of the present subject matter. 
     As used herein, the term “substantially” denotes elements having a recited relationship (e.g., parallel, perpendicular, aligned, etc.) within acceptable manufacturing tolerances. For example, as used herein, the term “substantially parallel” is used to denote elements that are parallel or that vary from a parallel arrangement within an acceptable margin of error, such as +/−5°, although it will be recognized that greater and/or lesser deviations can exist based on manufacturing processes and/or other manufacturing requirements. 
     In various embodiments, a wire tensioner including a wire tensioner tip is disclosed. The wire tensioner is configured to apply tension to a wire coupled to a circular fixator. The wire is inserted through the wire tensioner tip and the wire tensioner. The wire tensioner tip can include an engagement body configured to abut an outer surface of a ring of a circular fixator to maintain the wire tensioner in a fixed position during tensioning. The wire tensioner tip can include a pivoting and/or a fixed engagement body. The wire tensioner tip can include one or more projections configured to engage an outer surface of the ring and prevent movement, such as sliding and angulation, of the wire tensioner during tensioning. 
       FIG. 1A  is an isometric view of a circular fixator  100  according to some embodiments of this disclosure.  FIG. 1B  shows the circulator fixator  100  with the patient&#39;s foot fixed by wires  412 , following the procedures.  FIGS. 2 and 3  show plan and side elevation views of the circular fixator  100 . 
     The circular fixator  100  is a device comprising a plurality of rings  102 ,  130  and  142 . In some embodiments, one ring  102  of the plurality of rings is elongated. The elongated ring  102  has a proximal portion  102   a  and a distal portion  102   b . The elongated ring  102  is configured so that the distal portion  102   b  can be rigidly attached to the first portion  102   a  in a first position parallel to or coplanar with the proximal portion  102   a . As shown in phantom in  FIG. 3  the distal portion  102   b  can be rigidly attached to the first portion  102   a  in a second position having a non-zero angle with respect to the proximal portion. In some embodiments, the non-zero angle is 90 degrees. 
     In some embodiments, the plurality of rings include first and second circular rings  142 ,  130  adapted to be positioned around a leg of a patient during fixation, and the first ring  142  is greater in diameter than the second ring  130  and  102 . This configuration permits the surgeon to maintain a constant distance. As a general rule of thumb, the clearance between the inner diameter of each ring and the nearest leg tissue is about two fingers&#39; breadth (e.g., about 3.7 cm to about 4 cm), at different heights along the patient&#39;s leg. Similarly, if the fixator is adapted for use on another extremity, a similar clearance between the inner diameter of each ring and the nearest tissue is used. Because the patient&#39;s calf is greater in diameter further from the ankle, the top ring  142  is correspondingly greater in inner diameter than the middle ring  130 . Because the ring  130  is smaller, it reduces the moment arm for pins or wires. For example, in one embodiment, the top ring  142  has an inner diameter of about 18 cm, and the middle ring  130  has an inner diameter of about 16 cm. This is just one example, and any combination of ring sizes can be used to accommodate the geometry of any given patient&#39;s calf. 
