An orthopedic fixation device comprising: - a coupling element, wherein the coupling element comprises a bore there through and an interior surface disposed about the bore; - a bone fastener, wherein the bone fastener comprises a head and an extension that extends from the head, wherein the head is configured for loading into the coupling element through the bottom of the bore; and - a locking clamp assembly, wherein the locking clamp assembly comprises: a clamp element, wherein the clamp element comprises a first clamp portion and a second clamp portion, wherein the first and second clamp portions (26, 28) each have an outer surface and an inner surface, wherein at least a portion of the outer surface is configured to engage the interior surface of the coupling element, and wherein at least a portion of the inner surface is configured to engage the head of the bone fastener; and a wedge element, wherein the wedge element comprises a wedge bore configured to receive an upper portion of the clamp element and an inner wedge surface disposed around at least a lower portion of the wedge bore, wherein the inner wedge surface is configured to engage at least portion of the outer surface of the first and second clamp portions (26, 28), characterized in that - the inner surface of the coupling element further comprises protuberances; - an upper portion of the wedge element further comprises an upper lip, wherein the protuberances of the coupling element are configured to engage the upper lip to secure the locking clamp assembly within the coupling element, and wherein when the locking clamp assembly is pushed downward such that the upper lip moves beyond the protuberances the first and second clamp portions (26, 28) are forced radially inward. - a coupling element, wherein the coupling element comprises a bore there through and an interior surface disposed about the bore; - a bone fastener, wherein the bone fastener comprises a head and an extension that extends from the head, wherein the head is configured for loading into the coupling element through the bottom of the bore; and - a locking clamp assembly, wherein the locking clamp assembly comprises: a clamp element, wherein the clamp element comprises a first clamp portion and a second clamp portion, wherein the first and second clamp portions (26, 28) each have an outer surface and an inner surface, wherein at least a portion of the outer surface is configured to engage the interior surface of the coupling element, and wherein at least a portion of the inner surface is configured to engage the head of the bone fastener; and a wedge element, wherein the wedge element comprises a wedge bore configured to receive an upper portion of the clamp element and an inner wedge surface disposed around at least a lower portion of the wedge bore, wherein the inner wedge surface is configured to engage at least portion of the outer surface of the first and second clamp portions (26, 28), characterized in that a clamp element, wherein the clamp element comprises a first clamp portion and a second clamp portion, wherein the first and second clamp portions (26, 28) each have an outer surface and an inner surface, wherein at least a portion of the outer surface is configured to engage the interior surface of the coupling element, and wherein at least a portion of the inner surface is configured to engage the head of the bone fastener; and a wedge element, wherein the wedge element comprises a wedge bore configured to receive an upper portion of the clamp element and an inner wedge surface disposed around at least a lower portion of the wedge bore, wherein the inner wedge surface is configured to engage at least portion of the outer surface of the first and second clamp portions (26, 28), characterized in that - the inner surface of the coupling element further comprises protuberances; - an upper portion of the wedge element further comprises an upper lip, wherein the protuberances of the coupling element are configured to engage the upper lip to secure the locking clamp assembly within the coupling element, and wherein when the locking clamp assembly is pushed downward such that the upper lip moves beyond the protuberances the first and second clamp portions (26, 28) are forced radially inward.