Method of securing tissue

• US 20020045902A1
• Filed: 10/29/2001
• Published: 04/18/2002
• Est. Priority Date: 08/09/1999
• Status: Active Grant

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Bonutti IP LLC
• Inventors: Bonutti, Peter M.
• Granted Patent: US 6,860,885 B2
• Time in Patent Office: Days
• US Class Current: 606/72
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/68 Internal fixation devices , including fasteners and spinal fixators, even if a part thereof projects from the skin bone staples A61B17/0642
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61F 2/0805 Implements for inserting tendons or ligaments
• CPC Class Codes: A61F 2/0811 Fixation devices for tendons or ligaments
• CPC Class Codes: Y10S 606/902 Cortical plate specifically adapted for a particular bone

Abstract

A retainer member formed of bone secures tissue against movement relative to a portion of a bone in a patient'"'"'s body. The retainer member is utilized to form an opening in a compact outer layer of a portion of the bone in the patient'"'"'s body. The retainer member formed of bone is advantageously enclosed in a tubular member or sleeve to prevent breaking of the retainer member during the forming of the opening in the bone. The extent of movement of the retainer member into the bone in the patient'"'"'s body is determined as the retainer member is moved into the bone. A suture may be connected with the retainer member and used to connect tissue with the bone. The retainer member may be positioned across a fracture in a bone to hold portions of the bone on opposite sides of the fracture against movement relative to each other. The retainer member may be used at a joint between end portions of bones to immobilize the joint. The joint may be released for movement by breaking the retainer member formed of bone.

Claims

1. A method of securing tissue against movement relative to a portion of a bone in a patient'"'"'s body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body.

2. A method as set forth in claim 1 further including the step of removing a hard surface area from a location on the portion of the bone in the patient'"'"'s body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body includes transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient'"'"'s body at the location where the hard surface area was removed.

3. A method as set forth in claim 2 wherein said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient'"'"'s body includes rotating the retainer member formed of bone about a central axis of the retainer member formed of bone.

4. A method as set forth in claim 2 wherein said step of transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient'"'"'s body includes applying an axially directed force against the retainer member formed of bone and pushing material of the portion of the bone in the patient'"'"'s body aside under the influence of the axially directed force.

5. A method as set forth in claim 1 wherein said step of utilizing the retainer member to form an opening in the portion of the bone in the patient'"'"'s body includes moving at least a portion of the retainer member through a compact outer layer of the portion of the bone into the patient'"'"'s body into cancellous bone enclosed by the compact outer layer.

6. A method as set forth in claim 1 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone into the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured.

7. A method as set forth in claim 1 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient'"'"'s body into the tissue to be secured.

8. A method as set forth in claim 1 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient'"'"'s body into a second portion of the bone in the patient'"'"'s body.

9. A method as set forth in claim 1 wherein the bone in the patient'"'"'s body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the first portion of the bone into the second portion of the bone.

10. A method as set forth in claim 1 wherein the portion of a bone in the patient'"'"'s body is a first bone and the tissue to be secured is a second bone in the patient'"'"'s body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.

11. A method as set forth in claim 10 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.

12. A method as set forth in claim 1 wherein said step of positioning the retainer member formed of bone in the patient'"'"'s body includes moving the retainer member formed of bone through a compact outer layer of bone into cancellous bone, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.

13. A method as set forth in claim 12 wherein said step of positioning the retainer member formed of bone in the patient'"'"'s body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.

14. A method as set forth in claim 12 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient'"'"'s body under the influence of force applied against the retainer member formed of bone by the cancellous bone.

15. A method as set forth in claim 1 wherein said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body includes enclosing the retainer member formed of bone with a sleeve, and applying force against a trailing end portion of the retainer member formed of bone to move a leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body.

16. A method as set forth in claim 1 wherein said step positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body and interrupting movement of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient'"'"'s body.

17. A method as set forth in claim 1 wherein the retainer member formed of bone includes a shank portion and a head end portion which projects radially outward from the shank portion, said step of connecting the retainer member formed of bone with the tissue to be secured includes pressing the head end portion of the retainer member formed of bone against the tissue to be secured.

