Patent Description:
Spinal fusion is a procedure in which damaged vertebrae are removed, and vertebrae adjacent to the removed vertebrae are fused together with graft material. The spine must be immobilized during fusion. To immobilize the spine, one or more fixation rods are anchored to the vertebrae to limit movement.

Fixation rods are anchored to vertebrae using bone screws that are driven into the vertebrae. Before a bone screw is driven into a vertebral body, a hole is prepared in the vertebral body in a minimally invasive manner with help of a universal drill guide system. In one possible procedure, a drill tube is passed through a small incision and navigated to a desired entry point on the vertebral body. A cortical punch is then advanced through the tube to punch a start hole in the cortical layer of bone. The cortical punch is then removed from the tube, and a drill bit is advanced through the tube to the start hole. Once the drill bit is aligned with the start hole, the surgical drill is powered on to drill a hole of a desired diameter and depth. After the screw hole is drilled, the drill guide is removed, and a bone screw can be driven into the screw hole.

When drilling a screw hole, the depth of drilling must be carefully controlled to ensure that the drill bit does not penetrate too far into the vertebral body. One option for control drill depth is to attach some type of drill stop on the drill tube to limit how far the tip of the drill bit extends past the end of drill tube in the patient. This option may be difficult to implement, however, if there are multiple drill bits and drill tubes of different sizes that must be accommodated.

Guiding drill bits to the proper location can be difficult. Therefore, some drill bits have passages that allow the drill bits to be passed over a Kirschner wire or "K-wire". A K-wire can be attached to a bone at a desired location to precisely navigate the drill bit and other instruments to that location. Although K-wires are helpful for navigation, they present a number of challenges when other instruments are used around them.

The multiple drill bits and the multiple drill tubes are especially needed in the case when different screw holes are to be drilled. In order to drill screw holes having different sizes to each other, the drill bits are designed to have different drill diameters or different dimensions to each other. Thus, the surgeon has to at first carefully select the desired drill bits and the corresponding drill tubes before assembling them. On one hand, selection errors can occur since it is not easy to recognize the (diameter) differences between the multiple drill bits and the multiple drill tubes. On the other hand, the selection process largely increases the operation duration.

Further prior art is known from <CIT> and <CIT>.

In connection with this, the present disclosure is based on the object of providing a universal drill guide system in which multiple drill bits and multiple drill tubes are easily selected to avoid operation errors while shortening the operation duration.

This object is achieved according to the present invention, as claimed in the accompanying claims, by a universal drill guide system comprising a plurality of drill tubes each with a drill bit passage; and a plurality of drill bits each insertable into the drill bit passage of a corresponding one of the plurality of drill tubes, respectively. Each of the drill bit passages has an inner diameter different from that of any one of the other drill bit passages. Each of the plurality of drill bits has an outer diameter different from that of any one of the other drill bits. The outer diameter of each of the plurality of drill bits corresponds to the inner diameter of a respective one of the drill bit passages In this way, each of the plurality of drill tubes is designed to work only with the respective one of the plurality of drill bits. Thereby, an insertion of an improper drill bit into an improper drill tube is avoided. At the same time, the surgeon can easily select the corresponding pair of drill bit and drill tube to shorten the operation duration. The universal drill guide system comprises further a universal drill guide. The plurality of drill tubes is insertable into an opening of the universal drill guide. The plurality of drill tubes have the same outer dimensions. Thereby, the different drill tubes can be inserted into the universal drill guide/ its opening in the same way. The assembly process of the drill tubes with the universal drill guide can be efficiently shortened. It is of particular advantage that the universal drill guide comprises an auto drill tube capture allowing the plurality of drill tubes to be inserted into the opening of the universal drill guide with a quick-fit connection. Thereby, the assembly of the drill tubes with the universal drill guide can be efficiently facilitated and shortened. Neither additional process, e.g. screwing into the universal drill guide nor additional auxiliary elements for the connection are needed. The auto drill tube capture includes a locking ring rotatable in the universal drill guide between a locking orientation and a release orientation.

Advantageous embodiments of the present disclosure are claimed in the subclaims and explained more precisely in the following.

Preferably, the plurality of drill tubes include (at least) a first drill tube, a second drill tube and a third drill tube, and the plurality of drill bits include (at least) a first drill bit corresponding to the first drill tube, a second drill bit corresponding to the second drill tube and a third drill bit corresponding to the third drill tube.

Each of the plurality of drill tubes has a matching indicium different from that of any one of the other drill tubes. Each of the plurality of drill bits has a matching indicium different from that of any one of the other drill bits. The matching indicium of each of the drill bits corresponds to the matching indicium of each of the plurality of drill tubes, respectively. Preferably, the different matching indicia appear in the form of different colored bands around a circumferential of each of the plurality of drill tubes and each of the plurality of drill bits. The indicia are used to assist the user in selecting the proper drill tube for the selected drill bit. Thereby, the selection process of the drill tube and the drill bit is facilitated and shortened, while a selection error can be efficiently prevented.

The auto drill tube capture further includes a compression spring exerting a biasing force on the locking ring to bias the locking ring in the locking orientation. The auto drill tube capture additionally comprises a switch to manually rotate the locking ring from the locking orientation to the release orientation against the biasing force of the compression spring.

It is preferable that the locking ring comprises a chamfer extending inwardly, which is orientated/configured such that a side wall of the drill tube inserted into the auto drill capture deflects the locking ring with an angle in a direction against the bias of the compression spring from the locking orientation. The locking ring remains deflected until a notch formed on an outer circumferential surface of the drill tube aligns with the chamfer. In this way, the drill tubes can be inserted into the universal drill guide with a quick-fit connection.

Each of the plurality of drill bits comprises a K-wire passage for receiving one of a plurality of K-wires. The K-wire passage of each of the plurality of drill bits has an inner diameter different from that of any one of the other K-wire passages. Each of the plurality of K-wires has an outer diameter different from that of the other K-wires. The outer diameter of each of the K-wires corresponds to the inner diameter of a respective one of the K-wire passages. Thereby, the K-wire can be received only by the corresponding drill bit. In other words, each of the plurality of drill bits is designed to work only with the respective one of the plurality of K-wires. The selection/assembling error can thus be prevented while the selection/ assembling duration can be shortened.

Moreover, each of the plurality of drill bits has a drilling diameter different from that of the other drill bits. In other words, the plurality of drill bits have different drilling diameters configured to drill different screw holes.

Furthermore, each of the plurality of drill bits has a proximal end for attachment to a drill driver and an opposite distal end with a cutting edge to drill a screw hole.

