Patent Description:
Treating bone injuries may require the surgeon to remove diseased or damaged bone such as disc and utilize spacer or inserts in combination with plates, screws, cages and the like to affix adjacent vertebra together. For extremity repair of a bone such as the distal radius a plate is affixed to maintain the surgeon set or optimal set position during the bone healing period.

<CIT> discloses a plate that is capable of spanning multiple segments of a cervical spine and has predetermined separation zones. The separation zones may be positioned in a segmentable plate such that when a portion of the segmentable plate would be applied to the vertebrae, the remaining separation zones in the plate, if any, would be supported by an underlying vertebrae. In use, the surgeon would determine the appropriate plate length needed and if the length needed was less than the length of the provided plate, the surgeon would remove the unneeded portion of the plate at the appropriate separation zone.

The invention relates to adjustable implant templates according to independent claim <NUM>. The present disclosure further describes methods that are not claimed but are considered as useful for understanding the invention. Briefly stated, kits providing swappable disposable radiopaque spinal disc spacers or inserts of various sizes and an instrument to insert and remove, "swap", the spacers are disclosed. The inserts may be partially radiolucent and partially radiopaque to facilitate visualization under X-rays/ fluoroscope. The trial plate may be partially radiolucent and partially radiopaque to facilitate visualization under X-rays/ fluoroscope. At least two inserts of varying sizes are supplied with a kit. In some instance the trial plates are flexible.

Flexible plastic, resin or polymer material forming a trial plate for use in surgery of bones including spine and extremities. The trial plate having at least one radiopaque region and which may have one radiolucent region. In some instances a main body includes one or more arms formed of subparts. Between the main body and subparts and between the subparts are frangible regions such a ribs or unbroken edges surrounding windows configured as predetermined break points to disassociate portions of an arm from the whole.

Aspects of implementations include kits containing one or more of a flexible plastic, resin or polymer trial plates for use is surgery of bones including spine and extremities. The trial plate having at least one radio opaque region and guides for positioning. In a kit trial plates of varying sizes may be provided to customize the trial.

Aspects of implementations of devices of flexible plastic, resin or polymer trial plates for use in surgery of bones include a flexible trial plate having a main body configured with at least one arm extending from the main body forming an elongated trial plate with adjustable arm(s) each extended arm provides at least two subarm. Subarms are partially separated from one another via one or more slots interposed between subarms; and, removal of subarms from an extended arm reduces the length of the trial plate. In some instances the slots are curved. The subarm(s) separated by slots are attached to each other and the main body through one or more frangible regions such as ribs or an unbroken side edge. In some instances an extended arm is reduced in size by disassociating other subarms via breaking or cutting a frangible region between subarms. At least a portion of the trial plate may be radiopaque. In some instances the curved slots approximates or defines the outline of an implant. In some instances a marker cue and/or a tool interface may be added.

Aspects of implementations of devices and methods of flexible plastic, resin or polymer trial plates for use in surgery of bones include a flexible trial plate having a main body configured with two arms extending from the main body forming an elongated trial plate with adjustable arms; each extended arm with at least two subarm. Subarms arm partially separated from one another via one or more slots and guides interposed between subarms; and, removal of subarms from at least one end of the extended arms reduces the length of the trial plate. In some instances at least one of the guides and the slots are curved. The subarms separated by slots are attached to each other and the main body through one or more frangible regions. In some instances an extended arm is reduced in size by disassociating other subarms via breaking or cutting a frangible region between subarms.

Aspects of implementations of devices and methods of flexible plastic, resin or polymer trial plates for use in surgery of bones include a flexible trial plate having a main body configured with arms extending from the main body forming an elongated trial plate with adjustable arms; each extended arm with at least two subarms. Subarms arm partially separated from one another via one or more slots or windows interposed between subarm and main body or between subarms; and, removal of subarm(s) reduce the length of the trial plate. In some instances the slots and/or windows are curved. In some instances the slots or windows are a complex shape formed of curved and straight regions. The subarms separated by slots are attached to each other and the main body through one or more ribs or unbroken edge regions. In some instances an extended arm is reduced in size by disassociating other subarms via breaking or cutting a frangible region between subarms. Break zones may be demarcated on unbroken edges to identify and/or facilitate breakage at specific points.

