Systems and methods for intramedullary nail implantation

Abstract

Intramedullary nails, systems, and methods. The intramedullary nail may include a generally elongate body extending from a first, distal end to a second, proximal end. The distal end may include one or more openings configured to receive one or more bone anchors that extend transversely through the distal end intramedullary nail, and thereby configured to secure the distal end of the nail. The proximal end may also include one or more openings configured to receive one or more bone anchors that extend transversely through the proximal end of the intramedullary nail, and thereby configured to secure the proximal end of the nail.

What is claimed is: 
     
         1 . An implant, comprising:
 an intramedullary nail having:
 a body elongated along a first axis, the body having a proximal portion and a distal portion; 
 a first aperture formed in the proximal portion, the first aperture defining a second axis transverse to the first axis at a first angle; and 
 a second aperture formed in the proximal portion, the second aperture defining a third axis transverse to the first axis at a second angle, the third axis intersecting with the second axis at the first axis and the first and second angles being complementary angles; and 
   a headless fastener extending from a first end to a second end, the headless fastener having a shaft configured to be positioned through the first aperture or the second aperture and the first end of the headless fastener configured to be positioned against or within bone.   
     
     
         2 . The implant of  claim 1 , wherein the first aperture is radially offset in an AP plane from a sagittal plane by a first degree and the second aperture is radially offset in the AP plane from the sagittal plane by a second degree which is larger than the first degree. 
     
     
         3 . The implant of  claim 2 , wherein the second degree is twice the first degree. 
     
     
         4 . The implant of  claim 1 , further including:
 a third aperture formed in the proximal portion, the third aperture defining a fourth axis transverse to the first axis at a third angle; and   a fourth aperture formed in the proximal portion, the fourth aperture defining a fifth axis transverse to the first axis at a fourth angle, the fifth axis intersecting with the fourth axis at the first axis and the third and fourth angles being complementary angles.   
     
     
         5 . The implant of  claim 4 , wherein the third aperture is radially offset in an AP plane from a sagittal plane by a first degree and the fourth aperture is radially offset in the AP plane from the sagittal plane by a second degree which is larger than the first degree. 
     
     
         6 . The implant of  claim 4 , further including at least one proximal opening configured to receive a locking screw. 
     
     
         7 . The implant of  claim 6 , further comprising:
 first and second fixation devices configured to pass through the first and third apertures or the second and fourth apertures; and   a third fixation device configured to pass through the proximal opening and pass posteriorly to the first and second fixation devices to define a fixed angle construct.   
     
     
         8 . The implant of  claim 1 , further including at least one distal aperture defining a sixth axis transverse to the first axis at an oblique angle. 
     
     
         9 . The implant of  claim 1 , wherein the headless fastener is fully threaded from the first end to the second end. 
     
     
         10 . The implant of  claim 9 , wherein the headless fastener has no head projecting past a major diameter of a screw thread. 
     
     
         11 . A system for inserting an intramedullary nail into a bone, the system comprising:
 an intramedullary nail having a proximal end, a distal end, at least one side surface extending between the proximal end and the distal end, and an aperture through the intramedullary nail; and   an insertion tool comprising:
 a handle portion, the handle portion defining a first connection assembly; 
 a coupling portion extending from the handle portion, the coupling portion configured to removably couple to the proximal end of the intramedullary nail; 
 an aiming guide having a body with at least one support block and a second connection assembly, wherein the first and second connection assemblies are configured to releasably interconnect the handle portion and the aiming guide; and wherein the at least one support block defines a guide sheath hole configured to receive a guide sheath therethrough, the guide sheath hole positioned such that, when the intramedullary nail is coupled to the coupling portion, the guide sheath hole substantially aligns with the aperture in the intramedullary nail. 
   
     
     
         12 . The system of  claim 11 , wherein one of the first or second connection assemblies includes at least one connection post and the other of the connection assemblies includes a post receiving hole; and a connection button which extends into the post receiving hole and is configured to releasably engage the connection post. 
     
     
         13 . The system of  claim 12 , wherein the connection post includes a circumferential slot and the connection button includes an engagement portion configured to selectively engage the circumferential slot. 
     
     
         14 . The system of  claim 11 , wherein one of the first or second connection assemblies includes at least two connection posts and the other of the connection assemblies includes at least two post receiving holes; and a connection button extends into one of the post receiving holes and is configured to releasably engage the connection post received therein. 
     
     
         15 . The system of  claim 11 , further comprising:
 a first retention member positioned along the guide sheath hole and configured to engage with a second retention member on the guide sheath to restrict movement of the guide sheath with respect to the guide sheath hole; and   a retention release mechanism disposed on the support block.   
     
     
         16 . The system of  claim 11 , further comprising:
 a cannula assembly including:
 a flexible cannula with a through passage extending therethrough; and 
 a rigid handle connected with the flexible cannula, 
 wherein the intramedullary nail is passed through the flexible cannula through passage during insertion. 
   
     
     
         17 . The system of  claim 16 , wherein the rigid handle, alone or in conjunction with flexible cannula, defines a pair of tibia pin guides, and the rigid handle further defines at least two femur pin guides. 
     
     
         18 . The system of  claim 16 , wherein the cannula assembly further comprises:
 a drill sleeve and a trocar configured to extend through the flexible cannula through passage.   
     
     
         19 . The system of  claim 16 , wherein the flexible cannula is integrally formed with the rigid handle. 
     
     
         20 . The system of  claim 16 , wherein the flexible cannula is over-molded onto the rigid handle.