Patent Application
20150230843
The present invention relates to approaches for controlling the unloading stress of Nitinol devices, and/or other shape memory material devices, in order to facilitate healing of diseased or damaged tissue. The present invention finds particular utility in the field of orthopedics, and specifically as an approach for creating and using devices for reducing fractures and generating and maintaining compression between bone fragments. While the present invention has application throughout the body, its utility will sometimes hereinafter be illustrated in the context of providing and using screws, staples, plates, and/or intramedullary devices for the repair of fractured or displaced bone tissue.
In the field of orthopedic surgery, it is common to rejoin broken bones. The success of the surgical procedure often depends on the ability to reapproximate the fractured bone, the amount of compression achieved between the bone fragments, and the ability to sustain that compression over a period of time. If the surgeon is unable to bring the bone fragments into close contact, a gap will exist between the bone fragments and the bone tissue will need to first fill that gap before complete healing can take place. Furthermore, gaps between bone fragments that are too large can allow motion to occur between the bone fragments, disrupting the healing tissue and thus slowing the healing process. Thus, non-unions, mal-unions, and delayed-unions of fractures can occur when the gap between bone fragments is too large. Optimal healing requires that the bone fragments be in close contact with each other, and for a compressive load to be applied and maintained between the bone fragments. Compressive strain between bone fragments has been found to accelerate the healing process in accordance with Wolf's Law.
Broken bones can be rejoined using screws, staples, plates, intramedullary devices, and other devices known in the art. These devices are designed to assist the surgeon with reducing the fracture and creating a compressive load between the bone fragments.
Screws are typically manufactured from either titanium or stainless steel alloys and may be lag screws or headless screws. Lag screws have a distal threaded region and an enlarged head. The head contacts the cortical bone surface and the action of the threaded region reduces the fracture and generates a compressive load. Headless screws typically have a threaded proximal region and a threaded distal region. A differential in the thread pitch of the two regions generates compression across the fracture site. There also exist fully-threaded headless compression screws that have a thread pitch which differs over the length of the single continuous thread.
Staples are formed from a plurality of legs (typically two legs, although sometimes more than two legs may be provided) connected together by a bridge. Staples are typically manufactured from stainless steel alloys, titanium alloys or Nitinol, a shape memory alloy. The staples are inserted into pre-drilled holes on either side of the fracture site.
Plates are also used to rejoin broken bones. These plates are generally formed from a sheet or ribbon of material having a plurality of holes formed therein. The plates are typically manufactured from either stainless steel alloys or titanium alloys. The plates are placed adjacent to a fracture so that the plate spans the fracture line, and then screws are inserted through the holes in the plate and into the bone fragments on either side of the fracture site so as to stabilize the bone fragments relative to one another.
Intramedullary devices are often used for fractures of the long bones; however, they are also frequently used in the phalanges, and specifically for the treatment of “hammer toe”, which is a deformity of the proximal interphalangeal joint of the second, third, or fourth toe causing the toe to be permanently bent, e.g., bent upwards. Typical intramedullary devices used in the phalanges have opposing ends that are adapted to grip the interior wall of the intramedullary canal. These intramedullary devices are typically made of titanium alloys, stainless steel alloys, Nitinol and/or other materials, e.g., PEEK. The titanium alloy devices and stainless steel alloy devices often have barbs or threaded regions at their opposing ends to grip the interior wall of the intramedullary canal. The Nitinol devices may have a pair of radially-extending “legs” at their opposing ends that expand outward when warmed to body temperature, with the pair of legs at each end of the device being disposed in a common plane.
While the foregoing devices (e.g., screws, staples, plates, and intramedullary devices) are designed to bring the bone fragments into close contact and to generate a compressive load between the bone fragments, the devices do not always succeed in accomplishing this objective. It is widely reported that the compressive load generated by these devices between the bone fragments dissipates rapidly as the bone relaxes and remodels around the device.
Nitinol can be used to improve the functional performance of these devices by utilizing either the shape memory effect of Nitinol or the superelastic properties of Nitinol to pull together the opposing bone fragments; however, the recovery forces generated by the Nitinol versions of these devices are often too great, and result in the devices “tearing through” the bone tissue and thus not providing a means to generate and maintain compression between the bone fragments. Thus there exists a clinical need for controlling the unloading stress of Nitinol devices, and/or other shape memory material devices, so as to allow for devices that are able to bring bone fragments into close proximity with each other, generate a compressive load, and maintain that compressive load for a prolonged period of time while healing occurs—without the negative effect of having the device “tear through” the bone tissue.
Furthermore, current Nitinol devices are single-action devices, i.e., they rely on either (i) the superelastic effect of Nitinol (i.e., the superelasticity of Nitinol) to create compression, or (ii) the shape memory effect of Nitinol (i.e., the temperature-induced shape change of Nitinol) to create compression. There exists a clinical need for devices (e.g., made of Nitinol and/or other shape memory materials) that can have a staged unloading of the device without the need for complex delivery devices (i.e., a first stage can be radially expanding to grip bone, and a second stage can be shortening to pull fragments together).
Finally, while Nitinol's superelastic and shape memory properties allow for many design possibilities, it can be clinically beneficial to provide Nitinol devices (and/or other shape memory material devices) that have regions which do not unload (i.e., regions which may be permanently deformed). By way of example but not limitation, it would be beneficial to provide a monolithic (i.e., one-piece) Nitinol plate (or a plate made of other shape memory materials) that in one region is able to generate compression through superelasticity or shape memory effect, but in another region is able to be contoured to the shape of the bone.
The present invention provides a novel approach for controlling the unloading stress of a Nitinol device and/or other shape memory material device. The device may be used to bring bone fragments into close proximity with each other, generate a compressive load between the bone fragments, and maintain that compressive load between the bone fragments while healing occurs.
Among other things, the present invention comprises approaches for controlling the unloading stress of screws, staples, plates, and intramedullary devices, etc. made out of Nitinol and/or another shape memory material. In accordance with the present invention, it is possible to provide devices that utilize Nitinol's superelastic properties (and/or the superelastic properties of another shape memory material) and/or Nitinol's shape memory effect (and/or the shape memory effect of another shape memory material) to generate a compressive load between the bone fragments and maintain that compressive load between the bone fragments while healing occurs; however, it is critical that the Nitinol device (and/or other shape memory material device) does not generate too great of an unloading stress, since excessive forces may cause damage to the bone or cause the device to “tear through” the bone.
In one form of the present invention, the invention comprises eliminating or reducing the Load Transition and Deflection Range from the Nitinol device's mechanical hysteresis curve (and/or other shape memory material device's mechanical hysteresis curve) when the device is deformed using superelasticity. This is accomplished by allowing the device to partially recover the elastic strain of the deformed device prior to use. This allows the device to recover strain during use at a nearly linear level (i.e., on the lower plateau of the mechanical hysteresis curve) without subjecting the bone tissue to stress loads that are above the lower plateau of the Nitinol device's mechanical hysteresis curve (and/or other shape memory material device's mechanical hysteresis curve).
In another form of the present invention, the invention comprises eliminating or reducing the Load Transition and Deflection Range from the Nitinol device's mechanical hysteresis curve (and/or other shape memory material device's mechanical hysteresis curve) when the device is deformed using the shape memory effect. This is accomplished by straining the device in its martensitic state and, when thereafter warmed to above its austenite start temperature, allowing the device to partially recover the elastic strain prior to use. This allows the deformed device to recover strain during use at a nearly linear level (i.e., on the lower plateau of the mechanical hysteresis curve) without subjecting the bone tissue to stress loads that are above the lower plateau of the Nitinol device's mechanical hysteresis curve (and/or other shape memory material device's mechanical hysteresis curve).
In another form of the present invention, the unloading of the Nitinol device (and/or other shape memory material device) is separated into (i) unloading caused by the superelasticity of the Nitinol (and/or other shape memory material), and (ii) unloading caused by the shape memory effect of the Nitinol (and/or other shape memory material). This is accomplished by providing a monolithic (i.e., one-piece) device having multiple temperature transition zones. Regions which are to unload via superlasticity may have very low transition temperatures, whereas regions which are to unload via the shape memory effect may have transition temperatures closer to that of the human body. Further, the unloading of the Nitinol device (and/or other shape memory material device) may be separated into (i) unloading caused by the shape memory effect of the Nitinol (and/or other shape memory material) at one As temperature, and (ii) unloading caused by the shape memory effect of the Nitinol (and/or other shape memory material) at a second, greater As temperature. This is accomplished by providing a monolithic (i.e., one-piece) device having multiple temperature transition zones. It should be appreciated that the unloading of the device can be controlled by allowing for partial strain recovery as detailed above (i.e., where partial unloading is allowed to occur prior to use).
In another form of the present invention, the Nitinol device (and/or other shape memory material device) can be configured so that some regions of the device unload their stress via superelasticity or shape memory effect, and other regions of the device do not unload their stress at all (i.e., they may be permanently deformed). This can be achieved by providing a device with different transition temperatures. The regions that do not unload their stress (i.e., that may be permanently deform) can have transition temperatures greater than body temperature, or can be fully annealed so as to not have a transition temperature. It should be appreciated that the regions of the device that do unload their stress via superelasticity or shape memory effect can be controlled by allowing for partial strain recovery as detailed above (i.e., where partial unloading is allowed to occur prior to use) and that the unloading of the device may occur in multiple stages.
Furthermore, it should be appreciated that it is possible to further control the unloading stress of the Nitinol device by varying percentages of cold work, and different transition temperatures, can be combined with each other, and with the aforementioned partial recovery approach (i.e., where partial unloading is allowed to occur prior to use) to further control the unloading stress of the Nitinol device (and/or other shape memory material device).
In one preferred form of the present invention, there is provided a method for applying compression to bone, said method comprising:
providing a shape memory material device;
deforming said shape memory material device using the superelastic properties of said shape memory material device so that said shape memory material device generates a stress level which is at or above the upper plateau of the mechanical hysteresis curve of said shape memory material device;
allowing said shape memory material device to recover a portion of its deformation so that said shape memory material device generates a stress level which is substantially at the lower plateau of said mechanical hysteresis curve of said shape memory material device;
mechanically constraining said shape memory material device;
deploying said shape memory material device so that said shape memory material device is in association with bone; and
releasing the mechanical constraint so that said shape memory material device applies compression to bone.
In another preferred form of the present invention, there is provided apparatus comprising:
a shape memory material device deformed using its superelastic properties and constrained so that said shape memory material device generates a stress level which is substantially at the lower plateau of the mechanical hysteresis curve of said shape memory material device.
In another preferred form of the present invention, there is provided a method for applying compression to bone, said method comprising:
providing a shape memory material device at a temperature below Ms;
deforming said shape memory material device while at a temperature below Ms using the shape memory effect properties of said shape memory material device so that said shape memory material device forms detwinned martensite;
applying a mechanical constraint to said shape memory material device that allows said shape memory material device to partially recover the deformation when said shape memory material device is heated to a temperature above As;
heating said shape memory material device to a temperature above As so that said shape memory material device recovers some strain via free recovery, whereupon said mechanical constraint limits further strain recovery and the stress in said mechanical device increases;
deploying said shape memory material device so that said shape memory material device is in association with bone; and
releasing said mechanical constraint so that said shape memory material device applies compression to bone.
In another preferred form of the present invention, there is provided apparatus comprising:
a shape memory material device which has been deformed while at a temperature below Ms, and which has then been heated to a temperature above As so that some of the strain is recovered via free recovery, and which has then been constrained so as to increase the stress within said shape memory material device without allowing additional strain recovery, such that when the constraint is thereafter removed, said shape memory material device generates a stress level which is substantially at the lower plateau of the mechanical hysteresis curve of said shape memory material device.
In another preferred form of the present invention, there is provided a method for applying compression to bone, said method comprising:
providing a shape memory material device having a first region having a first Af temperature and a second region having a second Af temperature, wherein the second Af temperature is higher than the first Af temperature;
straining said shape memory material device using at least one of the superelastic property of said shape memory material device and the shape memory effect property of said shape memory material device;
deploying said shape memory material device so that said shape memory material device is in association with bone; and
releasing the strain of said shape memory material device so that said shape memory material device applies compression to bone.
In another preferred form of the present invention, there is provided apparatus comprising:
a shape memory material device comprising a first region having a first Af temperature and a second region having a second Af temperature, wherein the second Af temperature is higher than the first Af temperature.
