WO2013113015A1

WO2013113015A1 - Clip for rib stabilization

Info

Publication number: WO2013113015A1
Application number: PCT/US2013/023476
Authority: WO
Inventors: Andrw W. SEYKORA; Oren S. BERNSTEIN; Eric THORSELL; Joel Gillard; Kyle A. LOUCKS
Original assignee: Acute Innovations Llc
Priority date: 2012-01-26
Filing date: 2013-01-28
Publication date: 2013-08-01
Also published as: US9237910B2; US20130197521A1

Abstract

System, including methods, apparatus, and kits, for rib stabilization. The system may comprise a clip member having a bridge region and a pair of leaf portions connected to each other by the bridge region. The clip member may be configured to be placed on a rib bone with the leaf portions disposed on opposite sides of the rib bone. The system also may comprise a securing member, such as a suture, to attach the clip member to the rib bone, with the securing member extending at least twice between the leaf portions.

Description

CLIP FOR RIB STABILIZATION

Cross-Reference to Priority Application

This application claims the priority of U.S. Provisional Patent Application Serial No. 61/590,955, filed January 26, 2012, which is incorporated herein by reference in its entirety for all purposes.

Cross-Reference to Other Material

The following patent is incorporated herein by reference in its entirety for all purposes: U.S. Patent No. 7,695,501 , issued April 13, 2010.

Introduction

The rib cage, or thoracic cage, is composed of bone and cartilage that surround the chest cavity and organs therein, such as the heart and the lungs. In humans, the rib cage typically consists of 24 ribs (interchangeably termed rib bones), twelve thoracic vertebrae, the sternum (or breastbone), and the costal cartilages. The ribs articulate with the thoracic vertebrae posteriorly and, with the exception of the bottom two pairs of ribs (the floating ribs), are connected to the sternum anteriorly using the costal cartilages.

One or more ribs may need to be stabilized temporarily after a thoracotomy, which is a surgical incision through the chest wall to provide access to the chest cavity. For example, a rib may sustain an iatrogenic fracture, that is, a fracture induced inadvertently by a surgeon. More particularly, a rib may be fractured by a surgeon when the thoracic cage is deformed to create an entry site to the chest cavity by spreading ribs and/or urging apart the halves of a cut sternum . In other cases, a surgeon may choose to perform an osteotomy by placing a cut through one or more ribs to provide better access to the chest cavity and/or to relieve pressure on the ribs. In any event, the chest cavity may be accessed medially (through the sternum), posterolateral^ (between ribs in a back region of the chest wall), anterolateral^ (between ribs in a front region of the chest wall), or the like, and one or more ribs near any of these positions may be fractured or cut during surgery.

Implants have been developed for rib fixation in trauma patients, particularly to treat flail chest produced by fracture of multiple adjacent ribs. However, such implants may not be necessary or desirable when only one or two ribs need to be stabilized, particularly when rib stabilization is only an ancillary procedure to be performed during a surgery.

Therefore, a rib stabilization system is needed for surgically-created rib discontinuities.

Summary

The present disclosure provides a system, including methods, apparatus, and kits, for rib stabilization. The system may comprise a clip member having a bridge region and a pair of leaf portions connected to each other by the bridge region. The clip member may be configured to be placed on a rib bone with the leaf portions disposed on opposite sides of the rib bone. The system also may comprise a securing member, such as a suture, to attach the clip member to the rib bone, with the securing member extending at least twice between the leaf portions.

Brief Description of the Drawings

Figure 1 is a view of selected aspects of an exemplary rib stabilization system including a clip member disposed on a fractured rib bone and attached with a securing member (e.g., a suture loop), in accordance with aspects of the present disclosure.

Figure 2 is a view of the rib stabilization system of Figure 1 , taken generally as in Figure 1 but in the absence of the securing member and with the clip member present on the rib bone as a larger form, before detachment of a pair of integral drill guides from the clip member to produce the smaller form shown in Figure 1 , in accordance with aspects of the present disclosure.

Figure 3 is a front elevation view of the clip member of Figure 2.

Figure 4 is a back elevation view of the clip member of Figure 2.

Figure 5 is an end view (a right side view) of the clip member of Figure 2, taken generally along line 5-5 of Figure 4 and with the securing member of Figure 1 preloaded in the clip member, before the free ends of the securing member are tied together.

Figure 6 is a top view of the clip member of Figure 2, taken after installation of the securing member as in Figure 1 .

Figure 7 is a front elevation view of the rib stabilization system of Figure 1 illustrating how the securing member can be hooked onto a hitching bracket of the clip member to tighten the securing member and compress the rib bone axially, in accordance with aspects of the present disclosure.

Figure 8 is end view of the rib stabilization system of Figure 1 , taken generally along line 8-8 of Figure 7 through the rib bone.

Figure 9 is a front elevation view of selected aspects of another exemplary rib stabilization system including another exemplary embodiment of a clip member disposed on a fractured rib bone and attached with a securing member, in accordance with aspects of the present disclosure.

Figure 10 is a perspective view of an exemplary embodiment of an implant for rib stabilization, with the implant including a pair of clip members connected integrally by a spanning member, in accordance with aspects of the present disclosure.

Detailed Description

An exemplary method of rib stabilization is provided. In the method, a clip member may be selected. The clip member may have a bridge region and a pair of leaf portions (e.g., a proximal leaf portion and a distal leaf portion) connected to each other by the bridge region. For example, the clip member may be U-shaped. The clip member may be disposed on a rib bone, with the leaf portions disposed on opposite sides of the rib bone. The clip member may (or may not) span a discontinuity of the rib bone. The clip member may be attached to the rib bone with a securing member, such as a suture, that extends between the leaf portions at least twice (e.g., exactly twice), and through the rib bone at least twice (e.g., exactly twice). The securing member may (or may not) span a discontinuity of the rib bone. In some embodiments, the securing member may be hooked onto a bracket of the clip member to tighten the securing member. In some embodiments, the securing member may extend along the rib bone through a retainer of the distal leaf portion. In some embodiments, the clip member may include at least one or a pair of integral drill guides that are detached from the proximal leaf portion after holes are formed through the rib bone along axes defined by the drill guide(s). In some embodiments, the securing member may be centered around an axis that extends through the bridge region, such as orthogonally through the bridge region.

