CN101516282A - Orthopedic plate system - Google Patents

Abstract

A plastic surgery medical device and method are disclosed, comprising a cylindrical plastic surgery plate and clamps, as well as fixation members for securing the plate to tissue such as bone. In one embodiment, the plate includes cylindrical sides and ends, and the clamps are adapted to fit thereon. Additional devices in the form of lateral connecting members and connecting plates for use with the plastic surgery plate are also disclosed. Methods for using the disclosed device are also described.

Description

Orthopedic Plate System

Background technique

In the field of orthopedic surgery, elongated plates or rods can be fixed to bones to hold and support them in a given position. For example, during the process of fusing injured vertebrae, the surgeon positions the vertebrae in the corrected position as desired. A plate (ie, a plate with flat upper and lower sides) is placed adjacent to or against the bone, and bone anchors are used to secure the plate to the bone. Bone screws or bolts may be used as bone anchors, and placement of such anchors is achieved by drilling one or more holes in the bone(s) and threading the anchors into the holes. The anchors may be threaded into holes through the plate, or the plate may be placed in place around the anchors after being threaded into the holes. The anchor and plate are secured to each other against relative movement. In this way, the bone can be held in the correct alignment and/or supported to heal.

Other orthopedic systems use rods to connect bone anchors and provide stability to tissues such as vertebrae. Such rods may, for example, be placed along the vertebrae and contoured to hold and support the bone in a desired position.

Description of drawings

Figure 1 is a side view of one embodiment of an orthopedic board system.

Fig. 2 is a top view of the embodiment of Fig. 1 .

FIG. 3 is an end view of the embodiment of FIG. 1 .

4 is a cross-sectional view of the embodiment of FIG. 1 taken along line 4-4 in FIG. 2 and viewed from the direction of the arrow.

5 is a cross-sectional view of the embodiment of FIG. 1 taken along line 5-5 in FIG. 1 and viewed in the direction of the arrows.

Figure 6 is a side view of one embodiment of an orthopedic plate system.

FIG. 7 is a top view of the embodiment of FIG. 6 .

FIG. 8 is an end view of the embodiment of FIG. 6 .

9 is a cross-sectional view of the embodiment of FIG. 6 taken along line 9-9 in FIG. 7 and viewed from the direction of the arrow.

Figure 10 is a cross-sectional view of the embodiment of Figure 6 taken along line 10-10 in Figure 6 and viewed from the direction of the arrow.

Figure 11 is a side view of one embodiment of an orthopedic plate system.

Fig. 12 is a top view of the embodiment of Fig. 11 .

FIG. 13 is an end view of the embodiment of FIG. 11. FIG.

14 is a cross-sectional view of the embodiment of FIG. 11 taken along line 14-14 in FIG. 12 and viewed from the direction of the arrow.

15 is a cross-sectional view of the embodiment of FIG. 11 taken along line 10-10 in FIG. 11 and viewed from the direction of the arrow.

Figure 16 is a perspective view of one embodiment of an orthopedic plate system.

FIG. 16A is a perspective view of a device that may be used with the embodiment of FIG. 16 .

Figure 17 is a perspective view of one embodiment of an orthopedic plate system.

Detailed ways

To facilitate an understanding of the principles of the disclosure, the description will be directed to the embodiments shown in the drawings, and specific language is used to describe the same features. It should be understood, however, that no limitation of the scope of the claims is intended and that such changes and further modifications to the described devices and further applications of the principles of the disclosure described herein will generally occur to those skilled in the art to which the disclosure relates.

Referring generally to FIGS. 1-5, one embodiment of an orthopedic implant system 20 is described. In this embodiment, implant system 20 includes plate member 22 , at least one clamp 24 , and bone fixation member 26 coupled to clamp 24 . Different numbers of any of these elements may be used without departing from the scope of the present disclosure. For example, multiple plate members 22 may be used in conjunction with one another, and additional jigs 24 and bone fixation members 26 may be used depending on the size, shape or other configuration of the plate members, the medical problem being addressed, and/or other factors.