Preferably, the universal drill guide comprises a drill stop. Each of the plurality of drill bits has a stop surface located between the proximal end and the distal end. The stop surface cooperates with the drill stop to limit how far the drill bits can be advanced into a bone during drilling. Improper depth of drilling can therefore be prevented.

The foregoing summary and the following detailed description will be better understood in conjunction with non-limiting examples shown in the drawing figures, of which:.

The following section describes different instruments used for fixation of the cervical spine according to the present disclosure.

In the present disclosure, "distal" basically means "in a direction away from a user/ surgeon towards a patient" and "proximal" basically means "in a direction towards the user/ surgeon away from the patient".

Referring to <FIG>, a universal drill guide system <NUM> is shown according to one example. The universal drill guide system <NUM> features a universal drill guide <NUM>. The universal drill guide <NUM> includes a tubular guide body <NUM> and a handle <NUM> that extends obliquely from the guide body <NUM>. The guide body <NUM> has a proximal end <NUM> defining a proximal opening <NUM> for receiving a drill bit, as will be described. The guide body <NUM> also has a distal end <NUM> defining a distal opening <NUM> for receiving a drill tube, as will be described. Furthermore, the guide body <NUM> features a drill stop <NUM> that limits drilling depth by limiting how far a drill bit is advanced through the guide body <NUM>. An optional navigation star unit <NUM> is attached to the universal drill guide <NUM> in <FIG>, which can be calibrated and used with conventional navigation systems.

The universal drill guide system <NUM> also includes a set of interchangeable drill tubes <NUM> and a set of interchangeable drill bits <NUM>. The set of interchangeable drill tubes <NUM> includes a first drill tube 150A, a second drill tube 150B, and a third drill tube 150C. The set of interchangeable drill bits <NUM> includes a first drill bit 200A, a second drill bit 200B and a third drill bit 200C. The number of the drill tubes <NUM> and the number of drill bits <NUM> are however not restricted to three. All of the drill tubes 150A, 150B and 150C, and all of the drill bits 200A, 200B and 200C are connectable to the universal drill guide <NUM>.

The first, second and third drill bits 200A, 200B and 200C are cannulated and have features designed to retain a K-wire, as will be explained in the next section of this description. The first, second and third drill bits 200A, 200B and 200C also have different drilling diameters. Each drilling diameter is configured to drill a screw hole of a specific size into a vertebral body. The first, second and third drill bits 200A, 200B and 200C each have a proximal end <NUM> for attachment to a drill driver and an opposite distal end <NUM> with cutting edges to drill a hole. The first, second and third drill bits 200A, 200B and 200C also have a reduced diameter section <NUM> adjacent to an enlarged diameter section <NUM>, forming an abrupt transition. This abrupt transition forms a stop surface <NUM> located between the proximal end <NUM> and the distal end <NUM>. The stop surfaces <NUM> cooperate with the drill stop <NUM> on the guide body <NUM> to limit how far the drill bits can be advanced into the vertebral body during drilling. The stop surfaces <NUM> also play a role in removing the drill bits 200A, 200B and 200C after a drilling operation, as will be explained in another section.

The first, second and third drill tubes 150A, 150B and 150C are designed to guide the advancement of the first, second and third drill bits 200A, 200B and 200C, respectively, during drilling. The first, second and third drill tubes 150A, 150B and 150C also keep the first, second and third drill bits 200A, 200B and 200C axially stable during drilling. Each of the first, second and third drill tubes 150A, 150B and 150C has a proximal end <NUM> for attachment to the guide body <NUM> and an opposite distal end <NUM> that is inserted into the patient at the drilling location. The proximal end <NUM> of each of the drill tubes 150A, 150B and 150C includes a notch <NUM> that facilitates attachment to the guide body <NUM>, as will be described in more detail.

The first, second and third drill tubes 150A, 150B and 150C define a drill bit passages <NUM> having inner diameters specially sized to receive the first, second and third drill bits 200A, 200B and 200C, respectively. Thus, the first, second and third drill bits 200A, 200B and 200C are designed to only work with the first, second and third drill tubes 150A, 150B and 150C, respectively. Indicia are provided on each of the first, second and third drill tubes 150A, 150B and 150C, and each of the first, second and third drill bits 200A, 200B and 200C, to assist the user in selecting the proper drill tube for the selected drill bit. Any type of indicia can be used. In the system <NUM>, the first drill tube 150A and the first drill bit 200A have matching indicia 160A, the second drill tube 150B and the second drill bit 200B have matching indicia 160B, and the third drill tube 150C and the third drill bit 200C have matching indicia 160C. The indicia 160A, 160B and 160C are unique and different from one another, and appear in the form of different colored bands around the circumference of each drill tube and drill bit.

Referring to <FIG>, the drill stop <NUM> has a shaft <NUM> and a stop plate <NUM> extending laterally from the shaft <NUM>. The stop plate <NUM> has a slot <NUM> having a slot dimension that is wide enough to permit passage of the distal sections of the first, second and third drill bits 200A, 200B and 200C through the stop plate <NUM>. The slot <NUM> is smaller than the cross sectional dimension of the stop surfaces <NUM> of the first, second and third drill bits 200A, 200B and 200C. In this arrangement, the stop plate <NUM> is configured to permit advancement of each of the first, second and third drill bits 200A, 200B and 200C through the stop plate <NUM> up until their respective stop surfaces <NUM> abut on the stop plate <NUM>. At such time, the drill bit has reached the selected drill depth, and further advancement of the drill bit through the guide body <NUM> is prevented.

Referring to <FIG>, the drill stop <NUM> can be raised or lowered to set a desired drilling depth setting. A spring loaded lock <NUM> releasably engages with the shaft <NUM> of the drill stop <NUM> to lock and unlock the shaft <NUM>. The shaft <NUM> has a series of circumferential grooves <NUM> in one side. The spring loaded lock <NUM> is configured to engage with one of the grooves <NUM> to lock the position of the shaft <NUM> under a spring bias. The spring loaded lock <NUM> includes a release button <NUM> that can be pressed inwardly as shown in <FIG>. Pressing the release button <NUM> inwardly disengages the spring loaded lock <NUM> from the shaft <NUM> so the shaft <NUM> can be raised or lowered relative to the guide body <NUM> to set the depth setting. Once the depth setting is set, the release button <NUM> is released as shown in <FIG> to allow the spring loaded lock <NUM> to engage with the shaft <NUM> under the spring bias. Engagement of the spring loaded lock <NUM> with the shaft <NUM> locks the vertical position of the shaft <NUM> relative to the guide body <NUM> and fixes the depth setting.

