Patent Description:
When a bone is damaged or fractured, bone plates are commonly attached to the outside surface of the damaged bone to stabilize the area and promote healing of the bone. Generally, the plates have a bone contacting side and a side facing away from the bone with a plurality of holes extending through the two surfaces. The plates are often designed for polyaxial and/or monoaxial screw placement.

From <CIT>, a surgical aiming system is known which comprises a triangular screw guide configured to attach two bone plates around a bone to the bone. For that purposes, the legs of the triangular screw guide comprise two different hole patterns. Another embodiment of a targeting arm is known from <CIT>.

In order to accurately place the screws, targeting guides are typically used. In the instance of monoaxial placement, there exists a need for a targeting guide that provides accurate placement of the screws while accommodating more than one plate configuration, thereby advantageously reducing the amount of tools required for a given surgery.

A targeting guide with the features of claim <NUM> is provided. Further optional features of the targeting guide are defined in the dependent claims. The targeting guide is configured as a targeting block and may be part of a targeting system for accurately implanting bone screws within a bone plate. The block has different sides extending that have different patterns corresponding to holes of a different bone plate. The holes of each side of the targeting block align axially with holes of the respective bone plate, based on the side of the targeting block that is utilized (facing the user). Opposing upper and lower sides of the block are designed to correspond to left and right versions of a bone plate of a first size and/or shape. The opposing lateral sides of the block are designed to correspond to left and right versions of a bone plate of a second size and/or shape. Accordingly, the targeting block is designed to accurately place screws within four different plates.

A first aspect of the disclosure includes a targeting guide for a bone plate. The targeting guide includes a body having an upper side and an opposite lower side, a first lateral side and a second opposite lateral side, a first plurality of holes extending through the upper and lower sides and arranged in a first pattern, a second plurality of holes extending through the first and second lateral sides and arranged in a different second pattern.

In other embodiments, the first plurality of holes and the second plurality of holes may be configured to receive bone screws therethrough. The first plurality of holes and the second plurality of holes may be configured to receive a monoaxial sleeve. The first pattern may include pairs of diagonal holes. The second pattern may include pairs of diagonal holes. The first pattern may include less holes than the second pattern. The first pattern of the targeting guide may align with a first pattern of holes of a first bone plate. The second pattern of the targeting guide may align with a second pattern of holes of a second bone plate different from the first bone plate. The second bone plate may be longer than the first bone plate. The body may be rectangular. The body may comprise at least one connection hole on each of the upper and lower sides and the first and second lateral sides of the body. The connection hole may have a different shape than each of the first holes and second holes. Each connection hole may be positioned at a proximal end of the block. One of the upper side and the lower side of the body may correspond to a left femur bone plate and the other side of the upper side and the lower side may correspond to a right femur plate.

Another aspect not forming part of the present invention includes a system for attaching a bone plate to bone. The targeting guide includes a body having an upper side and an opposite lower side, a first lateral side and a second opposite lateral side, a first plurality of guide holes extending through the upper and lower sides and arranged in a first pattern, a second plurality of guide holes extending through the first and second lateral sides and arranged in a different second pattern. The system further includes a first bone plate defining a first plurality of plate holes, and a second bone plate defining a second plurality of plate holes having a different pattern than the first plurality of plate holes. When the targeting guide is attached to the first bone plate, the first plurality of guide holes align with the first plurality of plate holes, and when the targeting guide is attached to the second bone plate, the second plurality of guide holes align with the second plurality of plate holes.

In other embodiments, each one of the first plurality of guide holes may include a central axis and each one of the first plurality of plate holes may include a central axis, the central axes of the first plurality of guide holes being coaxial with the central axes of the first plurality of plate holes being coaxial when the targeting guide is attached to the first bone plate. Each one of the second plurality of guide holes may include a central axis and each one of the second plurality of plate holes may include a central axis, the central axes of the second plurality of guide holes being coaxial with the central axes of the second plurality of plate holes when the targeting guide is attached to the second plate. The system may include a monoaxial sleeve having a proximal end received within any one of the holes of the targeting guide and a distal end received within an axially aligned hole of the bone plate. The first bone plate and the second bone plate each may have an oblong hole and the targeting guide has a connection hole. The system may further include a support having a distal end configured to attach to the oblong hole of the first plate and of the second plate and a proximal end configured to attach to the connection holes of the targeting guide.

