Patent Description:
A common problem associated with joint replacement surgery is the development of fractures around the prosthetic, known as periprosthetic fractures. For example in a Total Knee Replacement (TKR) procedure, fractures may occur in the femur around the prosthetic joint implanted at the distal portion of the femur. Various treatments are employed depending on the severity of the fractures and whether the prosthetic becomes loose. The fractures generally occur as a result of trauma or infection and in extreme cases may require additional surgical procedures in order to re-align the prosthetic knee and/or apply additional plates or rods, so that the fractures will heal properly. In most cases when a periprosthetic knee fracture occurs, the prosthesis remains well fixed to the bone beneath it and securing the bone to the part of the femur which has broken away is a challenge.

Mending such fractures is a challenge due to the lack of available healthy bone remaining around the location of the fractures. As a result, fracture fixation may be inadequate and the fracture may heal incorrectly, causing abnormal stresses on the prosthetic joint, which in turn may cause pain, stiffness, and potential TKR failure. Therefore, there is a need for improved surgical implants to mend periprosthetic fractures, and instruments for applying the improved surgical implants to the periprosthetic fractures. Such an improved surgical implant is disclosed in <CIT>.

<CIT> discloses further examples of intramedullary rod and blade assemblies and methods of implanting said assemblies. The assemblies provided herein are used in treating distal, proximal fractures, among other conditions, in large bones including, but not limited to: femurs, tibias, and humeri. The assemblies can include an intramedullary rod having a proximal end and coupling means configured to securely attach to a blade, such that no portion of the rod or the coupling means extend into the fractured fragment beyond the blade.

The invention is defined in the independent claim. Further advantageous embodiments are defined in the dependent claims.

Described herein is an instrument for setting a fracture in a bone and applying a bone plate to the fractured bone and method of using that instrument.

According to the present invention, an instrument for setting a fracture in a bone and affixing a bone plate to the fractured bone with a connection to an intramedullary rod fixed in the fractured bone is described. The instrument includes a connector for connecting the instrument to the intramedullary rod. At least two tines are movably connected to the connector and configured to orient the fractured bone with respect to the rod. Each tine has a distal end configured to contact the bone. At least one plate carrier is configured to receive the bone plate. The at least one plate carrier is movably connected to the connector and configured to move relative to the connector and the tines to position the bone plate adjacent the bone in a predetermined alignment with the intramedullary rod.

The invention will now be described by reference to exemplary embodiments and variations of those embodiments. Although the invention is illustrated and described herein with reference to specific embodiments, the invention is not intended to be limited to the details shown and described. Rather, various modifications may be made in the details within the scope of the claims and without departing from the invention.

<FIG> depict an exemplary embodiment of an instrument <NUM> (or portions thereof) for fracture alignment and plate compression, according to one exemplary embodiment of the invention. The instrument <NUM> generally includes a plate compression portion <NUM> that is releasably connected to a fracture alignment portion <NUM>. While the portions <NUM> and <NUM> may be releasably connected together, it should be understood that those portions <NUM> and <NUM> may be permanently connected together.

The plate compression portion <NUM>, which is best shown in <FIG> and <FIG>, generally comprises a four-way connector <NUM> having a t-shaped body extending along a longitudinal axis A and a transverse axis B oriented orthogonally from the longitudinal axis A. The components of the instrument <NUM> are mounted either directly or indirectly to the four-way connector <NUM>.

As best shown in <FIG>, the four-way connector <NUM> comprises a point of intersection where the axes A and B intersect. An upper cylindrical shaft <NUM> extends upwardly from the point of intersection along axis A, a lower cylindrical shaft <NUM> extends downwardly from the point of intersection along axis A, a slotted shaft <NUM> extends laterally from one side of the connector <NUM> along axis B, and another slotted shaft <NUM> extends laterally from an opposing side of the connector <NUM> along axis B. A third axis C intersects axes A and B and is normal to both axes A and B.

A blind threaded hole <NUM> (<FIG>) is disposed on the lower surface <NUM> of the shaft <NUM> and centered on the shaft <NUM> through axis A. A threaded post <NUM> extends upwardly from the top end of the upper cylindrical shaft <NUM> and is centered on the shaft <NUM> through axis A. A thru-hole <NUM> extends through the shafts <NUM> and <NUM> is aligned with axis B. A rectangular four-wall channel <NUM> is defined at the free end of each shaft <NUM> and <NUM>. The longitudinal axis of each channel <NUM> is parallel to axis C, and intersects and is normal to the axis B.

