U.S. patent application number 12/101571 was filed with the patent office on 2009-10-15 for apparatus and methods of fixating bone.
This patent application is currently assigned to Biomet Microfixation, Inc.. Invention is credited to Robert Travis McKee, Shawn David Roman, Shon David Steger, Bradley James Winterroth.
Application Number | 20090259263 12/101571 |
Document ID | / |
Family ID | 41059789 |
Filed Date | 2009-10-15 |
United States Patent
Application |
20090259263 |
Kind Code |
A1 |
Steger; Shon David ; et
al. |
October 15, 2009 |
APPARATUS AND METHODS OF FIXATING BONE
Abstract
Apparatus and methods of fixating bone include repairing or
remodeling a hard tissue defect with a composite bone structure.
The composite bone structure includes at least two hard tissues or
bones and a scaffold material fixed together by an adhesive
component. The apparatus and methods include positioning the hard
tissues/bones, conforming the scaffold material to at least a
portion of a surface of the hard tissues/bones, contacting the
adhesive component with the hard tissues/bones and the scaffold
material, and changing the material state of the adhesive component
to another material state at which the adhesive component fixes
together the hard tissues/bones and the scaffold material, thereby
forming a composite bone structure having a desired rigidity.
Inventors: |
Steger; Shon David; (Warsaw,
IN) ; McKee; Robert Travis; (Jacksonville, FL)
; Roman; Shawn David; (Orange Park, FL) ;
Winterroth; Bradley James; (Jacksonville, FL) |
Correspondence
Address: |
ARENT FOX LLP
1050 CONNECTICUT AVENUE, N.W., SUITE 400
WASHINGTON
DC
20036
US
|
Assignee: |
Biomet Microfixation, Inc.
Jacksonville
FL
|
Family ID: |
41059789 |
Appl. No.: |
12/101571 |
Filed: |
April 11, 2008 |
Current U.S.
Class: |
606/86R ;
606/151; 623/23.62 |
Current CPC
Class: |
A61F 2220/005 20130101;
A61B 2017/00951 20130101; A61F 2/2846 20130101; A61B 2017/00004
20130101; A61B 17/688 20130101; A61F 2002/30448 20130101; A61F
2/2875 20130101 |
Class at
Publication: |
606/86.R ;
606/151; 623/23.62 |
International
Class: |
A61F 5/00 20060101
A61F005/00; A61B 17/08 20060101 A61B017/08; A61F 2/28 20060101
A61F002/28 |
Claims
1. A method of fixating bone, comprising: connecting at least two
bones and a scaffold material with an adhesive component such that
the adhesive component is in contact with at least a portion of a
surface of each of the bones and the scaffold material; and
fixating the bones and the scaffold material to define a desired
structure having a desired rigidity based on changing a material
state of the adhesive component.
2. The method of claim 1, wherein the fixating further comprises
changing the material state of the adhesive component so that the
desired rigidity substantially corresponds to a rigidity of the
bones.
3. The method of claim 1, wherein the adhesive component comprises
a synthetic polymer, and wherein the fixating further comprises
exposing the adhesive component to a radiation-based initiator or a
chemical-based initiator operable to change the adhesive component
to a cured state.
4. The method of claim 1, wherein the adhesive component comprises
a synthetic polymer, and wherein the fixating further comprises
polymerizing the adhesive component to a partial polymerization
state, repositioning at least one of the bones while connected to
the adhesive component in the partial polymerization state, and
allowing or actively promoting further polymerizing of the adhesive
component from the partial polymerization state to a substantially
full polymerization state to fixate the repositioned bones and the
scaffold material.
5. The method of claim 4, wherein changing the adhesive component
to the substantially full polymerization state further comprises
exposing the adhesive component to an ambient radiation source not
directed primarily on the adhesive component or the scaffold
material.
6. The method of claim 1, wherein changing the material state of
the adhesive component further comprises changing the adhesive
component from a first perceived color to a second perceived color,
wherein the second perceived color is perceptively different from
the first perceived color.
7. The method of claim 1, wherein the scaffold material comprises a
first biocompatible material and the adhesive component comprises a
second biocompatible material, wherein the first biocompatible
material and the second biocompatible material have substantially
similar rates of resorption.
8. The method of claim 1, wherein the scaffold material and the
adhesive component both comprise substantially the same
biocompatible material.
9. The method of claim 1, wherein the adhesive component comprises
at least one material selected from the group comprising:
urethane-based, resorbable synthetic polymer and isocyanate-based,
resorbable synthetic polymer.
10. The method of claim 1, in which the bones are obtained from at
least one location selected from the group comprising: a cranial
skeleton location and a maxillofacial skeleton location.
11. The method of claim 1, further comprising adding an effective
amount of the adhesive component to the scaffold material.
12. The method of claim 1, further comprising holding the bones in
a desired relative orientation, conforming the scaffold material to
at least a portion of the surface of each of the bones while
positioned in the desired relative orientation, and changing the
material state of the adhesive component after the conforming and
while the bones are positioned in the desired relative
orientation.
13. The method of claim 12, wherein the holding further comprises
holding against a surface of a mold.
14. The method of claim 12, wherein the conforming further
comprises changing a material state of the scaffold material.
15. The method of claim 1, further comprising: accessing the bones
at a location within a body; removing the bones from the body;
holding the bones in a desired relative orientation outside of the
body; conforming the scaffold material to at least a portion of a
surface of each of the bones while positioned in the desired
relative orientation outside of the body; changing the material
state of the adhesive component after the conforming and while the
bones are positioned in the desired relative orientation outside of
the body; and securing the fixated bones and scaffold material to
at least a portion of a skeletal bone at the location within the
body.
