EP3813698A1 - Méthode et appareil pour le traitement de fractures osseuses, et/ou pour la fortification et/ou l'augmentation de la masse osseuse, notamment l'apport et l'utilisation d'implants composites, et nouvelles structures composites pouvant être utilisées pour des applications médicales et non médicales - Google Patents

Méthode et appareil pour le traitement de fractures osseuses, et/ou pour la fortification et/ou l'augmentation de la masse osseuse, notamment l'apport et l'utilisation d'implants composites, et nouvelles structures composites pouvant être utilisées pour des applications médicales et non médicales

Info

Publication number
EP3813698A1
EP3813698A1 EP19798937.9A EP19798937A EP3813698A1 EP 3813698 A1 EP3813698 A1 EP 3813698A1 EP 19798937 A EP19798937 A EP 19798937A EP 3813698 A1 EP3813698 A1 EP 3813698A1
Authority
EP
European Patent Office
Prior art keywords
bone
composite
implant
matrix material
fibers
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
EP19798937.9A
Other languages
German (de)
English (en)
Other versions
EP3813698A4 (fr
Inventor
Jeffrey A. D'agostino
Werner Blank
Charles HEGEDUS
Sandip Agarwal
Elizabeth Nelson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
206 Ortho Inc
Original Assignee
206 Ortho Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US16/025,639 external-priority patent/US11351261B2/en
Priority claimed from US16/040,164 external-priority patent/US10517654B2/en
Application filed by 206 Ortho Inc filed Critical 206 Ortho Inc
Publication of EP3813698A1 publication Critical patent/EP3813698A1/fr
Publication of EP3813698A4 publication Critical patent/EP3813698A4/fr
Pending legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A61K9/0024—Solid, semi-solid or solidifying implants, which are implanted or injected in body tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/02—Inorganic compounds
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7097—Stabilisers comprising fluid filler in an implant, e.g. balloon; devices for inserting or filling such implants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7233—Intramedullary pins, nails or other devices with special means of locking the nail to the bone
    • A61B17/7258—Intramedullary pins, nails or other devices with special means of locking the nail to the bone with laterally expanding parts, e.g. for gripping the bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/28—Bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/3094—Designing or manufacturing processes
    • A61F2/30965—Reinforcing the prosthesis by embedding particles or fibres during moulding or dipping
    • A—HUMAN NECESSITIES
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    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
    • A61K47/32—Macromolecular compounds obtained by reactions only involving carbon-to-carbon unsaturated bonds, e.g. carbomers, poly(meth)acrylates, or polyvinyl pyrrolidone
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    • A61K47/30—Macromolecular organic or inorganic compounds, e.g. inorganic polyphosphates
    • A61K47/34—Macromolecular compounds obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyesters, polyamino acids, polysiloxanes, polyphosphazines, copolymers of polyalkylene glycol or poloxamers
    • A—HUMAN NECESSITIES
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    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/40—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
    • A61L27/44—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
    • A61L27/446—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix with other specific inorganic fillers other than those covered by A61L27/443 or A61L27/46
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    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/40—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
    • A61L27/44—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
    • A61L27/48—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix with macromolecular fillers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
    • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L27/58—Materials at least partially resorbable by the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/72—Intramedullary pins, nails or other devices
    • A61B17/7291—Intramedullary pins, nails or other devices for small bones, e.g. in the foot, ankle, hand or wrist
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8897—Guide wires or guide pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00004—(bio)absorbable, (bio)resorbable, resorptive
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00526—Methods of manufacturing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00964—Material properties composite
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/28—Bones
    • A61F2002/2892—Tibia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2400/00—Materials characterised by their function or physical properties
    • A61L2400/06—Flowable or injectable implant compositions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L2430/00—Materials or treatment for tissue regeneration
    • A61L2430/02—Materials or treatment for tissue regeneration for reconstruction of bones; weight-bearing implants

Definitions

  • VASCULAR LESIONS (Attorney’s Docket No. 206 ORTHO-l 11137-0002 CON 2), which in turn:
  • This invention relates to methods and apparatus for treating bones, and more particularly to methods and apparatus for treating bone fractures and/or for fortifying and/or augmenting bone in mammals, and relates to novel composite structures which may be used for medical and non-medical applications.
  • current treatment options typically comprise external stabilizers (e.g., plaster casts, braces, etc.) and internal stabilizers (e.g.,
  • External stabilizers such as casts and external braces suffer from a number of disadvantages. For one thing, they can interfere with a patient’s normal daily activities, e.g., it can be difficult to wear clothing over a cast, or to operate a motor vehicle with a cast, etc. Furthermore, with animals, external casting and bracing of some fractures can be extremely difficult.
  • the soft tissue interposed between the bone and the external stabilizer is used to transmit load from the bone to the
  • Internal stabilizers such as pins, screws, bone plates, intramedullary nails, etc. generally provide a more effective stabilization of the fracture, since they are able to directly interface with the bone.
  • installing these internal stabilizers requires an invasive surgical procedure, e.g., a relatively large incision, etc.
  • the internal stabilizers screws, bone plates, intramedullary nails, etc.
  • bone cements may be injected into the interior of the bone in an attempt to stabilize the bone.
  • bone cements suffer from
  • methacrylate also known as PMMA
  • calcium salt-based cements calcium salt-based cements
  • bone cements are not suitable for use in many situations, particularly in long bones (e.g., the tibia).
  • the failure mode for brittle materials results in catastrophic failure that includes the creation of shards of material which are difficult to remove and create potential dangers for the anatomy.
  • the aforementioned polymers and cements can be molded into useful shapes or injected (i.e., applied in situ) which results in an anisotropic alignment of the polymer crystals, or they can be drawn and annealed by extrusion or pultrusion methods, which align the polymer crystals in an isotropic manner such that a favored directional mechanical advantage can be established that is greater than the molded or injected method. This is the way some polymer pins are formed. There are drawbacks to this practice and the materials used. There remains a top strength to the final form that may not be appropriate for all bone- reinforcement activities.
  • the isotropic alignment augments performance in one direction such as compression but may increase brittleness in side shear or torsion.
  • Material selection typically requires a trade-off between stiffness and strength or toughness.
  • Composite materials offer the ability to tune the mechanical properties of the material in different directions.
  • traditional composites suffer from the same trade-off between stiffness and strength or toughness.
  • Composites frequently fail from delamination and crack propagation in a linear path resulting in low fracture toughness.
  • condition e.g., osteoporosis
  • the present invention also relates to novel composite structures which may be used for medical and non-medical applications.
  • the present invention provides a new approach for treating bone fractures.
  • the present invention also provides a new approach for fortifying and/or augmenting a bone.
  • the present invention comprises the provision and use of a novel composite implant for treating bone fractures and/or for fortifying and/or augmenting a bone.
  • the composite implant is created from at least one reinforcing element, embedded within a matrix.
  • the matrix material of the composite implant can be either anisotropic or isotropic, depending on the requirements of the final construct.
  • the composite implant is disposed within the intramedullary canal of a bone, or within another opening in the bone, either directly or within a containment bag, so as to function as an internal“splint”, whereby to carry the stress created during patient activity. This allows a bone fracture to heal, or provides fortification and/or augmentation of a bone, with minimum inconvenience to the patient.
  • the composite implant comprises a plurality of components that are introduced sequentially into the patient, and assembled in-situ, wherein each of the components has a size and flexibility which allows it to be installed using a minimally invasive approach while collectively providing the required structural reinforcement for the bone which is being treated.
  • the properties of the composite implant can be custom tailored for different treatment situations, e.g., the composite implant can have different lengths and/or different cross-sectional dimensions, the composite implant can have different compressive and/or tensile strengths, etc., all according to the individual needs of a particular patient.
  • Composite implants have the added advantage of being tough, i.e., non- brittle, such that the failure mode does not result in catastrophic
  • the ductility of a composite implant, and the interlocking of reinforcing and/or fibrous elements contained within the implant, is resistant to complete separation, thus there may be an element that breaks down, however, the final composite implant will not fully segment.
  • the composite implant comprises three components: a containment bag, one or more reinforcing elements and an injectable matrix material.
  • the containment bag serves to protect the remaining components of the composite implant from the ingress of blood and/or other bodily fluids that might interfere with the deployment of the one or more reinforcing elements and/or interfere with the deployment or solidification of the
  • the containment bag also serves to constrain the flow of the injectable matrix material while the injectable matrix material is in its injectable state.
  • the containment bag is flexible and may be fabricated from a resorbable polymer such as a polyurethane, polylactic acid, glycolic acid or some mixture/copolymer thereof.
  • the containment bag may be formed from fibers that are woven, braided, knit, nonwoven, and/or otherwise worked so as to form a mesh bag. Suitable fibers include polylactic acid, polyglycolic acid, polydioxanone or mixtures/copolymers thereof.
  • the containment bag preferably has sufficient strength to allow the injectable matrix material to be injected into the containment bag under substantial pressure and/or vacuum so as to ensure good interfacial contact between the injectable matrix material and the one or more reinforcing elements, and to minimize voids within the containment bag, and to ensure good interfacial contact between the composite implant and the bone.
  • the mesh bag is hydrophobic so as to minimize the ingress of bodily fluids into the containment bag that may otherwise interfere with the deployment or solidification of the various components of the composite implant.
  • the mesh bag may have a limited porosity to allow some egress of the injectable matrix material out of the containment bag, e.g., to osseointegrate with the surrounding bone.
  • the containment bag may have a hydrophobicity and porosity that affects the biocompatibility and degradation of the composite implant by modulating the ingress of water into the interior of the containment bag.
  • the filling port is preferably constructed so that it may be closed off, e.g., by incorporating a one-way valve in the filling port or by providing a closure mechanism (e.g., a cap).
  • the containment bag also provides a way to control the degradation rate of the composite implant, by modifying the diffusion of water, blood, or other bodily fluids into the composite implant. Such ingress of fluids can degrade the composite implant (and/or its components) and reduce the mechanical properties of the composite implant at a faster (or slower) rate than may be desirable.
  • components can also be slowed (or accelerated) by the addition of high aspect ratio platelet- shaped additives, water-reactive compounds, and/or inorganic or organic buffering agents in the containment bag.
  • additives, compounds and/or buffering agents can be mixed (as additives) into the formulation of the containment bag, or can be contained in protective micro- or nano-capsules.
  • one or more compliant containment bags can be used for each composite implant.
  • This approach can provide an improved barrier, and can also serve as a“backup” in case the first containment bag leaks, e.g., due to tearing, scratching, or contact during a surgical procedure.
  • Microspheres that contain “self-healing” (or“self-sealing”) polymerizable chemistries can also be added into the formulation of the containment bag in order to prevent leakage due to accidental scratching and tearing.
  • the one or more reinforcing elements comprise (i) flexible reinforcing sheets (which are preferably in the form of flexible concentric reinforcing tubes or flexible rolled reinforcing sheets), with the flexible reinforcing sheets comprising filaments formed into a textile (i.e., woven, braided, knit, nonwoven, and/or otherwise worked so as to form the flexible reinforcing sheets) or incorporated into a film so as to form the flexible reinforcing sheets, (ii) flexible reinforcing rods, with the flexible reinforcing rods comprising a plurality of filaments which are held together by an outer sheath of a textile or film (which may or may not have the same composition as the aforementioned flexible reinforcing sheets), or by a compacted (wound or compressed, etc.) connecting structure of a textile or film, or by a binder such as an adhesive, with or without surface projections for improved integration with the injectable matrix material, (iii) particulates (e.g., particles,
  • the one or more reinforcing elements comprise flexible reinforcing sheets and/or flexible reinforcing rods
  • the one or more reinforcing elements preferably have sufficient column strength to allow longitudinal delivery into the containment bag by pushing, and preferably have a configuration (e.g., smooth outer surfaces, tapered ends, coatings, etc.) to facilitate movement past other reinforcing elements and/or intervening structures (e.g., catheter structures).
  • the one or more reinforcing elements comprise flexible reinforcing sheets (e.g., concentric tubes or rolled sheets) which are intended to be radially compressed during delivery to facilitate passage through a small opening (e.g., a catheter or surgical opening)
  • the flexible reinforcing sheets may comprise resilient elements (e.g., resilient rings) to assist their subsequent return to an expanded state when positioned within the containment bag.
  • the containment bag may also be coated with a pH buffering agent.
  • the pH buffering agent may comprise a positive charge, or cation, to counteract the release of any acid from the various elements disposed in the containment bag.
  • another such pH“safety mechanism” is to include a pH“release valve” in the containment bag, whereby to open the containment bag and release contents based on a pH trigger.
  • the filaments and particulates used to form the aforementioned reinforcing elements may be biodegradable or bioabsorbable, or non- biodegradable or non-bioabsorbable.
  • suitable biodegradable or bioabsorbable materials include polyglycolide (PGA), glycolide copolymers, glycolide/lactide copolymers (PGA/PLA), glycolide/trimethylene carbonate copolymers (PGA/TMC), stereoisomers and copolymers of polylactide, poly-L-lactide (PLLA), poly-D-lactide (PDLA), poly- DL-lactide (PDLLA), L-lactide, DL-lactide copolymers, L-lactide, D- lactide copolymers, lactide tetramethylene glycolide copolymers, lactide/trimethylene carbonate copolymers, lactide/delta-valerolactone copolymers, lactide
  • PEEK polyetheretherketone
  • carbon fiber and metals, ceramics, and glasses.
  • soluble glass As a reinforcement fiber, a particulate, a textile sheet, or as a filler, it is possible to use glass with varied solubility along its cross-section.
  • a dual solubility glass can be obtained by various processes, such as ion exchange, surface abrasion, or cladding.
  • the network former could yield degradable and/or soluable glasses- for example glasses comprised of phosphate, silicate, or borate, as well as bioglass.
  • This degradable and/or soluable glass typically contain ions (eg alkaline earth metals (eg beryllium, magnesium, calcium, strontium, barium, radium), alkali metals (eg lithium, sodium, potassium, rubidium, casesium) or other chemical formulas such as but limited to Na20, CaO,
  • our preferred core glass is a glass comprising of P205, NA20 and CaO and optionally at least one of the following magnesium oxide, boron oxide, Fe203, MgO, SrO, BaO, ZnO, and Ti02.
  • surface modifications or disruptions can be achieved in various ways, including ion exchange, vinyl monomers using free radial initators, cladding, sol-gel, chemical processes, such as acid/base etching, mechanical abrasion, or with oxidation or reduction techniques (plasma, corona, ozone treatment).
  • the temperature could be in the range of 130-1000C, more preferably 100-770C, most preferably 100-500C.
  • the time of incubation could be changed depending on the desired ion gradient for the requirements of the intended use. For some glasses with higher melting points, the range of the temperature may increase 2-fold (or more).
  • the melting point for silicon is l,4l4°C. If metal (e.g., titanium) is included with the silicon, the melting point increases to l,650°C.
  • This range incubation can be ⁇ 1 minute up to 2-1 hours or more, or up to weeks.
  • the solubility of the glass may also be controlled by using a dual solubility glass gradient obtained by modifying the glass phosphate-based glass fibres (PGF) has been shown, for example to be used to control the properties of biodegradable composites for potential application as bone fracture fixation devices and can be doped with Si or Fe (Acta biomaterialia 8:4 2012 Apr pg 1616-26).
  • PPF glass phosphate-based glass fibres
  • the refractive index of the glass may be tailored to create a modification of the light transfer in the glass.
  • the range can vary depending on the structure and surface modifications of glass in a range within liquids, e.g., approximately 1.33 (as high as diamond), 2.42 or greater (at room temperature) and the range may could change slightly based on the temperature of the body. This tailoring may be applied to any layer of the device.
  • the index of refraction is modulated such that the light is totally internally reflected.
  • light may be shined on the surface such that a propagated wave strikes the medium boundary at an angle larger than a particular critical angle with respect to the normal to the surface.
  • This may be utilized with any type of glass shape (e.g., a rod, a sheet, a sphere, etc.) so that light treatment or other targeted treatments could be applied to the surfaces.
  • the surface modifications to the glass can also change the roughness of the fiber/glass layers such that reflection and refraction can be modulated when energy is propagated through the fiber/glass.
  • the fibers/glass can act as a way to restrict one or more dimensions of the energy (sound, light, EM waves, etc) given the construction.
  • One example of the change in the index of refraction could be done with ion doping or ion swapping.
  • Various ions could be used including strontium This could be achieved by ion swapping as well.
  • each layer including the core, outer surface (c2) and one, two, three, or series of middle layers (c3) or a gradient layer could differ in properties such as the chemical durability, modifying the mechanical properties, and/or functionalizing the glass (eg ion doping). This could change the gradient over the distance of the glass (or coating) given the layer thickness.
  • the layer thickness could vary from atomic levels to mm thickness.
  • the glass has a cross section c and
  • the glass has a cross section c and where in the depth of the surface treatment (c2) is equal to or greater than than O.Olc.
  • the glass has a cross section c and where in the depth of the surface treatment (c2) equal to c.
  • the glass has a cross section c and
  • the glass has a cross section c and
  • depth of the surface treatment (c2) is less than or equal or equal to 0.25c and the depth of the surface treatment (c3) is less than or equal or equal to 0.25c.
  • the glass has a cross section c and where in the total depth of the surface treatment (c2) and the depth of the surface treatment (c3) are equal to the cross section of c.
  • the glass has a cross section c and where in the depth of the surface treatment (c3) is equal to or greater than O.Olc.
  • An aspect of the disclosure where in the depth of the surface treatment is from lpm up to about 400pm.
  • An aspect of the disclosure where in the depth of the surface treatment is from lpm up to about lOOpm.
  • An aspect of the disclosure where in the depth of the surface treatment is from lpm up to about 50pm.
  • An aspect of the disclosure where in the depth of the surface treatment is from 3pm up to about l50pm.
  • An aspect of the disclosure where in the depth of the surface treatment is from 2pm up to about l50pm.
  • surface treatments can be applied to glass fiber(s) when in their final form (post glass making) such as, but not limited to, a braid, textile mat, or in an aligned or unaligned composition.
  • Ion exchange is used commonly for glass strengthening, and is sometimes referred to as stuffing.
  • stuffing in ion exchange process, a larger size ion than that which are already in the matrix are inserted into the matrix, which puts stress on the surrounding atomic bonds and increases the strength of the glass.
  • soluble glasses one can potentially replace soluble ions such as sodium cation or phosphate anion with less soluble ions, such as calcium, magnesium, or iron cations, or with silicate anions, that are less soluble.
  • a typical ion exchange process is performed by dipping or soaking the glass fibers in molten salts of desired metals.
  • the time of soaking may be used to control the amount of ion exchange.
  • the soaking time could range from 1 second to multiple weeks or months, depending upon the desired properties of the glass fibers. It is also possible to utilize multiple soakings and/or multiple soaking times with different ions in sequence.
  • surface casting of the glass fibers may be achieved by coating the glass.
  • the glass fibers may be surface cast by dip coating, bombardment, incubation, etc. Additionally and/or optionally the glass fibers may be altered using light-based or mechanical techniques. The techniques can be performed in stages (or steps) - ideally one to three steps, or more than three steps.
  • Surface coatings via ion exchange can create a gradient of degradation and packing density in the glass fiber in order to achieve a tailored application.
  • the ion or material can be active such as a metal ion or functionalized metal particle or polymeric material in order to create a packing density that varies for each layer.
  • the ion or material coating can be deposited in steps.
  • the first step may introduce a larger ion into the glass in order to create a packing density that allows a second layer that has a smaller ion to increase packaging density by filling in more spaces or displacing the initial ions.
  • the gradient could start with a coating of a smaller ion or material followed by a larger ion or an equivalent sized ion to give a variable gradient.
  • These layers may be deposited via the examples above. The layers allow for like transfer and the coatings can change the index of a refraction from greater than 1.33 (to much higher) so that light can travel through these layers and could reflect or effect I controlled angle and wavelengths.
  • Ions and surface treatments can also be configured to release biological elements for activity for treatment or radiopaque material in order to identify the device using imaging techniques.
  • the surface can also be roughened in order to help with changing the mechanical properties and/or biocompatibility and/or integration into the bone.
  • the 4th ion being smaller than the lst ion, 2nd ion or a 3rd ion the 4th ion being the same than the lst ion, 2nd ion
  • the 6th ion being smaller than the lst ion, 2nd ion 3rd, 4th, or a 5th ion or the 6th ion being the same than the 2nd ion 3rd, or 4th, ion
  • Additional ion exchanges can be conducted to obtain the desired degradation rate and ion release profile.
  • eutectic mixture of salts with lower melting points e.g., strontium.
  • suitable eutectic salts include:
  • the glass (or other materials) that comprise the device may go through a heating process.
  • a heating process can range from 0°C to up to the melting temperature of metal, e.g., l,650°C.
  • Stronium has the ability to change the release rate from bioactive phosphate glasses on osteogenic differentiation of human mesenchymal stem cells
  • the basic goal is to disrupt the glass network on the surface to enhance the solubility.
  • Such disruption can be achieved by various ways, including chemical processes, such as acid/base etching, mechanical abrasion, or with plasma oxidation or reduction techniques.
  • Cladding refers to a process whereby the glass fiber is coated with a less soluble or insoluble layer. Such cladding can be achieved just after fiber production, or as a separate step, whereby the glass fiber is coated with dip-coated sol-gel glass.
  • the total fiber diameter can be 1 micron to 1 mm, preferably from 5 microns to 100 micron, and more preferably from 5 micron to 50 microns.
  • the core of the glass fiber can have a thickness ranging from 5% to 95% of the glass fiber, more
  • composition is gradual, with no defined core or shell boundaries.
  • other forms of glass fiber may comprise a glass sheet, a rod, a sphere, a triangular prism, a rectangular prism or any 3
  • the core of the glass fiber can have a solubility ranging from mg/cm 2 -h to 1*10 -1 mg/cm 2 -h.
  • the solubility of silicate could include the solubilities for anhydrous sodium metasilicate and the pentahydrate, which are 210 g/l at 20 °C and 610 g/l at 30 °C, respectively or other types of silicate. Examples are as follows:
  • Amorphous silicate glasses are only slightly attacked by water at ambient temperatures and can be solubilised only at elevated temperature and
  • Amorphous silica which precipitates when alkaline solutions are neutralized has a water solubility of 115 mg/l at 25 °C and neutral pH (Morey et al. 1964). Depending on both pH and concentration the respective solutions contain varying proportions of
  • monomeric tetrahedral ions oligomeric linear or cyclic silicate ions (e.g., di- or trisilicate ions) and polysilicate ions of three-dimensional structure.
  • the density could range from less than 1.24 g/cm3 to 750kg/m3 or higher.
  • the shell of the glass fiber can have a solubility that is 10% lower to lOOx lower, and preferably 20% lower to lOx lower.
  • the solubility can be 10% higher to lOOx higher, and preferably 20% higher to lOx higher.
  • alginate Alginates are linear polysaccharides composed of D-mannuronopyranosyl and L- guluronopyranosyl units.
  • Sodium alginate is formed by treatment of alginic acid (derived from natural sources) with sodium hydroxide or sodium carbonate.
  • a coating can be made consisting of various layers of sodium alginate and a suitable calcium salt which is insoluble at neutral pH, but soluble at low pH. As the glass fibers dissolve, they release phosphoric acid which can dissolve the calcium salt. The calcium ions generated can diffuse in the alginate coating, forming a swellable alginate gel, with improved mechanical properties compared to sodium alginate.
  • the multi-layered coatings can act as bulking agent, as a buffering agent, and as a dynamic method of maintain interfacial contact as fibers degrade.
  • the one or more reinforcing elements are selected by the physician so as to provide the composite implant with the desired size, stiffness and strength.
  • the physician may select from a variety of different reinforcing elements, each having a particular composition and length, and preferably deliver those reinforcing elements sequentially to the patient, whereby to provide the composite implant with the desired size, stiffness and strength.
  • the physician may, optionally, size the reinforcement elements to the appropriate length.
  • the injectable matrix material is preferably polymeric and is preferably biodegradable.
  • the injectable matrix material preferably has a molecular weight ranging from about 10 to about 100,000, and
  • the injectable matrix material preferably has a viscosity of about 1 cps to about 10,000 cps, or up to 100,000 cps at higher temperature.