Aspects of implementations of not claimed methods of flexible plastic, resin or polymer trial plates for use in surgery to dynamically adjust an implant template include comparing a trial plate with a selected implant; and, if the trial plate is longer then the implant breaking at least one frangible region to remove a to reduce the length of the flexible trial plate. In some instances at least one of guides and shaped slots define the outline, perimeter or silhouette of the implant are provided between subarms wherein only frangible regions connect said subarms.

In some instances at least a portion of a trial plate is radiopaque and a portion is radiolucent. In some instances one of the trial plates and one of the inserts is more radiopaque than the other.

The invention is illustrated in the <FIG>. The remaining figures illustrate examples that are useful for understanding the invention. The above-mentioned features of the present disclosure will become more apparent with reference to the following description taken in conjunction with the accompanying drawings wherein like reference numerals denote like elements and in which:.

As shall be appreciated by those having ordinary skill in the art, the figures are not to scale, and modifications to scale within a figure or across the figures are considered within the present disclosure.

Being disposable and single use the kit parts described herein avoid exposure of patients to radiopaque materials used herewith for all but a brief exposure. Further, the coating on coated embodiments may be extremely thin, to again limit the amount of such materials used or exposed to humans, due to the disposable nature of the kit parts.

<FIG> show a tool <NUM> having a handle <NUM> for grasping and a shaft <NUM> affixed to the handle at one end and a free end <NUM> having a threaded connection <NUM>. An insert <NUM> is disclosed of a size to approximate an intervertebral space. A kit may contain a plurality of inserts of varying sizes to give a surgeon choice in selecting the insert which best approximates an intervertebral space. The insert <NUM> is roughly a rounded square having an annular wall <NUM> surrounding a top surface <NUM> and a bottom surface <NUM>. A threaded catch <NUM> is formed in the insert to mate with the threaded connection <NUM>. The interface between the disc insert, top surface, and annular wall <NUM> forms a first perimeter <NUM> and the interface between the disc insert bottom surface and the annular wall <NUM> forms a second perimeter <NUM>.

Figures lA-6C show aspects of exemplary implementations of devices and system which may include a kit with inserts <NUM> of various sizes. The inserts can be formed of plastic having radiopaque material therein. The insert may be coated with a radiopaque material or marker on one or more of a top surface <NUM>, a bottom surface <NUM>, an annular wall <NUM> and a perimeter ll7/<NUM>. In some instances the insert may have radiolucent regions <NUM> or portions and radiopaque portions or regions <NUM>.

When the tool <NUM> is connected to the insert <NUM>, the insert is then inserted between a top vertebra "VI" and a bottom vertebra "V2".

A system includes a kit with various size and thickness inserts <NUM> each connectable to the tool. The surgeon assesses the physical space for an insert and tries various inserts to ascertain the right size for an implantable device. After assessing the size and height of the insert, which can include visualization of the insert between an upper vertebra and a lower vertebra via at least one radiopaque region <NUM>, radiopaque coating or marker. After the size and shape for the final spinal disc spacer device (not shown) is assessed the insert is removed and replaced with a disc insert (not shown).

The insert <NUM> may have perimeters <NUM>/<NUM> and either perimeter, or a portion thereof: may be fom1ed of or coated with a radiopaque material.

A trial plate <NUM> is also disclosed. A trial plate mimics the size and shape of a plate, cage or other device used in spinal fusion procedures. Part of the kit may include different sized trial plates. The trial plate may be coated <NUM> with a radiopaque material.

<FIG> show aspects of trial plate and insert combinations with varying radiopaque portions. Trial plates provide positioning guides <NUM> for the placement of drills, drill guides or fasteners (such as screws) for affixing a stabilizing device to vertebra during spinal fusion procedures. However, vertebra size and shape vary and a kit having multiple plates and/or inserts to choose from allows a surgeon to customize the fit to the patient Having flexibility in the plate material further aids the surgeon in fit. In some instances radiopaque guide regions <NUM> surround positioning guides <NUM>. In some instances radiopaque edge markers <NUM> are fom1ed at the edges of the trial plate. In some instances radiolucent regions <NUM> are also provided on the trial plate. In <FIG> the insert <NUM> is radiopaque and visible through the radiolucent portion <NUM> of the trial plate <NUM>.

