Sternal closure method and system

Patent metadata

Field	Value
Publication number	US-10639084-B2
Application number	US-201916682775-A
Country	US
Kind code	B2
Filing date	Nov 13, 2019
Priority date	Mar 15, 2013
Publication date	May 5, 2020
Grant date	May 5, 2020

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.

First claim

What is claimed is:

1. A method of closing a severed sternum, the method comprising:
providing or receiving a plate having plate apertures sized to receive a fastener;
providing or receiving a guide unit having tubular-shaped fastener guides sized to releasably hold the fastener, each of the fastener guides having a proximal opening for loading the fastener and a distal opening for discharging the fastener;
providing or receiving the fastener for each of the fastener guides;
positioning the plate over a first sternal bone portion and a second sternal bone portion;
positioning the guide unit over the plate such that the distal opening of each of the fastener guides is aligned with a corresponding one of the plate apertures;
driving each fastener out of the guide unit and tubular-shaped fastener guides and into plate apertures and at least one of the first sternal bone portion and the second sternal bone portion; and
withdrawing the guide unit from the plate,
wherein an outer peripheral shape of the guide unit corresponds to an outer peripheral shape of the plate.

2. The method of claim 1 , further comprising moving the first sternal bone portion towards the second sternal bone portion so as to reapproximate sides of the severed sternum.

3. The method of claim 1 , further comprising loading fasteners into the guide unit prior to positioning the guide unit over the plate.

4. The method of claim 1 , wherein the fastener guides have a slit extending from the proximal opening down toward the distal opening.

5. The method of claim 1 , wherein the plate apertures are circular and the fasteners are screws.

6. The method of claim 1 , further comprising:
providing or receiving a cerclage;
wrapping the cerclage around at least a portion of each of the first and second sternal bone portions.

7. The method of claim 6 , wherein placing the bracket comprises placing the bracket over or adjacent the cerclage.

8. The method of claim 6 , further comprising:
tensioning the cerclage to secure the first sternal bone portion to the second sternal bone portion.

9. The method of claim 6 , wherein the cerclage is a band formed of metallic or polymeric material.

10. The method of claim 6 , wherein two ends of the cerclage are twisted together to connect the two ends together.

11. The method of claim 1 , further comprising:
coupling the guide unit to the plate via mounting tabs.

12. The method of claim 11 , wherein withdrawing the guide unit from the plate comprises separating the mounting tabs from the plate.

13. The method claim 1 , wherein the fastener guides are positioned on a periphery of the guide unit.

14. The method of claim 1 , wherein each of the plate apertures of the plate are linked to each other by a narrower neck portion between adjacent plate apertures.

15. The method of claim 1 , wherein driving each fastener comprises driving a first fastener into the first sternal bone portion and then driving a second fastener into the second sternal bone portion.

16. The method of claim 1 , wherein placing the bracket comprises placing the bracket such that it conforms to contours of at least one of the first and second sternal pone portions.

17. The method of claim 1 , wherein positioning the guide unit over the plate comprises aligning the outer peripheral shape of the guide unit with at least a portion of the outer peripheral shape of the plate.

18. A sternal closure system, comprising:
a plate including a plurality of circular plate apertures, the plate configured to be secured to first and second sternal bone portions, and
a guide unit comprising fastener guides, wherein each of the fastener guides is a tube configured to releasably hold a fastener, the tube having a proximal opening for loading the fastener into the tube and for access by a driver and a distal opening to allow for discharging the fastener from the tube,
wherein the fastener guides are configured to be aligned with the plate apertures such that the distal opening of each tube aligns with a corresponding one of the plurality of circular plate apertures,
wherein an outer peripheral shape of the guide unit corresponds to an outer peripheral shape of the plate,
wherein the fastener is configured to be driven into a plate aperture of the plurality of plate apertures and into at least one of the first sternal bone portion or the second sternal bone portion, and
wherein the tube has a slit extending from the proximal opening down at least a portion of the tube.

19. The closure system of claim 18 , wherein the fastener guides are positioned on a periphery of the guide unit.

20. The closure system of claim 18 , wherein the guide unit includes mounting tabs configured to couple the guide unit to the plate.

21. The closure system of claim 18 , wherein the plate is configured to conform to contours of at least one of the first and second sternal bone portions.

22. The closure system of claim 18 , further comprising:
a cerclage configured to be wrapped around at least a portion of each of the first and second sternal bone portions.

23. The closure system of claim 22 , wherein the plate is structured to allow the cerclage to extend beneath the plate.

24. The closure system of claim 18 , wherein the plate includes a body and a plurality of feet extending from the body, wherein a bottom surface of the body is raised relative to a bottom surface of at least one foot of the plurality of feet.

25. The closure system of claim 18 , wherein each of the plate apertures of the plate are linked to each other by a narrower neck portion between adjacent plate apertures.

Assignees

• Zimmer Biomet Cmf & Thoracic Llc

Inventors

• Garcia Saddy
• Wilcox Bryan
• Witten Benjamin

Classifications

• A61B17/1728

  for holes for bone plates or plate screws · CPC title

• A61B17/7053

  with parts attached to bones or to each other by flexible wires, straps, sutures or cables · CPC title

• A61B2017/0619

  thermoplastic, e.g. for bonding, welding, fusing or cutting the suture by melting it · CPC title

• A61B2017/06057

  Double-armed sutures, i.e. sutures having a needle attached to each end · CPC title

• A61B2017/06104

  interconnected at their distal ends, e.g. two hollow needles forming a loop for passing a suture · CPC title