Apparatus and methods for securing a bone implant

Description

FIELD OF TECHNOLOGY

Aspects of the disclosure relate to providing apparatus and methods for securing an implant deployed in a bone. In particular, the disclosure relates to apparatus and methods for repairing bone fractures utilizing a device that is inserted into a bone and secured to the bone.

BACKGROUND

The human body includes long, short, flat, irregular and sesamoid bone. A long bone is characterized by a midshaft. The midshaft of a long bone is typically classified as the diaphysis. The end of such a bone is typically classified as the epiphysis. Bone that is transitional between the midshaft and the end is typically classified as the metaphysis.

Multi-segment fractures, of either the midshaft or end-bone, require alignment and stability in a manner that generates adequate fixation in multiple directions.

However, midshaft fractures and end-bone fractures are fundamentally different. The loading conditions, fracture patterns, alignment needed, and compression force to promote healing are different. Midshaft fractures have ample bone material on either side of the fracture in which anchors may be driven. End-bone fractures, especially on the articular surface may have thin cortical bone, soft cancellous bone, and minimal anchoring locations.

Midshaft fractures tend to be loaded primarily in bending and torsion. End-bone fractures tend to be loaded in complex and multi-directional stress patterns. Midshaft repair approaches, therefore, may not be appropriate for repair of end-bone fractures.

There are two primary categories for surgical fixation of a long bone fracture: (1) a device that is within the skin (internal fixation); and (2) a device that extends out of the skin (external fixation). There are two common types of internal fixation approaches for long bone surgery (a) a plate that is screwed to the outside of the bone; or (b) a rod that goes down the center of the bone.

Intramedullary rods, nails or implants, are more effective than plates and screws at minimizing soft-tissue trauma and complications. Moreover, appropriate sizing of an implant helps realignment and healing of the fracture. Proper sizing of an implant may ensure proper matching of the implant device to a patient's anatomy.

An implant deployed in an intramedullary cavity of a bone may be expandable. An expandable implant may provide proper anatomic alignment and allow appropriate sizing of the implant. However, bone fractures require alignment and stability in a manner that generates adequate fixation in multiple directions.

It would be desirable, therefore, to provide apparatus and methods for securing an implant deployed inside a bone.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 2 shows illustrative anatomy in connection with which the invention may be practiced;

FIG. 3 shows another illustrative apparatus along with illustrative anatomy in accordance with principles of the invention;

FIG. 4 shows a cross sectional view taken along lines 4-4 of the apparatus shown in FIG. 3;

FIG. 5 shows a partial sectional view of the apparatus shown in FIG. 3;

FIG. 6 shows a portion of the apparatus shown in FIG. 5;

FIG. 7A shows a sectional view of an apparatus in accordance with the principles of the invention;

FIG. 7B shows a cross section of the apparatus shown in FIG. 5;

FIG. 7C shows a cross section of the apparatus shown in FIG. 5 in a state that is different from the state shown in FIG. 7B;

FIG. 8 shows a perspective view of the apparatus shown in FIG. 1 in a view different than the view shown in FIG. 1;

FIG. 9 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 10 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 11A shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 11B shows a sectional view of the apparatus shown in FIG. 11 in a view different than the view shown in FIG. 11;

FIG. 12 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 13 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 14 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 15 shows a cross section of the apparatus shown in FIG. 14;

FIG. 16 shows information that may be used to manufacture apparatus shown in FIG. 15;

FIG. 17 shows another perspective view of the apparatus shown in FIG. 3;

FIG. 18 shows a sectional view of the apparatus shown in FIG. 17;

FIG. 19 shows a cross section of the apparatus shown in FIG. 17;

FIG. 20 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 21 shows information that may be used to manufacture apparatus in accordance with principles of the invention;

FIG. 22 shows information that may be used to manufacture apparatus in accordance with principles of the invention;

FIG. 23A shows information that may be used to manufacture apparatus in accordance with principles of the invention;

FIG. 23B shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 24A shows information that may be used to manufacture apparatus in accordance with principles of the invention;

FIG. 24B shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 25 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 26 shows a front view of the apparatus shown in FIG. 25;

FIG. 27 shows information that may be used to manufacture apparatus in accordance with principles of the invention;

FIG. 28 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 29 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 30 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 31A shows information that may be used to manufacture apparatus in accordance with principles of the invention;

FIG. 31B shows information that may be used to manufacture apparatus in accordance with principles of the invention;

FIG. 32 shows a side view of an illustrative apparatus in accordance with principles of the invention;

FIG. 33 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 34 shows an end view of the apparatus shown in FIG. 33;

FIG. 35 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 36 shows an end view of the apparatus shown in FIG. 35;

FIG. 37 shows a perspective view of the apparatus shown in FIG. 35 along with illustrative anatomy;

FIG. 38 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 39 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 40 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;

FIG. 41 shows a cross section of a portion of the apparatus shown in FIG. 40;

FIGS. 42(A)-(C) show a side view of illustrative apparatus in accordance with principles of the invention;

FIG. 43 shows a front view of an illustrative human Skeleton;

FIG. 44 shows a partial sectional view of a fractured bone;

FIG. 45 shows a perspective view of an illustrative apparatus for preparing illustrative anatomy for an apparatus in accordance with principles of the invention.

DETAILED DESCRIPTION

Apparatus and methods for securing an implant for a bone are provided. An implant may be secured to a bone to repair a fracture in the bone. The implant may be an expandable implant. The implant may be a non-expandable implant. The implant may be any suitable implant. For example, the implant may be an implant such as an implant that is shown and described in U.S. Patent Application Publication No. 2009/0182336 A1, which is hereby incorporated by reference in its entirety.

The bone may be accessed and prepared using any suitable technique such as that shown and described in U.S. patent application Ser. No. 13/009,657, which is hereby incorporated by reference in its entirety.

Copending U.S. patent application Ser. No. 13/043,330, entitled “APPARATUS AND METHODS FOR BONE REPAIR,” filed on Mar. 8, 2011 is hereby incorporated by reference herein in its entirety. Copending U.S. Provisional Application No. 61/450,112 filed on Mar. 7, 2011, is hereby incorporated by reference herein in its entirety.

The apparatus and methods may involve fixing an expandable implant deployed inside a fractured bone. The apparatus and methods may involve the expansion of devices in the interior region of the bone. The expansion may involve any suitable expansion mechanism or technique, such as one or more of the mechanisms and techniques that are shown and described in U.S. Patent Application Publication No. 2009/0182336 A1.

The implant may have a first base and a second base. The implant may have a bone implant component that extends between the first base and the second base. The first base and the second base may define a longitudinal axis. The bone implant component may deflect relative to the longitudinal axis in correspondence with relative displacement of the first base and the second base along the axis.

The apparatus may include: a first body that is substantially coaxial with the axis and longitudinally fixed to the first base; a second body that is substantially coaxial with the axis and longitudinally fixed to the second base; and an elongated engaging member that is configured to longitudinally fix a distance between the first body and the second body.

The distance may have a maximum value that corresponds to a fully collapsed state of the implant. The distance may have a minimum value that corresponds to a fully expanded state of the implant. The elongated engaging member may be configured to longitudinally fix the distance at any value in the range from about the maximum value to about the minimum value.

The fully collapsed state may correspond to a state in which the implant is configured to pass through an access hole in the bone. The fully expanded state may correspond to a state in which the implant is expanded outside the bone at standard temperature and pressure. Standard temperature and pressure may be any standard temperature and any standard pressure, such as about 0 degrees Centigrade and about 1 atmosphere of pressure.

The distance may control the expansion of the implant by controlling the length of the implant. The distance may correspond to a therapeutic length of the bone implant. The distance may correspond to a therapeutic radius of the bone implant.

The elongated member may be of unified construction, and of all the structures that may be configured to operate in conjunction with the implant, the elongated engaging member alone may be configured to fix the distance.

The distance may correspond to an expansion state of the bone implant. In an expanded state, the implant may provide structural support for a bone. The implant may be locked in a state of expansion. The implant may be fixed in a state of expansion. The implant may be locked or fixed in a state of expansion such that residual outward radial pressure on an inside wall of the bone may be substantially reduced or eliminated.

In a contracted state, the implant may provide structural support for the bone. The implant may be locked in a state of contraction. The implant may be fixed in a state of contraction. The implant may be locked or fixed in a state of contraction such that residual outward radial pressure on an inside wall of the bone may be substantially reduced or eliminated.

The elongated engaging member may be configured to apply tension between the first body and the second body. The elongated member may be of unified construction and of all the structures that are configured to operate in conjunction with the implant, the elongated engaging member alone may be configured to apply the tension.

In some embodiments, when the elongated member fixes the distance, the elongated member may engage the first body internal to the first body and the second body internal to the second body.

The first body may include a first tapped cannula. The second body may include a second tapped cannula. The elongated member may include a thread that is configured to engage the first tapped cannula and the second tapped cannula.

The thread may be sufficiently fine to avoid substantially changing the distance when the thread, after engaging the first tapped cannula, engages the second tapped cannula.

The second body may have an outer diameter. The first body may include a cylindrical portion that has an inner diameter that is greater than the outer diameter of the second body. The cylindrical portion may be configured to receive a portion of the second body.

The apparatus may include a scaffolding extends between the first base and the second base. The scaffolding may include the bone implant component. The scaffolding may be configured to support a bone.

In some embodiments, when the first base moves toward the second base, the scaffolding may expand away from the longitudinal axis.

The implant may include an anchoring substrate. The anchoring substrate may be disposed between the longitudinal axis and the scaffolding.

In some embodiments, an anchoring substrate may extend between the first and second bases. The anchoring substrate may include the bone implant component and may be configured to support a bone.

In some embodiments, when the first base moves toward the second base, the anchoring substrate may expand away from the longitudinal axis.

The implant may include a scaffolding that is, relative to the longitudinal axis, at a greater radial distance than is the anchor substrate.

A tab may extend from one or both of the first base and the scaffolding. A pocket may be present in one or both of the first base and the scaffolding. The tab may be biased such that it engages the pocket. The scaffolding may be substantially longitudinally and rotationally fixed to the first base by the engagement of the tab and the pocket.

In some embodiments, when the distance is fixed, the anchor substrate may be slidable along the longitudinal axis and angularly displaceable about the longitudinal axis.

The methods may include a method for controlling the expanded diameter of a bone implant inside a bone. The method may include controlling the length of the implant by fixing a distance between a first base and a second base using an elongated member that extends between the first base and the second base. The first and second bases may be substantially collinear. The method may include closing the elongated member inside the bone by closing an access hole through which the implant was delivered into the bone.

In some embodiments, the implant may have a fully collapsed state and a fully expanded state. The fully collapsed state may correspond to a state in which the implant is configured to pass through an access hole in the bone. The fully expanded state corresponding to a state in which the implant is expanded outside the bone at standard temperature and pressure. The method may include, when the implant has a fully collapsed state and a fully expanded state, fixing the distance at a value that is: not greater than a maximum value that corresponds to the fully collapsed state of the implant; and not less than a minimum value that corresponds to fully expanded state of the implant.

A method for treating a bone fracture is provided. The method may include positioning a first bone fragment at a reduced displacement relative to a second bone fragment such that the fracture is provisionally reduced. The method may include deploying an implant in an interior region of the bone, the implant having an expanded dimension that is greater than a corresponding dimension of the interior region. The method may include inserting into the implant a tension-storing element that prevents the implant from urging the first bone fragment away from the reduced displacement.

The positioning of a first bone fragment at a reduced displacement relative to a second bone fragment such that the fracture is provisionally reduced may include inserting a K-wire through the first bone fragment and the second bone fragment.

Inserting into the implant a tension-storing element that prevents the implant from urging the first bone fragment away from the reduced displacement may include fixing an axial distance between a first hub and a second hub. The first hub and the second hub may be configured to expand the implant when drawn together and collapse the implant when moved apart.

The method may include, after the deploying and before the inserting, adjusting the axial distance. Fixing the axial distance between a first hub and a second hub may include advancing the tension-storing element along the axial distance to engage a first body that is fixed to the first hub and a second body that is fixed to the second hub. The advancing the tension-storing element may include rotating the tension-storing element.

Apparatus for an expandable a bone implant is provided. The expandable implant may include a hub, a central axis member and a support member. The support member may include a first end and a second end. The first end and the second end may be spaced apart from each other along the central axis member. The support member may have a mid-section that is configured to deflect radially away from the central axis member when the implant expands.

The hub may include a support member terminal. The support member terminal may be configured to: fix the second end longitudinally relative to the central axis member during expansion of the implant; and fix the second end radially relative to the central axis member during the expansion.

In some embodiments, the support member terminal may include a clearance notch for the support member so that the second end may have an angular range of motion during the expansion.

The second end may include a tab. The support member terminal may include an enclosure. The enclosure may be configured to enclose the tab. The notch may be configured to traverse the enclosure.

The enclosure may include a first enclosure member. The enclosure may include a second enclosure member. The second enclosure member may be configured to be separated from the first enclosure member and admit the tab into the enclosure.

The first enclosure member may include a detent surface that limits the angular range of motion. The detent surface may include an end of the notch.

The second enclosure member may include a detent surface that limits the angular range of motion.

The support member terminal may be configured to rotate about the central axis member.

The support member terminal may be rotationally fixed relative to the central axis member.

Apparatus and methods for stabilizing a bone implant are provided. The bone may have an access hole for delivery of the implant. The access hole may have a hole wall.

The implant may include a stabilizer. The stabilizer may include an elongated member. The elongated member may be configured to extend along the hole, and between the implant, when the implant is deployed in the bone, and an anchor receiving feature. The anchor receiving feature may be configured to receive an anchor driven into the hole wall. The stabilizer may include one or more anchor receiving features.

The elongated member may include an extension that extends beyond the anchor receiving feature and is configured to articulate with a buttress plate.

The extension may include a first surface that is circumferential about the anchor receiving member. The buttress plate may include a second surface that is complementary to the first surface. Traction from an anchor received by the anchor receiving feature may be configured to brace the second surface against the first surface.

The elongated member may be configured to resist rotation of the implant in the hole. The elongated member may be configured to resist axial movement of the implant along the hole. The elongated member may be configured to resist rotation of the implant in the hole and axial movement of the implant along the hole.

The implant may include a locking mechanism for maintaining a shape of the implant. The locking mechanism may be configured to be locked by a screw inserted into the access hole. The screw may be adjustable after the anchor receiving feature has received the anchor.

The stabilizer may include a buttress plate anchored to the bone. The buttress plate may be positioned substantially parallel to a longitudinal axis of the bone. The buttress plate may be configured to resist rotational movement of the elongated member about a central axis of the hole.

The buttress plate may include a second anchor receiving feature configured to receive the anchor.

The buttress plate may be configured to resist axial movement of the elongated member along the hole.

The buttress plate may be configured to resist rotation of the elongated member in the hole and axial movement of the elongated member along the hole.

The buttress plate may include a second anchor receiving feature configured to receive the anchor.

The buttress plate may include a third anchor receiving feature configured to receive an anchor driven into an outer surface of a cortical wall of the bone.

The stabilizer may include a first edge adjacent to the first anchor receiving feature and a second edge adjacent to the first anchor receiving feature. The buttress plate may include a second anchor receiving feature that is configured to receive the anchor. The first edge and the second edge may define a pivot axis. The anchor may be configured to secure the buttress plate in contact with the bone and in a position substantially parallel to an outer surface of the bone.

In embodiments of the stabilizer that include a pivot axis, the buttress plate may be configured to resist rotation of the elongated member in the hole, axial movement of the elongated member along the hole and/or rotation and axial movement of the elongated member in the hole.

In embodiments of the stabilizer that include a pivot axis, the buttress plate may transmit no substantial bending moment about the pivot axis to the elongated member.

In embodiments of the stabilizer that include a pivot axis, the buttress plate may include a third anchor receiving feature configured to receive an anchor driven into an outer surface of a cortical wall of the bone.

The stabilizer may include a buttress plate anchored to the bone and positioned substantially parallel to a longitudinal axis of the bone. The buttress plate may include a first indent and a second indent. The elongated member may include a ridge.

The first indent and the second indent may be configured to engage the ridge and resist rotation of the elongated member in the hole. The first indent and the second indent may be configured to engage the ridge and resist axial movement of the elongated member along the hole. The first indent and the second indent may be configured to engage the ridge and resist rotation of elongated member about an axis perpendicular to a longitudinal axis of the implant.

In some embodiments, the elongated member may be configured to be positioned within the access hole after the implant has been deployed inside the bone.

The implant may be configured to be deployed through an access hole in a cortical wall of the bone. In some embodiments, the stabilizer may include an elongated member that is configured to extend between the implant, when the implant is deployed in the bone, and an anchor receiving feature that is configured to receive an anchor that is driven into an outer surface of the cortical wall. The elongated member may be configured to be deformed to position the anchor receiving feature along the outer surface of the cortical wall.

The stabilizer may include a buttress plate configured to be positioned over the elongated member. The buttress plate positioned over the elongated member may resist rotation of the elongated member about a central axis of the hole. The buttress plate positioned over the elongated member may resist rotation of the elongated member about an axis transverse to the elongated member.

In some embodiments that include an elongated member configured to be deformed, the elongated member may be configured to be attached to the implant after the implant is deployed in the bone.

In some embodiments, the stabilizer may include a site for an anchor receiving feature that is configured to receive an anchor driven into an outer surface of the cortical wall. An elongated member may be configured to extend between the implant, when the implant is deployed in the bone, and the site. A buttress plate may be positioned over the elongated member and configured to resist rotation of the elongated member about a central axis of the access hole, and axial movement of the elongated member transverse to the elongated member.

In some embodiments of a stabilizer including a site for an anchor receiving feature, the stabilizer may be attached to the implant after the implant is deployed in the bone.

The stabilizer may include an elongated member that is configured to extend along the hole and between the implant, when the implant is deployed in the bone, and a buttress collar. The buttress collar may be supported at an opening of the access hole. The elongated member may terminate at the buttress collar. The buttress collar may be substantially parallel to an outside surface of the cortical wall.

Some embodiments of the stabilizer having a buttress collar may include an anchor receiving feature configured to receive an anchor driven into the outside surface of the cortical wall.

In some embodiments of the stabilizer, an angle between a central axis of the access hole and a central axis of the implant may be adjustable. The stabilizer may include a locking mechanism configured to lock the adjustable angle. The elongated member may include an articulating surface. The adjustable angle may be between 0 degrees and 5 degrees, between degrees and 10 degrees, between 0 degrees and 15 degrees, between 0 degrees and 20 degrees, between 0 degrees and 25 degrees, between 0 degrees and 30 degrees, between 0 degrees and 35 degrees, between 0 degrees and 45 degrees, between 0 degrees and 90 degrees, or within any other suitable angular range.

System and methods for securing a bone implant in a bone, are provided. The system may include an expandable web having a front and a back. The web may be configured to be inserted in an interior of the bone. The web may include an expandable cell having an expanded diameter.

The system may include an anchor that may be configured to secure a fragment of the bone to the expandable web when the expandable web is inside the bone. The anchor may have an elongated shaft for penetrating the cell from the front and an engagement feature that extends transversely away from the shaft and may be configured to engage the back of the cell to apply tension between the cell and the bone fragment. The shaft may have a shaft diameter that is sufficiently great, relative to the expanded diameter, to prevent disengagement of the engagement feature from the back of the cell when the tension is applied.

The expanded diameter may be a diameter of the cell when the expandable web is in an expanded state before the engagement feature engages the back of the cell.

The expanded diameter may be a diameter of the cell when the expandable web is in an expanded state, the engagement feature is engaging the back of the cell, and the cell is elastically deformed by the tension.

The expanded diameter may be a diameter of the cell when the expandable web is in an expanded state, the engagement feature is engaging the back of the cell, and the cell is plastically deformed by the tension.

The anchor may be a screw. The engagement feature may be a spiral thread. When the anchor is a screw and the engagement feature a spiral thread, one or more of the screw root diameter, the screw thread diameter and the thread pitch is selected based on a failure strain of the cell.

When the anchor is a screw and the engagement feature is a spiral thread, one or more of the screw root diameter, the screw thread diameter and the thread pitch may be selected based on an elastic deformation limit of the cell.

When the anchor is a screw and the engagement feature is a spiral thread, a screw metric may be selected based on a failure strength of the cell.

The screw metric may be a screw major diameter. The screw metric may be a screw mean diameter. The screw metric may be a screw minor diameter. The screw metric may be a thread pitch. The screw metric may be a screw thread angle.

Apparatus and methods for securing components of a bone implant are provided. The apparatus may include a bracket that may be configured to receive a bone anchor. The apparatus may include an extension member that may be configured to support the bracket relative to a bone implant that is deployed inside the bone. The apparatus may include a fastening assembly that is configured to fasten: the bracket to the extension; and the extension to the implant.