16. The method of claim 1, further comprising performing a surface
preparation on at least a portion of the surface of each of the
bones, wherein the surface preparation improves an ability of the
adhesive component to attach to the respective portion of the
surface.
17. The method of claim 16, wherein performing the surface
preparation further comprises roughening the portion of the surface
of each of the bones, and wherein connecting further comprises
placing the scaffold material such that the adhesive component
contacts the respective roughened surfaces.
18. The method of claim 16, wherein performing the surface
preparation further comprises removing at least a portion of
periosteum from at least the portion of the surface of each of the
bones prior to the connecting with the scaffold material.
19. The method of claim 18, further comprising replacing the
portion of the periosteum over the scaffold material at each
portion of the surface of the bones after connecting the bones with
the scaffold material.
20. The method of claim 1, further comprising adding a bone void
filler between at least a portion of the bones.
21. The method of claim 1, further comprising adding a bone
growth-promoting material in contact with the bones.
22. A method of craniomaxillofacial surgery, comprising: accessing
at least two bones at least partially defining a hard tissue defect
at a location within a body, wherein the location comprises a
cranial location or a maxillofacial location; positioning the bones
into a desired relative orientation; conforming a scaffold material
to at least a portion of a surface of each of the bones; contacting
an adhesive component between at least a portion of each of the
bones and the scaffold material; and fixating the bones and the
scaffold material in the desired relative orientation to remodel
the hard tissue defect, wherein the fixating is based on changing
the adhesive component to a material state at which the adhesive
component fastens together the bones and the scaffold material with
a desired rigidity.
23. A composite bone structure, comprising: a first bone having a
first surface; at least one other bone, wherein each other bone
comprises a respective second surface; a scaffold material
positioned to connect the first bone and the at least one other
bone, wherein the scaffold material is adaptable to conform to the
first surface and each respective second surface; and an adhesive
component in contact with at least a portion of the first bone,
each other bone and the scaffold material, wherein the adhesive
component has a material state that is changeable to another
material state at which the adhesive component affixes the first
bone, each other bone and the scaffold material to define a
composite bone structure having a desired rigidity.
24. The composite bone structure of claim 23, wherein the desired
rigidity substantially corresponds to a rigidity of the first bone
and each other bone.
25. The composite bone structure of claim 23, wherein the adhesive
component comprises a synthetic polymer, wherein the another
material state comprises a cured state, and wherein the synthetic
polymer is operable to change to the cured state based on exposure
to a radiation-based initiator or a chemical-based initiator.
26. The composite bone structure of claim 23, wherein the adhesive
component is further operable to change from a first perceived
color prior to achieving the another material state to a second
perceived color at the another material state, wherein the second
perceived color is perceptively different from the first perceived
color.
27. The composite bone structure of claim 23, wherein the scaffold
material comprises a first biocompatible material and the adhesive
component comprises a second biocompatible material, wherein the
first biocompatible material and the second biocompatible material
have substantially similar rates of resorption.
28. The composite bone structure of claim 23, wherein the scaffold
material and the adhesive component each comprise substantially the
same biocompatible material.
29. The composite bone structure of claim 23, wherein the scaffold
material is operable to carry the adhesive component.
30. The composite bone structure of claim 23, wherein the adhesive
component comprises a urethane-based, resorbable synthetic
polymer.
31. The composite bone structure of claim 23, wherein at least the
first bone or the at least one other bone comprises a cranial bone
or a maxillofacial bone or a mandible.
32. The composite bone structure of claim 23, wherein the first
bone and each other bone in the composite bone structure have a
desired relative orientation.
33. The composite bone structure of claim 23, further comprising
periosteum positioned on the scaffold material.
34. The composite bone structure of claim 23, further comprising a
bone void filler positioned between at least two of the first bone
and each other bone.
35. The composite bone structure of claim 23, further comprising a
bone growth-promoting material positioned between at least two of
the first bone and the at least one other bone.
Description
BACKGROUND
[0001] The present technology relates to apparatus and methods of
treating or repairing hard tissue defects.
[0002] The treatment of a hard tissue defect, such as fractured or
misshapen bone, involves a number of complex surgical procedures.
More effective apparatus and methods are desired to enable such
treatment, and to promote and enhance tissue repair in terms of
clinical ease of use, cost, healing and efficacy.
SUMMARY
[0003] In some aspects, the present technology provides a method of
fixating bone comprising connecting at least two bones and a
scaffold material with an adhesive component such that the adhesive
component is in contact with at least a portion of a surface of
each of the bones and the scaffold material. The method further
includes fixating the bones and the scaffold material to define a
desired structure having a desired rigidity based on changing a
material state of the adhesive component.
[0004] In another aspect, a method of craniomaxillofacial surgery
comprises accessing at least two bones at least partially defining
a hard tissue defect at a location within a body, wherein the
location comprises a cranial location or a maxillofacial location.
The method further includes positioning the bones into a desired
relative orientation, conforming a scaffold material to at least a
portion of a surface of each of the bones, and contacting an
adhesive component between at least a portion of each of the bones
and the scaffold material. Additionally, the method includes
fixating the bones and the scaffold material in the desired
relative orientation to remodel the hard tissue defect. The
fixating is based on changing the adhesive component to a material
state at which the adhesive component fastens together the bones
and the scaffold material with a desired rigidity.