In another preferred form of the present invention, there is provided a method for applying compression to bone, said method comprising:
providing a shape memory material device having a first region having a first Af temperature and a second region having a second Af temperature, wherein the first Af temperature is below 37° C. and hence austenitic at 37° C. and the second Af temperature is above 37° C. and hence martensitic at 37° C.;
straining said first region of said shape memory material device at a temperature below 37° C. and maintaining the strain so that said first region exhibits superelasticity, and straining said second region of said shape memory material device at a temperature of below 37° C. so that said second region is deformed;
deploying said shape memory material device so that said shape memory material device is in association with bone; and
releasing the strain of said first region of said shape memory material device so that said shape memory material device applies compression to bone.
In another preferred form of the present invention, there is provided apparatus comprising:
a shape memory material device having a first region having a first Af temperature and a second region having a second Af temperature, wherein the first Af temperature is below 37° C. and hence austenitic at 37° C., and the second Af temperature is above 37° C. and hence martensitic at 37° C.
These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts and wherein:
Looking first at
As seen in
Nitinol exhibits two unique properties: shape memory effect (SME) and superelasticity (SE). These properties depend on the solid-solid, diffusionless phase transformation process known as martensitic transformation (
At different temperatures, different phase structures are preferred, and when the structure is cooled through the transition temperature, the martensitic structure forms from the austenitic phase. Austenite is the high-temperature, stress-free phase which has a high-symmetry crystal structure usually based on a cubic lattice (
Nitinol screws, staples, plates and intermedullary devices, as well as other devices, can be configured to utilize Nitinol's superelastic properties to generate and maintain compression across a fracture. The present invention discloses how to control the stress at which the Nitinol recovers its elastic deformation, i.e., the present invention discloses how to control the unloading of stress of Nitinol when utilizing superelasticity.
In superelasticity, at T>Af, the Nitinol is entirely in the parent austenitic phase. When the Nitinol is then mechanically loaded (i.e., strained), the stress in the Nitinol increases. There is a critical stress at which the crystal transforms from austenite to martensite. Stressing the material above this critical value results in device deformation, with the austenitic Nitinol transforming to martensitic Nitinol. Deformation can be as large as about 8% with elastic recovery. At T>Af, the martensitic Nitinol of the deformed device is unstable and, when the load is removed, the reverse phase transformation occurs (i.e., the martensite transforms to austenite), and the material fully regains its original shape. In practice, it is often advantageous to deform the Nitinol device, and then mechanically constrain the Nitinol device in its deformed shape, before providing the device to the surgeon. This allows the surgeon to release the mechanical constraint on the deformed device and, at T>Af, the device will fully regain its original shape. Thus, with superelasticity, the austenite-to-martensite-to-austenite transformation allows for a large amount of elastic deformation and shape recovery.
Looking now at
Since the alloy is at a temperature greater than As, the martensite is unstable (i.e., the Nitinol wants to return to the austenitic phase). When the strain is removed, the alloy recovers elastically from point C to D (the Deflection Range, i.e., εC-εB). The stress at point D (σA) represents the stress level at which martensite reverts back to austenite. Reversion occurs at essentially a constant stress (line DE). Finally, at point E, the material has become fully austenitic. Further stress recovery (from point E to O) occurs through the elastic recovery of the fully austenitic alloy.
Conventionally, once a Nitinol device is deformed to point C, the device is constrained so as to prevent the device from recovering the elastic stress. At this point the device may be packaged and sterilized. It is then provided to the surgeon ready for use. When the surgeon removes the constraint, the device is allowed to recover its deformation, recovering from point C to D (the Deflection Range, i.e., εC-εB), then to point E, and then to point O. As this occurs, the device transforms from stress-induced martensite to austenite.
It should be appreciated that when the Nitinol device is recovering strain in the Deflection Range (i.e., from point C to point D), a large Stress Transition (σE to σA) exists where the Nitinol device will unload stress at a value greater than the lower plateau (defined as line DE, stress level σA) of the Nitinol's mechanical hysteresis curve. In other words, when the deformed Nitinol is released at point C and allowed to recover its elastic deformation, the Nitinol device does not immediately unload at σA (i.e., the lower plateau stress level, as shown in
Even when the Nitinol device is not strained enough so as to induce elastic strain of the martensite (i.e., when the Nitinol device is not strained enough to transition along the line BC in
For this reason, the conventional approach of deforming a Nitinol device so as to create stress-induced martensite, restraining the Nitinol device in its deformed state, and then releasing the deformed device at the time of use, suffers from the disadvantage that the Stress Transition (σE-σA or σM-σA,
In accordance with the present invention, in order to eliminate or reduce the Stress Transition (i.e., σE-σA, or σM-σA,
Note that the amount of stress imposed on the bone by the unloading Nitinol device differs significantly between: (i) a first situation where the Nitinol device is stressed (e.g., to a 6% strain), then “backed off” to the lower plateau of the mechanical hysteresis curve, then further “backed off” along the lower plateau to a given level of strain (e.g., to a 4% strain), then constrained at that given level of strain (e.g., a 4% strain), and then released into the bone at that given level of strain (e.g., a 4% strain)—whereupon the maximum stress generated by the Nitinol device never rises above the lower plateau of the mechanical hysteresis curve (i.e., the maximum stress generated by the Nitinol device never rises above σA6% (see
In an alternative embodiment of the present invention, the unloading of the stress of Nitinol devices may be controlled using the shape memory effect (
In the shape memory effect, when T>Af, the Nitinol is in the more-ordered parent austenite phase. Under the stress-free condition, if the Nitinol is cooled to any temperature T<Mf, the martensitic transformation (MT) occurs and the material converts to the less-ordered martensitic phase. This is referred to as self-accommodating twinned martensite. If a mechanical load is then applied to the Nitinol and the stress level of the deformed Nitinol reaches a certain critical value, the pairs of martensitic twins begin “detwinning”. “Detwinning” is marked by an increasing level of stress with additional applied strain. Detwinned martensite is thermodynamically stable at T<As. Upon heating above As, the detwinned martensite transforms to its parent (austenite) phase, and the residual strain is fully recovered. However, if a mechanical constraint is used to prevent this free recovery to the Nitinol's original shape, the Nitinol device generates large recovery stresses.
Specifically, when Nitinol is deformed at a temperature below Ms, it deforms elastically along the line OA (
While the aforementioned shape memory effect of Nitinol can be used in devices to allow controlled deformation of the device, it is generally not preferred since the device needs to be kept at a temperature below Ms after the Nitinol device has been deformed and until it will be used. This can be difficult in practice, since cleaning, sterilization, and transportation often expose the Nitinol device to elevated temperatures. As such, it has become popular to constrain the deformed Nitinol device (as Constrained Martensite) immediately following deformation of the Nitinol device, while the Nitinol device is at a temperature below Ms. This allows the Nitinol device to remain deformed even if the Nitinol device is thereafter exposed to temperatures above As.
If the aforementioned Nitinol device is strained to point C, and then constrained, when thereafter warmed to a temperature above Ms, the Nitinol wants to flip from its unstable detwinned martensite state to its stable austenite state, and a large amount of force can be generated by the device as it transforms from the detwinned martensite state to the austenite state. If the deformed Nitinol is constrained at point C, and then heated to a temperature above As, the stress will increase to σE (
Again, the Deflection Range (i.e., the change in ε) and the Stress Transition (i.e., the change in σ) should be noted as the material transitions along the mechanical hysteresis curve of Nitinol. It should be appreciated that the stresses generated by the Nitinol device while operating in the Deflection Range (i.e., between σE and σA) may be too high for bone tissue. This may result in the Nitinol device damaging the bone and/or “tearing through” the bone. The use of Constrained Martensite can be preferable over superelasticity for the following reasons:
(1) When cooled to martensite (i.e., T<Mf), the Nitinol device can be strained at this softer, more formable phase, thus requiring a lower load to achieve the deformation, and thereby imposing less stress on the Nitinol device and reducing wear on the surface of the Nitinol device which is crucial to maintaining biocompatibility;
(2) the deformed device will stay deformed as long as it is kept at a temperature less than Ms, thereby limiting the force imposed on the constraint;
(3) the device can be mechanically constrained so as to prevent shape change if the device is warmed prematurely/accidentally to a temperature above Ms; and
(4) the device can be inserted into the body in the Constrained Martensitic condition and staged for shape recovery when the surgeon is ready.
In accordance with the present invention, there is also provided an approach for combining device deformation (by forming detwinned martensite) with controlling the stress level at which the Nitinol device recovers its elastic strain.
To achieve this objective, in one example, and looking now at
In a second example, the device can be cooled to a temperature below Ms and then deformed along lines OA, AB, and BC of its mechanical hysteresis curve. The Nitinol device can then be warmed to above its As temperature and strain recovery can be controlled, permitting recovery from εB to εA along the line CD via Free Recovery. When the strain level is at εA, a mechanical restraint can then be installed. At point D, the Nitinol device has recovered enough elastic strain so that the mechanical constraint is now limiting further strain recovery. This results in the stress increasing to σA (point E) with no additional strain recovery (Constrained Recovery). Subsequently, when the mechanical constraint is removed, the Nitinol device will recover its elastic strain along the lines EF and FO of its mechanical hysteresis curve. As is the case with the aforementioned stress-induced martensite, allowing partial strain recovery via the Nitinol's shape memory effect prior to mechanically constraining the Nitinol device allows the Nitinol device to unload directly at the lower plateau of the mechanical hysteresis curve of the Nitinol device.
It should be appreciated that it is possible to combine the controlled recovery of stress in Nitinol by combining superelastically straining the device with partial recovery via shape memory effect. In this example, and looking at
There are instances when a delayed, or staged, unloading of the stress in Nitinol is preferred for a Nitinol device. By way of example but not limitation, it may be beneficial for a Nitinol device to first radially expand to grip bone fragments and then, in a second stage, longitudinally shorten to pull the bone fragments into compression.
One way of accomplishing such a delayed, or staged, or “staggered”, unloading action is by forming the Nitinol device with regions having two (or more) different Af temperatures (
By way of further example but not limitation, heat treating (aging) the Nitinol material between about 300° C. and 550° C. causes Nickel-rich precipitation reactions to occur, changing the alloy's exact matrix composition. For example, heat treating (aging) Nitinol at about 400° C. for about 70 minutes will result in the Nitinol having an Af temperature of about 40° C.
It should be appreciated that the Nitinol device can be heat treated so as to allow the Nitinol device to have two or more Af temperatures greater than room temperature. Therefore, the Nitinol device will exhibit shape memory effect at the two (or more) Af temperatures. By way of example but not limitation, a Nitinol device can be made that radially expands at an Af temperature of 37° C. and shortens at an Af temperature of 50° C. When implanted into the body, the Nitinol device will radially expand via shape memory effect, and pouring warm saline over the device will trigger it to shorten via shape memory effect.
There may be instances where it is preferable to have the entire Nitinol device, or selected regions of the Nitinol device, not unload stress when deformed (i.e., be permanently deformed). This would allow a Nitinol device (or at least a portion of the Nitinol device) to take a set so that the Nitinol device can be contoured to a patient's anatomy. In practice, it may be desirable to have only specific regions of the Nitinol device not unload (i.e., be permanently deformed) at body temperature, while allowing other regions of the Nitinol device to unload via superelasticity or shape memory effect at body temperature. By way of example but not limitation, it may be clinically beneficial to create a fracture plate that has malleable end regions to allow those malleable end regions to be contoured longitudinally to the curvature of the bone, while having a superelastic bridge that can pull the bone fragments together in compression. In addition, it may be beneficial to form malleable end regions of a Nitinol device out of martensitic Nitinol, since martensitic Nitinol has a lower modulus which more closely matches the modulus of bone.
One way to accomplish multiple transition zones within a monolithic device (i.e., a one-piece device) is, for example, by selectively heat-treating regions of the Nitinol device to 400° C. for 70 minutes, while insulating adjacent regions of the Nitinol device to maintain temperatures below 300° C., thus preventing those insultated regions from being heat treated (aged) (
Special heat treatment fixtures can be provided to assist in the selective heat treatment of the Nitinol devices. Heat treatment fixtures can be provided that utilize resistive heating or inductive heating to selectively heat-treat regions of the Nitinol device. The Nitinol device can be heated with a fluidized sand/salt bath, or by conduction with a metallic fixture, preferably made out of aluminum or other materials with high heat-transfer coefficients. The regions where heat treating is not desired can be passively cooled by air (see
Using this heat treatment approach, it is possible to create monolithic devices (i.e., one-piece devices) that simultaneously provide both superelastic and malleable regions at body temperature. It is also possible to provide shape memory effect and malleable regions at body temperature. By way of example but not limitation, at body temperature, the Nitinol device shown in
The temperature differential between (i) the body that the Nitinol device will be installed into (assumed to be 37° C., which is the temperature of a human body), and (ii) the Af temperature of the shape memory material forming the Nitinol device affects the unloading characteristics (
In addition to the Af temperature of the Nitinol device, the stress levels of the upper and lower plateaus of the Nitinol's mechanical hysteresis curve are affected by the amount of “cold work” in the device (
Reduced amounts of cold work result in reduced strength. As the percent of cold work is increased, the stress level of the upper plateau rises, and the stress level of the lower plateau falls. The percentage of cold work in the Nitinol device affects its unloading characteristics. As the percentage of cold work increases, the unloading stress decreases.
