United States Patent [19J
`Kilpela et al.
`
`[54]
`
`INTRAMEDULLARY BONE FIXATION ROD
`
`[75]
`
`Inventors: Thomas N. Kilpela, Marquette, Mich.;
`Clayton R. Perry, St. Louis, Mo.;
`Kenneth A. Davenport; Matthew N.
`Songer, both of Marquette, Mich.
`
`[73] Assignee: Pioneer Laboratories, Inc., Marquette,
`Mich.
`
`[21] Appl. No.: 09/243,988
`
`[22] Filed:
`
`Feb. 3, 1999
`
`Int. Cl? ..................................................... A61B 17/56
`[51]
`[52] U.S. Cl. .................................. 606/62; 606/64; 606/67
`[58] Field of Search .................................. 606/62-64, 67,
`606/72, 73, 96, 98
`
`[56]
`
`References Cited
`
`U.S. PATENT DOCUMENTS
`
`D. 379,855
`5,034,013
`5,041,115
`5,263,955
`5,429,640
`5,472,444
`5,505,734
`5,697,930
`5,766,174
`5,971,986
`
`6/1997 Perry .
`7/1991 Kyle eta!. .
`8/1991 Frigg et a!. .
`11/1993 Baumgart eta!. .
`7/1995 Shuler et a!. .
`12/1995 Huebner et a!. .
`4/1996 Caniggia eta!. .
`12/1997 Homan et a!. .
`6/1998 Perry .
`10/1999 Santori et a!. ............................ 606/62
`
`01HER PUBLICATIONS
`
`A portion of a catalog of the ORTHoNAIL™ Humeral Nail
`of Orthologic Company, dated 1996.
`A data sheet to the Speedlok Self-Guided Femoral Nail
`System (2 pages) 1998, General Orthpedics, Inc.
`
`111111
`
`1111111111111111111111111111111111111111111111111111111111111
`US006123708A
`[11] Patent Number:
`[45] Date of Patent:
`
`6,123,708
`Sep.26,2000
`
`A data sheet entitled The Cane by Acumed (2 pages), Aug.
`1996.
`A brochure entitled POLAR US by Acumed, Inc. Aug., 1996
`(4 pages).
`A brochure entitled POLAR US PLUS Surgical Technique of
`Acumed, Inc. Dec., 1995, (14 pages).
`A brochure entitled CHIODO ENDOVIS NAIL CITIEFFE
`(8 pages, Dec. 1995.
`An article of Jeanette E. Dalton et al. entitled "A Biome(cid:173)
`chanical Comparison of Intramedullary Nailing System For
`the Humerus".
`Journal of Orthopaedic Trauma, vol. 7, No. 4, pp. 367-374
`(Nov. 1993).
`
`Primary Examiner-Michael Buiz
`Assistant Examiner-Julian W. Woo
`Attorney, Agent, or Firm---Gerstman, Ellis & McMillan,
`Ltd.
`
`[57]
`
`ABSTRACT
`
`A nail (or rod) for axial insertion into a large bone for
`support thereof, which comprises an elongated nail body
`having a central bore extending through the nail body from
`the proximal end along a proximal portion of the nail, and
`typically terminating at point spaced between the ends. The
`nail may also define a transversely flattened distal portion
`extending proximally from the distal end. In the embodi(cid:173)
`ment shown, an open slot may extend centrally and longi(cid:173)
`tudinally from the distal end along the distal portion to an
`inner slot end which is spaced between the ends of the nail.
`The nail body defines a plurality of transverse holes extend(cid:173)
`ing therethrough for receiving bone screws for supporting
`securance of the nail to a bone while the nail occupies the
`intramedullar space of the bone.
`
`21 Claims, 1 Drawing Sheet
`
`20
`
`ZIMMER 1006
`Page 1
`
`

`
`U.S. Patent
`
`Sep. 26, 2000
`
`6,123, 708
`
`FIG. 1
`45
`
`FIG. 2
`
`FIG. 3
`
`18
`
`31
`
`FIG. 4
`
`.-52
`
`/
`
`30
`
`30
`
`/18
`
`31
`
`20
`
`47
`
`22
`
`so
`
`18
`
`10
`
`,,
`
`1 I
`I I
`/I
`I I
`J I
`I I
`
`J
`J
`J
`I
`
`20-
`
`...--18
`
`40
`
`ZIMMER 1006
`Page 2
`
`

`
`6,123,708
`
`1
`INTRAMEDULLARY BONE FIXATION ROD
`
`BACKGROUND OF THE INVENTION
`
`Intramedullary nails (known also as intramedullary rods)
`are well known for use in orthopedic surgery for repairing
`fractures of large bones, particularly the humerus. Recent
`examples of such intramedullary nails are disclosed in Perry
`U.S. Des. Pat. No. 379,855, Perry U.S. Pat. No. 5,766,174,
`and Itouran et al. U.S. Pat. No. 5,697,930, among others.
