in fig1 a typical fragmentation of the distal radius 81 is shown . in this case three fragments 82 , 85 , 86 are formed . a dorsal ulnar fragment 82 , an intra - articular fragment 85 and a palmar lip fragment 86 . this fragmentation pattern is used for descriptive purposes only , in order to explain the invention . for the fixation of the intra - articular fragment 85 a buttress according to the invention is used . in the embodiment shown in fig2 to 4 there is only one major part , namely a first part 41 or buttress pin . the distal end of the first part 41 is formed as a buttress 49 . in this embodiment the first part 41 is u - shaped in top view , and is furnished with pointed projections 45 for engagement with bone cortex . the buttress pin is secured to the stable bone with a bone screw 44 cooperating with a washer 46 . buttressing of an intra - articular fragment 85 from the intraosseous side is not limited to use in the distal radius . other joints , such as the elbow , knee , and ankle , are suitable for this type of device . fig5 shows application of the buttress pin of fig2 to 4 on a fracture . the buttress pin is driven up behind the fragment 85 to push it against the adjacent cortex . in this position the device is secured to the stable bone 81 with the bone screw 44 cooperating with the washer 46 . the pointed projections 45 help to give a stable fixation . this device 41 is stiff enough to allow the fragment 85 to be maintained in position against the opposite side of the joint . on the other hand , the device 41 is flexible enough to allow it to be removed after fracture healing without significant disruption of bone . thus , this device 41 buttresses from the intraosseous side of the fragment . all existing buttress plates place the buttress on the superficial surface of the bone . it will be additionally noted that the device 41 provides an intraosseous buttress to the cortical fragment 82 as shown in fig5 . this provides a stable floor against which this cortical fragment may abut , providing additional stability to this fragment . it is readily apparent that the device is capable of being used as an intraosseous buttress for either an intra - articular fragment , an unstable cortical fragment , or a combination of the two . for the fixation of the dorsal ulnar fragment 82 a small fragment clamp according to the invention is used . the basic design of the small fragment clamp is to provide a form of sandwiching effect for fixation of the fragment 82 . this effect combines an intraosseous buttress with an extraosseous buttress in order to further constrain movement of the fragment , without the need of invasively drilling through the fragment . the fragment clamp is made of two parts . the first part grabs the fragment 82 from the undersurface and the second part grips the upper surface of the fragment 82 . in a first embodiment of the fragment clamp shown in fig6 to 8 the first part 1 has two cross tabs 6 , 7 . the distal one 7 acts as a fulcrum or axis of rotation of the first part 1 on the second part 2 . this prevents the first part 1 from lifting up out of the second part 2 . both the first part 1 and the second part 2 have pointed projections 5 for engagement with bone cortex . in this embodiment the first part 1 is linear in top view and is bent in side view , the forward bent section being intended to grip and buttress on the intraosseous side of the fragment 82 . the second part 2 has a general u - shape with two legs 3 . to secure the components to the stable bone 81 , bone screws 4 are applied through holes in the tabs 6 , 7 . this fixation also secures the components 1 , 2 to each other . since the first and second parts 1 , 2 are not directly coupled , the surgeon may slide the first part 1 distally or proximally depending upon the size of the fragment intended to be firxed . once the device is applied , however , the two parts 1 and 2 no longer move relative to each other . the pressure of the cross tabs 6 , 7 on the second part 2 essentially joins the first and second parts 1 , 2 together . in a second embodiment of the fragment clamp shown in fig9 to 11 the first part 11 has a cross pin 17 , acting as a fulcrum for rotation of the first part . as in the first embodiment the first part 11 is linear having a bent section in side view , and the second part 12 has a general u - shape with two legs 13 in top view and is linear in side view . fixation for the second embodiment is accomplished with bone screws 14 passing through a matching washer 16 . the washer 16 locks the first and second parts 11 , 12 to each other as well as to the bone 81 . both the first and second parts 11 , 12 have pointed projections 15 for engagement with bone cortex . a third embodiment of the fragment clamp is shown in fig1 to 14 . in this embodiment the first and second parts 21 , 22 have the same general shape as in the above embodiments . furthermore they are furnished with pointed projections 25 for engagement with bone cortex . the second part 22 has a cross pin 27 and a cross bar 26 bridging the legs 23 of the second part 22 . the cross bar 26 is furnished with an opening for receiving a bone screw 24 securing the device to the stable bone 81 . the cross bar 26 is also used to capture an upwardly directed hook 28 on the first part 21 . in this embodiment the device has been limited to two components . fig1 a to 15f show one way to secure the device according to the third embodiment to a stable bone 81 . the first part 21 is first placed by having it pass through the fracture 83 . if necessary a notch 84 is removed or a transosseous hole is made to allow the passage of the first part 21 . when the first part has been placed with the pointed projection 25 in engagement with and buttressing the intraosseous side of an unstable fragment 87 , the second part 22 is placed on top of the first part 21 in a position where the hook 28 of the first part 21 is captured by the cross bar 26 . finally a bone screw 24 passing through an opening in the cross bar 26 secures the device to the stable bone . as the screw 24 is fastened the projections 25 of the first and second parts 21 , 22 will