HK1184354A - Apparatus and methods for bone repair - Google Patents

Description

Device and method for bone repair

Cross Reference to Related Applications

This application is a non-provisional application of U.S. provisional application No.61/311,494 filed on 8.2010, and U.S. provisional application No.61/378,822 filed on 31.2010, the entire disclosures of both provisional applications being incorporated herein by reference.

Technical Field

Aspects of the present disclosure relate to providing devices and methods for repairing bone fractures. In particular, the present disclosure relates to devices and methods for repairing bone fractures using instruments inserted into the bone.

Background

Fracture fixation may involve the use of structures to counteract or partially counteract forces acting on the fractured bone or associated bone fragments. In general, fracture fixation may provide longitudinal (along the long axis of the bone), transverse (across the long axis of the bone), and rotational (about the long axis of the bone) stability. Fracture fixation may also preserve conventional biological and healing functions.

Fracture fixation often involves addressing loading conditions, fracture patterns, alignment, compression forces, and other factors, which may be different for different types of fractures. For example, a mid-section fracture may have sufficient bone material on either side of the crack in which the anchor is driven. End bone fractures, particularly fractures on the articular surface, may have thin cortical bone, soft cancellous bone, and fewer possible anchoring locations. Typical fracture fixation methods may involve one or both of the following: (1) instruments located within the skin (internal fixation); and (2) instruments extending from the skin (external fixation).

Internal fixation methods often involve plates that are screwed onto the outside of the bone.

The plate is generally characterized by minimally invasive surgery, supporting the fractured bone segment from one side outside the bone, and screws anchored into the plate and bone.

Multiple-segment fractures of the middle or end bones may require alignment and stability in a manner that produces adequate fixation in multiple directions. The implants may be used to treat mid-bone fractures and end-bone fractures.

Proper positioning, size, shape, orientation, and accessibility of bone fragments and anatomical features, among other factors, can increase the medical effectiveness of the implant.

Thus, it would be desirable to provide devices and methods for repairing bone.

Drawings

The objects and advantages of the present invention will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference numerals refer to like parts throughout, and in which:

fig. 1 illustrates an exemplary apparatus in accordance with the principles of the present invention along with an exemplary anatomical structure in conjunction with which the present invention may be practiced.

FIG. 2 shows a view of the apparatus and the cross-sectional structure shown in FIG. 1 taken along line 2-2 (shown in FIG. 1).

FIG. 3 shows a view of the apparatus and the cross-sectional structure shown in FIG. 1 taken along line 3-3 (shown in FIG. 1).

Fig. 4 shows a view of the device and anatomy shown in fig. 1 taken along line 4-4 (shown in fig. 1).

Figure 5 shows the anatomical structure shown in figure 1.

Fig. 6 shows a portion of the device shown in fig. 1 and a portion of the anatomy shown in fig. 1.

Fig. 7 illustrates another exemplary apparatus according to the principles of the present invention.

FIG. 8 illustrates a partial cross-sectional view of the device shown in FIG. 7 taken along line 8-8 (shown in FIG. 7).

Fig. 9 illustrates yet another exemplary apparatus according to the principles of the present invention.

Fig. 10 illustrates yet another exemplary apparatus in accordance with the principles of the present invention along with an exemplary anatomical structure in conjunction with which the present invention may be practiced.

FIG. 11 shows a view of the device and anatomical structure shown in FIG. 10 taken along line 11-11 (shown in FIG. 10).

Fig. 12A illustrates yet another exemplary apparatus in accordance with the principles of the present invention along with an exemplary anatomical structure in conjunction with which the present invention may be practiced.

Fig. 12B illustrates yet another exemplary apparatus according to the principles of the present invention.

Fig. 13 shows a view of the device and anatomical structure shown in fig. 12A taken along line 13-13 (shown in fig. 12A).

Fig. 14 illustrates yet another exemplary apparatus according to the principles of the present invention.

Fig. 15 illustrates yet another exemplary apparatus according to the principles of the present invention.

FIG. 16 shows a view of the device shown in FIG. 15 taken along line 16-16 (shown in FIG. 15).

Fig. 17 illustrates yet another exemplary apparatus in accordance with the principles of the present invention along with an exemplary anatomical structure in conjunction with which the present invention may be practiced.

Fig. 18 illustrates an apparatus that may be used in conjunction with an apparatus according to the principles of the present invention, along with an exemplary anatomical structure with which the present invention may be practiced.

Fig. 19 illustrates yet another exemplary apparatus according to the principles of the present invention.

Fig. 20 illustrates yet another exemplary apparatus according to the principles of the present invention.

Fig. 21 illustrates yet another exemplary apparatus in accordance with the principles of the present invention along with an exemplary anatomical structure in conjunction with which the present invention may be practiced.

Fig. 22 illustrates yet another exemplary apparatus in accordance with the principles of the present invention along with an exemplary anatomical structure in conjunction with which the present invention may be practiced.

Fig. 23 illustrates yet another exemplary apparatus according to the principles of the present invention.

Fig. 24 illustrates yet another exemplary apparatus according to the principles of the present invention.

Fig. 25 shows a view of the device shown in fig. 24 taken along line 25-25 (shown in fig. 24).

Fig. 26 schematically illustrates an exemplary embodiment of the device of fig. 25 in a different state from that shown in fig. 25.

Fig. 27 illustrates another exemplary anatomical structure in connection with which the present invention may be practiced.

Fig. 28 illustrates yet another exemplary anatomical structure in connection with which the present invention may be practiced.

Detailed Description

Devices and methods for repairing bone are provided. The devices and methods may involve transferring a mechanical load from a first bone fragment to a second bone fragment. The first and second bone fragments may be located in any region of a bone. For example, the first bone fragment may be located at an end of the bone. The second bone fragment may be located in a shaft region of the bone.

Bone fragments located at the ends of the bone may be separated from bone fragments located in the shaft region of the bone by cracks. The crack may interfere with the transfer of load from the bone fragment located at the end of the bone to the bone fragment located in the stem region of the bone. The transmission of the load through the crack may interfere with the healing of the crack. The transmission of the load through the crack may result in damage to bone fragments located in the vicinity of the crack. The bone fragments located in the shaft region of the bone may have sufficient mechanical integrity to transfer loads to other skeletal structures.

The device may be delivered into the interior region of the bone via one or more access holes. The one or more access holes may be provided by a bone drill, bone saw, or any other suitable instrument, such as one or more of the instruments shown and described in U.S. patent application publication No.2009/0182336a1, U.S. patent application No.13/043,190, filed 3/8/2011, U.S. patent application No.13/009,657, and U.S. provisional patent application No.61/450,112, filed 3/7/2011, all of which are incorporated herein by reference in their entirety.

The interior region may be prepared by any suitable bone cavity preparation instrument, such as one or more of the instruments shown and described in the aforementioned patent application publications and applications.

The devices and methods may involve expansion of an instrument in an interior region of the bone. The expansion may involve any suitable expansion mechanism or technique, such as one or more of those shown and described in the aforementioned patent publications and applications.

The bone may define a bisecting longitudinal plane that bisects the bone along a longitudinal axis of the bone.

The apparatus may include and the method may involve a bone framework, and the method may involve a bone framework. The frame may comprise an elongate member. Each of the elongated members may be inserted substantially completely into the bone and then locked to another of the elongated members. The elongated member may define a triangular area inside the bone.

The elongate member may comprise a subchondral member. The elongated member may include a first inclined member. The first inclined member may be configured to span from a first subchondral position to a second diaphyseal position. The second diaphyseal position may be obliquely across the longitudinal bisecting plane from the first subchondral member.

The elongated member may include a second inclined member. The second inclined member may be configured to span from a second subchondral position to a first diaphyseal position. The first diaphyseal position may be obliquely across the longitudinal bisecting plane from the second subchondral member.

The subchondral member may be tubular.

The first inclined member may be tubular.

The elongate member may comprise a diaphyseal member. The diaphyseal member may be configured to span from the first diaphyseal position to the second diaphyseal position.

The subchondral member may include a subchondral tubular structure. The subchondral tubular structure may include a cell configured to receive a bone anchor. The cell may be one of a plurality of cells, each of the plurality of cells configured to receive a bone anchor.

The unit may be an open unit. The open cell may have a diameter sufficient for receiving a portion of the bone anchor. The cell may be a closed cell. The closure unit may have a diameter sufficient for receiving a portion of the bone anchor. The closure element may be deformed such that its diameter expands in response to stress from the anchor. The stress may cause the closure unit to open such that the unit can receive the anchor.

The subchondral tubular structure may be expandable.

The first inclined member may comprise an inclined tubular structure. The angled tubular structure may be configured to directly engage the subchondral tubular structure at the first subchondral location.

The diaphyseal member may comprise a diaphyseal tubular structure. The diaphyseal tubular structure may include a cell that is one of a plurality of cells, each cell configured to receive a bone anchor. The unit may be an open unit. The cell may be a closed cell.

The diaphyseal tubular structure may be expandable. The diaphyseal tubular structure may be configured to directly engage the first inclined member at the second diaphyseal position.

The second inclined member may be configured to transmit a compressive force in a radially outward direction with respect to a longitudinal axis of the bone to the first diaphyseal position. The diaphyseal member may be configured to transmit tension in a radially inward direction about a longitudinal axis of the bone to the first diaphyseal position.

The second inclined member and the diaphyseal member may be configured such that the radially outward force has substantially the same magnitude as the magnitude of the radially inward force.

