Abstract: The present invention relates to apparatus for use in neurosurgery, and to a method of positioning neurosurgical apparatus. The stereoguide comprises first and second guide elements through which instruments are passed along an axis of insertion towards a target and a first clamp (25) having a clamping position on the axis between the guide elements and the target.

Abstract: A prosthetic metatarsal implant comprising a head and a neck extending from the head. A stem having at least one anchoring aperture extending transversely therethrough extends from the neck for insertion into a metatarsal bone. Means received by the at least one anchoring aperture for anchoring the stem in the metatarsal bone.

Abstract: A two piece graft fixation arrangement includes a graft block engageable with a graft and a transverse member engageable with the graft block to fix the graft block in a bone tunnel. Instruments and methods are presented for installing a graft in a bone tunnel and anchoring the graft with a transverse member placed through a transverse bore intersecting the bone tunnel.

Abstract: A locking nail for treating fractures of tubular bones has at least one cross-bore is provided at one end for the reception of a bone screw. The nail has a female thread at the end with the cross-bore for connection to a nail retention screw. The nail has an anti-rotation feature to anti-rotationally secure the rotational position of a joining sleeve which joins a targeting apparatus relative to the locking nail.

Abstract: A transverse guide assembly for use in passing a transverse pin through a host bone and through a transversely-extending region formed in an interference screw, wherein the transverse guide assembly includes a key member, a boom member and a guide member, and further wherein the key member is adapted to be connected to a keyway formed in the proximal end of the interference screw, the boom member is connected to the key member and supports the guide member outboard of the interference screw, and the guide member is configured to support a drill for forming a hole to receive the transverse pin which extends transversely through the host bone and the transversely-extending region formed in the interference screw.

Abstract: A surgical assist device and method that can be used to assist a surgeon in site selection and suture placement to re-attach the glenoid labrum to the shoulder's glenoid bone. The device and method includes an arcuate shaped bow arm, an angle guide attached to the bow arm at a selected location along the bow arm, a sleeve guide, and a target tool releasably connected to the angle guide. A tip end of the sleeve guide is extended in surgery and is configured to intersect and pass through an aperture of the target tool. The tip end of the sleeve guide includes at least one tooth that embeds in the glenoid bone and holds the sleeve guide in position. A guide pin such as a suture carrier is extended through the sleeve guide. The sleeve guide is then removed leaving the sutures in the correct repair location.

Abstract: An instrument assembly for inserting a lateral fastener into a lateral bore of a stem body implanted into a bone. The instrument assembly includes an outrigger having an alignment tube extending laterally from the stem body, wherein the outrigger can be coupled with the stem body such that the alignment tube extends coaxially with the lateral bore.

Abstract: A two piece graft fixation arrangement includes a graft block engageable with a graft and a transverse member engageable with the graft block to fix the graft block in a bone tunnel. Instruments and methods are presented for installing a graft in a bone tunnel and anchoring the graft with a transverse member placed through a transverse bore intersecting the bone tunnel.

Abstract: Orthopedic implant insertion instruments for precision guiding of a fracture fixation implant into fractured bone to promote healing are disclosed. The implant insertion instruments comprise an insertion handle for implantation of a first fixation implant, an aiming arm for precise guiding of a second fixation implant into bone, a guide sleeve for protection of soft tissue and for translational and rotational control of the second fixation implant, and a drive shaft with coupling screw for attachment to the second fixation implant and for driving the second fixation element through the aiming arm and guide sleeve into the fractured bone. The implant insertion instruments also include a soft tissue clearance device to aid the surgeon in inserting the first fixation implant into the fractured bone. Also disclosed is a measuring device that reduces measuring errors made by a user and a measuring device that determines implant length, diameter, and angle of insertion.

Abstract: An implantation system for a locking nail has an aiming device, wherein the locking nail is formed for detachable attachment to the aiming device at the one end thereof. The nail has two locking holes on the other end and has an exterior feature such as a groove connecting the locking holes which groove is parallel to the axis, or indentations or elevations running in the perimeter direction in the region of the locking holes. The aiming device has a rigid aiming arm with a free end portion having three aiming bores arranged in a plane generally parallel to the axis. The outer two of the aiming bores are located at a distance from each other which corresponds to the distance of the distal locking holes of the locking nail. The system further has a connecting piece universally movable on the aiming arm. The connecting piece has an accommodation aperture for selective detachable attachment to a rod-like nail adapter which, on its part, has a coupling for detachable attachment of the locking nail.