The fastening assembly may include a first state in which the bracket is movable relative to the implant, and a second state in which the bracket is locked relative to the implant.

In the first state, the bracket may be movable from a first distance from the implant to a second distance from the implant.

In the first state, the bracket may be movable from a first angle relative to the implant to a second angle relative to the implant.

In the first state, the bracket may be movable from: a first distance from the implant to a second distance from the implant; and a first angle relative to the implant to a second angle relative to the implant.

The fastening assembly may include a fastener. The fastener may be configured to press the extension toward the implant and induce friction between the extension and the bracket.

The apparatus may include an expansion bushing. The fastener may be configured to drive the expansion bushing toward the implant to press the extension toward the implant and expand the extension to interfere with movement of the bracket.

The bracket may have a tubular section. The extension may have a tubular section that is within the bracket tubular section. The expansion bushing may include a portion that is within the extension tubular section. The fastener may include a screw. The screw may have a portion that is within the expansion bushing.

Apparatus and methods for a bone implant are provided. The bone implant may include a central axis member. The bone implant may include a first expandable web that may be supported coaxially about the central axis member. The bone implant may include a second expandable web that may be supported coaxially about the central axis member and within the first expandable web.

The central axis member may define a longitudinal axis. The first expandable web may have a first mesh cell density. The first mesh cell density may vary along the axis, so that the first expandable web, when expanded, has a first radius that is based on the first mesh cell density; and the second expandable web has a second mesh cell density. The second mesh cell density may vary along the axis, so that the second expandable web, when expanded, has a second radius that is based on the second mesh cell density.

In some embodiments, along substantially the entire length of the second web, a ratio of the first radius to the second radius may be substantially constant.

In some embodiments, along a length of the second web, a ratio of the first radius to the second radius may be substantially constant.

The second radius may have a second radius maximum between a distal end of the second web and a proximal end of the second web. The second radius may decrease substantially linearly from the maximum toward the distal end. The second radius may decrease substantially linearly from the maximum toward the proximal end.

In some embodiments, between the distal end of the second web and the proximal end of the second web a difference between the second radius and the first radius may define a radial offset. The radial offset may have an offset minimum that corresponds to the second radius maximum.

The offset minimum may be sufficiently small that, when the first expandable web bears a radial load, the first expandable web deforms to transmit the load to the second expandable web at the second radius maximum.

The first expandable web may include a first plurality of open cells. The second expandable web may include a second plurality of open cells. The first and second pluralities may be configured to engage an anchor and deliver tension to the anchor to retain a bone fragment that is engaged with the anchor.

The second expandable web may be rotatably supported about the longitudinal axis such that the second expandable web can rotate in response to interference from the anchor during engagement of the second expandable web by the anchor.

Apparatus and methods for a bone implant having different zones of flexibility are provided. The implant may include a structural component. The structural component may have an expanded state, a collapsed state, a longitudinal axis and a transverse axis to the longitudinal axis. The transverse axis may be perpendicular to the longitudinal axis. The structural component may include, along the longitudinal axis: a first zone; a second zone; and a third zone.

The first zone may have a first resistance to bending about the transverse axis. The second zone and the third zone may have a second resistance to bending about the transverse axis. In the collapsed state, the first resistance to bending may be greater than the second resistance to bending.

The second resistance to bending in the expanded state may be greater than the second resistance to bending in the collapsed state.

The first zone may include a first cell and the third zone may include a second cell. The first cell may be circumferentially spaced, about the longitudinal axis, a first distance, from the second cell and longitudinally spaced, along the longitudinal axis, a second distance from the second cell. The second zone may include a link from the first cell to the second cell.

An increase in the first distance may correspond to an increase in flexibility of the second zone about the transverse axis. An increase in the second distance corresponds to an increase in flexibility of the second zone about the transverse axis.

The first zone may include a third cell. The third cell may be circumferentially spaced, about the longitudinal axis, a third distance, from the second cell and longitudinally spaced, along the longitudinal axis, a fourth distance from the second cell.

The third zone may include a fourth cell. The fourth cell may be circumferentially spaced, about the longitudinal axis, the first distance from the third cell and longitudinally spaced, along the longitudinal axis the second distance from the third cell.

The second zone may include, when the link is a first link, a second link from the third cell to the fourth cell. In the expanded state, the first link may stack upon the second link. The link may tortuously link the first cell and the second cell.

The first zone may include a first cell and the third zone may include a second cell. The first cell may be circumferentially aligned, about the longitudinal axis, with the second cell and longitudinally spaced, along the longitudinal axis, a distance from the second cell. The second zone may include a link from the first cell to the second cell. The link may tortuously links the first cell to the second cell.

The link may include a “V” shaped link, the link may have an apex, a first leg and a second leg. Under compression along the longitudinal axis, the first leg and the second leg may collapse about the apex.

The implant may include a structural component. The implant may have an expanded state, a collapsed state and a longitudinal axis. The structural component may include a first structural member extending along the longitudinal axis. The structural component may include a second structural member extending along the longitudinal axis and spaced circumferentially about the longitudinal axis from the first member.

The structural component may include a cross support that spans from the first member to the second member. The cross support may include a member having a joint. The member may be configured to be folded about the joint in the collapsed state and unfolded about the joint in the expanded state.

In some embodiments, when the cross support is folded, an angle of the member may be substantially 0 degrees and when the cross support is unfolded, the angle of the member may be substantially 180 degrees.

The unfolded cross support may limit an expansion of the implant from the longitudinal axis.

The support component may define a plane. The implant may have a longitudinal axis that lies in the plane, a first transverse axis that lies in the plane and is perpendicular to the longitudinal axis and a second transverse axis that is perpendicular to the longitudinal axis and perpendicular to the plane.

The support component may have a first resistance to bending about the longitudinal axis or about the first transverse axis. The support component may have a second resistance to bending about the second transverse axis. The first bending resistance may be greater than the second bending resistance.

The support component may include a first member and a second member. The first member may have a third resistance to bending about the longitudinal axis or about the first transverse axis and a fourth resistance to bending about the second transverse axis. The second member may have a fifth resistance to bending about the longitudinal axis or about the first transverse axis and a sixth resistance to bending about the second transverse axis.

The support component may include a first anchor receiving feature and a second anchor receiving feature. The first anchor receiving feature and the second anchor receiving feature may be configured to receive an anchor that lies in the plane.

Apparatus and methods for a multi-fold single layer implant for a bone are provided.

The implant may include a central axis member that defines a longitudinal axis. The implant may include an expandable web that may be supported coaxially about the central axis member.

The expandable web may include a first mesh cell density that may vary longitudinally along a first segment of the expandable web. The expandable web may include a second mesh cell density that may vary longitudinally along a second segment of the expandable web. The expandable web may include a third mesh cell density that varies longitudinally along a third segment of the expandable web. The expandable web may include a fourth mesh cell density that varies longitudinally along a fourth segment of the expandable web. The expandable web may include a fifth mesh cell density that varies longitudinally along a fifth segment of the expandable web.

When the expandable web is in an expanded state, the first segment may have a first profile, the second segment may have a second profile, the third segment may have a third profile, the fourth segment may have a fourth profile, and the fifth segment may have a fifth profile.

In an unexpanded state, the first, second, third, fourth and fifth segments may be consecutively longitudinally ordered. In the expanded state, the first and fifth segments may be concave facing each other. The second and fourth segments may bridge, respectfully, from the first segment to the third segment and from the third segment to the fifth segment.

In the expanded state, the third segment may be substantially cylindrical.

In the expanded state, the third segment may be ellipsoidal. For example, when viewed transversely relative to the central axis, the third segment may have an outline that is ellipsoidal.

In the expanded state, the first segment may have a first segment maximum radius, the third segment may have a third segment maximum radius, the fifth segment may have a fifth segment maximum radius, and both the first segment maximum radius and the fifth segment maximum radius may be greater than the third segment maximum radius.

A ratio of one of the first segment maximum radius and the fifth segment maximum radius to the third segment maximum radius may be at least 1.1.

Apparatus and methods for a hat shaped multi-fold single layer implant for a bone are provided.

The implant may include a central axis member that defines a longitudinal axis. The implant may include an expandable web that may be supported coaxially about the central axis member.

The expandable web may include a first mesh cell density that varies longitudinally along a first segment of the expandable web. The expandable web may include a second mesh cell density that varies longitudinally along a second segment of the expandable web. The expandable web may include a third mesh cell density that varies longitudinally along a third segment of the expandable web.

When the expandable web is in an expanded state, the first segment may have a first profile, the second segment may have a second profile and the third segment may have a third profile.

In an unexpanded state, the second segment may be longitudinally between the first segment and the third segment. In the expanded state, the first segment may be ellipsoidal, the third segment may be concave facing the first segment and the second segment may bridge from an outer radius of the third segment to an adjacent tip of the first segment.

In the expanded state, the second segment may have a portion that is concave facing the first segment.

In the expanded state, the second segment may have a portion that is convex facing the first segment.

In the expanded state the first segment may have a first segment maximum radius, the third segment may have a second segment maximum radius and the third segment maximum radius may be greater than the first segment maximum radius.

A ratio of the third segment maximum radius to the first segment maximum radius may be at least 1.1.

In the expanded state the first segment may have a first longitudinal diameter. In the expanded state, the second and third segments together may define a second longitudinal diameter. In the expanded state, the first longitudinal diameter may be greater than the second longitudinal diameter.

A ratio of the first longitudinal diameter to the second longitudinal diameter may be at least 2.5.

In the expanded state, the first segment may have a first segment maximum radius. In the expanded state, the third segment may have a second segment maximum radius. In the expanded state, the first segment maximum radius may be greater than the third segment maximum radius. A ratio of the first segment maximum radius to the third segment maximum radius may be at least 1.1.

In the expanded state the first segment may have a first longitudinal diameter. In the expanded state, the second and third segments together may define a second longitudinal diameter. The second longitudinal diameter may be greater than the first longitudinal diameter. A ratio of the second longitudinal diameter to the first longitudinal diameter may be at least 2.5.

Apparatus and methods for a non-round implant for a bone are provided.

The implant may include a central axis member that may define a longitudinal axis. The implant may include an expandable web that may be supported coaxially about the central axis member.

When the expandable web is in an expanded state, the first segment may have a first profile, the second segment may have a second profile and the third segment may have a third profile.

In an unexpanded state, the second segment may be longitudinally between the first segment and the third segment. In the expanded state, the first profile may be a substantially conical shape that opens toward the second segment. In the expanded state, the third segment may be substantially planar and substantially normal to the central axis member. In the expanded state, the second segment may bridge from an outer radius of the first segment to an outer radius of the third segment.

In the expanded state, the second profile may be substantially conical and may have a first radius at a joint with the first profile and may have a second radius at a joint with the third profile. The second radius may be greater than the first radius. A ratio of the second radius to the first radius may be at least 1.1.

Apparatus and methods for a bone engaging member for a an implant for a bone are provided.

The implant, when deployed inside the bone, may define, at a distal end of the implant, an enclosed region. The bone engaging member may be configured to extend out of the region and into the bone.

The implant may include a support structure that converges toward a distal end of the implant. The bone engaging member may be configured to diverge from the support structure and extend into the bone.

The bone engaging member may not be fixed directly to the support structure. The bone engaging member may be fixed directly to the support structure.

The bone engaging member may be configured to extend for a first length of the bone engaging member alongside a supporting member of the implant along and for a second length of the bone engaging member into the bone.

The first length may extend substantially perpendicular to a surface of the support structure.

The bone engaging member may be configured to extend substantially perpendicular to the surface of the support structure after an expansion of the implant.

The bone engaging member may be configured to extend into a cancellous portion of the bone.

The bone engaging member may be configured to resist translational motion of the implant relative to the bone.

The bone engaging member may be configured to resist rotational motion of the implant relative to the bone.

The bone engaging member may be one of several bone engaging members that diverge from the support structure and extend into the bone.

The bone engaging member may include a distal tip. The distal tip may be configured to coordinate with an internal geometry of the bone.

The bone engaging member may be configured to be fixed to the implant at a proximal end of the implant.

The bone engaging member may be configured, when the implant is deployed through an access hole in the bone, to be inserted into the access hole after the implant is deployed in the bone.

The bone engaging member may be configured, when the implant is deployed through an access hole in the bone, to be inserted into the access hole after the implant.

One or more surfaces of the apparatus may be coated with agents that promote bone ingrowth. The agents may include calcium phosphate, heat treated hydroxylapatite, Basic fibroblast growth factor (bFGF)-coated hydroxyapatite, hydroxyapatite/tricalcium phosphate (HA/TCP), and other suitable agents, including one or more of those listed in Table 1.

One or more surfaces of the apparatus may be coated with agents that inhibit or prohibit bone ingrowth. Such surfaces may include impermeable and other materials such as one or more of those listed in Table 1.

One or more surfaces of the apparatus may be coated with agents that may elute therapeutic substances such as drugs.

The apparatus and portions thereof may include any suitable materials. Table 1 lists illustrative materials that may be included in the apparatus and portions thereof.

TABLE 1

Materials

Category
Type
Material

Metals
Nickel titanium alloys
Nitinol

Stainless steel alloys
304

316L

BioDur ® 108 Alloy

Pyromet Alloy ® CTX-909

Pyromet ® Alloy CTX-3

Pyromet ® Alloy 31

Pyromet ® Alloy CTX-1

21Cr—6Ni—9Mn Stainless

21Cr—6Ni—9Mn Stainless

Pyromet Alloy 350

18Cr—2Ni—12Mn Stainless

Custom 630 (17Cr—4Ni)

Stainless

Custom 465 ® Stainless

Custom 455 ® Stainless Custom

450 ® Stainless

Carpenter 13-8 Stainless

Type 440C Stainless

Cobalt chromium
MP35N

alloys
Elgiloy

L605

Biodur ® Carpenter CCM alloy

Titanium and titanium
Ti—6Al—4V/ELI

alloys
Ti—6Al—7Nb

Ti—15Mo

Tantalum

Tungsten and tungsten

alloys

Pure Platinum

Platinum-Iridium

alloys

Platinum-Nickel

alloys

Niobium

Iridium

Conichrome

Gold and Gold alloys

Absorbable

Pure Iron

metals

magnesium alloys

Polymers

Polyetheretherketone (PEEK)

polycarbonate

polyolefin's

polyethylene's

polyether block amides (PEBAX)

nylon 6

6-6

12

Polypropylene

polyesters

polyurethanes

polytetrafluoroethylene (PTFE)

Poly(phenylene sulfide) (PPS)

poly(butylene terephthalate)

PBT

polysulfone

polyamide

polyimide

poly(p-phenylene oxide) PPO

acrylonitrile butadiene

styrene (ABS)

Polystyrene

Poly(methyl methacrylate)

(PMMA)

Polyoxymethylene (POM)

Ethylene vinyl acetate

Styrene acrylonitrile resin

Polybutylene

Membrane

Silicone

materials

Polyether block amides (PEBAX)

Polyurethanes

Silicone polyurethane

copolymers

Nylon

Polyethylene terephthalate

(PET)

Goretex ePTFE

Kevlar

Spectra

Dyneena

Polyvinyl chrloride (PVC)

Absorbable

Poly(glycolic acid) (PGA)

polymers

Polylactide (PLA),

Poly(ε-caprolactone),

Poly(dioxanone)

Poly(lactide-co-glycolide)

Radiopaque

Barium sulfate

materials

Bismuth subcarbonate

Biomaterials
Collagen
Bovine, porcine, ovine, amnion

membrane

Bone growth

Demineralized bone matrix

factors

Bone morphogenic proteins

(BMP)

Calcium phosphate

Heat-treated hydroxylapapatite

Basic fibroblast growth factor

(bFGF)-coated hydroxyapaptite

Hydroxyapaptite/tricalcium

phosphate (HA/TCP

Anti-

microbial

Coatings

The apparatus may be provided as a kit that may include one or more of a structural support, an anchoring substrate, a central axis member, an anchor, a delivery instrument and associated items.

Apparatus and methods in accordance with the invention will now be described in connection with the FIGS. The FIGS. show illustrative features of apparatus and methods in accordance with the principles of the invention. The features are illustrated in the context of selected embodiments. It will be understood that features shown in connection with one of the embodiments may be practiced in accordance with the principles of the invention along with features shown in connection with another of the embodiments.

Apparatus and methods described herein are illustrative. Apparatus and methods of the invention may involve some or all of the features of the illustrative apparatus and/or some or all of the steps of the illustrative methods. The steps of the methods may be performed in an order other than the order shown and described herein. Some embodiments may omit steps shown and described in connection with the illustrative methods. Some embodiments may include steps that are not shown and described in connection with the illustrative methods.

Illustrative embodiments will now be described with reference to the accompanying drawings, which form a part hereof.

The apparatus and methods of the invention will be described in connection with embodiments and features of an illustrative bone implants and associated hardware and instrumentation. The implants and associated hardware and instruments will be described now with reference to the FIGS. It is to be understood that other embodiments may be utilized and structural, functional and procedural modifications may be made without departing from the scope and spirit of the present invention.

FIG. 1 shows illustrative implant 100. Implant 100 may be implanted in a bone (not shown). Implant 100 is elongated along its longitudinal axis LI (in which I indicates implant). Implant 100 may include an outer expandable web 106. Implant 100 may include an inner expandable web 108. Expandable web 106 may be expanded to a radial distance from LI. Expandable web 108 may be expanded to a radial distance from LI.

Implant 100 may include stabilizer 101. Stabilizer 101 may include buttress plate 102. Buttress plate 102 may be elongated along a longitudinal axis LBP (in which BP indicates buttress plate). Longitudinal axis LBP may form angle θ with longitudinal axis LI. In some embodiments, angle θ may be adjustable.

Stabilizer 101 may be secured to a bone with anchor 114. Anchor 114 may secure buttress plate 102 to the bone. Buttress plate 102 may be secured to the bone with anchor 116.

Implant 100 may include an expansion locking screw 112 for locking expandable web 106 and/or expandable web 108 at a distance from LI. Stabilizer 101 may be secured to implant 100 using any suitable approach, such as with tabs 118.

Expandable web 106 may extend from proximal base 130 to distal hub 110. (“Distal,” relative to “proximal,” generally means the leading end of an apparatus that is inserted, or is to be inserted, in the body.) Expandable web 108 may extend from a proximal base (not shown) to distal hub 120.

Expandable web 106 may include an arrangement of cells 122. Expandable web 108 may include an arrangement of cells 124. An arrangement of cells 122 and/or cells 124 may be any suitable arrangement and may include an arrangement that provides different zones of flexibility.

Cell 122 may be configured to expand. Cell 124 may be configured to expand. Cell 122 may be expanded by expansion of expandable web 106. Cell 124 may be expanded by expandable web 108.

Cell 122 may be configured to receive any suitable anchor, such as anchor 126. Cell 124 may be configured to receive any suitable anchor such as anchor 126. Anchor 126 may be configured to penetrate expandable web 106 and/or expandable web 108. Anchor 126 may penetrate expandable web 106 and/or expandable web 108 at two or more locations (not shown).

Implant 100 may include component 128. Component 128 may extend longitudinally along axis LI. Component 128 may extend between distal hub 110 and proximal hub 130.

FIG. 2 illustrates anatomical features of a fractured bone B. An implant such as implant 100 may be deployed inside bone B to repair bone B.

Bone B is illustrated as a radius that is fractured at fractures Fh and Fa. Bone B includes bone portions Pb, Ph and Pa in distal end D. Bone segment Pb is the largest portion of bone B. Bone segment Ph is a head portion of bone B. Bone segments Ph and Pa include articular surface AS. Bone portions Pb, Ph and Pa are separated or partially separated along fractures Fa and Fh. Fracture Fa transects articular surface AS. Fracture Fh transects head of bone B.

Bone B, shown in a cross section that includes approximate longitudinal axis LB, includes cortical bone BCO and cancellous bone BCA. Cortical bone BCO may have a bone surface BS. Deployment of an implant into distal end D of bone B may require an access hole. Deployment of the implant may require displacement of cancellous bone BCA. Inside the bone B, the implant may engage cancellous bone BCA. Engagement with cancellous bone BCA may secure the implant to bone B.

Bone B may be provided with access hole H in cortical bone BCO. Hole H may have a hole wall HW. Hole wall HW may be a site for securing a stabilizer such as stabilizer 302 (shown in FIG. 3) to bone B. Hole H may have central axis CH. Transverse axis TCH may be perpendicular to central axis CH.

Bone B may be provided with access hole I in cortical bone BCO. An apparatus inserted in access hole I, may be required to travel a distance xI through intermedullary space IS to reach a head portion of bone B. An apparatus inserted through hole I may require bending to travel through intermedullary space IS to reach a head portion of bone B.