Looking next at
In one preferred form of the invention, compression screw 1100 and internal retaining pin 1200 are provided in the form of a sterilized kit. The kit may include additional instruments to aid in the implantation of the screw (e.g., k-wire, drill bit, screw size guide, etc.).
Compression screw 1100 is shown in greater detail in
Proximal threaded region 1105 and distal threaded region 1115 are connected by a hollow central bridge region 1125. Hollow central bridge region 1125 can be strained and reversibly elongated by virtue of the fact that compression screw 1100 is manufactured from a shape memory material (e.g., a material capable of exhibiting superelasticity and/or a temperature-induced shape change), which may be a metal alloy (e.g., Nitinol) or a polymer (e.g., appropriately processed PEEK). By way of example but not limitation, where compression screw 1100 is formed out of Nitinol, hollow central bridge region 1125 can be strained and reversibly elongated by up to 8% without taking a set. By straining and reversibly elongating hollow central bridge region 1125 prior to implantation across a fracture line in bone, and by thereafter releasing that strain after implantation across the fracture line, contracting hollow central bridge region 1125 can provide additional compression to the bone fracture.
Compression screw 1100 comprises a drive feature 1130 (e.g., a slot) in proximal threaded region 1105 for engagement by an appropriate driver (not shown) of the sort well known in the art, whereby to turn compression screw 1100 (e.g., into bone). Additionally, the distal threaded region 1115 of compression screw 1100 preferably comprises self-drilling features 1135 (e.g., cutting edges) of the sort well known in the screw art, and self-tapping features 1140 (e.g., flutes) of the sort well known in the screw art.
Compression screw 1100 comprises a central lumen 1145 which extends the length of the compression screw. Central lumen 1145 generally comprises a distal bore 1150, an intermediate counterbore 1155 and a proximal counterbore 1160. Intermediate counterbore 1155 has a diameter which is wider than the diameter of distal bore 1150, and an annular shoulder 1165 is formed at the intersection of distal bore 1150 and intermediate counterbore 1155. Annular shoulder 1165 preferably lies in a plane perpendicular to the longitudinal axis of the compression screw. Proximal counterbore 1160 has a diameter which is wider than the diameter of intermediate counterbore 1155, and an annular shoulder 1170 is formed at the intersection of intermediate counterbore 1155 and proximal counterbore 1160. Proximal counterbore 1160 is threaded, e.g., with an internal thread 1175 (for purposes of clarity, not shown in
Internal retaining pin 1200 is shown in greater detail in
More particularly, internal retaining pin 1200 comprises proximal threaded region 1205 and distal cylindrical region 1215. Internal retaining pin 1200 is cannulated so as to allow a k-wire to be passed through internal retaining pin 1200 as will hereinafter be discussed, and has a drive feature 1220 in its threaded proximal region 1205 to facilitate turning internal retaining pin 1200, whereby to insert internal retaining pin 1200 into compression screw 1100 or to remove internal retaining pin 1200 from compression screw 1100, as will hereinafter be discussed. To this end, internal retaining pin 1200 comprises a central lumen 1225 which extends the length of internal retaining pin 1200. Central lumen 1225 preferably comprises a distal section 1230, an intermediate section 1235 and a proximal section 1240. Distal section 1230 has a diameter which is wider than the diameter of intermediate section 1235, and a shoulder 1245 is formed at the intersection of distal section 1230 and intermediate section 1235. Proximal section 1240 has a widest diameter which is wider than the diameter of intermediate section 1235, and a shoulder 1250 is formed at the intersection of intermediate section 1235 and proximal section 1240. Proximal section 1240 has a hexagonal (or other non-circular) cross-section, whereby to provide the aforementioned drive feature 1220, whereby to enable turning internal retaining pin 1200 into, or out of, compression screw 1100, as will hereinafter be discussed.
As seen in
Internal retaining pin 1200 is provided so as to selectively maintain compression screw 1100 in a strained (i.e., stretched) configuration and, when internal retaining pin 1200 is removed from compression screw 1100, to allow compression screw 1100 to attempt to return to its unstrained (i.e., unstretched) configuration.
More particularly, and looking now at
Straining compression screw 1100 in the “cold” condition is preferable because it takes considerably less force to strain the non-austenitic material. The load that is required to stretch the compression screw may be less than half that required to stress the material in its austenitic phase. Furthermore, the surface finish of the compression screw is critical to its biocompatibility. Prior to straining, the compression screw may be passivated to remove embedded surface contaminants that may have resulted from the manufacturing process. Passivation also creates a biocompatible oxide layer on the surface of the screw. Straining the compression screw with a high load (i.e., the type of high load required to stress the compression screw in an austenitic phase) can damage this biocompatible oxide layer, and can embed particles into the surface of the threaded regions of the compression screw. Lower loads (i.e., the type of loads required to stress the compression screw in a non-austenitic phase) will minimize any damage to the surface finish.
With compression screw 1100 “cold” (i.e., maintained below its austenite start temperature, more preferably below its martensite start temperature, and most preferably below its martensite finish temperature) and strained (i.e., stretched), internal retaining pin 1200 is installed in compression screw 1100. More particularly, with compression screw 1100 maintained below its austenite start temperature, internal retaining pin 1200 is advanced into compression screw 1100 so that proximal threaded region 1205 of internal retaining pin 1200 is fully seated in threaded proximal counterbore 1160 of compression screw 1100, and so that the distal end of internal retaining pin 1200 abuts annular shoulder 1165 in compression screw 1100, whereby to lock compression screw 1100 in its strained (i.e., stretched) state.
Compression screw 1100 can now be warmed above its austenite start temperature and compression screw 1100 will not foreshorten due to the presence of internal retaining pin 1200 within compression screw 1100.
However, when internal retaining pin 1200 is thereafter removed from compression screw 1100, compression screw 1100 will attempt to revert back to its non-strained (i.e., unstretched) length, i.e., compression screw 1100 will attempt to foreshorten. As a result, when a strained compression screw 1100 is deployed across the fracture line in bone and internal retaining pin 1200 is thereafter removed, the compressive force generated by the differential pitch of proximal threaded region 1105 and distal threaded region 1115 is supplemented by the additional compressive force created by the foreshortening of hollow central bridge region 1125.
Note that compression screw 1100 is configured so that the force that is generated as compression screw 1100 foreshortens is less than the pullout force of distal threaded region 1115 and proximal threaded region 1105, so that compression screw 1100 does not “tear through” the bone tissue when attempting to foreshorten. More particularly, compression screw 1100 is specifically engineered so not to “tear through” the bone tissue. The compressive forces of compression screw 1100 can be controlled by modulating the material properties of the compression screw and/or the geometry of the compression screw. The percentage of cold work in the shape memory material forming compression screw 1100 affects the compressive force generated by the compression screw. As the percentage of cold work increases, the compression force declines. A compression screw should, preferably, have between about 15% and 55% cold work to control the recovery force of the compression screw.
Another material property that affects the screw's compression force is the temperature differential between the body that the compression screw will be implanted into (assumed to be 37° C., which is the temperature of a human body) and the austenite finish temperature of the shape memory material forming compression screw 1100. A smaller temperature differential between the two will result in the screw generating a small compressive load; conversely, the larger the temperature differential between the two will result in a screw generating a larger compressive load. The shape memory material that the compression screw is made out of should, preferably, have an austenite finish temperature of greater than about −10° C., resulting in a temperature differential of less than about 47° C. when the compression screw is implanted (assuming that the compression screw is implanted in a human body).
Screw geometry also affects the compression force generated. The cross-sectional area of the hollow central bridge region 1125 affects the compression force. As the cross-sectional area increases, so does the compression force that the compression screw 1100 will generate. In this respect it should be appreciated that it is beneficial for the compression force generated by foreshortening compression screw 1100 to be constant as the bone relaxes and remodels. Thus, the cross-section of hollow central bridge region 1125 of compression screw 1100 preferably has a constant cross-section over its entire length. Cross-sections that are not uniform over the length of hollow central bridge region 1125 can result in an increase or decrease in compression as the compression screw shortens.
The screws threads are critical for transmitting the compression force to the bone without “tearing through” the bone. The height of the screw threads, the number of threads per inch (pitch), and the geometry of the screw threads are all critical to the screw's ability to not “tear through” the bone. The proximal and distal threaded regions may be of different lengths. The length of the distal thread region may be equal to or greater than the length of the proximal thread region. The distal thread region should, preferably, be at least 20% of the total screw length. Additionally, the thread height of the distal threads should, preferably, be equal to or greater than the thread height of the proximal threads. The distal thread geometry may also be mirrored from that of the proximal thread geometry. This creates threaded regions where the load-bearing thread face is nearly perpendicular to the longitudinal axis of the compression screw. The resulting thread form has high shear strength.
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As noted above, compression screw 1100 is provided with a drive feature 1130, whereby to turn compression screw 1100 into bone. Drive feature 1130 can be a standard screw drive feature such as a drive slot, a Philips (cruciform) drive configuration, a hex or hexalobe recess, or other engagement feature of the sort well known in the art.
As also noted above, internal retaining pin 1200 is provided with a drive feature 1220, whereby to advance internal retaining pin 1200 into compression screw 1100 or to remove internal retaining pin 1200 from compression screw 1100. While drive feature 1220 is shown herein as comprising a hex recess, other drive features of the sort well known in the art may also be used.
In addition, as noted above, internal retaining pin 1200 is preferably releasably secured to compression screw 1100 via a screw mechanism (e.g., proximal screw thread 1210 of internal retaining pin 1200 engaging internal thread 1175 of compression screw 1100). However, if desired, other connection mechanisms (e.g., a bayonet mount) may be used to releasably connect internal retaining pin 1200 to compression screw 1100.
It should also be appreciated that compression screw system 1005 need not be delivered over a k-wire. In this case, compression screw 1100 and internal retaining pin 1200 need not be fully cannulated.
In addition to the foregoing, in the preceding section, compression screw is described as being strained (i.e., stretched) prior to the insertion of internal retaining pin 1200 into the compression screw. However, if desired, internal retaining pin 1200 can be inserted into compression screw 1100 without compression screw 1100 being pre-strained (i.e., without compression screw 1100 being pre-stretched), in which case internal retaining pin 1200 can be used to strain (i.e., stretch) compression screw 1100, i.e., by virtue of the engagement of the advancing distal tip of internal retaining pin 1200 with annular shoulder 1165 of compression screw 1100.
And in the foregoing description, compression screw 1100 is described as being stretched while it is at a temperature below its austenite start temperature, and with the internal retaining pin being inserted into the compression screw while the compression screw is maintained below its austenite start temperature. However, if desired, compression screw 1100 may be stretched while it is at a temperature above its austenite start temperature, whereby to create stress-induced martensite, with the internal retaining pin being inserted into the compression screw while the compression screw is maintained in its stretched condition.
If desired, compression screw system 1005 may be deployed using two separate drivers, i.e., a first driver for deploying compression screw 1100 into the bone and a second driver for removing internal retaining pin 1200 from the deployed compression screw 1100. However, if desired, a single two-part driver may be used, where one part of the two-part driver deploys the compression screw 1100 into the bone and a second part of the two-part driver removes internal retaining pin 1200 from the deployed compression screw 1100.
By way of example but not limitation, and looking now at
It should be appreciated that with the compression screw system 1005 shown in
In another form of the invention, internal retaining pin 1200 can be incorporated as part of a single-use delivery device, where portions of the single-use delivery device engage compression screw 1100 and hold compression screw 1100 in its stretched condition until compression screw 1100 is released from the delivery device, as will hereinafter be discussed in further detail. Preferably, in this form of the invention, compression screw 1100 is provided pre-strained and pre-loaded onto the delivery device, which is preferably a single-use delivery device that may be disposable.
More particularly, and looking now at
In one preferred form of the invention, compression screw 1100A, cannulated inner driver 1405, cannulated outer driver 1410 and coupling cap 1415 are provided in the form of a sterilized kit. The kit may include additional instruments to aid in the implantation of the screw (e.g., k-wire, drill bit, screw size guide, etc.).
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Cannulated inner driver 1405 is shown in greater detail in
Compression screw interface region 1435 has a proximal threaded region 1440 adjacent to the distal end of shaft 1430. Proximal threaded region 1440 comprises proximal thread 1445 that has an identical pitch to proximal thread 1110A of the proximal threaded region 1105A of compression screw 1100A.