[0005] In a further aspect, a composite bone structure comprises a
first bone having a first surface and at least one other bone,
wherein each other bone comprises a respective second surface. The
composite bone structure also includes a scaffold material
positioned to connect the first bone and the at least one other
bone, wherein the scaffold material is adaptable to conform to the
first surface and each respective second surface. Additionally, the
composite bone structure includes an adhesive component in contact
with at least a portion of the first bone, each other bone and the
scaffold material, wherein the adhesive component is changeable to
a material state at which the adhesive component affixes the first
bone, each other bone and the scaffold material to define a
composite bone structure having a desired rigidity.
[0006] Further areas of applicability of the present teachings will
become apparent from the detailed description provided herein. It
should be understood that the detailed description and specific
examples, while indicating various embodiments of the technology
described below, are intended for purposes of illustration only and
are not intended to limit the scope of the teachings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] The present teachings will become more fully understood from
the detailed description and the accompanying drawings,
wherein:
[0008] FIG. 1 is a perspective view of representative sites of hard
tissue defects subject to treatment or repair according to the
technology described herein;
[0009] FIG. 2 is a diagrammatic representation of one aspect of a
representative method of fixating bone to treat the hard tissue
defect of FIG. 1;
[0010] FIG. 3 is an exploded, cross-sectional view of one aspect of
representative components of a composite bone implant;
[0011] FIG. 4 is a cross-sectional view of the composite bone
implant of FIG. 3 forming a desired structure;
[0012] FIG. 5 is a cross-sectional view of the composite bone
implant of FIG. 3 in a final state;
[0013] FIG. 6 is a transverse cross-sectional view of another
aspect of a composite bone structure; and
[0014] FIG. 7 is a cross-sectional view of the composite bone
structure in plane 7-7 of FIG. 6.
DETAILED DESCRIPTION
[0015] The following description of technology is merely exemplary
of the subject matter, manufacture and use of one or more
inventions, and is not intended to limit the scope, application, or
uses of any specific invention claimed in this application or in
such other applications as may be filed claiming priority to this
application, or patents issuing therefrom.
[0016] Referring to FIG. 1, the described apparatus and methods of
fixating bone relate to therapies or treatments for a hard tissue
defect, which includes fractured or misshapen or deficient bone in
a body of a patient. The hard tissue defect may be located anywhere
on the body, and will be discussed specifically in relation to a
maxillofacial defect 10 or a cranial defect 12 on a skull 14 of a
patient. For example, the apparatus and methods of fixating bone
may include procedures such as, but not limited to: cranial or
calvarial vault remodeling; maxillary complex fracture fixation
procedures; comminuted bone procedures; cranial or neurosurgical
flap procedures; craniosynostosis procedures; infant craniofacial
surgery; pediatric reconstructive procedures; pediatric mid-face
and craniofacial trauma procedures; brow-lift procedures;
bone-graft procedures in the mid-face, mandible or craniofacial
skeleton; trauma and reconstructive procedures of the mid-face or
craniofacial skeleton, including frontal, parietal, temporal,
sphenoid and occipital bones; fixation of fractures of the maxilla,
zygoma, zygomatic arch, orbital rim, frontal sinus wall, nasal,
ethmoid and lacrimal bones; iliac crest graft cover; mandibular
osteotomies; tumor reconstruction in the mid-face or craniofacial
procedures; Lefort fractures (I,II,III); proximal tibia revisions;
and generally any bone defect correction procedure. Additionally,
as referred to herein, the term "hard tissue" relates to bone,
skeletal or ossified tissue, which is relatively hard and rigid as
compared to other bodily tissue such as skin.
General Method
[0017] Referring to FIG. 2, in one aspect, a method of fixating
bone to provide therapy for or treatment of a hard tissue defect
includes obtaining two or more bones (Block 19). For example, the
bones may be obtained from the site of the hard tissue defect, as
the treatment or therapy may involve remodeling the defect into a
desired structure. Optionally, as indicated by dashed lines, the
method may include preparing at least a portion of a surface of
each of the bones (Block 21). The surface preparation is provided
to enhance an ability of the bone to be fixated. The method
involves positioning the bones for fixation (Block 23) in a desired
relative orientation to achieve a desired remodeled structure.
Further, the method includes conforming a scaffold material, as
defined below, to at least a portion of the surface of each of the
bones (Block 25). For example, the scaffold material may be
positioned in contact with the respective prepared surfaces.
Moreover, the method includes contacting an adhesive component with
and between each of the bones and the scaffold material (Block 27).
The adhesive component or a portion of the adhesive component may
be carried by the scaffold material, or may be added to the
construct, or both. Optionally, as indicated by dashed lines, the
method may include adding additional therapeutic or structural
materials, or both, to the structure (Block 29). For example, bone
growth-promoting materials may be added to promote bone fusion, or
bone void fillers such as bone cement or bone-growth scaffold may
be added to fill in gaps between the bones. Additionally, the
method includes fixating the bones and the scaffold material (Block
31) to form a composite hard tissue or bone structure that defines
at least a portion of the desired remodeled structure. The fixating
includes changing a state of at least the adhesive component, and
optionally of the scaffold material, to secure the bones and the
scaffold material in the desired relative orientation. Each of the
aforementioned actions will be more fully discussed below.