The first and second inclined members may form a node. The first oblique member may be configured to transmit a compressive force from the first subchondral location to the node. The junction may be configured to transfer a first portion of the compressive force along the first inclined member to the second diaphyseal position. The junction may be configured to transfer a second portion of the compressive force to the first diaphyseal position along the second inclined member.

The first and second inclined members may be configured to form a node. The second oblique member may be configured to transmit a compressive force from the first subchondral location to the node. The junction may be configured to transfer a first portion of the compressive force along the first inclined member to the second diaphyseal position. The junction may be configured to transfer a second portion of the compressive force to the first diaphyseal position along the second inclined member.

The device may comprise and the method may involve a tubular implant for the bone.

The tubular implant may include: a first end configured to be hostingly coupled to the bone in a loaded position; and a second end configured to couple to the bone at a diaphyseal position. The diaphyseal position may pass from the loading position through the longitudinal bisecting plane of the bone.

The second end may terminate at a surface that is oblique to the length of the implant. The surface may be substantially parallel to a diaphyseal surface of the bone. The diaphyseal surface may be an outer cortical bone surface of the bone. The diaphyseal surface may bound an access hole in the cortical bone.

The tubular implant may include a tubular inner surface. The second end may include an anchor receiving structure in the tubular inner surface. The anchor receiving structure may be configured to receive an anchor. The anchor may be configured to penetrate cortical bone adjacent the anchor receiving structure and penetrate cortical bone passing through the longitudinal bisecting plane of the bone from the anchor receiving structure.

The tubular inner surface may define a pocket at the second end that receives a portion of the head of the anchor between an inner wall of the cortical bone and an outer wall of the cortical bone.

The tubular implant may include a tubular wall. The tube wall may define a first elongated window and a second elongated window. The second elongated window may be opposite the first elongated window. Each of the first and second elongated windows may be configured to receive a body of an anchor and engage with an engagement structure of the anchor.

The first and second elongated windows are configured to cooperatively support the anchor at an angle to the tubular implant, the angle defined by the angle at which the anchor enters the first elongated window.

The tubular implant may be expandable. The tubular implant may include a mesh of anchor receiving cells.

The device may include and the method may relate to a device for treating an end of a bone.

Some of the methods may include preparing an elongate subchondral cavity transverse to a longitudinal axis of the bone; expanding a mesh of anchor receiving units in the subchondral cavity; and engaging the mesh with an anchor anchored to a portion of the bone.

The expanding may include expanding a mesh having a central axis and a diameter that varies along the central axis.

The device may include and the method may involve the anchor receiving a bone support. The bone support may comprise a tubular wall. The tube wall may define a first elongated window. The tube wall may define a second elongated window. The second elongated window may be opposite the first elongated window. Each of the first and second elongated windows may be configured to be transverse to a body of the anchor. Each of the first and second elongated windows may be configured to engage with an engagement structure of the anchor.

The anchor may be a screw. The body may be a screw root. The engagement structure may be a screw threaded portion.

The first and second elongated windows may be configured to cooperatively support the anchor at an angle to the tubular implant. The angle may range from (a) perpendicular to the implant to (b) an angle defined by an outer diameter of the tubular implant, a radius of the anchor, and a longitudinal displacement between an end of the first elongated window and an end of the second elongated window.

The tube wall may be a first tube wall. The support may comprise a second tube wall. The second tube wall may include a transverse slot. The transverse slot may be configured to move to different positions along the first and second elongated windows. The transverse slot may be configured to be passed through by the body of the anchor and engaged with an engagement feature of the anchor.

The first tube wall may be nested inside the second tube wall. The second tube wall may be nested inside the first tube wall.

The first elongated window, the second elongated window, and the transverse slot may be configured to cooperatively support the anchor against rotation about a longitudinal axis of the first tubular wall. The first elongated window, the second elongated window, and the transverse slot may be configured to cooperatively support the anchor against rotation about a longitudinal axis of the second tubular wall.

The device may include and the method may involve cutting a tubular bone support. The cutting tubular bone support may include a web of tubular anchor receiving cells; and a serrated ring. The serrated ring may be configured to saw out an access hole. The access hole may be for delivering the bone bearing into the bone interior region.

The cutting tubular bone support may be configured to lock within the bone support frame after being delivered into the intramedullary space.

The cutting tubular support may comprise a non-porous tube longitudinally adjacent the tubular mesh.

The device may include and the method may involve a bone anchor base. The bone anchor base may include: a first elongate member comprising a first anchor receiving structure; a second elongate member comprising a second anchor receiving structure; and a coupling configured to resist separation of the second elongate member from the first elongate member in response to a lateral force.

The bone anchor base may include: a first elongate member comprising a first anchor receiving structural web; and a second elongate member comprising a second anchor receiving structural web. The second elongate member may be configured to be deployed in the interior region of the bone alongside the first elongate member.

If the elongate member is expandable, the delivery state diameter may be a contracted diameter. If the elongate member is not expandable, the delivery state diameter may be a static diameter.

The first elongate member may have a first delivery state diameter. The first elongate member may be configured to be delivered to the interior region through a guide tube having an inner diameter. The second elongate member may have a second delivery state diameter. The second elongate member may be configured to be delivered to the interior region through the guide tube. The sum of the first and second delivery state diameters may be greater than the inner diameter. The first and second elongated members may be sequentially deployed in the interior region. The sum of the first and second delivery state diameters may be less than the inner diameter. The first and second elongated members may be deployed in the interior region simultaneously.

The first elongated member may have a first longitudinal axis. The second elongated member may have a second longitudinal axis. The first and second elongated members may be deployed in the interior region such that the first and second longitudinal axes are substantially parallel.

The first and second elongated members may be members of a group of elongated members. The bone anchor base may have a central axis. The central axis may be the center of the set of elongate members.

The first elongated member may have a first longitudinal axis. The second elongated member may have a second longitudinal axis. If the first and second longitudinal members are expandable, the first and second longitudinal axes may be substantially conically arranged about the central axis when the first and second elongate members are expanded in the interior region.

The first web may include a first anchor receiving structure. The second web may include a second anchor receiving structure. The first and second anchor receiving structures may be sufficiently aligned with one another to engage a bone anchor penetrating the bone fragment.

Each member of the set may be configured to be deployed in the interior region of the bone alongside another member of the set.

The first member of the set may be configured to transfer a load from the first bone fragment to the second bone fragment via the second member of the set. The first and second members of the set may transmit loads via surface contact between the first and second members. The first and second members of the set may transmit loads via the coupling. The first and second members of the set may transmit load via the anchor.

The coupling may be configured to resist separation of the first and second elongate members by a bone anchor during transverse movement of the first and second elongate members.

The coupling may be configured to resist separation of the first and second elongate members by a bone anchor during loading of the first and second elongate members.

One or both of the first and second elongated members may be expandable.

One or both of the first and second elongated members may have a radius that varies along the length of the elongated member.

The first anchor receiving structure may include open cells located in an open cell web.

The first anchor receiving structure may include closed cells in a closed cell network.

The first anchor receiving structure may include a tubular portion. The tubular portion may define an anchor receiving slot. The tubular portion may define an anchor receiving aperture.

The bone anchor base may further include a plurality of elongated members in addition to the first and second elongated members. The coupling may be configured to resist separation of each of the plurality of elongate members, the first elongate member, and the second elongate member from another of the plurality of elongate members, the first elongate member, and the second elongate member.

One or more surfaces of the device may be coated with an agent that promotes bone in-growth. The formulations may include calcium phosphate, heat treated hydroxyapatite, basic fibroblast growth factor (bFGF) coated hydroxyapatite, hydroxyapatite/tricalcium phosphate (HA/TCP), and other suitable formulations, including one or more of those listed in table 1.

One or more surfaces of the device may be coated with an agent that inhibits or inhibits bone in-growth. These surfaces may include impermeable materials and other materials, such as one or more of those listed in table 1.

One or more surfaces of the device may be coated with a formulation that can elute a therapeutic substance, such as a drug.

The device and portions thereof may comprise any suitable material. Table 1 lists exemplary materials that may be included in the device and portions thereof.

TABLE 1 materials

The device may be provided as a kit that may include one or more of a structural support, an anchoring substrate, a central shaft member, an anchor, a delivery instrument, and associated articles.

The apparatus and method according to the present invention will now be described with reference to the accompanying drawings.

The drawings illustrate exemplary structures of apparatus and methods according to the principles of the invention. The apparatus and methods of the present invention may involve some or all of the exemplary structures. These structures are illustrated in the context of selected embodiments. 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. The steps of the exemplary method may be performed in an order different than that shown or described herein. Some embodiments may omit steps shown or described in connection with the exemplary method. Some embodiments may include steps not shown or described in connection with the exemplary methods. It is to be understood that the structures shown in connection with one of the embodiments may be implemented in accordance with the principles of the invention, along with the structures shown in connection with one or more other embodiments.

Fig. 1 shows an exemplary framework 100 in bone B. The bone frame 100 may be used to fracture fragments of bone relative to one another. In FIG. 1, bone B is shown as including a crack F_hAnd F_aThree fragments separated: p_b、P_hAnd P_a. The frame 100 may be used for two-part fractures, three-part fractures, or fractures having more than three parts.

The frame 100 may include a subchondral member 102. Subchondral member 102 may be used to support one or more bone fragments, such as P_hAnd P_a. Subchondral member 102 may include one or more anchor receiving structures, such as anchor receiving structure 104. An anchor (e.g., anchor 106) may anchor debris P_hAnd P_aIs secured to subchondral member 102.