18. A method as set forth in claim 1 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient'"'"'s body to a second location relative to the portion of the bone in the patient'"'"'s body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body includes utilizing the retainer member to form the opening at the second location.

19. A method as set forth in claim 18 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured with the retainer member formed of bone prior to performing said step of utilizing the retainer member to form the opening at the second location.

20. A method as set forth in claim 18 wherein said step of utilizing the retainer member formed of bone to form the opening at the second location is performed prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.

21. A method as set forth in claim 1 wherein said step of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes moving a member into the portion of the bone in the patient'"'"'s body to form an opening of a first size, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body includes increasing the size of the opening formed in the bone in the patient'"'"'s body from the first size to a second size which is larger than the first size.

22. A method as set forth in claim 1 wherein said step of positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes moving a thin elongated member into the portion of the bone in the patient'"'"'s body, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body includes guiding movement of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body with the thin elongated member.

23. A method as set forth in claim 1 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone into the tissue to be secured and applying force to the retainer member to tension the tissue to be secured, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body is performed while maintaining the tension in the tissue to be secured.

24. A method as set forth in claim 1 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving a tubular member into the tissue to be secured, applying force to the tubular member to tension the tissue to be secured, and positioning the retainer member formed of bone in the tubular member, said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body includes moving at least a portion of the retainer member formed of bone from the tubular member into the portion of the bone in the patient'"'"'s body.

25. A method as set forth in claim 24 further including the step of disengaging the tubular member from the tissue to be secured and the retainer member formed of bone after performing said step of utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body.

27. A method as set forth in claim 26 wherein said step of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes utilizing the retainer member formed of bone to form an opening in a compact outer layer of the portion of the bone in the patient'"'"'s body.

28. A method as set forth in claim 26 wherein said step of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes enclosing the retainer member formed of bone with a sleeve, applying force against a trailing end portion of the retainer member formed of bone, and moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body under the influence of force applied against the trailing end portion of the retainer member formed of bone while the retainer member formed of bone is enclosed by the sleeve.

29. A method as set forth in claim 28 further including the step of interrupting movement of the leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient'"'"'s body.

30. A method as set forth in claim 26 further including the step of tensioning the tissue to be secured prior to moving the retainer member formed of bone into the portion of the bone in the patient'"'"'s body.

26. A method of securing tissue against movement relative to a portion of a bone in a patient'"'"'s body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body, and connecting the retainer member formed of bone with the tissue to be secured, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured include moving the retainer member formed of bone through the tissue to be secured and into the portion of the bone in the patient'"'"'s body with a first end portion of the retainer member formed of bone leading and a second end portion of the retainer member formed of bone trailing, and interrupting movement of the retainer member formed of bone relative to the portion of the bone in the patient'"'"'s body and to the tissue to be secured with the first end portion of the retainer member formed of bone disposed in engagement with the portion of the bone in the patient'"'"'s body and with the second end portion of the retainer member formed of bone disposed in engagement with the tissue to be secured.

31. A method of securing tissue against movement relative to a portion of a bone in a patient'"'"'s body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes positioning the retainer member formed of bone in a tubular member, applying force against a trailing end portion of the retainer member formed of bone while the retainer member is at least partially enclosed by the tubular member, and forming an opening in the portion of the bone in the patient'"'"'s body under the influence of force transmitted from the retainer member formed of bone to the portion of the bone in the patient'"'"'s body while the retainer member is at least partially enclosed by the tubular member, said step of forming an opening in the bone in the patient'"'"'s body includes moving at least a portion of the retainer member formed of bone out of the end portion of the tubular member into the portion of the bone in the patient'"'"'s body.

32. A method as set forth in claim 31 further including the step of removing a hard surface area from a location on a compact outer layer of the portion of the bone in the patient'"'"'s body, said step of forming an opening in the portion of the bone in the patient'"'"'s body includes transmitting force from an end portion of the retainer member formed of bone to the portion of the bone in the patient'"'"'s body at the location where the hard surface area on the compact outer layer was removed.