In one embodiment, the plate member 22 is generally in the form of an elongated oval having a first side or rail 32, a second side or rail 34, a first end 36, and a second end 38. . In the depicted embodiment, the sides 32 , 34 and the ends 36 , 38 define or surround a space 40 . Each side 32 , 34 has a length between ends 36 and 38 , and the side 32 , 34 of a particular embodiment is substantially straight throughout its entire length between ends 36 and 38 . The sides 32, 34 are further cylindrical, eg substantially circular in cross-section perpendicular to the longitudinal axis of the sides 32, 34. Similarly, ends 36 and 38 are substantially cylindrical, eg also substantially circular in cross-section perpendicular to the central axis. In the depicted embodiment, the sides 32 , 34 each have a respective diameter that is equal to each other and equal to the diameter of the ends 36 , 38 . Accordingly, the plate member 22 can be viewed as a generally cylindrical single rod bent into a continuous substantially elliptical shape so that its ends meet. It can also be seen as two parallel cylindrical rods bent at the ends to meet each other. Due to the lack of corners or material concentrations, the cylindrical shape of the sides 32, 34 may allow the plate member 22 to bend about any axis or under torque more easily without cutting, assembling and manipulating the two rods. This also enables the use of the plate member 22 with a variety of implants designed for use with cylindrical stems. Of course, the diameter of each side can be different from the other and/or the diameter of the end, and other structural changes can be made.

One embodiment of a clamp 24 may be used for the plate member 22 . The embodiment of clamp 24 shown in FIGS. 1-5 includes a yoke member 52 and a crown member 54 . Yoke member 52 has an upper portion 56 that is slightly thinner than a lower portion 58 . In a particular embodiment, the upper portion 56 is sized to be inserted through the space 40 of the plate member 22 and has a threaded portion 60 . In a particular embodiment, the upper portion has a width dimension substantially equal to the distance between the closest points of sides 32 and 34 of plate member 22 . The upper portion 56 may also include an opening or aperture 62 . At least some of the apertures 62 may include a print or contour 64 (eg, a hexagonal print, TORX print, or similar surface) or otherwise for engagement by a tool. In the depicted embodiment, the lower portion 58 of the yoke member 52 has a cavity 66 , a slot 68 towards the open end of the cavity 66 , and a beveled edge 70 . Cavity 66 is sized to receive at least a portion of a bone fixation member, such as member 26, as described further below. Cavity 66 may communicate with aperture 62 in upper portion 56 and may also be open toward the side of yoke member 52 with surfaces 72 , 74 generally facing plate member 22 . Ring member 76 is shown positioned within groove 68 . The inner dimension of the ring member 76 when within the groove 68 is smaller than the outer dimension of the portion of the securing member within the cavity 66 . The ring member 76 may be generally C-shaped for an unstressed structure and be substantially flat or undulating, and alternatively be slightly larger than the diameter of the groove 68 so that the ring member 76 is retained in the groove 68 . Alternatively, ring member 76 may have other configurations or properties, such as being made of a shape memory material.

The illustrated embodiment of the crown member 54 has an upper surface 78 through which an aperture 80 extends, an inner surface 82 that may be substantially spherical, and an extension finger 84 . Crown member 54 is generally sized to removably fit within cavity 66 such that ring member 76 may be between crown member 54 and bevel 70 . Aperture 80 communicates with cavity 66 and in the depicted embodiment is substantially aligned with aperture 62 of upper portion 56 of yoke member 52 . In the depicted embodiment, the fingers 84 of the crown member 54 extend at least slightly beyond the surfaces 72 , 74 .