A fastener <NUM> is positioned through the hole <NUM> in the connector <NUM>. The fastener <NUM> includes an elongated shaft <NUM>. A pair of wings <NUM>, or other manipulable feature, is provided at the proximal end of the shaft <NUM>. Those of ordinary skill in the art will recognize that the proximal end of the shaft <NUM> may have a variety of head types, such as Phillips, slotted, hex, etc. that can be used for rotating the shaft <NUM>. A gear <NUM> having teeth on its outer perimeter is disposed on the proximal end of the shaft directly adjacent the wings <NUM>. The gear <NUM> is non-rotatably connected to the shaft <NUM>. The gear <NUM> may be integrally formed on the shaft <NUM>, or, alternatively, the gear <NUM> may be non-rotatably connected to the shaft <NUM> by a toothed interface (like that of gear <NUM>). The distal tip <NUM> of the shaft <NUM> is threaded. A toothed region <NUM> is defined on the distal end of the shaft <NUM> at a location proximal of the distal tip <NUM>.

A gear <NUM> has a toothed surface on its outer perimeter, and a toothed surface on its inner perimeter. The teeth on the inner perimeter of the gear <NUM> are meshed with the toothed region <NUM> of the fastener <NUM> so that the gear <NUM> rotates along with the fastener <NUM>. A threaded hex nut <NUM> is configured to be threadedly connected to the threaded distal tip <NUM> of the fastener <NUM>, thereby captivating the fastener <NUM>, the gear <NUM>, the gear <NUM> and the connector <NUM> together.

Two plate carriers 44a and 44b are slidably connected to the connector <NUM>. The plate carriers 44a and 44b are similar and may be referred to either individually or collectively as plate carrier(s) <NUM>. Each plate carrier <NUM> includes an L-shaped body. The L-shaped body includes a first elongated portion <NUM> that extends parallel to axis C. The first elongated portion <NUM> has a substantially rectangular shape with a rounded edge <NUM> at its free end. An elongated recess <NUM> is defined within the first elongated portion <NUM>, thereby defining a top rail 49a and a bottom rail 49b on the portion <NUM>.

In the plate carrier 44a, a set of teeth 50a extend along the interior side of the bottom rail 49b. In the plate carrier 44b, a set of teeth 50b extend along the interior side of the top rail 49a, The teeth 50a of the plate carrier 44a mesh with the outer teeth of the gear <NUM>, whereas the teeth 50b of the other plate carrier 44b mesh with the outer teeth of the gear <NUM>.

A second elongated portion <NUM> of each plate carrier <NUM> vertically depends from the first elongated portion <NUM>. The portion <NUM> extends substantially parallel to axis A and orthogonal to portion <NUM>. The portion <NUM> meets the portion <NUM> at a ninety degree bend <NUM> in the plate carrier <NUM>. The distal end <NUM> of the second elongated portion <NUM> is bent inwardly towards the connector <NUM> (in an assembled form of the instrument). The second elongated portion <NUM> is shaped to compliment the shape of the plate <NUM> that is connected to the plate carrier <NUM>.

A plate <NUM> is mounted to each plate carrier <NUM> by a clip, fastener, magnet, connector, channel or other mounting surface, for example, or any other means for mounting that is known to those skilled in the art. Specifically, plate 55a is mounted to plate carrier 44a, and plate 55b is mounted to plate carrier 44b. The plates <NUM> are substantially identical. The plates <NUM> are configured to be mounted to a bone for securing a periprosthetic fracture in that bone. A series of holes <NUM> are defined in the plate <NUM>.

Although each plate <NUM> is shown having two holes <NUM> at its top end, the pattern of holes <NUM> may continue along the entire length of the plate <NUM>. Also, if the plate <NUM> includes more than the holes <NUM> that are shown, a pattern of holes (not shown) may be disposed in the plate carrier <NUM>, such that the holes in the plate carrier <NUM> will register with the holes in the plate <NUM>. Further details of the plate <NUM> are described in <CIT>.