Subchondral member 102 may include a mitered surface 108. Mitered surface 108 may be angled to align with surface S of bone B_bAnd (5) the consistency is achieved. Mitered surface 108 may define a "scoop" 110 at 112 of subchondral member 102. Scoop 110 may conform to an access hole (not shown) in bone B. The access hole may be opposite to the surface S_bAnd is angled. Scoop 110 may include an anchor receiving structure 114.

The anchor receiving structure 114 may face an inner wall of the access hole (not shown) such that the oblique anchor 116 may be driven into cortical bone surrounding the access hole through the anchor receiving structure 114. Scoop 110 may define a pocket in the cortical bone for receiving a portion or all of anchor head 118 of angled anchor 116.

Subchondral member 102 may traverse a longitudinal bisecting plane P1b from subchondral position S1 to subchondral position S₂。

The frame 100 may include a tilt member 120. The inclined member 120 may be moved from the subchondral position S₁Across a longitudinal bisecting plane P_1bTo the diaphyseal position D₂。

Inclined member 120 may be used to transfer loads from end bone fragments such as P_hTo long bone fragments such as P_b。

The inclined member 120 may include one or more anchor receiving structures such as anchor receiving structure 122. The inclined member 120 may be positioned at the subchondral location S by any suitable technique₁Is secured to subchondral member 102. For example, the inclined member 120 may be pinned to the subchondral member 102 by the anchor 106. Angle alpha₂May be selected for the location D of the inclined member 120 at the diaphysis₂Is correctly set.

The inclined member 120 may include a scoop 124. Scoop 124 may have one or more of the same structures as scoop 110.

The tilt anchor 116 may be a tilt member of the frame 100. The oblique anchor 116 may be moved from the subchondral position S₂Across a longitudinal bisecting plane P_1bTo the diaphyseal position D₁。

The tilt anchor 116 may be used to load the distal bone fragment (e.g., P)_a) To long bone fragments such as (P)_b）。

The tilt anchor 116 may intersect the tilt member 120 to form a junction 126. Node 126 may distribute loads from subchondral member 102 to diaphyseal position D₁(along the oblique anchor 116) and diaphyseal position D₂(along the inclined member 120).

The inclined member 120 may include a slot 128 and a slot 130 (not shown) opposite the slot 128. The slot 128 may have a width large enough to allow the root 131 of the tilt anchor 116 to pass through but small enough to engage the threaded portion 132 of the tilt anchor 116. The slot 130 may have a root 131 large enough to pass the oblique anchor 116 through but large enough to allow the oblique anchor to passIs small enough to engage the threaded portion 132 of the tilt anchor 116. The tilt anchor 116 may thereby be retained by the slots 128 and 130. The slot 130 may have a width large enough to pass the root 131 of the tilt anchor 116 and the threaded portion 132 of the tilt anchor 116. When the tilt anchor 116 is retained by the slots 128 and 130, the tilt member 116 may resist the in-direction α to a greater extent than when the tilt anchor 116 is retained by only one of the slots 128 and 130₁And-alpha₁The rotation of (2).

The diaphyseal anchor 134 may be positioned from diaphyseal position D₂Across a longitudinal bisecting plane P_1bTo the diaphyseal position D₁。

When the frame 100 is disposed on one or more bone fragments (e.g., fragment P)_hAnd fragment P_a) At time, the tilt anchor 116 may be at diaphyseal position D₁Exerts a radially outward force M₁. The inclined member 120 may be in the diaphyseal position D₂Exerts a radially outward force M₃. The diaphyseal anchors 134 may be passed through the diaphyseal locations D, respectively₁And D₂Exerts a radially inward force M₂And M₄While partially or completely forcing the radially outward force M₁And M₃And (4) balancing.

FIG. 2 shows a view of the frame 100 in bone B taken along line 2-2 (shown in FIG. 1).

FIG. 3 shows a view of the frame 100 in bone B taken along line 3-3 (shown in FIG. 1).

FIG. 4 shows a view of the frame 100 in bone B taken along line 4-4 (shown in FIG. 1).

Fig. 5 shows a view along line 5-5 (shown in fig. 4) of an exemplary subchondral access hole HS and oblique access hole HD in bone B. Access hole HS may be drilled at an angle β to bone axis LB. Access hole HD may be drilled at an angle γ to bone axis L. Any suitable method for drilling or sawing a hole may be used, including methods as shown and described in U.S. patent application publication No.2009/0182336a1 or U.S. patent application No.13/009,657.

Cortical bone BCO at diaphysis position D2 may provide a base for scoop 124 (shown in fig. 1). Cortical bone BCO at subchondral position S2 may provide a base for scoop 110 (shown in fig. 1).

Subchondral member 102 can be inserted into hole H_SIn (1). The inclined member can be inserted into the hole H_DIn (1). Tang 140 (shown in fig. 1), which may include an anchor through-hole, may be inserted into slot 402 (shown in fig. 4) of subchondral member 102. Anchor 142 (shown in FIG. 1) may be inserted to be at subchondral location S₁The inclined member 120 is pinned to the subchondral member 102.

The practitioner may choose to treat a particular crack using subchondral member 102, oblique member 120, oblique anchor 116, and not using diaphyseal anchor 134.

Fig. 6 shows an exemplary arrangement 600 of the components of the framework 100. The practitioner may choose to treat a particular crack using the arrangement 600. Arrangement 600 may include a tilt member 120, a tilt anchor 116, and a diaphyseal anchor 134. The anchor 106 may be received by a hole 602 in the tang 140.

Fig. 7 illustrates an exemplary translational anchor receiving structure 700 that may be used in conjunction with a framing element, such as the inclined member 120 (shown in fig. 1), or any other tubular framing element, such as a tubular framing element that may correspond to any of the framing elements shown in fig. 1.

The anchor receiving structure 700 may include an inner tube 702. The anchor receiving structure 700 may include an outer tube 704. Outer tube 704 may include an elongated window 706 and an elongated window 708. The elongated window 708 may be opposite the elongated window 706. Inner tube 702 may include transverse slot 710 and transverse slot 712. The transverse slot 712 may be opposite the transverse slot 710.

(a) The intersection of elongated window 706 with transverse slot 710 and (b) the intersection of elongated window 708 with transverse slot 712 may define two corresponding anchors, which may be large enough to allow an anchor root, such as 131 (shown in fig. 1), to pass through and small enough to engage an anchor threaded portion, such as 132 (shown in fig. 1).

Inner tube 702 may be slidable within outer tube 704 such that the transverse slots can be disposed at different positions relative to slot windows 706 and 708 to accommodate anchors at different positions. The two-tube construction may provide additional strength to the framing element.

Fig. 8 illustrates a cross-sectional view of the translating anchor receiving structure 700 taken along line 8-8 (shown in fig. 7).

Fig. 9 illustrates an exemplary bone support 900. Bone support 900 may be used in conjunction with one or more of the elements of frame 100 (shown in fig. 1). Bone support 900 may be used in bone B in an orientation corresponding to one of the orientations of the elements of frame 100.

Bone support 900 may include a non-porous tubular portion 902. Bone support 900 may include a web portion 904. Bone support 900 may include scoop 906. Bone support 900 may include one or more features similar to scoop 110.

Bone support 900 may have an overall length L_o. The imperforate tubular portion 902 may have a length L_s. The web portion 904 may have a length L_w. Length L_SAnd L_wMay have a length with respect to L_oAny suitable size. The imperforate tubular portion 902 and the web portion 904 may each occupy along the length L_oAny suitable location of (a). The non-porous tubular portion 902 and the mesh portion 904 may be arranged in any suitable order relative to one another.

Bone support 900 may include more than one non-porous tubular portion, such as non-porous tubular portion 902. Bone support 900 may include more than one web portion, such as web portion 904.

The web portion 904 may include cells such as cell 908. Unit 908 may receive a bone anchor, such as anchor 106 (shown in fig. 1).

Fig. 10 shows an exemplary implant 1000 in bone B. In FIG. 10, bone B is shown as including a crack F_hTwo fragments separated: p_bAnd P_h. Implant 1000 or portions thereof may be used in conjunction with two-part fractures, three-part fractures, or fractures having more than three parts.

Implant 1000 may include subchondral member 1002. Subchondral member 1002 may be used to support one or more fragments such as P_h. Subchondral member 1002 may include a mesh 1004. The mesh 1004 may include one or more anchor receiving structures. Anchors, such as anchor 1006, may secure fragment Ph to subchondral member 1002.

The anchor receiving structure 1008 may face an inner wall (not shown) of an access hole for the subchondral member 1002 such that the oblique anchor 1016 may be driven into cortical bone surrounding the access hole through the anchor receiving structure 1008. Subchondral member 1002 may define a pocket in the cortical bone for receiving a portion or all of anchor head 1018 of oblique anchor 1016.

Subchondral member 1002 may be moved from subchondral position S₁Across a longitudinal bisecting plane P_1b(shown in FIG. 1) to subchondral position S₂。

Implant 1000 may include oblique anchors 1020. The tilt anchor 1020 may be at diaphyseal position D₂Is engaged with diaphyseal member 1022. The oblique anchor 1020 may be in a subchondral position S₁Is engaged with subchondral member 1002. Tilt anchor 1020 may be positioned from diaphyseal position D₂Across a longitudinal bisecting plane P_1bTo the subchondral position S₁。

Tilt anchor 1020 may be in subchondral position S with tilt anchor 1016₂At diaphyseal position D in a manner similar to that of cortical bone₂Is engaged with cortical bone.