An embodiment of a bone fixation member 26 is also shown. In general, the described embodiment of the bone fixation member 26 includes a head 90 having an inner drive footprint 92 such as described above with respect to footprint 64 and a threaded shank 94 . The head 90 is substantially spherical in part and includes one or more ridges 96 which may be circumferential. As noted above, the head portion 90 is sized to fit within the cavity 66 and held there by the ring member 76 so that the bone fixation member 26 can be positioned polyaxially with respect to the yoke member 52 . While the bone fixation member 26 is shown in this embodiment as a screw, it could instead be a hook or other type of orthopedic implant or device.

A nut 100 is also provided in the illustrated embodiment. The nut 100 has an internal thread 102, a lower opening 104, which may be partially beveled and partially substantially cylindrical, and may also include a widened lower part 106 extending laterally slightly further than the Plane to drive the upper part 108 . The upper member 108 may include different footprints or configurations for actuation.

In use, the clamp 24 and bone fixation member 26 may be connected prior to surgery, or at any time convenient to the surgeon or others. Crown member 54 is inserted into cavity 66 of yoke 52 prior to or over insertion of bone fixation member 26 into cavity 66 . Ring member 76 may be positioned about stem 94 and inserted through ramped opening 70 into cavity 66 . Ring member 76 may be compressed if appropriate, for example if it is a C-shaped member with an unstressed diameter greater than the diameter of lumen 66, as described above. Ring member 76 enters cavity 66 and is at least partially seated within groove 68 . Thus, the described embodiment places the head 90 of the bone fixation member 26 between the ring member 76 and the crown member 54 within the cavity 66 of the yoke member 52 .

Bone fixation member 26 and clamp 24 are attached to tissue, such as a vertebra. In one embodiment, a hole sized for bone fixation member 26 may be drilled in the vertebrae. A threaded rod 94 is inserted into the hole and in one embodiment a tool (not shown) with a suitably configured tip is inserted into the footprint 92 and also through the yoke member when the bone fixation member 26 and clamp 24 are preassembled. The aperture 62 of the crown member 52 and the hole 80 of the crown member 54 are rotated to thread the rod 94 into the bone. When the rod 94 is threaded into the bone to the desired depth, the tool is removed from the yoke member 52 . Clamp 24 may be rotated about head 90 of bone fixation member 26 and/or pivoted to a relative position as desired by the surgeon.

The plate member 22 is then placed over the clamp 24 by inserting the upper portion 56 of the yoke member 52 through the space 40 of the plate member 22 . The sides 32 , 34 of the plate member 22 may abut the fingers 84 of the crown member 54 . Plate member 22 may be adjusted relative to jig 24 and/or the combination of plate member 22 and jig 24 may be adjusted relative to bone fixation member 26 as desired by the surgeon. Nut 100 is threaded onto upper portion 56 of yoke member 52 and is fastened against plate member 22 . Tightening the nut 100 compresses the plate member 22 towards the crown member 54 and the bone fixation member 26 is clamped between the surface 82 of the crown member 54 and the ring member 76 .

It will be appreciated that another jig 24 and bone fixation member 26 may be placed in other tissue, such as adjacent vertebrae, and connected to plate member 22 substantially as described above. Additionally or alternatively, other types of bone implants or orthopedic devices may be attached to adjacent bone or other tissue, or the form of connection between plate members 22 may be simplified and further simplify the orthopedic implant or instrument .

Plate member 22 may be used with various jigs, bone fixation members, and other implant structures. Examples of some of the jigs 124 and bone fixation members 126 are shown in FIGS. 6-10 . Clamp 124 includes a U-shaped yoke member 152 with a pair of legs 156 and a base 158 with an aperture 162 therein. In the depicted embodiment, the orifice 162 has a flared generally conical upper section 164a and a lower section 164b, which may also be generally conical and flared or may be of a generally spherical or other configuration or its combination. Each leg 156 forms a recess 165 with the base 158 . In a particular embodiment, the recess 165 is curved with a radius of curvature substantially equal to the radius of the sides 32 , 34 of the plate member 22 . As shown in this embodiment, in one embodiment the recess 165 is adjacent or adjoins slightly less than a quarter of the circumference of the side of the plate member 22 to more easily place the plate member 22 next to the yoke member 152 . In embodiments where the recess 164 is adjacent or adjoins slightly more than a quarter of the circumference of the side of the plate member 22, the yoke member 152 may snap onto the sides 32, 34 of the plate member 22, or one of the ends 36, 38. One is inserted between the legs 156 and the yoke member 152 can be slid along the plate member 22 into the relative position.

