Apparatus And Methods For Securing A Bone Implant

  *US09993277B2*
  US009993277B2                                 
(12)United States Patent(10)Patent No.: US 9,993,277 B2
  et al. (45) Date of Patent:Jun.  12, 2018

(54)Apparatus and methods for securing a bone implant 
    
(75)Inventor: Conventus Orthopaedics, Inc.,  Maple Grove, MN (US) 
(73)Assignee:Conventus Orthopaedics, Inc.,  Maple Grove, MN (US), Type: US Company 
(*)Notice: Subject to any disclaimer, the term of this patent is extended or adjusted under 35 U.S.C. 154(b) by 0 days. 
(21)Appl. No.: 14/492,599 
(22)Filed: Sep.  22, 2014 
(65)Prior Publication Data 
 US 2015/0012096 A1 Jan.  8, 2015 
 Related U.S. Patent Documents 
(62) .
Division of application No. 13/043,190, filed on Mar.  8, 2011, now Pat. No. 8,906,022 .
 
(60)Provisional application No. 61/311,494, filed on Mar.  8, 2010.
 
 Provisional application No. 61/378,822, filed on Aug.  31, 2010.
 
Jan.  1, 2013 A 61 B 17 8858 F I Jun.  12, 2018 US B H C Jan.  1, 2013 A 61 B 17 68 L I Jun.  12, 2018 US B H C Jan.  1, 2013 A 61 F 2 28 L I Jun.  12, 2018 US B H C Jan.  1, 2013 A 61 B 17 8061 L A Jun.  12, 2018 US B H C
(51)Int. Cl. A61B 017/56 (20060101); A61B 017/88 (20060101); A61F 002/28 (20060101); A61B 017/68 (20060101); A61B 017/80 (20060101)
(58)Field of Search  606/300-321, 62-64

