U.S. patent application number 13/625680 was filed with the patent office on 2013-10-10 for apparatus and methods for fracture repair.
This patent application is currently assigned to CONVENTUS ORTHOPAEDICS, INC. The applicant listed for this patent is CONVENTUS ORTHOPAEDICS, INC. Invention is credited to Michael P. Brenzel, Paul Hindrichs.
Application Number | 20130267953 13/625680 |
Document ID | / |
Family ID | 40851328 |
Filed Date | 2013-10-10 |
United States Patent
Application |
20130267953 |
Kind Code |
A1 |
Brenzel; Michael P. ; et
al. |
October 10, 2013 |
APPARATUS AND METHODS FOR FRACTURE REPAIR
Abstract
Apparatus and methods for bone fracture repair. The apparatus
may include a structural support for positioning a first bone
segment relative to a second bone segment. The apparatus may
include an anchoring substrate. The anchoring substrate may be
configured to compress the first bone segment to the second bone
segment. The anchoring substrate may transmit tension from a distal
bone segment anchor in the first bone segment to a proximal bone
segment anchor in the second bone segment. The apparatus may be
configured to be deployed percutaneously in an inner cavity of a
bone. The apparatus may be installed in an open fracture. The
apparatus may be expanded, self-expanding or configured for
mechanically actuation. Some embodiments of the apparatus may
include a central axis member that may be used in conjunction with
expansion of one or both of the structural support and the
anchoring substrate to configure the apparatus.
Inventors: |
Brenzel; Michael P.; (St.
Paul, MN) ; Hindrichs; Paul; (Plymouth, MN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
CONVENTUS ORTHOPAEDICS, INC |
Maple Grove |
MN |
US |
|
|
Assignee: |
CONVENTUS ORTHOPAEDICS,
INC,
Maple Grove
MN
|
Family ID: |
40851328 |
Appl. No.: |
13/625680 |
Filed: |
September 24, 2012 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
12353855 |
Jan 14, 2009 |
8287538 |
|
|
13625680 |
|
|
|
|
61090999 |
Aug 22, 2008 |
|
|
|
61020778 |
Jan 14, 2008 |
|
|
|
Current U.S.
Class: |
606/62 |
Current CPC
Class: |
A61B 17/725 20130101;
A61B 17/70 20130101; A61B 17/7225 20130101; A61B 17/8858 20130101;
A61B 17/863 20130101; A61B 17/7233 20130101; A61B 2017/8655
20130101; A61B 17/7275 20130101; A61B 17/7258 20130101; A61B 17/869
20130101; A61B 17/7097 20130101 |
Class at
Publication: |
606/62 |
International
Class: |
A61B 17/72 20060101
A61B017/72 |
Claims
1. An apparatus for treating a fracture of a bone, the fracture
including segments, the bone having an inner cavity, the apparatus
comprising: a structural support for positioning a first of the
bone segments relative to a second of the bone segments, the
structural support being configured to be deployed in the inner
cavity; and an anchoring substrate configured to compress the first
bone segment to the second bone segment, the anchoring substrate
being configured to be deployed in the inner cavity.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a nonprovisional of U.S. Provisional
Applications Nos. 61/020,778, filed on Jan. 14, 2008, and
61/090,999, filed on Aug. 22, 2008, both of which are hereby
incorporated by reference in their entireties.
FIELD OF TECHNOLOGY
[0002] Aspects of the disclosure relate to providing apparatus and
methods for repairing bone fractures. In particular, the disclosure
relates to apparatus and methods for repairing bone fractures
utilizing a device that is inserted into a bone.
BACKGROUND
[0003] Currently, there are many known ways to treat long bone
fractures. Common fracture treatments include: (1) non-surgical
immobilization; (2) osteosuture and tension band technologies; (3)
percutaneous fixation (e.g., using pins, wires, screws etc.); (4)
rigid intramedullary nailing (e.g., using a large rod and external
screws); (5) flexible plate osteosynthesis (e.g., a "load sharing"
suture); (6) arthroplasty (e.g., using a prosthesis); (7) plating
and other indication-specific techniques. Severe fractures that
meet certain clinical criteria may require surgical repair rather
than non-surgical immobilization.
[0004] The midshaft of an elongated or long bone is typically
classified as the diaphysis. The end of such a bone is typically
classified as the epiphysis. Bone that is transitional between the
midshaft and the end is typically classified as the metaphysis.
[0005] Metaphysis and epiphysis bone are typically less dense, more
cancellous (porous), and less cortical than diaphysis bone. Repair
of metaphysis and epiphysis fractures are often complicated by
their proximity to a joint. Because of such bone quality and
anatomical differences, fixation of plates and screws in metaphysis
and epiphysis bone is typically more difficult than fixation of
plates and screws in diaphysis bone. This may be especially true if
the patient is elderly and suffers from osteoporosis.
[0006] In general, fracture fixation may provide longitudinal
(along the long axis of the bone), transverse (across the long axis
of the bone), and rotational (about the long axis of the bone)
stability. Fracture fixation may also preserve normal biologic and
healing function.
[0007] There are two primary categories for surgical fixation: (1)
a device that is within the skin (internal fixation); and (2) a
device that extends out of the skin (external fixation). There are
two common types of internal fixation approaches for long bone
surgery (a) a plate that is screwed to the outside of the bone; or
(b) a rod that goes down the center of the bone.
[0008] Plates and screws are characterized by relatively invasive
surgery, support of fractured bone segments from one side outside
of bone, and screws that anchor into the plate and through the
entire bone. Successful repair is dependent on fracture pattern,
bone quality, physician skill set, and patient tolerance of a
foreign body. Plates and screws may not properly address the
alignment and stability requirements for periarticular and
intrarticular fractures.
[0009] Intramedullary rods or nails, such as those used in mid
shaft treatments, are more effective than plates and screws at
minimizing soft-tissue trauma and complications. However, rods and
nails often do not stabilize multi-segment fractures in many cases.
The typical intramedullary rod or nail is fixed in diameter and is
introduced into the medullary canal through an incision. In cases
where there is a medullary plenum larger than the rod, rotational
and transverse stability may be compromised. If a larger rod is
used, reaming of the entire shaft length may be necessary. Such
reaming may thin out existing cortical bone support. Also,
predetermined threaded screw holes in the rods may limit the ways
in which different fracture patterns can be reduced and
stabilized.
[0010] Flexible intramedullary rod-like solutions utilize
structures that can be inserted into the medullary cavity through
an access site, which can then become rigid. These solutions may be
easier for the user to install than rigid intramedullary rods.
These structures may be reinforced with polymers or cements.
Flexible intramedullary solutions, similar to rigid intramedullary
rods, may have limited benefits for periarticular or intrarticular
fractures. Multi-segment fractures, of either the midshaft or
end-bone, require alignment and stability in a manner that
generates adequate fixation in multiple directions.
[0011] Midshaft fractures and end-bone fractures are fundamentally
different. The loading conditions, fracture patterns, alignment
needed, and compression force to promote healing are different.
Midshaft fractures have ample bone material on either side of the
fracture in which anchors may be driven. End-bone fractures,
especially on the articular surface may have thin cortical bone,
soft cancellous bone, and minimal anchoring locations.
[0012] Midshaft fractures tend to be loaded primarily in bending
and torsion. End-bone fractures tend to be loaded in complex and
multi-directional stress patterns. Midshaft repair approaches,
therefore, may not be appropriate for repair of end-bone
fractures.
[0013] Appropriate sizing of an implant helps realignment and
healing of the fracture. As a result, many different sizes of known
repair products are often stored in inventories to ensure proper
matching of the implant device to a patient's anatomy. The
inventories may be a burden to hospitals and insurance carriers,
but they may be necessary to provide to a surgeon intraoperative
flexibility.
[0014] It would be desirable, therefore, to provide apparatus and
methods for proper anatomic alignment and stabilization, while
reducing trauma and complications.
BRIEF DESCRIPTION OF THE DRAWINGS
[0015] The objects and advantages of the invention will be apparent
upon consideration of the following detailed description, taken in
conjunction with the accompanying drawings, in which like reference
characters refer to like parts throughout, and in which:
[0016] FIG. 1 is a side view of apparatus in accordance with the
principles of the invention disposed;
[0017] FIG. 1A is a perspective view of the apparatus shown in FIG.
1;
[0018] FIG. 1B is a partial sectional view of the apparatus shown
in FIG. 1A;
[0019] FIG. 1C is front view of the apparatus shown in FIG. 1A in
accordance with the principles of the invention;
[0020] FIG. 2 is a front view of an illustrative human
skeleton;
[0021] FIG. 3 is a partial sectional view of a fractured bone;
[0022] FIG. 4 is a perspective view showing a body portion that may
be treated using the apparatus shown in FIG. 1;
[0023] FIG. 5 is a perspective view showing the a portion of the
body portion shown in FIG. 4;
[0024] FIG. 6 is a sectional view of apparatus in accordance with
the principles of the invention;
[0025] FIG. 7 is a sectional view of apparatus shown in FIG. 6
along with additional apparatus in accordance with the principles
of the invention;
[0026] FIG. 8 is a sectional view of apparatus shown in FIG. 1
along with additional apparatus in accordance with the principles
of the invention;
[0027] FIG. 9 is a partial sectional view of apparatus shown in
FIG. 1 along with additional apparatus in accordance with
principles of the invention;
[0028] FIG. 10 is a partial sectional view showing the use of the
apparatus shown in FIG. 1 along with additional apparatus in
accordance with the principles and methods of the invention;
[0029] FIG. 11 is a partial sectional view of the apparatus shown
in FIG. 1 along with additional apparatus in accordance with the
principles of the invention;
[0030] FIG. 12 is a partial sectional view of the apparatus shown
in FIG. 1 along with additional apparatus in accordance with the
principles of the invention;
[0031] FIG. 13 is a partial sectional view of the apparatus shown
in FIG. 1 along with additional apparatus in accordance with the
principles of the invention;
[0032] FIG. 14 is a partial sectional view of the apparatus shown
in FIG. 1 along with additional apparatus in accordance with the
principles of the invention;
[0033] FIG. 15 is a partial sectional view of the apparatus shown
in FIG. 1 along with additional apparatus in accordance with the
principles of the invention;
[0034] FIG. 16 is a partial sectional view of the apparatus shown
in FIG. 1 along with additional apparatus in accordance with the
principles of the invention;
[0035] FIG. 17 is a partial sectional view of the apparatus shown
in FIG. 1 along with additional apparatus in accordance with the
principles of the invention;
[0036] FIG. 18 is a partial sectional view of apparatus in
accordance with the principles of the invention;
[0037] FIG. 19 is a perspective view of apparatus in accordance
with the principles of the invention;
[0038] FIG. 20 is a partial sectional view of apparatus in
accordance with the principles of the invention;
[0039] FIG. 21 is an end view of the apparatus shown in FIG.
20;
[0040] FIG. 22 is a partial sectional view of apparatus shown in
FIG. 1;
[0041] FIG. 23 is a perspective view of apparatus in accordance
with the principles of the invention;
[0042] FIG. 24 is a partial sectional view of the apparatus shown
in FIG. 23;
[0043] FIG. 25 is a side view of apparatus in accordance with the
principles of the invention;
[0044] FIG. 26 is a side view of apparatus in accordance with the
principles of the invention;
[0045] FIG. 27 is a perspective view of apparatus in accordance
with the principles of the invention;
[0046] FIG. 28A is a side view of apparatus in accordance with the
principles of the invention;
[0047] FIG. 28B is a side view of apparatus in accordance with the
principles of the invention;
[0048] FIG. 28C is a partial sectional view of apparatus in
accordance with the principles of the invention;
[0049] FIG. 29 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0050] FIG. 30 is sectional view of a portion of the apparatus
shown in FIG. 29;
[0051] FIG. 31 is a side view of apparatus in accordance with the
principles of the invention;
[0052] FIG. 32 is a sectional view of apparatus shown in FIG.
31;
[0053] FIG. 33 is a perspective view of apparatus in accordance
with the principles of the invention;
[0054] FIG. 34 is a perspective view of apparatus in accordance
with the principles of the invention;
[0055] FIG. 35 is a perspective view of apparatus in accordance
with the principles of the invention;
[0056] FIG. 36 is a perspective view of apparatus in accordance
with the principles of the invention;
[0057] FIG. 37 is a perspective view of apparatus in accordance
with the principles of the invention;
[0058] FIG. 38 is a perspective view of apparatus in accordance
with the principles of the invention;
[0059] FIG. 39 is a perspective view of apparatus in accordance
with the principles of the invention;
[0060] FIG. 40 is a partial sectional view of apparatus shown in
FIG. 39;
[0061] FIG. 41 is a perspective view of apparatus in accordance
with the principles of the invention;
[0062] FIG. 42 is a perspective view of apparatus in accordance
with the principles of the invention;
[0063] FIG. 43 is a perspective view of apparatus in accordance
with the principles of the invention;
[0064] FIG. 44 is a perspective view of apparatus in accordance
with the principles of the invention;
[0065] FIG. 45 is a perspective view of apparatus in accordance
with the principles of the invention;
[0066] FIG. 46 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0067] FIG. 47 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0068] FIG. 48 is a perspective view of apparatus in accordance
with the principles of the invention;
[0069] FIG. 49 is a perspective view of apparatus in accordance
with the principles of the invention;
[0070] FIG. 50 is a perspective view of apparatus in accordance
with the principles of the invention;
[0071] FIG. 51 is a perspective view of apparatus in accordance
with the principles of the invention;
[0072] FIG. 52 is a perspective view of apparatus in accordance
with the principles of the invention;
[0073] FIG. 53 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0074] FIG. 54 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0075] FIG. 55 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0076] FIG. 56A is a perspective view of apparatus in accordance
with the principles of the invention;
[0077] FIG. 56B is a side view of the apparatus shown in FIG.
56A;
[0078] FIG. 56C is an end view of the apparatus shown in FIG.
56A;
[0079] FIG. 57A is a perspective view of apparatus in accordance
with the principles of the invention;
[0080] FIG. 57B is a side view of the apparatus shown in FIG.
57A;
[0081] FIG. 57C is an end view of the apparatus shown in FIG.
57A;
[0082] FIG. 58 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0083] FIG. 59 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0084] FIG. 60 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0085] FIG. 61 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0086] FIG. 62 is a perspective view of apparatus in accordance
with the principles of the invention;
[0087] FIG. 63 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0088] FIG. 64 is a side view of apparatus in accordance with the
principles of the invention inside a body portion;
[0089] FIG. 65 is a perspective view showing the use of apparatus
in accordance with the principles of the invention;
[0090] FIG. 66 is a perspective view of apparatus in accordance
with the principles of the invention;
[0091] FIG. 67 is a perspective view of apparatus in accordance
with the principles of the invention; and
[0092] FIG. 68 is an illustrative flow diagram that shows a method
in accordance with the principles of the invention.
DETAILED DESCRIPTION OF THE INVENTION
[0093] Apparatus and methods for fracture repair are provided. The
apparatus may include a structural support for positioning a first
bone segment relative to a second bone segment. The structural
support may be configured to be deployed in an inner cavity of a
bone. The apparatus may include an anchoring substrate. The
anchoring substrate may be configured to compress the first bone
segment to the second bone segment. The anchoring substrate may be
configured to be deployed in the inner cavity.
[0094] The term "bone segment" may refer to portions or fragments
of a bone. The term "structural support" may include a "structural
cage."
[0095] The structural support may be self-expanding. The structural
support may be expanded by balloon. The structural support may be
expanded by mechanical actuation. The anchoring substrate may be
self-expanding. The anchoring substrate may be expanded by balloon.
The anchoring support may be expanded by mechanical actuation.