The bone fixation member 126 is a bolt with an intermediate head 190 between a threaded shaft 194 for attachment to tissue such as vertebrae and an upper threaded portion 195 . Examples of such bolts are disclosed in US Patent No. 6,280,445, the entire contents of which are incorporated herein by reference. The head 190 may have a substantially spherical upper portion 197 that adjoins the lower orifice section 164b and is rotatable relative to the lower orifice section 164b. Upper threaded portion 195 includes an internal footprint 199 for driving bone fixation member 126 . Footprint 199 may be configured as described above with respect to footprints 64 and 92 .

Nut 200 is also shown in this embodiment. Nut 200 is similar to that described in US Patent No. 6,315,779, which is incorporated herein by reference in its entirety. The illustrated embodiment of the nut 200 includes an internal thread 202, a lower cylindrical skirt 203 surrounding a lower opening 204, and a widened lower part 206 extending laterally slightly further than an upper part 208 having an outer flat to drive. The upper member 108 may include different footprints or configurations for actuation. The bottom side 209 of the nut 200 is flared and may be substantially conical. In addition to the nut 200, a washer 210 may be provided and has a planar bottom side 212, a curved or conical upper side 214, and a hole or slot 216 that allows the upper threaded portion 195 of the bone fixation member 126 to Movement relative to washer 210 in at least one plane. Nut 200 and washer 210 can form a pre-assembled unit if used together, and skirt 203 can be overhanged or otherwise expanded to prevent nut 200 from falling off washer 210 while retaining nut 200 to move along and relative to washer 210 ability to rotate.

In use, the clamp 124 may be attached to either or both of the bone fixation member 126 and the plate member 22 prior to surgery or at any time convenient to the surgeon or others. In one embodiment, bone fixation member 126 is attached to tissue, such as a vertebra. For example, a hole sized for the threaded rod 194 of the bone fixation member 26 may be drilled in the vertebrae. Threaded rod 194 is inserted into the hole and in one embodiment a tool (not shown) with a suitably configured tip is inserted into footprint 192 and then turned to thread threaded rod 194 into the bone. When the rod 194 is threaded into the bone to the desired depth, the tool is removed.

If the clip 124 was not previously attached, the clip 124 is placed on the bone fixation member 126 such that the upper threaded portion extends over the clip 124 and the intermediate head 190 abuts the clip 124, eg, at least partially within the aperture portion 162b. The jig 124 can be rotated about the head 190 of the bone fixation member 126 and/or turned into a relative position as desired by the surgeon. Plate member 124 may be placed over bone fixation member 126 and adjacent to clamp 124 if plate member 22 has not been previously attached to clamp 124 . In this position, the sides 32 , 34 of the plate member 22 are at least partially within the recess 165 of the clamp 124 and the upper threaded portion 195 of the bone fixation member 126 extends through the space 40 of the plate member 22 .

Plate member 22 and clamp 124 may be adjusted relative to bone fixation member 126 by at least rotating bone fixation member 126 along the plane of slot 216 and/or the length of plate member 22 as desired by the surgeon. The nut 200 and washer 210 are placed over the upper threaded portion 195 of the bone fixation member 126 and the nut 200 is threaded down and tightened to press the washer 210 against the plate member 22 . Tightening the nut 100 also pulls the bone fixation member 126 such that its head 190 presses the clamp 124 against the plate member 22, thereby locking the structure. It will be appreciated that the nut 200 may be used without the washer 210 or with a different washer. It is further understood that in other embodiments, nut 100 , with or without a washer, such as washer 210 , or other types of nuts may be used with securing member 126 . For example, a nut such as nut 200' (FIGS. 11-15) may be provided having a substantially planar bottom surface. Locking plate member 22 , clamp 124 , and bone fixation member 126 using a nut, such as nut 200 ′, may substantially limit or prevent planar or multi-axial positioning of bone fixation member 126 relative to clamp 124 and plate member 22 .