 
(56)References Cited
 
 U.S. PATENT DOCUMENTS
 1,362,513  A  12/1919    Skinner     
 1,344,327  A  6/1920    Wilson     
 1,493,240  A  5/1924    Bohn     
 1,685,380  A  9/1928    Shultz     
 2,137,710  A  12/1937    Anderson     
 2,485,531  A  1/1948    Dzus et al.     
 2,493,598  A  1/1950    Rozek     
 2,537,070  A  1/1951    Longfellow     
 2,580,821  A  1/1952    Nicola     
 2,730,101  A  1/1956    Hoffman     
 2,780,223  A  2/1957    Haggland     
 2,898,963  A  8/1959    Courtot     
 3,143,915  A  8/1964    Tendler     
 3,143,916  A  8/1964    Rice     
 3,146,892  A  9/1964    White     
 3,181,533  A  5/1965    Heath     
 3,386,169  A  6/1968    Scialom     
 3,495,586  A  2/1970    Regenbogen     
 3,517,128  A*6/1970    Hines 606/197
 3,593,342  A  7/1971    Niebauer et al.     
 3,602,218  A*8/1971    Riordan 206/363
 3,623,164  A  11/1971    Bokros     
 3,640,280  A  2/1972    Slanker et al.     
 3,702,611  A  11/1972    Fishbein     
 3,710,789  A  1/1973    Ersek     
 3,744,488  A  7/1973    Cox     
 3,745,590  A  7/1973    Stubstad     
 3,759,257  A  9/1973    Fischer et al.     
 3,760,802  A  9/1973    Fischer et al.     
 3,779,239  A  12/1973    Fischer et al.     
 3,805,775  A  4/1974    Fischer et al.     
 3,828,790  A  8/1974    Curtiss et al.     
 3,835,859  A  9/1974    Roberts et al.     
 3,886,600  A  6/1975    Kahn et al.     
 3,909,853  A  10/1975    Lennox     
 3,917,249  A  11/1975    Constantine     
 3,946,445  A  3/1976    Bentley et al.     
 3,970,075  A  7/1976    Sindelar et al.     
 3,986,504  A  10/1976    Avila     
 3,992,726  A  11/1976    Freeman et al.     
 4,036,107  A  7/1977    Constantine     
 4,091,806  A  5/1978    Aginsky     
 4,124,026  A  11/1978    Berner et al.     
 4,156,296  A  5/1979    Johnson et al.     
 4,180,871  A  1/1980    Hamas     
 4,190,044  A  2/1980    Wood     
 4,193,139  A  3/1980    Walker     
 4,194,250  A  3/1980    Walker     
 4,203,444  A  5/1980    Bonnell et al.     
 4,204,531  A  5/1980    Aginsky     
 4,213,208  A  7/1980    Marne     
 4,227,518  A  10/1980    Aginsky     
 4,229,840  A  10/1980    Gristina     
 4,231,121  A  11/1980    Lewis     
 4,262,665  A  4/1981    Roalstad et al.     
 4,273,128  A  6/1981    Lary     
 4,274,398  A  6/1981    Scott et al.     
 4,275,717  A  6/1981    Bolesky     
 4,293,962  A  10/1981    Fuson     
 4,313,434  A  2/1982    Segal     
 4,349,922  A  9/1982    Agee     
 4,352,212  A  10/1982    Greene et al.     
 4,430,991  A  2/1984    Darnell     
 4,438,762  A  3/1984    Kyle     
 4,453,539  A  6/1984    Raftopoulos et al.     
 4,473,070  A  9/1984    Matthews et al.     
 4,485,816  A  12/1984    Krumme     
 4,502,554  A  3/1985    Jones     
 4,519,100  A  5/1985    Wills et al.     
 4,522,200  A  6/1985    Stednitz     
 4,530,114  A  7/1985    Tepic     
 4,548,199  A  10/1985    Agee     
 4,572,186  A  2/1986    Gould et al.     
 4,573,448  A  3/1986    Kambin     
 4,585,000  A  4/1986    Hershenson     
 4,590,930  A  5/1986    Kurth et al.     
 4,601,290  A  7/1986    Effron et al.     
 4,608,965  A*9/1986    Anspach, Jr. 600/101
 4,611,594  A*9/1986    Grayhack 606/127
 4,619,122  A  10/1986    Simpson     
 4,627,434  A  12/1986    Murray     
 4,634,445  A  1/1987    Helal     
 4,643,177  A  2/1987    Sheppard et al.     
 4,644,951  A  2/1987    Bays     
 4,646,738  A  3/1987    Trott     
 4,655,203  A  4/1987    Tormala et al.     
 4,660,557  A  4/1987    Collis     
 4,662,371  A  5/1987    Whipple et al.     
 4,665,906  A  5/1987    Jervis     
 4,669,237  A  6/1987    Constantine     
 4,674,488  A  6/1987    Nashef et al.     
 4,705,027  A  11/1987    Klaue     
 4,721,103  A  1/1988    Freedland     
 4,730,608  A  3/1988    Schlein     
 4,731,087  A  3/1988    Sculco et al.     
 4,751,922  A  6/1988    DiPietropolo     
 4,772,261  A*9/1988    Von Hoff 604/175
 4,777,942  A  10/1988    Frey et al.     
 4,782,833  A  11/1988    Einhorn et al.     
 4,790,302  A  12/1988    Colwill et al.     
 4,809,793  A  3/1989    Hailey     
 4,820,305  A  4/1989    Harms et al.     
 4,875,474  A  10/1989    Border     
 4,886,062  A  12/1989    Wiktor     
 4,914,818  A  4/1990    Hall et al.     
 4,921,478  A  5/1990    Solano et al.     
 4,941,466  A  7/1990    Romano     
 4,946,459  A  8/1990    Bradshaw et al.     
 4,954,126  A*9/1990    Wallsten 600/36
 4,955,916  A  9/1990    Carignan et al.     
 4,969,888  A  11/1990    Scholten et al.     
 4,973,257  A  11/1990    Lhotak     
 4,978,349  A  12/1990    Frigg     
 4,998,539  A*3/1991    Delsanti 128/898
 5,002,546  A  3/1991    Romano     
 5,015,255  A  5/1991    Kuslich     
 5,030,201  A*7/1991    Palestrant 600/568
 5,035,714  A  7/1991    Willert et al.     
 5,053,036  A  10/1991    Perren et al.     
 5,057,103  A  10/1991    Davis     
 5,059,193  A*10/1991    Kuslich 606/247
 5,059,206  A*10/1991    Winters 606/213
 5,062,845  A  11/1991    Kuslich et al.     
 5,066,296  A  11/1991    Chapman et al.     
 5,067,957  A  11/1991    Jervis     
 5,071,407  A*12/1991    Termin 604/104
 5,084,050  A  1/1992    Draenert     
 5,100,423  A*3/1992    Fearnot 604/22
 5,102,413  A  4/1992    Poddar     
 5,108,404  A  4/1992    Scholten et al.     
 5,108,435  A  4/1992    Gustavson et al.     
 5,112,333  A  5/1992    Fixel     
 5,113,846  A  5/1992    Hiltebrandt et al.     
 5,116,335  A  5/1992    Hannon et al.     
 5,122,134  A  6/1992    Borzone et al.     
 5,129,906  A*7/1992    Ross 606/77
 5,135,527  A*8/1992    Ender 606/62
 5,139,497  A  8/1992    Tilghman et al.     
 5,151,103  A  9/1992    Tepic et al.     
 5,169,402  A  12/1992    Elloy     
 5,171,284  A  12/1992    Branemark     
 5,174,374  A  12/1992    Hailey     
 5,180,382  A  1/1993    Frigg et al.     
 5,190,545  A  3/1993    Corsi et al.     
 5,190,546  A  3/1993    Jervis     
 5,190,548  A  3/1993    Davis     
 5,197,966  A  3/1993    Sommerkamp     
 5,197,967  A  3/1993    Wilson     
 5,197,971  A*3/1993    Bonutti 604/105
 5,201,741  A  4/1993    Dulebohn     
 5,203,773  A*4/1993    Green 604/104
 5,221,261  A  6/1993    Termin et al.     
 5,236,431  A  8/1993    Gogolewski et al.     
 5,242,017  A  9/1993    Hailey     
 5,242,461  A  9/1993    Kortenbach et al.     
 5,250,048  A  10/1993    Gundolf     
 5,263,955  A  11/1993    Baumgart et al.     
 5,269,785  A  12/1993    Bonutti     
 5,275,602  A  1/1994    Shimizu et al.     
 5,275,608  A  1/1994    Forman et al.     
 5,281,225  A  1/1994    Vicenzi     
 5,281,226  A  1/1994    Davydov et al.     
 5,286,249  A  2/1994    Thibodaux     
 5,307,790  A  5/1994    Byrne     
 5,314,486  A  5/1994    Zang et al.     
 5,326,205  A  7/1994    Anspach et al.     
 5,334,184  A  8/1994    Bimman     
 5,358,405  A  10/1994    Imai     
 5,376,097  A  12/1994    Phillips     
 5,376,100  A*12/1994    Lefebvre 604/22
 5,378,239  A  1/1995    Termin et al.     
 5,380,328  A  1/1995    Morgan     
 5,397,320  A*3/1995    Essig 606/110
 5,415,660  A  5/1995    Campbell et al.     
 5,423,823  A  6/1995    Schmieding     
 5,431,671  A  7/1995    Nallakrishnan     
 5,437,665  A  8/1995    Munro     
 5,437,674  A  8/1995    Worcel et al.     
 5,439,464  A  8/1995    Shapiro     
 5,445,639  A  8/1995    Kuslich et al.     
 5,454,365  A*10/1995    Bonutti 600/204
 5,458,599  A  10/1995    Adobbati     
 5,458,648  A  10/1995    Berman et al.     
 5,462,547  A  10/1995    Weigum     
 5,467,763  A  11/1995    McMahon et al.     
 D365,634  S  12/1995    Morgan     
 5,474,557  A  12/1995    Mai     
 5,480,447  A  1/1996    Skiba     
 5,496,277  A  3/1996    Termin et al.     
 5,496,330  A*3/1996    Bates 606/113
 5,499,981  A  3/1996    Kordis     
 5,501,695  A*3/1996    Anspach, Jr. 411/34
 5,505,734  A  4/1996    Caniggia et al.     
 5,509,919  A  4/1996    Young     
 5,512,037  A  4/1996    Russell et al.     
 5,527,316  A  6/1996    Stone et al.     
 5,531,792  A*7/1996    Huene 411/24
 5,536,267  A  7/1996    Edwards et al.     
 5,540,693  A  7/1996    Fisher     
 5,545,162  A  8/1996    Huebner     
 5,554,163  A  9/1996    Shturman     
 5,556,408  A  9/1996    Farhat     
 5,571,098  A  11/1996    Domankevitz et al.     
 5,571,189  A  11/1996    Kuslich     
 5,578,035  A  11/1996    Lin     
 5,582,577  A  12/1996    Lund et al.     
 5,582,618  A  12/1996    Chin et al.     
 5,586,983  A  12/1996    Sanders et al.     
 5,586,985  A  12/1996    Putnam et al.     
 5,586,990  A  12/1996    Hahnen et al.     
 5,591,169  A  1/1997    Benoist     
 5,591,170  A  1/1997    Spievack et al.     
 5,597,378  A  1/1997    Jervis     
 5,602,935  A  2/1997    Yoshida et al.     
 5,620,414  A  4/1997    Campbell     
 5,620,445  A  4/1997    Brosnahan et al.     
 5,624,440  A  4/1997    Huebner     
 5,624,447  A  4/1997    Myers     
 5,626,580  A  5/1997    Brosnahan     
 5,628,747  A  5/1997    Richelsoph     
 5,645,589  A  7/1997    Li     
 5,658,280  A  8/1997    Issa     
 5,658,283  A  8/1997    Huebner     
 5,660,188  A  8/1997    Groiso     
 5,662,649  A  9/1997    Huebner     
 5,667,509  A  9/1997    Westin     
 5,676,545  A  10/1997    Jones     
 5,676,699  A  10/1997    Gogolewski et al.     
 5,681,310  A  10/1997    Yuan et al.     
 5,683,389  A  11/1997    Orsak     
 5,685,826  A  11/1997    Bonutti     
 5,693,011  A*12/1997    Onik 604/22
 5,697,981  A  12/1997    Ison et al.     
 5,707,374  A  1/1998    Schmidt     
 5,709,697  A  1/1998    Ratcliff et al.     
 5,718,704  A  2/1998    Medoff     
 5,725,541  A  3/1998    Anspach, III et al.     
 5,728,047  A  3/1998    Edoga     
 5,728,098  A  3/1998    Sherman et al.     
 5,730,704  A  3/1998    Avitall     
 5,741,266  A  4/1998    Moran et al.     
 5,741,282  A  4/1998    Anspach et al.     
 5,758,713  A  6/1998    Fallet     
 5,779,703  A  7/1998    Benoist     
 5,792,106  A  8/1998    Mische     
 5,810,721  A  9/1998    Mueller et al.     
 5,814,044  A  9/1998    Hooven     
 5,817,098  A  10/1998    Albrektsson et al.     
 5,824,095  A  10/1998    Di Maio, Jr. et al.     
 5,827,289  A  10/1998    Reiley et al.     
 5,827,312  A  10/1998    Brown et al.     
 D403,069  S  12/1998    Drewry et al.     
 5,853,054  A  12/1998    McGarian et al.     
 5,876,399  A  3/1999    Chia et al.     
 5,879,352  A  3/1999    Filoso et al.     
 5,879,355  A  3/1999    Ullmark     
 5,885,258  A  3/1999    Sachdeva et al.     
 5,885,282  A  3/1999    Szabo     
 5,888,196  A  3/1999    Bonutti     
 5,891,147  A  4/1999    Moskovitz et al.     
 5,893,850  A  4/1999    Cachia     
 5,897,556  A  4/1999    Drewry et al.     
 5,908,423  A  6/1999    Kashuba et al.     
 5,915,036  A  6/1999    Grunkin et al.     
 5,919,195  A  7/1999    Wilson et al.     
 5,925,039  A  7/1999    Landingham     
 5,928,239  A  7/1999    Mirza     
 5,935,127  A  8/1999    Border     
 5,938,699  A  8/1999    Campbell     
 5,941,878  A  8/1999    Medoff     
 5,951,467  A  9/1999    Picha et al.     
 5,951,556  A  9/1999    Faccioli et al.     
 5,957,884  A  9/1999    Hooven     
 5,964,698  A  10/1999    Fowler     
 5,976,134  A  11/1999    Huebner     
 5,980,525  A  11/1999    Bryant et al.     
 5,984,932  A  11/1999    Yoon     
 5,984,937  A  11/1999    Morse et al.     
 5,997,538  A  12/1999    Asnis et al.     
 6,001,099  A  12/1999    Huebner     
 6,015,406  A  1/2000    Goble et al.     
 6,019,762  A  2/2000    Cole     
 6,019,947  A  2/2000    Kucherov     
 6,030,406  A  2/2000    Davis     
 6,033,412  A  3/2000    Losken et al.     
 6,045,564  A  4/2000    Walen     
 6,048,309  A  4/2000    Flom et al.     
 6,053,922  A  4/2000    Krause et al.     
 6,056,750  A  5/2000    Lob     
 6,068,642  A  5/2000    Johnson et al.     
 6,068,648  A  5/2000    Cole et al.     
 6,074,392  A  6/2000    Durham     
 6,093,162  A  7/2000    Fairleigh et al.     
 6,096,040  A  8/2000    Esser     
 6,113,603  A  9/2000    Medoff     
 6,120,472  A  9/2000    Singer, Jr.     
 6,120,504  A  9/2000    Brumback et al.     
 6,123,704  A  9/2000    Hajianpour     
 6,126,662  A  10/2000    Carmichael et al.     
 6,127,597  A  10/2000    Beyar et al.     
 6,129,762  A  10/2000    Li     
 6,142,935  A  11/2000    Flom et al.     
 6,143,012  A  11/2000    Gausepohl     
 6,149,651  A  11/2000    Drewry et al.     
 6,149,689  A  11/2000    Grundei     
 6,156,069  A  12/2000    Amstutz     
 6,162,223  A  12/2000    Orsak et al.     
 6,162,224  A  12/2000    Huebner     
 6,171,309  B1  1/2001    Huebner     
 6,174,312  B1  1/2001    Laminger     
 6,197,027  B1  3/2001    Hajianpour     
 6,200,330  B1  3/2001    Benderev et al.     
 6,216,573  B1  4/2001    Moutafis et al.     
 6,221,074  B1  4/2001    Cole et al.     
 6,221,102  B1  4/2001    Baker et al.     
 6,224,600  B1  5/2001    Protogirou     
 6,224,604  B1  5/2001    Suddaby     
 6,231,576  B1  5/2001    Frigg et al.     
 6,235,043  B1  5/2001    Reiley et al.     
 6,238,417  B1  5/2001    Cole     
 6,241,734  B1  6/2001    Scribner et al.     
 6,248,110  B1  6/2001    Reiley et al.     
 6,258,096  B1  7/2001    Seki     
 6,261,289  B1*7/2001    Levy 606/62
 6,280,474  B1  8/2001    Cassidy et al.     
 6,296,639  B1  10/2001    Truckai et al.     
 6,299,642  B1  10/2001    Chan     
 6,302,915  B1  10/2001    Cooney, III et al.     
 6,306,141  B1  10/2001    Jervis     
 6,312,467  B1  11/2001    McGee     
 6,319,255  B1  11/2001    Grundei et al.     
 6,322,591  B1  11/2001    Ahrens     
 6,331,166  B1  12/2001    Burbank et al.     
 6,332,885  B1  12/2001    Martella     
 6,332,886  B1  12/2001    Green et al.     
 6,337,142  B2  1/2002    Harder et al.     
 6,348,053  B1  2/2002    Cachia     
 6,364,909  B1  4/2002    McGee     
 6,365,555  B1  4/2002    Moser et al.     
 6,375,666  B1  4/2002    Mische     
 6,383,188  B2  5/2002    Kuslich et al.     
 6,402,753  B1  6/2002    Cole et al.     
 6,411,729  B1  6/2002    Grunkin     
 6,416,517  B2  7/2002    Harder et al.     
 6,423,070  B1  7/2002    Zeppelin     
 6,440,138  B1  8/2002    Reiley et al.     
 6,447,514  B1  9/2002    Stalcup et al.     
 6,447,515  B1  9/2002    Meldrum     
 6,447,518  B1  9/2002    Krause et al.     
 6,454,810  B1  9/2002    Lob     
 6,468,207  B1  10/2002    Fowler     
 6,475,789  B1  11/2002    Cech et al.     
 6,488,685  B1  12/2002    Manderson     
 6,491,694  B1  12/2002    Orsak     
 6,511,481  B2  1/2003    von Hoffmann et al.     
 6,517,541  B1  2/2003    Sesic     
 6,527,775  B1  3/2003    Warburton     
 6,533,788  B1  3/2003    Orbay     
 6,540,770  B1  4/2003    Tornier et al.     
 6,544,267  B1  4/2003    Cole et al.     
 6,551,321  B1*4/2003    Burkinshaw 606/62
 6,554,833  B2*4/2003    Levy 606/62
 6,575,973  B1  6/2003    Shekalim     
 6,575,978  B2  6/2003    Peterson et al.     
 6,582,467  B1  6/2003    Teitelbaum et al.     
 6,585,736  B2  7/2003    Hajianpour     
 6,585,770  B1  7/2003    White et al.     
 6,610,839  B1  8/2003    Morin et al.     
 6,613,052  B1  9/2003    Kinnett     
 6,613,054  B2  9/2003    Scribner et al.     
 6,617,110  B1  9/2003    Cech et al.     
 6,632,224  B2  10/2003    Cachia et al.     
 6,641,616  B1  11/2003    Grundei     
 6,645,210  B2  11/2003    Manderson     
 6,648,890  B2  11/2003    Culbert et al.     
 6,652,585  B2  11/2003    Lange     
 6,656,187  B1  12/2003    Camino     
 6,656,219  B1  12/2003    Wiktor     
 6,660,009  B1  12/2003    Azar     
 6,660,041  B1  12/2003    Grundei     
 6,676,665  B2*1/2004    Foley 600/201
 6,679,886  B2  1/2004    Weikel et al.     
 6,682,565  B1  1/2004    Krishnan     
 6,685,706  B2  2/2004    Padget et al.     
 6,689,138  B2  2/2004    Léchot et al.     
 6,692,496  B1  2/2004    Wardlaw     
 6,701,174  B1  3/2004    Krause et al.     
 6,709,433  B1  3/2004    Schoenefeld     
 6,711,432  B1  3/2004    Krause et al.     
 6,712,073  B2  3/2004    Manderson     
 6,712,858  B1  3/2004    Grundei et al.     
 6,719,761  B1  4/2004    Reiley et al.     
 6,719,793  B2  4/2004    McGee et al.     
 6,740,090  B1  5/2004    Cragg et al.     
 6,746,451  B2  6/2004    Middleton et al.     
 6,749,611  B2  6/2004    Venturini et al.     
 6,755,831  B2  6/2004    Putnam et al.     
 6,755,862  B2  6/2004    Keynan     
 6,761,722  B2  7/2004    Cole et al.     
 6,767,350  B1  7/2004    Lob     
 6,775,401  B2  8/2004    Hwang et al.     
 6,780,185  B2*8/2004    Frei 606/68
 6,783,530  B1  8/2004    Levy et al.     
 6,783,532  B2  8/2004    Steiner et al.     
 6,783,533  B2  8/2004    Green et al.     
 6,793,655  B2  9/2004    Orsak     
 6,793,659  B2  9/2004    Putnam     
 6,811,568  B2  11/2004    Minamikawa     
 6,827,723  B2  12/2004    Carson     
 6,827,743  B2  12/2004    Eisermann et al.     
 6,849,051  B2  2/2005    Sramek et al.     
 6,852,128  B2  2/2005    Lange     
 6,866,665  B2  3/2005    Orbay     
 6,887,243  B2  5/2005    Culbert     
 6,890,333  B2  5/2005    von Hoffmann et al.     
 6,893,444  B2  5/2005    Orbay     
 6,908,465  B2  6/2005    von Hoffmann et al.     
 6,911,046  B2  6/2005    Schulter     
 6,913,605  B2  7/2005    Fletcher et al.     
 6,923,813  B2  8/2005    Phillips et al.     
 6,923,817  B2  8/2005    Carson et al.     
 6,923,828  B1  8/2005    Wiktor     
 6,926,720  B2  8/2005    Castañeda     
 6,932,086  B1  8/2005    Hajianpour     
 6,942,666  B2  9/2005    Overaker et al.     
 6,942,668  B2  9/2005    Padget et al.     
 6,949,101  B2  9/2005    McCleary et al.     
 6,951,561  B2  10/2005    Warren et al.     
 6,953,313  B2  10/2005    Tylosky     
 6,975,894  B2  12/2005    Wehrli et al.     
 6,984,248  B2  1/2006    Hyde, Jr.     
 6,986,771  B2  1/2006    Paul et al.     
 6,989,011  B2  1/2006    Paul et al.     
 6,991,656  B2  1/2006    Mears     
 7,008,425  B2  3/2006    Phillips     
 7,008,428  B2  3/2006    Cachia et al.     
 7,008,430  B2  3/2006    Dong et al.     
 7,011,662  B2  3/2006    Lechot et al.     
 7,018,332  B1  3/2006    Masson et al.     
 7,018,380  B2  3/2006    Cole     
 7,022,069  B1  4/2006    Masson et al.     
 7,025,789  B2  4/2006    Chow et al.     
 7,041,104  B1  5/2006    Cole et al.     
 7,041,138  B2  5/2006    Lange     
 7,048,542  B2  5/2006    Von Arx et al.     
 7,052,498  B2  5/2006    Levy et al.     
 7,063,701  B2  6/2006    Michelson     
 7,070,601  B2  7/2006    Culbert et al.     
 7,090,676  B2  8/2006    Huebner et al.     
 7,097,646  B2  8/2006    Schantz     
 7,097,648  B1  8/2006    Globerman et al.     
 7,122,033  B2*10/2006    Wood 606/41
 7,122,043  B2  10/2006    Greenhalgh et al.     
 7,122,052  B2  10/2006    Greenhalgh     
 7,131,995  B2  11/2006    Biedermann et al.     
 7,137,987  B2  11/2006    Patterson et al.     
 7,141,054  B2  11/2006    Vandewalle     
 7,141,067  B2  11/2006    Jones et al.     
 7,147,640  B2  12/2006    Huebner et al.     
 7,153,307  B2  12/2006    Scribner et al.     
 7,153,309  B2  12/2006    Huebner et al.     
 7,160,302  B2  1/2007    Warburton     
 7,160,331  B2  1/2007    Cooney et al.     
 7,172,595  B1  2/2007    Goble     
 7,175,625  B2  2/2007    Culbert     
 7,179,024  B2  2/2007    Greenhalgh     
 7,189,237  B2  3/2007    Huebner     
 7,189,240  B1  3/2007    Dekel     
 7,195,589  B1  3/2007    Masson et al.     
 7,195,633  B2  3/2007    Medoff et al.     
 7,214,227  B2  5/2007    Colleran et al.     
 7,220,282  B2  5/2007    Kuslich et al.     
 7,229,441  B2  6/2007    Trieu et al.     
 7,235,079  B2  6/2007    Jensen et al.     
 7,237,556  B2  7/2007    Smothers et al.     
 7,255,712  B1  8/2007    Steinberg     
 7,258,692  B2  8/2007    Thelen et al.     
 7,264,622  B2  9/2007    Michelson     
 7,267,678  B2  9/2007    Medoff     
 7,282,053  B2  10/2007    Orbay     
 7,294,130  B2  11/2007    Orbay     
 7,300,449  B2  11/2007    Mische     
 7,306,603  B2  12/2007    Boehm, Jr. et al.     
 7,306,683  B2  12/2007    Cheung et al.     
 7,311,711  B2  12/2007    Cole     
 D560,128  S  1/2008    Diederich et al.     
 7,322,938  B2  1/2008    Burbank et al.     
 7,326,249  B2  2/2008    Lange     
 7,329,228  B2  2/2008    Burbank et al.     
 7,341,601  B2  3/2008    Eisermann et al.     
 7,344,539  B2  3/2008    Serhan et al.     
 7,354,453  B2  4/2008    McAfee     
 7,422,360  B2  9/2008    Kozyuk     
 7,465,318  B2  12/2008    Sennett et al.     
 7,476,226  B2  1/2009    Weikel et al.     
 7,481,815  B2  1/2009    Fernandez     
 7,485,119  B2  2/2009    Thelen et al.     
 7,488,320  B2  2/2009    Middleton     
 7,488,329  B2  2/2009    Thelen et al.     
 D589,147  S  3/2009    Colleran et al.     
 7,500,977  B2  3/2009    Assell et al.     
 7,507,241  B2  3/2009    Levy et al.     
 7,520,879  B2  4/2009    Justis et al.     
 7,527,632  B2*5/2009    Houghton 606/108
 7,563,263  B2  7/2009    Orbay et al.     
 7,569,061  B2  8/2009    Colleran     
 7,578,824  B2  8/2009    Justin et al.     
 7,588,575  B2  9/2009    Colleran et al.     
 7,588,577  B2  9/2009    Fencl et al.     
 7,588,588  B2  9/2009    Spitler et al.     
 7,601,152  B2  10/2009    Levy et al.     
 7,611,515  B2  11/2009    Wolford et al.     
 7,621,950  B1  11/2009    Globerman et al.     
 7,632,277  B2  12/2009    Woll et al.     
 7,632,310  B2  12/2009    Clifford et al.     
 7,666,226  B2  2/2010    Schaller     
 7,670,339  B2  3/2010    Levy et al.     
 7,670,374  B2  3/2010    Schaller     
 7,670,375  B2  3/2010    Schaller     
 7,682,364  B2  3/2010    Reiley et al.     
 7,695,471  B2  4/2010    Cheung et al.     
 7,695,502  B2  4/2010    Orbay et al.     
 7,704,251  B2  4/2010    Huebner et al.     
 7,708,742  B2  5/2010    Scribner et al.     
 7,713,271  B2  5/2010    Warburton et al.     
 7,717,472  B2  5/2010    Johnson     
 7,722,612  B2  5/2010    Sala et al.     
 7,722,626  B2  5/2010    Middleman et al.     
 7,727,264  B2  6/2010    Orbay et al.     
 7,731,720  B2  6/2010    Sand et al.     
 7,749,232  B2  7/2010    Salerni     
 7,758,500  B2  7/2010    Boyd et al.     
 7,785,368  B2  8/2010    Schaller     