  • the matrix material is preferably a multi-component polymer system that is mixed immediately prior to introduction into the patient. Preferably, each of the components and the mixture have
  • the injectable matrix material may contain a biocompatible solvent, with the solvent reducing viscosity so as to allow the matrix material to be injected, and with the solvent
  • the solvent may
  • the injectable matrix material is preferably an organic polymer that can be formed via a polymerization process.
  • the injectable matrix material may also comprise a bioactive or insoluble filler material, a therapeutic agent, and/or an agent to enhance visibility while imaging the composite implant.
  • the injectable matrix material comprises a polymer comprising a blend of (i) one or more reactants with a least two functional groups, (ii) a low molecular weight functional modifier, and (iii) a poly functional aliphatic or cycloaliphatic isocyanate crosslinker.
  • the matrix polymer may, optionally, also include (iv) a catalyst.
  • the un- crosslinked blend has a glass transition temperature of between about 170°
  • the first component i.e., one or more reactants with at least two functional groups
  • the first component preferably comprises (a) hydroxyl functional reaction products of a C2 to C16 aliphatic or cycloaliphatic or heterocyclic diols or triols or tetrols or blends of these polyols with a saturated or unsaturated C2 to C36 aliphatic dicarboxylic or tricarboxylic acid, anhydrides or lactones and/or lactides and/or glycolides and/or carbonates or blends of these carboxylic acids, or (b) amine functional aspartic acid ester, or (c) CH-active compounds, or blends of the foregoing.
  • the second component i.e., a low molecular weight functional modifier
  • a low molecular weight functional modifier preferably comprises an aliphatic or cycloaliphatic or heterocyclic diol with C2 to C12 carbons.
  • the third component i.e., a poly functional aliphatic or cycloaliphatic isocyanate crosslinker
  • a poly functional aliphatic or cycloaliphatic isocyanate crosslinker preferably comprises an isocyanurate (trimer), iminooxadiazine dione (asymmetric trimer), biuret, allophanate or uretdione (dimer) derivative (with an average functionality of between 1 to 6) of an C4 to C15 aliphatic or cycloaliphatic diisocyanate or lysine diisocyanate, or a C4 to C15 aliphatic or cycloaliphatic diisocyanate or lysine diisocyanate.
  • the crosslinked network has a crosslink density with an average molecular weight between crosslinks of between 10-200, 200 to 500, or greater than 500.
  • the fourth (optional) component i.e., a catalyst
  • a catalyst is preferably selected from the group of metals such as bismuth, potassium, aluminum, titanium, zirconium compounds or a t- amine, or organo-tin compounds.
  • the foregoing polymer blend is reactive at a temperature of between 5° C to 150° C, or 10° C to 70° C, or 10° C to 50° C to form a rigid polymer matrix with a Tg (glass transition temperature) between 273.2° K (0° C) and 423° K (150° C), more preferably between 273° K (0° C) and 373° K (100° C), and more preferably between 313° K (40° C) and 343° K (70° C), and more preferably greater than 303 °K (30°C) and is biodegradable over a maximum 5 year period and preferably within a 3 year period.
  • the polymer may also be cross-linked using other common energy processes such as lasers, energy processes such as lasers, energy beams and ultraviolet light or other energy sources.
  • the molar ratio of the above matrix is 0.2 to 2 reactant functional group to isocyanate functional group.
  • the molar ratio of the matrix is 0.2 to 2 reactant functional group to isocyanate functional group.
  • the cross-linked network is formed at a temperature of between 20° C to 60° C within a time period of less than 24 hours or greater than 24 hours up to 1 month.
  • the cross-linked network may also be formed at temperatures lower than 20°C or greater than 60°C, for periods less than 24 hours or greater than 24 hours (e.g., up to one month).
  • the matrix may also include a non-reactive polyester plasticizer in the amount of 0-30 % of the weight of the matrix or 30%
  • the plasticizer for the matrix may consist of non-reactive
  • the coatings and/or matrix can then have a thickness of 0.1 A to
  • the matrix may also include a non-reactive polyester plasticizer in the amount of 0-30 % of the weight of the matrix, or 30% and above.
  • the plasticizer for the matrix may comprise non-reactive aliphatic
  • the coatings and/or matrix can then have a thickness of 0.1 A to 1000mm with an average pore size of .001 microns to 1000 microns.
  • a thickening agent may be added to control the viscosity and can be achieved through a hot mixer of resin and polymers.
  • the coating may contain 0 wt % to 40% or greater than 40% wt. %.
  • the matrix can have a polydisperion index (pdi) ⁇ 1.1, ⁇ 1.5, between 1-2, or less than 2.5.
  • the matrix can contain other typical ingredients used in composites, and other formulated products such as paints, inks, adhesives and sealants. These other ingredients may be pigment or filler particles, surfactants, defoamers, and other commonly known and used additives
  • the above glass transition temperature Tg of the reactant can be obtained by measurements or also by calculation using the William Landel Ferry Equation (WLF) M.L.Williams, R.F.Landel and J.D.Ferry,
  • WLF William Landel Ferry Equation
  • hftp://www.wemerblank.corn/equat/ViSCTEMP3.htrn provides a simple method to convert viscosity of an oligomeric polymer to the Tg.
  • the above CH active compounds are the malonic acid ester of above diols or triols or an acetoacetic ester of the above diols or triols.
  • a novel composite comprising (i) a barrier (which may be a containment bag or coating) which is water permeable and which contains hydrolyzable sites so that the barrier will break down over time when placed in an aqueous environment (e.g., water, the body, etc.); (ii) a flowable/settable matrix which is hydrolyzable so that the matrix will break down over time when contacted by an aqueous environment; and (iii) reinforcing elements which are disposed within the flowable/settable matrix and which, when they come into contact with an aqueous environment, break down and give off catalysts which modify (e.g., increase) the hydrolysis of the matrix material.
  • the barrier provides a means for regulating the degradation of the matrix material
  • the reinforcing elements provide a means for modifying (e.g., increasing) the hydrolysis of the matrix material.
  • the composite implant is disposed within the intramedullary canal of a bone, or within another opening in the bone, so as to function as an internal “splint”, whereby to carry the stress created during patient activity. This allows a bone fracture to heal, or provides fortification and/or augmentation of bone, with minimum inconvenience to the patient.
  • each element of the composite implant is capable of being delivered to a fracture site in a minimally invasive manner (e.g., with an access point as small as 3 mm) and assembled within the body, i.e., with an in situ construction.
  • This form of the invention is advantageous, inasmuch as the final composite implant will have strength commensurate with the non-fractured bone and will be physically tough (i.e., non-brittle) but will have low impact on the patient’s soft tissue during implantation, thereby allowing a quicker return to activities.
  • a containment bag can be used to protect the remaining components of the composite implant from the ingress of blood and/or other bodily fluids that might interfere with the deployment of the one or more reinforcing elements and/or interfere with the deployment or solidification of the injectable matrix material.
  • the components of the composite implant are introduced sequentially into the patient, and assembled in-situ, thereby allowing the composite implant to be installed using a minimally invasive approach.
  • the aforementioned composite implant is preassembled for insertion via“open” procedures when minimally invasive procedures are not required or are not advantageous to the patient.
  • a pre-formed composite implant may be molded or pultruded so as to form a strong composite implant with features such as barbs, threads, and/or other mechanical features
  • the composite implant is constructed using bioabsorbable materials, the composite nature of the composite implant will deliver superior strength and toughness performance over products produced with a pure or blended polymer matrix.
  • the protrusion pultrusion or extrusion that includes a reinforcement element will not have the restriction on diameter imposed on polymer protrusion since alignment of the matrix polymer crystals is of secondary import to the inclusion of the reinforcing element.
  • the composite implant may be secured mechanically (threads) or by further use of injectable matrix material to fill the spaces and act as liquid threads for the composite implant.
  • pre-cured pins or rods can be fabricated and used to assemble the composite implant.
  • These pre- cured pins or rods may be fabricated from the reinforcement elements and injectable matrix materials described elsewhere in this application, and can be formed via processes such as extrusion, pultrusion, or molding.
  • reinforcement elements formed from fiber braids can be preassembled as pre- cured rods for insertion via“open” procedures when minimally invasive procedures are not required or are not
  • pre-cured rods or pins can be used in the procedure.
  • the pre-cured rods or pins may be substantially rigid or they may have a limited degree of flexure. It is not required that the polymer matrix in the pins or rods be fully cured; they can be cured after assembly.
  • one or more of such pre-cured rods or pins can be used in the procedure.
  • 1 or 2, or at least 3 or more, 4 or more, or 5 or more rods can be used in a procedure, preferably with maximum of 50 rods (or higher), or preferably a maximum of 40 rods, and more preferably a maximum of 30 rods.
  • 15-25 rods are used, which yields an excellent reinforcement element-to-matrix material ratio (by volume) for optimal composite implant performance.
  • the bending modulus of the rods can be between 1 GPa to 200 GPa, preferably greater than 10 GPa, more preferably greater than 15 GPa, and more preferably greater than 20 GPa.
  • the rods or pins can have the same material, modulus or shape, and rods of different materials, shapes and modulus can be chosen depending on the application or procedure.
  • the rods or pins can be heated to improve their flexibility for easier insertion in the bone, or the containment bag.
  • the diameter of the rods is less than 5 mm, more preferably less than 4 mm, more preferably less than 3 mm, and most preferably between 0.25 mm and 2.5 mm. However, for some larger rods, the diameter may be greater than 5 mm. It should be noted it is not required for all the rods or pins to have the same material, modulus, diameters or shape, and rods of different materials, shapes, diameters and modulus can be chosen depending on the application or procedure.
  • the composite implant may be used in the following manner to treat a fracture in the tibia.
  • the first step is to create an access hole into the bone that is to be treated.
  • the hole is made into the intramedullary canal distal to, or proximal to, the fracture site.
  • the second step is to remove or harvest the bone marrow (and/or other matter) in the intramedullary canal, and to clean the intramedullary canal, so as to provide a space for the composite implant. This is done through the access hole previously created.
  • the device for removing or harvesting of the bone marrow from the intramedullary canal comprises a catheter with provision for introducing a liquid or gas into the intramedullary canal and suction for removal of material from the intramedullary canal.
  • the liquid or gas can be used to disrupt the content in the intramedullary canal or prepare the intramedullary canal for a composite implant.
  • the liquid or gas can be introduced in a continuous, pulsed, or intermittent flow.
  • a rotatable flexible rod with a shaped end or attachment at the distal end, is optionally used to disrupt the bone marrow in the intramedullary canal so as to aid in the removal of the bone marrow.
  • a tissue trap is utilized.
  • the third step is to place a flow restrictor plug in the intramedullary canal distal to, and/or proximal to, where the composite implant will be placed in the intramedullary canal. Again, this is done through the access hole previously created.
  • the flow restrictor plugs may be placed prior to the removal or harvest of the bone marrow (and/or other matter) to define the area to be cleaned. Where two flow restrictor plugs are used, the two flow restrictor plugs may be connected to one another.
  • the fourth step is to return the bone to proper alignment.
  • the fifth step is to introduce the containment bag into the
  • the containment bag is introduced into the
  • the containment bag may comprise an auxiliary channel to allow monitoring and control of subsequent pressure within the containment bag.
  • the auxiliary channel may be used to remove entrapped air from the composite implant during filling of the containment bag with the injectable matrix material.
  • the auxiliary channel may also be used to pressurize or depressurize (create a vacuum) the injectable matrix material so as to enhance bonding of the injectable matrix material with adjacent structures (e.g., the reinforcing elements, the containment bag, bone, etc.).
  • This auxiliary channel may be parallel to the delivery catheter, or inside the delivery catheter, or the auxiliary channel may be at the distal end of the containment bag.
  • valve at the distal end of the containment bag, or at other strategic regions of the containment bag, that can limit pressure within the containment bag.
  • the sixth step is to sequentially introduce the one or more
  • reinforcing elements into the containment bag. This is done through the access hole previously created. Note that the flexible nature of the reinforcing elements facilitates their delivery into the containment bag via the access hole previously created.
  • the reinforcing elements are reversibly made flexible via external energy, such as the application of heat or an electrical current, prior to insertion through the catheter, and attain maximum strength (or return to full strength) once delivered to the target area to be splinted.
  • the one or more reinforcing structures are preferably introduced into the containment bag sequentially so as to build up a reinforcing mass.
  • a plurality of flexible concentric reinforcing tubes are sequentially inserted into the containment bag, with one flexible reinforcing tube being nested inside another, and a plurality of flexible reinforcing rods are sequentially inserted within the innermost concentric reinforcing tube.
  • the flexible reinforcing sheets (which are preferably in the form of concentric tubes or rolled sheets) are delivered to the interior of the containment bag by pushing them out of a delivery tube or, alternatively, by carrying them into the containment bag while held within a delivery tube and then retracting the delivery tube, whereby to expose the flexible reinforcing sheets.
  • the size and number of concentric reinforcing tubes and reinforcing rods are selected so as to meet the individual needs of a particular patient.
  • the number of concentric reinforcing tubes utilized in the composite implant, and/or their lengths and/or cross-sectional dimensions, and/or the number of reinforcing rods used, and/or their lengths and/or cross-sectional dimensions, may be selected according to the individual needs of a particular patient.
  • the number, length, and cross-sectional dimensions of the reinforcing tubes, and the number, length, and cross-sectional dimensions of the reinforcing rods are selected so as to provide a composite implant having variable stiffness along its length, e.g., a composite implant having a stiffer central region (e.g., 20 GPa) and less stiff distal and proximal ends (e.g., 3 GPa), whereby to prevent stress risers from being created at the ends of the composite implant.
  • the reinforcing tubes, and the reinforcing rods are preferably provided in a variety of sizes with a range of mechanical properties for appropriate selection by the physician; alternatively, the reinforcing tubes and/or reinforcing rods may be sized at the time of use by the physician.
  • the reinforcing rods may include a polymer matrix, and the combination may be pre-cured to a rigid, or somewhat flexible, state so as to provide for the easier insertion of the reinforcing rods.
  • a guidewire may be provided to facilitate introduction of the one or more reinforcing elements into the containment bag. This guidewire is preferably attached to the distal end of the containment bag using an adhesive or other non-permanent attachment means.
  • the guidewire can be detached from the containment bag by pulling or twisting the guidewire.
  • the guidewire may be absorbable, in which case it may be left in the patient at the conclusion of the procedure.
  • one or more of reinforcing fibers, braids, pins, or rods are placed inside the containment bag before the containment bag is inserted into the bone canal, in which case the foregoing sixth step may not be required.
  • the seventh step is to introduce the injectable matrix material into the containment bag. Again this is done through the access hole previously created.
  • an injection tube is used to deliver the injectable matrix material into the containment bag under pressure, where it flows over and through the one or more reinforcement structures contained within the containment bag. Vacuum may be used during the delivery of the injectable matrix material to aid in the wetting out of the reinforcement structures and removal of trapped air. Vacuum may be achieved through a medical facility’s common“wall” suction or through volume evacuation via a disposable syringe, such as a 60 cc syringe from Becton-Dickinson. The injection tube is withdrawn after the matrix material is injected into the containment bag.
  • the injection tube is, preferably, also capable of transmitting an energy wave (such as electro- magnetic, or electro-mechanical such as ultrasonic vibration, light) into the injectable matrix material in cases where pulsatile flow or the application of vibrational forces is required to aid injecting the matrix material into the containment bag or to initiate curing of the matrix material.
  • an energy wave such as electro- magnetic, or electro-mechanical such as ultrasonic vibration, light
  • the eighth step is to solidify the injectable matrix material so that the matrix material, the one or more reinforcing elements and the
  • the solidification process occurs at a rate that allows for complete filling and wet-out of the composite structure prior to achieving a gel-like state within minutes and hardens to a reasonably immovable mass within tens of minutes with a full hard state achieved within 5 days.
  • the ninth step is to close the wound.
  • the present invention comprises the provision and use of a novel composite implant for treating bone fractures (and/or for fortifying and augmenting a bone).
  • the composite implant is disposed within the intramedullary canal of the bone (or within another opening in the bone) so as to function as a“splint”, whereby to carry the stress created during patient activity.
  • This approach allows the bone fracture to heal (or provides fortification and/or augmentation of a bone) with minimum inconvenience to the patient.
  • the composite implant comprises a plurality of components that are introduced sequentially into the patient, and assembled in situ, thereby allowing the composite implant to be installed using a minimally invasive approach.
  • the properties of the composite implant can be custom tailored for different treatment situations, e.g., the composite implant can have different lengths and/or cross-sectional dimensions, the composite implant can have different mechanical properties, e.g. compressive and/or tensile strengths, etc., all according to the individual needs of a particular patient.
  • the components of the composite implant are assembled or manufactured external to the body, and then introduced to the implant site, e.g., as an implant of various geometries such as pins, screws, or nails.
  • the injectable matrix material may partially pre-manufactured external to the body, and further impregnated or interfaced with the implant site by an additional amount of the injectable matrix material hardened after the composite implant has been introduced to the implant site in order to support the bone.
  • the reinforcement braids can be combined with a polymer-based matrix and the combination of braids and matrix pre-cured so as to form pins or rods, and these pre-cured pins or rods can then be introduced into the containment bag in the bone canal, followed by the injection of additional injectable matrix material to achieve the composite implant.
  • a single braid or fiber can be combined with matrix material so as to form the pins or rods; or multiple braids or fibers can be “glued together” with matrix material so as to form the pins or rods.
  • a single pin or rod can be placed inside the containment bag with matrix material, whereby to form the composite implant; or multiple pins or rods can be placed inside the containment bag with matrix material, whereby to form the composite implant.
  • a method for treating a bone comprising:
  • a composite implant comprising a containment bag, an injectable matrix material for positioning within the containment bag, wherein the injectable matrix material is flowable and settable, and at least one reinforcing element for positioning within the containment bag and integration with the injectable matrix material, the at least one reinforcing element adding sufficient strength to the injectable matrix material such that when the composite implant is disposed in a cavity in a bone, the composite implant supports the bone;
  • the containment bag comprises a permeation barrier for providing at least one of (i) prohibiting or modulating the release of injectable matrix material out of the containment bag into the surrounding environment, and (ii) prohibiting or modulating the ingress of body fluids into the interior of the containment bag, whereby to regulate contact of body fluids with the injectable matrix material and the reinforcing elements, whereby to regulate the degredation rate of the injectable matrix material and the reinforcing elements.
  • a method for treating a bone comprising:
  • the containment bag comprises a permeation barrier for providing at least one of (i) prohibiting or modulating the release of injectable matrix material out of the containment bag into the surrounding environment, and (ii) prohibiting or modulating the ingress of body fluids into the interior of the containment bag, whereby to regulate contact of body fluids with the injectable matrix material and the reinforcing elements, whereby to regulate the degredation rate of the injectable matrix material and the reinforcing elements;
  • the at least one reinforcing element in the containment bag; flowing the injectable matrix material into the containment bag so that the injectable matrix material interfaces with the at least one reinforcing element; and transforming the injectable matrix material from a flowable state to a non-flowable state so as to establish a static structure for the composite implant, such that the composite implant supports the adjacent bone.
  • thermoplastic polymer implant comprising a thermoplastic polymer matrix and a high modulus fiber component having a tensile modulus from about 8 GPa to about 400 GPa.
  • a method for treating a bone comprising:
  • the at least one reinforcing element comprises a high modulus fiber component having a tensile modulus of about 1 GPa to about 900 GPa or greater;
  • the at least one reinforcing element in a cavity in the bone; flowing the injectable matrix material into the cavity in the bone so that the injectable matrix material interfaces with the at least one reinforcing element; and transforming the injectable matrix material from a flowable state to a non- flowable state so as to establish a static structure for the composite implant, such that the composite implant supports the adjacent bone.
  • a method for treating a bone comprising:
  • At least one high modulus fiber component having a tensile modulus from about .08 (Polyethene) GPa to about 100 GPa, a % Elongation from 2 (ABS + 30% Glass Fiber) to about 500% (HDPE), and/or a ultimate tensile strength of lOMPa to l50MPa (Polyimide+Glass Fiber) or greater wherein the at least one high modulus fiber component comprises a rod having a cross-section selected from the group consisting of round and circular;
  • the injectable matrix material comprises a thermoplastic polymer matrix
  • a method for treating a bone comprising:
  • At least one high modulus fiber component having a tensile modulus from about .08 (Polyethene) GPa to about 100 GPa, a % Elongation from 2 (ABS + 30% Glass Fiber) to about 500% (HDPE), and/or a ultimate tensile strength of lOMPa to l50MPa (Polyimide+Glass Fiber) or greater, wherein the high modulus fiber component comprises a plurality of fibers, and further wherein the high modulus fiber component is pre-loaded with an injectable matrix material just prior to implantation so as to together form a composite implant, wherein the injectable matrix material comprises a thermoplastic polymer matrix;
  • a polymer implant comprising a high modulus fiber reinforcing component and a urethane polymer matrix.
  • a method for treating a bone comprising:
  • a method for treating a bone comprising:
  • a method for treating a bone comprising:
  • a composite implant comprising an injectable matrix material which is flowable and settable, and at least one reinforcing element for integration with the injectable matrix material, the injectable matrix material comprising a resin, and the at least one reinforcing element adding sufficient strength to the injectable matrix material such that when the composite implant is disposed in a cavity in a bone, the composite implant supports the bone.
  • the present invention also relates to novel composite structures which may be used for medical and non-medical applications.
  • barrier being configured to selectively pass water, and said barrier being degradable in the presence of water
  • a matrix material for disposition within said barrier, wherein said matrix material has a flowable state and a set state, and wherein said matrix material is degradable in the presence of water;
  • At least one reinforcing element for disposition within said barrier and integration with said matrix material, wherein said at least one reinforcing element is degradable in the presence of water, and further wherein, upon the degradation of said at least one reinforcing element in the presence of water, provides an agent for modulating the degradation rate of said matrix material in the presence of water.
  • barrier being configured to selectively pass water, and said barrier being degradable in the presence of water
  • a matrix material for disposition within said barrier, wherein said matrix material has a flowable state and a set state, and wherein said matrix material is degradable in the presence of water;
  • At least one reinforcing element for disposition within said barrier and integration with said matrix material, wherein said at least one reinforcing element is degradable in the presence of water, and further wherein, upon the degradation of said at least one reinforcing element in the presence of water, provides an agent for modulating the degradation rate of said matrix material in the presence of water;
  • a method for treating a bone comprising:
  • a barrier said barrier being configured to selectively pass water, and said barrier being degradable in the presence of water;
  • a matrix material wherein said matrix material has a flowable state and a set state, and wherein said matrix material is degradable in the presence of water; and
  • at least one reinforcing element which is degradable in the presence of water, and further wherein, upon the degradation of said at least one reinforcing element in the presence of water, provides an agent for modulating the degradation rate of said matrix material in the presence of water;
  • barrier being configured to selectively pass water, and said barrier being degradable in the presence of water
  • a matrix material for disposition within said barrier, wherein said matrix material has a flowable state and a set state, and wherein said matrix material is degradable in the presence of water;
  • At least one reinforcing element for disposition within said barrier and integration with said matrix material, wherein said at least one reinforcing element comprises at least one soluble glass fiber, and further wherein said at least one soluble glass fiber comprises an inner core surrounded by an outer shell, and further wherein said at least one soluble glass fiber is degradable in the presence of water.
  • At least one reinforcing element wherein said at least one reinforcing element comprises at least one soluble glass fiber, and further wherein said at least one soluble glass fiber comprises an inner core surrounded by an outer shell, and further wherein said at least one soluble glass fiber is degradable in the presence of water a matrix material for disposition around said at least one reinforcing element, wherein said matrix material has a flowable state and a set state, and wherein said matrix material is degradable in the presence of water.