engage the bone cortex and stabilize the position of the device . thus , the bone fragment 87 is sandwiched between the first and second parts 21 , 22 and is secured to the stable bone 81 . in some cases a hole is made in the stable bone at some distance from the actual fracture site . the first part is inserted through said hole . the rest of the device is secured as described above . sometimes a special tap or clamping device is used to temporarily fix the first part to the stable bone . the unstable fragment is then placed on top of the intraosseous arms of the first part and the second part is thereafter placed on top . finally the tap is replaced with a screw and washer . in fig1 to 18 a fourth embodiment of the fragment clamp according to the invention is shown . this embodiment resembles the previous embodiments in having a first linear part 31 and a second u - shaped part 32 with two legs 33 . the first and second parts 31 , 32 have projections 35 for engagement with bone cortex . in this embodiment there is no cross tab on the first part 31 , instead the bone fragment itself prevents the first part 31 from lifting up out of the second part 32 . the proximal end of the first part 31 has a hook 38 which allows passage of a screw 34 . the screw passes through a washer 36 . this design is cheap and simple to manufacture . application of this device on a bone is shown in fig1 and 20 . fig2 shows a cross - section taken along line xx -- xx in fig1 . as in the example shown in fig1 a to 15f the first part 31 is first passed through the fracture 83 , with or without a notch having been taken out . when the first part 31 is positioned the second part 32 is placed with the legs 33 of the second part 32 on both sides of the first part 31 and with the distal ends of the legs 33 on the upper side of the fragment 82 . then the washer 36 is placed bridging the legs 33 of the second part 32 . the washer 36 has a hole for receiving a bone screw 34 in alignment with the center of the hook 38 of the first part 31 . finally , the bone screw 34 secures the device on the stable bone 81 whereby the distal ends of the first and second parts 31 , 32 sandwich the fragment 83 . thus , the first part 31 forms an intraosseous buttress and the second part 32 forms an extraosseous buttress . fig3 shows one further embodiment of the fragment clamp according to the present invention . this embodiment has a first u - shaped part 91 with two legs 97 and a second u - shaped part 92 with two legs 93 . before placing the first part 91 , the legs 97 of said part 91 are bent depending on the site of the fracture 83 . application of this device on a bone is shown in fig3 and 32 . fig3 shows a cross - section taken along the line xxxii -- xxxii in fig3 . when applying the fragment clamp , the first part 91 is first passed through the fracture 83 , with or without a the notch having been taken out . then the second part 92 is placed with the legs 93 of said part 92 on both sides of the first part 91 and with the distal ends of the legs 93 on the upper side of the fragment 82 . both the first and second parts have pointed projections 95 for engagement with bone cortex . a washer 96 is then placed bridging the legs 93 of the second part 92 . the washer 96 receives a bone screw 94 , which secures the device on the stable bone 81 . thus , the distal ends of the first and second parts 91 , 92 sandwich the fragment 83 . the first part 91 forms an intraosseous buttress and the second part 92 forms an extraosseous buttress . some embodiments of the small fragment clamp allow the first part to be placed at a variable distance along the first component allowing central &# 34 ; fingers &# 34 ; extending as far as or farther than the outer fingers if desired or much shorter if desired . this feature allows the bend in the first part to be placed at the level of the fracture site where it would allow the first part to track up against the inner cortex of the bone fragment 82 . the above described embodiments are only examples of possible designs for a device according to the invention . in other embodiments the different parts of the embodiments shown are combined with different parts of the other embodiments . thus , in further embodiments , both the first and second parts have u - shape in top view , the lengths of the legs of the u - shape differ , the number of arms on the intraosseous and the extraosseous side vary etc . in one embodiment there are two arms intraosseous and one arm extraosseous . in the embodiment shown in fig2 to 23 the small fragment clamp is made in one piece . the clamp includes a base 62 and in side view a bent first part 61 for gripping and buttressing on the intraosseous side of a bone fragment . for gripping and buttressing on the extraosseous side of the bone fragment the clamp is provided with two straight legs 63 , which are parallel with the first , bent part 61 . both the first part 61 and the two legs 63 have pointed projections 65 for engagement with cortex . to secure the clamp to the stable bone , bone screws 64 are applied through holes in the base 62 of the clamp . in fig2 to 26 a further embodiment according to the invention is shown , having both a clamping function and an intra - articular buttress function . the first part 71 has a general u - shape in top view with two legs 77 connected with a loop 78 . in side view the legs 77 of the first part 71 show an intra - articular buttress 79 connected to the end of a bent section of the legs 77 , which bent section cooperates with legs 73 of the second part 72 to grip a bone fragment . to secure the clamp and the intra - articular buttress to the stable bone a bone screw 74 is used . the screw 74 passes through a washer 76 , bridging the legs 73 of the second part 72 , and passes through the loop 78 of the first part . an example of application of the device of fig2 to 26 is shown in fig2 and 28 . fig2 shows a cross - section taken along the line xxviii -- xxviii in fig2 . the first part 71 is first passed through the fracture , with or without a notch having been taken out , or through a hole made in the stable bone . to position the first