 7,806,929  B2  10/2010    Brown     
 7,811,291  B2  10/2010    Liu et al.     
 7,828,802  B2  11/2010    Levy et al.     
 7,837,612  B2  11/2010    Gill et al.     
 7,842,041  B2  11/2010    Liu et al.     
 7,846,162  B2  12/2010    Nelson et al.     
 7,879,038  B2  2/2011    Reiley et al.     
 7,879,103  B2  2/2011    Gertzman et al.     
 7,905,909  B2  3/2011    Orbay et al.     
 7,909,825  B2  3/2011    Saravia et al.     
 7,909,827  B2  3/2011    Reiley et al.     
 7,909,873  B2  3/2011    Tan-Malecki et al.     
 7,914,533  B2  3/2011    Nelson et al.     
 7,931,689  B2  4/2011    Hochschuler et al.     
 7,942,875  B2  5/2011    Nelson et al.     
 7,959,634  B2  6/2011    Sennett     
 7,959,638  B2  6/2011    Osorio et al.     
 7,959,683  B2  6/2011    Semler et al.     
 7,967,827  B2  6/2011    Osorio et al.     
 7,967,865  B2  6/2011    Schaller     
 7,972,340  B2  7/2011    Sand et al.     
 7,988,735  B2  8/2011    Yurek et al.     
 8,007,498  B2  8/2011    Mische     
 RE42,757  E  9/2011    Kuslich et al.     
 8,021,365  B2  9/2011    Phan     
 8,021,366  B2  9/2011    Phan     
 8,043,334  B2  10/2011    Fisher et al.     
 8,057,544  B2  11/2011    Schaller     
 8,105,236  B2  1/2012    Malandain et al.     
 8,109,933  B2  2/2012    Truckai et al.     
 8,114,084  B2  2/2012    Betts     
 8,118,952  B2  2/2012    Gall et al.     
 8,128,627  B2  3/2012    Justin et al.     
 8,152,737  B2  4/2012    Burbank et al.     
 8,157,804  B2  4/2012    Betts     
 8,226,719  B2  7/2012    Melsheimer et al.     
 8,241,335  B2  8/2012    Truckai et al.     
 8,287,538  B2  10/2012    Brenzel et al.     
 8,287,539  B2  10/2012    Nelson et al.     
 8,287,541  B2  10/2012    Nelson et al.     
 8,317,791  B2  11/2012    Phan     
 8,353,911  B2  1/2013    Goldin et al.     
 8,366,717  B1  2/2013    Jordan et al.     
 8,366,773  B2  2/2013    Schaller et al.     
 8,409,211  B2  4/2013    Baroud     
 8,430,879  B2  4/2013    Stoneburner et al.     
 8,439,917  B2  5/2013    Saravia et al.     
 8,485,798  B2  7/2013    Sheth et al.     
 8,491,591  B2  7/2013    Fürderer     
 8,496,394  B2  7/2013    Schneider     
 8,496,657  B2  7/2013    Bonutti et al.     
 8,496,658  B2  7/2013    Stoneburner et al.     
 8,500,357  B2  8/2013    Stahle     
 8,505,879  B2  8/2013    Ruan     
 8,506,199  B2  8/2013    Rump et al.     
 8,512,398  B2*8/2013    Alkhatib 623/2.11
 8,568,413  B2  10/2013    Mazur et al.     
 8,579,537  B2  11/2013    VanLandingham et al.     
 8,597,276  B2*12/2013    Vongphakdy 604/523
 8,906,022  B2  12/2014    Krinke et al.     
 8,961,518  B2  2/2015    Taylor et al.     
 9,155,574  B2  10/2015    Saravia et al.     
 2001//0018588  A1  8/2001    Harder et al.     
 2001//0034526  A1  10/2001    Kuslich et al.     
 2001//0049530  A1*12/2001    Culbert 606/63
 2001//0053912  A1  12/2001    Frigg     
 2002//0013600  A1*1/2002    Scribner 606/192
 2002//0015517  A1  2/2002    Hwang et al.     
 2002//0029081  A1  3/2002    Scarborough et al.     
 2002//0032444  A1  3/2002    Mische     
 2002//0055742  A1  5/2002    Lieberman     
 2002//0055785  A1  5/2002    Harris     
 2002//0065530  A1  5/2002    Mische     
 2002//0068974  A1  6/2002    Kuslich et al.     
 2002//0111629  A1  8/2002    Phillips     
 2002//0111690  A1  8/2002    Hyde     
 2002//0120269  A1  8/2002    Lange     
 2002//0120270  A1  8/2002    Trieu et al.     
 2002//0123750  A1  9/2002    Eisermann et al.     
 2002//0133153  A1  9/2002    Hyde, Jr.     
 2002//0133156  A1  9/2002    Cole     
 2002//0133172  A1  9/2002    Lambrecht et al.     
 2002//0133175  A1  9/2002    Carson     
 2002//0138149  A1  9/2002    Hyde, Jr.     
 2002//0143329  A1  10/2002    Serhan et al.     
 2002//0143333  A1  10/2002    von Hoffmann et al.     
 2002//0143334  A1  10/2002    Hoffmann et al.     
 2002//0143335  A1  10/2002    von Hoffmann et al.     
 2002//0147451  A1  10/2002    McGee     
 2002//0147455  A1  10/2002    Carson     
 2002//0165461  A1  11/2002    Hayzelden et al.     
 2002//0171208  A1  11/2002    Lechot et al.     
 2002//0173813  A1  11/2002    Peterson et al.     
 2002//0183758  A1  12/2002    Middleton et al.     
 2002//0191823  A1  12/2002    Wehrli et al.     
 2003//0040805  A1  2/2003    Minamikawa     
 2003//0055373  A1  3/2003    Sramek et al.     
 2003//0055425  A1  3/2003    Hajianpour     
 2003//0069582  A1  4/2003    Culbert     
 2003//0069645  A1  4/2003    Ball et al.     
 2003//0074075  A1*4/2003    Thomas, Jr. 623/17.16
 2003//0083660  A1  5/2003    Orbay     
 2003//0083662  A1  5/2003    Middleton     
 2003//0093076  A1  5/2003    Venturini et al.     
 2003//0097132  A1  5/2003    Padget et al.     
 2003//0097133  A1  5/2003    Green et al.     
 2003//0105461  A1  6/2003    Putnam     
 2003//0109932  A1  6/2003    Keynan     
 2003//0120273  A1  6/2003    Cole     
 2003//0130660  A1*7/2003    Levy 606/63
 2003//0153918  A1  8/2003    Putnam et al.     
 2003//0187449  A1  10/2003    McCleary et al.     
 2003//0216738  A1  11/2003    Azar     
 2003//0220641  A1  11/2003    Thelen et al.     
 2003//0220644  A1  11/2003    Thelen et al.     
 2003//0220646  A1  11/2003    Thelen et al.     
 2003//0220698  A1  11/2003    Mears et al.     
 2003//0225407  A1  12/2003    Estrada, Jr.     
 2004//0024410  A1  2/2004    Olson, Jr. et al.     
 2004//0039384  A1  2/2004    Boehm, Jr. et al.     
 2004//0044413  A1  3/2004    Schulter     
 2004//0049192  A1  3/2004    Shimizu     
 2004//0078082  A1  4/2004    Lange     
 2004//0087956  A1  5/2004    Weikel et al.     
 2004//0092946  A1  5/2004    Bagga et al.     
 2004//0102777  A1  5/2004    Huebner     
 2004//0102778  A1  5/2004    Huebner et al.     
 2004//0102788  A1  5/2004    Huebner et al.     
 2004//0106925  A1  6/2004    Culbert     
 2004//0138665  A1  7/2004    Padget et al.     
 2004//0143264  A1  7/2004    McAfee     
 2004//0153080  A1  8/2004    Dong et al.     
 2004//0153114  A1  8/2004    Reiley et al.     
 2004//0153115  A1  8/2004    Reiley et al.     
 2004//0167528  A1  8/2004    Schantz     
 2004//0167625  A1  8/2004    Beyar et al.     
 2004//0181221  A1  9/2004    Huebner et al.     
 2004//0193163  A1  9/2004    Orbay     
 2004//0193164  A1  9/2004    Orbay     
 2004//0193165  A1  9/2004    Orbay     
 2004//0193251  A1  9/2004    Rudnick et al.     
 2004//0193267  A1  9/2004    Jones et al.     
 2004//0208717  A1  10/2004    Greenhalgh     
 2004//0214311  A1  10/2004    Levy     
 2004//0220678  A1  11/2004    Chow et al.     
 2004//0230193  A1*11/2004    Cheung 606/63
 2004//0236327  A1  11/2004    Paul et al.     
 2004//0236328  A1  11/2004    Paul et al.     
 2004//0236339  A1  11/2004    Pepper     
 2004//0249375  A1  12/2004    Agee et al.     
 2004//0260289  A1  12/2004    Padget et al.     
 2004//0260297  A1  12/2004    Padget et al.     
 2004//0267269  A1  12/2004    Middleton et al.     
 2005//0010231  A1  1/2005    Myers     
 2005//0015129  A1  1/2005    Mische     
 2005//0015154  A1  1/2005    Lindsey et al.     
 2005//0033366  A1  2/2005    Cole et al.     
 2005//0043733  A1  2/2005    Eisermann et al.     
 2005//0065522  A1  3/2005    Orbay     
 2005//0065523  A1  3/2005    Orbay     
 2005//0065524  A1  3/2005    Orbay     
 2005//0065526  A1  3/2005    Drew et al.     
 2005//0070902  A1  3/2005    Medoff     
 2005//0085813  A1  4/2005    Spitler et al.     
 2005//0085818  A1  4/2005    Huebner     
 2005//0085824  A1  4/2005    Castaneda     
 2005//0085921  A1  4/2005    Gupta et al.     
 2005//0113836  A1*5/2005    Lozier 606/80
 2005//0113892  A1  5/2005    Sproul     
 2005//0113929  A1  5/2005    Cragg et al.     
 2005//0119749  A1  6/2005    Lange     
 2005//0124972  A1  6/2005    Mische et al.     
 2005//0125066  A1  6/2005    McAfee     
 2005//0131407  A1  6/2005    Sicvol et al.     
 2005//0142163  A1*6/2005    Hunter 424/423
 2005//0143734  A1*6/2005    Cachia 606/60
 2005//0154331  A1  7/2005    Christie et al.     
 2005//0159749  A1  7/2005    Levy et al.     
 2005//0177172  A1  8/2005    Acker et al.     
 2005//0182399  A1  8/2005    Levine     
 2005//0192578  A1  9/2005    Horst     
 2005//0197537  A1  9/2005    Bonadio et al.     
 2005//0209557  A1  9/2005    Carroll et al.     
 2005//0216000  A1  9/2005    Colleran et al.     
 2005//0216007  A1  9/2005    Woll et al.     
 2005//0216008  A1*9/2005    Zwirnmann 606/281
 2005//0228391  A1  10/2005    Levy et al.     
 2005//0234472  A1  10/2005    Huebner     
 2005//0240188  A1*10/2005    Chow 606/247
 2005//0240190  A1  10/2005    Gall et al.     
 2005//0240193  A1  10/2005    Layne et al.     
 2005//0245928  A1  11/2005    Colleran et al.     
 2005//0251142  A1  11/2005    Hoffmann et al.     
 2005//0261779  A1  11/2005    Meyer     
 2005//0267483  A1  12/2005    Middleton     
 2005//0273138  A1  12/2005    To et al.     
 2005//0277936  A1  12/2005    Siravo et al.     
 2005//0277978  A1  12/2005    Greenhalgh     
 2005//0283154  A1  12/2005    Orbay et al.     
 2005//0283159  A1  12/2005    Amara     
 2005//0288676  A1  12/2005    Schnieders et al.     
 2005//0288795  A1*12/2005    Bagga 623/23.51
 2006//0002980  A1*1/2006    Ringeisen 424/426
 2006//0004362  A1  1/2006    Patterson et al.     
 2006//0004462  A1  1/2006    Gupta     
 2006//0009771  A1  1/2006    Orbay et al.     
 2006//0015123  A1  1/2006    Fencl et al.     
 2006//0036240  A1  2/2006    Colleran et al.     
 2006//0036244  A1  2/2006    Spitler et al.     
 2006//0047787  A1  3/2006    Agarwal et al.     
 2006//0052788  A1  3/2006    Thelen et al.     
 2006//0058621  A1  3/2006    Wehrli et al.     
 2006//0058826  A1  3/2006    Evans et al.     
 2006//0064005  A1  3/2006    Triano et al.     
 2006//0064106  A1  3/2006    Fernandez     
 2006//0064164  A1*3/2006    Thelen 623/16.11
 2006//0064173  A1  3/2006    Guederian et al.     
 2006//0069392  A1  3/2006    Renzi Brivio et al.     
 2006//0079894  A1  4/2006    Colleran et al.     
 2006//0079905  A1  4/2006    Beyar et al.     
 2006//0085009  A1  4/2006    Truckai et al.     
 2006//0089647  A1*4/2006    Culbert 606/65
 2006//0089648  A1  4/2006    Masini     
 2006//0100631  A1  5/2006    Sullivan et al.     
 2006//0100706  A1*5/2006    Shadduck 623/17.11
 2006//0106390  A1  5/2006    Jensen et al.     
 2006//0106394  A1  5/2006    Colleran     
 2006//0116773  A1  6/2006    Cooney et al.     
 2006//0122600  A1  6/2006    Cole     
 2006//0122610  A1  6/2006    Culbert et al.     
 2006//0142760  A1  6/2006    McDonnell     
 2006//0142858  A1  6/2006    Colleran et al.     
 2006//0149281  A1  7/2006    Reiley et al.     
 2006//0149379  A1  7/2006    Kuslich et al.     
 2006//0155289  A1  7/2006    Windhager et al.     
 2006//0173454  A1  8/2006    Spitler et al.     
 2006//0178737  A1  8/2006    Furcht et al.     
 2006//0184192  A1*8/2006    Markworth 606/198
 2006//0187748  A1  8/2006    Kozyuk     
 2006//0189994  A1  8/2006    Wolford et al.     
 2006//0195103  A1  8/2006    Padget et al.     
 2006//0200061  A1  9/2006    Warkentine     
 2006//0200140  A1  9/2006    Lange     
 2006//0200143  A1  9/2006    Warburton     
 2006//0217730  A1  9/2006    Termanini     
 2006//0229602  A1  10/2006    Olsen     
 2006//0235264  A1*10/2006    Vassallo 600/37
 2006//0241629  A1  10/2006    Krebs et al.     
 2006//0241630  A1  10/2006    Brunnett et al.     
 2006//0241671  A1  10/2006    Greenhalgh     
 2006//0241776  A1  10/2006    Brown et al.     
 2006//0247637  A1  11/2006    Colleran et al.     
 2006//0264944  A1  11/2006    Cole     
 2006//0264945  A1*11/2006    Edidin 606/63
 2006//0264950  A1  11/2006    Nelson et al.     
 2006//0264951  A1  11/2006    Nelson et al.     
 2006//0264952  A1  11/2006    Nelson et al.     
 2006//0271053  A1  11/2006    Schlapfer et al.     
 2006//0271061  A1  11/2006    Beyar et al.     
 2006//0271198  A1  11/2006    McAfee     
 2006//0276797  A1  12/2006    Botimer     
 2007//0012491  A1*1/2007    Vasta 180/65.1
 2007//0016188  A1  1/2007    Boehm et al.     
 2007//0016198  A1  1/2007    Boehm et al.     
 2007//0016199  A1  1/2007    Boehm et al.     
 2007//0016211  A1  1/2007    Botimer     
 2007//0016283  A1  1/2007    Greenhalgh et al.     
 2007//0016300  A1  1/2007    Kuslich     
 2007//0027230  A1  2/2007    Beyar et al.     
 2007//0032567  A1  2/2007    Beyar et al.     
 2007//0043373  A1  2/2007    Sala et al.     
 2007//0049936  A1  3/2007    Colleran et al.     
 2007//0055379  A1  3/2007    Stone et al.     
 2007//0066480  A1  3/2007    Moser et al.     
 2007//0073342  A1  3/2007    Stone et al.     
 2007//0100285  A1  5/2007    Griffin et al.     
 2007//0112427  A1  5/2007    Christy et al.     
 2007//0118132  A1  5/2007    Culbert et al.     
 2007//0123876  A1  5/2007    Czartoski et al.     
 2007//0123877  A1  5/2007    Goldin et al.     
 2007//0123886  A1  5/2007    Meyer et al.     
 2007//0123936  A1  5/2007    Goldin et al.     
 2007//0123995  A1  5/2007    Thelen et al.     
 2007//0129746  A1  6/2007    Mische     
 2007//0142919  A1  6/2007    Cooney et al.     
 2007//0173745  A1  7/2007    Diederich et al.     
 2007//0173835  A1  7/2007    Medoff et al.     
 2007//0173838  A1  7/2007    Li     
 2007//0173839  A1  7/2007    Running et al.     
 2007//0173939  A1*7/2007    Kim 623/17.11
 2007//0179505  A1  8/2007    Culbert     
 2007//0198043  A1  8/2007    Cox et al.     
 2007//0213727  A1  9/2007    Bottlang et al.     
 2007//0219634  A1  9/2007    Greenhalgh et al.     
 2007//0225568  A1  9/2007    Colleran     
 2007//0225721  A1  9/2007    Thelen et al.     
 2007//0225726  A1  9/2007    Dye et al.     
 2007//0225810  A1  9/2007    Colleran et al.     
 2007//0233091  A1  10/2007    Naifeh et al.     
 2007//0233105  A1  10/2007    Nelson et al.     
 2007//0244485  A1  10/2007    Greenhalgh et al.     
 2007//0255287  A1  11/2007    Rabiner     
 2007//0270855  A1  11/2007    Partin et al.     
 2007//0276392  A1  11/2007    Beyar et al.     
 2007//0276405  A1  11/2007    Huebner et al.     
 2007//0282443  A1  12/2007    Globerman et al.     
 2007//0283849  A1  12/2007    Edidin et al.     
 2007//0288097  A1  12/2007    Hurowitz     
 2008//0009868  A1  1/2008    Gotfried et al.     
 2008//0009874  A1  1/2008    Meridew et al.     
 2008//0009875  A1*1/2008    Sankaran 606/84
 2008//0009877  A1  1/2008    Sankaran et al.     
 2008//0012317  A1  1/2008    Johnson     
 2008//0015601  A1  1/2008    Castro et al.     
 2008//0019970  A1  1/2008    Gorman     
 2008//0021474  A1  1/2008    Bonutti et al.     
 2008//0039854  A1  2/2008    Rabiner     
 2008//0041629  A1  2/2008    Aronstam et al.     
 2008//0053575  A1  3/2008    Cheung et al.     
 2008//0058804  A1  3/2008    Lechot et al.     
 2008//0065072  A1  3/2008    Spitler et al.     
 2008//0065073  A1  3/2008    Perriello et al.     
 2008//0065074  A1  3/2008    Yeung et al.     
 2008//0065140  A1  3/2008    Bonutti     
 2008//0071356  A1  3/2008    Greenhalgh et al.     
 2008//0077117  A1  3/2008    Miller et al.     
 2008//0077172  A1*3/2008    Miller 606/191
 2008//0077174  A1  3/2008    Mische     
 2008//0086133  A1  4/2008    Kuslich et al.     
 2008//0097332  A1  4/2008    Greenhalgh et al.     
 2008//0103501  A1  5/2008    Ralph et al.     
 2008//0103519  A1  5/2008    Bonutti     
 2008//0108996  A1  5/2008    Padget et al.     
 2008//0114364  A1  5/2008    Goldin et al.     
 2008//0119886  A1*5/2008    Greenhalgh 606/200
 2008//0125784  A1  5/2008    Rabiner et al.     
 2008//0125805  A1  5/2008    Mische     
 2008//0132896  A1  6/2008    Bowen et al.     
 2008//0133017  A1  6/2008    Beyar et al.     
 2008//0140078  A1  6/2008    Nelson et al.     
 2008//0140130  A1  6/2008    Chan et al.     
 2008//0149115  A1  6/2008    Hauck et al.     
 2008//0161805  A1  7/2008    Saravia et al.     
 2008//0161825  A1  7/2008    Greenhalgh et al.     
 2008//0167657  A1  7/2008    Greenhalgh     
 2008//0177261  A1  7/2008    Mcminn     
 2008//0183171  A1  7/2008    Elghazaly et al.     
 2008//0194868  A1  8/2008    Kozyuk     
 2008//0195104  A1  8/2008    Sidebotham et al.     
 2008//0195105  A1  8/2008    Sidebotham et al.     
 2008//0200915  A1  8/2008    Globerman et al.     
 2008//0200951  A1  8/2008    McAfee     
 2008//0208202  A1  8/2008    Williams     
 2008//0208230  A1  8/2008    Chin et al.     
 2008//0208261  A1  8/2008    Medoff     
 2008//0208320  A1*8/2008    Tan-Malecki 623/1.17
 2008//0212405  A1  9/2008    Globerman et al.     
 2008//0228192  A1  9/2008    Beyar et al.     
 2008//0249436  A1  10/2008    Darr     
 2008//0255560  A1  10/2008    Myers et al.     
 2008//0262495  A1  10/2008    Coati et al.     
 2008//0269742  A1  10/2008    Levy et al.     
 2008//0269745  A1  10/2008    Justin     
 2008//0269746  A1  10/2008    Justin     
 2008//0269747  A1  10/2008    Justin     
 2008//0269748  A1  10/2008    Justin et al.     
 2008//0269749  A1  10/2008    Shalaby et al.     
 2008//0269750  A1  10/2008    Justin     
 2008//0269776  A1  10/2008    Justin et al.     
 2008//0275448  A1  11/2008    Sackett et al.     
 2008//0275449  A1  11/2008    Sackett et al.     
 2008//0287950  A1  11/2008    Frigg et al.     
 2008//0287951  A1  11/2008    Stoneburner et al.     
 2008//0288003  A1  11/2008    McKinley     
 2008//0294163  A1  11/2008    Chou et al.     
 2008//0294166  A1  11/2008    Goldin et al.     
 2008//0294167  A1  11/2008    Schumacher et al.     
 2008//0294169  A1  11/2008    Scott et al.     
 2008//0294205  A1  11/2008    Greenhalgh et al.     
 2008//0319444  A9  12/2008    Osorio et al.     
 2009//0005782  A1*1/2009    Chirico 606/63
 2009//0012522  A1  1/2009    Lob     
 2009//0012564  A1*1/2009    Chirico 606/246
 2009//0018542  A1  1/2009    Saravia et al.     
 2009//0018656  A1  1/2009    Clifford et al.     
 2009//0018666  A1  1/2009    Grundei et al.     
 2009//0024204  A1  1/2009    Greenhalgh et al.     
 2009//0048620  A1  2/2009    Weiss et al.     
 2009//0048629  A1  2/2009    Rabiner     
 2009//0048672  A1  2/2009    Essenmacher     
 2009//0054900  A1  2/2009    Rabiner et al.     
 2009//0076517  A1  3/2009    Reiley et al.     
 2009//0088752  A1  4/2009    Metzinger et al.     
 2009//0104586  A1  4/2009    Cardoso et al.     
 2009//0112196  A1  4/2009    Rabiner et al.     
 2009//0112330  A1  4/2009    Grundei     
 2009//0125028  A1*5/2009    Teisen 606/63
 2009//0131952  A1  5/2009    Schumacher et al.     
 2009//0131992  A1  5/2009    Greenhalgh et al.     
 2009//0138015  A1  5/2009    Conner et al.     
 2009//0143781  A1  6/2009    Mische     
 2009//0143827  A1  6/2009    Levy et al.     
 2009//0149890  A1  6/2009    Martin     
 2009//0149956  A1  6/2009    Greenhalgh et al.     
 2009//0157080  A1  6/2009    Warburton     
 2009//0163918  A1  6/2009    Levy et al.     
 2009//0177206  A1  7/2009    Lozier et al.     
 2009//0177239  A1  7/2009    Castro     
 2009//0182336  A1*7/2009    Brenzel 606/62
 2009//0216232  A1  8/2009    Buford, III et al.     
 2009//0228007  A1  9/2009    Justin et al.     
 2009//0228008  A1  9/2009    Justin et al.     
 2009//0275995  A1  11/2009    Truckai et al.     
 2009//0281628  A1*11/2009    Oglaza 623/17.15
 2009//0292323  A1*11/2009    Chirico 606/86 R
 2009//0318981  A1  12/2009    Kang     
 2010//0023010  A1  1/2010    Nelson et al.     
 2010//0087821  A1  4/2010    Trip et al.     
 2010//0094292  A1*4/2010    Parrott 606/62
 2010//0094347  A1  4/2010    Nelson et al.     
 2010//0100184  A1*4/2010    Krueger 623/17.12
 2010//0114181  A1  5/2010    Lob     
 2010//0131019  A1  5/2010    Lob     
 2010//0137862  A1*6/2010    Diao 606/62
 2010//0145397  A1  6/2010    Overes et al.     
 2010//0161061  A1  6/2010    Hunt     
 2010//0222884  A1  9/2010    Greenhalgh     
 2010//0241120  A1  9/2010    Bledsoe et al.     
 2010//0241123  A1  9/2010    Middleton et al.     
 2010//0241176  A1  9/2010    Lob     
 2010//0249785  A1  9/2010    Betts     
 2010//0256638  A1  10/2010    Tyber et al.     
 2010//0286481  A1  11/2010    Sharp et al.     
 2010//0286692  A1*11/2010    Greenhalgh 606/63
 2011//0077650  A1  3/2011    Braun et al.     
 2011//0087227  A1*4/2011    Mazur 606/62
 2011//0137313  A1  6/2011    Jensen et al.     
 2011//0144645  A1  6/2011    Saravia et al.     
 2011//0178520  A1*7/2011    Taylor 606/62
 2011//0190832  A1*8/2011    Taylor 606/86 R
 2011//0218585  A1  9/2011    Krinke et al.     
 2011//0218626  A1*9/2011    Krinke 623/16.11
 2011//0282346  A1  11/2011    Pham et al.     
 2011//0295255  A1*12/2011    Roberts 606/64
 2011//0306975  A1*12/2011    Kaikkonen 606/63
 2011//0307021  A1*12/2011    Anderson 606/86 R
 2011//0307072  A1*12/2011    Anderson 623/23.53
 2011//0313537  A1*12/2011    Anderson 623/23.54
 2012//0029633  A1*2/2012    Anderson 623/16.11
 2012//0065638  A1  3/2012    Moore     
 2012//0152872  A1  6/2012    Didehvar     
 2012//0179161  A1  7/2012    Rains et al.     
 2012//0209265  A1*8/2012    Pool 606/55
 2012//0209273  A1  8/2012    Zaretzka et al.     
 2012//0232533  A1  9/2012    Veldman et al.     
 2012//0239038  A1  9/2012    Saravia et al.     
 2012//0253410  A1*10/2012    Taylor 606/329
 2013//0006245  A1  1/2013    Stoneburner et al.     
 2013//0012942  A1  1/2013    Nelson et al.     
 2013//0116693  A1  5/2013    Nelson et al.     
 2013//0165935  A1  6/2013    Griffiths et al.     
 2013//0231665  A1  9/2013    Saravia et al.     
 2013//0267953  A1  10/2013    Brenzel et al.     
 2013//0325007  A1  12/2013    Beyar et al.     
 2013//0345765  A1*12/2013    Brockman 606/86 R
 2014//0031823  A1  1/2014    Mazur et al.     
 2014//0058390  A1  2/2014    Taylor et al.     
 2014//0074093  A9  3/2014    Nelson et al.     
 2014//0088707  A1*3/2014    Donner 623/17.11
 2014//0128870  A1  5/2014    Brenzel et al.     
 2014//0200618  A1*7/2014    Donner 606/281
 2015//0141996  A1  5/2015    Taylor et al.     
 2015//0164514  A1  6/2015    Wlodarski et al.     
 2015//0173805  A1*6/2015    Donner 606/279
 2015//0320459  A1  11/2015    Brenzel et al.     