Yet another aspect not forming part of the present invention includes a method that includes the steps of selecting between a first bone plate and a second bone plate, the first and second bone plates having different patterns of bone plate holes; selecting between a plurality of sides of a targeting guide based on the selected bone plate; attaching the targeting guide to the selected bone plate.

The present invention generally relates to a targeting guide to be used in conjunction with a bone plate and screws for monoaxial screw placement of the bone plate on the bone. Those of skill in the art will recognize that the following description is merely illustrative of the principles of the invention, which may be applied in various ways to provide many different alternative embodiments.

In describing certain aspects of the inventions disclosed herein, specific terminology will be used for the sake of clarity. However, the inventions are not intended to be limited to any specific terms used herein, and it is to be understood that the invention is defined and limited by the appended claims. In the drawings and in the description which follows, when referring to the term "proximal" in the context of the bone, the term "proximal" refers to the end of the bone plate or targeting block that is closer to the heart, while the term "distal" refers to the end of the bone plate or targeting block that is further from the heart. In the drawings and in the description which follows, when referring to the term "proximal" refers to the end of the instrumentation, or portion thereof, which is closest to the operator in use, while the term "distal" refers to the end of the instrumentation, or portion thereof, which is farthest from the operator in use.

The tools described below are designed to facilitate efficient and accurate screw insertion during surgery. <FIG> depict a targeting guide system <NUM> including a targeting block <NUM>, supports or handles <NUM>, and instrumentation <NUM>. Targeting guide system <NUM> is designed to facilitate the accurate placement of screws within holes of bone plates and into engagement with the bone. In some instances, the trajectory of the bone screw placement may be monoaxial, or along one single axis, and in other instances, it is contemplated, that the trajectory of the bone screw placement may be polyaxial, along more than one axis. The system is configured to correspond to any type of bone plate, and is particularly useful where at least two bone plates having different lengths from one another and/or left and right plate versions are included. The different cooperations between the guide and the plates being achieved through rotation of the targeting guide, for instance, with different bone plate sizes and/or shapes being engageable upon <NUM> degrees rotation of the guide, and the right-left configuration being engageable upon <NUM> degrees rotation.

The targeting systems disclosed herein are designed for use on any bones. Specifically, the targeting guide blocks are configured for connection to any type of plate.

In <FIG> the targeting system is shown as an example with a femur bone plate for use with femur fractures. Specifically, in <FIG>, the targeting guide system of the present disclosure is shown with an interprosthetic femur plate, although the system may be used with other femur plates, including proximal femur plates and distal femur plates, as well as plates designed for other bones. In certain instances, such as for example with the use of interprosthetic and proximal femur plates, such targeting guides may be also used for plates that are peri-prosthetic.

<FIG> shows plates <NUM>, <NUM>' each including a plurality of screw holes <NUM>, <NUM>' for polyaxial or monoaxial placement of screws within the holes. Each hole <NUM> includes a central axis extending in the direction from the upper and lower surfaces of the plate. Plates with such holes are described in further detail in <CIT>. Plate <NUM> and plate <NUM>' are substantially similar except that plate <NUM>' has a greater length than plate <NUM>'. As a result, plate <NUM> and plate <NUM>' have a different arrangement of holes <NUM>, <NUM>' due to the difference in length. Namely, plate <NUM> has twelve holes <NUM> positioned between oblong holes <NUM> and arranged in six pairs of diagonal holes; whereas, plate <NUM>' has thirteen holes <NUM>' positioned between oblong holes <NUM>' with six pairs of diagonal holes and an additional hole. As described herein, targeting guide system <NUM> facilitates accurate insertion of the screws within holes <NUM>, <NUM>' of plates <NUM>, <NUM>'. Further, plates <NUM>, <NUM>' each include at least one oblong hole <NUM>, <NUM>' for connection of a support or handle, as will be discussed in further detail below. Plates <NUM>, <NUM>' are both interprosthetic plates designed to be connected to the bone between total hip and total knee arthroplasties, and each plate <NUM>, <NUM>' includes two oblong holes; whereas, for proximal and distal plates, the plates generally include one oblong hole, shown in <FIG>, and discussed in further detail below. In the examples shown, the oblong holes of the plate, form a connection point between the plate and the block via a handle. Thus, as described in further detail below, plates with one oblong hole are described with one handle, and plates with two oblong holes are described with two handles each being connected at a respective one of the two oblong holes.

