Patent Description:
In addition, wires, cables, and/or plates may be used to secure bone pieces/segments created by planned surgical cutting, such as an osteotomy. For example, a hip replacement prosthesis may be secured within an intramedullary canal of a proximal femur via cement or bone ingrowth into a porous surface of a press-fit stem. In some instances, a revision procedure, which entails the removal of the previously implanted prosthesis, may be required due to prosthesis wear or loosening, infection, periprosthetic fracture, and the like. In order to remove a securely fixed prosthesis and/or cement mantle from a proximal femur, a trochanteric or extended trochanteric osteotomy may be performed whereby the greater trochanter and, in the case of an extended osteotomy, an extended region of bone inferior to the greater trochanter are resected from the remaining femur in order to expose the prosthesis to facilitate its removal.

In each instance, whether in the case of a fracture or planned cutting, the bone, unless unsalvageable, must be reconstructed and held together, preferably in a compressed manner. In some instances, the bone is reconstructed about a joint prosthesis so that the bone not only heals to itself but also heals in a manner to retain the prosthesis.

Bone reconstruction involving proximal femoral fractures, such as trochanteric fractures, often include the wrapping of cables, such as Dall-Miles cables, about the proximal femur so as to compress and secure the bone pieces to each other and, in some cases, about a portion of a prosthesis. Such cables are sometimes utilized in conjunction with plates. Such plates are often placed on a lateral aspect of the femur with one or more cables coupled to the plate.

However, such plates, which can be bulky and may extend over the greater trochanter and down to the diaphysis of the bone, have a tendency to migrate particularly since several soft tissue structures attach and apply force to the greater trochanter during ambulation. In addition, soft tissue structures that pass over the greater trochanter can rub against the plate during ambulation. Such rubbing may also lead to trochanteric bursitis or other localized soft tissue inflammation. Moreover, plate migration can lead to non-union of the bone pieces which may further result in joint dislocation and periprosthetic joint infection. Thus, further developments are desirable.

Document <CIT> relates to an implant for refixation of the greater trochanter on which an osteotomy has been performed or which is fractured.

Document <CIT> discloses a bone fixation system that has at least one cerclage cable and an elongate bone plate.

Document <CIT> provides for a system, devices and methods for facilitating stabilization of periarticular fractures.

The present invention relates to a bone plate as claimed hereafter.

The present disclosure describes various bone plates and methods of bone fixation utilizing such bone plates. Such methods, although not forming part of the present invention, generally include the placement of the bone plates in a medial position adjacent to a lesser trochanter of a femur. The bone plates may be initially secured from migration via bone screws and/or bone spikes. The bone plates may also include a roughened/textured surface that can also initially secure the plate during intraoperative placement via friction and can be created via additive manufacturing or by machining the inner surface to obtain the desired surface texture. Two or more cables, such as Dall-Miles cables, may be coupled to the plate and routed about the proximal femur in order to secure bone pieces to each other. The medial positioning of the bone plates reduces incidences of migration, non-fusion, soft tissue irritation, and/or bursitis relative to lateral placement. Migration is also limited via the securement features, such as the bone screws, spikes, tensioned cables and roughened surfaces. Moreover, the shapes of the plates may be such that they can be positioned at least partially about the lesser trochanter such that the protruding nature of the lesser trochanter can help prohibit migration of the plates.

The invention is illustrated in the <FIG> and <FIG>. The remaining figures illustrate examples that are useful for understanding the invention. The features, aspects, and advantages of the present invention will become better understood with regard to the following description, appended claims, and accompanying drawings in which:.

As used herein unless stated otherwise, the term "proximal" means closer to the heart, and the term "distal" means further from the heart. The term "anterior" means toward the front part of the body or the face, the term "posterior" means toward the back of the body. The term "medial" means closer to or toward the midline of the body, and the term "lateral" means further from or away from the midline of the body. The term "inferior" means closer to or toward the feet, and the term "superior" means closer to or toward the crown of the head. As used herein, the terms "about," "generally," and "substantially" are intended to mean that slight deviations from absolute are included within the scope of the term so modified.