In an assembled form of the plate compression portion <NUM>, the first elongated portion <NUM> of the plate carrier 44a is mounted in the channel <NUM> of the shaft <NUM>, the first elongated portion <NUM> of the plate carrier 44b is mounted in the channel <NUM> of the shaft <NUM>, and the shaft <NUM> of the fastener <NUM> is positioned through the hole <NUM> in the connector <NUM>. The gear <NUM> is positioned within the channel <NUM> of the connector shaft <NUM> and the teeth of the gear <NUM> are meshed with the teeth 50a of the plate carrier 44a. The gear <NUM> is mounted to the distal end of the shaft <NUM> and the internal teeth of the gear <NUM> are meshed with the teeth <NUM> of the shaft <NUM>. The gear <NUM> is positioned within the channel <NUM> of the connector shaft <NUM> and the outer teeth of the gear <NUM> are meshed with the teeth 50b of the plate carrier 44b. The threaded hex nut <NUM> is threadedly connected to the threaded distal tip <NUM> of the fastener <NUM>, thereby connecting the gear <NUM>, the gear <NUM>, the connector <NUM> and the fastener <NUM> together. The plates <NUM> are releasably mounted to respective plate carriers 44a and 44b by any means known in the art, such as a clip, clamp or fastener.

The fracture alignment portion <NUM>, which is best shown in <FIG>, generally comprises a base <NUM> having a socket <NUM>, a lid <NUM> having a socket <NUM>, the lid <NUM> being adjustably connected to the base <NUM>, a ball shaft <NUM> having a ball <NUM> at its end for engaging the sockets <NUM> and <NUM> to form a ball and socket joint, and a series of pointed tines <NUM> that are removably mounted within apertures <NUM> formed in the base <NUM> by fasteners <NUM>.

Referring now to the individual features of the fracture alignment portion <NUM>, the base <NUM> is a cylindrical body having a top surface <NUM>, a bottom surface <NUM> opposite the top surface <NUM>, and a side wall <NUM> extending between the top surface <NUM> and the bottom surface <NUM>. A lip <NUM> extends upwardly from the top surface <NUM> forming part of the side wall <NUM>. Mechanical threads <NUM> are provided on the outer circumference of the lip <NUM>. The socket <NUM> is an annulus having an opened defined at its center that is aligned with the longitudinal axis D of the base <NUM>. The socket <NUM> protrudes from the top surface <NUM> to a height that is less than the height of the lip <NUM> (i.e., the socket <NUM> is recessed relative to the lip <NUM>).

A series of rectangular shaped apertures <NUM> are defined along the perimeter of the side wall <NUM>. Each aperture <NUM> is normal to axis D and extends in a direction toward the axis D. A series of holes <NUM> (<FIG>) extending parallel to axis D are defined on the bottom surface <NUM> of the base <NUM>. Each hole <NUM> intersects one of the apertures <NUM>, as shown in <FIG>. A fastener <NUM> is configured to be mounted in one of the holes <NUM> for securing a tine <NUM> in the aperture <NUM> that intersects said one of the holes <NUM>.

The lid <NUM> is a cylindrical member having a top exterior facing surface <NUM> (<FIG>), a bottom interior facing surface <NUM> (i.e., facing the base <NUM>) opposite the top surface <NUM>, and a side wall <NUM> extending downward from the circumference of the bottom surface <NUM>. Mechanical threads <NUM> are provided on the inner circumference of the wall <NUM>. A socket <NUM> extends downwardly from the bottom surface <NUM> of the lid <NUM> (in the same direction as the wall <NUM>). Like the socket <NUM>, the socket <NUM> of the lid <NUM> is an annulus having an opening <NUM> defined at its center that is aligned with the longitudinal axis D of the base <NUM> in an assembled form of the fracture alignment portion <NUM>. The opening <NUM> passes through the thickness of the lid <NUM> and is chamfered on the top surface <NUM> of the lid <NUM> to accommodate swiveling motion of the shaft <NUM>. The socket <NUM> protrudes from the bottom surface <NUM> to a height that is less than the height of the wall <NUM> (i.e., the socket <NUM> is recessed relative to the wall <NUM>).

The ball shaft <NUM> includes a shaft <NUM>, a ball <NUM> disposed at the proximal end of the shaft <NUM>, mechanical threads <NUM> at the distal end of the shaft <NUM> and a flange <NUM> positioned adjacent and proximally of the threads <NUM>. The ball <NUM> is sized to be seated between the sockets <NUM> and <NUM> to form a ball and socket joint. The ball <NUM> is capable of swiveling on the sockets <NUM> and <NUM>.