In <FIG> the trial plate is radiopaque except for the positioning guides
<NUM>. In <FIG> the trial plate <NUM> is radiopaque, but less radiopaque then the insert <NUM> or portions.

<FIG> illustrate a partial diagram of an arm/hand extremity and aspects of flexible radiopaque trial plates. <FIG> is a system overview of a flexible radiopaque trial plate and extremity <NUM>. The Ulna and Radius are shown in conjunction with a flexible at least partially radiopaque trial plate <NUM>. <FIG> illustrate additional flexible at least partially radiopaque trial plates <NUM> and additional device <NUM> showing the placement of positioning guides, radiopaque and radiotranslucent material and/or coating on flexible trial plates and associated methods of use as described in references to <FIG>.

By selection of concentrations of the radiopaque materials the insert or trial plate may be made distinguishable from the other. In some implementations, suitable materials for the inse1t or trial plate may include them1ocomp (compound EX06430H from material manufacturer: Sabic Innovative Plastics, <NUM> Plastics Avenue Pittsfield, MA <NUM>), which may include barium sulfate and ULTEM™ polyetherimide resin; other suitable materials can include tantalum, gold, platinum, iridium, palladium, and rhodium and are well recognized for their biocompatibility. Radiopaque coatings can be applied to plastics using a high-vacuum deposition process that results in dense thin - film coatings (typically less than <NUM>) that adhere to the surface of the device.

One or more of Barium Sulfate (BaSO4), Bismuth Subcarbonate (Bi2O2(CO3)), Bismuth Oxychloride (BiOCl), Bismuth Trioxide (Bi2O3), Barium or any salt thereof: e.g., barium aluminate, barium carbonate, barium hydroxide, barium oxide, barium fluoride, barium sulfide, barium titanate and Tungsten (W) may be used to provide radiopacity to one or more inserts or trial plates in some implementations. Radiopaque materials may be combined with and mixed into materials used for injection molding and thereby distributed throughout at least a portion of a device so manufactured.

Additional radiopaque: materials include iodine or salt thereof; organic iodine molecules used for contrast include iohexol, iodixanol, ioversol, diatrizoic acid [(or its anionic form, diatrizoate), also known as amidotrizoic acid, or <NUM>,<NUM>-diacetamido-<NUM>,<NUM>,<NUM>- triiodobenzoic], Iothalamate (used as the meglumine or sodium salt, or a combination), Ioxaglate (Ioxaglic acid (trade name Hexabrix)). They also include lead and lead salts and they include Bismuth compounds, such as bismuth trioxide, bisthmuth subcarbonate, bismuth oxychloride.

Additional radiopaque materials include alloys of transition metals, especially Cr and Co, but also including Ag, Au, Cd, Hf, In, Ir, La, Mo, Nb, Os, Pd, Pt, Re, Rh, Ru, Pd, Sb, Sn, Ta, Te, V, W, and Zr.

Alloys comprising Co, Cr,MO, Ni may be used as radiopaque coatings or additives. In some instances the plastic, resin or polymer base material contains or is coated with contains one or more of about <NUM>% to <NUM>% Cr; about <NUM>% to <NUM>% Ni; about <NUM>% to <NUM>% Mo; up to about <NUM>% Co: about <NUM>% to <NUM>% Cu; and may include trace amounts of Al and Ti.

In some instances the flexible plastic, resin or polymer base material contains or is coated with contains one or more of chromium <NUM>-<NUM> wt%; Molybdenum <NUM> max. Tungsten <NUM> max. Cobalt <NUM>-<NUM> Iron <NUM> max.

In some instances the flexible plastic, resin or polymer base material contains or is coated with contains stainless steel, nitinol, tantalum, MP35N alloy, platinum, titanium.