`Other humeral nails or rods (for the humerus) are commer(cid:173)
`cially available for clinical use, such as the Ultramodular
`Trauma System of Howmedica, the modular nail of Richards
`Company, the Uniflex Humeral Nail of Biomet, and the
`Polarus Humeral Nail of Acumed.
`Humeral nails or rods are used to repair the breakage of
`a large or long bone such as the humerus by advancing the
`nail axially through the hollow interior of the bone so that
`the nail cross the fracture site. Then, screws are applied to
`the nail through transverse apertures in the nail, extending
`through the bone on both sides of the site so that the nail is
`attached to portions of the bone on each side of the fracture,
`thus securing the bone into a single, immoveable piece once
`again and allowing healing to take place along the fracture
`site.
`The various designs of intramedullary nail, and specifi(cid:173)
`cally humeral nails, which are available and known have
`certain disadvantages. For example, there is the danger that
`a humeral nail can have an oversized tip, so that when it is
`forcefully, longitudinally advanced into the bone interior,
`the oversized tip can be too large for the size of the bone
`medulla and split the bone, which can happen without
`warning. This of course, is a clinical disaster, greatly
`increasing the severity of the bone injury. With many prior
`art humeral nails, the problem is difficult to avoid, since the
`transverse dimensions of the medulla or marrow portion of
`the bone vary widely from patient to patient.
`Also, problems can arise because the transverse bone
`screws which pass through the humeral nail can be insuffi(cid:173)
`ciently solidly retained to the humeral nail, causing the
`possibility of a small amount of "play" in the system, which
`of course transfers to the bone. However, if set screws are
`used in the bore of a tubular humeral nail for transverse
`screw retention, then it is not possible to use a guidewire
`system, as is highly desirable in many circumstances to aid
`in the emplacement of the humeral nail, because when the
`guidewire passes through the bore of such a humeral nail,
`the set screw of course interferes with the passage of the
`guidewire. Thus, although the use of set screws might be
`desirable to help to stabilize the bond between the emplaced
`humeral nail and transverse bone screws, this cannot be
`easily used with a guidewire system.
`By this invention, an intramedullary nail (or rod) is
`provided, and specifically a humeral nail, which can be
`firmly secured to the transverse bone screws used with such
`a nail on a reliable basis. Also, the tip of the intramedullary
`nail of this invention is capable of entering into firm engage(cid:173)
`ment with hard portions of the bone from a location within
`the medulla of the bone where the marrow resides, without
`providing so much pressure on the bone that there is a
`significant risk of fracture due to the outward pressure
`exerted by the emplaced nail.
`
`DESCRIPTION OF THE INVENTION
`
`By this invention, a rod (Also called a nail) for axial
`insertion into a large (long) bone is provided for the support
`thereof. The rod comprises an elongated rod body having a
`
`5
`
`20
`
`2
`proximal end and a distal end. A central bore extends
`through the rod body from the proximal end along a proxi(cid:173)
`mal portion of the rod, with the bore terminating at a point
`which is spaced between the ends. The rod also defines a
`transverse, flattened distal portion which extends from the
`distal end toward a central portion of the rod. An open slot
`also extends centrally and longitudinally from the distal end
`along the distal portion to an inner slot end, which is also
`spaced between the ends. As is common, the rod body
`defines a plurality of transverse holes extending there-
`10 through.
`Accordingly, the distal portion of the rod, with its open
`slot, becomes more flexible then the typical distal ends of
`humeral rods of the prior art. When longitudinally inserted
`15 into the bone interior, the distal end can be more easily
`flexed inwardly by the walls of the hard bone portion outside
`of the rod, so that the tip of the humeral rod enters into firm,
`retentative relation with the hard, outer portions of the bone
`without exerting so much external pressure that there is a
`risk of bone fracture. Rather, the distal end portion of the rod
`or nail of this invention, with its slot, exerts a more limited
`outward pressure against the hard bone exterior, even if the
`distal end of the rod or nail of this invention turns out to be
`slightly oversized for the particular bone. Also, the legs of
`25 the rod that are defined on either side of the slot can be
`distracted outwardly as desired by the surgeon, by driving a
`tapered bone screw between the legs in the slot.