  • an implant comprising:
  • a core structure comprising:
  • the rod reinforcement component comprises a thermoplastic matrix and a plurality of fibers disposed within the thermoplastic matrix
  • the sheet reinforcement component comprises a thermoplastic matrix and a plurality of fibers disposed within the thermoplastic matrix
  • an implant comprising:
  • a core structure comprising:
  • each sheet reinforcement component comprises a
  • thermoplastic matrix and a plurality of fibers disposed within the thermoplastic matrix
  • the plurality of sheet reinforcement components are arranged in layers so as to form the core structure, and further wherein the layers of sheet reinforcement components are arranged so that at least some of the fibers of one layer are transverse to at least some of the fibers of another layer.
  • an implant comprising:
  • a core structure comprising:
  • the rod reinforcement component comprises a thermoplastic matrix and a plurality of fibers disposed within the thermoplastic matrix
  • barrier being configured to selectively pass water, and said barrier being degradable in the presence of water
  • a matrix material for disposition within said barrier, wherein said matrix material has a flowable state and a set state, and wherein said matrix material is degradable in the presence of water;
  • At least one reinforcing element for disposition within said barrier and integration with said matrix material, wherein said at least one reinforcing element is degradable in the presence of water, and further wherein, upon the degradation of said at least one reinforcing element in the presence of water, provides an agent for modulating the degradation rate of said matrix material in the presence of water;
  • the at least one reinforcement element comprises a plurality of soluble glass fibers, wherein each of said plurality of soluble glass fibers comprises a solubility gradient profile ranging from 100% of the solubility of the initial glass to a surface-modified solubility of less than the solubility of the initial glass.
  • At least one reinforcing element wherein said at least one reinforcing element comprises at least one soluble glass fiber, and further wherein said at least one soluble glass fiber is degradable in the presence of water and comprises a surface-modified solubility which is different than the solubility of the remainder of said at least one soluble glass fiber;
  • a matrix material for disposition around said at least one reinforcing element, wherein said matrix material has a flowable state and a set state, and wherein said matrix material is degradable in the presence of water.
  • At least one reinforcing element wherein said at least one reinforcing element comprises at least one soluble glass fiber, and further wherein said at least one soluble glass fiber is degradable in the presence of water and comprises an independently-adjustable solubility gradient profile;
  • a matrix material for disposition around said at least one reinforcing element, wherein said matrix material has a flowable state and a set state, and wherein said matrix material is degradable in the presence of water.
  • a composite comprising a polymer comprising a blend of (i) one or more reactants with at least two functional groups, (ii) a low molecular weight functional modifier, and (iii) a poly functional aliphatic or cycloaliphatic isocyanate crosslinker;
  • said one or more reactants with at least two functional groups comprises one selected from the group consisting of (a) hydroxyl functional reaction products of a C2 to C16 aliphatic or cycloaliphatic or heterocyclic diols or triols or blends of these polyols with a saturated or unsaturated C2 to C36 aliphatic dicarboxylic or tricarboxylic acid, anhydrides or lactones and/or lactides and/or glycolides and/or carbonates or blends of these carboxylic acids, (b) amine functional aspartic acid ester, (c) CH- active compounds, and (d) blends of the foregoing.
  • FIGs. 1 and 2 are schematic views of a composite implant formed in accordance with the present invention
  • Figs. 3 and 4 are schematic views of a concentric reinforcing tube that may be used to form the composite implant of Figs. 1 and 2;
  • Figs. 5 and 6 are schematic views of a rolled sheet that may be used to form the composite implant of Figs. 1 and 2;
  • Figs. 6 A and 6B are schematic views showing how a flexible rolled reinforcing sheet may be radially compressed during delivery to the containment bag (Fig. 6A) and thereafter radially expanded (Fig. 6B) within the containment bag;
  • Figs. 7 and 8 are schematic views of a flexible reinforcing rod that may be used to form the composite implant of Figs. 1 and 2;
  • Figs. 8A, 8B, 8C and 8D are schematic views showing alternative forms of the flexible reinforcing rods of the present invention.
  • Figs. 9-23 are schematic views showing a composite implant being assembled in situ so as to treat a bone fracture
  • Figs. 24-26 show alternative forms of the composite implant of the present invention.
  • Fig. 27 shows how the guidewire used to deliver the composite implant may also be used to reduce a fracture and/or to help stabilize the fracture
  • Fig. 28 is a graph showing material modulus vs. fiber volume
  • Fig. 29 shows how the reinforcing elements may be formed from fibers comprising columnar axial supports and angular cross fibers;
  • Fig. 30 shows the flexural modulus of various composite implants
  • Fig. 31 shows the flexural modulus of other composite implants
  • Fig. 32 shows the flexural modulus of still other composite implants
  • Fig. 33 shows various composite implant configurations
  • Fig. 34 shows other composite implant configurations
  • Fig. 35 shows still other composite implant configurations
  • Fig. 36 shows additional composite implant configurations
  • Fig. 37 shows load versus position for various composite implants
  • Fig. 38 shows flex modulus versus hours submerged for coated and uncoated containment bags
  • Fig. 39 shows matrix fill volume versus time for different composite implant constructions
  • Fig. 40 is a graph showing the flexural modulus of various glass reinforcing elements
  • Fig. 42 is a graph showing composite pin weight loss versus starting pin glass content
  • Fig. 43 is a graph showing pH versus time for various composite structures
  • Fig. 44 is a graph showing pH versus time for other composite structures
  • Fig. 45 is a schematic view showing a composite structure in the form of a screw
  • Fig. 46 is a schematic view showing a syringe formed out of a composite structure
  • Fig. 47 is a schematic view showing a reinforcing element which may be used in the composite structure forming a syringe
  • Figs. 48-60 are schematic views showing exemplary applications of the present invention.
  • Fig. 61 is a schematic view showing possible packing of triangular pins or circular pins to form a larger implant inside the IM canal, wherein the empty spaces are filled with polymer matrix to glue the pins together;
  • Figs. 62-66 are schematic views showing surface treatment of glass fibers to modify their modulus.
  • Fig. 67a - 67b are schematic views showing the cross-section of reinforcement components
  • Fig. 68a - 68b are schematic views of the cross-section of reinforcement components showing the axes used to determine the cross-section ratio
  • Fig. 69 shows a cross sectional configuration of the composite and the staggered alignment of reinforcement elements
  • Fig. 70a - 70b schematic views showing alternative forms of the core layers of the present invention
  • Fig. 7 la - 7ld show alternative cross sectional configurations of a composite implant
  • the present invention provides a new approach for treating bone fractures using a composite implant.
  • the present invention also provides a new approach for fortifying and/or augmenting a bone using a composite implant.
  • the present invention also relates to novel composite structures which may be used for medical and non-medical applications.
  • the present invention comprises the provision and use of a novel composite implant for treating bone fractures and/or for fortifying and/or augmenting a bone.
  • the composite implant is disposed within the intramedullary canal of a bone, or within another opening in the bone, so as to function as an internal“splint”, whereby to carry the stress created during patient activity. This allows a bone fracture to heal, or provides fortification and/or augmentation of a bone, with minimum inconvenience to the patient.
  • the composite implant comprises a plurality of components that are introduced sequentially into the patient, and assembled in-situ, wherein each of the components has a size and flexibility that allows it to be installed using a minimally invasive approach while collectively providing the required structural reinforcement for the bone that is being treated.
  • the properties of the composite implant can be custom tailored for different treatment situations, e.g., the composite implant can have different lengths and/or different cross- sectional dimensions, the composite implant can have different compressive and/or tensile strengths, etc., all according to the individual needs of a particular patient.
  • the composite implant of the present invention is amenable to both in situ fabrication and pre operative assembly of more conventional means.
  • pre-cured pins may be used in these embodiments as a reinforcing element, or pre-cured pins may be used in conjunction with a splint as an additional securement or supporting device within the composite implant.
  • the pre-cured pin may be in the form of a sphere, a rod, a prism with 3 or more sides, etc.
  • the pre-cured pin may be a screw, a nail, or a degradable orthopedic device that can be driven into the splint as part of the reinforcement element, in order to facilitate securement or treatment of the bone fracture, etc.
  • the composite implant 5 comprises three components: a containment bag 10, one or more reinforcing elements 15 and an injectable matrix material 20.
  • the containment bag 10 serves to protect the remaining components of the composite implant from the ingress of blood and/or other bodily fluids that might interfere with the deployment of the one or more reinforcing elements 15 and/or interfere with the deployment or solidification of the injectable matrix material 20.
  • the containment bag 10 also serves to constrain the flow of the injectable matrix material 20 while the injectable matrix material 20 is in its injectable state.
  • the containment bag consists of a flexible enclosure (bag) and may include a biodegradable sealing mechanism such as a valve V (see Figs. 12, 13, 20 and 22).
  • the containment bag is flexible and may be fabricated from a resorbable polymer such as a polyurethane, polylaxctic acid, glycolic acid or some mixture/copolymer thereof, or thermoplastics such as polycaprolactones (PCL), polylactic acids (PLA), polyhydroxybutyrates (PHB), polyhydroxyalkanoates (PHA), poly(3-hydroxybutyrate-co-3-hydroxyvalerates) (PHBV), citric acid polymers such as polydiolcitrates, citric acid polyurethanes, urethane-doped citric acid-based polyesters, and poly (xylitol-co-citrate), High amylose com starch, PCTFE (aclar UltRX 4000), parlyene C, PHBV-6, PLA/PEM A/A1203 ,
  • hexamethylene di-isocyanate SPLA, amino phosphonic acid, Evlon, and variations and blends and copolymers thereof, with variable crystallinity and/or molecular weight so as to adjust the rate of the ingress of water or aqueous fluid through the bag.
  • Polymers that are otherwise not biodegradable in ambient conditions can become biodegradable in ambient conditions by means of incorporating a water activated catalyst and introducing an aqueous environment.
  • the polymers listed previously can also be compounded within a range of 1-25% volume fraction, preferably 2-10% volume fraction, with nano- and/or micro particulate with a range of sizes from 1 nm to 100 um, and may, optionally, have a range of aspect ratios (either aligned or misaligned), from 1-500 (length/diameter).
  • the particulates can have high aspect ratio, such as 5: 1 , or 10: 1 , or 50: 1 , 100: 1 , or 500:1.
  • the high aspect ratio structures consist of flakes of biocompatible glass, such as bioactive glass.
  • flakes can be synthesized by coating a thin film of glass precursors on a flat surface, letting the precursors cure, for example via sol-gel reaction.
  • the thin film can then be crushed to form flakes of bioglass particles with high aspect ratios.
  • the particulate can be inorganic materials such as bioabsorbable glasses, calcium phosphate salts of any Ca/P ratio, carbon nano-structures, or nano-clays such as cloisite, halloysite, bentonite, or montmorillonite, or modified nanoclays such as
  • the particulate can be used to improve mechanical properties of the bag. Particulate that is insoluble in a time frame relative to the surrounding material and/or the composite within the barrier can act as a torturous path for water delaying ingress of aqueous media. Both improved mechanical properties and improved water barrier properties are particularly effectively implemented when the aspect ratio is 10: 1 or greater, preferably 100: 1 or greater, for two dimensions over a third such as with clays, iron oxide, aluminum oxide, silicon carbide, and magnesium hydroxide (after certain heating schedules). The use of particulate is not limited to these uses.
  • dispersants and sizings / coatings may be required.
  • a dispersant based on poly-hydroxy- stearic acid will be biocompatible and assure proper spacing of the particulate within the polymer layer. Similar sizings to those listed in the“sizings” section are also appropriate for aiding in bond strength and quality for the particulates in the containment bag.
  • the containment bag 10 may be formed from fibers that are woven, braided, knit, electro-spun, nonwoven, and/or otherwise worked so as to form a mesh bag.
  • Suitable fibers include polylactic acid, polyglycolic acid, polydioxanone or mixtures/copolymers thereof, carbon fibers, bioresorbable and soluble glasses, and/or metal, and/or PHBs.
  • the containment bag can be formed by constructing sequential or alternating layers, typically between 1 and 25 layers, preferably between 2 and 7 layers, of the same or varying materials in any combination, either by alternating axial orientation or not, such as by co-extrusion, heat pressing, or by any method of combining the materials.
  • There is a“layer multiplication” technique that can build alternating nano-layers of material that decreases the water permeation tremendously.
  • polymer layers with and without particulate can be sequentially built using methods such as solvent dip coating, dip casting, spray coating, and vapor deposition.
  • the layers can be designed for different purposes such as a high solvent (water) barrier layer (WVP- water vapor permeability - between 10 -2 g*mm/m 2 *days and 102 g*mm/m 2 *days,
  • WVP- water vapor permeability between 10 -2 g*mm/m 2 *days and 102 g*mm/m 2 *days
  • the containment bag preferably has sufficient strength to allow the injectable matrix material to be injected into the containment bag under substantial pressure so as to ensure good interfacial contact between the injectable matrix material and the one or more reinforcing elements, the containment bag and the bone, and to minimize voids within the containment bag.
  • the containment bag may be hydrophobic so as to minimize the ingress of bodily fluids into the containment bag that may otherwise interfere with the deployment or solidification or accelerate the degradation of the various components of the composite implant.
  • the containment bag may have a limited porosity to allow some egress of the injectable matrix material 20 out of the containment bag, e.g., to osseointegrate with the surrounding bone.
  • porosity may be varied across the extent of the containment bag so as to provide regions of greater or lesser porosity to the injectable matrix material 20, thus providing control of the ability of the injectable matrix material to infiltrate the surrounding bone.
  • the containment bag may be coated with a resorbable metal layer, such as magnesium, silver, nickel, titanium, and/or metal alloys such as magnesium calcium alloys.
  • a resorbable metal layer such as magnesium, silver, nickel, titanium, and/or metal alloys such as magnesium calcium alloys.
  • Such coatings can be applied via vapor coating, sputtering, atomic layer deposition, chemical vapor deposition, or electroplating and electroless plating.
  • metal layers provide reduced diffusion, but can also react with water to provide basic/alkaline products that can act as buffering and degradation control agents for the polymer matrix and/or glass fibers.
  • metal nano- or micro- particles can be added to the injectable matrix material and/or the containment bag.
  • Such coatings can be made by the surface reaction of ethyoxysilanes such as tetraethoxysilane, methyltriethoxysilane, dimethyldiethoxysilane, or
  • trimethylethoxysilane polycarbosilane, or polysilazanes such as
  • a polysaccharide such as, but not limited to, Chitosan, Chitosan/PLA, or Chitin may also be used to coat the containment bag.
  • Wang et al developed a method for thermally-induced phase separation to prepare polyglycolic acid PGA- (chitosan hybrid matrices with low toxicity).
  • the weight ratio of PGA to chitosan can range between 1:9 (PGA to Chitosan) to 9:1, 7:3, or 3:7.
  • This technique may also be performed with PLA (using the same rations as previously mentioned).
  • the pore size ranges from 0.001 Angstroms to 500 Angstroms (or more). The pore size can then help to determine the rate of degradation.
  • the composition may also comprise additional therapeutic molecules, or molecules for facilitating wound healing (or otherwise to deliver localized treatments). Alternatively and/or additionally, the
  • the above coatings can be applied to the outside and/or inside surfaces of the containment bag, or can be included as an intermediate layer, for example, magnesium- or magnesium alloy-based metal foil that is sandwiched between other layers of the containment bag.
  • the porosity of the containment bag may be set so as to regulate the permeability of body fluids into the interior of the containment bag, whereby to regulate contact of those body fluids with the injectable matrix material and the reinforcing elements, whereby to regulate the degredation rate of the injectable matrix material and the reinforcing elements.
  • containment bag 10 comprises a structural barrier for constraining the disposition of one or more reinforcing elements 15 and injectable matrix material 20 within the bone.
  • containment bag 10 may comprise a permeation barrier for prohibiting or modulating the release of injectable matrix material 20 out of containment bag 10 and into the surrounding environment.
  • containment bag 10 may comprise a permeation barrier for prohibiting or modulating the ingress of body fluids into the interior of the containment bag (and hence regulating the degradation rate of injectable matrix material 20 and/or reinforcing elements 15 contained within the containment bag).
  • containment bag 10 comprises a PHA, e.g., Polyhydroxybutyrate (PHB), poly-3 -hydroxybutyrate (P3HB), poly-4- hydroxybutyrate (P4HB), polyhydroxyvalerate (PHV), polyhydroxyhexanoate (PHH), polyhydroxyoctanoate (PHO), 3HA acids, etc.
  • PHA Polyhydroxybutyrate
  • P3HB poly-3 -hydroxybutyrate
  • P4HB poly-4- hydroxybutyrate
  • PV polyhydroxyvalerate
  • PH polyhydroxyhexanoate
  • PHO polyhydroxyoctanoate
  • 3HA acids etc.
  • containment bag 10 comprises copolymers made from made from monomers, e.g., glycolic acid, lactic acid, 3- hydroxypropionic acid (3HP), 4-hydroxybutyrate (4HB), 5- hydroxyvalerate (5HV), 3-hydroxyhexanoate (3HH), 6-hydroxyhexanoate (6HH), 3- hydroxyoctanoate (3HO), etc.
  • monomers e.g., glycolic acid, lactic acid, 3- hydroxypropionic acid (3HP), 4-hydroxybutyrate (4HB), 5- hydroxyvalerate (5HV), 3-hydroxyhexanoate (3HH), 6-hydroxyhexanoate (6HH), 3- hydroxyoctanoate (3HO), etc.
  • containment bag 10 comprises a PHA copolymer, e.g., polyhydroxyoctanoate-co-hexanoate (PHOH), polyhydroxybutyrate-co-valerate (PHBV), 3- polyhydroxybutytrate-co-4- polyhydroxybutyrate (PHBco4HB), 3- polyhydroxybutytrate-co - 5 -polyhydroxy valerate, 3 -polyhydroxybutytrate-co-6-polyhydroxyhexanoate, poly-3- hydroxybutyrate-co-4-hydroxybutyrate copolymer, PHB4HB, PHBco4HB, PLA/P(3HB-3HH), etc.
  • PHA copolymer e.g., polyhydroxyoctanoate-co-hexanoate (PHOH), polyhydroxybutyrate-co-valerate (PHBV), 3- polyhydroxybutytrate-co-4- polyhydroxybutyrate (PHBco4HB), 3- polyhydroxybutytrate-co - 5 -polyhydroxy
  • containment bag 10 comprises a layered structural barrier for constraining the disposition of one or more reinforcing elements 15, optionally from 3 to 50 elements, or 4 to 30 elements, or 5 to 25 elements, and injectable matrix material 20 within the bone.
  • the inner layer of the containment bag 10 may comprise a permeation barrier for prohibiting or modulating the ingress of body fluids into the interior of the containment bag (and hence regulating the degradation rate of injectable matrix material 20 and/or reinforcing elements 15 contained within the containment bag) using a bioabsorbable polymer such as, but not limited to, poly lactic-acid with suspended insoluble particulate such as Magnesium Hydroxide with a plate- like
  • the particulates can have high aspect ratio, such as 5:1, or 10:1, or 50:1, 100:1, or 500:1.
  • the high aspect ratio structures consist of flakes of
  • biocompatible glass such as bioactive glass.
  • These flakes can be synthesized by coating a thin film of glass precursors on a flat surface, letting the precursors cure, for example via sol-gel reaction. The thin film can then be crushed to form flakes of bioglass particles with high aspect ratios.
  • a central layer of the containment bag may be constructed of an adhesive, relatively compliant bioabsorbable material such as poly ( ⁇ -capralactone) with or without suspended particulate that supplies a toughness and compliance to the bag structure.
  • the final outer layer could be created using a bioabsorbable polymer with suspended bio- compatibalizing agents, such as Hydroxy-apatite, such that the external layer of the balloon is compatibalized with the bone endosteum.
  • One or more such containment bags can be used for each composite implant. Where more than one containment bag is used for the composite implant, the multiple containment bags can provide an improved barrier, and/or can also serve as a“backup” in case the first containment bag leaks, due to tearing, scratching, or contact during a surgical procedure. Microspheres that contain“self- healing” (or“self-sealing”) polymerizable chemistries can also be added to the formulation of the containment bag to prevent leakage due to accidental scratching and tearing.
  • Containment bags will conform to the bone and thus they will be manufactured with varying physical properties to accommodate varying anatomies.
  • the balloon could have markers on the balloon for visual guidance using imaging techniques. Below are physical properties of the balloons, see examples 114-116.
  • the balloon i.e., the containment bag
  • the diameter of the balloon could be in a range of 0.1 mm to 150 mm, or over 150 mm.
  • the balloon i.e., the containment bag
  • the balloon may comprise a plurality of layers (e.g., layers configured to solubilize at different rates, etc.). The number of layers could be 1 to 7 layers, 2 to 12 layers, 3 to 20 layers or 1 to 30 layers (or higher), etc.
  • containment bag 10 may be formed out of one or more of the materials used to form reinforcing elements 15 and/or one or more of the materials used to form injectable matrix material 20, appropriately processed so as to provide the functional requirements of containment bag 10.
  • the filling port is preferably constructed so that it may be closed off, e.g., by incorporating a one-way valve (e.g., the valve V shown in Figs. 12, 13, 20 and 22) in the filling port or by providing a closure mechanism (e.g., a cap).
  • a one-way valve e.g., the valve V shown in Figs. 12, 13, 20 and 22
  • a closure mechanism e.g., a cap
  • a sealing mechanism is required to contain and seal the resin injection entry site while the composite solidifies.
  • the sealing mechanism is a mechanical valve (e.g., the valve V shown in Figs. 12, 13, 20 and 22) and further is constructed of bioabsorbable polymers including some or all of those listed for the containment bag previously.
  • the valve can have one or more seal mechanisms such as overlapping, hinged plates, or normally closed living hinges made of a compliant material.
  • the sealing mechanism can be a rapidly curing reactive polymer system with or without a high barrier to water entry. A combination of a mechanical system with a polymeric system can also be envisioned.
  • the mechanism has structural features that allow it to be releasably connected to a catheter or other delivery device.
  • This separable valve connection e.g., the valve V shown in Figs. 12, 13, 20 and 22
  • the bag allows for the bag to be delivered to an intramedullary space, sequentially filled with the composite components, then sealed upon separation and removal of the directing catheter.
  • a preferred form of the sealing mechanism envisions a structure consisting of a series of two“duck-bill” valves separated by an open space of between 1 mm and 50 mm axially or greater.
  • the structure has a separable connection to a catheter through and within which composite components are deliverable.
  • the valves close due to applied vacuum, a normally closed design, or positive pressure from the resin with a portion of the resin filling the space between the two valves.
  • the catheter is then separated from the bag, which remains in situ.
  • the one or more reinforcing elements 15 comprise (i) flexible reinforcing sheets 22 (which are preferably in the form of concentric tubes such as is shown in Figs. 3 and 4 or rolled sheets such as is shown in Figs. 5 and 6), with the flexible reinforcing sheets 22 comprising filaments 23 formed into a textile (i.e., woven, braided, knit, nonwoven, and/or otherwise worked so as to form the flexible reinforcing sheets 22) or incorporated into a film so as to form the flexible reinforcing sheets 22, (ii) flexible reinforcing rods 35 (Figs.
  • the one or more reinforcing elements comprise flexible reinforcing sheets and/or flexible reinforcing rods
  • the one or more reinforcing elements preferably have sufficient column strength to allow longitudinal delivery into the containment bag by pushing, and preferably have a configuration (e.g., textured outer surfaces, tapered ends, etc.) to facilitate movement past other reinforcing elements and/or intervening structures (e.g., catheter structures).
  • the one or more reinforcing elements preferably can be introduced by means of a delivery catheter or sheath.
  • the one or more reinforcing elements comprise flexible reinforcing sheets (e.g., concentric tubes or rolled sheets) which are intended to be radially compressed during delivery to facilitate passage through a small opening (e.g., a catheter or surgical opening)
  • the flexible reinforcing sheets e.g., concentric tubes or rolled sheets
  • the resilient elements may be thermosensitive or have a shape memory.
  • the composite implant of the present invention is formed from reinforcing elements that may be made up of fibers from various materials or “rods” of homogeneous or heterogeneous elements, configured in a solid, wound, braided, woven, or interlink- stacked manner.
  • the rods may or may not be likewise interwoven by further braiding, weaving, or winding elements of similar or different fibrous elements.
  • the filaments, fibers, and particulates used to form the aforementioned reinforcing elements may be biodegradable or bioabsorbable, or non- biodegradable or non-bioabsorbable.
