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Internal cord fixation device

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US20020188297A1
US20020188297A1 US10115446 US11544602A US2002188297A1 US 20020188297 A1 US20020188297 A1 US 20020188297A1 US 10115446 US10115446 US 10115446 US 11544602 A US11544602 A US 11544602A US 2002188297 A1 US2002188297 A1 US 2002188297A1
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Prior art keywords
bone
cord
fracture
fastener
fig
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US10115446
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Edward Dakin
Albert Lippincott
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Dakin Edward B.
Lippincott Albert L.
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/88Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8861Apparatus for manipulating flexible wires or straps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/683Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin comprising bone transfixation elements, e.g. bolt with a distal cooperating element such as a nut
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84Fasteners therefor or fasteners being internal fixation devices
    • A61B17/842Flexible wires, bands or straps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/044Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors with a threaded shaft, e.g. screws
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10STECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S606/00Surgery
    • Y10S606/916Tool for installing or removing orthopedic fastener

Abstract

Methods and apparatuses for fixing a bone fragment or a bone prosthesis onto a bone. To affix a bone fragment to the bone, an internal fastener is attached from within the interior of the bone to a bone fragment with a length of flexible, inelastic cord extending within the bone interior and attached to the fastener and passing outwardly through an opening in a second bone fragment. The fastener and cord are so positioned as to draw respective fracture surfaces together to reduce the fracture when the cord is pulled outwardly of the opening in the second bone fragment. A second fastener desirably is attached to the bone opening, this fastener including an open bore to receive the cord and a lock to secure the cord to this fastener and maintain the cord under tension.