 
 FOREIGN PATENT DOCUMENTS 
 
       CA       2007210       A1                11/1990      
       CA       2452508       A1                1/2003      
       CA       2609175       A1                12/2005      
       CA       2608693       A1                11/2006      
       CA       2537171       C                8/2007      
       CA       2669737       A1                5/2008      
       CA       2670263       A1                5/2008      
       CA       2670438       A1                5/2008      
       CA       2678911       A1                9/2008      
       CA       2685046       A1                11/2008      
       CA       2727453       A1                12/2009      
       CA       2738478       A1                4/2010      
       CN       2326199                         6/1999      
       CN       1530079                         9/2004      
       CN       1533260       A                9/2004      
       CN       2699849       Y                5/2005      
       CN       1909848       A                2/2007      
       CN       100379388                         4/2008      
       CN       101208053       A                6/2008      
       CN       101404946                         4/2009      
       CN       101636119       A                1/2010      
       DE       923085                         7/1949      
       DE       3146065       A1                5/1983      
       DE       3234875       A1                3/1984      
       DE       198800197       U1                8/1988      
       DE       3922044       A1                2/1991      
       DE       4217236                         11/1993      
       DE       202006017194       U1                2/2007      
       DE       102006016213                         10/2007      
       EP       0145166       A2                6/1985      
       EP       145166       A2                6/1985      
       EP       145166       A3                8/1986      
       EP       253526       A1                1/1988      
       EP       263292       A1                4/1988      
       EP       275871       A1                7/1988      
       EP       355035       A2                2/1990      
       EP       381462       A2                8/1990      
       EP       396519       A1                11/1990      
       EP       401650       A1                12/1990      
       EP       409769       A1                1/1991      
       EP       420542       A1                4/1991      
       EP       440371       A1                8/1991      
       EP       442137       A1                8/1991      
       EP       475077       A2                3/1992      
       EP       487669       A1                6/1992      
       EP       491211       A1                6/1992      
       EP       508710       A1                10/1992      
       EP       525352       A1                2/1993      
       EP       611560       A1                8/1994      
       EP       745352       A2                12/1996      
       EP       546162       B1                9/1997      
       EP       807419       A2                11/1997      
       EP       819413       A2                1/1998      
       EP       931513       A2                7/1999      
       EP       0941037                         9/1999      
       EP       0941037       B1                9/1999      
       EP       1099412       A2                5/2001      
       EP       1132051       A2                9/2001      
       EP       674495       B1                11/2001      
       EP       1155661       A1                11/2001      
       EP       1203569       A1                5/2002      
       EP       900065       B1                6/2002      
       EP       1277442       A2                1/2003      
       EP       1300122       A2                4/2003      
       EP       1348384       A2                10/2003      
       EP       1354562                         10/2003      
       EP       1372496       A1                1/2004      
       EP       1391186       A1                2/2004      
       EP       1098600       B1                3/2004      
       EP       1277442       A3                3/2004      
       EP       1396231       A1                3/2004      
       EP       1410765       A2                4/2004      
       EP       1442718       A1                8/2004      
       EP       1442729       A1                8/2004      
       EP       1454592       A2                9/2004      
       EP       1459686       A2                9/2004      
       EP       1484077       A2                12/2004      
       EP       1079752       B1                1/2005      
       EP       1484077       A3                1/2005      
       EP       1495729       A1                1/2005      
       EP       1148825       B1                3/2005      
       EP       1148850       B1                4/2005      
       EP       1522268       A1                4/2005      
       EP       1227765       B1                5/2005      
       EP       1535579       A2                6/2005      
       EP       1563795       A1                8/2005      
       EP       1582159       A1                10/2005      
       EP       1582160       A1                10/2005      
       EP       1582161       A1                10/2005      
       EP       1582162       A1                10/2005      
       EP       1582163       A1                10/2005      
       EP       1582164       A1                10/2005      
       EP       1634548       A2                3/2006      
       EP       1639953       A1                3/2006      
       EP       1669035       A1                6/2006      
       EP       1073371       B1                8/2006      
       EP       1454592       A3                8/2006      
       EP       1700572       A1                9/2006      
       EP       1702572       A2                9/2006      
       EP       1714618       A2                10/2006      
       EP       1787593       A1                5/2007      
       EP       1808143       A1                7/2007      
       EP       1815813       A2                8/2007      
       EP       1820462       A1                8/2007      
       EP       1011464       B1                1/2008      
       EP       1905367       A1                4/2008      
       EP       1905392       A1                4/2008      
       EP       1915959       A2                4/2008      
       EP       1920721       A2                5/2008      
       EP       1923019       A1                5/2008      
       EP       1277442       B1                7/2008      
       EP       1972308       A1                9/2008      
       EP       1987785       A2                11/2008      
       EP       2014261       A1                1/2009      
       EP       2025292       A1                2/2009      
       EP       1459689       B1                4/2009      
       EP       1484077       B1                6/2009      
       EP       1073371       B2                7/2009      
       EP       1459689       B3                11/2009      
       ES       2251888                         5/2006      
       FR       2653006       A1                4/1991      
       FR       2686788                         8/1993      
       FR       2781360                         1/2000      
       GB       2173565       A                10/1986      
       GB       2268068       A                1/1994      
       GB       2274993                         8/1994      
       JP       1310664       A                12/1989      
       JP       2000287983                         10/2000      
       JP       2001506524                         5/2001      
       JP       2001509040                         7/2001      
       JP       200481681                         3/2004      
       JP       2007125386                         5/2007      
       JP       2008500140       A                1/2008      
       JP       2008540037       A                11/2008      
       JP       2009160399                         7/2009      
       JP       2010510040       A                4/2010      
       JP       2010510041       A                4/2010      
       JP       2010510042       A                4/2010      
       JP       2010522046       A                7/2010      
       JP       2010524642       A                7/2010      
       JP       2011523889       A                8/2011      
       JP       2012504027       A                2/2012      
       JP       2012518511                         8/2012      
       RU       2004104359       A                2/2005      
       WO       WO89/04150       A1                5/1989      
       WO       WO89/07056       A1                8/1989      
       WO       WO90/03764       A1                4/1990      
       WO       WO90/11726       A1                10/1990      
       WO       WO91/02493       A1                3/1991      
       WO       WO91/06260       A1                5/1991      
       WO       WO91/06265       A1                5/1991      
       WO       WO91/11962       A1                8/1991      
       WO       WO91/19461       A1                12/1991      
       WO       WO94/24938       A1                11/1994      
       WO       WO94/27507       A1                12/1994      
       WO       WO94/28824       A2                12/1994      
       WO       WO95/14433       A1                6/1995      
       WO       WO95/14433       A1                6/1995      
       WO       WO95/20362       A1                8/1995      
       WO       WO95/31159       A1                11/1995      
       WO       WO96/02202       A1                2/1996      
       WO       WO96/02203       A1                2/1996      
       WO       WO96/05783       A1                2/1996      
       WO       WO96/06041       A1                2/1996      
       WO       WO96/07161       A1                3/1996      
       WO       WO96/16607       A1                6/1996      
       WO       WO96/17557       A1                6/1996      
       WO       WO96/18354       A2                6/1996      
       WO       WO96/18354       A2                6/1996      
       WO       WO96/18354       A3                8/1996      
       WO       WO96/25118       A1                8/1996      
       WO       WO96/40476       A1                12/1996      
       WO       WO97/03611       A1                2/1997      
       WO       WO97/03611       A1                2/1997      
       WO       WO97/18775       A1                5/1997      
       WO       WO97/42602       A1                11/1997      
       WO       WO97/42912       A1                11/1997      
       WO       WO97/47251       A1                12/1997      
       WO       WO98/01077       A1                1/1998      
       WO       WO98/05261       A2                2/1998      
       WO       WO98/07392       A1                2/1998      
       WO       WO98/19616       A1                5/1998      
       WO       WO98/24380       A1                6/1998      
       WO       WO98/26725       A1                6/1998      
       WO       WO98/38918       A1                9/1998      
       WO       WO98/46169       A1                10/1998      
       WO       WO98/56301       A1                12/1998      
       WO       WO99/22661       A1                5/1999      
       WO       WO99/22662       A1                5/1999      
       WO       WO99/37219       A1                7/1999      
       WO       WO99/47055       A1                9/1999      
       WO       WO99/51149       A1                10/1999      
       WO       WO99/53843       A1                10/1999      
       WO       WO99/55248       A1                11/1999      
       WO       WO99/62416       A1                12/1999      
       WO       WO00/06037       A1                2/2000      
       WO       WO00/09024       A1                2/2000      
       WO       WO00/12036       A1                3/2000      
       WO       WO00/12036       A1                3/2000      
       WO       WO00/21455       A1                4/2000      
       WO       WO00/25681       A1                5/2000      
       WO       WO00/28906       A1                5/2000      
       WO       WO00/30551       A1                6/2000      
       WO       WO00/30569       A1                6/2000      
       WO       WO00/38586       A1                7/2000      
       WO       WO00/42954       A2                7/2000      
       WO       WO00/44319       A1                8/2000      
       WO       WO00/44321       A2                8/2000      
       WO       WO00/44946       A1                8/2000      
       WO       WO00/45712       A1                8/2000      
       WO       WO00/45714       A1                8/2000      
       WO       WO00/45715       A1                8/2000      
       WO       WO00/45722       A1                8/2000      
       WO       WO00/47119       A1                8/2000      
       WO       WO00/48534       A1                8/2000      
       WO       WO00/71038       A1                11/2000      
       WO       WO00/76414       A1                12/2000      
       WO       WO01/08571       A1                2/2001      
       WO       WO01/28443       A1                4/2001      
       WO       WO01/34045       A1                5/2001      
       WO       WO01/49193       A1                7/2001      
       WO       WO01/54598       A1                8/2001      
       WO       WO01/60268       A1                8/2001      
       WO       WO01/60268       A1                8/2001      
       WO       WO01/76493       A1                10/2001      
       WO       WO01/76514       A2                10/2001      
       WO       WO01/78015       A2                10/2001      
       WO       WO01/80751       A1                11/2001      
       WO       WO01/85042       A1                11/2001      
       WO       WO02/13700       A2                2/2002      
       WO       WO02/13716       A1                2/2002      
       WO       WO02/17794       A1                3/2002      
       WO       WO02/17794       A1                3/2002      
       WO       WO02/24088       A2                3/2002      
       WO       WO02/34107       A2                5/2002      
       WO       WO02/34148       A2                5/2002      
       WO       WO02/37935       A2                5/2002      
       WO       WO02/45606       A1                6/2002      
       WO       WO02/49517       A1                6/2002      
       WO       WO02/058575       A1                8/2002      
       WO       WO02/067824       A2                9/2002      
       WO       WO02/078555       A1                10/2002      
       WO       WO02/089683       A1                11/2002      
       WO       WO02/096306       A1                12/2002      
       WO       WO03/007830       A1                1/2003      
       WO       WO03/013336       A2                2/2003      
       WO       WO02/17794       A8                3/2003      
       WO       WO03/030760       A1                4/2003      
       WO       WO03/043488       A2                5/2003      
       WO       WO03/045257       A2                6/2003      
       WO       WO30/47440       A1                6/2003      
       WO       WO03/068090       A1                8/2003      
       WO       WO02/17794       A9                9/2003      
       WO       WO20/04008949       A2                1/2004      
       WO       WO20/04017817       A2                3/2004      
       WO       WO20/04021904                         3/2004      
       WO       WO20/04030549       A1                4/2004      
       WO       WO20/04039271                         5/2004      
       WO       WO20/04064603       A2                8/2004      
       WO       WO20/04078220       A2                9/2004      
       WO       WO20/04078221       A2                9/2004      
       WO       WO20/04086934       A2                10/2004      
       WO       WO20/04092431       A1                10/2004      
       WO       WO20/04093633       A2                11/2004      
       WO       WO20/04098453       A2                11/2004      
       WO       WO20/04103209       A2                12/2004      
       WO       WO20/04110292       A2                12/2004      
       WO       WO20/04110300       A2                12/2004      
       WO       WO20/04112661       A1                12/2004      
       WO       WO20/05000159       A2                1/2005      
       WO       WO20/05020830       A1                3/2005      
       WO       WO20/05020833       A2                3/2005      
       WO       WO20/05023085       A2                3/2005      
       WO       WO20/05032326       A2                4/2005      
       WO       WO20/05032340       A2                4/2005      
       WO       WO20/05039651       A2                5/2005      
       WO       WO20/05041799       A1                5/2005      
       WO       WO20/05044122       A1                5/2005      
       WO       WO20/05051971       A1                6/2005      
       WO       WO20/05055874       A2                6/2005      
       WO       WO20/05020833       A3                7/2005      
       WO       WO20/05070314       A1                8/2005      
       WO       WO20/05092223       A2                10/2005      
       WO       WO20/05094693       A1                10/2005      
       WO       WO20/05094705       A2                10/2005      
       WO       WO20/05094706       A1                10/2005      
       WO       WO20/05096975       A2                10/2005      
       WO       WO20/05102196       A1                11/2005      
       WO       WO20/05107415       A2                11/2005      
       WO       WO20/05112804       A1                12/2005      
       WO       WO20/05112804       A1                12/2005      
       WO       WO20/05122931       A1                12/2005      
       WO       WO20/05122932       A2                12/2005      
       WO       WO20/05123171       A2                12/2005      
       WO       WO20/06011152       A2                2/2006      
       WO       WO20/06020530       A2                2/2006      
       WO       WO20/06023793       A2                3/2006      
       WO       WO20/06026323       A2                3/2006      
       WO       WO20/06026323       A2                3/2006      
       WO       WO20/05112804       A9                4/2006      
       WO       WO20/06026323       A9                4/2006      
       WO       WO20/06041460       A1                4/2006      
       WO       WO20/06041460       A1                4/2006      
       WO       WO20/06042188       A2                4/2006      
       WO       WO20/06042189       A2                4/2006      
       WO       WO20/06042334       A2                4/2006      
       WO       WO20/06034396       A3                5/2006      
       WO       WO20/06051547       A2                5/2006      
       WO       WO20/06055448       A1                5/2006      
       WO       WO20/06063083       A1                6/2006      
       WO       WO20/06066228       A2                6/2006      
       WO       WO20/06068682       A1                6/2006      
       WO       WO20/10065855       A1                6/2006      
       WO       WO20/06089929       A1                8/2006      
       WO       WO20/06090379       A2                8/2006      
       WO       WO20/06034436       A3                10/2006      
       WO       WO20/06108067       A2                10/2006      
       WO       WO20/06113800       A2                10/2006      
       WO       WO20/06116760       A2                11/2006      
       WO       WO20/06116761       A2                11/2006      
       WO       WO20/06124764       A1                11/2006      
       WO       WO20/06124764       A1                11/2006      
       WO       WO20/06124937       A2                11/2006      
       WO       WO20/06127904       A1                11/2006      
       WO       WO20/06127904       A1                11/2006      
       WO       WO20/07002933       A2                1/2007      
       WO       WO20/07008177       A1                1/2007      
       WO       WO20/07009107       A2                1/2007      
       WO       WO20/07009123       A2                1/2007      
       WO       WO20/07011994       A2                1/2007      
       WO       WO20/07012046       A2                1/2007      
       WO       WO20/07025236       A2                3/2007      
       WO       WO20/07040949       A2                4/2007      
       WO       WO20/07041665       A2                4/2007      
       WO       WO20/06124937       A3                5/2007      
       WO       WO20/07053960       A1                5/2007      
       WO       WO20/07058943       A2                5/2007      
       WO       WO20/07059243       A1                5/2007      
       WO       WO20/07059243       A1                5/2007      
       WO       WO20/07059246       A1                5/2007      
       WO       WO20/07059259       A1                5/2007      
       WO       WO20/07059259       A1                5/2007      
       WO       WO20/07065137       A2                6/2007      
       WO       WO20/07069251       A2                6/2007      
       WO       WO20/07073488       A2                6/2007      
       WO       WO20/07076308       A2                7/2007      
       WO       WO20/07076374       A2                7/2007      
       WO       WO20/07076376       A2                7/2007      
       WO       WO20/07076377       A2                7/2007      
       WO       WO20/07078692       A2                7/2007      
       WO       WO20/07079237       A2                7/2007      
       WO       WO20/07082151       A2                7/2007      
       WO       WO20/07084239       A2                7/2007      
       WO       WO20/07092813       A2                8/2007      
       WO       WO20/07092813       A2                8/2007      
       WO       WO20/07092841       A2                8/2007      
       WO       WO20/07092841       A2                8/2007      
       WO       WO20/07036815       A2                9/2007      
       WO       WO20/07114982       A1                10/2007      
       WO       WO20/07115108       A1                10/2007      
       WO       WO20/07117571       A2                10/2007      
       WO       WO20/07120539       A2                10/2007      
       WO       WO20/07092841       A3                11/2007      
       WO       WO20/07124130       A2                11/2007      
       WO       WO20/07127255       A2                11/2007      
       WO       WO20/07127260       A2                11/2007      
       WO       WO20/07131002       A2                11/2007      
       WO       WO20/07134134       A2                11/2007      
       WO       WO20/07079237       A3                12/2007      
       WO       WO20/07145824       A2                12/2007      
       WO       WO20/08004229       A2                1/2008      
       WO       WO20/08006117       A2                1/2008      
       WO       WO20/08016910       A2                2/2008      
       WO       WO20/08019397       A2                2/2008      
       WO       WO20/08035849       A1                3/2008      
       WO       WO20/08037454       A1                4/2008      
       WO       WO20/08043254       A1                4/2008      
       WO       WO20/08058960       A2                5/2008      
       WO       WO20/08059027       A2                5/2008      
       WO       WO20/08060277       A2                5/2008      
       WO       WO20/08060277       A2                5/2008      
       WO       WO20/08063265       A1                5/2008      
       WO       WO20/08064346       A2                5/2008      
       WO       WO20/08064347       A2                5/2008      
       WO       WO20/08064347       A2                5/2008      
       WO       WO20/08064350       A2                5/2008      
       WO       WO20/08076330       A1                6/2008      
       WO       WO20/08076330       A1                6/2008      
       WO       WO20/08076357       A1                6/2008      
       WO       WO20/08094407       A1                8/2008      
       WO       WO20/07011353       A3                9/2008      
       WO       WO20/07092813       A3                9/2008      
       WO       WO20/08109566       A1                9/2008      
       WO       WO20/08112308       A1                9/2008      
       WO       WO20/08116170       A2                9/2008      
       WO       WO20/08116175       A2                9/2008      
       WO       WO20/08118945       A1                10/2008      
       WO       WO20/08121608       A2                10/2008      
       WO       WO20/08132728       A1                11/2008      
       WO       WO20/08134287       A2                11/2008      
       WO       WO20/08134758       A1                11/2008      
       WO       WO20/08139456       A2                11/2008      
       WO       WO20/08144709       A2                11/2008      
       WO       WO20/08144709       A2                11/2008      
       WO       WO20/07078692       A3                12/2008      
       WO       WO20/08121608       A3                1/2009      
       WO       WO20/08134287       A3                1/2009      
       WO       WO20/09006622       A2                1/2009      
       WO       WO20/09007331       A2                1/2009      
       WO       WO20/09009772       A1                1/2009      
       WO       WO20/09010412       A1                1/2009      
       WO       WO20/09012347       A1                1/2009      
       WO       WO20/09026070       A1                2/2009      
       WO       WO20/09027325       A1                3/2009      
       WO       WO20/09039430       A1                3/2009      
       WO       WO20/06026323       A3                4/2009      
       WO       WO20/06026397       A3                4/2009      
       WO       WO20/09045751       A1                4/2009      
       WO       WO20/09059227       A1                5/2009      
       WO       WO20/09067568                         5/2009      
       WO       WO20/09072125       A1                6/2009      
       WO       WO20/09076086       A1                6/2009      
       WO       WO20/08144709       A3                7/2009      
       WO       WO20/09088376       A1                7/2009      
       WO       WO20/09094478       A1                7/2009      
       WO       WO20/08060277       A3                9/2009      
       WO       WO20/08112912       A3                9/2009      
       WO       WO20/09132333       A2                10/2009      
       WO       WO20/09143374       A2                11/2009      
       WO       WO20/09143496       A1                11/2009      
       WO       WO20/08112875       A3                12/2009      
       WO       WO20/09146457       A1                12/2009      
       WO       WO20/09152270       A1                12/2009      
       WO       WO20/09152272       A1                12/2009      
       WO       WO20/09152273       A1                12/2009      
       WO       WO20/09132333       A3                1/2010      
       WO       WO20/08139456       A3                2/2010      
       WO       WO20/10037038       A2                4/2010      
       WO       WO20/10056895       A1                5/2010      
       WO       WO20/10062379       A1                6/2010      
       WO       WO20/10091242       A1                8/2010      
       WO       WO20/10035156       A1                11/2010      