An exemplary system for rib stabilization is provided. The system may comprise a clip member having a bridge region and a proximal leaf portion and a distal leaf portion connected to each other by the bridge region. The clip member may be configured to be placed on a rib bone with the leaf portions disposed on opposite sides of the rib bone. The system also may comprise a securing member to attach the clip member to the rib bone, with the securing member including a suture. The clip member may, for example, have any combination of a bracket to engage the suture (e.g., with the bracket configured to permit the suture to be hooked onto the bracket to tighten the securing member), a retainer provided by the distal leaf portion to hold the suture, and/or integral drill guides that are detachable after use, among others.

The rib stabilization system disclosed herein may have substantial advantages over other approaches to rib repair. The advantages may include any combination of the following: faster and easier installation, better confomnability of the implant to a rib bone, bioresorbability, less stress shielding of the rib bone (to produce more rapid healing), and/or adjustable axial compression of the rib bone, among others.

These and other aspects of the present disclosure are described in the following sections: (I) exemplary rib stabilization system, (II) methods of rib stabilization, (III) exemplary system combinations, and (IV) examples.

I. Exemplary Rib Stabilization System

This section describes an exemplary rib stabilization system 20; see Figures 1 -8. The system may include a stabilizing implant or device 22 comprising at least one clip member 24. The clip member (and/or implant/device) may be attached to a rib bone 26 with a securing member 28 that includes a suture, with the clip member (and/or implant/device) spanning a discontinuity 30, such as a fracture or cut, in the rib bone. (The clip member interchangeably may be termed a clip, a plate, an implant, and/or a device.)

Clip 24 may have a pair of leaf portions 32, 34 connected to each other by a bridge region 36. Each leaf portion interchangeably may be termed a mounting portion and/or a clip region, and may include a plate region. When the clip is disposed on rib bone 26, the leaf portions may be disposed on opposite sides 38, 40 of the rib bone, to opposingly flank the rib bone. Proximal leaf portion 32 (interchangeably termed the front region of the clip) may be positioned adjacent outer side 38 of the rib bone and adjacent/against an outer surface region thereof (i.e., relatively closer to the surgeon and/or the exterior of the recipient of the clip (the subject/patient)). Distal leaf portion 34 (interchangeably termed the back or rear region of the clip) may be positioned on inner side 40 of the rib bone and adjacent/against an inner surface region thereof (i.e., relatively farther from the surgeon and/or the exterior of the recipient of the clip and relatively closer to (or in) the chest cavity). The outer and inner surface regions of the rib bone may be anterior, lateral, or posterior surface regions, among others, of a rib bone and/or rib cage. The leaf portions may face each other and may be separated by a receiving space for a rib bone. The leaf portions may project the same or different distances from the bridge region to fomn a U-shaped structure. For example, proximal leaf portion 32 can project farther from the bridge region than the distal leaf portion, to extend to a more caudal/inferior position on the rib bone. Each leaf portion may or may not project past the inferior/caudal boundary of the rib bone.

Bridge region 36 may be disposed on a superior (or rostral) side 42 of the rib bone, adjacent/against a superior/rostral surface region thereof that extends between the outer surface region and the inner surface region of the rib bone. Alternatively, the clip may be installed in an inverted configuration, with bridge region 36 disposed on an inferior (or caudal) side 44 of rib bone 26, adjacent/against an inferior/caudal surface region thereof that extends between an outer surface region and an inner surface region of the rib bone. Accordingly, the bridge region may be described as a top region (or a bottom region) of the clip.

Securing member 28 may extend at least twice between proximal leaf portion 32 and distal leaf portion 34. The securing member may extend twice between the leaf portions on a pair of separate paths through rib bone 26, namely, through each of a pair of holes 46, 48 formed in rib bone 26. Each hole may be a bore or through- hole that extends from outer side 38 to inner side 40 of rib bone 26. The holes may be spaced longitudinally along rib bone 26 from each other, and may be formed on respective opposite sides of rib discontinuity 30, or may be formed on the same side of a rib discontinuity (see Example 2).

Securing member 28, alone or in combination with clip 24, may form a loop 50. The loop may be centered around an axis 52 (interchangeably termed a receiving axis) that extends through the bridge region and through rostral/superior and caudal/inferior surface regions of the rib bone (see Figure 6). For example, to form a complete circuit, the loop may extend on inner side 40, generally axially along the rib bone and over/through distal leaf portion 34, to hole 46, then through hole 46 to outer side 38, next generally axially along the rib bone on outer side 38 and over proximal leaf portion 32, to hole 48, then through hole 48, and back to distal leaf portion 34. The securing member thus may attach the clip to the rib bone without traversing the superior or inferior sides of the rib bone outside bone.

The securing member may include one or more pieces/lengths of suture (i.e., a surgical thread, string, cord, wire, cable, etc.). In other words, the suture may be any long, flexible piece(s) of material capable of extending along various nonlinear paths, such a path extending at least twice through a rib bone. The suture may be formed of natural and/or artificial materials, such as a bioresorbable or non- resorbable polymer (e.g., plastic), metal, or the like. Each piece/length of suture may be composed of a single fiber/filament or a bundle of two or more fibers/filaments. Exemplary securing members may include a single length/piece of suture (or a pair of lengths/pieces of suture) having a pair of free ends 54 that can be fastened to each other (see Figures 5 and 6). The ends can be fastened to each other by tying the ends together to form a knot, twisting the ends together, engagement of the ends with a separate suture-locking device (e.g., a suture clamp, a crimp block, etc.), or the like. In some cases, the securing member may be integrally attached to the clip member, such as by over-molding the clip member around a region(s) of a preformed securing member, forming the securing member as a continuous extension of the clip member, or the like. Figures 2-6 show a larger form of clip 24 having a central body region 60 and a pair of integral drill guides 62, 64 (interchangeably termed guide regions). (Figures 1 , 7, and 8 show a smaller form of the clip lacking the guides.) Each drill guide may define a guide axis 66 along which the tip of a hole-forming tool (a drill), such as a rotary drill or a percussive drill, may be advanced to create one of holes 46, 48 (see Figures 1 and 2).