Turning to <FIG> and <FIG>, targeting guide is in the form of block <NUM> shown as having the shape of a rectangular prism with six rectangular faces. With reference to <FIG>, targeting block <NUM> extends between a proximal end <NUM> and distal end <NUM>, corresponding to the relative positioning of the bone plate on the bone. A length of block <NUM> is defined between proximal and distal ends <NUM>, <NUM>. Block <NUM> includes upper side <NUM> and opposing lower side <NUM>, and block <NUM> further includes first lateral side <NUM> and an opposing lateral side <NUM>, each extending between upper side <NUM> and lower side <NUM>.

Each of the upper and lower sides <NUM>, <NUM> and first and second lateral sides <NUM>, <NUM> define a first connection hole <NUM> extending therethrough at proximal end <NUM> and a second connection hole <NUM> at distal end <NUM>. <FIG> shows connection hole <NUM>, which is configured for connection to a handle to allow the block <NUM> to connect to both plates <NUM>, <NUM>'. Each connection hole <NUM> is positioned within a cavity portion <NUM> which is recessed from the adjacent surface of the block. Further, each connection hole <NUM> is substantially round with two elongate wings <NUM> extending in the proximal-distal direction of the block, shown in <FIG>.

As shown in <FIG>, block <NUM> includes a plurality of first holes <NUM> extending through the upper and lower sides and along a portion of the length of block <NUM> between first and second connection holes 220A. Each first hole <NUM> has a central axis extending in the direction of the upper and lower sides of the block. Block <NUM> further includes a plurality of second holes <NUM> extending through the first and second lateral sides and along a portion of the length of the block <NUM> between first and second connection holes 220B. Each second hole <NUM> has a central axis extending in the direction of the first and second lateral sides of the block.

First holes <NUM> and second holes <NUM> are identical in shape, and have a substantially circular shape. In particular, as shown, the holes are mostly circular and may have at least two opposing flat sides (best shown in <FIG>).

The plurality of first holes <NUM> are arranged in a first pattern that is different from a second pattern in which the plurality of second holes <NUM> are arranged. Namely, the first pattern corresponds to and matches the holes <NUM> of a first bone plate <NUM> having a first length, and the second pattern corresponds to and matches the holes <NUM>' of a second bone plate <NUM>' having a second length different from the first length. For example, as shown in <FIG>, holes <NUM> are arranged in a pattern including six diagonal pairs of holes <NUM> so as to correspond to the holes <NUM> of the shorter plate <NUM>; whereas, holes <NUM> are arranged in a pattern including six diagonal pairs of holes <NUM> and a thirteenth hole so to correspond to holes <NUM>' of the longer plate <NUM>'.

Thus, block <NUM> can be attached to the bone with upper and lower sides <NUM>, <NUM> extending parallel to the bone to attach to and fix bone plate <NUM> to bone. Block <NUM> can be rotated <NUM> degrees such that first and second lateral sides <NUM>, <NUM> extend parallel to the bone. In this configuration, block <NUM> is attached to and facilitates the fixing of bone plate <NUM>' to the bone. In this manner, each block <NUM> accommodates two different bone plates. In this example, the bone plates have different lengths and different patterns of screw holes thereon; however, it is contemplated that that the bone plates may have different shapes, profiles and screw hole designs from one another as well.

Moreover, block <NUM> is designed for use with both the left and right sides of the body. For example, block <NUM>, as shown in <FIG>, with first lateral side <NUM> positioned upward such that the first lateral side extends parallel to the bone, and second lateral side <NUM> is relatively closer to the bone than is first lateral side <NUM>, the block <NUM> is configured to attach a bone plate <NUM>' to the left femur of a patient. This is identified on the first lateral side <NUM>, which is marked with "LEFT" to allow surgeons with easy identification. Rotation of block <NUM><NUM> degrees, such that second lateral side <NUM> is upward and first lateral side <NUM> is relatively closer to the bone than is second lateral side <NUM>, allows for connection of block <NUM> to bone plate <NUM>' to the right femur of a patient.