Additional parts or kits may be provided separately for embodiments as described above or in other embodiments. For example, as shown in FIGS. 16-17 , a cross connector 300 is shown connecting the plate members 22 . The connector 300 includes a connecting member 302 , a post 304 and a nut 306 . Connecting member 302 includes a block portion 308 having a first opening 310 therethrough for receiving at least a portion of an elongated member (eg, an orthopedic rod R) and a second opening 312 for receiving therethrough. A set screw (not shown) is threaded therein, which locks the elongated member R relative to the block member 308 . Connecting member 302 further includes an extension portion 316 extending laterally from block portion 308 , and in a particular embodiment extension portion 316 is substantially perpendicular to a surface of block portion 308 . In the depicted embodiment, one side of the extension portion 316 includes two recesses 318 which may have a substantially cylindrical shape and may have a diameter substantially the same as the diameter of the sides 32 , 34 of the plate member 22 . The recess 318 is adapted to receive at least a portion of the sides 32 , 34 of the plate member 22 , and in one embodiment, the walls of the recess 318 contact the respective sides 32 , 34 of the plate member 22 . As shown in the embodiment of FIGS. 16-17 , the recess 318 is on the side of the extension portion 316 that faces away from the block portion 308 and the elongate member R substantially. It is understood that the recess 318 may be on either side of the extension 316 . A hole is provided through the extension 316 between the recesses 318 .

In the depicted embodiment, post 304 includes a body 320 with a generally cylindrical upper portion 322 and a lower flange 324 . The upper portion 322 may be threaded and include a footprint 326 such as a hexagon, texel, or other configuration to accommodate a tool. Flange 324 generally extends laterally from body 320 , although it may extend around other portions of the perimeter of body 320 or around the entire perimeter of body 320 . In particular embodiments, the flange 324 has an end 328 that is angled relative to the rest of the flange 324 and may be substantially planar, may form a part-spherical surface, or may be of other configurations. As described further below, the flange 324 is sized such that at least portions of the ends 328 may abut portions of the sides 32 , 34 of the plate member 22 . Nut 306 is internally threaded and sized to be threaded onto upper portion 322 of post 304 .

Attachment 300 may be attached to plate member 22 at the surgeon's convenience prior to surgery or during surgery. The extension 316 is positioned above or below the plate member 22 such that the sides 32 , 34 of the plate member 22 are at least partially within the recess 318 of the extension 316 . The upper portion 322 of the post 304 is inserted through the space 40 of the plate member 22 and the hole 319 such that the end 328 of the flange 324 is adjacent or abuts the sides 32 , 34 of the plate member 22 . Nut 306 is threaded onto and fastened against extension 316 (in the depicted embodiment) thereby locking plate member 22 between extension 316 and flange 324 . Alternatively, connector 300 may be attached underneath plate member 22 (ie opposite to that shown in FIGS. 16-17 ), and nut 306 may directly contact plate member 22 with flange 324 abutting extension 316 . Plate member 22 may be locked between nut 306 and flange 324 . Before or after connecting the connector 300 to the plate member 22, an elongate member R, such as a spinal rod, is inserted into the block portion 308 and locked by set screws (not shown).

