Apparatus and methods for treatment of a bone

Apparatus and methods for treatment of a bone. The apparatus may include an implant. The implant may include an implant tail and an implant head configured to expand, inside the bone, from a collapsed state to an expanded state. The apparatus may include an intramedullary rod defining a central longitudinal rod axis. The intramedullary rod may include a guide segment configured to guide the implant head into the bone and support the implant tail. The intramedullary rod may include an elongated extension member spaced radially apart from the central longitudinal axis. The extension member may be configured to provide clearance for the implant head as the implant head is advanced, in the collapsed state, into the bone. The extension member may be configured to provide clearance for the implant head in the expanded state.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a nonprovisional of U.S. Provisional Application No. 62/528,476, filed on Jul. 4, 2017, which is hereby incorporated herein by reference in its entirety.

BACKGROUND

Bone fracture fixation may involve using structures to counteract or partially counteract forces on a fractured bone or associated bone fragments. In general, fracture fixation may provide longitudinal (along the longitudinal axis of the bone), transverse (across the longitudinal axis of the bone), and rotational (about the longitudinal axis of the bone) stability. Fracture fixation may also preserve normal biologic and healing function.

Bone fracture fixation often involves addressing loading conditions, fracture patterns, alignment, compression force, and other factors, which may differ for different types of fractures. For example, midshaft fractures may have ample bone material on either side of the fracture in which anchors may be driven. End-bone fractures, especially near the articular surface may have thin cortical bone, soft cancellous bone, and relatively fewer possible anchoring locations.

Multi-segment fractures, of either the midshaft or end-bone, may require alignment and stability in a manner that generates adequate fixation in multiple directions.

Placement of the structures may be important for proper healing of the bone.

It would be desirable, therefore, to provide apparatus and methods for placement of structures.

DETAILED DESCRIPTION OF THE INVENTION

Apparatus and methods for reducing a fracture of a bone are provided.

Apparatus and methods for implanting an implant into a target site in the bone are provided.

Apparatus and methods for securing the fractured bone are provided.

The apparatus may include, and the methods may involve, a jig. The jig may include features that spatially register external bone anatomy to an implant target site in the bone. The jig features may be used to direct one or more wires, screws, cavity preparation devices, plates and implants, or other suitable items, so that the implant may be delivered to the site.

Drilling and cavity preparation may be performed using apparatus and methods described in U.S. patent application Ser. No. 13/009,657, filed on Jan. 19, 2011, now U.S. Pat. No. 8,961,518, and/or U.S. patent application Ser. No. 14/568,301, filed on Dec. 12, 2014, both of which are hereby incorporated by reference herein in their entireties.

Reduction of a fracture and apparatus and methods for inserting an implant into a bone, may be performed using apparatus and methods described in U.S. patent application Ser. No. 13/043,330, filed on Mar. 8, 2011, and/or in U.S. patent application Ser. No. 13/414,695, filed on Mar. 7, 2012, both of which are hereby incorporated by reference herein in their entireties.

The implant may be an implant that is not expandable. The implant may be an expandable implant. The implant may self-expand when deployed and/or when rotated. The implant may be expanded using one or more actuating mechanisms. The implant may be radially expandable. The implant, when expanded, may form a mesh cage. The mesh cage may include interconnected cells. The implant, when expanded, may take on any suitable shape. The implant may be expanded from an unexpanded state to an expanded state. The unexpanded state may be a collapsed state.

The implant may be implanted in any suitable bone in the human body. The implant may be implanted in any suitable bone in an animal. A suitable bone may be a bone with a metaphyseal and a diaphyseal region, or any other suitable bone. For example, the bone may be a lateral condylar fracture in a horse. The lateral condylar fracture may be a fracture of the third metacarpal or cannon bone on the distal or lower end of the horse.

The implant may occupy a volume in the interior of the bone after it has been expanded. The implant may occupy the volume when the implant is positioned at the target site and expanded to form a mesh cage. The volume may define a three-dimensional area within the interior. The volume may occupy a portion of the interior. A volume occupied by the implant when the implant is positioned at a target site and radially expanded may be referred to herein as an ‘implantation region.’

The implant may occupy a first volume when it is positioned at the target site prior to expansion. The implant may occupy a second volume when it is positioned at the target site and after it has been expanded.

The implant may include an implant head. The implant may include an implant tail. An implant shaft may be releasably coupled to the implant tail. The implant head may be formed from laser cut tube stock. The implant tail may be formed from laser cut tube stock. The implant head, when expanded, may form a mesh cage. The mesh cage may form a lattice-like structure defining a plurality of openings. The mesh cage may be an anchoring substrate. The mesh cage may be a mesh anchoring substrate.

The implant tail may be coupled to the implant head. The implant tail may be fixedly attached to the implant head, removably attached to the implant head, or of unitary or monolithic structure with the implant head. A portion of the implant tail may have a tubular shape. All of the implant tail may have a tubular shape. The implant tail may include a first end and a second end. The first end may be coupled to the implant head. The second end may be coupled to the implant shaft. The second end may be releasably coupled to the implant shaft.

The implant may include a base. The base may be positioned between the implant head and the implant tail.

The second end of the implant tail may be so shaped that, after the implant is implanted in the bone, the second end conforms to a contour of the bone surface abutting the second end. The second end may sit flush with the bone surface.

The second end may be so shaped that, after the implant is implanted in the bone, the second end sits below the bone surface. The second end may be so shaped that, after the implant is implanted in the bone, the second end protrudes above the bone surface.

The bone may be any suitable bone in the human body. The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone. The surface contour may be a two-dimensional or three-dimensional shape. The surface contour encompass two, three, four, or more different points or demarcation points on the surface of the bone. The points or lines may be at different elevations from the longitudinal axis. The points or lines may be at different angular displacements about the bone longitudinal axis. Thus, the surface contour may encompass a region of the bone surface having “topography” that varies longitudinally along the bone. Thus, the surface contour may encompass a region of the bone surface having “topography” that varies circumferentially about the bone.

The bone may include two or more surface contours. Each surface contour may extend along a portion of the bone surface.

A surface contour may include an anatomical landmark. A surface contour may include two or more anatomical landmarks. An anatomical landmark may include any anatomical structure of a bone in the human body that is used as an orientation point for medical measurements. A landmark may include a tuberosity, articular surface, condyle, a transitional location between a metaphyseal and a diaphyseal region, an end of a bone or any other suitable landmark. Exemplary landmarks may include a protuberance, such as a protuberance at a point on a bone where muscles or ligaments are attached, or any other suitable protuberance. When the bone is a proximal humerus, an anatomical landmark may include a greater tuberosity, an intertubercular groove, a lesser tuberosity, a surgical neck and an anatomical neck.

The apparatus may include the jig. The jig may be a reduction jig or any suitable jig or fixture. The jig may be used to facilitate the reduction of a bone fracture. The jig may be used to attain reduction of a bone fracture. The jig may be used to maintain reduction of the bone fracture. The jig may be used to facilitate provisional reduction of the fracture. The jig may be used to facilitate the securing of a bone. The bone may be any bone in the human body. The bone may be a fractured bone. The bone may be an osteoporotic bone. The bone may be a bone in need of therapeutic care.

The fracture may define one or more fragments or segments. For the purposes of this application, the term fragment and the term segment may be interchangeable. A segment or fragment may be used to call out any piece of a bone.

The jig may be shaped to span a fracture line of the fracture. The fracture line may be a typical fracture line. The fracture line may be an atypical fracture line. The jig, when secured to the fractured bone, may provide stability across one or more fracture lines of the bone. The jig, when secured to the bone, may provide stability across one or more planes defined by the bone. The jig may include a member that spans across a fracture site of a bone. The jig may include two members that span across a fracture site of the bone.

The bone may be a humerus bone. The jig may be applied to a proximal portion of the humerus bone. The jig may be shaped to span a typical fracture line of a proximal humeral fracture. A typical fracture line may be along a surgical neck of a proximal humerus.

The jig may be used with a plurality of surgical approaches. The surgical approaches may include a delto-pectoral approach, a deltoid split approach, an antegrade approach, a percutaneous approach, and any other suitable approach. A percutaneous approach may be a surgical approach performed primarily through a small incision the skin.

The jig may be formed from any suitable material. The material may be biocompatible. The material may be radiopaque. Radiopaque materials may include plastic, carbon fiber or Polyetheretherketone (“PEEK”). The material may include metal such as stainless steel, Nitinol, other alloy, titanium alloys, aluminum alloys, composites of carbon fiber, or one or more plastics or epoxy resin. The jig may include a “soft” material. If the jig includes soft material, such as a plastic or epoxy resin, metal bushings may be incorporated into bores defined by the jig to provide more sound bearing surfaces for securing, penetrating and/or rotating members.

The reduction, provisional reduction and/or securing of a bone administered using the jig may assist a physician in repairing a bone fracture. The reduction, provisional reduction and/or securing of a bone administered using the jig may assist a physician in implanting the implant in an interior of a bone. For example, a shape of the jig and/or a plurality of holes defined by the jig may enable a physician to implant the implant in a bone interior without being obstructed by the jig and/or members supported by the jig. For example, the physician may implant an implant into an intramedullary canal of a bone without encountering obstruction by either the jig or members supported by the jig.

Two or more of the numerous jig features shown or described herein may be employed together in an individual jig.

The apparatus may include a plate. The plate may be releasably coupled to the jig. The plate may be used without the jig. The plate may be a surgical plate.

The plate may be formed from any suitable material such as a polymer, metal, composite such as a composite of carbon fiber, stainless steel, titanium alloys, aluminum alloys, Nitinol other alloy, a polymer or any other suitable material. The plate may provide buttressing support to a fracture. The plate may be removed from the bone prior to anchoring the implant to the bone. The plate may be anchored to the bone and to the implant and then left in place.

The plate may be used as a reduction jig or fixture. The plate may be used to facilitate the reduction of a bone fracture. The plate may be used to attain reduction of a bone fracture. The plate may be used to maintain reduction of the bone fracture. The plate may be used to facilitate provisional reduction of the fracture. The plate may be used to facilitate the securing of a bone. The bone may be any bone in the human body. The bone may be a fractured bone. The bone may be an osteoporotic bone. The bone may be a bone in need of therapeutic care.

The plate may be shaped to span a fracture line of the fracture. The fracture line may be a typical fracture line. The fracture line may be an atypical fracture line. The plate, when secured to the fractured bone, may provide stability across one or more fracture lines of the bone. The plate, when secured to the bone, may provide stability across one or more planes defined by the bone. The plate may include a member that spans across a fracture site of a bone. The plate may include two members that span across a fracture site of the bone.

The bone may be a humerus bone. The plate may be applied to a proximal portion of the humerus bone. The plate may be shaped to span a typical fracture line of a proximal humeral fracture. A typical fracture line may be along a surgical neck of a proximal humerus.

The plate may be used with a plurality of surgical approaches. The surgical approaches may include a delto-pectoral approach, a deltoid split approach, an antegrade approach, a percutaneous approach, and any other suitable approach. A percutaneous approach may be a surgical approach performed primarily through a small incision the skin.

The reduction, provisional reduction and/or securing of a bone administered using the plate may assist a physician in repairing a bone fracture. The reduction, provisional reduction and/or securing of a bone administered using the plate may assist a physician in implanting the implant in an interior of a bone. For example, a shape of the plate and/or a plurality of holes defined by the plate may enable a physician to implant the implant in a bone interior without being obstructed by the plate and/or members supported by the plate. For example, the physician may implant an implant into an intramedullary canal of a bone without encountering obstruction by either the plate or members supported by the plate.

Two or more of the numerous plate features shown or described herein may be employed together in an individual plate.

The plate may include features that are shown and described herein in connection with the jig. The jig may include features that are shown and described herein in connection with the plate.

Apparatus disclosed herein may define a hole. The hole may point in a direction. The direction may be a direction of a central axis of the hole.

Apparatus disclosed herein may define a bottom surface. The bottom surface may complement a surface contour of a bone. The bottom surface may complement the surface contour of when the bottom surface is in contact with the bone. The bottom surface may complement the surface contour when the bottom surface is in contact with the bone.

The apparatus may include apparatus for, and the methods may involve, delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour that extends along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include the jig. The jig may have one or more features in common with any other jig or plate disclosed herein. The jig may include a bottom surface.

The jig may define one or more pluralities of holes (may be referred to herein as “fixation element holes”). The bottom surface may complement the surface contour. When the bottom surface is seated complementarily against the surface contour, a plurality of holes may point into the interior, but not into the volume to be occupied by the implant when the implant is positioned at the target site and radially expanded. The implant, when expanded, may form a mesh cage.

A plurality of holes may be sized to provide clearance for the implant in an interior of the bone.

A plurality of holes may be sized to receive fixation element. A fixation element, when passed through the plurality of holes, may engage the bone or fragment. Fixation elements that may be driven through one or more of the plurality of holes include pins, wires, K-wires, drills, needles, suture, cable, a threaded K-wire coupled to a nut to provide compression and/or threaded K-wires or any other suitable fixation element.

The plurality of holes may be located throughout the jig. The plurality of holes may be located throughout the jig so that fixation elements can be driven into a bone above and below a fracture line defined by a bone. The plurality of holes may assist a physician in securing the jig at a proper anatomical position on the bone. Fixation elements passed through the plurality of holes and into the bone may releasably couple the jig to the bone.

A fixation element hole may be sized too small to receive a screw.

Each of the fixation element holes may be smaller than holes for receiving screws (“screw holes”). Fixation element holes of the jig may be too small to receive a screw that can be received by a screw hole of the same jig.

Size ranges for the plurality of holes may include any size range suitable to one skilled in the art, for example a range between 1 mm and 6 mm.

Table 1 shows selected illustrative size ranges for a hole sized for receiving a fixation element having lower and upper limits.

For example, for the plate configured to be applied to a proximal humerus bone, the plurality of holes may be 2.5 mm or smaller and a screw hole may be 3 mm or larger.

A screw hole may be sized too small to receive an unexpanded implant.

One or more of the plurality of holes may be internally threaded.

A threaded hole may receive a screw.

A threaded hole may receive an externally threaded bushing. The externally threaded bushing may define a bore. The bore may be sized to receive a fixation element. The bushing may assist a physician in guiding a fixation element through a hole defined by the jig and into a bone interior.

An internally threaded hole may be used as a K-wire bushing guide.

Two or more of the plurality of holes may be internally threaded.

All of the pluralities of holes may be internally threaded.

One or more of the plurality of holes may be not threaded.

The jig may define a bottom face. The bottom face may include the bottom surface. The bottom surface may define a portion of the bottom face. The bottom surface may define the bottom face. The bottom face may include two or more bottom surfaces.

The bottom surface may be a first bottom surface. The bottom face may include a second bottom surface. The second bottom surface may not complement a surface contour of the bone. The surface contour may be a first surface contour. The bone may include a second surface contour that extends along a surface of the bone between two or more points at different elevations from the longitudinal axis. The second bottom surface may complement the second surface contour. The surface contour may be a first surface contour, the bone may be a first bone and the longitudinal axis may be a second longitudinal axis. A second bone may include a second surface contour that extends along a surface of the second bone between two or more points at different elevations from a second longitudinal axis defined by the second bone. The second bottom surface may complement the second surface contour.

The jig may define a target hole. The target hole may be sized to receive a fixation element. A fixation element advanced through the target hole may be referred to herein as a “target wire.” When the bottom surface of the jig is seated complementarily against the surface contour, the target hole may point to the target site. The target site may be a location in the bone interior where a physician may desire to position an end of the implant. The end of the implant may be an end of an implant head distal a physician when the implant is implanted in a bone.

The target hole may be tapered.

When a fixation element is advanced through the target hole and into an interior of a bone, a practitioner may position a tip of the fixation element at or near the target site. The practitioner may position the end of the implant at or near the point in the bone penetrated by the tip of the target wire. The head of the implant may be positioned at a point in the bone proximal to the point penetrated by the tip of the target wire. The head of the implant may be positioned at a point in the bone distal to the point penetrated by the tip of the target wire.

Where the bone is a proximal humerus bone, the target site may be a center of a head of the proximal humerus bone. When the bottom surface is seated complementarily against the surface contour, the target hole may point to a center-center location in the interior of the proximal humeral head. Driving a target wire through the target hole may advance the tip of the target wire towards the center-center location in the interior of the proximal humeral head.

Where the bone is a proximal humerus bone, the surface contour may include a greater tuberosity. The surface contour may include an intertubercular groove. The surface contour may include a deltoid insertion. The surface contour may include two or more of the greater tuberosity, the intertubercular groove and the deltoid insertion.

The implant may be a first implant and the volume may be a first volume. Each of the plurality of holes may point into the interior, but not into the first volume or into a second volume occupied by a second implant when the second implant is positioned at the target site and radially expanded. The second implant, when expanded, may form a mesh cage.

The jig may include an indicator. The indicator may be a notch, a slit, a depression, or any other suitable demarcation on a top or side face of the jig. When the bottom surface is seated complementarily against the surface contour, the indicator may register to a location on the surface for initiating an access hole for accessing the target site. A location on the surface for initiating an access hole may be referred to herein as an “access position.” The access position may be a location on the surface adjacent the indicator. A distance between the location and the target site may correspond to a length of the implant.

An access hole may be initiated by drilling through the surface to form a hole. An access hole may be a hole on a surface of the bone through which a practitioner may access a target site in a bone interior. An access hole may be a hole on a surface of the bone for accessing the target site along a straight path.

The jig may include an indicator. The indicator on the jig may be spaced apart from the target hole. When the bottom surface of the jig is seated complementarily on a surface contour of a bone, a spatial separation between the target hole and the target site may have a second length. The second length may be known based on an anatomy of the bone.

The jig may include a first indicator and a second indicator. When the bottom surface is seated complementarily against the surface contour, the first indicator may register to a first location on the surface for initiating a first access hole for accessing the target site. When the bottom surface is seated complementarily against the surface contour, the second indicator may register to a second location on the surface for initiating a second access hole for accessing the target site. A distance between the first location and the target site may correspond to a first implant length. A distance between the second location and the target site corresponds to a second implant length. The first implant length may be different from the second implant length.

Where the jig includes a transverse member, a first longitudinal member and a second longitudinal member, the jig may include a first indicator and a second indicator. The first indicator may be located on the first longitudinal member. The second indicator may be located on the second longitudinal member. Each of the first indicator and the second indicator may register to a location on the bone for initiating an access hole.

The plurality of holes may include a first hole and a second hole. The first hole may point in a first direction. The second hole may point in a second direction. The first direction may be divergent from the second direction. The first direction may be convergent with the second direction. The first direction may be non-parallel with the second direction. The first direction may be parallel with the second direction.

The plurality of holes may point in non-parallel directions. Some of the plurality of holes may point in parallel directions. Some of the plurality of holes may point in different directions. Each the plurality of holes may point in a unique trajectory. None of the trajectories may be parallel.

None of the plurality of holes may transect the jig at a right angle. One or more of the trajectories defined by the plurality of holes may transect the jig at right angles. All of the trajectories defined by the plurality of holes may transect the jig at right angles.

When the bottom surface is seated complementarily against the surface contour, the jig may partially define an area on the surface of the bone for initiating an access hole for accessing the target site.

The jig may include a longitudinal member. The jig may be elongated along a longitudinal axis of the bone.

The jig may include a longitudinal member and a transverse member extending away from the longitudinal member. The transverse member may extend away from the longitudinal member. The transverse member may assist in stabilizing the fracture across a fracture line defined by the fractures site. The longitudinal member may include the bottom surface. The transverse member may include the bottom surface. The longitudinal member and the transverse member may include the bottom surface. The bottom surface may be a first bottom surface, the surface contour may be a first contour and the surface may be a first surface. The longitudinal member may include the first bottom surface. The transverse member may include a second bottom surface. The second bottom surface may complement a second surface contour that extends along a second surface of the bone between two or more points at different elevations from the longitudinal axis.

The jig may include a longitudinal member and a transverse member extending away from the longitudinal member. When bone is a proximal humerus bone, the surface contour may include a greater tuberosity and an intertubercular grove. The transverse member may include a first bottom surface complementing the greater tuberosity. The longitudinal member may include a second bottom surface complementing the intertubercular groove.

The jig may include a longitudinal member and a transverse member extending away from the longitudinal member. Where bone is a proximal humerus bone, the surface contour may include a greater tuberosity, an intertubercular grove and a deltoid insertion. The transverse member may include a first bottom surface complementing the greater tuberosity. The longitudinal member may include a second bottom surface complementing the intertubercular groove. The longitudinal member may include a third bottom surface distal the transverse member. The third bottom surface may complement the deltoid insertion and a lateral aspect of the humerus shaft.

The jig may include a positioning hole. The positioning hole may be located at an end of the jig. The positioning hole may be sized to receive a fixation element. When the bottom surface is seated complementarily against the surface contour, the positioning hole may point in a direction. The direction may be tangent to the bone. The direction may not transect a surface of the bone.

When the bone is proximal humerus bone, the direction may be tangent to a top of the greater tuberosity. A bottom surface of the jig extending away from the positioning hole may complement a surface contour of the humerus defined by a greater tuberosity. The bottom surface complementing the surface contour of the greater tuberosity may be used by a practitioner as a greater tuberosity locator. For example, positioning the bottom surface of the jig on the greater tuberosity may provide a physician with tactile feedback indicating that the jig has been properly positioned on the bone.

The jig may include a first longitudinal member, a second longitudinal member, a first transverse member and a second transverse member. The first transverse member may define a first end and a second end. The first longitudinal member may extend away from the first end. The second longitudinal member may extend away from the second end. The second transverse member may define a third end and a fourth end. The second transverse member may be positioned between the first longitudinal member and the second longitudinal member. The third end may adjoin the first longitudinal member along a length of the first longitudinal member. The fourth end may adjoin the second longitudinal member along a length of the second longitudinal member. The first longitudinal member may define a first longitudinal axis. The second longitudinal member may define a second longitudinal axis. The second transverse member may define a third longitudinal axis. The third longitudinal axis may transect the first longitudinal axis and the second longitudinal axis at a right angle. The third longitudinal axis may transect the first longitudinal axis and the second longitudinal axis at an oblique angle. The third longitudinal angle may transect the first longitudinal axis at a right angle and the second longitudinal axis at an oblique angle.

The jig may include a first longitudinal member, a second longitudinal member and a transverse member. The transverse member may define a first end and a second end. The first longitudinal member may extend away from the first end. The second longitudinal member may extend away from the second end. The bottom surface may be a first bottom surface, the surface contour may be a first surface contour and the surface may be a first surface. The bone may include a second surface contour that extends along a second surface of the bone between two or more points at different elevations from the longitudinal axis. The bone may include a third surface contour that extends along a third surface of the bone between two or more points at different elevations from the longitudinal axis. The transverse member may include the first bottom surface. The first longitudinal member may include a second bottom surface complementing the second surface contour. The second longitudinal member may include the third bottom surface complementing the third surface contour.