A plurality of tines <NUM> (one shown) are configured to be mounted within the apertures <NUM> of the base <NUM>, as described above. Each tine <NUM> comprises a thin elongated member having a rectangular or square cross-section. The elongated member <NUM> includes an intermediate section <NUM> having a pre-determined length, a proximal end <NUM> that extends orthogonally relative to the section <NUM> (i.e., toward axis D), and a distal end <NUM> that also extends orthogonally relative to the section <NUM> in the same direction as the proximal end <NUM>. The cross-sectional shape of the proximal end <NUM> compliments the shape of the aperture <NUM> in which the tine <NUM> is inserted. The distal portion <NUM> of the intermediate section <NUM> is bent toward the axis D.

A sharp and pointed spike <NUM> is formed at the distal end <NUM> of the tine <NUM>. As best shown in <FIG>, the spike <NUM> has a threaded post <NUM> that is configured to be threadedly engaged with an opening <NUM> that is formed at the distal end <NUM> of the tine <NUM>. Alternatively, the spike <NUM> may be integrated with the tine <NUM>.

According to another embodiment of the tine <NUM>' shown in <FIG>, a clamp <NUM> is mounted to the distal end <NUM>' of the tine <NUM>'. More particularly, the clamp <NUM> has a threaded post <NUM>' that is configured to be threadedly engaged with an opening <NUM>' that is formed at the distal end <NUM>' of the tine <NUM>'. The clamp <NUM> includes a rounded semi-cylindrical surface 67a that is configured to contact the bone <NUM> without puncturing the bone <NUM>. The clamp <NUM> and the spike <NUM> may be used interchangeably on the instrument <NUM>.

In an assembled form of the fracture alignment portion <NUM>, a plurality of tines <NUM> (preferably at least three, and more preferably four) are fixedly mounted within apertures <NUM> of the base <NUM> by separate fasteners <NUM>. At least three tines <NUM> are required to sufficient constrain the bone <NUM> to which the tines <NUM> are attached. The tines <NUM> may be evenly spaced apart by <NUM> degrees about the circumference of the base <NUM>, for example, The threads <NUM> of the lid <NUM> are mounted to the threads <NUM> of the base <NUM>, and the ball <NUM> of the ball shaft <NUM> is captivated between the sockets <NUM> and <NUM>. The threaded end <NUM> of the ball shaft <NUM> protrudes from the top end of the lid <NUM>. It should be understood that the lid <NUM> may be mounted to the base <NUM> in other ways, such as by a clip, a clamp, a magnet, a ratchet, a bolt, a screw, a fastener, and so forth.

Although only one tine <NUM> and one fastener <NUM> are shown in <FIG>, it should be understood that the instrument preferably has four tines <NUM> and four fasteners <NUM>. However, the instrument may have any number of tines <NUM> and corresponding fasteners <NUM>.

<FIG> depicts a process for aligning a fracture and applying plates to the aligned fracture. It should be understood that the description that follows is not limited to any particular step or sequence of steps. The steps may be performed out of order.

Turning now to assembly and operation of the instrument <NUM>, the rod <NUM> is positioned within holes formed in the medullary cavity of a femur bone <NUM> and a femoral implant <NUM> that is fixed to a distal portion 104b of the bone <NUM>. A peri prosthetic fracture <NUM> separates the distal portion 104b of the bone <NUM> from a proximal portion 104a of the bone <NUM>. The details of the rod <NUM> and the femoral implant <NUM> are disclosed in <CIT>. It should be understood that the instrument <NUM> is not limited for use with a femur.

The instrument <NUM> is then ready for connection to the rod <NUM>. As shown in <FIG>, the threaded shaft <NUM> of the plate compression portion <NUM> is first threaded onto a threaded hole <NUM> formed at a distal end of an intramedullary rod <NUM> until the connector <NUM> abuts the distal end of the rod <NUM>. The male threads on the threaded shaft <NUM> and the female threads in the threaded hole <NUM> are tailored such that, once the shaft <NUM> is connected to the hole <NUM>, each hole <NUM> of one plate 55a registers both axially and radially with one hole <NUM> in the rod <NUM>, and another hole <NUM> in the opposite plate 55b. Indicia in the form of markings may be provided on (i) the connector <NUM> at a location adjacent the shaft, and (ii) the distal end of the rod <NUM>, to ensure proper radial alignment between the connector <NUM> and the rod <NUM>.