  • suitable biodegradable or bioabsorbable materials include polyglycolide (PGA), glycolide copolymers, glycolide/lactide copolymers (PGA/PLA),
  • glycolide/trimethylene carbonate copolymers PGA/TMC
  • stereoisomers and copolymers of polylactide poly-L-lactide (PLLA), poly-D-lactide (PDLA), poly- DL-lactide (PDLLA), L-lactide, DL-lactide copolymers, L-lactide, D-lactide copolymers, lactide tetramethylene glycolide copolymers, lactide/trimethylene carbonate copolymers, lactide/delta-valerolactone copolymers, lactide/epsilon- caprolactone copolymers, polydepsipeptide (glycine-DL-lactide copolymer), polylactide/ethylene oxide copolymers, asymmetrically 3,6-substituted poly- 1 ,4- dioxane-2,4-diones, polyhydroxyalkanoates (PHA), poly(3-hydroxybutyrate
  • PEEK polyetheretherketone
  • PEKK polyetherketoneketone
  • the glass compositions are based on the glass compounds selected from the group consisting of P205, Si02 and B203.
  • Additional element(s) of the glass are selected from the group consisting of Cu, Sr, Zn, Fe, Mn, Cr, V, Nb, Mo, W, Ba, Co, S, Al, Ti, Y, Mg, Si, F, Zn and/or Ni. See table below.
  • the glass used is a borate-based glass material containing the following (all percentages are by weight, unless stated otherwise):
  • the glass used is a silicate based glass material containing the following (all percentages are by weight, unless stated otherwise):
  • the glass used is a phosphate based glass material containing the following (all percentages are by weight, unless stated otherwise):
  • the one or more reinforcing elements 15 are selected by the physician so as to provide the composite implant with the desired size and mechanical properties, e.g. stiffness and strength.
  • the physician may select from a variety of different reinforcing elements, each having a particular composition and length, and preferably deliver those reinforcing elements sequentially to the patient, whereby to provide the composite implant with the desired size and attributes of stiffness and strength.
  • the one or more reinforcing elements 15 comprise from about 5% to 85% (by volume) of the composite implant, typically at least 20% (by volume) of the composite implant.
  • the reinforcing properties of the one or more reinforcing elements 15 may be modified by changing the materials, dimensions, shape, and surface characteristics of the fibers, filaments, and particulates.
  • the reinforcing properties of the one or more reinforcing elements 15 may be modified by changing the orientation, volume, twist, and angle of the fibers and filaments within the reinforcing elements.
  • the fibers and filaments are typically set at an acute angle to intersecting fibers and filaments in order to strengthen the reinforcing structure, but the angle may be any angle between 0 degrees and 90 degrees.
  • the properties of the composite implant may be modified by changing the orientation of one or more of the reinforcing elements 15, and/or by changing the volume of one or more of the reinforcing elements 15.
  • the properties of the composite implant may be modified by changing the layup or selection of one or more of the reinforcing elements 15.
  • the reinforcing properties, and degradation profiles, of the one or more reinforcing elements 15 may be modified by changing the material, dimensions, shape, orientation, volume, and surface features of the fibers, filaments, and/or particulates used to form the one or more reinforcing elements 15.
  • the reinforcement elements comprise a textile
  • its reinforcing properties and degradation profile may be modified by changing the materials, orientation, length, shape, volume, twist, and angle of the fibers and filaments within the textile of the reinforcing elements.
  • the fibers and filaments in a textile of a reinforcing element are preferably set at an acute angle to intersecting fibers and filaments, but the angle may vary between 0 degrees and 90 degrees or random.
  • the reinforcement element may also comprise metal wire and/or glass reinforcement with fiber soluble and controlled degradation properties that can be controlled by means such as the diameter of the materials used, etc. It will be appreciated that the properties of the composite implant may be modified by changing the layup or selection of one or more of the reinforcing elements.
  • degradation profiles, of the one or more reinforcing elements may be modified by changing the material, dimensions, shape, orientation, volume, and/or surface features of the fibers, filaments, and/or particulates used to form the one or more reinforcing elements.
  • the shape of the reinforcement elements is generally important.
  • interwoven or braided materials can be formed as space fillers and skeletons for the composite implant.
  • the shapes can be tailored for the intended use, for example, triangular- or ribbon- shaped.
  • a triangular braided rod can be used as the reinforcement backbone of a composite implant.
  • the triangular shape i.e., triangular cross-section
  • cylindrical shapes i.e., cylindrical cross-section
  • the nesting of flat against flat sides of the triangular shape provides a large surface area for inter-rod binding by the resin.
  • the triangular shape allows for numerous configurations such as horizontal inter locking of greater than two triangular rods resulting in a flat rod-like trapezoidal composite implant shape. This shape provides manufacturing flexibility, inasmuch as a single back-bone braid could be configured into multiple final products.
  • the triangular shape allows for very tight groupings of materials that allow for very high fiber volumes not possible with circular braids or other reinforcement materials which will always tend to have larger gaps between parallel axial reinforcement elements.
  • the reinforcing fibers or braids can also be pre-cured with polymer matrix to form pins or rods, which can then be used for the composite implant. Forming pre-cured pins or rods can facilitate their handling and can prevent or retard degradation of the glass fiber in moisture.
  • the high modulus fiber may have a surface coated with a sizing agent or primer that provides additional adhesion between an acrylic resin injectable matrix material and the high modulus fiber, and can optionally act as a secondary catalyst for the polymerization of the acrylic monomers.
  • the high modulus fiber may be surface coated with an amino functional material selected from at least one of the following materials: amino silanes, lysine, polyamines, amino acids and polyamino acids.
  • the reinforcement fibers can be cleaned or surface oxidized using various means described in the literature including plasma treatment, corona treatment, ozone treatment, and acidic/basic treatment. Such treatments can also be used to introduce specific chemical moieties, such as hydroxyl groups, on the surface of the fibers that can that react or provide improved adhesion with the polymer matrix.
  • Compatibility among the specific components that comprise a composite structure is essential in order to ensure optimal interfacial bonding, mechanical properties, physical properties, and osseointegration.
  • Compounds known as coupling agents or compatibilizers which may be incorporated into the components of the composite implant, serve to enhance the chemical bonding between the specific components of the composite implant.
  • the interfacial bond strength between the containment bag, reinforcing elements, injectable matrix material, and bone can be enhanced through the addition of a variety of compatibilizers, e.g., calcium phosphate, hydroxyapatite, calcium apatite, fused-silica, aluminum oxide, apatite- wollastonite glass, bioglass, compounds of calcium salt, phosphorus, sodium salt and silicates, maleic anhydride, diisocyanate, epoxides, silane, and cellulose esters.
  • compatibilizers e.g., calcium phosphate, hydroxyapatite, calcium apatite, fused-silica, aluminum oxide, apatite- wollastonite glass, bioglass, compounds of calcium salt, phosphorus, sodium salt and silicates, maleic anhydride, diisocyanate, epoxides, silane, and cellulose esters.
  • These agents may be incorporated into, and/or applied to, the components of the composite implant through a number of methods, e.g., plasma deposition, chemical vapor deposition, dip coating, melt-blending, spin or spray-on.
  • a specific example is the application of a silane coupling agent to glass fiber reinforcement in order to increase its interfacial bonding strength with the injectable matrix material.
  • Another example is the vapor deposition of calcium phosphate onto the inner surface of the containment bag such that the bonding between the injectable matrix material and the containment bag is enhanced.
  • osseoconductive material such as fused-silica with aluminum oxide
  • osseoconductive material will improve their adhesion to each other and accelerate osseointegration.
  • the fibers may be sized with a resorbable metal layer, such as magnesium, silver, nickel, titanium or metal alloys such as magnesium calcium alloys.
  • a resorbable metal layer such as magnesium, silver, nickel, titanium or metal alloys such as magnesium calcium alloys.
  • Such coatings can be applied via vapor coating, sputtering, atomic layer deposition, chemical vapor deposition, or electroplating and electroless plating.
  • Another possible coating can be ceramic coatings on the fibers.
  • Such coatings can be made by the surface reaction of ethyoxysilanes such as tetraethoxysilane,
  • methyltriethoxysilane dimethyldiethoxysilane, or trimethylethoxysilane
  • polycarbosilane or polysilazanes such as perhydropolysilazane or polysilizane modified polyamines.
  • sizing utilizes inorganic salts such as metal phosphates.
  • This approach for sizing is similar to the pretreatment process of metals, wherein acids are used to corrode the metal and thus form metal salt on the surface which delays any further attack.
  • phosphate salts of iron, calcium, magnesium, zinc and nickel, etc. are used.
  • the sizing can be applied to phosphate glass fibers by immersion in a suitable metal-salt solution which yields inert phosphate salts that are insoluble in water. This process is self-limiting, as the reaction takes place only as long as phosphate ions are released from the glass surface.
  • the reaction can take place in a reactive medium such as an alcohol or glycol. Mixture of salts is preferred due the formation of smaller crystal sizes.
  • This process could also be combined with an organic pretreatment.
  • This combination of salt/organic pretreatment could also act as an adhesion promoter.
  • the immersion can occur by dipping, soaking, spraying or other techniques using for coating materials and can occur multiple times for greater coverage. This incubation time may be less that 1 minute, between 2-5 minutes or up two multiple weeks.
  • the glass fibers may be heated from 30°C up to l200°C (or higher). The fiber may then be rinsed and/or vacuum dried. Multiple iterations can be performed with the same compound or different salts. It is also possible to use only a metal phosphate, and diffuse some metal ions into the glass fiber and obtain a metal clad fiber.
  • a polysaccharide such as, but not limited to, chitosan, chitosan/PLA, or Chitin can also be used to coat the fiber.
  • Wang et al developed a method for thermally-induced phase separation to prepare polyglycolic acid PGA-(chitosan hybrid matrices with low toxicity). This method may be used in both sizing and matrix composition.
  • the weight ratio PGA to chitosan can range between 1:9 (PGA to Chitosan) to 9: 1, 7:3, or 3:7. This technique may also be performed using PLA (using the same rations as previously mentioned).
  • the pore size ranges from 0.001 Angstroms to 500 Angstroms or more. The pore size can help to determine the rate of degradation.
  • the sizing and/or matrix material may also comprise additional therapeutic molecules, or molecules for facilitating wound healing (or otherwise to deliver localized treatments).
  • the coating on the fiber and/or the matrix material and/or the containment bag may comprise quantum dots to allow for thermal decomposition or radiopaque material.
  • the coating on the fiber and/or the matrix material and/or the containment bag may also have the following chemical properties including but not limited to linear polymine, reactive amino groups, reactive hydroxyl groups, chelates (metal ions)
  • reinforcing elements 15 may be formed out of one or more of the materials used to form containment bag 10 and/or one or more of the materials used to form injectable matrix material 20, appropriately processed so as to provide the functional requirements of reinforcing elements 15.
  • the injectable matrix material 20 is preferably polymeric and is preferably biodegradable.
  • the injectable matrix material 20 is designed to be polymerized in situ but may be pre-formed prior to the application.
  • the matrix material is preferably a multi-component polymer system that is mixed immediately prior to introduction into the patient.
  • the injectable matrix material 20 may contain a biocompatible solvent, with the solvent reducing viscosity so as to allow the matrix material to be injected, and with the solvent thereafter rapidly diffusing from the composite implant so as to facilitate or provide stiffening of the composite implant 5.
  • the solvent may also be used to alter the porosity of the injectable matrix material 20.
  • the injectable matrix can be polyurethane, epoxy, polyurea, polyurea urethane, acrylate, acrylate urethane, propylene glycol fumarate, polycarbonate, polystyrene, or polycitrate esters.
  • polyurethanes are utilized as the injectable matrix material, although other suitable chemistry systems will be apparent to those skilled in the art.
  • the polyurethanes are produced through the reaction of a difunctional or multifunctional isocyanate with a difunctional or multifunctional compound containing an active hydrogen, including water, hydroxyl materials and amines.
  • the urethane polymer matrix may comprise at least two individual components that are mixed together to initiate the curing reaction, wherein a first component contains isocyanate functionalities and a second component contains active hydrogen functionalities capable of reacting with the isocyanate functionalities so as to form at least one from the group consisting of urethane, urea, biuret and allophonate groups during the crosslinking reaction.
  • the first component may be selected from the group consisting of a diisocyanate molecule, a triisocyanate molecule, a polyisocyanate molecule having at least two isocyanate groups per molecule, an isocyanate capped polyol having at least two free isocyanate groups per molecule, an isocyanate capped polyether polyol having at least two free isocyanate groups per molecule and an isocyanate capped polyester polyol having at least two free isocyanate groups per molecule.
  • Suitable isocyanates useful in the practice of this invention include, but are not limited to, aromatic diisocyanates such as 1,2 and 1,4 toluene diisocyanate and blends, 2,4-toluene diisocyanate, 2,6-toluene diisocyanate, 2,2'-5
  • diphenylmethane diisocyanate 2,4'-diphenylmethane diisocyanate, 4,4'- diphenylmethane diisocyanate, diphenyldimethylmethane diisocyanate, dibenzyl diisocyanate, naphthylene diisocyanate, phenylene diisocyanate, xylylene diisocyanate, methylene diphenyl diisocyanate (MDI) and polymeric MDI having an isocyanate functionality from about 2.2 to about 2.8 isocyanate groups per molecule, 4,4'-oxybis(phenylisocyanate) or tetramethylxylylene diisocyanate;
  • MDI methylene diphenyl diisocyanate
  • polymeric MDI having an isocyanate functionality from about 2.2 to about 2.8 isocyanate groups per molecule, 4,4'-oxybis(phenylisocyanate) or tetramethylxylylene diiso
  • aliphatic diisocyanates such as tetramethylene diisocyanate, hexamethylene diisocyanate, dimethyl diisocyanate, lysine diisocyanate, methyl lysine
  • diisocyanate lysine triisocyanate, 2-methylpentane-l, 5-diisocyanate, 3- methylpentane- 1 ,5-diisocyanate or 2,2,4-trimethylhexamethylene diisocyanate; and alicyclic diisocyanates such as isophorone diisocyanate, cyclohexane diisocyanate, hydrogenated xylylene diisocyanate, hydrogenated diphenylmethane diisocyanate, hydrogenated trimethylxylylene diisocyanate, 2,4,6-trimethyl 1,3- phenylene diisocyanate.
  • alicyclic diisocyanates such as isophorone diisocyanate, cyclohexane diisocyanate, hydrogenated xylylene diisocyanate, hydrogenated diphenylmethane diisocyanate, hydrogenated trimethylxylylene diisocyanate, 2,4,6-trimethyl 1,3- pheny
  • the first component may be a polyol isocyanate having a weight average molecular weight from about 100 to about 100,000.
  • the first component may be a blend of diisocyanate or triisocyanate molecules with a polyol capped isocyanate having two, three or four isocyanate groups per molecule in a ratio of about 1 :99 percent by weight to about 99: 1 percent by weight of the total isocyanate component and has a viscosity at 25 degrees C from about 1 cps to about 10,000 cps or up to 100,000 cps at higher temperature.
  • the present invention comprises the use of these same multi-functional isocyanates with multifunctional amines or multifunctional substituted amines, multifunctional ketimines, multifunctional aldimines, isocyanurates or biurets.
  • such multifunctional amines may include hexamethylene diamine, isophorone diamine, and lysine. Also trifunctional isocyanates such as lysine triisocyanates. Examples of substituted amines may include N- substituted diaspartic acid derivatives. Examples of multifunctional ketimines and aldimines may be made from the multifunctional amines mentioned previously and methyl isobutyl ketone or isobutyraldehyde.
  • the second component may be produced by the reaction product of a diamine, triamine or tetramine component with an activated vinyl component selected from the group consisting of dialkyl maleate, dialkyl fumarate, an acrylic acid ester and vinyl ester, wherein the reaction ratio is from about one equivalent of amine functionality to about one equivalent of vinyl functionality to about four equivalents of amine functionality to about one equivalent of vinyl functionality.
  • the second component may be a blend of a polyol component and an aspartate molecule having from about 1% to about 99% polyol component and from about 99% to about 1% aspartate, wherein at least one of the polyol component and the aspartate molecule has a functionality towards isocyanate of at least 2.1 active hydrogen groups per diisocyanate molecule and a viscosity from about 1 cps to about 100000 cps at 25 degrees C or within a higher or lower temperature range.
  • the second component may be selected from the group consisting of a polyol having at least two hydroxyl groups and up to four hydroxyl groups per molecule where the hydroxyl groups are primary or secondary hydroxyls, a polyether polyol having at least two hydroxyl groups and up to four hydroxyl groups per molecule, a polyester polyol having at least two hydroxyl groups and up to four hydroxyl groups per molecule where the polyester is formed by the reaction of a diol or trio with a diacid, a polyester polyol having at least two hydroxyl groups and up to four hydroxyl groups per molecule where the polyester is formed by the reaction of hydroxyacid which is then endcapped with a diol or triol, an aspartate molecule, an amine molecule having from at least two amine groups to four amine groups per molecule where the amine groups are a primary or secondary amines, alkoxylated amines having at least two terminal amine groups per molecule, and a compound containing at least two of the following
  • the polyester polyol is selected from a reaction mixture primarily of adipic acid with diethylene glycol, ethylene glycol or butane diol.
  • the second component can comprise a biodegradable crosslinker with hydroxyl functionality such as 3-hydroxy-N,N-bis(2-hydroxyethyl)butanamide, or a blend of polyols along with the biodegradable crosslinker.
  • a biodegradable crosslinker with hydroxyl functionality such as 3-hydroxy-N,N-bis(2-hydroxyethyl)butanamide, or a blend of polyols along with the biodegradable crosslinker.
  • the aromatic isocyanates are generally favored.
  • the aliphatic isocyanates are generally favored.
  • the aliphatic isocyanates are preferred.
  • the isocyanate component is reacted with a polyol to produce a polyurethane.
  • Suitable polyols include, but not limited to, diols and triols of polycaprolactone, poly(caprolactone-co-lactide) and poly(caprolactone-co-lactide-co-glycolide) .
  • Suitable dihydroxy compounds which may be utilized in the practice of this invention include, but are not limited to, ethylene glycol, propylene glycol, butylene glycol, hexylene glycol and polyols including polyalky lene oxides, polyvinyl alcohols, and the like.
  • the polyol compounds can be a polyalkylene oxide such as polyethylene oxide (“PEO”), polypropylene oxide (“PPO”), block or random copolymers of polyethylene oxide (PEO) and polypropylene oxide (PPO).
  • Higher functional polyol compounds are also useful and can include glycerin, 1,2,4- butanetriol, trimethylol propane, pentaerythritol and dipentaerythritol, 1, 1,4,4- tetrakis(hydroxymethyl)cyclohexane. Also polyols such as sugars or starch.
  • polystyrene resin can include triethanol amine and N,N,N',N'- Tetrakis(2- hydroxyethyl)ethylenediamine.
  • polyol materials discussed above may be used alone or, optionally, as mixtures thereof.
  • the foregoing materials are merely examples of useful components for producing polyurethanes and should not be viewed as a limitation of the present invention.
  • These higher functional polyol materials will produce highly crosslinked polyurethanes with high hardness and stiffness.
  • the multifunctional hydroxyl material may include at least one bioabsorbable group to alter the degradation profile of the resulting branched, functionalized compound.
  • Bioabsorbable groups which may be combined with the multifunctional compound include, but are not limited to, groups derived from glycolide, glycolic acid, lactide, lactic acid, caprolactone, dioxanone, trimethylene carbonate, 3-hydroxypropionic acid (3HP), 4- hydroxybutyrate (4HB), 5- hydroxyvalerate (5HV), 3-hydroxyhexanoate (3HH), 6- hydroxyhexanoate (6HH), 3-hydroxyoctanoate (3HO), and combinations thereof.
  • the multifunctional compound may include trimethylol propane in combination with dioxanone and glycolide.
  • Methods for adding bioabsorbable groups to a multifunctional compound are known in the art.
  • the bioabsorbable groups may be present in an amount ranging from about 50 percent to about 95 percent of the combined weight of the multifunctional compound and bioabsorbable groups, typically from about 7 percent to about 90 percent of the combined weight of the multifunctional compound and
  • the multifunctional compound can have a weight (average molecular weight) ranging from about 50 to about 50000, typically from about 100 to about 30000, and preferably between about 150 to about 5000, and typically possesses a functionality ranging from about 2 to about 6.
  • the polycaprolactone diols and triols provide polyurethanes that are biodegradable.
  • the isocyanate is reacted with a polyol to produce a prepolymer.
  • Methods for endcapping the polyol with an isocyanate are known to those skilled in the art.
  • a polycaprolactone diol may be combined with isophorone diisocyanate by heating to a suitable temperature ranging from about 55 degrees C to about 80 degrees C, typically about 70 degrees C.
  • the resulting diisocyanate- functional compound may then be stored until combined with additional polyol to form the final polyurethane product.
  • amine compounds and organometallic complexes. They can be further classified as to their specificity, balance, and relative power or efficiency.
  • Tertiary amine catalysts are selected based on whether they drive the urethane (polyol+isocyanate, or gel) reaction, the urea (water+isocyanate, or blow) reaction, or the isocyanate trimerization reaction (e.g., using potassium acetate, to form isocyanurate ring stmcture). Since most tertiary amine catalysts will drive all three reactions to some extent, they are also selected based on how much they favor one reaction over another.
  • polyurethane catalysts are the organometallic compounds based on mercury, lead, tin (dibutyl tin dilaurate), bismuth (bismuth octanoate), titanium complexes, zirconium complexes, zinc complexes (imidazole complexed zinc), and iron complexes.
  • dibutyl tin dilaurate is a widely used catalyst in many polyurethane formulations.
  • Stannous octoate is another catalyst that may be used.
  • Another useful catalyst is l,8-diazabicyclo[5.4.0]undec-7-ene (DBU).
  • dibutyl tin dilaurate is a favored catalyst at concentrations below 0.5% and more preferably at concentrations below 0.2% by weight.
  • the urethane polymer matrix may be crosslinked.
  • polyurethanes Apart from polyol-isocyanate reaction, there are other approaches for obtaining polyurethanes.
  • One possible approach for obtaining a crosslinked polyurethane is through the reaction of dicarbonate with an amine.
  • One way of synthesizing the dicarbonate is reacting sorbitan with an alkyl carbonate, though other approaches are certainly possible.
  • Another possible crosslinked polyurethane is the reaction of phosphate ester polyol with isocyanate.
  • the phosphate ester polyol can be obtained by the reaction of phosphoric acid with an epoxide.
  • the crosslinked urethane polymer matrix may be configured to start degrading in the body within about 1 month to about 36 months after implantation in the body.
  • the crosslinked urethane polymer matrix may be configured to lose at least 50% of its original mechanical strength after 6 months in the body.
  • the crosslinked urethane polymer matrix may be configured to lose at least 80% of its original mechanical strength after 12 months in the body.
  • the composite implant is created via the injection of a matrix material, preferably polymeric, through and around the reinforcing elements that may be a series of braided fibers, axial rods, bundled rods, bundled braided rods or other such configurations that conform to previous descriptions.
  • the maximum compressive and flexural modulus of the composite implant is that of the theoretical compressive and flexural modulus of a composite implant formed completely out of reinforcing elements
  • the minimum compressive and flexural modulus of the composite implant is that of the theoretical compressive and flexural modulus of a composite implant formed completely out of injectable matrix material.
  • the final compressive and flexural modulus of the composite material is directly related to the percent composition of fiber volume and will lie between the two values. Additionally, in one
  • the reinforcing elements may be braided into geometric formations which further increase or decrease the mechanical properties of the composite implant.
  • a composite implant with all axial reinforcement elements will have highest resistance to tension and compression, while a composite implant with braided reinforcement elements with no axial reinforcement, but biased reinforcement at approximately 45° to the axis of the composite implant, would be strong in flexural modulus but not as strong in compression.
  • woven sheets of materials used as reinforcement elements may be designed with differing weave configurations to achieve similar ends.
  • injectable matrix material 20 may be formed out of one or more of the materials used to form containment bag 10 and/or one or more of the materials used to form reinforcing elements 15, appropriately processed so as to provide the functional requirements of injectable matrix material 20.