Description

    FIELD OF THE INVENTION
  • [0001]
    This invention pertains to the field of fixation devices for bones.
  • BACKGROUND OF THE INVENTION
  • [0002]
    Simple fractures of bones are readily treated by bringing the fracture surfaces together and holding them in the desired orientation with respect to one another through the use of splints, casts and the like. Bones in general have dense outer, strong cortical portions and interior, non-cortical portions that may include cancellous bone.
  • [0003]
    Comminuted fractures and fractures involving the breakage of a bone into numerous bone fragments are more difficult to deal with since one must attempt to reposition each bone fragment in an orientation relative to each other bone fragment so that the fragments may knit together properly. For this purpose, physicians have often used metal plates that attach to the outer cortical surfaces of the bones and which utilize bone screws to hold the bone fragments in position.
  • [0004]
    Another method involves the use of cerclage procedures in which a wire is, in effect, wrapped about a broken bone to hold the fragments in place, the cerclage wire occasionally penetrating through the bone. Reference is made to Johnson et al., U.S. Pat. No. 4,146,022. Yet another method taught in Berger, U.S. Pat. No. 5,658,310, involves anchoring the balloon portion of a balloon catheter in the medullary cavity at one end of a long bone having a transverse fracture, and stretching the remaining portion of the elastic catheter across the fracture interface within the bone to maintain the fracture interface in compression. It would appear that unless the elastic catheter traverses the precise center of the bone at the fracture site (which may be difficult to accomplish, considering the bowed or curved nature of most bones), compressive forces will be uneven across the fracture site. That is, the compressive forces on the side of the bone nearest the catheter will be greater than the compressive forces on the opposite side of the bone, generating an unwanted bending moment across the fracture site.
  • [0005]
    Surgical procedures used to mount bone plates and cerclage elements to a bone often require supportive tissue that is normally joined to the bone to be cut from the bony tissue to enable direct visual access to the bone. With cerclage procedures, one must entirely encircle a bone in order to hold the bony parts together.
  • [0006]
    Procedures using bone plates and cerclage elements often tend to interrupt blood flow to the damaged bone fragments, and thus hinder the healing process. Moreover, the use of bone plates and cerclage elements, particularly the former, can lead to stress shielding of the fracture site. It is well known (Wolff's law) that bone growth is stimulated when stress is applied. However, continuous, excessive pressure applied to a bone may cause unwanted resorption of bone at the pressure site. In order to promote healing of bone fractures, the fracture surfaces that are brought together during reduction of the fracture should be subject to cyclic or periodic compressive forces so as to stimulate the growth of new bone across the fracture interface without causing bone resorption. When a fracture interface is immobilized, as by a cast, the bone material that is deposited at the fracture interface may have a collagen fiber matrix that is random rather than aligned with the fiber matrix of bone on either side of the fracture, the healed fracture interface being weaker in tension than bone on either side of the interface.
  • [0007]
    Some bone fractures result in the production of many bone fragments, and proper reduction of the fracture requires the fragments to be carefully reassembled next to each other with their fracture surfaces in contact. Bone screws and bone plate devices commonly are used for this purpose. Using bone screw techniques, two bone fragments may be joined together, and these two fragments as a unit may be moved into approximation with a third fragment and joined to it, and so on. Fragments that are thus joined together by rigid screws cannot move with respect to other fragments, and mismatching of the fracture surfaces as the first several fragments are joined together can have a compounding effect, causing mal-union or non-union of fracture surfaces and resulting in far less than perfect bone fragment assembly and healing.
  • SUMMARY OF THE INVENTION
  • [0008]
    The invention involves an orthopedic fixation system for fixing a bone to an element which is a bone fragment or a prosthesis. The system includes a length of flexible, inelastic cord, a first fastener for attaching the cord to the element; and a second fastener for fastening the cord to the bone. At least one of the fasteners has an opening through which the cord may pass from the interior of the bone to the exterior to enable the element to be securely mounted to the bone.
  • [0009]
    In one embodiment, the invention involves a fracture relief system in which bone fragments are brought together by internal, inelastic flexible cords to counter forces tending to widen the fracture interfaces when the bone is stressed through normal, though often restricted, physical activity of a patient. Movement of fracture surfaces away from each other thus is prevented, but the flexible, inelastic cords do not restrict the transfer of compressive stress from one fragment to another across fracture interfaces during physical activity. That is, the cords do not prevent the bone fragments forming a fracture interface from converging slightly to enable stress transfer. Due to their inelastic nature, the flexible cords do not maintain the fracture interface in compression during rest, and thus resorption of bone due to excessive constant compressive force is largely avoided.
  • [0010]
    In another embodiment, the invention relates to a bone fracture reduction system for positioning bone fragments with respect to each other to reduce a fracture and promote healing. The system comprises a flexible, inelastic cord having an end portion, a fastener attached to the end portion of the cord and adapted for attachment to a bone fragment in a direction generally coaxial to the axis of the end portion, and a second fastener attachable to the other bone fragment and having an opening through which the cord can be drawn to place the cord in tension. The second fastener includes a lock for locking the cord to the second fastener to restrain separation of the bone fragments.
  • [0011]
    In a further embodiment, the invention provides a bone fracture reduction system for reducing and promoting healing of a bone fracture. The fracture reduction system comprises a fractured bone normally having an exterior cortical portion and a non-cortical interior, the bone having bone fragments with confronting fracture surfaces. An internal fastener is attached from within the bone interior to a first bone fragment with a length of flexible, inelastic cord extending within the bone interior and attached to said fastener and passing outwardly through an opening in a second bone fragment. The fastener and cord are so positioned as to draw respective fracture surfaces together to reduce the fracture upon tensioning of the cord extending outwardly through said opening. A second, external fastener desirably is attached to the bone opening, this fastener including an open bore to receive the cord and a lock to secure the cord to this fastener.
  • [0012]
    The invention also relates to a method for positioning fragments of a bone fracture with respect to each other to reduce the fracture and promote healing of a bone which normally has an exterior cortical portion and a non-cortical interior, the bone fragments having confronting fracture surfaces forming a fracture interface. The method comprises attaching from within the interior of the bone to a first bone fragment an internal fastener to which is attached a length of flexible, inelastic cord, and drawing the cord through an opening formed in a second bone fragment to draw the fragments together in a direction to reduce the fracture. The cord preferably is secured to the second bone fragment to maintain the bone fragments in a predetermined position to transfer compressive loads through the fracture interface during physical activity. Desirably, the method includes the step of determining the direction of tensile force desired to draw the fracture surfaces together, and positioning the cord approximately parallel to that direction. A tensioning instrument may be provided, the instrument having a first end portion grasping the cord that protrudes outwardly from the second bone fragment and a second end portion in contact with the external fastener, the method including the step of operating the instrument so as to separate said end portions and thus place the cord in tension to draw the bone fragments into the desired position.
  • [0013]
    A plurality of internal fasteners may be fastened to different ones of a plurality of bone fragments, the internal fasteners having attached to them the length of flexible inelastic cord. The internal fasteners are so positioned with respect to each other that when the cord is tensioned, the bone fragments are drawn together in directions to properly join their respective fracture surfaces. As desired, one or more of the interior fasteners may include a pulley surface, such as that provided by an eyelet, over which the cord is movably trained to change the direction of the cord within the interior of the bone, the method including the step of pulling the cord over the pulley surface to tension the cord and properly position the bone fragments with respect to each other.
  • [0014]
    The flexible, inelastic cord system and methods of the invention may be employed to mount prosthetic devices to bone, such as acetabular cups to the acetabulum, bone plates to long bones, etc. Speaking broadly, a length of flexible, inelastic cord may be fastened at one end to a bone of a patient, the cord extending within the bone to a prosthesis which is to be held to the bone. For example, in the case of an acetabular cup, several cords may be employed that extend generally radially outwardly of the cup within the pelvis to maintain the acetabular cup in position.
  • BRIEF DESCRIPTION OF THE DRAWING
  • [0015]
    [0015]FIG. 1 is a partial cross sectional view of a fractured bone to which a cord fracture fixation device of the invention is being applied to reduce the fracture;
  • [0016]
    [0016]FIG. 2 is an exploded view, in partial cross section, of a device of the invention shown in FIG. 1;
  • [0017]
    [0017]FIG. 3 is a partially exploded view, in partial cross section, of the device shown in FIG. 2;
  • [0018]
    [0018]FIG. 4 is a partially exploded view, in partial cross section, of a modification of the device shown in FIG. 3;
  • [0019]
    [0019]FIG. 5 is a partially exploded view, in partial cross section, of another modification of the device shown in FIG. 3;
  • [0020]
    [0020]FIG. 6A is a view in partial cross section, of a fastener of the invention having a pulley surface;
  • [0021]
    [0021]FIG. 6B is an exploded view of another fastener useful in the invention;
  • [0022]
    [0022]FIG. 7 is a perspective view, partially broken away, of a step in the installation of the pulley attachment element of FIG. 6A;
  • [0023]
    [0023]FIG. 8 is a partial cross sectional view of a fractured bone to which several cord fracture fixation devices are being applied to reduce the fracture;
  • [0024]
    [0024]FIG. 9A is a broken away cross sectional view of an elbow olecranon fracture to which a fracture fixation device of the invention is being applied;
  • [0025]
    [0025]FIG. 9B is a broken-away, cross sectional view taken along line 9B-9B of FIG. 9A;
  • [0026]
    [0026]FIG. 10 is an end-on cross sectional view of a fractured bone to which a fracture fixation device of the invention has been applied;
  • [0027]
    [0027]FIG. 11A is a side view of a bone plate shown also in FIGS. 9A and B;
  • [0028]
    [0028]FIG. 11B is a top view of the plate of FIG. 11A;
  • [0029]
    [0029]FIG. 11C is a cross sectional view taken along line 11C-11C of FIG. 11B;
  • [0030]
    [0030]FIG. 12A is a schematic representation of the pelvis, showing the location of a fracture in the ilium to be reduced by a method of the invention;
  • [0031]
    [0031]FIG. 12B is a cross sectional view of the pelvis of FIG. 12A showing a step in the reduction of the fracture; and
  • [0032]
    [0032]FIG. 12C is a cross sectional view of the pelvis of 12A showing the reduced bone.
  • [0033]
    [0033]FIG. 13A is a schematic perspective view of a portion of the pelvis showing an acetabular cup prosthesis held in position by a cord system of the invention;
  • [0034]
    [0034]FIG. 13B is a partially broken away side view of the prosthesis shown in FIG. 13A;
  • [0035]
    [0035]FIGS. 14A, B and C are schematic representations of the distal end portion of the humerus showing different steps in the placement of a cord system of the invention;
  • [0036]
    [0036]FIG. 14D shows a toggle type cord fixation system employed in the humerus mounted on a flexible installation rod and shown during insertion of the toggle;
  • [0037]
    [0037]FIG. 14E is a perspective view of a toggle of the type shown also in FIG. 14D; and
  • [0038]
    [0038]FIG. 14F is a schematic view, in partial cross section, of the humerus showing a fracture relieved through the use of the toggle and cords shown in FIGS. 14A-14E.
  • DESCRIPTION OF THE PREFERRED EMBODIMENTS
  • [0039]
    As used herein, “cord” refers to any of a variety of materials that are strong in tension, inelastic, flexible, and biocompatible. If desired, the cord can be made of an organic suture material, or may be made from bioabsorbable materials such as poly (lactic acid). Preferably, however, the cord is made of a metal wire, preferably in the form of a metal wire braid for improved flexibility. Stainless steel is an appropriate and preferred material. The cords are sufficiently flexible so that they substantially straighten within the bone interior when placed under sufficient tension to draw bone fragments together, that is, under a tension of about 5 or more newtons. The cords may be made of a single material or composite, or may include sections of different materials chosen for their particular properties such as strength, flexibility, and radiopacity to enable the cords to be readily visualized by fluoroscopy.
  • [0040]
    The cords are sufficiently flexible as to exhibit substantially no axial compressive strength; that is, strength to resist axially applied compressive forces. The cords may be sufficiently stiff as to enable cord ends to be threaded through the eyelets of pulley-like fasteners and the like, but not sufficiently stiff to prevent bone fragments joined by a cord from converging, as is the case with, for example, bone screws or rigid pins such as Steinman pins.
  • [0041]
    The cords also are inelastic. “Inelastic”, as used herein, means that when a cord is placed in sufficient tension to draw bone fragments together, i.e., under tensile forces ranging generally from about 5 to about 800 newtons, the cord stretches elastically only a very small amount if at all, so that the internal cord lengths extending from one bone fragment to another within a bone are under essentially no tension after the fragments have been properly anastomatized. Preferably, the cords demonstrate elastic recovery at body temperature of no more than about 10% upon release of a stretching force of 800 newtons.
  • [0042]
    As a result, the fracture interfaces are not stressed in compression by the cords when a patient is at rest, compression stress instead being applied intermittently through physical activity.
  • [0043]
    Referring first to FIG. 1, which illustrates a simple version of the invention, a fractured bone 10 is shown in schematic form as having a cortical portion 12 and an interior portion 14 that is non-cortical. “Cortical” bone refers to the hard, dense, outer shell of a bone that bears stress in normal physical activities. The interior or non-cortical portion of some bones may simply be hollow, or may have interconnected trebeculae of cancellous bone. The cortical shell portion of bones typically ranges in thickness from about 2 to about 10 mm. As shown in FIG. 1, the bone has been broken into two bone fragments 16, 18. The fracture surfaces of these bone fragments are shown at 16.1 and 18.1, respectively.
  • [0044]
    In the cortical bone portion 12 of fragment 18, there is placed a screw-type internal fastener 20, the designation “internal” referring to the fact that the fastener is attached to the bone fragment 18 from within the non-cortical interior of the bone. A flexible cord 22 attached to the fastener 20 extends across the interior of the bone as shown. Another screw-type fastener 24 is attached to the cortical portion of the other bone fragment 16. Fastener 24 may be termed an “external” fastener because it is attached to the bone fragment 16 from the exterior of the bone rather than the interior. Fastener 24 has a hollow bore through which the cord 22 passes to the exterior of the bone. A hand-operated cord tensioning instrument 26, which bears against the fastener 24 and also which pulls the cord 22, is used to tension the cord. A commercially available instrument of this type, commonly known as a Hall tensioning instrument, is described in Hall, U.S. Pat. No. 4,050,464, the teachings of which are incorporated herein by reference.
  • [0045]
    Fasteners 20 and 24 are so positioned that when the cord between them is placed in tension, the fracture surfaces 16.1, 18.1 will be brought together at a fracture interface with the interface being maintained under compression as long as the cord 22 is maintained in tension. The external fastener 24 is provided with a locking device 28 in the form of a screw that is received in a threaded bore in the fastener 24 and which, in this embodiment, clenches the cord between the fastener and screw to hold it in place. The tensioning instrument 26 is operated until the cord 22 between the fasteners is straightened and the fracture surfaces of the fragments are properly joined. While moderate cord tension is maintained, the locking screw 28 is inserted in the fastener 24 to clamp the cord in place. Slight further movement of the fragments toward each other relieves the tension in the cords, and the cords thereafter serve to prevent separation of the fracture surfaces as a patient engages in normal (although likely initially restricted) physical activity while freely permitting stress transfer across the fracture interfaces. Inasmuch as the newly formed bone at the fracture interface is subjected to stresses normally borne by that bone, the resulting collagen fiber matrix having the correct alignment and providing a strong union between bone fragments.
  • [0046]
    It is of importance to properly locate the fasteners 20, 24 so that the resulting direction of the cord 22 is such as to reduce the fracture and maintain the bone fragments in the proper position for healing. A variety of devices and instruments may be employed to properly place the fasteners. Internal fastener 20 can generally be placed where needed because the fracture site itself is open and accessible to the surgeon.
  • [0047]
    The procedure associated with FIG. 1 involves the steps of gaining access from the interior of the bone to the desired position for the fastener 20, drilling a small pilot hole through the cortical bone at this location from the bone interior, providing the fastener 20 with cord attached, and threading the fastener into the pilot hole, the fastener cutting its own threads. If the site for the fastener 20 cannot be readily accessed, an access hole can be drilled into the opposite side of the bone across from the desired site and the site may be accessed through this hole with the cord being drawn downwardly (in FIG. 1) through the hole formed for the external fastener 24. Although the fasteners 20, 24 in FIG. 1 and the fasteners described below are illustrated as having an elongated portion (threaded in FIG. 1) that extends approximately perpendicular to the surface of the bone, the fasteners may be attached at such other angles to the bone surface as may be appropriate to allow the force vector of the cord to parallel the axis of the fastener.
  • [0048]
    As described in greater detail below, one may employ a flexible, elongated tool to reach into the bone interior to properly place the fastener. A guide wire may first be placed in the bone interior with the tip of the wire adjacent the position of the desired internal fastener. The elongated tool may have a hollow interior to enable it to slide over the guide wire and into the proper position, following which the tool may be operated to perform the needed drilling and fastener replacement procedures. Fluoroscopy may be employed to aid the surgeon in this procedure.
  • [0049]
    The surgical procedures involved in the present invention are particularly beneficial for several reasons. First, through careful placement of the fasteners, the desired force vectors may be obtained to pull two or more bone fragments together and affect proper union of their respective fracture surfaces. Second, placement of the fasteners is a fairly simple technique and does not require substantial tissue division or removal of supportive tissue (i.e., muscle, tendon) from a bone.
  • [0050]
    [0050]FIGS. 2 and 3 show the fastener and cord structure described above in connection with FIG. 1. The cord 22 may have an enlarged end portion 22.1 which may be a crimped-on sleeve, a welded-on collar, etc. The cord 22 is inserted in a hollow bore 20.1 formed through the fastener 20, the enlarged end 22.1 of the cord coming to rest within an enlarged distal end portion 20.2 of the bore. The proximal end 20.3 of the internal fastener 20 is provided with an appropriate shape, such as a hexagonal perimeter or recess, to enable it to be turned by an appropriate tool such as a hollow, flexible nut driver as shown in FIG. 7 or an Allen wrench, or by some other means.
  • [0051]
    Internal fastener 20 desirably has self-cutting threads 20.4 of a design commonly utilized for bone screws. The cord and the fasteners must be sufficiently strong, of course, to bear the expected tensile stress to be placed on the cord. The external fastener 24 in FIGS. 2 through 5 has similar thread-cutting threads 24.2, and a generally hexagonal head or other appropriate shaped proximal end 24.1 to receive a tool such as the nut-driver of FIG. 7, the tool preferably having a hollow interior through which may pass the cord 22.
  • [0052]
    As shown best in FIG. 2, the exterior fastener 24 has an interior bore 24.3 sized to slidingly receive the cord 22. At the proximal end of this fastener, the bore has a widened, proximally open portion with interior threads 24.4 sized to threadingly receive the threads 28.1 of a locking screw 28. The threaded bore 24.4 has one or more, preferably four, circumferentially spaced, axially extending slots 24.5 that are sufficiently wide to permit the cable to pass into them as shown in FIGS. 3-5. Locking screw 28 is formed with a rounded distally facing nose 28.2 configured to come into contact with the cord when the cord extends through the slot 24.5, as shown in FIG. 3, the cord being pinched between the nose 28.2 and the interior of the fastener 24 to lock the cord in place. In the event the cord must be re-tensioned to adjust the position of a bone fragment, the locking screw 28 can be backed out readily from the fastener 24, the cord re-tensioned as needed, and the locking screw 28 repositioned in the fastener.
  • [0053]
    Several different internal fasteners are shown in FIGS. 4 and 5. FIG. 4 illustrates a fastener 20.5 in the form of a toggle, the fastener having an elongated, axially slotted shank 20.6 carrying at its distal end a pair of elongated arms 20.8 capable of swinging from the folded position shown in dashed lines in FIG. 4 to the fully extended position shown in solid lines in FIG. 4, the arms being pivotally attached to the shank by a pivot pin 20.7. In use, the internal fastener 20.5 is passed from the interior of the bone through a hole formed in a bone fragment until the arms 20.8 clear the hole, following which the arms may move into the position shown in solid lines in FIG. 4 to contact the outer surface of the bone and thus anchor itself to the bone.
  • [0054]