     Each ring  102 ,  130  and  142  has a first (e.g., top) face, a second (e.g., bottom) face, and at least one slot. For example, ring  102  has slots  104 ,  110 ,  116 ,  122 ; ring  130  has four slots, including slots  132 ,  138 ; and ring  142  has slots  144 ,  150 ,  154 , and  160 . Each slot is defined by first and second interior edges of its respective ring  102 ,  130  and  142  on opposing sides of the slot. Each slot (e.g.,  104 ) penetrates from the first face of the ring (e.g.,  102 ) to the second face. The first (e.g., top) face of each ring (e.g.,  102 ) has a first scallop-shaped recess (e.g.,  106   a ) adjacent the slot  104  on the first edge and a second scallop-shaped recess (e.g.,  106   b ) adjacent the slot  104  on the second edge. The slot  104  terminates at an opening  108   a ,  108   b  at each respective end of the slot. The openings  108   a ,  108   b  have a dimension that is substantially greater than a width of the slot  106 . Similarly, in the example of  FIG. 1 , slot  110  has scallop-shaped recesses  112   a ,  112   b  and end openings  114   a ,  114   b ; slot  116  has recesses  118   a ,  118   b  and end openings  120   a ,  120   b ; slot  122  has recesses  124   a ,  124   b  and end openings  126   a ,  126   b ; slot  132  has recesses  134   a ,  134   b  and end openings  136   a ,  136   b ; slot  138  has recesses  140   a ,  140   b  and end openings  141   a ,  141   b ; slot  144  has recesses  146   a ,  146   b  and end openings  148   a ,  148   b ; slot  150  has recesses  151   a ,  151   b  and end openings  152   a ,  152   b ; and slot  160  has recesses  162   a ,  162   b  and end openings  164   a ,  164   b.    
     In other embodiments, instead of a scallop-shaped recess  134   a ,  134   b ,  146   a ,  146   b , one or more of the rings include recess pockets. In some embodiments the circular fixator includes at least one ring  102  having scallop shaped recesses  106   a ,  106   b ,  112   a ,  112   b ,  118 a,  118   b , and at least one ring having recess pockets. The rings without the scallops may permit the fixation device  300  to move toward the wire more quickly without any chance of becoming caught in a scallop. Additionally, the recesses without scallops allow the surgeon to fix the fixation device  300  anywhere along the length of the slots, and the surgeon is not limited to any discrete set of fixed locations. If a wire is run perpendicular to the slots, there is little chance that the fixation device  300  can slip in the slot. If the wires are to be run perpendicular or nearly perpendicular to the slots, the surgeon may prefer that the rings without scallops are used for ease of use. On the other hand, the greater the angle between the wires and the slots, the greater the benefit of the scallops, for preventing slippage. 
     The device further includes a plurality of posts  270  joining each one of the plurality of rings  130 ,  142  to an adjacent one of the plurality of rings. In some embodiments, the center ring  130  is connected to the top ring  142  by fixed posts  270 , and the center ring  130  is connected to the bottom ring  102  by a plurality of calibrated struts  260 . The calibrated struts permit accurate and even adjustments to the distance between the bottom ring  102  and the center ring  130  (e.g., for compression/distraction of the foot or height adjustments to the desired height). In some embodiments, all of the posts  270  are of the same fixed type. In some embodiments, as shown in  FIG. 1A , one or more of the posts  270  can be replaced by suitably configured plates  271 , threaded rods, spacers, or struts. For example, the plates  271  can each have a respective vertical slot  272 . Each slot  272  has openings  273  at the top and bottom of the slot. The slots  272  can have the same width as the slots  112   a ,  112   b , and the openings  273  can have the same size as the openings  114   a ,  114   b . The slots  272  of the plates  271  can receive fixations elements  330 , and the openings  273  can receive plugs  170 , for pre-loading the fixation elements  330 , in the manner described below. In other embodiments, any combination of posts  270 , plates  271 , rods, spacers and/or struts can be used. 
     In some embodiments, each scallop-shaped recess (e.g.,  112   a ,  112   b ) comprises a plurality of curved arcs, and each curved arc subtends an angle in a range from about 10 degrees to 170 degrees. In some embodiments, the subtended angle is in a range from 30 degrees to 150 degrees. In some embodiments, the subtended angle is in a range from 30 degrees to 150 degrees. In some embodiments, the subtended angle is in a range from 60 degrees to about 120 degrees. In some embodiments, each scallop-shaped recess comprises a plurality of circular arcs, each circular arc subtending an angle of about 90 degrees. The arcs subtend an angle that is sufficiently large to resist slipping of any fixation device relative to the slot, particularly if any force component is applied to the fixation device  330  parallel to the direction of the slot (e.g.,  110 ). In some embodiments, the rings  102 ,  130 ,  142  comprise a metal, such as aluminum or titanium. 