Some of the implants shown and described herein may be deployed through hole H. Some of the implants shown and described herein may be deployed through hole I. An implant that is configured to be deployed through hole H may include features for securing the implant to bone tissue at or near hole H. An implant that is configured to be deployed through hole I may include features for enabling the implant to deform during the bending and expand for operational use. It will be understood that an implant may include securement features that are appropriate for the access hole through which the implant is to be deployed even though the implant is illustrated herein with a particular type of securement feature such as a stabilizer.

FIG. 3 shows implant 301 deployed inside bone B. Bone B may have one or more features in common with bone B (shown in FIG. 1). Implant 301 may have one or more features in common with implant 100 (shown in FIG. 1). Longitudinal axis LI of implant 100 may correspond to central axis CH of hole H.

Stabilizer 302 may have one or more features in common with tail 103 (shown in FIG. 1). Stabilizer 302 may secure implant 301 to bone B. Stabilizer 302 may include anchor receiving feature 304. Anchor receiving feature 304 may be configured to receive an anchor (not shown) driven into hole wall HW.

FIG. 4 shows a view of a portion of implant 301 taken along lines 4-4 (shown in FIG. 3). Expandable web 106 may extend from proximal base 130 to distal base 410. Distal base 410 may include one or more of the features of distal hub 110. Distal base 410 may be longitudinally fixed to component 128.

Proximal base 130 may be longitudinally fixed to tapped cannulated body 406 using any suitable approach, such as tabs 118 (shown in FIG. 1). Tabs 118 may be biased to engage a pocket (not shown) in cannulated body 406.

Implant 301 may include proximal base 404. Expandable web 108 may extend from proximal base 404 to distal base 412. Distal base 412 may include one or more of the features of distal hub 120.

Implant 301 may include tapped cannulated body 402. Tapped cannulated body 402 may be longitudinally fixed to distal base 410.

Implant 301 may include locking screw 112. Locking screw 112 may be threaded. Locking screw 112 may threadedly engage tapped cannulated body 406 and/or tapped cannulated body 402. Locking screw 112 may fix distance xCB between tapped cannulated body 406 and tapped cannulated body 402.

Distance xCB fixed by locking screw 112 may correspond to an expansion radius RO of expandable web 106 from longitudinal axis LI. Distance xCB fixed by locking screw 112 may correspond to a therapeutic radius RO of expandable web 106. A therapeutic ration RO may reduce tension of implant on bone B.

Expandable web 108 may be slidable along axis LI and/or angularly displaceable about axis LI after distance xCB has been fixed.

FIG. 5 shows distal hub 110. Expandable web 106 may be fixed to distal hub 110. Distal hub 110 may have one or more of the feature of first distal base 410. Distal hub 110 may be configured for expandable web 106 to be angularly displaced about axis LI. Distal hub 110 may be longitudinally fixed to component 128. Distal hub 110 may be rotationally fixed to component 128.

Distal hub 110 may include end cap 501. End cap 501 may include a detent configured to limit angular displacement of expandable web 106 about axis LI. Distal hub 110 may include cap 502. Distal hub 110 may include enclosure member 504.

FIG. 6 shows another embodiment of distal hub 110. Enclosure member 504 may include enclosures 602 configured to enclose tabs 606. Notch 604 may allow expandable web 106 an angular range of motion about axis LI. Angular motion of expandable web 106 about axis LI may correspond to an expansion or collapsing of expandable web 106.

Cap 502 may retain tab 602 in enclosure 504. Cap 502 may be notched to allow angular motion of expandable web 106 about axis LI. Cap 502 may include a notch (shown in FIG. 7A) for expandable web 106 to be collapsed about axis LI.

FIG. 7A shows another embodiment of distal hub 110. Cap 502 may include notch 702 for angular movement of expandable web 106 about axis LI. Angular movement of expansion web 106 about axis LI may be limited by an end 704 of notch 702. Cap 502 may retain tabs 606 in enclosure 504. Enclosure 504 and cap 502 may be configured for expandable web 106 to collapse about axis LI.

FIG. 7B shows a cross section of distal hub 110 and distal hub 120. Distal hub 110 may be configured for expandable web 108 to expand to angle η. Distal hub 120 may be configured for expandable web 108 to expand to angle ϵ. Angle ϵ may be greater than angle η. Distal hub 110 and distal hub 120 may be fix translation of an expandable web along axis LI. Distal hub 110 and distal hub 120 may allow rotation about axis LI. Distal hub 110 and distal hub 120 may allow expansion about axis LI. Distal hub 110 and distal hub 120 may be configured to provide different expansion radii (not shown) from axis LI.

FIG. 7C shows a cross section of distal hub 110 and distal hub 120. Distal hub 110 and distal hub 120 may be configured for expandable web 106 and expandable web 108 to collapse upon each other. Distal hub 110 and distal hub 120 may be configured for expandable web 106 to be substantially parallel to expandable web 108 in a collapsed position.

FIG. 8 shows illustrative stabilizer 101 for implant 100. Stabilizer 101 may include elongated member 103. Elongated member 103 may include anchor receiving feature 802. Anchor receiving feature 802 may be configured to receive anchor 114. Anchor 114 may be driven into hole wall HW (shown in FIG. 2). Anchor 114 may resist axial motion of elongated member 103 along longitudinal axis LI.

Stabilizer 101 may include a pivot axis P. Buttress plate 102 may resist rotation of elongated member 103 in hole H (shown in FIG. 2). Buttress plate 102 may resist rotation of elongated member 103 about an axis perpendicular to P. Longitudinal axis LI of implant 100 may be perpendicular to P. Central axis CH (shown in FIG. 2) of hole H may be perpendicular to P.

Buttress plate 102 may include anchor receiving feature 804. Anchor receiving feature 804 may be configured to receive an anchor driven into cortical bone BCO (shown in FIG. 2). Longitudinal axis LBP of buttress plate 102 may be parallel to bone surface BS. Bone surface BS and/or longitudinal axis LBP may be perpendicular to P. Anchor receiving feature 804 may receive anchor 116 (shown in FIG. 1).

FIG. 9 shows illustrative stabilizer 902. Stabilizer 902 may include elongated member 916. Stabilizer 902 may include elongated member 906. Stabilizer 902 may include buttress plate 904. Elongated member 906 may include extension 912. Buttress plate 904 may include extension 914.

Extension 912 may be configured to articulate with extension 914. Traction from anchor 114 received by anchor receiving feature 908 may be configured to brace the extension 912 against extension 914.

Stabilizer 902 may include anchor receiving feature 908. Anchor receiving feature 908 may be configured to receive and anchor driven into hole wall HW (shown in FIG. 2). Stabilizer 902 may include anchor receiving feature 910. Anchor receiving feature 910 may be configured to receive an anchor driven into an outer surface BS (shown in FIG. 2) of cortical bone BCO (shown in FIG. 2).

Anchor 114 may be driven through anchor receiving feature 908 into hole wall HW. Elongated member 906 may include an anchor receiving feature (not shown) configured to receive anchor 114. Anchor 116 may be driven through anchor receiving feature 910 into outer surface BS of cortical bone BCO. Longitudinal axis LBP of buttress plate 804 may be positioned such that longitudinal axis LBP is substantially parallel to bone surface BS. Longitudinal axis LBP of buttress plate 804 may be positioned such that longitudinal axis LBP is transverse to bone surface BS.

Stabilizer 902 may be configured to resist axial movement of implant 900 along longitudinal axis LI. Stabilizer 902 may be configured to resist angular rotation of implant 900 about longitudinal axis LI. Stabilizer 902 may be configured to resist rotation of implant 900 in hole H.

FIG. 10 shows illustrative stabilizer 1000. Stabilizer 1000 may include elongated member 1004. Stabilizer 1000 may include buttress plate 1006. Buttress plate 1006 may include anchor receiving features 1008. Anchor receiving features 1008 may be configured to receive an anchor driven into a surface BS of cortical bone BCO.

Elongated member 1004 may be deformable. Elongated member 1004 may be deformed such that end 1002 is substantially parallel to longitudinal axis LI and end 1010 is substantially parallel to longitudinal axis LBP of buttress plate 1006. Deformation of elongated member 1004 may correspond to angle θ.

FIG. 11A shows illustrative implant 1100. Implant 1100 may include stabilizer 1101. Stabilizer 1101 may include elongated member 1106. Elongated member 1106 may include one or more of the features of elongated member 1004. Stabilizer 1101 may include buttress plate 1102.

Buttress plate 1102 may be configured to be positioned over elongated member 1106. Buttress plate 1102 may be configured to resist rotation of elongated member 1106 about longitudinal axis LI. Implant 1100 may be inserted into hole H (shown in FIG. 2). Buttress plate 1102 may be configured to resist rotation of elongated member 1106 in hole H. Axis TEM is transverse to axis LBP. Buttress plate 1102 may be configured to resist transverse movement of elongated member 1106.

Buttress plate 1102 may include anchor receiving feature 1108. Anchor receiving feature 1108 may be configured to receive an anchor driven into an outer surface BS of cortical bone BCO (shown in FIG. 2). Elongated member 1106 may include a corresponding site for receiving an anchor driven through anchor receiving feature 1108.

Stabilizer 1101 may be configured for locking screw 112 to be adjusted after stabilizer 1101 has been secured to bone B (shown in FIG. 2).

FIG. 11B shows an illustrative view of stabilizer 1101 configured to restrict movement of elongated member 1106.

FIG. 12 shows illustrative stabilizer 1200. Stabilizer 1200 may include elongated member 1212. Elongated member 1212 may extend from an implant (not shown) to buttress collar 1202. Elongated member 1212 may extend along hole wall HW (shown in FIG. 2). Elongated member 1212 may include longitudinal axis LEM. Longitudinal axis LEM may be substantially parallel to central axis CH of hole H and/or a longitudinal axis of an implant (not shown). Buttress collar 1202 may be supported at an opening of access hole H (shown in FIG. 2). Buttress collar 1202 may include a longitudinal axis LBC substantially parallel to bone surface BS (shown in FIG. 2).

Stabilizer 1200 may include an anchor receiving feature (not shown) configured to receive an anchor, such as anchor 1204, driven into bone surface BS. Stabilizer 1200 may include aperture 1211 for adjusting a locking screw (not shown). The locking screw may include one or more of the features of locking screw 112 (shown in FIG. 1).

FIG. 13 shows illustrative stabilizer 1308 for implant 1312. Stabilizer 1308 may include elongated member 1306. Stabilizer 1308 may include buttress collar 1304. Buttress collar 1304 may have longitudinal axis LBC. Longitudinal axis LBC may be substantially parallel to bone surface BS (shown in FIG. 2).

Implant 1312 may have longitudinal axis LI. Angle θ between axis LI and LBC may be adjustable. Elongated member 1306 may include articulating surface 1302. Articulating surface 1302 may be configured for stabilizer 1308 to engage implant 1312 at angle λ between central axis CS of stabilizer 1308 and longitudinal axis LI of implant 1312. Central axis CS may correspond to central axis CH of hole H (shown FIG. 2).

Angle λ may be fixed by a locking screw (not shown) inserted into aperture 1316. The locking screw may be configured to fix angle λ and an expansion (not shown) of implant 1312 from longitudinal axis LI. The locking screw may include one or more of the features of locking screw 112 (shown in FIG. 1)

Stabilizer 1308 may include an anchor receiving feature (not shown). The anchor receiving feature may be configured to receive anchor 1314. The anchor receiving feature may be configured to direct anchor 1314 into an outer surface BS of cortical bone BCO (shown in FIG. 2).

FIG. 14 shows illustrative apparatus 1400 for implant 1408. Apparatus 1400 may include bracket 1406. Bracket 1406 may include anchor receiving feature 1404. Apparatus 1400 may include extension member 1410. Extension member 1410 may be configured to support bracket 1406 relative to implant 1408.

Apparatus 1400 may include locking screw 1402. Lock screw 1402 may be configured to fix bracket 1406 relative to implant 1408. Bracket 1406 may be fixed at a distance xBI from implant 1408. Bracket 1406 may be fixed at an angle relative to implant 1408.

FIG. 15 shows a cross section of apparatus 1400. Apparatus 1400 may include expansion bushing 1504. Expansion bushing 1504 may be untapped. Extension member 1410 may include tabs 1502.

Locking screw 1402 may be configured to pass through expansion bushing 1504 and engage a tapped portion of implant 1408. Screw 1402 may be configured to drive expansion bushing 1504 toward implant 1408. Expansion bushing 1504 may be configured to press extension member 1410 toward implant 1408. Expansion bushing 1504 may be configured to expand tabs 1502.

Expansion of tabs 1502 may induce friction between extension member 1410 and bracket 1404. Friction between extension member 1401 and bracket 1404 may interfere with movement of bracket 1404 relative to implant 1408. Friction between extension member 1410 and bracket 1404 may fix rotation of bracket 1404 about axis LI relative to implant 1408. Friction between extension member 1410 and bracket 1404 may fix distance xBI between bracket 1406 and implant 1408.

FIG. 16 shows illustrative extension member 1410. Extension member 1401 may include tabs 1502. Extension member 1410 may be rolled into a cylindrical shape. In a cylindrical configuration, edge 1604 may be contiguous with edge 1602.

FIG. 17 shows illustrative implant 301. Implant 301 may include expandable web 106 and expandable web 108. Expandable web 106 may be supported coaxially about implant component 128. Expandable web 108 may be supported coaxially about implant component 128. Expandable web 108 may be within expandable web 106.

Expandable web 106 may include a plurality of cells 122. Cells 122 may be configured to engage an anchor as shown in FIG. 40. The plurality of cells 122 may include any suitable density of cells 122. Expandable web 106 may include a density of cells 122 that varies along longitudinal axis LI of implant 301.

FIG. 18 shows illustrative inner structure 1800 of implant 301. Inner structure 1800 may include expandable web 108. Expandable web 108 may include a plurality of cells 124. Cells 124 may be configured to engage an anchor as shown in FIG. 40. The plurality of cells 124 may include any suitable density of cells 124. Expandable web 108 may include a density of cells 124 that varies along longitudinal axis LI of implant 301. Expandable web 108 may be rotatably supported about axis LI.

FIG. 19 shows a cross section of illustrative implant 301. Expandable web 106 may include any suitable density of cells 122. Expandable web 106 may include a density of cells 122 that varies along longitudinal axis LI such that expandable web has a radius RO.

Expandable web 108 may include any suitable density of cells 124. Expandable web 108 may include a density of cells 124 that varies along longitudinal axis LI such that expandable web has a radius RI. Radius RI may include a maximum value RI. A difference between RO and a maximum value RI may correspond to radial offset 1902. Radial offset 1902 may be configured to be sufficiently small such that when expandable web 106 bears a radial load (not shown), expandable web 106 may deform along radial offset 1902 to transmit the radial load to expandable web 108 at maximum value RI.

FIG. 20 shows an illustrative cut pattern 2000 for an expandable web. Cut pattern 2000 includes distal end 2018. Cut pattern 2000 includes proximal end 2020. Cut pattern 2000 includes edge 2010. Cut pattern 2000 includes edge 2012.

Edge 2010 may be configured to abut edge 2012 to form a cylindrical shape about longitudinal axis LCP. “Rolling” cut pattern 2000 about axis LCP may correspond to an expandable web in a collapsed configuration. To achieve a “rolled” configuration cut pattern 2000 may be cut in a cylindrical tube.

Cut pattern 2000 may include zone 2002. Cut pattern 2000 may include zone 2004. Cut pattern 2000 may include zone 2006. Zone 2004 may include flexing members 2014. Zone 2002 may include collapsed cell pattern 2016. Zone 2006 may include a collapsed cell pattern with a higher cell density than zone 2002.

In a “rolled” configuration about axis LCP, flexing members 2014 of zone 2004 may be configured to have a less of a resistance to bending about transverse axis TCP perpendicular to axis LCP than collapsed cells 2016 of zone 2002

Increasing or decreasing a density of a collapsed cell pattern such as cell pattern 2016 may correspond to an increase or decrease of resistance to bending about axis TCP. Increasing or decreasing angle l between flexing members such as flexing members 2014 and a collapsed cell pattern such as collapsed cell pattern 2016 may corresponds to an increase or decrease in bending resistance.

Bending features of cut pattern 2000 may facilitate deployment of an implant based on cut pattern 2000 through a hole in a bone such as hole I.

FIG. 21 shows illustrative expandable implant 2100. Implant 2100 may include one or more of the features of cut pattern 2000. Z2 may correspond to an expanded state of zone 2002 of cut pattern 2000. Z1 may correspond to an expanded state of zone 2004 of state of cut pattern 2000. Z3 may correspond to an expanded state of zone 2006 of cut pattern 2000.

In an expanded state, flex members of Z1 may provide axial stiffness to implant 2100. Under axial compression along LI, flex members of Z1 may stack upon each other and resist further compression along axis LI. In a compressed state, flex member of Z1 may facilitate deployment of an implant through a hole such as hole I.

FIG. 22 shows illustrative cut pattern 2200. Cut pattern 2200 may be “rolled” about longitudinal axis LCP to form an expandable web, such as expandable web 106 and/or 108 in a collapsed state. To achieve a “rolled” configuration cut pattern 2200 may be cut in a cylindrical tube.

Cut pattern 2200 may include zone 2202. Cut pattern 2200 may include zone 2204. Zone 2202 may include a different cell density than zone 2204. Cell density of a zone may be configured to improve engagement with an anchor.

Zone 2204 may include flexing members 2206. Zone 2204 may include cell pattern 2208.

In a “rolled” configuration about axis LCP, flex member 2206 may have less of a resistance to bending about transverse axis TCP perpendicular to longitudinal axis LCP than cell pattern 2208. An increase or decrease in a length of legs of flex member 2218 may correspond to an increase or decrease in resistance to bending about axis TCP. An increase or a decrease in the angle between legs of flex member 2218 may correspond to an increase or decrease in resistance to bending about axis TCP.

In an expanded state, flex members 2206 may provide axial stiffness to an implant. Under axial compression along LCP, the legs of flex member 2218 may collapse about the apex, and resist further compression along axis LCP. Flex members 2206 may facilitate deployment of an implant through a hole such as hole I.

FIG. 23A shows illustrative cut pattern 2300. Cut pattern 2300 may include collapsed cell pattern 2302. Cut pattern 2300 may include support component 2306. Cut pattern 2300 may include support component 2304.

Cut pattern 2300, may lay flat in plane P. Cut pattern 2300 may be configured to be “rolled” about longitudinal axis LCP such that edge 2308 and edge 2310 are adjacent. To achieve a “rolled” configuration cut pattern 2300 may be cut in a cylindrical tube. Longitudinal axis LCP may correspond to a longitudinal axis of an implant, such as longitudinal axis LI of implant 100.

In a “rolled” configuration, cut pattern 2300 may be configured to expand and/or collapse about axis LCP. Width xSM of support component 2304 and width xSM of support component 2306 may be configured to lie perpendicular to plane P. Width xSM of support component 2304 and width xSM of support component 2306 may be configured to lie parallel to plane P.

Support component 2304 and support component 2306 may have a resistance to bending about transverse axis T1. Support component 2304 and support component 2306 may have a resistance to bending about transverse axis T2.

Transverse axis T2 may lie in plane P and may be perpendicular to axis LCP. Transverse axis T1 may be perpendicular to plane P and perpendicular to axis LCP. A bending resistance of support component 2304 about axis T2 may be different than a bending resistance of support component 2306 about axis T1.

When width xSM is configured to lie in and/or parallel to plane P, support component 2303 and support component 2306 may have a greater resistance to bending about axis T1 than a resistance to bending about axis T2. When width xSM is configured to be perpendicular to plane P, a bending resistance of support component 2304 and support component 2306 about axis T2 may be configured to be greater than the bending resistance about axis T1.

Width xSM may be configured to lie in and/or parallel to plane P when an implant, based on cut pattern 2300, is inserted in bone B through hole H (shown in FIG. 2). Width xSM may be configured to be perpendicular to plane P when an implant, based on cut pattern 2300, is expanded inside intermedullary space IS (shown in FIG. 2).

Support member 2304 may be configured to be rotatable with respect to plane independently of support member 2306. Support member 2306 may be configured to be rotatable with respect to plane independently of support member 2304. In one configuration, support member 2304 may lie in and/or parallel to plane P, and support member 2306 may be perpendicular to plane P.

FIG. 23B shows illustrative expandable implant 2322. Illustrative implant 2322 may include using cut pattern 2300 or any suitable cut pattern. Implant 2322 may include longitudinal axis LI. Implant 2322 may include inner expandable web 2316. Implant 2322 may include outer expandable web 2320. Implant 2322 may include support member 2314. Support member 2314 may define a plane, the plane including LI and transverse axis T2 perpendicular to LI.

Axis T2 is perpendicular to LI and perpendicular to the plane defined by T1 and LO. Support member 2314 may be more flexible about axis T1 than about axis T2.