<FIG> depict a fixation plate/implant <NUM> according to an embodiment of the present disclosure. Fixation plate <NUM> generally includes a front side or bone contacting side <NUM>, a back side <NUM> opposite the front side <NUM>, a plate body <NUM>, appendages <NUM>, and a cable protrusion <NUM>.

Appendages or arm members <NUM> extend outwardly from body <NUM>. In the embodiment depicted, plate <NUM> includes four appendages 30a-d in which a first and second appendage 30a-b are located at a superior end of plate <NUM>, while a third and fourth appendage 30c-d are located at an inferior end of plate <NUM>. First and second appendages 30a-b are generally separated from each other by a superior cut-out or recess <NUM>, which is shown to have a parabolic shape. Similarly, first and third appendages 30a, 30c are separated by a first side cut-out or recess 36a, while second and fourth appendage 30b, 30d are separated by a second side cut-out or recess 36b disposed opposite the first side recess 36a. Such side cut-outs 36a-b are also parabolic in shape but have different dimensions from that of superior cut-out <NUM>. In this regard, superior cut-out <NUM> is dimensioned so that it can receive and conform to a perimeter of a lesser trochanter of a femur, such as lesser trochanter <NUM> of bone <NUM> of <FIG>. In other words, plate <NUM> is intended to lie flush or close to flush against an outer cortex of femur <NUM> at a location adjacent and generally inferior to lesser trochanter <NUM>. Superior cut-out <NUM> is shaped and dimensioned to receive at least a portion of lesser trochanter <NUM> of a patient's bone so that first and second appendages 36a-b cradle lesser trochanter <NUM> and lie flush against the bone immediately surrounding lesser trochanter <NUM>. Appendages 30a-d also each include a screw hole <NUM> extending therethrough from back side <NUM> of plate <NUM> to front side <NUM> thereof. Such screw holes <NUM> are configured to each receive a bone screw for initial securement of plate <NUM> to bone and may be biased or unbiased screw holes.

Cable protrusion or cable mound <NUM> extends backwardly from the back side <NUM> of plate <NUM> and in particular a back side of body <NUM>. Protrusion <NUM> defines passageways or channels <NUM> that extend entirely therethrough. In the embodiment depicted, protrusion <NUM> includes two passageways <NUM> that are oriented in a parallel fashion relative to each other. Protrusion <NUM> is preferably placed over a center of geometry of plate <NUM> and passageways <NUM> are preferably located near the center of geometry with one passageway <NUM> being on an opposite side of the center of geometry from another passageway <NUM>. This central placement of protrusion <NUM> and passageways <NUM> minimizes effects from unbalanced cable tensile forces thereby reducing the chances of plate migration from its intended position. Also, more or less passageways <NUM> are contemplated. For example, plate <NUM> may include a single passageway <NUM> through protrusion <NUM> or may include three or four passageways <NUM>. Passageways <NUM> are configured to receive cables or wires, such as Dall-Miles cables, therethrough. Protrusion <NUM> may be crimped by a tool so that passageways <NUM> are collapsed onto a cable therein in order to secure the cable from loosening. Passageways <NUM> are aligned with first and second side cut-outs 36a-b such that longitudinal axes of passageways <NUM> extend over side cut-outs 36a-b. Cut-outs 36a-b extend inwardly toward protrusion <NUM> and terminate adjacent thereto. In this regard, side cut-outs 36a-b provide clearance for cables extending from passageways <NUM> such that cables can be wrapped about a bone with minimal impingement from plate <NUM>.

Body <NUM> is in the form of a plate that has a thickness defined between the back and front sides <NUM>, <NUM> of plate <NUM> and, in particular, a bone contacting surface and a back side surface of body <NUM>. Similar to protrusion <NUM>, body <NUM> also includes passageways or channels <NUM> that extend entirely therethrough and, in the particular embodiment, a first and second passageway <NUM>. However, such passageways <NUM> extend vertically in a superior-inferior direction between the bone contacting surface and back side surface of body <NUM>, whereas passageways <NUM> extend side to side transverse to the superior-inferior direction. In this regard, passageways <NUM> intersect or, in other words, open up to superior cut-out <NUM>. Passageways <NUM> may be parallel to each other or may be oriented at various angles relative to each other and may be positioned at various distances from each other. For example, passageways <NUM> can be angled relative to each other up to about <NUM> degrees. Moreover, where passageways <NUM> are angled toward each other, they angle toward each other in an inferior direction such that their point of intersection is located inferior to plate <NUM>.