Rotation of block <NUM> by <NUM> degrees allows for use of a different plate, which in the example shown, has a different length. Additionally or alternatively, the blocks may cooperate with two different bone plates that each have a different peripheral shape and/or different screw hole designs and screw hole sizes. Rotation of block <NUM> by <NUM> degrees allows for use of the block with both the right and the left side of the body. Thus, a single block <NUM> is usable with four different plates, the left and right of a first plate of a first size, and the left and right of a second plate of a second size.

As noted above, block <NUM> includes indicia, such as indication as to the correct orientation of the guide for left and right versions of a given plate size. Moreover, block <NUM>, as shown, includes an indication of the orientation of the guide with respect to the "Proximal Side" and "Distal Side" of the plate, as well as an indication of the type of plate ("Interprosthetic" in the version shown) along with plate size on different sides of the block indicating orientation with respect to a given plate size.

Turning to <FIG>, handle <NUM> is shown which facilitates the connection of block <NUM> to a bone plate <NUM>. Handle <NUM> includes wheel <NUM>, shaft <NUM> and grip <NUM>. Handle <NUM> extends between proximal end <NUM>, closest to the operator in use, which connects to block <NUM>, and distal end <NUM> which connects to oblong hole <NUM> of bone plate <NUM>.

Grip <NUM> defines the portion of the handle for the surgeon to hold and manipulate and defines a cannulation through the length of the grip for receiving shaft <NUM>. Grip <NUM> defines at least one window <NUM> for viewing the shaft <NUM>. In the illustrated example, grip <NUM> includes four windows <NUM>. Distal end <NUM> includes engagement portion <NUM> which is designed to be received within oblong holes <NUM> of bone plate <NUM>. Engagement portion <NUM> has a necked portion defined by wings <NUM> such that the diameter of the engagement portion is greater across wings <NUM> than at the adjacent distal end. Further, engagement portion <NUM> includes flexure strips <NUM> extending in the proximal-distal direction of the handle <NUM> to allow the engagement portion <NUM> to flex into the oblong hole <NUM>.

Shaft <NUM> is positioned within the cannulation of grip <NUM> in order to securely fix the handle <NUM> to the bone plate <NUM>. Shaft <NUM> includes knob <NUM> at a proximal end of the shaft, the knob <NUM> can be rotated in order to thread the shaft to handle <NUM>, which spreads distal end <NUM> of handle <NUM>. The expansion of distal end <NUM> fixes the handle within oblong hole <NUM> of plate <NUM>. With the shaft <NUM> and grip <NUM> secured to one another via the threading, knob <NUM> abuts the proximal end of the grip <NUM>. Knob <NUM> is configured to engage connection holes <NUM> of block <NUM>.

Handle <NUM> further includes wheel <NUM> defines cannulation <NUM> therethrough and further includes cap <NUM> at a proximal end of the wheel and connection element <NUM> extending distally from the cap <NUM>. Connection element <NUM> is configured to be received within connection holes <NUM> of block <NUM> and within knob <NUM> of shaft <NUM> to fix the wheel to the shaft-grip assembly. Connection element <NUM> includes thread <NUM> for threading engagement with a proximal end of the knob <NUM> of shaft <NUM>. Wheel <NUM> further includes through hole <NUM> extending through cap <NUM> in a direction oblique to cannulation <NUM>. Through hole <NUM> is configured to receive a driver, which can increase the arm in order to rotate wheel <NUM> during connection to block <NUM> and the shaft-grip assembly.

Targeting system <NUM> also includes various instrumentation, including guiding sleeves, for allowing for accurate and safe placement of the screws within holes <NUM> of bone plate <NUM> and into bone. Such instrumentation are shown in <FIG>, although will be described in greater detail below with regard to their function during the use of targeting guide system <NUM>. As shown in <FIG>, system <NUM> includes a set of instruments <NUM> that includes among other tools, described in detail below, tissue protection sleeve <NUM>, drill sleeve <NUM> and trocar <NUM>. Tissue protection sleeve <NUM> alone or in combination with drill sleeve <NUM> facilitate monoaxial placement of screws within the sleeve, through the guide block, and into holes <NUM> of the bone plate at a single axis. Tissue protection sleeve <NUM> includes an outer flange <NUM> at a proximal end thereof to be received within holes <NUM>, <NUM> of block <NUM> and enable tissue protection sleeve to be locked within the holes to prevent movement. In other examples, tissue protection sleeve <NUM> and holes <NUM>, <NUM> are sized to allow movement of the tissue protection sleeve within the hole at a plurality of axes, angled relative to the central axis of the holes <NUM>, <NUM> to accommodate placement of the screws at a plurality of axes relative to holes <NUM>, <NUM> and bone plate holes <NUM>.