The jig may include a first longitudinal member, a second longitudinal member and a transverse member. The transverse member may define a first end and a second end. The first longitudinal member may extend away from the first end. The second longitudinal member may extend away from the second end. The bottom surface may be a first bottom surface, the surface contour may be a first surface contour, the surface may be a first surface, the bone may be a first bone and the longitudinal axis may be a first longitudinal axis. The second bone may include a second surface contour that extends along a second surface of the bone between two or more points at different elevations from a second longitudinal axis. The first longitudinal member may include the first bottom surface. The second longitudinal member may include a second bottom surface complementing the second surface contour. Both the first bone and the second bone may define a third surface contour. The transverse member may define a third bottom surface complementing the third surface contour.

The jig may include a first longitudinal member, a second longitudinal member and a transverse member. The transverse member may define a first end and a second end. The first longitudinal member may extend away from the first end. The second longitudinal member may extend away from the second end. The bone may be a left humerus. A second bone may be a right humerus. The transverse member may include the first bottom surface. The first bottom surface may complement a greater tuberosity of the left humerus and a greater tuberosity of the right humerus. The first longitudinal member may include a second bottom surface complementing an intertubercular groove of the left humerus. The second longitudinal member may include a third bottom surface complementing an intertubercular groove of the right humerus.

The jig may include one or more suturing holes. A suturing hole may allow for attachment of a suture to the jig. Attachment of a suture to the jig may facilitate tying the jig to soft tissue. The suturing holes may be sized for suturing. The suturing holes may have characteristics different from the plurality of holes.

The jig may be configured to receive the plate. The jig may define an opening for receiving the plate. The jig may partially define an area for receiving the plate. The jig may include a coupling mechanism for removably coupling the plate to the jig. When the jig includes a first longitudinal member, a second longitudinal member and a transverse member, the first longitudinal member may include a first coupling mechanism for removably coupling the plate to the jig. The second longitudinal member may include a second coupling mechanism for removably coupling the plate to the jig.

The jig may be configured to be releasably coupled to the plate. A first apparatus may be described herein as being configured to be releasably coupled to a second apparatus. Releasably coupled apparatus may be releasably coupled by a coupling mechanism. The coupling mechanism may include a screw for coupling the first apparatus to the second apparatus, a press fit, a toggle feature, a rotational hook mechanism and any other fastener concept known to those skilled in the art.

For example, the jig may define a first bore extending through the jig and the plate may define a second bore extending through the plate. The first bore and the second bore may be threaded. Driving a screw through the first bore and into the second bore may couple the jig to the plate. Any other suitable coupling mechanisms may be used to couple the jig to the plate.

The jig may include a first longitudinal member, a second longitudinal member and a transverse member. The transverse member may define a first transverse member end and a second transverse member end. The first longitudinal member may define a first longitudinal member end and a second longitudinal member end. The second longitudinal member may define a third longitudinal member end and a fourth longitudinal member end. The first transverse member end may adjoin the first longitudinal member end. The second transverse member end may adjoin the third longitudinal member end. The second longitudinal member end may adjoin the fourth longitudinal member end. The transverse member, the first longitudinal member and the second longitudinal member may define an opening for receiving the plate. When the transverse member is a first transverse member, a second transverse member may be positioned between, and connected to, the second longitudinal member and the fourth longitudinal member end. The transverse member, the first longitudinal member and the second longitudinal member may define an opening for receiving the plate. The first transverse member, the second transverse member, the first longitudinal member and the second longitudinal member may define an opening for receiving the plate.

The jig may be configured to provide therapy to a first bone and a second bone. The jig may include a first bottom surface and a second bottom surface. The first bottom surface may conform to a surface contour of the first bone. The second bottom surface may conform to a surface contour of the second bone. The jig may include two or more bottom surfaces that conform to a surface contour of a first bone and two or more bottom surfaces that conform to a surface contour of a second bone.

For example, the first bone may be a right humerus. The first bone may include a first surface contour defined by a first greater tuberosity of the first bone and a second surface contour defined by a first intertubercular groove of the first bone. The second bone may be a proximal portion of a left humerus. The second bone may include a third surface contour defined by a second greater tuberosity of the second bone and a fourth surface contour defined by a second intertubercular groove of the second bone.

The transverse member may include a first bottom surface. The first bottom surface may complement the first surface contour and the third surface contour. The first longitudinal member may include a second bottom surface. The second bottom surface may complement the fourth surface contour. The second longitudinal member may include a third bottom surface. The third bottom surface may complement the second surface contour.

The jig may define an opening. When the bottom surface is seated complementarily against the surface contour, the opening may define an area on the surface of the bone for initiating an access hole for accessing the target site.

When the jig defines an opening, the opening may have a width. The width may be at least twice as wide as a diameter defined by the first holes. The width may be one and a half times as wide as a diameter defined by the first holes. The width may range from 6 mm to 8 mm. The width may range from 6 mm to 12 mm. The jig may have a longitudinal axis. The width may be perpendicular to the longitudinal axis. The opening may define a length. The length may have any suitable size. The length of the opening may range from 6 mm to 8 mm. The length of the opening may range from 6 mm to 12 mm. The opening may be sized to provide clearance for the implant in the non-expanded state. The implant, in the non-expanded state, may have a diameter. The diameter may be any suitable diameter. The diameter may be 7 mm, 8 mm, 9 mm, or any other suitable diameter.

When the jig defines an opening, the jig may include a guide. The guide may extend away from the opening. The guide may fix or partially fix an access angle used by a practitioner for preparing the access hole. The access angle may be an angle between a longitudinal central axis of the guide and a longitudinal axis of the bone. When the bottom surface is seated on the surface contour, a central axis defined by the guide may point to the target site. When the bottom surface is seated on the surface contour, a central axis defined by the guide may point in a direction that does not intersect with the target site.

The guide may assist a practitioner in preparing the access hole and advancing the implant through the access hole towards the target site. The guide may receive one or more bushings during a surgical procedure. The guide may be used to direct a fixation element through the access hole and into the interior of the bone. The guide may be used to direct a drill through the access hole and into the interior of the bone. The guide may be used to direct an unexpanded implant through the access hole and into the interior of the bone.

The guide may include a guide inner surface. The guide inner surface may be sized to provide clearance for an implant.

The guide may define a guide central axis extending through the guide inner surface. The guide inner surface may be cylindrical, partially cylindrical and partially flat, or any other suitable shape. The guide inner surface may include a cylindrical portion. The guide may be cut from a tube angled at an angle oblique to the jig. The tube may be cut away from the jig after it becomes tangent to the jig.

The guide may receive a bushing. The bushing may be used to protect soft tissue from drills or other instruments inserted into the jig. The bushing may direct a target wire into a bone at a fixed angle relative to a longitudinal axis of the bone. The bushing may direct a cavity preparation device into a bone at a fixed angle relative to a longitudinal axis of the bone. The busing may direct an implant into a bone at a fixed angle relative to a longitudinal axis of the bone. The bushing may include a collar that mates with the guide

The guide may receive a bushing sized to receive a fixation element. The guide may receive a bushing sized to receive a drill. The guide may receive a bushing sized to receive a cavity preparation device. The guide may receive a bushing sized to receive an implant. The guide may receive a bushing sized to receive a drill, an implant and a cavity preparation device. A drill outer circumference, a cavity preparation device outer circumference and an implant outer circumference may be equal. The guide may receive a first bushing disposed within a second bushing. The first bushing may be sized to receive a fixation element. The second bushing may be sized to receive a drill. The second bushing may be sized to receive a cavity preparation device. The second bushing may be sized to receive an implant.

When the first bushing, disposed within the second bushing, is positioned in the guide, a practitioner may insert a fixation element through the first bushing. The practitioner may advance the fixation element towards the target site. The practitioner may confirm that the tip of the fixation element is positioned in a desired location within the interior. The desired location may be a target site. When a tip of the fixation element is positioned at the desired location, the practitioner may remove the first bushing from within the second bushing. The practitioner may drive a cannulated drill over the fixation element, through the second bushing and towards the target site. The practitioner may remove the first bushing and the fixation element and drive a solid drill towards the desired location. After drilling, the practitioner may remove the drill. After drilling, the practitioner may insert a cavity preparation device through the second bushing and into the interior. When the cavity is prepared, the practitioner may remove the cavity preparation device. When the cavity is prepared, the practitioner may insert an implant through the second bushing and into the interior.

The apparatus may include a bushing (may be referred to herein as an “insert”). The insert may be shaped to be inserted into the guide. The insert may define an insert outer surface. The insert outer surface may match the guide inner surface. The insert outer surface may define an insert outer central axis. The insert may include an insert inner surface. The insert inner surface may define a lumen. The insert inner surface may define an inner insert central axis. The guide may define a slot and the insert may include a projection. When the insert is seated within the guide the projection may be positioned within the insert.

A central axis defined by the guide may be parallel to the insert outer central axis. A central axis defined by the guide may be coaxial with the insert outer central axis. The guide central axis may be parallel to the insert inner central axis. The guide central axis may not be parallel to the insert inner central axis.

A practitioner may insert a fixation element through a first insert disposed within the guide and into the interior. The practitioner may determine that an access angle of the fixation element is undesirable. The practitioner may determine that the access angle is undesirable based at least in part on a position of the fixation element within the bone. The access angle may be an angle between a bone longitudinal axis and a first insert inner central axis. The practitioner may remove the first insert. The practitioner may place a second insert within the guide. The second insert may define a second insert inner central axis. Replacing the first insert with the second insert may change the access angle without necessitating moving the jig along the bone surface.

The apparatus may include apparatus for, and the methods may involve, delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis and include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include the jig. The jig may include a bottom surface. The jig may define a plurality of holes and a target hole. The bottom surface may complement the surface contour.

The apparatus may include the plate. The plate may be configured to be releasably coupled to the jig. The plate may define an opening.

When the bottom surface is seated complementarily against the surface contour and the plate is coupled to the jig, each of the plurality of holes may point into the interior but not into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the bottom surface is seated complementarily against the surface contour and the plate is coupled to the jig, the target hole may point to the target site. When the bottom surface is seated complementarily against the surface contour and the plate is coupled to the jig, the opening may define an area on the surface of the bone for preparing an access hole for accessing the target site.

Each of the plurality of holes may be sized to receive a fixation element.

The plate may define a hole sized for receiving a screw (may be referred to herein as a “screw hole”). The screw may be any suitable screw, such as an anchoring screw or a surgical screw. The screw may be cannulated. The screw may not be cannulated. The screw hole may be threaded. The screw hole may be configured to receive a bushing. The bushing may assist a practitioner in guiding a screw through the screw hole. A screw hole may be too small to provide passage of the implant in an unexpanded state. The screw hole may be tapered.

The screw holes may be internally threaded. The screw holes may not be internally threaded. The screw holes may have a diameter. The diameter may be any suitable size.

Table 2 shows selected illustrative size ranges for a hole sized for receiving a screw having lower and upper limits.

When the bottom surface is seated complementarily against the surface contour and the plate is coupled to the jig, the screw hole may point into the interior and into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the bottom surface is seated complementarily against the surface contour and the plate is coupled to the jig, the screw hole may point into the interior and not into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage.

The plate may define holes sized for receiving screws (may be referred to herein as “screw holes”).

When the bottom surface is seated complementarily against the surface contour and the plate is coupled to the jig, the screw holes may point into the interior and into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the bottom surface is seated complementarily against the surface contour and the plate is coupled to the jig, and the screw holes include a first screw hole and a second screw hole, the first screw hole may point into the interior and into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. The second screw hole may point into the interior and into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage.

The plate may define a hole sized for receiving a fixation element (may be referred to herein as a “fixation element hole”). The plate may define holes sized for receiving fixation elements (may be referred to herein as “fixation element holes”).

The opening may be a first opening. The jig may define a second opening. The plate may be positioned on the surface of the bone in an area defined by the second opening.

The jig may include a transverse member and a longitudinal member. When the plate is coupled to the jig, a first side of the plate may abut the transverse member. When the plate is coupled to the jig, a second side of the plate may abut the longitudinal member. When the plate is coupled to the jig, a first side of the plate may abut the transverse member and a second side of the plate may abut the longitudinal member.

The jig may include a transverse member and a longitudinal member. When the plate is coupled to the jig, the first side of the plate may be adjacent the transverse member. When the plate is coupled to the jig, a second side of the plate may be adjacent the longitudinal member. When the plate is coupled to the jig, the first side of the plate may be adjacent the transverse member and the second side of the plate may be adjacent the transverse member.

The jig may include a transverse member and a longitudinal member. When the plate is coupled to the jig, the first side of the plate may be adjacent to, but not in physical contact with, the transverse member. When the plate is coupled to the jig, a second side of the plate may be adjacent to, but not in physical contact with, the longitudinal member. When the plate is coupled to the jig, the first side of the plate may be adjacent to, but not in physical contact with, the transverse member and the second side of the plate may be adjacent to, but not in physical contact with, the transverse member.

The jig may include a transverse member, a first longitudinal member, and a second longitudinal member. The transverse member may define a first end and a second end. The first longitudinal member may extend away from the first end. The second longitudinal member may extend away from the second end. The plate may include a first side, a second side, and a third side. When the plate is coupled to the jig, the first side may abut the transverse member, the second side may abut the first longitudinal member and the third side may abut the second longitudinal member. When the plate is coupled to the jig, one of the sides of the plate may abut one of the members of the jig. When the plate is coupled to the jig, two of the sides of the plate may abut two of the members of the jig.

The jig may include a transverse member, a first longitudinal member, and a second longitudinal member. The transverse member may define a first end and a second end. The first longitudinal member may extend away from the first end. The second longitudinal member may extend away from the second end. The plate may include a first side, a second side, and a third side. When the plate is coupled to the jig, the first side may be adjacent the transverse member, the second side may be adjacent the first longitudinal member and the third side may be adjacent the second longitudinal member. When the plate is coupled to the jig, one of the sides of the plate may be adjacent one of the members of the jig. When the plate is coupled to the jig, two of the sides of the plate may be adjacent two of the members of the jig.

The jig may include a transverse member, a first longitudinal member, and a second longitudinal member. The transverse member may define a first end and a second end. The first longitudinal member may extend away from the first end. The second longitudinal member may extend away from the second end. The plate may include a first side, a second side, and a third side. When the plate is coupled to the jig, the first side may be adjacent to, but not in physical contact with, the transverse member, the second side may be adjacent to, but not in physical contact with, the first longitudinal member and the third side may be adjacent to, but not in physical contact with, the second longitudinal member. When the plate is coupled to the jig, one of the sides of the plate may be adjacent to, but not in physical contact with one of the members of the jig. When the plate is coupled to the jig, two of the sides of the plate may be adjacent to, but not in physical contact with, two of the members of the jig.

The jig may include an indicator. When the bottom surface is seated complementarily against the surface contour, the indicator may register to a location on the surface of the bone for initiating an access hole for accessing the target site. A distance between the location and the target site may correspond to a length of the implant.

The jig may include a first indicator and a second indicator. When the bottom surface is seated complementarily against the surface contour, the first indicator may register to a first location on the surface of the bone for initiating a first access hole for accessing the target site, and the second indicator may register to a second location on the surface of the bone for initiating a second access hole for accessing the target site. A distance between the first location and the target site may correspond to a first implant length. A distance between the second location and the target site may correspond to a second implant length. The first implant length may be different from the second implant length.

The plate may include an indicator. When the plate is coupled to the jig and the bottom surface is seated complementarily against the surface contour, the indicator may register to a location on the surface of the bone for initiating an access hole for accessing the target site. A distance between the location and the target site may correspond to a length of the implant.

The plate may include a first indicator and a second indicator. When the plate is coupled to the jig and the bottom surface is seated complementarily against the surface contour, the first indicator may register to a first location on the surface of the bone for initiating a first access hole for accessing the target site, and the second indicator may register to a second location on the surface of the bone for initiating a second access hole for accessing the target site. A distance between the first location and the target site may correspond to a first implant length. A distance between the second location and the target site may correspond to a second implant length. The first implant length may be different from the second implant length.

The plurality of holes defined by the jig may include a first hole and a second hole. The first hole may point in a first direction. The second hole may point in a second direction. The first direction may be divergent from the second direction.

The plurality of holes defined by the jig may include a first hole and a second hole. The first hole may point in a first direction. The second hole may point in a second direction. The first direction may be convergent with the second direction.

The plurality of holes defined by the jig may include a first hole and a second hole. The first hole may point in a first direction. The second hole may point in a second direction. The first direction may be non-parallel to the second direction.

The bone may be any suitable bone. The bone may be a proximal humerus bone. The target site may be a center of a head of the proximal humerus bone. The surface contour may include a greater tuberosity. The surface contour may include a deltoid insertion.

The jig may include a positioning hole. When the bone is a proximal humerus bone, when the bottom surface is seated complementarily against the surface contour, the positioning hole may point in a direction tangent to a top of a greater tuberosity.

The jig may include suturing holes.

The apparatus may include apparatus for, and the methods may involve, delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include a first jig. The first jig may have one or more features in common with any other jig or plate disclosed herein. The first jig may include a bottom surface. The first jig may define a plurality of holes. The first jig may define a target hole. The bottom surface may complement the surface contour.

The apparatus may include a second jig. The second jig may have one or more features in common with any other jig or plate disclosed herein. The second jig may be configured to be releasably coupled to the first jig. The second jig may define an opening.

When the bottom surface is seated complementarily against the surface contour and the first jig is releasably coupled to the second jig, each of the plurality of holes may point into the interior, but not into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the bottom surface is seated complementarily against the surface contour and the first jig is releasably coupled to the second jig, the target hole may point to the target site. When the bottom surface is seated complementarily against the surface contour and the first jig is releasably coupled to the second jig, the opening may define an area on the surface of the bone for preparing an access hole for accessing the target site.

The second jig may include a guide. The guide may extend away from the bone surface and away from the opening.

The apparatus may further include an insert configured to be inserted into the guide. The guide may include a guide inner cylindrical surface. The guide may define a guide central axis. The insert may include an insert outer cylindrical surface and an insert inner cylindrical surface. The insert outer cylindrical surface may define an insert outer central axis. The insert inner cylindrical surface may define an insert inner central axis. The guide central axis may be parallel to the insert outer central axis and the guide central axis may not be parallel to the insert inner central axis. The guide central axis may be parallel to the insert outer central axis and the guide central axis may be parallel to the insert inner central axis.

The apparatus may further include the plate configured to be releasably coupled to a bottom surface of the second jig. The plate may have one or more features in common with any other jig or plate disclosed herein. the bottom surface of the second jig may define a recessed area. The plate may be positioned in the recessed area.

The apparatus may include apparatus for, and the methods may involve, delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The longitudinal axis may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include the plate. The plate may have one or more features in common with any other jig or plate disclosed herein.

The plate may be thinner than a conventional plate. For example, for a given bone, a plate in accordance with the invention may be half as thick, two thirds as thick, or otherwise thinner than a conventional plate used for the given bone. A portion of the plate used for a proximal humerus may have a thickness of less than 2 mm, whereas a conventional plate may have a thickness of 4-6 mm. The thickness of the plate may vary along the length of the plate.

The plate may include a bottom surface. The bottom surface may complement the surface contour.

The plate may define first holes sized for receiving screws (may be referred to herein as “screw holes”). A screw received by a screw hole defined by the plate may be a compression screw, a lagging screw, or a locking screw. A head of a compression or lagging screw may not fully engage the plate, but may apply a compressional force to the plate. A head of a locking screw may fully engage the plate.

The plate may define second holes sized for receiving fixation elements.

The plate may define an opening. The opening may be sized for providing passage of the implant in a non-expanded state through the plate. When the bottom surface of the plate is seated complementarily on a surface contour of a bone, the opening defined by the plate may include an access position. When a bottom surface of the plate is seated complementarily on a surface contour of a bone, the opening may be positioned on the bone surface for providing passage of the implant through the plate. When a bottom surface of the plate is seated complementarily on a surface contour of a bone, the opening may be positioned for providing passage of the implant to the site.

The opening may be tapered.

The opening defined by the plate may have a width. The width may be at least twice as wide as a diameter defined by the screw holes. The width may be one and a half times as wide as a diameter defined by the first holes. The width may range from 6 mm to 8 mm. The width may range from 6 mm to 12 mm. The plate may have a longitudinal axis. The width may be perpendicular to the longitudinal axis. The opening may define a length. The length may have any suitable size. The length of the opening may range from 6 mm to 8 mm. The length of the opening may range from 6 mm to 12 mm.

The opening may be sized to provide clearance for the implant in the non-expanded state. The implant, in the non-expanded state, may have a diameter. The diameter may be any suitable diameter. The diameter may be 7 mm, 8 mm, 9 mm, or any other suitable diameter.

The plate may define a plate longitudinal axis. When the bottom surface is seated complementarily against the surface contour, the longitudinal axis may be aligned with a longitudinal axis of the bone. The opening may be elongated along the plate longitudinal axis. The plate may also define a short axis. The short axis may be transverse to the longitudinal axis.

When the bottom surface is seated complementarily against the surface contour, the first holes may point into the interior and into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the bottom surface is seated complementarily against the surface contour, the second holes may point into the interior and not into the volume. When the bottom surface is seated complementarily against the surface contour, the opening may be positioned for providing passage of the implant to the site.

One or more of the first holes sized for receiving screws may not be threaded. One or more of the first holes sized for receiving screws may be internally threaded. A hole sized for receiving a screw may be referred to herein as a “screw hole.” Holes sized for receiving screws may be referred to herein as “screw holes.” A threaded screw hole may receive an externally threaded bushing. A threaded screw hole may be sized to receive a screw and a bushing inserted into the screw hole.

A screw hole may have a diameter. The diameter may be any suitable size. The diameter may range from 3 mm to 5 mm. The diameter may range from 2 mm to 6 mm. The diameter may range from 1 mm to 6 mm. The diameter may range from 0.035 of an inch to 6 mm or more. The largest diameter of a screw hole defined by the plate may be smaller than a diameter of a head of a screw received by the plate. This may enable the screw to engage the plate without passing through the plate. The screw may be a compression screw. The screw may be a locking screw.

The plate may define third holes sized for receiving screws. The third holes may have one or more features in common with the first holes. When the bottom surface is seated complementarily against the surface contour, the third holes may point into the interior and not into the volume. The plate may include a first end and a second end. The third holes may include a first third hole and a second third hole. The first third hold may be positioned at the first end. The second third hole may be positioned at the second end. The third holes may include a first third hole and two or more second third holes. The first third hold may be positioned at the first end. The two or more second third holes may be positioned at the second end.