[0096] The structural support may be used as a frame to position
and align the bone segments. Anchors may used to secure the bone
segments to the anchoring substrate. The anchoring substrate may be
tensioned to compress the bone segments against each other. Some
embodiments of the apparatus may include a central axis member. The
central axis member may be used in conjunction with expansion of
one or both of the structural support and the anchoring substrate.
The central axis member may be used in conjunction with the
tensioning of the anchoring substrate after anchors are placed. A
proximal anchor may be used to fix one end of the apparatus to a
bone segment to "lock in" the tensioning of the anchoring
substrate.
[0097] The apparatus may include delivery apparatus. The delivery
apparatus may deliver one or more portions of the apparatus, such
as the structural support and the anchoring substrate, through an
access hole in the bone and into the intramedullary cavity in the
bone. The portions may be delivered in a contracted or collapsed
state. The portions may then be expanded for repair of the
fracture.
[0098] The apparatus and methods may involve reducing, aligning,
compressing and/or stabilizing the fracture from within the
intramedullary cavity. In some instances, the resulting stabilized
bone may then heal while maintaining mobility of the patient.
[0099] The apparatus and methods may provide stabilization in axial
bending, torsion, rotation, compression, and may provide
inter-segment tension or compression.
[0100] The stabilization may repair compacted and impacted
fractures, control length, and control alignment of the fracture
segments. The apparatus may separate the tasks of revision,
reduction, fixation, stabilization, rotation and offset.
[0101] The apparatus and methods may distribute load between the
apparatus and native bone. The apparatus may have flexibility and
modulus that are similar to native bone. Some embodiments may
provide apparatus that is selectively weaker than or stronger than
the native bone to promote beneficial fracture healing
response.
[0102] The apparatus and methods may be used for closed reduction,
open reduction, and minimally invasive surgical procedures ("MIS").
The apparatus and methods may facilitate arthroscopic surgical
procedures. The apparatus and methods may provide percutaneous
fracture repair. In such repair, the apparatus may be deployed into
the cavity of a bone through a small incision.
[0103] The apparatus may be delivered at a point other than that of
the fracture site. This may help reduce soft tissue damage. The
apparatus may be delivered into an intramedullary cavity through a
small access hole that may be placed along the midshaft of the long
bone in an area in which minimal soft tissues would need to be
displaced.
[0104] The apparatus and methods may reduce the need to place
foreign bodies in muscle, tendon and nerve areas. As such, the
apparatus and methods may reduce tissue erosion and disintegration.
Preservation of the soft tissue may reduce chronic pain and
stiffness. The apparatus and methods may reduce infection risk
because of its noninvasiveness.
[0105] In some embodiments, the apparatus and methods may be made
completely from biologically friendly metals such as titanium and
Nitinol. Such materials reduce the risk of infection and do not
generally interfere with normal biological processes within the
fractured bone.
[0106] The apparatus and methods may be used to repair many
different types of bones. For example, the apparatus and methods
may be used to repair long bones, short bones, flat bones,
irregular bones, and sesamoid bones.
[0107] The apparatus and methods may be used to repair many
different types of fractures. For example, the apparatus and
methods may be used to repair comminuted fractures, epiphyseal
fractures, metaphyseal fractures, mid shaft fractures,
intra-articular fractures, periarticular fractures, multipart
fractures and other types of fractures.
[0108] The apparatus may be used in the reconstruction of fractured
joints. The apparatus and methods may also facilitate such joint
replacements by providing an adequate anchoring substrate. For
example, the apparatus and methods may provide stable anchoring for
a prosthesis, and reduce aseptic loosening.
[0109] The terms "end-bone" and "end-bone fracture" may be used to
refer to fractures that occur in the epiphyseal or metaphyseal
region of long bones. Such fractures include peri-articular and
intra-articular fractures.
[0110] The apparatus and methods may be used to treat osteoporotic
bone, indications involving poor bone quality. In connection with
such indications, the apparatus may compensate for deficiencies in
native bone and may reduce concerns regarding stress shielding. The
apparatus and methods may be used in connection with fusion of
bones and joints for various indications including arthritis.
[0111] The apparatus and methods may be used in conjunction with
bone cement or in place of bone cement. In some embodiments, the
apparatus may act as a bone filler. For example, the apparatus may
be used for filling bone void in connection with the treatment of
cysts and tumors. The apparatus may behave as an osteoconductive
scaffold to promote bone growth.
[0112] The apparatus and methods may be used in connection with
provisional alignment for staged repair procedures, such as
revisions, high energy trauma, or other cases in which there is
infection or soft tissue that needs to heal before bone fixation is
completed. The apparatus and methods may be used in combination
with various antibiotics that promote healing.
[0113] The structural support may prevent bone segments from moving
inward, so the apparatus may reduce the likelihood of collapse of
the fracture. The apparatus may conform to the shape of bone and
may thus minimize undue stresses. For example, the apparatus and
methods may reduce hoop stress by selecting a degree of implant
expansion or stiffness.
[0114] The apparatus may be self-centering, because it expands into
the bone cavity. Many of the cavities are not straight like a pipe;
they vary depending on the anatomy. The apparatus may be straight,
bent, curved, and cavity-compliant.
[0115] The apparatus and methods may provide anchoring at the
distal end of the apparatus. This feature may be used for repairs
of articular fractures and fractures with small or mobile bone
segments.
[0116] The apparatus and methods may provide for the use of small
anchors, because the apparatus provides structural support for the
bone segments that require anchoring.
[0117] The apparatus and methods may provide anchoring in any
suitable direction. Some embodiments may provide anchoring in any
plane.
[0118] Because the anchoring substrate expands toward the inside
surface of the bone segments, relatively shorter anchors may be
used in comparison with typical repair methods. For the same
reason, the use of a screw that is longer than required to engage
the anchoring substrate will not result in driving the screw into
or through bone that is opposite the anchored segment. This is so
because the screw will terminate in the intramedullary cavity.
[0119] The apparatus and methods may be used in conjunction with
plates, screws, pins, external fixators, replacement joints, bone
graft matrices, factor based bone substitutes, and cell based bone
substitutes.
Delivery Instrument
[0120] The delivery instrument may deliver the apparatus to the
intramedullary cavity through an access hole in the bone. The
delivery instrument may be used to remove the apparatus from the
intramedullary cavity through the access hole. The delivery
instrument may engage the apparatus by any suitable mechanism,
including one or more of threading, a socket, a pin, a snap, a
collet, a cable, and any other suitable mechanism.
[0121] The mechanism may deliver, expand, adjust, rotate, lock,
release and recapture the apparatus. Each of the acts, and other
suitable acts, may be performed independently on the structural
cage, the anchor substrate, the central axis member, locking
features, and associated coupling mechanisms. The delivery device
may include a handle set capable of delivering the forces needed to
actuate the mechanism or mechanisms.
[0122] The delivery instrument may include a sheath to help deliver
the apparatus in a compacted state. The shaft of sheath may be
bendable to access the intramedullary cavity. In some embodiments,
the delivery instrument may not have a sheath. In those
embodiments, the delivery instrument may push the apparatus into
place unguarded.
[0123] The delivery instrument may be radio opaque in whole or in
part.
[0124] In some embodiments, the delivery instrument may be attached
to a flexible scope or endoscope. In some embodiments, the delivery
instrument may be integrated with the flexible scope or
endoscope.
Structural Support
[0125] The structural support may provide one or more of axial,
bending, torsional, and positional structural support to the
fracture segments. The structural support may reduce or eliminate
adverse effects such as stress risers. The structural support may
provide a guide or surface for alignment of the fracture segments
during reduction and healing.
[0126] The structural support may be configured in a contracted
state and introduced through a hole in the shaft of the bone. The
structural support may have sufficient flexibility in the
contracted state to conform to curvature in an access pathway.
[0127] The structural support may be positioned inside the
intramedullary cavity near a fracture site. The structural support
may be expanded. When expanded, the structural support may be
rigid. The structural support may be expanded sufficiently to fill
the available cavity and/or displace low density material that may
border the cavity. Expansion may vary along the surface of the
structural support such that the expanded structural support may
conform to irregular cavity shapes.
[0128] In some embodiments, an expansion state may be maintained
with or without the structural support being in a stressed
condition. Radial pressure against the cavity walls can be tailored
along the length of the structural support. The structural support
may provide strain relief in desired locations to promote
healing.
[0129] The expansion of the structural support may be elastic. This
may be achieved using a spring material that returns to its
original configuration shape or pressure after release from the
contracted state.
[0130] The expansion of the structural support may be plastic. The
structural support may be deformed into a desired expanded
configuration. The deformation may be achieved by a mechanism, such
as a lever or reciprocating manipulators that change the length of
the structural support. The lever or manipulators may shorten the
distance between two portions of the structural member. Shortening
the distance may cause radial expansion of a portion of the
structural support.
[0131] Force for shortening the distance may be supplied by a
central axis member that may transect the structural support. The
resulting shape could be derived from a combination of the
expansion described and the resistance of the cavity walls.
[0132] The deformation may be achieved by direct force, such as by
a balloon.
[0133] The structural support may be expanded torsionally. The
torsional expansion may be either elastic or plastic in nature. For
example, the distal end of the structural support may be rotated
relative to the proximal end. The structural support may then
expand to fill the cavity.
[0134] Many different materials could be utilized to achieve the
desire expansion and strength features described.
[0135] The structural support may include support members that form
a cage or a portion of a cage. The support members may have one or
more of many different configurations. The structural support may
have any suitable number of support members. For example, the
number of support members may be 1, 2, 3, 4, 5, 6, 7, 8, 10, 25,
50, 100 or more.
[0136] The support members may have any suitable cross-sectional
shape. For example, the support members may have one or more of the
following cross-sectional shapes: round, flat, rectangular, "I"
beam, tubular, stranded, twisted and many others.
[0137] The structural support may have any suitable shape. For
example, the structural support may be round, cylindrical, flat,
rectangular, spiral, helical, wisk or egg beater like, egg like or
oval, branching or free-ended.
[0138] The structural support may be constructed from unitary or
multi-component assemblies. The structural support may be:
machined, laser cut form a tube, etched from a sheet, assembled and
joined strips, molded, deposited and or sintered.
[0139] The proximal end of the structural support may join and lock
to the anchor substrate. The proximal end may also interface with
the delivery instrument. The proximal end may have suitable
features for delivery, actuation, locking and release. Such
features may include, for example, one or more thread, socket, pin,
snap, collet, cable mechanisms and other suitable mechanism.
Anchoring Substrate
[0140] The apparatus may include one or more anchoring substrates.
An anchoring substrate may receive one or more anchors and hold
them in a desired position with or without the joint assistance of
the structural support and with or without cancellous bone. The
anchoring substrate may be sized and shaped such that it may be
engaged by an anchor that penetrates into the intramedullary
space.
[0141] The anchoring substrate may be sized and shaped such that
once the anchoring element penetrates into the intramedullary
space, the anchoring substrate may engage the anchor. The anchoring
substrate may provide to an anchor tension that is supplemental to
tension caused by the engagement of the anchor and the anchoring
substrate.
[0142] There are several methods by which the anchors and the
anchoring substrate may engage.
[0143] Some of the methods are passive engagement methods. In
passive engagement, anchoring substrate features may be
appropriately sized to engage an anchor. For example, the anchor
and anchoring substrate may be configured such that they engage in
a manner analogous to a screw and hole. A laser cut structure could
take any shape necessary to achieve appropriate anchor engagement
and retention. The receiving cavities ("cells") could be round,
square, slotted, triangle, or any shape that facilitated
engagement. The geometry of the cells may be that of a shortening
design. The cells may form a matrix, a "fabric," or a "cloth." The
anchoring substrate may include a single layer or multiple
layers.
[0144] Matrix characteristics may be varied along an axis of the
anchoring substrate to provide anchoring characteristics along the
axis. For example, cell geometry may be varied to provide
engagement with different types of anchors. Anchoring substrate
thickness may be varied to provide different degrees of anchor
retention strength and forces.
[0145] There are several approaches to active engagement. One such
approach is cell size reduction. The anchoring substrate may be
deformed such that the size of cells is reduced. The cell size
reduction may cause tightening (or locking) of the cell onto the
anchor.
[0146] Another such approach involves relative displacement between
first and second anchoring substrates. The relative displacement
effectively reduces cell size when corresponding cells are offset
from each other. The relative displacement may be axial,
rotational, radial, etc. . . . The relative displacement may trap
an anchor between the two displaced anchoring substrates and
effectively lock or hold the anchor. Cells of selected shapes,
either similar or different, in the first and second anchoring
substrates may be moved in a cooperative manner to trap or engage
the anchor.
[0147] Another such approach involves twisting the anchoring
substrate. This action may be similar to stretching and locking the
anchor in the medium of the substrate. Other approaches include
wrapping, plicating and bunching the anchoring substrate. A
plicated or bunched configuration may exert force by having several
layers of material binding on the anchor at one time, effectively
wire tying the anchor.
[0148] The arrangement of different portions of the anchoring
substrate may be selected to facilitate engagement with an anchor.
Portions of the anchoring substrate may extend radially away from a
central or longitudinal axis of the apparatus or the anchoring
substrate. Portions of the anchoring substrate may be supported in
a perpendicular orientation with respect to the axis.
[0149] After the anchoring substrate is engaged with an anchor, the
anchoring substrate may apply tension to the anchor. The tension
may urge the anchor to move relative to the structural element.
This can be accomplished by moving the anchoring substrate in an
axial direction relative to the structural member. If the anchoring
substrate is moved proximally relative to the structural support,
tension would be applied to the anchors and their corresponding
fracture segments.
[0150] The tension may be achieved by reducing the diameter of the
anchoring substrate. This can be accomplished though lengthening
and therefore reducing the anchoring substrate diameter. The
tension may be applied by wrapping, folding, twisting, rotating or
radially pulling in the anchoring substrate. The plicated or
bunched configuration mentioned above may be used for this
approach.
[0151] In some embodiments, the anchoring substrate may be internal
to the structural support. In some embodiments, the anchoring
substrate may be external to the structural support. Some
embodiments may include one or more anchoring substrates that are
internal to the structural support and one or more anchoring
substrates that are external to the structural support. In some
embodiments, the anchoring substrate may be attached to the
structural support.
[0152] In some embodiments, the anchoring substrate may cooperate
mechanically with the structural support. The anchor substrate may
provide structural integrity to the device. For example, the matrix
may include interlockable features. The interlocking features may
become interlocked during or after the anchoring substrate is
expanded.
[0153] In some embodiments, the anchoring substrate may be
mechanically independent of the structural support. This may allow
for relative movement between the anchoring substrate and the
structural support.
[0154] The anchoring substrate may be expandable. The anchoring
substrate may expand simultaneously with the structural support.
The anchoring substrate may be expanded by the structural support.
The anchoring substrate may be expanded by a delivery device such
as a balloon. The substrate may be self-expanding. Self-expanding
embodiments may include spring like elements. Self-expanding
embodiments may include elements that include shape memory
materials, such as shape memory alloys. In some embodiments, the
anchoring substrate may be non-expanding. In some embodiments, the
anchoring substrate may be expandable by mechanical actuation.
[0155] The anchoring substrate may be constructed in many different
forms and of many different materials. The forms may include, for
example, braid, mesh, weave, strand, laser cut members, deposited
members or other filament construction. The anchoring substrate
cells may be round elements, square element, rectangular elements,
or profiled, or a combination of cell types. The anchor substrate
cells may be designed to mimic bone and act as a growth or graft
scaffold.
[0156] The anchoring substrate may be made form a unitary element
such as an extruded tube or flat sheet with a pattern cut into it
that would facilitate engagement. Examples include a laser-cut
tube, a stamped or etched sheet, and other suitable approaches.
[0157] The anchoring substrate may be made of many materials
including but not limited to; Nitinol, Titanium, steel alloys,
polymers, porous materials, sponge like materials, sintered metal,
etched materials, deposited material, extruded material and molded
materials.