part 71 with the intra - articular buttress 79 and the legs 77 in the desired positions it may be necessary to bend either part somewhat in one direction or other . when the first part 71 has been placed the unstable fragment 82 to be gripped by the fragment clamp is placed on top of the legs 77 of the first part 71 , which legs 77 function as a buttress for the fragment 82 . then the second part 72 and the washer 76 are placed . the washer 76 bridges the legs 73 of the second part 72 and has an aperture for receiving the bone screw 74 in alignment with the center of the loop 78 of the first part 71 . finally , the bone screw 74 secures the device on the stable bone 81 whereby the legs 73 , 77 of the first and second parts sandwich the dorsal ulnar fragment 82 at the same time as the intra - articular buttress 79 of the first part 71 buttresses an intra - articular fragment 85 . in fig2 a further device is shown applied on a fracture , having both a clamping function and an intra - articular buttress function . in this embodiment the first part 51 grips on the lower side of a first fragment 82 at the same time as an intra - articular buttress 59 of the first part 51 forces a second fragment 85 against the opposite side of the joint . the second part 52 grips on the upper side of the first fragment 82 . this device is secured to the stable bone 81 with a bone screw 54 passing through a washer 56 . as in the previous embodiments pointed projections are used to stabilize the device further . in some embodiments there are no pointed projections and in other embodiments there are one or more raised areas for contact with the bone . in a further embodiment ( not shown ) a two piece first part is used , which can be coupled during insertion at the site of bone penetration . the method of placement of the device according to the invention sometimes require the removal of a small notch of bone to allow passage of the first part . the first part is flexible enough to allow its removal simply by sliding this member proximally at the time of device removal . in cases where the patient has a severe fragmentation and possibly soft bone ( osteoporosis ), there is a risk that that the legs of the second part find a crack between the fragments and fall within the crack . to avoid this risk a small plate 100 is placed between the extraosseous surface of the fragments and the legs 93 of the second part 92 . in this way the load of the clamp is spread over a wider area . although the plate 100 is shown in fig3 in connection with the device according to fig3 , a person skilled in the art realizes that said plate could be used with any fragment clamp according to the invention . in its most simple embodiment the plate 100 is a simple straight plate . in further embodiments the plate is furnished with means 103 , 104 to constrain the plate from migrating . two examples of this are shown in cross - section and enlarged in fig3 and 35 . the plate 101 according to fig3 has a raised area 103 between the legs 93 of the second part of the fragment clamp . the plate 102 according to fig3 is furnished with two seats 104 for receiving the legs 93 of the upper part of the fragment clamp . in a further embodiment ( not shown ) the plate has two slots at the distal edge to allow the legs 93 near the tip to pass through to the bone . in still a further embodiment ( not shown ) two small holes are placed near the distal edge of the plate to allow the pointed projections of the outer component to gain some purchase on the plate . thus , the plate is constrained from migrating by co - operation between the legs 93 of the clamp and a constraining means 103 , 104 of the plate 101 , 102 . if needed , the plate 100 , 101 , 102 is bent to conform to the dorsal surface as an option ( not shown ) the legs of both the first part and the second part are delivered straight i . e . not bent in side view . in this case the legs of the first part are custom bent depending on the fracture site , the size of the fragments etc . before application by the surgeon . in this embodiment it is possible to cut the ends of the legs to desired lengths and optionally bend in a point at the end if desired . the first and second parts of this device are preferably made of wires having a diameter between 0 . 010 &# 34 ; to 0 . 250 &# 34 ;. in one embodiment 0 . 045 &# 34 ; wire is used and in a second embodiment 0 . 054 &# 34 ; wire is used . in other embodiments the first and second parts are not made of wires , in which case the crosssection of the legs of each part has the shape of a bar , plate , triangle , hexagonal or the like . in one further embodiment ( not shown ) at least one of the legs of the first and / or second part is bent or angled in top view . the above bent or curved sections are predominantly arranged at the tip of the legs , but in some embodiments the entire legs ( or leg ) has a bent or angled shape as viewed from above . the expressions lower , upper etc as used in the description are used for convenience and only refers to the drawings specifically referred to , without any limitations to the actual design of the products . the above detailed description has referred to but a limited number of embodiments of the present invention , but it will be readily perceived by a person skilled in the art that the present invention encompasses a large number of embodiments without departing from the spirit and scope of the appended claims .
the present invention relates to an implantable clamp for fixation of one or more bone fragments to a stable bone . the clamp has two basic functions , namely a buttress function and a clamp function . either function or both may be employed depending on the fracture picture . the clamp has a first part having a front part bent into a buttress and / or into a lower part of a clamp . further , the clamp may comprise a second part constituting the upper part of the clamp . a screw is used to secure the clamp to the stable bone . the buttress of the clamp is utilized to press an intra - articular fragment against an adjacent joint surface . the clamp is utilized to capture and secure a bone fragment .