Systems and methods for fusion of anatomical joints

Abstract

The present disclosure relates to improved plate and screw systems for use in fusion and other surgical procedures, which improve the ability to effectively affix adjacent bodies without gapping or experiencing loss of compression over time. The systems include plates having armatures configured to receive bushings, the bushings configured to pivot and rotate and thereby permit a greater degree of orientation of corresponding screws placed through the bushings. In embodiments, the bushings comprise anti-rotation elements which lock the bushings in a desired orientation. Methods for use of the components described herein are also disclosed.

What is claimed is: 
     
         1 . A surgical system, comprising:
 a plate comprising one or more armatures, each of the one or more armatures offset from and extending about 90 degrees to the x-axis of the plate;   the plate comprising at least one bore configured to receive a first screw oriented in a z-axis relative to the plate;   the one or more armatures comprising a recess located at a distal end of the armature and having an inner surface;   a bushing having an outer surface complementary to the inner surface of the recess and configured to be selectively received by and retained by the recess, wherein the bushing further comprises a through hole accessible via the recess when the bushing is retained therein;   a second screw comprising a threaded portion, a non-threaded portion and a screw head having an outer surface complementary to the through hole of the bushing, wherein the threaded and non-threaded portions of the second screw pass through the through hole of the bushing, and wherein the outer surface of the screw head is configured to be retained within the through hole of the bushing, and wherein the second screw is oriented in the direction of and normal to the orientation of the first screw.   
     
     
         2 . The surgical system of  claim 1 , wherein rotation of the screw once the screw head is retained within the bushing rotates the bushing relative to the recess. 
     
     
         3 . The surgical system of  claim 2 , wherein further rotation of the bushing secures the position of the bushing relative to the recess, thereby securing the bushing and the screw in a fixed orientation relative to the plate. 
     
     
         4 . The surgical system of  claim 3 , wherein the inner surface of the recess tapers from a proximal surface of the plate to a distal surface of the plate, and wherein the bushing is secured within the recess by a frictional or interference fit between the bushing and the recess after being advanced within the recess by a predetermined distance. 
     
     
         5 . The surgical system of  claim 3 , wherein the bushing is permitted to pivot while retained by the recess but prior to being secured in the recess, allowing the screw orientation to be adjusted relative to the plate. 
     
     
         6 . The surgical system of  claim 3 , wherein the screw head comprises threading on the outer surface and the through hole of the bushing comprises a complementary threading to the threading on the outer surface of the screw head, and wherein the bushing retains the screw head by threaded engagement between the screw head and the bushing. 
     
     
         7 . The surgical system of  claim 3 , wherein the bushing further comprises a groove located about an outer circumference of the bushing and adapted to receive an anti-rotation element within the groove. 
     
     
         8 . The surgical system of  claim 7 , wherein the anti-rotation element is configured to be positioned within the groove of the bushing, the anti-rotation element further comprising a key for engagement with a notch on the inner surface of the recess. 
     
     
         9 . The surgical system of  claim 8 , wherein the anti-rotation element is substantially circular. 
     
     
         10 . The surgical system of  claim 8 , wherein the anti-rotation element is c-shaped. 
     
     
         11 . The surgical system of  claim 10 , wherein the anti-rotation element may be selectively removed from the groove of the bushing. 
     
     
         12 . The surgical system of  claim 7 , wherein the groove does not extend about an entire outer circumference of the bushing. 
     
     
         13 . The surgical system of  claim 8 , wherein the rotation of the bushing causes the key of the anti-rotation element to engage the notch of the inner surface of the recess and prohibit further rotation of the bushing. 
     
     
         14 . The surgical system of  claim 1 , wherein the plate comprises two armatures, each of the armatures comprising a recess having an inner surface for respectively receiving and retaining a first and second bushing, each of the first and second bushings comprising a groove located about an outer circumference of the bushing and adapted to receive an anti-rotation element within the groove, the anti-rotation elements configured to be positioned within the grooves of the bushings, each anti-rotation element further comprising a key for engagement with a notch on the inner surface of the recess and locking the bushings relative to the recesses when the key engages the notch of the inner surface of the bushing. 
     
     
         15 . The surgical system of  claim 14  further comprising:
 a third screw configured to be received by the second bushing; 
 wherein the armatures are located on opposing ends of the plate, and wherein the second and third screws are oriented to converge towards one another while avoiding contact; and 
 wherein the first, second and third screws are oriented in three orthogonal planes. 
 
     
     
         16 . The surgical system of  claim 1 , wherein the at least one bore is located at a distal end of the plate and about the x-axis of the plate. 
     
     
         17 . A surgical assembly, comprising:
 a thin plate having first and second sides,   the thin plate comprising one or more cylindrical bores extending therethrough;   the thin plate further comprising two or more armatures extending from the first or second side of the plate;   the two or more armatures comprising a recess having an inner surface and a notch located along the inner surface;   each of the two or more armatures adapted to receive a bushing configured to fit within the recess of the corresponding armature and having an outer profile that is complementary to the inner surface of the recess within which it is received, the bushings permitted to pivot or rotate within the recesses;   each bushing having at least one outwardly-extending protrusion; and   wherein the bushing is prevented from pivoting or rotating once the outwardly-extending protrusion engages the notch along the inner surface of the recess.   
     