33. A method as set forth in claim 31 wherein said step of forming an opening in the portion of the bone in the patient'"'"'s body includes pushing material forming a compact outer layer of the portion of the bone in the patient'"'"'s body aside under the influence of the force transmitted from a leading end portion of the retainer member formed of bone to the compact outer layer.

34. A method as set forth in claim 31 wherein said step of forming an opening in the portion of the bone in the patient'"'"'s body includes moving the leading end portion of the retainer member formed of bone through a compact outer layer of the portion of the bone in the patient'"'"'s body into cancellous bone.

35. A method as set forth in claim 31 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone through the tissue to be secured, separating the tubular member from the retainer member formed of bone, and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured after performing said step of moving a portion of the retainer member formed of bone through the tissue to be secured.

36. A method as set forth in claim 31 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through the portion of the bone in the patient'"'"'s body into the tissue to be secured.

37. A method as set forth in claim 31 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member through a first portion of the bone in the patient'"'"'s body into a second portion of the bone in the patient'"'"'s body.

38. A method as set forth in claim 31 wherein the bone in the patient'"'"'s body is divided into a first portion and a second portion by a fracture and the tissue to be secured is the second portion of the bone, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured include moving a portion of the retainer member formed of bone through the first portion of the bone into the second portion of the bone.

39. A method as set forth in claim 31 wherein the bone in the patient'"'"'s body is a first bone and the tissue to be secured is a second bone in the patient'"'"'s body, said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the first bone into the second bone to prevent relative movement between the first and second bones.

40. A method as set forth in claim 39 further including the step of breaking the retainer member formed of bone to enable relative movement to occur between the first and second bones.

41. A method as set forth in claim 31 wherein said step of positioning the retainer member formed of bone in the patient'"'"'s body includes moving the retainer member formed of bone through a compact outer layer into cancellous, said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.

42. A method as set forth in claim 41 wherein said step of positioning the retainer member formed of bone in the patient'"'"'s body includes changing the orientation of the retainer member formed of bone relative to the compact outer layer of bone after performing said step of moving the retainer member formed of bone through the compact outer layer into cancellous bone.

43. A method as set forth in claim 42 wherein said step of transmitting force between the tissue to be secured and the retainer member through a suture includes maintaining the retainer member in a spaced apart relationship with the compact outer layer of the bone in the patient'"'"'s body under the influence of force applied against the retainer member formed of bone by the cancellous bone.

44. A method as set forth in claim 31 wherein said step of applying force against a trailing end portion of the retainer member formed of bone while the retainer member formed of bone is enclosed by the tubular member includes engaging the trailing end portion of the retainer member with a pusher member, said step of moving the leading end portion of the retainer member formed of bone out of the end portion of the tubular member being interrupted when the pusher member is in a predetermined position relative to the tubular member.

45. A method as set forth in claim 31 further including the step of forming an initial opening in the portion of the bone in the patient'"'"'s body, said step of forming an opening in the portion of the bone in the patient'"'"'s body under the influence of force transmitted from a leading end portion of the retainer member formed of bone to the portion of the bone in the patient'"'"'s body includes enlarging the initial opening in the portion of the bone in the patient'"'"'s body.

47. A method as set forth in claim 46 wherein the retainer member is formed of bone, said step of moving the retainer member into the first and second bones includes utilizing the retainer member formed of bone to at least partially form an opening in at least one of the bones.

48. A method as set forth in claim 46 wherein said step of breaking the retainer member to release the first and second bones for movement relative to each other includes bending a joint between the first and second bones.

49. A method as set forth in claim 46 wherein said step of moving the retainer member into the first and second bones includes utilizing the retainer member to form an opening extending through the first bone and to form an opening extending into the second bone.

50. A method as set forth in claim 46 wherein said step of moving the retainer member into the first and second bones includes moving the retainer member through connective tissue disposed between the first and second bones.