     As shown in  FIGS. 4-5 , in some embodiments, at least one of the fixation devices  300  comprises a bolt  330 , a nut  334  and a washer  340 . The bolt  330  has head  332  and a threaded portion  331  sized to fit through the slot (e.g.,  112   a ,  112   b ). The bolt  330  includes a side slot  348  in a side surface of the threaded portion  331 , for receiving a wire  412 . The washer  340  is shaped to fit a respective one of the curved arcs on the scallop-shaped recess  114   a ,  114   b  on each side of the slot  110  of the ring  102 . In some embodiments, the washer  340  has a textured gripping surface  346  for securely positioning the wire. The washer  340  has two curved edges  343  adapted for fitting the curved arcs of the scallop shaped recesses. The remaining two edges of the washer can be flat. The gripping surface can have ridges, barbs, splines, slots, a knurled surface, or the like. In some embodiments, the opening (e.g.,  114   a ,  114   b ) at each end of each slot (e.g.,  112   a ,  112   b ) is adapted to receive a nut  334  of a fixation device  330  through the opening. In some embodiments, the slot (e.g.,  112   a ,  112   b ) is adapted to receive a threaded portion  331  of the fixation device  330  through the slot, but the slot has a width that is smaller than a dimension of the nut  334 . Thus, once the nut  334  is affixed to the threaded portion  331 , the fixation device  330  can be inserted into the openings (e.g.,  114   a ,  114   b ) but cannot fall out of the slots. The fixation devices can be pre-assembled, and the pre-assembled fixation devices can pre-loaded onto the slots prior to surgery. The openings (e.g.,  114   a ,  114   b ) can be then be plugged to prevent release of the fixation devices  330 . 
     Some embodiments further comprise at least one post having a threaded body portion adapted to fit through the slot (e.g.,  110 ) of the ring  102 . The post has a longitudinal slot through the post (and parallel to the longitudinal axis of the post) for receiving a bolt of the fixation device  300 . In some embodiments, the surgeon can also insert rods into the bone using the circulator fixator  100 . A pin cube  351  can be mounted in the slot (e.g.,  154 ) for fixing the pin (also referred to as a rod). International Application Publication WO2015/167581, entitled “CIRCULAR FIXATOR SYSTEM AND METHOD,” published on Nov. 5, 2015, is incorporated herein by reference in its entirety. 
     After coupling a wire  412  to one or more fixation devices  300 , the wire  412  can be tensioned to position one or more bones. As shown in  FIG. 6 , a wire tensioner  400  can be coupled to a wire  412  extending from a first fixation device  330   a  and/or a second fixation device  330   b . The wire  412  extends through a side slot  348  of the fixation device  330   a ,  330   b  and can be loosely and/or firmly held by a washer  340 . The wire  412  is inserted through an opening (see  FIG. 7B ) in a wire tensioner tip  402 . In some embodiments, an actuation mechanism  406  of the wire tensioner  400  defines a wire slot  410  extending from a first end  408   a  to a second end  408   b . The wire  412  extends at least partially into the wire slot  410 . 
     A handle portion  404  includes a first handle  404   a  and a second handle  404   b  that can be squeezed (or otherwise actuated) to apply tension to the wire  412  extending through the wire tensioner tip  402 . The handles  404   a ,  404   b  can be actuated to apply a predetermined amount of tension to the wire  412  corresponding to a selected movement and/or selected position of at least one bone. In some embodiments, the wire tensioner  400  can include an indicator  414  configured to provide a visual indication regarding the amount of tension applied to the wire  412 . The wire tensioner  400  can include a locking bar  416  to lock the wire tensioner  400  at a selected tension. 