Support member 2314 may include anchor receiving feature 2324. Anchor receiving feature may be configured to receive anchor 2318. Support member 2314 may include anchor receiving feature 2326. Anchor receiving feature 2326 may be configured to receive anchor 2314. Anchors 2314 and 2316 may be driven in a direction substantially parallel to the plane defined by LI and T2.

Implant 2322 may be orientated such that in a collapsed configuration a bending resistance about axis T1 is greater than a bending resistance about axis T2. Implant 2322 may be oriented such that in an expanded configuration, a resistance to bending about T2 is greater than a resistance to bending about axis T1.

For example, a multilayered implant such as implant 2322 may be orientated in one configuration in a collapsed configuration. The layers of implant 2322 may be rotated relative to each other when the layers are expanded or implanted in the bone. Relative rotation of the layers of implant 2322 may provide flexible in a plane while collapsed but rigid in the plane in the implanted and/or expanded state. Relative rotation of layers of an implant may facilitate insertion of the implant into a bone and/or implantation of the implant in a bone through a radiused path. Relative rotation of layers of an implant may facilitate insertion of the implant into a bone and/or implantation of the implant in a bone through a hole such as hole I.

FIG. 24A shows illustrative cut pattern 2400. Cut pattern 2400 may include structural member 2410. Cut pattern 2400 may include cross support 2402. Cut pattern 2400 may include cross support 2404. Cross support 2404 may include joint 2408. Cross support 2402 may include joint 2406.

Cut pattern 2400 may be configured to be expandable along axis ECP. Cut pattern 2400 may be collapsed along axis ECP. Cut pattern 2400 may be “rolled” about axis LCP. In a “rolled configuration” cut pattern 2400 may be expanded and/or collapsed about axis LCP. To achieve a “rolled” configuration cut pattern 2400 may be cut in a cylindrical tube.

Cross support 2402 may be configured to unfold about joint 2406 when cut pattern 2400 is expanded. Cross support 2404 may be configured to unfold about joint 2408 when cut pattern 2400 is expanded. Cross support 2402 may be configured to fold about joint 2406 when cut pattern 2400 is collapsed. Cross support 2404 may be configured to fold about joint 2408 when cut pattern 2400 is collapsed.

FIG. 24B shows illustrative implant 2412. Implant 2412 may include structural member 2418. Implant 2412 may include structural member 2420. Implant 2412 may include cross support 2414. Implant 2412 may include cross support 2416. FIG. 24B shown cross supports 2414 and 2416 in between a folded and unfolded state.

Cross supports 2414 and 2416 may be folded to facilitate insertion of implant 2412 into a bone and/or implantation of the implant in a bone through a hole such as hole I. Cross supports 2414 and 2416 may be unfolded to increase axial stiffness of implant 2412.

FIG. 25 shows illustrative expandable implant component 2500. Implant component 2500 may include cross support 2402. Implant component 2500 may include cross support 2404. Implant component 2500 structural member 2410. FIG. 25 shows cross support 2402 in a configuration unfolded about joint 2406. FIG. 25 shows cross support 2404 in a configuration unfolded about joint 2408. In an unfolded configuration, cross support 2402 and/or 2404 may be configured to provide radial support for implant component 2500 about longitudinal axis LIC.

Cross supports 2402 and/or 2404 may be configured to limit a radial expansion of component 2500. Limiting an expansion of component 2500 may limit the buckling of structural support 2410 thereby increasing axial stiffness of the component 2500. In a collapsed state, folded cross supports 2402 and/or 2404 may facilitate insertion of the implant into a bone through a hole such as hole I.

FIG. 26 shows a view of implant component 2500 along lines 5-5. FIG. 25 shows implant component 2500 in an expanded state about axis LIC. Cross support 2402 may be configured to limit a radial expansion R1 of implant component 2500 from axis LEW. Structural component 2404 may be configured to limit a radial expansion R2 of implant component 2500 from axis LIC. Limiting an expansion of component 2500 may limit a “buckling” of structural support 2410 thereby increasing axial stiffness of the component 2500.

FIG. 27 shows illustrative cut pattern 2700. Cut pattern may be “rolled” about a longitudinal axis (not shown) such that edge 2712 is configured to be adjacent to edge 2714. In a “rolled” configuration, cut pattern 1700 may be expandable from the longitudinal axis.

Cut pattern 2700 may include cell density 2702 that varies longitudinally when segment 2701 is expanded about a longitudinal axis of an implant. Cut pattern 2700 may include cell density 2704 that varies longitudinally when segment 2704 is expanded about a longitudinal axis. Cut pattern 2700 may include cell density 2706 that varies longitudinally when segment 2703 is expanded about a longitudinal axis of an implant. Cut pattern 2700 may include cell density 2708 that varies longitudinally when segment 2704 is expanded about a longitudinal axis of an implant. Cut pattern 2700 may include cell density 2710 that varies longitudinally when segment 2705 is expanded about a longitudinal axis of an implant.

To achieve a “rolled” configuration cut pattern 2700 may be cut in a cylindrical tube.

FIG. 28 shows illustrative expandable implant 2800, Implant 2800 may be configured to expand into an “umbrella” shape. Illustrative implant 2800 may include proximal end 2802 and distal end 2804, Distal end 2804 may have an expansion radius that is larger than an expansion radius of proximal end 2802. Expandable implant 2800 may be based on a single expandable web.

A larger expansion radius may support fractured segments of bone B. A larger expansion radius may support non-fractured segments of bone B. Implant 2800 may fill, partially or completely intramedullary space IS inside bone B. Implant 2800 may be used if bone B does not contain sufficient cancellous bone BCA at the distal end of intramedullary space IS.

Implant 2800 may provide multiple points of contact for implant anchors, such as anchor 126, (shown in FIG. 1) on a single expandable web.

FIG. 29 shows illustrative expandable implant 2900. Implant 2900 may be configured to expand into a “top hat” shape. Illustrative implant 2900 may include proximal member 2904 and distal member 2902. Distal member 2902 may have an expansion radius that is larger than an expansion radius of proximal member 2904, Implant 29 may include one or more of the features of implant 28.

Implant 2900 may include one expandable web having different cell densities when expanded from a longitudinal axis LI. Implant 2900 may include a first segment 2908 that is configured to expand into a profile that is ellipsoidal.

Implant 2900 may include a third segment 2906 that is configured to expand into a profile that is concave facing the first segment. Implant 2900 may include a second segment 2910 that is configured to expand into a profile that bridges from an outer radius of the third segment to an adjacent tip of the first segment.

Implant 2900 may include two or more expandable webs configured to form the “top hat” shape. The two or more expandable webs may be fixed to implant 2900 using distal hubs 110 and/or 120 (shown in FIG. 1).

FIG. 30 shows illustrative implant 3130. Implant 3130 may include longitudinal axis LI, distal hub 110 and proximal hub 110. Implant 3130 may be configured to expand into a spherical profile or “lollipop” shape. An anchor, such as anchor 126 (shown in FIG. 1) may easily engage implant 3130 without being deflected away.

FIG. 31A shows illustrative cut pattern 3138. Cut pattern 3130 may be configured to expand into a “lollipop” shape (shown in FIG. 30).

FIG. 31B shows illustrative cut pattern 3100. Cut pattern 3100 may be “rolled” about a longitudinal axis (not shown) such that edge 3118 is configured to be adjacent to edge 3116. In a “rolled” configuration, cut pattern 3100 may be expandable from the longitudinal axis. To achieve a “rolled” configuration cut pattern 3100 may be cut in a cylindrical tube.

Cut pattern 3100 may include longitudinal cell density 3102. Cut pattern 3100 may include longitudinal cell density 3104. Cut pattern 3100 may include longitudinal cell density 3106.

Cell density 3102 may be configured to expand into a first profile and a second profile. Cell density 3104 may be configured to expand into a first profile, a second profile and a third profile. Cell density 3106 may be configured to expand into a first profile. A first profile may include a substantially conical shape. A third profile may be substantially planar and substantially normal to the longitudinal axis (not shown). A second profile may be configured to bridge between the first profile and the third profile.

Cut pattern 3100 may be configured to be expandable about the longitudinal axis (not shown) into profiles that may include rectangle, rhombic, triangular, oval, round, and/or non-symmetric shapes. Cut pattern 3100 may be expandable about the longitudinal axis (not shown) into profiles that have a cross section that may include rectangle, rhombic, triangular, oval, round, and/or non-symmetric cross shapes.

FIG. 32 shows illustrative implant 3200. Implant 3200 may include longitudinal axis LI. Implant 3200 may include expandable web 3210 expandable about axis LI. Implant 3200 may include expandable web 3208 expandable about axis LI. Expandable web 3210 may be external to expandable web 3208.

Expandable web 3210 may be configured to expand into profile 3202 about axis LI. Profile 3202 may be substantially conical. Expandable web 3210 may be configured to expand into profile 3206 about axis LI. Profile 3206 may be substantially planar and substantially normal to longitudinal axis LI. Profile 3204 may be configured to expand about axis LI and bridge between profile 3202 and profile 3206.

FIG. 33 shows illustrative implant 3300. Implant 3300 may include supporting member 3302. Supporting member 3302 may extend from proximal end 3306 of implant 3300 to distal end 3308 of implant 3300. Implant 3300 may include bone engaging member 3304. Bone engaging member 3304 may extend from proximal end 3306 of implant 3300 alongside support member 3302 for length 3312. Bone engaging member 3304 may diverge from support member 3302 for length 3314. Bone engaging member 3304 may diverge from support member 3302 at angle φ.

Tip 3310 may be configured to engage cancellous bone BCA of bone B (shown in FIG. 2). Bone engaging member 3304 may be configured to resist translational movement between implant 3300 and bone B. Bone engaging member 3304 may be configured to resist rotational movement between implant 3300 and bone B.

FIG. 34 shows a view of implant 3300 from proximal end 3306. Bone engaging member 3304 may be configured to extend alongside support member 3302 in a direction substantially perpendicular to a surface 3402 of support member 3302. Bone engaging member 3304 may be configured to provide axial support to implant 3300 along a longitudinal axis (not shown) of implant 3300. Bone engaging member 3304 may be configured to provide radial support to implant 3300 about a longitudinal axis (not shown) of implant 3300.

Angle α formed between bone engaging member 3304 and support member 3302 may be substantially 90 degrees. Bone engaging member 3304 and support member 3302 may form a “L”, “U” or any other suitable shape.

FIG. 35 shows illustrative implant 3500. Implant 3500 may include web 3504. Implant 3500 may include support structure 3502. Implant 3500 may include bone engaging member 3506. Bone engaging member 3506 may pass through web 3504. Bone engaging member 3506 may pass through web 3504 at angle μ between web 3504 and bone engaging member 3506.

Bone engaging member 3506 may pass through support structure 3502. Bone engaging member 3506 may pass through support structure 3502 at angle β between support structure 3502 and bone engaging member 3506.

Bone engaging member 3502 may be independent of implant 3500. Bone engaging member 3506 may be configured to be inserted into access hole H (showing in FIG. 1) after implant 3500.

Tip 3508 may engage cancellous bone BCA of bone B (shown in FIG. 2). Bone engaging member 3506 may be configured to resist translational movement between implant 3500 and bone B. Bone engaging member 3506 may be configured to resist rotational movement between implant 3500 and bone B.

FIG. 36 shows a distal view of illustrative implant 3500. One or more bone engaging member 3505 may be configured to engage cancellous bone BCA. One or more bone engaging members 3506 may

FIG. 37 shows illustrative expandable implant 3700 inside bone B (shown in FIG. 2). Bone B is shown with fractures Fh and Fa. Implant 3700 may be configured to repair fractures Fh and Fa. Anchors 3702 and 3704 may be configured to fix bone portions Pa and Ph to implant 3700.

Bone engaging member 3506 may be configured to resist translational motion between implant 3700 and bone B. Bone engaging member 3506 may be configured to resist rotational motion between implant 3700 and bone B. Bone engaging member 3606 may engage cancellous bone BCA. Bone engaging member 3506 may engage cortical bone BCO.

FIG. 38 shows illustrative implant 3800. Implant 3800 may include expandable web 3804. Implant 3800 may include scissor type locking mechanism 3802. Locking mechanism 3802 may be located at a distal end of implant 3800. Locking mechanism 3802 may be configured to expand. Locking mechanism 3802 may be configured to collapse. Locking mechanism 3802 may be configured to expand and/or collapse by rotating about pivot axis PD.

Scissor type locking mechanism 3802 may be configured to engage bone B. Scissor type locking mechanism 3802 may be configured to fix implant 3800 to bone B. Locking mechanism 3802 may be configured to resist rotational motion between implant 3800 and bone B. Locking mechanism 3802 may be configured to resist translational motion between implant 3800 and bone B.

Implant 3800 may include scissor type locking mechanism 3806. Locking mechanism 3806 may be located at a proximal end of implant 3800. Locking mechanism 3806 may include pivot axis PP. Locking mechanism may expand and/or collapse about axis PP. Locking mechanism 3806 may include one or more of the features of locking mechanism 3802.

FIG. 39 shows illustrative implant 3900. Implant 3900 may include expandable web 3804. Implant 3900 may include scissor type locking mechanism 3806. Implant 3900 may include scissor type locking mechanism 3902.

Scissor type locking mechanism 3902 may be configured to fix implant 3900 to bone B (shown in FIG. 2). Locking mechanism 3902 may be configured to pivot about pivot axis PD. Expansion of locking mechanism 3902 against bone B may fix implant 3900 relative to bone B. Locking mechanism 3902 may be configured to resist rotational motion between implant 3900 and bone B. Locking mechanism 3902 may be configured to resist translational motion between implant 3900 and bone B.

FIG. 40 shows illustrative web 4000. Web 4000 may be representative of webs that may be used in connection with implants shown and described herein. For example, a web such as web 4000 may be included in implant 100 (shown in FIG. 1), implant 300 (shown in FIG. 3), implant 1312 (shown in FIG. 13), implant 2100 (shown in FIG. 21), implant 2320 (shown in FIG. 23b), implant 2800 (shown in FIG. 28), implant 2900 (shown in FIG. 29), implant 3130 (shown in FIG. 31a), implant 3200 (shown in FIG. 32), implant 3500 (shown in FIG. 25), implant 3804 (shown in FIG. 38) and any other suitable implants.

Web 4000 may include one or more cells such as cell 4002. Web 4000 may include a front 4010 and a back 4012. Cell 4002 is configured to receive anchor 4004. Anchor 4004 may have one or more features in common with anchors such as anchor 114, 116, and 126 (shown in FIG. 1), 1204 (shown in FIG. 12), 1314 (shown in FIG. 13) and any other suitable anchors. Anchor 4004 may be configured to secure a fragment of bone B to web 4000.

Cell 4002 may have an opening that is large enough to allow passage of anchor root 4006 through cell 4002 without deformation of cell 4002 when anchor 4004 is oriented normal to cell 4002. Such a cell may be referred to as an “open cell.” If anchor 4004 were to penetrate cell 4002 at an oblique angle, such that less than the full opening of cell 4002 were present in a plane normal to anchor 4004, cell 4002 may deform to accommodate root 4006.

Cell 4002 may be open by virtue of expansion from a closed state. Cell 4002 may be fabricated in an open state. Cell 4002 may be implanted in bone B (shown in FIG. 2) in an open state. Cell 4002 may be implanted in bone B (shown in FIG. 2) in a closed state. Cell 4002 may be expanded after deployment in bone B.

Anchor 4004 may include engagement feature 4008. Engagement feature 4008 may be configured to engage the back 4012 of cell 4002 and apply tension between cell 4002 and a bone fragment of bone B. Anchor 4004 may be configured to prevent disengagement of engagement feature 4004 from back 4012 of cell 4002 when tension is applied. Cell 4002 may be configured to eb elastically deformed when tension is applied.

FIG. 41 shows illustrative threaded anchor 4100. Threaded anchor 4100 may be configured to apply tension between a fragment of bone B and web 4000. Threaded anchor 4100 may be configured to engage cell 4002 based on a metric of threaded anchor 4100. Threaded anchor 4100 may include root 4102. Threaded anchor 4100 may include crest 4104.

A metric of threaded anchor 4100 may include major diameter Dmaj, minor diameter Dmin, mean diameter Dmean, thread angle σ, thread pitch δ. A metric of threaded anchor 4100 may be selected based on a limitation on how much tension may be applied to a cell such as cell 4002.

FIGS. 42(A)-(C) show illustrative threaded anchors 4230, 4220 and 4200. Anchors 4230, 4220 and 4200 may include one or more of the metrics of threaded anchor 4100. Anchor 4230 includes head portion 4234. Head portion 4234 may include axis 4232. Anchor 4220 includes head portion 4224. Head portion 4224 may include axis 4222. Anchor 4200 includes head portion 4204. Head portion 4204 may include axis 4202.

Head portions 4234, 4224 and 4202 may be configured to form an angle Φ with bone surface BS (shown in FIG. 2). Based on angle Φ, an anchor most atraumatic to bone B may be selected.

FIG. 43 shows illustrative skeleton S. Skeleton S includes illustrative bones Si in which illustrative implants described herein may be used as shown and described in connection with bone B (shown in FIG. 2). Table 2 includes a partial list of bones Si.

TABLE 2

Bones S_i.

Reference

numeral in

Bone
FIG. 2

Distal Radius
S₀

Humerus
S₁

Proximal Radius and Ulna (Elbow)
S₂

Metacarpals
S₃

Clavicle
S₄

Ribs
S₅

Vertebrae
S₆

Ulna
S₇

Hip
S₈

Femur
S₉

Tibia
S₁₀

Fibula
S₁₁

Metatarsals
S₁₂

FIG. 44 schematically shows anatomy of bone B (shown in FIG. 2). Anatomical features of bone B are listed in Table 2. Apparatus and methods in accordance with the principles of the invention may involve one or more of the anatomical features shown in Table 3. Features of bone B may be described in reference to bone axis LB (in which B indicates bone) and radius RB (in which B indicates bone).

TABLE 3

Anatomical features of some of the bone types that may be treated by

the apparatus and methods.

Reference numeral

Anatomical feature
in FIG. 44

Articular surface
B₀

Cancellous, spongy or trabecular bone
B₁

Medullary cavity
B₂

Cortical or dense bone
B₃

Periosteum
B₄

Proximal articular surface
B₅

Diaphysis or midshaft
B₆

Metaphysis or end region
B₇

Epiphysis
B₈

Articular surface
B₉

The terms “end-bone” and “end-bone fracture” may be used to refer to fractures that occur in the epiphyseal or metaphyseal region of long bones. Such fractures include peri-articular and intra-articular fractures.

FIG. 45 shows illustrative instrument guide 4500 for positioned at site H′ on bone B. Illustrative instrument guide 4500 may be configured to prepare bone B for delivery of illustrative implants described herein. Broach head 4524 may be delivered through guide 4500 to target region R_tof intramedullary space IS. Target region R_tis illustrated as being within cancellous bone B_CA, but could be in either, or both, of cancellous bone B_CAand cortical bone B_CO. Side template 4530 and top template 4532 are registered to guide tube 4520. Arm 4531 may support template 4530. A practitioner may position templates 4530 and 4532 such that templates 4530 and 4532 “project” onto target region R_tso that guide 4500 will guide broach head 4524 to target region R_t.

Template 4530 may include lobe outline 4534 and shaft outline 4536 for projecting, respectively, a “swept-out” area of broach head 4524 and a location of shaft-like structure 4525. Template 4532 may include lobe outline 4538 and shaft outline 4540 for projecting, respectively, a target “swept-out” area of broach head 4524 and a target location of shaft-like structure 4525. Templates 4530 and 4532 may be configured to project a shape of any suitable instrument that may be deployed, such as a drill, a coring saw, a prosthetic device or any other suitable instrument.

Fluoroscopic imaging may be used to position templates 4530 and 4532 relative to target region R_t.

Broach head 4524 may rotate in intramedullary space IS to clear intramedullary bone matter so that a prosthetic device may be implanted. Broach head 4524 may be driven and supported by broach control 4526 and broach sheath 4527.

Guide 4500 may include base 4502. Alignment members 4504 and 4506 may extend from base 4502 to align guide centerline CL_Gof guide 4500 with bone centerline CL_BSof the top surface of bone B. One or both of alignment members 4504 and 4506 may be resilient. One or both of alignment members 4504 and 4506 may be stiff.

Alignment members 4504 and 4506 (not shown) may be relatively free to slide along surfaces of bone B. Guide 4500 may include contacts 4508 and 4510 that may engage bone B along centerline CL_BS. Contacts 4508 and 4510 may extend from a bottom surface (not shown) of guide 4500. Contacts 4508 and 4510 may prevent guide centerline CL_Gfrom rotating out of alignment with bone centerline CL_BS.