`The central bore referred to above in the rod of this
`invention preferably terminates at an aperture in the side
`30 wall of the rod. Thus a rod of this invention can be emplaced
`using a guidewire technique, where the guidewire has been
`pre-emplaced in the patient, by advancing the bone along the
`guidewire, where the guidewire extends through a proximal
`portion of the rod in a bore thereof, and the guidewire
`35 extends along a distal portion of the rod outside of the rod
`or in the slot described above.
`The central bore and the open slot of the rod of this
`invention may be separated by a partition, so that they are
`not in open communication with each other. The partition is
`40 typically made of the metallic material of the rod.
`Alternatively, if desired, the open slot may communicate
`directly with the central bore. In this circumstance, the
`central bore does not require a side wall aperture since the
`guidewire can extend through the distal portion of the nail of
`45 this invention in the open slot thereof.
`At least one of the transverse holes may be located
`adjacent to the distal end. Such a transverse hole may carry
`a tapered cortical screw or the like for locking securance of
`the rod in the bone. Typically, such a transverse hole passes
`50 through the open, longitudinally extending slot. In this
`circumstance, as previously stated the cortical screw can be
`used to distract the legs or fins of the rod body, which fins
`are the portions of the rod along each side of the slot. Thus,
`securance of the rod within the bone can be promoted by the
`55 action of such cortical screws positioned transversely in
`apertures which extend through the slot-defining fins of the
`rod adjacent to the distal end.
`The Side edges of the rod distal portion may be straight.
`Alternatively, a first portion of the transversely flattened rod
`60 distal portion may have a width that is greater than the width
`of a second portion of the transversely flattened distal
`portion. The first portion is nearer to the distal end than the
`second portion, so that the structure of the distal portion of
`the rod may resemble a paddle with a flaring outer end to an
`65 extent. Preferably in this circumstance, the distal portion has
`opposed, smooth, arcuate side edges defining this paddle
`shape.
`
`ZIMMER 1006
`Page 3
`
`

`
`3
`The purpose of such a latter shape, when present, is that
`the transversely enlarged "paddle" portion of the rod can aid
`locking in the distal humeral canal in the preferred situation
`where the rod or nail is for the humerus. The narrower
`"neck" portion can aid in preventing fracture of the humeral 5
`shaft during insertion and afterward, since it may reside in
`a portion of the medulla of the humerus which is narrower
`than other portions, so that the narrowed neck portion
`resides therein without exerting much outward pressure on
`the bone. Also, the narrowed neck portion provides added
`resilience to that portion of the rod which is distal to the 10
`narrowed neck portion, including the first, wider portion
`discussed above.
`It is also preferred for at least one of the transverse holes
`to intersect the central bore in the proximal rod portion. A set
`screw may occupy the bore in a position to retain a bone 15
`screw extending through the above transverse hole that
`intersects the central bore. This may be provided as a factory
`preinserted or preloaded set screw, to facilitate the surgical
`procedure.
`Also, preferably, such a set screw may carry an axial 20
`aperture, to permit a guidewire to extend completely through
`the central bore despite the presence of the set screw. Thus,
`the humeral rod may be installed by a guidewire technique,
`as is frequently a surgical desire, while at the same time the
`set screw may be pre-emplaced and ready to secure a 25
`transverse screw for retaining the rod in the desired position
`in the humerus or other long bone.
`It is also preferred for at least one of the transverse holes
`which intersect the central bore of the nail to define on each
`side of the central bore axially spaced first wall sections, 30
`which are separated by and connected with circumferentially
`spaced second wall sections. These sections are propor(cid:173)
`tioned to permit threaded engagement of a screw in the
`transverse hole by the first wall sections, while the screw is
`disengaged and spaced from the second sections. Typically, 35
`the first wall sections may be almost fiat or slightly concave,
`and the second sections may be more concave, so that the
`transverse hole forms a substantial oval to avoid second
`section engagement with a transverse screw extending
`straight through the hole. This arrangement can be used to 40
`allow the transverse screw to rotate about 5 to 30 degrees in
`each horizontal direction, preferably about 15 degrees, spe(cid:173)
`cifically in a horizontal plane which is essentially perpen(cid:173)
`dicular to the longitudinal axis of the rod. At the same time,
`the screw cannot rotate or otherwise move in a direction 45
`transverse to that horizontal plane, but it can rotate about its
`own axis. Thus, a nail which can carry transverse screws
`with this characteristic can better accommodate various
`bone geometries pertaining, for example, to the head of the
`humerus, when compared with a retention screw in a trans- 50
`verse hole that lacks this characteristic.
