Sternal closure cerclage, plate implant and instrumentation

• US 10,307,193 B2
• Filed: 11/17/2017
• Issued: 06/04/2019
• Est. Priority Date: 03/15/2013
• Status: Active Grant

• Current Assignee: Zimmer Biomet CMF and Thoracic, LLC (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Zimmer Biomet CMF and Thoracic, LLC (Zimmer Biomet Holdings, Inc.)
• Inventors: Garcia, Saddy, Wilcox, Bryan, Witten, Benjamin
• Primary Examiner(s): Sevilla, Christian A
• Application Number:
  US15/815,783
• Publication Number:
  US 20180132864A1
• Time in Patent Office: 564 Days
• CPC Class Codes: A61B 17/0466 Suture bridges
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/06004 Means for attaching suture to needle tipping A61B17/06195; connecting wire to other metallic objects B21F15/00
• CPC Class Codes: A61B 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/062 Needle manipulators
• CPC Class Codes: A61B 17/1606 of forceps type, i.e. having two jaw elements moving relative to each other
• CPC Class Codes: A61B 17/1611 the two jaw elements being integral with respective elongate shaft elements
• CPC Class Codes: A61B 17/1642 for producing a curved bore
• CPC Class Codes: A61B 17/1728 for holes for bone plates or plate screws
• CPC Class Codes: A61B 17/1789 for the sternum
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 17/683 comprising bone transfixation elements, e.g. bolt with a distal cooperating element such as a nut
• CPC Class Codes: A61B 17/7053 with parts attached to bones or to each other by flexible wires, straps, sutures or cables
• CPC Class Codes: A61B 17/8076 for the ribs or the sternum
• CPC Class Codes: A61B 17/808 Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
• CPC Class Codes: A61B 17/82 for bone cerclage apparatus for manipulating wires or straps A61B17/8861; wires, bands or straps other than cerclage A61B17/842
• CPC Class Codes: A61B 17/823 for the sternum
• CPC Class Codes: A61B 17/86 Pins or screws or threaded wires; nuts therefor A61B17/72 take precedence
• CPC Class Codes: A61B 17/8861 : Apparatus for manipulating flexible wires or straps devices for inserting Kirschner wires A61B17/1697
• CPC Class Codes: A61B 17/8869 : Tensioning devices
• CPC Class Codes: A61B 2017/00734 : battery operated
• CPC Class Codes: A61B 2017/0417 : T-fasteners
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/06038 : soldered, brazed or welded
• CPC Class Codes: A61B 2017/06057 : Double-armed sutures, i.e. sutures having a needle attached to each end
• CPC Class Codes: A61B 2017/06071 : with an abrupt angle formed between two adjacent sections
• CPC Class Codes: A61B 2017/0608 : J-shaped
• CPC Class Codes: A61B 2017/06104 : interconnected at their distal ends, e.g. two hollow needles forming a loop for passing a suture
• CPC Class Codes: A61B 2017/0619 : thermoplastic, e.g. for bonding, welding, fusing or cutting the suture by melting it

Abstract

A system including a bone punch tool and a needle guide. The bone punch tool can include a support arm having a support arm proximal portion and a support arm distal portion, a pivot arm having a pivot arm proximal portion and a pivot arm distal portion, and an arcuate punch configured to punch through bone. The pivot arm distal portion can be pivotably coupled to the support arm distal portion, such that the pivot arm proximal portion is configured to be moved away from the support arm proximal portion to extend the arcuate punch into a punch position to punch an arcuate hole through bone. The needle guide can be configured to guide a needle through the arcuate hole.

Claims

1. A closure system for securing a first bone portion to a second bone portion, the closure system comprising:

a bracket including a plurality of bracket apertures, the bracket configured to be secured to the first and second bone portions;

a cerclage configured to extend around the first and second bone portions to secure the first bone portion to the second bone portion; and

a plurality of fastener guides preloaded with fasteners, wherein the fastener guides are configured to be aligned with the bracket apertures, and the preloaded fasteners are configured to be driven through the bracket apertures into the first bone portion or the second bone portion.

2. The closure system of claim 1, wherein at least one fastener guide of the plurality of fastener guides comprises an elongated tube.

3. The closure system of claim 1, wherein each fastener guide of the plurality of fastener guides is connected to form a guide unit.

4. The closure system of claim 1, wherein the bracket fixedly engages a first end of the cerclage.

5. The closure system of claim 1, wherein a second end of the cerclage is configured to be moved relative to a first end of the cerclage to tension the cerclage.

6. The closure system of claim 1, wherein the bracket comprises a body and a plurality of legs extending from the body.

7. The closure system of claim 1, wherein at least a portion of the cerclage is configured to be received in an opening of the bracket.

24. The closure system of claim 1, wherein at least a portion of the cerclage is configured to extend beneath a raised portion of the bracket.