Another device that may be connected to plate member 22 is an additional connecting or stabilizing member, such as the embodiment of connecting plate 400 shown in FIG. 16 . In this embodiment, the attachment plate 400 includes an attachment portion 402 for attachment to the plate member 22 and a plate portion 404 for attachment to other tissue or devices, such as the sacrum or a device implanted in the sacrum. The linking portion 402 includes a hole 406 therethrough and a slot 408 therethrough, wherein the slot 408 lies in a plane substantially perpendicular to the axis of the hole 406 . The slot 408 is wide enough to allow the plate member 22 to pass therethrough such that the space 40 of the plate member 22 communicates with the hole 406 . If the hole 406 is internally threaded, a set screw 409 may be provided to lock the attachment portion 402 relative to the plate member 22 . Optionally, whether or not the holes 406 are threaded, the posts 304 and nuts 306 may be provided and used to lock the joint portion 402 relative to the plate member 22 , substantially as described above with respect to the connecting member 300 and the plate member 22 .

In the depicted embodiment, the plate portion 404 has at least one hole 410 therethrough adapted to receive a bone screw implanted in the sacrum or other bone, or may be adapted to receive other types of orthopedic implants. or equipment. In the embodiment of FIG. 16 , two bone screws 412 extend through one or more holes 410 . It will be appreciated that bone screws are provided through the plate portion 404 and individually threaded holes are provided for set screws whose heads overlap the heads of the bone screws to prevent loosening of the bone screws or removal of the bone screws from the bone. pull out. The plate portion 303 and the joining portion 402 are oriented relative to each other to ensure some orthopedic correction or anatomical positioning. For example, the depicted embodiment of the connection plate 400 shows a plate portion 404 that is not planar with the joining portion 402 and forms an obtuse angle therebetween. Such a configuration is advantageous when used with a plate member 22 connected to the lower lumbar or sacral spine (eg L5 or S1 ) where the surgeon also wishes to connect laterally to the sacrum or other bone. The angle between the link portion 402 and the plate portion 404 can be varied (either by bending the link plate 400 or by providing various angles of the link plate 400 within the kit) to best suit the anatomy or the needs of the patient. In other embodiments, the plate portion 404 and the link portion 402 may be substantially planar relative to each other, may be twisted so that they are not planar but share a longitudinal axis, or otherwise configured.

Attachment plate 400 may be attached to plate 22 at the surgeon's convenience, prior to the surgical procedure or during the surgical procedure. The end 36 or 38 of the plate member 22 is inserted through the slot 408 of the attachment portion 402 as desired by the surgeon such that the connecting plate 400 is placed on the plate member 22 . When the hole 406 is threaded and a screw 409 is provided, the screw 409 is threaded into the hole 406 and against the plate member 22, thereby pressing the plate member 22 towards the joint portion 402 to lock them together. If post 304 and nut 306 are used, upper portion 322 of post 304 is inserted through hole 406 of joint portion 402 and through space 40 of plate member 22 such that flange 324 is adjacent or abuts joint portion 402 and upper portion 322 is removed from the joint. Portion 402 extends out. The nut 306 is threaded onto the post 304 and tightened against the link portion 402 compressing the slot 408 to lock the plate member 22 therein. Alternatively, hole 406 and/or flange 324 may be sized such that flange 324 may fit through at least part of hole 406 and end 328 of flange 324 is adjacent or abuts side 32 , 34 of plate member 22 . Tightening the nut 306 against the joining portion 402 causes the plate member 22 to be clamped between the flange 324 and the joining portion 402 . The plate portion 404 may be attached to tissue or other implant or device either before or after the attachment portion 402 is attached to the plate member 22 . However, where the plate member 22 can move in one or more directions prior to securing the plate member 22 to bone or other tissue, if it is first attached to the tissue or device via the plate portion 404 and then attached to the plate member 22, the connecting plate 400 can be used more easily.

Referring now generally to FIG. 17 , another embodiment of a connection plate 400 ′ connected to the plate member 22 is shown. The connection plate 400' is substantially the same as the connection plate 400, with the addition of a second plate portion 404a. In this embodiment, joint portion 402 is between plate portions 404 and 404a, and plate portion 404a is angled relative to joint portion 402 such that plate portions 404 and 404a are not planar but substantially parallel. Plate portion 404a includes holes 410a through which screws 412a or other implants or devices may extend, such as into bone. Other aspects described above with respect to plate portion 404 may also be found in plate portion 404a.