Abstract: An instrumentation guide for orthopedic surgery having guide body includes at least one alignment guide. An attachment member is securable to the guide body and provides for the attachment of an orthopedic device such as an intramedullary nail. A transfer member which can be both engaged and disengaged with the instrumentation guide while a nail is secured to the attachment member is used to transmit insertion and removal forces to the nail through the attachment member. The transfer member may be formed out of a metal material and be removed from the guide body, which may be substantially radio transparent, while the nail is still attached to the guide body to facilitate the acquisition of radiographic images. The transfer member include an inner shaft and an outer sleeve which are relatively rotatable. The transfer member may also include a quick connect mechanism.

Abstract: The invention is a device, and a method of using the device, for securing an intermedullary (IM) orthopedic nail within a fractured long bone of a human or large animal. The nail is provided with a plurality of target apertures, a portion of which are located above and below the fracture point of the bone. The device further comprises a jig adapted to be securely affixed to the IM nail, the jig having proximal and distal target arms, each having a plurality of apertures adapted to align with the target apertures. When properly secured, the apertures of the jig align with the target apertures of the nail, and alignment devices are provided to accurately drill variable diameter holes through the bone cortex at the target apertures. A leading end of the slot finder is provided with a cross-sectional geometry substantially identical to the cross-sectional geometry of the target apertures, and enables the surgeon to be sure the slot finder is in the target aperture of the nail.

Abstract: A locking nail for treating fractures of tubular bones has two parallel cross-bores that are axially spaced apart provided on the distal end of said nail and optionally at least one additional cross-bore is provided on the proximal end thereof for receiving bone screws. The nail includes a groove which is parallel to a longitudinal axis of the nail is formed into the outer side of the nail. The groove extends into the distal bores on both sides and merges into the bore. The longitudinal axis of the groove intersects the axis of each cross-bore.

Abstract: In a distal targeting system a hand-held location pad is integral with a guide section for a drill or similar surgical instrument, and has a plurality of magnetic field generators. A sensor, such as a wireless sensor, having a plurality of field transponders, is disposed in an orthopedic appliance, such as an intramedullary nail. The sensor is capable of detecting and discriminating the strength and direction of the different fields generated by the field generators. Control circuitry, preferably located in the location pad is responsive to a signal of the sensor, and determines the displacement and relative directions of an axis of the guide section, and a bore in the orthopedic appliance. A screen display and optional speaker in the location pad provide an operator-perceptible indication that enables the operator to adjust the position of the guide section so as to align its position and direction with the bore.

Abstract: An intramedullary nail fastener targeting and bone compression/distraction device provides bone fastener alignment and compression or distraction of the bone. The intramedullary nail fastener targeting and bone compression/distraction device has a nail carrier portion, a bone fastener alignment and drill jig portion, and a compression/distraction mechanism. Various sizes of intramedullary nails are retained by the device while alignment carriages provides for proper drilling of the bone and placement of bone fasteners such as screws. The compression/distraction mechanism provides measured compression or distraction of the bone prior to final bone fastener placement.

Abstract: A method and apparatus for fixing a ligament in a bone tunnel by cross-pinning the ligament in the bone tunnel.

Abstract: A jig assembly includes a jig having an elevated first portion having holes or slots to align a drill with screw holes in an intramedullary portion of a fixation device, and a lower second portion having openings in axial alignment with holes on a plate portion of the fixation device. The jig may be locked relative to the fixation device. The jig assembly further includes one or more of sleeves, drill guides and gauges for facilitating the drilling of appropriate holes into bone both beneath and above the fixation device.