Each drill guide may project laterally from an edge of body region 60 and/or proximal leaf portion 32 of the clip to form a protrusion 68 on an outer surface region of the clip (see Figures 2 and 3). The protrusion may be cylindrical. Each drill guide may (or may not) be detachably connected to body region 60 of the clip via proximal leaf portion 32. The drill guide may be continuous with body region 60 of the clip. For example, clip 24 may form a frangible site 70 connecting each drill guide to the proximal leaf portion (see Figures 3 and 4), which allows the drill guide to be broken off of the clip after use. The frangible site may, for example, be a groove, opposing grooves formed in inner and outer surface regions of the clip, and/or a set of perforations, among other others, that allow each drill guide to be removed from the clip (e.g., snapped off) after formation of a corresponding hole 46 or 48, and before a surgical incision is closed over the clip. In other embodiments, each drill guide may be provided by a discrete guide piece that is attached to a body piece of the clip.

Each drill guide may define an aperture 72 that is coaxial with guide axis 66

(see Figures 2 and 3). The aperture may be elongated parallel to guide axis 66, such that guides 62 and 64 project away from the rib bone (see Figure 2), in a direction transverse to a plane defined by a plate region of proximal leaf portion 32, and much farther than the average thickness of the proximal leaf portion. Aperture 72 may be open not only at both ends but also along a lateral side thereof. For example, each guide may define an axial slot 74 (interchangeably termed a suture slot) formed in a wall of protrusion 68 and contiguous with aperture 72 (see Figure 3). Slot 74 may be bounded by a lateral edge of proximal leaf portion 32 at the base of the guide, which allows securing member 28 to be threaded axially through aperture 72, and then removed from the aperture/guide, at a suitable time, by lateral motion of the securing member and/or guide. Guides 62 and 64 may be slotted so that securing member 28 is temporarily held in place while the surgeon passes the securing member from inward of the rib bone to outward of the rib bone. The guides then can be snapped off once the securing member has been passed and, optionally, tied. The guides can ensure proper location and depth of holes 46, 48. For example, each guide can function as a stop to prevent a drill from being advanced too far past the inner surface region of the rib bone.

Figures 2, 3, and 5-8 show additional projections that may be formed on the front side of clip 24. The clip may have a hitching bracket 80 that projects from an outer surface region 82 of proximal leaf portion 32. (Bracket 80 interchangeably may be termed a receiver, a hitching post, or a peg.) Bracket 80 may form a lip 84 that projects upwards in a spaced relation from a plate region of proximal leaf portion 32 to create a recess 88 (interchangeably termed a slot) between the lip and the plate region (see Figure 5). Securing member 28 can be hooked onto bracket 80 by urging the securing member over lip 84 and into recess 88, to increase tension on (i.e., tighten) the securing member (also see Figures 7 and 8). The clip also may have a pair of ridges 90 (interchangeably termed suture guide ridges) formed on outer surface region 82 adjacent respective guides 62, 64 (see Figures 3, 6, and 8). The ridges may support end regions of securing member 28 during installation and may direct the end regions centrally on the proximal leaf portion, to help to ensure that the securing member is in the correct place during installation. Also, ridges 90 may restrict the clip from twisting about the long axis of the rib bone by engaging the securing member to prevent the securing member from slipping to a position below the ridges (e.g., caudal to the proximal leaf portion on the rib bone).

Figures 4, 5, and 6 show a retainer 100 formed by distal leaf portion 34. The retainer may project from an outer surface region 102 of a plate region of distal leaf portion 34, and may have a tubular structure. The retainer may form an opening, such as a channel 104, to receive and hold securing member 28. The channel may define an axis 106 that extends parallel to a local long axis of rib bone 26, and parallel to a through-axis 1 10 defined by clip 24. Through-axis 1 10 is at least generally parallel to, and at least generally equidistant from the leaf portions and the bridge region of the clip. Securing member 28 may be pre-loaded into retainer 100 before the clip is disposed on rib bone 26 (see Figure 5). Figure 3 shows further aspects of the clip's geometry. The clip may be made flexible by a relatively thinner bridge region, which may be stiffened by one or more rib members 120 (interchangeably termed stiffening ribs). The rib members may be formed on an outer (or inner) surface region of the bridge region. The average thickness of the bridge region may be less than the average thickness of the plate regions of one or both leaf portions, as measured between the outer and inner surface regions of the clip. In some cases, the bridge region may have an average thickness that is no more than about 75% or 50% of the average thickness of the plate regions of the leaf portions.

Figures 7 and 8 illustrate the forces generated by the tension of securing member 28. The tension may be created and/or increased by fastening the free ends of the securing member to each other and/or by hooking the fastened securing member onto bracket 80. In these views, securing member 28 is shown in phantom outline for a less-tensioned configuration, before being hooked onto bracket 80, and with solid lines for a more-tensioned configuration that removes any slack in the fastened securing member, after being hooked onto bracket 80. Tension on the securing member may apply compressive force to rib bone 26 longitudinally between holes 46, 48, indicated by arrows at 122 (see Figure 7). Also, tension on the securing member may apply rostral-caudal force, indicated by an arrow at 124, that urges bridge region 36 toward rib bone 26 (and clip member 24 is urged caudally/inferiorly on the rib bone) (see Figure 8). Rostral-caudal forces may be generated with the securing member by positioning holes 46, 48 more caudally/inferiorly along rostral- caudal axis 126 than bracket 80 and retainer 100 (see Figure 8) (and/or farther from bridge region 36 than the bracket and retainer. Further, the tensioned securing member may apply compressive force on leaf portions 32, 34, indicated by force arrows at 128, to urge the leaf portions toward each other (and toward respective, adjacent outer or inner surface regions of rib bone 26).

Hooking the suture loop onto the hitching bracket may apply compressive forces to the rib bone and/or clip along three generally orthogonal axes. The compressive forces may include axial compression of the rib bone at the fracture or cut in the rib bone. Also, the compressive forces may urge the proximal and distal leaf portions of the clip toward each other against the rib bone and may create a downward force pulling the bridge region to the rib bone, thereby pulling the clip tight to the rib bone on three sides.