Anchors
[0158] Anchors may facilitate the attachment of bone segments to
the anchoring substrate. The anchors may mate, couple, engage, lock
and otherwise interact with the anchoring substrate. Some of the
anchors may be configured to engage the bone. Some of the anchors
may be configured to not engage the bone.
[0159] An anchor may have an elongated element. The elongated
element may include one or catch features that are configured to
engage the anchoring substrate. The engagement may be occur
substantially immediately after penetration of the anchoring
substrate by the anchor. The engagement may occur only after a
predetermined length of the elongated member has passed into the
anchoring substrate. Some anchors may lock to the anchoring
substrate. Some anchors may not lock to the anchoring substrate
[0160] Catch features may be self-actuating. Catch features may be
user actuated.
[0161] Anchors may have any suitable length. Anchors of different
lengths may be used in conjunction with the apparatus. The anchors
can be configured to enter and engage the anchoring substrate with
an end portion of the anchor. Those anchors, after they are locked,
may terminate inside the anchoring substrate. Some anchors may be
configured to pass through the anchoring substrate and engage bone
on an opposite side of the anchoring substrate. Some anchors may be
configured to not engage bone on either side of the anchoring
substrate. Example anchors include: screws, helical elements, T
bar, barbed features, anchors cut from a tube, with tabbed
features.
[0162] In some embodiments, anchors may be used in conjunction with
buttress elements such as plates, washers, spacers and the
like.
[0163] A proximal anchor may be inserted to anchor a proximal
portion of the anchoring substrate to the bone. In some
embodiments, the proximal anchor may be engaged to preserve tension
in the anchoring substrate. In some embodiments, the proximal
anchor may be configured to adjust the tension.
Central Axis Member
[0164] In embodiments that include a central axis member, the
central axis member may be used to position the apparatus, actuate
one or more changes (e.g., of expansion state or stress state) of
the apparatus, move one portion of the apparatus relative to
another portion of the apparatus and provide mechanical support
(e.g., rigidity) to the apparatus.
[0165] In some embodiments, the apparatus may have a distal end and
a proximal end. The support structure may have a distal end and a
proximal end. The anchoring substrate may have a distal end and a
proximal end. The central axis member may have a distal end and a
proximal end. In some embodiments, the central axis member may
extend proximally beyond the proximal ends of the structural
support and the anchoring member. In those embodiments, an
intermediate portion of the central axis member may generally align
with the proximal ends of the structural support and the anchoring
substrate.
[0166] The central axis member may be used to maintain rigidity of
the structural support and/or the anchoring substrate. In those
embodiments, the distal end of the central axis member may be
longitudinally fixed to the distal end of the structural support
and/or the anchoring substrate. The proximal end or intermediate
portion of the central axis member may be longitudinally fixed to
the proximal end of the structural support and/or the anchoring
substrate.
[0167] The central axis member may be used to adjust the length of
the structural support and/or the anchoring substrate. In those
embodiments, the distal end of the central axis member may be fixed
to the distal end of the structural support and/or anchoring
substrate. The proximal ends of the structural support and/or
anchoring substrate may be longitudinally movable (whether
linearly, rotationally or otherwise) with respect to the central
axis member. As such, the central axis member may be used to expand
the structural support or the anchoring substrate. The central axis
member may be used to lock the apparatus in an expanded
configuration. The central member may be locked in place by other
elements of the apparatus.
[0168] In some embodiments, the central axis member may be used to
place a lower or upper limit on the longitudinal separation between
distal and proximal ends of the support structure and/or anchoring
substrate. This may be accomplished by providing detents at
selected locations along the central axis member.
[0169] In some embodiments, the central axis member may be used to
linearly displace the structural support relative to the anchoring
substrate or the anchoring substrate relative to the support
structure. The central axis member may be used to linearly displace
one anchoring substrate relative to another anchoring substrate. In
such embodiments, the central axis member may be longitudinally
fixed to whichever of the structural support and the anchoring
substrate that is to be moved relative to another.
[0170] The central axis member may be used to mechanically load the
structural support and/or the anchoring substrate. The load may be
in tension, compression or rotation. The load may be applied by
suitable engaging the central axis member with a portion of the
structural support and/or anchoring substrate. The central axis
member may then be loaded, for example, at its proximal end. The
central axis member may then transfer the load through the
engagement with the structural support and/or anchoring
structure.
[0171] Where the central axis member is longitudinally fixed to the
structural support and/or anchoring substrate, it may remain free
to rotate. Where the central axis member is not longitudinally
fixed, the apparatus may include suitable bushings, bearings,
frictional surfaces and the like to permit suitable linear
displacement and/or rotation between the central axis member and
the structural support and/or anchoring substrate.
[0172] For example, the central axis member may be longitudinally
fixed to the distal end of the structural support and rotationally
fixed to the proximal end of the anchoring substrate. The distal
end of the anchoring substrate may or may not be rotationally fixed
to the distal end of the support structure. The central axis may
thus be used in different configurations to deform (e.g., wrap,
fold, twist, etc.) the anchoring substrate. Similar configurations
may be used to deform the structural support.
[0173] In some embodiments, the central axis member may include or
serve as an anchoring substrate. The central axis member may be
removable so that it may be removed from the apparatus after its
desired effect is achieved.
[0174] The central member may be flexible or rigid. The central
member may be integral with one or both of the structural support
and the anchoring substrate. The central axis member may include
one or more cables, coils, thread, braids, extrusions, beading,
rods, bundles, strands, meshes, nested elements and the like.
Apparatus Removal
[0175] The apparatus may be removable from the bone. Approaches for
removal may include collapsing the apparatus.
[0176] In some instances, tissue may grow into interstices of the
apparatus. Energy (e.g., vibrations, ultrasonic energy, heat and
the like) may be coupled into the apparatus to release the tissue.
When heat energy is used, the heat may be generated from energy in
any suitable form, such as radio frequency, microwave, induction,
electrical resistance, and others.
[0177] The apparatus and methods may include removal instruments
such as a hollow drill, a coring drill and the like. The apparatus
may fit inside one or more of such instruments.
Bone Ingrowth
[0178] One or more surfaces of the apparatus may be coated with
agents that promote bone ingrowth. The agents may include calcium
phosphate, heat treated hydroxylapatite, Basic fibroblast growth
factor (bFGF)-coated hydroxyapatite, hydroxyapatite/tricalcium
phosphate (HA/TCP), and other suitable agents, including one or
more of those listed in Table 1.
[0179] One or more surfaces of the apparatus may be coated with
agents that inhibit or prohibit bone ingrowth. Such surfaces may
include impermeable and other materials such as one or more of
those listed in Table 1.
Drug Delivery
[0180] One or more surfaces of the apparatus may be coated with
agents that may elute therapeutic substances such as drugs.
Complications
[0181] The apparatus and methods may include means to address
complications that may be associated with bone implants. One such
complication is infection. The apparatus and methods may include
features that counteract infection. For example, such a feature may
include a coating. The coating may include antibiotics such as
tobramycin or other effective antimicrobials. Another such feature
may be the delivery of heat to raise the apparatus temperature
sufficiently high to kill bacteria and other undesirable tissues on
or near the implant.
Installation
[0182] The following is one illustrative method of installation of
the apparatus in a bone that has a fracture. The procedure may be
completed either in an inpatient or an outpatient setting. [0183]
1. Provisionally reduce the fracture using standard techniques
[0184] 2. Access the intramedullary cavity in a location that
causes minimal tissue damage to the patient and sufficient access
for the physician; proximal or distal. [0185] 3. Introduce a
delivery catheter into the bone near the area of the fracture.
Position can be confirmed on fluoroscopy. [0186] 4. Deploy the
structural support. A positioning aid, which may be a central axis
member, may be used. External manipulation may be applied. [0187]
5. Reposition the fractured bone into its ideal healing location.
The positioning aid may then be locked into the wall of the
intramedullary cavity by deploying the anchoring mechanism. [0188]
6. Deploy an anchor tensioning element (such as an anchoring
substrate) into the space inside the structural support and near
the location of the fracture. [0189] 7. Deploy anchors in the
fracture fragments, either externally or internally, depending on
accessibility. The anchors are driven through both the fragments
and the anchoring substrate. [0190] 8. Confirm location of the
fragments via x-ray, fluoro, or direct visualization. Apply tension
as needed to position the fracture in the desired position with
adequate pressure on the fragment surfaces to stabilize the
fracture for healing. [0191] 9. Lock the apparatus in place. [0192]
10. Disengage delivery instruments from the apparatus. Remove the
delivery instruments from the patient, and close patient.
[0193] Numerous other steps may be involved and many different
sequences of steps may be practiced without departing from the
principles of the invention.
Materials
[0194] The apparatus and portions thereof may include any suitable
materials. Table 1 lists illustrative materials that may be
included in the apparatus and portions thereof.
TABLE-US-00001 TABLE 1 Materials Category Type Material Metals
Nickel titanium alloys Nitinol Stainless steel alloys 304 316L
BioDur .RTM. 108 Alloy Pyromet Alloy .RTM. CTX-909 Pyromet .RTM.
Alloy CTX-3 Pyromet .RTM. Alloy 31 Pyromet .RTM. Alloy CTX-1
21Cr--6Ni--9Mn Stainless 21Cr--6Ni--9Mn Stainless Pyromet Alloy 350
18Cr--2Ni--12Mn Stainless Custom 630 (17Cr--4Ni) Stainless Custom
465 .RTM. Stainless Custom 455 .RTM. Stainless Custom 450 .RTM.
Stainless Carpenter 13-8 Stainless Type 440C Stainless Cobalt
chromium MP35N alloys Elgiloy L605 Biodur .RTM. Carpenter CCM alloy
Titanium and titanium Ti--6Al--4V/ELI alloys Ti--6Al--7Nb Ti--15Mo
Tantalum Tungsten and tungsten alloys Pure Platinum Platinum -
Iridium alloys Platinum - Nickel alloys Niobium Iridium Conichrome
Gold and Gold alloys Absorbable Pure Iron metals magnesium alloys
Polymers Polyetheretherketone (PEEK) polycarbonate polyolefin's
polyethylene's polyether block amides (PEBAX) nylon 6 6-6 12
Polypropylene polyesters polyurethanes polytetrafluoroethylene
(PTFE) Poly(phenylene sulfide) (PPS) poly(butylene terephthalate)
PBT polysulfone polyamide polyimide poly(p-phenylene oxide) PPO
acrylonitrile butadiene styrene (ABS) Polystyrene Poly(methyl
methacrylate) (PMMA) Polyoxymethylene (POM) Ethylene vinyl acetate
Styrene acrylonitrile resin Polybutylene Membrane Silicone
materials Polyether block amides (PEBAX) Polyurethanes Silicone
polyurethane copolymers Nylon Polyethylene terephthalate (PET)
Goretex ePTFE Kevlar Spectra Dyneena Polyvinyl chrloride (PVC)
Absorbable Poly(glycolic acid) (PGA) polymers Polylactide (PLA),
Poly(.epsilon.-caprolactone), Poly(dioxanone)
Poly(lactide-co-glycolide) Radiopaque Barium sulfate materials
Bismuth subcarbonate Biomaterials Collagen Bovine, porcine, ovine,
amnion membrane Bone growth Demineralized bone matrix factors Bone
morphogenic proteins (BMP) Calcium phosphate Heat-treated
hydroxylapapatite Basic fibroblast growth factor (bFGF)-coated
hydroxyapaptite Hydroxyapaptite/tricalcium phosphate (HA/TCP Anti-
microbial Coatings
[0195] The apparatus may be provided as a kit that may include one
or more of a structural support, an anchoring substrate, a central
axis member, an anchor, a delivery instrument and associated
items.
[0196] Apparatus and methods in accordance with the invention will
now be described in connection with the FIGS. The FIGS. show
illustrative features of apparatus and methods in accordance with
the principles of the invention. The features are illustrated in
the context of selected embodiments. It will be understood that
features shown in connection with one of the embodiments may be
practiced in accordance with the principles of the invention along
with features shown in connection with another of the
embodiments.
[0197] Apparatus and methods described herein are illustrative.
Apparatus and methods of the invention may involve some or all of
the features of the illustrative apparatus and/or some or all of
the steps of the illustrative methods. The steps of the methods may
be performed in an order other than the order shown and described
herein. Some embodiments may omit steps shown and described in
connection with the illustrative methods. Some embodiments may
include steps that are not shown and described in connection with
the illustrative methods.
[0198] Illustrative embodiments will now be described with
reference to the accompanying drawings, which form a part
hereof.
[0199] The apparatus and methods of the invention will be described
in connection with embodiments and features of an illustrative bone
repair device and associated hardware and instrumentation. The
device and associated hardware and instruments will be described
now with reference to the FIGS. It is to be understood that other
embodiments may be utilized and structural, functional and
procedural modifications may be made without departing from the
scope and spirit of the present invention.
[0200] FIG. 1 shows illustrative device 100 implanted in bone B,
which is illustrated as a radius. Bone B includes bone portions
P.sub.B, P.sub.h and P.sub.a in distal end D. Bone segment P.sub.B,
is the largest portion of bone B. Bone segment Ph is a head
portion. Bone segments P.sub.h and P.sub.a include articular
surface AS. Bone portions P.sub.B, P.sub.h and P.sub.a are
separated or partially separated along fractures F.sub.a and
F.sub.h. Fracture F.sub.a transects articular surface AS. Fracture
F.sub.h transects head H.
[0201] It will be appreciated that bone portions P.sub.B, P.sub.h
and P.sub.a define an illustrative fracture in bone B. Device 100
may be used to treat fractures that have a greater or lesser number
of bone portions. The bone portions may have different shapes,
orientations and sizes from those shown in FIG. 1. It will be
appreciated also that the fracture shown in FIG. 1 is illustrated
as a fracture near the end of a long bone, but device 100 may be
used to treat fractures in other portions of long bones, such as
the midshaft, and in bones that may be identified as being other
than long bones, e.g., vertebrae.
[0202] Device 100 is elongated along its longitudinal axis L.sub.D
(in which D indicates device). Device 100 is in intramedullary
space IS of bone B. Distal end 102 of device 100 is in epiphyseal
region E of bone B. Proximal end 104 is in or adjacent diaphyseal
region D of bone B. Portions of device 100 that are between distal
end 102 and proximal end 104 are in metaphyseal region M of bone
B.
[0203] Device 100 may include structural cage 105. Structural cage
105 may include support members 106. Support members 106 may extend
from cage base 108 to distal hub 110. (The direction extending from
cage base 108 will be referred to as the "distal direction." The
opposite direction will be referred to as the "proximal direction."
"Distal," relative to "proximal," generally means the leading end
of apparatus that is inserted, or is to be inserted, in the body.)
The distance along axis LD between cage base 108 and distal hub 110
may be adjusted to change the shape of support members 106.
[0204] When cage base 108 is maximally spaced apart from distal hub
110, structural cage 105 is in a compressed state. When cage base
108 and distal hub 110 are pushed or drawn together, structural
members 106 are deflected radially outward along radial direction
R.sub.D (in which "D" indicates device). In this way, structural
cage 105 may expand. Device 100 is shown in an expanded state. In
some embodiments, structural members 106 and anchor substrate 124
may self-expand radially. This may draw base 108 and distal hub 110
together longitudinally.
[0205] Structural cage 105 may be used to provide support to bone
portions P.sub.B, P.sub.a and P.sub.h. The support may include
aligning and stabilizing bone segments P.sub.B, P.sub.a and P.sub.h
during reduction and/or healing. The support may be subchondral
support. Structural cage 105 may be used to provide load resistance
to bone B during healing.