The universal drill guide <NUM> includes two sets of indicia on the exterior that provide the user with a visual indicator of the selected depth setting. A first set of indicia <NUM> include a vertical series of markings 128a on the side of the guide body <NUM>. A second set of indicia <NUM> include a vertical series of markings 148a on the shaft <NUM>. Each of the marking 128a, 148a is labeled with a unique number corresponding to a depth in millimeters or other unit of measure. The markings 128a are oriented on a different side of the universal drill guide <NUM> than the markings 148a. This placement of redundant markings on two different sides addresses situations where the surgeon can only see one side of the universal drill guide <NUM>.

The guide body <NUM> includes an auto drill tube capture <NUM> that allows each of the first, second and third drill tubes 150A, 150B and 150C to be connected to the distal opening <NUM> in a quick-connect coupling/ with a quick-fit connection. The auto drill tube capture <NUM> allows a user to insert one of the drill tubes 150A, 150B and 150C into the guide body <NUM> and lock it in place without touching any locking mechanisms on the guide body <NUM>. The drill tube is simply inserted into the distal opening <NUM> until it engages with an automatic lock. Each of the drill tubes 150A, 150B and 150C has a different inner diameter to accommodate one of the drill bits, as noted above. However, all of the drill tubes 150A, 150B and 150C have the same outer dimensions that engage with the drill stop <NUM> and the auto drill tube capture <NUM>. Therefore, all of the drill tubes 150A, 150B and 150C interact with the auto drill tube capture <NUM> the same way.

Referring to <FIG>, the auto drill tube capture <NUM> includes a spring loaded locking ring <NUM> inside the guide body <NUM>. The locking ring <NUM> is configured to snap into the notches <NUM> formed in each of the drill tubes 150A, 150B and 150C. The locking ring <NUM> is rotatable in the guide body <NUM> between a locking orientation and a release orientation. A pair of compression springs <NUM> exert a counterclockwise biasing force on the locking ring <NUM> to bias the locking ring <NUM> in the locking orientation. Each compression spring <NUM> bears against a locking tab <NUM> that extends in a proximal direction or upwardly from the rest of the locking ring <NUM>.

The locking tabs <NUM> and the compression springs <NUM> are captive in a pair of slots <NUM>. One end of each compression spring <NUM> bears against an end wall <NUM> of the slot <NUM>, and the opposite end of the spring <NUM> bears against the locking tab <NUM>. In this arrangement, the locking ring <NUM> is maintained in the locking orientation unless the user manually rotates the locking ring <NUM> to the release orientation. The locking ring <NUM> can be rotated by exerting a clockwise force on a switch <NUM> that is attached to the locking ring. The switch <NUM> extends through an elongated aperture <NUM> in the guide body <NUM> and is exposed on the exterior of the guide body <NUM>.

When the locking ring <NUM> is in the locking orientation, as shown in <FIG>, the compression springs <NUM> have released energy to push the locking tabs <NUM> in a counterclockwise direction in their respective slots <NUM> to rotate the locking ring <NUM> counterclockwise. When the locking ring <NUM> is in the release orientation, as shown in <FIG>, the locking tabs <NUM> are rotated in a clockwise direction to compress the compression springs <NUM> in their respective slots <NUM> under stored energy. The user can move the locking ring <NUM> from the locking orientation to the release orientation by manually rotating the switch <NUM> in the clockwise direction.

<FIG> show a sequence in which a drill tube, in this example the first drill tube 150A, is inserted into the guide body <NUM> and locked in place by the locking ring <NUM>. The same sequence occurs when the second drill tube 150B and the third drill tube 150C are inserted into the guide body <NUM>.

The drill tube 150A is inserted through the distal opening <NUM> and into a passage <NUM> formed in the guide body <NUM>, as shown in <FIG>. The locking ring <NUM> is initially disposed in the locking orientation. The drill tube 150A is advanced into the passage <NUM> until it enters the locking ring <NUM>, as shown in <FIG>. As the drill tube 150A continues to advance, the drill tube 150A contacts an interior surface of the locking ring <NUM>, as shown in <FIG>. This contact between the drill tube 150A and the locking ring <NUM> causes the locking ring <NUM> to rotate out of the locking orientation. Contact with the locking ring <NUM> occurs at a chamfer <NUM> on the locking ring <NUM> that extends into the passage <NUM>. The proximal end and the sidewall of the drill tube 150A contact the chamfer <NUM> as the drill tube 150A is advanced proximally in the passage <NUM>. The orientation of the chamfer <NUM> is configured such that the side wall of the drill tube 150A deflects the locking ring <NUM> with a small distance/ a small angle in a counterclockwise direction against the bias of the compression springs <NUM>, storing additional energy in the springs <NUM>. This deflection begins in <FIG> and continues in <FIG>.

As the drill tube 150A is advanced further into the passage <NUM>, the locking ring <NUM> remains deflected until the notch <NUM> in the drill tube 150A aligns with the chamfer <NUM>, as shown in <FIG>. When this alignment occurs, the force deflecting the locking ring <NUM> is temporarily released, allowing the compression springs <NUM> to expand and return to their relaxed state. This expansion causes locking ring <NUM> to rotate back toward the locking orientation. The chamfer <NUM> snaps radially inwardly into the notch <NUM> under the bias of the compression springs <NUM>. The axial dimension of the locking ring <NUM> is substantially equal to the axial dimension of the slot <NUM>, such that the axial position of the drill tube 150A is fixed and locked in the guide body <NUM>.

<FIG> shows a cross section showing the locking ring <NUM> in the locking orientation. The portion of the locking ring <NUM> that engages with the notch <NUM> is circled. <FIG> shows a cross section showing the locking ring <NUM> in the release orientation. In this condition, no portion of the locking ring <NUM> extends into the notch <NUM>. As can be appreciated from these two Figures, the drill tube 150A can be removed from the guide body <NUM> by rotating the switch <NUM> in the counterclockwise direction against the bias of the compression springs <NUM>. This rotation moves the chamfer <NUM> out of the notch <NUM>, as shown in <FIG>. In this state, the drill tube 150A is no longer axially restrained by the locking ring <NUM> and can be pulled out of the guide body <NUM>.