`The set screw carried in the bore can then be used to
`reliably hold such a transverse screw in a desired rigid
`position, once the properly adjusted position of the trans(cid:173)
`verse bone retention screw has been achieved.
`
`55
`
`DESCRIPTION OF THE DRAWINGS
`Referring to the drawings, FIG. 1 is an elevational view,
`taken partially in longitudinal section, of a bone fixation nail
`or rod in accordance with this invention;
`FIG. 2 is an elevational view of the nail or rod of FIG. 1
`rotated 90 degrees about its axis;
`FIG. 3 is a longitudinal sectional view of the nail or rod
`from the view of FIG. 2; and
`FIG. 4 is an enlarged, detailed, sectional view of a
`proximal hole for transverse bone screws found in the nail
`or rod of FIG. 1.
`
`6,123,708
`
`4
`DESCRIPTION OF SPECIFIC EMBODIMENT
`
`Referring to the drawings, bone fixation nail or rod 10
`comprises an elongated nail body 12 having a proximal end
`14 and a distal end 16. Central bore 18 extends through the
`nail body from proximal end 14, through a proximal portion
`of the nail. Bore 18 terminates at an open side groove 20
`spaced between the ends of nail 10, where, in this
`embodiment, the bore opens to the exterior through side
`groove 20 at said point.
`Adjacent to distal end 16, nail 10 defines a transversely
`flattened distal portion 22, as particularly seen in FIGS. 2
`and 3, compared with FIG. 1. An open slot 24 extends
`centrally and longitudinally from distal end 16 along the
`distal portion 22 to an inner slot end 26, which is spaced
`between ends 14, 16 of the nail.
`Nail 10 also carries a plurality of transverse holes 28, 30
`extending therethrough. Transverse holes 28 are positioned
`adjacent to the distal end 16 of the nail, while transverse
`holes 30 are positioned generally perpendicular to holes 28,
`adjacent to proximal end 14.
`One or more central transverse holes 31 may also be
`provided.
`Central bore 18 and particularly the side aperture groove
`20 that connects with central bore 18 is separated by a
`partition portion 32 from open communication with slot 24.
`Partition portion 32 is part of the rod itself, which is typically
`made of a known, surgically implantable metal alloy.
`However, if desired, central bore 20 may connect with slot
`24 so that a guidewire can pass axially through the entire
`length of nail 10.
`If desired, and as shown in FIG. 2, at least one of
`transverse holes 28 may carry a tapered screw 34 such as a
`cortical screw for locking securance of the nail 10 in the
`bone. Both transverse holes 28 may carry such a screw 34
`in those circumstances where two of such holes are present.
`Thus, nail 10 may be inserted deep into the marrow or
`medulla of the bone, and be secured there at its distal tip with
`cortical locking by tapered cortical locking screws 34, or
`non-tapered, cylindrical screws if desired, which screws
`pass transversely through the bone and slot 24 of nail10. As
`previously discussed, tapered screws 34 may be used to
`spread or distract legs 35 as they advance as desired by the
`surgeon.
`Furthermore, if desired, a first portion 36 of the trans(cid:173)
`versely flattened distal portion 22 (as in FIG. 1) may have a
`width that is greater than the width of a second portion 38
`of the transversely flattened, distal portion 22, with first
`portion 36 being nearer to distal end 16 than second portion
`38. The advantage of this, as described above, provides
`resilience to the distal end portion of the nail, permitting
`better fitting of the nail into the humerus, for which this
`particular nail is designed, or another bone.
`Side edges 40 of the transversely flattened distal portion
`22 are preferably smooth, and also arcuate to accommodate
`the varying widths 36, 38 of flattened portion 22, if present.