51. A method as set forth in claim 46 wherein an end portion of the first bone is disposed adjacent to an end portion of the second bone, said step of moving the retainer member into the first and second bones includes moving a portion of the retainer member through the end portion of the first bone into the end portion of the second bone.

46. A method of securing a first bone in a patient'"'"'s body against movement relative to a second bone in the patient'"'"'s body, said method comprising the steps of moving a retainer member into the first and second bones, retaining the first and second bones against movement relative to each other with the retainer member, and, thereafter, breaking the retainer member to release the first and second bones for movement relative to each other.

52. A method of securing tissue against movement relative to a portion of a bone in a patient'"'"'s body, said method comprising the steps of connecting a suture with a retainer member formed of bone, positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body, and connecting the retainer member formed of bone with the tissue to be secured by engaging the tissue to be secured with the suture, said step of positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes forming an opening in the portion of the bone in the patient'"'"'s body under the influence of force transmitted from a leading end portion of the retainer member formed of bone to the portion of the bone in the patient'"'"'s body, and moving the retainer member into the opening in the portion of the bone in the patient'"'"'s body with the suture extending from the opening formed in the bone in the patient'"'"'s body.

53. A method as set forth in claim 52 wherein said step of forming an opening in a compact outer layer of the portion of the bone in the patient'"'"'s body under the influence of force transmitting from a leading end portion of the retainer member formed of bone to the portion of the bone in the patient'"'"'s body includes inserting the retainer member into a tubular member, positioning an end portion of the tubular member adjacent to the portion of the bone in the patient'"'"'s body, and applying force against a trailing end portion of the retainer member formed of bone while the retainer member is at least partially enclosed by the tubular member.

54. A method as set forth in claim 52 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes tensioning the suture, said step of positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes retaining the retainer member formed of bone against movement relative to the portion of the bone in the patient'"'"'s body under the influence of force transmitted from the suture to the retainer member formed of bone by transmitting force between the retainer member formed of bone and cancellous bone in the portion of the bone in the patient'"'"'s body while the retainer member formed of bone is spaced from a compact outer layer of the portion of the bone in the patient'"'"'s body.

55. A method as set forth in claim 52 further including the step of changing the orientation of the retainer member formed of bone relative to the portion of the bone in the patient'"'"'s body after performing said step of moving the retainer member formed of bone into the opening in the portion of the bone in the patient'"'"'s body.

56. A method as set forth in claim 52 wherein said step of connecting the retainer member formed of bone with the tissue to be secured by engaging the tissue to be secured with the suture includes pulling on first and second sections of the suture which extend from the retainer member formed of bone.

58. A method as set forth in claim 57 further including the step of removing a hard surface area from a location on the compact outer layer of the portion of the bone disposed on the first side of the fracture, said step of utilizing the leading end portion of the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone disposed on the first side of the fracture includes transmitting force from the leading end portion of the retainer member formed of bone to the compact outer layer of the portion of the bone on the first side of the fractures at the location where the hard surface area was removed.

59. A method as set forth in claim 57 further including the steps of positioning the retainer member formed of bone in a tubular member, and positioning an end portion of the tubular member adjacent to the compact outer layer of the portion of the bone disposed on a first side of the fracture, said step of utilizing the leading end portion of the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone disposed on the first side of the fracture includes applying force against a trailing end portion of the retainer member formed of bone while the retainer member formed of bone is at least partially enclosed by the tubular member.

60. A method as set forth in claim 59 wherein said step of utilizing the leading end portion of the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone disposed on the second side of the fracture includes applying force against the trailing end portion of the retainer member formed of bone while the retainer member formed of bone is at least partially enclosed by the tubular member.

61. A method as set forth in claim 57 wherein said step of utilizing the leading end portion of the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone disposed on a first side of the fracture includes moving the leading end portion of the retainer member through an outer area on the compact outer layer of the portion of the bone disposed on the first side of the fracture and subsequently moving the leading end portion of the retainer member through an inner area on the compact outer layer of the portion of the bone disposed on the first side of the fracture, said step of utilizing the leading end portion of the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone disposed on the second side of the fracture includes moving the leading end portion of the retainer member through an inner area on the compact outer layer of the portion of the bone disposed on the second sidle of the fracture.