Front side <NUM> of plate <NUM> is a bone contacting side of plate <NUM> which may include a roughened/textured surface, as best shown in <FIG>. Such surface can be produced via additive manufacturing, machining, or grit blasting, for example, so as to produce a desired surface texture and roughness. The roughened surface could be in the form of stippling, corrugations, or a diamond shaped pattern, for example. When positioned against bone cortex, such surface generates friction that helps prevent migration of the plate.

Front side <NUM> of plate <NUM> is curved in at least two planes. In particular, front side <NUM> of plate <NUM> is concavely curved in a transverse/horizontal plane that intersects plate <NUM> and bisects it into superior and inferior portions. The superior portion includes arm members 30a-b, and the inferior portion includes arm members 30c-d. Back side <NUM> of plate <NUM> is correspondingly convexly curved. The concave curvature of front side <NUM> also tapers inwardly from a superior end toward an inferior end of plate such that a radius of curvature is greater at the superior end than at the inferior end of plate <NUM>. Front side <NUM> is also convexly curved in a coronal/vertical plane that is perpendicular to the transverse plane and bisects plate <NUM> into side portions where a first side portion includes arm members 30a and 30c and a second side portion includes arm members 30b and 30d. Such dual curvature is intended to correspond to the geometry of the proximal femur particularly in the region surrounding the lesser trochanter and primarily inferior to it.

In some embodiments, plate <NUM> can be bent beyond its initial configuration by a surgeon via a plate bender in situ, such as in trauma scenarios, in order to conform to a patient's specific geometry. In other embodiments, a kit can be provided with multiple plates, like that of plate <NUM>, such that the plates in the kit have differing lengths and widths to account for various patient anatomies and fracture configurations. In even further embodiments, the dual curvature and tapered shape can be matched to a population of femurs in order to obtain a best fit to a particular patient. This may be achieved through an analysis of a bone database. For example, the Stryker® Orthopaedics Modeling and Analytics (SOMA) database may be used to create the geometry of plate <NUM>. The SOMA database contains detailed medical images of thousands of bones from diverse populations of individuals. Geometric data of the bone region in question (i.e., area surrounding and including the lesser trochanter) can be extrapolated from a designated population to which the patient is a part (e.g., a representative sample of bones having the same designated characteristic(s) such as race, gender, height, or a combination thereof). A virtual implant may be overlaid onto a virtual bone image that represents the geometric data extracted from the designated population. The virtual implant may be manipulated either manually within a virtual space by a user or via an automated function that manipulates the virtual implant to conform to the virtual bone in the target area of interest. The final virtual implant, which may have other modifications added to it, such as surface finishes, can then be utilized in manufacturing software, such as software for additive manufacturing, to manufacture the implant in accordance with the generated virtual implant. It should be understood that patient specific versions of plate <NUM> can be similarly created for a patient's specific and unique geometry, such as via medical images (e.g., CT, MRI, or x-ray images) of the patient's femur.

In addition to that described above and illustrated in the figures, various other operations will now be described. It should be understood that the following operations do not have to be performed in the exact order described below. Instead, various steps may be handled in a different order or simultaneously. Steps may also be omitted or added unless otherwise stated therein.

Plate <NUM> can be utilized to reconstruct bone, such as femur <NUM>, which may be fractured due to injury, such as a fracture of the greater trochanter <NUM>, or segmented due to a surgical intervention, such as a trochanteric osteotomy. It should be understood that the methods described herein can be performed in the context of bone fracture reduction and repair and reconstruction of bone segmentation due to an osteotomy. Proximal femoral osteotomies may be performed to remove a well fixed hip prosthesis and/or bone cement utilized to secure such prosthesis. In this regard, a greater trochanteric osteotomy may be performed to expose portions of the hip prosthesis within an intramedullary canal of the bone <NUM> such that burrs, osteotomes, and other instruments can be used free the implant from the bone <NUM>. Trochanteric osteotomies can include an extended type in which the greater trochanter <NUM> and an extended region of bone extending inferior from the greater trochanter <NUM> down to the femoral diaphysis <NUM> is resected away from the remaining femur <NUM>. Trochanteric osteotomies that are not of the extended type involve the resection of the greater trochanter <NUM> but not the extended region inferior to it. Thus, reconstructions of extended trochanteric osteotomies involve the union of a much larger segment of bone than a non-extended type of osteotomy. Plate <NUM> can be utilized in a reconstruction of both an extended trochanteric osteotomy and a non-extended trochanteric osteotomy.