`As is shown herein, transverse holes 30 intersect central
`bore 18 adjacent to proximal end 14 of nail10. Set screws
`60 42 each occupy a threaded portion of bore 18, being posi(cid:173)
`tioned to retain a cancellous bone screw 44 or the like,
`having threads 43 along part of their lengths. Each bone
`screw 44 extends through one of transverse holes 30. Each
`set screw 42 has an axial aperture 45 to permit a guidewire
`65 to extend completely through central bore 18 as previously
`described, to facilitate emplacement of nail10 in the bone in
`a desired surgical manner.
`
`ZIMMER 1006
`Page 4
`
`

`
`6,123,708
`
`5
`Thus, nail or rod 10 can be secured to the bone which it
`occupies both adjacent to its proximal end 14 and its distal
`end 16 by the use of transverse screws.
`It is further preferred for the transverse holes 30, which
`intersect central bore 18, to define on each side of central
`bore 18 (as shown in FIG. 4), a pair of axially spaced first
`wall sections 46 spaced along the longitudinal axis 47 of rod
`10. First wall sections 46 of each hole 30 are separated by
`and connected with a pair of circumferentially spaced sec(cid:173)
`ond wall sections 48. First wall sections 46 define transverse 10
`ridges which may engage threads of screw 44, or, as shown,
`there may be no threaded engagement, but screw 44 may
`merely be clamped with set screw 42 for retention. The
`circumferentially spaced second wall sections 48 are gen(cid:173)
`erally disengaged from screw 44, since the entire aperture
`formed by the respective wall sections 46, 48 is of a 15
`generally oval shape. Because of this, it becomes possible
`for screws 44 in holes 30 to rotate about a plane which is
`essentially perpendicular to the longitudinal axis 47 of nail
`10, as shown by the dotted line position of screw 44 in FIG.
`4. Because of the slightly canted portion 50 of nail 10 20
`adjacent to proximal end 14, this plane will not be exactly
`horizontal from the viewpoint of FIG. 1. Despite this, screw
`44 cannot be rotated up and down, parallel to axis 47.
`Screws 44 are shown oversized relative to holes 30, being
`actually removable from holes 30.
`However, as previously described, this capability to
`(essentially) horizontally rotate screws 44 as nail10 is being
`emplaced facilitates the attachment and securance of nail10
`within and to the bone, such as the humerus. Then, when
`screws 44 have been properly secured, set screws 46 may be 30
`rotated and advanced to provide added securance and rigid-
`ity to the entire system by pressing against screws 44 and
`retaining them in rigid manner relative to nail10. Set screws
`30 may be of a common type that are advanceable with an
`Allen wrench, having a recessed, hexagonal space 52 for 35
`receiving such a wrench. Typically, until secured by set
`screws 42, cancellous bone screws 44 may be rotated about
`15 degrees on either side, while being firmly retained against
`any significant vertical rotation (i.e., parallel to nail longi(cid:173)
`tudinal axis 47), until set screw 42 secures them rigidly 40
`relative to nail 10.
`The above has been offered for illustrative purposes only,
`and is not intended to limit the scope of the invention of this
`application, which is as defined in the claims below.
`That which is claimed:
`1. A nail for axial insertion into a bone for support thereof,
`which comprises:
`an elongated nail body having a proximal end and a distal
`end; a central bore extending through said nail body
`from the proximal end along a proximal portion of said 50
`nail and terminating at a point spaced between said
`ends; said nail also defining a transversely flattened
`distal portion extending proximally from said distal
`end, and an open slot extending centrally and longitu(cid:173)
`dinally from said distal end along said distal portion to 55
`an inner slot end spaced between said ends, said nail
`body defining a plurality of transverse holes extending
`therethrough.
`2. The nail of claim 1 in which said central bore termi(cid:173)
`nates at an aperture in the side wall of said nail.
`3. The nail of claim 1 in which said central bore and said
`open slot are separated by a partition portion preventing
`open communication with each other.
`4. The nail of claim 1 in which at least one of said
`transverse holes is located adjacent to said distal end and
`carries a tapered screw extending through said open slot for
`locking securance of the nail in a bone.
`
`6
`5. The nail of claim 1 in which a first portion of said
`transversely flattened distal portion has a width that is
`greater than the width of a second portion of said trans(cid:173)
`versely flattened distal portion, said first portion being
`5 nearer to the distal end than said second portion.
`6. The nail of claim 1 in which said distal portion has
`opposed, smooth side edges.