The clip may have features focused on making installation easy, repeatable, and stable. The features may include a general "U" shape in one or more lengths and widths that may be contoured further, such as by therm oforming, to fit a variety of rib shapes and sizes (e.g., thicknesses).

The clip and securing member of the present disclosure may be formed of any suitable biologically compatible material, such as metal, plastic, or the like. In exemplary embodiments, the clip is molded of plastic (e.g., from a bioresorbable polymer), and both the clip and the securing member are bioresorbable. (The terms "bioresorbable" and "bioabsorbable" are interchangeable.) Further aspects of rib stabilization and of clip members and securing members that may be suitable are described elsewhere in the present disclosure, such as in Sections II and IV, and in the references identified above under Cross-References, which are incorporated herein by reference, namely, U.S. Provisional Patent Application Serial No. 61/590,955, filed January 26, 2012; and U.S. Patent No. 7,695,501 , issued April 13, 2010.

II. Methods of Rib Stabilization

This section describes exemplary methods of rib stabilization with a device or implant that includes at least one clip attached to bone with a flexible securing member (e.g., a suture). The steps described in this section may be performed in any suitable order and combination and with any of the apparatus, features, or approaches described elsewhere in the present disclosure.

A rib bone to be stabilized may be selected. The rib bone may have at least one discontinuity, such as a fracture or cut, among others. The discontinuity may be located at any suitable position along the selected rib bone, such as a medial, anterior, lateral, or posterior position of a rib cage that includes the rib bone. In some cases, the fracture or cut may be produced during a surgical procedure, either deliberately or inadvertently by a surgeon. The discontinuity may be produced and stabilized during the same surgical operation.

An implantable device for rib stabilization may be selected. The device may include one or more clip members. The clip may be a selected from a set of clips having different sizes/shapes (i.e., different separation distances between the leaf portions, different lengths/widths of leaf portions, different radii of curvature for the bridge region, etc.). In some cases, different clips can be connected together on a multi-limbed (e.g., Y-shaped) bar that may be used by the surgeon as a sizer. Once the correct size is determined the surgeon can snap the clip at the connection point located at the base of the clip, removing the clip from the sizer. The remaining clips and sizer may be discarded or used on another fracture/cut within the same case (i.e., on the same subject during the same surgery).

The selected clip is prepared for installation. The surgeon may prep the clip for installation by selecting suture and feeding the suture through a retainer, such as a suture channel, located in the back of the clip, or the clip may be supplied preloaded with suture.

The clip also may be thermoformed intraoperatively to provide a better fit to the rib bone. Heating the clip may be performed off the rib bone, such as in a bath or oven, or on the rib bone, such as with a heat pack or heat gun, to render the clip more conformable. The clip may be composed of a polymer having a relatively low glass transition temperature (e.g., less than about 75 °C or 65 °C, among others). The clip (or a region thereof) may be heated above the glass transition temperature, and then the heated clip may be reshaped, for example, compressed (or expanded) to urge the leaf portions closer together (or farther apart). The clip may be reshaped off or on the rib bone. In exemplary embodiments, the clip may be composed of polylactic acid, which has a glass transition temperature of about 60 °C.

The clip loaded with a length of suture may be positioned on the rib bone with the discontinuity generally centered between the left and right ends of the clip. The suture ends may be kept on the front side of the rib (e.g., adjacent the proximal leaf portion of the clip). A clamp and/or a surgical assistant may hold the clip in place while the surgeon drills a pair of holes through the rib bone. The holes may be drilled through apertures (such as elongated apertures or slots) defined by the clip, for example, along guide axes defined by integral drill guides. Alternatively, the holes may be drilled at positions outside the clip's footprint, such as lateral to the proximal leaf portion on opposing sides thereof. The holes may be positioned more inferiorly/caudally, and/or farther from the bridge region, than bracket 80 and/or retainer 100.

After the holes are drilled in the rib bone, a suture passer/retriever may be used to pass (e.g., pull) an end region of the suture through each hole. A suture end region disposed adjacent each end of the suture retainer of the clip may be passed through a corresponding hole in the rib bone. Each suture end region may be pulled from inward of the rib bone to outward of the rib (i.e., from the inner side to the outer side of the rib bone).

After both ends of the suture are passed through respective holes in the rib bone, the surgeon may tie the ends of the suture together to form a loop. The loop may create compression at the rib discontinuity and flex the clip such that the leaf portions are pulled together, and tight against the rib bone. The surgeon then can tighten the suture (and the stability of the rib and clip) by pulling an outer portion of the suture loop upward in front of the clip and hooking the suture loop onto the hitching bracket of the clip, where the suture can rest in the slot formed by the bracket.

If the selected clip has removable drill guides, the guides can be removed at any suitable time. In any event, with the suture tied and elevated into the slot of the hitching bracket, the stability of the discontinuity may be optimized. The suture may create axial compression of the rib at the discontinuity, may pull the clip downward from the front and the back, bringing the top of the clip tight against the rib. The clip may be squeezed from the front and back, bringing the front and back of the clip tight against the outer and inner rib surface regions.

Further aspects of rib stabilization are described elsewhere in the present disclosure and in the references identified above under Cross-References, which are incorporated herein by reference, namely, U.S. Provisional Patent Application Serial No. 61/590,955, filed January 26, 2012; and U.S. Patent No. 7,695,501 , issued April 13, 2010.

III. Exemplary System Combinations

The apparatus disclosed herein may be utilized and/or grouped in any suitable manner to provide a system, which may be supplied as a kit. The system (or kit) may include one or more clip members and one or more securing members. The system also or alternatively may include any combination of the following: a drill to form holes in bone, one or more clamps to engage and hold the clip members during installation, a suture passer/retriever, and instructions for use. Each system component may be configured for single use (e.g., clip members and securing members) or for multiple use (e.g., the drill, clamps, and/or suture/retriever). Some or all of the components of each system (or kit) may be provided in a sterile condition, such as packaged in a sterile container.

IV. Examples

The following examples describe selected aspects and embodiments of the present disclosure related to implants for rib stabilization. These examples are included for illustration and are not intended to limit or define the entire scope of the present disclosure.