Contacts 4508 and 4510 may assure alignment of guide 4500 with the surface of bone B, because two points of contact may be stable on an uneven surface even in circumstances in which 3, 4 or more contacts are not stable.

Guide 4500 may include lateral cleats 4512 and 4514 (not shown). Lateral cleats 4512 and 4514 may engage the surface of bone B to prevent guide 4500 from rotating in direction θ about guide centerline CL_G. Lateral cleats 4512 and 4514 may be resilient to allow some sliding over bone B.

When a practitioner positions guide 4500 on bone B, alignment members 4504 and 4506 may be the first components of guide 4500 to engage bone B. Alignment members 4504 and 4506 may bring guide centerline CL_Ginto alignment with bone centerline CL_BSbefore contacts 4508 and 4510 and cleats 4512 and 4514 engage bone B. Then, in some embodiments, cleats 4512 and 4514 may engage bone B to inhibit rotation in direction θ. Then, in some embodiments, contacts 4508 and 4510 may engage bone B along bone centerline CL_BS. Contacts 4508 and 4510 may have sharp points to provide further resistance to de-alignment of guide centerline CL_Gfrom bone centerline CL_BS. In some embodiments, there may be no more than two contacts (e.g., 4508 and 4510) to ensure that the contacts are in line with bone centerline CL_BS.

Guide 4500 may include stem 4516 and grip 4518. A practitioner may manually grip grip 4518. In some embodiments, a torque-limiter (not shown) may be provided to limit the torque that the practitioner can apply via grip 4518 to contacts 4508 and 4510.

Guide tube 4520 may receive and guide any suitable instrument. Guide tube 4520 may be oriented at angle α with respect to handle 4516. In some embodiments, angle α may be fixed. In some embodiments, angle α may be adjustable. In some embodiments, templates 4530 and 4532 may be fixed relative to guide tube 4520. In some embodiments, including some embodiments in which α is adjustable and some in which α is not adjustable, guide tube 4520 may be oriented so that the axis L_GTof guide tube 4520 intersects bone B at substantially the same point as does axis L_Hof stem 4516. Grip 4518 will thus be positioned directly over the center of hole site H′.

Guide 4500 may include channels 4542 and 4544 (not shown). Rods 4546 and 4548 may be inserted through channels 4542 and 4544, respectively, through cortical bone B_CO. Rods 4546 and 4548 may stabilize guide 4500 on bone B. Rods 4546 and 4548 may be K-wires. Rods 4546 and 4548 may be inserted using a wire drill.

Apparatus and methods described herein are illustrative. Apparatus and methods of the invention may involve some or all of the features of the illustrative apparatus and/or some or all of the steps of the illustrative methods. The steps of the methods may be performed in an order other than the order shown and described herein. Some embodiments of the invention may omit steps shown and described in connection with the illustrative methods. Some embodiments of the invention may include steps that are not shown and described in connection with the illustrative methods.

Although the invention has been described in terms of particular embodiments and applications, one of ordinary skill in the art, in light of this teaching, can generate additional embodiments and modifications without departing from the spirit of or exceeding the scope of the principles of the invention. Accordingly, it is to be understood that the drawings and descriptions herein are proffered by way of example to facilitate comprehension of the invention and should not be construed to limit the scope thereof.

Thus, apparatus and methods for fracture repair have been provided. Persons skilled in the art will appreciate that the present invention can be practiced by other than the described embodiments, which are presented for purposes of illustration rather than of limitation. The present invention is limited only by the claims that follow.

Claims

1. A bone implant defining a longitudinal axis and comprising: an orthopedic mesh of expandable cells, the orthopedic mesh being operationally expandable, away from the longitudinal axis, inside a bone, the expandable cells including distal cells, each distal cell supporting a stem that extends away from the distal cell toward a hub, each stem supporting a tab that extends transverse to the stem, the hub defining enclosures, each enclosure;retaining a corresponding one of the tabs;providing clearance for the corresponding tab to rotate inside the enclosure; anddefining a clearance notch that allows a corresponding one of the stems an angular range of motion with respect to the longitudinal axis.
2. The bone implant of claim 1 the hub further comprising: a distal end-cap that, in operation, prevents the tabs from sliding out of a distal side of the enclosures; anda proximal end-cap that, in operation, prevents the tabs from sliding out of a proximal side of the enclosures.
3. The bone implant of claim 2 wherein the distal end-cap includes a detent surface that, in operation, limits the angular range of motion of the stems during expansion of the orthopedic mesh.
4. The bone implant of claim 3 wherein the distal end-cap covers a planar area defined by each of the enclosures.
5. The bone implant of claim 2 wherein the proximal end-cap includes a plurality of clearance notches, each clearance notch of the proximal end cap aligned with a corresponding one of the clearance notches to defined by the hub.
6. The bone implant of claim 2 wherein, at least one of the distal end-cap or the proximal end-cap is separable from the hub to admit the tabs into the enclosures.
7. The bone implant of claim 1 wherein the hub is an outer-distal hub and the expandable orthopedic mesh is an outer expandable orthopedic mesh, the bone implant further comprising: an inner expandable orthopedic mesh; andan inner-distal hub that fixes a distal end of the inner expandable orthopedic mesh longitudinally relative to the longitudinal axis.
8. The bone implant of claim 7, wherein, the inner-distal hub and the outer-distal hub are circular, the inner-distal hub has a diameter that is less than a diameter of the outer-distal hub.
9. The bone implant of claim 8 wherein: the clearance notches in the outer-distal hub are a first plurality of clearance notches; andthe inner-distal hub defines a second plurality of clearance notches.
10. The bone implant of claim 9, wherein, in operation, the second plurality of clearance notches provide stems of the inner expandable orthopedic mesh with an angular range of motion such that the stems of the inner expandable mesh may be positioned, with respect to the longitudinal axis, at any angle ϵ, wherein 0°≤ϵ≤90°.
11. The bone implant of claim 10 wherein, in operation, the first plurality of clearance notches provide the stems of the outer expandable orthopedic mesh with the angular range of motion such that the stems of the outer expandable orthopedic mesh may be positioned, with respect to the longitudinal axis, at any angle η, wherein 0°≤η≤90°.
12. The bone implant of claim 1 wherein the hub is rotatable about the longitudinal axis.
13. The bone implant of claim 1 wherein the hub is rotationally fixed relative to the longitudinal axis.
14. The bone implant of claim 1 wherein: in a collapsed state, the expandable orthopedic mesh defines a cylindrical surface; andeach of the tabs has a face that comprises an extension of the cylindrical surface.
15. A bone implant comprising: an expandable orthopedic web;a plurality of stems that extend from a distal end of the expandable orthopedic web;a plurality of circumferential members, each circumferential member extending transversely from a corresponding one of the stems; anda hub that defines a plurality of enclosures, each enclosure: retaining a corresponding one of the circumferential members and providing clearance for rotation of the retained circumferential member when the expandable orthopedic web expands; andcomprising a notch that provides clearance for a stem that supports the retained circumferential member and not for the retained circumferential member itself.
16. The bone implant of claim 15 wherein the hub is an outer hub and the expandable orthopedic web is an outer expandable orthopedic web, the bone implant further comprising: an inner expandable orthopedic web;a plurality of inner stems extending from the inner expandable orthopedic web;a plurality of inner circumferential members, each inner circumferential member extending transversely to a corresponding one of the plurality of inner stems; andan inner hub comprising a plurality of inner enclosures, each inner enclosure that retains a corresponding one of the plurality of inner circumferential members.
17. The bone implant of claim 16, wherein: the inner hub and the outer hub are circular; andthe inner hub has a diameter that is less than a diameter of the outer hub.
18. The bone implant of claim 16 wherein each inner enclosure comprises a notch that provides clearance for a corresponding inner stem and not for an inner circumferential member that extends transversely to the corresponding inner stem.
19. The bone implant of claim 16, wherein, the bone implant defines a longitudinal axis and, in operation, the notches of the inner hub provide the inner expandable orthopedic web with an angular range of motion such that each of the inner stems may be positioned, relative to the longitudinal axis, at any angle ϵ, wherein 0°≤ϵ≤90°.
20. The bone implant of claim 16, wherein: the bone implant defines a longitudinal axis;the inner expandable orthopedic web, in a collapsed state, is positioned substantially parallel to the longitudinal axis; andthe outer expandable orthopedic web, in a collapsed state, is positioned substantially parallel to the longitudinal axis.
21. The bone implant of claim 15 wherein, in operation, when the expandable orthopedic web expands, the notch allows the stem to move from a position substantially parallel to a longitudinal axis of the bone implant to a position that is greater than 0° and less than or equal to 90° relative to the longitudinal axis.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No. 13/043,190, filed on Mar. 8, 2011, which claims the benefit of U.S. Provisional Applications No. 61/311,494, filed on Mar. 8, 2010 and 61/378,822 filed on Aug. 31, 2010, all of which are hereby incorporated by reference in their entireties.

US Referenced Citations (1008)