In some instances the flexible plastic, resin or polymer base material contains or is coated with contains chromium: vanadium; molybdenum; cobalt; titanium: aluminum; zirconium; silicon; and nickel;.

In some instances the fiexible plastic, resin or polymer base material contains or is coated with contains nickel-cobalt-chromium alloy.

In some instances the flexible plastic, resin or polymer base material contains or is coated with contains nickel-cobalt-chromium-molybdenum alloy.

In some instances the flexible plastic, resin or polymer base material contains or is coated with contains chromium, and further containing molybdenum, nickel, cobalt, and tungsten, and minor amounts of at least one of aluminum, niobium, titanium and vanadium.

In some instances the flexible plastic, resin or polymer base material contains or is coated with contains nickel-titanium alloy including a ternary element selected from the group consisting of iridium, platinum, gold, rhenium, tungsten, palladium, rhodium, tantalum, silver, ruthenium and halfnium.

In some instances the flexible plastic, resin or polymer base material contains or is coated with contains nitinol, titanium, titanium-vanadium-aluminum alloy, cobalt-chromium alloy, cobalt-chromium-molybdenum alloy, cobalt-nickel-chromium- molybdenum alloy, biocompatible stainless steel, tantalum, niobium, hafnium, tungsten.

In some instances the flexible plastic, resin or polymer base material contains or is coated with contains stainless steel, Nitinol, cobalt-chromium-nickel- molybdenum-iron alloy, or cobalt-chrome alloy or chonichrome.

In some instances the flexible plastic, resin or polymer base mate1ial contains or is coated with a cobalt alloy comprising from <NUM> to <NUM> weight percent chromium, from <NUM> to <NUM> weight percent molybdenum, up to <NUM> nickel, up to <NUM> iron, up to <NUM> manganese, and greater than <NUM> weight percent cobalt.

In some instances the flexible plastic, resin or polymer base material contains or is coated with a radiopaque cladding layer selected from the group consisting of platinum, gold, tantalum, tungsten, a platinum-iridium alloy, and palladium.

In some instances the flexible plastic, resin or polymer base material contains or is coated with an alloy comprising, by weight: a) at least about <NUM>% nickel; b) greater than <NUM>% to about <NUM>% molybdenum; c) greater than about <NUM>% of a combination of chromium and molybdenum: d) from zero to about <NUM>% cobalt; and e) greater than zero to about <NUM>% iron.

In some instances the flexible plastic, resin or polymer base material contains or is coated with an alloy comprising iron, chromium, and a first element selected from a group consisting of platinum, ruthenium, palladium, iridium, rhodium, gold, and osmium, the alloy having less than about <NUM>%, by weight of nickel and having a radiopacity greater than the radiopacity of UNS S31673.

In some instances the flexible plastic, resin or polymer base material contains or is coated with at least <NUM>% by weight of iron, from about <NUM>% by weight to about <NUM>% by weight of chromium, and greater than about <NUM>% by weight of a first element having a density greater than <NUM>/cc, the alloy having less than or equal to <NUM>% by weight of nickel and having a radiopacity greater than the radiopacity of UNS S31673.

In some instances the flexible plastic, resin or polymer base material contains or is coated with a nonmagnetic alloy comprising at least <NUM>% by weight of iron, between about <NUM>% and about <NUM>% by weight of chromium, less than about <NUM>% by weight of molybdenum, less than about <NUM>% by weight of cobalt, less than about <NUM>%; by weight of manganese, less than about <NUM>% by weight of copper, less than about <NUM>% by weight of nickel, less than about <NUM>% by weight of nitrogen, and between about <NUM>% and about <NUM>% by weight of a first element selected from a group consisting of platinum, ruthenium, palladium, iridium, rhodium, gold, and osmium, the alloy being substantially austenitic.

In some instances the flexible plastic, resin or polymer base material contains or is coated with a nonmagnetic nickel-cobalt-chromium-molybdenum [MP35N] alloy, platinum, titanium, a suitable biocompatible alloy, a suitable biocompatible material, and a combination thereof.