Example 1. Clip Member with Longer Bridge Region

This example describes an exemplary clip member 140 having a bridge region 36 that has a greater characteristic dimension, measured along rib bone 26, than a loop fomned by securing member 28; see Figure 9.

Clip 140 may have any of the features described above for clip 24. For example, the clip may have a U-shaped structure formed by proximal leaf portion 32, distal leaf portion 34, and bridge region 36. The proximal leaf portion may define a pair of apertures 142, 144 through which holes 46, 48 may be drilled in rib bone 26. The apertures, which may or may not be elongated to provide slots, may be longer and/or larger in diameter, than holes 46, 48, to permit axial compression of the rib bone when the securing member is tightened. In other words, the position of holes 46, 48 with respect to apertures 142, 144 may change as a region of rib bone 26 between holes 46, 48 is compressed axially. The length or characteristic dimension of the clip, measured parallel to through-axis 1 10, may be greater at bridge region 36 than the distance between holes 46, 48 and/or apertures 142, 144. In other embodiments, proximal leaf portion 32 may lack apertures 142, 144 and may taper more aggressively as the proximal leaf portion projects from the bridge region, such that holes 46, 48 can be fomned lateral to, instead of through, the proximal leaf portion. Stated differently, holes 46, 48 can be fomned outside the footprint of the clip on bone (i.e., outside the footprint of the proximal and/or distal leaf portions). Bridge region 36 of clip 140 may define one or more openings 146 that expose rostral/superior surface areas 148 of the rib bone. Access to areas 148 may facilitate re-attachment of intercostal muscle to the rib bone.

Example 2. Implant with Pair of Clip Members

This example describes an exemplary implant 160 having a pair of clip members 162, 164 connected by a spanning member 166; see Figure 10.

Each clip member 162, 164 may have any combination of the features described elsewhere herein for clips, such as leaf portions 32, 34, bridge region 36, a U-shape, hitching bracket 80, and apertures 142, 144. However, spanning member 166 may be positioned to span a discontinuity in the rib bone. (Each of clip members 162, 164 may or may not also span a discontinuity in the rib bone.) The spanning member may be attached to the rib bone with a securing member. In some cases, each clip member and the spanning member may be attached with a respective, distinct securing member.

Example 3. Selected Embodiments I

This example describes selected methods and apparatus of the present disclosure, presented as a series of numbered paragraphs.

1 . A method of rib stabilization, comprising: (A) disposing a plate on a rib bone with the plate spanning a discontinuity of the rib bone; and (B) attaching the plate to the rib bone with a suture member that spans the discontinuity, extends through the rib bone on opposing sides of the discontinuity, and applies axial compression to the rib bone.

2. The method of paragraph 1 , wherein the suture member does not extend completely around the rib bone.

3. The method of paragraph 1 or 2, further comprising a step of hooking the suture member onto a receiver formed by the plate to increase and/or set a tension of the suture member.

4. The method of any of paragraphs 1 -4, wherein the discontinuity is a fracture produced during a surgery.

5. The method of paragraph 4, wherein the surgery includes an incision through the chest wall of a subject. 6. The method of any of paragraphs 1 -5, wherein the discontinuity is a cut introduced during surgery.

7. The method of any of paragraphs 1 -6, wherein the plate includes a clip having a proximal region and a distal region separated by a receiving space, and wherein the step of disposing positions the rib bone in the receiving space with the proximal region and the distal region opposingly flanking the rib bone.

8. The method of paragraph 7, wherein the clip is generally U-shaped.

9. The method of paragraph 7 or 8, wherein the clip includes a bridge region that connects the proximal region to the distal region.

10. The method of paragraph 9, wherein the bridge region includes a pair of integral connection members that each extend from the proximal region to the distal region, and wherein the connection members are separated from each other to form an opening in the bridge region.

1 1 . The method of paragraph 9 or 10, wherein an average thickness of the bridge region is less than an average thickness of the proximal region and/or distal region.

12. The method of any of paragraphs 9-1 1 , wherein the step of disposing positions the bridge region adjacent a superior surface region of the rib bone.

13. The method of any of paragraphs 7-12, wherein the distal region includes a retainer portion that holds the suture member.

14. The method of paragraph 13, wherein the distal region includes an outer surface that faces away from the rib bone, and wherein the retainer portion projects from the outer surface.

15. The method of paragraph 13 or 14, wherein the retainer portion defines an opening, and wherein the suture member extends through the opening before the tension is applied.

16. The method of paragraph 15, wherein the clip defines a first axis along which the rib bone extends through the clip after the clip is disposed on the rib bone, and wherein the opening defines a second axis oriented at least generally parallel to the first axis.

17. The method of any of paragraphs 1 -16, further comprising a step of hooking the suture member onto a receiver formed by the plate to increase and/or set a tension of the suture member, wherein the plate forms a projection, and wherein the step of hooking includes a step of placing the suture member into a slot defined at least partially by the projection.

18. The method of any of paragraphs 1 -17, wherein the plate defines a pair of apertures, and wherein the step of placing includes a step of placing the suture member through each of the apertures.

19. The method of any of paragraphs 1 -18, wherein the plate include a proximal plate portion and a pair of guides projecting proximally from the plate portion, further comprising a step of forming a pair of holes through the rib bone with each hole being coaxial with one of the guides, wherein the guides are optionally detachable.

20. The method of paragraph 18 or 19, further comprising a step of forming a pair of holes through the rib bone with each hole being coaxial with one of the apertures.

21 . The method of any of paragraphs 18-20, wherein the clip defines an axis along which the rib bone extends, and wherein each aperture is elongated in a direction at least generally parallel to axis.

22. The method of any of paragraphs 1 -21 , wherein the step of placing includes a step of placing the suture member through the rib bone from a pair of positions that are inward of the rib bone.

23. The method of any of paragraphs 1 -22, wherein the suture member is placed through one or more holes formed in the rib bone by needles connected to the suture member.

24. The method of any of paragraphs 1 -23, wherein the rib bone has an outer surface opposing an inner surface, and wherein the suture member is placed through one or more holes formed from the outer surface of the rib bone.