The tilt anchor 1020 may be used to transfer loads from an end bone fragment such as P_hTo long bone fragments such as P_b。

Tilt anchor 1016 may be moved from subchondral position S₂Across a longitudinal bisecting plane P_1bTo the diaphyseal position D₁. The inclined member 1016 may be in the diaphyseal position D₁Is engaged with diaphyseal member 1022.

Angled anchor 1016 may be used to direct loads from an end bone fragment such as P_hTo long bone fragments such as P_b。

Tilt anchor 1016 may be tilted with respect to tilt anchor 1020.

The diaphyseal member 1022 may be located from diaphyseal position D₂Across a longitudinal bisecting plane P_1bTo the diaphyseal position D₁. The diaphyseal member 1022 may include a mesh 1030. The mesh 1030 may include one or more anchor receiving structures, such as 1032.

Anchor receiving elements such as 1008, 1024, 1026 and 1028 may form a junction with the oblique anchor. The unit may be large enough to pass the root of the anchor and small enough to engage the threaded portion of the anchor. This may function as a pin joint, where the anchor may inefficiently or not transmit torque to the subchondral and diaphyseal members. Torque may be more efficiently transferred by configuring the anchors to penetrate through additional cells located in the subchondral member or diaphyseal member, such as cells disposed on different aspects of the respective subchondral member or diaphyseal member (e.g., spaced apart along a diameter or chord).

When implant 1000 is in one or more bone fragments, such as fragment P_hCan be in diaphyseal position D when loaded, tilt anchor 1016₁Exerts a radially outward force N₁. The tilt anchor 1020 may be at diaphyseal position D₂Exerts a radially outward force N₃. The diaphyseal member 1022 may be positioned at diaphyseal position D₁And D₂Exerts a radially inward force N₂And N₄While partially or fully balancing the radially outward force N₁And N₃。

One or both of subchondral member 1002 and diaphyseal member 1022 may be expandable.

One or both of the subchondral member 1002 and the diaphyseal member 1022 may be delivered into the interior of the bone B in a manner similar to the delivery of the subchondral member 102 and the diaphyseal member 134 (shown in fig. 1).

The practitioner may choose to treat a particular crack using subchondral member 1002, angled anchor 1020, angled anchor 1016, and not using diaphyseal member 1022.

Fig. 11 shows a view of implant 1000 in bone B taken along line 11-11 (shown in fig. 10).

Fig. 12A shows an exemplary implant 1200 in bone B. In FIG. 12A, bone B is shown as including a crack F_hTwo fragments separated: p_bAnd P_h. Implant 1000 or portions thereof may be used in conjunction with two-part fractures, three-part fractures, or fractures having more than three parts.

Implant 1200 may be used to support one or more bone fragments such as P_h. Implant 1200 includes web 1202. Web 1202 may include one or more anchor receiving structures such as unit 1203. Implant 1200 may include structural ring 1205. Web 1202 may expand away from or toward structural ring 1205. Web 1202 may expand both away and towards structural ring 1205. Structural ring 1205 may not be included in implant 1202. In such an embodiment, web 1202 may be expandable along the length of implant 1200.

An additional tubular mesh (not shown) may be disposed substantially coaxially within mesh 1202 to provide additional anchoring strength. An additional tubular mesh (not shown) may be disposed substantially coaxially about the mesh 1202 to provide additional anchoring strength. An additional tubular mesh (not shown) may be disposed coaxially within web 1202 about web 1202 to provide additional anchoring strength.

Anchors, such as anchor 1206, may secure fragment Ph to implant 1202 at one or more of the cells.

Implant 1200 may span a longitudinal bisecting plane P from anchor position S3_1b(shown in FIG. 1) to the diaphyseal position D₂. Implant 1200 may lie substantially in a longitudinal bisecting plane P_1bSubchondral position in (shown in fig. 1) spans to diaphyseal position D₂. Implant 1200 may be positioned so as not to pass through plane P_1bFrom a subchondral position to a diaphyseal position.

Implant 1200 may include anchor 1208. Anchor 1208 may be in diaphyseal position D₂To anchor the implant 1200 to cortical bone. Although anchor 1208 is shown as being disposed coaxially with web 1202, anchor 1208 may be passed at diaphyseal position D₂Transversely through the cortical bone and then engages the unit at the diaphyseal end 1210 of the web 1202 to anchor the implant 1200 to bone B.

Implant 1200 may include a bone for placement at diaphyseal position D₂Is anchored to cortical bone (not shown). Any suitable bracket may be used. For example, the carrier may have one or more structures similar to scoop 110 (shown in fig. 1). The bracket may have an anchor receiving structure that faces an inner wall (not shown) of an access hole for the implant 1200 such that an anchor (not shown) is driven into cortical bone surrounding the access hole through the anchor receiving structure.

The anchor 1208 may be axially oriented relative to the implant 1200. The anchors 1208 may engage a bracket (not shown) located at diaphyseal position D2 (which may be secured to cortical bone) and the diaphyseal end 1210 of the implant 1200 to secure the implant 1200 to cortical bone at diaphyseal position D2. The stem end 1210 may include a threaded bushing (not shown) for engaging the anchor 1208. The anchor 1208 may have threads for engaging a threaded bushing.

Implant 1200 may be used to transfer loads from an end bone fragment, such as Ph, to a long bone fragment, such as P_b。

Implant 1200 may be used to urge bone fragment Ph to bone fragment P at fracture F by tensioning mesh 1202 between anchors 1206 and 1208_bThe above.

The anchor receiving unit, e.g., 1203, may have one or more structures similar to the unit, e.g., 1008 (shown in fig. 10).

Implant 1200 may be delivered to the interior of bone B in a manner similar to the delivery of subchondral member 102 and diaphyseal member 134 (shown in fig. 1).

Fig. 12B shows an exemplary stabilizer 1220. Stabilizer 1220 may be at diaphyseal position D₂Or any other suitable location on bone B, to secure proximal end 1212 of implant 1200 to bone B. Stabilizer 1220 may include an elongated member 1232. Elongate member 1232 can extend from a proximal end of implant 1200 (not shown) to support collar 1222. The elongate member 1232 may extend along the wall of the access hole through which the implant 1200 is deployed. The elongated member 1232 may include a longitudinal axis L_EM. Longitudinal axis L_EMMay be substantially parallel to the central axis C of the bore_HAnd/or the longitudinal axis of the implant. The support collar 1222 may be supported at the opening of the bore. The support collar 1222 may include a surface substantially parallel to the bone surface B_S(shown in FIG. 12A) longitudinal axis L_BC。

Stabilizer 1220 can include a channel configured to receive an anchor (e.g., driven into bone surface B)_SInner anchor 1224) of the anchor receiving structure (not shown).

Proximal end 1212 of implant 1200 may be secured to bone B using any other suitable means.

Fig. 13 shows a view of implant 1200 in bone B taken along line 13-13 (shown in fig. 12). Anchor 1302 penetrates web 1202 at cell 1304. Anchor 1302 exits web 1202 at cell 1306. Engagement with web 1202 at two different cells may provide additional stability to anchor 1302. Engagement with web 1202 at two different cells may allow torque to be transferred between web 1202 and anchor 1302. Anchors 1308 may also enter into one cell, pass inside of web 1202 and exit web 1202 at a different cell.

Web 1202 includes cells that face radially along the length of implant 1200 such that anchors 1302 and 1308 can be arranged at a range of angles to each other.

Fig. 14 shows an implant 1400. Implant 1400 may include a non-porous tubular portion 1402. Implant 1400 may include web portion 1404. Implant 1400 may include saw portion 1406.

The distal end 1408 of the implant 1400 may be engaged with a rotation source, such as a drill handle (not shown), to rotate the implant 1400 about its longitudinal axis. The rotation source may comprise a manual handle. The rotation source may comprise a motorized drill motor. When rotated, teeth 1410 may cut into a bone, such as B (shown in fig. 1) to provide an access hole to the interior of bone B.

The mesh portion 1404 may be disposed in the interior. Non-porous tubular portion 1402 may be disposed within the interior. Anchor receiving element 1412 may receive bone fragments (e.g., P)_B、P_aAnd P_hOne or more) anchors secured to the implant 1400.

Implant 1400 may be deployed in any suitable location in bone B. For example, implant 1400 may span from subchondral position S1 to subchondral position S₂. Implant 1400 may span from one of the subchondral locations to diaphyseal location D₁And diaphysis position D₂One of them. The implant 1400 may span from one of the diaphyseal positions to another of the diaphyseal positions.

Implant 1400 may be used as one or more elements of frame 100 (shown in fig. 1). Implant 1400 may be used as one or more of the elements of implant 100 (shown in fig. 10).

The distal portion 1408 may include a scoop (not shown). The scoop may have one or more structures similar to scoop 110 (shown in fig. 1).

Implant 1400 may have an overall length L_p. Imperforate tubular portion 1402 may have a length L_t. The webbed portion 1404 may have a length L_x. Length L_tAnd L_xMay have a length with respect to L_pAny suitable size. The imperforate tubular portion 1402 and the web portion 1404 may each occupy along the length L_pAny suitable location of (a). The imperforate tubular portion 1402 and the web portion 1404 may be arranged in any suitable order relative to each other.

The implant 1400 may include more than one non-porous tubular portion, such as non-porous tubular portion 1400. Implant 1400 may include more than one web portion, such as web portion 1404.

The peripheral teeth 1414 may retain a plug (plug) of bone B. The bone pegs may be removed after cutting the access holes. The plug may be left on the inside of the implant 1400 to promote healing. Tissue other than the plug may be cored out of or held inside the implant 1400 and left inside the implant 1400 to promote healing.