 OTHER PUBLICATIONS
  
  US 7,063,700, 06/2006, Michelson (withdrawn)
  US 7,201,752, 04/2007, Huebner et al. (withdrawn)
  International Search Report for International Application No. PCT/US14/69907, Jun. 4, 2015.
  Written Opinion for International Application No. PCT/US14/69907, Jun. 4, 2015.
  App No. PCT/US 09/30971 International Search Report, Mar. 6, 2009.
  App No. PCT/US 09/30971 Written Opinion of the International Searching Authority, Mar. 6, 2009.
  App No. PCT/US2011/21074 International Search Report, May 23, 2011.
  App No. PCT/US2011/21074 Written Opinion of the International Searching Authority, May 23, 2011.
  App No. PCT/US2011/021735 International Search Report, May 25, 2011.
  App No. PCT/US2011/021735 Written Opinion of the International Searching Authority, May 25, 2011.
  App No. PCT/US2011/027597 International Search Report, Jul. 6, 2011.
  App No. PCT/US2011/027597 Written Opinion of the International Searching Authority, Jul. 6, 2011.
  App No. PCT/US2011/027602 International Search Report, Jul. 5, 2011.
  App No. PCT/US2011/027602 Written Opinion of the International Searching Authority, Jul. 5, 2011.
  Putnam, Matthew D., et al., “Distal Radial Metaphyseal Forces in an Extrinsic Grip Model: Implications for Post fracture Rehabilitation,” American Society for Surgery of the Hand, 25A: 469-475, May 2000.
  Higgins, Thomas F., et al., “A Biomechanical Analysis of Fixation of Intra-Articular Distal Radial Fractures with Calcium-Phosphate Bone Cement,” The Journal of Bone and Joint Surgery, 84:1579-1586, Needham, Massachusetts, Sep. 2002.
  Stoeckel et al., “Self-Expanding Nitinol Stents—Material and Design Considerations,” Nitinol Devices & Components, Fremont, California, 2003.
  Rozenthal, Tamara D., et al., “Functional Outcome and Complications After Volar Plating for Dorsally Displaced, Unstable Fractures of the Distal Radius,” The Journal of Hand Surgery, 31A: 359-365, Mar. 2006.
  Keast-Butler, Oliver, et al., “Biology Versus Mechanics in the Treatment of Distal Radial Fractures,” The Journal of Orthopedic Trauma, 22: S91-S95, Philadelphia, Pennsylvania, Sep. 2008.
  Mudgal, Chaitanya S., et al., “Plate Fixation of Osteoporotic Fractures of the Distal Radius,” The Journal of Orthopedic Trauma, 22: S106-S115, 2008, Philadelphia, Pennsylvania, Sep. 2008.
  Bogoch, Earl R., et al., “The Osteoporosis Needs of Patients with Wrist Fractures,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  Arora, Rohit, et al., “A Representative Case of Osteoporotic Distal Radius Fracture,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  Firoozabadi, Reza, et al., “Qualitative and Quantitative Assessment of Bone Fragility and Fracture Healing Using Conventional Radiography and Advanced Imaging Technologies—Focus on Wrist Fracture,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  Goldhan, Jorg, et al., “What Counts: Outcome Assessment After Distal Radius Fractures in Aged Patients,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  Hoang-Kim, Amy, et al., “Wrist Fractures in Osteoporotic Patients,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  Kettler, Mark, et al., “Do We Need to Include Osteoporosis in Today's Classification of Distal Radius Fractures?” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  Downing, Martin R., et al., “Assessment of Inducible Fracture Micromotion in Distal Radial Fractures Using Radiostereometry,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  Suhm, Norbert, et al., “Injectable Bone Cement Augmentation for the Treatment of Distal Radius Fractures: A Review,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  Van Lenthe, G. Harry, et al., “Quantification of Bone Structural Parameters and Mechanical Competence at the Distal Radius,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  Parkinson, Ian H., et al., “Whole Bone Geometry and Bone Quality in Distal Forearm Fracture,” The Journal of Orthopedic Trauma, vol. 22, No. 8, Supplement, Philadelphia, Pennsylvania, Sep. 2008.
  “Medtronic—Abdominal Stent Graft System, Instructions for Use,” Medtronic, Inc., Minneapolis-Minnesota, 2008.
  Jupiter, Jesse B., et al., “Operative Management of Distal Radial Fractures with 2.4-Millimeter Locking Plates. A Multicenter Prospective Case Series,” The Journal of Bone and Joint Surgery, 91: 55-65, doi:10.2106-JBJS.G.01498, Needham, Massachusetts, Jan. 1, 2009.
  App No. PCT/US2012/028145 International Search Report, Sep. 13, 2012.
  App No. PCT/US2012/028145 Written Opinion of the International Searching Authority, Sep. 13, 2012.
  Ilyas, Asif M., “Intramedullary Fixation of Distal Radius Fractures,” Elsevier, Inc. on behalf of the American Society for Surgery of the Hand, New York, New York, Feb. 2009.
  Figl, Markus, et al., “Volar Fixed-Angle Plate Osteosynthesis of Unstable Distal Radius Fractures: 12 Months Results,” Springer, New York, New York, Feb. 19, 2009.
  Photograph, OrthopaedicLIST, 2010, Wilmington, North Carolina.
  Barnes, C. Lowry, et al., “Advanced Core Decompression System,” Wright, 2008, Arlington, Tennessee.
  “OptiMesh 1500E—Percutaneous Interbody Fusion Surgical Technique,” Spineology Inc., Feb. 2010, Saint Paul, Minnesota.
  Corti, G., et al., “Acute Vertebral Body Compression Fracture treated with OptiMesh—Indications, Applications and First Clinical Results,” Eurospine, 2005, Uster-Zürich Switzerland.
  Advanced Core Decompression System—Surgical Technique, Wright, 2010, Arlington, Tennessee.
  State Intellectual Property Office of the People's Republic of China—Chinese Official Action for Chinese Patent Application No. 201180021809.7, Aug. 1, 2014.
  Office Action in U.S. Appl. No. 14/929,757, dated Jul. 21, 2016.
  Office Action in U.S. Appl. No. 14/929,757, dated Jan. 17, 2017.
  Office Action in Chinese Application No. 201510621438.6, dated Feb. 8, 2018, State Intellectual Property Office Of The People's Republic Of China.
  English Language Translation of Office Action in Chinese Application No. 201510621438.6, dated Feb. 8, 2018.
 
 
     * cited by examiner
 
     Primary Examiner —Ellen C Hammond
     Assistant Examiner —Stuart S Bray
     Art Unit — 3733
     Exemplary claim number — 1
 
(74)Attorney, Agent, or Firm — Weiss & Arons LLP

(57)

Abstract

Apparatus and methods for securing a bone implant are provided. The implant may be an expandable implant. The implant may be a non-expandable implant. The implant may be for repairing a bone fracture. The implant may be secured to a bone by anchors. The implant may include anchor receiving features. The anchor receiving features may be configured to direct an anchor into cortical bone. The anchor receiving features may be configured to receive an anchor driven through cortical bone. The implant may include bone engaging members configured to engage cancellous bone. An implant may include different profiles. The different profiles may be configured to secure the implant. The profiles may be configured to support the bone. The implant may have different flexing properties configured to position the implant in the bone. The implant may be positioned to receive an anchor driven through an outside of the bone.
21 Claims, 49 Drawing Sheets, and 51 Figures


CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application is a divisional of U.S. application Ser. No. 13/043,190, filed on Mar. 8, 2011, which claims the benefit of U.S. Provisional Applications No. 61/311,494, filed on Mar. 8, 2010 and 61/378,822 filed on Aug. 31, 2010, all of which are hereby incorporated by reference in their entireties.

FIELD OF TECHNOLOGY

[0002] Aspects of the disclosure relate to providing apparatus and methods for securing an implant deployed in a bone. In particular, the disclosure relates to apparatus and methods for repairing bone fractures utilizing a device that is inserted into a bone and secured to the bone.

BACKGROUND

[0003] The human body includes long, short, flat, irregular and sesamoid bone. A long bone is characterized by a midshaft. The midshaft of a long bone is typically classified as the diaphysis. The end of such a bone is typically classified as the epiphysis. Bone that is transitional between the midshaft and the end is typically classified as the metaphysis.
[0004] Multi-segment fractures, of either the midshaft or end-bone, require alignment and stability in a manner that generates adequate fixation in multiple directions.
[0005] However, midshaft fractures and end-bone fractures are fundamentally different. The loading conditions, fracture patterns, alignment needed, and compression force to promote healing are different. Midshaft fractures have ample bone material on either side of the fracture in which anchors may be driven. End-bone fractures, especially on the articular surface may have thin cortical bone, soft cancellous bone, and minimal anchoring locations.
[0006] Midshaft fractures tend to be loaded primarily in bending and torsion. End-bone fractures tend to be loaded in complex and multi-directional stress patterns. Midshaft repair approaches, therefore, may not be appropriate for repair of end-bone fractures.
[0007] There are two primary categories for surgical fixation of a long bone fracture: (1) a device that is within the skin (internal fixation); and (2) a device that extends out of the skin (external fixation). There are two common types of internal fixation approaches for long bone surgery (a) a plate that is screwed to the outside of the bone; or (b) a rod that goes down the center of the bone.
[0008] Intramedullary rods, nails or implants, are more effective than plates and screws at minimizing soft-tissue trauma and complications. Moreover, appropriate sizing of an implant helps realignment and healing of the fracture. Proper sizing of an implant may ensure proper matching of the implant device to a patient's anatomy.
[0009] An implant deployed in an intramedullary cavity of a bone may be expandable. An expandable implant may provide proper anatomic alignment and allow appropriate sizing of the implant. However, bone fractures require alignment and stability in a manner that generates adequate fixation in multiple directions.
[0010] It would be desirable, therefore, to provide apparatus and methods for securing an implant deployed inside a bone.

BRIEF DESCRIPTION OF THE DRAWINGS

[0011] FIG. 1 shows perspective view of an illustrative apparatus in accordance with principles of the invention;
[0012] FIG. 2 shows illustrative anatomy in connection with which the invention may be practiced;
[0013] FIG. 3 shows another illustrative apparatus along with illustrative anatomy in accordance with principles of the invention;
[0014] FIG. 4 shows a cross sectional view taken along lines 4-4 of the apparatus shown in FIG. 3;
[0015] FIG. 5 shows a partial sectional view of the apparatus shown in FIG. 3;
[0016] FIG. 6 shows a portion of the apparatus shown in FIG. 5;
[0017] FIG. 7A shows a sectional view of an apparatus in accordance with the principles of the invention;
[0018] FIG. 7B shows a cross section of the apparatus shown in FIG. 5;
[0019] FIG. 7C shows a cross section of the apparatus shown in FIG. 5 in a state that is different from the state shown in FIG. 7B;
[0020] FIG. 8 shows a perspective view of the apparatus shown in FIG. 1 in a view different than the view shown in FIG. 1;
[0021] FIG. 9 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0022] FIG. 10 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0023] FIG. 11A shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0024] FIG. 11B shows a sectional view of the apparatus shown in FIG. 11 in a view different than the view shown in FIG. 11;
[0025] FIG. 12 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0026] FIG. 13 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0027] FIG. 14 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0028] FIG. 15 shows a cross section of the apparatus shown in FIG. 14;
[0029] FIG. 16 shows information that may be used to manufacture apparatus shown in FIG. 15;
[0030] FIG. 17 shows another perspective view of the apparatus shown in FIG. 3;
[0031] FIG. 18 shows a sectional view of the apparatus shown in FIG. 17;
[0032] FIG. 19 shows a cross section of the apparatus shown in FIG. 17;
[0033] FIG. 20 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0034] FIG. 21 shows information that may be used to manufacture apparatus in accordance with principles of the invention;
[0035] FIG. 22 shows information that may be used to manufacture apparatus in accordance with principles of the invention;
[0036] FIG. 23A shows information that may be used to manufacture apparatus in accordance with principles of the invention;
[0037] FIG. 23B shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0038] FIG. 24A shows information that may be used to manufacture apparatus in accordance with principles of the invention;
[0039] FIG. 24B shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0040] FIG. 25 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0041] FIG. 26 shows a front view of the apparatus shown in FIG. 25;
[0042] FIG. 27 shows information that may be used to manufacture apparatus in accordance with principles of the invention;
[0043] FIG. 28 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0044] FIG. 29 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0045] FIG. 30 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0046] FIG. 31A shows information that may be used to manufacture apparatus in accordance with principles of the invention;
[0047] FIG. 31B shows information that may be used to manufacture apparatus in accordance with principles of the invention;
[0048] FIG. 32 shows a side view of an illustrative apparatus in accordance with principles of the invention;
[0049] FIG. 33 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0050] FIG. 34 shows an end view of the apparatus shown in FIG. 33;
[0051] FIG. 35 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0052] FIG. 36 shows an end view of the apparatus shown in FIG. 35;
[0053] FIG. 37 shows a perspective view of the apparatus shown in FIG. 35 along with illustrative anatomy;
[0054] FIG. 38 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0055] FIG. 39 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0056] FIG. 40 shows a perspective view of an illustrative apparatus in accordance with principles of the invention;
[0057] FIG. 41 shows a cross section of a portion of the apparatus shown in FIG. 40;
[0058] FIGS. 42(A)-(C) show a side view of illustrative apparatus in accordance with principles of the invention;
[0059] FIG. 43 shows a front view of an illustrative human Skeleton;
[0060] FIG. 44 shows a partial sectional view of a fractured bone;
[0061] FIG. 45 shows a perspective view of an illustrative apparatus for preparing illustrative anatomy for an apparatus in accordance with principles of the invention.