The drill bits 200A, 200B and 200C each have an outer diameter that corresponds to the inner diameter of the drill tubes 150A, 150B and 150C, respectively. Each of the drill bits 200A, 200B and 200C is long enough to extend from above the drill stop <NUM> to beyond the distal end of the drill tube 150A when the drill tube 150A is attached to the guide body <NUM>.

After drilling is completed, it is sometimes necessary to remove the drill driver and the universal drill guide <NUM> from the operating side while leaving the drill tube and drill bit in place. This can be a technical challenge, because the drill stop <NUM> is engaged with the drill bit as shown in <FIG>. Therefore, the universal drill guide <NUM> includes a mechanism that pivots the drill stop <NUM> counterclockwise and away from the drill bit as the universal drill guide <NUM> is released from the drill tube. This is accomplished with a camming mechanism <NUM> that interconnects the locking ring <NUM> with the shaft <NUM> of the drill stop <NUM>, as shown in <FIG>.

The locking ring <NUM> includes a cam slot <NUM> that drives a cam following pin <NUM> at the bottom of the shaft <NUM>. With this arrangement, rotation of the locking ring <NUM> clockwise (or left in the Figures) causes the shaft <NUM> and drill stop <NUM> to simultaneously rotate counterclockwise (or right in the Figures), moving the drill stop <NUM> away from the drill bit so that the universal drill guide <NUM> can be lifted off of the drill tube while the drill tube and drill bit remain in the patient. The process of lifting universal drill guide <NUM> off of drill tube 150A is illustrated in <FIG>.

It can be seen in <FIG> that the switch <NUM> on the locking ring <NUM> is rotated clockwise or to the left. This pivots the drill stop <NUM> counterclockwise or to the right. While disengaging the drill stop from drill bit 200A, the universal drill guide <NUM> can be lifted off of the drill tube 150A and the drill bit without being inhibited, as shown in <FIG>.

The first, second and third drill bits 200A, 200B and 200C are cannulated and have features designed to retain a K-wire, as described previously. The drill bits 200A, 200B and 200C are generally the same, but have a few differences. The outer diameters of the drill bits 200A, 200B and 200C are different, with each outer diameter configured to drill a hole of a different size. The inner diameter of the drill bit 200A is smaller than the inner diameters of the drill bits 200B and 200C, with the inner diameter of the drill bit 200A configured to allow a K-wire having a diameter of <NUM> to pass through the drill bit 200A. The inner diameters of the drill bits 200B and 200C are larger, each configured to allow a K-wire having a diameter of <NUM> to pass through the drill bits 200B, 200C. The drill bits 200A, 200B and 200C also have different colored indicia on their exterior to assist the user in pairing each drill bit with its corresponding drill tube.

Referring now to <FIG>, a drill bit assembly with the drill bit 200A will be described in more detail, with the understanding that the same description applies to the drill bits 200B and 200C. The drill bit 200A is shown with a K-wire <NUM>. The K-wire <NUM> extends through a passage <NUM> that extends through the drill bit 200A from the proximal end <NUM> to the distal end <NUM>. The K-wire <NUM> has a proximal end <NUM>, a distal end <NUM> and a wire body <NUM> extending between the proximal and distal ends. The distal end <NUM> has a sharp pointed end <NUM> that can be punched into the bone at a selected location. Once the K-wire <NUM> is punched into the bone, a surgeon can pass a cannulated bone screw, a drill bit, or other instruments over the K-wire and advance it to the selected location to perform an operation.

The K-wire <NUM> is significantly longer than the drill bit 200A. Therefore, the K-wire <NUM> can extend through the drill bit 200A with the proximal end <NUM> of the K-wire projecting proximally and outside of the proximal end <NUM> of the drill bit 200A. At the same time, the K-wire <NUM> can extend through the drill bit 200A with the distal end <NUM> of the K-wire projecting distally and outside of the distal end <NUM> of the drill bit 200A. The K-wire <NUM> is releasably securable inside the drill bit 200A as an assembly that allows the K-wire and the drill bit to be drilled into a bone together.

Referring to <FIG>, K-wire <NUM> is releasably secured to the inside of the drill bit 200A during drilling by a retention mechanism <NUM> that is built into the drill bit. The retention mechanism <NUM> is configured to engage with the K-wire <NUM> to prevent axial advancement of the K-wire relative to the drill bit 200A during drilling. This retention ensures that the K-wire <NUM> and the drill bit 200A are inserted together and advance the same amount into the bone. The retention mechanism <NUM> also allows torque applied to the drill bit 200A to be transferred to the K-wire <NUM>. Thus, the K-wire <NUM> and the drill bit 200A rotate in unison when the retention features are engaged. A torque driver can apply torque to the K-wire <NUM> and the drill bit 200A in unison to plant the K-wire in the bone and form a pilot hole for a bone screw. Once the pilot hole is drilled, the drill bit 200A can be disengaged from the K-wire <NUM> and removed from the patient while leaving the K-wire in the bone.

The retention mechanism <NUM> includes a retention clip <NUM> configured to releasably engage with a locking groove <NUM> on an exterior portion of the K-wire <NUM>. The locking grooves and the retention clips according to the present disclosure can have various forms and geometries. For example, the locking groove can extend around a portion of the K-wire, or completely surround the K-wire in a circumferential manner. The retention clip can be clipped onto the exterior of the drill bit, or be formed integrally with the drill bit. The retention clip can also have an inward-extending retention end that can be pressed into the locking groove to limit axial displacement of the K-wire in the drill bit.

The retention clip <NUM> has a hub portion <NUM> that attaches the retention clip to the drill bit 200A. The retention clip <NUM> also has a retention end <NUM> opposite the hub portion <NUM>. The retention end <NUM> projects radially inwardly through a sidewall of the drill bit <NUM> to engage with the locking groove <NUM> of the K-wire <NUM>.

The K-wires according to the present disclosure can have a geometry in the locking groove that allows torque to be transferred from the drill bit/the retention clip to the K-wire. For example, the K-wire can have a flat surface on a portion of its exterior in the groove that engages with a flat edge on the retention end of the retention clip. <FIG> shows an example of a K-wire <NUM> with a locking groove <NUM> that has a four-sided square-shaped section <NUM> in the groove. The K-wire <NUM> can work with a retention clip formed in a drill bit according to any of the previous examples, such as the drill bit 200A.