    [0054]FIG. 4 also shows, as the exterior fastener, a dynamic compression plate 24.5 of known design, the plate having a ramped orifice 24.6. Within the orifice is received a complementary shaped insert 24.7 having an aperture 24.8 threaded to receive the locking screw 28. Cord 22 extends through the aperture 24.8, and the locking screw locks the cord to the insert.
  • [0055]
    Illustrated in FIG. 5 is an internal fastener 20.9 having a body carrying a pair of spring-loaded arms 30. Arms 30 are capable of being elastically pressed inwardly against the body 30.1 of the fastener to enable the fastener to be received through a bore formed in a bone fragment, the arms 30 springing outwardly into contact with the walls of the bore to anchor the fastener in place. Various other fasteners of the types used to anchor sutures, such as the well known “fishhook” types, may be used.
  • [0056]
    As described in greater detail below, the internal fastener may have an internally extending eyelet or ring to provide a pulley-like surface over which the cord may be trained. With reference particularly to FIGS. 6A and 7, fastener 32 is provided with a body 32.1 having self-tapping threads adapted to screw into cortical bone (into which is first preferably drilled a small pilot hole) and a hexagonal head 32.2. The fastener includes a swivel body 32.3 that carries an eyelet 32.4 and that is attached to the threaded body 32.1 by means of a swivel mounting shown best in FIG. 6A. As illustrated, the threaded body 32.1 may have a hollow interior within which is rotatably mounted the swivel body with the latter having a flared end engaging the threaded body and preventing the swivel body from escaping.
  • [0057]
    Referring now to FIG. 7, a tool for mounting the threaded internal fasteners of the invention is shown generally at 34. The tool includes a distal end 34.1 having a hexagonally shaped recess to encounter the hexagonally shaped head portion of the fasteners, but Allen wrench configurations (in which the tool has a solid hexagonal end portion and the fastener head has a hexagonal recess) and various other tool/fastener shape configurations may be used as well. The tool includes an elongated body portion 34.2 and handle portion 34.3 which may be conveniently knurled, as shown. Desirably, the tool is hollow so that a cord 22 can pass entirely through the tool, through the eyelet 32.4 of the fastener 32, and back through the handle of the tool. In this fashion, when the tool is rotated about its axis to thread the threaded body 32.1 into cortical bone, the proximally extending eyelet 32.4 may remain substantially rotationally stationary to avoid twisting the cord. If desired, the distally open end 34.1 of the tool may have an axially extending, distally open slot such as that shown at 34.4 through which the cord 22 may extend when fasteners of the type shown in FIGS. 1-3 are threaded into bone. As mentioned above, the hollow interior of the tool may be employed to follow over a previously placed guide wire.
  • [0058]
    FIGS. 8-10 illustrate various ways in which the devices of the invention may be employed. Referring first to FIG. 8, an elongated bone 10 is shown as having been broken into three bone fragments 36, 38 and 40. Cord systems of the type shown in FIGS. 1-3 are mounted at solid, unbroken end portions of the bones, the cords being shown as 42 and 44. A series of small bone plates 46, each having a curved bottom surface to fit against the exterior of the bone, are provided. Each of the bone plates has a central bore 46.1 for receiving an external fastener 24 and has one or more bores 46.2 extending within the bone plate generally parallel to the axis of the bone and capable of slidably receiving the cords 42, 44. One fracture 38.1 is reduced through the use of the cords 42.1, 42.2, and the other fracture 38.2 is reduced through the use of cords 42.3 and 42.4. Note that the latter cords each have proximal ends passing through a single external fastener 24. The cords 42, 44 extend laterally through the bores 46.2 in the bone plates, the cords being appropriately manipulated to properly bring together the fracture surfaces of the bone fragments. Cords 42, 44 may be locked to the end-most bone plates and to such other plates as may be desired through use of such locking devices as are typified in FIGS. 11A-11C; that is, a threaded bore such as that designated as 56.7 in these figures may be formed in the bone plates of FIG. 8 at an angle to and intersecting the cord-receiving bores 46.2. A set screw 46.3 or the like may be threaded into the threaded bore to engage the cord and lock it to the plate.
  • [0059]
    [0059]FIGS. 9A and 9B show the reduction of an olecranon fracture of the type that might result from trauma to the ulna by a fall on the outstretched hand, i.e., by the severely tensioned triceps. It is important here to reduce the fracture by drawing the bone fragments together and maintaining the fragments in proper alignment during healing, the fracture interface resisting separation under the force of the triceps. Here, an internal fastener 32 of the type shown in FIGS. 6A and 7 is placed from within the interior of the bone into the bone fragment 48, as shown in FIG. 9A. A second interior fastener 50 is placed distally from the fracture site within the ulna, as shown in the drawing, the vector between the fasteners 32, 50 denoting the direction of the resulting tensile forces that will be placed on the cord 52 extending between them. The fastener 50 may, if desired, include a pulley surface of the tape provided by the eyelet 32.4 of the fastener 32 in FIG. 9A, or may be of a different design such as the type shown in FIG. 6B. The latter fastener comprises a ring 50.1 to be received against the surface of the bone 54, and a bone screw 50.2 having a ring-contacting wide head such as the hexagonal head shown at 50.3, the threaded portion of the screw 50.2 being sized to pass through the ring 50.1 and into a pilot hole 54.1 formed in the bone to securely fasten the fastener 50 to the bone. Cords 52, 52.1 are attached to the fastener by a crimp such as shown at 50.4 or by other means.
  • [0060]
    Fractures of such bones as the olecranon and the patella can result from extremely high tensile forces that are generated, in the case of the olecranon, by the triceps muscle, and, in the case of the patella, by the quadriceps muscle group. Reduction of fractures in these bones in the past has been accomplished through the use of external wires in what has become known as a “figure of eight” technique, the wires being trained around the ends of pins protruding from the bone fragments and the wires themselves laying against the outer bone surface. This external fixation technique has many of the drawbacks associated with cerclage techniques in that placement of the wires requires exposure of substantial exterior bone surface areas with associated loss of connective and supportive tissue. The use of extensive external wire structures can be largely avoided or eliminated in accordance with the present invention.
  • [0061]
    Referring again to FIG. 9A, the cord 52 extends from the fastener 50 through the eyelet 32.4 of the fastener 32 and thence out through an opening formed in the bone. If desired, the fastener 50 can be attached by utilizing screw fasteners having self-drilling and self-tapering screw portions, as shown in FIG. 7. An elongated tool having a right-angled drill adapter can be employed to attach the fastener to the bone. The cord 52.1 similarly is drawn out through the opening formed in the bone. An exterior fastener of the type described in connection with FIGS. 1-3 may be employed at the opening of the bone, the cords 52, 52.1 passing outwardly through the fastener. After suitable tension has been applied to the cords, the cords can be secured to the fastener in the manner described above. If desired, the external fastener may include a bone plate 56 as shown. Preferably, two generally parallel but transversely spaced cord systems are employed, as shown in FIG. 9B.
  • [0062]
    It will be understood that as the cord 52 is tensioned, the bone fragment 48 will be pulled to the right into contact with the ulna to reduce the fracture. Fastener 32 acts as a pulley; as the externally extending portion of cord 52 is pulled, some mechanical advantage is obtained to reduce the fracture. If desired, only the cord 52 need be employed in this procedure to reduce the fracture and to maintain the fracture interface in position. It will be observed that in this event, the cord will exert force on the bone plate 56 in the direction of the fastener 32, and to counteract this force, the cord 52.1 may be employed to provide a counteracting, substantially balancing force vector. It will be noted that the cords 52, 52.1 together are positioned to counter the force exerted by the triceps, shown as T in FIG. 9A.
  • [0063]
    The bone plate 56 shown in FIGS. 9A and 9B is also illustrated in greater detail in FIGS. 11A, 11B and 11C. The plate 56 may be made of plastic or steel or other biocompatable, rigid material, and includes a top 56.1, a bottom 56.2 which is slightly concave in order to fit more closely the convex surface of bone such as the ulna as shown in FIGS. 9A and 9B, identical side walls 56.3 and identical end walls 56.4 tapered so as to avoid trauma to overlying soft tissue. Cord-receiving bores 56.5, 56.6 are formed at an acute angle to the top and bottom walls 56.1, 56.2, as illustrated best in FIGS. 11A and 11C. These bores intersect intermediate the top and bottom walls, and threaded bores 56.7 are formed in the side walls 56.3 and extend toward each other so as to intersect the bores 56.5, 56.6 at their point of intersection. The threaded bores 56.7 are so oriented as to receive a set screw (not shown) which, when fully inserted, engages cords passing through the bores 56.5, 56.6 to lock them in place.
  • [0064]
    [0064]FIG. 10 further illustrates the use of pulley-like fasteners within a bone. This figure shows a bone end-on, the bone having been broken into three fragments 58, 60, 62. Internal fasteners of the type shown at 32 in FIGS. 6A and 7 are placed from the interior of the bone into each of bone fragments 60, 62 with the cord 64 extending through the pulley-like eyelets of these fasteners. Both ends of the cord are drawn out of the bone through an external fastener 24 of the type shown in FIGS. 1-3, the latter being carried by bone fragment 58. The internal fasteners 32 and the external fastener 24 are so positioned that when the ends of the cord that extend outwardly through the external fastener are placed in tension and are then secured to the fastener 24 through the locking screw 28, the fragments are urged together to properly reduce the fracture and to prevent the fracture surfaces from separating. It should be understood that the pulley surfaces of the fasteners 32 enable slight movement of the cord 64 as stress is applied to balance any tensile forces in the cords and thus avoid unwanted shifting of one bone fragment with respect to another due to unequal loading.
  • [0065]
    Note also in connection with FIG. 10 that the vector of the resultant force applied to each bone fragment is not parallel to the direction of the cords, but rather depends for each fragment upon the angle between the cord segments leading to that fragment and the tension in each cord segment. Assuming that the tension in each of the three cord segments fracture reduction occurs is approximately the same, the vector of the resultant force acting on each fastener approximately bisects the angle between the cord segments leading to that fastener, and knowledge of this relationship may aid the surgeon in proper placement of the fasteners.
  • [0066]
    [0066]FIGS. 12A, 12B and 12C show steps in the reduction of a fracture of the ilium of the pelvis, the fracture being designated generally as 66. It is desired here to run a flexible, inelastic cord of the invention from within the pelvis to cortical bone on the far side of the fracture, fastening the cord to the cortical bone, the cord thus running past the fracture site and exiting the pelvis on the near side of the fracture site. Referring to FIG. 12B, installation of the cord and internal fastener is facilitated through the use of an external drill mechanism 68 as illustrated in this figure, and comprising a hand grip 68.1, a rotatable handle 68.2, a chuck 68.3, and a gear mechanism (not shown) that causes the chuck to rotate about its axis in response to turning of the handle 68.2. The drill may be of the type marketed by DePuy as its Modified Pease Bone Drill, Model 2079-00. A flexible cable 68.4 is provided, the cable being of known design and torsionally stiff so that rotation of the cable at its end where attached to the chuck 68.3 results in rotation of the cable at its distal end 68.5. An internal fastener of the type shown in FIG. 3 is shown at 70, and is provided with a hexagonal head which is inserted within a hexagonal end of the flexible cable 68.4 such that as the cable is rotated about its axis, the threaded fastener 70 is threaded into cortical bone with the cord (not shown) extending from the fastener through the hollow interior of the flexible cable 68.4 such that when the fastener 70 has been suitably fastened to cortical bone, the flexible cable can be withdrawn from the pelvis leaving behind it the flexible, inelastic cord within the bone.
  • [0067]
    The cord in FIG. 12C is designated 72, and extends from the internal fastener 70 across the fracture 66, around the bends in the ilium, and exits the pelvis through an external fastener of the type described above and designated 74. Although only one such cord is shown in the drawing, a plurality of such cords, extending in the necessary directions to reduce the fracture, may be employed. The cord 72 is placed under tension to reduce the fracture, and then is secured in the external fastener 74 in the manner described above to prevent the fracture interface from reopening.
  • [0068]
    [0068]FIG. 13A shows use of the cord system of the invention for fixation of a prosthetic acetabular cup to the acetabulum of a patient. Designated 80 in FIG. 13A is a prosthetic acetabular cup, commonly comprising a cup-shaped metal jacket 82 formed of titanium or other biocompatible metal, and an inner cup 84 having a generally hemispherical cavity in it to receive the ball of the femur. The outer surface of the metal jacket 82 may have threads or spikes or other surface configurations enabling it to grip tightly to the bony acetabulum once the latter has been surgically shaped to receive the prosthesis. In accordance with the invention, the generally cup-shaped metal jacket 82 is provided with a series of apertures 86 (FIG. 13B) which may be threaded to receive lock nuts 88, the threaded apertures and lock nuts themselves forming an external fastener as generally referred to above. Internal fasteners 90 are attached from within the pelvic bone to the cortical bone thereof in the manner described above in connection with FIGS. 12B and 12C, the flexible, inelastic cords 92 extending within the pelvis back through the apertures 86 in the acetabular cup prosthesis. Desirably, 3 or 4, or more, such cords are employed, extending preferably generally radially outwardly from the cup in a variety of different directions. The ends of the cords are individually suitably tensioned to properly position the acetabular cup prosthesis 80, the ends of the cords extending into the jacket then being locked in place through the use of the locking screws 88. The polymeric inner cup 84 is then placed in the jacket. The purpose of the flexible, inelastic cords 92 is to hold the acetabular prosthesis in place and, as needed, to repair fractures in the pelvis as well.
  • [0069]
    Referring now to FIGS. 14A-D, these figures depict how the flexible, inelastic cords of the invention may be used to reduce fracture of a long bone such as the humerus. A fractured humerus is designated 96 and includes a medullar canal 98 bounded by cortical bone 100. The fracture site is shown best in FIGS. 14D and 14F, the fracture interface being designated 102. At its distal end, on either side of the olecranon, the humerus has thin walled portions through which are drilled holes 104, 106 for introduction of a cord system of the invention.
  • [0070]
    The holes 104, 106 may be formed through the use of a drill of the type described above, the drill having a flexible shaft shown schematically as 108 in FIG. 14A. The elongated bores formed by the drill 108 converge at a point spaced proximally from the olecranon, and further movement of the flexible drill shaft upwardly (proximally) within the medullary canal 98 serves to remove some of the tissue in the canal to make way for the cord system. It is desired, once the cord system is in place, that a pair of spaced cords traverse the fracture site within the medullary canal, each cord exiting at one of the holes 104, 106. For ease in placement of the cord system, each of the cords may initially exit through hole 106, with one of the cords thereafter being drawn downwardly through hole 104. This may be accomplished as shown in FIGS. 14B and 14C. A wire 110 having a loop at one end is inserted through the hole 104, the loop then being snared by a hook-shaped end of a snare wire 112 that is inserted through the other hole 106. The snare wire then can be removed and discarded.
  • [0071]
    Through the hole 106 is introduced a flexible, hollow introducer tube 114 carrying within it a toggle 116, the toggle being of the type shown best in FIGS. 14C through 14F. Turning to these figures, the toggle is shown as having an extended orientation in which it is received in the tube 114 (FIG. 14C) and in which it is eventually deployed in the medullary canal (FIG. 14F), and an articulated orientation (FIG. 14F) permitting it to be moved within the close confines of the medullary canal during placement of the toggle.
  • [0072]
    Referring to FIG. 14E, the toggle mechanism typified in the drawing has a body formed of a pair of parallel, spaced, elongated body strips 118 joined at their ends by transverse pins 120. Two pairs of parallel gripping arms 122 are provided, the arms of each pair being spaced and joined at their ends by a rod 124, and it is to these rods extending between the arms 122 of each pair that the ends of the cords 130, 132 are respectively attached through the use of eyelet connectors 126. The pins 120 that join the body strips 118 also pass outwardly through holes formed in the gripping arms intermediate their ends so that the gripping arms can pivot about the pins between extended and articulated orientations. Each gripping arm has an end 128 opposite the ends joined by the rods 124 that is serrated or otherwise configured for gripping to bone.
  • [0073]
    To properly position the toggle, a pair of flexible push rods 140, 142 are provided within the introducer tube 114, each push rod extending outwardly of the introducer tube as shown in FIG. 14D and being attached to manually graspable rings 144 that permit the push rods to move axially and also rotationally. The push rods may have transverse grooves, as shown at 146 in FIG. 14E, adjacent their ends, the grooves being sized to receive the transverse pins 120. The grooves may be disengaged from the pins 120 simply by rotating the push rods through 90 degrees. One thus may position the toggle as desired within the medullary canal through relative axial movement of the push rods 140, 142, and once the body of the toggle is in its desired location, the push rods may be rotated to disengage them from the toggle so that they can be removed. Moreover, once the body of the toggle has been oriented as desired, and optionally before removal of the push rods, tension is placed on the cords 130, 132, causing the arms 122 to pivot in the direction of the arrow A in FIG. 14E to cause the ends 128 of the arms to extend outwardly of the toggle body as shown best in FIG. 14F into gripping contact with bone on each side of the medullary canal.
  • [0074]
    Returning now to FIG. 14C, the flexible introducer tube 114, including within it the toggle 116 to which are connected the pair of flexible cords 130, 132, is pushed upwardly through the medullaryy canal to a point at which anchoring of the cords is desired, this, in FIG. 14D, being near the head of the humerus where the medullary canal becomes wider. The toggle 116 is then held in place within the medullary canal by the push rods 140, 142 attached to the transverse pins 120 of the toggle body, and the flexible tube 114 is then withdrawn slightly to expose the toggle within the medullary canal. By appropriate axial movement of the push rods, the toggle arms ends 128 are deployed outwardly into contact with the bone. Once approximate deployment of the toggle has been accomplished, the flexible tube 114 may be removed distally through the hole 106. Further manipulation of the push rods with respect to each other and to the bone may be required to achieve proper orientation of the toggle within the medullary canal. A 90 degree twist of each push rod frees it from the toggle and enables the push rods to be individually removed from the medullary canal. Of course, in this and other procedures described herein, fluoroscopy is used to insure proper placement of elements of the cord system.
  • [0075]
    At this point, it will be noted that both of the flexible, inelastic cords 130, 132 exit from the hole 106. The wire 110 with formed loop is now attached to one of the cords, cord 130 in this example, and pulling the wire 110 from the hole 104 draws the fastened cord 130 outwardly through the hole 104.
  • [0076]
    [0076]FIG. 14F shows the flexible, inelastic cord system in place in the humerus, the toggle device 116 being firmly anchored near the head of the humerus, the flexible, inelastic cords 130, 132 extending in a spaced orientation downwardly through the medullary canal with cord 130 exiting from the medullary canal through the hole 104 and cord 132 exiting from the other hole 106. External fasteners of the type described above in connection with FIG. 2 and designated 134 are screwed into the holes 104, 106 with the cords extending through these fasteners. By suitably pulling on the cords 130, 132 from the distal end of the humerus, one may bring together the fracture surfaces as desired. By spacing the cords from one another, the possibility of placing one side of the bone in tension and the other in compression is largely avoided. Once the bones have been appropriate located, the locking screws 136 are screwed into the ends of the fasteners 134, locking the cords in place. Because the cords are inelastic, any tension remaining in the cords after attachment of the locking screws 136 is quickly lost.
  • [0077]
    The invention is particularly adapted for use in situations in which a bone has been fractured into a number of fragments that need to be carefully brought back into alignment, with compression being generated at the fracture interfaces during physical activity to promote fracture healing. The use of external splints, casts, bandages, cerclage elements, and the like to reduce fractures in badly fractured bones is quite difficult. Exterior pressure must be used to force bones into the correct position and continued adequate compression of all or most of the fracture interfaces is difficult to attain. Through the use of the invention, in which fasteners are placed into bone fragments from the interior of the bone, with flexible cords being employed within the bone, to pull, rather than push, the fragments into place, the force vectors needed for proper fracture reduction and interface compression can be readily chosen at the time of surgery. When many bone fragments are involved, a surgeon may find it desirable to lead two, three or more cords out of the opening formed in one fragment with the interior ends of the cords attached to the variety of fragments via internal fasteners, the surgeon then operating the cords independently of each other to move the bone fragments into the desired position using fluoroscopy as needed to visualize the cords and proper placement of the bone fragments. The use of a cord having a degree of radiopacity aids visualization of the cord.
  • [0078]
    While a preferred embodiment of the present invention has been described, it should be understood that various changes, adaptations and modifications may be made therein without departing from the spirit of the invention and the scope of the appended claims.