  • the injectable matrix material comprises a polymer comprising a blend of (i) one or more reactants with a least two functional groups 1 to 99% by weight, (ii) a low molecular weight functional modifier 0.1 to 99% by weight, and (iii) a poly functional aliphatic or
  • the matrix polymer may, optionally, also include (iv) a catalyst.
  • the un-crosslinked blend has a glass transition temperature of between of about 170°
  • the first component i.e., one or more reactants with a least two functional groups
  • the first component preferably comprises (a) hydroxyl functional reaction products of a C2 to C 16 aliphatic or cycloaliphatic or heterocyclic diols or triols or blends of these polyols with a saturated or unsaturated C2 to C36 aliphatic dicarboxylic or tricarboxylic acid, anhydrides or lactones and/or lactides and/or glycolides and/or carbonates or blends of these carboxylic acids, or (b) amine functional aspartic acid ester, or (c) CH-active compounds, or blends of the foregoing.
  • the second component i.e., a low molecular weight functional modifier
  • a low molecular weight functional modifier preferably comprises an aliphatic or cycloaliphatic or heterocyclic diol with C2 to C12 carbons.
  • the third component i.e., a poly functional aliphatic or cycloaliphatic isocyanate crosslinker
  • a poly functional aliphatic or cycloaliphatic isocyanate crosslinker preferably comprises an isocyanurate (trimer),
  • iminooxadiazine dione asymmetric trimer
  • biuret, allophanate or uretdione (dimer) derivative with an average functionality of between 2.0 to 4 of an C4 to C15 aliphatic or cycloaliphatic diisocyanate or lysine diisocyanate, or a C4 to C15 aliphatic or cycloaliphatic diisocyanate or lysine diisocyanate.
  • the crosslinked network has a crosslink density with an average molecular weight between crosslinks of less than 500, between 200 to 500, or greater than 250.
  • the fourth (optional) component i.e., a catalyst
  • a catalyst is preferably selected from the group of metals such as bismuth, potassium, aluminum, titanium, zirconium compounds or a t-amine, or organo-tin compounds.
  • the foregoing polymer blend is reactive at a temperature of between 5°C and l50°C, or lO°C to 70°C, or 10° C to 50° C to form a rigid polymer matrix with a Tg (glass transition temperature) between 273.2° K (0° C) and 423° K (150° C), more preferably between 273° K (0° C) and 373° K (100° C), and more preferably between 313° K (40° C) and 343° K (70° C), and more preferably greater than 303 °K (30°C), and is biodegradable over a maximum 5 year period and more preferably within a 3 year period.
  • Tg glass transition temperature
  • the molar ratio of the above matrix is 0.8 to 1.3 reactant functional group to isocyanate functional group.
  • the crosslinked network is formed at a temperature of between 20° C to 60° C within a time period of less than 24 hours.
  • the matrix may also include a non-reactive polyester plasticizer in the amount of 0-30 % of the weight of the matrix or greater than 30% of the weight of the matrix.
  • the plasticizer for the matrix may consist of non-reactive aliphatic polyesters as shown in U.S. Patent No. 5,047,054 among others.
  • the above glass transition temperature Tg of the reactant can be obtained by measurements or also by calculation using the William Landel Ferry Equation (WLF) M.L. Williams, R.F.Landel and J.D.Ferry, J.Am.Chem.Soc.77, 3701(1955).
  • WLF William Landel Ferry Equation
  • the website htp://www.wemerblaiik.com/equat/YiSC EMP3.htm provides a simple method to convert viscosity Tg of an oligomeric polymer to the Tg. This could range from -20C (Polypropylene) to 215 (polynorbornene) or higher (fuzed quartz 1200).
  • the above CH active compounds are the malonic acid ester of above diols or triols or an acetoacetic ester of the above diols or triols.
  • the injectable matrix material 20 may also comprise a bioactive or insoluble filler material, a therapeutic agent, and/or an agent to enhance visibility while imaging the composite implant.
  • the injectable matrix material may include a filler in the form of biocompatible, insoluble and / or osteoconductive particles or short fibers.
  • the first or primary filler preferably in the form of particles, may also provide porosity, bone ingrowth surfaces and enhanced permeability or pore connectivity or resistivity to water permeation.
  • One suitable particulate filler material is tricalcium phosphate, although other suitable filler materials will be apparent to those skilled in the art such as orthophosphates, monocalcium phosphates, dicalcium phosphates, tricalcium phosphates, tetracalcium phosphates, amorphous calcium phosphates and combinations thereof.
  • biodegradable/bioresorbable glasses can be utilized as a filler.
  • the inorganic filler particles have mean diameters ranging from about 1 micron to about 20 microns and lengths of 1 micron to 500 microns.
  • the inorganic filler particles can have different shapes, including spherical, platelet- shaped, isotropic or anisotropic, fibers including nanofibers, rods, nanotubes, and nanorods.
  • the porosity and compressive properties of the matrix material may be modified by using additional fillers that may be inorganic, organic or another suitable biocompatible material.
  • additional fillers may be inorganic, organic or another suitable biocompatible material.
  • Such refinements include the addition of particles having mean diameters ranging from about 10 microns to about 500 microns or a mean diameter of less than 1 micron.
  • the additional filler materials may be provided in one or more size distributions.
  • the composite implant can become porous after implantation so as to aid the resorption and bone healing process.
  • This porosity can be generated by various mechanisms including the preferential resorption of filler, such as calcium sulfate or a-tricalcium phosphate, bioglass or of a polymeric component.
  • the composite implant may also include an additional porogen.
  • the porogen is sugar or a polysaccharide, such as dextran,but other biocompatible porogens will be apparent to those skilled in the art such as crystalline materials in the form of soluble salts.
  • the filler either inorganic or polymeric, may be present in combined amount ranging from about 10 to about 50 wt % of the matrix composition. In certain cases it may be desirable to have the filler content over 50 wt %. If a porogen is added, it will preferably be present in an amount ranging from about 15 to about 50 wt %.
  • Therapeutics Agents can include agents that promote bone formation, or for relief of pain.
  • Agents may include, but are not limited to, parathyroid hormone, vitamin D, calcitonin, calcium, P04, non-steroidal anti inflammatory drugs (NSAIDS) such as, but not limited to, acetaminophen, salicylates (aspirin, diflunisal, salsalate), acetic acid derivatives (indomethacin, ketorolac, sulindac etodolac, diclofenac, nabumetone), propionic acid derivatives (ibuprofen, naproxen, flurbiprofen, ketoprofen, oxaprozin, fenoprofen, loxoprofen), fenamic acid derivatives (meclofenamic acid, mefenamic acid,
  • Therapeutic agents delivered locally can use a carrier vehicle to provide a protective environment, provide target delivery to cells or within cells, provide locally delivery, timed delivery, staged delivery and/or use delivery technology know in the art.
  • the therapeutic agents can also include bone growth activating factors, such as bone morphogenetic proteins (BMPs), FGF (fibroblast growth factor), VEGF (vascular endothelial growth factor), PDGF (platelet derived growth factor), or PGE2 (prostaglandin E2).
  • Bone morphogenetic proteins can include BMP1, BMP2, BMP3, BMP4, BMP5, BMP6, BMP7, BMP8a, BMP8b, BMP10, or BMP15.
  • the therapeutic agents can also include inorganic material processed by the body as a vitamin such as Fe, Ca, P, Zn, B, Mg, K, Mn, Ce, Sr. These elements are built into a predictably solubilizing component of the composite tuned for a consistent release.
  • the injectable matrix material may include one or more particles or liquid agents to enhance visibility while imaging the composite implant.
  • the injectable matrix material may include bismuth oxychloride, bismuth subcarbonate, barium, barium sulfate, ethiodol, tantalum, titanium dioxide, tantalumpentoxide, tungsten, strontium carbonate, strontium halides platinum, titanium, silver, gold, palladium, iridium, osmium, copper, niobium, molybdenum, strontium, strontium salts and gallium, iodine substituted compounds/polymers, and/or alloys such as nickel-titanium, nickel-manganese- gallium, platinum-iridium, platinum-osmium to enhance the visibility of the injectable matrix material under fluoroscopy.
  • the reinforcement element can be flexible reinforcing rods 35 (Figs. 7, 8,
  • the filaments, fibers, and particulates used to form the aforementioned flexible may be biodegradable or bioabsorbable, or non-biodegradable or non- bioabsorbable.
  • Appropriate fibers, filaments, sizing, and polymer matrix have been described at other locations in this application.
  • the pre-cured pins may be coated with an appropriate material that provides, but is not limited to, one of more of the following features: enhanced wettability and bonding to the matrix material; increase in reinforcement dimensions; modulation of hydro-diffusion access to the reinforcement material.
  • the coating on pre-cured pins may or may not be biocompatible, and it may or may not be biodegradable.
  • the coatings on the pre-cured pins can have a thickness ranging from 10 nm to 2 mm, preferably between 100 nm and 100 microns, and more preferably between 1 micron and 100 microns.
  • the coating can be organic, inorganic, or hybrid, and can be formed by one or more of the following processes: dip coating, spray coating, vapor coating, vacuum deposition, sputter deposition, atomic layer deposition, magnetron sputtering, RF sputtering, fluidized bed coating, Wurster process, and surface polymerization.
  • the pre-cured pins can be encapsulated in a thin film using packaging processes such as blister packaging or capsule packaging. Thin films in such cases can be a polymer film, an inorganic film, an organic-inorganic hybrid film, or a polymer film coated with a layer of metal.
  • the pre-cured pin may be coated with a resorbable metal layer, such as magnesium, and metal alloys such as magnesium calcium alloys.
  • a resorbable metal layer such as magnesium, and metal alloys such as magnesium calcium alloys.
  • Such coatings can be applied via vapor coating, sputtering, atomic layer deposition, chemical vapor deposition, or electroplating and electroless plating.
  • Other possible coatings can include ceramic coatings on the fibers.
  • Such coatings can be made by the surface reaction of ethyoxysilanes such as tetraethoxysilane, methyltriethoxysilane, dimethyldiethoxysilane, or trimethylethoxysilane; polycarbosilane, or
  • polysilazanes such as perhydropolysilazane- or polysilizane- modified polyamines.
  • inorganic salts such as metal phosphates.
  • This approach for coating is similar to the pretreatment process of metals, wherein acids are used to corrode the metal and thus form metal salt on the surface which delays any further degradation.
  • acids are used to corrode the metal and thus form metal salt on the surface which delays any further degradation.
  • phosphate salts of iron, calcium, magnesium, zinc, nickel, etc. are used.
  • the coating can be applied on pre-cured pins by immersion in a suitable metal-salt solution which yield inert phosphate salts that are insoluble in water. This process is self-limiting, as the reaction takes place only as long as phosphate ions are released from the glass surface.
  • the reaction can take place in a reactive medium such as an alcohol or glycol.
  • a mixture of salts is preferred due the formation of smaller crystal size.
  • This process could also be combined with an organic pretreatment.
  • This combination of salt/organic pretreatment could also act as an adhesion promoter.
  • the glass fibers can be rinsed and/or vacuum dried. Multiple iterations can be performed with the same compound or different salts. It is also possible to use only a metal phosphate, and diffuse some metal ions into the glass fiber and obtain a metal clad fiber.
  • the pre-cured pins can be cleaned or surface oxidized using various means described in the literature including plasma treatment, corona treatment, ozone treatment, and acidic/basic treatment. Such treatments can also be used to introduce specific chemical moieties, such as hydroxyl groups, on the surface of the pins which can react or provide improved adhesion with the polymer matrix.
  • the coating can also include fillers that act as self-buffering or degradation-controlling agents.
  • Suitable inorganic bases can be added, such as salts and oxides of alkaline metals, including basic mono-, di-, and tri-phosphates, calcium oxide, calcium hydroxide, magnesium oxide, magnesium hydroxide, bioglass flakes, calcium phosphate, beta tricalcium phosphate, hydroxyapatite, potassium stearate and sodium stearate.
  • Particles of metals such as magnesium, iron, titanium, and zinc or metal alloys, such as magnesium base alloys, can also be added.
  • Other possible fillers include water-reactive particles, such as calcium oxide or cobalt chloride.
  • Organic bases such as polyamines, bispidines, and proton sponges, are examples of self-buffering agents.
  • the self-buffering or degradation controlling agents can be encapsulated in a micro- capsules that can be released upon application of a trigger, such as pressure or pH.
  • the coating can be designed for different purposes such as a high barrier properties, with WVP - water vapor permeability - between 10 -2 g*mm/m 2 *days and 102 g*mm/m 2 *days, preferably between 0.2 and 20 g*mm/m 2 *days, or more
  • the shape of the flexible rod is generally important.
  • the shapes can be tailored for the intended use, for example, triangular- or ribbon- shaped.
  • a triangular braided rod can be used as the reinforcement backbone of a composite implant.
  • the triangular shape i.e., triangular cross-section
  • cylindrical shapes i.e., cylindrical cross-section
  • the triangular shape is more applicable to a triangular intramedullary canal, additionally, each flat providing a plane of contact to spread impact force rather than a point load as occurs with a circular configuration.
  • the nesting of flat against flat sides of the triangular shape provides a large surface area for inter-rod binding by the resin.
  • the triangular shape allows for numerous configurations such as horizontal inter-locking of greater than two triangular rods resulting in a flat rod- like trapezoidal composite implant shape. This shape provides manufacturing flexibility, inasmuch as a single back-bone braid could be configured into multiple final products.
  • the triangular shape allows for very tight groupings of materials that allow for very high fiber volumes not possible with circular braids or other reinforcement materials which will always tend to have larger gaps between parallel axial reinforcement elements.
  • the composite implant is created via the introduction of the injectable matrix material, preferably polymeric, through and around the reinforcing elements, which may comprise a plurality of braided fibers, axial rods, bundled rods, bundled braided rods or other such configurations.
  • the matrix material and reinforcing elements may be surrounded by a barrier which may be used to regulate the rate at which water contacts the matrix material and reinforcing elements.
  • a novel composite comprising (i) a barrier (which may be a containment bag or coating) which is water permeable and which contains hydrolyzable sites so that the barrier will break down over time when placed in an aqueous environment (e.g., water, the body, etc.); (ii) a flowable/settable matrix which is hydrolyzable so that the matrix will break down over time when contacted by an aqueous environment; and (iii) reinforcing elements which are disposed within the flowable/settable matrix and which, when they come into contact with an aqueous environment, break down and give off catalysts which modify (e.g., increase) the hydrolysis of the matrix material.
  • a barrier which may be a containment bag or coating
  • a barrier which is water permeable and which contains hydrolyzable sites so that the barrier will break down over time when placed in an aqueous environment (e.g., water, the body, etc.)
  • a flowable/settable matrix which is hydrolyzable
  • the barrier provides a means for regulating the degradation of the matrix material
  • the reinforcing elements provide a means for modifying (e.g., increasing) the hydrolysis of the matrix material.
  • the maximum compressive and flexural modulus of the composite implant is that of the theoretical compressive and flexural modulus of a composite implant formed completely out of reinforcing elements, and the minimum
  • compressive and flexural modulus of the composite implant is that of the theoretical compressive and flexural modulus of a composite implant formed completely out of injectable matrix material.
  • the final compressive and flexural modulus of the composite implant is directly related to the percent composition of fiber volume in the composite implant, i.e., a composite implant comprising a 70% fiber volume will more closely mimic the properties of the reinforcing elements than the properties of the injectable matrix material. More particularly, Fig. 28 shows a manner by which implant strength can be varied based on the ratio of constituent reinforcing elements (and the underlying“fiber” that makes up the constituent reinforcing elements). Once the required strength of the composite implant is known, a composite implant can be customized that uses an amount of distributed“fiber” reinforcing elements within the injectable matrix material.
  • the ratio of fiber volume to matrix volume determines the ultimate strength of the composite implant, with the strength somewhere between the strength of the injectable matrix material and that of the reinforcing element(s). Additionally, the form of the fibers as they are constructed within the reinforcing elements determines where and how that strength is achieved. Fibers arranged in columnar axial supports (see Fig. 29) shift implant strength to compression and tension. Angular cross fibers (from a weave or braid) shift strength to bending and resistance to torsion. A mix of both results in a more balanced implant construct.
  • reinforcing elements of E-glass (45 GPa) braid was used to reinforce PLA matrix (2 GPa) in a composite implant.
  • the mix was
  • a stiff composite product is chosen in the 20-80 GPa modulus range, which is appropriate in some applications using a material described hereafter in the non-resorbable reinforcement elements. If the composite implant is to be fully bio-resorbable, then the composite implant may have a 7-45 GPa modulus range as is appropriate to splint most long bone fractures.
  • the directions of reinforcement element fibers can create materials configured with lower moduli in the 500 MPa to 1 GPa range for craniofacial fractures and other small bone repairs as needed.
  • a combination of fibers with different moduli and other properties can be used to further vary the ultimate strength of the composite implant.
  • a glass fiber material could be combined with a polypropylene or PLLA material to produce appropriate moduli with the capability to be cut during manufacturing and resealed via heat treatment or the friction of the cutting blade.
  • a mix of bioresorbable fibers with non-bioresorbable fibers within a braided or woven reinforcement matrix would create an eventual pathway, after the material bioresorbs, for blood flow or other fluid transit.
  • the reinforcing elements may be braided into geometric formations which further increase or decrease the mechanical properties of the composite implant.
  • a composite implant with“all axial” reinforcement elements will have the highest resistance to tension and compression
  • a composite implant with braided reinforcement elements having“no axial” reinforcement elements, but including reinforcement elements set at approximately 45° to the axis of the composite implant would be strong in flexural modulus but not as strong in compression.
  • woven sheets of materials used as reinforcement elements may be designed with differing weave configurations to achieve similar results.
  • Devices, or parts of devices, that could be created using the present invention include, but are not limited to, fabrics such as clothing and parachutes, materials used in cars (both interiors and exteriors), vascular supports (both interior and exterior). Rigid materials such as bottles, syringes, bone- supporting materials, packaging materials, catheters, and stents may also be formed using the present invention. Consumables used in other applications, such as the abrasives used in particle blasting for paint and rust removal, could also benefit from the present invention.
  • the composite implant 5 is disposed within the intramedullary canal of a bone, or within another opening in the bone, so as to function as an internal “splint”, whereby to carry the stress created during patient activity. This allows a bone fracture to heal, or provides fortification and/or augmentation of bone, with minimum inconvenience to the patient.
  • the components of the composite implant 5 are introduced sequentially into the patient, and assembled in-situ, thereby allowing the composite implant 5 to be installed using a minimally invasive approach.
  • the composite implant is pre-assembed by a manufacturer and provided to the surgeon in a sterile manner for implantation.
  • the fracture site would be directly accessed and the composite implant placed in the intramedullary canal, with or without a containment bag. Additional injectable matrix material could be used to form-fit the composite implant to the
  • the composite implant can be fixed using mechanical means such as implant screw threads, press-fit in the canal, or another form of bone cement.
  • the composite implant 5 may be used in the following manner to treat a fracture in the tibia.
  • the first step is to create an access hole 50 into the bone that is to be treated.
  • an access port 52 may be disposed in access hole 50 so as to facilitate delivering elements through access hole 50.
  • the hole is made into the intramedullary canal distal to, or proximal to, the fracture site.
  • the modular nature of the composite implant means that the composite implant can be introduced into the intramedullary canal of the bone that is to be treated through an access hole that is smaller than the final form of the composite implant. For example, in the case of where the composite implant is to fill an intramedullary canal that is 10 mm in diameter, the required access hole may be only 3 mm in diameter.
  • the composite implant may be deployed using a minimally invasive procedure that may be carried out in an office setting or surgicenter setting rather than in a conventional operating room.
  • Access hole 50 is preferably drilled at an acute angle to the bone which is being treated, e.g., at an angle of approximately 45 degrees, but it may be drilled at an angle anywhere between 0 degrees and 90 degrees, either proximal or distal to the fracture. This allows the components of the composite implant to be more easily introduced into the intramedullary canal.
  • the second step is to remove or harvest the bone marrow (and/or other matter) in the intramedullary canal, and to clean the intramedullary canal, so as to provide a space for the composite implant 5. This is done through the access hole 50 previously created. Removal of fat and other resident tissue improves the function of the IM fixation device and potentially reduces complications. For example, one aspect that is known to promote fracture healing is the relative stability of the fractured segments. With the canal cleaner device, stability can be enhanced by complete canal filling and generating interlock with the irregularities within the canal. In another example, displacement of fat from the canal into the blood stream can result in blockage of blood vessels which can result in
  • the device for removing or harvesting of the bone marrow from the intramedullary canal comprises a catheter 55 with provision for introducing a liquid or gas into the intramedullary canal and suction for removal of material from the intramedullary canal.
  • the liquid or gas can be used to disrupt the content in the intramedullary canal or prepare the intramedullary canal for a composite implant.
  • the liquid or gas can be introduced in a continuous, pulsed, or intermittent flow.
  • a rotatable flexible rod 60 with a shaped end or attachment at the distal end (e.g., having one or more wire loops, brushes, cutting tips, etc., which may or may not be made out of a shape memory material such as Nitinol, and which may or may not be steerable), is optionally used to disrupt the bone marrow in the intramedullary canal so as to aid in the removal of the bone marrow.
  • a tissue trap is utilized.
  • Fig. 11 shows the intramedullary canal of the bone after it has been appropriately prepared.
  • the third step is to place a flow restrictor plug 65 in the intramedullary canal distal to, and/or proximal to, where the composite implant 5 will be placed in the intramedullary canal. Again, this is done through the access hole 50 previously created. Where two flow restrictor plugs 65 are used, the two flow restrictor plugs may be connected to one another. The flow restrictor plugs 65 may be optionally placed prior to removing or harvesting the bone marrow.
  • the fourth step is to return the bone to proper alignment.
  • the fifth step is to introduce the containment bag 10 into the intramedullary canal via the access hole 50 previously created.
  • the containment bag 10 is introduced into the intramedullary canal through a delivery catheter 70, and is releasably attached to a catheter that is used for subsequent delivery of the remaining components of the composite implant, i.e., the one or more reinforcement elements 15 and the injectable matrix material 20.
  • the catheter may have markers on its exterior surface so as to allow the physician to determine the position of the containment bag 10 within the bone by direct visualization of the markers on the exterior surface of the catheter.
  • containment bag 10 may have markers thereon so as to allow the physician to determine the position of the containment bag 10 within the bone by indirect visualization (e.g., fluoroscopy, CT, etc.).
  • indirect visualization e.g., fluoroscopy, CT, etc.
  • the containment bag 10 may comprise an auxiliary channel to allow monitoring and control of subsequent pressurization with the injectable matrix material. This auxiliary channel may be parallel to the delivery catheter, or inside the delivery catheter, or the auxiliary channel may be at the distal end of the containment bag.
  • valve at the distal end of the containment bag, or at other strategic regions of the containment bag, that can limit pressure within the containment bag.
  • Valves could be positioned at either end of the containment device or both. These valves could aide in the release of the material and could be activated mechanically, remotely by optics (waveguides, xrays, light) or by physiological triggers such as local changes in pH.
  • Fig. 14 shows containment bag 10 disposed within the intramedullary canal of the bone.
  • the sixth step is to sequentially introduce the one or more reinforcing elements 15 into the containment bag 10. This is done through the access hole 50 previously created. Note that the flexible nature of the reinforcing elements 15 facilitates their delivery into the containment bag 10 via the access hole 50 previously created.
  • the one or more reinforcing structures 15 are preferably introduced into the containment bag sequentially so as to build up a reinforcing mass. In one preferred form of the invention, and looking now at Figs.
  • a plurality of flexible reinforcing sheets 22 are sequentially inserted into the containment bag 10, with one flexible reinforcing concentric tube 22 being nested inside another, and a plurality of flexible reinforcing rods 35 are sequentially inserted within the innermost flexible concentric reinforcing tube 22 (Figs. 17-19).
  • the flexible reinforcing sheets 22 (which are preferably in the form of concentric tubes such as is shown in Figs. 3 and 4 or rolled sheets such as is shown in Figs.
