Combination intra-medullary and extra-medullary fracture stabilization with aligning arm

Abstract

A device provides a variety of fracture fixation options should a fracture occur after total hip arthroplasty or total knee arthroplasty, and provides associated methods and apparatus for application of provided fixation. The ability to pre-engineer fracture fixation contingent solutions into femoral or tibial components provides for a distinct clinical advantage in the planning and execution for periprosthetic fracture fixation. Said methods and apparatus include targeting devices which allow for intimate association of fixed angle locking screws in pre-drilled holes in an existing prosthetic, femoral nail, or other components including additional fixation components. Such apparatus and methods further include the use of alignment devices and other components to allow for ease of repair of fractures utilizing the pre-engineered solutions.

1 . A fracture fixation apparatus for securing a plurality of bone segments including at least one fracture between the plurality of bone segments, comprising:
 an intramedullary structure;   one or more intramedullary fasteners;   wherein the intramedullary structure comprises a plurality of intramedullary structure holes for accepting one or more of the intramedullary fasteners;   an extramedullary structure;   one or more angular stable extramedullary fasteners;   wherein the extramedullary structure comprises a plurality of extramedullary structure holes for accepting one or more of the extramedullary fasteners;   an aligning arm, for mechanically registering the intramedullary structure and the extramedullary structure;   wherein the aligning arm comprises one or more first alignment features for providing mechanical alignment of at least one of the intramedullary fasteners with respective ones of the intramedullary structure holes, so as to allow for insertion of the at least one of the intramedullary fasteners within the respective ones of the intramedullary structure holes in mechanical registration;   wherein the aligning arm further comprises one or more second alignment features for providing mechanical alignment of at least one of the angular stable extramedullary fasteners with respective ones of the extramedullary structure holes, so as to allow for insertion of the at least one angular stable extramedullary fasteners within the respective ones of the extramedullary structure holes in mechanical registration; and   wherein the aligning arm further comprises one or more third alignment features for providing mechanical alignment of at least one additional angular stable fastener with both at least one of the extramedullary structure holes and with at least one of the intramedullary structure holes, so as to allow for insertion of the at least one additional angular stable fastener within at least one respective extramedullary structure hole and at least one respective intramedullary structure hole in mechanical registration.   
     
     
         2 . The apparatus of  claim 1  wherein the intramedullary structure is further configured to provide fixation of at least one fracture between the plurality of bone segments. 
     
     
         3 . The apparatus of  claim 1  wherein the extramedullary structure is further configured to provide fixation of at least one fracture between the plurality of bone segments. 
     
     
         4 . The apparatus of  claim 1  wherein both the extramedullary structure and the intramedullary structure are further configured to provide fixation of at least one fracture between the plurality of bone segments. 
     
     
         5 . The apparatus of  claim 1  wherein at least one of the one or more intramedullary fasteners fastener is an angular stable fastener. 
     
     
         6 . The apparatus of  claim 1  wherein the at least one additional angular stable fastener is threaded into the intermedullary structure. 
     
     
         7 . The apparatus of  claim 1  wherein the one or more first alignment features comprise respective one or more cannula. 
     
     
         8 . The apparatus of  claim 1  wherein the one or more second alignment features comprise respective one or more cannula. 
     
     
         9 . The apparatus of  claim 1  wherein the intramedullary structure is further configured to provide a) access to an intramedullary canal and b) clearance associated with at least one feature of an in situ prothesis. 
     
     
         10 . The apparatus of  claim 9  wherein the clearance associated with the at least one feature of the in situ prothesis comprises an intercondylar notch of a distal femoral component of a knee prothesis. 
     
     
         11 . The apparatus of  claim 10  wherein the prothesis is the distal femur prothesis and is associated with an arthroplasty. 
     
     
         12 . The apparatus of  claim 1  where at least one of the intramedullary fasteners also serves as at least one of the angular stable extramedullary fasteners. 
     
     
         13 . The apparatus of  claim 1  where at least one of the intramedullary fasteners also serves as at least one of the angular stable extramedullary fasteners and a angularly stable intermedullary fastener. 
     
     
         14 . The apparatus of  claim 1  wherein one or more additional angularly stable fasteners serve as a angularly stable fastener with respect to both the extramedullary structure and the intramedullary structure. 
     
     
         15 . The apparatus of  claim 1  wherein at least one of the angular stable extramedullary fasteners also engages the intermedullary structure. 
     
     
         16 . The apparatus of  claim 1  further comprising:
 the intramedullary structure having an intramedullary structure feature; 
 the extramedullary structure having an extramedullary structure feature; and 
 wherein the intramedullary structure feature and the extramedullary structure feature further enable use of the intramedullary structure together with the extramedullary structure. 
 