Claims (42)

I claim:
1. An orthopedic fixation system for fixing a bone to an element which is a bone fragment or a prosthesis, comprising a length of flexible, inelastic cord, a first fastener for attaching the cord to said element; a second fastener for fastening the cord to the bone, at least one of the fasteners having an opening through which the cord may pass from the interior of the bone to the exterior to enable said element to be securely mounted to the bone portion.
2. An orthopedic fixation system comprising a bone having an exterior cortical portion and a non-cortical interior, an element which is a prosthesis or a bone fragment, a length of inelastic, flexible cord; a first fastener attaching the cord to said element, a second fastener attaching the cord to the bone, the cord extending from said first fastener within the interior of the bone to the second fastener.
3 The orthopedic fixation system of claim 2 wherein at least one of said fasteners includes an opening through which said cord passes from the interior of the bone to the exterior, said at least one fastener including a lock for locking the cord to the fastener through which it passes.
4. The orthopedic fixation system of claim 3 wherein at least one of said fasteners includes a threaded portion adapted to be screwed into bone.
5. The orthopedic fixation system of claim 2 wherein said element is a bone fragment resulting from a fracture of said bone, said bone fragment and bone having mating fracture surfaces that are prevented from separating by said cord extending between them.
6. The orthopedic fixation system of claim 5 wherein at least one of said fasteners includes an elongated toggle portion adapted to pass in a generally coaxial direction through a bore formed in said bone or bone fragment and to assume a position generally normal to said axis against an outer surface of said bone or bone fragment.
7. The orthopedic fixation system of claim 5 wherein at least one of said fasteners includes a threaded portion adapted to be screwed into bone.
8. The orthopedic fixation system of claim 5 wherein at least one of said fasteners includes a bone plate adapted to engage a bone surface.
9. The orthopedic fixation system of claim 5 including a third fastener fastenable to bone and having a surface within said interior over which said cord may be movably trained to change the direction of said cord between the first and second fasteners.
10. The orthopedic fixation system of claim 5 wherein at least one of said fasteners includes an opening through which said cord passes from the interior of the bone to the exterior, said at least one fastener including a lock for locking the cord to the fastener through which it passes.
11. The orthopedic fixation system of claim 10 wherein said opening comprises a bore at least partially threaded and within which the cord extends, and wherein said lock comprises a threaded member threadingly received in the bore and capable of engaging said cord to restrain cord movement.
12. The orthopedic fixation system of any one of claims 2-11 including a tensioning instrument adapted to contact the cord and at least one of said fasteners to place the cord in tension by drawing said cord outwardly through said fastener.
13. A bone fracture reduction system for reducing and promoting healing of a bone fracture, comprising a bone normally having an exterior cortical portion and a non-cortical interior, the bone having bone fragments with generally confronting fracture surfaces, an internal fastener attached from within said interior to a first bone fragment, a length of flexible, inelastic cord extending within said bone interior and attached to said internal fastener and passing outwardly through an opening in a second bone fragment, said internal fastener and cord being so positioned as to draw respective fracture surfaces together to reduce said fracture upon tensioning of the cord extending outwardly through said opening.
14. The bone fracture reduction system of claim 13 including a lock locking the cord to said second fragment.
15. The bone fracture reduction system of claim 14 wherein said interior fastener includes a threaded portion screwed into said cortical portion from within said bone interior.
16. The bone fracture reduction system of claim 13 wherein said first bone fragment has an outer, cortical surface and wherein said first fastener includes an elongated toggle supported against said outer surface portion.
17. The bone fracture reduction system of claim 13 including an external fastener attached to said second fragment and having a hollow interior through which said cord extends.
18. The bone fracture reduction system of claim 17 wherein said hollow interior of the second fastener is at least partially threaded, and wherein said lock comprises a threaded member threadingly received in said hollow interior, said cord being operatively grasped between said threaded member and said hollow interior to restrain cord movement within said second fastener.
19. The bone fracture reduction system of claim 17 wherein said bone is a long bone having a medullary cavity, said internal fastener being carried attached from within the medullary canal to one of the bone fragments and said length of flexible, inelastic cord extending from said internal fastener through said external fastener across a fracture interface and more closely adjacent one side of said medullary canal than the other side thereof, the bone fracture reduction system including a second flexible, inelastic cord and an external fastener attached to said second fragment and through which said second cord extends, said second cord being arranged on generally the opposite side of said medullary canal from said first cord, whereupon said cords may be independently adjusted so as to resist bending moments applied at the transverse fracture site.
20. The bone fracture reduction system of claim 19 wherein said internal fastener comprises a pair of fasteners each having threaded portions threaded into said first bone fragment on opposite sides of the medullary canal.
21. The bone fracture reduction system of claim 19 wherein said internal fastener comprises an elongated fastener adapted for insertion and capture within the medullary canal of the first bone fragment with said cords extending from said fastener adjacent opposite sides of the intermedullary canal.
22. The bone fracture reduction system of claim 13 wherein said one bone fragment has a bore extending through its cortical portion and wherein said second fastener includes a plate adapted to engage the outer surface of the cortical portion.
23. The bone fracture reduction system of claim 13 including a third fastener fastened from the interior of said bone to a third bone fragment and having a pulley surface over which said cord is movably trained to change the direction of said cord within the interior of said bone.
24. The bone fracture reduction system of claim 13 including a plurality of internal fasteners attached from within said bone interior to different ones of said bone fragments, said fasteners and cord being so positioned as to draw respective fracture surfaces of said bone fragments together to reduce said fracture upon tensioning of the cord extending outwardly through said opening.
25. The bone fracture reduction system of claim 23 wherein at least one of said interior fasteners includes a pulley surface over which said cord is movably trained to change the direction of said cord within the interior of said bone.
26. The bone fracture reduction system of claim 23 wherein each of said interior fasteners includes a pulley surface over which said cord is movably trained to change the direction of said cord within the interior of said bone.
27. Method for positioning fragments of a bone fracture with respect to each other to reduce the fracture and promote healing of a bone which normally has an exterior cortical portion and a non-cortical interior, the bone fragments having confronting fracture surfaces forming a fracture interface, the method comprising attaching from within the interior of the bone to a first bone fragment an internal fastener to which is attached a length of flexible, inelastic cord, drawing said cord through a bore formed in a second bone fragment to draw said fragments together in a direction to relieve the fracture.
28. The method of claim 27 including the step of securing the cord to said second bone fragment to restrain separation of the bone fragments at the fracture interface.
29. The method of claim 27 including the step of determining the direction of tensile force desired to draw said fracture surfaces toward each other, and positioning said cord parallel to said direction.
30. The method of claim 27 wherein said internal fastener has a threaded end, the method including the step of screwing said threaded end from the interior of said bone into a cortical portion of said first bone segment.
31. The method of claim 27 wherein said internal fastener has an elongated toggle portion, the method including the step of forming a bore through said first bone fragment, and passing said toggle from the interior of the bone through said bore to enable the toggle to lie against a cortical outer surface of said first bone fragment.
32. The method of claim 27 including the step of attaching to the second bone fragment an external fastener through which the cord can be drawn, and locking the cord to the latter fastener.
33. The method of claim 32 including the step of providing a tensioning instrument having a first portion grasping said cord and a second portion in contact with said external fastener, and operating said instrument so as to separate said portions and to place said cord in tension.
34. The method of claim 27 comprising attaching a plurality of internal fasteners to different ones of a plurality of bone fragments, said internal fasteners having attached to them said length of flexible cord, said internal fasteners being so positioned with respect to each other that when said cord is tensioned, said fragments are drawn together in directions to reduce the fracture.
35. The method of claim 34 wherein at least one of said interior fasteners includes a pulley surface over which said cord is movably trained to change the direction of said cord within the interior of said bone, the method including the step of pulling said cord over said pulley surface.
36. The method of claim 34 wherein each of said interior fasteners includes a pulley surface over which said cord is movably trained to change the direction of said cord within the interior of said bone, the method including the step of pulling said cord over said pulley surfaces.
37. Method for reducing a bone fracture in a bone having a cortical exterior portion and a non-cortical interior, said fractured bone having at least three bone fragments in which first and second fragments have first mating fracture surfaces and second and third bone fragments have second, different mating fracture surfaces, the method comprising attaching one end of a length of flexible cord from within the bone interior to the first bone fragment, attaching a pulley bearing said cord to the second bone fragment, the other end of said cord passing outwardly of the bone through an opening in the third bone fragment, tensioning said cord to draw together said mating fracture surfaces to relieve the fractures, and securing said tensioned cord to said third bone fragment.
38. Method for reducing a bone fracture comprising at least two pairs of bone fragments, a first pair of bone fragments having first mating fracture surfaces and a second pair of bone fragments having second, different mating fracture surfaces, and wherein one bone fragment may be common to each of the first and second pairs, the bone having an exterior cortical portion and an interior non-cortical portion, the method comprising
a. attaching one end of a length of flexible cord from the interior of the bone to one fragment of said first pair, said cord extending through an opening in the other bone fragment of said first pair in a direction so that when said cord is placed in tension, the first mating fracture surfaces are drawn toward each other;
b. attaching one end of a second length of flexible cord from the interior of the bone to one fragment of said second pair, said second length of cord extending through an opening in the other bone fragment of said second pair in a direction so that when said cord is placed in tension, the second mating fracture surfaces are drawn toward each other; and
c. appropriately adjusting tension in said cords with respect to each other to reduce the fracture surfaces.
39. The method of claim 38 including the step of securing the tensioned cords to said other bone fragments.
40. Method for reducing a bone fracture of a bone having a cortical exterior portion and a non-cortical interior, the fracture comprising at least three bone fragments each having fracture surfaces mating with fracture surfaces of the other fragments, the method comprising:
a. attaching from the interior of the bone to each of two of said bone fragments a fastener having a pulley surface over which is trained a length of flexible cord;
b. drawing said cord through an opening in a third bone fragment and tensioning said cord to draw said fracture surfaces together; and
c. securing said cord to said third bone fragment to respect to each other to reduce the fracture surfaces.
41. Method for reducing a bone fracture of an elongated bone having a medullary canal and a generally transverse fracture dividing the bone into first and second bone fragments, comprising
a. attaching from the interior of the bone to one of said bone fragments an internal fastener from which extends at least two flexible, inelastic cord lengths;
b. drawing said cord lengths through openings formed in said second bone fragment at spaced positions along the interior of the medullary canal of that fragment so that said cord lengths are spaced from one another within the medullary canal at the fracture site; and
c. securing said cords to said second bone fragment to reduce the fracture surfaces, said spaced cords resisting bending moments at the fracture site.
42. A bone fracture reduction system for use in reducing a fracture of a long bone producing first and second bone fragments, comprising an internal fastener adapted for insertion and capture within the medullary canal of one bone fragment, a pair of flexible, inelastic cords attached at laterally spaced points to and extending from said internal fastener, and a pair of spaced external fasteners attachable to the other of said bone fragments and having openings through which said cords may respectively pass on opposite sides of the medullary canal, whereby said cords may traverse the fracture site within the medullary canal on opposite sides thereof to resist bending moments at the fracture site.
US10115446 1998-09-28 2002-04-02 Internal cord fixation device Abandoned US20020188297A1 (en)