`7. The nail of claim 1 in which at least one of said
`transverse holes intersects said central bore, and a set screw
`occupies said bore in a position to retain a bone screw
`extending through said one traverse hole, said set screw
`having an axial aperture to permit a guidewire to extend
`completely through said central bore.
`8. The nail of claim 1 in which at least one of said
`transverse holes intersects said central bore said hole
`defining, on each side of said central bore, axially spaced
`first wall sections separated by and connected with circum(cid:173)
`ferentially spaced second wall sections, said first wall sec(cid:173)
`tions being proportioned to permit threaded engagement of
`a screw in said transverse hole while the screw is disengaged
`from said second wall sections, allowing said screw to rotate
`through an arc in a plane essentially perpendicular to the
`longitudinal axis of said nail.
`9. The nail of claim 8 in which said at least one of said
`25 transverse holes has a set screw that occupies said bore in a
`position to retain a bone screw extending through said one
`traverse hole, said set screw having an axial aperture to
`permit a guidewire to extend completely through said central
`bore.
`10. The nail of claim 9 in which at least one of said
`transverse holes is located adjacent to said distal end and
`carries a tapered screw extending through said open slot for
`locking securance of the nail in a bone.
`11. A nail for axial insertion into a bone for support
`thereof, which comprises:
`an elongated nail body having a proximal end and a distal
`end; a central bore extending through said nail body
`from the proximal end along a proximal portion of said
`nail and terminating at a point spaced between said
`ends at an aperture in the side wall of said nail; said nail
`also defining a transversely flattened distal portion
`extending proximally from said distal end, and an open
`slot extending centrally and longitudinally from said
`distal end along said distal portion to an inner slot end
`spaced between said proximal and distal ends, said nail
`body defining a plurality of transverse holes extending
`therethrough, a first portion of said transversely flat(cid:173)
`tened distal portion having a width that is greater than
`the width of a second portion of said transversely
`flattened distal portion, said first portion being nearer to
`the distal end than said second portion.
`12. The nail of claim 11 in which said distal portion has
`opposed, smooth, arcuate side edges.
`13. The nail of claim 12 in which at least one of said
`transverse holes is located adjacent to said distal end and at
`least one of said transverse holes is located adjacent to said
`proximal end and intersecting said central bore, and a set
`screw occupies said central bore in a position to retain a
`bone screw extending through said transverse hole adjacent
`60 to said proximal end, said set screw having an axial aperture
`to permit a guidewire to extend completely through said
`central bore.
`14. The nail of claim 13 in which said transverse hole
`adjacent to the proximal end defines, on each side of said
`65 central bore, axially spaced first wall sections, separated by
`and connected with circumferentially spaced second wall
`sections, said wall sections being proportioned to permit
`
`45
`
`ZIMMER 1006
`Page 5
`
`

`
`6,123,708
`
`5
`
`7
`threaded engagement of the screw in said transverse hole by
`said first wall sections while the screw is disengaged from
`said second wall sections, allowing said screw to rotate
`through an arc in a plane essentially perpendicular to the
`longitudinal axis of said nail.
`15. A nail for axial insertion into a bone for support
`therefor, which comprises:
`an elongated nail body having a proximal end and a distal
`end; a central bore extending through said nail body
`from the proximal end at least along a proximal portion 10
`of said nail, at least one transverse hole located adjacent
`to said proximal end and intersecting said central bore;
`and a set screw that occupies said bore in a position to
`retain a bone screw extending through said at least one
`transverse hole, said set screw having an axial aperture 15
`to permit a guidewire to extend completely through
`said central bore.
`16. The nail of claim 15 in which a distal portion of said
`nail is transversely flattened.
`17. The nail of claim 15 in which said at least one
`transverse hole which intersects said central bore defines, on
`each side of said central bore, axially spaced first wall
`sections separated by and connected with circumferentially
`spaced second wall sections, said first wall sections being
`proportioned to permit threaded engagement of a screw in
`said transverse hole, while the screw is disengaged from said
`second wall sections, allowing said screw in the hole to
`rotate through an arc in a plane essentially perpendicular to
`the longitudinal axis of said nail.