Fig. 15 shows an exemplary dual network 1500. Dual net 1500 may include an outer net 1502. Dual net 1500 may include an inner net 1504. Dual mesh 1500 may be included in a tubular implant, such as implant 900 (shown in fig. 9), implant 1000 (shown in fig. 10), implant 1200 (shown in fig. 12), implant 1400 (shown in fig. 14), and any other suitable implant.

The outer net 1502 may be expandable. Inner web 1504 may be expandable.

Outer net 1502 and inner net 1504 may include anchor receiving units, such as 1506 and 1508, respectively. Cells 1506 may have a uniform cell density along the length of web 1502. Cells 1506 may have varying cell densities along the length of web 1502. Cells 1508 may have a uniform cell density along the length of web 1504. Cells 1508 may have a varying cell density along the length of web 1504. The cell density along web 1502 may be the same or different than the cell density along web 1504.

Anchors (not shown) that penetrate mesh 1502 may also penetrate mesh 1504. Anchors may engage the mesh 1502 at the entry and exit cells. Anchors may engage web 1504 at the entry and exit units. The anchor may thus engage the twin mesh 1500 at 1, 2, 3 or 4 cells. As the number of engagements increases, the fixing strength of the anchor to the double net 1500 increases. As the distance between engagements increases, the strength of the anchor fixation to the double net 1500 increases.

Outer mesh 1502 and inner mesh 1504 may be held in a substantially coaxial configuration by a bushing, interface, collar, or any other suitable mechanism.

FIG. 16 shows a view of twin web 1500 taken along line 16-16 (shown in FIG. 15).

Some embodiments may include an implant (which includes an inner web 1504). Inner web 1504 may be expandable. When inner web 1504 is in the expanded state, it may have a larger diameter than when it is in the contracted state. The view shown in FIG. 16 shows a diameter D that may correspond to a contracted diameter and an expanded diameter, respectively_cAnd D_e。

Fig. 17 shows an exemplary implant 1700 in bone B. In FIG. 17, bone B is shown as including a crack F_hTwo fragments separated: p_bAnd P_h. Implant 1700 or portions thereof may be used in conjunction with two-part fractures, three-part fractures, or fractures having more than three parts.

Implant 1700 may include a mesh 1704. The net 1704 may include one or more anchor receiving structures.

Implant 1700 may include one or more additional webs. The one or more additional nets may be internal or external to the net 1704. The one or more additional webs may provide additional anchor engaging structures. This additional engagement structure may provide additional strength to the engagement of the anchor with implant 1700.

The anchor receiving structure may include a cell such as cell 1702. An anchor (e.g., anchor 1706) can anchor debris P_hAnd P_bSecured to implant 1700.

Implant 1700 may be moved from subchondral position S₂Across a longitudinal bisecting plane P_1b(shown in FIG. 1) to subchondral position S₁。

Oblique anchor 1708 may engage mesh 1704 of implant 1700. Tilt anchor 1708 may be at diaphyseal position D₂Is engaged with cortical bone. Tilt anchor 1708 may be from diaphyseal position D₂Across a longitudinal bisecting plane P_1bTo net 1704. Tilt anchor 1708 may not be from diaphyseal position D₂Across a longitudinal bisecting plane P_1bTo net 1704.

When one or more additional meshes are disposed in implant 1700, anchor 1708 may be engaged with the one or more additional meshes.

Angled anchor 1708 may be used to load from an end bone fragment such as P_hTo long bone fragments such as P_b。

Implant 1700 may be delivered to the interior of bone B in a manner similar to the delivery of subchondral member 102 and diaphyseal member 134 (shown in fig. 1).

Implant 1700 may include central shaft member 1710. Implant 1700 may include proximal base 1712. Implant 1700 may include a distal base 1714. Displacement of proximal base 1712 axially away from distal base 1714 may cause web 1704 to retract toward central axis member 1710. Displacement of proximal base 1712 axially toward distal base 1714 may cause web 1704 to expand away from central axis member 1710.

At a particular axial location on the mesh 1704, the mesh 1704 may have a cell density around the circumference of the mesh 1704. The cell density may be different for different axial positions on the web 1704. Thus, the web 1704 may have an expansion radius that varies axially across the web 1704. Implant 1700 may thus have a shape defined by the cell density along mesh 1704. The shape may be non-cylindrical.

Any suitable broach may be used to shape the cavity of the inner side of bone B to follow the non-cylindrical shape of implant 1700.

Fig. 18 shows an exemplary instrument guide 1800 disposed at site H' on bone B. H 'is shown as a diaphyseal position, but H' can also be used to drill an access hole (e.g., H)_s(shown in fig. 5)) of the subchondral position.

The broach head 1824 may be resilient such that the broach head forces cancellous bone B_CABut not cortical bone B_CODisplacement, even at cracks where sharp cortical bone projections may be present. Broach head 1824 may be delivered through introducer 1800 to target region R of intramedullary space IS_t. Target region R_tShown in cancellous bone B_CAInside, but can be located in cancellous bone B_CAAnd cortical bone B_COEither or both. Side template 1830 and top template 1832 are aligned with guide tube 1820. Arm 1831 may support template 1830. The practitioner can set templates 1830 and 1832 such that templates 1830 and 1832 "project" onto target region R_tSo that the introducer 1800 guides the broach head 1824 to the target region R_tIn (1).

The template 1830 may include a blade profile 1834 and a shaft profile 1836 for projecting the "swept" area of the broach head 1824 and the position of the shaft-like structure 1825, respectively. The template 1832 may include a blade profile 1838 and a shaft profile 1840 for projecting the "swept-out" area of the broach head 1824 and the location of the shaft-like structure 1825, respectively. Templates 1830 and 1832 may be configured to project the shape of any suitable instrument that may be deployed, such as a drill, coring saw, prosthetic device, or any other suitable instrument.

Fluorescence imaging can be used to map templates 1830 and 1832 relative to target region R_tAnd (6) positioning.

Broach head 1824 may be rotated within intramedullary space IS to clear intramedullary bone material so that a prosthetic device may be implanted. Broach head 1824 may be driven and supported by broach control portion 1826 and broach sheath 1827.

The introducer 1800 may include a base 1802. Alignment members 1804 and 1806 may extend from base 1802 to center introducer centerline CL of introducer 1800_GBone center line CL from the top surface of bone B_BSAnd (6) aligning. One or both of alignment members 1804 and 1806 may be elastic. One or both of alignment members 1804 and 1806 may be rigid.

Alignment members 1804 and 1806 (not shown) may slide relatively freely along the surface of bone B. Introducer 1800 may include contacts 1808 and 1810, and contacts 1808 and 1810 may be along centerline CL_BSEngaging bone B. The contacts 1808 and 1810 may extend from a bottom surface (not shown) of the introducer 1800. Contacts 1808 and 1810 may prevent introducer centerline CL_GRotated to be in line with the bone centerline CL_BSOut of alignment.

The contacts 1808 and 1810 may ensure that the introducer 1800 is aligned with the surface of the bone B, as the two contact points may be stable on uneven surfaces, even if 3, 4, or more contacts are unstable.

Introducer 1800 may include lateral cleats 1812 and 1814 (not shown). Lateral cleats 1812 and 1814 may engage the surface of bone B to prevent introducer 1800 from rotating about introducer centerline CL_GRotating in the direction theta. Lateral cleats 1812 and 1814 may be resilient to allow some sliding over bone B.

When the practitioner places the introducer 1800 on bone B, the alignment members 1804 and 1806 may be the first component of the introducer 1800 to engage bone B. Alignment members 1804 and 1806 may engage introducer centerline CL before contacts 1808 and 1810 and cleats 1812 and 1814 engage bone B_GBrought to the center line CL of the bone_BSAnd (6) aligning. Subsequently, in some embodiments, cleats 1812 and 1814 may engage bone B to inhibit rotation in direction θ. Subsequently, in some embodiments, the contacts 1808 and 1810 may follow the bone centerline CL_BSEngaging bone B. The contact portions 1808 and 1810 may have sharp points to provide alignment to the introducer centerline CL_GAnd the bone center line CL_BSFurther resistance to misalignment. In some embodiments, there may be no more than two contacts (e.g., 1808 and 1810) to ensure contact with the bone centerline CL_BSIn a straight line.

The introducer 1800 may include a stem 1816 and a grip 1818. The practitioner can manually grasp the grip 1818. In some embodiments, a torque limiter (not shown) may be provided to limit the torque that a practitioner can apply to the contact portions 1808 and 1810 via the grip 1818.

Guide tube 1820 may receive and guide any suitable instrument. Guide tube 1820 may be oriented at an angle α to handle 1816. In some embodiments, the angle α may be fixed. In some embodiments, the angle α may be adjustable. In some embodiments, templates 1830 and 1832 may be fixed relative to guide tube 1820. In some embodiments (including some embodiments in which a is adjustable and some embodiments in which a is non-adjustable), guide tube 1820 may be oriented such that axis L of guide tube 1820_GTAt an axis L with the stem 1816_HIntersecting bone B at substantially the same location. The grip 1818 will thus be disposed directly on the center of the hole site H'.

The introducer 1800 may include channels 1842 and 1844 (not shown). Rods 1846 and 1848 may be inserted through cortical bone B via passages 1842 and 1844, respectively_CO. Rods 1846 and 1848 may stabilize the introducer on bone B. Rods 1846 and 1848 may be K-wire. Rods 1846 and 1848 may be inserted using a wire drill.

