A sternotomy is a procedure performed to separate a sternum of a patient to gain access to the chest cavity of the patient, such as for corrective heart procedures. During a sternotomy procedure a vertical (superior to inferior) cut is made through the sternum allowing the sternum to be cracked or separated into two or more portions to provide access to the chest cavity. Following a procedure within the chest cavity, the sternum must be closed. Commonly, sternotomies are closed or repaired using one or more wire cerclages wrapped around the sternal halves. In some cases, at least one rigid bone plate is used to bridge and secure to the approximated and reduced sternal halves using bone screws.
In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.
Sternotomies are often performed on a sternum of a patient (such as prior to a cardiac procedure) by creating a midline resection and separating two halves or portions of the sternum for access to the chest cavity of the patient. Following the procedure, the sternum is often repaired using one or more wire cerclages to hold the sternal halves in place while the halves heal together. While wire cerclages can help to prevent medial-lateral separation (or relative movement of the halves) of the sternum, wire cerclages are sometimes ineffective at limiting relative anterior-posterior movement of the halves and at limiting relative superior-inferior movement of the halves. Wire cerclages can also unintentionally penetrate outer portions of the sternum. Rigid bone plates are a strategy often used to address the shortcomings of wire cerclages. Rigid bone plates can be secured to each portion or half of the sternum and can help to limit relative movement of the sternal halves in all directions. Nevertheless, it can be difficult to position and secure the bone plates following reduction of the sternal halves.
This disclosure helps to address these issues by including a fastener cartridge configured to support fasteners and the bone plate for positioning of the bone plate and fasteners on the sternal portions. The cartridge can be configured to support and retain fasteners therein for alignment with bores of the bone plate and can hold the bone plate while fasteners are driven out of the cartridge, through the bone plate, and into bone. In this way, the plate system can help to provide reliable fastener driving during securing of the bone plate. Additionally, the cartridge can be configured to quickly receive and retain fasteners therein to help improve speed of a procedure. Further, the cartridge can be releasably connectable to a placement tool for improved ergonomics and leverage during securing of the plate. Also, the cartridge can include a lock to releasably secure the plate to the cartridge for additional security during fastening of the plate to bone.
The above discussion is intended to provide an overview of the subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The description below is included to provide further information about the present patent application.
The plating system 100 can include a wand 102. The wand 102 can include a handle 104, a shaft 106, a tip 108, and a shoulder 110. The plating system 100 can also include fasteners 112a-112n. As shown in
The wand 102 can be a rigid or semi-rigid instrument made of materials such as metals, plastics, foams, elastomers, ceramics, composites, or combinations thereof. In some examples, the wand 102 can be comprised of biocompatible materials such as such as one or more of stainless steels, cobalt-chromium, titanium variations, polyether ether ketone (PEEK), polyether ketone ketone (PEKK), or the like.
The body 116 can be a rigid or semi-rigid body. The body 116 can be made of materials such as metals, plastics, foams, elastomers, ceramics, composites, or combinations thereof. In some examples, the body 116 can be comprised of biocompatible materials such as such as one or more of stainless steels, cobalt-chromium, titanium variations, polyether ether ketone (PEEK), polyether ketone ketone (PEKK), or the like. In one example, the body 116 can be comprised of PEEK and can be coated with titanium and/or a hydroxyapatite coating. The lock 118 can be connected to the body 116 and can be operable to secure a plate to the body 116. The retention bores 122 can be configured to receive and retain fasteners therein, as discussed in further detail with respect to
As shown in
The shoulder 110 can be configured to engage a head of the fasteners 112, such as for applying a force to the fasteners 112, as discussed in further detail below, to force the fastener 112a into the bore 122a. Optionally, the shoulder 110 can be configured to engage the cartridge 114 to guide insertion of the fasteners 112 into the retention bores 122 at a proper depth or position.
The sleeve 124a can be a sleeve or tube insertable into a bore of the body 116 of the cartridge 114. The retention sleeve 124a can include extensions 126a-126d extending from a base portion 128 of the sleeve 124a. Though three of the extensions 126 are shown in
Each extension 126a can include a proximal retention feature 130 and a distal retention feature 132. The retention features 130 and 132 can be projections or extensions from their respective extension configured to extend radially into the retention bore 122a. Each proximal retention feature 130 and distal retention feature 132 can include a radially inner diameter forming an opening that is smaller than that of a head 134 of the fastener 112a, such that the retention features 130 and 132 can engage the head 134 of the fastener for retention of the fastener within the retention bore 122a.