<FIG> show targeting guide system <NUM> in use on a femur bone. With bone plate <NUM> positioned against bone, handles <NUM> are each attached to oblong holes <NUM> of the bone plate <NUM> at engagement portion <NUM> of grip <NUM>. Shaft <NUM> is positioned within grip <NUM> and tightened to establish a solid link between the plate and the shaft-grip assembly, shown in <FIG>. This step is performed twice to attach the two handles to the two oblong holes <NUM> of the plate <NUM>.

The user chooses the appropriate block <NUM> as well as the appropriate sides of the block, i.e. upper and lower sides or lateral sides, which will be used as the aiming guide for the bone plate holes. Based on the size of the bone plate, the block <NUM> can be rotated <NUM> degrees and based on whether the plate is the left side or the right of the body, the block <NUM> can be rotated <NUM> degrees.

With the necessary side extending parallel to the bone, the user inserts cap <NUM> of shaft <NUM> within one of the connection holes <NUM> at the bottom side, i.e. the side parallel to and closest to the bone. <FIG> shows each wheel <NUM> placed within one of the two connection holes <NUM> on the top side, i.e. the side parallel to and furthest away from the bone, and rotated to connect the wheel <NUM> to the block <NUM> and to shaft <NUM>. As shown in <FIG>, a driver <NUM> can be placed within through hole <NUM> to create a longer arm for easier rotation of the wheel. Both supports or handles <NUM> are connected and the targeting block <NUM> is positioned above and aligned with the bone plate <NUM> such that respective holes <NUM> (or <NUM> depending on the position of the block) align with the respective hole <NUM> of plate <NUM>. In this manner, the central axis of a hole <NUM> is coaxial with the corresponding central axis of the respective hole <NUM> of plate <NUM>.

Trocar <NUM> is inserted into drill sleeve <NUM> and the assembly is inserted into tissue protection sleeve <NUM>, which is a monoaxial sleeve. As shown in <FIG>, tissue protection sleeve <NUM> is then placed within a hole <NUM> (or <NUM> depending upon which side of the block is utilized, but for simplicity only hole <NUM> will be used for the description of use) and the corresponding hole <NUM> of plate <NUM>. Tissue protection sleeve <NUM> is rotated to lock the tissue protection sleeve into hole <NUM> and then guided into hole <NUM> of the bone plate.

Trocar <NUM> is then removed in order to begin drilling of the screw hole into bone. <FIG> show drill sleeve <NUM> and tissue protection sleeve <NUM> within hole <NUM> of block <NUM>. Drill bit <NUM> is positioned within drill sleeve <NUM> and torqued to form the hole into which a locking or non-locking screw will be implanted.

Drill sleeve <NUM> is removed prior to tapping or screw insertion. A screwdriver, with screw attached, shown in <FIG>, is placed within tissue protection sleeve and to fix the screw in the bone along the axis defined by holes <NUM> of block <NUM>. In this manner, the screw is positioned along the monoaxial trajectory of the hole <NUM>.

The sleeve assembly can be moved to various holes <NUM> to implant a plurality of screws through block <NUM> and into engagement with bone plate <NUM> and the bone to provide fixation of the bone plate to the bone. Each holes <NUM> of block <NUM> allows for accurate monoaxial screw placement of the locking or non-locking screws within bone plate <NUM>.

<FIG> show targeting guide system <NUM> including targeting block <NUM>, bone plate <NUM>, handle <NUM> and instrumentation <NUM>. Like reference numerals refer to like elements in this embodiment, but with numbers in the <NUM> series, and the differences will between systems <NUM> and <NUM> will be discussed.

System <NUM> is identical to system <NUM> in many respects, except that system <NUM> is designed to be used in conjunction with proximal and distal plates having one oblong hole <NUM>, as shown in <FIG>. Therefore, the system includes one handle <NUM> for connection to the one oblong hole <NUM> of the plate <NUM>.

<FIG> shows plates <NUM> and <NUM>', which are similar to plates <NUM>, <NUM>'. Plate <NUM> has a shorter length than plate <NUM>', which causes the arrangement or pattern of holes <NUM> to be different from the pattern of holes <NUM>' on plate <NUM>', with plate <NUM>' having an additional hole <NUM>'.