Turning now to <FIG>, the threaded shaft <NUM> of the fracture alignment portion <NUM> is then threadedly connected to the threaded hole <NUM> of the connector <NUM> of the plate compression portion <NUM> until the flange <NUM> abuts the lower surface of the connector <NUM>. It should be understood that the threaded connections between the male shafts and female holes described above may be reversed without departing from the scope of the invention. For example, the shaft <NUM> of the connector <NUM> may include a threaded hole that is threaded onto a threaded post on the end of the rod <NUM>. Alternatively, the threaded connections may be replaced with slotted connections to ensure proper radial and axial alignment.

Turning now to <FIG>, the individual tines <NUM> (preferably at least four) of the fracture alignment portion <NUM> are slid toward the distal portion 104b of the bone <NUM>. As the tines <NUM> are translated toward the bone <NUM>, the proximal end <NUM> of each tine <NUM> slides within its respective aperture <NUM> in the base <NUM> until the spike <NUM> at the distal end of the tine <NUM> contacts the fractured distal portion 104b of the bone <NUM>. It is noted that the tines <NUM> are adjustable so that they can conform to various patient anatomies.

Thereafter, the fasteners <NUM> at the bottom of the base <NUM> are rotated to lock the tines <NUM> in a fixed position relative to the base <NUM>. The physician may hammer the distal end of each tine <NUM> to embed the spikes <NUM> into the fractured bone 104b. Thereafter, the base <NUM>, the tines <NUM> and the fractured bone 104b (along with the implant <NUM>) are interconnected.

Turning now to <FIG>, at this stage of operation, the lid <NUM> is loosely connected to the base <NUM> such that the base <NUM> and the lid <NUM> are capable of pivoting with respect to the ball shaft <NUM>. Pivoting is possible because the ball <NUM> of the ball shaft <NUM> is not compressed to any significant degree between the sockets <NUM> and <NUM>.

The physician then pivots the base <NUM>, the lid <NUM> and the tines <NUM> together, by an angle E (for example), in order to set the fracture <NUM> of the bone <NUM>. The base <NUM>, the lid <NUM>, the tines <NUM> and the bone 104b pivot together and relative to the ball shaft <NUM>, The ball shaft <NUM> cannot rotate relative to the bone <NUM> because the ball shaft <NUM> is connected to the connector <NUM>, which is connected to the rod <NUM>, which is connected through the bone <NUM>. Compare the fracture <NUM> shown in <FIG> with the set fracture <NUM> shown in <FIG>.

Turning now to <FIG>, once the fracture <NUM> is properly set, the fracture alignment portion <NUM> is locked in position with respect to the rod <NUM>. More particularly, the threaded portion of the lid <NUM> is rotated onto the threads <NUM> of the base <NUM> (as indicated by the arrow) thereby compressing the ball <NUM> of the ball shaft <NUM> between the sockets <NUM> and <NUM>. Once the lid <NUM> is sufficiently secured to the base <NUM>, the base <NUM> and the lid <NUM> cannot be moved relative to the ball shaft <NUM>. At this point, the base <NUM>, the lid <NUM>, the tines <NUM>, the ball shaft <NUM>, the connector <NUM>, the rod <NUM> and the entire bone <NUM> are interconnected. At this stage of operation, the distal portion 104b of the bone <NUM> is fixed relative to the rod <NUM> and the proximal portion 104a of the bone <NUM>.

Turning now to <FIG>, now that the fracture <NUM> is set, the physician rotates the fastener <NUM>, thereby simultaneously rotating both gears <NUM> and <NUM> that are connected to the fastener <NUM>. As described above, the teeth of the gear <NUM> are meshed with teeth 50a of the plate carrier 44a, whereas the teeth of the gear <NUM> are meshed with teeth 50b of the plate carrier 44b.

Rotation of the gear <NUM> in the clockwise direction (as shown by the arrow) causes the plate carrier 44a to translate inwardly toward the bone <NUM> as the teeth on the rotating gear <NUM> drive the teeth 50a of plate carrier 44a. More specifically, the first elongated portion <NUM> of the plate carrier 44a travels within the channel <NUM> of the connector <NUM> as the second elongated portion <NUM> moves the plate <NUM> that is connected thereto toward the bone <NUM>.