The first holes may include a first screw hole and a second screw hole. The first screw hole may point in a first direction. The second screw hole may point in a second direction. The first direction may diverge from the second direction. The first direction may converge with the second direction. The first direction may be oblique with the second direction. The first direction may be parallel to the second direction.

The first screw hole may be spaced apart from a plate longitudinal axis by a first distance. The second screw hole may be spaced apart from the plate longitudinal axis by a second distance. The first distance may be equal to the second distance. The first distance may be greater than or less than the second distance. The plate may define a plate short axis. The plate short access may be perpendicular to the plate longitudinal axis. A plate short axis may transect the first screw hole and the second screw hole.

The plate may include a locking slot. The locking slot may be defined by the plate. The locking slot may be partially defined by the plate and extend into the opening. The locking slot may include a plurality of slots. The locking slot may include slots that are not perpendicular to a surface of the bone. One or more of the slots may engage a head of a screw. A head of a screw advanced through the locking slot may engage one of the slots. The slots may act as a locking feature for a screw.

The locking slot may include a slanted side. The slanted side may be positioned perpendicular to a plate longitudinal axis. The slanted side may slant in a direction perpendicular to an axis of the implant when the bottom surface of the plate is seated complementarily on the surface contour and the implant is implanted in the bone surface.

The implant, when expanded, may form a mesh cage with interconnected cells.

When the bottom surface is seated complementarily against the surface contour, the opening may define an area on the surface for preparing an access hole for accessing the target site.

The opening may have a width. The width may be at least twice as wide as a diameter defined by the first holes. The width may be at least one and a half times as wide as a diameter defined by the first holes. The width may extend along at least half of a plate short axis. The width may extend along at least two thirds of a plate short axis. The first holes may define a diameter ranging from 3 mm to 5 mm and the opening may define a width ranging from 6 mm to 8 mm. The opening may be sized to provide clearance for the implant. The implant may have a diameter, in a non-expanded state, ranging from 6 mm to 12 mm.

The opening may have a length. The length may be elongated along a length longitudinal axis. The plate may have a plate longitudinal axis. The length longitudinal axis may be parallel or coaxial with a plate longitudinal axis and the width may be perpendicular to the plate longitudinal axis. The length longitudinal axis may be oblique to the plate longitudinal axis and the width may be oblique to the plate longitudinal axis. The length longitudinal axis may be perpendicular to the plate longitudinal axis and the width may be parallel to the plate longitudinal axis.

The length of the opening may be longer than a diameter of an implant tail. The length may of the opening may be longer than the diameter of an implant shaft. The length may be sized to facilitate deployment of the implant through the plate at an angle oblique to the plate longitudinal axis. The length may be sized to facilitate deployment of the implant through the bone at an angle oblique to the bone longitudinal axis. The implant may be deployed through the plate at a 30° angle from a plate longitudinal axis. The implant may be deployed through the plate at a 45°, 44°, 43°, 42°, 41°, 40°, 39°, 38°, 37°, 36°, 35°, 34°, 33°, 32°, 31°, 30°, 29°, 28°, 27°, 26°, 25°, 24°, 23°, 22°, 21°, 20°, 19°, 18°, 17°, 16° or 15° angle, or at any angle in any range defined by any two of the foregoing angles, from a plate longitudinal axis. The length may be sized to facilitate deployment of the implant through the plate at two or more angles relative to a bone longitudinal axis. The length may be sized to facilitate deployment of the implant through the bone at two or more angles relative to a bone longitudinal axis.

The opening may be tapered. The opening may transect the plate at an angle oblique to a plate longitudinal axis. The width of the opening may be constant along the length of the opening. The width of the opening may vary along the length of the opening.

The plate may include a target hole. The target hole may be sized to receive a fixation element. When the bottom surface is seated complementarily against the surface contour, the target hole may point to the target site.

The plate may include a positioning hole. The positioning hole may be sized to receive a fixation element. When the bottom surface is seated complementarily against the surface contour, the positioning hole may point in a direction tangent to the bone surface.

The bone may be any suitable bone. When the bone is a proximal humerus bone, when bottom surface is seated complementarily against the landmark, the positioning hole may point in a direction tangent to a greater tuberosity.

The plate may define a plate longitudinal axis. The opening may be elongated along the plate longitudinal axis. The plate longitudinal axis may be aligned with a longitudinal axis of the bone when the bottom surface is seated complementarily against the surface contour. The plate may also define a short axis. The short axis may be transverse to the longitudinal axis. The short axis may be transverse to the plate longitudinal axis.

The plate may include holes having a diameter sized for suturing.

The apparatus may include the jig. The jig may be configured to be releasably coupled to the plate. The plate may define a top face. The jig may define a jig bottom surface. The jig bottom surface may be shaped to be positioned on at least a portion of the top face. The jig may be positioned on the plate when the jig bottom surface is seated on the at least a portion of the top face. The jig bottom surface may be seated on some of the top face. The jig bottom surface may be seated on all of the top face.

The jig bottom surface may be a first jig bottom surface. The jig may include a second jig bottom surface. When the first jig bottom surface is positioned on the plate, the second jig bottom surface may extend away from the plate. The second jig bottom surface may include a positioning hole. The second bottom surface may include one, two or more holes for receiving a fixation element. The second bottom surface may not conform to the plate.

The opening may be a plate opening. The jig may define a jig opening. When the jig is coupled to the plate, the jig opening may be positioned above the plate opening. The plate opening may define a plate opening central axis. The jig opening may define a jig opening central axis. The plate opening central axis may be coaxial with the jig opening central axis.

The plate may define a threaded plate bore. The jig may define a threaded jig bore. When the jig is positioned on the plate, the threaded jig bore may be positioned above the threaded plate bore. Driving a screw through the threaded jig bore and into the threaded plate bore may releasably couple the jig to the plate.

The jig may define third holes sized for receiving screws. Holes defined by the jig for receiving screws may be threaded. A threaded screw hole defined by the jig may receive an externally threaded bushing. A threaded screw hole may be sized to receive a screw and a bushing inserted into the screw hole. The largest diameter of a screw hole defined by the jig may be larger than a diameter of a head of a screw. This may enable the screw to pass through the screw hole defined by the jig without engaging the jig.

The jig may define fourth holes sized for receiving fixation elements. Fixation element holes defined by the jig may have one or more features in common with fixation element holes defined by the plate.

When the jig is coupled to the plate and the bottom surface is seated complementarily against the surface contour, the third holes may point into the interior and into the volume. When the jig is coupled to the plate and the bottom surface is seated complementarily against the surface contour, the fourth holes may point into the interior and not into the volume. When the jig is coupled to the plate, the third holes may be positioned above the first holes. When the jig is coupled to the plate, the fourth holes may be positioned above the second holes.

The jig may include a guide leading to the opening. The guide may be sized for providing passage of the implant in a non-expanded state through the opening.

The third holes may include a first third hole and a second third hole. The first third hole may point in a first direction. The second third hole may point in a second direction. The first direction may diverge from the second direction. The first direction may converge with the second direction. The first direction may be parallel to the second direction. The first direction may be oblique to the second direction.

The first third hole may be spaced apart from the second third hole along the jig longitudinal axis. The first third hole may be spaced apart from the jig longitudinal axis by a first distance. The second third hole may be spaced apart from the jig longitudinal axis by a second distance. The first distance may be equal to the second distance. The first distance may be greater than or less than the second distance. The jig may define a plate short axis. The jig short access may be perpendicular to the jig longitudinal axis. A jig short axis may transect the first third hole and the second third hole.

The jig may have a perimeter. The perimeter may define a channel. The channel may be an open channel. When the jig is coupled to the plate, a surface of the channel may be tangent to a hole defined by the plate. The hole defined by the plate may be one of the second holes. When a fixation element is advanced through the channel, the fixation element may define a fixation element central axis that is coaxial with a central axis of the hole. The channel may be an open channel that has an arcuate cross section. The second holes may include a fixation element hole. When the jig is coupled to the plate, the channel may be positioned above the fixation element hole. The channel may guide a fixation element into the fixation element hole. The channel may be used by a practitioner to guide a fixation element into a bone.

The jig may include an aperture. The aperture may extend through a thickness of the jig. The aperture may be sized to receive a first bushing. The aperture may also be sized to receive a second bushing. The aperture may include a first threaded opening sized to receive the first bushing. The aperture may include a second threaded opening sized to receive the second bushing. The first threaded opening may have an arcuate cross section. The second threaded opening may have an arcuate cross section.

The jig may include a positioning hole. When the jig is coupled to the plate and the bottom surface is seated complementarily against the surface contour, the positioning hole may point in a direction tangent to the bone surface. When the bone is a proximal humerus bone, when the bottom surface is seated complementarily against the surface contour and the jig is coupled to the plate, the positioning hole may define a direction tangent to a greater tuberosity.

When the jig includes a guide, the guide may include an aperture positioned on an outer face of the guide. The aperture may extend through a thickness of the guide. The aperture may be used by a practitioner to pass a threaded fixation element coupled to a nut through the guide and into a bone fragment. The nut may be seated on a top surface of the aperture. The nut may be used to provide compressional force to the bone fragment.

When the jig includes a guide, the guide may include a slot. The slot may be positioned on a guide opening. The guide opening may be configured to receive a bushing. The slot may be configured to engage a portion of a bushing inserted into the guide.

When a bottom surface of the jig conforms to a top surface of the plate and the jig is configured to be releasably coupled to the plate, a jig screw hole may define a jig screw hole central axis and a plate screw hole may define a plate screw hole central axis. When the jig is releasably coupled to the plate, the jig screw hole may be positioned above the plate screw hole. When the jig is releasably coupled to the plate, the jig screw hole central axis may extend along the plate screw hole central axis.

When a bottom surface of the jig conforms to a top surface of the plate and the jig is configured to be releasably coupled to the plate, each jig screw hole may define a jig screw hole central axis and each plate screw hole may define a plate screw hole central axis. When the jig is releasably coupled to the plate, each jig screw hole may be positioned above a plate screw hole. When the jig is releasably coupled to the plate, each jig screw hole may define a jig screw hole central axis that lies along a screw hole central axis defined by a screw hole positioned underneath each jig screw hole.

When a bottom surface of the jig conforms to a top surface of the plate and the jig is configured to be releasably coupled to the plate, one of the jig plurality of holes may define a jig hole central axis and a plate hole may define a plate hole central axis. When the jig is releasably coupled to the plate, the jig hole central axis be positioned above the plate hole. When the jig is releasably coupled to the plate, the jig hole central axis may extend along the plate hole central axis.

When a bottom surface of the jig conforms to a top surface of the plate and the jig is configured to be releasably coupled to the plate, each of the jig plurality of holes may define a jig hole central axis. When the jig is releasably coupled to the plate, some or all of the jig plurality of holes may be positioned above plate holes. When the jig is releasably coupled to the plate, some or all of the jig plurality of holes may define a jig hole central axis that extends along a plate hole central axis defined by a plate hole positioned underneath each of the some or all of the jig plurality of holes.

The apparatus may include apparatus for, and the methods may involve, delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include the jig. The jig may have one or more features in common with any other jig or plate disclosed herein. The jig may be configured to be releasably coupled to the plate. The plate may have one or more features in common with any other jig or plate disclosed herein. The plate may include a plate bottom surface. The plate bottom surface may complement the surface contour. The jig may include a jig bottom surface. The jig bottom surface may be shaped to conform to a top surface of the plate.

The jig may define a plurality of holes sized for receiving fixation elements. The jig may define screw holes sized for receiving screws. The jig may define an opening for passage of the implant in a non-expanded state through the jig and to the target site. The passage may be along a straight path oblique to a longitudinal axis of the jig.

When the jig is releasably coupled to the plate and the plate bottom surface is seated complementarily against the surface contour, the plurality of holes may point into the interior and into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the jig is releasably coupled to the plate and the plate bottom surface is seated complementarily against the surface contour, the screw holes may point into the interior and not into the volume. When the jig is releasably coupled to the plate and the plate bottom surface is seated complementarily against the surface contour, the opening may be positioned for providing passage of the implant to the site.

The screw holes may be jig screw holes. The plate may define plate fixation element holes sized for receiving fixation elements and plate screw holes sized for receiving screws. When the jig is coupled to the plate, the plurality of holes may be positioned above the plate screw holes and the jig screw holes may be positioned above the plate screw holes.

The jig may include a guide. The guide may extend away from the opening. The guide may have an inner lumen. The inner lumen may define a central axis collinear with the path.

The jig bottom surface may be a first jig bottom surface. The jig may include a second jig bottom surface. The second jig bottom surface may include a positioning hole. When the jig is releasably coupled to the plate, the first jig bottom surface may be positioned on the plate and the second jig bottom surface may extend away from the plate. When the jig is releasably coupled to the plate and the plate bottom surface is seated complementarily against the surface contour, the positioning hole may point in a direction tangent to the bone surface.

The plate may define a threaded plate bore. The jig may define a threaded jig bore. When the bottom surface of the jig is positioned on the plate, the threaded jig bore may be positioned above the threaded plate bore. Driving a screw through the threaded jig bore and into the threaded plate bore may releasably couple the jig to the plate.

The screw holes may include a first screw hole and a second screw hole. The first screw hole may point in a first direction. The second screw hole may point in a second direction. The first direction may diverge from the second direction. The first direction may converge with the second direction. The first direction may be parallel to the second direction. The first direction may be oblique to the second direction.

The jig may have a perimeter that defines a channel. When the jig is coupled to the plate, a surface of the channel may be tangent to a hole defined by the plate. The hole defined by the plate may be one of the second holes. When a fixation element is advanced through the channel, the fixation element may define a fixation element central axis that is coaxial with a central axis of the hole. The channel may be an open channel that has an arcuate cross section. The second holes may include a fixation element hole. When the jig is coupled to the plate, the channel may be positioned above the fixation element hole. The channel may guide a fixation element into the fixation element hole.

The jig may define an aperture. The aperture may be sized to receive a first bushing. The aperture may be sized to receive a second bushing. The aperture may include a first threaded opening sized to receive a first bushing. The aperture may include a second threaded opening sized to receive the second bushing. The first threaded opening and the second threaded opening may both be open channels that each have an arcuate cross section.

The jig may include a positioning hole. When the jig is coupled to the plate and the plate bottom surface is seated complementarily against the surface contour, the positioning hole may point in a direction tangent to the bone surface. When the bone is a proximal humerus bone, when the plate bottom surface is seated complementarily against the surface contour and the jig is coupled to the plate, the positioning hole may point in a direction tangent to a greater tuberosity.

When the jig includes a guide, the guide may include an aperture. The aperture may be positioned on an outer face of the guide. The aperture may extend through a thickness of the guide.

When the jig includes a guide, the guide may include a slot. The slot may be positioned on a guide opening. The guide opening may be configured to receive a bushing. The slot may be configured to engage a portion of a bushing inserted into the guide.

The opening may be a jig opening. The plate may include a plate opening. The plate opening may be an opening for passage of the implant in a non-expanded state through the jig and to the target site. The passage may be along a straight path oblique to a longitudinal axis of the jig. When the jig is coupled to the plate, the jig opening may be positioned above the plate opening. When the jig is coupled to the plate, a central axis defined by the jig opening may be coaxial with a central axis defined by the plate opening.

The apparatus may include apparatus for, and the methods may involve, delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include the plate. The plate may have one or more features in common with any other jig or plate disclosed herein. The plate may include a bottom surface. The bottom surface may complement the surface contour. The plate may define a positioning hole. The plate may define first holes sized for receiving screws. The plate may define second holes sized for receiving fixation elements. The plate may define an opening sized for providing passage of the implant in a non-expanded state through the plate.

When the bottom surface is seated complementarily against the surface contour, the positioning hole may point in a direction tangent to the surface. When the bottom surface is seated complementarily against the surface contour, the first holes may point toward a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the bottom surface is seated complementarily against the surface contour, the second holes may point away from the volume. When the bottom surface is seated complementarily against the surface contour, the opening may be positioned for providing passage of the implant through the plate and to the site.

The bone may be any suitable bone. When the bone is a proximal humerus bone, the surface contour may include a greater tuberosity and the plate may be aligned with the greater tuberosity when the positioning hole points in a direction tangent to the greater tuberosity.

The plate may include a target hole.

The apparatus may include apparatus for, and the methods may involve, implanting the implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour that extends along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include a first plate. The first plate may have one or more features in common with any other jig or plate disclosed herein. The first plate may include a bottom surface. The bottom surface may complement the surface contour. The plate may define first holes sized for receiving screws. The plate may define second holes sized for receiving fixation elements. The plate may define a first opening.

The apparatus may include a second plate. The second plate may have one or more features in common with any other jig or plate disclosed herein. The second plate may be shaped to be positioned in the first opening. The second plate may be configured to be anchored to the first plate. The second implant may be configured to be anchored to the implant when the second plate is positioned on the bone surface and the implant is implanted at the target site.

The second plate may define a second opening. The second opening may be sized for receiving a tail of the implant when the implant is implanted in the target site. The second opening may define a second opening circumference. The second opening circumference may be larger than an outer circumference defined by the tail of the implant.

When the bottom surface is seated complementarily against the surface contour, the first holes may point into the volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the bottom surface is seated complementarily against the surface contour, the second holes may point into the interior and not into the volume.

The bottom surface may be a first bottom surface. The second plate may define a second bottom surface. The second bottom surface may conform to the surface contour.

The apparatus may include apparatus supporting the implant when the implant is implanted at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include a first plate. The first plate may have one or more features in common with any other jig or plate disclosed herein. The first plate may include a first plate bottom surface. The first plate bottom surface may complement the surface contour. The first plate may define first holes sized for receiving screws. The first plate may define second holes sized for receiving fixation elements. The first plate may define a first opening.

The apparatus may include a second plate. The second plate may have one or more features in common with any other jig or plate disclosed herein. The second plate may be configured to be positioned on top of the first plate. The second plate may be configured to be releasably coupled to the first plate. The second plate may be configured to be anchored to the first plate. The second plate may include a screw hole for receiving an anchoring screw. The first plate may include a bore for receiving a screw. The anchoring screw may be advanced through the screw hole and into the bore to anchor the second plate to the first plate.

The second plate may include a second bottom surface conforming to a contour of a portion of a top surface of the first plate. The second plate may include a second opening. When the second plate is positioned on the first plate, the second opening may be positioned on top of the first opening. When the second plate is positioned on the first plate, a first opening central axis may be coaxial with a second opening central axis.

The second plate may include a tube. The tube may extend through the second opening at an angle oblique to a central axis of the second plate. When the second plate is positioned on the first plate and the first bottom surface is seated on the surface contour, the tube may extend through the second opening and the first opening and into the interior. The tube may extend into the interior at an angle oblique to a central axis of the second plate. The tube may extend into the interior at an angle oblique to a central axis of the first plate.

The tube may be sized for coaxially mounting to a tail of the implant when the implant is implanted in the target site. The tube may define an inner lumen. The inner lumen may have an inner lumen circumference. The inner lumen circumference may be larger than an outer circumference of the tail of the implant.

When the first bottom surface is seated complementarily against the surface contour, the first holes may point into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the first bottom surface is seated complementarily against the surface contour, the second holes may point into the interior and not into the volume.

The apparatus may include apparatus for, and the methods may involve, delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include the jig. The jig may have one or more features in common with any other jig or plate disclosed herein. The jig may include a bottom surface. The bottom surface may complement the surface contour. The jig may define a plurality of holes.

The jig may define a positioning hole. When the bottom surface is seated complementarily against the surface contour, the positioning hole may point in a direction tangent to the bone surface.

The jig may define an opening for passage of the implant in a non-expanded state through the jig and to the target site. The passage may be a passage along a straight path oblique to a longitudinal axis of the jig.

The jig may include a guide. The guide may extend away from the bone surface and the opening. The guide may have an inner surface. The inner surface may define a central axis collinear with the path.

When the bottom surface is seated complementarily against the surface contour, each of the plurality of holes may point into the interior but not a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the bottom surface is seated complementarily against the surface contour, the opening may define an area on the surface for preparing an access hole for accessing the target site.

The jig may define a target hole. When the bottom surface is seated complementarily against the surface contour, the target hole may point to the target site.

The bone may be any suitable bone. When the bone is a proximal humerus bone, the direction may be tangent to a greater tuberosity. When the bone is a proximal humerus bone, the surface contour may include an intertubercular groove.

The apparatus may further include an insert. The insert may be configured to be inserted into the guide. The guide may include a guide inner cylindrical surface and defines a guide central axis. The insert may include an insert outer cylindrical surface and an insert inner cylindrical surface. The insert outer cylindrical surface may define an insert outer central axis. The insert inner cylindrical surface may define an insert inner central axis. The guide central axis may be parallel to the insert outer central axis and the guide central axis may not be parallel to the insert inner central axis. The guide central axis may be parallel to the insert outer central axis and the insert inner central axis.

The apparatus may include the plate. The plate may have one or more features in common with any other jig or plate disclosed herein. The plate may be configured to be releasably coupled to a bottom surface of the jig. The bottom surface of the jig may define a recessed area. The recessed area may be configured to receive the plate. The plate may be configured to be positioned in the recessed area. The recessed area may conform to a contour of a top face of the plate. The recessed area may conform to a contour of a perimeter of the plate.

The apparatus may include apparatus for, and the methods may involve, delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour that extends along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include the plate. The plate may have one or more features in common with any other jig or plate disclosed herein. The plate may include a plate bottom surface. The plate bottom surface may complement a first portion of the surface contour. The plate may define an opening.

The apparatus may include the jig. The jig may have one or more features in common with any other jig or plate disclosed herein. The jig may be configured to be releasably coupled to an end of the plate. The jig may include a jig bottom surface. The jig may define a plurality of holes. The jig bottom surface may complement a second portion of the surface contour.

When the jig bottom surface is seated complementarily against the second portion of the surface contour, each of the plurality of holes may point into the interior but not into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage. When the plate bottom surface is seated complementarily against the first portion of the surface contour, the opening may define an area on the surface for preparing an access hole accessing the target site.

The jig may define a target hole.

The jig may define a positioning hole. When the bone is a proximal humerus bone, the second portion of the surface contour may include a greater tuberosity and, when the jig bottom surface is seated complementarily against the greater tuberosity, the positioning hole may point in a direction tangent to the greater tuberosity.

The jig bottom surface may be a first jig bottom surface. The jig may include a second jig bottom surface. The second jig bottom surface may be configured to be positioned on a portion of a top surface of the plate. The second jig bottom surface may conform to a surface contour of the portion of the top surface of the plate.

When the jig is a first jig and the end is a first end, the apparatus may further include a second jig. The second jig may be configured to be releasably coupled to a second end of the plate. The second jig may include a guide. The guide may extend away from the opening.

The apparatus may include apparatus for, and the methods may involve, repairing a bone defining a longitudinal axis. The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include the implant. The implant may be implanted at a target site in an interior of the bone. The implant may have an implant tail and an implant head. A portion of the implant tail may have a tubular shape. The implant head may include an expandable mesh cage.