     In use, the wire tensioner  400  applies tension to a wire  412  after the wire  412  is passed through the patient. The wire  412  is initially coupled to a first fixation device  330   a  and/or a second fixation device  330   b . One of the fixation devices, such as the second fixation device  330   b , is tightened to anchor (or fix) a first end of the wire  412 . The second fixation device, such as the first fixation device  330   a , is partially tightened to maintain the wire  412  within the side slot  348  while still allowing some movement of the wire  412  within the side slot  348 . The tensioner  400  is coupled to a second end of the wire  412  extending from the first fixation device  330   a . A selected tension is applied to the wire  412  by the tensioner  400  and the first fixation device  330   a  is further tightened to fix the wire  412  at the selected tension. The tensioner  400  can be released from the wire  412  after tightening the first and/or second fixation devices  330   a ,  330   b.    
     Although embodiments are illustrated and discussed herein including tensioning handles  404   a ,  404   b , it will be appreciated that any suitable wire tensioner configured to receive a wire tensioner tip  402  can be used and is within the scope of this disclosure. For example, in some embodiments, a wire tensioner may include a cylinder configured to be coupled to a wire tensioner tip  402  and rotated to apply tension to a wire  412  inserted through the wire tensioner tip  402 . In other embodiments, handles, rotatable cylinders, and/or any other suitable elements can be configured to apply tension to wire  412  inserted through a wire tensioning tip  402 . 
       FIGS. 7A-7G  illustrates a wire tensioner tip  402   a  configured to be coupled to a wire tensioner  400 , in accordance with some embodiments. The wire tensioner tip  402   a  includes a body  450  extending from a proximal (or rear) surface  452  to a distal (or front) surface  454 . The body  450  includes a first (or upper) extension  456   a  and a second (or lower) extension  456   b . The first and second extensions  456   a ,  456   b  are spaced apart by a ring slot  470 . In some embodiments, the first extension  456   a  includes a curved (or arced) outer surface  458   a  and a flat inner surface  458   b . The flat inner surface  458   b  is configured to abut a first surface of a ring, such as ring  142 . The second extension  456   b  includes a flat outer surface  460   a  and a spaced apart flat inner surface  460   b . The flat inner surface  460   b  is configured to abut a second surface of a ring, such as ring  142 . Although embodiments are discussed herein with respect to ring  142 , it will be appreciated that the wire tensioner tip  402   a  can be configured for use with any of the rings  102 ,  130 ,  142  and/or any other suitable ring of a circulator fixator  100 . 
     The ring slot  470  is sized and configured to receive a ring of the circular fixator  100  therein, such as ring  142 . The slot  470  can have a width equal to and/or greater than the thickness of the ring  142 . In some embodiments, the first and second extensions  456   a ,  456   b  each have a length related to the width of the ring  142 . For example, in some embodiments, the upper extension  456   a  has a length X 1  sufficient to extend from a first edge  180   a  of a ring  142   a  to a second edge  180   b  and the lower extension  456   b  has a length X 2  sufficient to extend from the first edge  180   a  of the ring  142   a  to a first side  182   a  of a slot  144  defined by the ring  142   a  (see  FIG. 8 ). Although specific embodiments are discussed herein, it will be appreciated that the upper extension  456   a  and/or the lower extension  456   b  can define any suitable lengths X 1 , X 2 . 
     In some embodiments, the upper extension  456   a  defines a visualization cutout  460  extending from the outer surface  458   a  to the inner surface  458   b . The visualization cutout  460  can be sized and configured to allow visualization of a fixation device  330 , as described in greater detail below. The visualization cutout  460  is positioned within the upper extension  456   a  such that at least a portion of the visualization cutout  460  overlaps a slot  144  defined in the ring  142   a  when the ring  142   a  is inserted into the ring slot  470 . 