Compression screw interface region 1435 also comprises a drive feature 1450 which is disposed distal to proximal thread 1445. Drive feature 1450 is designed to interface with drive feature 1130A on compression screw 1100A. By way of example but not limitation, where drive feature 1130A on compression screw 1100A comprises a hex recess, drive feature 1450 on compression screw interface region 1435 comprises a hex driver (
Thus, in this form of the invention, compression screw interface region provides a modified form of internal retaining pin for holding compression screw 1100A in a stretched condition. However, inasmuch as drive feature 1450 on compression screw interface region 1435 does not lock, in a longitudinal sense, to drive feature 1130A on compression screw 1100A (although it does lock, in a rotational sense, to drive feature 1130A on compression screw 1100A), cannulated outer driver 1410 is used to hold a strained (i.e., stressed) compression screw 1100A in its strained (i.e., stretched) condition on compression screw interface region 1435 until compression screw 1100A is released from cannulated inner driver 1405 and cannulated outer driver 1410, as will hereinafter be discussed in further detail.
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It will be appreciated that when compression screw 1100A is secured to cannulated inner driver 1405 by means of cannulated outer driver 1410, the distal end of hollow cylindrical region 1455 of cannulated inner driver 1405 abuts annular shoulder 1165A of compression screw 1100A, so that compression screw 1100A can be warmed to a temperature above its austenite start temperature without the compression screw shortening.
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Compression screw system 1400 can be used to aid in the healing of fractured bone, e.g., the scaphoid of the wrist, diaphysis of the fifth metatarsal, and the proximal interphalangeal joint of the second, third, fourth or fifth toe. More particularly, and looking now at
When the distal end of cannulated outer driver 1410 contacts the cortical surface of bone fragment 1310, the compression screw 1100A can be turned further with cannulated outer driver 1410 so as to reduce the fracture and generate compression between the bone fragments 1310, 1315. More particularly, when the cannulated outer driver 1410 is turned further, compression screw 1100A pulls the bone fragments further together (i.e., in the manner of a lag screw).
Thereafter, compression screw 1100A is advanced out of cannulated outer driver 1410 and further into the bone. To this end, coupling cap 1415 is removed, and drive handle 1425 of cannulated outer driver 1410 is held stationary while drive handle 1420 of cannulated inner driver 1405 is turned, so that drive feature of cannulated inner driver 1405 turns drive feature 1130A of compression screw 1100A so as to advance compression screw 1100A along internal thread of cannulated outer driver 1410 and further into the bone. This causes cannulated inner driver 1405 to countersink compression screw 1100A. As this occurs, the differential pitch between proximal screw thread 1110A and distal screw thread 1120A further reduces the fracture and generates further compression through the aforementioned differential thread pitch.
As compression screw 1100A exits cannulated outer driver 1410 and becomes thoroughly countersunk, compression screw 1100A becomes disengaged from internal thread 1465 of cannulated outer driver 1410, thereby allowing compression screw 1100A to attempt to foreshorten. Inasmuch as proximal threaded region 1105A and distal threaded region 1115A of compression screw 1100A are disposed in bone fragments 1310, 1315, respectively, the compression screw will generate and maintain an additional compressive load across the fracture line 1305 as the compression screw foreshortens, thereby enhancing healing.
It should be appreciated that compression screw system 1400 need not be delivered over a k-wire. In this case, compression screw 1100A, cannulated inner driver 1405 and coupling cap 1415 need not be fully cannulated.
In addition to the foregoing, in the preceding section, compression screw 1100A is described as being strained (i.e., stretched) prior to being mounted to cannulated inner driver 1405. However, if desired, compression screw 1100A can be mounted to cannulated inner driver 1100A without compression screw 1100A being pre-strained (i.e., pre-stretched), in which case cannulated inner driver 1405 can be used to strain (i.e., stretch) compression screw 1100A, i.e., by virtue of the engagement of the distal tip of cannulated inner driver 1405 with annular shoulder 1165A of compression screw 1100 when cannulated outer driver 1410 engages compression screw 1100A and pulls compression screw 1100A proximally.
And in the foregoing description, compression screw 1100A is described as being stretched while it is at a temperature below its austenite start temperature, and then being loaded onto the cannulated inner driver and locked into position (i.e., with the cannulated outer driver) while the compression screw is maintained below its austenite start temperature. However, if desired, compression screw 1100A may be stretched while it is at a temperature above its austenite start temperature, whereby to create stress-induced martensite, and the compression screw mounted onto the cannulated inner driver and locked into position (i.e., with the cannulated outer driver) while the compression screw is maintained in its stretched condition.
Test Data
It has been reported that the “mean time to union” for a non-displaced scaphoid fracture is 6 to 8 weeks. At the time of insertion, nominally similar dimensioned conventional compression screws (between 3.0 and 3.6 mm distal major diameter), generate on average about 155N of compressive force. Comparatively, the compression screw system of the present invention is capable of generating additional compression (for example, about 190N) because of an increased thread pullout resistance.
Following the first 12 hours after implantation, compression decays on average by about 43% for conventional compression screws. For some conventional compression screws, that decay is as high as 55%. The compression screw system of the present invention loses only about 20% of its compression over a 12 hour period. This occurs as the bone relaxes and remodels around the threads. After this 12 hour period, a new steady state of compression of around 100N or greater of compression is achieved and maintained, and correlates with the force generated by the novel compression screw as it recovers its strain in the hollow central bridge region. This compressive load is actively maintained until the novel compression screw has fully restored the strain. It should be appreciated that the force generated by the novel compression screw as it recovers can be modified for different bone qualities and indications by adjusting the parameters discussed above.
It should be noted that larger diameter compression screws of the present invention can generate and maintain greater compressive loads, and conversely, smaller diameter compression screws of the present invention will generate and maintain lesser compressive loads. Since the recovery force is a function of the cross-sectional area of the novel compression screw's central counterbore 1145A, a cannulated 7.5 mm screw (distal major diameter) can generate and maintain about 400N of force. Larger diameter compression screws of the present invention can support greater compressive loads since the threaded regions may be longer and/or deeper and thus have greater surface area to distribute the force over.
Further Aspects
In one preferred embodiment of the present invention, the force generated by the compression screw is controlled by stretching (i.e., straining) the compression screw approximately 8%, and then allowing the compression screw to partially recover (e.g., to shorten) so that the compression screw is approximately 6% longer than its original length. With the compression screw stretched 6% longer than its original length, a constraint (e.g., the aforementioned internal retaining pin 1200) can be removably installed on the compression screw to prohibit further recovery. The partial recovery of strain (i.e., from an 8% stretch to a 6% stretch) occurs in the Load Transition zone at stress levels that may be in excess of the shear strength of bone. In other words, by allowing the compression screw to partially recover from strain prior to implantation (i.e., from an 8% stretch to a 6% stretch), the highest stress levels associated with the upper plateau at 8% stretch may be prevented from being applied to the bone, and only the lower plateau stress levels associated with the remaining 6% stretch may be applied to the bone (i.e., partial recovery of strain prior to implantation occurs in the load transition zone). Following implantation of the compression screw, the constraint (e.g., the aforementioned internal retaining pin 1200) can be removed from the compression screw, thereby allowing the compression screw to attempt to recover the remaining strain. The subsequent strain recovery will occur directly at the stress level of the lower plateau of the mechanical hysteresis curve of the Nitinol compression screw. The stress level of the lower plateau may be less than the shear strength of the bone, thereby keeping the screw threads from stripping in the bone.
By way of example but not limitation, a cannulated Nitinol headless compression screw can manufactured. The Nitinol material properties can have an upper plateau stress of 400 MPa and a lower plateau stress of 100 MPa. The hollow central region of the compression screw may have an outer diameter of 2.3 mm and an inner cannulation of 1.5 mm. Thus, the “active region” of the compression screw has a cross-sectional area of 2.4 mm2, and would thus generate 955 N at the upper plateau of the mechanical hysteresis curve and 238 N at the lower plateau of the mechanical hysteresis curve.
The compression screw may have proximal threads with a major diameter of 4.6 mm, a thread depth of 0.45 mm, a thread pitch of 1.1 mm and a threaded length of 3.0 mm.
The compression screw may have distal threads with a major diameter of 3.6 mm, a thread depth of 0.65 mm, a thread pitch of 1.25 mm and a threaded length of 12 mm.
The proximal head of the compression screw will sit in cortical bone and the distal thread of the compression screw will sit mainly in cancellous bone. Normal healthy cortical bone may have a shear strength of approximately 60 MPa. Normal healthy cancellous bone may have an ultimate shear strength of approximately 4.3 MPa.
In cortical bone, the pullout force of the proximal threads is approximately 1915 N. In cancellous bone, the pullout force of the distal threads is approximately 467 N. At the level of stress of the upper plateau of the Nitinol's mechanical hysteresis curve, the proximal threads will not strip in the cortical bone as the compression screw attempts to shorten (955 N generated by compression, pullout force 1915 N) but the distal threads will strip as the compression screw attempts to shorten (955 N generated by compression, pullout force 466.9 N). However, by operating at the level of stress of the lower plateau of the Nitinol's mechanical hysteresis curve, the compression screw generates only 238 N of compression, which is less than the pullout force in the healthy cancellous bone, and thus the compression screw will not pull out.
It should be appreciated that unloading on the lower plateau of the Nitinol's mechanical hysteresis curve is even more important when the patient is osteoporotic/osteopenic. Osteoporotic and osteopenic bone will have even a lower shear strength.
Novel Staple Comprising Elastic Bridge with Two Elastic Legs
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Novel staple 2005 is preferably an integral, monolithic structure manufactured from a single piece of shape memory material (e.g., a material capable of exhibiting superelasticity and/or a temperature-induced shape change). The shape memory material may be a metal alloy (e.g., Nitinol) or a polymer (e.g., appropriately processed PEEK). Staple 2005 is designed to reduce fractures and generate and maintain greater, and more uniform, compression between bone fragments to aid in fracture healing. Staple 2005 comprises an elastic bridge 2010 and two elastic legs 2015. Bridge 2010 and legs 2015 meet at a pair of curved hinge regions 2020 which are also elastic. Legs 2015 may have barbed teeth 2025 to help the legs of the staple grip into the bone after implantation (see below) and prevent the legs of the staple from working their way back out of the bone. In the un-restrained state, legs 2015 of staple 2005 are bent inward with an angle of less than 90°. By way of example but not limitation, in one preferred form of the invention, legs 2015 extend at an angle of about 45° to the longitudinal axis of bridge 2010 when in their unrestrained state.
Prior to implantation, bridge 2010 of staple 2005 can be reversibly strained outward (i.e., stretched longitudinally) and legs 2015 of staple 2005 can be reversibly bent to a position substantially perpendicular to bridge 2010 (
Upon insertion of the strained staple 2005 into the prepared fracture site, the constraint on bridge 2010 and legs 2015 is removed, whereupon staple 2005 attempts to return to its original un-restrained state (
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Note that with delivery device 2030, the delivery device is constructed so that upon squeezing handles 2045, the legs of the staple are first bent to perpendicular and then, when the legs of the staple are substantially perpendicular, the bridge of the staple is elongated.
Note that staple 2005 is configured so that the force that is generated as staple 2005 reconfigures (i.e., as bridge 2010 foreshortens and legs 2015 bend inward) is less than the “tear through” force of the bone receiving legs 2015, i.e., staple 2005 is specifically engineered so as to not “tear through” the bone tissue when attempting to reconfigure. Delivery device 2030 preferably includes the aforementioned locking feature 2055 which enables the surgeon to control the extent to which the staple is strained (e.g., to bend only the legs of the staple, or to both bend the legs of the staple and strain the bridge of the staple, and to control the extent to which the bridge is stretched), thereby allowing the surgeon to tailor the compressive forces and recoverable strain imposed on the anatomy, depending on bone quality. The compressive forces of staple 2005 can be controlled by modulating the material properties of the staple and/or the geometry of the staple.
The percentage of cold work in the shape memory material forming staple affects the compressive force generated by the reconfiguring staple. As the percentage of cold work increases, the compression force declines. A staple should, preferably, have between about 15% and 55% cold work to control the recovery force of the staple; however, other degrees of cold work may be used, and/or the material may not be cold worked at all.
Another material property that affects the staple's compression force is the temperature differential between the body that the staple will be implanted into (assumed to be 37° C., which is the temperature of a human body) and the austenite finish temperature of the shape memory material forming staple 2005. A smaller temperature differential between the two will result in the staple generating a smaller compressive load; conversely, a larger temperature differential between the two will result in the staple generating a larger compressive load. The shape memory material that the staple is made out of should, preferably, have an austenite finish temperature of greater than about −10° C., resulting in a temperature differential of about 47° C. when the staple is implanted (assuming that the staple is implanted in a human body).