In operation of some examples, when a fastener, such as the fastener 112a is secured to the tip 108 of the wand 102, a user can manipulate the handle 104 to position a tip or leading portion of the fastener within the retention bore 122a of the sleeve 124a, as shown in
Because the distal retention feature 132 are closer to the connection point between the extensions 126 and the base portion 128, a force required to cause radially outward deflection of the extensions 126 sufficient for the head 134 to pass is larger for the distal retention features 132 than the proximal retention features 130. In this way, the distal retention features 132 can limit further distal movement of the fastener 112a through the retention bore 122a unless a user increases the proximal to distal force applied to the fastener 112a.
Also, once the head 134 clears the proximal retention features 130, the extensions 126 can deflect back radially inward, capturing the fastener 112a between the proximal retention features 130 and the distal retention features 132. Optionally, the proximal retention features 130 can include a distal flat surface (or non-ramped surface) such that proximal movement of the fastener 112a to engage the proximal retention features 130 will require a large force to cause radially outward deflection of the extensions 126, helping to retain the fastener 112a therein.
When a user desires to drive the fastener 112a out of the retention bore 122a, the user can apply a proximal to distal force to the head 134 to engage the distal retention features 132 sufficient to cause radially outward deflection of the extensions 126 to expand an opening or passage of the distal retention features 132 to allow movement of the fastener 112a into and through the retention bore 122a such that the fastener 112a can be driven into a plate and a bone, as discussed in further detail below.
The placement tool 138 can include a handle 140 (shown in
The chamfers 161 and 160 of the distal tip and the stop 154, respectively, can be configured to engage the chamfer 152 of the inlet of the placement bore 120 to guide insertion of the connector 144 into the placement bore 120. The stop 154 of the connector 144 can be configured to engage the counterbore to limit insertion of the connector 144 into the placement bore 120. The chamfers 160 and 161 of the connector 144 can also help the connector 144 to pass through the snap ring 148, which can also be chamfered on both a proximal side and a distal side.
For example,
In operation, as shown in
Prior to the steps of the method 1100 being performed, a sternotomy or midline resection can be created in a sternum. When it is desired to close the sternum, a step 1102 can be performed where a user can operate a wand to retrieve a fastener. For example, a user can operate a wand 102 to retrieve a fastener 112. At step 1104, a first retention feature of the retention bore can be engaged with the fastener to deflect the first retention feature to engage a second retention feature with the fastener to retain the fastener within the retention bore to insert the fastener into a retention bore of a cartridge using the wand. For example, the first retention feature 130a of the retention bore 122a can be engaged with the fastener 112a to deflect the first retention feature 130a to engage a second retention feature 132a with the fastener to retain the fastener 112a within the retention bore 122a to insert the fastener 112a into the retention bore 120a of the cartridge 114 using the wand 102.
At step 1106, a boss of the cartridge can be inserted into a connection bore of a plate to align the retention bore with a fastener bore of the plate. For example. For example, the boss 174 of the cartridge 114 can be inserted into a connection bore 172 of a plate 136 to align the retention bores 122 with the fastener bores 122 of the plate 136.
At step 1108, a cam of the cartridge can be operated to engage a body of the plate to secure the plate to the cartridge. For example, the cam 164 of the cartridge 114 can be operated to engage the body 168 of the plate 136 to secure the plate 136 to the cartridge 114. At step 1110, a placement tool can be connected to a cartridge. For example, the placement tool 138 can be connected to the cartridge 114. At step 1112, a fastener can be driven from the cartridge into the plate and into bone. For example, the fastener 112a can be driven from the cartridge 114 (e.g., out of the retention bore 122a) into one of the fastener bores 170 of plate 136 and into bone. At step 1114, the plate can be disengaged or disconnected from the cartridge. For example, the lock 118 can be operated to disengage the cam 164 from the plate 136 to disconnect the plate 136 from the cartridge 114.
Though above devices and methods are discussed herein with reference to a sternum or sternotomy, the devices and methods can be used with other bones or bone portions. For example, the plate 136 and the cartridge 114 can be configured and used to repair a fractured rib, clavicle, femur, tibia, fibula, humerus, radius, ulna, or the like.
The following, non-limiting examples, detail certain aspects of the present subject matter to solve the challenges and provide the benefits discussed herein, among others.
Example 1 is a plate system for securing to a bone, the plate system comprising: a plate including a plate body, the plate body defining: a fastener bore configured to receive a fastener for securing the plate to the bone; and a connection bore; a cartridge including a cartridge body, the cartridge body defining: a retention bore configured to retain a fastener therein; and a boss insertable into the connection bore to align the retention bore with the fastener bore; and an actuator connected to the cartridge and operable to secure the plate to the cartridge.