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US10115446 US20020188297A1 (en) 1998-09-28 2002-04-02 Internal cord fixation device

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US10115446 US20020188297A1 (en) 1998-09-28 2002-04-02 Internal cord fixation device
US10629007 US7410489B2 (en) 1998-09-28 2003-07-29 Internal cord fixation device

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US09162036 Continuation US6368326B1 (en) 1998-09-28 1998-09-28 Internal cord fixation device

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Cited By (46)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060265003A1 (en) * 2005-05-23 2006-11-23 Custom Spine, Inc. Spinal rod inserter
US20070073293A1 (en) * 2003-10-16 2007-03-29 Martz Erik O System and method for flexible correction of bony motion segment
US20070144539A1 (en) * 2005-11-09 2007-06-28 Van Der Burg Erik Glossoplasty using tissue anchor glossopexy with volumetric tongue reduction
US20070225736A1 (en) * 2006-03-23 2007-09-27 Ethicon Endo-Surgery, Inc. Suture Tensioning Device
US20080023012A1 (en) * 2005-02-08 2008-01-31 Aspire Medical, Inc. Glossopexy adjustment system and method
US7338490B2 (en) 2002-05-21 2008-03-04 Warsaw Orthopedic, Inc. Reduction cable and bone anchor
US20080058613A1 (en) * 2003-09-19 2008-03-06 Imaging Therapeutics, Inc. Method and System for Providing Fracture/No Fracture Classification
US20080066769A1 (en) * 2005-02-08 2008-03-20 Aspire Medical, Inc. Airway implants and methods and devices for insertion and retrieval
US20080077154A1 (en) * 2006-09-21 2008-03-27 Edwards Scott G System and method of bone compression and fixation
WO2008064346A2 (en) * 2006-11-22 2008-05-29 Sonoma Orthopedic Products, Inc. Fracture fixation device, tools and methods
US20080287951A1 (en) * 2007-03-22 2008-11-20 Stoneburner James D Segmented intramedullary structure
US20090287213A1 (en) * 2006-11-21 2009-11-19 Oliver Pieske Implant for long bones and treatment method
US20100016899A1 (en) * 2008-07-18 2010-01-21 Jeffrey Gelfand Clavicle fixation
WO2010062379A1 (en) * 2008-11-25 2010-06-03 Sonoma Orthopedic Products, Inc. Bone fracture fixation screws, systems and methods of use
US7846162B2 (en) 2005-05-18 2010-12-07 Sonoma Orthopedic Products, Inc. Minimally invasive actuable bone fixation devices
US20100331892A1 (en) * 2009-06-30 2010-12-30 Fell Barry M Bone repair system and method
US20110040168A1 (en) * 2002-09-16 2011-02-17 Conformis Imatx, Inc. System and Method for Predicting Future Fractures
US20110087227A1 (en) * 2008-12-18 2011-04-14 Mazur Kal U Bone fixation device, tools and methods
US20110098757A1 (en) * 2009-10-28 2011-04-28 Craig Schelling Compression plate kit and methods for repairing bone discontinuities
US20110105885A1 (en) * 2002-09-16 2011-05-05 Imatx, Inc. Methods of Predicting Musculoskeletal Disease
US8096995B2 (en) 2005-02-17 2012-01-17 Kyphon Sarl Percutaneous spinal implants and methods
US8096994B2 (en) 2005-02-17 2012-01-17 Kyphon Sarl Percutaneous spinal implants and methods
US8105357B2 (en) 2006-04-28 2012-01-31 Warsaw Orthopedic, Inc. Interspinous process brace
US8114135B2 (en) * 2009-01-16 2012-02-14 Kyphon Sarl Adjustable surgical cables and methods for treating spinal stenosis
US8167890B2 (en) 2005-02-17 2012-05-01 Kyphon Sarl Percutaneous spinal implants and methods
US20120172936A1 (en) * 2010-12-29 2012-07-05 Tarsus Medical Inc. Methods and devices for treating a syndesmosis injury
US8287539B2 (en) 2005-05-18 2012-10-16 Sonoma Orthopedic Products, Inc. Fracture fixation device, tools and methods
US8371307B2 (en) 2005-02-08 2013-02-12 Koninklijke Philips Electronics N.V. Methods and devices for the treatment of airway obstruction, sleep apnea and snoring
US20130110173A1 (en) * 2011-10-28 2013-05-02 Warsaw Orthopedic, Inc. Attachment mechanism for material and bone
US8588365B2 (en) 2000-08-29 2013-11-19 Imatx, Inc. Calibration devices and methods of use thereof
US8600124B2 (en) 2004-09-16 2013-12-03 Imatx, Inc. System and method of predicting future fractures
US8639009B2 (en) 2000-10-11 2014-01-28 Imatx, Inc. Methods and devices for evaluating and treating a bone condition based on x-ray image analysis
US8649481B2 (en) 2000-08-29 2014-02-11 Imatx, Inc. Methods and devices for quantitative analysis of X-ray images
US8781191B2 (en) 2003-03-25 2014-07-15 Imatx, Inc. Methods for the compensation of imaging technique in the processing of radiographic images
US8840617B2 (en) 2010-02-26 2014-09-23 Warsaw Orthopedic, Inc. Interspinous process spacer diagnostic parallel balloon catheter and methods of use
US8939917B2 (en) 2009-02-13 2015-01-27 Imatx, Inc. Methods and devices for quantitative analysis of bone and cartilage
US8961516B2 (en) 2005-05-18 2015-02-24 Sonoma Orthopedic Products, Inc. Straight intramedullary fracture fixation devices and methods
US9011507B2 (en) 2009-10-28 2015-04-21 Orthopro Llc Compression plate kit and methods for repairing bone discontinuities
US9060820B2 (en) 2005-05-18 2015-06-23 Sonoma Orthopedic Products, Inc. Segmented intramedullary fracture fixation devices and methods
US9155574B2 (en) 2006-05-17 2015-10-13 Sonoma Orthopedic Products, Inc. Bone fixation device, tools and methods
US9161745B2 (en) 2011-10-05 2015-10-20 Mark A. Dodson Modular retractor and related method
US9267955B2 (en) 2001-05-25 2016-02-23 Imatx, Inc. Methods to diagnose treat and prevent bone loss
US9737294B2 (en) 2013-01-28 2017-08-22 Cartiva, Inc. Method and system for orthopedic repair
US9767551B2 (en) 2000-10-11 2017-09-19 Imatx, Inc. Methods and devices for analysis of x-ray images
US9770278B2 (en) 2014-01-17 2017-09-26 Arthrex, Inc. Dual tip guide wire
US9814499B2 (en) 2014-09-30 2017-11-14 Arthrex, Inc. Intramedullary fracture fixation devices and methods

