Method and Apparatus for Sternal Closure

• US 9,642,661 B2
• Filed: 12/02/2013
• Issued: 05/09/2017
• Est. Priority Date: 02/03/2006
• Status: Active Grant

• Current Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Inventors: Stone, Kevin T., Berelsman, Brian K., Wagner, Zachary
• Primary Examiner(s): Dornbusch, Dianne
• Application Number:
  US14/094,311
• Publication Number:
  US 20140088655A1
• Time in Patent Office: 1,254 Days
• 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 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• 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 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• 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 17/8076 for the ribs or the sternum
• CPC Class Codes: A61B 17/823 for the sternum
• CPC Class Codes: A61B 17/842 Flexible wires, bands or straps A61B17/72, A61B17/82, A61B17/86 take precedence
• CPC Class Codes: A61B 17/8869 Tensioning devices
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06185 hollow or tubular hollow suture needles A61B2017/061

Abstract

A method and apparatus for securing a fractured or sectioned sternum in a patient'"'"'s body is disclosed. The apparatus can include an attachment member and an adjustable flexible member construct. The attachment member can have a flexible member holder. The adjustable flexible member construct can have first and second ends and a body defining at least one passage portion. The first and second ends can be passed into and through the at least one passage portion via first and second openings associated with the at least one passage portion of the adjustable flexible member construct to form a pair of loops. The attachment member can be configured to be coupled to at least one of the formed pair of loops. The adjustable flexible member construct can be positioned about the sternum and can be reduced to compress the fractured or sectioned sternum.

Claims

1. A method for securing a fractured or sectioned sternum in a patient'"'"'s body, comprising:

forming an adjustable flexible member construct including;

providing a flexible member having first and second ends and a body defining first and second passage portions spaced apart from each other by a first portion of the flexible member;

passing the first end into and through the second passage portion and then into and through the first passage portion to form a first loop;

passing the second end into and through the first passage portion in an opposite direction as the first end and then into and through the second passage portion in an opposite direction as the first end to form a second loop; and

coupling an attachment member to the first and second loops;

encircling the fractured or sectioned sternum by at least partially wrapping the formed adjustable flexible member construct about the sternum;

coupling the first portion of the adjustable flexible member construct opposite the loops to the attachment member; and

reducing the adjustable flexible member construct to compress the fractured or sectioned sternum.

2. The method of claim 1, wherein reducing the adjustable flexible member construct to compress the fractured or sectioned sternum comprises applying tension to the first and second ends of the adjustable flexible member construct such that a size of the first and second loops is decreased thereby compressing the fractured or sectioned sternum;

and wherein the adjustable flexible member construct automatically remains in a reduced position about the sternum.

3. The method of claim 2, further comprising:

forming first and second pairs of holes through a manubrium of the sternum, each pair of holes being on opposed sides of a section or fracture of the sternum;

wherein forming a flexible member construct includes forming a plurality of flexible member constructs;

passing a first flexible member construct of the plurality of formed flexible member constructs through the first pair of holes and a second flexible member construct of the plurality of formed flexible member constructs through the second pair of holes such that the attachment members and passing portions of the first and second flexible member constructs are on an anterior side of the sternum;

coupling first portion of the first and second flexible member constructs opposite the loops to their respective attachment members; and

reducing the first and second constructs to compress the fractured or sectioned sternum.

4. The method of claim 3, further comprising passing the first and second flexible member constructs through the first and second pairs of holes such that the first and second constructs overlap each other so as to form an X-shaped pattern.

5. The method of claim 3, further comprising:

encircling the sternum with a third flexible member construct of the plurality of formed flexible member constructs adjacent an intercostal space;

coupling the first portion of the third flexible member construct opposite the loops to its respective attachment member; and

reducing the third adjustable flexible member construct to compress the fractured or sectioned sternum.

6. The method of claim 3, further comprising:

providing a single passage portion adjustable flexible member construct;

coupling the single passage portion adjustable flexible member construct to the first and second adjustable flexible member constructs before coupling the first portion of the first and second adjustable flexible member constructs to their respective attachment members; and

tensioning the single passage portion adjustable flexible member construct to a reduced size after reducing the first and second constructs to reduce the fractured or sectioned sternum, the single passage portion adjustable flexible member construct automatically maintaining the reduced size.

7. The method of claim 6, wherein the single passage portion adjustable flexible member construct is orientated substantially perpendicular to the first and second adjustable flexible member constructs.

8. The method of claim 1, wherein encircling the fractured or sectioned sternum further comprises passing the adjustable flexible member construct around the posterior side of the sternum with a needle passing member detachably coupled to the first portion of the adjustable flexible member construct.

9. The method of claim 1, wherein forming an adjustable flexible member construct includes coupling the first and second ends to a tensioning member;

and

wherein reducing the adjustable flexible member construct to compress the fractured or sectioned sternum includes engaging the tensioning member to simultaneously decrease a size of the first and second loops to compress the fractured or sectioned sternum.

10. The method of claim 1, further comprising applying an orthopedic mesh to at least an anterior side of the fractured or sectioned sternum such that at least a portion of the adjustable flexible member construct rests on the orthopedic mesh.

11. The method of claim 10, further comprising applying a platelet concentrate, antibiotic concentrate, or combinations thereof, to the adjustable flexible member construct, the orthopedic mesh, or combinations thereof.