DETAILED DESCRIPTION

[0062] Apparatus and methods for securing an implant for a bone are provided. An implant may be secured to a bone to repair a fracture in the bone. The implant may be an expandable implant. The implant may be a non-expandable implant. The implant may be any suitable implant. For example, the implant may be an implant such as an implant that is shown and described in U.S. Patent Application Publication No. 2009/0182336 A1, which is hereby incorporated by reference in its entirety.
[0063] The bone may be accessed and prepared using any suitable technique such as that shown and described in U.S. patent application Ser. No. 13/009,657, which is hereby incorporated by reference in its entirety.
[0064] Copending U.S. patent application Ser. No. 13/043,330, entitled “APPARATUS AND METHODS FOR BONE REPAIR,” filed on Mar. 8, 2011 is hereby incorporated by reference herein in its entirety. Copending U.S. Provisional Application No. 61/450,112 filed on Mar. 7, 2011, is hereby incorporated by reference herein in its entirety.
[0065] The apparatus and methods may involve fixing an expandable implant deployed inside a fractured bone. The apparatus and methods may involve the expansion of devices in the interior region of the bone. The expansion may involve any suitable expansion mechanism or technique, such as one or more of the mechanisms and techniques that are shown and described in U.S. Patent Application Publication No. 2009/0182336 A1.
[0066] The implant may have a first base and a second base. The implant may have a bone implant component that extends between the first base and the second base. The first base and the second base may define a longitudinal axis. The bone implant component may deflect relative to the longitudinal axis in correspondence with relative displacement of the first base and the second base along the axis.
[0067] The apparatus may include: a first body that is substantially coaxial with the axis and longitudinally fixed to the first base; a second body that is substantially coaxial with the axis and longitudinally fixed to the second base; and an elongated engaging member that is configured to longitudinally fix a distance between the first body and the second body.
[0068] The distance may have a maximum value that corresponds to a fully collapsed state of the implant. The distance may have a minimum value that corresponds to a fully expanded state of the implant. The elongated engaging member may be configured to longitudinally fix the distance at any value in the range from about the maximum value to about the minimum value.
[0069] The fully collapsed state may correspond to a state in which the implant is configured to pass through an access hole in the bone. The fully expanded state may correspond to a state in which the implant is expanded outside the bone at standard temperature and pressure. Standard temperature and pressure may be any standard temperature and any standard pressure, such as about 0 degrees Centigrade and about 1 atmosphere of pressure.
[0070] The distance may control the expansion of the implant by controlling the length of the implant. The distance may correspond to a therapeutic length of the bone implant. The distance may correspond to a therapeutic radius of the bone implant.
[0071] The elongated member may be of unified construction, and of all the structures that may be configured to operate in conjunction with the implant, the elongated engaging member alone may be configured to fix the distance.
[0072] The distance may correspond to an expansion state of the bone implant. In an expanded state, the implant may provide structural support for a bone. The implant may be locked in a state of expansion. The implant may be fixed in a state of expansion. The implant may be locked or fixed in a state of expansion such that residual outward radial pressure on an inside wall of the bone may be substantially reduced or eliminated.
[0073] In a contracted state, the implant may provide structural support for the bone. The implant may be locked in a state of contraction. The implant may be fixed in a state of contraction. The implant may be locked or fixed in a state of contraction such that residual outward radial pressure on an inside wall of the bone may be substantially reduced or eliminated.
[0074] The elongated engaging member may be configured to apply tension between the first body and the second body. The elongated member may be of unified construction and of all the structures that are configured to operate in conjunction with the implant, the elongated engaging member alone may be configured to apply the tension.
[0075] In some embodiments, when the elongated member fixes the distance, the elongated member may engage the first body internal to the first body and the second body internal to the second body.
[0076] The first body may include a first tapped cannula. The second body may include a second tapped cannula. The elongated member may include a thread that is configured to engage the first tapped cannula and the second tapped cannula.
[0077] The thread may be sufficiently fine to avoid substantially changing the distance when the thread, after engaging the first tapped cannula, engages the second tapped cannula.
[0078] The second body may have an outer diameter. The first body may include a cylindrical portion that has an inner diameter that is greater than the outer diameter of the second body. The cylindrical portion may be configured to receive a portion of the second body.
[0079] The apparatus may include a scaffolding extends between the first base and the second base. The scaffolding may include the bone implant component. The scaffolding may be configured to support a bone.
[0080] In some embodiments, when the first base moves toward the second base, the scaffolding may expand away from the longitudinal axis.
[0081] The implant may include an anchoring substrate. The anchoring substrate may be disposed between the longitudinal axis and the scaffolding.
[0082] In some embodiments, an anchoring substrate may extend between the first and second bases. The anchoring substrate may include the bone implant component and may be configured to support a bone.
[0083] In some embodiments, when the first base moves toward the second base, the anchoring substrate may expand away from the longitudinal axis.
[0084] The implant may include a scaffolding that is, relative to the longitudinal axis, at a greater radial distance than is the anchor substrate.
[0085] A tab may extend from one or both of the first base and the scaffolding. A pocket may be present in one or both of the first base and the scaffolding. The tab may be biased such that it engages the pocket. The scaffolding may be substantially longitudinally and rotationally fixed to the first base by the engagement of the tab and the pocket.
[0086] In some embodiments, when the distance is fixed, the anchor substrate may be slidable along the longitudinal axis and angularly displaceable about the longitudinal axis.
[0087] The methods may include a method for controlling the expanded diameter of a bone implant inside a bone. The method may include controlling the length of the implant by fixing a distance between a first base and a second base using an elongated member that extends between the first base and the second base. The first and second bases may be substantially collinear. The method may include closing the elongated member inside the bone by closing an access hole through which the implant was delivered into the bone.
[0088] In some embodiments, the implant may have a fully collapsed state and a fully expanded state. The fully collapsed state may correspond to a state in which the implant is configured to pass through an access hole in the bone. The fully expanded state corresponding to a state in which the implant is expanded outside the bone at standard temperature and pressure. The method may include, when the implant has a fully collapsed state and a fully expanded state, fixing the distance at a value that is: not greater than a maximum value that corresponds to the fully collapsed state of the implant; and not less than a minimum value that corresponds to fully expanded state of the implant.
[0089] A method for treating a bone fracture is provided. The method may include positioning a first bone fragment at a reduced displacement relative to a second bone fragment such that the fracture is provisionally reduced. The method may include deploying an implant in an interior region of the bone, the implant having an expanded dimension that is greater than a corresponding dimension of the interior region. The method may include inserting into the implant a tension-storing element that prevents the implant from urging the first bone fragment away from the reduced displacement.
[0090] The positioning of a first bone fragment at a reduced displacement relative to a second bone fragment such that the fracture is provisionally reduced may include inserting a K-wire through the first bone fragment and the second bone fragment.
[0091] Inserting into the implant a tension-storing element that prevents the implant from urging the first bone fragment away from the reduced displacement may include fixing an axial distance between a first hub and a second hub. The first hub and the second hub may be configured to expand the implant when drawn together and collapse the implant when moved apart.
[0092] The method may include, after the deploying and before the inserting, adjusting the axial distance. Fixing the axial distance between a first hub and a second hub may include advancing the tension-storing element along the axial distance to engage a first body that is fixed to the first hub and a second body that is fixed to the second hub. The advancing the tension-storing element may include rotating the tension-storing element.
[0093] Apparatus for an expandable a bone implant is provided. The expandable implant may include a hub, a central axis member and a support member. The support member may include a first end and a second end. The first end and the second end may be spaced apart from each other along the central axis member. The support member may have a mid-section that is configured to deflect radially away from the central axis member when the implant expands.
[0094] The hub may include a support member terminal. The support member terminal may be configured to: fix the second end longitudinally relative to the central axis member during expansion of the implant; and fix the second end radially relative to the central axis member during the expansion.
[0095] In some embodiments, the support member terminal may include a clearance notch for the support member so that the second end may have an angular range of motion during the expansion.
[0096] The second end may include a tab. The support member terminal may include an enclosure. The enclosure may be configured to enclose the tab. The notch may be configured to traverse the enclosure.
[0097] The enclosure may include a first enclosure member. The enclosure may include a second enclosure member. The second enclosure member may be configured to be separated from the first enclosure member and admit the tab into the enclosure.
[0098] The first enclosure member may include a detent surface that limits the angular range of motion. The detent surface may include an end of the notch.
[0099] The second enclosure member may include a detent surface that limits the angular range of motion.
[0100] The support member terminal may be configured to rotate about the central axis member.
[0101] The support member terminal may be rotationally fixed relative to the central axis member.
[0102] Apparatus and methods for stabilizing a bone implant are provided. The bone may have an access hole for delivery of the implant. The access hole may have a hole wall.
[0103] The implant may include a stabilizer. The stabilizer may include an elongated member. The elongated member may be configured to extend along the hole, and between the implant, when the implant is deployed in the bone, and an anchor receiving feature. The anchor receiving feature may be configured to receive an anchor driven into the hole wall. The stabilizer may include one or more anchor receiving features.
[0104] The elongated member may include an extension that extends beyond the anchor receiving feature and is configured to articulate with a buttress plate.
[0105] The extension may include a first surface that is circumferential about the anchor receiving member. The buttress plate may include a second surface that is complementary to the first surface. Traction from an anchor received by the anchor receiving feature may be configured to brace the second surface against the first surface.
[0106] The elongated member may be configured to resist rotation of the implant in the hole. The elongated member may be configured to resist axial movement of the implant along the hole. The elongated member may be configured to resist rotation of the implant in the hole and axial movement of the implant along the hole.
[0107] The implant may include a locking mechanism for maintaining a shape of the implant. The locking mechanism may be configured to be locked by a screw inserted into the access hole. The screw may be adjustable after the anchor receiving feature has received the anchor.
[0108] The stabilizer may include a buttress plate anchored to the bone. The buttress plate may be positioned substantially parallel to a longitudinal axis of the bone. The buttress plate may be configured to resist rotational movement of the elongated member about a central axis of the hole.
[0109] The buttress plate may include a second anchor receiving feature configured to receive the anchor.
[0110] The buttress plate may be configured to resist axial movement of the elongated member along the hole.
[0111] The buttress plate may be configured to resist rotation of the elongated member in the hole and axial movement of the elongated member along the hole.
[0112] The buttress plate may include a second anchor receiving feature configured to receive the anchor.
[0113] The buttress plate may include a third anchor receiving feature configured to receive an anchor driven into an outer surface of a cortical wall of the bone.
[0114] The stabilizer may include a first edge adjacent to the first anchor receiving feature and a second edge adjacent to the first anchor receiving feature. The buttress plate may include a second anchor receiving feature that is configured to receive the anchor. The first edge and the second edge may define a pivot axis. The anchor may be configured to secure the buttress plate in contact with the bone and in a position substantially parallel to an outer surface of the bone.
[0115] In embodiments of the stabilizer that include a pivot axis, the buttress plate may be configured to resist rotation of the elongated member in the hole, axial movement of the elongated member along the hole and/or rotation and axial movement of the elongated member in the hole.
[0116] In embodiments of the stabilizer that include a pivot axis, the buttress plate may transmit no substantial bending moment about the pivot axis to the elongated member.
[0117] In embodiments of the stabilizer that include a pivot axis, the buttress plate may include a third anchor receiving feature configured to receive an anchor driven into an outer surface of a cortical wall of the bone.
[0118] The stabilizer may include a buttress plate anchored to the bone and positioned substantially parallel to a longitudinal axis of the bone. The buttress plate may include a first indent and a second indent. The elongated member may include a ridge.
[0119] The first indent and the second indent may be configured to engage the ridge and resist rotation of the elongated member in the hole. The first indent and the second indent may be configured to engage the ridge and resist axial movement of the elongated member along the hole. The first indent and the second indent may be configured to engage the ridge and resist rotation of elongated member about an axis perpendicular to a longitudinal axis of the implant.
[0120] In some embodiments, the elongated member may be configured to be positioned within the access hole after the implant has been deployed inside the bone.
[0121] The implant may be configured to be deployed through an access hole in a cortical wall of the bone. In some embodiments, the stabilizer may include an elongated member that is configured to extend between the implant, when the implant is deployed in the bone, and an anchor receiving feature that is configured to receive an anchor that is driven into an outer surface of the cortical wall. The elongated member may be configured to be deformed to position the anchor receiving feature along the outer surface of the cortical wall.
[0122] The stabilizer may include a buttress plate configured to be positioned over the elongated member. The buttress plate positioned over the elongated member may resist rotation of the elongated member about a central axis of the hole. The buttress plate positioned over the elongated member may resist rotation of the elongated member about an axis transverse to the elongated member.
[0123] In some embodiments that include an elongated member configured to be deformed, the elongated member may be configured to be attached to the implant after the implant is deployed in the bone.
[0124] In some embodiments, the stabilizer may include a site for an anchor receiving feature that is configured to receive an anchor driven into an outer surface of the cortical wall. An elongated member may be configured to extend between the implant, when the implant is deployed in the bone, and the site. A buttress plate may be positioned over the elongated member and configured to resist rotation of the elongated member about a central axis of the access hole, and axial movement of the elongated member transverse to the elongated member.
[0125] In some embodiments of a stabilizer including a site for an anchor receiving feature, the stabilizer may be attached to the implant after the implant is deployed in the bone.
[0126] The stabilizer may include an elongated member that is configured to extend along the hole and between the implant, when the implant is deployed in the bone, and a buttress collar. The buttress collar may be supported at an opening of the access hole. The elongated member may terminate at the buttress collar. The buttress collar may be substantially parallel to an outside surface of the cortical wall.
[0127] Some embodiments of the stabilizer having a buttress collar may include an anchor receiving feature configured to receive an anchor driven into the outside surface of the cortical wall.
[0128] In some embodiments of the stabilizer, an angle between a central axis of the access hole and a central axis of the implant may be adjustable. The stabilizer may include a locking mechanism configured to lock the adjustable angle. The elongated member may include an articulating surface. The adjustable angle may be between 0 degrees and 5 degrees, between degrees and 10 degrees, between 0 degrees and 15 degrees, between 0 degrees and 20 degrees, between 0 degrees and 25 degrees, between 0 degrees and 30 degrees, between 0 degrees and 35 degrees, between 0 degrees and 45 degrees, between 0 degrees and 90 degrees, or within any other suitable angular range.
[0129] System and methods for securing a bone implant in a bone, are provided. The system may include an expandable web having a front and a back. The web may be configured to be inserted in an interior of the bone. The web may include an expandable cell having an expanded diameter.
[0130] The system may include an anchor that may be configured to secure a fragment of the bone to the expandable web when the expandable web is inside the bone. The anchor may have an elongated shaft for penetrating the cell from the front and an engagement feature that extends transversely away from the shaft and may be configured to engage the back of the cell to apply tension between the cell and the bone fragment. The shaft may have a shaft diameter that is sufficiently great, relative to the expanded diameter, to prevent disengagement of the engagement feature from the back of the cell when the tension is applied.
[0131] The expanded diameter may be a diameter of the cell when the expandable web is in an expanded state before the engagement feature engages the back of the cell.
[0132] The expanded diameter may be a diameter of the cell when the expandable web is in an expanded state, the engagement feature is engaging the back of the cell, and the cell is elastically deformed by the tension.
[0133] The expanded diameter may be a diameter of the cell when the expandable web is in an expanded state, the engagement feature is engaging the back of the cell, and the cell is plastically deformed by the tension.
[0134] The anchor may be a screw. The engagement feature may be a spiral thread. When the anchor is a screw and the engagement feature a spiral thread, one or more of the screw root diameter, the screw thread diameter and the thread pitch is selected based on a failure strain of the cell.
[0135] When the anchor is a screw and the engagement feature is a spiral thread, one or more of the screw root diameter, the screw thread diameter and the thread pitch may be selected based on an elastic deformation limit of the cell.
[0136] When the anchor is a screw and the engagement feature is a spiral thread, a screw metric may be selected based on a failure strength of the cell.
[0137] The screw metric may be a screw major diameter. The screw metric may be a screw mean diameter. The screw metric may be a screw minor diameter. The screw metric may be a thread pitch. The screw metric may be a screw thread angle.
[0138] Apparatus and methods for securing components of a bone implant are provided. The apparatus may include a bracket that may be configured to receive a bone anchor. The apparatus may include an extension member that may be configured to support the bracket relative to a bone implant that is deployed inside the bone. The apparatus may include a fastening assembly that is configured to fasten: the bracket to the extension; and the extension to the implant.
[0139] The fastening assembly may include a first state in which the bracket is movable relative to the implant, and a second state in which the bracket is locked relative to the implant.
[0140] In the first state, the bracket may be movable from a first distance from the implant to a second distance from the implant.
[0141] In the first state, the bracket may be movable from a first angle relative to the implant to a second angle relative to the implant.
[0142] In the first state, the bracket may be movable from: a first distance from the implant to a second distance from the implant; and a first angle relative to the implant to a second angle relative to the implant.
[0143] The fastening assembly may include a fastener. The fastener may be configured to press the extension toward the implant and induce friction between the extension and the bracket.
[0144] The apparatus may include an expansion bushing. The fastener may be configured to drive the expansion bushing toward the implant to press the extension toward the implant and expand the extension to interfere with movement of the bracket.
[0145] The bracket may have a tubular section. The extension may have a tubular section that is within the bracket tubular section. The expansion bushing may include a portion that is within the extension tubular section. The fastener may include a screw. The screw may have a portion that is within the expansion bushing.
[0146] Apparatus and methods for a bone implant are provided. The bone implant may include a central axis member. The bone implant may include a first expandable web that may be supported coaxially about the central axis member. The bone implant may include a second expandable web that may be supported coaxially about the central axis member and within the first expandable web.
[0147] The central axis member may define a longitudinal axis. The first expandable web may have a first mesh cell density. The first mesh cell density may vary along the axis, so that the first expandable web, when expanded, has a first radius that is based on the first mesh cell density; and the second expandable web has a second mesh cell density. The second mesh cell density may vary along the axis, so that the second expandable web, when expanded, has a second radius that is based on the second mesh cell density.
[0148] In some embodiments, along substantially the entire length of the second web, a ratio of the first radius to the second radius may be substantially constant.
[0149] In some embodiments, along a length of the second web, a ratio of the first radius to the second radius may be substantially constant.
[0150] The second radius may have a second radius maximum between a distal end of the second web and a proximal end of the second web. The second radius may decrease substantially linearly from the maximum toward the distal end. The second radius may decrease substantially linearly from the maximum toward the proximal end.
[0151] In some embodiments, between the distal end of the second web and the proximal end of the second web a difference between the second radius and the first radius may define a radial offset. The radial offset may have an offset minimum that corresponds to the second radius maximum.
[0152] The offset minimum may be sufficiently small that, when the first expandable web bears a radial load, the first expandable web deforms to transmit the load to the second expandable web at the second radius maximum.
[0153] The first expandable web may include a first plurality of open cells. The second expandable web may include a second plurality of open cells. The first and second pluralities may be configured to engage an anchor and deliver tension to the anchor to retain a bone fragment that is engaged with the anchor.
[0154] The second expandable web may be rotatably supported about the longitudinal axis such that the second expandable web can rotate in response to interference from the anchor during engagement of the second expandable web by the anchor.
[0155] Apparatus and methods for a bone implant having different zones of flexibility are provided. The implant may include a structural component. The structural component may have an expanded state, a collapsed state, a longitudinal axis and a transverse axis to the longitudinal axis. The transverse axis may be perpendicular to the longitudinal axis. The structural component may include, along the longitudinal axis: a first zone; a second zone; and a third zone.
[0156] The first zone may have a first resistance to bending about the transverse axis. The second zone and the third zone may have a second resistance to bending about the transverse axis. In the collapsed state, the first resistance to bending may be greater than the second resistance to bending.
[0157] The second resistance to bending in the expanded state may be greater than the second resistance to bending in the collapsed state.
[0158] The first zone may include a first cell and the third zone may include a second cell. The first cell may be circumferentially spaced, about the longitudinal axis, a first distance, from the second cell and longitudinally spaced, along the longitudinal axis, a second distance from the second cell. The second zone may include a link from the first cell to the second cell.
[0159] An increase in the first distance may correspond to an increase in flexibility of the second zone about the transverse axis. An increase in the second distance corresponds to an increase in flexibility of the second zone about the transverse axis.
[0160] The first zone may include a third cell. The third cell may be circumferentially spaced, about the longitudinal axis, a third distance, from the second cell and longitudinally spaced, along the longitudinal axis, a fourth distance from the second cell.
[0161] The third zone may include a fourth cell. The fourth cell may be circumferentially spaced, about the longitudinal axis, the first distance from the third cell and longitudinally spaced, along the longitudinal axis the second distance from the third cell.
[0162] The second zone may include, when the link is a first link, a second link from the third cell to the fourth cell. In the expanded state, the first link may stack upon the second link. The link may tortuously link the first cell and the second cell.
[0163] The first zone may include a first cell and the third zone may include a second cell. The first cell may be circumferentially aligned, about the longitudinal axis, with the second cell and longitudinally spaced, along the longitudinal axis, a distance from the second cell. The second zone may include a link from the first cell to the second cell. The link may tortuously links the first cell to the second cell.
[0164] The link may include a “V” shaped link, the link may have an apex, a first leg and a second leg. Under compression along the longitudinal axis, the first leg and the second leg may collapse about the apex.
[0165] The implant may include a structural component. The implant may have an expanded state, a collapsed state and a longitudinal axis. The structural component may include a first structural member extending along the longitudinal axis. The structural component may include a second structural member extending along the longitudinal axis and spaced circumferentially about the longitudinal axis from the first member.
[0166] The structural component may include a cross support that spans from the first member to the second member. The cross support may include a member having a joint. The member may be configured to be folded about the joint in the collapsed state and unfolded about the joint in the expanded state.
[0167] In some embodiments, when the cross support is folded, an angle of the member may be substantially 0 degrees and when the cross support is unfolded, the angle of the member may be substantially 180 degrees.
[0168] The unfolded cross support may limit an expansion of the implant from the longitudinal axis.
[0169] The support component may define a plane. The implant may have a longitudinal axis that lies in the plane, a first transverse axis that lies in the plane and is perpendicular to the longitudinal axis and a second transverse axis that is perpendicular to the longitudinal axis and perpendicular to the plane.
[0170] The support component may have a first resistance to bending about the longitudinal axis or about the first transverse axis. The support component may have a second resistance to bending about the second transverse axis. The first bending resistance may be greater than the second bending resistance.
[0171] The support component may include a first member and a second member. The first member may have a third resistance to bending about the longitudinal axis or about the first transverse axis and a fourth resistance to bending about the second transverse axis. The second member may have a fifth resistance to bending about the longitudinal axis or about the first transverse axis and a sixth resistance to bending about the second transverse axis.
[0172] The support component may include a first anchor receiving feature and a second anchor receiving feature. The first anchor receiving feature and the second anchor receiving feature may be configured to receive an anchor that lies in the plane.
[0173] Apparatus and methods for a multi-fold single layer implant for a bone are provided.
[0174] The implant may include a central axis member that defines a longitudinal axis. The implant may include an expandable web that may be supported coaxially about the central axis member.
[0175] The expandable web may include a first mesh cell density that may vary longitudinally along a first segment of the expandable web. The expandable web may include a second mesh cell density that may vary longitudinally along a second segment of the expandable web. The expandable web may include a third mesh cell density that varies longitudinally along a third segment of the expandable web. The expandable web may include a fourth mesh cell density that varies longitudinally along a fourth segment of the expandable web. The expandable web may include a fifth mesh cell density that varies longitudinally along a fifth segment of the expandable web.
[0176] When the expandable web is in an expanded state, the first segment may have a first profile, the second segment may have a second profile, the third segment may have a third profile, the fourth segment may have a fourth profile, and the fifth segment may have a fifth profile.
[0177] In an unexpanded state, the first, second, third, fourth and fifth segments may be consecutively longitudinally ordered. In the expanded state, the first and fifth segments may be concave facing each other. The second and fourth segments may bridge, respectfully, from the first segment to the third segment and from the third segment to the fifth segment.
[0178] In the expanded state, the third segment may be substantially cylindrical.
[0179] In the expanded state, the third segment may be ellipsoidal. For example, when viewed transversely relative to the central axis, the third segment may have an outline that is ellipsoidal.
[0180] In the expanded state, the first segment may have a first segment maximum radius, the third segment may have a third segment maximum radius, the fifth segment may have a fifth segment maximum radius, and both the first segment maximum radius and the fifth segment maximum radius may be greater than the third segment maximum radius.
[0181] A ratio of one of the first segment maximum radius and the fifth segment maximum radius to the third segment maximum radius may be at least 1.1.
[0182] Apparatus and methods for a hat shaped multi-fold single layer implant for a bone are provided.
[0183] The implant may include a central axis member that defines a longitudinal axis. The implant may include an expandable web that may be supported coaxially about the central axis member.
[0184] The expandable web may include a first mesh cell density that varies longitudinally along a first segment of the expandable web. The expandable web may include a second mesh cell density that varies longitudinally along a second segment of the expandable web. The expandable web may include a third mesh cell density that varies longitudinally along a third segment of the expandable web.
[0185] When the expandable web is in an expanded state, the first segment may have a first profile, the second segment may have a second profile and the third segment may have a third profile.
[0186] In an unexpanded state, the second segment may be longitudinally between the first segment and the third segment. In the expanded state, the first segment may be ellipsoidal, the third segment may be concave facing the first segment and the second segment may bridge from an outer radius of the third segment to an adjacent tip of the first segment.
[0187] In the expanded state, the second segment may have a portion that is concave facing the first segment.
[0188] In the expanded state, the second segment may have a portion that is convex facing the first segment.
[0189] In the expanded state, the second segment may have a portion that is convex facing the first segment.
[0190] In the expanded state the first segment may have a first segment maximum radius, the third segment may have a second segment maximum radius and the third segment maximum radius may be greater than the first segment maximum radius.
[0191] A ratio of the third segment maximum radius to the first segment maximum radius may be at least 1.1.
[0192] In the expanded state the first segment may have a first longitudinal diameter. In the expanded state, the second and third segments together may define a second longitudinal diameter. In the expanded state, the first longitudinal diameter may be greater than the second longitudinal diameter.
[0193] A ratio of the first longitudinal diameter to the second longitudinal diameter may be at least 2.5.
[0194] In the expanded state, the first segment may have a first segment maximum radius. In the expanded state, the third segment may have a second segment maximum radius. In the expanded state, the first segment maximum radius may be greater than the third segment maximum radius. A ratio of the first segment maximum radius to the third segment maximum radius may be at least 1.1.
[0195] In the expanded state the first segment may have a first longitudinal diameter. In the expanded state, the second and third segments together may define a second longitudinal diameter. The second longitudinal diameter may be greater than the first longitudinal diameter. A ratio of the second longitudinal diameter to the first longitudinal diameter may be at least 2.5.
[0196] Apparatus and methods for a non-round implant for a bone are provided.
[0197] The implant may include a central axis member that may define a longitudinal axis. The implant may include an expandable web that may be supported coaxially about the central axis member.
[0198] The expandable web may include a first mesh cell density that may vary longitudinally along a first segment of the expandable web. The expandable web may include a second mesh cell density that may vary longitudinally along a second segment of the expandable web. The expandable web may include a third mesh cell density may vary longitudinally along a third segment of the expandable web.
[0199] When the expandable web is in an expanded state, the first segment may have a first profile, the second segment may have a second profile and the third segment may have a third profile.
[0200] In an unexpanded state, the second segment may be longitudinally between the first segment and the third segment. In the expanded state, the first profile may be a substantially conical shape that opens toward the second segment. In the expanded state, the third segment may be substantially planar and substantially normal to the central axis member. In the expanded state, the second segment may bridge from an outer radius of the first segment to an outer radius of the third segment.
[0201] In the expanded state, the second profile may be substantially conical and may have a first radius at a joint with the first profile and may have a second radius at a joint with the third profile. The second radius may be greater than the first radius. A ratio of the second radius to the first radius may be at least 1.1.
[0202] Apparatus and methods for a bone engaging member for a an implant for a bone are provided.
[0203] The implant, when deployed inside the bone, may define, at a distal end of the implant, an enclosed region. The bone engaging member may be configured to extend out of the region and into the bone.
[0204] The implant may include a support structure that converges toward a distal end of the implant. The bone engaging member may be configured to diverge from the support structure and extend into the bone.
[0205] The bone engaging member may not be fixed directly to the support structure. The bone engaging member may be fixed directly to the support structure.
[0206] The bone engaging member may be configured to extend for a first length of the bone engaging member alongside a supporting member of the implant along and for a second length of the bone engaging member into the bone.
[0207] The first length may extend substantially perpendicular to a surface of the support structure.
[0208] The bone engaging member may be configured to extend substantially perpendicular to the surface of the support structure after an expansion of the implant.
[0209] The bone engaging member may be configured to extend into a cancellous portion of the bone.
[0210] The bone engaging member may be configured to resist translational motion of the implant relative to the bone.
[0211] The bone engaging member may be configured to resist rotational motion of the implant relative to the bone.
[0212] The bone engaging member may be one of several bone engaging members that diverge from the support structure and extend into the bone.
[0213] The bone engaging member may include a distal tip. The distal tip may be configured to coordinate with an internal geometry of the bone.
[0214] The bone engaging member may be configured to be fixed to the implant at a proximal end of the implant.
[0215] The bone engaging member may be configured, when the implant is deployed through an access hole in the bone, to be inserted into the access hole after the implant is deployed in the bone.
[0216] The bone engaging member may be configured, when the implant is deployed through an access hole in the bone, to be inserted into the access hole after the implant.
[0217] One or more surfaces of the apparatus may be coated with agents that promote bone ingrowth. The agents may include calcium phosphate, heat treated hydroxylapatite, Basic fibroblast growth factor (bFGF)-coated hydroxyapatite, hydroxyapatite/tricalcium phosphate (HA/TCP), and other suitable agents, including one or more of those listed in Table 1.
[0218] One or more surfaces of the apparatus may be coated with agents that inhibit or prohibit bone ingrowth. Such surfaces may include impermeable and other materials such as one or more of those listed in Table 1.
[0219] One or more surfaces of the apparatus may be coated with agents that may elute therapeutic substances such as drugs.
[0220] The apparatus and portions thereof may include any suitable materials. Table 1 lists illustrative materials that may be included in the apparatus and portions thereof.
[0221] 
[00001] [TABLE-US-00001]
  TABLE 1
 