In Example 2, the subject matter of Example 1 optionally includes wherein the actuator includes a cam rotatable between a locked position and an unlocked position, the cam engageable with the plate body in the locked position to secure the plate to the cartridge.
In Example 3, the subject matter of Example 2 optionally includes wherein the actuator includes a handle operable to rotate the cam.
In Example 4, the subject matter of any one or more of Examples 1-3 optionally include wherein the cartridge body includes a retention feature extending into the retention bore to retain the fastener within the retention bore.
In Example 5, the subject matter of Example 4 optionally includes wherein the retention feature is configured to reversibly deflect outward to allow the fastener to pass through the retention bore of the cartridge and into the fastener bore of the plate.
In Example 6, the subject matter of Example 5 optionally includes wherein the retention feature at least partially defines the retention bore.
In Example 7, the subject matter of any one or more of Examples 1-6 optionally include wherein the cartridge body includes a plurality of projections extending from the body to engage the plate when the boss is inserted into the connection bore.
In Example 8, the subject matter of any one or more of Examples 1-7 optionally include wherein the plate body defines a plurality of fastener bores and wherein the cartridge body includes a plurality of retention bores, each retention bore alignable with one of the plurality of fastener bores when the boss is inserted into the connection bore.
In Example 9, the subject matter of any one or more of Examples 1-8 optionally include a placement tool including: a handle; a shaft including a proximal portion extending from the handle and a distal portion opposite the proximal portion; and a connector connected to the distal portion of the shaft.
In Example 10, the subject matter of Example 9 optionally includes wherein the cartridge body includes a placement bore configured to receive the connector therein to secure the placement tool to the cartridge body.
In Example 11, the subject matter of Example 10 optionally includes wherein the cartridge body includes a snap connector located at least partially within the placement bore and configured to engage the connector to secure the placement tool to the cartridge body.
Example 12 is a fastener cartridge comprising: a body defining a plurality of retention bores each extending through the body and each configured to retain a fastener therein; a boss extending from the body and insertable into a connection bore of a bone plate to align each retention bore with a fastener bore of the bone plate; a cam connected to the body and rotatable between a locked position and an unlocked position, the cam engageable with a body of the plate in the locked position to secure the plate to the cartridge; and an actuator connected to the cartridge and operable to rotate the cam.
In Example 13, the subject matter of Example 12 optionally includes wherein the body includes a retention feature extending into the retention bore to retain the fastener within the retention bore.
In Example 14, the subject matter of Example 13 optionally includes wherein the retention feature is configured to reversibly deflect outward to allow the fastener to pass through the retention bore and into a fastener bore of the plate.
In Example 15, the subject matter of Example 14 optionally includes wherein the retention feature at least partially defines the retention bore.
In Example 16, the subject matter of any one or more of Examples 12-15 optionally include wherein the body includes a plurality of projections extending from the body to engage the plate when the boss is inserted into the connection bore.
Example 17 is a method for using a fastener cartridge, the method comprising: operating a wand to retrieve a fastener; inserting the fastener into a retention bore of a cartridge using the wand; inserting a boss of the cartridge into a connection bore of a plate to align the retention bore with a fastener bore of the plate; and operating a cam of the cartridge to engage a body of the plate to secure the plate to the cartridge.
In Example 18, the subject matter of Example 17 optionally includes wherein inserting the fastener into the retention bore includes engaging a first retention feature of the retention bore with the fastener to deflect the first retention feature to engage a second retention feature with the fastener to retain the fastener within the retention bore.
In Example 19, the subject matter of Example 18 optionally includes driving the fastener past the second retention feature and into the fastener bore.
In Example 20, the subject matter of Example 19 optionally includes wherein driving the fastener past the second retention feature includes reversibly deflecting the second retention feature.
In Example 21, the subject matter of any one or more of Examples 19-20 optionally include securing the fastener to bone.
In Example 22, the subject matter of Example 21 optionally includes operating the cam of the cartridge to disengage the body of the plate.
In Example 23, the apparatuses or method of any one or any combination of Examples 1-22 can optionally be configured such that all elements or options recited are available to use or select from.
The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.
In the event of inconsistent usages between this document and any documents so incorporated by reference, the usage in this document controls. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim.
The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
This application claims the benefit of U.S. Provisional Patent Application Ser. No. 63/324,530, filed on Mar. 28, 2022, the benefit of priority of which is claimed hereby, and which is incorporated by reference herein in its entirety.
Number | Date | Country | |
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63324530 | Mar 2022 | US |