     
     
         17 . A fracture fixation apparatus for securing a plurality of bone segments including at least one fracture associated with the plurality of bone segments, comprising:
 an intramedullary structure;   one or more angular stable fasteners;   wherein the intramedullary structure comprises a plurality of intramedullary structure holes for accepting one or more of the angular stable fasteners;   an extramedullary structure;   wherein the extramedullary structure comprises a plurality of extramedullary structure holes for accepting one or more of the angular stable fasteners;   an aligning arm, for mechanically registering the intramedullary structure and the extramedullary structure;   wherein the aligning arm comprises one or more first alignment features for providing mechanical alignment of at least one of the intramedullary structure holes with at least one of the extramedullary structure holes to form mechanically aligned holes; and   the aligning arm further comprises one or more second alignment features for providing mechanical alignment of at least one angular stable fastener with the mechanically aligned holes, so as to allow for insertion of the at least one angular stable fastener within at least one respective extramedullary structure hole and at least one respective intramedullary structure hole in mechanical registration.   
     
     
         18 . The apparatus of  claim 17  wherein the intramedullary structure is further configured to provide fixation of at least one fracture between the plurality of bone segments. 
     
     
         19 . The apparatus of  claim 17  wherein the extramedullary structure is further configured to provide fixation of at least one fracture between the plurality of bone segments. 
     
     
         20 . The apparatus of  claim 17  wherein both the extramedullary structure and intramedullary structure are further configured to provide fixation of at least one fracture between the plurality of bone segments. 
     
     
         21 . The apparatus of  claim 17  wherein the one or more second alignment features comprise respective one or more cannula. 
     
     
         22 . The apparatus of  claim 17  further comprising:
 the intramedullary structure having an intramedullary structure feature;
 the extramedullary structure having an extramedullary structure feature; and 
 wherein the intramedullary structure feature and the extramedullary structure feature further enable use of the intramedullary structure together with the extramedullary structure. 
 
 
     
     
         23 . The apparatus of  claim 1  wherein:
 the intramedullary structure is one of a plurality of intramedullary structures each comprising a plurality of intramedullary structure holes for accepting one or more of the intramedullary fasteners; 
 the extramedullary structure is one of a plurality of extramedullary structures each comprising a plurality of extramedullary structure holes for accepting one or more of the angular stable extramedullary fasteners; and
 the aligning arm is further for mechanically registering the plurality of intramedullary structures with the plurality of extramedullary structures. 
 
 
     
     
         24 . A method of securing an intramedullary structure to a bone, the method comprising:
 positioning the intramedullary structure at least partially within the bone;   positioning an extramedullary structure adjacent the bone, the extramedullary structure having a plurality of extramedullary structure holes;   placing an arm in alignment with the intramedullary structure and the extramedullary structure, such that one or more first alignment features of the arm are in alignment with a plurality of intramedullary structure holes formed in the intramedullary structure, and such that one or more second alignment features of the arm are in alignment with respective ones of the plurality of extramedullary structure holes;   inserting one or more intramedullary fasteners into the holes in the intramedullary structure;   inserting one or more angular stable extramedullary fasteners into the extramedullary structure holes; and   inserting one or more additional angular stable fasteners into at least one extramedullary structure hole and at least one intramedullary structure hole.   
     
     
         25 . The method of  claim 24  wherein the intramedullary structure provides fixation of at least one fracture between a plurality of bone segments. 
     
     
         26 . The method of  claim 24  wherein the extramedullary structure provides fixation of at least one fracture between a plurality of bone segments. 
     
     
         27 . The method of  claim 24  wherein both the extramedullary structure and intramedullary structure provides fixation of at least one fracture between a plurality of bone segments. 
     
     
         28 . The method of  claim 24  wherein at least one of the one or more intramedullary fasteners fastener is a angular stable fastener. 
     
     
         29 . The method of  claim 24  wherein the at least one additional angular stable fastener is threaded into the intermedullary structure. 
     
     
         30 . The apparatus of  claim 1  wherein one or more of the intramedullary structure and the extramedullary structure are further for spanning one or more fractures to provide fracture fixation. 
     
     
         31 . The apparatus of  claim 17  wherein one or more of the intramedullary structure and the extramedullary structure are further for spanning one or more fractures to provide fracture fixation. 
     
     
         32 . The method of  claim 24  additionally comprising:
 positioning one or more of the intramedullary structure and the extramedullary structure to span one or more fractures to provide fracture fixation.