[0206] Device 100 may include anchoring substrate 112. Substrate
112 may be engaged by anchors such as 114 and 116. Anchor 114
fastens bone segment Ph to substrate 112. Anchor 116 fastens bone
segment Pa to substrate 112. The anchors may engage substrate 112
in a wide range of positions. The anchors may engage substrate 112
from a wide range of angles. Each of the anchors may apply a force
to its respective bone portion. The force may be oriented to
appropriately position the bone portions for healing. The force may
be directed at least in part toward axis LD. The force may be
considered an inward force (at least partially in direction
-R.sub.D). Structural cage 105 may apply to the bone portions a
force that is directed at least in part away from axis L.sub.D. The
force from structural cage 105 may be considered an outward force
(at least partially in direction R.sub.D).
[0207] Anchors 114 and 116 are illustrated as threaded screws, but
any suitable anchors may be used.
[0208] The anchors, anchoring substrate and support structural cage
may thus be used in concert to select for each bone portion one or
more of a desired position, orientation and force. One or both of
the position and orientation may be selected by appropriate
selection of anchor size, anchor position, anchor tension,
structural cage size, and support member configuration and
position. Because the position and orientation may be selected, the
bone portions may be appropriately aligned relative to each
other.
[0209] Device 100 may include stem 128. Stem 128 may extend in the
proximal direction from cage base 108. Stem 128 may include stem
anchoring substrate 118 and proximal base 120. Stem anchoring
substrate 118 may support proximal base 120. Anchor 122 may fasten
stem 128 to bone B portion P.sub.B. Anchor 122 may be engaged such
that it applies longitudinal and/or rotational forces to device
100. Anchor 122 may be engaged such that it applies a radial force
to device 100. The radial force may induce or counteract bending of
device 100 along axis L.sub.D. Anchor 122 may apply a resistive
longitudinal force to device 100. The resistive longitudinal force
may resist forces applied to device 100 by distal anchors 114 and
116.
[0210] Proximal base 120 may support device retention feature 122.
Device retention member 126 may be used to engage device 100 for
insertion and manipulation. A device manipulator (not shown) may be
used in conjunction with device retention member 126 to draw device
100 in the proximal direction.
[0211] Device may include illustrative central member hub 130.
Central member hub 130 may be used to recapture and remove device
100 after deployment.
[0212] Drawing device 100 in the proximal direction may adjust
forces (tensile, compressive or both) between bone portions
P.sub.a, P.sub.h and P.sub.B. Drawing device 100 in the proximal
direction may adjust the orientation and position of bone portions
P.sub.a with respect to P.sub.B. In some embodiments, anchor 122
may be used to retain the compressive forces after device 100 is
drawn in the proximal direction.
[0213] Device 100 may include central axis member 124. Central axis
member 124 may extend from distal hub 110, through cage base 108
and through proximal base 120 into intramedullary space IS of bone
B. Central axis member 124 may be used to effect expansion of
structural cage 105. Some embodiments may not include central axis
member 124. (In some embodiments, anchoring substrate 112 may be
drawn proximally relative to structural cage 105 to adjust the
tension while maintaining the position and support of the bone
segments.)
[0214] In some embodiments, central axis member 124 may be used to
expand structural cage 105 by applying tension between hub 100 and
cage base 108 and/or 120. In some embodiments, this may be done by
applying simultaneously a proximally directed force to central axis
member 124 and a distally directed force to cage base 108. In some
embodiments, central axis member may be rotatably connected to hub
110 and threaded through cage base 108. In those embodiments,
structural cage 105 may be expanded by rotating central axis member
124. In some embodiments, structural cage 105 may be
self-expanding.
[0215] The final expanded shape may be designed into the structure
of structural cage 105. The final expanded shape may be limited by
the space available in the cavity. The expansion may be elastic and
may be based on a spring material that returns to a predetermined
shape.
[0216] Device 100 in its compressed state may be delivered into the
body through a small access incision along the mid shaft section
bone (D, in FIG. 1) in an area where soft tissue disruption can be
minimized.
[0217] FIG. 1A shows device 100 in isometric view. Structural cage
105 includes support members 106. Support members 106 may expand or
contract along direction R.sub.D based on relative positioning of
cage base 108 and hub 110 along device axis L.sub.D. Support cage
105 may be contracted for introduction into intramedullary space
IS.
[0218] Support cage 105 is illustrated as having six support
members 106. It will be appreciated that any suitable numbers of
support members may be used. for example, support cage 105 may have
a number of support members 106 in the range of 2-40 or more than
40.
[0219] Support members 106 are illustrated as having a rectangular
cross-sectional shape. It will be appreciated that support members
106 may have any suitable cross-sectional shape. For example, the
cross-sectional shape may be round, square, braided, stranded or
profiled. Support cage 105 may include support members that have
different cross-sectional shapes, dimensions or material
properties. When support members have different shapes, dimensions
or material properties, support cage 105 may undergo non-radial
deformation. Such deformation may be helpful for conforming device
100 to the inside of bone B (including bone segments P.sub.a,
P.sub.h and P.sub.B).
[0220] Support members 106 are illustrated as being joined at cage
base 108 and hub 110. The ends of the members are shown joined at
both ends. In some embodiments, support members 106 may have one or
more free or partially free ends.
[0221] Support members 106 may be cut of a single tube or could be
made independently and then joined.
[0222] Anchoring substrate 112 is present inside structural cage
105. Anchoring substrate 112 may have a collapsed state and an
expanded state. The collapsed state may be used for delivery. The
expanded state may be used for deployment and fracture repair.
[0223] In some embodiments, anchoring substrate 112 may include a
laser-cut structure. Anchoring substrate 112 may be constructed so
as to engage with an anchor such as 114 (shown in FIG. 1) and hold
the anchor under a mechanical load. In some embodiments, anchoring
substrate 112 may be affixed to support cage 105. Anchoring
substrate 112 may be affixed to one or more of hub 110, one or more
portions of support members 106, central axis member 124, cage base
108 and proximal base 120.
[0224] In some embodiments, anchoring substrate 112 may not be
affixed to device 100 (although it may be retained by support cage
105). Such lack of attachment may facilitate adjustment of the
tension and loading of bone segments.
[0225] FIG. 1B is a cross-sectional view taken along lines 1B-1B
(shown in FIG. 1A). FIG. 1B shows central axis member 124 running
from hub 110 (not shown) through anchoring substrate base 132
(which is concentrically within cage base 108), stem 128, proximal
base 120 and device retention member 126.
[0226] Central member hub 130 protrudes proximally from device
retention member 126. Central member hub 130 may be configured to
be engaged to adjust or control tension and or rotation of central
member 124. Manipulation of central member hub 130 may facilitate
delivery and expansion of structural cage 105, and or anchor
substrate 112. Central member hub 130 may maintain tension between
distal and proximal ends of structural cage 105 or anchoring
substrate 112.
[0227] Device retention member 126 may be used to in connection
with delivery, manipulation and or removal of device 100.
[0228] Stop 134 on central axis member 124 may be drawn in proximal
direction D.sub.P by pulling central member hub 130 in direction
D.sub.P relative to stem 128. In some embodiments, this may be
accomplished by pushing device retention member 126 distally
(-D.sub.P) while pulling central member hub 130 proximally. The
pushing and pulling may be accomplished using apparatus and methods
shown and described herein or known grasping device
instruments.
[0229] Stop 134 will urge anchoring substrate base 108 in direction
D.sub.P. Anchoring substrate base 108 will then draw anchoring
substrate 112 in direction D. Motion of anchoring substrate 112 in
direction DP will apply force to anchors 114 and 116. The force may
have a distal component and a radially inward (-R.sub.D) component.
The force may thus compress bone segments Pa and Ph against bone
segment P.sub.B (shown in FIG. 1).
[0230] Stop 134 may transfer longitudinal force from device
retention member 126 in a proximal direction to anchor substrate
112 through the coupling mechanism between device retention member
126, proximal base 120 and central member hub 130. Alternatively
central axis member 124 may be coupled mechanically to cage base
108 by a ratchet, screw or other suitable mechanism.
[0231] FIG. 1C shows a view taken along lines 1C-1C (shown in FIG.
1A). FIG. 1C shows expanded support cage 105 (including hub 110)
and expanded anchoring substrate 112. Locking anchor 122 is also
shown.
[0232] One or more of the surfaces or elements of device 100 may
include a coating. The coating may include an agent. The agent may
provide a bone growth promotion agent, a bone growth inhibition or
prohibition agent, a drug eluting agent or any other suitable
agent.
[0233] FIG. 2 shows illustrative skeleton S. Skeleton S includes
illustrative bones S.sub.i in which device 100 (shown in FIG. 1)
may be used as shown and described in connection with bone B (shown
in FIG. 1). Table 2 includes a partial list of bones S.sub.i.
TABLE-US-00002 TABLE 2 Bones S.sub.i. Reference numeral in Bone
FIG. 2 Distal Radius S.sub.0 Humerus S.sub.1 Proximal Radius and
Ulna (Elbow) S.sub.2 Metacarpals S.sub.3 Clavicle S.sub.4 Ribs
S.sub.5 Vertebrae S.sub.6 Ulna S.sub.7 Hip S.sub.8 Femur S.sub.9
Tibia S.sub.10 Fibula S.sub.11 Metatarsals S.sub.12
[0234] FIG. 3 schematically shows anatomy of bone B (shown in FIG.
1). Anatomical features of bone B are listed in Table 3. Apparatus
and methods in accordance with the principles of the invention may
involve one or more of the anatomical features shown in Table 3.
Features of bone B may be described in reference to bone axis
L.sub.B (in which B indicates bone) and radius R.sub.B (in which B
indicates bone).
TABLE-US-00003 TABLE 3 Anatomical features of some of the bone
types that may be treated by the apparatus and methods. Reference
numeral Anatomical feature in FIG. 3 Articular surface B.sub.0
Cancellous, spongy or trabecular bone B.sub.1 Medullary cavity
B.sub.2 Cortical or dense bone B.sub.3 Periosteum B.sub.4 Proximal
articular surface B.sub.5 Diaphysis or midshaft B.sub.6 Metaphysis
or end region B.sub.7 Epiphysis B.sub.8 Articular surface
B.sub.9
[0235] The terms "end-bone" and "end-bone fracture" may be used to
refer to fractures that occur in the epiphyseal or metaphyseal
region of long bones. Such fractures include peri-articular and
intra-articular fractures.
[0236] FIG. 4 shows portion 400 of an illustrative surgical
environment in which a fracture in bone B may be diagnosed and
treated. Patient P may be sedated appropriately. A limb nerve block
may be administered. A pressure cuff may be used to maintain limb Q
in a relatively blood-free state. Limb Q may be supported by
procedure table 402 and any other appropriate supports to manage
the position of bone B during surgery. Environment 400 may include
imaging system 404.
[0237] FIG. 5 shows illustrative therapeutic scenario 500. In
scenario 500, manual traction techniques are applied to reestablish
anatomic reduction in fracture F.sub.p in bone B.
[0238] Provisional or temporary reduction is often undertaken in
fracture repair to restore bone segments to their normal positions
before they are anchored.
[0239] When the number of bone segments is small and/or the
dislocation of the bone segments is modest, closed reduction
techniques may be employed. Closed reduction does not include
incisions and utilizes manual traction by one or more physicians.
The physicians will utilize different tension, compression, and
bending motions to reestablishing normal bone segment positioning.
A physician or assistant may maintain the normal bone segment
positions during an implant procedure.
[0240] For more displaced fracture patterns, a limited open
reduction can be utilized. K-Wires, external probes, and special
clamps can be employed for the provisional reduction. Small
incisions can be made allowing the probes and clamps to aid in
repositioning the fracture segments. Once the bone segments are in
position k-wires can be utilized to maintain the reduction. K-Wires
are approximately 1-2 mm in diameter metallic wires that can be
driven across fracture lines to provide temporary support. The
k-wires may be positioned and then removed strategically to
facilitate the procedure in a way that reduces interference with
bone cavity preparation or implant deployment.
[0241] FIG. 6 shows illustrative sheath 600. Hollow sheath 600 is
shown entering intramedullary space IS of bone B. Sheath 600 may
include lumen 610. Lumen 610 may provide access to intramedullary
space IS. Sheath 600 enters intramedullary space IS at position
602. Position 602 may be in diaphyseal section D of bone B.
Position 602 may be selected to minimize soft tissue damage. Near
position 602, a small incision may be made in the soft tissue (not
shown). The tissue may be displaced to reveal bone surface BS.
[0242] A standard orthopaedic drill instrument may be used to
create access hole 604 in bone B. Axis hole 604 may be drilled
along axis L.sub.h. Axis L.sub.h may form an angle A with bone axis
L.sub.B. Angle A may be an acute angle.
[0243] Hole 604 may be similar to commonly drilled bone access
holes. Hole 604 may be sufficiently small that hole 604 does not
cause stress risers at position 602. Distal end 606 of sheath 600
may be advanced, through intramedullary canal IC, into metaphyseal
region M of bone B. Proximal end 608 of sheath 600 may be
positioned in hole 604. Distal end 606 may be disposed in any
portion of intramedullary space IS, such as in the end-bone.
[0244] Sheath 600 may be a thin-walled flexible cannula. Sheath 600
may be similar to the cannulas that are commonly used in minimally
invasive or percutaneous interventional procedures elsewhere in the
body. Sheath 600 may be made of rigid metal that is shaped to
promote access to intramedullary space IS.
[0245] FIG. 7 shows illustrative intramedullary space reamer 700.
Reamer 700 may be expandable and contractible. Reamer 700 may in a
contracted state be inserted in proximal end 608 of sheath 600
(shown in FIG. 6). Reamer shaft 702 may be used to advance reamer
700 through lumen 610 into metaphyseal region M of bone B. Reamer
700 may have suitable features at or about surface 704 for removing
undesirable tissue, such as cancellous bone, from the end-bone.
Reamer shaft 702 may rotate reamer surface 704 about, and translate
it along, bone axis L as appropriate to prepare the end-bone for
further treatment.
[0246] In some embodiments, the use of reamer 700 may be consistent
with procedures that are used in the implantation of intramedullary
nails. Such procedures include the application of one or more of
ultrasonic energy, vibration, RF energy, pressure, rotation, water
jetting, suction and other suitable mechanisms to remove the
undesirable tissue. In some embodiments, reamer 700 may have one or
more of the following features: expansion, fixed size
(non-expanding), uni-directional reaming, multi-directional
reaming, rigid reamer shaft 702, flexible reamer shaft 702 and
steerability.
[0247] FIG. 8 shows a stage in the delivery of device 100 to
end-bone of bone B. In FIG. 8, device delivery apparatus 800 is
engaged with device retention element 126 at the proximal end of
device 100. Shaft 802 may control positioning and rotation of
device delivery apparatus 800. Delivery apparatus 800 may include a
keyed grasper for engagement and disengagement of portions of
device 100 (shown in FIG. 1). Device 100 is in a compressed state.
Device 100 is positioned within lumen 610 of sheath 600. Distal hub
110 of device 100 is in epiphyseal region E of bone B. Support
members 106 and stem 128 are also shown within lumen 610.
[0248] FIG. 9 shows a subsequent step in the delivery of device 100
to the end-bone of bone B. In FIG. 9, device delivery apparatus 800
has moved device 100 distally out of sheath 600. Structural cage
105 has been expanded in the end-bone. In the example illustrated,
the end-bone spans from the bone segments to midshaft D of bone B
intramedullary space IS.
[0249] FIG. 9 also shows proximal delivery apparatus controller
900. Controller 900 may include handle 902, trigger mechanism 904
and set screw 906. Handle 902 may be used to apply, via shaft 802,
the forces that are necessary to position and expand device 100.
Trigger mechanism 904 may be used to engage or disengage device
retention member 126.