Number	Name	Date	Kind
1362513	Skinner	Dec 1919	A
1344327	Wilson	Jun 1920	A
1493240	Bohn	May 1924	A
1685380	Shultz	Sep 1928	A
2137710	Anderson	Dec 1937	A
2485531	Dzus et al.	Jan 1948	A
2493598	Rozek	Jan 1950	A
2537070	Longfellow	Jan 1951	A
2580821	Nicola	Jan 1952	A
2730101	Hoffman	Jan 1956	A
2780223	Haggland	Feb 1957	A
2898963	Courtot	Aug 1959	A
3143915	Tendler	Aug 1964	A
3143916	Rice	Aug 1964	A
3146892	White	Sep 1964	A
3181533	Heath	May 1965	A
3386169	Scialom	Jun 1968	A
3495586	Regenbogen	Feb 1970	A
3517128	Hines	Jun 1970	A
3593342	Niebauer et al.	Jul 1971	A
3602218	Riordan	Aug 1971	A
3623164	Bokros	Nov 1971	A
3640280	Slanker et al.	Feb 1972	A
3702611	Fishbein	Nov 1972	A
3710789	Ersek	Jan 1973	A
3744488	Cox	Jul 1973	A
3745590	Stubstad	Jul 1973	A
3759257	Fischer et al.	Sep 1973	A
3760802	Fischer et al.	Sep 1973	A
3779239	Fischer et al.	Dec 1973	A
3805775	Fischer et al.	Apr 1974	A
3828790	Curtiss et al.	Aug 1974	A
3835859	Roberts et al.	Sep 1974	A
3886600	Kahn et al.	Jun 1975	A
3909853	Lennox	Oct 1975	A
3917249	Constantine	Nov 1975	A
3946445	Bentley et al.	Mar 1976	A
3970075	Sindelar et al.	Jul 1976	A
3986504	Avila	Oct 1976	A
3992726	Freeman et al.	Nov 1976	A
4036107	Constantine	Jul 1977	A
4091806	Aginsky	May 1978	A
4124026	Berner et al.	Nov 1978	A
4156296	Johnson et al.	May 1979	A
4180871	Hamas	Jan 1980	A
4190044	Wood	Feb 1980	A
4193139	Walker	Mar 1980	A
4194250	Walker	Mar 1980	A
4203444	Bonnell et al.	May 1980	A
4204531	Aginsky	May 1980	A
4213208	Marne	Jul 1980	A
4227518	Aginsky	Oct 1980	A
4229840	Gristina	Oct 1980	A
4231121	Lewis	Nov 1980	A
4262665	Roalstad et al.	Apr 1981	A
4273128	Lary	Jun 1981	A
4274398	Scott et al.	Jun 1981	A
4275717	Bolesky	Jun 1981	A
4293962	Fuson	Oct 1981	A
4313434	Segal	Feb 1982	A
4349922	Agee	Sep 1982	A
4352212	Greene et al.	Oct 1982	A
4430991	Darnell	Feb 1984	A
4438762	Kyle	Mar 1984	A
4453539	Raftopoulos et al.	Jun 1984	A
4473070	Matthews et al.	Sep 1984	A
4485816	Krumme	Dec 1984	A
4502554	Jones	Mar 1985	A
4519100	Wills et al.	May 1985	A
4522200	Stednitz	Jun 1985	A
4530114	Tepic	Jul 1985	A
4548199	Agee	Oct 1985	A
4572186	Gould et al.	Feb 1986	A
4573448	Kambin	Mar 1986	A
4585000	Hershenson	Apr 1986	A
4590930	Kurth et al.	May 1986	A
4601290	Effron et al.	Jul 1986	A
4608965	Anspach, Jr.	Sep 1986	A
4611594	Grayhack	Sep 1986	A
4619122	Simpson	Oct 1986	A
4627434	Murray	Dec 1986	A
4634445	Helal	Jan 1987	A
4643177	Sheppard et al.	Feb 1987	A
4644951	Bays	Feb 1987	A
4646738	Trott	Mar 1987	A
4655203	Tormala et al.	Apr 1987	A
4660557	Collis	Apr 1987	A
4662371	Whipple et al.	May 1987	A
4665906	Jervis	May 1987	A
4669237	Constantine	Jun 1987	A
4674488	Nashef et al.	Jun 1987	A
4705027	Klaue	Nov 1987	A
4721103	Freedland	Jan 1988	A
4730608	Schlein	Mar 1988	A
4731087	Sculco et al.	Mar 1988	A
4751922	DiPietropolo	Jun 1988	A
4772261	Von Hoff	Sep 1988	A
4777942	Frey et al.	Oct 1988	A
4782833	Einhorn et al.	Nov 1988	A
4790302	Colwill et al.	Dec 1988	A
4809793	Hailey	Mar 1989	A
4820305	Harms et al.	Apr 1989	A
4875474	Border	Oct 1989	A
4886062	Wiktor	Dec 1989	A
4914818	Hall et al.	Apr 1990	A
4921478	Solano et al.	May 1990	A
4941466	Romano	Jul 1990	A
4946459	Bradshaw et al.	Aug 1990	A
4954126	Wallsten	Sep 1990	A
4955916	Carignan et al.	Sep 1990	A
4969888	Scholten et al.	Nov 1990	A
4973257	Lhotak	Nov 1990	A
4978349	Frigg	Dec 1990	A
4998539	Delsanti	Mar 1991	A
5002546	Romano	Mar 1991	A
5015255	Kuslich	May 1991	A
5030201	Palestrant	Jul 1991	A
5035714	Willert et al.	Jul 1991	A
5053036	Perren et al.	Oct 1991	A
5057103	Davis	Oct 1991	A
5059193	Kuslich	Oct 1991	A
5059206	Winters	Oct 1991	A
5062845	Kuslich et al.	Nov 1991	A
5066296	Chapman et al.	Nov 1991	A
5067957	Jervis	Nov 1991	A
5071407	Termin	Dec 1991	A
5084050	Draenert	Jan 1992	A
5100423	Fearnot	Mar 1992	A
5102413	Poddar	Apr 1992	A
5108404	Scholten et al.	Apr 1992	A
5108435	Gustavson et al.	Apr 1992	A
5112333	Fixel	May 1992	A
5113846	Hiltebrandt et al.	May 1992	A
5116335	Hannon et al.	May 1992	A
5122134	Borzone et al.	Jun 1992	A
5129906	Ross	Jul 1992	A
5135527	Ender	Aug 1992	A
5139497	Tilghman et al.	Aug 1992	A
5151103	Tepic et al.	Sep 1992	A
5169402	Elloy	Dec 1992	A
5171284	Branemark	Dec 1992	A
5174374	Hailey	Dec 1992	A
5180382	Frigg et al.	Jan 1993	A
5190545	Corsi et al.	Mar 1993	A
5190546	Jervis	Mar 1993	A
5190548	Davis	Mar 1993	A
5197966	Sommerkamp	Mar 1993	A
5197967	Wilson	Mar 1993	A
5197971	Bonutti	Mar 1993	A
5201741	Dulebohn	Apr 1993	A
5203773	Green	Apr 1993	A
5221261	Termin et al.	Jun 1993	A
5236431	Gogolewski et al.	Aug 1993	A
5242017	Hailey	Sep 1993	A
5242461	Kortenbach et al.	Sep 1993	A
5250048	Gundolf	Oct 1993	A
5263955	Baumgart et al.	Nov 1993	A
5269785	Bonutti	Dec 1993	A
5275602	Shimizu et al.	Jan 1994	A
5275608	Forman et al.	Jan 1994	A
5281225	Vicenzi	Jan 1994	A
5281226	Davydov et al.	Jan 1994	A
5286249	Thibodaux	Feb 1994	A
5307790	Byrne	May 1994	A
5314486	Zang et al.	May 1994	A
5326205	Anspach et al.	Jul 1994	A
5334184	Bimman	Aug 1994	A
5358405	Imai	Oct 1994	A
5376097	Phillips	Dec 1994	A
5376100	Lefebvre	Dec 1994	A
5378239	Termin et al.	Jan 1995	A
5380328	Morgan	Jan 1995	A
5397320	Essig	Mar 1995	A
5415660	Campbell et al.	May 1995	A
5423823	Schmieding	Jun 1995	A
5431671	Nallakrishnan	Jul 1995	A
5437665	Munro	Aug 1995	A
5437674	Worcel et al.	Aug 1995	A
5439464	Shapiro	Aug 1995	A
5445639	Kuslich et al.	Aug 1995	A
5454365	Bonutti	Oct 1995	A
5458599	Adobbati	Oct 1995	A
5458648	Berman et al.	Oct 1995	A
5462547	Weigum	Oct 1995	A
5467763	McMahon et al.	Nov 1995	A
D365634	Morgan	Dec 1995	S
5474557	Mai	Dec 1995	A
5480447	Skiba	Jan 1996	A
5496277	Termin et al.	Mar 1996	A
5496330	Bates	Mar 1996	A
5499981	Kordis	Mar 1996	A
5501695	Anspach, Jr.	Mar 1996	A
5505734	Caniggia et al.	Apr 1996	A
5509919	Young	Apr 1996	A
5512037	Russell et al.	Apr 1996	A
5527316	Stone et al.	Jun 1996	A
5531792	Huene	Jul 1996	A
5536267	Edwards et al.	Jul 1996	A
5540693	Fisher	Jul 1996	A
5545162	Huebner	Aug 1996	A
5554163	Shturman	Sep 1996	A
5556408	Farhat	Sep 1996	A
5571098	Domankevitz et al.	Nov 1996	A
5571189	Kuslich	Nov 1996	A
5578035	Lin	Nov 1996	A
5582577	Lund et al.	Dec 1996	A
5582618	Chin et al.	Dec 1996	A
5586983	Sanders et al.	Dec 1996	A
5586985	Putnam et al.	Dec 1996	A
5586990	Hahnen et al.	Dec 1996	A
5591169	Benoist	Jan 1997	A
5591170	Spievack et al.	Jan 1997	A
5597378	Jervis	Jan 1997	A
5602935	Yoshida et al.	Feb 1997	A
5620414	Campbell	Apr 1997	A
5620445	Brosnahan et al.	Apr 1997	A
5624440	Huebner	Apr 1997	A
5624447	Myers	Apr 1997	A
5626580	Brosnahan	May 1997	A
5628747	Richelsoph	May 1997	A
5645589	Li	Jul 1997	A
5658280	Issa	Aug 1997	A
5658283	Huebner	Aug 1997	A
5660188	Groiso	Aug 1997	A
5662649	Huebner	Sep 1997	A
5667509	Westin	Sep 1997	A
5676545	Jones	Oct 1997	A
5676699	Gogolewski et al.	Oct 1997	A
5681310	Yuan et al.	Oct 1997	A
5683389	Orsak	Nov 1997	A
5685826	Bonutti	Nov 1997	A
5693011	Onik	Dec 1997	A
5697981	Ison et al.	Dec 1997	A
5707374	Schmidt	Jan 1998	A
5709697	Ratcliff et al.	Jan 1998	A
5718704	Medoff	Feb 1998	A
5725541	Anspach, III et al.	Mar 1998	A
5728047	Edoga	Mar 1998	A
5728098	Sherman et al.	Mar 1998	A
5730704	Avitall	Mar 1998	A
5741266	Moran et al.	Apr 1998	A
5741282	Anspach et al.	Apr 1998	A
5758713	Fallet	Jun 1998	A
5779703	Benoist	Jul 1998	A
5792106	Mische	Aug 1998	A
5810721	Mueller et al.	Sep 1998	A
5814044	Hooven	Sep 1998	A
5817098	Albrektsson et al.	Oct 1998	A
5824095	Di Maio, Jr. et al.	Oct 1998	A
5827289	Reiley et al.	Oct 1998	A
5827312	Brown et al.	Oct 1998	A
D403069	Drewry et al.	Dec 1998	S
5853054	McGarian et al.	Dec 1998	A
5876399	Chia et al.	Mar 1999	A
5879352	Filoso et al.	Mar 1999	A
5879355	Ullmark	Mar 1999	A
5885258	Sachdeva et al.	Mar 1999	A
5885282	Szabo	Mar 1999	A
5888196	Bonutti	Mar 1999	A
5891147	Moskovitz et al.	Apr 1999	A
5893850	Cachia	Apr 1999	A
5897556	Drewry et al.	Apr 1999	A
5908423	Kashuba et al.	Jun 1999	A
5915036	Grunkin et al.	Jun 1999	A
5919195	Wilson et al.	Jul 1999	A
5925039	Landingham	Jul 1999	A
5928239	Mirza	Jul 1999	A
5935127	Border	Aug 1999	A
5938699	Campbell	Aug 1999	A
5941878	Medoff	Aug 1999	A
5951467	Picha et al.	Sep 1999	A
5951556	Faccioli et al.	Sep 1999	A
5957884	Hooven	Sep 1999	A
5964698	Fowler	Oct 1999	A
5976134	Huebner	Nov 1999	A
5980525	Bryant et al.	Nov 1999	A
5984932	Yoon	Nov 1999	A
5984937	Morse et al.	Nov 1999	A
5997538	Asnis et al.	Dec 1999	A
6001099	Huebner	Dec 1999	A
6015406	Goble et al.	Jan 2000	A
6019762	Cole	Feb 2000	A
6019947	Kucherov	Feb 2000	A
6030406	Davis	Feb 2000	A
6033412	Losken et al.	Mar 2000	A
6045564	Walen	Apr 2000	A
6048309	Flom et al.	Apr 2000	A
6053922	Krause et al.	Apr 2000	A
6056750	Lob	May 2000	A
6068642	Johnson et al.	May 2000	A
6068648	Cole et al.	May 2000	A
6074392	Durham	Jun 2000	A
6093162	Fairleigh et al.	Jul 2000	A
6096040	Esser	Aug 2000	A
6113603	Medoff	Sep 2000	A
6120472	Singer, Jr.	Sep 2000	A
6120504	Brumback et al.	Sep 2000	A
6123704	Hajianpour	Sep 2000	A
6126662	Carmichael et al.	Oct 2000	A
6127597	Beyar et al.	Oct 2000	A
6129762	Li	Oct 2000	A
6142935	Flom et al.	Nov 2000	A
6143012	Gausepohl	Nov 2000	A
6149651	Drewry et al.	Nov 2000	A
6149689	Grundei	Nov 2000	A
6156069	Amstutz	Dec 2000	A
6162223	Orsak et al.	Dec 2000	A
6162224	Huebner	Dec 2000	A
6171309	Huebner	Jan 2001	B1
6174312	Laminger	Jan 2001	B1
6197027	Hajianpour	Mar 2001	B1
6200330	Benderev et al.	Mar 2001	B1
6216573	Moutafis et al.	Apr 2001	B1
6221074	Cole et al.	Apr 2001	B1
6221102	Baker et al.	Apr 2001	B1
6224600	Protogirou	May 2001	B1
6224604	Suddaby	May 2001	B1
6231576	Frigg et al.	May 2001	B1
6235043	Reiley et al.	May 2001	B1
6238417	Cole	May 2001	B1
6241734	Scribner et al.	Jun 2001	B1
6248110	Reiley et al.	Jun 2001	B1
6258096	Seki	Jul 2001	B1
6261289	Levy	Jul 2001	B1
6280474	Cassidy et al.	Aug 2001	B1
6296639	Truckai et al.	Oct 2001	B1
6299642	Chan	Oct 2001	B1
6302915	Cooney, III et al.	Oct 2001	B1
6306141	Jervis	Oct 2001	B1
6312467	McGee	Nov 2001	B1
6319255	Grundei et al.	Nov 2001	B1
6322591	Ahrens	Nov 2001	B1
6331166	Burbank et al.	Dec 2001	B1
6332885	Martella	Dec 2001	B1
6332886	Green et al.	Dec 2001	B1
6337142	Harder et al.	Jan 2002	B2
6348053	Cachia	Feb 2002	B1
6364909	McGee	Apr 2002	B1
6365555	Moser et al.	Apr 2002	B1
6375666	Mische	Apr 2002	B1
6383188	Kuslich et al.	May 2002	B2
6402753	Cole et al.	Jun 2002	B1
6411729	Grunkin	Jun 2002	B1
6416517	Harder et al.	Jul 2002	B2
6423070	Zeppelin	Jul 2002	B1
6440138	Reiley et al.	Aug 2002	B1
6447514	Stalcup et al.	Sep 2002	B1
6447515	Meldrum	Sep 2002	B1
6447518	Krause et al.	Sep 2002	B1
6454810	Lob	Sep 2002	B1
6468207	Fowler	Oct 2002	B1
6475789	Cech et al.	Nov 2002	B1
6488685	Manderson	Dec 2002	B1
6491694	Orsak	Dec 2002	B1
6511481	von Hoffmann et al.	Jan 2003	B2
6517541	Sesic	Feb 2003	B1
6527775	Warburton	Mar 2003	B1
6533788	Orbay	Mar 2003	B1
6540770	Tornier et al.	Apr 2003	B1
6544267	Cole et al.	Apr 2003	B1
6551321	Burkinshaw	Apr 2003	B1
6554833	Levy	Apr 2003	B2
6575973	Shekalim	Jun 2003	B1
6575978	Peterson et al.	Jun 2003	B2
6582467	Teitelbaum et al.	Jun 2003	B1
6585736	Hajianpour	Jul 2003	B2
6585770	White et al.	Jul 2003	B1
6610839	Morin et al.	Aug 2003	B1
6613052	Kinnett	Sep 2003	B1
6613054	Scribner et al.	Sep 2003	B2
6617110	Cech et al.	Sep 2003	B1
6632224	Cachia et al.	Oct 2003	B2
6641616	Grundei	Nov 2003	B1
6645210	Manderson	Nov 2003	B2
6648890	Culbert et al.	Nov 2003	B2
6652585	Lange	Nov 2003	B2
6656187	Camino	Dec 2003	B1
6656219	Wiktor	Dec 2003	B1
6660009	Azar	Dec 2003	B1
6660041	Grundei	Dec 2003	B1
6676665	Foley	Jan 2004	B2
6679886	Weikel et al.	Jan 2004	B2
6682565	Krishnan	Jan 2004	B1
6685706	Padget et al.	Feb 2004	B2
6689138	Léchot et al.	Feb 2004	B2
6692496	Wardlaw	Feb 2004	B1
6701174	Krause et al.	Mar 2004	B1
6709433	Schoenefeld	Mar 2004	B1
6711432	Krause et al.	Mar 2004	B1
6712073	Manderson	Mar 2004	B2
6712858	Grundei et al.	Mar 2004	B1
6719761	Reiley et al.	Apr 2004	B1
6719793	McGee et al.	Apr 2004	B2
6740090	Cragg et al.	May 2004	B1
6746451	Middleton et al.	Jun 2004	B2
6749611	Venturini et al.	Jun 2004	B2
6755831	Putnam et al.	Jun 2004	B2
6755862	Keynan	Jun 2004	B2
6761722	Cole et al.	Jul 2004	B2
6767350	Lob	Jul 2004	B1
6775401	Hwang et al.	Aug 2004	B2
6780185	Frei	Aug 2004	B2
6783530	Levy et al.	Aug 2004	B1
6783532	Steiner et al.	Aug 2004	B2
6783533	Green et al.	Aug 2004	B2
6793655	Orsak	Sep 2004	B2
6793659	Putnam	Sep 2004	B2
6811568	Minamikawa	Nov 2004	B2
6827723	Carson	Dec 2004	B2
6827743	Eisermann et al.	Dec 2004	B2
6849051	Sramek et al.	Feb 2005	B2
6852128	Lange	Feb 2005	B2
6866665	Orbay	Mar 2005	B2
6887243	Culbert	May 2005	B2
6890333	von Hoffmann et al.	May 2005	B2
6893444	Orbay	May 2005	B2
6908465	von Hoffmann et al.	Jun 2005	B2
6911046	Schulter	Jun 2005	B2
6913605	Fletcher et al.	Jul 2005	B2
6923813	Phillips et al.	Aug 2005	B2
6923817	Carson et al.	Aug 2005	B2
6923828	Wiktor	Aug 2005	B1
6926720	Castañeda	Aug 2005	B2
6932086	Hajianpour	Aug 2005	B1
6942666	Overaker et al.	Sep 2005	B2
6942668	Padget et al.	Sep 2005	B2
6949101	McCleary et al.	Sep 2005	B2
6951561	Warren et al.	Oct 2005	B2
6953313	Tylosky	Oct 2005	B2
6975894	Wehrli et al.	Dec 2005	B2
6984248	Hyde, Jr.	Jan 2006	B2
6986771	Paul et al.	Jan 2006	B2
6989011	Paul et al.	Jan 2006	B2
6991656	Mears	Jan 2006	B2
7008425	Phillips	Mar 2006	B2
7008428	Cachia et al.	Mar 2006	B2
7008430	Dong et al.	Mar 2006	B2
7011662	Lechot et al.	Mar 2006	B2
7018332	Masson et al.	Mar 2006	B1
7018380	Cole	Mar 2006	B2
7022069	Masson et al.	Apr 2006	B1
7025789	Chow et al.	Apr 2006	B2
7041104	Cole et al.	May 2006	B1
7041138	Lange	May 2006	B2
7048542	Von Arx et al.	May 2006	B2
7052498	Levy et al.	May 2006	B2
7063701	Michelson	Jun 2006	B2
7070601	Culbert et al.	Jul 2006	B2
7090676	Huebner et al.	Aug 2006	B2
7097646	Schantz	Aug 2006	B2
7097648	Globerman et al.	Aug 2006	B1
7122033	Wood	Oct 2006	B2
7122043	Greenhalgh et al.	Oct 2006	B2
7122052	Greenhalgh	Oct 2006	B2
7131995	Biedermann et al.	Nov 2006	B2
7137987	Patterson et al.	Nov 2006	B2
7141054	Vandewalle	Nov 2006	B2
7141067	Jones et al.	Nov 2006	B2
7147640	Huebner et al.	Dec 2006	B2
7153307	Scribner et al.	Dec 2006	B2
7153309	Huebner et al.	Dec 2006	B2
7160302	Warburton	Jan 2007	B2
7160331	Cooney et al.	Jan 2007	B2
7172595	Goble	Feb 2007	B1
7175625	Culbert	Feb 2007	B2
7179024	Greenhalgh	Feb 2007	B2
7189237	Huebner	Mar 2007	B2
7189240	Dekel	Mar 2007	B1
7195589	Masson et al.	Mar 2007	B1
7195633	Medoff et al.	Mar 2007	B2
7214227	Colleran et al.	May 2007	B2
7220282	Kuslich et al.	May 2007	B2
7229441	Trieu et al.	Jun 2007	B2
7235079	Jensen et al.	Jun 2007	B2
7237556	Smothers et al.	Jul 2007	B2
7255712	Steinberg	Aug 2007	B1
7258692	Thelen et al.	Aug 2007	B2
7264622	Michelson	Sep 2007	B2
7267678	Medoff	Sep 2007	B2
7282053	Orbay	Oct 2007	B2
7294130	Orbay	Nov 2007	B2
7300449	Mische	Nov 2007	B2
7306603	Boehm, Jr. et al.	Dec 2007	B2
7306683	Cheung et al.	Dec 2007	B2
7311711	Cole	Dec 2007	B2
D560128	Diederich et al.	Jan 2008	S
7322938	Burbank et al.	Jan 2008	B2
7326249	Lange	Feb 2008	B2
7329228	Burbank et al.	Feb 2008	B2
7341601	Eisermann et al.	Mar 2008	B2
7344539	Serhan et al.	Mar 2008	B2
7354453	McAfee	Apr 2008	B2
7422360	Kozyuk	Sep 2008	B2
7465318	Sennett et al.	Dec 2008	B2
7476226	Weikel et al.	Jan 2009	B2
7481815	Fernandez	Jan 2009	B2
7485119	Thelen et al.	Feb 2009	B2
7488320	Middleton	Feb 2009	B2
7488329	Thelen et al.	Feb 2009	B2
D589147	Colleran et al.	Mar 2009	S
7500977	Assell et al.	Mar 2009	B2
7507241	Levy et al.	Mar 2009	B2
7520879	Justis et al.	Apr 2009	B2
7527632	Houghton	May 2009	B2
7563263	Orbay et al.	Jul 2009	B2
7569061	Colleran	Aug 2009	B2
7578824	Justin et al.	Aug 2009	B2
7588575	Colleran et al.	Sep 2009	B2
7588577	Fencl et al.	Sep 2009	B2
7588588	Spitler et al.	Sep 2009	B2
7601152	Levy et al.	Oct 2009	B2
7611515	Wolford et al.	Nov 2009	B2
7621950	Globerman et al.	Nov 2009	B1
7632277	Woll et al.	Dec 2009	B2
7632310	Clifford et al.	Dec 2009	B2
7666226	Schaller	Feb 2010	B2
7670339	Levy et al.	Mar 2010	B2
7670374	Schaller	Mar 2010	B2
7670375	Schaller	Mar 2010	B2
7682364	Reiley et al.	Mar 2010	B2
7695471	Cheung et al.	Apr 2010	B2
7695502	Orbay et al.	Apr 2010	B2
7704251	Huebner et al.	Apr 2010	B2
7708742	Scribner et al.	May 2010	B2
7713271	Warburton et al.	May 2010	B2
7717472	Johnson	May 2010	B2
7722612	Sala et al.	May 2010	B2
7722626	Middleman et al.	May 2010	B2
7727264	Orbay et al.	Jun 2010	B2
7731720	Sand et al.	Jun 2010	B2
7749232	Salerni	Jul 2010	B2
7758500	Boyd et al.	Jul 2010	B2
7785368	Schaller	Aug 2010	B2
7806929	Brown	Oct 2010	B2
7811291	Liu et al.	Oct 2010	B2
7828802	Levy et al.	Nov 2010	B2
7837612	Gill et al.	Nov 2010	B2
7842041	Liu et al.	Nov 2010	B2
7846162	Nelson et al.	Dec 2010	B2
7879038	Reiley et al.	Feb 2011	B2
7879103	Gertzman et al.	Feb 2011	B2
7905909	Orbay et al.	Mar 2011	B2
7909825	Saravia et al.	Mar 2011	B2
