Orthopaedic fixation devices, systems and methods

1. A ratchet fastener, comprising:

a base including a fastening portion including threads and a ratchet portion including teeth that at least partially surround a boss; and

a ratchet wheel including a central aperture that receives the boss to couple the ratchet wheel to the base in mating arrangement with the teeth, the ratchet fastener configured to receive a tether, the ratchet wheel rotatable relative to the ratchet portion of the base for tightening the tether,

wherein the boss includes a protrusion proximal to a top edge of the boss extending radially outward from a center of the boss, wherein the central aperture includes a ledge extending substantially circumferentially around the central aperture and extending radially inward toward a center of the central aperture, wherein a cut-out in the ledge is configured to allow the protrusion to pass through the central aperture when the cut-out and the protrusion are aligned, and wherein the protrusion extends over the ledge when the boss is received in the central aperture and the cut-out and the protrusion are misaligned.

2. The ratchet fastener of claim 1 , wherein the boss includes a fastener aperture therein that extends through the boss.

3. The ratchet fastener of claim 2 , wherein the fastener aperture of the boss and the central aperture in the ratchet wheel are aligned concentrically when the ratchet wheel is coupled to the base in mating arrangement with the teeth.

4. The ratchet fastener of claim 3 , in combination with a bone screw, wherein the bone screw includes a threaded exterior portion, and wherein the fastener aperture of the boss is interiorly threaded for mating with the threaded exterior portion of the bone screw.

5. The ratchet fastener of claim 1 , wherein the ratchet wheel includes a pawl configured to engage the teeth and allow the ratchet wheel to rotate in a first direction while preventing rotation in an opposite direction.

6. The ratchet fastener of claim 1 , wherein the boss projects from a central portion of a ratchet recess in which the ratchet wheel is received, the teeth positioned along an interior-facing sidewall of the ratchet recess.

7. The ratchet fastener of claim 1 , wherein the ratchet wheel includes an open tether slot in an outer surface of the ratchet wheel, the tether receivable in the open tether slot when tightening the tether.

8. The ratchet fastener of claim 1 , wherein the base includes an open tether channel in an outer surface of the base, the tether receivable in the open tether channel when tightening the tether.

9. A ratchet fastener, comprising:

a base including a fastening portion including threads and a ratchet recess including teeth,

the ratchet recess including an interior-facing sidewall from which the teeth extend radially inward toward a center of the ratchet recess; and

a ratchet wheel disposed in the ratchet recess in mating arrangement with the teeth, the ratchet fastener configured to receive a tether, the ratchet wheel rotatable relative to the ratchet portion of the base for tightening the tether,

wherein the ratchet recess includes a boss projecting from a central portion of the ratchet recess, the boss receivable in the ratchet wheel when the ratchet wheel is disposed in the ratchet recess in mating arrangement with the teeth,

wherein the boss includes a protrusion proximal to a top edge of the boss extending radially outward from a center of the boss, wherein the central aperture includes a ledge extending substantially circumferentially around the central aperture and extending radially inward toward a center of the central aperture, wherein a cut-out in the ledge is configured to allow the protrusion to pass through the central aperture when the cut-out and the protrusion are aligned, and wherein the protrusion extends over the ledge when the ratchet wheel is disposed in the ratchet recess and the cut-out and the protrusion are misaligned.

10. The ratchet fastener of claim 9 , wherein the boss includes a fastener aperture therein that extends through the boss.

11. The ratchet fastener of claim 10 , wherein the fastener aperture of the boss and a central aperture in the ratchet wheel are aligned concentrically when the ratchet wheel is disposed in the ratchet recess in mating arrangement with the teeth.

12. The ratchet fastener of claim 11 , wherein the fastener aperture of the boss includes a threaded interior portion.

13. The ratchet fastener of claim 12 in combination with a bone screw that includes a threaded exterior portion for mating with the threaded interior portion of the fastener aperture of the boss.

14. The ratchet fastener of claim 9 , wherein the ratchet wheel includes a pawl configured to engage the teeth and allow the ratchet wheel to rotate in a first direction while preventing rotation in an opposite direction.

15. The ratchet fastener of claim 9 , wherein the ratchet wheel includes an open tether slot in an outer surface of the ratchet wheel, the tether receivable in the open tether slot when tightening the tether.

16. The ratchet fastener of claim 9 , wherein the base includes an open tether channel in an outer surface of the base, the tether receivable in the open tether channel when tightening the tether.