[0250] FIG. 10 shows the fastening of bone segment P.sub.a to
anchoring substrate 112. A small incision may be made in skin K in
an optimal location. Then, a small pilot hole may be made in the
bone segment P.sub.a. Provisional reduction may be maintained by
assistant's hand 1002, tong/clamp type instruments, k-wires or
other known methods. Support 1004 may be provided to position bone
segments P.sub.a, P.sub.h and P.sub.B, for the insertion of anchor
116. Then, instrument 1000 may be used to drive anchor 116 through
bone segment P.sub.a. Instrument 1000 may be a screwdriver or other
suitable instrument.
[0251] FIG. 11 shows anchor 114 fastening bone segment Ph to
anchoring substrate 112. Device 100 may be stabilized in bone B
using device delivery apparatus 800.
[0252] FIG. 12 shows tensioning device 100 in intramedullary space
IS of bone B. Anchors 114 and 116 have been completely or almost
completely driven into bone segments P.sub.h and P.sub.a,
respectively. Anchors 114 and 116 are secured inside bone B by
anchoring substrate 112. The inward forces applied by anchors 114
and 116, in concert with anchoring substrate 112, and the outward
forces applied by support members 106 of structural cage 105, have
brought bone segments P.sub.h and P.sub.a into alignment along
fracture F.sub.a and have closed fracture F.sub.a. The torque
(applied to the anchors), angle and positioning of anchors 114 and
116 may be selected to provide a desired contact force between bone
segments P.sub.h and P.sub.a along fracture F.sub.a. The anchors
may lock to anchor substrate 112 to prevent unintentional
removal.
[0253] Fracture F.sub.h remains open by separation amount .DELTA.f,
which separates P.sub.a and P.sub.h from P.sub.B, the main segment
of bone B. Intersegment compression of bone segments P.sub.a,
P.sub.h and P.sub.B, may be provided using one or more of device
100, device delivery apparatus 800 and delivery apparatus
controller 900. The compression may help reduce or eliminate
.DELTA.f. The compression may promote healing. The compression may
provide stability to the bone segments in rotation and bending.
[0254] In some embodiments, the compression may be provided by
drawing device 100 in proximal direction D.sub.p, substantially.
Length T of device 100 may be fixed, at least temporarily. For
example, length T may be held fixed using a mechanical relationship
of central axis member 124 to cage base 108 and hub 110. Device 100
may then be drawn in direction D.sub.p by device delivery apparatus
800. Device delivery apparatus 800 may be drawn in direction
D.sub.p by shaft 802. Shaft 802 may be drawn through lumen 610
using delivery apparatus controller 900.
[0255] Device 900 may include a mechanism that may be activated by
a trigger or lever such as 904 or 906. Shaft 802 may be drawn by
drawing delivery apparatus controller 900 in direction D.sub.h
along axis L.sub.h. Distal end 606 of sheath 600, to the extent
that it remains in intramedullary space IS, will travel generally
along direction D.sub.p and draw device 100 in that direction via
device delivery apparatus 800.
[0256] In some embodiments, length T may be allowed to extend when
device 100 is drawn in direction D.sub.p. Hub 110 may be
substantially retained in position relative to bone segment
P.sub.a. Cage base 108 may be allowed to be displaced in direction
D.sub.p. This may reduce radius R.sub.D of structural cage 105.
When the radius of structural cage 105 is reduced, radially outward
forces on bone may be reduced, canceled or reversed.
[0257] As the length of device 100 is increased while its radius
decreases, device 100 may collapse partially or completely to its
delivered state. Depending on the diameter of intramedullary space
IS of bone, B such contraction may be desirable to obtain proper
placement of the bone segments. After proper bone segment position
is obtained, the radial diameter can be adjusted to achieve the
desired shape and radial force. This condition can then be
maintained by locking central axis member 124 at distal and
proximal ends of device 100.
[0258] In some embodiments, a proximal portion of anchoring
substrate 112 may be drawn in direction D.sub.p. This may draw
anchors such as 114 and 116 in direction D.sub.p and direction
-R.sub.B. Anchoring substrate 112 may be drawn in direction D.sub.p
with a force that is greater, lesser or equal to that by which
structural cage 105 is drawn in direction D.sub.p.
[0259] In some embodiments, a physician may assess and, if
appropriate, adjust one or more of segments Pa, Ph and PB to
achieve a desired alignment. The assessment may be performed using
fluoroscopic imaging, for example, using imaging system 404 (shown
in FIG. 4). The assessment may be done under direct visualization
during a full surgical cut down procedure.
[0260] FIG. 13 shows the application of force .PHI. in direction
D.sub.p. Force .PHI. is applied to device 100 at device retention
member 126 by device delivery apparatus 800. .DELTA.f of fracture F
has been stabilized, reduced or substantially eliminated. Anchor
122 is now inserted through bone B into stem 128. Anchor 122 may
retain proximal portion of device 100 at or near an axial position
along bone axis L.sub.B. Anchor 122 may prevent device 100 from
rotating about bone axis L.sub.B. Anchor 122 may preserve the
intersegment compression between bone segments P.sub.a, P.sub.h and
P.sub.B. More generally, anchor 122 may preserve one or more of a
desired position, orientation and state of stress for each of the
individual bone segments. Anchor 122 may carry all or some of the
load. Friction between structural cage 105 and other portions of
device 100 may bear some of the load.
[0261] In some embodiments, the role of anchor 122 may be fulfilled
by several anchors that may be used to lock device 100 in bone B
while preserving the compression. Proximal anchors may gain
purchase from both sides of the bone or just through one side. The
angle of the anchors may range from near parallel to axis L.sub.D
to perpendicular to axis L.sub.D.
[0262] FIG. 14 shows the release of device retention member 126 (by
device delivery apparatus 800, which in FIG. 14 has been withdrawn
into sheath 600). Device retention member 126 is shown as a simple
keyed ball end that may be retained with a known grasping
instrument. Other types of retention mechanisms are also considered
and envisioned with respect to embodiments of the invention
including but not limited to; threaded, socket, pinned, snap,
collet, and any other mechanism known in the art.
[0263] FIG. 15 shows device in a final implanted state with sheath
600 (not shown) removed from intramedullary space IS of bone B.
Device 100 retains segments P.sub.a, P.sub.h and P.sub.B, in
compression relative to each other. Fractures F.sub.a and F.sub.h
are reduced.
[0264] FIG. 16 shows that device 100 may be recaptured in
intramedullary space IS and removed from bone B. Illustrative
delivery/recapture device 1600 may engage central member hub 130.
Engagement member 1602 at the distal end of delivery/recapture
device 1600 may slide over central member hub 130 and engage device
retention member 126. Support members 106 of support cage 105 may
contract as they are drawn into sheath 600.
[0265] FIG. 17 shows closure assembly 1700 that may be used to
close hole 604 and preserve access to device 100 in bone B. Closure
assembly 1700 may include plug 1702. Plug 1702 may seal or
substantially seal hole 604. Plug 1702 may cap cannula 1704.
Cannula 1704 may provide access to central member hub 130 (not
shown) and device retention member 126 (not shown). Flange 1706 may
engage with one or both of central member hub 130 (not shown) and
device retention member 126 (not shown). Flange 1706 may be affixed
to sheath 1704. Cannula 1704 may be configured to apply force to
device 100 to adjust tension or radial diameter in structural cage
105 or anchoring substrate 112.
[0266] In some embodiments, some or all of the functionality
provided by cannula 1704 may be provided by a cable or a shaft (not
shown). In some of those embodiments, plug 1702 may be a threaded
or ribbed plug, or a screw-like plug, that is linked to the
cable.
[0267] Cap 1702 may be removed to insert an instrument such as
engagement member 1602 to recapture device 100 in a manner such as
that shown in FIG. 16.
[0268] FIG. 18 shows illustrative delivery/recapture member 1802,
which in some embodiments may be an alternative to device retention
member 126 in a device such as 100 (shown in FIG. 1).
Delivery/recapture member 1802 may be formed from a tube. Notch
1810 may be cut into the tube. Any appropriate number of notches
such as 1810 may be present in delivery/recapture member 1802.
Delivery/recapture member 1802 may include ferrule 1804, which may
be affixed to proximal end 1806 of device stem 1806. Stem 1806 may
correspond to stem 128 of device 100 (shown in FIG. 1).
[0269] Recapture instrument 1812 may include one or more blades
such as blade 1814. Recapture instrument 1812 and blade 1814 may be
cut from a tube to match delivery/recapture member 1802 and notch
1810, respectively. Recapture instrument 1812 may be delivered
through a sheath such as 600 (shown in FIG. 6) into an
intramedullary space to retrieve a device attached to stem
1808.
[0270] Recapture instrument 1812 may be aligned with
delivery/recapture member 1802. Blade 1814 may be inserted into
cut-out 1816 in delivery/recapture member 1802. Recapture
instrument 1812 may be rotated such that blade 1814 moves into
notch 1810. Recapture instrument 1812 may thus engage
delivery/recapture member 1802 to pull the device in proximal
direction D.sub.P. Blade 1814 and delivery/recapture member 1802
may bend radially out of plane from each other to disengage. The
bending may be achieved by bending or releasing a spring-like
mechanism or by plastic deformation of recapture instrument
1812.
[0271] FIG. 19 shows illustrative device 1900. Device 1900 may have
features that function like some or all of the corresponding
features of device 100 (shown in FIG. 1). For example, device 1900
may include supports 1906 that form cage 1905. Cage 1905 may
include cage base 1908. Anchoring substrate base 1932 may be
present concentrically within cage base 1908. Device retention
member 1926 may extend proximally from anchoring substrate base
1932. Device 1900 does not include a stem such as stem 128.
Proximal anchor 1932 may be used to engage a bone such as B (shown
in FIG. 1) with the proximal end of anchoring substrate 1912.
[0272] FIG. 20 shows a cross-section of device 1900 taken along
lines 20-20 (shown in FIG. 19). Illustrative central axis member
1924 is fixed at hub 1910 of support cage 1905. Central axis member
1924 may include flange 1902. Flange 1902 may be mechanically
locked into chamber 1904 of device retention member 1926. In some
embodiments, central axis member 1924 may be moved axially until
flange 1902 snaps into chamber 1904. This may lock-in central axis
member 1924 between proximal end 1920 and distal end 1922 of device
1900 and thus provide axial tension that may support the radial
stiffness of device 1900. Central axis member 1924 may distribute
tension that may be applied to device retention member 1926 between
proximal end 1920 and distal end 1922 of device 1900.
[0273] In some embodiments, device 1900 may be expanded before
deployment (as in an open reduction). In such embodiments,
structural support 1905 and anchoring substrate 1932 may be
longitudinally fixed with respect to each other at proximal end
1920 and distal end 1922 of device 1900.
[0274] FIG. 21 shows, in cross-section, illustrative ratchet
mechanism 2100. Ratchet mechanism 2100 may be used to preserve
tension in a central axis member such as 124 (shown in FIG. 1). A
portion of such a central axis member may be embodied as ribbed
member 2102. Ribbed member 2102 may be drawn through tabbed member
2104 in proximal direction D.sub.P. Rib 2106 may be drawn in
direction DP by deflecting annular tab 2108. After rib 2106 passes
annular tab 2108, annular tab 2108 moves back to its rest position
(as shown) and prevents rib 2106 from moving back to a position
that is distal to annular tab 2108.
[0275] Ratchet mechanism 2100 may be provided in or about an
anchoring substrate base such as 132, in or about a stem such as
128, in or about a proximal base such 120 or in or about device
retention member 126 (all shown in FIG. 1). Tabbed member 2104 may
be longitudinally fixed to the device. The central axis member may
be provided over a portion of its length with ribbed member 2102.
The central axis member may thus be drawn in proximal direction
D.sub.P and locked in place by annular tabs 2108. This may preserve
tension in portions of the central axis member that are distal of
tabs 2108.
[0276] Ratchet features may take on any shape or form to facilitate
one-way locking. The one-way locking may be permanent or
releasable. In some embodiments, tabs 2104 may be releasable so
that ribbed member 2102 may be adjusted in either longitudinal
direction.
[0277] The ratchet features may be incorporated into the apparatus.
The ratchet features may be integral to one or more portions of the
apparatus. For example, device stems, such as those shown in FIG.
25 may include complementary ratchet features so that when the
stems are in a concentric relationship, the inner stem can move in
only one direction.
[0278] FIG. 22 shows an end view of ratchet mechanism 2100 (shown
in cross section, along lines 21-21, in FIG. 21).
[0279] FIG. 23 shows illustrative stacking rings 2300 that may form
all or a portion of a central axis member such as 124 (shown in
FIG. 1). The rings are shown as one continuous helix. In some
embodiments, the rings may be individual annular rings with
stacking features similar to helical stacking rings 2300.
[0280] FIG. 24 is a cross-sectional view taken along lines 24-24.
The helical rings form S-links that interlock with each other under
longitudinal loading of the stack--either in compression or in
tension. The shape of stacking rings 2300 is such that may they
wedge together in either compression or tension and effectively
reduce the mechanical degree of freedom to move relative to each
other. All or a portion of a central axis member such as 124 (shown
in FIG. 1) may include a segment of helical rings 2300. When loaded
in tension or compression, the central axis member may become
straight and rigid. The straightness and rigidity may increase the
amount of load, whether in tension, compression, or bending, that
may be supported by a device such as 100.
[0281] FIG. 25 shows illustrative device 2500, which is in
accordance with the principles of the invention. Device 2500 may
include central axis member 2502. Central axis member 2502 may
include cellular body 2504. Central axis member 2502 may include
device retention member 2506.
[0282] Device 2500 may include intermediate member 2507.
Intermediate member 2507 may include anchoring substrate 2506.
Anchoring substrate 2506 is shown in an expanded state.
Intermediate member 2507 may include stem 2508. Stem 2508 may be
continuous with anchoring substrate 2506. Neck support 2510 may
provide structural support and connection between anchoring
substrate 2506 and stem 2508. When anchoring substrate 2506 is in a
contracted state, intermediate member 2507 may contract to a
diameter substantially equivalent to that of stem 2508. Device
retention member 2512 may be present at the end of stem 2508.
[0283] Device 2500 may include outer member 2514. Outer member 2514
may include support cage 2516. Support cage 2516 is shown in an
expanded state. Outer member 2514 may include stem 2518. Stem 2518
may be continuous with support cage 2516. Neck support 2520 may
provide structural support and connection between support cage 2516
and stem 2518. When support cage 2516 is in a contracted state,
outer member 2514 may contract to a diameter substantially
equivalent to that of stem 2528. Device retention member 2522 may
be present at the end of stem 2518.
[0284] FIG. 25 shows inner member 2502, intermediate member 2507
and outer member 2514 separate from each other, but they may be
used together to perform some or all of the functions of device 100
(shown in FIG. 1). Inner member 2502, intermediate member 2507 and
outer member 2514 may respectively correspond, at least in part, to
a central axis member such as 124, an anchoring substrate such as
112 and a support cage such as 105 (shown in FIG. 1).
[0285] One or both of intermediate member 2507 and outer member
2514 may be self-expanding. One or both of intermediate member 2507
and outer member 2514 may be expandable by mechanical
actuation.
[0286] FIG. 26 shows device 2500 in an assembled and expanded
configuration. Inner member 2502 extends longitudinally inside
intermediate member 2507. Intermediate member 2507 extends
longitudinally inside outer member 2514. Device retention members
2506, 2512 and 2522 extend from the proximal end of device 2500.
Proximal anchor 2524 transects stems 2518 (of outer member 2514)
and 2508 (of intermediate member 2507, not shown) and cellular body
2504 of inner member 2502.
[0287] In the absence of proximal anchor 2524, inner member 2502,
intermediate member 2507 and outer member 2514 may be moved
longitudinally, with respect to each other, along axis LD. The
relative motion may be induced by delivery/recapture instruments
engaged with each of the device retention members. For example, a
delivery/recapture instrument such as 1812 (shown in FIG. 18) may
be provided for each of the device retention members. The three
recapture instruments may be coaxial with each other.