The apparatus may include the plate. The plate may have one or more features in common with any other jig or plate disclosed herein. The plate may include a bottom surface. The plate may include a tube extending away from the bottom surface. The tube may define a central axis. The central axis may be oblique to a longitudinal axis of the plate. The tube may be configured to be coaxially mounted on the implant tail.

The bottom surface may complement the surface contour. When the bottom surface is seated complementarily against the surface contour, the central axis may point to the target site.

The tube may have an outer diameter. The outer diameter may be lesser than a diameter of an access hole. The outer diameter may be large enough for passage of the implant in a non-expanded state.

The tube may have an inner diameter. The inner diameter may be greater than an outer diameter of the implant tail. The inner diameter may be large enough for passage of the implant in a non-expanded state. In operation, when the implant is implanted in the bone and the bottom surface of the plate abuts a surface of the bone, the tube may be coaxially mounted on the implant tail.

The plate may define a hole sized to receive a screw. The screw may be a screw for anchoring the plate to the implant. The hole sized to receive the screw may point in a direction. When the implant is implanted in the bone and the bottom surface of the plate abuts a surface of the bone, the direction may point to a bore defined by the implant tail. The bone may be sized to receive the screw. When the implant is implanted and expanded in the bone and the bottom surface of the plate abuts a surface of the bone, the direction may point to the implant head.

The plate may define a first screw hole and a second screw hole. The first screw hole may point in a first direction and the second screw hole may point in a second direction. When the implant is implanted in the bone and the bottom surface of the plate abuts a surface of the bone, the first direction may point to a bore defined by the implant tail. The bone may be sized to receive the screw. When the implant is implanted and expanded in the bone and the bottom surface of the plate abuts a surface of the bone, the first direction may point to the implant head. When the implant is implanted and expanded in the bone and the bottom surface of the plate abuts a surface of the bone, the second direction may point into an interior of the bone but not into a volume occupied by the implant in the interior.

The apparatus may include apparatus for, and the methods may involve, implanting the implant in an interior of a bone. The apparatus may include apparatus for supporting the implant after implantation. The implant may be implanted at a target site in the interior.

The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include the plate. The plate may have one or more features in common with any other jig or plate disclosed herein. The plate may define an internally threaded hole. The hole may point in a direction that is oblique to a longitudinal axis of the plate. The direction may be defined by a hole central axis.

The plate may include a bottom surface. The bottom surface may complement the surface contour. When the bottom surface is seated complementarily against the surface contour, the hole may define an area on the surface for preparing an access hole for accessing the target site. When the bottom surface is seated complementarily against the surface contour, the direction may point to the target site.

The apparatus may include a first externally threaded tube. The first externally threaded tube may be configured to mate with the internally threaded hole. When the first tube mates with the hole, the first tube may extend away from a surface of the bone.

The apparatus may include a second externally threaded tube. The second externally threaded tube may be configured to mate with the internally threaded hole. When the second tube mates with the hole the second tube may extend into the interior.

The first tube may define a first inner diameter. The first inner diameter may be greater than a diameter of the implant in a non-expanded state. In operation, the implant may be advanced through the first tube and towards the target site.

The second tube may define a second inner diameter. The second inner diameter may be greater than an outer diameter of a tail of the implant. In operation, when the implant is implanted in the bone, the first tube may be removed from the plate. In operation, when the implant is implanted in the bone, the second tube may be configured to be coaxially mounted on the tail. In operation, when the implant is implanted in the bone, the second tube may be coaxially mounted on the tail.

The plate may define holes sized for receiving screws. The plate may define holes sized for receiving fixation elements.

The apparatus may include, and the methods may involve, apparatus for delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include means for aligning the apparatus with the surface contour when the apparatus is in direct contact with the bone surface. Apparatus may be in direct contact with the bone surface when there is no intervening apparatus between the apparatus and the bone surface.

The apparatus may include means for guiding fixation elements into a bone interior. The guiding may provide clearance for expanding the implant inside the bone. The apparatus may include means for guiding a target wire toward the target site in the bone interior.

The bone may be a proximal humerus bone. The surface contour may include a first anatomical landmark. The first anatomical landmark may be a bicipital groove.

The surface contour may include a second anatomical landmark. The apparatus may include means for aligning the apparatus with the second anatomical landmark when the apparatus is in direct contact with the bone. The second anatomical landmark may be a greater tuberosity.

The means for guiding fixation elements may include a first means and a second means. The first means and the second means may be spaced apart from each other. The first means and the second means may guide the fixation elements along non-parallel paths. The first means and second means may guide the fixation elements along convergent paths. The first means and second means may guide the fixation elements along divergent paths. The first means and the second means may guide the fixation elements along parallel paths.

The apparatus may include means for identifying a location on the bone surface suitable for inserting the implant so that the head of the implant will be disposed at the target site.

The apparatus may include means for identifying an area on the surface of the bone that includes an access position.

The apparatus may include means for identifying a plurality of locations on the bone surface. Each of the plurality of locations may be suitable for inserting the implant having a length so that the head of the implant will be disposed at the target site.

The apparatus may include positioning means for positioning the apparatus relative to an anatomical landmark defined by the bone.

When the bone is a proximal humerus bone, the apparatus may include means for guiding a wire over a top of a greater tuberosity.

When the bone is a proximal humerus bone, the target site may be a center region in a head of the proximal humerus bone.

The apparatus may include means for guiding one or more devices into a bone interior at an acute angle relative to a longitudinal axis of the bone.

The apparatus may include means for guiding a drill into a bone interior at an acute angle relative to a longitudinal axis of the bone.

The apparatus may include means for guiding a cavity preparation device into a bone interior at an acute angle relative to a longitudinal axis of the bone.

The apparatus may include means for guiding the implant into a bone interior at an acute angle relative to a longitudinal axis of the bone.

The apparatus may include means for receiving anchoring members. The anchoring members may be configured to anchor the apparatus to the bone. The means for receiving the anchoring members may include means for guiding a fixation element into a head of the implant.

The means for receiving anchoring members may include means for guiding a fixation element into a tail of the implant. The means for receiving anchoring members may include means for guiding a fixation element into the bone.

The apparatus may include means for receiving the plate. The plate may define a hole for passage of the implant into the bone interior. The apparatus may include means for removably coupling the plate to the apparatus.

The apparatus may include means for receiving the jig. The jig may define a hole for passage of the implant into the bone interior. The apparatus may include means for removably coupling the jig to the apparatus.

The apparatus may include means for providing passage of the implant through the apparatus and into the bone interior.

The apparatus may include means for defining an area on the bone surface. The area on the bone surface may be for initiating an access hole. The implant may be deployed through the access hole.

The apparatus may include, and the methods may involve, apparatus for delivery of an implant at a target site in an interior of a bone. The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along a surface of the bone between two or more points at different elevations from the longitudinal axis.

The apparatus may include an implant delivery base. The implant delivery base may have a base bottom surface.

The base bottom surface may complement the surface contour.

The base bottom surface may be shaped to nest in an opening of the plate. A portion of the base bottom surface may be shaped to nest in an opening of the plate.

The implant delivery base may have a base top surface. The base top surface may be flat. The base top surface may be curved. The base top surface may include a flat portion. The base top surface may include a curved portion.

The implant delivery base may define a channel. The channel may extend through an interior of the implant delivery base. The channel may extend away from the base bottom surface in a direction. The direction may define an angle oblique to the bottom surface. The channel may be sized to provide passage of the implant. The channel may be configured to receive a bushing. When the bottom surface is seated complementarily on the surface contour, a central axis of the channel may point towards the target site.

The base bottom surface may be shaped to nest in an opening of the plate. A portion of the base bottom surface may be shaped to nest in an opening of the plate. A bottom surface of the plate may complement the surface contour. When the implant delivery base is nested in an opening of the plate and the plate bottom surface is seated complementarily on the surface contour, a central axis of the channel may point towards the target site. The opening may define an area on the surface of the bone for preparing an access hole for accessing the target site.

The apparatus may include a post. The post may be supported by the implant delivery base. The post may extend away from the base top surface. The post may be releasably coupled to the implant delivery base. The post may be fixedly attached to the implant delivery base. The post may be cannulated. The cannula may be sized to receive a screw. The post may define a surface shaped to receive a reduction device.

The apparatus may include the reduction device. The reduction device may be configured to be slidingly coupled to the post. The reduction device may be releasably coupled to the post. The reduction device may be configured to slide along the post so that, in operation, a bottom surface of the reduction device is positioned on skin covering the bone.

The reduction device may be configured to be snapped onto the post. The reduction device may define an opening sized to be removably coupled to the post. The opening may be sized to fit on the surface defined by the post for receiving the reduction device. The opening may be sized to be coupled to an outer face of the post.

The apparatus may include the plate. The base bottom surface may be configured to releasably interconnect with the plate. The plate may define an opening. The opening may be sized for passage of an implant. A plate bottom surface may complement the surface contour. The base bottom surface may conform to a top face of the plate. The base bottom surface may conform to a portion of a top face of the plate. The base bottom surface may be shaped to nest in the opening of the plate. A first portion of the base bottom surface may be contoured to nest in the opening of the plate. A second portion of the base bottom surface may be contoured to seated on a top face of the plate. The base bottom surface may be shaped to be seated on a top face of the plate.

When the implant delivery base is coupled to the plate, the channel may extend away from the opening. When the plate bottom surface is seated complementarily on the surface contour and the implant delivery base is coupled to the plate, a central axis defined by the channel may point to the target site. The opening may define an area on the surface of the bone for preparing an access hole for accessing the target site.

The plate may define screw holes sized to receive screws. The screw holes may receive a bushing. The bushing may be sized to receive a screw. The bushing may be sized to receive a fixation element. When the plate bottom surface is seated complementarily against the surface contour, the screw holes may point into the interior, but not into a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage.

The reduction device may define a plurality of holes. The plurality of holes may be sized for receiving fixation elements. Each of the plurality of holes may transect the reduction device at a right angle. When the base bottom surface is seated complementarily on the surface contour, each of the plurality of holes may point into the interior and not into a volume occupied by the implant when the implant is positioned at the target site and expanded to form a cage. Fixation elements driven through the plurality of holes and into the interior may provide clearance for the implant.

The implant may be a first implant. The reduction device may define a first plurality of holes and a second plurality of holes. The first plurality of holes may be positioned at a first distance away from a central axis of the reduction device. The first plurality of holes may point into the interior of the bone and not into a volume occupied by the first implant in the interior when the first implant is positioned at the target site and radially expanded to form a mesh cage. The first plurality of holes may include a first hole and a second hole. The first hole may be spaced apart from the second hole along a direction oblique to the central axis of the reduction device. The first hole may be spaced apart from the second hole along a direction perpendicular to the central axis of the reduction device. Each of the second plurality of holes may be displaced a second distance away from the central axis of the reduction device. The second plurality of holes may point into the interior of the bone and not into a volume occupied by a second implant in the interior when the second implant is positioned at the target site and radially expanded to form a mesh cage. The second plurality of holes may include a third hole and a fourth hole. The third hole may be spaced apart from the fourth hole along a direction perpendicular to the central axis of the reduction device. The third hole may be spaced apart from the fourth hole along a direction oblique to the central axis of the reduction device. The first volume may be different from the second volume. The second distance may be different from the first distance.

The reduction device may define a screw hole sized to receive a screw. The apparatus may include a bushing. The screw hole may be configured to receive the bushing.

The reduction device may define a plurality of holes. The holes may be sized for receiving fixation elements. The holes may be sized for receiving bushings. The holes may be sized for receiving screws. A top face of the reduction device may be flat. A top face of the reduction device may be curved.

When the base bottom surface is seated complementarily on the surface contour, the screw hole may point to a volume in the interior of the bone occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage.

The base bottom surface may be configured to releasably interconnect with the plate. The plate may define a plate screw hole sized to receive the screw. The plate may define a bottom surface complementing the surface contour. The reduction device may define a reduction device screw hole. When the implant delivery base is releasably coupled to the plate, a central axis defined by the reduction device screw hole may be coaxial with a central axis defined by the plate screw hole. When the bottom surface is seated complementarily on the surface contour and the implant delivery base is interconnected with the plate, the plate screw hole and the reduction device screw hole may point to a volume. The volume may be a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage.

The base bottom surface may be configured to releasably interconnect with the plate. The plate may define a slot configured to engage a head of the screw. The plate may define a plate bottom surface complementing the surface contour. When the implant delivery base is interconnected with the plate, a central axis defined by the screw hole may pass through the slot. When the bottom surface of the plate is seated complementarily on the surface contour and the implant delivery base is interconnected with the plate, the screw hole may point to a volume. The volume may be a volume occupied by the implant in the interior when the implant is positioned at the target site and radially expanded to form a mesh cage.

The reduction device may define an aperture sized for receiving screws. The reduction device may define an aperture sized for receiving a fixation element. The aperture may extend along a longitudinal central axis of the reduction device. The base bottom surface may be configured to releasably interconnect with the plate. The plate may define a screw hole configured to engage a screw. The plate may define a plate bottom surface complementing the surface contour. When the implant delivery base is interconnected with the plate, a central axis defined by the screw hole may pass through the aperture without transecting the aperture. When the bottom surface of the plate is seated complementarily on the surface contour and the implant delivery base is interconnected with the plate, the screw hole may point to a volume occupied by the implant in the interior when the implant is positioned at the target site and expanded to form a cage.

The base bottom surface may be configured to releasably interconnect with the plate. The plate may define a slot configured to engage a head of a screw. The plate may define a plate bottom surface complementing the surface contour. When the bottom surface of the plate is seated complementarily on the surface contour and the implant delivery base is interconnected with the plate, a bore central axis of a bore defined by an implant tail of the implant, when the implant is positioned at the target site, may extend through the slot without transecting the slot. The bore central axis may extend through the aperture and transects a central longitudinal axis of the aperture.

The implant delivery base may define a first bore. The first bore may be positioned on the base top surface. The first bore may extend through the implant delivery base at an angle oblique to the base bottom surface. The implant delivery base may define a second bore. The second bore may be positioned on the base top surface. The second bore may extend through the base at an angle oblique to the base bottom surface. The first bore may be spaced apart from the second bore along a direction transverse to an implant delivery base bottom-surface longitudinal axis. The first bore may be spaced apart from the second bore along a direction perpendicular to a longitudinal axis of a bottom surface of the implant delivery base. The first bore and the second bore may both be sized to receive a fixation element.

When the top surface includes a curved portion, the first bore may extend thought the implant delivery base and form a notch on a shoulder defined by an outer surface of the channel. The top surface may include the shoulder. The implant delivery base may include a second bore having the same geometrical properties as the first bore disposed on an opposite side of the shoulder.

The implant delivery base may define a third bore. The third bore may be positioned on the base top surface. When the top surface includes a curved portion, the third bore may form a notch on the shoulder. The third bore may define a direction perpendicular to the implant delivery base central axis. The implant delivery base may define a fourth bore. The fourth bore may be positioned on the base top surface. When the top surface is curved, the fourth bore may be positioned on the shoulder. The fourth bore may have the same geometrical properties as the third bore and be disposed on an opposite side of the shoulder.

When the base bottom surface is seated complementarily on the surface contour, the first bore and the second bore may point into the interior, but not into a volume occupied by the implant in the interior, when the implant is positioned at the target site and radially expanded to form a mesh cage.

The post may define an inner lumen. The inner lumen may be sized for advancing a screw through the inner lumen. When the bottom surface is seated complementarily against the surface contour and the implant is implanted in the bone, the inner lumen may define an inner lumen central axis. The inner lumen central axis may be coaxial with a central axis of a bore defined by a tail of the implant.

The implant delivery base may include a longitudinal member. The longitudinal member may extend away from the channel. The longitudinal member may extend away from the channel along a longitudinal axis defined by the bottom surface.

A bottom face of the longitudinal member may include the base bottom surface. When the base bottom surface is seated complementarily on the surface contour, the longitudinal member may extend along the longitudinal axis of the bone.

The longitudinal member may define a screw hole sized for receiving a screw. The longitudinal member may define a slot sized for receiving a screw. The longitudinal member may include a recess for engaging the plate.

The apparatus may include, and the methods may involve, apparatus for positioning an implant in an implantation region inside a fractured bone. The apparatus may include an elongated base member. The apparatus may include an elongated targeting member. The apparatus may include a first swing arm. The first swing arm may be pivotally affixed to the base member. The first swing arm may be pivotally affixed to the targeting member.

The apparatus may include a second swing arm. The second swing arm may be pivotally affixed to the base member. The second swing arm may be pivotally affixed to the targeting member.

The base member may define a longitudinal axis. The first swing arm may be pivotally affixed to the base member at a first position along the longitudinal axis of the base member. The second swing arm may be pivotally affixed to the base member at a second position along the longitudinal axis of the base member. The first position along the longitudinal axis of the base member may be spaced apart from the second position along the longitudinal axis of the base member.

The targeting member may define a longitudinal axis. The first swing arm may be pivotally affixed to the targeting member at a first position along the longitudinal axis of the targeting member. The second swing arm may be pivotally affixed to the targeting member at a second position along the longitudinal axis of the targeting member. The first position along the longitudinal axis of the targeting member may be spaced apart from the second position along the longitudinal axis of the targeting member.

A first distance spacing the first position along the longitudinal axis of the base member apart from the second position along the longitudinal axis of the base member may be equal to, or substantially equal to, a second distance spacing the first position along the longitudinal axis of the targeting member apart from the second position along the longitudinal axis of the targeting member.

The first and second swing arms may be pivotally affixed to the base member and pivotally affixed to the targeting member. The first and second swing arms may be pivotally affixed to the base member and to the targeting member such that the first and second swing arms are maintained parallel to each other. The first and second swing arms may be pivotally affixed to the base member and to the targeting member such that the base member and the targeting member are maintained parallel to each other.

The base member may define a receptacle. The receptacle may extend along a longitudinal axis of the base member. The receptacle may be sized to receive a fixation element. The receptacle may receive the fixation element at a position on the fixation element that is operatively external to the bone. The receptacle may be sized such that the base member fits snugly over the fixation element. For example, the fixation element may be a K-wire. The receptacle may be sized to receive a length of a shaft of the K-wire.

A tip of the fixation element may be positioned inside a bone. The tip may identify a target site inside the bone. The fixation element may be referred to herein as a target wire. The bone may be any suitable bone. For example, the bone may be a radius, a humerus or any other bone shown below inFIG. 3. When the bone is a humerus, the tip may be positioned in a head of the humerus.

The base member may include a set screw. The set screw may be configured to lock the base member to the fixation element when a tip of the fixation element is in the bone and a shaft of the fixation element that is operatively outside the bone is positioned within the receptacle.

When the fixation element is positioned within the receptacle, the targeting member, in operation, may move along a circumference of a circle centered at the tip of the fixation element that is within the bone. The tip of the fixation element may identify a distal end of a target site for the implant inside the bone. A distal end of the targeting member may move along the circumference.

When the targeting member, in operation, moves along the circumference, the targeting member may indicate an access position. The targeting member may indicate the access position at an intersection of the circumference and an outer surface of the bone. The targeting member may indicate the access position regardless of an angle between a longitudinal axis of the fixation element and a longitudinal axis of the bone.

The tip of the fixation element (when positioned in the bone) and the access position may define a longitudinal axis. The longitudinal axis defined by the tip of the fixation element and the access position may correspond to a longitudinal axis of an implantation region inside the bone. The longitudinal axis of an implantation region may define an angle, with respect to a longitudinal axis of the bone, at which an implant may be positioned inside the bone.

The targeting member may include an indicator. The indicator may be positioned at an end of the targeting member. In operation, the indicator may be positioned at a distal end of the targeting member. The indicator may be positioned at an end of the targeting member that, in operation, is configured to intersect an outer surface of the bone.

The receptacle defined by the base member may be configured to position the base member with respect to the fixation element. The receptacle may be configured to position the base member with respect to the fixation element such that, in operation, an indicator of the targeting member is positioned on a circumference of a circle centered at the tip of the fixation element.

A position of the indicator with respect to a tip of the fixation element (when the tip is positioned inside the bone) may define a radius of the circle. The radius of a circle centered at a tip of the fixation element may correspond to a length of an implant inserted into the bone. The position of the indicator may be determined by a position of the base member with respect to the fixation element. The position of the indicator may be determined by a length of the receptacle along a longitudinal axis of the base member. Apparatus may be adjustable to identify an appropriate access position for different size implants. For example, a length of the receptacle may be adjustable.

The first and second swing arms may space the base member apart from the targeting member. The first and second swing arms may position an indicator of the targeting member on a circumference of the circle centered about the tip of the bone penetrating member.

When a fixation element is positioned within the receptacle, the targeting member may be positioned with respect to the bone such that when, in operation, the targeting member contacts an outer surface of the bone, the targeting member defines an access position on the outer surface of the bone.

The access position may be a location on the outer surface of the bone where an access hole may be initiated. The access hole may be formed by drilling at the access position. The access position may define a length of an implantation region inside the bone. For example, a maximum length of an implantation region may extend from a tip of a fixation element positioned inside the bone to the access position on the outer surface of the bone. The access position may define a longitudinal axis that extends from a proximal end of the implantation region to a distal end of the implantation region. The distal end of the implantation region may correspond to a target site inside the bone. The target site may correspond to a tip of a fixation element positioned inside the bone. The proximal end of the implantation region may correspond to the access position.

The targeting member may include a first concave surface. The first concave surface may be configured to guide a drill into the bone at the access position. The first concave surface may be configured to guide a drill into the bone such that the drill is oriented substantially perpendicular to a longitudinal axis of the bone.

The targeting member may include a second concave surface. The second concave surface may be configured to guide a drill into the bone. The second concave surface may be configured to guide a drill into the bone at the access position. The second concave surface may be configured to guide a drill into the bone at the access position such that the drill is oriented at an oblique angle to a longitudinal axis of the bone. The angle may be less than 90 degrees and greater than 5 degrees. The angle may define a longitudinal axis of an implantation region.

The first swing arm may include an elongated body. The first swing arm may include a clevis. The first swing arm may be pivotally affixed to the base member by a pin that passes through the clevis and through the base member. The base member may include a clearance holes for receiving the pin.

The targeting member may include a channel. The channel may have a longitudinal axis. The first swing arm may be pivotally affixed within the channel by a pin that passes through the first swing arm and passes perpendicular to the longitudinal axis of the channel. The targeting member may include a pair of clearance holes. A first clearance hole may be on a first side of the channel. A second clearance hole may be on a first side of the channel. The first and second clearance holes may be positioned such that the pin inserted into the first and second clearance holes traverses the channel. The pin may pass through the first clearance hole, pass through a clearance hole in the first swing arm and pass through the second clearance hole.