  • the size and number of flexible concentric reinforcing tubes 22 and reinforcing rods 35 are selected so as to meet the individual needs of a particular patient.
  • the number of flexible concentric reinforcing tubes 22 utilized in the composite implant, and/or their lengths and/or cross-sectional dimensions, and/or the number of reinforcing rods 35 used, and/or their lengths and/or cross-sectional dimensions, may be selected according to the individual needs of a particular patient.
  • the number, length, and cross-sectional dimensions of the reinforcing tubes, and the number, length, and cross-sectional dimensions of the reinforcing rods are selected so as to provide a composite implant having variable stiffness along its length, e.g., a composite implant having a stiffer central region (e.g., 20 GPa) and less stiff distal and proximal ends (e.g., 3 GPa), whereby to prevent stress risers from being created at the ends of the composite implant.
  • the reinforcing tubes, and the reinforcing rods are preferably provided in a variety of sizes for appropriate selection by the physician; alternatively, the reinforcing tubes and/or reinforcing rods may be sized at the time of use by the physician.
  • a guidewire 75 may be provided to facilitate introduction of the one or more reinforcing elements into the containment bag. This guidewire 75 is preferably attached to the distal end of the containment bag 10 using an adhesive or other non-permanent attachment means. After the one or more reinforcement elements 15 have been placed in the containment bag, the guidewire 75 can be detached from the containment bag 10 by pulling or twisting the guidewire.
  • the guidewire 75 may be absorbable, in which case it may be left in the patient at the conclusion of the procedure.
  • the seventh step is to introduce the injectable matrix material 20 into the containment bag. Again this is done through the access hole 50 previously created.
  • the injectable matrix material is formed from two or more components that are mixed immediately prior to injection into the patient. This may occur through use of a static mixer fed by multiple syringes. Alternatively the components may be mixed in a remote container and then loaded into a syringe that is connected to the injection tube.
  • an injection tube 80 is used to deliver the injectable matrix material 20 into the containment bag 10 under pressure, where it flows over and through the one or more reinforcement structures 15 contained within the containment bag 10.
  • the injection tube is first positioned in the distalmost section of the containment bag, then withdrawn during the injection process for a retro-grade fill.
  • the injection tube 80 is withdrawn after the matrix material is injected into the containment bag.
  • the injection tube is, preferably, also capable of transmitting an energy wave into the injectable matrix material in cases where pulsatile flow or the application of vibrational forces is required to aid injecting the matrix material into the containment bag. Vacuum may be used to facilitate wetting out of the
  • reinforcement structures by removal of trapped air from the composite through a secondary access pathway within the balloon catheter.
  • the eighth step is for the injectable matrix material to solidify so that the matrix material 20, the one or more reinforcing elements 15 and the containment bag 10 become a single solidified structure 5 (Figs. 22 and 23) capable of providing support across the fracture line while the bone fracture heals.
  • an expandable device e.g., a balloon
  • the expandable device may be a biodegradable form or feature of the injection catheter. More
  • the expandable device e.g., balloon
  • the expandable device may be used to enhance the penetration of the injectable matrix material into and between one or more reinforcing elements, the containment bag and the bone, and to enhance the interfacial bond between the injectable matrix material and the one or more reinforcing elements, between the injectable matrix material and the containment bag, and between the injectable matrix material and the bone.
  • this solidification occurs through a chemical reaction that proceeds at a rate that allows sufficient time for injection before the viscosity increases to a point where injection and flow into and around the reinforcements is no longer possible. Generally this time is less than five to ten minutes.
  • the composite implant can contour as needed to the geometry of the intramedullary canal of the bone, i.e., in Fig. 22 the composite implant has a substantially linear shape to match the substantially linear shape of the intramedullary canal of the tibia, whereas in Fig. 23 the composite implant has a contoured shape to match the contour of the clavicle.
  • the ninth step is to close the wound.
  • the present invention comprises the provision and use of a novel composite implant for treating bone fractures (and/or for fortifying and augmenting a bone).
  • the composite implant is disposed within the
  • the composite implant comprises a plurality of components that are introduced sequentially into the patient, and assembled in situ, thereby allowing the composite implant to be installed using a minimally invasive approach.
  • the properties of the composite implant can be custom tailored for different treatment situations, e.g., the composite implant can have different lengths and/or cross- sectional dimensions, the composite implant can have different compressive and/or tensile strengths, etc., all according to the individual needs of a particular patient.
  • containment bag 10 may be omitted.
  • the one or more reinforcing elements 15 and injectable matrix material 20 are deployed directly into the intramedullary canal (or other opening) in the bone that is being treated, without an intervening containment bag 10.
  • the reinforcement rods can be placed in a deflated balloon (i.e., the containment bag) prior to its insertion into the body, which will eliminate the need for the surgeon/physician to separately place the reinforcement rods in the containment bag in a separate step.
  • the reinforcement rods can include individual braids or fibers, and/or pre-cured pins and rods (where matrix material is combined with the braids or fibers and then pre-cured).
  • the pre-cured pin may be provided in various shapes including, but not limited to, a sphere, a rectangular prism, a cylinder, a triangular prism, a prism with sides greater than four, etc.
  • composite implant 5 may be formed out of flexible reinforcing sheets 22 without any flexible reinforcing rods 35 (Fig. 24); with flexible reinforcing rods 35 and without any flexible reinforcing sheets 22 (Fig. 25); and with a laminated construction comprising both flexible reinforcing sheets 22 and flexible reinforcing rods 35 (Fig. 26).
  • Fig. 27 shows how guidewire 75 may be used to reduce a fracture prior to delivery of the composite implant. More particularly, in this form of the invention, guidewire 75 has an enlargement 85 formed at one end, with enlargement 85 being disposed exterior to the bone being treated, and with the opposite end 90 of guidewire 75 emerging from port 52.
  • a fixture 95 may be positioned within the intramedullary canal of the bone, adjacent to enlargement 85, so as to direct guidewire 75 along the longitudinal channel of the bone and thereby facilitate fracture reduction and delivery of the composite.
  • metal support rods are commonly used to support the revision.
  • Polymer intramedullar support rods are typically not strong enough to survive insertion intact.
  • a pre-cured, small diameter composite implant pin, formed with the components described herein, will have the required strength for intact insertion and maintain enough support strength through the healing process.
  • a preferred embodiment is bioresorbable and may include a bioresorbable surface coating as previously described.
  • a composite implant pin formed in accordance with the present invention, may be implanted into the supporting halves of the bone and fixed in place using injectable matrix material as a gap-filling adhesive (bulk filler), with the specific design of the composite implant pin preferably meeting the material properties of the surrounding bone, i.e., the modulus, porosity, etc. of the surrounding bone.
  • injectable matrix material as a gap-filling adhesive (bulk filler)
  • bulk filler with matched modulus to the bone, will eliminate stress risers and allow natural healing-inducing strains to be applied to the bone.
  • segments of bone together e.g., such as may be required with tibial
  • the fractured segments are re-aligned, and at least one continuous bone tunnel (e.g., the intramedullary canal) is
  • the modularity of the invention and method is maintained when used in a non-minimally invasive manner.
  • open surgery is required or desired, such as with traumatic injuries or patient- specific circumstances (e.g., osteoporosis, osteogenesis imperfecta), the containment bag and
  • reinforcing elements can be assembled outside of the body and introduced into the continuous bone tunnel (e.g., the intramedullary canal) before or after injection of the injectable matrix material, then the bones are re
  • This method could include the situation where a large composite implant, constituting a sub-segment (or a series of small composite implants constituting a series of sub- segments) was pre-cured and supplied by the manufacturer as with the small bone indication above and fit to the continuous bone tunnel (e.g., the intramedullary canal) with or without a containment bag, using a gap-filling injectable matrix material (preferably having bone-like material properties) to secure the composite implant in place.
  • a gap-filling injectable matrix material preferably having bone-like material properties
  • Mechanical shapes and fasteners can be formed around a core composite implant so as to form screw threads on the composite implant.
  • the mechanical shapes and fasteners formed on the core composite implant are preferably composed of injectable matrix material having material properties similar to bone. Formation of mechanical shapes and fasteners having material properties similar to bone will reduce post-implantation thread wear and allow for natural healing due to similar strains between the native bone and composite implant.
  • Other forms of mechanical shapes and fasteners can include bent pins, clips with semi- elastic properties, bone anchors (e.g., toggling bone anchors which catch on internal bone structure, etc.), and/or other mechanical fasteners required for anatomical (e.g., soft tissue) repairs.
  • a pultrusion technique wherein a resin is applied over a rolled reinforcement element sheet or a braided or woven core of reinforcement element would give the ability to create long pins that may or may not be bioresorbable with a much higher modulus than that of current molded pure or blended polymer fixation elements.
  • the geometry of the reinforcing elements are non-circular space-filling designs.
  • a specific and preferred shape is a reinforcing element in the form of a rod having a
  • Rods having a triangular cross-section are advantageous in that any impact force applied on a single rod component will be spread across a plane of contact, instead of the impact force being concentrated on a point contact such as the case with a rod having a circular cross-section.
  • modularity of a“triangular rod” allows for stacked configurations of squares, trapezoids and other useful configurations to be produced, all with very high fiber contents. Pre-formed composite implants can be created in a flat-rod configuration, using multiple aligned
  • the composite implant comprises a
  • thermoplastic polymer implant comprising a thermoplastic polymer matrix and a high modulus fiber component having a tensile modulus from about 8 GPa to about 400 GPa.
  • the fiber content of the thermoplastic polymer implant may be from about 5 volume percent to about 75 volume percent.
  • the fiber content of the thermoplastic polymer implant may be from about 25 volume percent to about 50 volume percent.
  • the fiber component may be selected from the group consisting of E glass, bio glass, soluble glass, resorbable glass, carbon fiber, polyaramid fiber, PET fiber, polylactic acid homopolymer or copolymer fiber, polycaprolactone fiber, ceramic fiber, polyhydroxyalkanoate homopolymer or copolymer fiber, PEEK fiber or combinations thereof.
  • the fiber component may comprise at least one from the group consisting of a plurality of single filaments, woven filaments, braided filaments and composite mesh containing at least one compositional fibers.
  • the fiber component comprises a high modulus fiber having a modulus greater than 10 GPa compressive strength and a low modulus thermoplastic fiber having a modulus less than 8 GPa compressive strength, and the low modulus thermoplastic fiber is pre-melted so as to provide a position-retaining structure for the high modulus fibers.
  • the fiber component may have a length-to-width aspect ratio of at least 20:1.
  • the high modulus fiber component comprises a matrix
  • the thermoplastic polymer matrix is combined with the fiber matrix via a solution-casting process.
  • thermoplastic polymer matrix may be applied from a solvent solution to a fiber construct through multiple application steps, wherein the solvent is removed after each step so as to allow for full wetting of the fiber surfaces and removal of any voids from trapped solvent components.
  • the high modulus fiber component may comprise a matrix, and the thermoplastic polymer matrix may be combined with the fiber matrix via a melt coating process.
  • the melt coating process may be a pultrusion of a T bar fiber extrusion process.
  • biodegradable or bioabsorbable materials polylactic acid homopolymer or copolymer, polycaprolactone, ceramic, polyglycolide (PGA), glycolide
  • polydepsipeptide glycine-DL-lactide copolymer
  • polylactide/ethylene oxide copolymers asymmetrically 3 ,6-substituted poly- 1 ,4-dioxane-2,4-diones
  • polyhydroxyalkanoate (PHA) homopolymer or copolymer poly(3- hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), poly-b hydroxybutyrate (PHB),
  • PEO polyethylene oxide
  • silk silk
  • collagen derivatized hyaluronic acid resorbable or soluble glasses
  • resorbable ceramic resorbable metal and chitin polymers.
  • thermoplastic polymer implant be constructed so that it starts to degrade in the body within about 1 month to about 24 months after implantation in the body.
  • thermoplastic polymer implant may be constructed so that it loses at least 50% of its original mechanical strength after 3 months in the body.
  • thermoplastic polymer implant may be constructed so that it loses at least 50% of its original mechanical strength after 6 months in the body.
  • thermoplastic polymer implant may be constructed so that it loses at least 80% of its original mechanical strength after 12 months in the body.
  • thermoplastic polymer implant may be constructed so that about 1% to about 25% of the thermoplastic polymer matrix is replaced by a crosslinking polymer component so as to provide improved adhesive strength between the thermoplastic polymer matrix and the high modulus fiber component.
  • the high modulus fiber component comprises a matrix
  • the thermoplastic polymer matrix is applied to the fiber matrix in the form of a fine powder and then heat fused to consolidate the subsequent molten thermoplastic polymer matrix around the high modulus fiber component.
  • the high modulus fiber component comprises a matrix
  • the thermoplastic polymer matrix is applied to the fiber matrix via electro spinning of the thermoplastic polymer matrix and the resultant voids filled with a composition which polymerizes into a high molecular weight polymer.
  • thermoplastic polymer matrix may comprise vinyl monomers which are cured using free radical initiators, UV radiation, gamma ray irradiation, or infrared radiation.
  • thermoplastic polymer matrix may be cured through a ring opening, condensation or addition reaction or specialized re actions related to these and known to those skilled in the art. For example, two polymers together in a ring opening or condensation reaction, in conjunction with controlling the
  • the high modulus fiber component may be coated with the thermoplastic polymer matrix and they are then bonded together with a crosslinking resin so as to produce the final thermoplastic polymer implant geometry.
  • the crosslinking resin may comprise a urethane or urea composition.
  • the high modulus fiber component may comprise a braided rod having a triangular cross-section.
  • the high modulus fiber component may comprise a braided rod having a circular cross-section.
  • thermoplastic polymer implant is formed prior to implantation.
  • the thermoplastic polymer implant may comprise a rod having a substantially circular cross-section.
  • the thermoplastic polymer implant may comprise a rod having a substantially triangular cross-section.
  • the rod may be cannulated.
  • the cannulation is created by forming the thermoplastic polymer implant over a mandrel and then removing the mandrel after the thermoplastic polymer implant is cured.
  • the thermoplastic polymer implant comprises at least two high modulus fiber components each comprising a braided rod having a triangular cross-section, and the at least two high modulus fiber components combine to form larger structures.
  • the thermoplastic polymer implant may be formed into a shape selected from the group consisting of a screw, a rod, a pin, a nail and a bone anchor.
  • a method for treating a bone comprising: selecting at least one reinforcing element to be combined with an injectable matrix material so as to together form a composite implant capable of supporting the bone, wherein the at least one reinforcing element comprises a high modulus fiber component having a tensile modulus of about 8 GPa to about 400 GPa; positioning the at least one reinforcing element in a cavity in the bone; flowing the injectable matrix material into the cavity in the bone so that the injectable matrix material interfaces with the at least one reinforcing element; and transforming the injectable matrix material from a flowable state to a non-flowable state so as to establish a static structure for the composite implant, such that the composite implant supports the adjacent bone.
  • the hole may extend at an acute angle to the intramedullary canal.
  • the at least one reinforcing element may be flexible, and the at least one reinforcing element may be flexed in order to pass through the hole and into the intramedullary canal.
  • the at least one reinforcing element may be flexible both radially and longitudinally.
  • the at least one reinforcing element may comprise a plurality of reinforcing elements, wherein each of the reinforcing elements is individually capable of being passed through the hole, and further wherein the plurality of reinforcing elements collectively form a structure too large to be passed through the hole.
  • the at least one reinforcing element may comprise at least one from the group consisting of a flexible reinforcing sheet, a flexible reinforcing rod, and particulates.
  • the at least one reinforcing element may comprise a flexible reinforcing sheet in the form of a tube.
  • the at least one reinforcing element may comprise at least two flexible reinforcing sheets arranged concentrically.
  • the at least one reinforcing element may comprise a flexible reinforcing sheet having an arcuate cross-section.
  • the at least one reinforcing element may comprise a flexible reinforcing sheet having a planar cross-section.
  • the at least one reinforcing element may comprise a flexible reinforcing sheet comprising filaments formed into a textile.
  • the at least one reinforcing element may comprise a flexible reinforcing sheet comprising filaments connected by a film.
  • the at least one reinforcing element may comprise a flexible reinforcing rod comprising filaments held together.
  • the at least one reinforcing element may comprise a flexible reinforcing rod and the filaments are held together by an outer sheath.
  • the outer sheath may comprise filaments formed into a textile.
  • the at least one reinforcing element may comprise a flexible reinforcing rod and the filaments are held together by a compacted connecting structure of a textile or film.
  • the connecting structure may be compacted by at least one of winding and compressing.
  • the at least one reinforcing element may comprise a flexible reinforcing rod and the filaments may be held together by a binder.
  • the at least one reinforcing element may comprise particulates.
  • the at least one reinforcing element may comprise at least one flexible reinforcing sheet and at least one flexible reinforcing rod.
  • the at least one flexible reinforcing sheet and the at least one flexible reinforcing rod may be selected so as to form the composite implant with a desired stiffness.
  • the composite implant may have a stiffer central region and less stiff distal and proximal ends.
  • the injectable matrix material may comprise a polymer.
  • the composite implant may further comprise a containment bag, and the at least one reinforcing element may be positioned within the containment bag after the containment bag has been positioned within the cavity in the bone.
  • a method for treating a bone comprising: selecting at least one high modulus fiber
  • the at least one high modulus fiber component comprises a rod having a cross- section selected from the group consisting of round and circular; flowing an injectable matrix material into the cavity in the bone so that the injectable matrix material interfaces with the at least one high modulus fiber component so as to form a composite implant, wherein the injectable matrix material comprises a thermoplastic polymer matrix; and transforming the injectable matrix material from a flowable state to a non-flowable state so as to establish a static structure for the composite implant, such that the composite implant supports the adjacent bone.
  • the composite implant may comprise a containment bag, and the at least one high modulus fiber component may be positioned within the containment bag after the containment bag has been positioned within the cavity in the bone.
  • a method for treating a bone comprising: selecting at least one high modulus fiber
  • the high modulus fiber component comprises a plurality of fibers, and further wherein the high modulus fiber component is pre-loaded with an injectable matrix material just prior to implantation so as to together form a composite implant, wherein the injectable matrix material comprises a thermoplastic polymer matrix; positioning the composite implant in a cavity in the bone; flowing additional injectable matrix material into the high modulus fiber component so that the injectable matrix material exudes from the surfaces of the high modulus fiber component and interfaces with the surrounding bone cavity; and transforming the injectable matrix material from a flowable state to a non-flowable state so as to establish a static structure for the composite implant, such that the composite implant supports the adjacent bone and or approximated soft tissue.
  • the composite implant comprises
  • a polymer implant comprising a high modulus fiber reinforcing component and a urethane polymer matrix.
  • the high modulus fiber reinforcing component may be present in an amount from about 10 volume percent to about 75 volume percent of the polymer implant and wherein the modulus of the high modulus fiber reinforcing component is from about 6 GPa to about 90 GPa.
  • the high modulus fiber reinforcing component may be selected from the group consisting of E glass, carbon fiber, bio glass, soluble glass, resorbable glass, ceramic fiber, and polylactic acid homopolymer and copolymer fibers
  • the high modulus fiber reinforcing component may be disposed in the polymer implant in a uniaxial direction along the major axis of the polymer implant.
  • the high modulus fiber reinforcing component may comprise a woven or braided construct.
  • the orientation of the woven or braided construct of the high modulus fiber reinforcing component may be held in position by a lower modulus fiber construct, wherein the lower modulus fiber construct comprises up to 10% by weight of the total high modulus fiber reinforcing component and with the lower modulus fiber construct having a melting point between about 40 degrees C and about 200 degrees C, such that the high modulus fiber reinforcing component is made more rigid for application into the polymer implant before curing of the urethane polymer matrix.
  • the high modulus fiber reinforcing component may have a length-to- width aspect ratio of at least 20:1.
  • the urethane injectable matrix material may be formed as described above in the section entitled“Injectable Matrix Material”.
  • the urethane polymer matrix may comprise at least two individual components that are mixed together to initiate the curing reaction, wherein a first component contains isocyanate functionalities and a second component contains active hydrogen functionalities capable of reacting with the isocyanate
  • the first component may be selected from the group consisting of a diisocyanate molecule, a triisocyanate molecule, a polyisocyanate molecule having at least two isocyanate groups per molecule, an isocyanate capped polyol having at least two free isocyanate groups per molecule, an isocyanate capped polyether polyol having at least two free isocyanate groups per molecule and an isocyanate capped polyester polyol having at least two free isocyanate groups per molecule.
  • the first component may be selected from the group consisting of isophorone diisocyanate, hexamethylene diisocyanate, lysine diisocyanate, methyl lysine diisocyanate, lysine triisocyanate, toluene diisocyanate 1,2 and 1,4 and blends, methylene diphenyl diisocyanate (MDI) and polymeric MDI having an isocyanate functionality from about 2.2 to about 2.8 isocyanate groups per molecule.
  • MDI methylene diphenyl diisocyanate
  • polymeric MDI having an isocyanate functionality from about 2.2 to about 2.8 isocyanate groups per molecule.
  • the first component may be a blend of diisocyanate or triisocyanate molecules with a polyol capped isocyanate having two, three or four isocyanate groups per molecule in a ratio of about 1 :99 percent by weight to about 99: 1 percent by weight of the total isocyanate component and has a viscosity at 25 degrees C from about 250 cps to about 5,000 cps.
  • the second component may be selected from the group consisting of a polyol having at least two hydroxyl groups and up to four hydroxyl groups per molecule where the hydroxyl groups are primary or secondary hydroxyls, a polyether polyol having at least two hydroxyl groups and up to four hydroxyl groups per molecule, a polyester polyol having at least two hydroxyl groups and up to four hydroxyl groups per molecule where the polyester is formed by the reaction of a diol or triol with a diacid, a polyester polyol having at least two hydroxyl groups and up to four hydroxyl groups per molecule where the polyester is formed by the reaction of hydroxyacid which is then endcapped with a diol or triol, an aspartate molecule, an amine molecule having from at least two amine groups to four amine groups per molecule where the amine groups are a primary or secondary amines, alkoxylated amines having at least two terminal amine groups per molecule, and a compound containing at least two of the
  • the second component may be produced by the reaction product of a diamine, triamine or tetramine component with an activated vinyl component selected from the group consisting of dialkyl maleate, dialkyl fumarate, an acrylic acid ester and vinyl ester, wherein the reaction ratio is from about one equivalent of amine functionality to about one equivalent of vinyl functionality to about four equivalents of amine functionality to about one equivalent of vinyl functionality.
  • the second component may be a blend of a polyol component and an aspartate molecule having from about 1% to about 99% polyol component and from about 99% to about 1% aspartate, wherein at least one of the polyol component and the aspartate molecule has a functionality towards isocyanate of at least 2.1 active hydrogen groups per diisocyanate molecule and a viscosity from about 250 cps to about 5000 cps at 25 degrees C.
  • the urethane polymer matrix may be crosslinked.
  • the crosslinked urethane polymer matrix may be configured to start degrading in the body within about 1 month to about 24 months after implantation in the body.
  • the crosslinked urethane polymer matrix may be configured to lose at least 50% of its original mechanical strength after 6 months in the body.
  • the crosslinked urethane polymer matrix may be configured to lose at least 80% of its original mechanical strength after 12 months in the body.
  • the polymer implant may be prepared prior to implantation.
  • the polymer implant may be prepared in situ.
  • the high modulus fiber reinforcing component may be braided and may comprise a rod having a triangular cross-section.
  • the polymer implant may be prepared prior to implantation.
  • the high modulus fiber reinforcing component may be braided and may comprise a rod having a circular cross-section.
  • the rod may be cannulated.
  • Cannulation may be created by forming the polymer implant over a mandrel and then removing the mandrel after the implant is cured.
  • the polymer implant may comprise at least two high modulus fiber reinforcing components each comprising a braided rod having a triangular cross- section, and further wherein the at least two high modulus fiber reinforcing components combine to form larger structures.
  • the polymer implant may be formed into a shape selected from the group consisting of a screw, a rod, a pin, a nail and a bone anchor.