[0288] In some embodiments, one or more of inner member 2502,
intermediate member 2507 and outer member 2514 may be coupled to
each other at the distal end of device 2500 to obtain an
appropriate response to the application of longitudinal and
rotational forces that may be applied to one or more of inner
member 2502, intermediate member 2507 and outer member 2514. The
response may be modified by coupling one or more of inner member
2502, intermediate member 2507 and outer member 2514 to each other
at a more proximal portion of device 2500.
[0289] Inner member 2502, intermediate member 2507 and outer member
2514 are shown having closed distal ends. In some embodiments, one
or more of the members may have an open or free distal end.
[0290] In some embodiments of the invention, device 2500 may not
include inner member 2502. Those embodiments may include
intermediate member 2507 and outer member 2514. In some
embodiments, device 2500 may include two or more intermediate
members 2507 and or two or more outer members 2514. For example, in
some embodiments, device 2500 may include inner member 2502,
intermediate member 2507, outer member 2514 and, external to outer
member 2514, a fourth member (not shown), that is similar to
intermediate member 2507. In some embodiments, device 2500 may
include, internal to the other members, a fourth member (not shown)
that is similar to outer member 2514. The device may include,
radially outside the fourth member, intermediate member 2507, a
fifth member (not shown) that is similar to intermediate member
2507, and outer member 2514.
[0291] FIG. 27 shows outer member 2514 in a contracted state. In
some embodiments, outer member 2514 may have bending flexibility
along longitudinal axis L.sub.D, as shown in FIG. 27. Inner member
2502 and intermediate member 2507 may also have bending flexibility
along longitudinal axis LD. The flexibility may facilitate access
into intramedullary space IS of bone B. In some embodiments, the
contracted configuration of device 2500 may include curvature to
facilitate access into intramedullary space IS of bone B.
[0292] FIG. 28A shows illustrative two-member fracture repair
device 2800. Device 2800 is shown in a contracted state. Device
2800 may be self-expanding or balloon-expanding. Device 2800 may
include cage member 2802 and anchoring member (inside cage member
2802) 2804.
[0293] Cage member 2804 may include support cage 2806. Support cage
2806 may include support members 2810. Support members 2810 may
terminate at distal hub 2812 and cage base 2814. Cage stem 2816 may
extend proximally from cage base 2814. Cage stem 2816 may terminate
at device retention member 2818. Support cage 2806 may be expanded
in an intramedullary space IS (shown in FIG. 1).
[0294] Anchoring member 2804 may include anchoring substrate 2820.
Anchoring member 2804 may include anchoring stem 2822 and device
retention member 2824. In the contracted state, anchoring member
2804 may slide longitudinally within cage member 2804.
[0295] FIG. 28B shows device 2800 in the expanded state. Support
cage 2806 is expanded. Anchoring substrate 2820 is expanded.
[0296] FIG. 28C shows is a partial cross section, taken along lines
28C-28C (shown in FIG. 28B) of device 2800 in the expanded state.
Anchoring substrate 2820 is present inside support cage 2806.
Anchoring stem 2822 is present inside cage stem 2816. Device
retention member 2824 is present inside cage stem 2816.
[0297] Distal anchors may attach bone segments to anchoring
substrate 2820. Device retention members 2824 and 2818 may be
translated longitudinally, together or relative to each other, to
apply force to the anchors in proximal direction D.sub.P and inward
radial direction -R.sub.D.
[0298] Device 2800 may be self-expanding. Device 2800 may be
plastically deformable and be expanded by an outside force. One or
more elements of device 2800 may be made from a unitary member such
as a laser cut tube. One or more elements of device 2800 may be
made individually and later assembled.
[0299] FIG. 29 shows illustrative bone fracture repair device 2900,
which is in accordance with the principles of the invention. Device
2900 is shown inserted inside humerus B.sub.H. Humerus B.sub.H
includes fractures F.sub.1 and F.sub.2, which separate bone
segments P.sub.1 and P.sub.2, respectively, from bone segment P.
Device 2900 may include support cage 2902. Device 2900 may include
anchoring substrate 2904. Support cage 2902 and anchoring substrate
2906 are shown in an expanded state. Device 2900 may include
central axis member 2924.
[0300] Anchor 2907 and 2908 may be present to anchor bone segments
P.sub.1 and P.sub.2, respectively, to anchoring substrate 2904.
[0301] Device 2900 may include relative displacement actuator 2910.
Actuator 2910 may effect relative displacement of support cage
2902, anchoring support 2904 and central member 2906. During
delivery of device 2900 to intermedullary space IS, device 2900 may
be in a contracted state (not shown). During deployment, device
2900 may be expanded. The expansion may be performed, for example,
by differential movement, along device longitudinal axis LD, of
proximal portion 2912 of support cage 2902 and proximal portion
2914 of anchoring substrate 2904. During deployment, anchor 2907
and 2908 may be inserted after expansion of device 2900.
[0302] Device 2900 may include relative displacement actuator 2910
for effecting the differential displacement. Actuator 2910 may
include threaded support cage base 2916. Threaded support cage base
2916 may be longitudinally fixed to proximal end 2912 of support
cage 2902. Threaded support cage base 2916 may include a first
threaded longitudinal bore (not shown).
[0303] Actuator 2910 may include double threaded anchoring
substrate base 2918. Double threaded substrate base 2918 may be
fixed to proximal portion 2914 of anchoring substrate 2904. Double
threaded substrate base 2918 may have outer threads 2920 that may
be screwed into the first longitudinal threaded bore of support
cage base 2916. Double threaded substrate base 2918 may include a
second threaded longitudinal bore (not shown).
[0304] Actuator 2910 may include threaded central axis member base
2922. Threaded central axis member base 2922 may be fixed to the
proximal end of central axis member 2906. Threaded central axis
member base 2922 may have outer threads 2924 that may be screwed
into the second threaded longitudinal bore in double threaded
substrate base 2918.
[0305] One or more control instruments may be deployed by catheter
to rotate one or more of cage base 2916, double threaded anchoring
substrate base 2918 and threaded central axis member base 2922 to
achieve desired displacement or displacements between the proximal
portions of support cage 2902, anchoring substrate 2904 and central
axis member 2906. The differential displacements may expand the
device during deployment.
[0306] After deployment of device 2901, anchors 2907 and 2908 may
be inserted through bone segments P1 and P2, respectively, into
anchoring substrate 2904. After insertion of anchors 2907 and 2908,
relative displacement actuator 2910 may be used to adjust the
stress state of bone segments P.sub.1 and P.sub.2. For example,
double threaded anchoring substrate base 2918 may be rotated such
that it moves in proximal direction DP relative to support cage
base 2916. This relative motion would draw bone segments P.sub.1
and P.sub.2, relative to support cage 2902, in proximal direction
DP and in inward radial direction -R.sub.D.
[0307] After appropriate positioning of device 2900 and appropriate
relative displacement of support cage 2902 and anchoring substrate
2904, a proximal anchor such as 1922 (shown in FIG. 19) may be
inserted through femur B.sub.F and anchoring substrate 2904 to hold
device 2900 in place.
[0308] FIG. 30 shows a cross-sectional view of device 2910 taken
along lines 29-29 in FIG. 29. FIG. 29 shows threaded support cage
base 2916 longitudinally fixed to proximal portion 2912 of support
cage 2902. Double threaded anchoring substrate base 2918 is
threaded into the first threaded bore of support cage base 2916.
Double threaded anchoring substrate base 2918 is longitudinal fixed
to proximal portion 2914 of anchoring substrate 2904. Threaded
central axis member 2922 is threaded into the second threaded bore
of double threaded anchoring substrate base 2918. Central axis
member 2906 extends in distal direction (-D.sub.P) from threaded
central axis member 2922.
[0309] FIG. 31 shows illustrative balloon-expandable fracture
repair device 3100. Device 3100 may include outer structural member
3102. Outer structural member 3102 may include structural cage
3104, stem 3106 and device retention member 3108. Device 3100 may
include anchoring member 3110. Anchoring member 3110 may include
anchoring substrate 3112, anchoring member stem 3114 and device
retention member 3116.
[0310] Structural cage 3104 and anchoring substrate 3112 may be
positioned in a contracted state in an intramedullary space of a
bone using device retention members 3108 and 3116, respectively.
The device retention members may be used to position structural
cage 3104 and substrate 3112 longitudinally relative to each
other.
[0311] Balloon 3118 may be present inside anchoring substrate 3112.
Catheter 3120 may provide appropriate gas pressure for inflation of
anchoring substrate 3112.
[0312] Membrane 3130 may be present about outer structural member
3102. Membrane 3130 may substantially entirely cover device 3130.
Membrane 3130 may be disposed on the exterior or interior of device
3100, or between described elements of device 3100.
[0313] Membrane 3130 may include elastic material. Membrane 3130
may include non-elastic material. Membrane 3130 may include woven
polyester, EPTFE film, a PET balloon, a silicon film, a
polyurethane film, any suitable material that may be produced in a
film form, any suitable material that may inhibit tissue growth,
any suitable biocompatible, biodegradable and/or bioabsorbable
material, and any other suitable material.
[0314] Membrane 3130 may facilitate the removal of the device 100
by inhibiting bone growth into device 100. In some embodiments,
membrane 3130 may inhibit ingrowth of tissue in interstitial spaces
of device 3100.
[0315] In some embodiments, membrane 3130 may facilitate the
delivery or recapture of material that may be used in connection
with device 3100, such as bone cement.
[0316] Membrane 3130 may be structurally integrated into device
3100. Membrane 3130 may be configured to be used with device 3100
as an ancillary or accessory component. The component may be used
as needed for fracture repair.
[0317] In some embodiments, membrane 3130 may be used to expand
structural cage 3104. In some embodiments, membrane 3130 may be
used to expand anchoring substrate 3112. In such embodiments,
membrane 3130 may be detachable from structural cage 3104 and/or
anchoring substrate 3112. Membrane 3130 may then remain implanted
in the intramedullary space IS.
[0318] In some embodiments, membrane 3130 may be removable
independently of other elements of device 3100.
[0319] Membrane 3130 may include an agent. The agent may be
impregnated in membrane 3130. The agent may be present as a coating
on membrane 3130. The agent may provide a bone growth promotion
agent, a bone growth inhibition or prohibition agent, a drug
eluting agent or any other suitable agent.
[0320] FIG. 32 shows a cross sectional view taken along lines 32-32
of device 3100. FIG. 32 shows catheter 3120 entering anchoring
substrate 3112. Balloon 3118 may be filled from ports 3122 in
catheter 3120. Anchoring substrate contour 3124 may be
predetermined by its materials and construction (or both).
[0321] FIG. 33 shows illustrative anchoring member 3300. Anchoring
member 3300 may be used in a device such as device 3100 (shown in
FIG. 31) and may correspond to anchoring member 3110. Anchoring
member 3300 may include distal ring 3302, anchoring substrate 3304,
stem 3306 and device retention member 3308.
[0322] In some embodiments, a balloon such as 3118 (shown in FIG.
31) may be inserted inside anchoring member 3300 to expand
anchoring member 200. In some embodiments, device 3300 may be
self-expanding.
[0323] Collar 3302 has a substantially fixed radius and may not
expand. Collar 3302 may include rings 3303. Rings 3303 may be
arranged in a nested configuration in which rings 3303 are
partially or substantially perpendicular to axis L.sub.D. Rings
3303 may be coaxial with axis L.sub.D. In such configurations,
rings 3303 may facilitate coupling to a central axis member such as
124 (shown in FIG. 1) and/or a structural cage such as 105 (shown
in FIG. 1).
[0324] When a balloon is used for expansion, the balloon may be
situated a sufficient distal distance away from stem 3306 so that
the radius of stem 3306 remains substantially the same during
expansion of the balloon.
[0325] Anchoring substrate 3304 may include expansion band 3310.
Expansion band 3310 includes expansion cells such as 3312, which
may deform along directions C.sub.D and -C.sub.D under radially
outward (direction RD) stress from the expanding balloon. Band 3310
has a number of expansion cells along its circumference. The number
of expansion cells along the circumference of a band such as 3310
is referred as the cell density.
[0326] Groups of cells that are relatively expandable in response
to a longitudinal compression may be considered to have a high
"expansion ratio." Groups of cells that are relatively inexpandable
in response to the same longitudinal compression may be considered
to have a low "expansion ratio." Variations in cell density, cell
shape, cell "leg" (material bordering the cell that separates the
cell from other cells or material) (or "strut") length, cell leg
thickness and other suitable parameters may be used to vary the
expansion ration.
[0327] Anchoring substrate 3304 may include expansion band 3314.
Expansion band 3314 has a cell density that is greater than the
cell density of band 3310. When subjected to outward radial force
from the balloon, expansion band 3314 will thus expand in radial
direction R.sub.D more than expansion band 3310 will expand.
Expansion band 3316 has the same cell density as expansion band
3314. Expansion band 3318 has the greatest cell density and
therefore may expand in radial direction R.sub.D more than the
other expansion bands.
[0328] The longitudinal variation in cell density along
longitudinal anchoring substrate 3340 may result in a radial
expansion that varies. Cell density, band width (such as band 3316
width 3318) and band position along axis L.sub.D may be chosen to
provide an expanded contour of anchoring substrate 3304 that
conforms in a desired way to a support cage such as 105 (shown in
FIG. 1) or an intramedullary space such as IS (shown in FIG. 1).
Circumferential variations (in direction C.sub.D) in cell density
may provide circumferentially varying expansion radii. Such
variations may be used to provide an anchoring substrate that has a
contour that corresponds to, or contours with, an asymmetric
intramedullary cavity, such as at the end of a humerus.
[0329] FIG. 34 shows illustrative anchoring substrate 3402 for a
fracture repair device in accordance with the principles of the
invention. Anchoring substrate 3402 may be supported at distal end
3404 by flange 3406. Anchoring substrate 3402 may be supported at
proximal end 3408 by flange 3410. Central axis member 3412 may be
longitudinally fixed to flange 3406. Flange 3410 may be
substantially free to translate with respect to central axis member
3412. This allows distance T between the flanges to decrease so
that anchoring substrate 3402 can expand in radial direction
R.sub.D.
[0330] Device 3400 may be self-expanding. Anchoring substrate 3402
may include braided mesh. In some embodiments, device 3400 may
include multiple anchoring substrates.
[0331] FIG. 35 shows anchoring substrate 3414 in an expanded state
between flanges 3406 and 3410. Flange 3410 has been moved distally
up central axis member 3412. Anchoring substrate 3414 corresponds
to anchoring substrate 3402 (shown in FIG. 34), but may have a
longitudinally varying cell density and may therefore expand to a
greater radius then can anchoring substrate 3402.
[0332] After anchors are attached to anchor substrate 3414, flange
3410 may be drawn proximally to reduce the diameter of the
substrate and apply a tensile force to the attached anchor
elements. During such diameter reduction, the shape of the cells in
anchoring substrate 3414 may change. For example, the cells may, in
the expanded state, be generally square. In the contracted (or
relatively contracted) state, the cells may be diamond-shaped or
trapezoidal. The shape change may increase the strength of the
engagement between the anchoring substrate 3414. The shape change
may effectively lock the anchor into anchoring substrate 3414.
[0333] FIG. 36 shows illustrative anchoring substrate 3600 for a
fracture repair device in accordance with the principles of the
invention. Anchoring substrate 3600 may be attached to a central
axis member (not shown). Anchoring substrate 3600 may be welded,
crimped, woven or otherwise attached to the central axis member
along the length of the central axis member. For example, radially
inner portions 3602 may be attached to the central axis member.