It can be seen that the components shown in the various figures are not limited to use with the embodiment described or illustrated therein, but can be used in or in conjunction with other embodiments. Thus, for example, one plate member 22 may be used with one jig 24 and jig 124 , and the components shown with respect to jig 24 may be used with jig 124 .

The components of the implant system of the present invention may be manufactured in the form of a kit containing a single component in multiple sizes and configurations, or in multiple sizes and multiple configurations containing all the components included in the system of the present invention. Constructed in the form of a kit. Such a kit may include, for example, a set of elongate members 22 and/or 100 of different lengths and with different numbers or orientations of slots and/or bores. In the case of elongate member 100 , the kit may include a set of elongate members having different degrees of curvature along longitudinal axis 106 . Sets of washers, bolts, screws and nuts disclosed herein may also be provided. Furthermore, a tool such as a wrench or a screwdriver that is compatible with the components of the implant system of the present invention may also be included.

The devices of the present invention are preferably constructed of strong biocompatible materials such as stainless steel, titanium, certain plastics, or other well known materials.

While the invention has been shown and described in detail in the drawings and foregoing description, it is to be considered illustrative and not limiting in character, it being understood that only preferred embodiments have been shown and described and that all Changes and improvements are within the spirit of the claimed invention.

Claims (25)

1. A device comprising: a plate member having substantially cylindrical first and second sides and first and second ends, said sides and said ends defining an enclosed space; a clamp adjacent to the plate member, the clamp having a first recess for receiving at least a portion of the first side of the plate member and for receiving at least a portion of the second side of the plate member the second recess of a bone fixation member connected to the jig; and A locking member adapted to retain the plate member to the jig and the bone fixation member. 2. The apparatus of claim 1, wherein the clamp comprises a yoke member having an upper portion extending through the space and a lower portion having a lower surface and a cavity opening through the lower surface and a crown member , the crown member is slidably received within the cavity and has at least one transversely extending finger. 3. The apparatus of claim 2, wherein the yoke member has an opening through the upper portion and in communication with the cavity. 4. The apparatus according to claim 3, wherein said bone fixation member is a bone screw having a threaded shaft and a head, said head having an aperture through which a tightening workpiece can extend through said upper portion of said yoke member. The opening and into the orifice of the head. 5. The apparatus of claim 3, wherein said first side has a diameter and said second side has a diameter, both said diameters being substantially equal. 6. The apparatus of claim 5, wherein the end is substantially circular in cross-section and has a diameter, the diameter of the end being substantially equal to the diameter of the side. 7. The apparatus of claim 2, wherein the first side has a diameter and the second side has a diameter, and at least one of the diameters is substantially non-uniform along its respective side. 8. The apparatus of claim 1, wherein the clamp member comprises a substantially U-shaped member having a first leg, a second leg and a base portion having a hole therethrough through which the first The first recess is at least partially defined by the leg and the base portion, and the second recess is at least partially defined by the second leg and the base portion. 9. The device of claim 8, wherein the bone fixation member comprises a bolt having a first threaded portion for attachment to bone, an intermediate head and a second threaded portion, and wherein the second threaded portion extends Through the hole of the U-shaped member and the space of the plate member. 10. The apparatus of claim 9, wherein the locking member comprises a nut. 11. The apparatus of claim 9, wherein the locking member comprises a nut and a washer, the washer being between the nut and the plate member. 12. The apparatus of claim 1, wherein said first side of said plate member has a diameter and said second side of said plate member has a diameter, and said first recess has a diameter thereof equal to the diameter of the first side of the plate member, and the second recess has a diameter equal to the diameter of the second side of the plate member. 