Families Citing this family (161)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6984241B2 (en) 1996-09-13 2006-01-10 Tendon Technology, Ltd. Apparatus and methods for tendon or ligament repair
FR2768324B1 (en) 1997-09-12 1999-12-10 Jacques Seguin A surgical instrument for percutaneously, fixing one to the other two zones of soft tissue, usually spaced apart
US6045551A (en) 1998-02-06 2000-04-04 Bonutti; Peter M. Bone suture
US7563267B2 (en) 1999-04-09 2009-07-21 Evalve, Inc. Fixation device and methods for engaging tissue
US6752813B2 (en) 1999-04-09 2004-06-22 Evalve, Inc. Methods and devices for capturing and fixing leaflets in valve repair
US20040044350A1 (en) 1999-04-09 2004-03-04 Evalve, Inc. Steerable access sheath and methods of use
US8216256B2 (en) * 1999-04-09 2012-07-10 Evalve, Inc. Detachment mechanism for implantable fixation devices
US7811296B2 (en) 1999-04-09 2010-10-12 Evalve, Inc. Fixation devices for variation in engagement of tissue
WO2000060995A9 (en) 1999-04-09 2002-06-13 Evalve Inc Methods and apparatus for cardiac valve repair
US6319252B1 (en) 1999-07-23 2001-11-20 Mcdevitt Dennis System and method for attaching soft tissue to bone
US6517542B1 (en) * 1999-08-04 2003-02-11 The Cleveland Clinic Foundation Bone anchoring system
US6635073B2 (en) 2000-05-03 2003-10-21 Peter M. Bonutti Method of securing body tissue
US6447516B1 (en) 1999-08-09 2002-09-10 Peter M. Bonutti Method of securing tissue
US6527794B1 (en) 1999-08-10 2003-03-04 Ethicon, Inc. Self-locking suture anchor
ES2223442T3 (en) * 1999-11-25 2005-03-01 Zimmer Gmbh Surgical instrument for tensioning a tension cable type.
US6368343B1 (en) 2000-03-13 2002-04-09 Peter M. Bonutti Method of using ultrasonic vibration to secure body tissue
US20050038435A1 (en) * 2000-08-22 2005-02-17 J. Dean Cole Intramerdullary canal diameter reducer background of the invention
US6994725B1 (en) * 2000-10-03 2006-02-07 Medicinelodge, Inc. Method and apparatus for reconstructing a ligament
GB0024898D0 (en) * 2000-10-11 2000-11-22 Ellis Dev Ltd A connector
US6733506B1 (en) * 2000-11-16 2004-05-11 Ethicon, Inc. Apparatus and method for attaching soft tissue to bone
US7229441B2 (en) * 2001-02-28 2007-06-12 Warsaw Orthopedic, Inc. Flexible systems for spinal stabilization and fixation
US7344539B2 (en) * 2001-03-30 2008-03-18 Depuy Acromed, Inc. Intervertebral connection system
US20020198527A1 (en) * 2001-06-21 2002-12-26 Helmut Muckter Implantable screw for stabilization of a joint or a bone fracture
GB0116247D0 (en) * 2001-07-04 2001-08-29 Univ Loughborough Surgical techniques and devices
US6736819B2 (en) * 2001-10-18 2004-05-18 Kishore Tipirneni System and method for fixation of bone fractures
US20100312292A1 (en) * 2001-10-18 2010-12-09 Orthoip, Llc Lagwire system and method for the fixation of bone fractures
US20090048606A1 (en) * 2001-10-18 2009-02-19 Fxdevices Llc Guide system and method for the fixation of bone fractures
US20090131990A1 (en) * 2001-10-18 2009-05-21 Kishore Tipirneni Bone screw system and method
US9060809B2 (en) * 2001-10-18 2015-06-23 Orthoip, Llc Lagwire system and method for the fixation of bone fractures
US20090254129A1 (en) * 2007-04-30 2009-10-08 Kishore Tipirneni Bone screw system and method for the fixation of bone fractures
US8828067B2 (en) 2001-10-18 2014-09-09 Orthoip, Llc Bone screw system and method
US20080243132A1 (en) * 2001-10-18 2008-10-02 Fx Devices, Llc Tensioning system and method for the fixation of bone fractures
US20090131991A1 (en) * 2001-10-18 2009-05-21 Kishore Tipirneni System and method for the fixation of bone fractures
US8679167B2 (en) * 2001-10-18 2014-03-25 Orthoip, Llc System and method for a cap used in the fixation of bone fractures
US8702768B2 (en) * 2001-10-18 2014-04-22 Orthoip, Llc Cannulated bone screw system and method
US20090306718A1 (en) * 2001-10-18 2009-12-10 Orthoip, Llc Filament and cap systems and methods for the fixation of bone fractures
US20090131936A1 (en) * 2001-10-18 2009-05-21 Kishore Tipirneni System and method for the fixation of bone fractures
US20080243191A1 (en) * 2001-10-18 2008-10-02 Fx Devices, Llc Adjustable bone plate fixation system and metho
US20060235408A1 (en) * 2001-11-09 2006-10-19 Wang Robert C Apparatus and methods for bone fracture fixation
US7235077B1 (en) * 2001-11-09 2007-06-26 Board Of Regents Of The University And Community College System Of Nevada On Behalf Of The University Of Nevada, Reno Bone fixation device and method
US6719765B2 (en) 2001-12-03 2004-04-13 Bonutti 2003 Trust-A Magnetic suturing system and method
US6974462B2 (en) * 2001-12-19 2005-12-13 Boston Scientific Scimed, Inc. Surgical anchor implantation device
US7048754B2 (en) 2002-03-01 2006-05-23 Evalve, Inc. Suture fasteners and methods of use
US9155544B2 (en) 2002-03-20 2015-10-13 P Tech, Llc Robotic systems and methods
US7867236B2 (en) * 2003-12-30 2011-01-11 Zimmer, Inc. Instruments and methods for preparing a joint articulation surface for an implant
US7922772B2 (en) * 2002-05-24 2011-04-12 Zimmer, Inc. Implants and related methods and apparatus for securing an implant on an articulating surface of an orthopedic joint
FR2843291B1 (en) * 2002-08-06 2005-06-03 Univ Aix Marseille Ii semi-automatic suture device of realization with the aid of surgical thread
DE50304843D1 (en) * 2003-02-12 2006-10-12 Zimmer Gmbh An apparatus for implant removal
US7833225B2 (en) * 2003-04-24 2010-11-16 Orthohelix Surgical Designs, Inc. Method and device for bone stabilization using a threaded compression wire
US7497864B2 (en) 2003-04-30 2009-03-03 Marctec, Llc. Tissue fastener and methods for using same
US7255700B2 (en) * 2003-06-18 2007-08-14 Biomet Sports Medicine, Inc. Device and method of fastening a graft to a bone
US20050101961A1 (en) * 2003-11-12 2005-05-12 Huebner Randall J. Bone screws
US20050125066A1 (en) * 2003-12-08 2005-06-09 Innovative Spinal Technologies Nucleus replacement securing device and method
US7771483B2 (en) * 2003-12-30 2010-08-10 Zimmer, Inc. Tibial condylar hemiplasty implants, anchor assemblies, and related methods
US8852195B2 (en) * 2004-07-09 2014-10-07 Zimmer, Inc. Guide templates for surgical implants and related methods
US7608092B1 (en) 2004-02-20 2009-10-27 Biomet Sports Medicince, LLC Method and apparatus for performing meniscus repair
EP1750592B1 (en) 2004-05-14 2016-12-28 Evalve, Inc. Locking mechanisms for fixation devices
WO2005112833A1 (en) * 2004-05-20 2005-12-01 Pearsalls Limited Improvements in and relating to surgical implants
US8052592B2 (en) 2005-09-27 2011-11-08 Evalve, Inc. Methods and devices for tissue grasping and assessment
US8137382B2 (en) 2004-11-05 2012-03-20 Biomet Sports Medicine, Llc Method and apparatus for coupling anatomical features
US8672969B2 (en) 2006-09-29 2014-03-18 Biomet Sports Medicine, Llc Fracture fixation device
US8652171B2 (en) 2006-02-03 2014-02-18 Biomet Sports Medicine, Llc Method and apparatus for soft tissue fixation
US9271713B2 (en) 2006-02-03 2016-03-01 Biomet Sports Medicine, Llc Method and apparatus for tensioning a suture
US8500818B2 (en) 2006-09-29 2013-08-06 Biomet Manufacturing, Llc Knee prosthesis assembly with ligament link
US8562647B2 (en) 2006-09-29 2013-10-22 Biomet Sports Medicine, Llc Method and apparatus for securing soft tissue to bone
US8128658B2 (en) 2004-11-05 2012-03-06 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to bone
US8303604B2 (en) 2004-11-05 2012-11-06 Biomet Sports Medicine, Llc Soft tissue repair device and method
US8298262B2 (en) 2006-02-03 2012-10-30 Biomet Sports Medicine, Llc Method for tissue fixation
US8801783B2 (en) 2006-09-29 2014-08-12 Biomet Sports Medicine, Llc Prosthetic ligament system for knee joint
US8088130B2 (en) 2006-02-03 2012-01-03 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US8968364B2 (en) * 2006-02-03 2015-03-03 Biomet Sports Medicine, Llc Method and apparatus for fixation of an ACL graft
US8118836B2 (en) 2004-11-05 2012-02-21 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US8574235B2 (en) 2006-02-03 2013-11-05 Biomet Sports Medicine, Llc Method for trochanteric reattachment
US9408599B2 (en) 2006-02-03 2016-08-09 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US8652172B2 (en) 2006-02-03 2014-02-18 Biomet Sports Medicine, Llc Flexible anchors for tissue fixation
US8597327B2 (en) 2006-02-03 2013-12-03 Biomet Manufacturing, Llc Method and apparatus for sternal closure
US8936621B2 (en) 2006-02-03 2015-01-20 Biomet Sports Medicine, Llc Method and apparatus for forming a self-locking adjustable loop
US9538998B2 (en) * 2006-02-03 2017-01-10 Biomet Sports Medicine, Llc Method and apparatus for fracture fixation
US8361113B2 (en) 2006-02-03 2013-01-29 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US20060190042A1 (en) * 2004-11-05 2006-08-24 Arthrotek, Inc. Tissue repair assembly
US9149267B2 (en) 2006-02-03 2015-10-06 Biomet Sports Medicine, Llc Method and apparatus for coupling soft tissue to a bone
US9078644B2 (en) 2006-09-29 2015-07-14 Biomet Sports Medicine, Llc Fracture fixation device
US8562645B2 (en) 2006-09-29 2013-10-22 Biomet Sports Medicine, Llc Method and apparatus for forming a self-locking adjustable loop
US7905904B2 (en) 2006-02-03 2011-03-15 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US8998949B2 (en) 2004-11-09 2015-04-07 Biomet Sports Medicine, Llc Soft tissue conduit device
US7857830B2 (en) 2006-02-03 2010-12-28 Biomet Sports Medicine, Llc Soft tissue repair and conduit device
US8034090B2 (en) 2004-11-09 2011-10-11 Biomet Sports Medicine, Llc Tissue fixation device
US7909851B2 (en) 2006-02-03 2011-03-22 Biomet Sports Medicine, Llc Soft tissue repair device and associated methods
US8251998B2 (en) 2006-08-16 2012-08-28 Biomet Sports Medicine, Llc Chondral defect repair
US7914539B2 (en) 2004-11-09 2011-03-29 Biomet Sports Medicine, Llc Tissue fixation device
US20060189993A1 (en) 2004-11-09 2006-08-24 Arthrotek, Inc. Soft tissue conduit device
WO2011034628A1 (en) * 2005-02-07 2011-03-24 Evalve, Inc. Methods, systems and devices for cardiac valve repair
CA2597066C (en) * 2005-02-07 2014-04-15 Evalve, Inc. Methods, systems and devices for cardiac valve repair
US20060200127A1 (en) * 2005-02-23 2006-09-07 Ismail Wardak M Method and apparatus for external fixation of bone fractures
US20090187216A1 (en) * 2006-05-18 2009-07-23 Arthrex, Inc. Fenestrated swivel anchor for knotless fixation of tissue
US7951198B2 (en) * 2005-05-10 2011-05-31 Acumed Llc Bone connector with pivotable joint
WO2006133130A3 (en) * 2005-06-03 2007-04-19 Alan Rory Mcleod Fibrous spinal implant and method of implantation
EP1909687A1 (en) * 2005-07-13 2008-04-16 Boston Scientific Scimed, Inc. Snap fit sling anchor system and related methods
US20070233145A1 (en) * 2005-08-18 2007-10-04 Biocomposites Ltd. Tensegrity osteotomy system
US7905903B2 (en) 2006-02-03 2011-03-15 Biomet Sports Medicine, Llc Method for tissue fixation
US9370350B2 (en) 2011-11-10 2016-06-21 Biomet Sports Medicine, Llc Apparatus for coupling soft tissue to a bone
US9357992B2 (en) 2011-11-10 2016-06-07 Biomet Sports Medicine, Llc Method for coupling soft tissue to a bone
US9381013B2 (en) 2011-11-10 2016-07-05 Biomet Sports Medicine, Llc Method for coupling soft tissue to a bone
US9357991B2 (en) 2011-11-03 2016-06-07 Biomet Sports Medicine, Llc Method and apparatus for stitching tendons
US7749250B2 (en) 2006-02-03 2010-07-06 Biomet Sports Medicine, Llc Soft tissue repair assembly and associated method
US7959650B2 (en) 2006-09-29 2011-06-14 Biomet Sports Medicine, Llc Adjustable knotless loops
US7837717B2 (en) * 2006-03-24 2010-11-23 Depuy Products, Inc. Fastening system for internal fixation
JP5389337B2 (en) * 2006-05-18 2014-01-15 オーソレクス,インコーポレイテッド Sweeper Bell anchor for knotless fixation of tissue
US8202295B2 (en) 2006-07-20 2012-06-19 Kaplan Lee D Surgical instruments
WO2008011417A3 (en) * 2006-07-20 2008-11-20 Lee D Kaplan Surgical instruments
US9750492B2 (en) * 2006-08-04 2017-09-05 Depuy Mitek, Llc Suture anchor system with tension relief mechanism
US9788825B2 (en) 2006-08-04 2017-10-17 Depuy Mitek, Llc Suture anchor with relief mechanism
US8506636B2 (en) 2006-09-08 2013-08-13 Theken Spine, Llc Offset radius lordosis
US8074591B2 (en) * 2006-09-25 2011-12-13 Nuvasive, Inc. Embroidery using soluble thread
US7658751B2 (en) 2006-09-29 2010-02-09 Biomet Sports Medicine, Llc Method for implanting soft tissue
US7955388B2 (en) * 2006-11-01 2011-06-07 Acumed Llc Orthopedic connector system
US7942104B2 (en) * 2007-01-22 2011-05-17 Nuvasive, Inc. 3-dimensional embroidery structures via tension shaping
US7946236B2 (en) * 2007-01-31 2011-05-24 Nuvasive, Inc. Using zigzags to create three-dimensional embroidered structures
WO2008098125A3 (en) * 2007-02-08 2008-11-06 Alan Mcleod Medical implants with pre-settled cores and related methods
US8500739B2 (en) * 2007-04-06 2013-08-06 DePuy Synthes Products, LLC Securing device to secure fixation devices to bone portions
US9017381B2 (en) 2007-04-10 2015-04-28 Biomet Sports Medicine, Llc Adjustable knotless loops
US20100131069A1 (en) * 2007-08-01 2010-05-27 Jeffrey Halbrecht Method and system for patella tendon realignment
EP2178468B1 (en) 2007-08-01 2016-06-22 Jeffrey Halbrecht System for patella tendon realignment
JP5341901B2 (en) 2007-10-25 2013-11-13 スミス アンド ネフュー インコーポレーテッドSmith & Nephew,Inc. Anchor assembly
US8591584B2 (en) * 2007-11-19 2013-11-26 Nuvasive, Inc. Textile-based plate implant and related methods
CN104224292B (en) 2007-12-17 2017-04-12 新特斯有限责任公司 Dynamic bone fixation element and a method of use of the element
WO2009129272A3 (en) * 2008-04-15 2009-12-23 Lonnie Paulos Tissue microfracture apparatus and methods of use
CN102098969B (en) 2008-07-17 2013-07-17 史密夫和内修有限公司 Surgical devices
US20150127047A1 (en) * 2008-10-23 2015-05-07 CMC Group LLC Sling suspension system for supporting the thumb of a patient after basal joint arthroplasty
US20100106254A1 (en) 2008-10-23 2010-04-29 Delsignore Jeanne L Surgical implantable stabilizer sling for basal joint arthroplasty
WO2010054493A9 (en) * 2008-11-14 2010-07-15 Axus Medical Suisse Gmbh Intramedullary apparatus for arthrodesis or osteosynthesis
US8870876B2 (en) 2009-02-13 2014-10-28 Tarsus Medical Inc. Methods and devices for treating hallux valgus
US9808236B2 (en) * 2009-04-17 2017-11-07 Advanced Bone Anchor, Llc Internal joint bracing system and suture anchoring assembly therefore
US8961576B2 (en) * 2010-04-18 2015-02-24 Advanced Bone Anchor, Llc Internal joint bracing system and suture anchoring assembly therefore
US20100305710A1 (en) 2009-05-28 2010-12-02 Biomet Manufacturing Corp. Knee Prosthesis
US9050078B2 (en) * 2009-06-21 2015-06-09 Aesthetics Point Ltd. Implanted medical device useful for cosmetic surgery
US20110004242A1 (en) * 2009-07-01 2011-01-06 Stchur Robert P Knotless suture fixation device and method
US8652183B1 (en) 2009-07-07 2014-02-18 Mari S Truman Multi-angle orthopedic expansion head fastener
US9278004B2 (en) 2009-08-27 2016-03-08 Cotera, Inc. Method and apparatus for altering biomechanics of the articular joints
US9861408B2 (en) 2009-08-27 2018-01-09 The Foundry, Llc Method and apparatus for treating canine cruciate ligament disease
ES2477581T3 (en) 2009-08-27 2014-07-17 Cotera, Inc. Apparatus for the redistribution of forces in joint unions
US9668868B2 (en) 2009-08-27 2017-06-06 Cotera, Inc. Apparatus and methods for treatment of patellofemoral conditions
EP3042615A1 (en) 2009-09-15 2016-07-13 Evalve, Inc. Methods, systems and devices for cardiac valve repair
US8277459B2 (en) 2009-09-25 2012-10-02 Tarsus Medical Inc. Methods and devices for treating a structural bone and joint deformity
US8652141B2 (en) * 2010-01-21 2014-02-18 Tarsus Medical Inc. Methods and devices for treating hallux valgus
US8696719B2 (en) 2010-06-03 2014-04-15 Tarsus Medical Inc. Methods and devices for treating hallux valgus
US9023088B2 (en) * 2010-09-08 2015-05-05 DePuy Synthes Products, Inc. Fixation device with magnesium core
US8562651B2 (en) * 2011-03-30 2013-10-22 Warsaw Orthopedic, Inc. Sacroiliac terminal anchor device and method
US8771352B2 (en) 2011-05-17 2014-07-08 Biomet Sports Medicine, Llc Method and apparatus for tibial fixation of an ACL graft
US9283019B2 (en) * 2011-06-08 2016-03-15 Warsaw Orthopedic, Inc. Flexible guide wire
US8506597B2 (en) 2011-10-25 2013-08-13 Biomet Sports Medicine, Llc Method and apparatus for interosseous membrane reconstruction
CN104203132B (en) 2011-11-14 2017-08-01 不列颠哥伦比亚大学 Intramedullary fixation system for a fracture of the pelvis acetabulum and treatment
EP3135233A1 (en) 2011-12-14 2017-03-01 DePuy Synthes Products, LLC Device for compression across fractures
US9259217B2 (en) 2012-01-03 2016-02-16 Biomet Manufacturing, Llc Suture Button
EP2822483B1 (en) 2012-03-09 2015-09-16 George J. Sikora Microfracture apparatuses
KR20140143791A (en) 2012-03-13 2014-12-17 신세스 게엠바하 Dynamic bone fixation element
US9468466B1 (en) 2012-08-24 2016-10-18 Cotera, Inc. Method and apparatus for altering biomechanics of the spine
US9757119B2 (en) 2013-03-08 2017-09-12 Biomet Sports Medicine, Llc Visual aid for identifying suture limbs arthroscopically
CA2949060A1 (en) 2014-05-12 2015-11-19 DePuy Synthes Products, Inc. Sacral fixation system
US9615822B2 (en) 2014-05-30 2017-04-11 Biomet Sports Medicine, Llc Insertion tools and method for soft anchor
US9700291B2 (en) 2014-06-03 2017-07-11 Biomet Sports Medicine, Llc Capsule retractor