Obtain Bones
[0018] As discussed above, at least two bones are obtained (Block
19). For example, in one aspect, referring to FIGS. 1 and 3, the at
least two bones 30 and 32 (FIG. 3) may be obtained from a surgical
site or location, such as the site of hard tissue defect 10 or 12
(FIG. 1). Further, referring to FIGS. 6 and 7, for example, more
than two bones 30, 32 and 33 may include bones associated with a
hard tissue defect 11, such as a fracture or multiple fractures in
a long bone, in a zygomatic arch, or in any other skeletal
structure. Although discussed as being obtained from hard tissue
defect 10 or 11 or 12, it should be further understood that in
other aspects obtaining bones 30 and 32 (and/or 33) may include
obtaining one or more bone segments from other bodily locations,
obtaining one or more allograft bone segments, or any combination
thereof. Further, although discussed in terms of the at least two
bones 30 and 32, it should be understood that the described aspects
are not limited thereto, but may include any number of bone
segments. Moreover, the two or more bones 30 and 32 may include at
least one portion of bone connected to a skeletal structure, or at
least one separate bone segment, or both. Additionally, the at
least two bones 30 and 32 include hard tissue, which as noted above
comprises bone, skeletal and/or ossified tissue. For example, in
some aspects, the at least two bones 30 and 32 may be fractured
portions of bone, such as may result from local trauma. In other
aspects, for example, the at least two bones 30 and 32 may be
deformed portions of bone. Further, the term "bone" may include a
bone, any part or segment of a bone, or any fragment of a bone.
[0019] Additionally, obtaining the at least two bones 30 and 32 may
further include a surgical procedure including accessing a
harvesting location in the body of the patient. For example, the
surgical procedure may include making an incision through the skin
and other soft tissue of the patient at the harvesting location to
expose one or more of the at least two bones 30 or 32. Further,
obtaining the at least two bones 30 or 32 may include removing
fractured portions of bone from the accessed location,
repositioning fractured portions of bone within the accessed
location, cutting the bone at the accessed location to define one
or more of the at least two bones 30 or 32, or a combination of
both. Alternatively or in addition, as noted above, obtaining the
at least two bones 30 or 32 may further include obtaining one or
more allograft bone segments.
Prepare Surfaces
[0020] Referring again to FIG. 2, the method optionally includes
applying a surface preparation to at least a portion of a surface
of the bones 30 and 32 (and, optionally, 33) (Block 21). Although
the surface preparation (Block 21) is shown in FIG. 2 and discussed
herein as occurring prior to the positioning of bones 30 and 32
(Block 23), the surface preparation may be applied at any time
before, during or after the positioning. Referring to FIGS. 3, 6
and 7, the surface preparation may include any surface treatment
effective to increase an ability of adhesive component 34 to secure
scaffolding material 36 or 37 to the respective bones 30 and 32
(and 33), to improve fusion with an adjacent bone segment, to shape
the respective bones 30 or 32 (or 33) into a desired form, or any
combination thereof It should be noted that the surface treatment
may be applied to any surface used to connect together one or more
bones or a bone and the scaffold material.
[0021] Referring specifically to FIG. 3, in one aspect, the surface
preparation may be applied to at least a respective portion, such
as portions 38 and 40, of a respective external or top surface 42
and 44 of the respective bones 30 and 32. It should be noted,
however, that internal or bottom surfaces, and/or side surfaces may
likewise be treated depending on the particular circumstance or
preference of the user. In one aspect, the respective portion 38
and 40 substantially corresponds to an area in which scaffolding
material 36 will be placed. The surface preparation may include
roughening the top or external-facing surface 42 and 44. In this
respect, the top or external-facing surface 42 and 44 faces away
from the body of the patient, and opposed to a respective bottom or
internal-facing surface 46 and 48. For example, such surface
roughening may comprise mechanically abrading the respective bone
surfaces, such as with a surgical tool having an abrading element,
or may comprise removal of a portion of the surface, such as with a
surgical tool having a cutting element. Alternatively, or in
addition, the surface preparation may be applied to respective side
surfaces 52 and 54, defined between each respective top or
external-facing surface 42 and 44 and each respective bottom or
internal-facing surface 46 and 48, to improve an ability of the
respective side surfaces 52 and 54 to fuse to one another or alter
the bonding interface with the adhesive component 34.
[0022] Referring to FIG. 4, additionally or alternatively, in other
aspects, the surface preparation may include temporarily or
permanently removing or peeling back a periosteum layer 50 from the
respective portions 38 and 40 of the respective top or
external-facing surfaces 42 and 44 of the bones 30 and 32. Further,
the surface preparation may include reshaping one or more of bones
30 and 32 to obtain a desired remodeled structure to treat hard
tissue defect 10 or 12. Alternatively, or in addition, the surface
preparation may further include drying the respective portions 38
and 40 of the surfaces of bones 30 and 32 to enable improved
contact with scaffold material 36 and/or adhesive component 34. In
yet other aspects, the surface preparation may include applying a
chemical to perform one or more actions, such as removing the
periosteum layer 50, roughening at least a portion of respective
surfaces of bones 30 and 32, reforming the shape of one or more
bones 30 and 32, drying the surface, removing a selected material
from the surface, such as a lipid, or any combination thereof.