25. The method of any of paragraphs 1 -24, further comprising a step of tying ends of the suture member together such that the suture member forms a loop.

26. The method of paragraph 25, wherein the step of tying is performed after the suture member is placed through the rib bone on opposing side of the discontinuity, further comprising a step of hooking the loop onto a receiver formed by the plate to increase a tension of the suture member. 27. The method of any of paragraphs 1 -24, wherein the suture member includes a plurality of stops arranged along the suture member, further comprising a step of hooking the suture member onto a receiver formed by the plate to produce engagement between a stop and the receiver.

28. The method of any of paragraphs 1 -27, wherein the suture member and/or the plate is bioabsorbable.

29. The method of any of paragraphs 1 -28, further comprising a step of thermofomning the plate, optionally after disposing the plate on the rib bone.

30. The method of any of paragraphs 1 -29, further comprising a step of heating the plate to a fomnable state immediately before or during a surgical operation.

31 . A device for rib stabilization, comprising: a plate formed as a clip having a proximal region and a distal region separated from each other by a receiving space for a rib bone, the proximal region defining a pair of apertures and having a receiver configured to hold a suture member that extends through the pair of apertures and is hooked onto the receiver in a tensioned condition.

32. The device of claim 31 , wherein the clip is generally U-shaped.

33. The device of claim 31 or 32, wherein the distal region includes a retainer portion to hold the suture member.

34. The device of claim 33, wherein the clip defines a first axis along which the received rib bone extends through the clip, and wherein the retainer portion includes an opening to receive the suture member along a second axis that is at least generally parallel to the first axis.

35. The device of any of claims 31 -34, wherein the clip includes a bridge region that connects the proximal region to the distal region, and wherein the bridge region is more flexible than the proximal region or the distal region.

36. The device of any of claims 31 -35, wherein the clip defines an axis along which the received rib bone extends through the clip, and wherein each aperture is elongate at least generally parallel to the axis.

37. The device of any of claims 31 -36, wherein the clip is bioabsorbable. Example 4. Selected Embodiments II

This example describes additional selected methods and apparatus of the present disclosure, presented as a series of numbered paragraphs.

I . A system for rib stabilization, comprising: (A) a clip member having a bridge region and a proximal leaf portion and a distal leaf portion connected to each other by the bridge region, the clip member being configured to be placed on a rib bone with the leaf portions disposed on opposite sides of the rib bone; and (B) a securing member to attach the clip member to the rib bone, the securing member including a suture.

2. The system of paragraph 1 , wherein the distal leaf portion includes a retainer to hold the securing member.

3. The system of paragraph 2, wherein the retainer defines an axis that is parallel to a plane defined by a plate region of the distal leaf portion.

4. The system of paragraph 2 or 3, wherein the retainer defines a channel that extends along the axis.

5. The system of any of paragraphs 2 to 4, wherein a plate region of the distal leaf portion has an outer surface region, and wherein the retainer projects from the outer surface region.

6. The system of any of paragraphs 2 to 5, wherein the clip member defines a through-axis along which a rib bone extends after the clip member is placed on the rib bone, and wherein the retainer defines an aperture that is parallel to the through-axis.

7. The system of any of paragraphs 2 to 6, wherein the securing member extends through an aperture defined by the retainer.

8. The system of any of paragraphs 2 to 7, wherein the securing member is axially slideable in the retainer.

9. The system of any of paragraphs 1 to 8, wherein ends of the securing member are tied to one another.

10. The system of any of paragraphs 1 to 9, wherein the securing member is disposed in a loop.

I I . The system of paragraph 10, wherein the loop is a suture loop. 12. The system of any of paragraphs 1 to 1 1 , wherein the proximal leaf portion includes a bracket configured to engage the securing member.

13. The system of paragraph 12, wherein the securing member has a pair of ends, and wherein the bracket is configured to hold the securing member after the ends of the securing member have been fastened to each other and the securing member has been hooked onto the bracket.

14. The system of paragraph 12 or 13, wherein the securing member is disposed in a loop that is hooked onto the bracket.

15. The system of paragraph 14, wherein unhooking the loop from the bracket loosens the securing member.

16. The system of any of paragraphs 12 to 15, wherein the bracket projects upward when the bridge region is disposed above the leaf portions.

17. The system of any of paragraphs 1 to 16, wherein the securing member extends between the leaf portions at least twice without overlapping the bridge region.

18. The system of any of paragraphs 1 to 17, wherein the securing member is centered around an axis that extends through the bridge region.

19. The system of paragraph 18, wherein the axis is orthogonal to the bridge region.

20. The system of any of paragraphs 1 to 17, wherein the securing member extends between the leaf portions exactly twice and forms a loop.

21 . The system of any of paragraphs 1 to 20, wherein the securing member is engaged with each leaf portion.

22. The system of paragraph 21 , wherein the securing member is not in contact with the bridge region.

23. The system of any of paragraph 1 to 22, wherein the clip member includes at least one integral drill guide connected to a leaf portion.

24. The system of paragraph 23, wherein each drill guide is attached to the proximal leaf portion by a frangible connection.

25. The system of paragraph 24, wherein the proximal leaf portion thins at the frangible connection. 26. The system of any of paragraphs 23 to 25, wherein the clip member includes a pair of detachable drill guides.

27. The system of any of paragraphs 23 to 26, wherein each drill guide defines an aperture that is elongated transverse to a plane defined by a plate region of the proximal leaf portion.

28. The system of any of paragraphs 23 to 27, wherein each drill guide defines an aperture that is open at opposing ends and open along a side of the drill guide to form a slot.

29. The system of any of paragraphs 1 to 28, wherein the clip member is formed of a bioresorbable polymer.

30. The system of any of paragraphs 1 to 29, wherein the securing member is fomned of a bioresorbable polymer.

31 . The system of any of paragraphs 1 to 30, wherein the securing member includes a pair of ends tied together to form a knot.

32. A method of rib stabilization, comprising: (A) selecting a clip member having a bridge region and a pair of leaf portions connected to each other by the bridge region; (B) disposing the clip member on a rib bone with the clip member spanning a discontinuity of the rib bone and the leaf portions disposed on opposite sides of the rib bone; and (C) attaching the clip member to the rib bone with a securing member that extends between the leaf portions at least twice, through the rib bone at least twice, and spans the discontinuity.