Staple geometry also affects the compression forces generated. The cross-sectional area of bridge 2010, and the cross-sectional area of legs 2015, affects the compression forces generated by the reconfiguring staple. As the cross-sectional areas increase, so do the compression forces that the reconfiguring staple will generate.
The staple legs are critical for transmitting the compression force to the bone without “tearing through” the bone. The height, width, and length of the staple legs, and the geometry of the staple legs, are all significant relative to the staple's ability to not “tear through” the bone. Staple legs with greater surface area are better able to distribute the compression force and thus not “tear through” the bone.
More particularly, the fracture 2090 to be fused is first re-approximated and reduced. A drill guide (not shown) of the sort well known in the art is used to drill two holes 2095 the correct distance apart to accommodate the legs 2015 of the strained staple 2005. Staple 2005 is loaded onto delivery device 2030, and delivery device 2030 is used to stretch bridge 2010 and straighten legs 2015 of staple 2005 (i.e., by squeezing together handles 2045). While still on delivery device 2030, legs 2015 of staple 2005 are placed into the pre-drilled holes 2095. Staple 2005 is then released from delivery device 2030, which allows the stretched bridge 2010 of staple 2005 to foreshorten so as to apply compression to the fracture line, and which allows the strained legs 2015 of staple 2005 to “kick in” and thereby apply additional inward pressure across the fracture line 2090. Thus, staple 2005 applies more uniform compression across the fracture site, generating compression across both the cortical and intramedullary surfaces, using the compressive forces generated by the foreshortening bridge 2010 of the strained staple 2005 and using the compressive forces generated by inwardly bending legs 2015 of the strained staple 2005.
Significantly, when bridge 2010 and legs 2015 of staple 2005 generate a compressive force, both the cortical regions of the bone fragments and the cancellous regions of the bone fragments are pulled together. This provides a superior balance of compression across different regions of the bone.
It should also be appreciated that, if desired, staple 2005 can be used to attach soft tissue to bone (e.g., to attach a rotator cuff to bone).
It should be appreciated that delivery device 2030 may not always seat the staple with the bridge of the staple seated directly against the cortical surface of the bone (i.e., the bridge of the staple may sit slightly above the cortical surface of the bone). Therefore, a tamp of the sort well known in the art may be used to fully seat the staple bridge against the cortical surface of the bone.
In some circumstances it can be desirable to modify delivery device 2030 so as to ensure that legs 2015 do not be bent past 90 degrees (relative to the longitudinal axis of bridge 2010) when staple 2005 is strained. More particularly, in some constructions, staple 2005 can require more force to stretch bridge 2010 than to bend legs 2015. In this circumstance, there is the possibility that legs 2015 will be bent to 90 degrees (relative to the longitudinal axis of bridge 2010) and then, as bridge 2010 is stretched, legs 2015 may be bent past 90 degrees (relative to the longitudinal axis of bridge 2010). Therefore, it can be desirable to provide means for preventing legs 2015 from being bent past 90 degrees (relative to the longitudinal axis of bridge 2010). To this end, and looking now at
In one preferred form of the invention, staple 2005 and delivery device are provided in the form of a sterilized kit. The kit may include additional instruments to aid in the implantation of the staple (e.g., k-wire, drill bit, staple size guide, tamp, etc.).
In the foregoing discussion, staple 2005 is strained so that, upon deployment in the bone, it will provide compression across a fracture line. However, it should also be appreciated that, if desired, staple 2005 can be configured to provide a distraction force to a bone. In this situation, staple 2005 can be configured and strained so that bridge 2010 can be compressed, and/or legs 2015 can be bent outward, such that when staple 2005 is deployed in bone, the reconfiguring staple can apply a distraction force to the bone, whereby to cause the bone to grow and thereby elongate.
Novel Staple Comprising Malleable Bridge with Two Elastic Legs
As discussed above, staple 2005 is manufactured from a shape memory material (e.g., a material capable of exhibiting superelasticity and/or a temperature-induced shape change). The shape memory material may be a metal alloy (e.g., Nitinol) or a polymer (e.g, appropriately processed PEEK). In this respect it should be appreciated that staple 2005 can be manufactured out of a single piece of shape memory material (i.e., so as to create an integral, monolithic structure), and the different regions of the staple worked differently, in a metallurgical sense, so that different regions of the staple have different mechanical properties and exhibit different mechanical characteristics, even as they form a single, integral, monolithic structure.
In one form of the invention, and as discussed above, staple 2005 can be manufactured so that bridge 2010 is elastic, legs 2015 are elastic, and curved hinge regions 2020 are elastic, in which case bridge 2010 can be elastically deformed, and legs 2015 can be elastically deformed, so that both bridge 2010 and legs 2015 provide compression to the fracture site after implantation. In this form of the invention, bridge 2010 and legs 2015 may be worked, metallurgically, so that they have the same or different mechanical properties.
However, in another form of the invention, staple 2005 can be manufactured so that bridge 2010 is malleable and non-superelastic (e.g., fully annealed Nitinol, or martensitic Nitinol with an austenite start temperature greater than body temperature), and legs 2015 and hinge regions 2020 are superelastic (e.g., austenite but capable of forming stress-induced martensite). This allows the malleable bridge 2010 of staple 2005 to be inelastically bent (i.e., to take a set) to accommodate a particular geometry of the cortical anatomy, while still allowing the superelastic legs 2015 of the staple to generate compression. By way of example but not limitation, many bones exhibit an hour-glass surface profile; moreover, certain orthopedic indications (e.g., an Akin Osteotomy) often results in a cortical surface that is concave when the bones are re-approximated. In these situations, a staple with a straight bridge will not sit flush on the bone surface, which can lead to patient discomfort. In this respect it should also be appreciated that where bridge 2010 is malleable and legs 2015 are superelastic, legs 2015 of staple 2005 may be manufactured at a more acute angle (
See
It may be desirable for staple 2005 to start with a bridge that is convex, e.g., such as the staple 2005 shown in
Thus, in a second form of the invention, staple 2005 is formed out of a single piece of shape memory material (i.e., so as to form a single, integral, monolithic structure), with the shape memory material being worked so that bridge 2010 is malleable (e.g., fully annealed Nitinol, or martensitic Nitinol with an austenite start temperature greater than body temperature) and legs 2015 are superelastic (e.g., austenite but capable of forming stress-induced martensite), such that bridge 2010 of staple 2005 may be bent to contour to the surface of the bone while the compressive force generated by the superelastic legs 2015 of the staple are used to help fuse the bone.
A bending device can be used to bend bridge 2010 of staple 2005 prior to implantation of the staple. An exemplary bending device 2100 is shown in
More particularly,
After the bridge of the staple has been bent to the desired geometry (e.g., the geometry shown in
Plier assembly 2130 is also used to insert the staple into the bone after the legs of the staple have been strained open to substantially parallel.
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With the bridge of the staple inelastically bent into the appropriate configuration and with the legs of the staple elastically strained to substantially parallel, the staple can be inserted into the pre-drilled holes 2175 in bone fragments 2165, 2170. The staple is then released from plier assembly 2130 and tamped to sit flush with the cortical surface, with the inelastically bent bridge 2010 of the staple more closely matching the surface contour of the bone. The elastically-strained superelastic legs 2015 of the staple applies a compressive force across the fracture.
If desired, where the staple is provided with a malleable bridge, the malleable bridge may be bent, or further bent, after the staple has been deployed in bone, e.g., to match, or to more closely match, the surface profile of the bone.
In some circumstances the bone may have a convex profile. In this circumstance, it may be desirable to set the staple so that its bridge has a convex configuration. To this end, and looking now at
It should also be appreciated that, if desired, staple 2005 can be used to attach soft tissue to bone (e.g., to attach a rotator cuff to bone).
It should be appreciated that delivery device 2130 discussed above may not always seat the staple with the bridge of the staple seated directly against the cortical surface of the bone (i.e., the bridge of the staple may sit slightly above the cortical surface of the bone). Therefore, a tamp of the sort well known in the art may be used to fully seat the staple bridge against the cortical surface of the bone.
In one preferred form of the invention, staple 2005, bending device 2100 and/or bending device 2180, and delivery device (i.e., plier assembly) 2130 are provided in the form of a sterilized kit. The kit may include additional instruments to aid in the implantation of the staple (e.g., k-wire, drill bit, staple size guide, tamp, etc.).
Test Data
Conventional shape memory staples typically generate between about 20N and about 120N of compressive force from the staple legs kicking inward.
The novel staple of the present invention having a stretched bridge as described herein generates a compressive load of greater than the 20N to 120N generated by other like-sized conventional staples, thereby providing significantly increased compressive forces without tearing through or otherwise damaging the bone. Additionally, the compressive force provided by the stretched bridge staple of the present invention is more uniformly distributed across the fracture line (i.e., across the cortical bone and the cancellous bone).
Further Aspects
In one preferred embodiment of the present invention, the force generated by the staple is controlled by stretching (i.e., straining) the bridge of the staple approximately 8%, and then allowing the bridge of the staple to partially recover (e.g., to shorten) so that the bridge of the staple is approximately 6% longer than its original length. With the staple stretched 6% longer than its original length, a constraint (e.g., delivery device 2030) can be removably used to prohibit further recovery of the stretched staple bridge. The stretched staple can then be implanted. The partial recovery of strain (i.e., from an 8% stretch to a 6% stretch) occurs in the Load Transition zone at stress levels that may be in excess of the shear strength of bone. In other words, by allowing the stretched staple bridge to partially recover from strain prior to implantation (i.e, from an 8% stretch to a 6% stretch), the highest stress levels associated with the upper plateau at 8% stretch may be prevented from being applied to the bone, and only the lower plateau stress levels associated with the remaining 6% stretch may be applied to the bone (i.e., partial recovery of strain prior to implantation occurs in the load transition zone). Following implantation of the staple, the constraint (e.g., the aforementioned delivery device 2030) can be removed from the staple, thereby allowing the staple to attempt to recover the remaining strain. The subsequent strain recovery will occur directly at the stress level of the lower plateau of the mechanical hysteresis curve of the Nitinol staple. The stress level of the lower plateau may be less than the shear strength of the bone, thereby keeping the staple legs from stripping in bone.
In another preferred embodiment of the present invention, shape memory materials may be used to manufacture staples that generate and maintain compression between bone fragments while also having a malleable bridge that may be bent to conform to the unique anatomical structure of each patient. Like traditional shape memory staples, this novel staple can have legs that are implanted in a parallel state and are allowed to “kick in” after implantation. However, during manufacturing, the staple bridge may be selectively heat treated at 400° C. for 70 minutes. This will selectively age the shape memory material so that the austenite finish temperature of only the bridge region of the staple is 40° C. (i.e., above body temperature). Thus the bridge will be martensitic and malleable. The surgeon can then bend the bridge of the staple so that it matches the contour of the bone.
The present invention comprises the provision and use of novel intramedullary devices that are better able to bring bone fragments into close proximity with each other, generate a compressive load, and maintain that compressive load for a prolonged period of time while healing occurs.
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First barbed end region 3010 comprises a plurality of barbs 3025 which, in their unbiased condition, flare outward from the longitudinal axis of intramedullary fusion device 3005 in the manner shown in
While
In one preferred form of the invention, barbs 3025 of first barbed end region 3010 are separated from one another by relatively small longitudinal gaps when barbs 3025 are strained to a position parallel to the longitudinal axis of intramedullary fusion device 3005, such that barbs 3025 collectively provide a substantially full circumferential structure for first barbed end region 3010 (i.e., when barbs 3025 are strained to a position parallel to the longitudinal axis of intramedullary fusion device 3005, barbs 3025 collectively provide a substantially continuous extension of central bridge region 3020 of intramedullary fusion device 3005). See
Second barbed end region 3015 comprises a plurality of barbs 3035 which, in their unbiased condition, flare outward from the longitudinal axis of intramedullary fusion device 3005 in the manner shown in
While
In one preferred form of the invention, barbs 3035 of second barbed end region 3015 are separated from one another by relatively small longitudinal gaps when barbs 3035 are strained to a position parallel to the longitudinal axis of intramedullary fusion device 3005, such that barbs 3039 collectively provide a substantially full circumferential structure for second barbed end region 3015 (i.e., when barbs 3035 are strained to a position parallel to the longitudinal axis of intramedullary fusion device 3005, barbs 3035 collectively provide a substantially continuous extension of central bridge region 3020 of intramedullary fusion device 3005). See
It should be appreciated that first barbed end region 3010 and second barbed end region 3015 may have different numbers of barbs, e.g., first barbed end region 3010 may comprise four barbs 3025 and second barbed end region 3015 may comprise three barbs 3035. However, it should be appreciated that regardless of the number of barbs 3025 provided on first barbed end region 3010, and regardless of the number of barbs 3035 provided on second barbed end region 3015, the barbs 3025 of first barbed end region 3010 preferably engage the surrounding bone about the full circumference of the intramedullary fusion device, and the barbs 3035 of second barbed end region 3015 preferably engage the surrounding bone about the full circumference of the intramedullary fusion device.