Position Bone Segments
[0023] Referring again to FIG. 2, the bones 30 and 32 (and,
optionally, 33) are placed in a desired relative position (Block
23). Although the relative positioning of the bones is shown in
FIG. 2 and discussed herein as occurring prior to the conforming of
the scaffold material (Block 25) and the contacting of the adhesive
component (Block 27), the relative positioning may occur once or
may occur multiple times before or after other steps of the
described methods. In one aspect, for example referring to FIGS. 3
and 4, respective side surfaces 52 and 54 are positioned opposing
one another and are moved into a desired orientation adjacent to
one another. In particular, as noted by arrows 56 and 58 (FIG. 3),
the at least two bones 30 and 32 are moved toward one another until
a desired orientation (FIG. 4) of bones 30 and 32 and/or side
surfaces 52 and 54 is achieved. In another aspect, for example, the
desired orientation may include a position wherein at least
portions, and preferably a majority, of respective side surfaces 52
and 54 are contiguous or are in contact with one another so as to
enable bone growth between the respective side surfaces 52 and 54.
However, gaps may exist or may be desirable between the at least
two bones 30 and 32. In some aspects, for example, such gaps may be
filled with a bone void filler, such as a bone cement or a
bone-growth scaffold.
[0024] Further, for example, the desired orientation (FIG. 4) may
include the respective top surfaces 42 and 44 having a desired
form, such as an arc, a plane, an orientation, or a combination
thereof. Further, for example, the desired orientation may
correspond to a desired remodeled structure to treat hard tissue
defect 10 or 12. It should be noted that the positioning of the at
least two bones 30 and 32 may include positioning in situ, in
vitro, or a combination thereof. Additionally, for example
referring to FIG. 7, the desired orientation may remodel the long
bone, zygomatic arch, or multiple fracture defect into a shape that
approximates a non-defective skeletal structure.
[0025] In an optional aspect, referring to FIG. 3, as indicated by
arrows 60 and 62, the positioning of bones 30 and 32 may include
positioning against a mold 64 having a mold surface 66 with a
desired shape. For example, the desired shape corresponds to a
desired orientation of bones 30 and 32, or a desired remodeled
structure to treat hard tissue defect 10 or 12. Although
illustrated as positioning bottom or internal-facing surfaces 46
and 48 of bones 30 and 32 against mold surface 66, it should be
understood that the optional positioning against mold 64 may
alternatively include positioning top or external-facing surfaces
42 and 44 against mold surface 66.
Conform Scaffold
[0026] Referring back to FIG. 2, the method further includes
conforming the scaffold material, which in some optional aspects
may include the adhesive component, to at least a portion of the
surface of each of the bones (Block 25). In one aspect, for example
referring to FIGS. 3 and 4, scaffold material 36 is moved in
direction 59 and placed across an interface or gap 68 (FIG. 4)
between the opposing side surfaces 52 and 54 of bones 30 and 32. In
particular, in one aspect, at least a part of scaffold material 36
is placed into contact with the opposing prepared surface portions
38 and 40 of bones 30 and 32, thereby bridging interface 68.
Although illustrated as a plane, it should be noted that interface
68 may comprise any shape or combination of shapes. Further, for
example, scaffold material 36 is positioned such that at least a
portion of adhesive component 34 connects between scaffold material
36 and the opposing prepared surface portions 38 and 40 of bones 30
and 32. As such, scaffold material 36, which may include or carry
adhesive component 34, is positioned in a manner to allow for
securing bones 30 and 32 (and, optionally, 33 in FIG. 7) in a
desired relative orientation, and to further bridge interface 68
(or defect 11 in FIG. 7) to promote bony fusion between the
adjacent bone segments.
[0027] In another aspect, referring to FIGS. 6 and 7, scaffold
material 37 may be wrapped around hard tissue defect 11, thereby
fully enveloping the defective skeletal structure. In this aspect,
the wrapping of the scaffold material 37 and subsequent fixation
provides support to the structure in multiple directions.
[0028] Scaffold material 36 (or 37) may comprise any material
capable of carrying adhesive component 34. For example, scaffold
material 36 (or 37) may include, but is not limited to, materials
such as a woven fabric, a mesh, a foam, a plate, a perforated
membrane, a sheet, a porous structure, a PolyLactide weave or any
combination thereof. Further, for example, scaffold material 36 (or
37) may have a surface that includes voids, peaks and valleys,
ridges, grooves, channels, any combination thereof, or any other
irregular surface that improves an ability of adhesive component 34
to bond or interdigitate with scaffold material 36 (or 37).
Further, for example, scaffold material 36 (or 37) may be
pre-impregnated with a desired or an effective amount of adhesive
component 34, or all or some portion of the desired or effective
amount of adhesive component 34 may be added to scaffold material
36 (or 37) at any time during the procedure described herein. For
example, the desired or effective amount of adhesive component may
comprise an amount effective to enable binding between scaffold
material 36 (or 37) and at least respective portions 38 and 40 of
respective bones 30 and 32, or to provide a desired rigidity or
stiffness to the resulting structure, or both. Additionally,
scaffold material 36 (or 37) may be sized so that the combination
of bone segments 30 and 32 and scaffold material 36 (or 37) define
a desired remodeled structure.
[0029] Further, scaffold material 36 (or 37) comprises a
biocompatible material. In some aspects, scaffold material 36 (or
37) further comprises a bioresorbable material. For example,
scaffold material 36 (or 37) may comprise a polymer, a resorbable
polymer, a urethane, a polyeurethane, a metal, a biocompatible
material, a calcium salt material, a tissue, collagen, cellulose or
combinations thereof In one example, which is not to be construed
as limiting, scaffold material 36 (or 37) may comprise a LACTOSORB
plate available from Biomet, Inc. of Warsaw, Ind.