A targeting member may include a gripper. A gripper may be affixed to the targeting member. A gripper may be affixed to a distal end of the targeting member. The gripper may be configured to stabilize the targeting member on an outside surface of the bone. The gripper may be configured to stabilize the targeting member on an outside surface of the bone when, in operation, the fixation element is positioned inside the receptacle and the targeting member contacts the outside surface of the bone.

The gripper may include a first projection. The gripper may include a second projection. The first projection may be spaced apart from the second projection by a distance. The distance may be greater than a width of the targeting member. The distance may be less than or equal to a width of the bone. The distance may be configured to stabilize the targeting member against an anatomical landmark of a bone. For example, the distance may be determined based on a width of a tuberosity on the bone. The distance may be greater than a width of the tuberosity. The anatomical landmark may be on an outer surface of the bone.

The first projection may be substantially parallel to the second projection. The gripper may be pivotally affixed to the targeting member. The gripper may be rigidly affixed to the targeting member.

When the bone is a humerus, the gripper may be configured to stabilize the targeting member on a humeral shaft of the humerus. In operation, when the targeting member contacts the outside surface of the bone, the first projection and the second projection may be aligned with a longitudinal axis of the implantation region. Being aligned may include being parallel or substantially parallel.

A targeting member may include a guide channel. The guide channel may be pivotally affixed to the targeting member. The guide channel may be pivotally affixed to a distal end of the targeting member. The guide channel may include an elongated concave surface. The guide channel may define a longitudinal axis. The guide channel may be configured such that when, in operation, the targeting member contacts an outer surface of the bone, the guide channel defines a longitudinal axis of the implantation region.

In operation, when the targeting member contacts an outer surface of the bone, the guide channel may define an angle between a longitudinal axis of the bone and the longitudinal axis of the implantation region. The angle may be any suitable angle. For example, the angle may be oblique with respect to the longitudinal axis of the bone. The angle may be perpendicular to a longitudinal axis of the bone.

A targeting member may include an angular stopping member. The angular stopping member may be pivotally affixed to the guide channel. The angular stopping member may be pivotally affixed to a swing arm. For example, the angular stopping member may be pivotally affixed to the second swing arm.

In operation, when the targeting member contacts an outside surface of the bone, the angular stopping member may be configured to support the guide channel. The angular stopping member may support the guide channel with respect to the access position. When the targeting member contacts the outside surface of the bone, the angular stopping member may be configured to support the guide channel along a longitudinal axis that is defined by the access position and a target site inside the bone. The target site may correspond to a tip of a target wire inserted into the bone. The guide channel may define a longitudinal axis of the implantation region.

When, in operation, the targeting member contacts an outside surface of the bone, the angular stopping member may be configured to support the guide channel at an angle to a longitudinal axis of the bone. The angle may be oblique. The angle may correspond to an angle between the longitudinal axis of the bone and a longitudinal axis of the implantation region. For example, the angle may be less than 90 degrees and greater than 5 degrees.

The angular stopping member may include a pair of opposing slots. A swing arm may be pivotally affixed to the angular stopping member by a pin that passes through the swing arm and into the pair of opposing slots. The pin may translate within the opposition slots. In operation, when the targeting member contacts the outer surface of the bone, movement of the pin in the opposing slots may adjust an angle between the guide channel and the longitudinal axis of the bone.

The apparatus may include, and the methods may involve, apparatus for identifying an access position on an outer surface of a bone. The apparatus may include a base member. The base member may be elongated. The base member may include a first sleeve. The first sleeve may be configured to slide over a length of a fixation element that is operational external to the bone. The fixation element may be a target wire. The base member may include a second sleeve. The second sleeve may be positioned at a proximal end of the base member. The apparatus may include a curved member. The curved member may be slidably mounted in the second sleeve.

When the first sleeve is positioned over the fixation element, the curved member may be configured to indicate the access position. When a tip of the fixation element is positioned inside the bone, an end of the curved member may be positioned on a circumference of a circle centered at the tip.

The fixation element may be inserted into the bone in a direction that, with respect to the bone, is lateral to medial. An end of the curved member may include a guide. The guide, when positioned at the at the access position, may indicate an angular direction for inserting an implant into the bone.

The angular direction may be aligned along a diameter of the circle centered at the tip of the target wire. A radius of the circle centered at the tip of the target wire may correspond to a length of the implant. The access position may lie on a circumference of the circle centered about the tip of the target wire when the tip is operationally inside the bone.

The curved member may be configured to indicate an access position on the circumference independent of a position of the base member with respect to a longitudinal axis of the bone. The curved member may be configured to indicate the access position independent of an angle between a longitudinal axis of the fixation element (when a tip of the fixation element is operatively inside the bone) and a longitudinal axis of the bone.

When the first sleeve is positioned over a portion of the fixation element that is operatively external to the bone, a longitudinal axis of the first sleeve may be positioned substantially perpendicular to a longitudinal axis of the bone. When the first sleeve is positioned over a portion of the fixation element that is operatively external to the bone, a longitudinal axis of the first sleeve may be positioned at an oblique angle to a longitudinal axis of the bone. When the bone is a humerus, a longitudinal axis of the implantation region passes through a head of the humerus.

The apparatus may include, and the methods may involve, apparatus for a guide for directing a fixation element into a tail of an implant. A fixation element may be a K-wire, anchor, screw or any suitable fixation device. The implant may be positioned inside a bone. The bone may be any suitable bone. For example, the bone may be any of the bones show below inFIG. 3. The tail may define a hole for clearance of a fixation element. The guide may include a guide tube. The guide may include a collar. The guide may include a bracket. The bracket may include a first end that holds the collar. The bracket may include a second end that holds the guide tube. The bracket may orient a longitudinal axis of the collar substantially perpendicular to a longitudinal axis of the guide tube.

The guide may be configured to cooperate with a shaft of an implant. The shaft may be tubular. The shaft may be elongated. The shaft may be configured to slide concentrically into the collar of the guide. The shaft may include a first end that is configured to engage the tail of the implant. The shaft may include a second end that is configured to engage the collar of the guide. When the first end of the shaft is engaged with the tail and the second end of the shaft is engaged with the collar, the guide tube may be aligned with the hole defined by the tail of the implant.

When the guide tube is aligned with the hole defined by the tail, the guide tube may direct an anchor through the bone and through the clearance hole defined by the tail. When the implant is deployed in the bone, the clearance hole may be positioned below an outer surface of the bone. When the implant is deployed in the bone, the clearance hole may not be visible from a vantage point outside the bone.

The hole may be a first hole. The tail may define a second hole. The first and second holes may define an emplacement axis. When the tail is circular, the emplacement axis may correspond to a diameter of the tail. A longitudinal axis of a fixation element positioned within the first and second holes may be aligned with the emplacement axis. When a first end of the implant shaft is engaged with the tail and a second end of the elongated implant shaft is engaged with the collar of the guide, a longitudinal axis of the guide tube may be aligned along the emplacement axis.

The second end of the bracket may include a passageway. The passageway may hold the guide tube. The passageway may orient the guide tube relative to the collar.

The passageway may define a longitudinal axis. The guide tube may be slidable in the passageway along the longitudinal axis. When the collar is engaged with the implant shaft, the guide tube may be slidable within the passageway between the bracket and the bone.

The guide tube may include a first flanged end. The guide tube may include a second flanges end. The first flanged end and the second flanged end may be spaced apart from each other along a longitudinal axis of the guide tube. The first and second flanged ends may prevent the guide tube from sliding out of the passageway.

The second end of the bracket may include a gasket. The gasket may be positioned in the bracket such that the gasket surrounds the guide tube when the guide tube in positioned in the passageway. The gasket may provide a friction fit that holds the guide tube at a position along a longitudinal axis of the passageway.

When the implant shaft is engaged with the collar, the guide tube may define a longitudinal axis that is substantially perpendicular to the implant shaft.

The guide tube may be a first guide tube. The second end of the bracket may hold a second guide tube. The second end of the bracket may include a first passageway and a second passageway. The first guide tube may be slidably mounted in the first passageway. The second guide tube may be slidably mounted in the second passageway.

A first end of the elongated implant shaft may engage a tail of the implant. A second end of the implant shaft may engage the collar. A clearance hole may be defined by the tail. The clearance hole may be a first hole. The bracket may align a first guide tube with the first hole defined by the tail. The bracket may align the second guide tube with a second hole defined by the tail.

The collar may include a key. The implant shaft may include a keyseat. The key may be configured to be releasably seated in the keyseat. The key may be configured to be releasably seated in the keyseat when the implant shaft is inserted into the collar. When the key is seated in the keyseat, the implant shaft may be axially and rotationally locked with respect to the collar.

The key may be a releasable key. The collar may include a static key. The implant shaft may include a slot that is configured to receive the static key. Engagement of the static key and the slot may be configured to align the releasable key with the keyseat. When the implant shaft is engaged with the tail of the implant, seating the key of the collar in the keyseat of the implant shaft may align the longitudinal axis of the guide tube with a clearance hole and/or an emplacement axis of the tail.

The implant shaft may include a first keyseat. The implant shaft may include a second keyseat. Seating a key of the collar in the first keyseat may space the collar a first distance apart from an end of the implant shaft. Seating a key of the collar in the second keyseat may space the collar a second distance from an end of the implant shaft. The end of the implant shaft may be the first end that is configured to engage the tail.

Apparatus are provided for directing fixation element from outside a bone, through the bone and into a volume defined by an implant positioned inside the bone. The volume maybe defined by an expandable web (alternatively referred to herein as expandable mesh or cage) of the implant. The implant may be positioned inside the bone. Apparatus may include an implant shaft. The implant shaft may be tubular. The implant shaft may define a longitudinal axis. The implant shaft may be configured to engage an implant positioned inside the bone. The implant shaft may engage a tail of the implant. The implant shaft may extend outside the bone.

Apparatus may include a collar that is configured to slidably engage the implant shaft. The collar may slide over the implant shaft. The collar may slidably engage the implant shaft at a position on the implant shaft that is operatively outside the bone.

The apparatus may include a boom. The boom may include an elongated passageway;

The apparatus may include a neck. The neck may include a first end. The first end of the neck may be fixed to the collar. The neck may include a second end. The second end of the neck may be fixed to the boom. When the collar is slidably engaged with the implant shaft, the elongated passageway may be positioned to direct a fixation element from outside the bone, through the bone and into the volume defined by the implant.

The boom may be positioned on the neck such that that the fixation element does not contact a central axis member of the implant. For example, the neck may position the boom to be “off center” with respect to a central longitudinal axis of the implant. The neck may position the boom such that the passageway is spaced apart from the central axis member of the implant.

When the collar is slidably engaged with the implant shaft, the elongated passageway maybe positioned substantially parallel to the implant shaft. The elongated passageway may be configured to direct a fixation element into the volume defined by the implant. When the collar is slidably engaged with the implant shaft, the elongated passageway may be configured to direct a fixation element into the volume defined by the implant at or near a center longitudinal axis of the implant.

When the collar is slidably engaged with the implant shaft, the elongated passageway maybe configured to direct a fixation element into the volume defined by the implant such that the fixation element is deflected by a center axis member of the implant.

The collar may be rotatable about the implant shaft. Rotating the collar about the implant shaft may position the elongated passageway about an outer perimeter of the volume defined by the implant.

The boom may be pivotally affixed to the neck. The boom may be pivotally affixed to the neck such that a longitudinal axis defined by the passageway is oriented at an oblique angle with a longitudinal axis defined by the implant shaft.

When a fixation element passes through the elongated passageway and into the bone, the boom may be configured to pivot such that fixation element is no longer within the elongated passageway (without removing the fixation element from the bone). After pivoting the boom, the collar may be rotatable at least 180 degrees about the implant shaft. After pivoting the boom, the collar may be rotatable 360 degrees about the implant shaft.

The collar may include a pair of kerfs. The pair of kerfs may separate a first trough from a second trough. When the collar is sildably engaged with the implant shaft, the first and second troughs may be spread apart by the implant shaft. When the collar is sildably engaged with the implant shaft, the first and second troughs may apply pressure to an outer surface of the implant shaft. The pressure applied by the first and second troughs may provide a friction fit that holds the collar in a position about the longitudinal axis of the implant shaft.

The apparatus may include, and the methods may involve, a washer. The washer may be a surgical washer that is implantable in a human body. The washer may define a central aperture. The central aperture may have a circumference. The washer may define an offset aperture. The offset aperture may be spaced apart from the central aperture at a position with respect to the circumference of the central aperture.

The central aperture may have a diameter that is larger than a diameter of the offset aperture. The washer may include solid material that joins the offset aperture to the central aperture. The washer may include a second offset aperture. The washer may include two or more offset apertures. The second offset aperture may be spaced apart from the central aperture and spaced apart from the first offset aperture. The central aperture and an offset aperture form a figure eight shape.

The apparatus may include, and the methods may involve, a suturable washer. The suturable washer may include an inner circumference that defines a central aperture. The suturable washer may include an outer perimeter that encloses the inner circumference. The outer perimeter may define a non-circular shape. The suturable washer may include solid material between the inner circumference and the outer perimeter. The suturable washer may include an offset circumference that is enclosed by the outer perimeter. The offset circumference may define an offset aperture.

The suturable washer may include solid material between an arc length of the offset circumference and a corresponding length of the outer perimeter covering the arc length. The solid material may vary in thickness between the arc length of the offset circumference and the length of the outer perimeter covering the arc length.

The suturable washer may include a first thickness of solid material between a first arc length of the offset circumference and a corresponding first length of the outer perimeter covering the first arc length. The suturable washer may include a second thickness of solid material between a second arc length of the offset circumference and an arc length of the inner circumference opposing the second arc length. The second thickness may be greater than the first thickness.

The suturable washer may include a uniform thickness of solid material between a first arc length of the offset circumference and a corresponding length of the outer perimeter covering the first arc length. The suturable washer may include a variable thickness of solid material between a second arc length of the offset circumference and an arc length of the inner circumference convexly opposing the second arc length.

An offset circumference may be a first offset circumference. The suturable washer may include a second offset circumference that is enclosed by the outer perimeter. The second offset circumference may define a second offset aperture. The first offset circumference may be equal in length to the second offset circumference.

The suturable washer may include a first segment of solid material between a first arc length of the first offset circumference and a corresponding length of the outer perimeter covering the first arc length. The suturable washer may include a second segment of solid material between a second arc length of the second offset circumference and a corresponding second length of the outer perimeter covering the second arc length.

The first segment of solid material may be spaced apart from the second segment of solid material. The spacing may be defined by the outer perimeter. The first arc length may be positioned convexly opposing the second arc length. A distance spacing the first segment of solid material apart from the second segment of solid material may vary along the convexly opposing first and second arc lengths. A distance spacing the first segment of solid material apart from the second segment of solid material may vary along the outer perimeter.

The suturable washer may include a first arc length of the first offset circumference that is positioned convexly opposing a second arc length of the inner circumference. The suturable washer may include a third arc length of the second offset circumference that is positioned convexly opposing a fourth arc length of the inner circumference.

The suturable washer may include solid material between an arc length of the offset circumference and an arc length of the inner circumference convexly opposing the arc length of the offset circumference. Solid material may vary in thickness between an arc length of the offset circumference and a convexly opposing arc length of the inner circumference.

The suturable washer may include an offset aperture that is moveable about an axis. The axis may be tangential to an inner circumference that defines the central aperture and tangential to an offset circumference. The axis may be a longitudinal axis that passes between an inner circumference and an offset circumference. An offset aperture may be bent to allow for sutures to be threaded through the offset aperture. The offset aperture may be bent after a fixation element is inserted into the central aperture. A fixation element inserted into the central aperture may engage the bone and affix the washer to the bone.

An inner circumference that defines central aperture may also define a first plane. An outer perimeter of a washer may define a second plane. The first plane may be spaced apart from the second plane. The first plane may be substantially parallel to the second plane.

In operation, when the washer is positioned on an outside surface of a bone, the outer perimeter of the washer may be positioned closer to the bone than a central aperture of the washer. A distance spacing the outer perimeter apart from the central aperture may correspond to a distance spacing the first plane apart from the second plane.

In operation, when a washer is positioned on an outside surface of a bone, a central aperture of the washer may be positioned closer to the bone than the outside perimeter of the washer. A distance spacing the outer perimeter apart from the central aperture may correspond to a distance spacing the first plane apart from the second plane.

In operation, when suturable washer is positioned on an outside surface of a bone, the outer perimeter may be positioned closer to the bone than the central aperture. A distance spacing the outer perimeter apart from the central aperture may correspond to a distance spacing the first plane apart from the second plane.

An inner circumference that defines the central aperture may also define a first plane. An offset circumference may define a second plane. The first plane may be positioned at an oblique angle to the second plane.

The apparatus may include, and the methods may involve, an implantable, suturable washer. The washer may define a central aperture. The central aperture may include a central circumference. The washer may define an offset aperture. An offset aperture may include an offset circumference. The offset aperture may be fixed at a position along the central circumference.

The offset aperture may be a first offset aperture. The position may be a first position. The washer may define a second offset aperture. The second aperture may be fixed at a second position along the central circumference.

The central circumference of the washer may define a central plane. The offset circumference of the offset aperture may define an offset plane. The offset aperture may be moveable with respect to the central aperture. The offset aperture may be moveable with respect to the central aperture when the central aperture is fixed to the bone. The offset aperture may be moveable with respect to the central aperture such that movement of the offset aperture changes an angle between the central plane and the offset plane. The offset aperture may be moveable with respect to the central aperture such that movement of the offset aperture does not change the position of the offset aperture with respect to the central circumference.

First and second offset apertures may each be independently moveable with respect to the central aperture. A washer may include two or more offset apertures. Each of the offset apertures may be moveable with respect to the central aperture.

The apparatus may include, and the methods may involve, an implantable, suturable washer. The washer may include a central aperture that defines a central plane. The central aperture may be defined by a central circumference. The washer may include a flanged outer skirt. The flanged outer skirt may encircle the central aperture. The flanged outer skirt may define an outer plane.

The washer may include a mid-section. The mid-section may extend between the central aperture and the flanged outer skirt. The mid-section may space the central plane apart from the outer plane. The mid-section may define a surface. A slope of the surface may vary between the central plane and the outer plane.

The washer may include a plurality of offset apertures. The plurality of offset apertures may be distributed circumferentially around the central aperture. Each of the plurality of offset apertures may include an offset circumference. The mid-section of the washer may include a first arc length of the offset circumference. The flanged outer skirt of the washer may include a second arc length of the offset circumference.

A washer may include a rim surrounding the central aperture. In operation, when a fixation element, such as an anchor, is driven through the central aperture into a bone, the rim may be pressed against the bone by a head of the anchor.

In operation, when an anchor is driven through the central aperture into a bone, the flanged outer skirt and the mid-section of the washer may space the rim apart from the bone. In operation, when an anchor is driven through the central aperture of the washer into a bone, the mid-section of the washer may be positioned concavely facing an outer surface of the bone.

In operation, when an anchor is driven through the central aperture of the washer into a bone, the mid-section of the washer may be positioned convexly facing an outer surface of the bone. When the mid-section is convexly facing the outer surface of the bone, an offset aperture of the washer may be spaced apart from the bone.

Apparatus for coupling an implant positioned inside a bone to a tool positioned outside the bone is provided. The apparatus may include a tail of the implant. The tail may include an internally threaded segment. The tail may include a beveled segment.

The apparatus may include an implant shaft. The implant shaft may be a hollow implant shaft. The implant shaft may include a beveled segment. The beveled segment of the implant shaft may be configured to mate with the beveled segment of the tail. The implant shaft may include a flange positioned inside the implant shaft. The flange may define an aperture.

The apparatus may include a locking screw. The locking screw may be cannulated. The locking screw may include a threaded segment. The threaded segment may slide past the flange inside the hollow tube when the locking screw is inserted into the hollow implant shaft. For example, the major diameter of the threaded segment of the locking screw may be less than a diameter of the aperture defined by the flange.

The locking screw may include a shoulder. The shoulder may abut the flange when the locking screw is inserted into the implant shaft. When the locking screw is inserted into the implant shaft and the threaded segment of the locking screw engages the internally threaded segment of the tail, the locking screw may axially lock the implant shaft to the tail.

The implant shaft may include one or more fingers protruding from the beveled segment of the implant shaft. The tail may include one or more indentations that are configured to mate with the one or more fingers of the implant shaft. When the locking screw threadedly engages the tail, the one or more fingers may mate with the one or more indentations. When the one or more fingers mate with the one or more indentations, the implant shaft may be rotational fixed with respect to the tail.

Apparatus and methods for repairing a bone are provided. The bone may be fractured. Apparatus and methods may be used to repair the fracture. For example, apparatus and methods may be used to reduce the fracture. Apparatus and methods may be used to maintain a reduction of fracture.

Apparatus may include the implant. The implant may include the implant tail. The implant may include the implant head. The tail may be expandable. The tail may be configured to self-expand. The tail may be non-expandable.

The implant may have a collapsed state. In the collapsed stated, the implant may have a uniform diameter. The head may be expandable. The head may be configured to self-expand. The head may not be expandable.

The head may be configured to expand, inside the bone from a collapsed state into an expanded state.

Apparatus may include an intramedullary rod. The rod may define a central longitudinal rod axis. The rod may define an outer surface. The outer surface may be any suitable surface.

The rod may define a cylindrical outer surface. The rod may define a conical outer surface. The rod may include a first segment that defines a cylindrical outer surface and a second segment that defines a conical outer surface.

The rod may include a guide segment. The guide segment may be configured to guide an implant head into the bone. The guide segment may be configured to support the implant tail. The guide segment may support the implant tail after the implant head is positioned inside the bone.

The rod may include an elongated extension member. The elongated extension member may be spaced radially apart from the central longitudinal rod axis. The elongated extension member may be configured to provide clearance, with respect to an outer surface of the rod, for tools inserted into the bone. Without the clearance provided by dimensions of the elongated members, the tools would be obstructed by an outer surface of the rod. Exemplary tools may include a drill, implant, wire, anchor, reamer, guide tube or any other suitable tool may be inserted into the bone to repair the bone.

For example, the elongated extension member may provide clearance for the implant head as the implant head is advanced, in the collapsed state, through the guide segment into the bone. The elongated member may provide clearance that allows the implant head to be positioned inside the bone without being obstructed by an outer surface of the rod.

The elongated extension member may provide clearance for the implant head in the expanded state. The elongated member may allow the implant head to expand without being obstructed by an outer surface of the rod.

The rod further may include a ring-shaped segment. The ring-shaped segment may bridge between the guide segment and the elongated extension member. The central longitudinal rod axis may pass through the ring-shaped segment. The central longitudinal axis may pass through an aperture of the ringed-shaped segment. The ringed-shaped segment may be part of the guide segment.

The rod may define a cylindrical volume.