  • a method for treating a bone comprising: selecting at least one high modulus fiber reinforcing component to be combined with a urethane polymer matrix so as to together form a polymer implant capable of supporting the bone; positioning the at least one high modulus fiber reinforcing component in a cavity in the bone; flowing the urethane polymer matrix into the cavity in the bone so that the urethane polymer matrix interfaces with the at least one high modulus fiber reinforcing component; and transforming the urethane polymer matrix from a flowable state to a non-flowable state so as to establish a static structure for the polymer implant, such that the polymer implant supports the adjacent bone.
  • the cavity in the bone may comprise the intramedullary canal.
  • the intramedullary canal may be accessed through a hole having a diameter smaller than the diameter of the intramedullary canal.
  • the hole may extend at an acute angle to the intramedullary canal.
  • the at least one high modulus fiber reinforcing component may be flexible, and the at least one high modulus fiber reinforcing component must be flexed in order to pass through the hole and into the intramedullary canal.
  • the at least one high modulus fiber reinforcing component may be flexible both radially and longitudinally.
  • the at least one high modulus fiber reinforcing component may comprise a plurality of reinforcing elements, wherein each of the reinforcing elements is individually capable of being passed through the hole, and further wherein the plurality of reinforcing elements collectively form a structure too large to be passed through the hole.
  • the at least one high modulus fiber reinforcing component may comprise at least one from the group consisting of a flexible reinforcing sheet, a flexible reinforcing rod, and particulates.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing sheet in the form of a tube.
  • the at least one high modulus fiber reinforcing component may comprise at least two flexible reinforcing sheets arranged concentrically.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing sheet in the form of a rolled sheet.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing sheet having an arcuate cross-section.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing sheet having a planar cross-section.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing sheet comprising filaments formed into a textile.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing sheet comprising filaments connected by a film.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing rod comprising filaments held together.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing rod and the filaments are held together by an outer sheath.
  • the outer sheath may comprise filaments formed into a textile.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing rod and the filaments are held together by a compacted connecting structure of a textile or film.
  • the connecting structure may be compacted by at least one of winding and compressing.
  • the at least one high modulus fiber reinforcing component may comprise a flexible reinforcing rod and the filaments are held together by a binder.
  • the at least one high modulus fiber reinforcing component may comprise particulates.
  • the at least one high modulus fiber reinforcing component may comprise at least one flexible reinforcing sheet and at least one flexible reinforcing rod.
  • the at least one flexible reinforcing sheet and the at least one flexible reinforcing rod may be selected so as to form the polymer implant with a desired stiffness.
  • the polymer implant may have a stiffer central region and less stiff distal and proximal ends.
  • the polymer implant further may comprise a containment bag, and the at least one high modulus fiber reinforcing component may be positioned within the containment bag after the containment bag has been positioned within the cavity in the bone.
  • a method for treating a bone comprising: selecting at least one pre-formed polymer implant created from at least one high modulus fiber reinforcing component combined with a urethane polymer matrix so as to together form a polymer implant capable of supporting the bone; positioning the at least one pre-formed polymer implant in a cavity in the bone; flowing a urethane polymer matrix into the cavity in the bone so that the urethane polymer matrix interfaces with the at least one pre-formed polymer implant; and transforming the urethane polymer matrix from a flowable state to a non-flowable state so as to establish a static structure for the polymer implant, such that the polymer implant supports the adjacent bone.
  • the polymer implant may further comprise a containment bag, and the at least one high modulus fiber reinforcing component may be positioned within the containment bag after the containment bag has been positioned within the cavity in the bone.
  • a method for treating a bone comprising: selecting at least one high modulus fiber reinforcing component which is pre-loaded with a urethane polymer matrix just prior to implantation so as to together form a polymer implant capable of supporting the bone once fully cured; positioning at least one high modulus fiber reinforcing component in a cavity in the bone; flowing additional urethane polymer matrix into the at least one high modulus fiber reinforcing component so that the urethane polymer matrix exudes from the surfaces of the at least one high modulus fiber reinforcing component and interfaces with the surrounding bone cavity; and transforming the urethane polymer matrix from a flowable state to a non-flowable state so as to establish a static structure for the polymer implant, such that the polymer implant supports the adjacent bone and or approximated soft tissue.
  • the composite implant comprises a high modulus fiber reinforcing component and resin injectable matrix material.
  • the high modulus fiber reinforcing component may be of the sort disclosed above.
  • the resin injectable matrix material may be an acrylic resin composition comprising a mixture of prepolymerized acrylic resins or styrene acrylic resins having molecular weights from about 200 to 20,000 daltons and acrylic monomers selected from at least one of the following: methacrylic acid, methyl
  • the acrylic resin composition described above may also have additional additives such as inorganic fillers, stabilizers to prevent cure of the acrylic monomers during storage and activators to accelerate the free radical cure of the acrylic system.
  • the resin matrix may also be a polyurethane having terminal isocyanate functionality and a viscosity from about 800 cps to about 10,000 cps at the temperature when the urethane resin matrix is applied to the high modulus fibers and a viscosity of at least 50,000 cps at 20-25 degrees C.
  • the resin matrix may have a terminal isocyanate functionality and be applied to the high modulus fiber at a temperature from about 100 degrees C to about 200 degrees C, the high modulus fiber having been surface coated with a sizer or primer that provides additional adhesion between the urethane resin matrix and the high modulus fiber and can optionally act as a secondary catalyst for further molecular weight increase of the urethane resin matrix and adhesion to the high modulus fiber.
  • the composite implant comprises a resin matrix and a high modulus fiber reinforcing component, wherein the compressive modulus ratio between the cured resin injectable matrix material and the high fiber reinforcing component is from about 1:3 to about 1:20, and the flexural modulus ratio between the cured resin injectable matrix material and the high fiber reinforcing component is about 1:3 to about 1: 10.
  • the resin injectable matrix material may be applied to the high modulus fiber component of the composite implant in a continuous process, with the resin injectable matrix material having a viscosity (at application temperature) of from about 2 Pas to about 2000 Pas, with fiber content of from about 5 volume percent to about 75 volume percent.
  • the high fiber reinforcing component may be selected from at least one of the following materials: E-glass, bio glass, soluble glass, resorbable glass, carbon fiber, polyaramid fiber, PET fiber, ceramic fiber, PEEK fiber, fibers formed from homopolymers or copolymers of one or more monomers selected from D lactic acid, L lactic acid dilactides of D and L isomers, glycolic acid, and/or combinations thereof.
  • the composite implant comprises a high fiber reinforcing component which comprises a series of single filaments, woven filaments or a composite mesh containing one or more different compositional fibers.
  • the high modulus fiber reinforcing component may comprise a very high modulus fiber (e.g., a fiber having a modulus greater than about 80 GPa compressive strength) and a low modulus thermoplastic fiber (e.g., a fiber having a modulus less than 8 GPa), where the thermoplastic fiber is pre melted so as to provide a retaining structure for the rigid fibers.
  • the resin injectable matrix material is an acrylic resin composition
  • an acrylic resin composition comprising a mixture of prepolymerized acrylic resins (or styrene acrylic resins) having molecular weights from about 200 to 20,000 daltons, and acrylic monomers selected from at least one of the following: methacrylic acid, methyl methacrylate, ethyl methacrylate, butyl methacrylate, acrylic acid, methyl acrylate, ethyl acrylate, butyl acrylate ethylene glycol diacrylate, ethylene glycol dimethacrylate, trimethylol propane triacrylate and trimethylol propane triamethacrylate, and an organic peroxide free radical initiator, with the mixture having an initial viscosity from about 200 cps to about 5000 cps at 20-25 degrees C.
  • the acrylic resin composition described above may also comprise additional additives, e.g., inorganic fillers, stabilizers to prevent cure of the acrylic monomers during storage, and/or activators to accelerate the free radical cure of the acrylic system.
  • the high modulus fiber reinforcing component may have a surface which is coated with a sizing agent, or a primer, which provides additional adhesion between the acrylic resin matrix and the high modulus fiber reinforcing component, and which can optionally act as a secondary catalyst for the polymerization of the acrylic monomers.
  • the high modulus fiber reinforcing component may be surface coated with an amino functional material selected from at least one of the following materials: amino silanes, lysine, polyamines, amino acids and polyamino acids.
  • the resin injectable matrix material comprises a polyurethane having terminal isocyanate functionality and a viscosity from about 800 cps to about 10,000 cps (at the temperature when the urethane resin matrix is applied to the high modulus fiber reinforcing component) and a viscosity of at least 50,000 cps at 20-25 degrees C.
  • the resin injectable matrix material may also comprise a polyurethane having terminal isocyanate functionality, which is applied to the high modulus fiber at a temperature from about 100 degrees C to about 200 degrees C.
  • the high modulus fiber reinforcing component may be surface coated (e.g., with a sizer or primer) that provides additional adhesion between the urethane resin injectable matrix material and the high modulus fiber reinforcing component, and which can optionally act as a secondary catalyst for further molecular weight increase of the urethane resin injectable matrix material and can facilitate adhesion to the high modulus fiber.
  • the high modulus fiber reinforcing component may also be surface coated with an amino functional material selected from at least one of the following materials: amino silanes, lysine, polyamines, amino acids, and polyamino acids.
  • the resin injectable matrix material is a polyurethane
  • the composite implant may also contain residual isocyanate groups in the composite structure such that they can be stored in a dry inert atmosphere without further crosslinking reactions, and then, when applied in the body (i.e., where moisture is present), will further cure until no residual isocyanate groups are present.
  • This composite implant may also comprise up to about 4% by weight of polymer-bound isocyanate groups in the structure and/or the composite implant may provide a foamed surface structure in the body during final cure so as to accommodate the special difference between the polymer implant and the cavity constructed to accommodate the polymer implant, thus providing improved strength and stiffness to the repaired bone area.
  • composition of matter that results in high modulus composite materials that are capable of biodegrading or bioabsorbing due to ambient (e.g., bodily or environmental) conditions.
  • the utility of the materials range from the aforementioned medical implants to other medical devices (e.g., syringes) to a wide variety of non-medical applications, e.g., packaging materials (such as packages, packaging, disposable pallets, etc.), landscaping films, trash bags, etc.
  • Non-degradable polymers are very quickly manufactured through processes such as injection molding, extrusion, pultrusion, heat pressing, etc., however, the final material may not be strong enough for some applications.
  • the polymers can be strengthened through the addition of high modulus fiber particles, however, the resulting increase in stiffness is usually offset by making the material brittle.
  • Full composites are designed to provide the targeted strength profiles for very long life or high strength materials that polymers alone do not provide, however, they are commonly associated with the difficulty in waste management previously described.
  • the present invention provides a new approach for creating high strength mechanical structures for materials with defined useful life-cycles that will biodegrade or bioabsorb due to the normal environment envisioned at end of life.
  • the present invention also provides a new approach for using such material degradation to provide utility or delivery of a local alteration of environmental conditions.
  • the present invention comprises the provision and use of a novel composite comprising a biodegradable or bioabsorbable flowable polymer (i.e., the injectable matrix material, sometimes referred to simply as“the matrix”) and a high modulus reinforcing element to create useful structures.
  • the composite is created from at least one reinforcing element, embedded within a matrix.
  • the final composite structure can be either anisotropic or isotropic, depending on the requirements of the final construct.
  • the final composite is susceptible to complete or partial degradation or dissolution due to ambient (e.g., bodily or environmental) conditions including, but not limited to, immersion in water, saline (physiologic, oceanographic, etc.), the presence of naturally- occurring or intentionally- added enzymes or chemicals, etc.
  • the materials are designed for their working environment.
  • structural storage of food goods once depleted, may be designed to rapidly degrade in high salt content water such as the ocean, allowing ocean-going vessels to reduce waste without adversely affecting the environment.
  • the present invention is capable of degrading into sub components engineered such that the local area (e.g., the body or the body).
  • the duration, intensity, and sequence of the release of remnants of the degradation process can be designed to produce pH shifts in a local area (e.g., the body or the environment) or to release other compounds into the local area (e.g., the body or the environment).
  • a local area e.g., the body or the environment
  • a bio-degradable textile may be produced that is highly flexible but tensile-reinforced.
  • the textile in the form of a fabric, may be designed for coverage over garden materials as initial protective barriers that degrade over a time period of weeks into either basic or acidic materials beneficial to the plant material below the protective barrier.
  • High tensile strength allows the composite material to be spread over large areas by industrial mechanisms without fear of tearing the protective material.
  • the matrix material is preferably polymeric and preferably bioabsorbable and/or biodegradable.
  • the matrix material may be an organic polymer that can be formed via a polymerization process and/or the matrix material may also comprise a bioactive filler material and/or a degradation or deposition agent.
  • the reinforcement material is preferably a bio-degradeable, water-soluble, bio-absorbable or carbon-neutral material with a modulus engineered for higher tensile or compressive properties than the surrounding matrix material.
  • the reinforcing elements can be particulate, nano-sized, or fiberous in nature, preferably with an aspect ratio of from about 1 :5 to > 1 : 100.
  • the reinforcing elements can be coated with another material that provides, but is not limited to, one of more of the following features: enhanced bonding to the matrix material; increase in reinforcement dimensions; modulation of hydro-diffusion access to the reinforcement material, etc.
  • the matrix material may contain a biocompatible solvent, with the solvent reducing viscosity so as to allow the matrix material to flow easily, and with the solvent thereafter diffusing from the composite so as to facilitate or provide stiffening and/or to impart or alter the porosity of the matrix material.
  • a biocompatible solvent with the solvent reducing viscosity so as to allow the matrix material to flow easily, and with the solvent thereafter diffusing from the composite so as to facilitate or provide stiffening and/or to impart or alter the porosity of the matrix material.
  • the present invention comprises a new approach for creating high strength composite structures with defined useful life-cycles that will biodegrade or bioabsorb due to the normal environment envisioned at the end of life.
  • thermoplastic matrix-based composite with disparate reinforcing elements, the mix of which provides increased material strength and advantages in chemical interactions such that degradation time and the effects on the local area (e.g., body or environment) are controlled.
  • thermosetting matrix material is combined with disparate reinforcing elements, the mix of which provides increased material strength and advantages in chemical interactions such that degradation time and the effects on the local area (e.g., body or environment) are controlled.
  • the present invention provides a new approach for creating high strength composite structures with defined useful life-cycles that will biodegrade or bioabsorb due to the normal environment envisioned at end of life.
  • the present invention also provides a new approach for using such material degradation to provide utility or the delivery of a local alteration of the host area (e.g., the body or environment) conditions.
  • the present invention comprises the provision and use of a novel composite comprising a biodegradable or bioabsorbable flowable polymer (i.e., the matrix) and biodegradable or bioabsorbable high modulus reinforcing elements to create useful composite structures.
  • the composite comprises a thermoset (i.e., the matrix) with high 20 modulus, high bioglass content (i.e., the reinforcing elements).
  • the composite is preferably configured for liquid injection and subsequent setting, although it may also be preformed.
  • the matrix comprises polyurethane due to its promotion of high strength and biodegradability.
  • the composite comprises at least one reinforcing element, embedded within a matrix.
  • the final composite material can be either anisotropic or isotropic, depending on the requirements of the final construct.
  • the final composite is susceptible to complete or partial degradation or dissolution due to the host area (body or environmental) conditions including, but not limited to, immersion in water, saline (physiologic, oceanographic, etc.), the presence of naturally-occurring or intentionally- added enzymes or chemicals.
  • the composite is designed for its work environment.
  • structural storage of food goods, once depleted may be designed to rapidly degrade in high salt content water such as the ocean, allowing ocean going vessels to reduce waste without adversely affecting the environment.
  • the flowable matrix can be a crosslinkable thermoset polymer such as a polyurethane, epoxy, polyurea, polyurea urethane, acrylate, acrylate urethane, propylene glycol fumarate, polycarbonate, polystyrene, or polycitrate esters. They may contain degradable bonds such as polyesters, including polylactic acid, polyglycolic acid, polyhydroxybutyric acid, polycaprolactone, polymalic acid, polydioxanes; polyanhydrides such as polysebacic acid or polyadipic acid;
  • polyamides such as polyiminocarbonates and polyaminoacids
  • phosphorus based degradable bonds such as polyphosphates, polyphosphonates, and
  • polyphosphazenes or other biodegradable polymers such as polycyanoacrylates, polyorthoesters, polyacetals, or poly dihy drop yrans.
  • thermoplastic polymer matrix is selected from the following biodegradable or bioabsorbable materials: polylactic acid homopolymer or copolymer, polycaprolactone, ceramic, polyglycolide (PGA), glycolide
  • polylactide copolymers glycolide/lactide copolymers (PGA/PLA), and polylactic acid co- caprolactone block copolymer or random copolymer, polyglycolic acid co- polylactic acid block or random copolymer, glycolide/trimethylene carbonate copolymers (PGA/TMC), stereoisomers and copolymers of polylactide, poly-L- lactide (PLLA), poly-D-lactide (PDLA), poly-DL-lactide (PDLLA), L-lactide, DL- lactide copolymers, L-lactide, D-lactide copolymers, lactide tetramethylene glycolide copolymers, lactide/trimethylene carbonate copolymers, lactide/delta- valerolactone copolymers, lactide/epsilon-caprolactone copolymers,
  • polydepsipeptide glycine-DL-lactide copolymer
  • polylactide/ethylene oxide copolymers asymmetrically 3 ,6-substituted poly- 1 ,4-dioxane-2,4-diones
  • polyhydroxyalkanoate (PHA) homopolymer or copolymer poly(3- hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), poly-b hydroxybutyrate (PHB),
  • PEO polyethylene oxide
  • silk silk
  • collagen derivatized hyaluronic acid resorbable or soluble glasses
  • resorbable ceramic resorbable metal and chitin polymers.
  • the polymer matrix is applied to a fiber reinforcement in the form of a fine powder and then heat fused to consolidate the subsequent molten polymer matrix around the high modulus fiber component.
  • the high modulus fiber component comprises a matrix, and a thermoplastic polymer matrix is applied to the fiber matrix via electro spinning of the thermoplastic polymer and then heat fused to consolidate the subsequent molten thermoplastic polymer matrix around the high modulus fiber component.
  • the high modulus fiber component comprises a matrix, and the thermoplastic polymer matrix is applied to the fiber matrix via electrospinning of the thermoplastic polymer matrix and the resultant voids filled with a composition which polymerizes into a high molecular weight polymer.
  • the thermoplastic polymer matrix may comprise vinyl monomers which are cured using free radical initiators, UV radiation, gamma ray irradiation, or infrared radiation.
  • the thermoplastic polymer matrix may be cured through a condensation or addition reaction or specialized reactions related to these and known to those skilled in the art.
  • the thermoplastic polymer matrix may be cured through a urethane or epoxide resin process.
  • the high modulus fiber component may be coated with the thermoplastic polymer matrix and they are then bonded together with a crosslinking resin so as to produce the final thermoplastic polymer implant geometry.
  • the thermoplastic polymer may be formed into a shape selected from the group consisting of a screw, a rod, a pin, a nail and a bone anchor.
  • Options of final practical use may include pre-cured objects requiring significant but sub-metal structural strength.
  • the invention lends itself to modular assembly with a thermoplastic or thermoset such as a polyurethane thermoset adhesive.
  • the present invention also lends itself to substantially any application wherein the embedded reinforcing elements have their access to water restricted prior to the desired point of elimination, at which time water access to the bioabsorbable fiber releases ions as agents that change the pH and assist catalytic hydrolysis of the polyurethane and the subsequent biodegradation according to established test methods like ASTM D6400, D7081, etc.
  • bioabsorbable glass i.e., the reinforcing elements
  • the reinforcing elements is present from about 5 Vol % to about 65 Vol % of the composite. Since this is a biodegradable process, ordinary glass and other ceramic/metal fibers (including carbon fiber, carbon fibrils and carbon nanoparticles), which are not considered to be organic carbon, are not included in the organic carbon biodegradation process. Therefore, the reinforcing elements can also include inorganic particles that may or may not act as further agents for degradation such as, but not limited to, fibers and particles of wollastonite, talcs, clays, metal silicates, etc.
  • a set of bio-degradable ingredients are used to produce materials with higher moduli than a bio-degradable polymer alone, even when reinforced with fiber particles.
  • the composite is formed from the basic building blocks of the matrix and reinforcing elements, wherein the reinforcing elements may be formed using textile engineering techniques and primarily continuous, bio-degradable, bio-resorbable or bio-neutral fibers.
  • Fibers i.e., the reinforcing elements
  • aspect ratios of at least 20: 1 are preferably used to form structures capable of being completely immersed and bonded with a thermoset-, thermoplastic- or acrylic -based bio-degradable, bio-resorbable or bio-neutral matrix material to form a desired shape once the matrix material has been transformed from a flowable to non-flowable state.
  • the required strength of the composite can be customized and distributed by using an appropriate amount of distributed“fiber” reinforcing elements within the homogeneous matrix.
  • Fibers arranged in columnar axial supports shift implant strength to compression, tension, and bending.
  • Angular cross-fibers (termed bias, often seen in weaving or braids) shift strength to torsional resistance and hoop strength, thereby reducing the risk of catastrophic failures.
  • the matrix material is preferably polymeric and bioabsorbable and/or biodegradable in response to regional (bodily or environmental) stimuli such as, but not limited to, water, saline, and naturally or artificially-introduced enzymes.
  • the matrix material may be a synthetic polymer or an organic polymer that can be formed via a polymerization process flowable under thermoplastic processes, a polymer requiring thermosetting processes or acrylic materials.
  • the matrix may also comprise a bioactive filler material and/or a degradation or deposition agent.
  • the matrix is a thermoplastic solution where the introduction of bioabsorbable glass and bioglass (i.e., the reinforcing elements) assists the ambient hydrolytic breakdown of biodegradable polymers which are currently only broken down at elevated temperatures.
  • the use of such reinforcing elements to accelerate the hydrolytic breakdown of the matrix material is particularly advantageous where effective hydrolysis must take place at bodily temperatures or temperatures acceptable to the local environment.
  • Polymers specifically sensitive to this inventive approach include, but not limited to, are polylactic acid homo and copolymers, polycaprolactone, polybutylene succinate homo and copolymers, polybutylene succinate co adipate, polyethylene glycol terephthalate co adipate, poly butylene glycol adipate co terephthalate, etc.
  • catalytic levels or sub 10% levels of bioabsorbable glass is used in these applications in powder, chopped fiber or continuous fiber form.
  • thermoplastic composite system may also include 0.1% to 20% of an inorganic material that, when immersed in an aqueous environment at
  • temperatures of about 5 degrees C to about 40 degrees C, and having a pH from 5.5 to 8 will result in the aqueous micro-environment of the composite component to change by at least 0.5 pH, and preferably about 1.5 to 3 pH, thus accelerating the hydrolytic breakdown of the matrix (e.g., polyester or polyester polyurethane) components so that the molecular weight is reduced by a factor of 4 to 20 in the defined timescale, making the residual low molecular weight fragments extremely brittle in nature and susceptible to microbial attack.
  • matrix e.g., polyester or polyester polyurethane
  • the matrix material may also be a multi-component polymer system that is mixed immediately prior to final structural formation.
  • the matrix material may contain a biocompatible solvent, with the solvent reducing viscosity so as to allow the matrix material to flow easier, and with the solvent thereafter rapidly diffusing so as to facilitate or provide stiffening or curing of the composite structure.
  • the solvent may also be used to alter the porosity of the matrix material.
  • polyurethanes are used as the matrix material, although other suitable chemistry systems will be apparent to those skilled in the art.
  • the polyurethanes are produced through the reaction of difunctional, or multifunctional, or polyfunctional, isocyanate molecules having at least two reactive functional groups per molecule, with a difunctional or multifunctional compound containing two or more active hydrogen (including water) groups capable of reacting with an isocyanate group, such active hydrogen groups may include primary and secondary aliphatic hydroxyl materials and amines, primary, secondary and aromatic amine, aliphatic and aromatic thiols, urethane and urea groups.