Central bridge region 3020 preferably comprises a generally cylindrical shape and is preferably sized so as to have an outer diameter somewhat less than the major diameters of first barbed end region 3010 and second barbed end region 3015 when their barbs 3025, 3035, respectively, have been strained to a position parallel to the longitudinal axis of intramedullary fusion device 3005.
Intramedullary fusion device 3005 may be used to secure together two bone fragments under compression. By way of example but not limitation, and looking now at
First the distal end of the metatarsal 3050 is cut off to correct the deformity and create a bone face 3055 suitable for fusion (
Next, the surgeon inserts a k-wire 3070 through the distal end of the toe, phalange 3060 and into the metatarsal 3050 (
Following removal of k-wire 3070, phalange 3060 is flexed downward so as to expose the prepared metatarsal face 3055 (
Next, with retaining tabs 3030, 3040 constraining barbs 3025, 3035, respectively, of first barbed end region 3010 and second barbed end region 3015, respectively, to their “inboard” position (i.e., as shown in
Next, retaining tab 3040 is removed so that barbs 3035 of second barbed end region 3015 are allowed to expand outwardly and grip the side wall of canal 3075 of phalange 3060 (
It should be appreciated that novel intramedullary fusion device 3005 can first be implanted into phalange 3060 and then implanted into metatarsal 3050 if the surgeon so chooses.
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In
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It should also be appreciated that the central bridge region 3020 can be processed so as to be malleable (i.e., to take a set). At body temperature, the barb regions 3010 and 3015 can be superelastic while central bridge region 3020 can be fully annealed Nitinol or martensitic Nitinol, such that central bridge region 3020 is malleable and can take a set. This allows the surgeon to deform central bridge region 3020 at the time of surgery so that it assumes the bend desired.
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Intramedullary fusion device 3090 is manufactured from a shape memory material (e.g., a material capable of exhibiting superelasticity and/or a temperature-induced shape change). The shape memory material may be a metal alloy (e.g., Nitinol) or a polymer (e.g., appropriately processed PEEK). Looking now at
First barbed end region 3105 comprises a plurality of barbs 3120 which, in their unbiased condition, flare outward from the longitudinal axis of intramedullary fusion device 3090 in the manner shown in
Second barbed end region 3110 comprises a plurality of barbs 3125, which, in their unbiased condition, flare outward from the longitudinal axis of intramedullary fusion device 3090 in the manner shown in
Note that barbs 3120 of first barbed end region 3105 are flared in a direction which is opposite to that of barbs 3125 of second barbed end region 3110.
Central bridge region 3115 preferably comprises a generally cylindrical shape and is configured so that it can be selectively strained (i.e., stretched) longitudinally and constrained in that position (e.g., via the aforementioned internal restrainer 3095 and locking pin 3100). As will hereinafter be discussed, upon removing locking pin 3100, internal restrainer 3095 will release the constraint on central bridge region 3115, whereupon central bridge region 3115 will attempt to foreshorten. As will also hereinafter be discussed, this foreshortening can be harnessed to apply compression between two bone fragments.
In order to allow central bridge region 3115 to be constrained in its longitudinally stretched state, intramedullary fusion device 3090 preferably comprises cutouts 3130, disposed in first barbed end region 3105 and second barbed end region 3110, that allow central bridge region 3115 to be constrained in its longitudinally stretched state by internal restrainer 3095, as will hereinafter be discussed.
Internal restrainer 3095 is shown in further detail in
As noted above, central bridge region 3115 of intramedullary fusion device 3090 can be strained (i.e., longitudinally stretched), locked in that position via internal restrainer 3095 and locking pin 3100 and, upon removing locking pin 3100, internal restrainer 3095 will release the constraint on central bridge region 3115 of intramedullary fusion device 3090, whereupon central bridge region 3115 will attempt to foreshorten. More particularly, and looking now at
Intramedullary fusion system 3085 may be used to secure together two bone fragments and apply compression to the fracture line. By way of example but not limitation, and looking now at
First, the distal end of metatarsal 3050 is cut off to correct the deformity and create a bone face 3055 suitable for fusion (
Next, the surgeon inserts k-wire 3070 through the distal end of the toe, then through phalange 3060 and into metatarsal 3050 (
Following removal of k-wire 3070, phalange 3060 is flexed downward so as to expose the prepared metatarsal face 3055 (
Intramedullary fusion device 3090, which has previously been strained (i.e., its central bridge region 3115 longitudinally stretched) and locked in this state with internal restrainer 3095 and locking pin 3100, is then implanted into canal 3075 in phalange 3060 (
Phalange 3060 is then reoriented so that first barbed end region 3105 is aligned with canal 3080 in metatarsal 3050, and then phalange 3060 is advanced towards metatarsal 3050 so that first barbed end region 3105 enters canal 3080 of metatarsal 3050 (
Phalange 3060 is advanced towards metatarsal 3050 until face 3065 of phalange 3060 engages face 3055 of metatarsal 3050. At this point barbs 3120 of first barbed end region 3105 and barbs 3125 of second barbed end region 3110 prevent phalange 3060 and metatarsal 3050 from moving apart.
With intramedullary fusion device 3090 firmly secured to both phalange 3060 and metatarsal 3050, locking pin 3100 is then removed from internal restrainer 3095 (
If desired, internal restrainer 3095 may be left in place within intramedullary fusion device 3090 or, more preferably, internal restrainer 3095 may be removed from intramedullary fusion device 3090 after intramedullary fusion device 3090 has been set, e.g., by grasping internal restrainer 3095 with a grasping tool and drawing internal restrainer 3095 longitudinally out of intramedullary fusion device 3090 and then out canal 3075 of phalange 3060. Alternatively, internal restrainer 3095 can be automatically removed from intramedullary fusion device 3090 when locking pin 3100 is removed from internal restrainer 3095, e.g., by providing the distal end of locking pin 3100 and the proximal end of internal restrainer 3095 with an appropriate “catch mechanism” so that the retreating locking pin 3100 engages internal restrainer 3095 and carries internal restrainer 3095 out of intramedullary fusion device 3090 and then out canal 3075 of phalange 3060.
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Intramedullary fusion device 3090 is specifically engineered so not to “tear through” the bone tissue when central bridge region 3115 foreshortens. The compressive forces of intramedullary fusion device 3090 can be controlled by modulating the material properties of the intramedullary fusion device and/or the geometry of the intramedullary fusion device.
The percentage of cold work in the shape memory material forming intramedullary fusion device 3090 affects the compressive force generated by the intramedullary fusion device. As the percentage of cold work increases, the compression force declines. The intramedullary fusion device should, preferably, have between about 15% and 55% cold work to control the recovery force of the intramedullary device.
Another material property that affects the intramedullary fusion device's compression force is the temperature differential between the body that the intramedullary fusion device will be implanted into (assumed to be 37° C., which is the temperature of a human body) and the austenite finish temperature of the shape memory material forming intramedullary fusion device 3090. A smaller temperature differential between the two will result in the intramedullary fusion device generating a small compressive load; conversely, the larger the temperature differential between the two will result in the intramedullary device generating a larger compressive load. The shape memory material that the intramedullary fusion device is made out of should, preferably, have an austenite finish temperature of greater than about −10° C., resulting in a temperature differential of less than about 47° C. when the intramedullary fusion device is implanted (assuming that the intramedullary fusion device is implanted in a human body).
The geometry of the intramedullary fusion device also affects the compression force generated. The cross-sectional area of the hollow central bridge region 3115 affects the compression force. As the cross-sectional area increases, so does the compression force that the intramedullary fusion device 3090 will generate. In this respect it should be appreciated that it is beneficial for the compression force generated by the foreshortening of intramedullary fusion device 3090 to be constant as the bone relaxes and remodels. Thus, the cross-section of hollow central bridge region 3115 of intramedullary fusion device 3090 preferably has a constant cross-section over its entire length. Cross-sections that are not uniform over the length of hollow central bridge region 3115 can result in an increase or decrease in compression as the intramedullary fusion device foreshortens.
The barbs 3120, 3125 are important for transmitting the compression force to the bone without “tearing through” the bone. The height, width, and number of barbs 3120, 3125 on the intramedullary device 3090 are all important to the intramedullary device's ability to not “tear through” the bone.
It should also be appreciated that shape memory material can be processed to exhibit two-way shape memory. The intramedullary fusion device 3090 can be trained to have an austenitic shape (i.e., barbs expanded) and a martensitic shape (i.e., barbs extending parallel to the longitudinal axis of intramedullary fusion device 3090) In this case, the barbs can be in their austenitic shape at about body temperature. The barbs can be deformed via the creation of stress induced martensite to implant the intramedullary fusion device. If the intramedullary fusion device thereafter needs to be removed, the intramedullary fusion device may be cooled (e.g., with cold saline) to a temperature below the austenite start temperature of the shape memory material, and more preferably below the martensite start temperature of the shape memory material, and most preferably below the martensite finish temperature of the shape memory material. When cooled, the intramedullary fusion device 3090 will take on its martensitic shape (i.e., the barbs laying parallel to the longitudinal axis of the intramedullary fusion device), and the surgeon can easily remove the intramedullary fusion device.
Additionally, the intramedullary fusion device can be made such that central bridge region 3115 of intramedullary fusion device 3090 has one austenite start temperature, and such that barbs 3120, 3125 have a lower austenite start temperature. Thus, the intramedullary fusion device can be stretched at a temperature less than the austenite start temperature of central bridge region 3115 but above the austenite start temperature of barbs 3120, 3125. Thus barbs 3120, 3125 will be in the austenite phase and able to undergo a stress induced martensite transformation during insertion of intramedullary fusion device 3090 into a bone canal. Maintaining the intramedullary fusion device at a temperature below the austenite start temperature of central bridge region 3115 allows the intramedullary fusion device to remain in its elongated state. The intramedullary fusion device can then be advanced into a bone canal as discussed above. When the central bridge region 3115 warms (either to body temperature, or to a temperature above body temperature, e.g., through the application of warm saline), central bridge region 3115 will foreshorten, generating and maintaining compression across the fracture line.
It should also be appreciated that central bridge region 3115 of intramedullary fusion device 3090 can be processed so as to be malleable (i.e., to take a set). At body temperature, first barbed end region 3105 and second barbed end region 3110 can be superelastic while central bridge region 3115 can be fully annealed Nitinol or martensitic Nitinol. This allows the surgeon to deform the implant at the time of surgery to the bend desired.
Further Aspects
In one preferred embodiment of the present invention, the force generated by the intramedullary fusion device (e.g., intramedullary fusion device 3005) is controlled by stretching (i.e., straining) the device approximately 8%, and then allowing the device to partially recover (e.g., to shorten) so that the device is approximately 6% longer than its original length. With the device stretched 6% longer than its original length, a constraint or constraints (e.g., the aforementioned retaining tabs 3030, 3040) can be removably installed on the device to prohibit further recovery. The device can then be implanted. The partial recovery of strain (i.e., from an 8% stretch to a 6% stretch) occurs in the Load Transition zone at stress levels that may be in excess of the shear strength of bone. In other words, by allowing the device to partially recover from strain prior to implantation (i.e., from an 8% stretch to a 6% stretch), the highest stress levels associated with the upper plateau at 8% stretch may be prevented from being applied to the bone, and only the lower plateau stress levels associated with the remaining 6% stretch may be applied to the bone (i.e., partial recovery of strain prior to implantation occurs in the load transition zone). Following implantation of the device, the constraint or constraints (e.g., the aforementioned retaining tabs 3030, 3040) can be removed from the device, thereby allowing the device to attempt to recover the remaining strain. The subsequent strain recovery will occur directly at the stress level of the lower plateau of the mechanical hysteresis curve of the Nitinol device. The stress level of the lower plateau may be less than the shear strength of the bone, thereby keeping the device from damaging in the bone.