Locking grooves according to the present disclosure can be bounded by a proximal end wall and a distal end wall. The proximal and distal end walls can have different geometries that control axial displacement of the K-wire relative to the surrounding drill bit. In the example in <FIG>, the locking groove <NUM> has a proximal end wall <NUM> and a distal end wall <NUM>. The distal end wall <NUM> is substantially perpendicular to a longitudinal axis <NUM> of the K-wire <NUM>. This forms a stop <NUM> that can abut on the retention end <NUM> of the retention clip <NUM> when the retention clip <NUM> is engaged in the locking groove <NUM>, thereby preventing relative displacement of the K-wire <NUM> in the distal direction. In contrast to the distal end wall <NUM>, the proximal end wall <NUM> consists of inclined surfaces <NUM> extending at an acute angle relative to the longitudinal axis <NUM>. The inclined surfaces <NUM> form a ramped section <NUM> that allows the retention end <NUM> of the retention clip <NUM> to gradually deflect outwardly and slide out of the locking groove <NUM> during withdrawal of the drill bit 200A from the K-wire <NUM> after drilling is completed.

The retention clip <NUM> is operable in a locked mode and a released mode. In the locked mode, the retention end <NUM> is pressed and held inwardly in the locking groove, as shown in <FIG>. This locks the axial position of the K-wire <NUM> relative to the drill bit <NUM> during drilling. After drilling is complete, the inward force on the retention end <NUM> can be removed, leaving the retention clip <NUM> in the released mode. In the released mode, it is possible to move the drill bit <NUM> in a proximal direction relative to the K-wire <NUM> until the drill bit is completely removed from the K-wire. This allows the drill bit 200A to be withdrawn from a patient while leaving the K-wire <NUM> in the patient for further use.

Referring to <FIG>, the retention clip <NUM> has a partially-cylindrical hub portion <NUM> configured to clip onto the rounded exterior of a drill bit, similar to a pocket clip on a pen. The retention clip <NUM> also has a flexible arm <NUM> between hub portion <NUM> and a retention end <NUM>. The flexible arm <NUM> allows the retention end <NUM> to flex radially outwardly under stored energy as the drill bit is withdrawn from the K-wire. The retention end <NUM> remains deflected in an outward position as the drill bit is removed from the K-wire. Once the drill bit is removed from the K-wire, the retention end <NUM> snaps back in the radially inward direction to its relaxed state shown in <FIG>.

Force can be applied to the retention ends of the retention clips in a radially inward direction to press and hold the retention clips in the engaged mode with the locking groove. The inward force can be applied in a number of ways. <FIG> show another example of a drill bit assembly with a drill bit <NUM>' and a movable sleeve <NUM>'. The movable Sleeve <NUM>' is slidable over the exterior of the drill bit <NUM>' between a first position and a second position. In the first position (<FIG>), the sleeve <NUM>' covers the retention end <NUM>' and applies an inward force to it to hold the retention clip <NUM>' in the engaged mode. In the second position (<FIG>), the sleeve <NUM>' is moved off of the retention end <NUM>', allowing the retention end <NUM>' to flex outwardly to permit disengagement of the retention clip <NUM>' from the locking groove on a K-wire <NUM>.

In other examples, a separate instrument can be used to lock the retention clip into engagement with the K-wire. <FIG> show an example in which a retention clip <NUM> of a drill bit 200A is maintained in the engaged mode by a drill driver <NUM>. The drill driver <NUM> is clamped over the retention end <NUM> of the retention clip <NUM> and applies external force to maintain the retention clip <NUM> in the engaged mode in a four-sided locking groove <NUM> of a K-wire <NUM>.

Referring to <FIG>, a drill removal tool <NUM> is shown according to one example. The drill removal tool <NUM> is designed to remove a cannulated drill bit from the bone after a hole is drilled, while leaving the K-wire in place in the bone. Once the drill bit is removed from the K-wire, a bone screw can be advanced over the K-wire and driven into the screw hole. The drill removal tool <NUM> can be used with any combination of drill bit, drill tube and K-wire. For purposes of this description, the drill removal tool <NUM> will be described in use with the same drill bit 200A, drill tube 150A and K-wire <NUM> described previously.

The drill removal tool <NUM> includes a first support end <NUM>, a second support end <NUM> and a toothed rack <NUM> extending between the first support <NUM> end and second support end <NUM>. The first support end <NUM> includes a wire clamp <NUM> operable to clamp onto the K-wire <NUM>. The second support end <NUM> include a C-shaped base <NUM> configured to fit snugly around the drill tube 150A. A drill bit remover <NUM> is axially displaceable on the toothed rack <NUM> between the first support end <NUM> and the second support end <NUM>.

Referring to <FIG>, the wire clamp <NUM> is configured to be passed over the exposed end of the K-wire <NUM> in an unlocked state, and subsequently clamp the K-wire <NUM> in a locked state. The wire clamp <NUM> includes a hollow housing <NUM> which extends from the first support end <NUM>. The hollow housing <NUM> defines a clamp passage <NUM> having a proximal end <NUM>, a distal end <NUM> and a converging section <NUM> between the proximal end <NUM> and the distal end <NUM>. The proximal end <NUM> has an internal thread <NUM>. A knob <NUM> includes a dial <NUM> and a shaft <NUM> with an external thread <NUM> that mates with the internal thread <NUM> in the clamp passage <NUM>. The knob <NUM> defines a through bore <NUM> that axially receives a clamping pin <NUM>. The clamping pin <NUM> defines a through passage <NUM> and a wedge shaped collet <NUM> at its distal end <NUM>. The collet <NUM> has an outer diameter that gradually decreases toward the distal end <NUM>, forming a cone-shaped projection that conforms to the shape of the converging section <NUM>. The through passage <NUM> has an inner diameter adapted to receive the K-wire <NUM>.

The knob <NUM> is rotatable about a knob axis <NUM> between the unlocked state and the locked state. The knob axis <NUM> aligns coaxially with the through bore <NUM> and the through passage <NUM>. <FIG> shows the knob <NUM> in the unlocked state, and <FIG> shows the knob after it is rotated to the locked state. The internal thread <NUM> and the external thread <NUM> promote axial displacement of the knob <NUM> when the knob is rotated. The clamping pin <NUM> is axially fixed in the knob <NUM>, with the distal end <NUM> of the knob <NUM> abutting on the collet <NUM>. In this arrangement, the knob <NUM> and the clamping pin <NUM> move axially and in unison in the clamp housing <NUM> when the knob is rotated. The internal and the external threads <NUM>, <NUM> are oriented so that rotation of the dial <NUM> in a clockwise direction CW causes the knob <NUM> and the collet <NUM> to move distally into the converging section <NUM>. The tapered shape of the converging section <NUM> exerts inward force on the collet <NUM> as the clamping pin <NUM> moves distally, compressing the collet <NUM> so that it locks the K-wire <NUM> in a locked state.