`18. The method of repairing a bone which comprises:
`inserting a guidewire into the intramedullar space of a
`bone to provide a track for a nail to be subsequently
`advanced through the intramedullar space; advancing a
`nail having an elongated nail body with a central bore
`
`8
`extending from a proximal end through at least part of
`said nail body, with said guidewire passing through said
`central bore, said guidewire also passing through an
`aperture in a set screw which is threadedly and rotat(cid:173)
`ably retained in screw-relation within said central bore
`immediately proximal of a transverse hole through said
`nail, which hole communicates with said central bore;
`positioning said nail in a desired position in the bone;
`remaining said guidewire; transversely inserting a bone
`screw through said transverse hole to retain said nail
`and the bone together in secured relationship, and
`tightening said set screw against said transversely
`extending bone screw to firmly retain the bone screw
`relative to the nail.
`19. The method of claim 18 in which said set screw is
`installed in the bore of said nail prior to placement of the nail
`in the bone.
`20. The method of claim 18 in which other bone screws
`are inserted through other transverse holes of said nail to
`20 secure said nail to the bone.
`21. The method of installing a nail in the intramedullar
`space of a bone, said nail having proximal and distal ends
`and an open slot extending centrally and longitudinally from
`said distal end proximally to an inner slot end spaced
`25 between said ends, which method comprises: inserting said
`nail into the intramedullar space, and securing said nail to
`the bone with transversely positioned bone screws that
`extend through said nail, including the step of passing a
`tapered bone screw transversely though said open slot and
`30 rotating said tapered bone screw to advance said bone screw
`and to distract outwardly portions of said nail which are
`adjacent to said open slot.
`
`* * * * *
`
`ZIMMER 1006
`Page 6
`
`

`
`UNITED STATES PATENT AND TRADEMARK OFFICE
`CERTIFICATE OF CORRECTION
`
`PATENT NO.
`DATED
`INVENTOR(S)
`
`: 6,123,708
`:September 26,2000
`:Thomas N. Kilpela, Clayton R. Perry, Kenneth A. Davenport, Matthew N. Songer
`
`Page 1 of2
`
`It is certified that error appears in the above-identified patent and that said Letters Patent is
`hereby corrected as shown below:
`
`Column2,
`Line 58, "Side" should be --side--.
`
`Column 3,
`After line 55, add --Thus, by this invention, a bone may be repaired by the method
`which comprises: inserting a guidewire into the intramedullar space of a bone to provide
`a track for a nail to be subsequently advanced through the intramedullar space;
`advancing a nail through an elongated nail body with a central bore extending from a
`proximal end through at least part of said nail body, with said guidewire passing through
`said central bore, said guidewire also passing through an aperture in a set screw which is
`threadedly and rotatably retained in screw-relation within said central bore immediately
`proximal of a transverse hole through said nail, which hole communicates with said
`central bore; positioning said nail in a desired position in the bone; removing said
`guidewire; transversely inserting a bone screw through said transverse hole to retain
`said nail and the bone together in secured relationship; and tightening said set screw
`against said transversely extending bone screw to firmly retain the bone screw relative
`to the nail.
`
`The set screw may be installed in the bore of the nail prior to the placement of
`the nail in the bone. Also, other bone screws may be inserted through other transverse
`holes of the nail to secure the nail to the bone.
`
`As another aspect of this invention, the nail of this invention may be used in a
`method of installation in the intramedullar space of a bone, which comprises the steps
`of: inserting the nail into the intramedullar space, and securing the nail to the bone with
`transversely positioned bone screws that extend through the nail, including the step of
`passing a tapered bone screw transversely through the open slot and rotaing the tapered
`bone screw to advance the bone screw and to distract outwardly portions of the nail
`which are adjacent to the open slot.--
`
`ZIMMER 1006
`Page 7
`
`

`
`UNITED STATES PATENT AND TRADEMARK OFFICE
`CERTIFICATE OF CORRECTION
`
`PATENT NO.
`DATED
`INVENTOR(S)
`
`: 6,123,708
`:September 26,2000
`:Thomas N. Kilpela, Clayton R. Perry, Kenneth A. Davenport, Matthew N. Songer
`
`Page 2 of 2
`
`It is certified that error appears in the above-identified patent and that said Letters Patent is
`hereby corrected as shown below:
`
`Column 5,
`Line 31, "46" should be --42--.
`
`Column 8,
`Line 9, "remaining" should be --removing--.
`
`Signed and Sealed this
`
`Third Day of July, 2001
`
`Attest:
`
`Attesting Officer
`
`NICHOLAS P. GODICI
`Acting Director of the United States Patent and Trademark Pffice
`
`ZIMMER 1006
`Page 8