In a method of bone fixation utilizing plate <NUM>, the limb is abducted and the bone segments or pieces are reduced using a reduction clamp (not shown). Such reduction may be about a joint prosthesis, such as a femoral hip prosthesis, such that the bone segments are reduced over the prosthesis (not shown). Plate <NUM> is placed along a medial aspect of femur <NUM> just inferior to the lesser trochanter <NUM> such that the lesser trochanter <NUM> is at least partially positioned within superior cut-out <NUM> of plate <NUM>, as illustrated in <FIG>. Once in the desired position, bone screws are placed through each bone screw opening <NUM> and into the bone <NUM>. Such bone screws may be polyaxial bone screws so that they can be oriented at one of a multitude of different angles as desired by the surgeon. Bone screws can also be monolithic, biased, unbiased, serrated and/or self-tapping.

Cables, such as Dall-Miles cables, are preferably pre-threaded through passageways <NUM> of plate <NUM> prior to medial placement of the same such that each cable has at least one free end extending from plate <NUM>. As shown in <FIG>, beaded cables <NUM> are threaded through passageways <NUM> in an inferior to superior direction such that beads <NUM> of beaded cables <NUM> are positioned at an inferior end of plate <NUM>. However, it is contemplated that the cables can be threaded to plate <NUM> in-situ.

Free ends of each cable <NUM> extending from each passageway <NUM> are passed over and about a lateral aspect of the trochanteric bone segment, through the anterior abductor muscles, and back to plate <NUM> where they are threaded through openings <NUM> in protrusion <NUM>. Such cables <NUM> are then tensioned until the trochanteric osteotomy or fracture is reduced and rigidly fixed. The cables <NUM> are secured, such as by crimping protrusion <NUM>, and the remaining free ends of the cables are cut. The resultant construct would include two cables extending horizontally and vertically about the trochanteric bone segment. As can be envisioned from <FIG>, the medial placement of plate <NUM> inferior to lesser trochanter <NUM> allows cables to be passed over the greater trochanter <NUM> without interference from a femoral head <NUM> or neck <NUM>, whether artificial or natural.

However, in other embodiments, depending on the nature of the fracture or osteotomy, only horizontal or only vertical cables through passageways <NUM> or <NUM>, respectively, may only be utilized. For example, for an extended trochanteric osteotomy, two cables may be passed circumferentially about the femur, as illustrated in <FIG>, without them being routed up and over the greater trochanter. This may be beneficial in cases with poor bone quality. The use of plate <NUM> would distribute the cable tension over a greater area than just cables without plate <NUM> which could dig in and damage the bone. In some procedures where further securement is desired, bone openings may be drilled through the bone inferior to the bone segment to be rejoined. Cables extending through vertical passageways <NUM> may then passed over the greater trochanter <NUM> and down through bone openings about the trochanteric bone slegment. In still further embodiments, cables can be routed through both plate <NUM> at a medial side of a femur, as shown in <FIG>, and also through a second bone plate placed at a lateral side of femur, such as a standard lateral bone plate.

Fixation plate <NUM> can vary in many ways. The following describes many of such variations which are exemplified in the following embodiments. In this regard, the following fixation plate embodiments are generally similar to fixation plate <NUM> and utilized in the aforementioned method in a similar fashion except where explicitly stated or illustrated otherwise. As such, like elements are accorded like reference numerals but within a higher number series.

