A system for fastening soft tissue to bone includes a bone screw having a threaded shaft and a screw head having an underside with malleable protuberances that project toward a distal end of the threaded shaft. A fixation plate is coupled with the threaded shaft. The fixation plate has a proximal face that opposes the underside of the screw head, a distal face that faces away from the underside of the screw head, an outer peripheral edge that extends between the proximal and distal faces, a central opening for receiving the threaded shaft, and protrusions spaced from one another around the outer peripheral edge that extend distally beyond the distal face of the fixation plate. The system includes an insertion tool having a handle and a tubular shaft extending distally from the handle. The tubular shaft has a proximal shaft section having an inner diameter that closely matches an outer diameter of the screw head, and a distal shaft section having an inner surface with a groove that seats the outer peripheral edge of the fixation plate for releasable retaining the fixation plate within the distal shaft section.

This invention relates to a system and a method for affixing soft tissue to bones. The system for fixing soft tissue within a bone tunnel comprising a first fixation member having a proximal end and a distal end and a bore extending from said proximal end to said distal end, said first fixation member is adapted for insertion against a first portion of a soft tissue positioned within a bone tunnel, a second portion of said soft tissue emerging from said bone tunnel; a second fixation member adapted to engage said bore of said first fixation member, having means for restraining disengagement therewith and a proximal end; and a third fixation member adapted to engage said second portion of said soft tissue, having means for coupling onto said proximal end of said second fixation member and restraining disengagement therewith.

Syndesmotic fixation devices, systems, instruments, and methods thereof. An implant for stabilizing an ankle joint between a tibia and a fibula may include first and second anchors secured to the tibia and a suture configured to wrap around the fibula. The suture may be tensioned to provide a circumferential force around the fibula to stabilize the joint.

An apparatus configured to attach a first vertebral body and a second vertebral body is disclosed. The apparatus includes a fastener including an anchor and a polyaxial head rotatably attached to the anchor, the anchor configured to be fastened to the first vertebral body, and an anchor assembly configured to be received in an aperture of the second vertebral body. The anchor assembly is configured to be received in a head aperture of the polyaxial head. The polyaxial head has three rotational degrees of freedom relative to the anchor based on the rotatable attachment of the polyaxial head to the anchor.

A resilient washer has a one-piece washer body. The washer body has a central opening, an upper fastener interfacing section or bowl, a lower structure interfacing section or bowl and a resilient middle portion. The resilient middle portion connects the upper fastener interfacing section or bowl and the lower structure interfacing section or bowl. The resilient middle portion is configured to be locally collapsed when a fastener in the central opening is tightened into a structure. In one embodiment, the upper fastener interfacing section or bowl is annular, wherein the upper fastener interfacing section or bowl has a concavity for holding a head of the fastener. The concavity can be of a hemispherical shape. Preferably, the concavity has a smooth surface to allow polyaxial movement of a fastener.

A surgical instrument includes a first member defining a longitudinal axis and including a drive interface engageable with a first surface of a bone fastener. The first surface is configured for penetrating a sacrum. A second member includes a drive interface engageable with a second surface of the bone fastener to translate the second surface relative to the first surface such that the second surface engages an outer non-articular surface of an ilium to draw separated articular surfaces of the sacrum and the ilium into fixation. In some embodiments, systems and methods are disclosed. Systems and methods are disclosed.

An insert for receipt within a plate aperture having an inner wall along the plate aperture includes a body and collar. The body has inner and outer surfaces. The inner surface defines an insert aperture having a longitudinal axis. The collar extends from the outer surface in a first radial direction perpendicular to the longitudinal axis and extends along only a portion of the outer surface in a second radial direction transverse to the first radial direction and the longitudinal axis. The collar defines a first radial distance from the longitudinal axis at a first position of the collar and a second radial distance from the longitudinal axis at a second position of the collar that differs from the first radial distance. A fixation system includes the plate and insert which is receivable within the plate aperture such that the collar contacts and is slideable along the inner wall.

Devices, systems and methods for the treatment of spinal instability and/or stenosis of the spinal canal and neural foramina. In one embodiment, a functional spinal unit (FSU) of a subject is approached through a lateral or antero-lateral corridor, and both an anterior and posterior column of the FSU are manipulated, implanted and/or otherwise surgically treated through the same intra-abdominal surgical corridor. A method is disclosed to reach the posterior aspect of the FSU, wherein the intra-abdominal surgical corridor is extended posterior to the psoas major muscle and through the thoraco-lumbar fascia in order to reach the transverse process and/or facet joint. Multiple trajectories for bone screw fixation of the vertebral bone are additionally disclosed. In another embodiment, the FSU is approached through the above corridor and a second posterior skin incision and corridor. The combination of the corridors provided circumferential access to the FSU.

A polyaxial bone screw for attaching a rod to a vertebra comprises a fastener having a threaded shank and a head. A yoke has a rod receiving channel for receiving the rod. A screw support rotatably attached to the yoke has a cavity articulatingly and rotatably supporting the fastener head, a hole receiving the threaded fastener shank therethrough, and a plurality of slots for maximum screw angulation. A crown has an upper rod receiving surface, a lower surface in contact with the fastener head and a projecting surface in contact with the yoke. A biasing element between the screw support and the yoke applies biasing forces among the fastener, the crown, and the yoke to provide sufficient friction to retain the yoke in a manipulable position relative to the fastener. A set screw is supported by the yoke overcome the bias and to rigidly secure the components.

An implant for fusing a joint between first and second bone portions. The implant includes a screw member, and a washer polyaxially rotatable relative to the screw member. The screw member includes a head, a lag zone, and a threaded engagement zone. The implant includes a fusion zone for joint compression, extending from the washer to the proximal end of the engagement zone. Fenestrations may be present in the fusion zone. The length of the fusion zone ranges from about 10 mm to about 37 mm. Different surface finishes including roughened and non-roughened may be applied selectively to selected portions of the implant. In an embodiment, the joint is a sacro-iliac joint, and upon implantation the implant extends from the exterior of the ilium, across the joint and into the sacral vertebral body. Instrumentation and methods for preparing the joint and implanting the implant are disclosed.