The guide segment may be defined by a conical-shaped volume subtracted or removed from the cylindrical volume. A diameter of a base of the conical-shaped volume may have a diameter that is less than a diameter of the cylindrical volume.

The implant tail may include a first anchor receiving feature. The guide segment may include a guide surface defining a central longitudinal guide axis. The guide segment may include a second anchor receiving feature. The second anchor receiving feature may define a central longitudinal anchor axis. The central longitudinal anchor axis of the second anchor receiving feature may be perpendicular to, or substantially perpendicular to, the central longitudinal guide axis.

In operation, the implant tail may be supported by the guide surface. The implant tail may be supported by the guide surface such that the first anchor receiving feature and the second anchor receiving feature are aligned to receive the same anchor. Targeting tools positioned outside the bone may direct the anchor into the first anchor receiving feature and into the second anchor receiving feature.

The rod may include an outer surface. The outer surface may define a cylindrical surface. The outer surface may define a conical surface.

The rod may include a first body segment. The first body segment may extend along a first length of the central longitudinal rod axis. The first body segment may define a uniform diameter along the first length. The rod may include a second body segment. The second body segment may extend along a second length of the central longitudinal rod axis. The second body segment may define a diameter that varies along the second length.

The guide segment may include an inner radius. The guide segment may include an outer radius. The guide segment may include a guide surface. The guide surface may be defined by a thickness between the inner and outer radii. The guide surface may be defined by a cylindrical surface that intersects the guide segment.

The cylindrical guide surface may be an oblique, cylindrical surface. The cylindrical guide surface may have a diameter greater than a maximum diameter defined by the guide segment. The cylindrical guide surface may have a diameter smaller than a maximum diameter defined by the guide segment.

A length of the rod may be cannulated. A cannulated length of the rod may be threaded. The guide segment may have a length. A length of the guide segment may extend along the central longitudinal rod axis. A length of the guide segment may be cannulated. A length of the guide segment may be threaded.

The rod may include a first cannulated length. The rod may include a second cannulated length. The second cannulated length may be threaded. The second cannulated length may be spaced apart from the first length, along the central longitudinal rod axis, by a third length. The elongated extension member may extend along the third length.

The central longitudinal rod axis may intersect the central longitudinal guide axis at an angle. The angle of intersection may define a slope of the guide surface. For example, if the angle of intersection is θ, the slope of the guide surface may be defined as tan(θ). The angle of intersection may be any suitable value. For example, the angle of intersection may be less than 90 degrees. The angle of intersection may be between 45 and 15 degrees.

An outer surface of the rod may define a cylindrical surface. The cylindrical surface may be a first cylindrical surface. The implant, in the collapsed state, may define a second cylindrical surface. A diameter of the second cylindrical surface may be smaller than a diameter of the first cylindrical surface.

The guide segment may define a cylindrical outer surface. The elongated extension member may include the cylindrical outer surface. The elongated extension member may include an outer arc length. The outer arc length may be less than a maximum circumference of the cylindrical outer surface. The arc length may be less than half of the maximum circumference. The elongated extension member may have a thickness. The thickness may be less than a radius of the cylindrical outer surface.

The elongated extension member may define a length along the central longitudinal rod axis. The elongated extension member may define an outer surface area. The outer surface area defined by the elongated extension member may be less than an outer surface area of the length of the guide segment along the central longitudinal axis.

The elongated extension member may include a first mating feature. The first mating feature may be configured to mate with a second mating feature. The rod may be a first rod. A second rod may include the second mating feature. The first rod may be inserted into the bone. The second rod may extend from inside the bone outside the bone. Mating of the first and second mating features may allow force to be transferred the first rod.

The force may be applied to the second rod. The force may be transferred from the second rod to the first rod. The force may be transferred from the second rod to the first rod via the elongated extension member of the first rod. The force may be transferred from the second rod to the first rod along a central longitudinal rod axis of the first rod. The force may be transferred to the first rod without deforming the first rod. In operation the force transferred to the first rod may be sufficient to drive the first rod into the bone.

A mating feature may define a depression. The depression may be defined relative to an outer surface of a rod. A first mating feature may include a first depression. The first mating feature may include a second depression. The second depression may be spaced apart from the first depression. The second depression may be spaced apart from the first depression along a central longitudinal axis of the rod.

The elongated extension member may include an anchor receiving feature. The first depression may be spaced apart from the second depression by a diameter of the anchor receiving feature. The anchor receiving feature may be threaded.

A mating feature may include a depression and an edge of the elongated extension member. The edge of the elongated extension may be an end of the rod. A mating feature may define an aperture in the elongated extension member. A mating feature may include a protrusion. The protrusion may extend from an outer surface of the rod.

The rod may include a third mating feature. The third mating feature may be configured to mate with a tool positioned outside the rod.

The rod may include a tapered segment. The tapered segment may be configured to displace tissue inside the bone. In operation, as the rod is inserted into the bone, the tapered segment may displace tissue inside the bone. A guide segment of the rod may define a longitudinal guide axis. The longitudinal guide axis may be oblique to a central longitudinal axis of the rod. The elongated extension member may define a longitudinal extension axis. The longitudinal extension axis may be parallel to, or substantially parallel to, the central longitudinal rod axis.

The rod may include a plurality of anchor receiving features. The plurality of anchor receiving features may include a first anchor receiving feature. The first anchor receiving feature may define a first longitudinal axis. The first longitudinal axis may be oblique to a central longitudinal rod axis.

The plurality of anchor receiving features may include a second anchor receiving feature. The second anchor receiving feature may define a second longitudinal axis. The second longitudinal axis may be oblique to the central longitudinal rod axis.

The first longitudinal axis (defined by the first anchor receiving feature) may be positioned in a first plane. The first plane may be perpendicular to, or substantially perpendicular to, the central longitudinal rod axis. The second longitudinal axis (defined by the second anchor receiving feature) may be positioned in a second plane. The second plane may be parallel to, or substantially parallel to, the first plane and perpendicular to, or substantially perpendicular to, the central longitudinal rod axis.

The first longitudinal axis (defined by the first anchor receiving feature) may intersect the second longitudinal axis (defined by the second anchor receiving feature).

The plurality of anchor receiving features may include a third anchor receiving feature. The third anchor receiving feature may define a third longitudinal axis. The third longitudinal axis may be oblique to the central longitudinal rod axis and transverse to the first and second planes.

Methods for repairing a bone are provided. The repairing may include reducing a fracture in the bone. The methods may include maintaining a reduction of the fracture and promoting healing of the fracture.

Methods may include positioning a first rod perpendicular to, or substantially perpendicular to, a longitudinal axis of a second rod. Methods may include locking the first rod to the second rod. The locking may include driving an anchor, guided by a cannulated segment of the second rod, into a threaded anchor receiving feature of the first rod. The first rod may be locked to second rod outside the bone.

Methods may include inserting the first rod into an intramedullary cavity of the bone. Methods may include inserting the first rod into the bone though an articular surface-region of the bone. Methods may include inserting the first rod into the bone through any desirable accessible region of the bone.

Inserting the first rod into the bone may include applying a force to the second rod. The second rod may be locked to the first rod such that the force drives the first rod into the bone without deforming the first rod. The mating of the first and second mating features may reduce likelihood that the force applied to the second rod deforms the first rod.

The inserting may include driving the first rod into a femur along a femoral-shaft axis of the femur. The inserting may include driving the first rod into a humerus along a longitudinal axis defined by the humerus.

Methods may include securing targeting tools to the second rod. Methods may include using the targeting tools, securing the first rod to the bone.

Methods may include using one or more apertures in the targeting tools and positioning an anchor in a receiving feature of the first rod. The positioning may include mating a first mating feature of the first rod with a second mating feature of the second rod. The mating may include fitting the first mating feature into the second mating feature. The mating may include fitting the second mating feature into the first mating feature.

Methods may include positioning a joint linking the first rod to the second rod inside the bone. Methods may include affixing the targeting tools to the second rod outside the bone. Methods may include using the targeting tools, guiding a drill into the bone. Methods may include using a guide surface of the first rod, guiding the drill into the bone.

Methods may include using the targeting tools, guiding a reamer into the bone. Methods may include using a guide surface of the first rod, guiding the reamer into the bone.

Methods may include using the targeting tools guiding an anchor into an anchor receiving feature of the first rod that is obscured by an outside surface of the bone.

Methods may include positioning the implant inside the bone. Methods may include expanding the implant inside the bone. Methods may include using the targeting tools, securing the expandable implant to the bone.

Methods may include using a guide surface of the first rod, positioning the implant inside the bone. Methods may include securing the implant to the first rod. The implant may be secured to the first by driving an anchor from an outside on the bone, into the bone through the implant and through the first rod. The anchor may be guided into the bone, implant and rod using the targeting tools secured to the second rod.

The bone may be any suitable bone Si (see Table 5, below). For, example, the bone may be a humerus. The bone may be a femur. Methods may include securing the implant to a humerus such that a central longitudinal axis of the implant is positioned, relative to a central longitudinal axis of the first rod, at an angle that conforms to an angle of inclination of the humerus.

Methods may include securing the implant to a humerus such that a central longitudinal axis of the implant is positioned, relative to a central longitudinal axis of the humerus, at an angle that conforms to an angle of inclination of the humerus.

Methods may include expanding the implant within a head region of a bone. For example, methods may include expanding the implant within a head region of humerus. Methods may include expanding the implant within a head region of femur.

The bone may be a femur. Methods may include securing the implant to a femur such that a central longitudinal axis of the implant is positioned, relative to a central longitudinal axis of the rod, at an angle that conforms to an angle of inclination of the femur. Methods may include securing the implant to a femur such that a central longitudinal axis of the implant is positioned, relative to a central longitudinal axis of the femur, at an angle that conforms to an angle of inclination of the femur.

Methods may include affixing a third rod to the first rod. The third rod may be affixed to the first rod such that a central longitudinal axis of the first rod is parallel to, or substantially parallel to, a central longitudinal axis of the third rod. Methods may include securing targeting tools to the third rod. The targeting tools may be secured to the third rod outside the bone. A joint linking the first rod to the third rod may be positioned inside the bone.

Methods may include removing the targeting tools after the first rod is secured to the bone. Methods may include removing the second rod after the first rod is secured to the bone. Methods may include removing the second rod and the targeting tools after the first rod and the implant are secured to the bone.

Methods may include using a guide surface of the first rod, inserting the implant into the bone. The implant may be inserted into the bone using an access hole in cortical bone. A practitioner may provide access to the guide surface after the first rod is inserted into the bone by drilling the access hole. A drill used to form the access hole may be guided by a guide surface of the targeting tools secured to the second rod.

The targeting tools may be secured to the second rod by aligning a cut-out in the targeting tools with a rib that protrudes from an outer surface of the second rod. The targeting tools may be secured to the second rod by positioning a set screw of the targeting tools into a cut-out in the rib.

The apparatus may include, and the methods may involve, an elongated member. The elongated member may be configured to be coupled to the implant. The implant may include the implant tail.

The elongated member may include a sleeve. The sleeve may have a sleeve longitudinal axis. The apparatus may include an anchoring base. The anchoring base may be fixed to, and extend away from, the sleeve. The apparatus may include a threaded member. The threaded member may be fixed to the anchoring base and extend along the sleeve longitudinal axis. The threaded member may be spaced radially apart from the sleeve to define an annular space for receiving the implant tail.

The elongated member may not include a threaded member. The sleeve may be configured to be coupled to the implant tail using a snap-fit mechanism. The sleeve may define an inner threaded surface for screwing onto an outer threaded surface of the implant tail. The sleeve may be configured to be coupled to the implant tail by driving a screw through a hole defined by the sleeve and into a hole defined by the implant tail, the implant tail hole being coaxial with the sleeve hole.

The sleeve may define, transverse to the longitudinal axis, a constant outside diameter. The sleeve may define, transverse to the longitudinal axis, an outside diameter that varies along a length of the sleeve.

The anchoring base may define, transverse to an anchoring base longitudinal axis, a constant outside diameter. The anchoring base may define, transverse to an anchoring base longitudinal axis, an outside diameter that varies along a length of the anchoring base. The outside diameter may decrease along the length. A largest value of the outside diameter may be adjacent the sleeve.

The sleeve may define a first outside diameter transverse to the longitudinal axis. The anchoring base may define a second outside diameter, equal to the first outside diameter, transverse to the longitudinal axis.

The anchoring base may include a hollow mesh structure defining a plurality of openings. The anchoring base may define a base longitudinal axis. The mesh structure may extend circumferentially around the longitudinal axis. The mesh structure may have a first outside diameter transverse to a mesh longitudinal axis along a first portion of a length of the mesh structure and a second outside diameter, different from the first outside diameter, transverse to a mesh longitudinal axis along a second portion of the length of the mesh structure. The mesh structure may include a plurality of struts. The plurality of openings may be defined by the struts.

The anchoring base may include a first end. The anchoring base may include a second end, opposite the first end. The hollow mesh structure may be disposed between the first end and the second end. The sleeve may extend away from the first end. The second end may be tapered.

The anchoring base may define a hole. The hole may be a screw hole. A cross-section of the hole, transverse to a central axis of the hole, may be circular. The hole may have a first diameter parallel to an anchoring base longitudinal axis and a second diameter extending circumferentially about the anchoring base longitudinal axis, wherein the first length is at least double the second length. The hole may be a slot. The slot may be sized to receive an anchor. The anchor may be a screw.

The hole may be a first hole. The anchoring base may define a second hole, the second hole being spaced apart from the first hole along a longitudinal axis of the anchoring base. The first hole may have a first central axis pointing in a first direction. The second hole may have a second central axis pointing in a second direction different from the first direction. The second hole may have a second central axis pointing in a second direction perpendicular to the first direction. The second hole may have a second central axis pointing in a second direction parallel to the first direction.

The hole may be a first hole. The anchoring base may define a plurality of holes, the plurality of holes including the first hole. Each hole may be spaced apart from an adjacent hole along a longitudinal axis of the anchoring base.

The hole may be a first hole. The anchoring base may define a second hole extending through the anchoring base. The second hole may be spaced circumferentially apart, about an anchoring base longitudinal axis, from the first hole. A central axis extending through the first hole may transect a central axis extending through the second hole.

The anchoring base may include a first end and a second end opposite the first end. The anchoring base may include a plurality of longitudinal struts. Each strut may be coupled to, and extend between, the first and second end. Each strut may be and spaced apart from an adjacent strut circumferentially about an anchoring base longitudinal axis.

The apparatus may include the implant. The implant may include the implant head and the implant tail. The implant tail may include an inner threaded portion. The implant may include the implant base. The implant base may be positioned between the head and the tail. The implant tail may be sized to be seated in the annular space. The inner threaded portion may be threaded to mate with the threaded member. An inner face of the sleeve may have a circumference. An outer face of the implant tail may have the circumference. An outer face of the implant tail may have a circumference slightly smaller than the circumference.

In operation, the implant may be coupled to the elongated member, the implant tail may be seated in the annular space and the threaded member may engage the inner threaded portion. In operation, the implant may be coupled to the elongated member, the implant tail and a portion of the implant base may be seated in the annular space and the threaded member may engage the inner threaded portion. In operation, the implant may be coupled to the elongated member, the implant tail and the implant base may be seated in the annular space and the threaded member may engage the inner threaded portion.

The implant tail may be cylindrical. In operation, the implant may be coupled to the elongated member and the implant may fill the annular space. In operation, the implant may be coupled to the elongated member and the implant may fill a portion of the annular space.

The implant tail may have an angled face oblique to an implant tail longitudinal axis. In operation, the implant may be coupled to the elongated member and the implant may fill a portion of the annular space.

The implant tail may define a first hole and a second hole opposite the first hole across an implant tail longitudinal axis. The sleeve may define a third hole and a fourth hole across the sleeve longitudinal axis. In operation, the implant may be coupled to the elongated member and the first, second, third and fourth hole may be coaxial.

The sleeve and anchoring base, together, may be monolithic. The sleeve, threaded member and anchoring base, together, may be monolithic. The anchoring base and threaded member, together, may be monolithic.

The anchoring base may not define an opening.

The sleeve longitudinal axis may be coaxial with an anchoring base longitudinal axis. The sleeve longitudinal axis may be oblique to an anchoring base longitudinal axis.

The apparatus may include, and the methods may involve, a first expandable implant and a second expandable implant. The first expandable implant may be the implant. The second expandable implant may be the implant.

The first expandable implant may include a first base coupled to a first implant head. The first head, when expanded, may form a first mesh cage. The second expandable implant may include a second base coupled to a second implant head. The second head, when expanded, may form a second mesh cage. The first base may be configured to be coupled to the second base such that an outer face of the first base is positioned within an inner face of the second base.

In operation, the outer face of the first base may be positioned within the inner face of the second base and the first base may be coupled to the second base. An outer face of the first base may be threaded.

An inner face of the second base may be threaded to mate with the threads on the first base.

An inner face of the second base may be sized to receive an outer face of the first base.

The first base may define a protrusion. The second base may define a window. In operation, the outer face of the first base may be positioned within the inner face of the second base and the protrusion may extend through the window to couple the first base to the second base.

The second base may define a protrusion. The first base may define an opening. In operation, the outer face of the first base may be positioned within the inner face of the second base and the protrusion may extend through the opening to couple the first base to the second base.

In operation, the first base may be coupled to the second base, the first cage may define a first central axis and the second cage may define a second central axis coaxial with the first central axis. In operation, the first base may be coupled to the second base, the first cage may define a first central axis, and the second cage may define a second central axis oblique to the first central axis.

In operation, the first base may be coupled to the second base. The first head, when expanded, may define a first volume and the second head, when expanded, may define a second volume that is greater than the first volume. The first head, when expanded, may define a first volume and the second head, when expanded, may define a second volume that is different from the first volume.

The first implant may include a first shaft extending away from the first base. The second base may include a second shaft extending away from the second base. The first shaft may be configured to be coupled to the second shaft such that an outer face of the first shaft is positioned within an inner face of the second shaft.

The apparatus may include, and the methods may involve, the implant base having a first end and, opposite the first end, a second end. The apparatus may include a first mesh cage fixed to, and extending away from, the first end. The apparatus may include a second mesh cage fixed to, and extending away from, the second end. The first mesh cage may be expandable. The second mesh cage may be expandable.

The first mesh cage may be the implant head. The second mesh cage may be the implant head.

The base, the first and the second cage may together be formed from a monolithic laser-cut tube. The base and the first cage may together be formed from a first laser-cut tube. The second cage may be formed from a second laser-cut tube.

The first cage may define a first central axis. The second cage may define a second central axis coaxial with the first central axis. The second cage may define a second central axis oblique to the first central axis.

The implant base may define a hole. The hole may be a screw hole. The screw hole may be a first screw hole. The implant base may define a second screw hole.

The implant base may be cylindrical. The implant base may have an outside diameter perpendicular to a base longitudinal axis. The outside diameter may vary along a length of the base.

The first mesh cage may define a first volume. The second mesh cage may define the first volume. The second mesh cage may define a second volume different from the first volume.

The apparatus may include, and the methods may involve, a first mesh cage having a first hub and a first base. The apparatus may include a second mesh cage having a second hub and a second base. The apparatus may include a first elongated member extending between the first base and the second hub. The apparatus may include a second elongated member coupled to, and extending away from, the second base.

The first mesh cage may be expandable between a collapsed configuration and an expanded configuration. The second mesh cage may be expandable between a collapsed configuration and an expanded configuration.

The first mesh cage may be the implant head. The second mesh cage may be the implant head.

The first mesh cage may define a first central axis. The second mesh cage may define a second central axis. The first elongated member may define a third central axis. The second elongated member may define a fourth central axis. The first, second, third and fourth central axis may be coaxial.

The first elongated member may define a hole sized for receiving an anchor, such as a screw. The second elongated member may define a hole sized for receiving an anchor, such as a screw. The first elongated member may define a plurality of holes. The holes may be screw holes. The second elongated member may define a plurality of holes. The holes may be screw holes.

The first elongated member may include a hollow cylindrical mesh structure extending along a length of the first member. The mesh structure may extend circumferentially about a central axis of the first member. The second elongated member may include a hollow cylindrical mesh structure extending along a length of the second member. The mesh structure may extend circumferentially about a central axis of the second member.

The first mesh cage may define a first volume. The second mesh cage may define a second volume greater than the first volume. The second mesh cage may define the first volume.

The apparatus may include an intramedullary rod. The second elongated member may extend through a bore defined by the intramedullary rod.

The methods, which may involve the apparatus shown and described herein, may include a method for treating a bone having an interior. The method may include selecting a first implant having a first expandable mesh head and a first base. The method may include selecting a second implant having a second expandable mesh head and a second base. The method may include coupling the first base to the second base. The method may also include positioning the first and second implants in the interior.

The first implant may be the implant. The second implant may be the implant.

The positioning may be performed after the coupling. The positioning may be performed before the coupling.

The coupling may include threadingly engaging threads defined on an outer face of the first base with threads defined on an inner face of the second base. The coupling may include inserting the first base into the second base. The coupling may include advancing an inner face of the first base along an outer face of the second base.

The method may include, prior to the inserting, expanding the first expandable cage. The method may include, prior to the inserting, expanding the second expandable cage.

The method may include, after the inserting, expanding the first expandable cage. The method may include, after the inserting, expanding the second expandable cage.

The apparatus may include, and the methods may involve, a first intramedullary rod defining a screw hole having a central axis. The apparatus may include a second intramedullary rod configured to be coupled to the first rod. The apparatus may include the implant. The implant may be configured to be coupled to an end of the second rod. The implant may include the implant head that, when expanded, defines a volume. In operation, the second rod may be coupled to the first rod, the implant may be coupled to the second rod, the implant head may be in an expanded state and the central axis may point to the volume.

The hole may be a first hole and the central axis may be a first central axis. The first rod may define a second hole. The second hole may define a second central axis oblique to the first central axis. In operation, the second rod may be coupled to the first rod, the implant may be coupled to the second rod, the implant head may be in an expanded state and the second central axis may point to the volume. The first central axis may be parallel to the second central axis. The first central axis may be oblique to the second central axis.

The implant may include the implant base. The implant base may extend away from the implant head.

The end of the second rod may define an opening sized to receive the implant base.

An inner face of the implant base may include threads. An outer face of the end of the second rod may include threads configured to threadingly engage the threads on the inner face of the implant base.

An outer face of the implant base may include threads. The end of the second rod may define a threaded opening configured to threadingly engage the threads on the outer face of the implant base.

The implant may be a first implant. The expandable head may be a first expandable head. The apparatus may include a second implant. The second implant may include a second expandable head. The second implant may be configured to be coupled to an end of the second rod.

The second implant may include a base extending away from the second head. The end of the second rod may define an opening sized to receive the second implant base. The base may include threads, and the end of the second rod may be configured to threadingly engage the threads.