Novel Compression Plate Comprising Elastic Bridge Members
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Novel compression plate 4005 is preferably a structure manufactured from a single piece of shape memory material (e.g., a material capable of exhibiting superelasticity and/or a temperature-induced shape change). The shape memory material may be a metal alloy (e.g., Nitinol) or a polymer (e.g., appropriately processed PEEK). Compression plate 4005 is designed to reduce fractures and generate and maintain compression between bone fragments in order to aid in fracture healing. Compression plate 4005 generally comprises two opposing regions 4010 joined together by a pair of elastic bridge members 4015, and at least one opening 4020 formed in each of the two opposing regions 4010 for receiving fixation screws. Openings 4020 may have a countersunk feature (e.g., a bore-counterbore configuration) so as to allow the heads of the fixation screws to sit substantially flat with the top surface of compression plate 4005. Additionally, openings 4020 may be threaded so as to allow for positive engagement between the openings and the threaded fixation screws. In the un-restrained state, elastic bridge members 4015 are bowed outwardly, such as in the manner shown in
Prior to implantation, elastic bridge members 4015 of compression plate 4005 can be reversibly strained inwardly (i.e., bent laterally inwardly), thus increasing the distance 4025 (
During implantation, the strained (i.e., elongated) compression plate 4005 is positioned against the bone fragments and secured to those bone fragments by passing fixation screws through openings 4020 and into the bone fragments.
Removal of the induced strain on compression plate 4005 (provided by the delivery device, see below) results in compression plate 4005 attempting to return to its original un-restrained state (
Thus it should be appreciated that compression plate 4005 may be formed in a variety of linear and non-linear configurations, and may include two or more opposing regions 4010 and one or more elastic bridge members 4015. Thus, for example, in one form of the invention, compression plate 4005 may comprise a linear configuration having two opposing regions 4010 connected together by one or more elastic bridge members 4015. In another form of the invention, compression plate 4005 may comprise a linear configuration having three or more opposing regions 4010, each pair of opposing regions being connected together by one or more elastic bridge members 4015. In still another form of the invention, compression plate 4005 may comprise a non-linear configuration (e.g., a curved configuration) having two opposing regions 4010 connected together by one or more elastic bridge members 4015. In still another form of the invention, compression plate 4005 may comprise a non-linear configuration (e.g., a triangular configuration, a L-shaped configuration, etc.) having three or more opposing regions 4010, each pair of opposing regions being connected together by one or more elastic bridge members 4015. It will be appreciated that compression plate 4005 may also comprise still other configurations, e.g., square, circular, etc., all of which are considered to be within the scope of the present invention.
It will be appreciated that the fixation screws used with compression plate 4005 may be conventional fixation screws of the sort well known in the field of fracture fixation.
By way of example but not limitation, and looking now at
It will be appreciated that various delivery devices may be used to deploy compression plate 4005 in the body.
By way of example but not limitation, and looking now at
Novel Method for Applying Compression to a Fracture Using the
Novel Compression Plate
Now next at
First, compression plate 4005 is loaded onto the delivery device (e.g., delivery device 4200 discussed above) and elastic bridge members 4015 are compressed so that they are near-parallel (or at least more parallel). The constrained compression plate 4005 is then placed over the fracture line 4300 and holes 4310 are drilled through openings 4020. Screws (e.g., snap-off screws 4120 of snap-off screw system 4100) are installed (i.e., they are advanced through openings 4020 and into bone fragments 4305), thereby fixing compression plate 4005 to the bone fragments 4305. The constraining delivery device (e.g., delivery device 4200) is then removed and the compression plate 4005 is allowed to attempt to regain its original unconstrained shape, thereby generating and maintaining compression across the fracture site.
Note that compression plate 4005 is configured so that the force which is generated as compression plate 4005 reconfigures (i.e., as elastic bridge members 4015 return outwardly) is less than the “tear through” force of the bone which receives screws 4120, i.e., compression plate 4005 is specifically engineered so as to not “tear through” the bone tissue when attempting to reconfigure to its original foreshortened configuration. The compressive forces of compression plate 4005 can be controlled by (i) modulating the material properties of the compression plate, and/or (ii) varying the geometry of the compression plate.
The percentage of cold work in the shape memory material forming compression plate 4005 affects the compressive force generated by the reconfiguring compression plate. As the percentage of cold work increases, the compression force declines. A Nitinol compression plate should, preferably, have between about 15% and 55% cold work to control the recovery force of the compression plate; however, other degrees of cold work may be used, and/or the material may not be cold worked at all.
Another material property that affects the plate's compression force is the temperature differential between the body that the compression plate will be implanted into (assumed to be 37° C., which is the temperature of a human body) and the austenite finish temperature of the shape memory material forming compression plate 4005. A smaller temperature differential between the two will result in the compression plate generating a smaller compressive load; conversely, a larger temperature differential between the two will result in the compression plate generating a larger compressive load. When the compression plate is made out Nitinol, the compression plate should, preferably, have an austenite finish temperature of greater than about −10° C., resulting in a temperature differential of about 47° C. when the compression plate is implanted (assuming that the compression plate is implanted in a human body).
Plate geometry also affects the compression forces which are generated by the reconfiguring plate. More particularly, the cross-sectional area of elastic bridge members 4015 affects the compression forces generated by the reconfiguring plate. As the cross-sectional areas increase, so do the compression forces that the reconfiguring plate will generate. It should be appreciated that the force generated as an elastic bridge member 4015 attempts to recover from the constrained linear configuration (
In one preferred form of the invention, compression plate 4005 and delivery device 4200 are provided in the form of a sterilized kit. The kit may include additional instruments to aid in the implantation of the compression plate (e.g., k-wire, drill bit, plate size guide, screws, etc.). In one preferred form of the invention, compression plate 4005 is provided with an associated delivery device (e.g., delivery device 4200) in a sterile package, with elastic bridge members 4015 being pre-constrained (e.g., so that elastic bridge members 4015 are substantially straight, or at least more straight than when the elastic bridge members are in their unconstrained condition) in the sterile package by the delivery device (e.g., delivery device 4200).
Test Data
Static Elastic Bending: 25 mm interaxis width compression plates were tested. A 4-point bending load was applied on a tensile testing machine at a rate of 25.4 mm/min. Bending stiffness was calculated as the initial slope of load vs. displacement. The novel compression plate 4005 had comparable Bending Strengths (16.33 N/mm vs. 15.86 N/mm p=0.818) to conventional fracture fixation plates.
Compression Force: Greater interfragmentary compression has been found to enhance the healing of fractured bones. The compression plates of the present invention utilize the unique superelastic properties of Nitinol to enhance and sustain compression across the fracture plane. The compressive force generated by the novel compression plates of the present invention generate and maintain 180N of compression over nearly 1 mm of bone resorption.
Use of Plastic Threaded Inserts Between the Openings of the Compression Plate and the Fixation Screws
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Additionally, it should be appreciated that plastic threaded insert 4450 insulates the metallic fixation screw from compression plate 4005, thereby limiting galvanic corrosion between the compression plate 4005 and the metallic fixation screws.
Use of Other Types of Fasteners with the Novel Compression Plate
In the foregoing disclosure, compression plate 4005 is secured to bone fragments using threaded fixation screws. However, if desired, other types of fasteners may also be used to secure compression plate 4005 to bone fragments. By way of example but not limitation, pins may be used to secure compression plate 4005 to bone fragments.
Applying Distraction to Bone Using a Novel Distraction Plate
In the foregoing disclosure, compression plate 4005 has been discussed in the context of providing compression across a fracture. However, it should also be appreciated that, if desired, the apparatus can be modified so as to provide a distraction force to bone (e.g., to separate two bones or bone fragments, or to induce bone growth in a single bone, etc.).
By way of example but not limitation, and looking now at
Prior to implantation, elastic bridge members 4515 of distraction plate 4505 can be reversibly strained outwardly (i.e., forced outwardly), thus decreasing the distance 4525 between opposing regions 4510 (and hence openings 4520) of distraction plate 4505. A delivery device can be used to strain elastic bridge members 4515 so as to force elastic bridge members 4515 outwardly, e.g., a delivery device generally similar to the delivery device 4200, or the delivery device 4240, discussed above, except that the delivery device is configured to force elastic bridge members 4515 apart when appropriate.
During implantation, the strained (i.e., the forcibly foreshortened) distraction plate 4505 is secured to bone by passing fixation screws through openings 4520 and into the bone.
Removal of the induced strain on distraction plate 4505 (provided by the aforementioned delivery device) results in distraction plate 4505 attempting to return to its original un-restrained state (i.e., with elastic bridge members 4515 linearly aligned), thereby generating a distraction load on the bone to which distraction plate 4505 is secured (i.e., through elastic bridge members 4515, openings 4520 and fixation screws extending through openings 4520), and maintaining that distraction load on the bone for a prolonged period of time while healing occurs.
Further Aspects
In one preferred embodiment of the present invention, the force generated by the compression plate is controlled by stretching (i.e., straining) the compression plate approximately 8%, and then allowing the compression plate to partially recover (e.g., to shorten) so that the compression plate is approximately 6% longer than its original length. With the compression plate stretched 6% longer than its original length, a constraint (e.g., delivery device 4200) can be removably installed on the compression plate to prohibit further recovery. The compression plate can then be implanted. The partial recovery of strain (i.e., from an 8% stretch to a 6% stretch) occurs in the Load Transition zone at stress levels that may be in excess of the shear strength of bone. In other words, by allowing the compression plate to partially recover from strain prior to implantation (i.e., from an 8% stretch to a 6% stretch), the highest stress levels associated with the upper plateau at 8% stretch may be prevented from being applied to the bone, and only the lower plateau stress levels associated with the remaining 6% stretch may be applied to the bone (i.e., partial recovery of strain prior to implantation occurs in the load transition zone). Following implantation of the compression plate, the constraint (e.g., delivery device 4200) can be removed from the compression plate, thereby allowing the compression plate to attempt to recover the remaining strain. The subsequent strain recovery will occur directly at the stress level of the lower plateau of the mechanical hysteresis curve of the Nitinol compression plate. The stress level of the lower plateau may be less than the shear strength of the bone, thereby keeping the fixation screws (e.g., fixation screws 4120) associated with the compression plate from stripping in the bone.
In another embodiment of the present invention, it is possible to control the unloading of the shape memory compression plate as defined above while also providing regions of the compression plate that are malleable and can be contoured to the patient's specific anatomy. During manufacturing, regions of the compression plate may be selectively heat treated at 400° C. for 70 minutes. This will selectively age those regions of the shape memory material so that the austenite finish temperature of only those regions of the compression plate is 40° C. (i.e., above body temperature). Thus, those regions of the compression plate will be martensitic and malleable. The surgeon can then bend those regions of the compression plate so that it matches the contour of the bone.
Other Applications for Novel Compression Plate
The present invention also finds utility as a cervical compression plate, and/or as other spinal compression plates. Additionally, the novel compression plate can be used as a fixation device for sternal closure. The novel compression plate finds particular utility for sternal closures where the design of the compression plate allows the tensile forces on the anterior of the sternum (generated during respiration) to be converted to compressive forces.
Application to Shape Memory Materials Other than Nitinol
It should be appreciated that the unloading stress of shape memory materials other than Nitinol can also be controlled using the approaches described herein. More particularly, the approaches described herein are applicable for other shape memory materials that exhibit stress-strain mechanical hysteresis curves similar to that of Nitinol. These other shape memory materials may comprise metal alloys or polymers.
By way of example but not limitation, these other shape memory materials may comprise the following metal alloys:
Ag—Cd 44/49 atomic % Cd;
Au—Cd 46.5/50 atomic % Cd;
Cu—Al—Ni 14/14.5 weight % Al and 3/4.5 weight % Ni;
Cu—Sn approx. 15 atomic % Sn;
Cu—Zn 38.5/41.5 weight % Zn;
Fe—Pt approx. 25 atomic % Pt;
Mn—Cu 5/35 atomic % Cu;
Fe—Mn—Si;
Co—Ni—Al;
Co—Ni—Ga;
Ni—Fe—Ga;
Ti—Nb;
Ni—Ti approx. 55-60 weight % Ni;
Ni—Ti—Hf;
Ni—Ti—Pd; and
Ni—Mn—Ga.
Additionally, it should be appreciated that the approaches described herein can be applied to controlling the unloading stress of shape memory polymers that exhibit stress-strain mechanical hysteresis curves similar to that of Nitinol. These include, but are not limited to:
crosslinked polyurethane;
PEO-PET block copolymers; and
appropriately processed PEEK.
It should be appreciated that it may sometimes be desirable to “back off” the strain more than just the amount of strain required to operate on the lower plateau of the mechanical hysteresis curve for the shape memory material. In some cases (e.g., for a long compression screw), it may be desirable to have the screw shorten by a fixed number of millimeters following implantation, and this distance may be less than the full distance of the lower plateau of the mechanical hysteresis curve. By way of example but not limitation, for a 100 mm screw to shorten 2 mm, the screw can be strained to 8%, then “backed off” to 6% strain so as to be on the lower plateau of the mechanical hysteresis curve, and then “backed off” further along the lower plateau of the mechanical hysteresis curve until the screw is at only 2% strain, whereup the screw can be constrained. During use, the screw is then released from its 2% strain condition, whereupon it will shorten the desired 2 mm.