  Materials
  Category   Type   Material
 
  Metals   Nickel titanium alloys   Nitinol
    Stainless steel alloys   304
      316L
      BioDur ® 108 Alloy
      Pyromet Alloy ® CTX-909
      Pyromet ® Alloy CTX-3
      Pyromet ® Alloy 31
      Pyromet ® Alloy CTX-1
      21Cr—6Ni—9Mn Stainless
      21Cr—6Ni—9Mn Stainless
      Pyromet Alloy 350
      18Cr—2Ni—12Mn Stainless
      Custom 630 (17Cr—4Ni)
      Stainless
      Custom 465 ® Stainless
      Custom 455 ® Stainless Custom
      450 ® Stainless
      Carpenter 13-8 Stainless
      Type 440C Stainless
    Cobalt chromium   MP35N
    alloys   Elgiloy
      L605
      Biodur ® Carpenter CCM alloy
    Titanium and titanium   Ti—6Al—4V/ELI
    alloys   Ti—6Al—7Nb
      Ti—15Mo
    Tantalum  
    Tungsten and tungsten  
    alloys  
    Pure Platinum  
    Platinum-Iridium  
    alloys  
    Platinum-Nickel  
    alloys  
    Niobium  
    Iridium  
    Conichrome  
    Gold and Gold alloys  
  Absorbable     Pure Iron
  metals     magnesium alloys
  Polymers     Polyetheretherketone (PEEK)
      polycarbonate
      polyolefin's
      polyethylene's
      polyether block amides (PEBAX)
      nylon 6
      6-6
      12
      Polypropylene
      polyesters
      polyurethanes
      polytetrafluoroethylene (PTFE)
      Poly(phenylene sulfide) (PPS)
      poly(butylene terephthalate)
      PBT
      polysulfone
      polyamide
      polyimide
      poly(p-phenylene oxide) PPO
      acrylonitrile butadiene
      styrene (ABS)
      Polystyrene
      Poly(methyl methacrylate)
      (PMMA)
      Polyoxymethylene (POM)
      Ethylene vinyl acetate
      Styrene acrylonitrile resin
      Polybutylene
  Membrane     Silicone
  materials     Polyether block amides (PEBAX)
      Polyurethanes
      Silicone polyurethane
      copolymers
      Nylon
      Polyethylene terephthalate
      (PET)
      Goretex ePTFE
      Kevlar
      Spectra
      Dyneena
      Polyvinyl chrloride (PVC)
  Absorbable     Poly(glycolic acid) (PGA)
  polymers     Polylactide (PLA),
      Poly(ε-caprolactone),
      Poly(dioxanone)
      Poly(lactide-co-glycolide)
  Radiopaque     Barium sulfate
  materials     Bismuth subcarbonate
  Biomaterials   Collagen   Bovine, porcine, ovine, amnion
      membrane
  Bone growth     Demineralized bone matrix
  factors     Bone morphogenic proteins
      (BMP)
      Calcium phosphate
      Heat-treated hydroxylapapatite
      Basic fibroblast growth factor
      (bFGF)-coated hydroxyapaptite
      Hydroxyapaptite/tricalcium
      phosphate (HA/TCP
  Anti-    
  microbial    
  Coatings
 