7909827	Reiley et al.	Mar 2011	B2
7909873	Tan-Malecki et al.	Mar 2011	B2
7914533	Nelson et al.	Mar 2011	B2
7931689	Hochschuler et al.	Apr 2011	B2
7942875	Nelson et al.	May 2011	B2
7959634	Sennett	Jun 2011	B2
7959638	Osorio et al.	Jun 2011	B2
7959683	Semler et al.	Jun 2011	B2
7967827	Osorio et al.	Jun 2011	B2
7967865	Schaller	Jun 2011	B2
7972340	Sand et al.	Jul 2011	B2
7988735	Yurek et al.	Aug 2011	B2
8007498	Mische	Aug 2011	B2
RE42757	Kuslich et al.	Sep 2011	E
8021365	Phan	Sep 2011	B2
8021366	Phan	Sep 2011	B2
8043334	Fisher et al.	Oct 2011	B2
8057544	Schaller	Nov 2011	B2
8105236	Malandain et al.	Jan 2012	B2
8109933	Truckai et al.	Feb 2012	B2
8114084	Betts	Feb 2012	B2
8118952	Gall et al.	Feb 2012	B2
8128627	Justin et al.	Mar 2012	B2
8152737	Burbank et al.	Apr 2012	B2
8157804	Betts	Apr 2012	B2
8226719	Melsheimer et al.	Jul 2012	B2
8241335	Truckai et al.	Aug 2012	B2
8287538	Brenzel et al.	Oct 2012	B2
8287539	Nelson et al.	Oct 2012	B2
8287541	Nelson et al.	Oct 2012	B2
8317791	Phan	Nov 2012	B2
8353911	Goldin et al.	Jan 2013	B2
8366717	Jordan et al.	Feb 2013	B1
8366773	Schaller et al.	Feb 2013	B2
8409211	Baroud	Apr 2013	B2
8430879	Stoneburner et al.	Apr 2013	B2
8439917	Saravia et al.	May 2013	B2
8485798	Sheth et al.	Jul 2013	B2
8491591	Fürderer	Jul 2013	B2
8496394	Schneider	Jul 2013	B2
8496657	Bonutti et al.	Jul 2013	B2
8496658	Stoneburner et al.	Jul 2013	B2
8500357	Stahle	Aug 2013	B2
8505879	Ruan	Aug 2013	B2
8506199	Rump et al.	Aug 2013	B2
8512398	Alkhatib	Aug 2013	B2
8568413	Mazur et al.	Oct 2013	B2
8579537	VanLandingham et al.	Nov 2013	B2
8597276	Vongphakdy	Dec 2013	B2
8906022	Krinke et al.	Dec 2014	B2
8961518	Taylor et al.	Feb 2015	B2
9155574	Saravia et al.	Oct 2015	B2
20010018588	Harder et al.	Aug 2001	A1
20010034526	Kuslich et al.	Oct 2001	A1
20010049530	Culbert	Dec 2001	A1
20010053912	Frigg	Dec 2001	A1
20020013600	Scribner	Jan 2002	A1
20020015517	Hwang et al.	Feb 2002	A1
20020029081	Scarborough et al.	Mar 2002	A1
20020032444	Mische	Mar 2002	A1
20020055742	Lieberman	May 2002	A1
20020055785	Harris	May 2002	A1
20020065530	Mische	May 2002	A1
20020068974	Kuslich et al.	Jun 2002	A1
20020111629	Phillips	Aug 2002	A1
20020111690	Hyde	Aug 2002	A1
20020120269	Lange	Aug 2002	A1
20020120270	Trieu et al.	Aug 2002	A1
20020123750	Eisermann et al.	Sep 2002	A1
20020133153	Hyde, Jr.	Sep 2002	A1
20020133156	Cole	Sep 2002	A1
20020133172	Lambrecht et al.	Sep 2002	A1
20020133175	Carson	Sep 2002	A1
20020138149	Hyde, Jr.	Sep 2002	A1
20020143329	Serhan et al.	Oct 2002	A1
20020143333	von Hoffmann et al.	Oct 2002	A1
20020143334	Hoffmann et al.	Oct 2002	A1
20020143335	von Hoffmann et al.	Oct 2002	A1
20020147451	McGee	Oct 2002	A1
20020147455	Carson	Oct 2002	A1
20020165461	Hayzelden et al.	Nov 2002	A1
20020171208	Lechot et al.	Nov 2002	A1
20020173813	Peterson et al.	Nov 2002	A1
20020183758	Middleton et al.	Dec 2002	A1
20020191823	Wehrli et al.	Dec 2002	A1
20030040805	Minamikawa	Feb 2003	A1
20030055373	Sramek et al.	Mar 2003	A1
20030055425	Hajianpour	Mar 2003	A1
20030069582	Culbert	Apr 2003	A1
20030069645	Ball et al.	Apr 2003	A1
20030074075	Thomas, Jr.	Apr 2003	A1
20030083660	Orbay	May 2003	A1
20030083662	Middleton	May 2003	A1
20030093076	Venturini et al.	May 2003	A1
20030097132	Padget et al.	May 2003	A1
20030097133	Green et al.	May 2003	A1
20030105461	Putnam	Jun 2003	A1
20030109932	Keynan	Jun 2003	A1
20030120273	Cole	Jun 2003	A1
20030130660	Levy	Jul 2003	A1
20030153918	Putnam et al.	Aug 2003	A1
20030187449	McCleary et al.	Oct 2003	A1
20030216738	Azar	Nov 2003	A1
20030220641	Thelen et al.	Nov 2003	A1
20030220644	Thelen et al.	Nov 2003	A1
20030220646	Thelen et al.	Nov 2003	A1
20030220698	Mears et al.	Nov 2003	A1
20030225407	Estrada, Jr.	Dec 2003	A1
20040024410	Olson, Jr. et al.	Feb 2004	A1
20040039384	Boehm, Jr. et al.	Feb 2004	A1
20040044413	Schulter	Mar 2004	A1
20040049192	Shimizu	Mar 2004	A1
20040078082	Lange	Apr 2004	A1
20040087956	Weikel et al.	May 2004	A1
20040092946	Bagga et al.	May 2004	A1
20040102777	Huebner	May 2004	A1
20040102778	Huebner et al.	May 2004	A1
20040102788	Huebner et al.	May 2004	A1
20040106925	Culbert	Jun 2004	A1
20040138665	Padget et al.	Jul 2004	A1
20040143264	McAfee	Jul 2004	A1
20040153080	Dong et al.	Aug 2004	A1
20040153114	Reiley et al.	Aug 2004	A1
20040153115	Reiley et al.	Aug 2004	A1
20040167528	Schantz	Aug 2004	A1
20040167625	Beyar et al.	Aug 2004	A1
20040181221	Huebner et al.	Sep 2004	A1
20040193163	Orbay	Sep 2004	A1
20040193164	Orbay	Sep 2004	A1
20040193165	Orbay	Sep 2004	A1
20040193251	Rudnick et al.	Sep 2004	A1
20040193267	Jones et al.	Sep 2004	A1
20040208717	Greenhalgh	Oct 2004	A1
20040214311	Levy	Oct 2004	A1
20040220678	Chow et al.	Nov 2004	A1
20040230193	Cheung	Nov 2004	A1
20040236327	Paul et al.	Nov 2004	A1
20040236328	Paul et al.	Nov 2004	A1
20040236339	Pepper	Nov 2004	A1
20040249375	Agee et al.	Dec 2004	A1
20040260289	Padget et al.	Dec 2004	A1
20040260297	Padget et al.	Dec 2004	A1
20040267269	Middleton et al.	Dec 2004	A1
20050010231	Myers	Jan 2005	A1
20050015129	Mische	Jan 2005	A1
20050015154	Lindsey et al.	Jan 2005	A1
20050033366	Cole et al.	Feb 2005	A1
20050043733	Eisermann et al.	Feb 2005	A1
20050065522	Orbay	Mar 2005	A1
20050065523	Orbay	Mar 2005	A1
20050065524	Orbay	Mar 2005	A1
20050065526	Drew et al.	Mar 2005	A1
20050070902	Medoff	Mar 2005	A1
20050085813	Spitler et al.	Apr 2005	A1
20050085818	Huebner	Apr 2005	A1
20050085824	Castaneda	Apr 2005	A1
20050085921	Gupta et al.	Apr 2005	A1
20050113836	Lozier	May 2005	A1
20050113892	Sproul	May 2005	A1
20050113929	Cragg et al.	May 2005	A1
20050119749	Lange	Jun 2005	A1
20050124972	Mische et al.	Jun 2005	A1
20050125066	McAfee	Jun 2005	A1
20050131407	Sicvol et al.	Jun 2005	A1
20050142163	Hunter	Jun 2005	A1
20050143734	Cachia	Jun 2005	A1
20050154331	Christie et al.	Jul 2005	A1
20050159749	Levy et al.	Jul 2005	A1
20050177172	Acker et al.	Aug 2005	A1
20050182399	Levine	Aug 2005	A1
20050192578	Horst	Sep 2005	A1
20050197537	Bonadio et al.	Sep 2005	A1
20050209557	Carroll et al.	Sep 2005	A1
20050216000	Colleran et al.	Sep 2005	A1
20050216007	Woll et al.	Sep 2005	A1
20050216008	Zwirnmann	Sep 2005	A1
20050228391	Levy et al.	Oct 2005	A1
20050234472	Huebner	Oct 2005	A1
20050240188	Chow	Oct 2005	A1
20050240190	Gall et al.	Oct 2005	A1
20050240193	Layne et al.	Oct 2005	A1
20050245928	Colleran et al.	Nov 2005	A1
20050251142	Hoffmann et al.	Nov 2005	A1
20050261779	Meyer	Nov 2005	A1
20050267483	Middleton	Dec 2005	A1
20050273138	To et al.	Dec 2005	A1
20050277936	Siravo et al.	Dec 2005	A1
20050277978	Greenhalgh	Dec 2005	A1
20050283154	Orbay et al.	Dec 2005	A1
20050283159	Amara	Dec 2005	A1
20050288676	Schnieders et al.	Dec 2005	A1
20050288795	Bagga	Dec 2005	A1
20060002980	Ringeisen	Jan 2006	A1
20060004362	Patterson et al.	Jan 2006	A1
20060004462	Gupta	Jan 2006	A1
20060009771	Orbay et al.	Jan 2006	A1
20060015123	Fencl et al.	Jan 2006	A1
20060036240	Colleran et al.	Feb 2006	A1
20060036244	Spitler et al.	Feb 2006	A1
20060047787	Agarwal et al.	Mar 2006	A1
20060052788	Thelen et al.	Mar 2006	A1
20060058621	Wehrli et al.	Mar 2006	A1
20060058826	Evans et al.	Mar 2006	A1
20060064005	Triano et al.	Mar 2006	A1
20060064106	Fernandez	Mar 2006	A1
20060064164	Thelen	Mar 2006	A1
20060064173	Guederian et al.	Mar 2006	A1
20060069392	Renzi Brivio et al.	Mar 2006	A1
20060079894	Colleran et al.	Apr 2006	A1
20060079905	Beyar et al.	Apr 2006	A1
20060085009	Truckai et al.	Apr 2006	A1
20060089647	Culbert	Apr 2006	A1
20060089648	Masini	Apr 2006	A1
20060100631	Sullivan et al.	May 2006	A1
20060100706	Shadduck	May 2006	A1
20060106390	Jensen et al.	May 2006	A1
20060106394	Colleran	May 2006	A1
20060116773	Cooney et al.	Jun 2006	A1
20060122600	Cole	Jun 2006	A1
20060122610	Culbert et al.	Jun 2006	A1
20060142760	McDonnell	Jun 2006	A1
20060142858	Colleran et al.	Jun 2006	A1
20060149281	Reiley et al.	Jul 2006	A1
20060149379	Kuslich et al.	Jul 2006	A1
20060155289	Windhager et al.	Jul 2006	A1
20060173454	Spitler et al.	Aug 2006	A1
20060178737	Furcht et al.	Aug 2006	A1
20060184192	Markworth	Aug 2006	A1
20060187748	Kozyuk	Aug 2006	A1
20060189994	Wolford et al.	Aug 2006	A1
20060195103	Padget et al.	Aug 2006	A1
20060200061	Warkentine	Sep 2006	A1
20060200140	Lange	Sep 2006	A1
20060200143	Warburton	Sep 2006	A1
20060217730	Termanini	Sep 2006	A1
20060229602	Olsen	Oct 2006	A1
20060235264	Vassallo	Oct 2006	A1
20060241629	Krebs et al.	Oct 2006	A1
20060241630	Brunnett et al.	Oct 2006	A1
20060241671	Greenhalgh	Oct 2006	A1
20060241776	Brown et al.	Oct 2006	A1
20060247637	Colleran et al.	Nov 2006	A1
20060264944	Cole	Nov 2006	A1
20060264945	Edidin	Nov 2006	A1
20060264950	Nelson et al.	Nov 2006	A1
20060264951	Nelson et al.	Nov 2006	A1
20060264952	Nelson et al.	Nov 2006	A1
20060271053	Schlapfer et al.	Nov 2006	A1
20060271061	Beyar et al.	Nov 2006	A1
20060271198	McAfee	Nov 2006	A1
20060276797	Botimer	Dec 2006	A1
20070012491	Vasta	Jan 2007	A1
20070016188	Boehm et al.	Jan 2007	A1
20070016198	Boehm et al.	Jan 2007	A1
20070016199	Boehm et al.	Jan 2007	A1
20070016211	Botimer	Jan 2007	A1
20070016283	Greenhalgh et al.	Jan 2007	A1
20070016300	Kuslich	Jan 2007	A1
20070027230	Beyar et al.	Feb 2007	A1
20070032567	Beyar et al.	Feb 2007	A1
20070043373	Sala et al.	Feb 2007	A1
20070049936	Colleran et al.	Mar 2007	A1
20070055379	Stone et al.	Mar 2007	A1
20070066480	Moser et al.	Mar 2007	A1
20070073342	Stone et al.	Mar 2007	A1
20070100285	Griffin et al.	May 2007	A1
20070112427	Christy et al.	May 2007	A1
20070118132	Culbert et al.	May 2007	A1
20070123876	Czartoski et al.	May 2007	A1
20070123877	Goldin et al.	May 2007	A1
20070123886	Meyer et al.	May 2007	A1
20070123936	Goldin et al.	May 2007	A1
20070123995	Thelen et al.	May 2007	A1
20070129746	Mische	Jun 2007	A1
20070142919	Cooney et al.	Jun 2007	A1
20070173745	Diederich et al.	Jul 2007	A1
20070173835	Medoff et al.	Jul 2007	A1
20070173838	Li	Jul 2007	A1
20070173839	Running et al.	Jul 2007	A1
20070173939	Kim	Jul 2007	A1
20070179505	Culbert	Aug 2007	A1
20070198043	Cox et al.	Aug 2007	A1
20070213727	Bottlang et al.	Sep 2007	A1
20070219634	Greenhalgh et al.	Sep 2007	A1
20070225568	Colleran	Sep 2007	A1
20070225721	Thelen et al.	Sep 2007	A1
20070225726	Dye et al.	Sep 2007	A1
20070225810	Colleran et al.	Sep 2007	A1
20070233091	Naifeh et al.	Oct 2007	A1
20070233105	Nelson et al.	Oct 2007	A1
20070244485	Greenhalgh et al.	Oct 2007	A1
20070255287	Rabiner	Nov 2007	A1
20070270855	Partin et al.	Nov 2007	A1
20070276392	Beyar et al.	Nov 2007	A1
20070276405	Huebner et al.	Nov 2007	A1
20070282443	Globerman et al.	Dec 2007	A1
20070283849	Edidin et al.	Dec 2007	A1
20070288097	Hurowitz	Dec 2007	A1
20080009868	Gotfried et al.	Jan 2008	A1
20080009874	Meridew et al.	Jan 2008	A1
20080009875	Sankaran	Jan 2008	A1
20080009877	Sankaran et al.	Jan 2008	A1
20080012317	Johnson	Jan 2008	A1
20080015601	Castro et al.	Jan 2008	A1
20080019970	Gorman	Jan 2008	A1
20080021474	Bonutti et al.	Jan 2008	A1
20080039854	Rabiner	Feb 2008	A1
20080041629	Aronstam et al.	Feb 2008	A1
20080053575	Cheung et al.	Mar 2008	A1
20080058804	Lechot et al.	Mar 2008	A1
20080065072	Spitler et al.	Mar 2008	A1
20080065073	Perriello et al.	Mar 2008	A1
20080065074	Yeung et al.	Mar 2008	A1
20080065140	Bonutti	Mar 2008	A1
20080071356	Greenhalgh et al.	Mar 2008	A1
20080077117	Miller et al.	Mar 2008	A1
20080077172	Miller	Mar 2008	A1
20080077174	Mische	Mar 2008	A1
20080086133	Kuslich et al.	Apr 2008	A1
20080097332	Greenhalgh et al.	Apr 2008	A1
20080103501	Ralph et al.	May 2008	A1
20080103519	Bonutti	May 2008	A1
20080108996	Padget et al.	May 2008	A1
20080114364	Goldin et al.	May 2008	A1
20080119886	Greenhalgh	May 2008	A1
20080125784	Rabiner et al.	May 2008	A1
20080125805	Mische	May 2008	A1
20080132896	Bowen et al.	Jun 2008	A1
20080133017	Beyar et al.	Jun 2008	A1
20080140078	Nelson et al.	Jun 2008	A1
20080140130	Chan et al.	Jun 2008	A1
20080149115	Hauck et al.	Jun 2008	A1
20080161805	Saravia et al.	Jul 2008	A1
20080161825	Greenhalgh et al.	Jul 2008	A1
20080167657	Greenhalgh	Jul 2008	A1
20080177261	Mcminn	Jul 2008	A1
20080183171	Elghazaly et al.	Jul 2008	A1
20080194868	Kozyuk	Aug 2008	A1
20080195104	Sidebotham et al.	Aug 2008	A1
20080195105	Sidebotham et al.	Aug 2008	A1
20080200915	Globerman et al.	Aug 2008	A1
20080200951	McAfee	Aug 2008	A1
20080208202	Williams	Aug 2008	A1
20080208230	Chin et al.	Aug 2008	A1
20080208261	Medoff	Aug 2008	A1
20080208320	Tan-Malecki	Aug 2008	A1
20080212405	Globerman et al.	Sep 2008	A1
20080228192	Beyar et al.	Sep 2008	A1
20080249436	Darr	Oct 2008	A1
20080255560	Myers et al.	Oct 2008	A1
20080262495	Coati et al.	Oct 2008	A1
20080269742	Levy et al.	Oct 2008	A1
20080269745	Justin	Oct 2008	A1
20080269746	Justin	Oct 2008	A1
20080269747	Justin	Oct 2008	A1
20080269748	Justin et al.	Oct 2008	A1
20080269749	Shalaby et al.	Oct 2008	A1
20080269750	Justin	Oct 2008	A1
20080269776	Justin et al.	Oct 2008	A1
20080275448	Sackett et al.	Nov 2008	A1
20080275449	Sackett et al.	Nov 2008	A1
20080287950	Frigg et al.	Nov 2008	A1
20080287951	Stoneburner et al.	Nov 2008	A1
20080288003	McKinley	Nov 2008	A1
20080294163	Chou et al.	Nov 2008	A1
20080294166	Goldin et al.	Nov 2008	A1
20080294167	Schumacher et al.	Nov 2008	A1
20080294169	Scott et al.	Nov 2008	A1
20080294205	Greenhalgh et al.	Nov 2008	A1
20080319444	Osorio et al.	Dec 2008	A9
20090005782	Chirico	Jan 2009	A1
20090012522	Lob	Jan 2009	A1
20090012564	Chirico	Jan 2009	A1
20090018542	Saravia et al.	Jan 2009	A1
20090018656	Clifford et al.	Jan 2009	A1
20090018666	Grundei et al.	Jan 2009	A1
20090024204	Greenhalgh et al.	Jan 2009	A1
20090048620	Weiss et al.	Feb 2009	A1
20090048629	Rabiner	Feb 2009	A1
20090048672	Essenmacher	Feb 2009	A1
20090054900	Rabiner et al.	Feb 2009	A1
20090076517	Reiley et al.	Mar 2009	A1
20090088752	Metzinger et al.	Apr 2009	A1
20090104586	Cardoso et al.	Apr 2009	A1
20090112196	Rabiner et al.	Apr 2009	A1
20090112330	Grundei	Apr 2009	A1
20090125028	Teisen	May 2009	A1
20090131952	Schumacher et al.	May 2009	A1
20090131992	Greenhalgh et al.	May 2009	A1
20090138015	Conner et al.	May 2009	A1
20090143781	Mische	Jun 2009	A1
20090143827	Levy et al.	Jun 2009	A1
20090149890	Martin	Jun 2009	A1
20090149956	Greenhalgh et al.	Jun 2009	A1
20090157080	Warburton	Jun 2009	A1
20090163918	Levy et al.	Jun 2009	A1
20090177206	Lozier et al.	Jul 2009	A1
20090177239	Castro	Jul 2009	A1
20090182336	Brenzel	Jul 2009	A1
20090216232	Buford, III et al.	Aug 2009	A1
20090228007	Justin et al.	Sep 2009	A1
20090228008	Justin et al.	Sep 2009	A1
20090275995	Truckai et al.	Nov 2009	A1
20090281628	Oglaza	Nov 2009	A1
20090292323	Chirico	Nov 2009	A1
20090318981	Kang	Dec 2009	A1
20100023010	Nelson et al.	Jan 2010	A1
20100087821	Trip et al.	Apr 2010	A1
20100094292	Parrott	Apr 2010	A1
20100094347	Nelson et al.	Apr 2010	A1
20100100184	Krueger	Apr 2010	A1
20100114181	Lob	May 2010	A1
20100131019	Lob	May 2010	A1
20100137862	Diao	Jun 2010	A1
20100145397	Overes et al.	Jun 2010	A1
20100161061	Hunt	Jun 2010	A1
20100222884	Greenhalgh	Sep 2010	A1
20100241120	Bledsoe et al.	Sep 2010	A1
20100241123	Middleton et al.	Sep 2010	A1
20100241176	Lob	Sep 2010	A1
20100249785	Betts	Sep 2010	A1
20100256638	Tyber et al.	Oct 2010	A1
20100286481	Sharp et al.	Nov 2010	A1
20100286692	Greenhalgh	Nov 2010	A1
20110077650	Braun et al.	Mar 2011	A1
20110087227	Mazur	Apr 2011	A1
20110137313	Jensen et al.	Jun 2011	A1
20110144645	Saravia et al.	Jun 2011	A1
20110178520	Taylor	Jul 2011	A1
20110190832	Taylor	Aug 2011	A1
20110218585	Krinke et al.	Sep 2011	A1
20110218626	Krinke	Sep 2011	A1
20110282346	Pham et al.	Nov 2011	A1
20110295255	Roberts	Dec 2011	A1
20110306975	Kaikkonen	Dec 2011	A1
20110307021	Anderson	Dec 2011	A1
20110307072	Anderson	Dec 2011	A1
20110313537	Anderson	Dec 2011	A1
20120029633	Anderson	Feb 2012	A1
20120065638	Moore	Mar 2012	A1
20120152872	Didehvar	Jun 2012	A1
20120179161	Rains et al.	Jul 2012	A1
20120209265	Pool	Aug 2012	A1
20120209273	Zaretzka et al.	Aug 2012	A1
20120232533	Veldman et al.	Sep 2012	A1
20120239038	Saravia et al.	Sep 2012	A1
20120253410	Taylor	Oct 2012	A1
20130006245	Stoneburner et al.	Jan 2013	A1
20130012942	Nelson et al.	Jan 2013	A1
20130116693	Nelson et al.	May 2013	A1
20130165935	Griffiths et al.	Jun 2013	A1
20130231665	Saravia et al.	Sep 2013	A1
20130267953	Brenzel et al.	Oct 2013	A1
20130325007	Beyar et al.	Dec 2013	A1
20130345765	Brockman	Dec 2013	A1
20140031823	Mazur et al.	Jan 2014	A1
20140058390	Taylor et al.	Feb 2014	A1
20140074093	Nelson et al.	Mar 2014	A9
20140088707	Donner	Mar 2014	A1
20140128870	Brenzel et al.	May 2014	A1
20140200618	Donner	Jul 2014	A1
20150141996	Taylor et al.	May 2015	A1
20150164514	Wlodarski et al.	Jun 2015	A1
20150173805	Donner	Jun 2015	A1
20150320459	Brenzel et al.	Nov 2015	A1