Alternatively, it may be desirable to allow the surgeon to control the amount of compressive strain the device imparts. As an example, a staple can be provided to a surgeon that has a bridge that has been stretched to 8% strain, and then allowed to partially recover to a 6% strain prior to constraining the staple (thus allowing the staple to recover the remaining strain at the lower plateau of the mechanical hysteresis curve of the staple). The surgeon may then elect to “back off” the strain on the device to a lesser amount, dependent on the patient's needs. This can be accomplished by allowing for additional strain to be released by the surgeon prior to implantation of the device. Thus, in this form of the invention, the surgeon is able to tailor the specific amount of compression applied by the implanted device, by selectively releasing the strain on the device prior to implantation.
It should be understood that many additional changes in the details, materials, steps and arrangements of parts, which have been herein described and illustrated in order to explain the nature of the present invention, may be made by those skilled in the art while still remaining within the principles and scope of the invention.
This patent application: (1) is a continuation-in-part of pending prior U.S. patent application Ser. No. 14/539,650, filed Nov. 12, 2014 by MX Orthopedics, Corp. and Matthew Palmer et al. for SCREWS FOR GENERATING AND APPLYING COMPRESSION WITHIN A BODY (Attorney's Docket No. FONTE-49), which patent application in turn claims benefit of: (a) prior U.S. Provisional Patent Application Serial No. 61/902,338, filed Nov. 11, 2013 by MX Orthopedics, Corp. and Matthew Palmer et al. for SUPERELASTIC AND SHAPE MEMORY CANNULATED INTERFRAGMENTARY BONE COMPRESSION SCREW (Attorney's Docket No. FONTE-32 PROV); and(b) prior U.S. Provisional Patent Application Serial No. 61/903,820, filed Nov. 13, 2013 by MX Orthopedics, Corp. and Matthew Palmer et al. for BONE STAPLES, INTRAMEDULLARY FIXATION DEVICES, SOFT TISSUE ANCHORS AND PINS SCREWS CAN BE SHORTENED IN VIVO TO IMPROVE FRACTURE REDUCTION BY USING SUPERELASTIC OR SHAPE MEMORY EFFECT CHARACTERISTICS OF NITINOL (Attorney's Docket No. FONTE-34 PROV); (2) is a continuation-in-part of pending prior U.S. patent application Ser. No. 14/540,351, filed Nov. 13, 2014 by MX Orthopedics, Corp. and Matthew Palmer et al. for STAPLES FOR GENERATING AND APPLYING COMPRESSION WITHIN A BODY (Attorney's Docket No. FONTE-52), which patent application in turn claims benefit of: (a) prior U.S. Provisional Patent Application Ser. No. 61/903,820, filed Nov. 13, 2013 by MX Orthopedics, Corp. and Matthew Palmer et al. for BONE STAPLES, INTRAMEDULLARY FIXATION DEVICES, SOFT TISSUE ANCHORS AND PINS SCREWS CAN BE SHORTENED IN VIVO TO IMPROVE FRACTURE REDUCTION BY USING SUPERELASTIC OR SHAPE MEMORY EFFECT CHARACTERISTICS OF NITINOL (Attorney's Docket No. FONTE-34 PROV); (3) is a continuation-in-part of pending prior U.S. patent application Ser. No. 14/541,017, filed Nov. 13, 2014 by MX Orthopedics, Corp. and Matthew Palmer et al. for INTERMEDULLARY DEVICES FOR GENERATING AND APPLYING COMPRESSION WITHIN A BODY (Attorney's Docket No. FONTE-50), which patent application in turn: (a) is a continuation-in-part of pending prior U.S. patent application Ser. No. 13/624,643, filed Sep. 21, 2012 by MX Orthopedics, Corp. and Matthew Fonte for OSTEOSYNTHETIC SHAPE MEMORY MATERIAL INTRAMEDULLARY BONE STENT AND METHOD FOR TREATING A BONE FRACTURE USING THE SAME (Attorney's Docket No. FONTE-091014), which patent application claims benefit of: (i) prior U.S. Provisional Patent Application Ser. No. 61/537,766, filed Sep. 22, 2011 by Matthew Fonte for OSTEOSYNTHETIC SHAPE MEMORY MATERIAL INTRAMEDULLARY BONE STENTS AND METHODS FOR TREATING BONE FRACTURES USING THE SAME (Attorney's Docket No. FONTE-10 PROV); and(ii) prior U.S. Provisional Patent Application Ser. No. 61/570,091, filed Dec. 13, 2011 by Matthew Fonte for OSTEOSYNTHETIC SHAPE MEMORY MATERIAL INTRAMEDULLARY BONE STENTS AND METHODS FOR TREATING BONE FRACTURES USING THE SAME (Attorney's Docket No. FONTE-14 PROV); and(b) claims benefit of prior U.S. Provisional Patent Application Ser. No. 61/903,820, filed Nov. 13, 2013 by MX Orthopedics, Corp. and Matthew Palmer et al. for BONE STAPLES, INTRAMEDULLARY FIXATION DEVICES, SOFT TISSUE ANCHORS AND PINS SCREWS CAN BE SHORTENED IN VIVO TO IMPROVE FRACTURE REDUCTION BY USING SUPERELASTIC OR SHAPE MEMORY EFFECT CHARACTERISTICS OF NITINOL (Attorney's Docket No. FONTE-34 PROV); (4) is a continuation-in-part of pending prior U.S. patent application Ser. No. 14/658,009, filed Mar. 13, 2015 by MX Orthopedics, Corp. and Matthew Palmer et al. for PLATES FOR GENERATING, APPLYING AND MAINTAINING COMPRESSION WITHIN A BODY (Attorney's Docket No. FONTE-51), which patent application in turn claims benefit of: (a) prior U.S. Provisional Patent Application Ser. No. 61/952,524, filed Mar. 13, 2014 by MX Orthopedics, Corp. and Matthew Fonte et al. for SHAPE MEMORY COMPRESSION PLATE-ENHANCED COMPRESSION AT FRACTURE SITE (Attorney's Docket No. FONTE-38 PROV); (5) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 61/985,910, filed Apr. 29, 2014 by MX Orthopedics, Corp. and Matthew Palmer et al. for METHOD AND APPARATUS FOR TREATING A PATIENT, INCLUDING THE PROVISION AND USE OF A NOVEL MEDICAL DEVICE COMPRISING A SHAPE MEMORY MATERIAL AND UTILIZING A COMBINATION OF SHAPE MEMORY EFFECT AND SUPERELASTICITY (Attorney's Docket No. FONTE-41 PROV); (6) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/000,621, filed May 20, 2014 by MX Orthopedics, Corp. and Matthew Palmer et al. for METHOD AND APPARATUS FOR TREATING A PATIENT, INCLUDING THE PROVISION AND USE OF A NOVEL MEDICAL DEVICE COMPRISING A SHAPE MEMORY MATERIAL AND UTILIZING A COMBINATION OF SHAPE MEMORY EFFECT AND SUPERELASTICITY (Attorney's Docket No. FONTE-42 PROV); (7) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/004,033, filed May 28, 2014 by MX Orthopedics, Corp. and Matthew Palmer et al. for METHOD AND APPARATUS FOR TREATING A PATIENT, INCLUDING THE PROVISION AND USE OF A NOVEL MEDICAL DEVICE COMPRISING A SHAPE MEMORY MATERIAL AND UTILIZING A COMBINATION OF SHAPE MEMORY EFFECT AND SUPERELASTICITY (Attorney's Docket No. FONTE-43 PROV); (8) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/007,711, filed Jun. 4, 2014 by MX Orthopedics, Corp. and Matthew Palmer et al. for METHOD AND APPARATUS FOR TREATING A PATIENT, INCLUDING THE PROVISION AND USE OF A NOVEL MEDICAL DEVICE COMPRISING A SHAPE MEMORY MATERIAL AND UTILIZING A COMBINATION OF SHAPE MEMORY EFFECT AND SUPERELASTICITY (Attorney's Docket No. FONTE-44 PROV); (9) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/034,204, filed Aug. 7, 2014 by MX Orthopedics, Corp. and Matthew Fonte et al. for NITINOL ORTHOPEDIC IMPLANTS WITH SUPERELASTIC AND NON-SUPERELASTIC REGIONS (Attorney's Docket No. FONTE-45 PROV); (10) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/034,208, filed Aug. 7, 2014 by MX Orthopedics, Corp. and Matthew Fonte et al. for THREE DIMENSIONAL SPACER FABRIC TO INCREASE THE HOLDING POWER OF SCREWS (Attorney's Docket No. FONTE-46 PROV); (11) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/034,213, filed Aug. 7, 2014 by MX Orthopedics, Corp. and Matthew Fonte et al. for DELIVERY DEVICE FOR IMPLANTING A NITINOL STAPLE WITH A CONTROLLED AMOUNT OF COMPRESSION (Attorney's Docket No. FONTE-47 PROV); (12) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/050,430, filed Sep. 15, 2014 by MX Orthopedics, Corp. and Matthew Palmer et al. for DEVICES FOR ENHANCING THE FATIGUE AND MECHANICAL PROPERTIES OF BONE CEMENT (Attorney's Docket No. FONTE-48 PROV); (13) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/108,843, filed Jan. 28, 2015 by MX Orthopedics, Corp. and Matthew Palmer et al. for SELF-STRETCHING SCREWS FOR GENERATING AND APPLYING COMPRESSION WITHIN A BODY (Attorney's Docket No. FONTE-54 PROV); (14) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/137,496, filed Mar. 24, 2015 by MX Orthopedics, Corp. and Daniel Morgan et al. for STAPLES THAT DO NOT NEED TO BE TAMPED TO BE FULLY SEATED FOR GENERATING AND APPLYING COMPRESSION WITHIN A BODY (Attorney's Docket No. FONTE-55 PROV); (15) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/137,570, filed Mar. 24, 2015 by MX Orthopedics, Corp. and Daniel Morgan et al. for STAPLES THAT DO NOT NEED TO BE TAMPED TO BE FULLY SEATED FOR GENERATING AND APPLYING COMPRESSION WITHIN A BODY (Attorney's Docket No. FONTE-56 PROV); (16) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/137,614, filed Mar. 24, 2015 by MX Orthopedics, Corp. and Matthew Palmer et al. for STAPLES FOR GENERATING AND APPLYING COMPRESSION WITHIN A BODY (Attorney's Docket No. FONTE-57 PROV); (17) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/137,645, filed Mar. 24, 2015 by MX Orthopedics, Corp. and Matthew Palmer et al. for SCREW ADAPTERS TO INCREASE SCREW FIXATION STRENGTH IN BONE (Attorney's Docket No. FONTE-58 PROV); (18) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/149,706, filed Apr. 20, 2015 by MX Orthopedics, Corp. and Matthew Palmer et al. for SPACER FABRICS FOR USE IN SPINAL IMPLANT DEVICES (Attorney's Docket No. FONTE-59 PROV); and (19) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 62/149,714, filed Apr. 20, 2015 by MX Orthopedics, Corp. and Matthew Palmer et al. for RIGID FIXATION SYSTEMS FOR CARDIOTHORACIC FIXATION (Attorney's Docket No. FONTE-60 PROV). The twenty-five (25) above-identified patent applications are hereby incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| 61902338 | Nov 2013 | US | |
| 61903820 | Nov 2013 | US | |
| 61903820 | Nov 2013 | US | |
| 61537766 | Sep 2011 | US | |
| 61570091 | Dec 2011 | US | |
| 61903820 | Nov 2013 | US | |
| 61952524 | Mar 2014 | US | |
| 61985910 | Apr 2014 | US | |
| 62000621 | May 2014 | US | |
| 62004033 | May 2014 | US | |
| 62007711 | Jun 2014 | US | |
| 62034204 | Aug 2014 | US | |
| 62034208 | Aug 2014 | US | |
| 62034213 | Aug 2014 | US | |
| 62050430 | Sep 2014 | US | |
| 62108843 | Jan 2015 | US | |
| 62137496 | Mar 2015 | US | |
| 62137570 | Mar 2015 | US | |
| 62137614 | Mar 2015 | US | |
| 62137645 | Mar 2015 | US | |
| 62149706 | Apr 2015 | US | |
| 62149714 | Apr 2015 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 14539650 | Nov 2014 | US |
| Child | 14699837 | US | |
| Parent | 14540351 | Nov 2014 | US |
| Child | 14539650 | US | |
| Parent | 14541017 | Nov 2014 | US |
| Child | 14540351 | US | |
| Parent | 13624643 | Sep 2012 | US |
| Child | 14541017 | US | |
| Parent | 14658009 | Mar 2015 | US |
| Child | 13624643 | US |