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2143922A (en) * 1936-09-16 1939-01-17 Harry Herschel Leiter Bone surgery appliance
US5306290A (en) * 1993-02-12 1994-04-26 Mitek Surgical Products, Inc. Suture button
US5611801A (en) * 1994-11-29 1997-03-18 Pioneer Laboratories, Inc. Method and apparatus for bone fracture fixation
US6068648A (en) * 1998-01-26 2000-05-30 Orthodyne, Inc. Tissue anchoring system and method

Family Cites Families (41)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US887074A (en) 1907-05-11 1908-05-12 Antoine Depage Surgical screw-bolt.
US2501978A (en) 1947-04-26 1950-03-28 Wichman Heins Bone splint
US3477429A (en) 1967-06-30 1969-11-11 Sampson Corp Extra-cortical clamp with detachable tensioning tool for internal fixation of bone fractures
DE1958429A1 (en) 1969-11-21 1971-07-22 Johannes Dr Gaeckel Tensioning device for medical purposes
US3709218A (en) 1970-04-24 1973-01-09 W Halloran Combination intramedullary fixation and external bone compression apparatus
GB1519139A (en) 1974-06-18 1978-07-26 Crock H V And Pericic L L securing elongate members to structurs more especially in surgical procedures
GB1551706A (en) 1975-04-28 1979-08-30 Downs Surgical Ltd Surgical implant
GB1551707A (en) 1975-04-28 1979-08-30 Downs Surgical Ltd Surgical instrument
GB1551704A (en) 1975-04-28 1979-08-30 Downs Surgical Ltd Surgical implant
US4120298A (en) 1976-12-06 1978-10-17 Fixel Irving E Implant to secure the greater trochanter
US4146022A (en) 1977-11-16 1979-03-27 Ronald A. Johnson Fracture fixation by cerclage utilizing cortical bone tack and pull-out tension device
US4492226A (en) 1979-10-10 1985-01-08 Vsesojuzny Nauchno-Issledovatelsky I Ispytatelny Institut Meditsinskoi Tekhniki Device for uniting bone fragments
DE3319149C1 (en) 1983-05-26 1984-12-13 Karl Leibinger Arrangement for the mutual positional fixing of bone parts and tool for attaching this arrangement
EP0245287A1 (en) 1985-11-05 1987-11-19 Intreprinderea Industria Technico-Medicala Flexible implants for stable flexible osteosynthesis of fractures of femur and tibia, respectively and working instrumentation
US4708132A (en) 1986-01-24 1987-11-24 Pfizer-Hospital Products Group, Inc. Fixation device for a ligament or tendon prosthesis
US4790303A (en) 1987-03-11 1988-12-13 Acromed Corporation Apparatus and method for securing bone graft
FR2614781B1 (en) 1987-05-05 1989-08-04 Galline Yves Attachment device and tools for its installation, in particular for securing the trochanter at femur
DE3722538A1 (en) 1987-07-08 1989-01-19 Wasserstein Isidor Device for fixation of bone segments
US5116340A (en) 1989-01-26 1992-05-26 Songer Robert J Surgical securance apparatus
US4976740A (en) 1989-07-14 1990-12-11 Kleiner Jeffrey B Anchored femoral dome
US4976712A (en) 1990-03-30 1990-12-11 Vanderslik Julius Retaining sleeve for surgical pin
US5108397A (en) 1990-04-19 1992-04-28 Joseph White Method and apparatus for stabilization of pelvic fractures
US5562668A (en) 1990-07-31 1996-10-08 Johnson; David P. Tension device for anchoring ligament grafts
US5201733A (en) 1992-01-21 1993-04-13 Etheredge Iii James L Method and apparatus for internal fixation of fractures
US5156616A (en) 1992-02-10 1992-10-20 Meadows Bruce F Apparatus and method for suture attachment
FR2692774B1 (en) * 1992-06-25 1999-05-21 Bfl Medical Sarl Material used for the repair of ruptured Achilles tendon.
US5312410A (en) 1992-12-07 1994-05-17 Danek Medical, Inc. Surgical cable tensioner
US5324291A (en) 1992-12-21 1994-06-28 Smith & Nephew Richards, Inc. Bone section reattachment apparatus and method
US5449361A (en) 1993-04-21 1995-09-12 Amei Technologies Inc. Orthopedic cable tensioner
US5395374A (en) 1993-09-02 1995-03-07 Danek Medical, Inc. Orthopedic cabling method and apparatus
US5423850A (en) 1993-10-01 1995-06-13 Berger; J. Lee Balloon compressor for internal fixation of bone fractures
US5454812A (en) 1993-11-12 1995-10-03 Lin; Chih-I Spinal clamping device having multiple distance adjusting strands
US5536270A (en) 1994-02-24 1996-07-16 Pioneer Laboratories, Inc. Cable system for bone securance
US5788697A (en) * 1994-02-24 1998-08-04 Pioneer Laboratories, Inc. Cable tensioning device
US5569253A (en) * 1994-03-29 1996-10-29 Danek Medical, Inc. Variable-angle surgical cable crimp assembly and method
US5474554A (en) 1994-07-27 1995-12-12 Ku; Ming-Chou Method for fixation of avulsion fracture
US5571139A (en) 1995-05-19 1996-11-05 Jenkins, Jr.; Joseph R. Bidirectional suture anchor
US5569306A (en) * 1995-06-06 1996-10-29 Thal; Raymond Knotless suture anchor assembly
FR2737104B1 (en) * 1995-07-28 1997-09-19 Groupe Lepine Device for holding bone parts after osteotomy or bone fracture reduction and maintaining fractured bone parts, once these MET
GB9619787D0 (en) 1996-09-20 1996-11-06 Surgicarft Ltd Surgical fixation system
US5921986A (en) * 1998-02-06 1999-07-13 Bonutti; Peter M. Bone suture

