# US 8,771,272 B2 · Easily implantable and stable nail-fastener for skeletal fixation and method > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 8,771,272 B2 - Document ID: US8771272B2 - Status: Granted - Kind: B2 - Application number: 13/625,595 - Filed: 2012-09-24 - Published: 2013-01-31 - Granted: 2014-07-08 - Earliest claimed: 2010-06-18 - Assignees: Kettering University - Applicants: David LeCronier; Patrick Atkinson - Inventors: David LeCronier; Patrick Atkinson - Web page: https://patentgrep.com/patent/US8771272B2 ## CPC - A61B 17/725: {with locking pins or screws of special form} - A61B 17/686: {Plugs, i.e. elements forming interface between bone hole and implant or fastener, e.g. screw} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract An intramedullary nail (20) defining a bore (34) is inserted into a medullary canal (26) of a bone (24). A threaded fastener (22) has a compression portion (48) presenting a compression portion diameter (DCP) and a threaded portion (50) presenting a threaded portion diameter (DTP). The fastener (22) extends through a near cortex hole (40) and/or a far cortex hole (42), and the threaded portion (22) threadedly engages the bore (34). A compression transmission device (54) is disposed between a head (44) of the fastener (22) and the intramedullary nail (20) for transmitting the compressional load of the threaded fastener (22) to the intramedullary nail (20). An interior space of the compression transmission device (54) is greater than the compression portion diameter (DCP) providing space about the threaded fastener (22) for allowing the fastener axis (A) to be variously disposed relative to the interior space. ## Claims ### Claim 1 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a near cortex hole (40), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a threaded fastener (22) including a head (44) and an end (46) with a threaded portion (50) extending along a fastener axis (A) therebetween for threadedly engaging said bore (34) of said intramedullary nail (20), said threaded fastener (22) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said threaded portion (50) and said head (44) for extending through the near cortex hole (40) of the bone (24), a compression transmission device (54) extending longitudinally along said fastener axis (A) from a device top end (60) to a device bottom end (62), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said interior (58) extending continuously from said device top end (60) to said device bottom end (62) and continuously around said fastener axis (A) and said compression portion (48) of said threaded fastener (22), said compression transmission device (54) being disposed between said head (44) of said threaded fastener (22) and said intramedullary nail (20), and said interior space being greater than said compression portion diameter (DCP) of said fastener (22) for providing space at least partially about said threaded fastener (22) for allowing said fastener axis (A) to be variously disposed relative to said interior space. ### Claim 2 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a near cortex hole (40), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a threaded fastener (22) including a head (44) and an end (46) with a threaded portion (50) extending along a fastener axis (A) therebetween for threadedly engaging said bore (34) of said intramedullary nail (20), said threaded fastener (22) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said threaded portion (50) and said head (44) for extending through the near cortex hole (40) of the bone (24), a compression transmission device (54) surrounding said compression portion (48) of said threaded fastener (22), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said compression transmission device (54) being disposed between said head (44) of said threaded fastener (22) and said intramedullary nail (20), said interior space being greater than said compression portion diameter (DCP) of said fastener (22) for providing space at least partially about said threaded fastener (22) for allowing said fastener axis (A) to be variously disposed relative to said interior space, and wherein the near cortex hole (40) has a near cortex hole diameter (DNC), said exterior (56) of said compression transmission device (54) has an exterior diameter (DE), and said exterior diameter (DE) is equal to the near cortex hole diameter (DNC) such that said exterior (56) of said compression transmission device (54) engages the cortex (28) along the near cortex hole (40). ### Claim 3 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a near cortex hole (40), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a threaded fastener (22) including a head (44) and an end (46) with a threaded portion (50) extending along a fastener axis (A) therebetween for threadedly engaging said bore (34) of said intramedullary nail (20), said threaded fastener (22) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said