[0334] In some embodiments, anchoring substrate 3600 may be
attached at its distal and proximal ends to a central member such
as 124 (shown in FIG. 1) and along its length to a structural cage
such as 105 (shown in FIG. 1). This type of attachment may to
facilitate wrapping or folding through relative rotation between
the cage and central member. In some embodiments, anchoring
substrate 3600 may be present within a structural cage such as 105
(shown in FIG. 1), but may be unattached or uncoupled to the
structural cage.
[0335] Anchoring substrate 3600 may have sufficient elasticity to
retain folds 3603. Surfaces 3604 and radially outer portions 3606
may engage anchors that press bone segments against a support cage
such as 105 (shown in FIG. 1). Anchoring substrate 3600 may include
secondary folds 3608 to increase the availability of surfaces 3604
to receive anchors.
[0336] The central axis member may be rotated in direction -C.sub.D
to draw the anchors inward in direction -R.sub.D approximately
toward the central axis member. The central axis member may be
drawn proximally to apply longitudinal force to the bone
segments.
[0337] FIG. 37 shows illustrative anchoring substrate 3700 for a
fracture repair device in accordance with the principles of the
invention. Anchoring substrate 3700 may be constructed, attached to
a central axis member and actuated as is anchoring substrate 3600
(shown in FIG. 36). Anchoring substrate 3700 may include primary
folds 3702. Anchoring substrate 3700 may not include secondary
folds such as 3608 in anchoring substrate 3600.
[0338] Some embodiments may include threadlike elements that are
intertwined with anchoring substrate 3600 and/or a structural cage
such as 105 (shown in FIG. 1). The threadlike elements may be
connected to the central axis member to facilitate drawing portions
of the anchoring substrate or structural cage toward the device
axis. In some embodiments, the threadlike elements may be pulled
through the central axis member by a delivery instrument.
[0339] FIG. 38 shows illustrative anchoring substrate 3800 for a
fracture repair device in accordance with the principles of the
invention. Anchoring substrate 3800 may be attached to a central
axis member (not shown). Anchoring substrate 3800 may be welded,
crimped or otherwise attached to the central axis member near a
proximal end of the central axis member. For example, radially
inner and proximal portions 3802 may be attached to the central
axis member. Anchoring substrate may have sufficient elasticity to
retain helical folds 3803. Folded surfaces 3804 may engage anchors
that press bone segments against a support cage such as 105 (shown
in FIG. 1).
[0340] Distal end 3808 of anchoring member 3800 may be fixed to a
flange, such as 3406 (shown in FIG. 35). The central axis member
may be free to rotate in direction -C.sub.D with respect to the
flange. When the central axis member is so rotated, it may tighten
helical folds 3803 and draw the anchors inward in direction
-R.sub.D approximately toward the central axis member. The central
axis member may be drawn proximally to apply longitudinal force to
the bone segments.
[0341] FIG. 39 shows illustrative anchoring substrate 3900 for a
fracture repair device in accordance with the principles of the
invention. Anchoring substrate may include stacked disc-like folds
3902. Disc-like folds may expand and contract longitudinally and
radially in an accordion-like fashion.
[0342] FIG. 40 shows anchoring substrate 3900 in cross-section as
viewed along lines 40-40 (shown in FIG. 39). When proximal end 3904
and distal end 3906 (e.g., at flange 3908) are displaced
longitudinally toward each other, anchoring substrate 3900 may
compress longitudinally and disc-like folds 3902 may expand in
direction R.sub.D. When proximal end 3904 and distal end 3906
(e.g., at flange 3908) are displaced longitudinally away from each
other, anchoring substrate 3900 may extend longitudinally and
disc-like folds 3902 may contract in direction -R.sub.D.
[0343] The longitudinal extension may be used to deploy anchoring
substrate in a radially compressed state. After deployment,
anchoring substrate may be longitudinally compressed so that folds
3902 expand in radial direction R.sub.D. Anchors may then be
engaged with folds 3902. Anchoring substrate 3900 may then be
longitudinally extended to apply radially inward force to the
anchors. Tension in direction DP may then be applied to the anchors
by pulling proximal end 3904. Folds 3902 may be biased at angle B
in direction -D.sub.P so that when end 3904 is pulled, fold axes Lf
are pre-aligned with the anchors.
[0344] Proximal portion 3904 may be attached to a pull member (not
shown) that may be similar to a portion of a central axis member
such as 124 (as shown in FIG. 1B). Distal end 3906, at flange 3908,
may be attached to a portion of the device that remains
substantially longitudinally stationary when the pull device pulls
on proximal portion 3904. For example, flange 3908 may be fixed to
the distal end of a corresponding support cage such as 105 (shown
in FIG. 1).
[0345] FIG. 41 shows illustrative support cage 4100 for a fracture
repair device in accordance with the principles of the invention.
Support cage 4100 may include hub 4102 and base ring 4104. Spiral
support members 4106 extend between hub 4102 and base ring 4104. A
central axis member (not shown) may extend along device axis
L.sub.D. The central axis member may have a distal end that is
longitudinally fixed to hub 4102. The central axis member may
extend through base ring 4104. Base ring 4104 may be moved along
the central axis member. When base ring 4104 is moved away from hub
4102, spiral support members 4106 may extend longitudinally and
straighten. As spiral support members 4106 straighten, ring 4104
may rotate.
[0346] Longitudinal extension of support cage 4100 may configure
support cage 4100 for deployment. Longitudinal compression of
support cage 4100 may configure support cage 4100 for deployment
and engagement with bone segment anchors. In some embodiments,
support cage 4100 may be expanded and collapsed by application of
an external rotational force.
[0347] In some embodiments, support cage 4100 may be
self-expanding. In those embodiments, support cage 4100 may have a
relaxed state that is longitudinally compressed. Support cage 4100
may be longitudinally extended for deployment. Support cage 4100
may then return to its relaxed state after deployment.
[0348] FIG. 42 shows illustrative hybrid support cage and anchoring
substrate 4200. Hybrid cage/substrate 4200 may include support
members 4202. Support members 4202 may support bone segments such
as P.sub.a, P.sub.h and P.sub.B (shown in FIG. 1). Hybrid
cage/substrate 4200 may include substrate members 4204 for engaging
anchors such as 114 and 116 (shown in FIG. 1). Substrate members
4204 may be supported by support members 4202. Substrate members
4204 and 4202 may expand and contract radially as a single
unit.
[0349] Hybrid cage/substrate 4200 may include stem 4206 and device
retention member 4208. Support members 4202 may be integrated with
substrate members 4204 in a single-layer structure. Substrate
members 4204 may have features that are described herein in
connection with anchoring substrates such as 112 (shown in FIG. 1).
For example, the substrate members 4204 may be formed to facilitate
anchor mating and retention. Hybrid cage/substrate 4200 may be used
alone or in concert with layers of other hybrid cage/substrates
like 4200 or with layers of other constructs such as devices
previously described herein like central axis member 2502 (shown in
FIG. 25), intermediate member 2507 (shown in FIG. 25), anchoring
member 3300 (shown in FIG. 33) and outer member 2514 (shown in FIG.
25).
[0350] FIG. 43 shows illustrative fracture repair device 4300 in
accordance with the principles of the invention. Device 4300
includes anchoring substrate 4302 and support cage 4304. Anchoring
substrate 4302 is radially outside support cage 4304. Device 4300
may include distal hub 4306. Distal hub 4306 may provide support
for proximal end 4308 of central axis member 4310. Proximal base
4312 may support proximal portions of anchoring substrate 4302 and
support cage 4304. Central axis member 4310 may pass through
proximal base 4312. Central axis member 4310 may support device
retention member 4314.
[0351] FIG. 44 shows illustrative fracture repair device 4400 in
accordance with the principles of the invention. Device 4400 may
include structural cage 4402 and anchoring substrate 4404. Device
4400 may include bushing 4406 for sliding proximal portion 4408 of
structural cage 4402 along central axis member 4410. Device 4400
may include bushing 4412 for sliding proximal portion 4414 of
anchoring substrate 4404 along central axis member 4410. The
bushings may support device retention members such as 1802 (shown
in FIG. 18). The device retention members may be used to expand and
contract device 4400. Spherical or sphere-like embodiments of
device 440 may provide a high radial compression strength, and
generate high radial compression forces, based on the shape.
[0352] FIG. 45 shows illustrative fracture repair device 4500 in
accordance with the principles of the invention. Device 4500 may
include a train of substantially spherical or sphere-like
structural cages 4502, 4504 and 4506 inside outer structural cage
4508. Device 4500 may include as many cages as desired to make a
train of a desired length. In some embodiments, an anchoring
substrate like 4300 (shown in FIG. 43) may be present. The
anchoring substrate may be present within or outside of structural
cage 4508.
[0353] In some embodiments, the cages may be partially spherical.
An anchoring substrate is present inside each of the structural
cages. Device 4500 may include bushings 4510 and 4512 for
positioning proximal end 4516 of outer structural cage 4508 and
proximal end 4514 of the train, respectively, along central axis
member 4518. Central axis member 4518 may be rigidly fixed at outer
structural cage hub 4520. Structural cages 4502, 4504 and 4506,
outer structural cage 4508 and the anchoring substrates may be
expanded and collapsed by sliding bushings 4510 and 4512 along
central axis member 4518.
[0354] FIG. 46 shows illustrative fracture repair device 4600 in
accordance with the principles of the invention. Device 4600 is
shown in long bone B.sub.L in a view that is similar to the view of
device 4500 along lines 46-46 that is shown in FIG. 45. Device 4600
may include a train of substantially spherical structural cages
4602, 4604 and 4606 inside outer structural cage 4608. Device 4600
may transect fracture F.sub.L.
[0355] An anchoring substrate may be present inside each of
structural cages 4602, 4604 and 4606. Device 4600 may include
device retention member 4610. Device retention member 4610 may be
configured to slide relative to central axis member 4612. Central
axis member 4612 may terminate proximally at device recapture
member 4614. Central axis member 4612 may terminate distally at
outer structural cage hub 4616, to which central axis member 4612
may be rigidly fixed.
[0356] Structural cages 4602, 4604 and 4606, outer structural cage
4608 and the anchoring substrates may be expanded and collapsed by
sliding device retention member 4610 relative to device recapture
member 4614. Ratcheted bushings 4618 may be present to retain
device 4600 in an expanded state. After device 4600 is expanded,
anchors 4620, 4622 and 4624 may be inserted through bone segments
B.sub.L1 and B.sub.L2 to engage the anchoring substrates.
[0357] A compressive traction may be applied to fracture FL by
initially inserting anchors 4620 and 4622, drawing device 4600 in
proximal direction D.sub.P relative to bone segment B.sub.L2, and
subsequently inserting anchor 4624.
[0358] FIG. 47 shows illustrative fracture repair device 4700 in
accordance with the principles of the invention. Device 47 is shown
deployed in intramedullary space IS of long bone B.sub.L. Device 47
bridges across fracture F.sub.L. Device 47 may include structural
cage 4702. Device 47 may include anchoring substrate 4704.
Structural cage 4072 may be deployed in intramedullary space IS.
Structural cage 4072 may provide radially outward support to bone
segments B.sub.L1 and B.sub.L2. Anchoring substrate 4704 may be
deployed within structural cage 4072.
[0359] Anchoring substrate 4704 may be engaged by anchors 4706,
4708, 4710 and 4712 to stabilize bone segments B.sub.L1 and
B.sub.L2 against structural cage 4702. A compressive traction may
be applied to fracture FL by initially inserting anchors 4706 and
4708, drawing device 4700 in proximal direction DP relative to bone
segment B.sub.L2, and subsequently inserting anchors 4710 and
4712.
[0360] Device 4700 is shown with substantially open ends. In some
embodiments, device 4700 may have ends that terminate at a hub or a
base, such as are shown and described herein. Device 4700 may be
used as shown or in conjunction with other devices that are shown
and described herein.
[0361] FIG. 48 shows illustrative anchor 4800 that may be used with
a fracture repair device in accordance with the principles of the
invention. Anchor 4800 may include elongated member 4802, head 4804
and tabs 4806. Anchor 4800 may be deployed using torque, axial
pressure or both. Elongated member 4802 may be inserted through a
bone segment. Tabs 4806 may be elastically deformable so that when
anchor 4800 is inserted through the bone segment, tabs 4806 lie
substantially even with the outer surface of elongated member
4802.
[0362] End 4808 may pass through a cell in an anchoring substrate
such as 112 (shown in FIG. 1). One or more of tabs 4806 may engage
the anchoring substrate and prevent anchor 4800 from being
disengaged from the anchoring substrate. Tabs 4806 may deflect to
lie substantially even with the outer surface of elongated member
4802 when anchor 4800 penetrates the anchoring substrate.
[0363] In some embodiments, tabs 4806 may have a predeployment
state in which tabs 4806 may lie substantially even with the outer
surface of elongated member 4802. Tabs 4806 may be deployed after
anchor 4800 is inserted through the bone and the anchoring
substrate. Tabs 4806 may be deployed by inserting an actuator shaft
(not shown) in the lumen of elongated member 4802. The actuator
shaft may push tabs 4806 radially outward.
[0364] Tabs 4806 may include an extensions (not shown) that extend
into the lumen of anchor 4800. The extensions may be extend away
from the "plane" of the tabs. The extensions may facilitate the
deployment of the tabs when the actuator shaft is driven down the
lumen and contacts the extensions.
[0365] Elongated member 4802 may be constructed from tube stock.
Tabs 4806 may be punched or laser cut from the tube. Head 4804 may
be welded to elongated member 4802. Head 4804 may include driver
receptacle 4804. The diameter of the tube stock may be selected to
correspond to that of the anchoring substrate cells to maximize the
interference (and between tabs 4806 and the anchoring substrate.
Such selection may provide suitable retention of the anchors.
[0366] FIG. 49 shows illustrative anchor 4900 that may be used with
a fracture repair device in accordance with the principles of the
invention. Anchor 4900 may include elongated member 4902, head 4904
and thread segments 4906. Anchor 4900 may be deployed using torque,
axial pressure or both. Elongated member 4902 may be inserted
through a bone segment. Thread segments 4906 may be elastically
deformable to ease insertion in the bone segment and engagement
with the anchoring substrate. Parameters of thread segments 4906
may be selected for engagement with an anchoring substrate. The
parameters may include minor diameter, major diameter, pitch and
any other suitable parameters.
[0367] Thread segments 4906 may include circumferential faces 4908
and corresponding circumferential locking faces 4910.
Circumferential locking faces 4910 may catch in the anchoring
substrate and prevent anchor 4900 from unscrewing from the
anchoring substrate.
[0368] FIG. 50 shows illustrative anchor 5000 that may be used with
a fracture repair device in accordance with the principles of the
invention. Anchor 5000 may include elongated member 5002, head 5004
and thread segments 5006. Thread segments 5006 may have some or all
of the features of thread segments 4906 (shown in FIG. 49). For
example, thread segments 5006 may include circumferential faces
5008 and corresponding circumferential locking faces 5010.
Circumferential locking faces 5010 may catch in the anchoring
substrate and prevent anchor 5000 from unscrewing from the
anchoring substrate.
[0369] Anchor 5000 may be deployed using torque, axial pressure or
both.
[0370] Anchor 5000 may include articulating catch 5012.
Articulating catch 5012 may in a non-deployed state be present in
lumen 5014 of elongated member 5002. Rod 5014 may be depressed in
lumen 5014 and may push on leg 5018 of catch 5012. Leg 5018 may
urge hinge 5020 out of port 5022 in elongated member 5002.
Corresponding catch 5024 may be deployed in a similar fashion. Legs
5018 and 5026 may catch in the anchoring substrate after deployment
of catches 5012 and 5024. Anchor 5000 may thus be locked to the
anchoring substrate.
[0371] FIG. 51 shows illustrative anchor 5100 that may be used with
a fracture repair device in accordance with the principles of the
invention. Anchor 5100 may include spiral member 5102, head 5104
and notches 5106. Anchor 5100 may be deployed using torque, axial
pressure or both.