<FIG> depict bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes front <NUM> and back sides <NUM>, a body <NUM>, appendages 130a-b extending from body <NUM>, and a cable protrusion <NUM>. In addition, plate <NUM> includes bone screw openings <NUM> extending through plate <NUM> and cable passageways <NUM> extending side to side through protrusion <NUM>. However, plate <NUM> differs from plate <NUM> in that it has two appendages 130a-b, rather than four. Nonetheless, plate <NUM> has four bone screw openings <NUM> where two of such bone screw openings extend through appendages 130a-b, respectively, and two extend through opposite sides of body <NUM>. In this regard, plate <NUM> does not have side cut-outs, such as cut-outs <NUM>. In addition, plate <NUM> does not have vertical passageways, such as passageways <NUM>, extending through body <NUM>. As shown in <FIG>, plate <NUM> would be similarly positioned inferior to a lesser trochanter <NUM> of a femur in a method of fixation as plate <NUM> such that the lesser trochanter <NUM> is at least partially received within superior cut-out <NUM>.

<FIG> depict bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes back and front sides <NUM>, <NUM>, a body <NUM>, appendages 230a-d extending from body <NUM>, and a cable protrusion <NUM>. In addition, plate <NUM> includes bone screw openings <NUM> extending through plate <NUM>, cable passageways <NUM> extending through protrusion <NUM>, and cable passageways <NUM> extending through body <NUM>. However, bone plate <NUM> differs in that it does not have side cut-outs, but does include an inferior cut-out 234b in addition to superior cut-out 234a. Also, passageways <NUM> extend through body <NUM> side to side while passageways <NUM> extend vertically through protrusion <NUM>. In this regard, superior and inferior cut-outs 234a-b align with passageways <NUM> so that cables extending therethrough are not impinged by body <NUM>. Thus, in a method of bone fixation, cables horizontally wrapping about the bone segments extend through passageways <NUM> of body <NUM>, while cables wrapping vertically about the bone segments extend through passageways <NUM> of protrusion <NUM>.

<FIG> depicts plate <NUM>' which is a variation of plate <NUM>. Plate <NUM>', while also including a cable protrusion <NUM>', includes a singular cable passageway <NUM>' extending therethrough as opposed to more than one cable passageway like that of plate <NUM>. Such singular cable passageway <NUM>' is dimensioned to receive more than one cable therethrough.

<FIG> depicts bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes back and front sides <NUM>, <NUM>, a body <NUM>, appendages 330a-d extending from body <NUM>, and a cable protrusion <NUM>. In addition, plate <NUM> includes bone screw openings <NUM> extending through appendages 330a-d and cable passageways <NUM> extending through protrusion <NUM>. Moreover, plate <NUM> includes a superior cut-out <NUM> between first and second appendages 330a-b and opposing side cut-outs <NUM> between first and third appendages 330a, 330c and second and fourth appendages 330b, 330d, respectively. However, plate <NUM> differs from plate <NUM> in a similar fashion as that of plate <NUM>. In this regard, passageways <NUM> extending through protrusion <NUM> extend vertically, rather than side to side, and passageways <NUM> extending through body <NUM> extend side to side, rather than vertically in a superior-inferior direction. Also, passageways <NUM> intersect side cut-outs <NUM>.

<FIG> depicts bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes back and front sides <NUM>, <NUM>, a body <NUM>, and appendages 430a-d extending from body <NUM>. In addition, plate <NUM> includes bone screw openings <NUM> extending through appendages 430a-d and cable passageways <NUM> extending through body <NUM>. However, plate <NUM> does not include a cable protrusion. Also, cable passageways <NUM> extend through body <NUM> side to side. In this regard, plate <NUM> is a low profile plate <NUM> in so far as it does not have any protrusion extending from the back side <NUM> thereof. Plate <NUM> also includes an inferior cut-out 434b in addition to a superior cut-out 434a and side cut-outs <NUM>.

The following embodiments are also similar to plate <NUM>. However, instead of incorporating bone screw openings for bone screw fixation to a bone, such embodiments utilize spikes or prongs to engage bone and provide initial fixation to prohibit plate migration.