threaded portion (50) and said head (44) for extending through the near cortex hole (40) of the bone (24), a compression transmission device (54) surrounding said compression portion (48) of said threaded fastener (22), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said compression transmission device (54) being disposed between said head (44) of said threaded fastener (22) and said intramedullary nail (20), said interior space being greater than said compression portion diameter (DCP) of said fastener (22) for providing space at least partially about said threaded fastener (22) for allowing said fastener axis (A) to be variously disposed relative to said interior space, and wherein the near cortex hole (40) has a near cortex hole diameter (DNC), said exterior (56) of said compression transmission device (54) has an exterior diameter (DE), and said exterior diameter (DE) is less than the near cortex hole diameter (DNC) such that said compression transmission device (54) and the cortex (28) provide a space therebetween. ### Claim 4 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a near cortex hole (40), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a threaded fastener (22) including a head (44) and an end (46) with a threaded portion (50) extending along a fastener axis (A) therebetween for threadedly engaging said bore (34) of said intramedullary nail (20), said threaded fastener (22) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said threaded portion (50) and said head (44) for extending through the near cortex hole (40) of the bone (24), a compression transmission device (54) surrounding said compression portion (48) of said threaded fastener (22), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said compression transmission device (54) being disposed between said head (44) of said threaded fastener (22) and said intramedullary nail (20), said interior space being greater than said compression portion diameter (DCP) of said fastener (22) for providing space at least partially about said threaded fastener (22) for allowing said fastener axis (A) to be variously disposed relative to said interior space, and wherein the cortex (28) includes a far cortex hole (42) having a far cortex hole diameter (DFC), said threaded portion (50) of said threaded fastener (22) extends into the far cortex hole (42), said threaded portion (50) has a threaded portion diameter (DTP), and said threaded portion diameter (DTP) along the far cortex hole (42) is less than the far cortex hole diameter (DFC) such that said threaded fastener (22) and the cortex (28) provide a space therebetween. ### Claim 5 (depends on 4) An apparatus as set forth in claim 4 wherein said threaded portion diameter (DTP) of said threaded fastener (22) along said bore (34) of said intramedullary nail (20) is greater than said threaded portion diameter (DTP) along the far cortex hole (42). ### Claim 6 (depends on 1) An apparatus as set forth in claim 1 wherein the cortex (28) includes a far cortex hole (42) and said threaded portion (50) of said threaded fastener (22) threadedly engages the cortex (28) along the far cortex hole (42). ### Claim 7 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a near cortex hole (40), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a threaded fastener (22) including a head (44) and an end (46) with a threaded portion (50) extending along a fastener axis (A) therebetween for threadedly engaging said bore (34) of said intramedullary nail (20), said threaded fastener (22) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said threaded portion (50) and said head (44) for extending through the near cortex hole (40) of the bone (24), a compression transmission device (54) surrounding said compression portion (48) of said threaded fastener (22), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said compression transmission device (54) being disposed between said head (44) of said threaded fastener (22) and said intramedullary nail (20), said interior space being greater than said compression portion diameter (DCP) of said fastener (22) for providing space at least partially about said threaded fastener (22) for allowing said fastener axis (A) to be variously disposed relative to said interior space, and wherein said compression transmission device (54) extends from a device top end (60) to a device bottom end (62), said device top end (60) engages said head (44) of said fastener (22), and said device bottom end (62) engages said intramedullary nail (20). ### Claim 8 (depends on 7) An apparatus as set forth in claim 7 wherein said intramedullary nail (20) has an exterior surface extending longitudinally along a center nail axis (An), said exterior surface presents a counterbore surface (64) extending perpendicular to said center nail axis (An) and to a base surface (66), said base surface (66) extends parallel to said center nail axis (An) and presents a base diameter (Db) surrounding said bore (34), said