Abstract: An alignment guide for setting the position and depth of a guide pin to be inserted into a bone. The alignment guide includes a mechanical assembly for deploying a calibrated guide rod along a selected external surface of the bone and for adjusting the guide rod so it lies parallel to a desired path extending through the bone for a selected distance. The position and orientation of the guide rod may be adjusted using imaging means for viewing the location of the desired path extending through the bone parallel to the guide rod. The alignment guide is mechanically linked to apparatus for subsequently inserting a guide pin into the bone parallel to the guide rod. In one embodiment the alignment guide is designed to aid a surgeon in centering the guide pin to be inserted in the femoral head and neck without repeated trial-and-error drilling.

Abstract: An intramedullary nail fastener targeting and bone compression/distraction device provides bone fastener alignment and compression or distraction of the bone. The intramedullary nail fastener targeting and bone compression/distraction device has a nail carrier portion, a bone fastener alignment and drill jig portion, and a compression/distraction mechanism. Various sizes of intramedullary nails are retained by the device while alignment carriages provides for proper drilling of the bone and placement of bone fasteners such as screws. The compression/distraction mechanism provides measured compression or distraction of the bone prior to final bone fastener placement.

Abstract: A method and apparatus for reconstructing a ligament. In one preferred form of the invention, there is provided a graft ligament support block which comprises a body, and a graft hole and a transverse fixation pin hole extending through the body, with both the graft hole and the transverse fixation pin hole preferably extending substantially perpendicular to the longitudinal axis of the body. And in one preferred form of the invention, the invention also comprises an installation tool for inserting the graft ligament support block into the bone tunnel and, while supporting the graft ligament support block in the bone tunnel, forming a transverse tunnel in the host bone, with the transverse tunnel in the host bone being aligned with the transverse fixation pin hole in the graft ligament support block. In one preferred method of use, a graft ligament is looped through the graft hole in the graft ligament support block, and the graft ligament support block is mounted to the installation tool.

Abstract: A targeting apparatus for use in performing endofemoral osteotomy surgery has a support element provided with a drill guide. The apparatus has a connector for securing a support element to the proximal end of a prosthesis to be implanted. The apparatus includes a proximal location element which is shaped to extend around the great trochanter and muscle of the femur in which the implant is to be located. An adjustor is provided for adjusting the angular position of the drill guide in relation to the femur about a proximal-distal axis.

Abstract: A targeting apparatus for use in performing transfemoral osteotomy surgery includes a support element provided with a drill guide. A device is provided for securing the support element to a prosthesis to be implanted, and to a resectioned femur. An adjusting device for adjusting the angular position of the drill guide in relation to the resectioned femur about a proximal-distal axis is also included.

Abstract: A method for fixing a portion of a piece of tissue in a bone tunnel comprising the steps of placing the portion of a piece of tissue in the bone tunnel, advancing spaced-apart first and second metal wires though the bone, transversely of the bone tunnel, so as to intersect the bone tunnel and extend into the portion of a piece of tissue, removing one of the wires and replacing the one removed wire with a first rod, and removing the other of the wires and replacing the other removed wire with a second rod, whereby to retain the portion of a piece of tissue in the bone tunnel with the rods.

Abstract: A device for identifying the position of the distal holes for passage of securement screws provided in an intramedullary nail inserted in a medullary canal of a long bone, having an arm that protrudes from said medullary canal, provided with a fixing element for rotational and axial fixing to the end of said nail, the arm comprising a portion that protrudes outside the bone provided with elements for the coupling, at a selective distance, of a hollow stem which encloses a plurality of channels allowing sliding therein of guiding wires for guiding a cannulated bone drilling tool and at least one securement screw to be inserted after removal of the cannulated tool through the bone and distal holes of the intramedullary nail.

Abstract: A bone graft forming guide for providing a bone graft and a method of forming a bone graft. The guide includes a main body including a holder for holding a graft material and guide containing a pattern generally corresponding to the desired shaped of the bone graft. The forming guide may include a hole guide containing a plurality of hole guides arranged in a pattern generally corresponding to the desired shape of the bone graft. The forming guide may further include a cutting guide containing a pattern corresponding to the desired shape of the bone graft.