8. A closure system for securing a first bone portion to a second bone portion, the closure system comprising:

a bracket including a plurality of bracket apertures, the bracket configured to be secured to the first and second bone portions;

a cerclage configured to be looped around the first and second bone portions; and

a plurality of fastener guides preloaded with fasteners, wherein the plurality of fastener guides are configured to be aligned with the plurality of bracket apertures, and the preloaded fasteners are configured to be driven through the bracket aperture into the first bone portion or the second bone portion.

9. The closure system of claim 8, wherein at least a portion of the cerclage is covered by an outer member.

10. The closure system of claim 9, wherein the outer member is molded over or formed integrally with the cerclage.

11. The closure system of claim 8, wherein the cerclage is configured to be tensioned around the first and second bone portions to secure the first bone portion to the second bone portion.

12. The closure system of claim 11, wherein the fasteners are configured to be driven through the bracket apertures into the first or second bone portion to secure the tensioned cerclage between the bracket and the first or second bone portion.

13. The closure system of claim 8, wherein the bracket defines a window configured to receive a cutting device for cutting the cerclage.

14. The closure system of claim 8, wherein the bracket includes:

a body and a plurality of fastener-receiving portions, wherein a bottom surface of the body is raised relative to a bottom surface of at least one leg of the fastener-receiving portions.

15. A method, comprising:

looping a cerclage around first and second bone portions, the cerclage configured to be tensioned to adjoin the first bone portion to the second bone portion;

positioning a bracket over the first and second bone portions, the bracket comprising a plurality of bracket apertures;

aligning a plurality of fastener guides with the plurality of bracket apertures, wherein each of the plurality of fastener guides comprises an elongated tube and includes a preloaded fastener, wherein the plurality of fastener guides are connected to form a guide unit in a shape corresponding to a shape of the bracket; and

driving the plurality of preloaded fasteners through the bracket apertures and into the first or second bone portion.

16. The method of claim 15, further comprising:

passing a second end of the cerclage through an opening in the bracket.

17. The method of claim 15, further comprising:

tensioning the cerclage by moving a second end of the cerclage relative to the first end of the cerclage.

18. The method of claim 15, further comprising:

removing the plurality of fastener guides from the bracket without releasing tension of the cerclage or removing the fasteners.

19. The method of claim 15, further comprising:

inserting a cutting device through a window defined by the bracket to cut the cerclage.

20. The method of claim 15, wherein the bracket includes a body, wherein a bottom surface of the body is raised relative to a bottom of at least one of the plurality of bracket apertures.

21. A closure system for securing a first bone portion to a second bone portion, the closure system comprising:

a bracket including a plurality of bracket apertures, the bracket configured to be secured to the first and second bone portions; and

a guide unit including a plurality of fastener guides preloaded with fasteners,

wherein each fastener guide of the plurality of fastener guides comprises an elongated tube,

wherein a shape of the guide unit corresponds to a shape of the bracket and the fastener guides are configured to align with the bracket apertures, and

wherein the preloaded fasteners are configured to be driven through the bracket apertures into the first bone portion or the second bone portion.

22. The closure system of claim 21, further comprising:

a cerclage configured to extend around the first and second bone portions to secure the first bone portion to the second bone portion.

23. The closure system of claim 21, wherein the bracket comprises a body and a plurality of legs extending from the body, the plurality of bracket apertures being respectively positioned in the plurality of legs.

25. A closure system for securing a first bone portion to a second bone portion, the closure system comprising:

a bracket including a plurality of bracket apertures, the bracket configured to be secured to the first and second bone portions; and

a guide unit including;

a plurality of fastener guides; and

a plurality of fasteners;

wherein each of the plurality of fastener guides is preloaded with a fastener of the plurality of fasteners;

wherein each of the plurality of fastener guides is configured to be aligned with a respective one of the plurality of bracket apertures such that a shape of the guide unit corresponds to a shape of the bracket;

wherein each of the plurality of preloaded fasteners is configured to be driven out of the guide unite and through the bracket aperture into the first bone portion or the second bone portion to secure the bracket to the first and second bone portions.

26. The closure system of claim 25, further comprising:

a cerclage configured to be looped around the first and second bone portions.

27. The closure system of claim 26, wherein at least a portion of the cerclage is covered by an outer member that is molded over or formed integrally with the cerclage.

28. The closure system of claim 25, wherein the cerclage is configured to be tensioned around the first and second bone portions to secure the first bone portion to the second bone portion.

29. The closure system of claim 25, wherein the fasteners are configured to be driven through the bracket apertures into the first or second bone portions to secure the cerclage between the bracket and the first and second bone portions.

30. The closure system of claim 25, wherein the bracket defines a window configured to receive a cutting device for cutting the cerclage.

31. The closure system of claim 25, wherein the bracket includes:

a body and a plurality of legs extending from the body, wherein a bottom surface of the body is raised relative to a bottom surface of at least one leg of the plurality of legs.