bore (34) presents a bore diameter (DBR), said base diameter (Db) is greater than said bore diameter (DBR), and said device bottom end (62) of said compression transmission device (54) engages said base surface (66). ### Claim 9 (depends on 8) An apparatus as set forth in claim 8 wherein said base surface (66) is convex and said device bottom end (62) of said compression transmission device (54) engages said base surface (66). ### Claim 10 (depends on 8) An apparatus as set forth in claim 8 wherein a washer (72) presenting a convex surface is disposed on said base surface (66) said device bottom end (62) of said compression transmission device (54) engages said convex surface of said washer (72). ### Claim 11 (depends on 7) An apparatus as set forth in claim 7 wherein said intramedullary nail (20) has an exterior surface extending longitudinally along a center nail axis (An), said exterior surface presents a countersink surface (68) extending at an angle relative to said center nail axis (An) and to said bore (34), said countersink surface (68) has a countersink diameter (Dc), said bore (34) presents a bore diameter (DBR), said countersink diameter (Dc) is greater than said bore diameter (DBR), and said device bottom end (62) of said compression transmission device (54) contacts said countersink surface (68). ### Claim 12 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a near cortex hole (40), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a threaded fastener (22) including a head (44) and an end (46) with a threaded portion (50) extending along a fastener axis (A) therebetween for threadedly engaging said bore (34) of said intramedullary nail (20), said threaded fastener (22) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said threaded portion (50) and said head (44) for extending through the near cortex hole (40) of the bone (24), a compression transmission device (54) surrounding said compression portion (48) of said threaded fastener (22), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said compression transmission device (54) being disposed between said head (44) of said threaded fastener (22) and said intramedullary nail (20), said interior space being greater than said compression portion diameter (DCP) of said fastener (22) for providing space at least partially about said threaded fastener (22) for allowing said fastener axis (A) to be variously disposed relative to said interior space, and wherein said bore (34) of said intramedullary nail (20) is threaded and has a bore axis (Ab) extending between a near opening (36) and a far opening (38) transverse to said intramedullary nail (20) and presents a bore diameter (DBR), said bore diameter (DBR) includes a central bore diameter (DCBR) disposed centrally between said near opening (36) and said far opening (38) of said bore (34), and said bore diameter (DBR) increases from said central bore diameter (DCBR) to said near opening (36) and from said central bore diameter (DCBR) to said far opening (38) for allowing said fastener axis (A) to be skewed relative to said bore axis (Ab) while remaining threadedly engaged. ### Claim 13 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a near cortex hole (40), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a threaded fastener (22) including a head (44) and an end (46) with a threaded portion (50) extending along a fastener axis (A) therebetween for threadedly engaging said bore (34) of said intramedullary nail (20), said threaded fastener (22) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said threaded portion (50) and said head (44) for extending through the near cortex hole (40) of the bone (24), a compression transmission device (54) surrounding said compression portion (48) of said threaded fastener (22), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said compression transmission device (54) being disposed between said head (44) of said threaded fastener (22) and said intramedullary nail (20), said interior space being greater than said compression portion diameter (DCP) of said fastener (22) for providing space at least partially about said threaded fastener (22) for allowing said fastener axis (A) to be variously disposed relative to said interior space, and wherein said bore (34) of said intramedullary nail (20) is threaded and has a bore axis (Ab) extending between a near opening (36) and a far opening (38) transverse to said intramedullary nail (20) and presents a bore diameter (DBR), and said bore diameter (DBR) is consistent from said near opening (36) to said far opening (38). ### Claim 14 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a far cortex hole (42), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a threaded fastener (22) including a head (44) and an end (46) with a threaded portion (50) extending along a fastener axis (A) therebetween for extending through said bore (34) of said intramedullary nail (20) and threadedly engaging the cortex (28) along the far cortex hole (42), said threaded fastener (22) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said threaded portion (50) and said head (44), a compression transmission device (54) extending longitudinally along said fastener axis (A) from a from a device top end (60) to a device bottom end (62), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said interior (58) extending continuously from said device top end (60) to said device bottom end (62) and continuously around said fastener axis (A) and said compression portion (48) of said threaded fastener (22), said compression transmission device (54) being disposed between said head (44) of said threaded fastener (22) and said intramedullary nail (20), and said interior space being greater than said compression portion diameter (DCP) of said fastener (22) for providing space at least partially about said threaded fastener (22) for allowing said fastener axis (A) to be variously disposed relative to said interior space. ### Claim 15 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a near cortex hole (40), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a fastener (23) including a head (44) and an end (46) with a first portion (51) extending along a fastener axis (A) therebetween for frictionally engaging said bore (34) of said intramedullary nail (20), said fastener (23) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said first portion (51) and said head (44) for extending through the near cortex hole (40) of the bone (24), a compression transmission device (54) extending longitudinally along said fastener axis (A) from a from a device top end (60) to a device bottom end (62), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said interior (58) extending continuously from said device top end (60) to said device bottom end (62) and continuously around said fastener axis (A) and said compression portion (48) of said fastener (23), said compression transmission device (54) being disposed between said head (44) of said fastener (23) and said intramedullary nail (20), and said interior space being greater than said compression portion diameter (DCP) of said fastener (23) for providing space at least partially about said fastener (23) for allowing said fastener axis (A) to be variously disposed relative to said interior space. ### Claim 16 A nail-fastener apparatus for implantation into the medullary canal (26) surrounded by the cortex (28) of a bone (24) including a far cortex hole (42), comprising: an intramedullary nail (20) extending between a top end (30) and a bottom end (32) and defining a bore (34) for insertion into the medullary canal (26), a fastener (23) including a head (44) and an end (46) with a first portion (51) extending along a fastener axis (A) therebetween for extending through said bore (34) of said intramedullary nail (20) and frictionally engaging the cortex (28) along the far cortex hole (42), said fastener (23) including a compression portion (48) presenting a compression portion diameter (DCP) and extending along said fastener axis (A) between said first portion (51) and said head (44), a compression transmission device (54) extending longitudinally along said fastener axis (A) from a from a device top end (60) to a device bottom end (62), said compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, said interior (58) extending continuously from said device top end (60) to said device bottom end (62) and continuously around said fastener axis (A) and said compression portion (48) of said fastener (23), said compression transmission device (54) being disposed between said head (44) of said fastener (23) and said intramedullary nail (20), and said interior space being greater than said compression portion diameter (DCP) of said fastener (23) for providing space at least partially about said fastener (23) for allowing said fastener axis (A) to be variously disposed relative to said interior space. ### Claim 17 A method for implanting an intramedullary nail (20) into the medullary canal (26) surrounded by the cortex (28) of the bone (24) comprising the steps of: providing a bore (34) in the intramedullary nail (20) including threads, forming a near cortex hole (40) in the cortex (28), providing a threaded fastener (22) including a head (44) and an end (46) with a compression portion (48) presenting a compression portion diameter (DCP) and a threaded portion (50) extending along a fastener axis (A) between the head (44) and the end (46), providing a compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, disposing the compression transmission device (54) in the near cortex hole (40) and contacting the intramedullary nail (20) with the compression transmission device (54), extending the threaded fastener (22) through the compression transmission device (54), threadedly engaging the threaded portion (50) of the threaded fastener (22) to the intramedullary nail (20) along the bore (34), and providing the compression transmission device (54) with the interior