Foreign Referenced Citations (442)

Number	Date	Country
2007210	Nov 1990	CA
2452508	Jan 2003	CA
2609175	Dec 2005	CA
2608693	Nov 2006	CA
2537171	Aug 2007	CA
2669737	May 2008	CA
2670263	May 2008	CA
2670438	May 2008	CA
2678911	Sep 2008	CA
2685046	Nov 2008	CA
2727453	Dec 2009	CA
2738478	Apr 2010	CA
2326199	Jun 1999	CN
1530079	Sep 2004	CN
1533260	Sep 2004	CN
2699849	May 2005	CN
1909848	Feb 2007	CN
100379388	Apr 2008	CN
101208053	Jun 2008	CN
101404946	Apr 2009	CN
101636119	Jan 2010	CN
923085	Jul 1949	DE
3146065	May 1983	DE
3234875	Mar 1984	DE
198800197	Aug 1988	DE
3922044	Feb 1991	DE
4217236	Nov 1993	DE
202006017194	Feb 2007	DE
102006016213	Oct 2007	DE
0145166	Jun 1985	EP
145166	Jun 1985	EP
145166	Aug 1986	EP
253526	Jan 1988	EP
263292	Apr 1988	EP
275871	Jul 1988	EP
355035	Feb 1990	EP
381462	Aug 1990	EP
396519	Nov 1990	EP
401650	Dec 1990	EP
409769	Jan 1991	EP
420542	Apr 1991	EP
440371	Aug 1991	EP
442137	Aug 1991	EP
475077	Mar 1992	EP
487669	Jun 1992	EP
491211	Jun 1992	EP
508710	Oct 1992	EP
525352	Feb 1993	EP
611560	Aug 1994	EP
745352	Dec 1996	EP
546162	Sep 1997	EP
807419	Nov 1997	EP
819413	Jan 1998	EP
931513	Jul 1999	EP
0941037	Sep 1999	EP
0941037	Sep 1999	EP
1099412	May 2001	EP
1132051	Sep 2001	EP
674495	Nov 2001	EP
1155661	Nov 2001	EP
1203569	May 2002	EP
900065	Jun 2002	EP
1277442	Jan 2003	EP
1300122	Apr 2003	EP
1348384	Oct 2003	EP
1354562	Oct 2003	EP
1372496	Jan 2004	EP
1391186	Feb 2004	EP
1098600	Mar 2004	EP
1277442	Mar 2004	EP
1396231	Mar 2004	EP
1410765	Apr 2004	EP
1442718	Aug 2004	EP
1442729	Aug 2004	EP
1454592	Sep 2004	EP
1459686	Sep 2004	EP
1484077	Dec 2004	EP
1079752	Jan 2005	EP
1484077	Jan 2005	EP
1495729	Jan 2005	EP
1148825	Mar 2005	EP
1148850	Apr 2005	EP
1522268	Apr 2005	EP
1227765	May 2005	EP
1535579	Jun 2005	EP
1563795	Aug 2005	EP
1582159	Oct 2005	EP
1582160	Oct 2005	EP
1582161	Oct 2005	EP
1582162	Oct 2005	EP
1582163	Oct 2005	EP
1582164	Oct 2005	EP
1634548	Mar 2006	EP
1639953	Mar 2006	EP
1669035	Jun 2006	EP
1073371	Aug 2006	EP
1454592	Aug 2006	EP
1700572	Sep 2006	EP
1702572	Sep 2006	EP
1714618	Oct 2006	EP
1787593	May 2007	EP
1808143	Jul 2007	EP
1815813	Aug 2007	EP
1820462	Aug 2007	EP
1011464	Jan 2008	EP
1905367	Apr 2008	EP
1905392	Apr 2008	EP
1915959	Apr 2008	EP
1920721	May 2008	EP
1923019	May 2008	EP
1277442	Jul 2008	EP
1972308	Sep 2008	EP
1987785	Nov 2008	EP
2014261	Jan 2009	EP
2025292	Feb 2009	EP
1459689	Apr 2009	EP
1484077	Jun 2009	EP
1073371	Jul 2009	EP
1459689	Nov 2009	EP
2251888	May 2006	ES
2653006	Apr 1991	FR
2686788	Aug 1993	FR
2781360	Jan 2000	FR
2173565	Oct 1986	GB
2268068	Jan 1994	GB
2274993	Aug 1994	GB
1310664	Dec 1989	JP
2000287983	Oct 2000	JP
2001506524	May 2001	JP
2001509040	Jul 2001	JP
200481681	Mar 2004	JP
2007125386	May 2007	JP
2008500140	Jan 2008	JP
2008540037	Nov 2008	JP
2009160399	Jul 2009	JP
2010510040	Apr 2010	JP
2010510041	Apr 2010	JP
2010510042	Apr 2010	JP
2010522046	Jul 2010	JP
2010524642	Jul 2010	JP
2011523889	Aug 2011	JP
2012504027	Feb 2012	JP
2012518511	Aug 2012	JP
2004104359	Feb 2005	RU
WO8904150	May 1989	WO
WO8907056	Aug 1989	WO
WO9003764	Apr 1990	WO
WO9011726	Oct 1990	WO
WO9102493	Mar 1991	WO
WO9106260	May 1991	WO
WO9106265	May 1991	WO
WO9111962	Aug 1991	WO
WO9119461	Dec 1991	WO
WO9424938	Nov 1994	WO
WO9427507	Dec 1994	WO
WO9428824	Dec 1994	WO
WO9514433	Jun 1995	WO
WO9514433	Jun 1995	WO
WO9520362	Aug 1995	WO
WO9531159	Nov 1995	WO
WO9602202	Feb 1996	WO
WO9602203	Feb 1996	WO
WO9605783	Feb 1996	WO
WO9606041	Feb 1996	WO
WO9607161	Mar 1996	WO
WO9616607	Jun 1996	WO
WO9617557	Jun 1996	WO
WO9618354	Jun 1996	WO
WO9618354	Jun 1996	WO
WO9618354	Aug 1996	WO
WO9625118	Aug 1996	WO
WO9640476	Dec 1996	WO
WO9703611	Feb 1997	WO
WO9703611	Feb 1997	WO
WO9718775	May 1997	WO
WO9742602	Nov 1997	WO
WO9742912	Nov 1997	WO
WO9747251	Dec 1997	WO
WO9801077	Jan 1998	WO
WO9805261	Feb 1998	WO
WO9807392	Feb 1998	WO
WO9819616	May 1998	WO
WO9824380	Jun 1998	WO
WO9826725	Jun 1998	WO
WO9838918	Sep 1998	WO
WO9846169	Oct 1998	WO
WO9856301	Dec 1998	WO
WO9922661	May 1999	WO
WO9922662	May 1999	WO
WO9937219	Jul 1999	WO
WO9947055	Sep 1999	WO
WO9951149	Oct 1999	WO
WO9953843	Oct 1999	WO
WO9955248	Nov 1999	WO
WO9962416	Dec 1999	WO
WO0006037	Feb 2000	WO
WO0009024	Feb 2000	WO
WO0012036	Mar 2000	WO
WO0012036	Mar 2000	WO
WO0021455	Apr 2000	WO
WO0025681	May 2000	WO
WO0028906	May 2000	WO
WO0030551	Jun 2000	WO
WO0030569	Jun 2000	WO
WO0038586	Jul 2000	WO
WO0042954	Jul 2000	WO
WO0044319	Aug 2000	WO
WO0044321	Aug 2000	WO
WO0044946	Aug 2000	WO
WO0045712	Aug 2000	WO
WO0045714	Aug 2000	WO
WO0045715	Aug 2000	WO
WO0045722	Aug 2000	WO
WO0047119	Aug 2000	WO
WO0048534	Aug 2000	WO
WO0071038	Nov 2000	WO
WO0076414	Dec 2000	WO
WO0108571	Feb 2001	WO
WO0128443	Apr 2001	WO
WO0134045	May 2001	WO
WO0149193	Jul 2001	WO
WO0154598	Aug 2001	WO
WO0160268	Aug 2001	WO
WO0160268	Aug 2001	WO
WO0176493	Oct 2001	WO
WO0176514	Oct 2001	WO
WO0178015	Oct 2001	WO
WO0180751	Nov 2001	WO
WO0185042	Nov 2001	WO
WO0213700	Feb 2002	WO
WO0213716	Feb 2002	WO
WO0217794	Mar 2002	WO
WO0217794	Mar 2002	WO
WO0224088	Mar 2002	WO
WO0234107	May 2002	WO
WO0234148	May 2002	WO
WO0237935	May 2002	WO
WO0245606	Jun 2002	WO
WO0249517	Jun 2002	WO
WO02058575	Aug 2002	WO
WO02067824	Sep 2002	WO
WO02078555	Oct 2002	WO
WO02089683	Nov 2002	WO
WO02096306	Dec 2002	WO
WO03007830	Jan 2003	WO
WO03013336	Feb 2003	WO
WO0217794	Mar 2003	WO
WO03030760	Apr 2003	WO
WO03043488	May 2003	WO
WO03045257	Jun 2003	WO
WO3047440	Jun 2003	WO
WO03068090	Aug 2003	WO
WO0217794	Sep 2003	WO
WO2004008949	Jan 2004	WO
WO2004017817	Mar 2004	WO
WO2004021904	Mar 2004	WO
WO2004030549	Apr 2004	WO
WO2004039271	May 2004	WO
WO2004064603	Aug 2004	WO
WO2004078220	Sep 2004	WO
WO2004078221	Sep 2004	WO
WO2004086934	Oct 2004	WO
WO2004092431	Oct 2004	WO
WO2004093633	Nov 2004	WO
WO2004098453	Nov 2004	WO
WO2004103209	Dec 2004	WO
WO2004110292	Dec 2004	WO
WO2004110300	Dec 2004	WO
WO2004112661	Dec 2004	WO
WO2005000159	Jan 2005	WO
WO2005020830	Mar 2005	WO
WO2005020833	Mar 2005	WO
WO2005023085	Mar 2005	WO
WO2005032326	Apr 2005	WO
WO2005032340	Apr 2005	WO
WO2005039651	May 2005	WO
WO2005041799	May 2005	WO
WO2005044122	May 2005	WO
WO2005051971	Jun 2005	WO
WO2005055874	Jun 2005	WO
WO2005020833	Jul 2005	WO
WO2005070314	Aug 2005	WO
WO2005092223	Oct 2005	WO
WO2005094693	Oct 2005	WO
WO2005094705	Oct 2005	WO
WO2005094706	Oct 2005	WO
WO2005096975	Oct 2005	WO
WO2005102196	Nov 2005	WO
WO2005107415	Nov 2005	WO
WO2005112804	Dec 2005	WO
WO2005112804	Dec 2005	WO
WO2005122931	Dec 2005	WO
WO2005122932	Dec 2005	WO
WO2005123171	Dec 2005	WO
WO2006011152	Feb 2006	WO
WO2006020530	Feb 2006	WO
WO2006023793	Mar 2006	WO
WO2006026323	Mar 2006	WO
WO2006026323	Mar 2006	WO
WO2005112804	Apr 2006	WO
WO2006026323	Apr 2006	WO
WO2006041460	Apr 2006	WO
WO2006041460	Apr 2006	WO
WO2006042188	Apr 2006	WO
WO2006042189	Apr 2006	WO
WO2006042334	Apr 2006	WO
WO2006034396	May 2006	WO
WO2006051547	May 2006	WO
WO2006055448	May 2006	WO
WO2006063083	Jun 2006	WO
WO2006066228	Jun 2006	WO
WO2006068682	Jun 2006	WO
WO2010065855	Jun 2006	WO
WO2006089929	Aug 2006	WO
WO2006090379	Aug 2006	WO
WO2006034436	Oct 2006	WO
WO2006108067	Oct 2006	WO
WO2006113800	Oct 2006	WO
WO2006116760	Nov 2006	WO
WO2006116761	Nov 2006	WO
WO2006124764	Nov 2006	WO
WO2006124764	Nov 2006	WO
WO2006124937	Nov 2006	WO
WO2006127904	Nov 2006	WO
WO2006127904	Nov 2006	WO
WO2007002933	Jan 2007	WO
WO2007008177	Jan 2007	WO
WO2007009107	Jan 2007	WO
WO2007009123	Jan 2007	WO
WO2007011994	Jan 2007	WO
WO2007012046	Jan 2007	WO
WO2007025236	Mar 2007	WO
WO2007040949	Apr 2007	WO
WO2007041665	Apr 2007	WO
WO2006124937	May 2007	WO
WO2007053960	May 2007	WO
WO2007058943	May 2007	WO
WO2007059243	May 2007	WO
WO2007059243	May 2007	WO
WO2007059246	May 2007	WO
WO2007059259	May 2007	WO
WO2007059259	May 2007	WO
WO2007065137	Jun 2007	WO
WO2007069251	Jun 2007	WO
WO2007073488	Jun 2007	WO
WO2007076308	Jul 2007	WO
WO2007076374	Jul 2007	WO
WO2007076376	Jul 2007	WO
WO2007076377	Jul 2007	WO
WO2007078692	Jul 2007	WO
WO2007079237	Jul 2007	WO
WO2007082151	Jul 2007	WO
WO2007084239	Jul 2007	WO
WO2007092813	Aug 2007	WO
WO2007092813	Aug 2007	WO
WO2007092841	Aug 2007	WO
WO2007092841	Aug 2007	WO
WO2007036815	Sep 2007	WO
WO2007114982	Oct 2007	WO
WO2007115108	Oct 2007	WO
WO2007117571	Oct 2007	WO
WO2007120539	Oct 2007	WO
WO2007092841	Nov 2007	WO
WO2007124130	Nov 2007	WO
WO2007127255	Nov 2007	WO
WO2007127260	Nov 2007	WO
WO2007131002	Nov 2007	WO
WO2007134134	Nov 2007	WO
WO2007079237	Dec 2007	WO
WO2007145824	Dec 2007	WO
WO2008004229	Jan 2008	WO
WO2008006117	Jan 2008	WO
WO2008016910	Feb 2008	WO
WO2008019397	Feb 2008	WO
WO2008035849	Mar 2008	WO
WO2008037454	Apr 2008	WO
WO2008043254	Apr 2008	WO
WO2008058960	May 2008	WO
WO2008059027	May 2008	WO
WO2008060277	May 2008	WO
WO2008060277	May 2008	WO
WO2008063265	May 2008	WO
WO2008064346	May 2008	WO
WO2008064347	May 2008	WO
WO2008064347	May 2008	WO
WO2008064350	May 2008	WO
WO2008076330	Jun 2008	WO
WO2008076330	Jun 2008	WO
WO2008076357	Jun 2008	WO
WO2008094407	Aug 2008	WO
WO2007011353	Sep 2008	WO
WO2007092813	Sep 2008	WO
WO2008109566	Sep 2008	WO
WO2008112308	Sep 2008	WO
WO2008116170	Sep 2008	WO
WO2008116175	Sep 2008	WO
WO2008118945	Oct 2008	WO
WO2008121608	Oct 2008	WO
WO2008132728	Nov 2008	WO
WO2008134287	Nov 2008	WO
WO2008134758	Nov 2008	WO
WO2008139456	Nov 2008	WO
WO2008144709	Nov 2008	WO
WO2008144709	Nov 2008	WO
WO2007078692	Dec 2008	WO
WO2008121608	Jan 2009	WO
WO2008134287	Jan 2009	WO
WO2009006622	Jan 2009	WO
WO2009007331	Jan 2009	WO
WO2009009772	Jan 2009	WO
WO2009010412	Jan 2009	WO
WO2009012347	Jan 2009	WO
WO2009026070	Feb 2009	WO
WO2009027325	Mar 2009	WO
WO2009039430	Mar 2009	WO
WO2006026323	Apr 2009	WO
WO2006026397	Apr 2009	WO
WO2009045751	Apr 2009	WO
WO2009059227	May 2009	WO
WO2009067568	May 2009	WO
WO2009072125	Jun 2009	WO
WO2009076086	Jun 2009	WO
WO2008144709	Jul 2009	WO
WO2009088376	Jul 2009	WO
WO2009094478	Jul 2009	WO
WO2008060277	Sep 2009	WO
WO2008112912	Sep 2009	WO
WO2009132333	Oct 2009	WO
WO2009143374	Nov 2009	WO
WO2009143496	Nov 2009	WO
WO2008112875	Dec 2009	WO
WO2009146457	Dec 2009	WO
WO2009152270	Dec 2009	WO
WO2009152272	Dec 2009	WO
WO2009152273	Dec 2009	WO
WO2009132333	Jan 2010	WO
WO2008139456	Feb 2010	WO
WO2010037038	Apr 2010	WO
WO2010056895	May 2010	WO
WO2010062379	Jun 2010	WO
WO2010091242	Aug 2010	WO
WO2010035156	Nov 2010	WO

Non-Patent Literature Citations (46)

Entry
US 7,063,700, 06/2006, Michelson (withdrawn)
US 7,201,752, 04/2007, Huebner et al. (withdrawn)
International Search Report for International Application No. PCT/US14/69907, Jun. 4, 2015.
Written Opinion for International Application No. PCT/US14/69907, Jun. 4, 2015.
App No. PCT/US 09/30971 International Search Report, Mar. 6, 2009.
App No. PCT/US 09/30971 Written Opinion of the International Searching Authority, Mar. 6, 2009.
App No. PCT/US2011/21074 International Search Report, May 23, 2011.
App No. PCT/US2011/21074 Written Opinion of the International Searching Authority, May 23, 2011.
App No. PCT/US2011/021735 International Search Report, May 25, 2011.
App No. PCT/US2011/021735 Written Opinion of the International Searching Authority, May 25, 2011.
App No. PCT/US2011/027597 International Search Report, Jul. 6, 2011.
App No. PCT/US2011/027597 Written Opinion of the International Searching Authority, Jul. 6, 2011.
App No. PCT/US2011/027602 International Search Report, Jul. 5, 2011.
App No. PCT/US2011/027602 Written Opinion of the International Searching Authority, Jul. 5, 2011.
Putnam, Matthew D., et al., “Distal Radial Metaphyseal Forces in an Extrinsic Grip Model: Implications for Post fracture Rehabilitation,” American Society for Surgery of the Hand, 25A: 469-475, May 2000.
Higgins, Thomas F., et al., “A Biomechanical Analysis of Fixation of Intra-Articular Distal Radial Fractures with Calcium-Phosphate Bone Cement,” The Journal of Bone and Joint Surgery, 84:1579-1586, Needham, Massachusetts, Sep. 2002.
Stoeckel et al., “Self-Expanding Nitinol Stents—Material and Design Considerations,” Nitinol Devices & Components, Fremont, California, 2003.
Rozenthal, Tamara D., et al., “Functional Outcome and Complications After Volar Plating for Dorsally Displaced, Unstable Fractures of the Distal Radius,” The Journal of Hand Surgery, 31A: 359-365, Mar. 2006.
Keast-Butler, Oliver, et al., “Biology Versus Mechanics in the Treatment of Distal Radial Fractures,” The Journal of Orthopedic Trauma, 22: S91-S95, Philadelphia, Pennsylvania, Sep. 2008.
Mudgal, Chaitanya S., et al., “Plate Fixation of Osteoporotic Fractures of the Distal Radius,” The Journal of Orthopedic Trauma, 22: S106-S115, 2008, Philadelphia, Pennsylvania, Sep. 2008.
Bogoch, Earl R., et al., “The Osteoporosis Needs of Patients with Wrist Fractures,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
Arora, Rohit, et al., “A Representative Case of Osteoporotic Distal Radius Fracture,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
Firoozabadi, Reza, et al., “Qualitative and Quantitative Assessment of Bone Fragility and Fracture Healing Using Conventional Radiography and Advanced Imaging Technologies—Focus on Wrist Fracture,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
Goldhan, Jorg, et al., “What Counts: Outcome Assessment After Distal Radius Fractures in Aged Patients,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
Hoang-Kim, Amy, et al., “Wrist Fractures in Osteoporotic Patients,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
Kettler, Mark, et al., “Do We Need to Include Osteoporosis in Today's Classification of Distal Radius Fractures?” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
Downing, Martin R., et al., “Assessment of Inducible Fracture Micromotion in Distal Radial Fractures Using Radiostereometry,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
Suhm, Norbert, et al., “Injectable Bone Cement Augmentation for the Treatment of Distal Radius Fractures: A Review,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
Van Lenthe, G. Harry, et al., “Quantification of Bone Structural Parameters and Mechanical Competence at the Distal Radius,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
Parkinson, Ian H., et al., “Whole Bone Geometry and Bone Quality in Distal Forearm Fracture,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
“Medtronic—Abdominal Stent Graft System, Instructions for Use,” Medtronic, Inc., Minneapolis-Minnesota, 2008.
Jupiter, Jesse B., et al., “Operative Management of Distal Radial Fractures with 2.4-Millimeter Locking Plates. A Multicenter Prospective Case Series,” The Journal of Bone and Joint Surgery, 91: 55-65, doi:10.2106-JBJS.G.01498, Needham, Massachusetts, Jan. 1, 2009.
App No. PCT/US2012/028145 International Search Report, Sep. 13, 2012.
App No. PCT/US2012/028145 Written Opinion of the International Searching Authority, Sep. 13, 2012.
Ilyas, Asif M., “Intramedullary Fixation of Distal Radius Fractures,” Elsevier, Inc. on behalf of the American Society for Surgery of the Hand, New York, New York, Feb. 2009.
Figl, Markus, et al., “Volar Fixed-Angle Plate Osteosynthesis of Unstable Distal Radius Fractures: 12 Months Results,” Springer, New York, New York, Feb. 19, 2009.
Photograph, OrthopaedicLIST, 2010, Wilmington, North Carolina.
Barnes, C. Lowry, et al., “Advanced Core Decompression System,” Wright, 2008, Arlington, Tennessee.
“OptiMesh 1500E—Percutaneous Interbody Fusion Surgical Technique,” Spineology Inc., Feb. 2010, Saint Paul, Minnesota.
Corti, G., et al., “Acute Vertebral Body Compression Fracture treated with OptiMesh—Indications, Applications and First Clinical Results,” Eurospine, 2005, Uster-Zürich Switzerland.
Advanced Core Decompression System—Surgical Technique, Wright, 2010, Arlington, Tennessee.
State Intellectual Property Office of the People's Republic of China—Chinese Official Action for Chinese Patent Application No. 201180021809.7, Aug. 1, 2014.
Office Action in U.S. Appl. No. 14/929,757, dated Jul. 21, 2016.
Office Action in U.S. Appl. No. 14/929,757, dated Jan. 17, 2017.
Office Action in Chinese Application No. 201510621438.6, dated Feb. 8, 2018, State Intellectual Property Office Of The People's Republic Of China.
English Language Translation of Office Action in Chinese Application No. 201510621438.6, dated Feb. 8, 2018.

Related Publications (1)

	Number	Date	Country
	20150012096 A1	Jan 2015	US

Provisional Applications (2)

	Number	Date	Country
	61311494	Mar 2010	US
	61378822	Aug 2010	US

Divisions (1)

	Number	Date	Country
Parent	13043190	Mar 2011	US
Child	14492599		US

Apparatus and methods for securing a bone implant

Information

Patent Number

Date Filed

Date Issued

Inventors

Original Assignees

Examiners

Agents

CPC

Field of Search

US

CPC

International Classifications

Abstract