Abstract: A stent delivery system comprises a catheter having a distal end and a proximal end, and a self expanding stent device having a compressed state and an expanded state and being positioned along the catheter and close to the distal end thereof. The stent delivery system further comprises a capsule enclosing the self-expanding stent device in its compressed state along substantially the whole length thereof. The capsule has an open distal end and a proximal end fixed to the catheter. Further, the capsule has at least one perforation extending longitudinally of said capsule from the distal end substantially to the proximal end thereof. The stent delivery system also comprises a balloon positioned within the capsule so as to break the capsule along said at least one perforation when inflated, whereby the stent device may expand to its expanded state, Thereafter the catheter with the broken capsule may be withdrawn from a duct in which the catheter has been introduced to a desired position.

Abstract: A targeting apparatus for locking nails, has a connecting portion which is adapted to be fixedly connected to the end of a locking nail. The targeting apparatus has an arm which is connected to the nail connecting portion via a U or L-shaped portion. The arm has a plurality of bores to receive a drill guide sleeve wherein the bores are disposed at different angles. The targeting arm has supported thereon a rotatable sleeve but substantially is axially displaceable and has a series of cross-bores or apertures which are circumferentially and axially spaced wherein in the predetermined rotational positions of the rotatable sleeve, at least one aperture is aligned with a bore in the targeting arm. A detent is provided which locks the rotatable sleeve on the targeting arm in the selected individual rotational positions.

Abstract: An alignment guide for setting the position and depth of a guide pin to be inserted into a bone. The alignment guide includes a mechanical assembly for deploying a calibrated guide rod along a selected external surface of the bone and for adjusting the guide rod so it lies parallel to a desired path extending through the bone for a selected distance. The position and orientation of the guide rod may be adjusted using imaging means for viewing the location of the desired path extending through the bone parallel to the guide rod. The alignment guide is mechanically linked to apparatus for subsequently inserting a guide pin into the bone parallel to the guide rod. In one embodiment the alignment guide is designed to aid a surgeon in centering the guide pin to be inserted in the femoral head and neck without repeated trial-and-error drilling.

Abstract: An intramedullary nail, a device for inserting a screw into the same, and a insertion method thereof. Guide holes are formed between the nail inserted to the medullary cavity and a distal screw guide member. A guide wire having a much smaller diameter than each guide hole is inserted into the guide hole and drilling is then performed along the guide wire. Then, a metal screw is remained into the intramedullary nail to prevent the nail from moving up and down and twisting, thereby allowing easy and accurate insertion of the distal metal screw without an aid of an X-ray imaging device. Therefore, an operation time can be reduced, unnecessary bone damage or infection of a patient can be prevented and a patient and/or surgeon's exposure to X-ray radiations can be considerably reduced.

Abstract: A method and apparatus for fixing a ligament in a bone tunnel by cross-pinning the ligament in the bone tunnel.

Abstract: A screw delivery system and method are disclosed for use in a variety of surgical indications. The screw delivery system generally comprises an outer cannula, a guide, and various interventional devices such as bone drill bits and taps as well as an implant driver for inserting a screw. The method disclosed varies by indication, but is ordinarily intended for use as a minimally invasive procedure which is a combination of percutaneous and open techniques wherein a small midline incision is made over a surgical site and the screw delivery system provides a percutaneous portal through an incision distant from the small midline incision over the surgical site.

Abstract: A method and apparatus for fixing a ligament in a bone tunnel by cross-pinning the ligament in the bone tunnel.

Abstract: Targeting apparatus for use in performing endofemoral osteotomy surgery comprising a support element provided with a drill guide, means for securing a support element to the proximal end of a prosthesis to be implanted and which include a proximal location element which is shaped to extend around the great trochanter and muscles of the femur in which the implant is to be located, and means for adjusting the angular position of the drill guide in relation to the femur about a proximal-distal axis.

Abstract: A method for fixing a portion of a piece of tissue in a bone tunnel comprising the steps of placing the portion of a piece of tissue in the bone tunnel, advancing spaced-apart first and second metal wires though the bone, transversely of the bone tunnel, so as to intersect the bone tunnel and extend into the portion of a piece of tissue, removing one of the wires and replacing the one removed wire with a first rod, and removing the other of the wires and replacing the other removed wire with a second rod, whereby to retain the portion of a piece of tissue in the bone tunnel with the rods.