space being greater than the compression portion diameter (DCP) of the threaded fastener (22) for providing space at least partially about the threaded fastener (22) for allowing the fastener axis (A) to be variously disposed relative the interior space. ### Claim 18 (depends on 17) A method as set forth in claim 17 including engaging the head (44) of the threaded fastener (22) and the compression transmission device (54). ### Claim 19 (depends on 17) A method as set forth in claim 17 wherein the near cortex hole (40) has a near cortex hole diameter (DNC), the exterior (56) of the compression transmission device (54) presents an exterior diameter (DE), and including the step of providing the exterior diameter (DE) equal to the near cortex hole diameter (DNC) such that the exterior (56) of the compression transmission device (54) engages the cortex (28) along the near cortex hole (40). ### Claim 20 (depends on 17) A method as set forth in claim 17 wherein the near cortex hole (40) presents a near cortex hole diameter (DNC), the exterior (56) of the compression transmission device (54) presents an exterior diameter (DE), and including the step of providing the exterior diameter (DE) to be less than the near cortex hole diameter (DNC) such that the exterior (56) of the compression transmission device (54) and the cortex (28) define a space therebetween. ### Claim 21 (depends on 17) A method as set forth in claim 17 wherein the threaded portion (50) presents a threaded portion diameter (DTP), and including the steps of forming a far cortex hole (42) in the cortex (28) presenting a far cortex hole diameter (DFC) being greater than the threaded portion diameter (DTP), extending the threaded portion (50) of the fastener (22) into the far cortex hole (42) such that the threaded fastener (22) and the cortex (28) define a space therebetween along the far cortex hole (42). ### Claim 22 (depends on 21) A method as set forth in claim 21 including the step of providing the threaded portion diameter (DTP) of the threaded fastener (22) along the bore (34) of the intramedullary nail (20) to be greater than the threaded portion diameter (DTP) along the far cortex hole (42). ### Claim 23 (depends on 17) A method as set forth in claim 17 including the steps of forming a far cortex hole (42) in the cortex (28) and threadedly engaging the threaded portion (50) of the threaded fastener (22) and the cortex (28) along the far cortex hole (42). ### Claim 24 (depends on 17) A method as set forth in claim 17 wherein the intramedullary nail (20) has an exterior surface extending longitudinally along a center nail axis (An), the bore (34) has a bore diameter (DBR), and including the steps of providing a counterbore surface (64) in the exterior surface of the intramedullary nail (20), the step of providing the counterbore surface (64) includes providing the counterbore surface (64) perpendicular to the center nail axis (An) to a base surface (66), providing the base surface (66) to extend parallel to the center nail axis (An) and present a base diameter (Db) surrounding the bore (34), providing the base diameter (Db) to be greater than the bore diameter (DBR), and wherein the step of contacting the intramedullary nail (20) with the compression transmission device (54) includes engaging the base surface (66). ### Claim 25 (depends on 17) A method as set forth in claim 17 wherein the intramedullary nail (20) has an exterior surface extending longitudinally along a center nail axis (An), the bore (34) has a bore diameter (DBR), and including the steps of providing a countersink surface (68) having a countersink diameter (Dc) in the exterior surface, the step of providing the countersink surface (68) includes providing the countersink surface (68) at an angle relative to the center nail axis (An) to the bore (34), providing the countersink diameter (Dc) to be greater than the bore diameter (DBR), and wherein the step of contacting the intramedullary nail (20) with the compression transmission device (54) includes engaging the countersink surface (68). ### Claim 26 (depends on 17) A method as set forth in claim 17 wherein the bore (34) includes a near opening (36) and a far opening (38), and including the steps of providing the bore (34) to include a bore diameter (DBR) at the near opening (36) and the far opening (38) and a central bore diameter (DCBR) between the openings (36, 38), and wherein the bore diameter (DBR) increases from the central bore diameter (DCBR) to the near opening (36) and from the central bore diameter (DCBR) to the far opening (38) for allowing the fastener axis (A) to be skewed relative to the bore axis (Ab) while remaining threadedly engaged. ### Claim 27 (depends on 17) A method as set forth in claim 17 wherein the bore (34) of the intramedullary nail (20) is threaded and has a bore axis (Ab) extending between a near opening (36) and a far opening (38) transverse to the intramedullary nail (20) and presents a bore diameter (DBR), and the