<FIG> depicts bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes a body <NUM>, appendages 530a-d extending from body <NUM>, and a cable protrusion <NUM>. In addition, cable protrusion <NUM> includes cable passageways <NUM> extending therethrough. However, unlike plate <NUM>, plate <NUM> includes prongs or spikes <NUM> at the ends of each appendage <NUM>. Moreover, appendages 530a-d extend outwardly from body <NUM> and from each other and then curve back in a direction toward each other such that spikes <NUM> of a pair of appendages <NUM> generally face a corresponding spike <NUM> of an opposing pair. For example, a first pair includes first and second appendages 530a-b and a second pair includes third and fourth appendages 530c-d. The spike <NUM> of first appendage 530a faces the spike <NUM> of third appendage 350c while the spike <NUM> of second appendage 530b faces the spike <NUM> of fourth appendage 530d. Body <NUM> also includes a plurality of ribs <NUM> extending along a bone facing side thereof. Such ribs <NUM> act as hinges that give the body flexibility so that the first pair of spiked appendages 530a-b can move relative to the other pair 530c-d like a claw. In this regard, appendages 530a-d can rotate relative to body <NUM>. This creates spring-like structure in which the claw comprised of appendages 530a-d can be held in an open position and then released so that the natural bias of body <NUM> causes the spiked appendages 530a-d to move toward each other and grip whatever bone is positioned therebetween.

Thus, in use, plate <NUM> may be held open in a first position and then placed against the bone adjacent to a lesser trochanter where it is released so that appendages 530a-d move to a second position in which the spikes <NUM> of appendages 530a-b are positioned closer to appendages 530c-d than in the first position thereby gripping the bone to prohibit migration of plate <NUM>. Plate <NUM> can be placed onto the bone such that passageways <NUM> extend horizontally in a manner similar to passageways <NUM> when plate <NUM> is secured to femur <NUM>. However, plate <NUM> can also be placed onto a femur such that passageways <NUM> extend vertically in a similar manner to passageways <NUM> of plate <NUM>.

<FIG> depict bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes a front side <NUM>, a back side <NUM>, a body <NUM> and appendages 630a-d extending from body <NUM>. In addition a first and second appendage 620a-b are separated by a superior cut-out 634a, and third and fourth appendages 630c-d are separated by an inferior cut-out 634b. However, unlike plate <NUM>, a spike <NUM> extends frontward from each appendage 630a-d in lieu of a bone screw opening. Moreover, unlike plate <NUM>, spikes <NUM> extend straight in a backward direction and generally do not face each other. Plate <NUM> also does not include a cable protrusion or any passageways extending through body <NUM> like that of plate <NUM>. Instead, plate <NUM> has a plurality of grooves <NUM> extending along the back side <NUM> thereof and in a side to side direction transverse to the superior-inferior direction. In the embodiment depicted, plate <NUM> has two of such grooves <NUM>. However, more or less grooves <NUM> are contemplated depending on how many cables are utilized for reconstruction. Grooves <NUM> are configured to receive cables therein so as to help retain cables and prevent migration of the cables during the healing process.

Grooves <NUM> allows cables to be wrapped about bone segments prior to placement of plate <NUM>. In this regard, in a method of bone fixation, cables can be wrapped horizontally about a proximal femur as previously described with respect to plate <NUM>. Plate <NUM> may then be placed against the femur at a medial aspect thereof and adjacent to a lesser trochanter. The cables can then be aligned with a respective groove <NUM> and tightened so that the cables are received within their respective groove <NUM>. As each cable is tensioned, the tensile force of such cables press the plate <NUM> tightly against the femur so that spikes <NUM> dig into the bone which helps prevent migration of the plate <NUM> and, consequently, the cables themselves since they are retained by grooves <NUM> of plate <NUM>.

Plate <NUM> can have various spike configurations. For example, spikes <NUM> shown in <FIG> are wedge shaped projections that have sharpened ends that help cut into a femoral cortex. Bone plate <NUM> may have a roughened surface at the front side <NUM> thereof that may abut the bone once spikes <NUM> are engaged in order to enhance migration resistance.

<FIG> depict other spike configurations. Spike <NUM>' of <FIG> includes a backwardly projecting hook or barb <NUM> which catches on the bone once fully seated within the bone to prevent backing out of spike <NUM>'. Spike <NUM>" of <FIG> includes circumferential grooves <NUM> extending thereabout. Such grooves <NUM> facilities bone migration therein during the healing process which helps prevent spike from backing out of the bone.