     
         18 . The surgical assembly of  claim 17 , further comprising a screw adapted for operative engagement with a threaded hole of the bushing, wherein rotation of the screw beyond a predetermined amount rotates the bushing which urges the outwardly-extending protrusion to engage the notch and lock the position of the bushing relative to the thin plate. 
     
     
         19 . The surgical assembly of  claim 17 , wherein the two or more armatures comprise a first armature having a curved shape and having a first recess offset from the x-axis of the thin plate by about 90 degrees, and further comprising a second armature having a curved shape and having a second recess offset from the x-axis of the thin plate by about 90 degrees. 
     
     
         20 . The surgical assembly of  claim 19 , wherein the first and second armatures extend from the same side of the thin plate. 
     
     
         21 . The surgical assembly of  claim 19 , wherein the first and second armatures extend from opposite sides of the thin plate. 
     
     
         22 . The surgical assembly of  claim 19 , wherein the first and second armatures comprise different lengths. 
     
     
         23 . The surgical assembly of  claim 19  further comprising a third armature and a corresponding third recess. 
     
     
         24 . The surgical assembly of  claim 17 , wherein the bushings are secured within the recesses by a frictional or interference fit. 
     
     
         25 . The surgical assembly of  claim 17 , wherein the at least one outwardly-extending protrusion is selectively retractable, thereby allowing the bushing to pivot or rotate freely when the outwardly-extending protrusion is retracted. 
     
     
         26 . The surgical assembly of  claim 17 , wherein the recess tapers from a proximal surface of the thin plate to a distal surface of the thin plate. 
     
     
         27 . The surgical assembly of  claim 26 , wherein the outer surface of the bushing tapers to a matching degree as the recess. 
     
     
         28 . The surgical assembly of  claim 18 , wherein the screw is a cortical bone screw, a cancellous bone screw or a cannulated bone screw. 
     
     
         29 . An orthopedic implant system which comprises a spanning link having a longitudinal axis in the x direction and having a first spanning link fastener with a first spanning link fastener axis which forms an angle relative to the spanning link longitudinal axis from 80 degrees to 100 degrees, and a first leg link extending away in the y and z direction from the of the spanning link longitudinal axis and having a first leg link fastener aperture that receives a first leg link fastener which has a first leg link fastener axis that extends away from the first leg link fastener aperture in the direction of but not intersecting the first spanning link fastener axis. 
     
     
         30 . The orthopedic implant system as set forth in  claim 29 , wherein the first leg link forms a curve that defines at least 60 degrees of an arc. 
     
     
         31 . The orthopedic implant system as set forth in  claim 29 , wherein the first leg link length and the second leg link length are not the same. 
     
     
         32 . The orthopedic implant of  claim 29 , wherein one of the first leg link and the second leg link forms an arc of at least 75 degrees in the z direction. 
     
     
         33 . The orthopedic implant of  claim 32 , wherein one of the first leg link or the second leg link forms an arc of at least 85 degrees in the z direction. 
     
     
         34 . The orthopedic implant of  claim 29 , wherein the long spanning link has a length of 15 to 60 mm, a width of 2 to 5 mm, and a thickness of 1 to 2.5 mm, and the first leg link has a length of 8 to 20 mm extending from the first spanning link and a width of 2 of 5 mm and a thickness of 1 of 2.5 mm. 
     
     
         35 . The orthopedic implant as set forth in  claim 29 , wherein the spanning link further comprises an extension. 
     
     
         36 . The orthopedic implant as set forth in  claim 35 , wherein the extension includes an aperture configured to receive a fastener. 
     
     
         37 . The orthopedic implant as set forth in  claim 35 , wherein the extension receives the distal end of one of the fasteners. 
     
     
         38 . An orthopedic implant system having an outline consisting of a single spanning link that extends from 15 to 60 mm along a long axis and has two opposing terminal ends joined across a short axis at a width of 2 to 5 mm by two opposing long sides, and each of the terminal ends include a through aperture each of which receives a cross screw at least one the cross screws being a polyaxial compression screw, and wherein the cross screw axes are in differing planes and form an X-shape but which do not contact each other. 
     
     
         39 . An implant which comprises a first long curved spanning link having a top surface and a medial line along its length and a first end having a first ear having a first fastener aperture and a second end having a second ear having a second fastener aperture and the long spanning link is fixed at the first end by a first fastener that extends through the first fastener aperture at 90 degrees +/−10 degrees to the medial line of the spanning link and aperture and the long spanning link is fixed at the second end by a second fastener that extends through the second fastener aperture at 90 degrees +/−10 degrees to the medial line of the spanning link, a first leg link and a second leg link each extending away from the medial line of the spanning link and the first leg link and the second leg link each having a terminal aperture for a first and second leg link fastener respectively. 
     
     
         40 . An orthopedic implant system having an outline comprising a spanning link that extends from 15 to 60 mm along a long axis and has two opposing terminal ends joined across a short axis at a width of 2 to 5 mm by two opposing long sides and each of the terminal ends that each have a top surface and extend away from the long axis to collectively form a T-shape, and the legs each have an eyelet defining a surface around an aperture in a plane at from 60 to 120 degrees relative to the top surface of the respective leg, and each of which receives a cross screw with at least one being a polyaxial compression screw, and wherein the cross screw axes are in differing planes that form an X-shape but which do not interfere with each other.