In some instances the flexible plastic, resin or polymer base material contains or is coated with alloy consists essentially of: from about <NUM> to about <NUM> weight percent chromium; from about <NUM> to <NUM> weight percent molybdenum; up to about <NUM> weight percent manganese; up to about <NUM> weight percent nickel, up to about <NUM> weight percent iron; up to about <NUM> weight percent carbon.

In some instances the flexible plastic, resin or polymer base material contains or is coated with a cobalt-chromium alloy comprising by weight percent: about <NUM> to about <NUM>% cobalt; about <NUM> to about <NUM>% chromium; about <NUM> to about <NUM>%, manganese; and about <NUM> to about <NUM>% Al, In, GA, Sn, or Ge, or mixture thereof; optionally further comprising up to about <NUM>%, Fe, Ni, Pd, or Pt, or mixture thereof: up to about <NUM>% gold; up to
about <NUM>% Ta, Nb, Mo, W, or V or mixture thereof; up to about <NUM>%Ir, Ru, Re, Ti, Si or Cu or mixture thereof; and up to about <NUM>% Zr, Hf: B, Y, or a rare earth metal or mixture thereof.

In some instances the flexible plastic, resin or polymer base material contains or is coated with a cobalt-chromium dental alloy comprising by weight percent: about <NUM> to about <NUM>% cobalt; about <NUM> to about <NUM>% chromium; about <NUM> to about <NUM>% manganese; about <NUM> to about <NUM>%, iron, nickel, palladium, or platinum, or mixture thereof; about <NUM> to about <NUM>% Al, In, Ga, Sn, or Ge, or mixture thereof; about <NUM> to about <NUM>% gold; and about <NUM> to about <NUM>% Ir, Rum Re, Ti, Si, or Cu, or mixture thereof; optionally further comprising up to about <NUM>% Ta, Nb, Mo, W, or V, or mixture thereof: and up to about <NUM>%, Zr, Hf, B, Y, or a rare earth metal, or mixture thereof.

In some instances the flexible plastic, resin or polymer base material contains or is coated with a metal selected from the group consisting of platinum, gold, tantalum, tungsten, platinum-iridium and palladium.

In some instances the flexible plastic, resin or polymer base material contains or is coated with stainless steel <NUM>, nitinol, a cobalt-chromium alloy, and other materials of similar radiopacity, plus an metal selected from the group comprising gold, gold alloys, tantalum, tantalum alloys, platinum, platinum alloys and other materials of similar radiopacity including <NUM> stainless steel, MP35N alloy, and 35NLT alloys; L-<NUM> chromium-cobalt-tungsten-nickel alloys (nominally <NUM>-<NUM> wt%Cr, <NUM>-<NUM> ,wt% W, <NUM>-<NUM>% Ni).

To make the insert or trial plate distinguishable from the other the perimeter <NUM>/<NUM> may be radiopaque and the edge or annular wall <NUM> not, or vice versa. Or the perimeters may be more radiopaque than the trial plate <NUM>, <NUM>, <NUM>, <NUM> or portions thereof.