<FIG> depict bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes a body <NUM> and appendages 730a-d extending from body <NUM>. In addition, bone plate <NUM> includes a cable protrusion <NUM> extending backwardly therefrom that includes cable passageways <NUM> that extend in a side to side direction. However, unlike plate <NUM>, appendages 730a-d each have a spike extending frontwardly therefrom. Such spikes may be the same as those described above with regard to plate <NUM>.

<FIG> depict a bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes a body <NUM>, appendages 830a-b extending from body <NUM>, and a cable protrusion <NUM>. In addition, plate <NUM> includes cable passageways <NUM> extending side to side through protrusion <NUM>. However, plate <NUM> differs from plate <NUM> in that it has two appendages 830a-b, rather than four. Also, instead of bone screw openings, plate <NUM> includes a pair of spikes <NUM> extending frontwardly from plate <NUM> at an inferior end thereof. This differs from the previous spiked plates <NUM>, <NUM>, and <NUM> in that only two spikes are provided. However, as previously discussed, plate <NUM> would be placed adjacent a lesser trochanter such that at least a portion of the lesser trochanter would be positioned between appendages 830a-b. This relationship relative to lesser trochanter helps prevent migration of plate in a superior direction. The addition of spikes <NUM> helps prevent migration in other directions as well.

<FIG> depicts a bone fixation system according to an example of the present disclosure. Bone fixation system includes a medial fixation plate <NUM> and a lateral crown or brace <NUM>. Plate <NUM> is similar to other plates previously described herein in that it has a body <NUM> with a concave bone facing surface <NUM> and appendages 93a-b extending from body <NUM>. In addition, plate <NUM> has a cable protrusion <NUM> with passageways <NUM> extending side to side therethrough. However, unlike in the other embodiments, appendages 930a-b also include cable protrusions <NUM> with their own passageways <NUM> such that cables may be routed through the passageways <NUM>, <NUM> of protrusions <NUM>, <NUM> of appendages <NUM> and body <NUM>. This configuration helps direct and stabilize the cables wrapping about a bone, such as femur <NUM>.

Crown <NUM> is comprised of multiple arms <NUM> that depend downwardly to form an open umbrella shape or semi-spherical shape. In this regard, crown <NUM> is configured to be placed over the greater trochanter <NUM> so that arms <NUM> extend in a generally inferior direction. Each Arm <NUM> includes at least one passageway or channel <NUM> extending entirely therethrough and along its entire length. Crown <NUM> and plate <NUM> operate in conjunction with each other such that they each provide solid, stable structures to prevent cable slippage and migration over an extended period of time as the bone fragments heal.

In use, body <NUM> of plate is positioned inferior to lesser trochanter <NUM> of femur <NUM> so that appendages extend superiorly and cradle lesser trochanter <NUM>. The positioning of the lesser trochanter <NUM> between arms 930a-b prohibits migration of plate <NUM> in a superior direction. Crown <NUM> is placed over greater trochanter <NUM> so that its arms <NUM> extend inferiorly toward plate <NUM>, as shown. Cables may be preloaded through passageways <NUM>, <NUM>, <NUM> of both plate <NUM> and crown <NUM> so that once plate <NUM> and crown <NUM> are respectively positioned at the lesser and greater trochanters <NUM>, <NUM>, then cables can be tightened to secure the assembly. However, in other embodiments, cables can be threaded through plate and crown in-situ.

<FIG> depicts bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> except that protrusion <NUM> includes four passageways <NUM> rather than two. In addition, such passageways <NUM> are differently oriented compared to passageways <NUM>. In this regard, plate <NUM> includes a first pair of passageways 1042a and a second pair of passageways 1042b. First pair of passageways 1042a intersect the second pair of passageways 1042b. In other words, each passageway <NUM> defines a central axis and the central axes of the first pair of passageways 1042a intersect the central axes of second passageways 1042b, as illustrated in <FIG>. Such intersection preferably occurs at a perpendicular angle. However, other angles, such as <NUM>, <NUM>, and <NUM> degrees, are contemplated. In addition, both pairs of passageways 1042a-b extend in both an inferior-superior direction and a transverse direction. This arrangement allows either the first or second pair of passageways 1042a-b to be utilized during a procedure depending on the circumstances of the procedure. For example, first pair of passageways 1042a may be utilized in conjunction with one or more cables in a procedure on a left femur while second pair of passageways 1042b may be utilized in a procedure on a right femur.