bore diameter (DBR) is consistent from said near opening (36) to the far opening (38). ### Claim 28 A method for implanting an intramedullary nail (20) into the medullary canal (26) surrounded by the cortex (28) of the bone (24) comprising the steps of: providing a bore (34) in the intramedullary nail (20) including threads, forming a far cortex hole (42) in the cortex (28), providing a threaded fastener (22) including a head (44) and an end (46) with a compression portion (48) having a compression portion diameter (DCP) and a threaded portion (50) extending along a fastener axis (A) therebetween, providing a compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, contacting the intramedullary nail (20) with the compression transmission device (54), extending the threaded fastener (22) through the compression transmission device (54) and the bore (34) of the intramedullary nail (20), threadedly engaging the threaded portion (50) of the threaded fastener (22) to the cortex (28) along the far cortex hole (42), and providing the compression transmission device (54) with the interior space being greater than the compression portion diameter (DCP) of the threaded fastener (22) for providing space at least partially about the threaded fastener (22) for allowing the fastener axis (A) to be variously disposed relative the interior space. ### Claim 29 A method for implanting an intramedullary nail (20) into the medullary canal (26) surrounded by the cortex (28) of the bone (24) comprising the steps of: providing a bore (34) in the intramedullary nail (20) including threads, providing a threaded fastener (22) including a head (44) and an end (46) with a compression portion (48) presenting a compression portion diameter (DCP) and a threaded portion (50) presenting a threaded portion diameter (DTP) extending along a fastener axis (A), wherein the threaded portion (50) is disposed between the compression portion (48) and the end (46) and the compression portion diameter (DCP) is greater than the threaded portion diameter (DTP), forming a near cortex hole (40) in the cortex (28) having a near cortex hole diameter (DNC) being greater than the compression portion diameter (DCP), extending the threaded fastener (22) through the near cortex hole (40) and into the bore (34) until the compression portion (48) engages the intramedullary nail (20), and threadedly engaging the threaded portion (50) of the threaded fastener (22) to the intramedullary nail (20) along the bore (34). ### Claim 30 A method for implanting an intramedullary nail (20) into the medullary canal (26) surrounded by the cortex (28) of the bone (24) comprising the steps of: providing a bore (34) in the intramedullary nail (20), forming a near cortex hole (40) in the cortex (28), providing a fastener (23) including a head (44) and an end (46) with a compression portion (48) presenting a compression portion diameter (DCP) and a first portion (51) extending along a fastener axis (A) between the head (44) and the end (46), providing a compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, disposing the compression transmission device (54) in the near cortex hole (40) and contacting the intramedullary nail (20) with the compression transmission device (54), extending the fastener (23) through the compression transmission device (54), frictionally engaging the first portion (51) of the fastener (23) to the intramedullary nail (20) along the bore (34), and providing the compression transmission device (54) with the interior space being greater than the compression portion diameter (DCP) of the fastener (23) for providing space at least partially about the fastener (23) for allowing the fastener axis (A) to be variously disposed relative the interior space. ### Claim 31 A method for implanting an intramedullary nail (20) into the medullary canal (26) surrounded by the cortex (28) of the bone (24) comprising the steps of: providing a bore (34) in the intramedullary nail (20), forming a far cortex hole (42) in the cortex (28), providing a fastener (23) including a head (44) and an end (46) with a compression portion (48) having a compression portion diameter (DCP) and a first portion (51) extending along a fastener axis (A) therebetween, providing a compression transmission device (54) having an exterior (56) and an interior (58) defining an interior space, contacting the intramedullary nail (20) with the compression transmission device (54), extending the fastener (23) through the compression transmission device (54) and the bore (34) of the intramedullary nail (20), frictionally engaging the first portion (51) of the fastener (23) to the cortex (28) along the far cortex hole (42), and providing the compression transmission device (54) with the interior space being greater than the compression portion diameter (DCP) of the fastener (23) for providing space at least partially about the fastener (23) for allowing the fastener axis (A) to be variously disposed relative the interior space.