Simultaneous rotation of the gear <NUM> in the clockwise direction (as viewed from the perspective of <FIG>) causes the plate carrier 44b to translate inwardly toward the bone <NUM> as the teeth on the rotating gear <NUM> drive the teeth 50b of plate carrier 44b. The first elongated portion <NUM> of the plate carrier 44b travels within the channel <NUM> of the connector <NUM> as the second elongated portion <NUM> moves the plate <NUM> that is connected thereto toward the bone <NUM>. This process is continued until the plates <NUM> are firmly positioned against the bone <NUM>. As noted above, the holes <NUM> in the plates <NUM> and the holes <NUM> in the rod <NUM> are already in axial and radial alignment at this stage of the process.

The physician then positions a drill in one of the holes <NUM> in plate 55a, and drills a hole in the portion of bone <NUM> between the rod <NUM> and the plate 55a. The drill bit passes through one of the holes <NUM> in the rod <NUM>, and continues to drill a hole in the portion of bone <NUM> between the rod <NUM> and the plate 55b. The drill bit eventually protrudes through one of the holes <NUM> in plate 55b. The drill bit is then removed. As will be described hereinafter, a transfixing bolt <NUM> is then positioned through the straight hole that was formed by the drill bit for securing the plates <NUM> to the bone <NUM>. The aforementioned drilling step is repeated for each bolt <NUM> that is used to secure the plates <NUM> to the bone <NUM>.

A plurality of transfixing bolts <NUM> (one shown protruding from plate <NUM>) are used to fix the plates <NUM> to the bone <NUM> and the rod <NUM>, thereby compressing the aligned fracture <NUM>. Each transfixing bolt <NUM> (one shown) is positioned through a respective hole <NUM> in the plate 55a, through a respective transverse hole <NUM> (<FIG>) in the rod <NUM>, and through a respective hole <NUM> in the plate 55b. The free end of the bolt <NUM> is mounted to the outside of the plate 55b by a nut <NUM>. Further details of the process for using transfixing bolts <NUM> to fix the plates <NUM> to the bone <NUM> and the rod <NUM> are described in <CIT>. As another example, a transfixing screw may be positioned through a respective hole <NUM> in one of the plates <NUM>, through a respective transverse hole <NUM> in the rod <NUM>, and embedded into the bone <NUM>. It should be understood that various ways exist for attaching a plate to the rod, and the invention is not limited to any particular mounting process.

At this stage, the plates <NUM> are fixed to the bone <NUM> and the rod <NUM>, and the fracture <NUM> is stabilized. The instrument <NUM> can now be removed from the bone <NUM>.

Turning now to <FIG>, to remove the instrument <NUM> from the bone <NUM>, the tines <NUM> are first removed from the bone <NUM> using either a hammer or the physician's hand to remove the spikes <NUM> from the bone <NUM>. The fasteners <NUM> are loosened and the tines <NUM> may be removed from the instrument <NUM>, if so desired. The fastener <NUM> is then rotated in a counter-clockwise direction (as depicted by the arrow), thereby causing the plate carriers 44a and 44b to move outwardly (by virtue of the previously described geared arrangement) and separate from the plates <NUM>. The entire instrument <NUM> is then disconnected from the rod <NUM> by rotating the instrument <NUM> to disengage the threaded shaft <NUM> from the threaded hole <NUM> of the rod <NUM>. The instrument <NUM> may then be withdrawn and completely removed from the bone <NUM>. <FIG> depicts the bone <NUM> with the plates <NUM> applied thereto.

Claim 1:
An instrument (<NUM>) for setting a fracture in a bone and affixing a bone plate to the fractured bone with a connection to an intramedullary rod (<NUM>) fixed in the fractured bone, said instrument (<NUM>) comprising:
a connector (<NUM>) for connecting the instrument (<NUM>) to the intramedullary rod (<NUM>),
at least two tines (<NUM>), each tine (<NUM>) having a distal end (<NUM>) configured to contact the bone, the tines (<NUM>) movably connected to the connector (<NUM>) and configured to orient the fractured bone with respect to the rod; and
at least one plate carrier (44a, 44b) configured to receive the bone plate, the at least one plate carrier (44a, 44b) movably connected to the connector (<NUM>) and configured to move relative to the connector (<NUM>) and the tines (<NUM>) to position the bone plate adjacent the bone in a predetermined alignment with the intramedullary rod (<NUM>).