33. The method of paragraph 32, wherein the securing member extends through a pair of holes fomned in the rib bone, and wherein the step of attaching the clip member includes a step of creating a tensioned configuration of the securing member that applies axial compression to the rib bone between the pair of holes.

34. The method of paragraph 32 or 33, wherein the securing member includes a suture.

35. The method of any of paragraphs 32 to 34, wherein the step of attaching the clip member includes a step of tying a pair of suture ends to one another. 36. The method of any of paragraphs 32 to 35, wherein the securing member is a single length of suture, and wherein the step of attaching includes a step of forming a loop with the single length of suture.

37. The method of any of paragraphs 32 to 36, wherein the securing member extends at least twice through the rib bone between an inner surface region and an outer surface region of the rib bone and does not extend from the inner surface region to the outer surface region outside the rib bone.

38. The method of any of paragraphs 32 to 37, wherein the clip member includes a bracket, and wherein the step of attaching the clip member includes a step of hooking the securing member onto the bracket to tighten the securing member.

39. The method of paragraph 38, wherein the securing member extends through a first hole and a second hole in the rib bone, wherein an outer portion of the securing member extends from the first hole to the second hole on the outer side of the rib bone, and wherein the step of hooking repositions a central region of the outer portion closer to the bridge region.

40. The method of paragraph 39, wherein the leaf portions include a proximal leaf portion and a distal leaf portion, and wherein the proximal leaf portion includes the bracket and the distal leaf portion includes a retainer for the securing member, and wherein the first and second holes in the rib bone are located inferior to the bracket and the retainer after the step of hooking.

41 . The method of any of paragraphs 32 to 40, wherein the leaf portions include a proximal leaf portion and a distal leaf portion, and wherein the distal leaf portion includes a retainer for the securing member.

42. The method of paragraph 41 , wherein the distal leaf portion includes a plate region that defines a plane, and wherein the retainer defines an axis that is parallel to the plane.

43. The method of paragraph 41 or 42, wherein the securing member extends through the retainer parallel to a local long axis of the rib bone.

44. The method of any of paragraphs 32 to 43, wherein the step of attaching the clip member includes a step of producing a tensioned configuration of the securing member that urges the bridge region toward the rib bone, urges the leaf portions toward each other, and applies axial compression to the rib bone.

45. The method of any of paragraphs 32 to 44, wherein the clip member includes a pair of integral drill guides connected to a proximal leaf portion, further comprising a step of forming holes through the rib bone coaxial with the drill guides, and a step of detaching the drill guides from the proximal leaf portion.

46. A method of rib stabilization, comprising: (A) selecting a clip member having a bridge region and a pair of leaf portions connected to each other by the bridge region; (B) disposing the clip member on a rib bone with the leaf portions disposed on opposite sides of the rib bone; and (C) attaching the clip member to the rib bone with a securing member that extends exactly twice between the leaf portions via a pair of holes in the rib bone, the securing member being tensioned to apply axial compression to the rib bone between the pair of holes.

47. The method of paragraph 46, wherein the step of attaching the clip member includes a step of hooking the securing member onto a bracket provided by one of the leaf portions.

48. A method of rib stabilization, comprising: (A) selecting a clip member having a bridge region and proximal and distal leaf portions connected to each other by the bridge region, the proximal leaf portion including a bracket; (B) disposing the clip member on a rib bone with the proximal and distal leaf portions disposed on respective outer and inner sides of the rib bone; and (C) attaching the clip member to the rib bone with a securing member that is engaged with the bracket and that extends at least twice between the leaf portions.

49. The method of paragraph 48, wherein the step of attaching the clip member includes a step of fastening ends of the securing member to each other and a step of hooking the securing member onto the bracket after the step of fastening ends.

50. The method of paragraph 48 or 49, wherein the step of hooking applies axial compression to the rib bone.

51 . The method of any of paragraphs 48 to 50, wherein the step of hooking urges the bridge region toward the rib bone and urges the leaf portions toward each other. The disclosure set forth above may encompass multiple distinct inventions with independent utility. Although each of these inventions has been disclosed in its preferred form(s), the specific embodiments thereof as disclosed and illustrated herein are not to be considered in a limiting sense, because numerous variations are possible. The subject matter of the inventions includes all novel and nonobvious combinations and subcombinations of the various elements, features, functions, and/or properties disclosed herein. The following claims particularly point out certain combinations and subcombinations regarded as novel and nonobvious. Inventions embodied in other combinations and subcombinations of features, functions, elements, and/or properties may be claimed in applications claiming priority from this or a related application. Such claims, whether directed to a different invention or to the same invention, and whether broader, narrower, equal, or different in scope to the original claims, also are regarded as included within the subject matter of the inventions of the present disclosure. Further, ordinal indicators, such as first, second, or third, for identified elements are used to distinguish between the elements, and do not indicate a particular position or order of such elements, unless otherwise specifically stated.

Claims

WE CLAIM:

1 . A system for rib stabilization, comprising:

a clip member having a bridge region and a proximal leaf portion and a distal leaf portion connected to each other by the bridge region, the clip member being configured to be placed on a rib bone with the leaf portions disposed on opposite sides of the rib bone; and

a securing member to attach the clip member to the rib bone, the securing member including a suture.

2. The system of claim 1 , wherein the distal leaf portion includes a retainer to hold the securing member.

3. The system of claim 2, wherein the retainer defines an axis that is parallel to a plane defined by a plate region of the distal leaf portion.

4. The system of claim 3, wherein the retainer defines a channel that extends along the axis.

5. The system of claim 2, wherein a plate region of the distal leaf portion has an outer surface region, and wherein the retainer projects from the outer surface region.

6. The system of claim 2, wherein the clip member defines a through-axis along which a rib bone extends after the clip member is placed on the rib bone, and wherein the retainer defines an aperture that is parallel to the through-axis.