57. A method of treating a fractured bone, said method comprising the steps of engaging a compact outer layer of a portion of the bone disposed on a first side of the fracture with a leading end portion of a retainer member formed of bone, utilizing the leading end portion of the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone disposed on a first side of the fracture, moving the leading end portion of the retainer member formed of bone across the fracture, engaging the compact layer of a portion of the bone disposed on a second side of the fracture with a leading end portion of the retainer member formed of bone, and utilizing the leading end portion of the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone disposed on the second side of the fracture.

62. A method of securing tissue against movement relative to a portion of a bone in a patient'"'"'s body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body, and connecting the retainer member formed of bone with tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body, determining an extent of movement of the leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body, and interrupting said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body upon determining that the extent of movement of the leading end portion of the retainer member formed of bone corresponds to a predetermined extent of movement.

63. A method as set forth in claim 62 wherein said step of moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body includes utilizing the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone in the patient'"'"'s body.

64. A method as set forth in claim 63 further including the step of removing a hard surface area from a location on the compact outer layer of the portion of the bone in the patient'"'"'s body, said step of utilizing the retainer member formed of bone to form an opening includes transmitting force from the leading end portion of the retainer member formed of bone to the portion of the bone in the patient'"'"'s body at the location where the hard surface area on the compact outer layer was removed.

65. A method as set forth in claim 62 wherein said step of connecting the retainer member formed of bone with tissue to be secured includes moving a portion of the retainer member formed of bone through the tissue to be secured and transmitting force between an outer side surface area on the retainer member formed of bone and the tissue to be secured after performing said step of moving a portion of the retainer member formed of bone through the tissue to be secured.

66. A method as set forth in claim 62 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the portion of the bone in the patient'"'"'s body into the tissue to be secured.

67. A method as set forth in claim 62 wherein said steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured includes moving a portion of the retainer member through the portion of the bone in the patient'"'"'s body into a second portion of the bone in the patient'"'"'s body.

68. A method as set forth in claim 62 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes transmitting force between the tissue to be secured and the retainer member through a suture.

69. A method as set forth in claim 62 wherein said step of moving the leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body includes enclosing the retainer member formed of bone with a sleeve, and applying force against a trailing end portion of said retainer member formed of bone to move the leading end portion of the retainer member formed of bone into a compact outer layer of the portion of the bone in the patient'"'"'s body.

70. A method of securing tissue against movement relative to a portion of a bone in a patient'"'"'s body, said method comprising the steps of moving a shank portion of a retainer member formed of bone through the tissue to be secured, moving the shank portion of the retainer member formed of bone into a the portion of the bone in the patient'"'"'s body, and pressing a head end portion of the retainer member formed of bone against the tissue to be secured while the shank portion of the retainer member formed of bone extends into the portion of the bone in the patient'"'"'s body.

71. A method as set forth in claim 70 wherein said step of moving the shank portion of the retainer member formed of bone into a the portion of the bone in the patient'"'"'s body includes utilizing a leading end portion of the shank portion of the retainer member formed of bone to form an opening in a compact outer layer of the portion of the bone in the patient'"'"'s body.

72. A method as set forth in claim 71 further including the step of removing a hard surface area from a location on the compact outer layer of the portion of the bone in the patient'"'"'s body, said step of utilizing the leading end portion of the shank portion of the retainer member formed of bone to form an opening in the compact outer layer of the portion of the bone in the patient'"'"'s body includes transmitting force from the leading end portion of the shank portion of the retainer member formed of bone to the portion of the bone in the patient'"'"'s body at the location where the hard surface area on the compact layer was removed, said step of pressing a head end portion of the retainer member formed of bone against the tissue to be secured includes pressing the tissue to be secured against the compact outer layer of the portion of the bone in the patient'"'"'s body at the location where the hard surface area on the compact layer was removed.