     In some embodiments, a coupling extension  464  extends from the proximal surface  452  of the body  450 . The coupling extension  464  includes a centrally located circular boss  466 . The circular boss  466  and the body  402  define a continuous channel  468  extending therethrough substantially along a horizontal axis. The channel  468  is sized and configured to receive the wire  412  therethrough, as discussed in greater detail below. The coupling extension  464  is configured to couple the wire tensioner tip  402   a  to the wire tensioner  400 . Although embodiments are discussed herein including a wire tensioner tip  402   a  having a coupling extension  464 , it will be appreciated that the wire tensioner tip  402   a  can be coupled to the wire tensioner  400  using any suitable mechanism and/or can be formed integrally with the wire tensioner  400 . Although embodiments are discussed herein including a wire tensioning tip  402   a  having a coupling extension  464  configured to be coupled to the wire tensioner  400 , it will be appreciated that the coupling extension  464  can be positioned on and extend from the wire tensioner  400  and the wire tensioning tip  402   a  can include a cavity or other element configured to receive the coupling extension  464  therein. 
     In some embodiments, the wire tensioner tip  402   a  includes a pivoting engagement body  474  positioned between the first extension  456   a  and the second extension  456   b . The pivoting engagement body  474  is positioned at least partially within the ring slot  470  and is configured to abut an edge (or outer surface)  180   a  of a ring  142   a  when the ring  142   a  is positioned within the ring slot  470 . The pivoting engagement body  474  includes a body  476  defining a first hole  478  extending therethrough. The hole  478  is sized and configured to receive a pin  480  and/or other rotational coupling device therein. 
     A ring-facing surface  482  of the body  476  includes a plurality of projections  484  (e.g., teeth, diamond teeth, knurls, etc.) configured to abut an outer surface  180   a  of the ring  142   a . The pivoting engagement body  474  is configured to pivot about the pin  480  such that the ring-facing surface  482  (and by extension the plurality of projections  484 ) can be aligned at an angle with respect to a horizontal axis of the wire tensioner tip  402   a . For example, in some embodiments, the pivoting engagement body  474  can pivot a predetermined angle in one of a first and/or a second direction with respect to the horizontal axis of the wire tensioner tip  402 . Although embodiments are discussed herein including a plurality of projections  484 , it will be appreciated that similar performance may be provided by a textured and/or otherwise treated surface. 
       FIGS. 8-10B  illustrate the wire tensioner tip  402   a  coupled to a ring  142   a  of a circular fixator  100  in a straight engagement, in accordance with some embodiments. The ring  142   a  is positioned within the ring slot  470  between the first extension  456   a  and the second extension  456   b . An outer surface  180   a  of the ring  142   a  abuts a pivoting engagement body  474  (see  FIG. 9 ). The wire tensioner tip  402   a  provides stabilization and counter-force when tensioning a wire  412  during a surgical procedure. In some embodiments, the first extension  456   a  is configured to extend over a bolt  332  of a fixation device  330 . The first extension  456   a  can include a bolt cutout  484  extending from the inner surface  458   b  into the first extension  456   a . The bolt cutout  484  is sized and configured to receive a head of the bolt  332  therein. In some embodiments, the inner surface  458   b  of the first extensions  456   a  is positioned above the bolt  332  when the wire tensioner tip  402   a  is coupled to the ring  142   a.    
     The nut  334  of the fixation device  330  is configured to extend at least partially below the second extension  456   b  of the wire tensioner tip  402   a  such that the nut  334  can be tightened without removing the wire tensioner tip  402   a . In some embodiments, the second extension  456   b  defines a cutout  486  sized and configured to receive a nut  334  and a socket (not shown) therein. Although embodiments are shown with the wire tensioner tip  402   a  in a specific orientation, it will be appreciated that the wire tensioner tip  402   a  can be rotated 180° prior to being coupled to the ring  142   a  such that the second extension  456   b  is positioned above the ring  142   a  and the first extension  456   a  is positioned below the ring  142   a.    