In other examples described above, the plates may also have a different outer peripheral shape or the holes of each plate may differ in other characteristics additionally or alternatively.

<FIG> shows targeting block <NUM> which is identical to block <NUM> in most respects, except that each of the upper side <NUM>, lower side <NUM>, first lateral side <NUM> and second lateral side <NUM> includes one connection hole <NUM> rather than two as in block <NUM>. The one connection hole <NUM> is to correspond to the oblong hole <NUM> of plate <NUM>. Like block <NUM>, the upper and lower sides have a different arrangement of holes <NUM> than the first and second lateral sides have an arrangement of holes <NUM>. Holes <NUM> of upper and lower sides <NUM>, <NUM> match holes <NUM> of plate <NUM>; whereas, holes <NUM> of first and second lateral sides <NUM>, <NUM> to correspond to or match holes <NUM>' of the longer plate <NUM>'.

Referring to <FIG>, in use, one handle <NUM> connects at a distal end to the oblong hole <NUM> of bone plate <NUM> (as noted above, for simplicity, only bone plate <NUM> will be described in the use of the system <NUM>) and at a proximal end to block <NUM>. Generally, the oblong hole is positioned on a proximal portion of the bone plate, and the connection hole of the block is positioned on a proximal end of the block. At the distal end of the block, sleeve assembly <NUM> is attached to block <NUM> and plate <NUM>, as described above with reference to <FIG>. Sleeve assembly <NUM> is identical to sleeve assembly <NUM> described with reference to system <NUM> and includes a trocar, drill sleeve and tissue protection sleeve. Sleeve assembly <NUM> may be attached to the most distal hole <NUM> of block <NUM>, as shown in <FIG>, or it may be attached to a different hole on the distal portion of the block <NUM>.

The trocar is then removed and temporary plate fixator <NUM> is positioned through the drill-tissue protection sleeve assembly, as shown in <FIG>. The temporary plate fixator <NUM> has a threaded shaft <NUM> and a self-drilling, self-tapping tip <NUM> for quick insertion into cortical bone, shown in <FIG>. Temporary plate fixator <NUM> is rotated in a clockwise direction (as shown by the arrow) to tension block <NUM> to plate <NUM>. This creates a stable attachment of block <NUM> to plate <NUM>. With the distal end of block <NUM> attached to plate <NUM>, an additional tissue protection sleeve and drill sleeve may be needed, in the similar manner as described above in connection to placing the other screws within plate <NUM>.

As described above with reference to <FIG>, screws can be inserted into the additional holes <NUM> of block <NUM> and holes <NUM> of plate <NUM> to fix the plate to bone with accurate placement of the screws.

The targeting guide blocks of the present disclosure are formed from milled carbon fiber reinforced polyetherimide. Examples of dimensions of the blocks disclosed herein include a height and width both of about <NUM> and a length of about <NUM> to about <NUM>. However, such lengths of the desired block may be chosen based on the length of the desire plate. In certain examples, the blocks may be designed using three-dimensional printing. In some cases, the blocks may be made for single use.

Claim 1:
A targeting guide for a bone plate (<NUM>, <NUM>') comprising:
a body (<NUM>, <NUM>) having the form of a block, the body having an upper side (<NUM>, <NUM>) and an opposite lower side (<NUM>, <NUM>), a first lateral side (<NUM>, <NUM>) and a second opposite lateral side (<NUM>, <NUM>), each of said lateral sides (<NUM>, <NUM>, <NUM>, <NUM>) connecting the upper side (<NUM>, <NUM>) and the lower side (<NUM>, <NUM>), a first plurality of holes (<NUM>, <NUM>) extending through the upper and lower sides (<NUM>, <NUM>, <NUM>, <NUM>) and arranged in a first pattern configured to align with a first pattern of holes (<NUM>, <NUM>) of a first bone plate (<NUM>, <NUM>), a second plurality of holes (<NUM>, <NUM>) extending through the first and second lateral sides (<NUM>, <NUM>, <NUM>, <NUM>) and arranged in a different second pattern configured to align with a second pattern of holes (<NUM>', <NUM>') of a second bone plate (<NUM>', <NUM>') different from the first bone plate (<NUM>, <NUM>).