The end of the second rod may be a first end. The apparatus may include a third implant. The third implant may include a third expandable head. The third expandable head may be configured to be coupled to a second end of the second rod.

The third implant may include a base extending away from the third head. The second end of the second rod may define an opening sized to receive the third base. The base may include threads, and the second end of the second rod may be configured to threadingly engage the threads.

The apparatus may include, and the methods may involve, a cannulated intramedullary rod having a first end and a second end opposite the first end and the implant. The implant may be configured to be coupled to the first end. The implant may include the implant head, the implant tail and the implant base extending between the head and the tail. The apparatus may include an end cap configured to be coupled to the second end. The implant may be configured to be coupled to the first end such that the implant head extends away from the first end and the implant tail is seated in an interior of the rod.

The apparatus may include a threaded member coupled to, and extending away from, the end cap along a central axis of the end cap. An inner face of the implant tail may be threaded. The threaded member may be threaded to mate with the implant tail. In operation, the threaded member may extend through an interior of the rod, along a longitudinal axis of the rod, and may be engaged with the implant threaded surface.

The implant base may be a portion of the implant tail.

The methods, which may involve the apparatus shown and described herein, may include a method for repairing a bone. The bone may have a surface and an interior. The bone may have an elongated portion, a head including an articular surface, and a neck positioned between the elongated portion and the head.

The method may include placing a first intramedullary rod and the implant including a mesh cage coupled to an end of the first rod in the interior such that at least a portion of the mesh cage is positioned in the head. The method may include placing a second intramedullary rod in the interior such that the second rod extends along a length of the elongated portion. The placing may include coupling the second rod to the first rod.

The method may include advancing a screw through a hole defined by the second intramedullary rod. The method may include anchoring a distal end of the screw in the head of the articular surface. The anchoring may include driving the distal end into the mesh cage.

The method may include coupling the first rod to the implant. The implant may include a base extending away from the mesh cage. The base may include threads. The coupling of the mesh cage to the first rod may include threadingly engaging the base with a threaded portion of the first rod.

The method may include coupling the first rod to the implant. The implant may include a base extending away from the mesh cage. The coupling of the first rod to the implant may include positioning the base in an opening defined by the first rod.

The method may include threadingly engaging threads on a face of the hub with threads on a face of the rod. The method may include threadingly engaging threads on a face of the base with threads on a face of the rod.

When the mesh cage is an expandable mesh cage the method may include expanding the mesh cage. After the expanding, and before the placing of the first rod, the method may include coupling the mesh cage to the first rod.

When the mesh cage is an expandable mesh cage the method may include, after the positioning of the first rod and the implant in the head of the bone, expanding the mesh cage. The first rod may be cannulated. The implant may include an implant tail coupled to the mesh cage. Expanding the mesh cage may include advancing a threaded member along an interior of the first rod and engaging the threaded member with threads in an inner surface of the implant tail.

The method may include, after the expanding of the mesh cage, placing an end cap on a second end of the first rod, the second end being opposite the first end.

When the mesh cage is an expandable mesh cage the method may include expanding the mesh cage from a first volume to a second volume.

The coupling of the second rod to the first rod may include positioning the first rod in an opening defined by the second rod. The coupling of the second rod to the first rod may include positioning the second rod in an opening defined by the first rod.

When the screw is a first screw, the implant is a first implant, the mesh cage is a first mesh cage, and an end of the second rod is coupled to a second implant including a second mesh cage, the method may include advancing a second screw through the surface and into the second cage.

When the end of the second rod is a first end and a second end of the second rod is coupled to a third mesh cage, the method may include advancing a third screw through the surface and into the third cage

When the screw is a first screw and the hole is a first hole, the method may include driving a second screw through a second hole defined by the second intramedullary rod. The method may also include anchoring a distal end of the second screw in the head. The anchoring may comprise driving the distal end of the second screw into the mesh cage.

The first screw may be advanced through the first hole along a first axis. The second screw may be advanced through the second hole along a second axis. The first axis may be parallel to the second axis. The first axis may be oblique to the second axis.

The methods, which may involve the apparatus shown and described herein, may include a method for repairing a bone having a surface and an interior. The bone may have an elongated portion, a head including an articular surface, and a neck positioned between the elongated portion and the head.

The method may include placing an intramedullary rod coupled to a mesh cage at an end of the rod in the interior such that at least a portion of a mesh cage is positioned in the head. The mesh cage may be the implant head. The method may include placing a plate on the surface. The placing may include coupling the plate to the rod. The method may include driving a screw through a hole defined by the plate. The method may also include anchoring a distal end of the screw in the head. The anchoring may comprise driving the distal end into the mesh cage.

The method may include, before the placing of the rod, coupling the mesh cage to the rod. The method may include, before the placing of the rod and the coupling of the plate to the rod, expanding the mesh cage. The method may include expanding the mesh cage in the interior.

The end of the rod may be a first end. The coupling of the plate and the rod may include placing a second end of the rod inside an opening defined by the plate. The second end may be opposite the first end.

When the screw is a first screw and the hole is a first hole, the method may include driving a second screw through a second hole defined by the plate. The method may also include anchoring a distal end of the second screw in the head, the anchoring comprising driving the distal end of the second screw into the mesh cage.

The first screw may be advanced through the first hole along a first axis. The second screw may be advanced through the second hole along a second axis. The first axis may be parallel to the second axis. The first axis may be oblique to the second axis.

The methods, which may involve the apparatus shown and described herein, may include a method for repairing a bone having a surface and an interior. The method may include placing an intramedullary rod in the interior. The method may include advancing an expandable implant through a lumen defined by an interior of the rod. The method may include positioning the expandable implant in the interior such that a head of the implant is in the interior. The method may include expanding the head to form a mesh cage. The method may include anchoring the rod to the bone. The anchoring may include driving a first screw through the surface and into the mesh cage.

The methods, which may involve the apparatus shown and described herein, may include a method for implanting an expandable implant in an interior of a calcaneus bone having a bone surface. The method may include making an incision in soft tissue covering a posterior facet of the bone below a termination point, on the bone, of an Achilles' Tendon. The method may include providing, through the incision, an access hole on the bone surface. The method may include advancing the expandable implant through the access hole and into the interior. The method may include positioning a distal end of the implant in the interior. The method may include expanding the implant in the interior to form a mesh cage. The implant may be expanded such that such that a first portion of the mesh cage is adjacent a sinus tarsi space and a second portion of the mesh cage is adjacent a distal facet of the bone.

When the incision is a first incision the method may include making a second incision in soft tissue covering a lateral side of the posterior facet of the calcaneus. The method may include visualizing a position of a sinus space relative to a talus bone through the second incision.

The method may include, after the expanding, anchoring a distal end of a screw in the interior. The anchoring may include driving the screw through the bone surface and advancing a distal tip of the screw into the mesh cage.

The method may include positioning a plate on the posterior facet of the bone. The method may include, after the expanding, driving a screw through a hole defined by the plate and into the mesh cage.

The positioning of the plate may be performed after the advancing the expandable implant into the interior. The positioning of the plate may be performed before the advancing of the expandable implant into the interior. The advancing may be performed through an opening in the plate.

The methods, which may involve the apparatus shown and described herein, may include a method for implanting an expandable implant in an interior of a calcaneus bone having a bone surface. The method may include forming a split in an Achilles's tendon extending along a posterior facet of the bone. The method may include making an incision, through the split, in soft tissue covering the posterior portion facet. The method may include providing, through the incision, an access hole on the bone surface. The method may include advancing the expandable implant through the access hole and into the interior. The method may include positioning a distal end of the implant in the interior. The method may include expanding the implant in the interior to form a mesh cage such that a portion of the mesh cage is adjacent a distal facet of the calcaneus.

When the incision is a first incision the method may include making a second incision in soft tissue covering a lateral side of the posterior facet of the calcaneus. The method may include visualizing a position of a sinus tarsi space relative to a talus bone through the second incision.

The method may include, after the expanding, anchoring a distal end of a screw in the interior. The anchoring may include driving the screw through the bone surface. The anchoring may include advancing a distal tip of the screw into the expandable implant.

The method may include positioning a plate on the posterior facet. The method may include driving a screw through a hole defined by the plate and into the implant.

The positioning of the plate may be performed after the advancing the expandable implant. The positioning of the plate may be performed before the advancing the expandable implant. The advancing may be performed through an opening in the plate.

The methods, which may involve the apparatus shown and described herein, may include a method for implanting an expandable implant in an interior of a calcaneus bone having a bone surface. The method may include making an incision in soft tissue covering a distal facet of the bone. The method may include providing, through the incision, an access hole on the bone surface. The method may include advancing the expandable implant through the access hole and into the interior. The method may include positioning a distal end of the implant in the interior and perpendicular to, or substantially perpendicular to, a longitudinal axis extending along a length of the bone. The method may include expanding the implant in the interior to form a mesh cage such that a hub of the implant is adjacent the talus.

When the incision is a first incision the method may include making a second incision in soft tissue covering a lateral side of a posterior facet of the calcaneus. The method may include visualizing a position of a sinus space relative to a talus bone through the second incision.

The method may include, after the expanding, anchoring a distal end of a screw in the interior. The anchoring may include driving the screw through the bone surface. The method may include advancing a distal tip of the screw into the expandable implant.

The method may include positioning a plate on the distal facet. The method may include driving a screw through a hole defined by the plate and into the implant.

The apparatus may include, and the methods may involve, a first mesh that defines a longitudinal axis and is expandable about the axis and a second mesh that is expandable about the axis between the axis and the first mesh. Each of the first and second mesh may be configured to be longitudinally fixed to a central axis member that lies along the axis. The first mesh may have a first stress-strain modulus corresponding to compression of the first mesh along a direction not parallel to the axis. The second mesh may have a second stress-strain modulus corresponding to compression of the second mesh along the direction. “Modulus” may be an “effective modulus,” in that it may be an extrinsic property of the mesh, and may depend on one or more parameters, such as one or more of those shown in Table 3, or any other suitable parameters.

TABLE 3Illustrative modulus parametersIllustrative modulus parametersMesh thickness (wall thickness of tube, if mesh is made from a tube)Mesh axial length (expanded state)Mesh radius (expanded state)Mesh void fraction (percent of mesh surface corresponding to void)Mesh cell density

The first mesh may have a first thickness. The second mesh may have a second thickness. The second thickness may be greater than the first thickness.

The first mesh may be formed from a first material having a first stress-strain modulus corresponding to compression of the first mesh along a direction not parallel to the axis. The second mesh may be formed from a second material having a second stress-strain modulus corresponding to compression of the second mesh along the direction. The second modulus may be greater than the first modulus.

The first material may be formed from super elastic materials including nitinol, NiTiCu, titanium alloys, nickel alloys, spring steel alloys, carbon fiber composites, carbongraphene, shape-memory polymers, polyisoprene-based polymers, calcium iron arsenide CaFe2As2and similar materials. The second material may be formed from super elastic materials different from the first material including nitinol, NiTiCu, titanium alloys, nickel alloys, spring steel alloys, carbon fiber composites, carbon-graphene, shape-memory polymers, polyisoprene-based polymers, calcium iron arsenide CaFe2As2and similar materials.

The first thickness may be in the range 0.010 in. to 0.020 in. The second thickness may be in the range 0.015 in. to 0.040 in.

Table 4 shows selected illustrative first and second thickness ranges.

The apparatus may include, and the methods may involve, the implant head that includes a mesh anchoring substrate that is expandable away from a longitudinal axis of the substrate, and the base. The base may define an opening for receiving along the axis an elongated support having a catch.

The apparatus may include the support. The support may be configured to engage a hub at an end of the substrate that is opposite the base. The apparatus may also include a latch extending from the base in a direction away from the substrate. The latch may be configured to engage the catch to prevent withdrawal of the elongated support from the base.

The latch may include an arm and a protrusion from the arm. The latch may be configured to insert the protrusion into a recess in the elongated support when the protrusion is positioned at the recess. The catch may define a limit of the recess.

The base may define a cylindrical outer surface at a first radius from the axis. The arm may have a length that is disposed at the first radius in a state in which the protrusion is in the recess. The length may be disposed at second radius that is greater than the first radius in a state in which the protrusion is in contact with the elongated member at a location outside the recess.

The elongated support may define a recess. The recess may include the catch.

The anchoring substrate may be pretreated to induce contraction of the substrate along the axis. The contraction may collapse the anchoring substrate. The contraction may increase frictional engagement between the latch and the wall.

The support may include a threaded member. The threaded member may be configured to reduce a length of the support by threaded engagement with an internally threaded cannulated member. Reduction of the length may expand the anchoring substrate.

The apparatus may include, and the methods may involve, the implant that includes a mesh anchoring substrate that is expandable away from a longitudinal axis of the substrate and the tail at an end of the substrate. The tail may be configured for sliding engagement in a slot of the plate. The slot in operation may fix the implant relative to the plate axially along the axis, rotationally about the axis, and rotationally about the plate.

The apparatus may include the plate. The plate may be keyed to a groove in the tail. The plate may define a clearance opening having a first width, and the slot, the slot having a second width that is less that the first width. The first width may be greater than a diameter of the tail. The second width may be less than the diameter. The second width may be greater than a thickness of the tail at the groove.

The groove may be a plurality of grooves. The grooves may define a sliding direction along which the plate is configured to slide for insertion of the tail in the slot. In operation the sliding direction may be oblique to the axis.

The apparatus may include, and the methods may involve, the implant head that includes a mesh anchoring substrate that is expandable away from an elongated central support and the support. The support may define a transverse bore that in operation is disposed between a first end of the substrate and a second end of the substrate.

The bore may be sized for clearance of a screw that is configured for penetration and engagement of the substrate. The bore may have a diameter that is 0.0005″-0.001″ smaller than a thread diameter of a screw that is configured for penetration and engagement of the substrate. The thread diameter may be a largest thread diameter on the screw.

An inner face of the bore may include threads for threadingly engaging a screw that is configured for penetration and engagement of the substrate.

The methods, which may involve the apparatus shown and described herein, may include a method for treating a bone having a bone surface and a bone interior. The method may include one or more steps from any other method disclosed herein.

The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along the bone surface between two or more points at different elevations from the longitudinal axis.

The method for treating a bone having a bone surface and a bone interior may include making an incision in soft tissue covering the bone surface. The method may include placing a jig in direct contact with the bone surface. The placing may include seating a bottom surface of the jig complementarily against the surface contour. The bottom surface of the jig may complement the surface contour.

Direct contact with the bone surface may encompass a method in which there is no apparatus intervening between the jig or the plate and the bone surface.

After placing the jig on the bone surface, the method may include driving a first fixation element through a first hole defined by the jig and into a first fragment of the bone. After placing the jig on the bone surface, the method may also include driving a second fixation element through a second hole defined by the jig and into a second fragment of the bone.

The method may include removing the jig from the bone surface prior to closing the incision.

The method may include providing an access hole on the bone surface. The method may include inserting an implant through the access hole and into the bone interior.

The method may include closing the incision.

The bone may be a humerus bone. A portion of the bone being treated may include a proximal portion of the humerus bone. Making the incision may include making a deltopectoral incision. Making the incision may include making a deltoid split incision.

When the bone is a proximal humerus bone, the surface contour may include a greater tuberosity. The surface contour may include an intertubercular groove. The surface contour may include a deltoid insertion. The placing the jig may include aligning a first portion of the bottom surface of the jig with the greater tuberosity. The placing the jig may include aligning a second portion of the bottom surface of the jig with the intertubercular groove. The placing the jig may include aligning a third portion of the bottom surface of the jig with the deltoid insertion.

When the bone is a proximal humerus bone, the placing the jig may include palpitating a location of a lateral condyle. The placing the jig may include determining a position on the bone surface along a longitudinal axis of the humerus bone. The position may be a predetermined distance from the lateral condyle. The placing the jig may include aligning a member of the jig with the position.

When the bone is a proximal humerus bone, the placing the jig may include radiographically aligning a member of the jig with a surgical neck of the humerus bone. The surgical neck may be located at a base of a head of a proximal portion of the humerus bone.

The method may include releasably anchoring the jig to the bone.

The first hole and the second hole may be included in a plurality of holes. The plurality of holes may be defined by the jig. The method may include providing a plurality of fixation elements. The method may include guiding each of the fixation elements through one of the plurality of holes and into the bone interior.

The first hole may be spaced apart from the second hole. The guiding may include guiding the first fixation element and the second fixation element into the bone interior along convergent paths. The guiding may include guiding the first fixation element and the second fixation element into the bone interior along divergent paths. The guiding may include guiding the first fixation element and the second fixation element into the bone interior along parallel paths.

The method may include radially expanding the implant in the bone interior to form a mesh cage. The expanded implant may occupy a volume in the bone interior. The guiding the fixation elements may provide clearance for the volume.

The method may include radially expanding the implant in the bone interior to form a mesh cage. The expanded implant may occupy a region. The region may not be intersected by the fixation elements.

The method may include, when the bone is a proximal humerus bone, driving a target wire through a targeting hole defined by the jig and toward a center of an interior of a head of the proximal humerus bone. The method may include positioning a tip of the target wire in the center of the interior of the head.

The method may include, when the bone is a proximal humerus bone, driving a target wire through a targeting hole defined by the jig and tangent to a top of a greater tuberosity of the proximal humerus bone.

The placing the jig may include, when the bone is a proximal humerus bone, positioning a target defined by the jig. The target hole defined by jig may be positioned to point in a direction that intersects with a center region on a head of the proximal humerus bone.

The method may include driving a target wire through a target hole defined by the jig.

The providing the access hole may include advancing a fixation element through the bone surface toward a space in the bone that was penetrated by a tip of the target wire. The tip of the target wire may be at least partially retracted prior to advancing the fixation element.

The providing the access hole may include selecting a location on the bone adjacent a demarcation point included on the jig. The providing the access hole may include advancing a fixation element through the selected location toward a space in the bone that was penetrated by a tip of the target wire.

The providing the access hole may include selecting a demarcation point included on the jig from a plurality of demarcation points. Each demarcation point may correspond to an implant having a length. The providing the access hole may also include advancing a fixation element through a location on the surface of the bone adjacent the selected demarcation point and toward a space in the bone that was penetrated by a tip of the target wire. The implant inserted in the bone interior may have a length associated with the selected demarcation point.

The providing the access hole may include coupling a targeting apparatus to the target wire. The providing the access hole may include guiding a pointer included in the targeting apparatus onto a location the bone surface. The providing the access hole may include advancing a fixation element through the location and toward a space in the bone that was penetrated by a tip of the target wire.

The providing the access hole may include coupling a targeting apparatus to the target wire. The providing the access hole may include guiding a pointer included in the targeting apparatus onto a location on the bone surface. The providing the access hole may include identifying an angle relative to the bone surface at which the pointer abuts the bone surface and extends away from the bone surface. The providing the access hole may include advancing a fixation element through the location, at the identified angle, and toward a space in the bone that was penetrated by a tip of the target wire.

The providing the access hole may include removing a fixation element extending through the bone surface, wherein a tip of the fixation element is positioned adjacent a tip of the target wire. The providing the access hole may include inserting a drill through an opening on the bone surface initiated by the fixation element and advancing the drill towards the tip of the target wire. The providing the access hole may include inserting a drill through an opening on the bone surface initiated by the fixation element and advancing the drill towards the target site.

The providing the access hole may include inserting a cannulated drill over a fixation element, wherein a tip of the fixation element is positioned adjacent a tip of the target wire. The providing the access hole may include advancing the drill along the fixation element and towards an end of the fixation element positioned adjacent the target site. The providing the access hole may include advancing the drill along the fixation element and towards the target site.

The method may include providing a cavity in the bone interior. The cavity may extend away from the access hole. The implant may be inserted through the access hole and into the cavity.

The providing the cavity may include advancing a cannulated drill over the fixation element and towards the target site. The providing the cavity may include inserting a cavity preparation device through the access hole. The providing the cavity may include expanding the cavity preparation device. The providing the cavity may include rotating the cavity preparation device to cut material in the bone interior.

The method may include inserting an implant through the access hole. The method may include advancing an end of the implant to the target site. The method may include radially expanding the implant in the cavity. The method may include positioning an end of the implant disposed in the interior at the target site. The method may include radially expanding the implant in the cavity to form a mesh cage. The method may include rotating the implant in the cavity.

The method may include decoupling a first handle from an implant shaft. The method may include coupling a second handle to the implant shaft. The method may include rotating the implant within the cavity. The rotating may be driven by rotation of the second handle.

The method may include anchoring the implant to the bone. The anchoring may include coupling an anchoring jig onto a shaft of the implant. The anchoring may include guiding a screw through the anchoring jig. The anchoring may include guiding a screw through the bone surface. The anchoring may include guiding a screw into a tail of the implant.

The anchoring jig may be a first jig. The anchoring may include decoupling the first anchoring jig from the shaft. The anchoring may include coupling a second anchoring jig onto the shaft. The anchoring may include guiding a plurality of fixation elements through an elongated passageway defined by the second anchoring jig and into a head of the implant.

The method may include driving cannulated screws over the fixation elements and into the head of the implant. The method may include decoupling the shaft from the tail of the implant.

The anchoring may include placing the plate in direct contact with a bone surface. The placing may include positioning the plate so that a shaft of the implant extends through an opening defined by the plate. The anchoring may include coupling an anchoring jig onto the shaft. The anchoring may include guiding a screw through the anchoring jig, through the bone surface and into a tail of the implant.

The method may include anchoring the implant and the plate to the bone.

The anchoring may include placing the plate in direct contact with the bone surface. The placing may include positioning the plate so that a shaft of the implant extends through an opening defined by the plate. The anchoring may include coupling an anchoring jig onto the shaft. The anchoring may include fastening the plate to the tail of the implant by guiding a screw through the anchoring jig, through the plate and into a tail of the implant.

The anchoring may be a first anchoring jig. The method may include coupling a second anchoring jig to the shaft. The method may include guiding a plurality of fixation elements through a space defined by the second anchoring jig and into the head of the implant. The method may include driving cannulated screws over the fixation elements and into the head of the implant. The method may include decoupling the shaft from the tail of the implant.

The method may include driving a screw through a hole defined by the plate and into the head of the implant. The method may include driving a screw through a hole defined by the plate and into the bone interior. The method may include coupling a bushing to the hole. The method may include driving a screw through the bushing and into the hole.

The anchoring may include placing the plate in direct contact with the bone surface. The placing may include positioning the plate so that a shaft of the implant extends through an opening defined by the plate. The anchoring may include coupling an anchoring jig onto the shaft. The anchoring may include guiding a screw through the anchoring jig and into a tail of the implant. The anchoring may include driving a screw through the plate and into the tail of the implant.