7. The system of claim 2, wherein the securing member extends through an aperture defined by the retainer.

8. The system of claim 7, wherein the securing member is axially slideable in the retainer.

9. The system of claim 1 , wherein ends of the securing member are tied to one another.

10. The system of claim 1 , wherein the securing member is disposed in a loop.

1 1 . The system of claim 10, wherein the loop is a suture loop.

12. The system of claim 1 , wherein the proximal leaf portion includes a bracket configured to engage the securing member.

13. The system of claim 12, wherein the securing member has a pair of ends, and wherein the bracket is configured to hold the securing member after the ends of the securing member have been fastened to each other and the securing member has been hooked onto the bracket.

14. The system of claim 12, wherein the securing member is disposed in a loop that is hooked onto the bracket.

15. The system of claim 14, wherein unhooking the loop from the bracket loosens the securing member.

16. The system of claim 12, wherein the bracket projects upward when the bridge region is disposed above the leaf portions.

17. The system of claim 1 , wherein the securing member extends between the leaf portions at least twice without overlapping the bridge region.

18. The system of claim 17, wherein the securing member is centered around an axis that extends through the bridge region.

19. The system of claim 18, wherein the axis is orthogonal to the bridge region.

20. The system of claim 17, wherein the securing member extends between the leaf portions exactly twice and forms a loop.

21 . The system of claim 20, wherein the securing member is engaged with each leaf portion.

22. The system of claim 21 , wherein the securing member is not in contact with the bridge region.

23. The system of claim 1 , wherein the clip member includes at least one integral drill guide connected to a leaf portion.

24. The system of claim 23, wherein each drill guide is attached to the proximal leaf portion by a frangible connection.

25. The system of claim 24, wherein the proximal leaf portion thins at the frangible connection.

26. The system of claim 23, wherein the clip member includes a pair of detachable drill guides.

27. The system of claim 23, wherein each drill guide defines an aperture that is elongated transverse to a plane defined by a plate region of the proximal leaf portion.

28. The system of claim 23, wherein each drill guide defines an aperture that is open at opposing ends and open along a side of the drill guide to form a slot.

29. The system of claim 1 , wherein the clip member is formed of a bioresorbable polymer.

30. The system of claim 29, wherein the securing member is formed of a bioresorbable polymer.

31 . The system of claim 1 , wherein the securing member includes a pair of ends tied together to form a knot.

32. A method of rib stabilization, comprising:

selecting a clip member having a bridge region and a pair of leaf portions connected to each other by the bridge region;

disposing the clip member on a rib bone with the clip member spanning a discontinuity of the rib bone and the leaf portions disposed on opposite sides of the rib bone; and

attaching the clip member to the rib bone with a securing member that extends between the leaf portions at least twice, through the rib bone at least twice, and spans the discontinuity.

33. The method of claim 32, wherein the securing member extends through a pair of holes formed in the rib bone, and wherein the step of attaching the clip member includes a step of creating a tensioned configuration of the securing member that applies axial compression to the rib bone between the pair of holes.

34. The method of claim 32, wherein the securing member includes a suture.

35. The method of claim 34, wherein the step of attaching the clip member includes a step of tying a pair of suture ends to one another.

36. The method of claim 34, wherein the securing member is a single length of suture, and wherein the step of attaching includes a step of forming a loop with the single length of suture.

37. The method of claim 32, wherein the securing member extends at least twice through the rib bone between an inner surface region and an outer surface region of the rib bone and does not extend from the inner surface region to the outer surface region outside the rib bone.

38. The method of claim 32, wherein the clip member includes a bracket, and wherein the step of attaching the clip member includes a step of hooking the securing member onto the bracket to tighten the securing member.

39. The method of claim 38, wherein the securing member extends through a first hole and a second hole in the rib bone, wherein an outer portion of the securing member extends from the first hole to the second hole on the outer side of the rib bone, and wherein the step of hooking repositions a central region of the outer portion closer to the bridge region.

40. The method of claim 39, wherein the leaf portions include a proximal leaf portion and a distal leaf portion, and wherein the proximal leaf portion includes the bracket and the distal leaf portion includes a retainer for the securing member, and wherein the first and second holes in the rib bone are located inferior to the bracket and the retainer after the step of hooking.

41 . The method of claim 32, wherein the leaf portions include a proximal leaf portion and a distal leaf portion, and wherein the distal leaf portion includes a retainer for the securing member.

42. The method of claim 41 , wherein the distal leaf portion includes a plate region that defines a plane, and wherein the retainer defines an axis that is parallel to the plane.

43. The method of claim 41 , wherein the securing member extends through the retainer parallel to a local long axis of the rib bone.

44. The method of claim 32, wherein the step of attaching the clip member includes a step of producing a tensioned configuration of the securing member that urges the bridge region toward the rib bone, urges the leaf portions toward each other, and applies axial compression to the rib bone.

45. The method of claim 32, wherein the clip member includes a pair of integral drill guides connected to a proximal leaf portion, further comprising a step of forming holes through the rib bone coaxial with the drill guides, and a step of detaching the drill guides from the proximal leaf portion.

46. A method of rib stabilization, comprising:

disposing the clip member on a rib bone with the leaf portions disposed on opposite sides of the rib bone; and

attaching the clip member to the rib bone with a securing member that extends exactly twice between the leaf portions via a pair of holes in the rib bone, the securing member being tensioned to apply axial compression to the rib bone between the pair of holes.

47. The method of claim 46, wherein the step of attaching the clip member includes a step of hooking the securing member onto a bracket provided by one of the leaf portions.

48. A method of rib stabilization, comprising:

selecting a clip member having a bridge region and proximal and distal leaf portions connected to each other by the bridge region, the proximal leaf portion including a bracket;

disposing the clip member on a rib bone with the proximal and distal leaf portions disposed on respective outer and inner sides of the rib bone; and

attaching the clip member to the rib bone with a securing member that is engaged with the bracket and that extends at least twice between the leaf portions.

49. The method of claim 48, wherein the step of attaching the clip member includes a step of fastening ends of the securing member to each other and a step of hooking the securing member onto the bracket after the step of fastening ends.

50. The method of claim 48, wherein the step of hooking applies axial compression to the rib bone.

51 . The method of claim 48, wherein the step of hooking urges the bridge region toward the rib bone and urges the leaf portions toward each other.