Fig. 19 shows an exemplary mesh 1900. Mesh 1900 may represent a mesh that may be used in conjunction with the implants shown and described herein. For example, a mesh (e.g., mesh 1900) may be included in implant 900 (shown in fig. 9), implant 1000 (shown in fig. 10), implant 1200 (shown in fig. 12), implant 1400 (shown in fig. 14), implant 1700 (shown in fig. 17), and any other suitable implant.

Web 1900 may include one or more cells, such as cell 1902. Cell 1902 is configured to receive anchor 1904. Anchor 1904 may have one or more structures similar to anchors, such as anchors 106, 116, and 134 (shown in fig. 1), 1006, 1016, and 1020 (shown in fig. 10), 1206, and 1208 (shown in fig. 12), and any other suitable anchor.

Cell 1902 may have an opening large enough to allow anchor root 1906 to pass through cell 1902 without causing cell 1902 to deform when anchor 1904 is oriented perpendicular to cell 1902. Such a unit may be referred to as an "open unit". If anchor 1904 were to penetrate cell 1902 at an oblique angle such that there was a smaller opening in a plane perpendicular to anchor 1904 than the entire opening of cell 1902, cell 1902 may be deformed to accommodate root 1906.

Cell 1902 may be opened by expansion from a closed body. Cell 1902 may be manufactured in an open state. The cell 1902 may be implanted in bone B (shown in fig. 2) in an open state. Cell 1902 may be implanted in bone B (shown in fig. 2) in a closed state. Cell 1902 may expand after deployment into bone B.

Fig. 20 shows an exemplary tubular mesh 2000. (the web 2000 may be about the axis L_wCylindrical shape of (2). Only the web 2000 is shown lying on the axis L_wA portion of the front). The net 2000 mayRepresentative of meshes that may be used in conjunction with the implants shown and described herein. For example, a mesh (e.g., mesh 2000) may be included in implant 900 (shown in fig. 9), implant 1000 (shown in fig. 10), implant 1200 (shown in fig. 12), implant 1400 (shown in fig. 14), implant 1700 (shown in fig. 17), and any other suitable implant.

The mesh 2000 may include one or more cells, such as cell 2002. The unit 2002 is configured to receive an anchor, such as 1904 (shown in fig. 19).

The cell 2002 may have an opening large enough to allow the anchor root 1906 to pass through the cell 2002 without causing deformation of the cell 2002 when the anchor 1906 is oriented perpendicular to the cell 2002. Such a cell may be referred to as a "closed cell". If the anchor 2004 were to penetrate the cell 2002 at a perpendicular angle such that there is a full opening of the cell 2002 in a plane perpendicular to the anchor 1904, the cell 2002 would have to deform to accommodate the root 2006.

The cell 2002 may have a mechanically balanced state in which the cell 2002 is closed. The unit 2002 may be deployed in bone B (shown in fig. 2) in a closed, mechanically balanced state. Unit 2002 may be used to secure bone fragments by receiving anchors. The anchor may be an anchor having a root but no anchor engaging structure (e.g., k-wire). The cell 2002 may have a mechanically balanced state in which the cell 2002 is open.

Both the open and closed cells may be engaged with anchors having roots oriented at a wide range of angles with the cells. Since the closure unit must deform to receive the root anchor, the closure unit may require more support from the "rear" to engage with the anchor.

Fig. 21 illustrates an exemplary guide 2100. Introducer 2100 may be used to deploy one or more implants in bone B. The implant may be deployed in an access hole, such as one or more of the access holes shown in fig. 5, described herein in connection with the implant, or any other suitable access hole. For example, introducer 2100 may be used to deploy one or more implants, such as one or more of frame 100 (shown in fig. 1), implant 900 (shown in fig. 9), implant 1000 (shown in fig. 10), implant 1200 (shown in fig. 12), implant 1400 (shown in fig. 14), implant 1700 (shown in fig. 17), and any other suitable implant elements.

For simplicity, cracks such as F are not shown_hAnd F_a(shown in FIG. 2). Bone fragments such as P_b、P_aAnd Ph (shown in fig. 2) may be temporarily reduced using a k-wire prior to implantation of the implant using introducer 2100.

The introducer 2100 may include an articulated frame 2102. Frame 2102 can include a reference arm 2104. Frame 2102 can include reference arm 2106. Reference arm 2104 may be hinged to reference arm 2106 at hinge 2107. Reference arm 2104 may support guide tube 2108. Reference arm 2104 may support guide tube 2109. Reference arm 2106 may support guide tube 2110. Reference arm 2106 may support guide tube 2112.

Introducer 2100 may be configured to mount element E of an exemplary bone frame₁、E₂And E₃. Element E₁、E₂And E₃May correspond to a frame element of a frame, such as frame 100 (shown in fig. 1). Element E₁And E₂Can be connected at a joint J₁Where they intersect.

Reference arm 2104 can be formed by placing guide tube 2108 with element E₁Coaxially align and connect guide tube 2109 with joint J₁Aligned with element E₁And (6) aligning.

Anchors such as A₁May be deployed through guide tube 2109. Anchors such as A₂May be deployed through a guide tube (not shown) supported at one of the locations 2114. Each of the locations 2114 may be aligned with a corresponding one of the anchor receiving structures 2116.

Reference toArm 2106 can be moved an angle δ to align guide tubes 2110 and 2112 for element E, respectively₂And E₃Deployment of (3).

Element E₃Can be advanced to receive structure R with an anchor₀And (4) bonding. Anchor receiving structure R₀One or more of anchor receiving structure 122, anchor receiving structure 700, anchor receiving structure 1008, anchor receiving structure 1032, anchor receiving structure 1203, cell 1902, cell 2002, anchor receiving structure 2116, and any other suitable anchor receiving structure may be included.

Fig. 22 illustrates an exemplary introducer 2200. Introducer 2200 may be used to deploy one or more anchors into bone B. For example, introducer 2200 may be used to deploy one or more anchors for an implant (e.g., one or more of the elements of frame 100 (shown in fig. 1), implant 900 (shown in fig. 9), implant 1000 (shown in fig. 10), implant 1200 (shown in fig. 12), implant 1400 (shown in fig. 14), implant 1700 (shown in fig. 17), and any other suitable implant).

For simplicity, cracks (e.g., F) are not shown_hAnd F_a(shown in fig. 2)). The k-wire may be used to fragment bone (e.g., P) prior to implantation of an implant using introducer 2100_b、P_aAnd P_h(shown in fig. 2)) is temporarily decreased.

The k-wire may be used to drill pilot holes through bone fragments. The King wire may be connected to the anchor receiving structure (e.g., at element E)₄The anchor receiving structure R) are aligned. The k-wire may be threaded through the anchor receiving structure. The k-wire may be threaded through a portion of the bone B distal (relative to the anchor) from the anchor receiving structure. Hollow anchors (e.g., hollow anchor A)₃) May then be introduced into the guide hole along the kirschner wire. Hollow anchor A₃May be advanced into engagement with the anchor receiving structure. Hollow anchor A₃Can be advanced to interface with the distal bony portionAnd (6) mixing. Hollow anchor A₃May thereby be deployed to secure one or more bone portions to one another. Hollow anchor A₃Can be deployed thereby to secure one or more bone portions to element E₄The above.

Introducer 2200 can include a base 2202. Base 2202 may support pin 2204. Pin 2204 may be coupled to element E₄And coaxially engaged. Base 2202 may support rail 2206. The sliding guide 2208 can slide up and down on the guide rail 2206. End support 2212 may support rail 2206 opposite base 2202. Guide holes 2210 may be provided in the sliding guide 2208. Base 2202, pin 2204, and rail 2206 may be configured such that the guide hole and anchor receiving structure R₁And (6) aligning.

Anchor receiving structure R₁One or more of anchor receiving structure 122, anchor receiving structure 700, anchor receiving structure 1008, anchor receiving structure 1032, anchor receiving structure 1203, cell 1902, cell 2002, anchor receiving structure 2116, and any other suitable anchor receiving structure may be included.

The pilot hole 2210 may have one or more of a direction, length, width, and diameter selected based on the relative positions of the base 2202, the pin 2204, and the rail 2206 to align the K wire on the K wire₁Constraining Kirschner wire K while advancing through bone B₁Top end T and anchor receiving structure R of₁And (4) intersecting. The sliding guide 2208 is movable along the rail 2206 to accommodate different sized elements E4 and anchor receiving structures R₁Along the element E₄At different positions of the length of (a).

Base 2202 may be used to maintain sliding guide 2208 away from element E₄And faces the element E₄While pivoting relative to pin 2204 at a fixed radius. Base 2202 may pivot relative to pin 2204 while maintaining sliding guide 2208 at a fixed radius away from and facing anchoring structure R.

Base 2202 may include one or more pinsThe receiving portion 2214. Pin 2204 can be based on factors (e.g., element E)₄The angle relative to the long axis of the bone B and other suitable factors), the soft tissue thickness, the clearance of the associated device, and other operational considerations are arranged in a suitable one of the receptacles 2214.

One or more of the receivers 2214 may be used to support secondary alignment arms (not shown), bushing supports (not shown), or other secondary devices.

Fig. 23 illustrates an exemplary guide 2300. Guide 2300 may be used to deploy one or more anchors in bone B (shown in fig. 2). The anchor may be a k-wire, a screw, or any other suitable anchor. For example, guide 2300 may be used to deploy one or more anchors for an implant (e.g., one or more of the elements of frame 100 (shown in fig. 1), implant 900 (shown in fig. 9), implant 1000 (shown in fig. 10), implant 1200 (shown in fig. 12), implant 1400 (shown in fig. 14), implant 1700 (shown in fig. 17), and any other suitable implant).