The drill removal tool <NUM> is attachable over the K-wire <NUM>, the drill bit 200A and the drill tube in two steps. In a first step, the wire clamp <NUM> is passed over the K-wire. To pass the wire clamp <NUM> over the K-wire <NUM>, the knob <NUM> is rotated counterclockwise to the unlocked state so that the collet <NUM> is not compressed in the converging section <NUM> of the clamp passage <NUM>. Once the proximal end of the K-wire <NUM> passes through the wire clamp <NUM>, the second support end <NUM> and the C-shaped base <NUM> are pivoted toward the drill tube 150A in the direction shown by the curved arrow in <FIG>. The C-shaped base <NUM> is pivoted until the opening <NUM> in the C-shaped base receives the drill tube 150A in a snug fit.

Referring to <FIG>, the drill bit remover <NUM> includes a fork-shaped anvil <NUM> that defines a through slot <NUM>. The through slot <NUM> aligns with the clamp passage <NUM> and the opening <NUM>, forming a straight passage through all three parts of the drill removal tool <NUM>. The anvil <NUM> has a flat fork-lift surface <NUM> above through slot <NUM>. The through slot <NUM> and the fork-lift surface <NUM> are configured to engage with the drill bit 200A beneath the stop surface <NUM>, as mentioned earlier. The through slot <NUM> has a rounded end <NUM> with a diameter that is slightly larger than the reduced diameter section <NUM> on the drill bit 200A, but smaller than the enlarged diameter section <NUM>. Therefore, the anvil <NUM> is configured to receive the reduced diameter section <NUM> of the drill bit 200A into the through slot <NUM>, with the fork-lift surface <NUM> positioned beneath or distally with respect to the stop surface <NUM>. In this position, the fork-lift surface <NUM> abuts on the enlarged diameter section <NUM> at the stop surface <NUM>, as shown in <FIG>.

The drill bit remover <NUM> includes a sleeve <NUM> connected to the anvil <NUM>. The sleeve <NUM> surrounds the rack <NUM> and interconnects the anvil <NUM> with the C-shaped base <NUM>. A pinion housing <NUM> extends from one side of the sleeve <NUM> and contains a pinion <NUM>. The pinion <NUM> has a plurality of gear teeth <NUM> that mesh or engage with the teeth <NUM> on the rack <NUM> through an opening between the pinion housing <NUM> and the rack <NUM>. A wheel handle <NUM> is attached to the pinion <NUM> and extends outside of the pinion housing <NUM>. The wheel handle <NUM> and the pinion <NUM> are rotatable in unison relative to the pinion housing <NUM>. In this arrangement, the wheel handle <NUM> can be rotated to move the drill bit remover <NUM> up or down along the rack <NUM>.

Referring to <FIG> and <FIG>, a spring loaded pawl <NUM> releasably engages with the teeth <NUM> on the rack <NUM>. The pawl <NUM> is biased into engagement with the teeth <NUM> by a spring <NUM>. Engagement of the pawl <NUM> with the teeth <NUM> occurs automatically after the drill bit remover <NUM> is displaced along the rack <NUM>, and serves to lock the position of the drill bit remover <NUM> relative to the rack <NUM> to maintain the position of the anvil <NUM>. The pawl <NUM> is pivotable out of engagement with the teeth <NUM> against the bias of the spring <NUM> to release the pawl <NUM> and allow the drill bit remover <NUM> to be moved on the rack <NUM>. The pawl <NUM> can be pivoted out of engagement with the teeth <NUM> by depressing a tab <NUM> that extends from the pawl <NUM>. If desired, the strength of the spring <NUM> can be designed to hold the pawl <NUM> against the rack <NUM> but allow the pawl <NUM> to ride along the rack <NUM> when the wheel handle <NUM> is turned, in the manner of a ratchet. Alternatively, the strength of the spring <NUM> can be selected so that the pawl <NUM> will not disengage from the teeth <NUM> when the wheel handle <NUM> is turned, and only disengage from the teeth <NUM> when the user depresses the tab <NUM>.

The pinion <NUM> is positioned on the left side of the rack <NUM> when facing the wheel handle <NUM>. In this arrangement, rotation of the wheel handle <NUM> in the clockwise direction CW raises the anvil <NUM> upwardly, or toward the first support end <NUM>. This causes the fork-lift surface <NUM> to bear upwardly or proximally against the stop surface <NUM> on the drill bit 200A, displacing the drill bit 200A in the proximal direction. Therefore, to remove the drill bit 200A from the patient, without removing the K-wire <NUM>, the user first locks the wire clamp <NUM> to axially fix the K-wire <NUM>. Then, the user rotates the wheel handle <NUM> clockwise to move the drill bit 200A in the proximal direction relative to the K-wire <NUM>. This has the effect of withdrawing the drill bit 200A from the patient while not displacing the K-wire <NUM> and keeping the K-wire in place. The wheel handle <NUM> is rotated until the distal end <NUM> of the drill bit 200A is removed from the patient. Once the drill bit 200A is no longer in the patient, the wire clamp <NUM> is unlocked, and the C-shaped base <NUM> is detached from the drill tube 150A. This allows the drill removal tool <NUM> to once again move along the K-wire <NUM>. The drill bit removal tool <NUM> is then lifted off of the K-wire <NUM>, with the fork-lift surface <NUM> supporting the drill bit 200A such that the drill bit 200A is also removed from the K-wire <NUM>. After the drill bit removal tool <NUM> is removed from the K-wire <NUM>, the drill tube 150A can be removed from the patient, as well any tissue dilators. In the present example, the drill tube 150A extends through multiple telescopic dilators, the outermost dilator D being visible in <FIG>.

In an alternate MIS technique, the drill bit 200A can be drilled into the bone without the K-wire <NUM>. In such instances, the drill removal tool <NUM> can be used to insert the K-wire <NUM> into the bone through the drill bit 200A. To begin this technique, a universal drill guide such as the embodiment previously described is attached to a navigation unit and calibrated. The drill stop height is set and the appropriate drill tube is attached to the universal drill guide. An obturator is then inserted into the universal drill guide and drill tube and locked in place. The universal drill guide and obturator are then probed to the desired drilling position in the patient. The obturator is then removed from the universal drill guide and drill tube, and replaced with a cortical punch. The cortical punch is used to create a start hole in the cortical layer, and then removed. The appropriate drill bit is then attached to a driver, inserted into the universal drill guide, and advanced through the drill tube to drill a hole into the bone. Once the drill bit is drilled into bone, the universal drill guide is detached and removed from the drill tube, leaving the drill bit and the drill tube in place.