[0222] The apparatus may be provided as a kit that may include one or more of a structural support, an anchoring substrate, a central axis member, an anchor, a delivery instrument and associated items.
[0223] Apparatus and methods in accordance with the invention will now be described in connection with the FIGS. The FIGS. show illustrative features of apparatus and methods in accordance with the principles of the invention. The features are illustrated in the context of selected embodiments. It will be understood that features shown in connection with one of the embodiments may be practiced in accordance with the principles of the invention along with features shown in connection with another of the embodiments.
[0224] Apparatus and methods described herein are illustrative. Apparatus and methods of the invention may involve some or all of the features of the illustrative apparatus and/or some or all of the steps of the illustrative methods. The steps of the methods may be performed in an order other than the order shown and described herein. Some embodiments may omit steps shown and described in connection with the illustrative methods. Some embodiments may include steps that are not shown and described in connection with the illustrative methods.
[0225] Illustrative embodiments will now be described with reference to the accompanying drawings, which form a part hereof.
[0226] The apparatus and methods of the invention will be described in connection with embodiments and features of an illustrative bone implants and associated hardware and instrumentation. The implants and associated hardware and instruments will be described now with reference to the FIGS. It is to be understood that other embodiments may be utilized and structural, functional and procedural modifications may be made without departing from the scope and spirit of the present invention.
[0227] FIG. 1 shows illustrative implant 100. Implant 100 may be implanted in a bone (not shown). Implant 100 is elongated along its longitudinal axis LI (in which I indicates implant). Implant 100 may include an outer expandable web 106. Implant 100 may include an inner expandable web 108. Expandable web 106 may be expanded to a radial distance from LI. Expandable web 108 may be expanded to a radial distance from LI.
[0228] Implant 100 may include stabilizer 101. Stabilizer 101 may include buttress plate 102. Buttress plate 102 may be elongated along a longitudinal axis LBP (in which BP indicates buttress plate). Longitudinal axis LBP may form angle θ with longitudinal axis LI. In some embodiments, angle θ may be adjustable.
[0229] Stabilizer 101 may be secured to a bone with anchor 114. Anchor 114 may secure buttress plate 102 to the bone. Buttress plate 102 may be secured to the bone with anchor 116.
[0230] Implant 100 may include an expansion locking screw 112 for locking expandable web 106 and/or expandable web 108 at a distance from LI. Stabilizer 101 may be secured to implant 100 using any suitable approach, such as with tabs 118.
[0231] Expandable web 106 may extend from proximal base 130 to distal hub 110. (“Distal,” relative to “proximal,” generally means the leading end of an apparatus that is inserted, or is to be inserted, in the body.) Expandable web 108 may extend from a proximal base (not shown) to distal hub 120.
[0232] Expandable web 106 may include an arrangement of cells 122. Expandable web 108 may include an arrangement of cells 124. An arrangement of cells 122 and/or cells 124 may be any suitable arrangement and may include an arrangement that provides different zones of flexibility.
[0233] Cell 122 may be configured to expand. Cell 124 may be configured to expand. Cell 122 may be expanded by expansion of expandable web 106. Cell 124 may be expanded by expandable web 108.
[0234] Cell 122 may be configured to receive any suitable anchor, such as anchor 126. Cell 124 may be configured to receive any suitable anchor such as anchor 126. Anchor 126 may be configured to penetrate expandable web 106 and/or expandable web 108. Anchor 126 may penetrate expandable web 106 and/or expandable web 108 at two or more locations (not shown).
[0235] Implant 100 may include component 128. Component 128 may extend longitudinally along axis LI. Component 128 may extend between distal hub 110 and proximal hub 130.
[0236] FIG. 2 illustrates anatomical features of a fractured bone B. An implant such as implant 100 may be deployed inside bone B to repair bone B.
[0237] Bone B is illustrated as a radius that is fractured at fractures Fh and Fa. Bone B includes bone portions Pb, Ph and Pa in distal end D. Bone segment Pb is the largest portion of bone B. Bone segment Ph is a head portion of bone B. Bone segments Ph and Pa include articular surface AS. Bone portions Pb, Ph and Pa are separated or partially separated along fractures Fa and Fh. Fracture Fa transects articular surface AS. Fracture Fh transects head of bone B.
[0238] Bone B, shown in a cross section that includes approximate longitudinal axis LB, includes cortical bone BCO and cancellous bone BCA. Cortical bone BCO may have a bone surface BS. Deployment of an implant into distal end D of bone B may require an access hole. Deployment of the implant may require displacement of cancellous bone BCA. Inside the bone B, the implant may engage cancellous bone BCA. Engagement with cancellous bone BCA may secure the implant to bone B.
[0239] Bone B may be provided with access hole H in cortical bone BCO. Hole H may have a hole wall HW. Hole wall HW may be a site for securing a stabilizer such as stabilizer 302 (shown in FIG. 3) to bone B. Hole H may have central axis CH. Transverse axis TCH may be perpendicular to central axis CH.
[0240] Bone B may be provided with access hole I in cortical bone BCO. An apparatus inserted in access hole I, may be required to travel a distance xI through intermedullary space IS to reach a head portion of bone B. An apparatus inserted through hole I may require bending to travel through intermedullary space IS to reach a head portion of bone B.
[0241] Some of the implants shown and described herein may be deployed through hole H. Some of the implants shown and described herein may be deployed through hole I. An implant that is configured to be deployed through hole H may include features for securing the implant to bone tissue at or near hole H. An implant that is configured to be deployed through hole I may include features for enabling the implant to deform during the bending and expand for operational use. It will be understood that an implant may include securement features that are appropriate for the access hole through which the implant is to be deployed even though the implant is illustrated herein with a particular type of securement feature such as a stabilizer.
[0242] FIG. 3 shows implant 301 deployed inside bone B. Bone B may have one or more features in common with bone B (shown in FIG. 1). Implant 301 may have one or more features in common with implant 100 (shown in FIG. 1). Longitudinal axis LI of implant 100 may correspond to central axis CH of hole H.
[0243] Stabilizer 302 may have one or more features in common with tail 103 (shown in FIG. 1). Stabilizer 302 may secure implant 301 to bone B. Stabilizer 302 may include anchor receiving feature 304. Anchor receiving feature 304 may be configured to receive an anchor (not shown) driven into hole wall HW.
[0244] FIG. 4 shows a view of a portion of implant 301 taken along lines 4-4 (shown in FIG. 3). Expandable web 106 may extend from proximal base 130 to distal base 410. Distal base 410 may include one or more of the features of distal hub 110. Distal base 410 may be longitudinally fixed to component 128.
[0245] Proximal base 130 may be longitudinally fixed to tapped cannulated body 406 using any suitable approach, such as tabs 118 (shown in FIG. 1). Tabs 118 may be biased to engage a pocket (not shown) in cannulated body 406.
[0246] Implant 301 may include proximal base 404. Expandable web 108 may extend from proximal base 404 to distal base 412. Distal base 412 may include one or more of the features of distal hub 120.
[0247] Implant 301 may include tapped cannulated body 402. Tapped cannulated body 402 may be longitudinally fixed to distal base 410.
[0248] Implant 301 may include locking screw 112. Locking screw 112 may be threaded. Locking screw 112 may threadedly engage tapped cannulated body 406 and/or tapped cannulated body 402. Locking screw 112 may fix distance xCB between tapped cannulated body 406 and tapped cannulated body 402.
[0249] Distance xCB fixed by locking screw 112 may correspond to an expansion radius RO of expandable web 106 from longitudinal axis LI. Distance xCB fixed by locking screw 112 may correspond to a therapeutic radius RO of expandable web 106. A therapeutic ration RO may reduce tension of implant on bone B.
[0250] Expandable web 108 may be slidable along axis LI and/or angularly displaceable about axis LI after distance xCB has been fixed.
[0251] FIG. 5 shows distal hub 110. Expandable web 106 may be fixed to distal hub 110. Distal hub 110 may have one or more of the feature of first distal base 410. Distal hub 110 may be configured for expandable web 106 to be angularly displaced about axis LI. Distal hub 110 may be longitudinally fixed to component 128. Distal hub 110 may be rotationally fixed to component 128.
[0252] Distal hub 110 may include end cap 501. End cap 501 may include a detent configured to limit angular displacement of expandable web 106 about axis LI. Distal hub 110 may include cap 502. Distal hub 110 may include enclosure member 504.
[0253] FIG. 6 shows another embodiment of distal hub 110. Enclosure member 504 may include enclosures 602 configured to enclose tabs 606. Notch 604 may allow expandable web 106 an angular range of motion about axis LI. Angular motion of expandable web 106 about axis LI may correspond to an expansion or collapsing of expandable web 106.
[0254] Cap 502 may retain tab 602 in enclosure 504. Cap 502 may be notched to allow angular motion of expandable web 106 about axis LI. Cap 502 may include a notch (shown in FIG. 7A) for expandable web 106 to be collapsed about axis LI.
[0255] FIG. 7A shows another embodiment of distal hub 110. Cap 502 may include notch 702 for angular movement of expandable web 106 about axis LI. Angular movement of expansion web 106 about axis LI may be limited by an end 704 of notch 702. Cap 502 may retain tabs 606 in enclosure 504. Enclosure 504 and cap 502 may be configured for expandable web 106 to collapse about axis LI.
[0256] FIG. 7B shows a cross section of distal hub 110 and distal hub 120. Distal hub 110 may be configured for expandable web 108 to expand to angle η. Distal hub 120 may be configured for expandable web 108 to expand to angle ϵ. Angle ϵ may be greater than angle η. Distal hub 110 and distal hub 120 may be fix translation of an expandable web along axis LI. Distal hub 110 and distal hub 120 may allow rotation about axis LI. Distal hub 110 and distal hub 120 may allow expansion about axis LI. Distal hub 110 and distal hub 120 may be configured to provide different expansion radii (not shown) from axis LI.
[0257] FIG. 7C shows a cross section of distal hub 110 and distal hub 120. Distal hub 110 and distal hub 120 may be configured for expandable web 106 and expandable web 108 to collapse upon each other. Distal hub 110 and distal hub 120 may be configured for expandable web 106 to be substantially parallel to expandable web 108 in a collapsed position.
[0258] FIG. 8 shows illustrative stabilizer 101 for implant 100. Stabilizer 101 may include elongated member 103. Elongated member 103 may include anchor receiving feature 802. Anchor receiving feature 802 may be configured to receive anchor 114. Anchor 114 may be driven into hole wall HW (shown in FIG. 2). Anchor 114 may resist axial motion of elongated member 103 along longitudinal axis LI.
[0259] Stabilizer 101 may include a pivot axis P. Buttress plate 102 may resist rotation of elongated member 103 in hole H (shown in FIG. 2). Buttress plate 102 may resist rotation of elongated member 103 about an axis perpendicular to P. Longitudinal axis LI of implant 100 may be perpendicular to P. Central axis CH (shown in FIG. 2) of hole H may be perpendicular to P.
[0260] Buttress plate 102 may include anchor receiving feature 804. Anchor receiving feature 804 may be configured to receive an anchor driven into cortical bone BCO (shown in FIG. 2). Longitudinal axis LBP of buttress plate 102 may be parallel to bone surface BS. Bone surface BS and/or longitudinal axis LBP may be perpendicular to P. Anchor receiving feature 804 may receive anchor 116 (shown in FIG. 1).
[0261] FIG. 9 shows illustrative stabilizer 902. Stabilizer 902 may include elongated member 916. Stabilizer 902 may include elongated member 906. Stabilizer 902 may include buttress plate 904. Elongated member 906 may include extension 912. Buttress plate 904 may include extension 914.
[0262] Extension 912 may be configured to articulate with extension 914. Traction from anchor 114 received by anchor receiving feature 908 may be configured to brace the extension 912 against extension 914.
[0263] Stabilizer 902 may include anchor receiving feature 908. Anchor receiving feature 908 may be configured to receive and anchor driven into hole wall HW (shown in FIG. 2). Stabilizer 902 may include anchor receiving feature 910. Anchor receiving feature 910 may be configured to receive an anchor driven into an outer surface BS (shown in FIG. 2) of cortical bone BCO (shown in FIG. 2).
[0264] Anchor 114 may be driven through anchor receiving feature 908 into hole wall HW. Elongated member 906 may include an anchor receiving feature (not shown) configured to receive anchor 114. Anchor 116 may be driven through anchor receiving feature 910 into outer surface BS of cortical bone BCO. Longitudinal axis LBP of buttress plate 804 may be positioned such that longitudinal axis LBP is substantially parallel to bone surface BS. Longitudinal axis LBP of buttress plate 804 may be positioned such that longitudinal axis LBP is transverse to bone surface BS.
[0265] Stabilizer 902 may be configured to resist axial movement of implant 900 along longitudinal axis LI. Stabilizer 902 may be configured to resist angular rotation of implant 900 about longitudinal axis LI. Stabilizer 902 may be configured to resist rotation of implant 900 in hole H.
[0266] FIG. 10 shows illustrative stabilizer 1000. Stabilizer 1000 may include elongated member 1004. Stabilizer 1000 may include buttress plate 1006. Buttress plate 1006 may include anchor receiving features 1008. Anchor receiving features 1008 may be configured to receive an anchor driven into a surface BS of cortical bone BCO.
[0267] Elongated member 1004 may be deformable. Elongated member 1004 may be deformed such that end 1002 is substantially parallel to longitudinal axis LI and end 1010 is substantially parallel to longitudinal axis LBP of buttress plate 1006. Deformation of elongated member 1004 may correspond to angle θ.
[0268] FIG. 11A shows illustrative implant 1100. Implant 1100 may include stabilizer 1101. Stabilizer 1101 may include elongated member 1106. Elongated member 1106 may include one or more of the features of elongated member 1004. Stabilizer 1101 may include buttress plate 1102.
[0269] Buttress plate 1102 may be configured to be positioned over elongated member 1106. Buttress plate 1102 may be configured to resist rotation of elongated member 1106 about longitudinal axis LI. Implant 1100 may be inserted into hole H (shown in FIG. 2). Buttress plate 1102 may be configured to resist rotation of elongated member 1106 in hole H. Axis TEM is transverse to axis LBP. Buttress plate 1102 may be configured to resist transverse movement of elongated member 1106.
[0270] Buttress plate 1102 may include anchor receiving feature 1108. Anchor receiving feature 1108 may be configured to receive an anchor driven into an outer surface BS of cortical bone BCO (shown in FIG. 2). Elongated member 1106 may include a corresponding site for receiving an anchor driven through anchor receiving feature 1108.
[0271] Stabilizer 1101 may be configured for locking screw 112 to be adjusted after stabilizer 1101 has been secured to bone B (shown in FIG. 2).
[0272] FIG. 11B shows an illustrative view of stabilizer 1101 configured to restrict movement of elongated member 1106.
[0273] FIG. 12 shows illustrative stabilizer 1200. Stabilizer 1200 may include elongated member 1212. Elongated member 1212 may extend from an implant (not shown) to buttress collar 1202. Elongated member 1212 may extend along hole wall HW (shown in FIG. 2). Elongated member 1212 may include longitudinal axis LEM. Longitudinal axis LEM may be substantially parallel to central axis CH of hole H and/or a longitudinal axis of an implant (not shown). Buttress collar 1202 may be supported at an opening of access hole H (shown in FIG. 2). Buttress collar 1202 may include a longitudinal axis LBC substantially parallel to bone surface BS (shown in FIG. 2).
[0274] Stabilizer 1200 may include an anchor receiving feature (not shown) configured to receive an anchor, such as anchor 1204, driven into bone surface BS. Stabilizer 1200 may include aperture 1211 for adjusting a locking screw (not shown). The locking screw may include one or more of the features of locking screw 112 (shown in FIG. 1).
[0275] FIG. 13 shows illustrative stabilizer 1308 for implant 1312. Stabilizer 1308 may include elongated member 1306. Stabilizer 1308 may include buttress collar 1304. Buttress collar 1304 may have longitudinal axis LBC. Longitudinal axis LBC may be substantially parallel to bone surface BS (shown in FIG. 2).
[0276] Implant 1312 may have longitudinal axis LI. Angle θ between axis LI and LBC may be adjustable. Elongated member 1306 may include articulating surface 1302. Articulating surface 1302 may be configured for stabilizer 1308 to engage implant 1312 at angle λ between central axis CS of stabilizer 1308 and longitudinal axis LI of implant 1312. Central axis CS may correspond to central axis CH of hole H (shown FIG. 2).
[0277] Angle λ may be fixed by a locking screw (not shown) inserted into aperture 1316. The locking screw may be configured to fix angle λ and an expansion (not shown) of implant 1312 from longitudinal axis LI. The locking screw may include one or more of the features of locking screw 112 (shown in FIG. 1)
[0278] Stabilizer 1308 may include an anchor receiving feature (not shown). The anchor receiving feature may be configured to receive anchor 1314. The anchor receiving feature may be configured to direct anchor 1314 into an outer surface BS of cortical bone BCO (shown in FIG. 2).
[0279] FIG. 14 shows illustrative apparatus 1400 for implant 1408. Apparatus 1400 may include bracket 1406. Bracket 1406 may include anchor receiving feature 1404. Apparatus 1400 may include extension member 1410. Extension member 1410 may be configured to support bracket 1406 relative to implant 1408.
[0280] Apparatus 1400 may include locking screw 1402. Lock screw 1402 may be configured to fix bracket 1406 relative to implant 1408. Bracket 1406 may be fixed at a distance xBI from implant 1408. Bracket 1406 may be fixed at an angle relative to implant 1408.
[0281] FIG. 15 shows a cross section of apparatus 1400. Apparatus 1400 may include expansion bushing 1504. Expansion bushing 1504 may be untapped. Extension member 1410 may include tabs 1502.
[0282] Locking screw 1402 may be configured to pass through expansion bushing 1504 and engage a tapped portion of implant 1408. Screw 1402 may be configured to drive expansion bushing 1504 toward implant 1408. Expansion bushing 1504 may be configured to press extension member 1410 toward implant 1408. Expansion bushing 1504 may be configured to expand tabs 1502.
[0283] Expansion of tabs 1502 may induce friction between extension member 1410 and bracket 1404. Friction between extension member 1401 and bracket 1404 may interfere with movement of bracket 1404 relative to implant 1408. Friction between extension member 1410 and bracket 1404 may fix rotation of bracket 1404 about axis LI relative to implant 1408. Friction between extension member 1410 and bracket 1404 may fix distance xBI between bracket 1406 and implant 1408.
[0284] FIG. 16 shows illustrative extension member 1410. Extension member 1401 may include tabs 1502. Extension member 1410 may be rolled into a cylindrical shape. In a cylindrical configuration, edge 1604 may be contiguous with edge 1602.
[0285] FIG. 17 shows illustrative implant 301. Implant 301 may include expandable web 106 and expandable web 108. Expandable web 106 may be supported coaxially about implant component 128. Expandable web 108 may be supported coaxially about implant component 128. Expandable web 108 may be within expandable web 106.
[0286] Expandable web 106 may include a plurality of cells 122. Cells 122 may be configured to engage an anchor as shown in FIG. 40. The plurality of cells 122 may include any suitable density of cells 122. Expandable web 106 may include a density of cells 122 that varies along longitudinal axis LI of implant 301.
[0287] FIG. 18 shows illustrative inner structure 1800 of implant 301. Inner structure 1800 may include expandable web 108. Expandable web 108 may include a plurality of cells 124. Cells 124 may be configured to engage an anchor as shown in FIG. 40. The plurality of cells 124 may include any suitable density of cells 124. Expandable web 108 may include a density of cells 124 that varies along longitudinal axis LI of implant 301. Expandable web 108 may be rotatably supported about axis LI.
[0288] FIG. 19 shows a cross section of illustrative implant 301. Expandable web 106 may include any suitable density of cells 122. Expandable web 106 may include a density of cells 122 that varies along longitudinal axis LI such that expandable web has a radius RO.
[0289] Expandable web 108 may include any suitable density of cells 124. Expandable web 108 may include a density of cells 124 that varies along longitudinal axis LI such that expandable web has a radius RI. Radius RI may include a maximum value RI. A difference between RO and a maximum value RI may correspond to radial offset 1902. Radial offset 1902 may be configured to be sufficiently small such that when expandable web 106 bears a radial load (not shown), expandable web 106 may deform along radial offset 1902 to transmit the radial load to expandable web 108 at maximum value RI.
[0290] FIG. 20 shows an illustrative cut pattern 2000 for an expandable web. Cut pattern 2000 includes distal end 2018. Cut pattern 2000 includes proximal end 2020. Cut pattern 2000 includes edge 2010. Cut pattern 2000 includes edge 2012.
[0291] Edge 2010 may be configured to abut edge 2012 to form a cylindrical shape about longitudinal axis LCP. “Rolling” cut pattern 2000 about axis LCP may correspond to an expandable web in a collapsed configuration. To achieve a “rolled” configuration cut pattern 2000 may be cut in a cylindrical tube.
[0292] Cut pattern 2000 may include zone 2002. Cut pattern 2000 may include zone 2004. Cut pattern 2000 may include zone 2006. Zone 2004 may include flexing members 2014. Zone 2002 may include collapsed cell pattern 2016. Zone 2006 may include a collapsed cell pattern with a higher cell density than zone 2002.
[0293] In a “rolled” configuration about axis LCP, flexing members 2014 of zone 2004 may be configured to have a less of a resistance to bending about transverse axis TCP perpendicular to axis LCP than collapsed cells 2016 of zone 2002
[0294] Increasing or decreasing a density of a collapsed cell pattern such as cell pattern 2016 may correspond to an increase or decrease of resistance to bending about axis TCP. Increasing or decreasing angle l between flexing members such as flexing members 2014 and a collapsed cell pattern such as collapsed cell pattern 2016 may corresponds to an increase or decrease in bending resistance.
[0295] Bending features of cut pattern 2000 may facilitate deployment of an implant based on cut pattern 2000 through a hole in a bone such as hole I.
[0296] FIG. 21 shows illustrative expandable implant 2100. Implant 2100 may include one or more of the features of cut pattern 2000. Z2 may correspond to an expanded state of zone 2002 of cut pattern 2000. Z1 may correspond to an expanded state of zone 2004 of state of cut pattern 2000. Z3 may correspond to an expanded state of zone 2006 of cut pattern 2000.
[0297] In an expanded state, flex members of Z1 may provide axial stiffness to implant 2100. Under axial compression along LI, flex members of Z1 may stack upon each other and resist further compression along axis LI. In a compressed state, flex member of Z1 may facilitate deployment of an implant through a hole such as hole I.
[0298] FIG. 22 shows illustrative cut pattern 2200. Cut pattern 2200 may be “rolled” about longitudinal axis LCP to form an expandable web, such as expandable web 106 and/or 108 in a collapsed state. To achieve a “rolled” configuration cut pattern 2200 may be cut in a cylindrical tube.
[0299] Cut pattern 2200 may include zone 2202. Cut pattern 2200 may include zone 2204. Zone 2202 may include a different cell density than zone 2204. Cell density of a zone may be configured to improve engagement with an anchor.