     As shown in  FIG. 10A , the wire tensioner tip  402   a  is engaged with the ring  142   a  in a straight engagement such that the pivoting engagement body  474  is not-offset (i.e., is perpendicular with) a horizontal axis of the wire tensioner tip  402   a . In addition, the horizontal axis of the wire tensioner tip  402   a  is aligned with a radius R of the ring  142   a . As shown in  FIG. 10B , the ring-facing surface  482  of the pivoting engagement body  474  is engaged with the outer surface  180   a  of the ring  142   a . The plurality of teeth  484  create a frictional force with respect to the ring  142   a  and prevent movement (such as slippage, camming, etc.) of the wire tensioner  400  during tensioning of a wire  412 . 
       FIGS. 11-13B  illustrate the wire tensioner tip  402   a  coupled to a ring  142   a  of a circular fixator  100  in an angled engagement, in accordance with some embodiments. The pivoting engagement body  474  is offset (i.e., at a non-perpendicular angle) with respect to the horizontal axis of the wire tensioner tip  402   a . The horizontal axis of the wire tensioner tip  402   a  is also offset with respect to a radius of the ring  142   a . As shown in  FIG. 13B , the ring-facing surface  482   a  of the pivoting engagement body  474  is engaged with the outer surface  180   a  of the ring  142   a . The pivoting engagement body  474  is offset from the body  450  of the wire tensioner tip  402   a  but maintains alignment and engagement with the outer surface  180   a  of the ring  142   a . By maintaining alignment and engagement with the outer surface  180   a , the pivoting engagement body  474  prevents movement of the wire tensioner  400  when in an offset (or angled) engagement. 
       FIGS. 14A-14G  illustrate a wire tensioner tip  402   b  configured to be coupled to a wire tensioner  400 , in accordance with some embodiments. The wire tensioner tip  402   b  is similar to the wire tensioner tip  402   a  discussed above in conjunction with  FIGS. 7A-13B , and similar description is not repeated herein. The wire tensioner tip  402   b  includes a fixed engagement body  490  having a plurality of protrusions  494 ,  496   a ,  496   b  extending therefrom. The fixed engagement body  490  replaces the pivoting engagement body  474  of the wire tensioner tip  402   a . The fixed engagement body  490  includes a generally rectangular body  492  defining a threaded hole  478  extending therethrough. The threaded hole  478  is configured to receive a ball plunger configured to couple to an additional and/or alternative tensioner tip extender (not shown). 
     The fixed engagement body  490  includes a central protrusion  494  extending from the rectangular body  492 . The central protrusion  494  extends a predetermined distance into the ring slot  470 . The central protrusion  494  is sized and configured to be received within a notch  186  defined by a first edge  180   a  of a ring  142   b . The central protrusion  494  maintains the wire tensioner tip  402   b  when the wire tensioner tip  402  is engaged with the ring  142   b  in a straight engagement, as discussed in greater detail below. 
     In some embodiments, the fixed engagement body  490  includes a first side protrusion  496   a  and a second side protrusion  496   b  extending from the rectangular body  492 . The first side protrusion  496   a  and the second side protrusion  496   b  can be symmetrically disposed at either end of the rectangular body  492 . The first side protrusion  496   a  and the second side protrusion  496   b  extend a predetermined distance from rectangular body  492 . In some embodiments, the first side protrusion  496   a  and the second side protrusion  496   b  each extend a length equal to the length of the center protrusion  494 , although it will be appreciated that each of the center protrusion  494 , the first side protrusion  496   a , and/or the second side protrusion  496   b  can extend a greater and/or lesser length. The first side protrusion  496   a  and the second side protrusion  496   b  are sized and configured to be received within notches  186  defined by the first edge  180   a  of the ring  142   b , as discussed in greater detail below with respect to  FIG. 16B . In some embodiments, one or more of the protrusions  494 ,  496   a ,  496   b  can be omitted and/or additional protrusions can be added. 