[0372] Elongated member 5102 may be inserted through a bone
segment. A pilot hole in the bone segment may have a diameter
corresponding to diameter d of spiral member 5102. Spiral member
5102 may thus pass through the bone segment without substantial
rotation. In some embodiments, an anchor access hole in the bone
could be made for anchor 5100. The anchor access hole may have a
diameter that is no smaller than diameter d' of elongated member
5102 and is large enough to allow elongated member 5102 to be
helically threaded thru the hole. Such an access hole may be
smaller than a standard anchor hole.
[0373] Tip 5108 may then engage the anchoring substrate. Rotation
of anchor 5100 may then drive anchor 5100 relatively deeper into
the anchoring substrate. Notches 5106 may catch in the anchoring
substrate and prevent anchor 5100 from rotating out of engagement
with the anchoring substrate. End portion 5110 may be provided
without notches so that anchor 5100 may be backed out of the
anchoring substrate, if desired, before driving anchor 5100 into a
locked relationship with the anchoring substrate.
[0374] FIG. 52 shows illustrative anchor 5200 that may be used with
a fracture repair device in accordance with the principles of the
invention. Anchor 5200 may include elongated member 5202, head 5204
and catch 5206. Catch 5206 may be supported by and rotatable about
pin 5208. Catch 5206 may in a nondeployed state be present or
partially present in slot 5210 in elongated member 5202. For
example, catch 5206 may rotate in direction m such that tip 5212
rotates into slot 5210 and tip 5214 rotates into a position that
extends beyond elongated member 5202.
[0375] In such a configuration, elongated member 5202 may be
inserted through a bone segment. Tip 5214 may then traverse a
portion of the anchoring substrate. After the traverse, tip 5214
may rotate in the -m direction such that anchor 5200 returns to the
configuration shown in FIG. 52. The span of catch 5206 may exceed
the diameter of a cell in the anchoring substrate. Anchor 5200 may
thus be locked to the anchoring substrate.
[0376] In some embodiments, screw-actuator 5216 may be present in
bore 5218 of elongated member 5202. Screw-actuator 5216 may be
screwed into the bore. This action may reduce the effective length
of anchor 5200 and, therefore tension the bone segment to the
anchor substrate. In some embodiments, a tip (not shown) of
screw-actuator 5216 may deflect tip 5212 out of slot 5210 to rotate
catch 5206. Tip 5212 may be beveled to facilitate deflection by the
tip of screw-actuator 5216.
[0377] FIG. 53 shows anchors 5200 deployed and locked into
anchoring substrate 112 of device 100 (shown also in FIG. 1).
Anchors 5200 thus fasten bone segments Pa and Ph to anchoring
substrate 112.
[0378] FIG. 54 shows illustrative fracture repair device 5400 in
accordance with the principles of the invention. Device 5400 is
implanted in bone B. Wire 5402 passes through holes that are
drilled through bone segment P.sub.a, anchoring substrate 5404 and
bone segment PB to form loop 5406. The ends of wire 5402 may be
fastened to each other to secure bone portions P.sub.a, P.sub.h and
P.sub.B, to each other.
[0379] FIG. 55 shows illustrative fracture repair device 5500 in
accordance with the principles of the invention. Device 5500 is
shown deployed and locked in humerus B.sub.H. Support members 5502
generally conform to the contours of intramedullary space IS in
bone B.sub.H. Anchoring substrate applies tension in direction
D.sub.p to anchors 5504 and 5506. Proximal anchor 5508 retains the
tension.
[0380] Expanding cylindrical anchor 5510 is present coaxially about
structural cage base 5512. Anchor 5510 may expand radially when
compressed along axis L.sub.D. When anchor 5510 expands,
circumferential blades 5514 extend radially into bone B.sub.H.
Anchor 5510 may be compressed by longitudinally fixing distal end
5516 at a position on structural cage base 5512 and pushing
distally on proximal end 5518. A detent (not shown) may be provided
to prevent anchor 5510 from extending longitudinally. When locked
in the compressed state, anchor 5510 cuts into bone B.sub.H and
locks device 5500, or parts thereof, longitudinally. Anchor 5510
may be self-expanding when released from constraint. Anchor 5510
may be rotated during expansion to promote engagement with the
bone.
[0381] Expanding cylindrical anchor 5522 is shown connected
directly to anchoring substrate 5530. Anchor 5522 may be locked
after a desired tension is obtained in device 5500. Expanding
cylindrical anchor 5522 may have some or all of the features of
expanding cylindrical anchor 5510.
[0382] FIG. 56A shows illustrative expanding anchor 5600 that may
be used in accordance with the principles of the invention. Anchor
5600 may have some or all of the features of anchor 5510 (shown in
FIG. 55). Anchor 5600 may be cut from a tube. Compression along
axis L.sub.D causes articulation of living hinge 5604. The
articulation causes blades 5602 to extend radially away from axis
L.sub.D. Anchor 5600 may be self-expanding.
[0383] FIG. 56B shows a view of anchor 5600 from direction 56B-56B
(shown in FIG. 56A). FIG. 56C shows a view of anchor 5600 from
direction 56C-56C (shown in FIG. 56A).
[0384] FIG. 57A shows illustrative expanding helical anchor 5700
that may be used in accordance with the principles of the
invention. Helical anchor 5700 may have some or all of the features
of anchor 5510 (shown in FIG. 55). Anchor 5700 may be cut from a
tube. Compression along axis L.sub.D causes articulation of living
hinge 5704. The articulation causes blades 5702 to extend radially
away from axis L.sub.D. Anchor 5700 may be self-expanding.
[0385] FIG. 57B shows a view of anchor 5700 from direction 57B-57B
(shown in FIG. 57A). FIG. 57C shows a view of anchor 5700 from
direction 57C-57C (shown in FIG. 56A).
[0386] When helical anchor 5700 is rotated relative to surrounding
bone, it may move like a screw because of the helical form of
blades 5702. When helical anchor 5700 is rotated compressed and
rotated simultaneously, blades 5702 may carve out bone material
while anchor 5700 is being engaged in the bone. Carving out the
bone material may reduce hoop stress in the bone.
[0387] FIG. 58 shows illustrative bone fracture repair device 5800
in accordance with the principles of the invention in femur BF.
Device 5800 includes structural cage 5802 and anchoring substrate
5804. Anchors 5806 fasten portions (individual bone segments not
shown) of femur B.sub.F to anchoring substrate 5804. Structural
cage 5800 may include cage base 5808 which may be configured to
receive proximal anchor 5810. Proximal anchor 5810 may apply
tension to central axis member 5812. Proximal anchor 5810 may apply
tension to anchoring substrate 5804.
[0388] Device 5800 may be introduced at a site near point 5814 on
bone B.sub.F so that device 5800 may be delivered in an orientation
and at a position that is close to the desired deployed orientation
and position.
[0389] Buttress plate 5816 may be present adjacent bone BF.
Buttress plate 5816 may provide stability to anchors 5806 an 5814.
Buttress plate 5816 may distribute forces from anchors 5806 and
5814 to different portions of bone B.sub.F. Buttress plate 5816 may
accommodate as many anchors 5806 as appropriate to secure the
fracture. Buttress plate 5816 may have specially constructed mating
features to lock device 5800 at a desired angle with respect to
buttress plate 5816.
[0390] FIG. 59 shows illustrative bone fracture repair device 5900
in accordance with the principles of the invention in humerus
B.sub.H. In some embodiments, device 5900 may be completely
delivered and deployed through a single access hole (not shown).
Device 5900 includes structural cage 5902. Structural cage 5902 may
provide outward radial and longitudinal support for bone segments
P, P.sub.1 and P.sub.2.
[0391] Anchors may be delivered by steerable catheter into bone BH
and through a cage base such as 108 (shown in FIG. 1). Tethers 5904
and 5906 may apply inward radial and proximal tension to bone
segments P.sub.1 and P.sub.2, respectively. The tethers may be
delivered into humerus BH through an access hole (not shown) that
is proximal device 5900. Device 5900 may not include an anchoring
substrate.
[0392] T-bar anchor 5908 may anchor tether 5904 to bone segment
P.sub.1. T-bar anchor 5908 may have some or all of the features of
anchor 5200 (shown in FIG. 52). Screw-type anchor 5910 may anchor
tether 5906 to bone segment P.sub.2.
[0393] The tethers may be delivered through flared support tube
5912. Flared support tube 5912 may include one-way cleat 5914. The
tethers may be drawn in proximal direction Pd to apply tension to
the bone segments. One-way cleat 5914 may prevent release of the
tension.
[0394] FIG. 60 shows illustrative bone fracture repair device 6000
in accordance with the principles of the invention in humerus
B.sub.H. Device 6000 includes structural cage 6002. Structural cage
6002 may provide outward radial and longitudinal support for bone
segments P, P.sub.1 and P.sub.2. Structural cage 6002 and anchoring
substrate 6004. Anchors 6006, 6008 and 6010 may be delivered by
steerable catheter through cage base 6012 and into the interior of
anchoring substrate 6004. The anchors may then be inserted in bone
segments P.sub.1 and P.sub.2. The steerable catheter may then be
withdrawn. Anchoring substrate 6004 may then be drawn in proximal
direction D.sub.p using approaches shown and described herein or
other suitable methods. Drawing anchoring substrate 6004 in
direction D.sub.p may compress bone segments P.sub.1 and P.sub.2
against bone segment P.
[0395] FIG. 61 shows illustrative bone fracture repair device 6100
in accordance with the principles of the invention in bone B.
Device 6100 may be delivered to intramedullary space IS of bone B
through access hole 6101 in radial styloid S.
[0396] Device 6100 may include structural cage 6102, anchoring
substrate 6104 and central axis member 6106. Structural cage 6102
may include hub 6108, where support members 6110 rigidly join. Hub
6108 may support device retention member 6112.
[0397] Delivery sheath 6114 may provide access to intramedullary
space through styloid S. Delivery instruments (not shown) may
extend through delivery sheath 6114 and engage device retention
member 6112 for positioning and deployment of device 6100.
[0398] FIG. 62 shows illustrative plate 6200 that may be used in
connection with a bone fracture repair device in accordance with
the principles of the invention. Plate 6200 includes a plurality of
holes 6202 for passage of anchors.
[0399] Plate 6200 may support bone segments and a device such as
6300 (shown in FIG. 63) that is inside a bone. Plate 6200 may be
used during an open surgical procedure on the outer surface of the
bone. Plate 6200 may be stiff or flexible. The shape of plate 6200
may be selected for the capture of some or all of the bone segments
of the bone.
[0400] FIG. 63 shows illustrative bone fracture repair device 6300
in accordance with the principles of the invention. Device 6300 may
be used in connection with a plate such as 6200 (shown in FIG. 62).
Device 6300 may include structural cage 6302 and anchoring
substrate 6304. Anchors such as spiral anchors 6306 may be passed
through holes 6202 and bone segments P.sub.B, and P.sub.a. Anchors
6306 may have some or all of the features of anchors 5100 (shown in
FIG. 51). Anchors 6306 may anchor in, and lock to, anchoring
substrate 6304.
[0401] FIG. 64 shows device 4600 (shown in FIG. 46) deployed inside
vertebra V. Device 4600 provides outward radial support. Device
4600 may be used in vertebra V without anchors.
[0402] FIG. 65 shows an illustrative scenario for providing access
to proximal humerus PH. Introducing instrument 6502 may provide an
access hole in proximal humerus PH. Device 6504 may be introduced,
positioned, deployed and anchored near the end of proximal humerus
PH. Imaging device 6506 may be provided to provide visual
information about the location of anatomical features of proximal
humerus PH and device 6504.
[0403] FIG. 66 shows an illustrative scenario for deploying
illustrative bone fracture repair device 6600 in accordance with
the principles of the invention in open fracture F.sub.h of bone B.
Device 6600 may include structural cage 6602, anchoring substrate
6604 and central axis member 6606. Device 6600 may be inserted into
intramedullary space of bone B via fracture F.sub.h. Device 6600
may be inserted in a contracted state. Device 6600 may be inserted
in an expanded state.
[0404] FIG. 67 shows illustrative anchoring substrate 6700 that may
be used with a fracture repair device in accordance with the
principles of the invention. Anchoring substrate 6700 may include
elongated portion 6702. Elongated portion 6702 may be terminated
with end cap 6704. One or both of elongated portion 6702 and end
cap 6704 may include holes 6706. Holes 6706 may be engaged with
anchors to hold bone segments in place.
[0405] Anchoring substrate 6700 may be used for repairing bones
having open fractures such as fracture F.sub.h of bone B as shown
in FIG. 66. Anchoring substrate 6700 may be expandable. Anchoring
substrate may be non-expandable.
[0406] Apparatus and methods described herein are illustrative.
Apparatus and methods of the invention may involve some or all of
the features of the illustrative apparatus and/or some or all of
the steps of the illustrative methods. The steps of the methods may
be performed in an order other than the order shown and described
herein. Some embodiments of the invention may omit steps shown and
described in connection with the illustrative methods. Some
embodiments of the invention may include steps that are not shown
and described in connection with the illustrative methods.
[0407] Processes in accordance with the principles of the invention
may include one or more features of the processes illustrated in
FIG. 68. Some steps of the processes may be performed in an
inpatient setting. Some steps of the processes may be performed in
an outpatient setting.
[0408] FIG. 68 shows illustrative steps of process 6800 for
repairing a fracture. Process 6800 may begin at step 6802. At step
6802, a caregiver may provisionally reduce the fracture. At step
6804, the caregiver may establish access to the intramedullary
cavity in the fractured bone. At step 6806, the caregiver may
insert a catheter into the fractured bone. At step 6808, the
caregiver may confirm positioning of the catheter using fluoroscopy
(or any other suitable imaging approach). At step 6810, the
caregiver may deploy a structural support such as structural cage
105 (shown in FIG. 1). At step 6812, the caregiver may deploy an
anchoring substrate such as anchoring substrate 112 (shown in FIG.
1). At step 6814, the caregiver may insert anchors into the bone
segments and anchoring substrate. At step 6815, the caregiver may
apply tension. The tension may be applied to one or more of an
anchor, an anchoring substrate, a structural support or any of the
apparatus shown and described herein using any of the approaches
shown and described herein. At step 6816, the caregiver may confirm
bone segment location using medical imaging. At step 6818, the
caregiver may lock the insert devices in the intramedullary cavity.
At step 6820, the inserted devices may be disengaged from the
delivery system used to deliver the devices.
[0409] There are different combinations of implant sequences. Table
4 shows different illustrative sequences of treatment steps. Other
treatment steps and different sequences may also be practiced in
accordance with the principles of the invention.
TABLE-US-00004 TABLE 4 Illustrative fracture repair sequences.
Illustrative Illustrative sequence A Illustrative sequence B
sequence C Reduce fracture Anchor Manipulate segments Introduce
device Manipulate segments Engage segments Anchor segment to Engage
segments Anchor device Tension assembly to Tension segments Provide
tension to finalize reduction segments Anchor assembly Anchor or
secure Lock assembly segments Disengage from the Disengage Further
appropriate assembly steps Further appropriate Further appropriate
steps steps
[0410] There are numerous other steps that may be included.
Different embodiments of the apparatus shown and described herein
may be used in conjunction with different steps of process 6800,
whether or not shown in FIG. 68 or Table 4. For example, bone
cement may be applied, cancellous autograph may be inserted,
topical or internal antibiotics may be administered and any other
suitable therapies may be used.
[0411] Thus, apparatus and methods for fracture repair have been
provided. Persons skilled in the art will appreciate that the
present invention can be practiced by other than the described
embodiments, which are presented for purposes of illustration
rather than of limitation. The present invention is limited only by
the claims that follow.
* * * * *