73. A method as set forth in claim 70 wherein said step of pressing the head end portion of the retainer member formed of bone against the tissue to be secured includes engaging a first side of the tissue to be secured with the head end portion of the retainer member formed of bone and pressing a second side of the tissue to be secured against the portion of the bone in the patient'"'"'s body under the influence of force transmitted from the head end portion of the retainer member formed of bone.

74. A method of immobilizing a joint between first and second bone in a patient'"'"'s body, said method comprising the steps of moving a retainer member formed of bone through a portion of the first bone and into the second bone, and holding the first and second bones against movement relative to each other with the retainer member formed of bone.

75. A method as set forth in claim 74 wherein said step of moving a retainer member formed of bone through a portion of the first bone and into the second bone includes utilizing the retainer member formed of bone to form an opening in the second bone as the retainer member formed of bone moves into the second bone.

76. A method as set forth in claim 74 further including the step of releasing the first and second bones for movement relative to each other by breaking the retainer member formed of bone.

77. A method as set forth in claim 74 further including the step of positioning tissue at the joint between the first and second bones prior to performing said step of moving a retainer member formed of bone through a portion of the first bone and into the second bone.

78. A method as set forth in claim 74 further including the step of determining the extent of movement of a leading end portion of the retainer member formed of bone relative to the first bone and interrupting said step of moving the retainer member formed of bone through a portion of the first bone and into the second bone upon determining that the extent of movement of the leading end portion of the retainer member formed of bone corresponds to a predetermined extent of movement.

79. A method as set forth in claim 74 further including the step of inserting the retainer member formed of bone into a tubular member, and positioning the tubular member adjacent to the first bone, said step of moving a retainer member formed of bone through a portion of the first bone and into the second bone is at least partially performed with a portion of the retainer member formed of bone disposed in the tubular member.

80. A method as set forth in claim 79 wherein said step of moving a retainer member formed of bone through a portion of the first bone and into the second bone includes applying force against a trailing end portion of the retainer member formed of bone while the trailing end portion of the retainer member formed of bone is enclosed by the tubular member.

81. A method of securing tissue against movement relative to a portion of a bone in a patient'"'"'s body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes moving a thin elongated member into the portion of the bone in the patient'"'"'s body and moving the retainer member formed of bone along the thin elongated member into the portion of the bone in the patient'"'"'s body.

82. A method as set forth in claim 81 wherein said step of moving the retainer member formed of bone along the thin elongated member into the portion of the bone in the patient'"'"'s body includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body.

83. A method as set forth in claim 82 wherein said step of positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes the steps of enclosing the retainer formed of bone with a tubular member disposed adjacent to an outer side of the portion of the bone in the patient'"'"'s body, and applying force against a trailing end portion of the retainer member formed of bone.

84. A method as set forth in claim 81 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the retainer member formed of bone through the tissue.

85. A method as set forth in claim 81 wherein said step of connecting the retainer member formed of bone with the tissue to be secured includes moving the thin elongated member into the tissue to be secured and moving the retainer member formed of bone along the thin elongated member into the tissue to be secured.

86. A method as set forth in claim 81 further including the step of removing a hard surface area from a location on the portion of the bone in the patient'"'"'s body, said step of moving a thin elongated member into the portion of the bone in the patient'"'"'s body includes moving the thin elongated member into the portion of the bone in the patient'"'"'s body at the location where the hard surface area on the portion of the bone in the patient'"'"'s body was removed, said step of moving the retainer member formed of bone along the thin elongated member includes moving a leading end portion of the retainer member formed of bone into engagement with the portion of the bone in the patient'"'"'s body at the location where the hard surface area on the portion of the bone in the patient'"'"'s body was removed.

87. A method as set forth in claim 81 wherein said step of moving the retainer member formed of bone along the thin elongated member includes utilizing the retainer member formed of bone to form an opening in the portion of the bone in the patient'"'"'s body by pushing material forming the portion of the bone in the patient'"'"'s body aside under the influence of force transmitted through the retainer member formed of bone.