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2143922A (en) * 1936-09-16 1939-01-17 Harry Herschel Leiter Bone surgery appliance
US5306290A (en) * 1993-02-12 1994-04-26 Mitek Surgical Products, Inc. Suture button
US5611801A (en) * 1994-11-29 1997-03-18 Pioneer Laboratories, Inc. Method and apparatus for bone fracture fixation
US6068648A (en) * 1998-01-26 2000-05-30 Orthodyne, Inc. Tissue anchoring system and method

Cited By (82)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8588365B2 (en) 2000-08-29 2013-11-19 Imatx, Inc. Calibration devices and methods of use thereof
US8649481B2 (en) 2000-08-29 2014-02-11 Imatx, Inc. Methods and devices for quantitative analysis of X-ray images
US8639009B2 (en) 2000-10-11 2014-01-28 Imatx, Inc. Methods and devices for evaluating and treating a bone condition based on x-ray image analysis
US9767551B2 (en) 2000-10-11 2017-09-19 Imatx, Inc. Methods and devices for analysis of x-ray images
US9275469B2 (en) 2000-10-11 2016-03-01 Imatx, Inc. Methods and devices for evaluating and treating a bone condition on x-ray image analysis
US8913818B2 (en) 2000-10-11 2014-12-16 Imatx, Inc. Methods and devices for evaluating and treating a bone condition based on X-ray image analysis
US9267955B2 (en) 2001-05-25 2016-02-23 Imatx, Inc. Methods to diagnose treat and prevent bone loss
US7338490B2 (en) 2002-05-21 2008-03-04 Warsaw Orthopedic, Inc. Reduction cable and bone anchor
US8818484B2 (en) * 2002-09-16 2014-08-26 Imatx, Inc. Methods of predicting musculoskeletal disease
US20140355852A1 (en) * 2002-09-16 2014-12-04 Imatx, Inc. Methods of Predicting Musculoskeletal Disease
US20110105885A1 (en) * 2002-09-16 2011-05-05 Imatx, Inc. Methods of Predicting Musculoskeletal Disease
US9460506B2 (en) 2002-09-16 2016-10-04 Imatx, Inc. System and method for predicting future fractures
US8965075B2 (en) 2002-09-16 2015-02-24 Imatx, Inc. System and method for predicting future fractures
US20110040168A1 (en) * 2002-09-16 2011-02-17 Conformis Imatx, Inc. System and Method for Predicting Future Fractures
US8781191B2 (en) 2003-03-25 2014-07-15 Imatx, Inc. Methods for the compensation of imaging technique in the processing of radiographic images
US9155501B2 (en) 2003-03-25 2015-10-13 Imatx, Inc. Methods for the compensation of imaging technique in the processing of radiographic images
US20080058613A1 (en) * 2003-09-19 2008-03-06 Imaging Therapeutics, Inc. Method and System for Providing Fracture/No Fracture Classification
US20070073293A1 (en) * 2003-10-16 2007-03-29 Martz Erik O System and method for flexible correction of bony motion segment
US8600124B2 (en) 2004-09-16 2013-12-03 Imatx, Inc. System and method of predicting future fractures
US8965087B2 (en) 2004-09-16 2015-02-24 Imatx, Inc. System and method of predicting future fractures
US8096303B2 (en) * 2005-02-08 2012-01-17 Koninklijke Philips Electronics N.V Airway implants and methods and devices for insertion and retrieval
US20080023012A1 (en) * 2005-02-08 2008-01-31 Aspire Medical, Inc. Glossopexy adjustment system and method
US9408742B2 (en) * 2005-02-08 2016-08-09 Koninklijke Philips N.V. Glossopexy adjustment system and method
US8371307B2 (en) 2005-02-08 2013-02-12 Koninklijke Philips Electronics N.V. Methods and devices for the treatment of airway obstruction, sleep apnea and snoring
US8757163B2 (en) 2005-02-08 2014-06-24 Koninklijke Philips N.V. Airway implants and methods and devices for insertion and retrieval
US20080066769A1 (en) * 2005-02-08 2008-03-20 Aspire Medical, Inc. Airway implants and methods and devices for insertion and retrieval
US8167890B2 (en) 2005-02-17 2012-05-01 Kyphon Sarl Percutaneous spinal implants and methods
US8096995B2 (en) 2005-02-17 2012-01-17 Kyphon Sarl Percutaneous spinal implants and methods
US8096994B2 (en) 2005-02-17 2012-01-17 Kyphon Sarl Percutaneous spinal implants and methods
US7942875B2 (en) 2005-05-18 2011-05-17 Sonoma Orthopedic Products, Inc. Methods of using minimally invasive actuable bone fixation devices
US7846162B2 (en) 2005-05-18 2010-12-07 Sonoma Orthopedic Products, Inc. Minimally invasive actuable bone fixation devices
US8287541B2 (en) 2005-05-18 2012-10-16 Sonoma Orthopedic Products, Inc. Fracture fixation device, tools and methods
US9060820B2 (en) 2005-05-18 2015-06-23 Sonoma Orthopedic Products, Inc. Segmented intramedullary fracture fixation devices and methods
US8961516B2 (en) 2005-05-18 2015-02-24 Sonoma Orthopedic Products, Inc. Straight intramedullary fracture fixation devices and methods
US7914533B2 (en) 2005-05-18 2011-03-29 Sonoma Orthopedic Products, Inc. Minimally invasive actuable bone fixation devices
US8287539B2 (en) 2005-05-18 2012-10-16 Sonoma Orthopedic Products, Inc. Fracture fixation device, tools and methods
US20060265003A1 (en) * 2005-05-23 2006-11-23 Custom Spine, Inc. Spinal rod inserter
US8182509B2 (en) 2005-05-23 2012-05-22 Custom Spine, Inc. Spinal rod insertion method
US7871424B2 (en) * 2005-05-23 2011-01-18 Custom Spine, Inc. Spinal rod inserter
US20110071571A1 (en) * 2005-05-23 2011-03-24 Custom Spine, Inc Spinal Rod Insertion Method
US20070144539A1 (en) * 2005-11-09 2007-06-28 Van Der Burg Erik Glossoplasty using tissue anchor glossopexy with volumetric tongue reduction
US8186355B2 (en) * 2005-11-09 2012-05-29 Koninklijke Philips Electronics N.V. Glossoplasty using tissue anchor glossopexy with volumetric tongue reduction
US9393067B2 (en) 2005-11-09 2016-07-19 Koninklijke Philips N.V. Glassoplasty using tissue anchor glossopexy with volumetric tongue reduction
US20070225736A1 (en) * 2006-03-23 2007-09-27 Ethicon Endo-Surgery, Inc. Suture Tensioning Device
US8758405B2 (en) * 2006-03-23 2014-06-24 Ethicon Endo-Surgery, Inc Suture tensioning device
US8105357B2 (en) 2006-04-28 2012-01-31 Warsaw Orthopedic, Inc. Interspinous process brace
US9155574B2 (en) 2006-05-17 2015-10-13 Sonoma Orthopedic Products, Inc. Bone fixation device, tools and methods
US20080077154A1 (en) * 2006-09-21 2008-03-27 Edwards Scott G System and method of bone compression and fixation
US8317795B2 (en) 2006-09-21 2012-11-27 Scott G. Edwards System and method of bone compression and fixation
US8133225B2 (en) * 2006-11-21 2012-03-13 Oliver Pieske Implant for long bones and treatment method
US20090287213A1 (en) * 2006-11-21 2009-11-19 Oliver Pieske Implant for long bones and treatment method
US7909825B2 (en) 2006-11-22 2011-03-22 Sonoma Orthepedic Products, Inc. Fracture fixation device, tools and methods
US9259250B2 (en) 2006-11-22 2016-02-16 Sonoma Orthopedic Products, Inc. Fracture fixation device, tools and methods
WO2008064346A2 (en) * 2006-11-22 2008-05-29 Sonoma Orthopedic Products, Inc. Fracture fixation device, tools and methods
US8439917B2 (en) 2006-11-22 2013-05-14 Sonoma Orthopedic Products, Inc. Fracture fixation device, tools and methods
WO2008064346A3 (en) * 2006-11-22 2008-12-11 Sonoma Orthopedic Products Inc Fracture fixation device, tools and methods
US8430879B2 (en) * 2007-03-22 2013-04-30 Sonoma Orthopedic Products, Inc. Segmented intramedullary structure
US8496658B2 (en) 2007-03-22 2013-07-30 Sonoma Orthopedic Products, Inc. Segmented intramedullary structure
US20080287951A1 (en) * 2007-03-22 2008-11-20 Stoneburner James D Segmented intramedullary structure
US8282674B2 (en) 2008-07-18 2012-10-09 Suspension Orthopaedic Solutions, Inc. Clavicle fixation
US20100016899A1 (en) * 2008-07-18 2010-01-21 Jeffrey Gelfand Clavicle fixation
US9149312B2 (en) 2008-07-18 2015-10-06 Suspension Othopaedic Solutions Clavicle fixation
WO2010062379A1 (en) * 2008-11-25 2010-06-03 Sonoma Orthopedic Products, Inc. Bone fracture fixation screws, systems and methods of use
US20110087227A1 (en) * 2008-12-18 2011-04-14 Mazur Kal U Bone fixation device, tools and methods
US8568413B2 (en) 2008-12-18 2013-10-29 Sonoma Orthopedic Products, Inc. Bone fixation device, tools and methods
US8114135B2 (en) * 2009-01-16 2012-02-14 Kyphon Sarl Adjustable surgical cables and methods for treating spinal stenosis
US8939917B2 (en) 2009-02-13 2015-01-27 Imatx, Inc. Methods and devices for quantitative analysis of bone and cartilage
US9603642B2 (en) 2009-06-30 2017-03-28 The Penn State Research Foundation Bone repair system and method
US8728133B2 (en) 2009-06-30 2014-05-20 The Penn State Research Foundation Bone repair system and method
US20100331892A1 (en) * 2009-06-30 2010-12-30 Fell Barry M Bone repair system and method
US9011507B2 (en) 2009-10-28 2015-04-21 Orthopro Llc Compression plate kit and methods for repairing bone discontinuities
WO2011053520A1 (en) * 2009-10-28 2011-05-05 Orthopro Llc Compression plate kit and methods for repairing bone discontinuities
US8162996B2 (en) 2009-10-28 2012-04-24 Orthopro Llc Methods for repairing bone discontinuities
US20110098757A1 (en) * 2009-10-28 2011-04-28 Craig Schelling Compression plate kit and methods for repairing bone discontinuities
US8840617B2 (en) 2010-02-26 2014-09-23 Warsaw Orthopedic, Inc. Interspinous process spacer diagnostic parallel balloon catheter and methods of use
US20120172936A1 (en) * 2010-12-29 2012-07-05 Tarsus Medical Inc. Methods and devices for treating a syndesmosis injury
US9138219B2 (en) * 2010-12-29 2015-09-22 Tarsus Medical Inc. Methods and devices for treating a syndesmosis injury
US9161745B2 (en) 2011-10-05 2015-10-20 Mark A. Dodson Modular retractor and related method
US20130110173A1 (en) * 2011-10-28 2013-05-02 Warsaw Orthopedic, Inc. Attachment mechanism for material and bone
US9737294B2 (en) 2013-01-28 2017-08-22 Cartiva, Inc. Method and system for orthopedic repair
US9770278B2 (en) 2014-01-17 2017-09-26 Arthrex, Inc. Dual tip guide wire
US9814499B2 (en) 2014-09-30 2017-11-14 Arthrex, Inc. Intramedullary fracture fixation devices and methods

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EP1117338A1 (en) 2001-07-25 application

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