Guide 2300 may include one or more bases, such as base 2302. Base 2302 can include provisions for supporting an implant, e.g., implant E perpendicular to base 2302₅The receiving unit 2304. Implant E₅May be illustrated as a coring implant. Implant E₅Coring teeth C may be included. Implant E₅May include an anchor receiving structure R₂. Implant E₅May include an anchor receiving structure R₃. Implant E₅Any suitable number and type of anchor receiving structures may be included. For example, the anchor receiving structure R₂And R₃One or more of anchor receiving structure 122, anchor receiving structure 700, anchor receiving structure 1008, anchor receiving structure 1032, anchor receiving structure 1203, cell 1902, cell 2002, anchor receiving structure 2116, and any other suitable anchor receiving structure may be included.

Base 2302 can support implant E parallel thereto₅A supported directional reference arm 2306.

Reference arm 2308 can include a guide hole 2308.

Base 2302, receiver 2304 and reference arm 2306 can be configured such that guide hole 2308 and anchor receiving structure R₂And R₃Are aligned.

Guide hole 2308 may have one or more of a direction, length, width, and diameter selected based on the relative positions of base 2302, receiver 2304, and reference arm 2306 to constrain K₂And K₃Top end T of₂And T₃And implant E₅Is aligned to facilitate the k-wire with the anchor receiving structure R₂And R₃And (4) intersecting.

Base 2302 can maintain reference arm 2306 away from element E₅And faces the element E₅While at a fixed radius relative to the implant E₅Pivoting. Base 2302 can maintain reference arm 2306 away from anchoring structure R₂And R₃And faces the anchoring structure R₂And R₃While at a fixed radius relative to the implant E₅Pivoting.

The elements 2302 'and 2302' can represent the base 2302 relative to the anchor receiving structure R₂And R₃Alternating circumferential positions of. For example, element 2302' is shown at an angle η circumferentially distal from base 2302. Alternatively, elements 2302' and 2302 "may represent embodiments of guide 2300 that include one, two, or more than two bases. In these embodiments, bases 2302, 2302', 2302 ″, may share receptacle 2304. In some embodiments, one or more of bases 2302, 2302', 2302 "may be circumferentially fixed relative to another of the bases. In some embodiments, one or more of bases 2302, 2302', 2302 ", can be hinged and circumferentially displaceable relative to another of the bases.

Fig. 24 illustrates an exemplary multi-element implant 2400. Implant 2400 may include two or more elongate elements. Implant 2400 is illustrated as including 5 elements: 2402. 2404, 2406, 2408 and 2410. One, some, or all of elements 2402, 2404, 2406, 2408, and 2410 may have a structure similar to elements of an implant, such as truss 100 (shown in fig. 1), implant 900 (shown in fig. 9), implant 1000 (shown in fig. 10), implant 1200 (shown in fig. 12), implant 1400 (shown in fig. 14), implant 1700 (shown in fig. 17), and any other suitable implant. For example, one, some, or all of elements 2402, 2404, 2406, 2408 and 2410 may include a web of anchor receiving cells. One, some, or all of elements 2402, 2404, 2406, 2408, and 2410 may be expandable. One, some, or all of elements 2402, 2404, 2406, 2408, and 2410 may be non-expandable.

Elements 2402, 2404, 2406, 2408 and 2410 may provide structural strength to implant 2400. Elements 2402, 2404, 2406, 2408 and 2410 may each provide an anchor receiving structure for implant 2400. In embodiments of implant 2400 in which elements 2402, 2404, 2406, 2408 and 2410 include webs of anchor-receiving cells, an anchor (e.g., 1904 (shown in fig. 19)) may engage 1, 2, 3, 4 or more cells along a linear path. As the number of engagement units increases, the ability of implant 2400 to transmit tensile forces axially along the anchor and bending torques perpendicular to the axis of the anchor increases.

Implant 2400 may include retainer 2410. Retainer 2410 may maintain accessibility of elements 2402, 2404, 2406, 2408 and 2410. Retainer 2410 may include a ring 2412. Rings 2412 may be placed in elements 2402, 2404, 2406, 2408 and 2410 in the vicinity of strain relief cuts 2414. Bone pegs 2416 can be placed into the ends of elements 2402, 2404, 2406, 2408 and 2410 to expand the ends and hold ring 2412 in place. Rings 2412 can be fixed relative to each other to retain the ends of elements 2402, 2404, 2406, 2408 and 2410.

Implant 2400 may include retainer 2418. Retainer 2418 may maintain accessibility of elements 2402, 2404, 2406, 2408 and 2410 at a location longitudinally spaced from retainer 2410.

Fig. 25 shows a view of implant 2400 taken along line 25-25 (shown in fig. 24). Retainer 2418 may be along longitudinal axis L of implant 2400_MAnd (4) setting. Retainer 2418 may include radial arms 2420 that extend along radius R and through radially inner and outer slots 2422 and 2424 in elements 2402, 2404, 2406, 2408 and 2410.

Radial arms 2420 may include recesses (not shown) adjacent radially inner slots 2422 that retain portions of elements 2402, 2404, 2406, 2408 and 2410 at maximum radial positions. Radial arms 2420 may include recesses (not shown) adjacent radially outer slots 2424 that retain portions of elements 2402, 2404, 2406, 2408 and 2410 at maximum radial positions. Radial arms 2420 for an expandable element may include recesses corresponding only to inner slots 2422 to allow radially outer portions of the element to move away from axis L during expansion_MAnd (4) shifting. As the element contracts, the recess corresponding to the inner slot 2422 may be displaced radially outward from the slot to accommodate expansion of the element.

Fig. 26 shows an embodiment of implant 2500 in which elements 2402, 2404, 2406, 2408 and 2410 can expand inside bone B. To illustrate the expanded state of implant 2500, implant 2500 is shown without retainers 2410 and 2418. Elements 2402, 2404, 2406, 2408 and 2410 may include an expandable mesh (e.g., mesh 1704). The web may include a density along the axis L_MA modified anchor receiving unit (not shown) such that at proximal end 2602, the overall diameter of implant 2500 is not as large as the overall diameter at distal end 2604. For two or more of elements 2402, 2404, 2406, 2408 and 2410, the cell density is along longitudinal axis L_MMay be the same. For two or more of elements 2402, 2404, 2406, 2408 and 2410, the cell density is along the verticalTo the axis L_MThe variations in (c) may be different.

The implants shown and described herein (e.g., frame 100 (shown in fig. 1), implant 900 (shown in fig. 9), implant 1000 (shown in fig. 10), implant 1200 (shown in fig. 12), implant 1400 (shown in fig. 14), implant 1700 (shown in fig. 17), and any other suitable implant shown and described herein) may be used in any bone, such as bone B (shown in fig. 5). Table 2 includes bones S that may correspond to bones B_iPartial list of (a). Bone B may correspond to any long bone.

TABLE 2 bone S_i

Bone	Reference numerals in fig. 27
		Radius of distal end	S0
Humerus bone	S1
		Radius of proximal extremity and ulna (elbow)	S2
Metacarpal bone	S3
		Clavicle	S4
Ribs	S5
		Vertebra of spine	S6
Ulna bone	S7
		Hip bone	S8
Femur	S9
		Tibia bone	S10
Fibula	S11
		Metatarsal bone	S12

Fig. 27 shows a schematic skeleton S. Bones S include exemplary bone S_i。

Fig. 28 schematically shows the anatomy of bone B (shown in fig. 5). The anatomy of bone B is listed in table 3. Devices and methods according to principles of the present invention may involve one or more of the anatomical structures shown in table 3. The structure of the bone B can be referred to the bone axis L_B(wherein B represents bone) and a radius R_B(wherein B represents a bone).

TABLE 3 anatomical structures of some of the bone types that can be treated by the devices and methods

Anatomical structure	Reference numerals in fig. 28
		Articular surface	B0
Cancellous, spongy or trabecular bone	B1
		Medullary cavity	B2
Cortical or high density bone	B3
		Periosteum	B4
Proximal articular surface	B5
		Backbone or mid-section	B6
Metaphysis or end region	B7
		Epiphysis	B8
Articular surface	B9

The terms "end bone" and "end bone fracture" may be used to refer to fractures occurring in the epiphyseal or metaphyseal region of a long bone. These fractures include periarticular and intra-articular fractures.

Accordingly, devices and methods for fracture repair have been provided. It will be appreciated by those skilled in the art that the present invention can be practiced in embodiments other than the described embodiments, which are presented for purposes of illustration and not of limitation. The invention is limited only by the following claims.

Claims (63)

1. A bone frame comprising elongate members, each of the elongate members configured to:

substantially completely inserted into the bone; and then, subsequently,

locking to another of the elongated members, the elongated members defining a triangular area inside the bone.

2. The truss of claim 1 wherein the elongated members include subchondral members.

3. The truss of claim 2 wherein:

the bone defines a bisecting longitudinal plane; and

the elongate member further includes a first oblique member configured to span from a first subchondral location to a second diaphyseal location that is obliquely transverse to the bisecting longitudinal plane from the first subchondral member.

4. The truss of claim 3 wherein the elongated member further includes a second angled member configured to span from a second subchondral location to a first diaphyseal location, the first diaphyseal location being obliquely transverse to the plane from the second subchondral location.