       FIGS. 15-16B  illustrate the wire tensioner tip  402   b  coupled to a ring  142   b  in a straight engagement, in accordance with some embodiments. The ring  142   b  is at least partially inserted into the ring slot  470  the wire tensioner tip  402   b . A first edge  180   a  of the ring  142   b  abuts the fixed engagement body  490 . The outer edge  180   a  of the ring  142   b  defines a plurality of notches  186 . The protrusions  494 ,  496   a ,  496   b  extending from the fixed engagement body  490  are sized and configured to be received within one of the plurality of notches  186 . As shown in  FIG. 16B , in a straight engagement, the central protrusion  494  is positioned within a notch  186 . The central protrusion  494  and the notch  186  prevent movement (lateral movement, rotational movement, etc.) of the wire tensioner tip  402   b  during tensioning of a wire  412 . The outer side protrusions  496   a ,  496   b  are not engaged with the ring  142   b  due to the curvature of the ring  142 b. 
       FIGS. 17-18B  illustrate the wire tensioner tip  402   b  coupled to the ring  142   b  in an angled engagement, in accordance with some embodiments. The horizontal axis of the wire tensioner tip  402   b  is offset with respect to a radius of the ring  142   b . As shown in  FIG. 18B , a first side protrusion  496   a  is engaged with a notch  186  defined in the first surface  180   a  of the ring  142   b . The central protrusion  494  is also engaged with a notch  186 . The first side protrusion  496   a , the central protrusion  494 , and the notch  186  prevent movement (lateral movement, rotational movement, etc.) of the wire tensioner tip  402   b  during tensioning of a wire  412 . 
       FIGS. 19A-19E  illustrate a wire tensioner tip  402   c  configured to be coupled to a wire tensioner  400 , in accordance with some embodiments. The wire tensioner tip  402   c  is similar to the wire tensioner tip  402   b  discussed above in conjunction with  FIGS. 14A-18B , and similar description is not repeated herein. The fixed engagement body  490   a  of the wire tensioner tip  402   c  includes a triangular body  492   a  having an apex  498  centrally positioned with respect to the wire tensioner tip  402   c . A central protrusion  494  extends from the apex  498  of the triangular body  492   a.    
       FIGS. 20-21B  illustrate the wire tensioner tip  402   c  coupled to a ring  142   b  in a straight engagement, in accordance with some embodiments. The ring  142   b  is at least partially inserted into the ring slot  470  the wire tensioner tip  402   c . As shown in  FIG. 21B , in a straight engagement, the central protrusion  494  is positioned within a notch  186 . The central protrusion  494  and the notch  186  prevent movement (lateral movement, rotational movement, etc.) of the wire tensioner tip  402   c  during tensioning of a wire  412 . The outer side protrusions  496   a ,  496   b  are not engaged with the ring  142   b  in a straight engagement. 
       FIGS. 22-23B  illustrate the wire tensioner tip  402   c  coupled to the ring  142   b  in an angled engagement, in accordance with some embodiments. The horizontal axis of the wire tensioner tip  402   c  and the fixed engagement body  490   a  are offset with respect to a radius of the ring  142   b . As shown in  FIG. 23B , a first side protrusion  496   a  is engaged with a notch  186  defined in the first surface  180   a  of the ring  142   b . The first side protrusion  496   a  and the notch  186  prevent movement (lateral movement, rotational movement, etc.) of the wire tensioner tip  402   b  during tensioning of a wire  412 . The central protrusion  494  is not engaged with a notch, although it will be appreciated that the central protrusion  494  can be partially engaged with a notch when the angle between the horizontal axis of the wire tensioner tip  402   c  and the radius of the ring  142   a  is reduced. 
     Although the invention has been described in terms of exemplary embodiments, it is not limited thereto. Rather, the appended claims should be construed broadly, to include other variants and embodiments of the invention, which may be made by those skilled in the art without departing from the scope and range of equivalents of the invention.