13. The apparatus of claim 1, further comprising A transverse connecting member having a block portion having a first aperture for receiving an elongate member and an extension portion for receiving a screw to lock the elongate member within the block portion A second aperture, the extension having a first recess for receiving at least a portion of the first side of the plate member, a first recess for receiving at least a portion of the second side of the plate member two recesses and an aperture between said recesses of said transverse connecting member; a post member having a threaded portion and a flange portion, the post member extending through the space of the plate member and the hole of the extension portion of the transverse connecting member such that the flange portion is adjacent to all panel members; and A nut threadedly threaded onto the threaded portion of the post member such that the transverse connecting member is locked between the nut and the flange portion of the post member. 14. The apparatus of claim 1, further comprising: A transverse connecting member having a joint portion and at least one plate portion, the joint portion having a hole therethrough and a slot therethrough substantially perpendicular to the hole, the slot having a width sufficient to allow the plate member to pass through Through the slot, the plate portion has at least one hole therethrough adapted to receive a bone screw therethrough; and A screw threaded into the hole of the joint part and abuts against the plate member so that the joint part and the plate member can be locked together. 15. The apparatus of claim 14, wherein the joining portion is angled relative to the plate portion. 16. The apparatus of claim 1, further comprising: A transverse connecting member having a joint portion and at least one plate portion, the joint portion having a hole therethrough and a slot therethrough substantially perpendicular to the hole, the slot having a width sufficient to allow the plate member to pass through through the slot, the plate portion has at least one hole therethrough adapted to receive a bone screw therethrough; a post member having a threaded portion and a flange portion extending through the space of the plate member and the hole of the joint portion of the transverse connecting member such that the flange portion is adjacent to all panel members; and A nut threadedly threaded onto the threaded portion of the post member such that the transverse connecting member is locked between the nut and the flange portion of the post member. 17. A device comprising: A plate member having straight first and second sides and curved first and second ends, the first side being connected to the ends and the second side being connected to the ends, the first The first and second sides are substantially cylindrical throughout their length, and said sides and said ends define an enclosed space. 18. The apparatus of claim 17, further comprising: a clamp adjacent to the plate member, the clamp having a first recess for receiving at least a portion of the first side of the plate member, for receiving at least a portion of the second side of the plate member The second recess and the opening for receiving at least a portion of the bone fixation member. 19. The apparatus of claim 18, wherein the clamp includes a yoke member connected to the plate member and a crown member slidably located at least partially within the yoke member. 20. The apparatus of claim 18, wherein the clamp comprises a U-shaped member having a base portion, a first leg defining at least part of the first recess together with the base portion, and a base portion together with the base portion. The base portions together define at least part of a second leg of the second recess. 21. The apparatus of claim 17, further comprising: a transverse connecting member connected to the plate member, the transverse connecting member has a block portion and an extension portion, the block portion has a first aperture for receiving an elongated member and for receiving a screw to attach the an elongate member locks into a second aperture in the block portion, the extension portion has first and second recesses, the first recess has at least one of the first recesses contacting the first side of the plate member A portion of the wall, and the second recess has a wall contacting at least a portion of the second side of the plate member. 22. The apparatus of claim 21, wherein the recess faces generally away from the block portion. 23. The apparatus of claim 21, further comprising: a post member having a threaded portion and a flange portion, the post member extending through the space of the plate member and the extension portion such that the flange portion is adjacent to the plate member; and A nut threadedly threaded onto the threaded portion of the post member such that the transverse connecting member is locked between the nut and the flange portion of the post member. 24. The apparatus of claim 17, further comprising: A transverse connecting member having a joint portion and at least one plate portion, the joint portion having a hole therethrough and a slot therethrough substantially perpendicular to the hole, the slot having a width sufficient to allow the plate member to pass through Through the slot, the plate portion has at least one hole therethrough adapted to receive a bone screw therethrough. 25. Apparatus according to claim 24, further comprising means for locking the joining portion of the transverse connecting member to the plate member.

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