Contact the Adhesive with Bones And Scaffold
[0030] Referring back to FIG. 2, the method further includes
contacting the adhesive component between the bones and the
scaffold material (Block 27). As previously noted, adhesive
component 34 may be carried by scaffold material 36 or 37, or may
be separately added, or both. In one aspect, for example, scaffold
material 36 or 37 includes adhesive component 34 on a surface
facing the bones 30 and 32 (and, optionally, 33), thereby
connecting the bones and the scaffold material when the scaffold
material is adapted to conform to at least a portion of the
respective surfaces of the bones.
[0031] Additionally, adhesive component 34 may comprise any
material capable of forming a bond between scaffold material 36 or
37 and bones 30 and 32 (and, optionally, 33), whether by chemical
bonding, interdigitation or another method or combination of
methods used to form a mechanical bond between the scaffold
material and bone segments. Further, adhesive component 34
comprises a biocompatible material. In some aspects, adhesive
component 34 further comprises a bioresorbable material. For
example, adhesive component 34 may comprise a material such as a
polymer, a urethane, a polyeurethane, an amino acid containing
polymer, an acrylic, a cyanoacrylate, a polymethyl methacrylate
(PMMA), an alkylene bis(oligolactoyl)methacrylate, a fibrin-based
material, a bone welding material, or combinations thereof.
[0032] In one example, which is not to be construed as limiting,
adhesive component 34 may comprise a synthetic polymer, such as a
biodegradable, polyester urethane/urea composition. For example,
adhesive component 34 may comprise a combination of pre-polymers
operable to react to form a cross-linked polymer network. For
example, the combination of pre-polymers may include a first
pre-polymer having isocyanate groups, such as from the combination
of lysine di-isocyante and pentaerythritol, and a second
pre-polymer comprising a multi-branched polyol, such as poly(lactic
acid)polyol (PLA), polyglycolic acid (PGA), caprolactone, etc. For
example, the biodegradable, polyester urethane/urea composition may
comprise one of the NOVOSORB materials available from PolyNovo
Biomaterials Pty. Ltd. of Australia.
[0033] Additionally, in some aspects, adhesive component 34
comprises a plurality of states, including an initial unpolymerized
or minimally polymerized state prior to and upon positioning of
scaffolding material 36 (or 37) and bones 30 and 32 (and 33), then
a fully polymerized or cured state after such positioning, for
example, after exposure to an initiator 69 such as an additional
chemical component, a light or radiation wave, etc., as will be
discussed below in more detail.
[0034] Additionally, in some aspects, scaffold material 36 (or 37)
and adhesive component 34 may be formed from substantially the same
material. Alternatively or in addition, in some aspects where both
are bioresorbable, scaffold material 36 (or 37) and adhesive
component 34 may be formed from materials having substantially the
same rate of resorption, which may provide a therapeutic benefit
with respect to uniform degradation of the fixated structure,
avoiding inflammation, or providing improved healing.
Add Additional Materials
[0035] Referring to FIG. 2, the method may optionally include
adding additional therapeutic or structural materials, or both, to
the structure (Block 29). For example, bone growth-promoting
materials may be added to promote bone fusion. Further, for
example, void fillers such as bone cement or bone-growth scaffold
may be added to fill gaps between the bones. Additionally, other
therapeutic agents such as gene therapy agents, infection-avoidance
agents, pain-relieving agents, etc., may be added.
Fixate Bone Segments
[0036] As discussed above, and referring again to FIGS. 2, 4 and 7,
once the bone segments and scaffold material are positioned as
desired and contacted with the adhesive component, the bones and
scaffold material are fixated relative to one another to form a
composite bone structure (Block 31). In one aspect, for example,
fixating bones 30 and 32 (or 30, 32 and 33) is based on changing at
least adhesive component 34 from a first material state to a second
material state. At the first material state, adhesive component 34
may comprise a relatively flexible state. For example, in some
aspects, the first material state may be a liquid state, a
semi-solid state, or a non-rigid solid state. In some aspects, for
example, the first material state has a viscosity sufficient to
enable adhesive component 34 to be controllably positioned. For
example, adhesive component 34 may be controllably positioned by
having a viscosity and adhesion characteristic that allows adhesive
component 34 to be controllably maintained on a desired surface,
such as on a respective bone surface or on scaffold material, or
both, to allow a user to avoid contacting the adhesive component
with non-desired contact areas, such as areas within a surgical
site other than the prepared surfaces of the bones or other than
within scaffold material, or both. In any case, at the first
material state, adhesive component 34 comprises sufficient
flexibility to enable contact with bones and scaffold material. At
the second material state, adhesive component 34 is operable to
bind to scaffold material 36 as well as to two or more bones 30 and
32 (or 30, 32 and 33). Further, at the second material state,
adhesive component 34 forms a structure having a desired rigidity
or stiffness. The desired rigidity or stiffness may include, but is
not limited to, a range of rigidities or stiffnesses substantially
corresponding to the range of rigidities of hard tissue, such as
the particular hard tissue comprising one or more of bones 30 and
32 (or 30, 32 and 33). In any case, at the second material state,
adhesive component 34 comprises sufficient rigidity or stiffness to
resist movement of the bones and scaffold material from the desired
shape or orientation. For example, the amount of such resistance
may be based on typical skeletal loads at the given defect
location, or on the typical strength of bones in the defect
location, or both. Thus, referring to FIGS. 4, 5 and 7, adhesive
component 34, which may be carried by scaffolding material 36 or
37, changes into a state to secure scaffold material 36 (or 37) and
two or more bones 30 and 32 (or 30, 32 and 33) at a desired
orientation, thereby forming a composite bone structure 70 (FIG. 5)
or 71 (FIG. 7) having a desired shape or form to treat or remodel
hard tissue defect 10 or 12 (FIG. 1) or 11 (FIG. 7).