5. The truss of claim 4 wherein the subchondral member is tubular.

6. The truss of claim 5 wherein the first inclined member is tubular.

7. The truss of claim 4 wherein the elongated members further include a diaphyseal member spanning from the first diaphyseal position to the second diaphyseal position.

8. The truss of claim 7 wherein the subchondral member includes a subchondral tubular structure.

9. The truss of claim 8 wherein the subchondral tubular structure includes a cell that is one of a plurality of cells, each cell configured to receive a bone anchor.

10. The truss of claim 9 wherein the cells are open cells.

11. The truss of claim 10 wherein the cells are closed cells.

12. The truss of claim 9 wherein the subchondral tubular structure is expandable.

13. The truss of claim 8 wherein:

the first inclined member comprises an inclined tubular structure; and

the angled tubular structure is configured to directly engage the subchondral tubular structure at the first subchondral location.

14. The truss of claim 8 wherein the diaphyseal member comprises a diaphyseal tubular structure.

15. The truss of claim 14 wherein the diaphyseal tubular structure includes a cell that is one of a plurality of cells, each cell configured to receive a bone anchor.

16. The truss of claim 15 wherein the cells are open cells.

17. The truss of claim 16 wherein the cells are closed cells.

18. The truss of claim 15 wherein the diaphyseal tubular structure is expandable.

19. The truss of claim 14 wherein the diaphyseal member is configured to directly engage the first inclined member at the second diaphyseal position.

20. The truss of claim 14 wherein:

the second inclined member is configured to transmit a compressive force in a radially outward direction relative to a longitudinal axis of the bone to the first diaphyseal position; and

the diaphyseal member is configured to transmit tension in a radially inward direction relative to the longitudinal axis to the first diaphyseal position.

21. The truss of claim 20 wherein the second diagonal member and the diaphyseal member are configured such that the radially outward compressive force has substantially the same magnitude as the radially inward tensile force.

22. The truss of claim 19 wherein:

the first and second inclined members can be configured to form a node;

the first oblique member is configured to transmit a compressive force from the first subchondral location to the node; and is

The node is configured to:

transmitting a first portion of the compressive force to the second diaphyseal position along the first inclined member; and

transmitting a second portion of the compressive force to the first diaphyseal position along the second inclined member.

23. The truss of claim 19 wherein:

the first and second inclined members can be configured to form a node;

the second oblique member is configured to transmit a compressive force from the first subchondral location to the node; and is

The node is configured to:

transmitting a first portion of the compressive force to the second diaphyseal position along the first inclined member; and

transmitting a second portion of the compressive force to the first diaphyseal position along the second inclined member.

24. A tubular implant for a bone, the tubular implant comprising:

a first end configured to be coupled to the bone subchondral in a loaded position; and

a second end configured to couple to the bone at a diaphyseal position that is transverse to a longitudinal bisecting plane of the bone from the loaded position.

25. The tubular implant of claim 24 wherein the second end terminates on a surface oblique to a length of the implant and substantially parallel to a diaphyseal surface of the bone.

26. The tubular implant of claim 25 further comprising a tubular inner surface, wherein the second end includes an anchor receiving structure in the tubular inner surface configured to receive an anchor configured to penetrate cortical bone adjacent the anchor receiving structure and cortical bone across a longitudinal bisecting plane of the bone from the anchor receiving structure.

27. The tubular implant of claim 25 wherein at the second end, the tubular inner surface defines a pocket that receives a portion of the head of the anchor between an inner wall of the cortical bone and an outer wall of the cortical bone.

28. The tubular implant of claim 24 further comprising a tubular wall defining a first elongate window and a second elongate window opposite the first elongate window, each of the first and second elongate windows configured to receive a body of an anchor and engage an engagement feature of the anchor.

29. The tubular implant of claim 28 wherein the first and second elongate windows are configured to cooperatively support the anchor at an angle relative to the tubular implant, the angle defined by the angle at which the anchor enters the first elongate window.

30. The tubular implant of claim 24, which is expandable.

31. The tubular implant of claim 30 comprising a web of anchor receiving cells.

32. A method for treating an end of a bone, the method comprising:

preparing an elongate subchondral cavity transverse to a longitudinal axis of the bone;

expanding a mesh of anchor receiving units in the subchondral cavity; and

engaging the mesh of the anchor receiving unit with an anchor anchored to a portion of the bone.

33. The method of claim 32, wherein the expanding comprises expanding a mesh having a central axis and a diameter that varies along the central axis.

34. An anchor-receiving bone support includes a tube wall defining a first elongated window and a second elongated window opposite the first elongated window, each of the first and second elongated windows configured to be traversed by a body of an anchor and engaged with an engagement feature of the anchor.

35. The support of claim 34, wherein the first and second elongated windows are configured to cooperatively support the anchor at an angle relative to the tubular implant, the angle ranging from (a) an angle normal to the implant to (b) an angle defined by an outer diameter of the tubular implant, a radius of the anchor, and a displacement between an end of the first elongated window and an end of the second elongated window.

36. The support of claim 34, further comprising, when the tube wall is a first tube wall, a second tube wall having a transverse slot configured to move to different positions along the first and second elongated windows, the transverse slot configured to be traversed by the body of the anchor and engaged with the engagement feature of the anchor.

37. The support of claim 36 wherein the first tube wall nests inside the second tube wall.

38. The support of claim 36 wherein the second tube wall nests inside the first tube wall.

39. The support of claim 36 wherein the first elongated window, the second elongated window, and the transverse slot are configured to cooperatively support the anchor against rotation relative to a longitudinal axis of the first tube wall.

40. A tubular bone support comprising:

a tubular mesh of anchor receiving units; and

a serrated ring configured to saw an access hole for delivering the bone bearing into an internal region of a bone.

41. The tubular bone support of claim 40, configured to lock onto a bone support frame after delivery into the interior region.

42. The tubular bone support of claim 40, further comprising a non-porous tube longitudinally adjacent to the mesh.

43. A bone anchor base comprising:

a first elongate member comprising a first anchor-receiving structural web; and

a second elongate member comprising a second anchor-receiving structural web;

wherein the second elongate member is configured to be deployed in the interior region of the bone alongside the first elongate member.

44. The bone anchor substrate of claim 43,

the first elongate member has a first delivery state diameter and is configured to be delivered to the interior region through a guide tube having an inner diameter;

the second elongate member having a second delivery state diameter and configured to be delivered to the interior region through the guide tube; and

the sum of the first delivery state diameter and the second delivery state diameter is greater than the inner diameter.

45. The bone anchor substrate of claim 43, wherein:

the first elongate member has a first delivery state diameter and is configured to be delivered to the interior region through a guide tube having an inner diameter;

the second elongate member having a second delivery state diameter and configured to be delivered to the interior region through the guide tube; and

the sum of the first delivery state diameter and the second delivery state diameter is less than the inner diameter.

46. The bone anchor substrate of claim 43, wherein:

the first elongated member has a first longitudinal axis;

the second elongated member has a second longitudinal axis; and is

The first and second longitudinal axes are substantially parallel when the first and second elongated members are deployed in the interior region.

47. The bone anchor base of claim 43, wherein, when the bone anchor base has a central axis:

the first elongated member has a first longitudinal axis;

the second elongated member has a second longitudinal axis; and is

The first and second longitudinal axes are substantially conically arranged about the central axis when the first and second elongate members are expandable in the interior region.

48. The bone anchor substrate of claim 43, wherein:

the first web includes a first anchor receiving structure;

the second web includes a second anchor receiving structure; and is

The first and second anchor receiving structures are sufficiently aligned with one another to engage a bone anchor penetrating a fragment of the bone.

49. The bone anchor substrate of claim 48, wherein the first and second elongated members are members of a set of elongated members, each member of the set configured to be deployed in the interior region of the bone alongside another member of the set.

50. The bone anchor substrate of claim 49, wherein the first member of the set is configured to transfer a load from a first bone fragment to a second bone fragment via the second member of the set.

51. The bone anchor substrate of claim 50, wherein the first and second members of the set transmit loads to one another via surface contact.

52. The bone anchor substrate of claim 50, wherein the first and second members of the set transmit loads to one another via a coupling.

53. The bone anchor substrate of claim 50, wherein the first and second members of the set transmit loads to one another via the anchor.

54. The bone anchor substrate of claim 43, further comprising a coupling configured to resist separation of the second elongate member from the first elongate member in response to a force.

55. The bone anchor substrate of claim 43, further comprising a coupling configured to resist separation of the first and second elongate members by the bone anchor during passage of the first and second elongate members.

56. The bone anchor substrate of claim 43, wherein the coupling is configured to resist separation of the first and second elongated members by the bone anchor during loading of the first and second elongated members.

57. The bone anchor substrate of claim 43, wherein one of the first and second elongated members is expandable.

58. The bone anchor substrate of claim 43, wherein one of the first and second elongated members has a radius that varies along a length of the elongated member.

59. The bone anchor substrate of claim 43, wherein the first anchor receiving structure comprises open cells in an open cell network.

60. The bone anchor substrate of claim 43, wherein the first anchor receiving structure comprises closed cells in a closed cell mesh.

61. The bone anchor substrate of claim 43, wherein the first anchor receiving feature includes a tubular portion defining an anchor receiving slot.

62. The bone anchor substrate of claim 43, wherein the first anchor receiving structure includes a tubular portion defining an anchor receiving aperture.

63. The bone anchor substrate of claim 43, further comprising a plurality of elongate members, wherein the coupling is further configured to resist separation of each of the plurality of elongate members, the first elongate member, and the second elongate member from another of the plurality of elongate members, the first elongate member, and the second elongate member.