Abstract: A method and apparatus for fixing a ligament in a bone tunnel by cross-pinning the ligament in the bone tunnel.

Abstract: A targeting apparatus for use in performing transfemoral osteotomy surgery includes a support element provided with a drill guide. A device is provided for securing the support element to a prosthesis to be implanted, and to a resectioned femur. An adjusting device for adjusting the angular position of the drill guide in relation to the resectioned femur about a proximal-distal axis is also included.

Abstract: A combined surgical drill and screw guide utilizes a common support cylinder for first guiding the drill guide and then guiding the screw with no auxiliary screw guide insert required.

Abstract: A targeting system and method is disclosed for the distal locking of intramedullary nails. The targeting system comprises a first fixation system, a second fixation system, and an aiming guide. After implantation within the intramedullary canal of a bone, the distal screw holes of an intramedullary nail are first aligned using conventional radioscopy equipment. The targeting system is then introduced between the radioscopy equipment and the patient such that the aiming guide of the targeting system is roughly aligned with the distal screw holes. The first fixation system is adapted to be fixedly coupled to an operating surface upon which an intramedullary nail fixation procedure may be performed. The second fixation system is adpated to be fixedly coupled to the handle of the implanted intramedullary nail. Rough adjustments to the first and second fixation systems enable an initial positioning of a drill with a first distal screw hole.

Abstract: A device for identifying the position of the distal holes for passage of securement screws provided in an intramedullary nail inserted in a medullary canal of a long bone, having an arm that protrudes from said medullary canal, provided with a fixing element for rotational and axial fixing to the end of said nail, the arm comprising a portion that protrudes outside the bone provided with elements for the coupling, at a selective distance, of a hollow stem which encloses a plurality of channels allowing sliding therein of guiding wires for guiding a cannulated bone drilling tool and at least one securement screw to be inserted after removal of the cannulated tool through the bone and distal holes of the intramedullary nail.

Abstract: A positioning determining arrangement used for finding directions for perforations in bone structure surgery is attachable to a machine with a movable arm. The arrangement is provided with a first plate and a second plate, the first and second plates are substantially transparent to X-ray radiation in an orthogonal direction. The first and second plates are mounted in an orthogonal configuration and the first plate is provided with four round elements. The second plate can be mounted to a turnable and tiltable support for attachment t a machine. In this arrangement the X-ray magnification factor relating to two orthogonal X-ray radiographs, comprising the four round elements, taken of a bone structure is determined when two of the four round elements cover each other in both radiographs, the magnification factor being determined by a distance between two uncovered round elements of the four round elements and dependent on movement of the arm.

Abstract: A bone nail including a hollow shank which has at least one cross-bore to receive a bone screw. A retaining sleeve is inserted into the shank to receive one or more signal generators. The signal generators received in the sleeve are adapted to emit signals at a predetermined spacing from and in a predetermined alignment relative to the cross-bore wherein the retaining sleeve has recesses or through openings in its wall to accommodate the signal generators.

Abstract: An intramedullary device facilitates fixation after installing in a bone cavity by drilling a pilot opening from the interior of the device through the bone cortical to the exterior. The intramedullary device is equipped with an internal baffle system which is a stationary and can remain a permanent fixed element of the rod for unimpeded steering of a cutting tool from the interior of the device through the bone cortical to the bone exterior. The interior baffle may consist of a laterally inclined chute allowing a bone boring tool on an elongated power transmission cable to be guidedly advanced downwardly to the interior of the device to a pin opening for cutting the bone cortical from the inside and forming the all important initial pilot opening in the bone. The pilot opening can then be utilized to form a continuous channel by introducing a drill bit from the outside of the bone through the two predrilled openings in the device and then cutting through the opposite bone cortical.

Abstract: A screw delivery system and method are disclosed for use in a variety of surgical indications. The screw delivery system generally comprises an outer cannula, a guide, and various interventional devices such as bone drill bits and taps as well as an implant driver for inserting a screw. The method disclosed varies by indication, but is ordinarily intended for use as a minimally invasive procedure which is a combination of percutaneous and open techniques wherein a small midline incision is made over a surgical site and the screw delivery system provides a percutaneous portal through an incision distant from the small midline incision over the surgical site.