[0037] Optionally, in some aspects, the fixating may further
include changing the state of scaffold material 36 (or 37) from a
first state having substantial flexibility to a second state having
substantial rigidity or stiffness. For example, the substantial
flexibility comprises an amount of flexibility that allows scaffold
material 36 or 37 to conform to a surface of the two or more bones
30 and 32 (or 30, 32 and 33). Further, for example, the substantial
rigidity may include an amount of rigidity or stiffness at the
second state greater than the amount that existed at the first
state, which may include an amount of rigidity or stiffness to
resist movement of the bones and the scaffold material out of the
desired shape or form.
[0038] In particular, referring specifically to FIG. 4, in aspects
in which adhesive component 34, and optionally scaffold material 36
(or 37), comprises a polymer, the changing of states of adhesive
component 34 involves application of an initiator 69 operable to
change at least adhesive component 34 to a second polymer state
different from a first polymer state, wherein the second polymer
state comprises a cured state or a partially-cured or partial
polymerization state. For example, depending on the specific
procedure, it may be desirable to fully cure adhesive component 34
at one time, hence fully setting the form and structure of the
resulting composite bone structure 70 (or 71; FIG. 7). In other
aspects, for example, it may be desirable to only partially cure
adhesive component 34, allowing for later manipulation of the form
or structure of composite bone structure 70 or 71. For example, the
partial polymerization state is some state achieving less than
substantially all of the mechanical strength of the adhesive, where
mechanical strength may include one or more of bonding strength,
rigidity, or stiffness. In such a case, once composite bone
structure 70 or 71 has been completely positioned, then the method
may include changing from the second state of partial
polymerization to a third state of substantially full
polymerization or full cure, thereby securing the relative
orientation of composite bone structure 70 or 71.
[0039] As noted above, the state changes may be effected by
initiator 69. Initiator 69 may include, but is not limited to, a
radiation-based initiator, of which a light based initiator would
be one example, a temperature change-based initiator, a
chemical-based initiator, or any combination thereof or any
combination of different types of each one. For example, adhesive
component 34 may comprise a multi-part adhesive having at least two
parts, wherein combination of a second part with the first part
initiates a chemical reaction operable to change adhesive component
34 from the first relatively flexible state to the second
relatively rigid state. One example of such a multi-part adhesive
component 34 includes, but is not limited to, a biodegradable,
polyester urethane/urea composition such as one of the NOVOSORB
materials available from PolyNovo Biomaterials Pty. Ltd. of
Australia. In another example, the radiation-based, or more
specifically the light-based, initiator may comprise exposure to
one or more light waves or radiation waves having a desired
wavelength or range/band or ranges/bands of desired wavelengths to
effect curing of the adhesive component. For instance, with
adhesive component 34 comprising a urethane-based polymer, the
initiator 69 may comprise ambient light, which includes as a
component light of the wavelength of interest and which may slowly
cure the adhesive component. However, a light of greater intensity
and, specifically, with a greater intensity at a specific
wavelength or band of wavelengths may be used to accelerate the
light based curing process.
[0040] As noted above, the application of initiator 69 may differ
throughout the fixation process, such as in the case where a
partial fixation is achieved prior to a final fixation. For
example, in the case of adhesive component 34 comprising a polymer,
the method of causing polymerization up to a partial polymerization
state may further include exposing adhesive component 34 to a first
radiation at a first set of one or more wavelengths for a first
time period operable to achieve less than substantially all of the
mechanical strength of adhesive component. In this aspect, in one
example, the first radiation has a source including a laser or
other directed source that generates locally-focused radiation
waves directed substantially on adhesive material 34. In this case,
in one optional aspect, changing adhesive component 34 to the
substantially fully polymerized state may include additionally
exposing adhesive component 34 to the first radiation for a second
time period. In a different optional aspect, changing the adhesive
component to the substantially fully polymerized state may include
additionally exposing the adhesive component to a second radiation
for a second time period and/or at a second set of one or more
wavelengths different from the first set of one or more
wavelengths. For example, the second radiation may have a source
including a different type of laser or other directed light source,
or may include an ambient radiation source operable to generate
non-locally-focused light waves, i.e. radiation or light waves not
directed primarily on the adhesive component or the scaffold
material.
[0041] Optionally, in some aspects, adhesive component 34 (and/or
scaffold material 36 or 37) may have a different perceived color at
each material state. Thus, by changing from one perceived color to
another, which includes a shift in wavelength (for example, from
red to blue) or a shift in intensity (for example, from light blue
to dark blue), adhesive component 34 may provide a perceptible
visual indicator corresponding to the respective material state,
thereby aiding a surgeon or other party in ascertaining the
material state.
[0042] As noted above, although composite bone structure 70 or 71
has been discussed in terms of bones 30 and 32 or 30, 32 and 33,
any number of bones may be utilized. Similarly, one or more
composite bone structures 70 or 71 may be joined together, or
composite bone structure 70 or 71 and non-harvested bone, such as
adjacent to the site of hard tissue defect 10, 11 or 12, may be
joined together in a similar manner as described above for joining
two or more bones 30 and 32, or 30, 32 and 33.