Additional suitable materials for an insert or flexible trial plate base material (which is then coated with or has incorporated into a radiopaque material as previously mentioned) may include polypropylene (i.e., polyolefins, including polyethylene, polypropylene, polybutylene, etc), polyacrylate or methacrylates, polyalkyl(meth)acrylates), polypropylene sulfides, polybutylene terephthalates (including polyalkylene terephthalates or naphthalates). Pegylated copolymers, including pegylated styrenic block copolymer matrices: Polyurethanes, poly(N-vinylpyrrolidones), polycarbonates, polyphenylene oxides, polysiloxanes, phenoxy and epoxy resins. Additional compounds include synthetic polymers include, but are not limited to, aliphatic polyesters, poly(amino acids), copoly(ether-esters), polyalkylenes oxalates, polyanlides, tyrosine derived polycarbonates, poly(iminocarbonates), polyorthoesters, polyoxaesters, polyamidoesters, polyoxaesters containing amine groups, poly(anhydrides), polyphosphazenes, polysiloxanes, and combinations thereof. More specifically, biosynthetic polymers based on sequences found in poly(amino acid), poly(propylene fomarate), polyethylene, polyethylene terephthalate, poly(tetrafluoroethylene), polycarbonate, polypropylene and poly(vinyl alcohol), and combinations thereof. Examples of biodegradable polymers include aliphatic polyesters, poly(amino acids), polyalkylene oxalates, polyanlides, polyamido esters, poly(anhydrides), poly(beta-amino esters), polycarbonates, polyethers, polyoithoesters, polyphosphazenes, and combinations. More specific examples of biodegradable polymers include, but are not limited to, collagen (e.g., Collagen I or IV), fibrin, hyaluronic acid, polylactic acid (PLA), polyglycolic acid (PGA), polycaprolactone (PCL), poly(Lactide-co-Glycolide) (PLGA), polydioxanone (PDO), trimethylene carbonate (TMC), polyethyleneglycol (PEG), Collagen, PEG-DMA, or copolymers or mixtures thereof. Examples of non-biodegradable polymers include, but are not limited to, carbon, nylon, silicon, silk, polyurethanes, polycarbonates, polyacrylonitriles, polyanilines, polyvinyl carbazoles, polyvinyl chlorides, polyvinyl fluorides, polyvinyl imidazoles, polyvinyl alcohols, polystyrenes and poly(vinyl phenols), aliphatic polyesters, polyacrylates, polymethacrylates, acyl-sutostituted cellulose acetates, nonbiodegradable polyurethanes, polystyrenes, chlorosulphonated polyolefins, polyethylene
oxides, polytetrafluoroethylenes, polydialkylsiloxanes, and shape-memory materials such as poly (styrene-block-butadiene), copolymers or mixtures thereof.

In addition to the above materials thermoset or thermoplastic polymers or polymer resins, elastomers, or mixtures thereof may be used for the flexible trial plate base material which include those wherein the polymer or polymer resin contains an aromatic or heteroaromatic moiety, for example, phenyl, biphenyL pyridinyl, bipyridinyL naphthyl, pyrimidinyl, including derivative amides or esters of terephthalic acid or naphtha. Examples include those where the polymer or polymer resin comprises polyester, polyamide, polyethylene, polypropylene, polyethylenenaphthalate (PEN), polyethylene terephthalate (PET), polybutylene terephthalate (PBT), polyether etherketone (PEEK), polyamide, polyaryletherketone (PAEK), polyethersulfone (PES), polyethylenenimine (PEI), poly (p- phenylene sulfide) (PPS), polyvinyl chloride (PVC), :fluorinated or perfluorinated polymer (such as a polytetra:fluoroethylene (PTFE or TEFLON®), polyvinylidene difluoride(PVDF), a polyvinyl fluoride (PVF or TEDLAR®)).

Shown in <FIG> and <FIG> are aspects of a trial plate <NUM> that is a dynamic adjustable template or trial which may be one of radiopaque, have radiopaque regions or gradients, non-radiopaque. A main body <NUM> is shown with two extended am1s <NUM> and <NUM>'. In some instances at least one window gap <NUM> is formed by an annular wall is provided for visualization of structure below the device. Those of ordinary skill in the art will understand that a single am1ed variant wherein one of arms <NUM> and <NUM>' is removed is optionally a variant for some uses and is also within the scope of the disclosure. Each arm having an end <NUM> and each arm is configured into at least one subarms 420A-420C and 420A'-420C'
which are further separated from the main body and each other by adjustment openings or slots 430A-430C and 430A '-420C'. The slots may be further configured to form shaped gaps. Additional one or more windows, also referred to as separation guides or guides <NUM> formed by an annular wall <NUM> through the arm may be placed between subam1s. As illustrated in Figures 9A-10B the slotted regions may be curved, straight or a combination of curves arid straight sections.

<FIG> shows aspects of an implementation <NUM> with a body <NUM>, with two extended arms <NUM> and <NUM>' and subarms 420A-420C with straight slots 430A-430C and a window <NUM> through the subarm separating said subarm from the adjacent subarm via one or more connecting rib <NUM>. The location of the connecting ribs as shown in <FIG> may be ar1ywhere along the slot thereby fom1ing a window. The connecting ribs are generally perpendicular to the subarms. The subarms may also be attached to an adjacent subam1 or the main body via an unbroken edge <NUM>. A break zone <NUM> may be added to mark and/or provide a frangible region to disassociate at. The connecting ribs may be a lesser thickness that the arms, a greater thickness or the same thickness. The connecting ribs may be configured to be frangible through adjustment of said thickness. Forming slots or gaps or windows adjacent to ribs or frangible regions provide for visual inspection of areas under the trial plate between subarms.