Abstract: An apparatus and method using a laser in conjunction with a conventional tibial aiming device for assisting a surgeon in drilling collinear tibial and femoral tunnels during ACLR surgery. The laser is used to determine the angle at which to drill the tibial tunnel with respect to a femoral reference point selected by the surgeon so that the tunnels are collinear.

Abstract: A guide for positioning a tibial tunnel in anterior cruciate ligament (ACL) reconstruction. The guide includes a guide arm and a drill sleeve connected to the guide arm. A distal tip of the guide arm is configured to contact a femoral surface, and a distal tip of the drill sleeve is configured to contact a tibial surface when the distal tip of the guide arm contacts the femoral surface.

Abstract: An intramedullary cavity nail for the treatment of proximal femoral fractures, comprises a solid elongate body with a proximal portion (2) having at least one transverse bore for accommodating a corresponding screw (9, 10) for stabilizing the femoral neck, the proximal portion being joined to a distal portion (3) having at least one distal bore (16) for accommodating at least one diaphysis screw for stabilizing the distal part of the femur. The proximal portion (2) has a substantially constant diameter (.phi..sub.p) adapted to be stably anchored in a relatively limited length bore of the femur for reducing blood losses, while said distal portion (3) has a substantially constant diameter (.phi..sub.d) which is less than that of said proximal portion, for ease of insertion in the medullary canal of the femur without any drilling. The proximal and distal portions (2, 3) are substantially rectilinear and form between themselves a predetermined deviation angle (.beta.) in a lateral plane.

Abstract: The invention is directed to a target device for proximal and distal locking of medullary nails without X rays. The proximal and the distal target devices each have a U-shaped part, wherein guide bores are disposed in the widened end areas of the legs of the U-shaped parts. The medullary nail is fixedly connected with the proximal target device via a crosspiece and the proximal target device is connected with the distal target device by a pivotable and adjustable spacer. The distance of the end of the medullary nail from the distal target device is adjusted by a spacer element such that the center axes of the guide bores in the target devices are aligned with the center axes of channels or bores in the medullary nail, which channels communicate with the guide bores.

Abstract: An interlocking intramedullary nail system has a nail having an upper extremity, a lower extremity and transverse locking ducts in the upper and lower extremity, a plurality of fixation bone screws adapted to be received by the locking ducts, an attachable lower guide at the lower extremity of the nail, a perforator-guide detachably-fixed to the upper extremity of the nail, and an attachable upper guide at the upper part of the perforator-guide for precisely meeting the locking ducts in the upper extremity of the nail. A method of interlocking an intramedullary nail using this system attaches the perforator-guide to the nail, perforates a bone along its medullary canal with the nail and the perforator-guide until the upper part of the perforator-guide has left the bone, and attaches the upper guide to the upper part of the perforator-guide. Holes are drilled into the bone using the locking ducts of the upper guide and bone screws inserted into the upper extremity locking ducts to secure the nail to the bone.

Abstract: A method and apparatus for fixation and correction of spondylolisthesis anteriorly includes a disk cage which is inserted into the space between adjacent vertebrae, a drill guide for guiding and aligning a drill bit to angle an opening anteriorly between adjacent vertebrae, a distractor for temporarily aligning the vertebrae to position a disk cage and an elongated hollow screw positioned in said drilled opening through one vertebra, said disk cage and into said adjacent vertebra.

Abstract: A cannulated screw is employed to fasten an intramedullary nail to a bone of a patient. A guide is disposed within the intramedullary nail and registered with a preformed securing hole in the nail. Preferably, the guide is fabricated from a bio-absorbable material such as polyglycolic acid and fixedly registered to the distal securing holes. A flexible drill shaft is directed to the selected securing hole by the guide. The drill is operated to drill through the bone cortex and soft tissue of the patient to exit the skin of the patient. A cannulated fixation screw is fitted over the exposed drill bit and is then driven into the patient, guided by the drill bit back to the selected securing hole. The drill bit is then extracted and the cannulated screw is driven through the intramedullary nail into the opposite cortex of the bone. After all of the fixation screws have been placed, the intramedullary nail is fastened to the bone.