[0043] For example, the method of joining composite bone structure
to another bone may include positioning the composite bone
structure adjacent to at least one other bone at the implant site.
Further, the method may include positioning a second scaffold
material including a second adhesive component across at least a
portion of each of the composite bone structure and the at least
one other bone such that the second adhesive component is in
contact with both the composite bone structure and the at least one
other bone. When performing the conforming and the contacting, the
second scaffold material and the second adhesive component both
comprise a material state being substantially flexible. Finally,
this method includes fixating the composite bone structure and the
at least one other bone based on changing at least the second
adhesive component to another material state at which the second
adhesive component chemically or mechanically binds to the second
scaffold material, the composite bone structure and the at least
one other bone, thereby forming a structure having a desired
rigidity, as described above.
[0044] Additionally, it should be noted that although FIGS. 4 and 5
include bone segments 30 and 32 having periosteum 50, one or both
of bone segments 30 and 32 may be obtained without periosteum 50,
such as in the case of one or both segments 30 and 32 comprising
allograft bone or as in the case where the periosteum is removed
from the patient's own bone intraoperatively.
[0045] In another example, in some aspects, the method of FIG. 2
may be utilized specifically for craniomaxillofacial surgery. In
this case, for example, the method of craniomaxillofacial surgery
includes accessing at least two bones at least partially defining a
hard tissue defect at a location within a body, wherein the
location comprises a cranial location or a maxillofacial location
or mandible. In this case, at least one of the bones may be
obtained from the defect location, while one or more of the other
bones may be obtained from another harvesting location on the body,
or may be obtained as an allograft. In other cases, such as when a
reconstruction is desired using the existing hard tissue, the bones
may be obtained from the hard tissue location. Further, it should
be noted that at least one of the bones may be a portion of cranial
or maxillofacial bone at or adjacent to the hard tissue defect
location and connected to or integral with the skull. Additionally,
in this specific example, the hard tissue defect location comprises
one of a cranial location or a maxillofacial location.
[0046] Further, the method of craniomaxillofacial surgery includes
positioning the bones into a desired relative orientation.
Generally, the bones are positioned such that opposing surfaces of
the respective bone segments are facing one another, thereby
defining an interface between the bone segments.
[0047] Additionally, the method of craniomaxillofacial surgery
includes conforming a scaffold material to at least a portion of a
surface of each of the bones. Further, the method includes
contacting an adhesive component between at least a portion of each
of the bones and the scaffold material. In this case, for example,
the scaffold material spans the interface between the bones,
thereby allowing the adhesive component to define a connection
between the bones and the scaffold material. Additionally, to
enable achieving a desired contact between the scaffold material
and adhesive component and the bones, the scaffold material and the
adhesive component both comprise a first material state being
substantially flexible to allow such contact.
[0048] Additionally, the method of craniomaxillofacial surgery
includes fixating the bones and the scaffold material in the
desired relative orientation to remodel the hard tissue defect. In
this case, the fixating is based on changing at least the adhesive
component to a second material state at which the adhesive
component mechanically or chemically binds the bones and the
scaffold material, thereby forming a composite bone structure
having a desired rigidity. In an optional aspect, the fixating may
involve both the adhesive component and the scaffold material
changing into the second material state to define the relatively
rigid structure used to repair the hard tissue defect.
[0049] Thus, referring again to FIGS. 3-5 and 7, the
above-described methods allow for the formation of a composite bone
structure 70 (FIG. 5) or 71 (FIG. 7) that includes hard
tissues/bones 30 and 32, or 30, 32 and 33, joined together by an
adhesive component 34 carried by a scaffold material 36 or 37. For
example, referring to FIGS. 3-5, hard tissue/bone 30 has a first
surface 52 and hard tissue/bone 32 has a second surface 54, and
bones 30 and 32 are relatively positioned so as to define an
interface 68 between at least a portion of the respective surfaces
52 and 54. Further, scaffold material 36 is positioned adjacent to
at least a portion of the hard tissues/bones 30 and 32, such that
scaffold material 36 spans at least a portion of interface 68.
Further, adhesive component 34 is in contact with at least a
portion of each of the hard tissues/bones 30 and 32 and scaffold
material 36. Scaffold material 36 and adhesive component 34 both
initially comprise a first material state being substantially
flexible to enable their positioning relative to the respective
hard tissues/bones 30 and 32. After achieving the desired
positioning, at least adhesive component 34 is changeable to a
second material state at which adhesive component 34 binds to each
of the hard tissues/bones 30 and 32 and scaffold material 36,
thereby defining composite bone structure 70 having a desired
rigidity. Similarly, with respect to FIG. 7, scaffold material 37
wraps around hard tissues/bones 30, 32 and 33, and adhesive
component 34 affixes the hard tissues/bones 30, 32 and 33 and
scaffold material 37 in a desired orientation and further defines
composite bone structure 71 having a desired rigidity.
[0050] While the foregoing disclosure discusses illustrative
aspects and/or embodiments, it should be noted that various changes
and modifications could be made herein without departing from the
scope of the invention as defined by the appended claims.
Furthermore, although elements of the described aspects and/or
embodiments may be described or claimed in the singular, the plural
is contemplated unless limitation to the singular is explicitly
stated. Additionally, all or a portion of any aspect and/or
embodiment may be utilized with all or a portion of any other
aspect and/or embodiment, unless stated otherwise.
* * * * *