88. A method of securing tissue against movement relative to a portion of a bone in a patient'"'"'s body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body, and connecting the retainer member formed of bone with the tissue to be secured, said steps of positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body and connecting the retainer member formed of bone with the tissue to be secured include engaging a portion of the tissue to be secured, tensioning at least a portion of the tissue to be secured by moving the engaged portion of the tissue to be secured from a first location relative to the portion of the bone in the patient'"'"'s body to a second location relative to the portion of the bone in the patient'"'"'s body, and utilizing the retainer member formed of bone to hold the tissue at the second location by engaging the tissue and an opening formed in the portion of the bone in the patient'"'"'s body with the retainer member formed of bone.

89. A method as set forth in claim 88 wherein said step of engaging a portion of the tissue to be secured includes engaging the portion of the tissue to be secured at the first location with the retainer member formed of bone, said step of tensioning the tissue to be secured includes moving the engaged portion of the tissue and the retainer member formed of bone together from the first location to the second location.

90. A method as set forth in claim 88 further including the step of utilizing the retainer member formed of bone to form the opening at the second location prior to performance of said step of moving the engaged portion of the tissue to be secured from the first location to the second location.

91. A method as sat forth;

in claim 88 wherein said step of tensioning the tissue to be secured includes transmitting force from the retainer member formed of bone to the tissue to be secured.

92. A method of securing tissue against movement relative to a portion of a bone in a patient'"'"'s body, said method comprising the steps of positioning a retainer member formed of bone in the portion of the bone in the patient'"'"'s body, and connecting the retainer member formed of bone with the tissue to be secured, said step of positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes moving a thin elongated member into the portion of the bone in the patient'"'"'s body and guiding movement of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body with the thin elongated member.

93. A method as set forth in claim 92 wherein said step of positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes enclosing the retainer member formed of bone with a sleeve, and applying force against a trailing end portion of the retainer member formed of bone to move a leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body while guiding movement of the retainer member formed of bone with the thin elongated member.

94. A method as set forth in claim 92 wherein said step positioning the retainer member formed of bone in the portion of the bone in the patient'"'"'s body includes moving a leading end portion of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body and interrupting movement of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body when the leading end portion of the retainer member formed of bone has moved a predetermined distance into the portion of the bone disposed in the patient'"'"'s body.

95. A method as set forth in claim 92 wherein said step of guiding movement of the retainer member formed of bone into the portion of the patient'"'"'s body includes forming an opening in the portion of the bone in the patient'"'"'s body while performing said step of guiding movement of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body with the thin elongate member.

96. A method as set forth in claim 92 wherein said step of guiding movement of the retainer member formed of bone into the portion of the patient'"'"'s body includes forming an opening in the portion of the bone in the patient'"'"'s body with the retainer member formed of bone while performing said step of guiding movement of the retainer member formed of bone into the portion of the bone in the patient'"'"'s body with the thin elongated member.

97. A method of treating a fractured bone, said method comprising the steps of forming an opening which extends through a first portion of the bone on a first side of the fracture and into a second portion of the bone on a second side of the fracture, positioning a retainer member formed of bone in the opening with a first portion of the retainer member disposed in engagement with the first portion of the bone and a second portion of the retainer member disposed in engagement with the second portion of the bone, and blocking relative movement between the first and second portions of the bone with the retainer member formed of bone.

98. A method as set forth in claim 97 wherein said step of forming an opening which extends through a first portion of the bone into a second portion of the bone includes utilizing the retainer member formed of bone to at least partially form the opening.

99. A method as set forth in claim 98 further including the step of removing a hard surface area from a location on the first portion of the bone, said step of utilizing the retainer member formed of bone to at least partially form the opening in the bone includes transmitting force from the leading end portion of the retainer member formed of bone to the first portion of the bone at the location where the hard surface area was removed.

100. A method as set forth in claim 98 further including the steps of positioning the retainer member formed of bone in a tubular member, and positioning an end portion of the tubular member adjacent to the first portion of the bone, said step of utilizing the retainer member formed of bone to at least partially form an opening in the bone includes applying force against a trailing end portion of the retainer member formed of bone while the retainer member formed of bone is at least partially enclosed by the tubular member.