<FIG> depict bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> except that plate <NUM> has an extended body as compared to plate <NUM>. In other words, plate <NUM> has a greater superior-inferior length than plate <NUM>. In addition, while not shown, protrusion <NUM> may be longer in the superior-inferior direction than protrusion <NUM> so that passageways <NUM> are placed further apart than passageways <NUM> in plate <NUM>. However, in the embodiment depicted, protrusion <NUM> is identical to protrusion <NUM>.

<FIG> depicts bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes first and second appendages 1230a-b extending from a body <NUM>. However, plate <NUM> does not include third and fourth appendages. Although, it is contemplated that some embodiments of plate <NUM> may include third and fourth appendages. Plate <NUM> also differs in that body <NUM> is longer than body <NUM> and includes first and second cable protrusions 1230a-b extending from body <NUM>. Such protrusions 1240a-b are similar to protrusion <NUM> in that they each include a respective pair of passageways 1240a and 1242b extending in a transverse direction. Protrusions 1240a-b are separated from each other in a superior-inferior direction. A pair of through-openings <NUM> are located between protrusions 1240a-b and extend through body <NUM> from an outer surface to an inner surface thereof. Such through-openings <NUM> may intersect with openings <NUM>, which extend through plate <NUM> along a length thereof, or may be arranged so that they do not intersect with each other. Such through-openings <NUM> can each receive a cable, such as a beaded cable. The configuration of plate <NUM>, and even plate <NUM>, can be utilized in cases where multiple cable fixation options are desirable and/or where the bone pieces intended to be secured exist over a great length of the bone, such as in the case of extended osteotomies and fractures that are located beyond the trochanter.

<FIG> depicts bone plate <NUM>. Bone plate <NUM> is similar to bone plate <NUM> in that it includes first and second cable protrusions 1340a-b extending from body <NUM> and through-holes <NUM> extending through body <NUM> between protrusions. However, plate <NUM> differs in that that first cable protrusion 1340a is configured like protrusion <NUM> of plate <NUM>. In this regard, protrusion 1340a is diamond shaped and has two pairs of intersecting passageways 1342a-b which are oriented at oblique angles relative to a longitudinal axis of plate <NUM>.

The exemplary fixation plates and like hardware described herein may be formed layer-by-layer using an additive layer manufacturing (ALM), i.e., 3D printing, process so no separate connection mechanism is necessary to bring together any of the components of such implants. In some examples, ALM processes are powder-bed based and involve one or more of selective laser sintering (SLS), selective laser melting (SLM), and electron beam melting (EBM), as disclosed in <CIT>; <CIT>; <CIT>; and <CIT> as well as <CIT>. Other methods of ALM, which can be used to form the herein described implants, include stereolithography (SLA), fused deposition modeling (FDM), and continuous liquid interface production (CLIP).

When employing powder-bed based technologies, articles are produced in layer-wise fashion according to a predetermined digital model of such articles by heating, e.g., using a laser or an electron beam, multiple layers of powder, which preferably may be a metallic powder, that are dispensed one layer at a time. The powder is sintered in the case of SLS technology and melted in the case of SLM technology, by the application of laser energy that is directed in raster-scan fashion to portions of the powder layer corresponding to a cross section of the article. After the sintering or melting of the powder on one particular layer, an additional layer of powder is dispensed, and the process repeated, with sintering or melting taking place between the current layer and the previously laid layers until the article is complete. The powder layers similarly may be heated with EBM technology.

Claim 1:
A bone plate (<NUM>), comprising:
a body (<NUM>);
a first and second appendage (30a-b) extending from the body, the first and second appendage being separated by a recess (<NUM>), wherein the body and first and second appendage define a bone contacting surface of the bone plate, the bone contacting surface being concavely curved;
a protrusion (<NUM>) extending from the body and having a first and second passageway (<NUM>) extending therethrough; and
third and fourth passageways (<NUM>) extending through the body of the bone plate between the bone contacting surface and a back side surface of the body, wherein the third and fourth passageways extend vertically along a superior-inferior direction, and wherein the third and fourth passageways intersect the recess.