A tissue dilator D is attached to a dilator handle and advanced over the drill tube until it contacts the tissue surrounding the drill tube. The dilator is then pushed and rotated to dilate tissue. A tissue protector P is then advanced over the dilator. A K-wire can be then be inserted into the bone through the drill bit.

Referring to <FIG>, one process for inserting a K-wire <NUM> through the drill bit 200A is shown. In a first step, the K-wire <NUM> is loaded into drill removal tool <NUM>. The knob <NUM> is rotated to an unlocked position, and the K-wire <NUM> is inserted through the knob in the direction shown by the arrow in <FIG>. The K-wire <NUM> is advanced through the knob <NUM> until a long marking <NUM> on the K-wire is fully covered by the drill removal tool <NUM>. Once the K-wire <NUM> is advanced through the drill removal tool <NUM> to the appropriate position, the knob <NUM> is rotated to a locked position as shown by the arrow in <FIG> to lock the K-wire in the wire clamp <NUM>.

The drill removal tool <NUM> and the K-wire <NUM> are positioned over the proximal end <NUM> of the drill bit 200A. The K-wire <NUM> is then guided down into the drill bit 200A. The bottom portion of the drill removal tool <NUM> is pivoted toward the drill bit 200A and dilator D as shown in <FIG> until the drill bit is received in the through slot <NUM> of the anvil <NUM>. The drill removal tool <NUM> is pivoted while making sure that the anvil <NUM> is positioned beneath the stop surface <NUM>. Once the drill removal tool <NUM> is mounted to the drill bit 200A and dilator D, the knob <NUM> is rotated to the unlocked position in the direction shown in <FIG>.

The K-wire <NUM> is advanced downwardly into the drill bit 200A as shown in <FIG>. Once the long marking <NUM> is completely covered by the drill bit 200A, the knob <NUM> is rotated to the locked position as shown in <FIG>. The wheel handle <NUM> is then rotated, as shown in <FIG>, to move the anvil <NUM> upwardly relative to the toothed rack <NUM> and pull the drill bit 200A out of the bone. Once the drill bit 200A is pulled out of the bone, the drill removal tool <NUM> and the drill bit can be lifted and removed. The drill tube 150A and dilator D can then be removed from protector P, as shown in <FIG>.

Referring to <FIG>, a bone screw driver assembly with a bone screw driver <NUM> is shown according to one example. The bone screw driver <NUM> is designed to advance a bone screw over a K-wire and drive the bone screw into the bone while preventing forward (i.e. distal) advancement of the K-wire. To accomplish this, the bone screw driver assembly features a K-wire retention module <NUM>. For purposes of this description, the bone screw driver <NUM> and the K-wire retention module <NUM> will be described in use with the same K-wire <NUM> described previously.

The bone screw driver <NUM> has a shaft <NUM> that defines a proximal end <NUM>, a distal end <NUM> opposite the proximal end <NUM>, and a longitudinal through passage <NUM> between the proximal <NUM> and distal ends <NUM>. The passage <NUM> is configured such that the bone screw driver <NUM> can be passed over the proximal end of the K-wire <NUM> and advanced toward the distal end of the K-wire <NUM>. The proximal end <NUM> has an attachment mechanism (not visible) over which a handle <NUM> is attached. The attachment mechanism can be any suitable structure for receiving a handle, including but not limited to a hex shaped shaft. The handle <NUM> is configured to be gripped by a user and rotated to operate the bone screw driver <NUM>, much like a conventional screw driver. The distal end <NUM> has an external thread <NUM> configured to mate with an internal thread in a rod receiving component of a pedicle screw assembly. A knob <NUM> is provided on the shaft <NUM> to facilitate rotation of the shaft <NUM> to thread the external thread <NUM> into a rod receiving component.

Referring to <FIG>, the distal end <NUM> has a driver tip <NUM>. The driver tip <NUM> has a hexalobular extension <NUM> that fits into a similarly shaped recess in the head of the bone screw. The driver tip <NUM> also has a pair of tangs <NUM> located proximally relative to extension <NUM>. The tangs <NUM> are configured to slide into diametrically opposed slots in a rod receiving component when the external thread <NUM> is threaded into the internal thread of the rod receiver component. In this arrangement, the tangs <NUM> occupy the location where a fixation rod will be located.

The K-wire retention module <NUM> includes a housing <NUM> having a proximal end <NUM>, a distal end <NUM>, and a passage <NUM> extending between the proximal end <NUM> and the distal end <NUM>. The passage <NUM> aligns with the passage <NUM> of the bone screw driver <NUM>. In this arrangement, the bone screw driver <NUM> and the K-wire retention module <NUM> can be advanced over the K-wire <NUM> as a unit. <FIG> shows the bone screw driver <NUM> (without the handle <NUM> attached) in the process of being advanced over an implanted K-wire <NUM>. The driver tip <NUM> is secured to a cannulated polyaxial screw assembly <NUM> and a tab protector sleeve <NUM> that also pass over the K-wire <NUM>.

Referring to <FIG>, the K-wire retention module <NUM> has a roller assembly <NUM> contained within the housing <NUM>. The roller assembly <NUM> is operable in a disengaged mode and an engaged (or drive) mode. In the disengaged mode, the roller assembly <NUM> allows the K-wire retention module <NUM> and the bone screw driver <NUM> to advance freely along the length of the K-wire <NUM>. In the engaged mode, the roller assembly <NUM> engages with K-wire <NUM> and feeds the K-wire <NUM> through the housing <NUM> in a proximal direction as the bone screw driver <NUM> advances the polyaxial screw assembly <NUM> in a distal direction.

The roller assembly <NUM> includes a first spur gear 722a attached to the shaft <NUM> of the bone screw driver <NUM>, and a second spur gear 722b mated with the first spur gear 722a. The roller assembly <NUM> also includes a third spur gear 722c on the shaft <NUM> that is mated with a fourth spur gear 722d. The second spur gear 722b and the fourth spur gear 722d are attached to a secondary shaft <NUM> that extends parallel to the shaft <NUM>. The secondary shaft <NUM> has a worm gear <NUM> mated with a fifth spur gear 722e. The fifth spur gear 722e is attached to a first roller <NUM>, which is fixed to the fifth spur gear 722e so that the fifth spur gear 722e and the first roller <NUM> rotate in unison. A second roller <NUM> is positioned adjacent to the first roller <NUM> at a position to engage with the K-wire <NUM> on a side opposite the first roller <NUM>.