Break zones <NUM> which include but are not limited to divots, indentations, grooves, thin areas and weak regions may be fom1ed in the am1 configured to facilitate breakage at a designated area.

<FIG> shows aspects of an implementation <NUM> with a body <NUM>, with two extended arms <NUM> and <NUM>' and subarms 420A-420C. Non-parallel slots 430A-430C and a non-rectangular window <NUM> comprising curved p01tions <NUM> and straight portions <NUM> window through which a subarm is separated from the adjacent subarm via one or more connecting rib <NUM> or an unbroken edge which may have a break zone <NUM>. The connecting ribs and/or break zone form a gap between the subarms.

The slots and windows cooperate to form frangible regions configured to provide a weak area at which subarms may be disassociated from the arm, body and/or the trial plate. Rib or ribs <NUM> may be formed between subarms or the body and aim are interposed at edges or through the slot to connect adjacent arm members. The ribs are configured to be frangible or small enough in size to be subject to manual cutting.

Disassociation of subam1s is used to dynamically customize the length of said trial plate. The slots (as shown in <FIG>) may be open, closed, straight, curved, or a complex shape of curves and straight regions. The shape the guide or guides outline is configured to approximate a predetermined shape such as the shape of an implant the trial plate is used with whereby the implant (not shown) can be visualized to prepare a site for surgery, implantation and the like. Between two 1ibs the area of slot may be referred to as a window. The slots are an adjustment means as such they may be straight or form a complex non-linear path providing at least one of a visualization of an implant and a weakened area that can be broken to reveal the side edge <NUM> of the remaining portion of a subam1 and thereby approximating the shape and size of an implant. The slots define an absence of material in the trail plate. Subarms are connect to adjacent subarms and the main body (<NUM>) via frangible regions. In some instances additional guides <NUM> are also provided near slots. Although one additional guide <NUM> per subarm is shown, those of ordinary skill in the art will understand that a plurality of additional guides may be added without departing from the scope of the invention (See <FIG>). The separation guide may be configured to provide a fu1ther silhouette or path to shape an edge <NUM> which will be revealed after breaking off or otherwise disassociating subarm 420C from the device. The slots define a silhouette/outline or shape of the side edge. Separation guides adjacent to slots cooperate with the slots to define the silhouette or edge of a subarm.

On either side of the center of the trial plate <NUM> bumps (in one exemplar) are shown forming a visual and /or tactile marker <NUM>. Although shown as extended lateral edges from the trial plate, they may also be indentations, raised sections or indentations. The purpose of the markers are to provide a cue about where an implant would be positioned. The edges or subam1s or body of the trial plate may be radiopaque to facilitate viewing of same. Finally, a driver interface <NUM> is provide on the trial plate to form a connection with a tool used to one of hold, move, insert and remove the trial plate.

While the agent have been described in terms of what are presently considered to be the most practical and preferred implementations, it is to be understood that the disclosure need not be limited to the disclosed implementations. It is intended to cover various modifications and similar arrangements included within the scope of the claims. The present disclosure includes any and all implementations of the following claims.

Claim 1:
An adjustable implant template comprising:
a flexible trial plate (<NUM>) having a main body (<NUM>) and two arms (<NUM> and <NUM>') extending from said main body;
each said arm comprising:
at least two subarms (420A-C, 420A'-C') extending from each said arm (<NUM>);
one or more slots (<NUM>) interposed between said subarms and at least partially separating said subarms;
wherein removal of a subarm from at least one end of said arms reduces a length of said trial plate,
characterized in that the main body is monolithic,
and in that each arm comprises ribs (<NUM>) connecting said subarms and separating said subarms from said main body, defining said one or more slots.