  • Suitable isocyanates useful in the practice of this invention include, but are not limited to, aromatic diisocyanates such as 2,4-toluene diisocyanate, 2,6- toluene diisocyanate, 2,2'-diphenylmethane diisocyanate, 2,4'-diphenylmethane diisocyanate, 4,4'-diphenylmethane diisocyanate, diphenyldimethylmethane diisocyanate, dibenzyl diisocyanate, naphthylene diisocyanate, phenylene diisocyanate, xylylene diisocyanate, 4,4'-oxybis(phenylisocyanate) or
  • aliphatic diisocyanates such as tetramethylene diisocyanate, hexamethylene diisocyanate, dimethyl diisocyanate, lysine diisocyanate, lysine triisocyanate, methyl lysine diisocyanate, 2-methylpentane- l,5-diisocyanate, 3-methylpentane-l, 5-diisocyanate or 2,2,4- trimethylhexamethylene diisocyanate; and alicyclic diisocyanates such as
  • isophorone diisocyanate 4, 4’ methylene bis(cyclohexyl isocyanate) (HMDI) cyclohexane diisocyanate, hydrogenated xylylene diisocyanate, hydrogenated diphenylmethane diisocyanate, hydrogenated trimethylxylylene diisocyanate, 2,4,6-trimethyl l,3-phenylene diisocyanate.
  • HMDI methylene bis(cyclohexyl isocyanate)
  • the present invention comprises the use of these same multi-functional
  • multifunctional amines may include hexamethylene diamine, isophorone diamine, and lysine.
  • substituted amines may include N- substituted diaspartic acid derivatives.
  • multifunctional ketimines and aldimines may be made from the multifunctional amines mentioned previously and methyl isobutyl ketone or isobutyraldehyde.
  • the aliphatic isocyanates are generally favored. In one embodiment of the present invention, the aliphatic isocyanates are preferred.
  • the isocyanate component is reacted with a polyol to produce a polyurethane.
  • Suitable polyols include, but not limited to, polycaprolactone diol and polycaprolactone triol.
  • Suitable dihydroxy compounds which may be utilized in the practice of this invention include, but are not limited to, ethylene glycol, propylene glycol, butylene glycol, hexylene glycol and polyols including polyalkylene oxides, polyvinyl alcohols, and the like.
  • the polyol compounds can be a polyalkylene oxide such as polyethylene oxide (“PEO”), polypropylene oxide (“PPO”), block or random copolymers of polyethylene oxide (PEO) and
  • polypropylene oxide PPO
  • Higher functional polyol compounds are also useful and can include glycerin, l,2,4-butanetriol, trimethylol propane, pentaerythritol and dipentaerythritol, 1 , 1 ,4,4-tetrakis(hydroxymethyl)cyclohexane.
  • Other useful polyolsactive hydrogen containing molecules can include ethanolamine,
  • diethanolamine triethanol amine and N,N,N',N'-Tetrakis(2- hydroxyethyl)ethylenediamine
  • ethylene diamine diethylene triamine
  • triethylene tetramine tetraethylene pentamine
  • aspartate reaction products of a vinyl ester with a diamine, triamine or tetramine such as diethyl maleate, diethyl fumarate, acrylate and methacrylate esters with a diamine or triamine molecule.
  • polyol materials discussed above may be used alone or, optionally, as mixtures thereof.
  • the foregoing materials are merely examples of useful components for producing polyurethanes and should not be viewed as a limitation of the present invention.
  • These higher functional polyol materials will produce highly cross-linked polyurethanes with high hardness and stiffness.
  • the multifunctional hydroxyl material may include at least one bioabsorbable group to alter the degradation profile of the resulting branched, functionalized compound.
  • Bioabsorbable groups which may be combined with the multifunctional compound include, but are not limited to, groups derived from glycolide, glycolic acid, lactide, lactic acid, caprolactone, dioxanone, trimethylene carbonate, and combinations thereof.
  • the multifunctional compound may include trimethylol propane in combination with dioxanone and glycolide.
  • the multifunctional compound is modified to include bioabsorbable groups, the bioabsorbable groups may be present in an amount ranging from about 50 percent to about 95 percent of the combined weight of the multifunctional compound and bioabsorbable groups, typically from about 7 percent to about 90 percent of the combined weight of the multifunctional compound and bioabsorbable groups.
  • the multifunctional compound can have a weight (average molecular weight, all listed in kilodaltons) ranging from about 500 to about 50,000, typically from about 1,000 to about 3,000, and typically possesses active hydrogen functionality ranging from at least 2 to about 6, preferably from 2 to about 4.
  • the hydroxyl number of the polyol can range from 40 to 1000, preferably from 100 to 800.
  • the isocyanate index of the isocyanate component can range from 5% to 60%, preferably from 15% to 45%.
  • polycaprolactone diols and, triols and tetrols provide branching sites for polyurethanes that are biodegradable.
  • the isocyanate is reacted with a polyol to produce a prepolymer.
  • Methods for endcapping the polyol with an isocyanate are known to those skilled in the art.
  • a polycaprolactone diol may be combined with isophorone diisocyanate by heating to a suitable temperature ranging from about 55 degrees C to about 80 degrees C, typically about 70 degrees C. The resulting polycaprolactone diol may be combined with isophorone diisocyanate by heating to a suitable temperature ranging from about 55 degrees C to about 80 degrees C, typically about 70 degrees C. The resulting
  • diisocyanatefunctional compound may then be stored until combined with additional polyol to form the final polyurethane product.
  • Polyurethane catalysts can be classified into two broad categories, amine compounds and organometallic complexes. They can be further classified as to their specificity, balance, and relative power or efficiency.
  • tertiary amine catalysts such as triethylenediamine (TEDA, also known as l,4-diazabicyclo[2.2.2]octane or DABCO (a trademark of Air Products), dimethylcyclohexylamine (DMCHA), and dimethylethanolamine (DMEA).
  • TAA triethylenediamine
  • DMCHA dimethylcyclohexylamine
  • DMEA dimethylethanolamine
  • Tertiary amine catalysts are selected based on whether they drive the urethane (polyol + isocyanate, or gel) reaction, the urea (water + isocyanate, or blow) reaction, or the isocyanate trimerization reaction (e.g., using potassium acetate, to form isocyanurate ring structure). Since most tertiary amine catalysts will drive all three reactions to some extent, they are also selected based on how much they favor one reaction over another.
  • polyurethane catalysts are the organometallic compounds based on mercury, lead, tin ((for example dibutyl tin dilaurate), bismuth ((for example bismuth octanoate), titanium complexes and zinc.
  • Dibutyl tin dilaurate and stannous octoate are widely used catalysts in many polyurethane formulations.
  • Other catalysts include tertian amines such as triethylene diamide. Mixtures of organometal catalysts and blends of Tertian amines can be used to obtain the preferred gelling profile.
  • Applicable catalyst concentrations preferably range from 0.01% to 4% based on polyol content.
  • the reinforcing elements preferably comprise a biodegradeable, water- soluble, bio-absorbable or carbon-neutral material with a modulus engineered for higher tensile or compressive properties than the surrounding matrix.
  • the reinforcing elements may also be a mix of different materials with varying strength and degradation profiles as required for the final structure or its end of life degradation environment. Additionally the reinforcement materials may be chosen from structural members constructed using textile processing means, randomly oriented fibers, chopped fibers, or nano-size or greater particulates.
  • the reinforcement elements comprise a textile
  • its reinforcing properties and degradation profile may be modified by changing the materials, orientation, length, shape, volume, twist, and angle of the fibers and filaments within the textile of the reinforcing elements.
  • the fibers and filaments in a textile are preferably continuous with a high aspect ratio (length:width) preferably greater than 20: 1.
  • a preferred generic configuration is one with high axial fiber counts in relative balance with the biasing fiber counts and bias fiber angle.
  • the preferred axial fibenbias fiber ratio is between 10:90 and 90: 10, depending on the desired properties.
  • bias fiber angle is important for additional support as tensors splitting into additional axial support and torsional and burst resistivity; they are usually set at an acute angle to intersecting fibers and filaments, but the angle may vary between 0 degrees and 90 degrees or random.
  • bias fibers may be used to add hydrostatic pressure to draw flowable matrix into the center of non-planar reinforcing elements and to aid in the final cross-sectional shape without altering the overall cross-sectional footprint.
  • a textile engineered reinforcement element can modify the physical capabilities of the final product including braiding the reinforcing element over a removable mandrel to produce a cannulated final reinforcing element or weaving reinforcing planes for the use with low modulus, high ductility matrices for flexible sealing fabrics. Additional design changes include, but are not limited to, changing the orientation of one or more of the reinforcing elements, and/or by changing the volume of one or more of the reinforcing elements.
  • a textile-based reinforcing element may have the fiber volume and/or direction and/or weave and/or braid altered along its length in order to create the variable stiffness, wettability or other physical properties desired for the composite structure.
  • the one or more reinforcing elements comprise from about 5% to 75% (by volume) of the composite implant, typically at least 20% (by volume) of the composite implant.
  • suitable biodegradable or bioabsorbable filaments, fibers, and particulates used to form the aforementioned reinforcing elements include, but are not limited to, poly glycolic acid (PGA), glycolide copolymers, glycolide/lactide copolymers (PGA/PLA), glycolide/trimethylene carbonate copolymers
  • PGA/TMC stereoisomers and copolymers of polylactide, poly-L-lactide (PLLA), poly-D-lactide (PDLA), poly-DL-lactide (PDLLA), L-lactide, DLIDF- lactide copolymers, L-lactide, D-lactide copolymers, lactide tetramethylene glycolide copolymers, lactide/trimethylene carbonate copolymers, lactide/d- valerolactone copolymers, lactide/e-caprolactone copolymers, poly depsipep tide (glycine-DL-lactide copolymer), polylactide/ethylene oxide copolymers, asymmetrically 3, 6-substituted poly- l,4-dioxane-2,4-diones,
  • polyhydroxy alkanaote homopolymers, copolymers, terpolymers such as poly 3 hydroxybutyrate co 3 hydroxyvalerate poly 3 hydroxybutyrate co 4
  • polydihydropyrans polypeptides from alpha-amino acids, poly-beta-maleic acid (PMLA), poly-P-alkanoic acids, polyethylene oxide (PEO), silk, collagen, derivatized hyaluronic acid, resorbable or soluble glasses, resorbable ceramic, resorbable metal and chitin polymers.
  • suitable bio-neutral materials include natural polyesters and silks, polyvinyl alcohol, glass, ceramic, metal, and carbon fiber.
  • the reinforcing elements may be constructed of a variety of different fibers with different properties.
  • a thermoplastic fiber may be interwoven within portions of a higher modulus material in order to facilitate handling during cutting operations with a hot knife or, through the use of a heat gun, to reduce filament damage during storage.
  • the reinforcing elements may be coated (also called sized) with an appropriate material that provides, but is not limited to, one of more of the following features: enhanced bonding to the matrix material; increase in reinforcement dimensions; modulation of hydro-diffusion access to the reinforcement material.
  • Compatibility among the specific components that comprise a composite structure is essential in order to ensure optimal interfacial bonding, mechanical properties, physical properties, and degradation rates.
  • Compounds known as coupling agents, compatibilizers, or sizings which may be incorporated into the components of the composite, serve to enhance the chemical bonding between the specific components of the composite implant.
  • the interfacial bond strength between the reinforcing elements and the matrix material can be enhanced through the addition of a variety of compatibilizers, e.g., calcium phosphate, hydroxyapatite, calcium apatite, fused-silica, aluminum oxide, apatitewollastonite glass, bioglass, compounds of calcium salt, phosphorus, sodium salt and silicates, maleic anhydride, diisocyanatediisocyanates, epoxides, silanesilanes, and cellulose esters.
  • compatibilizers e.g., calcium phosphate, hydroxyapatite, calcium apatite, fused-silica, aluminum oxide, apatitewollastonite glass, bioglass, compounds of calcium salt, phosphorus, sodium salt and silicates, maleic anhydride, diisocyanatediisocyanates, epoxides, silanesilanes, and cellulose esters.
  • These agents may be incorporated into, and/or applied to, the components of the composite through a number of methods, e.g., plasma deposition, chemical vapor deposition, dip coating, melt-blending, spin or spray-on.
  • a specific example is the application of an alkyl, alkoxy silane and organo titanate coupling agent to glass fiber reinforcement in order to increase its interfacial bonding strength with the injectable matrix material.
  • the composite is capable of degrading into sub-components engineered such that the host area (e.g., the body or the local environment) is beneficially affected.
  • the duration, intensity, and sequence of the release of remnants of the degradation process can be designed to produce pH shifts in a local environment or to release other compounds into the local environment. For example, during the degradation of a material structure, there may be a rapid release of remnants for a burst of either acidic or basic pH shift, followed at a later period of time by the release of buffering solutions to re alter that environment.
  • a bio-degradable textile may be produced that is highly flexible but tensile-reinforced for strength.
  • the textile in the form of a fabric, may be designed for coverage over garden materials as initial protective barriers that degrade (over a time period of weeks) into either basic or acidic materials beneficial to the plant located below the protective barrier.
  • High tensile strength allows the composite to be spread over large areas by industrial mechanisms without fear of tearing.
  • both the matrix material and the reinforcing elements may also comprise a bioactive filler material.
  • the matrix material may include a filler in the form of biocompatible particles.
  • the first or primary filler preferably in the form of particles, may also provide porosity and enhanced permeability or pore connectivity.
  • One suitable particulate filler material is tricalcium phosphate, although other suitable filler materials will be apparent to those skilled in the art such as orthophosphates, monocalcium phosphates, dicalcium phosphates, tricalcium phosphates, and combinations thereof.
  • biodegradable glasses can be utilized as a filler.
  • the filler particles may comprise a degradable polymer such as polylactic acid, polyglycolic acid, polycaprolactone and co-polymers thereof.
  • the particles may also comprise degradable polymer containing one or more inorganic fillers.
  • the inorganic filler particles have mean diameters ranging from about 1 micron to about 20 microns.
  • the porosity and compressive properties of the matrix material may be modified by using additional fillers that may be inorganic, organic or another suitable bio-neutral or biodegradable material.
  • additional fillers may be inorganic, organic or another suitable bio-neutral or biodegradable material.
  • refinements include the addition of particles having mean diameters ranging from about 10 nm to about 50 microns or more, preferably from about 1 micron to 20 microns.
  • the additional filler materials may be provided in one or more size distributions.
  • the composite implant can become porous after implantation so as to aid the resorption process.
  • This porosity can be generated by various mechanisms including the preferential resorption of filler, such as calcium sulfate or a- tricalcium phosphate, bioglass or of a polymeric component.
  • the formulation can include a biocompatible solvent such as DMSO that is leached out of the implant post implantation.
  • the pores are preferably 100 pm in diameter with interconnectivity to allow bone ingrowth.
  • the composite implant may also include an additional porogen.
  • the porogen is sugar or a polysaccharide, such as dextran, but other biocompatible porogens will be apparent to those skilled in the art such as crystalline materials in the form of soluble salts.
  • the porogen may also be in the form of a quickly dissolving fiber within the reinforcing element.
  • the fiber may dissolve rapidly, within days for example, to create a channel for fluid transfer along the intramedullar canal, increase surface area for more rapid bio-dissolution of the remaining implant, or free up other fillers for timed migration to the local environment.
  • the present invention also provides a new approach for using such material degradation to provide utility or delivery of a local alteration of the host area (e.g., bodily or environmental) conditions.
  • a local alteration of the host area e.g., bodily or environmental
  • phosphate glasses are hygroscopic and, therefore, will begin to lose mass from the outside in, losing intimal contact with the surrounding matrix and thus diminishing the benefits of the composite implant.
  • the application of the layering techniques disclosed herein allow for tailoring and controlling the internal environment in relationship to the external environment so as to increase the shelf life and working life of the composite in order to make the product practical.
  • the fibers may be sized with a resorbable metal layer, such as magnesium, silver, nickel, titanium, and metal alloys such as magnesium calcium alloys.
  • a resorbable metal layer such as magnesium, silver, nickel, titanium, and metal alloys such as magnesium calcium alloys.
  • Such coatings can be applied via vapor coating, sputtering, atomic layer deposition, chemical vapor deposition, or electroplating and electroless plating.
  • Other possible coatings can include ceramic coatings on the fibers.
  • Such coatings can be made by the surface reaction of ethyoxysilanes such as tetraethoxysilane, methyltriethoxysilane, dimethyldiethoxysilane, or trimethylethoxysilane;
  • sizing utilizes inorganic salts such as metal phosphates.
  • This approach for sizing is similar to the pretreatment process of metals, wherein acids are used to corrode the metal and thus form metal salt on the surface which delays any further degradation.
  • phosphate salts of iron, calcium, magnesium, zinc, nickel, etc. are used.
  • the sizing can be applied to phosphate glass fibers by immersion in a suitable metal-salt solution which yield inert phosphate salts that are insoluble in water. This process is self-limiting, as the reaction takes place only as long as phosphate ions are released from the glass surface.
  • the reaction can take place in a reactive medium such as an alcohol or glycol.
  • a mixture of salts is preferred due the formation of smaller crystal size.
  • This process could also be combined with an organic pretreatment.
  • This combination of salt/organic pretreatment could also act as an adhesion promoter.
  • the glass fibers can be rinsed and/or vacuum dried. Multiple iterations can be performed with the same compound or different salts. It is also possible to use only a metal phosphate, and diffuse some metal ions into the glass fiber and obtain a metal clad fiber.
  • the reinforcement fibers can be cleaned or surface oxidized using various means described in the literature including plasma treatment, corona treatment, ozone treatment, and acidic/basic treatment. Such treatments can also be used to introduce specific chemical moieties, such as hydroxyl groups, on the surface of the fibers which can react or provide improved adhesion with the polymer matrix.
  • the composite implant can also include fillers that act as self-buffering or degradation-controlling agents.
  • Suitable inorganic bases can be added, such as salts and oxides of alkaline metals, including basic mono-, di-, and tri-phosphates, calcium oxide, calcium hydroxide, magnesium oxide, magnesium hydroxide, bioglass flakes, calcium phosphate, beta tricalcium phosphate, hydroxyapatite, potassium stearate and sodium stearate.
  • Particles of metals such as magnesium, iron, titanium, and zinc or metal alloys, such as magnesium base alloys, can also be added.
  • Other possible fillers include water-reactive particles, such as calcium oxide or cobalt chloride.
  • Organic bases such as polyamines, bispidines, and proton sponges, are examples of self-buffering agents.
  • the self-buffering or degradation controlling agents can be encapsulated in a micro- or nano-capsule, and are released under certain physiological conditions.
  • the composite implant may be coated with a resorbable metal layer, such as magnesium, silver, nickel, titanium, and metal alloys such as magnesium calcium alloys.
  • a resorbable metal layer such as magnesium, silver, nickel, titanium, and metal alloys such as magnesium calcium alloys.
  • Such coatings can be applied via vapor coating, sputtering, atomic layer deposition, chemical vapor deposition, or electroplating and electroless plating.
  • Such metal layers provide reduced diffusion, but can also react with water to provide basic/alkaline products that can act as buffering and degradation control agents for the polymer matrix and/or glass fibers.
  • Such coatings can be made by the surface reaction of ethyoxysilanes such as tetraethoxysilane, methyltriethoxysilane, dimethyldiethoxysilane, or
  • trimethylethoxysilane polycarbosilane, or polysilazanes such as
  • Hydrolytic breakdown of the composite can be catalyzed both by acid and basic conditions.
  • Acid conditions can be generated from phosphate anion release in the soluble glasses which is moderated by the choice of cations with
  • sodium/potassium being more soluble that calcium/magnesium and with aluminum /iron the least soluble.
  • Alkaline conditions are generated from the sodium ion release in the bioglass silicate glass compositions. Ion release has to be facilitated through the presence of an aqueous media.
  • a further adaption of the technology is to have the reinforcement component made up of several components which have differing chemical compositions where at least one of the components generates ions in an aqueous environment to move the pH from about 7 by at least 2 pH units in either an acidic or basic manner.
  • carbon fiber can be combined with either a bio absorbable silicate or phosphate fiber or ground powder to increase the mechanical strength properties but does not hydrolytically degrade whilst the silicate or phosphate fiber or ground powder provides the hydrolytic breakdown catalyst function.
  • Bio-based polymers are materials which are produced from renewable resources.
  • Bio-based polymers can be biodegradable (e.g., polylactic acid) or nondegradable (e.g., biopolyhethylene).
  • biodegradable polymers e.g., starch and polyhydroxyalkanoates
  • bio-based polymers offer important contributions by reducing the dependence on fossil fuels and through the related positive environmental impacts such as reduced carbon dioxide emissions.
  • Bio-based can be directly derived from agricultural feedstocks such as corn, soy, potatoes, and other carbohydrate feedstocks, or by bacterial fermentation processes by synthesizing the building blocks (monomers) from renewable resources, including
  • Biobased polyurethane can be derived by reacting bio-based polyol (for example from corn, vegetable oil, or castor oil) and/or bio-based isocyanate (from example from soy protein).
  • bio-based polyol for example from corn, vegetable oil, or castor oil
  • bio-based isocyanate from example from soy protein
  • isophorone diamine aspartic acid ester l7.04g isophorone diamine (O.lOmol) and 38.75g tert-butanol was combined, and 34.43g diethyl maleate (0.20mol) was added slowly. Reaction was N2 blanketed and heated to 35°C with stirring for 15 minutes. Reaction was allowed to sit at room
  • the outer sheath was constructed of 24 ends of l20d PLLA.
  • a Steeger 48 end horizontal braider was used.
  • 1.5mm braids were constructed around a core constructed of 90 ends of 75d PLLA, twisted at approximately 2 TPI.
  • the outer sheath was constructed of 24 ends of l20d PLLA, and 12 axial ends of l20d PLLA.
  • a Steeger 48 end horizontal braider was used.
  • Compression testing showed that the material had a compressive stiffness of 1.1 GPa and a yield strength of 56 MPa.
  • Compression testing showed that the material had a compressive stiffness of 1.1 GPa and a yield strength of 53MPa.

Abstract

La présente invention concerne un composite comprenant: une barrière, ladite barrière étant conçue pour laisser passer sélectivement l'eau, et ladite barrière étant dégradable en présence d'eau ; une matière matricielle destinée à être disposée au sein de ladite barrière, ladite matière matricielle ayant un état liquide et un état solide, et ladite matière matricielle étant dégradable en présence d'eau ; et au moins un élément de renforcement destiné à être disposé au sein de ladite barrière et intégré à ladite matière matricielle, ledit élément de renforcement étant dégradable en présence d'eau. De plus, après dégradation dudit élément de renforcement en présence d'eau, on obtient un agent pour la modulation de la vitesse de dégradation de ladite matière matricielle en présence d'eau.
EP19798937.9A 2018-05-09 2019-05-09 Méthode et appareil pour le traitement de fractures osseuses, et/ou pour la fortification et/ou l'augmentation de la masse osseuse, notamment l'apport et l'utilisation d'implants composites, et nouvelles structures composites pouvant être utilisées pour des applications médicales et non médicales Pending EP3813698A4 (fr)

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US201862669271P 2018-05-09 2018-05-09
US16/025,639 US11351261B2 (en) 2010-10-20 2018-07-02 Method and apparatus for treating bone fractures, and/or for fortifying and/or augmenting bone, including the provision and use of composite implants
US16/040,164 US10517654B2 (en) 2010-10-20 2018-07-19 Method and apparatus for treating bone fractures, and/or for fortifying and/or augmenting bone, including the provision and use of composite implants
PCT/US2019/031617 WO2019217748A1 (fr) 2018-05-09 2019-05-09 Méthode et appareil pour le traitement de fractures osseuses, et/ou pour la fortification et/ou l'augmentation de la masse osseuse, notamment l'apport et l'utilisation d'implants composites, et nouvelles structures composites pouvant être utilisées pour des applications médicales et non médicales

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CN103561787B (zh) * 2011-06-03 2016-08-17 新特斯有限责任公司 外科植入物
JP2016525379A (ja) * 2013-05-23 2016-08-25 ２０６ オーソ，インコーポレーテッド 複合材インプラントの提供および使用を含む、骨折を治療するための、ならびに／または、骨を補強および／もしくは増強するための方法および装置
EP3628249B1 (fr) * 2014-12-26 2023-12-06 Ossio Ltd Implants médicaux biocomposites renforcés de fibres continues

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US20210308264A1 (en) 2021-10-07
EP3813698A4 (fr) 2022-06-01

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