Referring to <FIG>, engagement and disengagement of the roller assembly <NUM> is controlled by a lever assembly <NUM>. The lever assembly <NUM> includes a spring-loaded lever <NUM> that is biased toward the engaged mode by a compression spring <NUM>. <FIG> shows components of the roller assembly <NUM> about to be advanced over the K-wire <NUM>. The lever <NUM> is positioned in the engaged mode by the spring <NUM>, which is fully expanded. In this mode, the first and the second rollers <NUM>, <NUM> are positioned close together, with little or no clearance between them. To advance the roller assembly <NUM> over the K-wire <NUM>, the lever <NUM> is pressed inwardly toward the K-wire, as shown in <FIG>. This moves the first and the second rollers <NUM>, <NUM> apart, allowing the roller assembly <NUM> to advance over the K-wire <NUM>. Once the K-wire <NUM> is received between the first and the second rollers <NUM>, <NUM>, the lever <NUM> can be released to allow the roller assembly <NUM> to return to the engaged mode under the bias of the spring <NUM>, which positions the rollers in direct engagement with the K-wire.

The polyaxial screw assembly <NUM> is driven into the bone over the K-wire <NUM> by applying clockwise torque to the proximal end <NUM> of the bone screw driver <NUM>. When clockwise torque is applied to the proximal end <NUM> of the screw driver <NUM> with the roller assembly <NUM> in the engaged mode, the roller assembly <NUM> will feed the K-wire <NUM> through the housing <NUM> in the proximal direction. Clockwise rotation of the shaft <NUM> rotates the first spur gear 722a and the third spur gear 722c in a clockwise direction, which in turn impart torque to the secondary shaft <NUM> through the second spur gear 722c and the fourth spur gear 722d. The secondary shaft <NUM> and the worm gear <NUM> rotate in a counterclockwise direction, which imparts torque to the fifth spur gear 722e. The fifth spur gear 722e drives the first roller <NUM> in a first direction. The second roller <NUM> is biased into engagement with the K-wire <NUM> and rotates in a second direction opposite first direction. The outer surfaces of the first and the second rollers <NUM>, <NUM> grip the surface of the K-wire <NUM> to draw the K-wire in the proximal direction relative to the housing <NUM>, so that the K-wire <NUM> is fed proximally as the polyaxial screw assembly <NUM> is driven distally into the bone.

Distal feeding of the K-wire <NUM> through the housing <NUM> is prevented by a ratchet wheel <NUM> and a pawl <NUM>. The pawl <NUM> engages with the ratchet wheel <NUM>, as shown in <FIG>, to prevent the shaft <NUM> from being rotated counterclockwise relative to the housing <NUM>, which would rotate the first and the second rollers <NUM>, <NUM> in a reverse direction that feeds the K-wire distally. The pawl <NUM> can be pivoted out of engagement with the ratchet wheel <NUM> by pressing the lever <NUM> inwardly against the spring <NUM>, as shown in <FIG>. This switches the roller assembly <NUM> to the disengaged mode and releases the K-wire <NUM>, allowing the bone screw driver <NUM> and the K-wire retention module <NUM> to be removed from the K-wire <NUM> without risk of distally advancing the K-wire <NUM>.

K-wire retention modules according to the present disclosure can be modular units that are detachably connectable to different types of instruments, including but not limited to instruments for tapping and driving. In the present example, the K-wire retention module <NUM> is detachably connected to the bone screw driver <NUM> with a quick fit connection <NUM> represented in <FIG>. The shaft <NUM> of the bone screw driver <NUM> snaps into the housing <NUM> using the quick fit connection <NUM>, which can be a hex drive, ¼ inch drive or AO drive that controls rotation.

Bone screw drivers according to the present disclosure can include various types of indicia for aiding the insertion of a bone screw. For example, the shaft <NUM> can have spaced lines that provide depth markings, similar to those on the universal drill guide <NUM>. Depth markings can provide the user with a visual indication of the depth to which the tip of the bone screw is advanced. Bone screw drivers can also include various features to aid in sterilization. For example, the shaft <NUM> has a series of apertures <NUM> that allows steam to access the inside of the shaft <NUM> during autoclaving and cleaning.

<FIG> show an alternate bone screw driver <NUM> and K-wire retention module <NUM> according to another embodiment. The K-wire retention module <NUM> is similar to the K-wire retention module <NUM>, but features a pinch lever <NUM> and pinch rollers <NUM>, <NUM>. The pinch lever <NUM> is normally in an open position to separate the pinch rollers <NUM>, <NUM>, as shown in <FIG> and <FIG>. The pinch lever <NUM> can be moved to a closed position, as shown in <FIG>, to engage with the rollers against the K-wire <NUM>. The pinch lever <NUM> can only stay closed (i.e. the drive can only remain engaged) when the K-wire <NUM> is positioned between the pinch rollers <NUM>, <NUM>.

The instruments described herein can be manufactured using various materials, including but not limited to various alloys of stainless steel. Alloy grade can be selected based on desired strength, hardness, corrosion resistance, galling properties and other performance criteria.

Claim 1:
A universal drill guide system (<NUM>) comprising:
a plurality of drill tubes (<NUM>) each with a drill bit passage; and
a plurality of drill bits (<NUM>) each insertable into the drill bit passage of a corresponding one of the plurality of drill tubes (<NUM>), respectively,
wherein each of the drill bit passages has an inner diameter different from that of any one of the other drill bit passages, and each of the plurality of drill bits (<NUM>) has an outer diameter different from that of any one of the other drill bits (<NUM>), the outer diameter of each of the plurality of drill bits (<NUM>) corresponding to the inner diameter of only a respective one of the drill bit passages,
the universal drill guide system (<NUM>) further comprising
a universal drill guide (<NUM>),
the plurality of drill tubes (<NUM>) having the same outer dimension and being insertable into an opening (<NUM>) of the universal drill guide (<NUM>),
wherein the universal drill guide (<NUM>) comprises an auto drill tube capture (<NUM>) allowing the plurality of drill tubes (<NUM>) to be inserted into the opening (<NUM>) of the universal drill guide (<NUM>) with a quick-fit connection,
characterized in that the auto drill tube capture (<NUM>) includes a locking ring (<NUM>) rotatable in the universal drill guide (<NUM>) between a locking orientation and a release orientation.