The method may include sliding a tube over a shaft attached to a tail of the implant until the plate abuts the bone surface. The tube may extend away from the plate at an oblique angle relative to a bottom surface of the plate. When the plate abuts the bone surface, the tube may be coaxially mounted on a tail of the implant. When the plate abuts the bone surface, the tube may be positioned in the bone interior. The method may include anchoring the plate to the implant.

The plate may be a first plate. The anchoring may include sliding a tube over a shaft attached to a tail of the implant until a second plate abuts the bone surface. The tube may extend away from the second plate at an oblique angle relative to a bottom surface of the second plate. When the second plate abuts the bone surface, the tube may be coaxially mounted on the tail of the implant and positioned in the bone interior. The anchoring may also include anchoring the second plate to the first plate.

The plate may be a first plate. Anchoring may include placing a second plate on the first plate. The placing the second plate may include positioning the second plate so that a shaft of the implant extends through an opening defined by the second plate. The anchoring may also include anchoring the second plate to the first plate.

The method may include placing the plate in direct contact with the bone surface. The plate may include a plate opening. The providing the access hole may be performed on a surface of the bone defined by the plate opening.

The plate may include a bottom surface. The bottom surface may complement the surface contour. The placing the plate may include seating a plate bottom surface complementarily on surface contour.

The jig may define a recess. The placing the plate may include placing the plate in the recess.

The placing the plate may include placing a first edge of the plate adjacent to a longitudinally extending leg of the jig. The placing the plate may include placing a second edge of the plate adjacent to a transverse leg of the jig.

The placing the plate may include placing a portion of a bottom surface of the plate in physical contact with a portion of a top surface of the jig. The placing the plate may include placing a top surface of the plate in physical contact with a portion of a bottom surface of the jig.

The method may include coupling the plate to the jig.

The method may include driving a target wire through a target hole defined by the jig. The method may include driving a fixation element through a positioning hole defined by the jig.

The method may include identifying a location on the bone for preparation of an access hole. The location on the bone may be defined by the plate opening. The method may include advancing a fixation element through the location and toward a space in the bone that was penetrated by a tip of the target wire.

The identifying may include coupling a targeting apparatus to the target wire. The identifying may also include guiding a pointer included in the targeting apparatus onto the bone surface defined by the plate opening.

The identifying may include selecting a location on the bone adjacent a demarcation point included on the plate and defined by the plate opening. The identifying may also include advancing a fixation element through the selected location toward a space in the bone that was penetrated by a tip of the target wire.

The method may include providing an access hole. The method may include providing a cavity in the bone interior. The cavity may extend away from the access hole. The providing the cavity may include inserting a cavity preparation device through the access hole. The providing the cavity may include expanding the cavity preparation device. The providing the cavity may include rotating the cavity preparation device to cut material in the bone interior.

The method may include inserting an implant into the cavity. The method may include radially expanding the implant in the cavity to form a mesh cage.

The method may include removing the plate from the bone surface. The method may include anchoring the implant to the bone.

The method may include anchoring the plate and the implant to the bone. The anchoring may include driving a screw through the plate and into a head of the implant. The anchoring may include driving a screw through the plate and into a tail of the implant. The anchoring may include driving a screw through the plate and into the bone interior.

The method may include attaching a washer to one or more of the screws before using the screw for anchoring.

The jig may be a first jig. The method may include removably coupling a second jig to the plate. The second jig may include a guide extending away from the bone surface and extending away from the plate opening.

The method may include removably coupling the second jig to the first jig.

The method may include providing an access hole on the bone surface. The providing the access hole may include inserting a drill through the guide. The providing the access hole may include drilling an access hole through the bone surface.

The method may include inserting a cavity preparation device through the guide and the access hole and into the bone interior. The method may include preparing a cavity in the bone interior. The method may include inserting an implant through the guide and the access hole into the cavity. The method may include radially expanding the implant in the cavity to form a mesh cage.

The method may include providing an access hole on the bone surface. The providing may include inserting an insert into the guide. The providing may include inserting a drill through the insert. The providing may include drilling an access hole through the bone surface. A central axis of the insert may not be parallel to a central axis of the guide. A central axis of the insert may be parallel to a central axis of the guide.

The method may include inserting a cavity preparation device through the insert and the access hole and into the bone interior. The method may include preparing a cavity in the bone interior. The method may include inserting an implant through the insert and the access hole into the cavity. The method may include radially expanding the implant in the cavity to form a mesh cage.

The method may include decoupling the second jig from the plate. The method may include removing the second jig from the plate. The method may include anchoring the plate and the implant to the bone.

The method may include removing the plate from the bone surface. The method may include anchoring the implant to the bone.

The jig may be a first jig. The method may include placing a second jig in direct contact with the bone surface. A portion of the second jig may abut the first jig. The second jig may include a guide extending away from the bone surface. The method may include removably coupling the second jig to the first jig.

The method may include providing an access hole on the bone surface. The providing may include inserting a drill through the guide and into the bone interior.

The method may include inserting a cavity preparation device through the guide and access hole and into the bone interior. The method may include expanding and rotating the cavity preparation device in the bone interior to create a cavity. The method may include inserting an implant through the guide and the access hole. The method may include positioning the implant in the cavity. The method may include radially expanding the implant in the cavity to form a mesh cage.

The method may include providing an access hole on the bone surface. The providing the access hole may include inserting an insert into the guide. The providing the access hole may include inserting a drill through the insert. The providing the access hole may include drilling an access hole through the bone surface. A central axis of the insert may not be parallel to a central axis of the guide. A central axis of the insert may be parallel to a central axis of the guide.

The method may include selecting an access angle for drilling into the bone. The access angle may be different from an access angle defined by the guide. The access angle defined by the guide may be a central axis of the guide. The method may include inserting an insert into the guide. A central axis of the insert may define the selected angle.

The method may include decoupling the second jig from the first jig. The method may include removing the second jig from the bone surface. The method may include anchoring the implant to the bone.

The method may include placing the plate on the bone surface, a tail of the implant being positioned in a plate opening. After placing the plate on the bone surface, the method may include anchoring the plate and the implant to the bone.

The method may include placing the plate in direct contact with the bone surface. The plate may include a threaded hole. The method may include screwing a first bushing into the threaded hole. The first bushing may extend away from the bone surface. The method may include providing an access hole on the bone surface. The providing may include inserting a drill through the first bushing. The method may include implanting an implant through the first bushing into the bone interior.

The method may include radially expanding the implant to form a mesh cage. The method may include decoupling an implant shaft from an implant tail. The method may include unscrewing the first bushing from the threaded hole. The method may include screwing a second bushing into the threaded hole. Screwing the second bushing into the threaded hole may advance the second bushing into the bone interior. Screwing the second bushing into the threaded hole may coaxially mount the second bushing onto the tail of the implant.

The methods, which may involve the apparatus shown and described herein, may include methods for bone fracture repair. The methods may include a method for treating a bone having a bone surface and a bone interior. The method may include one or more steps from any other method disclosed herein.

The method for treating a bone having a bone surface and a bone interior may include providing an access hole on the bone surface. The method may include inserting an implant through the access hole. The method may include implanting the implant in the bone interior. The method may include placing the plate in direct contact with the bone surface. The placing may include positioning the plate so that a shaft of the implant extends through an opening defined by the plate. The method may include decoupling the implant shaft from the implant tail.

The method may include anchoring the plate to the implant. The anchoring may include driving a fixation element through the plate and an implant head. The anchoring may include driving a fixation element through the plate and an implant tail. The anchoring may include driving a fixation element through the plate and the bone surface.

The method may include radially expanding the implant in the bone interior to form a mesh cage.

The plate may be a first plate. The method may include sliding a tube over a shaft attached to the tail of the implant until a second plate abuts the bone surface and abuts a recess defined by the first plate. The tube may extend away from the second plate at an oblique angle relative to a bottom surface of the second plate. When the second plate abuts the bone surface, the tube may be coaxially mounted on the tail of the implant and is positioned in the bone interior. The method may include anchoring the second plate to the first plate.

The anchoring may include placing a second plate in a recess defined by the first plate. The placing the second plate may include engaging the tail of the implant with the second plate. The method may include anchoring the second plate to the first plate.

The methods, which may involve the apparatus shown and described herein, may include methods for bone fracture repair. The methods may include a method for treating a bone having a bone surface and a bone interior.

The method for treating a bone having a bone surface and a bone interior may include providing an access hole on the bone surface. The method may include inserting an implant through the access hole. The method may include implanting the implant in the bone interior. The method may include radially expanding the implant in the bone interior to form a mesh cage. The method may include sliding a tube over a shaft attached to a tail of the implant until the plate abuts the bone surface. The tube may extend away from the plate at an oblique angle relative to a bottom surface of the plate. When the plate abuts the bone surface, the tube may be coaxially mounted on the tail of the implant and is positioned in the bone interior.

The method may include anchoring the implant to the bone. The method may include anchoring the plate to the bone. The method may include anchoring the plate to the implant.

The methods, which may involve the apparatus shown and described herein, may include a method for treating a bone having a bone surface and a bone interior. The method may include one or more steps from any other method disclosed herein.

The method for treating a bone having a bone surface and a bone interior may include placing the plate in direct contact with the bone surface. The plate may include a threaded hole. The method may include screwing a first bushing into the threaded hole. The first bushing may extend away from the bone surface. The method may include providing an access hole on the bone surface. The providing may include inserting a drill through the first bushing.

The method may include inserting an implant through the first bushing. The method may include implanting the implant in the bone interior.

The method may include radially expanding the implant to form a mesh cage. The method may include decoupling an implant shaft from a tail of the implant.

The method may include unscrewing the first bushing from the threaded hole. The method may include screwing a second bushing into the threaded hole. Screwing the second bushing into the threaded hole may advance the second bushing into the bone interior. Screwing the second bushing into the threaded hole may coaxially mount the second bushing onto the tail of the implant.

The method may include anchoring the implant to the bone. The method may include anchoring the plate to the bone. The method may include anchoring the plate to the implant.

The methods, which may involve the apparatus shown and described herein, may include a method for treating a bone having a bone surface and a bone interior. The method may include one or more steps from any other method disclosed herein.

The method for treating a bone having a bone surface and a bone interior may include placing the plate in direct contact with the bone surface. The plate may include a plate opening.

The method may include providing an access hole on the bone surface through the plate opening. The method may include inserting an implant through the access hole and into the bone interior through the plate opening. The implant may be an expandable mesh cage. The method may include radially expanding the implant in the interior to form a mesh cage.

The bone may be a proximal humerus bone. The method may include making a deltopectoral incision in soft tissue covering the bone. The method may include making a deltoid split incision in soft tissue covering the bone.

The bone may define a longitudinal axis. The bone may include a surface contour. The surface contour may extend along the bone surface between two or more points at different elevations from the longitudinal axis. A bottom surface of the plate may complement the surface contour. The placing the plate may include seating the bottom surface of the plate complementarily on the surface contour.

When the bone is a proximal humerus bone, the surface contour may include a greater tuberosity. The surface contour may include an intertubercular groove. The surface contour may include a deltoid insertion. The placing the plate may include aligning a first portion of the bottom surface of the plate with the greater tuberosity. The placing the plate may include aligning a second portion of the bottom surface of the plate with the intertubercular groove. The placing the plate may include aligning a third portion of the bottom surface of the plate with the deltoid insertion.

When the bone is a proximal humerus bone, the placing the plate may include palpitating a location of a lateral condyle. The placing the plate may include determining a position on the bone surface along a longitudinal axis of the humerus bone. The position may be a predetermined distance from the lateral condyle. The placing the plate may include aligning a member of the plate with the position.

When the bone is a proximal humerus bone, the placing the plate may include radiographically aligning a member of the plate with a surgical neck at a base of a head of the proximal humerus bone.

The method may include releasably anchoring the plate to the bone.

The method may include driving a fixation element through a hole defined by the plate and into the bone interior.

The hole may be one of a plurality of holes. The method may include providing a plurality of fixation elements. The method may include guiding each of the fixation elements through one of the plurality of holes and into the bone interior.

The hole may be a first hole. The fixation element may be a first fixation element. The method may include providing a second fixation element. The method may include guiding the first fixation element through the first hole and into the bone interior. The method may include guiding the second fixation element through a second hole and into the bone interior. The first hole may be spaced apart from the second hole. The guiding may include guiding the first fixation element and the second fixation element into the bone interior along convergent paths. The guiding may include guiding the first fixation element and the second fixation element into the bone interior along divergent paths.

The expanded implant may occupy an area in the bone interior. The guiding the fixation elements may provide clearance for the area. The expanded implant may occupy a region that is not intersected by the fixation elements.

In the embodiments where the bone is a proximal humerus bone, the method may include driving a target wire through a targeting hole defined by the plate and toward a center of an interior of a head of the proximal humerus bone. The method may include positioning a tip of the target wire in the center of the interior of the head. The method may include driving a target wire through a positioning hole defined by the plate and tangent to a top of a greater tuberosity.

In the embodiments where the bone is a proximal humerus bone, the placing the plate may include positioning a targeting defined by the plate to point in a direction that intersects with a center region on a head of the proximal humerus bone.

The method may include driving a target wire through a target hole defined by the plate.

The providing the access hole may include advancing a fixation element through a location on the bone surface defined by the plate opening and toward a space in the bone that was penetrated by a tip of the target wire.

The providing the access hole may include selecting a location on the bone adjacent a demarcation point included on the plate. The location on the bone may be defined by the plate opening. The providing the access hole may include advancing a fixation element through the selected location toward a space in the bone that was penetrated by a tip of the target wire.

The providing the access hole may include selecting a demarcation point included on the plate from a plurality of demarcation points. Each demarcation point may correspond to an implant of a corresponding length. The providing the access hole may include advancing a fixation element through a location on the bone adjacent the selected demarcation point and toward a space in the bone that was penetrated by a tip of the target wire. The location on the bone may be defined by the plate opening. The implant may have a length equal to a length of an implant corresponding to the selected demarcation point.

The providing the access hole may include coupling a targeting apparatus to the target wire. The providing the access hole may include guiding a pointer included in the targeting apparatus onto a location the bone surface. The location on the bone surface may be defined by the plate opening. The providing the access hole may include advancing a fixation element through the location and toward a space in the bone that was penetrated by a tip of the target wire.

The providing the access hole may include coupling a targeting apparatus to the target wire. The providing the access hole may include guiding a pointer included in the targeting apparatus onto a location on the bone surface. The location on the bone surface may be defined by the plate opening. The providing the access hole may include identifying an angle relative to the bone surface at which the pointer abuts the bone surface and extends away from the bone surface. The providing the access hole may include advancing a fixation element through the location, at the identified angle, and toward a space in the bone that was penetrated by a tip of the target wire.

The providing the access hole may include removing a fixation element extending through the bone surface, wherein a tip of the fixation element is positioned adjacent a tip of the target wire. The providing the access hole may include inserting a drill through an opening on the bone surface initiated by the fixation element and advancing the drill towards the tip of the target wire. The providing the access hole may include inserting a drill through an opening on the bone surface initiated by the fixation element and advancing the drill towards the target site.

The providing the access hole may include inserting a cannulated drill over a fixation element, wherein a tip of the fixation element is positioned adjacent a tip of the target wire. The providing the access hole may include advancing the drill along the fixation element and towards an end of the fixation element positioned adjacent the target site. The providing the access hole may include advancing the drill along the fixation element and towards the target site.

The method may include providing a cavity in the bone interior. The cavity may extend away from the access hole. The implant may be inserted through the access hole and into the cavity.

The providing the cavity may include inserting a cavity preparation device through the access hole. The providing the cavity may include expanding the cavity preparation device. The providing the cavity may include rotating the cavity preparation device to cut material in the bone interior.

The method may include radially expanding the implant in the cavity.

The method may include decoupling a first handle from an implant shaft. The method may include coupling a second handle to the implant shaft. The method may include rotating the implant within the cavity. The rotating may be driven by rotation of the second handle.

The method may include removing the plate from the surface of the bone. After removing the plate from the surface of the bone, the method may include anchoring the implant to the bone.

The method may include anchoring the plate to the bone and the implant.

The anchoring may include coupling an anchoring jig onto a shaft of the implant. The anchoring may include guiding a screw through the plate, through the bone surface and into a tail of the implant.

The anchoring may include driving a screw through the plate and into a head of the implant. The anchoring may include driving a screw through the plate and into a tail of the implant. The anchoring may include driving a screw through the plate and into the bone interior.

The anchoring may include providing a plurality of screws. The anchoring may include driving each of the plurality of screws through a threaded hole defined by the plate. Each of the screws may engage a head of the implant.

The anchoring jig may be a first anchoring jig. The anchoring may include decoupling the first anchoring jig from the shaft. The anchoring may include coupling a second anchoring jig onto the shaft. The anchoring may include guiding a plurality of fixation elements through a space defined by the second anchoring jig and into a head of the implant. The method may include driving cannulated screws over the fixation elements and into the head of the implant. The method may include decoupling the shaft from the tail of the implant.

The method may include sliding a washer onto a head of one of the cannulated screws. The method may include bending an eyelit of the washer to conform with the surface contour of the bone. The method may include suturing soft tissue to the eyelit of the washer.

When the plate is a first plate, the method may include sliding a tube over a shaft attached to a tail of the implant until a second plate abuts the bone surface. The tube may extend away from the second plate at an oblique angle relative to a bottom surface of the second plate. When the second plate abuts the bone surface, the tube may be coaxially mounted on a tail of the implant and positioned in the bone interior. The method may include anchoring the second plate to the first plate.

When the plate is a first plate, the method may include sliding a tube over a shaft attached to a tail of the implant until a second plate abuts a recess defined by the second plate. The tube may extend away from the second plate at an oblique angle relative to a bottom surface of the second plate. When the second plate abuts the recess surface, the tube may be coaxially mounted on a tail of the implant. When the second plate abuts the recess surface, the second plate may be positioned in the bone interior. The method may also include anchoring the second plate to the first plate.

When the plate is a first plate, the method may include positioning a second plate in a recess defined by the first plate so that a shaft of the implant extends through an opening defined by the second plate. The method may include anchoring the second plate to the first plate.

The method may include placing a jig on the plate. The placing the jig may include positioning a portion of a bottom surface of the jig on a top surface of the plate.

The method may include coupling the jig to the plate.

The method may include driving a target wire through a targeting hole defined by the jig.

The method may include driving a fixation element through a positioning hole defined by the jig.

The method may include providing a plurality of fixation elements. The method may include driving each of the plurality of fixation elements through a hole defined by the jig.

The method may include providing a bushing. The method may include coupling the bushing to a threaded screw hole defined by the jig. The method may include advancing a screw through the bushing and into an implant head.

The method may include removing jig from the plate prior to closing an incision.

The jig may be a first jig. The method may include placing a second jig on the plate. The second jig may include a guide. The guide may extend away from the plate opening. The providing the access hole may include inserting a drill through the guide. The inserting the implant through the access hole may include the implant through the guide. The method may include removing the first jig and the second jig from the plate prior to closing the incision.

The method may include removably coupling a jig to the plate. The jig may include a guide extending away from the bone surface and extending away from the plate opening. The providing the access hole may include inserting a drill through the guide. The inserting the implant through the access hole may include inserting the implant through the guide. The method may include removing the jig from the plate prior to closing the incision. The method may include removing the jig from the plate prior to anchoring the plate to the bone.

The method may include anchoring the plate to the implant. The anchoring may include driving a screw through a hole defined by the jig, through a hole defined by the plate, and into the implant.

The providing the access hole may include inserting an insert into the guide. The providing the access hole may include inserting a drill through the insert. The providing the access hole may include drilling the access hole through the bone surface. A central axis of the insert may not be parallel to a central axis of the guide. A central axis of the insert may be parallel to a central axis of the guide.

The providing the access hole may include inserting an insert into the guide. The providing the access hole may include inserting a drill through the insert. The providing the access hole may include drilling the access hole through the bone surface. Inserting the insert into the guide may dispose a central axis of the insert parallel to a central axis of the guide. Inserting the insert into the guide may dispose a central axis of the insert oblique to a central axis of the guide.

The method may include inserting a cavity preparation device through the guide and the access hole and into the bone interior. The method may include preparing a cavity in the bone interior. The method may include inserting an implant through the guide and into the cavity. The method may include radially expanding the implant in the cavity to form a mesh cage.

The method may include inserting a cavity preparation device through the insert and the access hole and into the bone interior. The method may include preparing a cavity in the bone interior. The method may include inserting an implant through the insert and the access hole into the cavity. The method may include radially expanding the implant in the cavity to form a mesh cage.

The method may include driving a fixation element through a hole defined by the jig and into the bone interior. The hole may be one of a plurality of holes. The method may include providing a plurality of fixation elements. The method may include guiding each of the fixation elements through one of the plurality of holes defined by the jig and into the bone interior. The expanded implant may occupy a volume in the bone interior. The guiding the fixation elements may provide clearance for the volume. The expanded implant may occupy a region that is not intersected by the fixation elements.

When the bone is a proximal humerus bone, the method may include driving a target wire through a target hole defined by the jig and toward a center of an interior of a head of the proximal humerus bone. The method may include positioning a tip of the target wire in the center of the interior of the head. When the bone is a proximal humerus bone, the method may include driving a target wire through a positioning hole defined by the jig and tangent to a top of a greater tuberosity.

When the bone is proximal humerus bone, the placing the plate may include positioning a target hole defined by the plate to define a direction that intersects with a center region on a head of the proximal humerus bone.

The method may include driving a target wire through a target hole defined by the jig.

The plate may include a guide. Providing the access hole may include advancing a fixation element through the guide toward a space in the bone that was penetrated by a tip of the target wire.

The method may include providing a cavity in the bone interior. The cavity may extend away from the access hole. The implant may be inserted through the guide, through the access hole and into the cavity. The providing the cavity may include advancing a cannulated drill over the fixation element, through the guide and to the target site. The providing the cavity may include inserting a cavity preparation device through the access hole. The providing the cavity may include expanding the cavity preparation device. The providing the cavity may include rotating the cavity preparation device to cut material in the bone interior.

The method may include inserting an implant through guide and through the access hole. The method may include advancing an end of the implant to the target site. The method may include radially expanding the implant in the cavity.

The method may include decoupling a first handle from an implant shaft. The method may include coupling a second handle to the implant shaft. The method may include rotating the implant within the cavity. The rotation may be driven by rotation of the second handle.

The method may include removing the plate and the jig from the surface of the bone. The method may include anchoring the implant to the bone after removing the plate and the jig from the surface of the bone.

The method may include coupling a nested bushing to a threaded screw hole defined by jig. The method may include driving a fixation element through a first hole defined by the nested bushing. The method may include removing a first portion of the nested bushing. The method may include driving a cannulated drill over the fixation element and through a second hole defined by the nested bushing. The method may include removing the cannulated drill and a second portion of the nested bushing. The method may include driving a cannulated screw over the fixation element and through a third hole defined by the nested bushing. The method may include advancing the screw into the bone interior and into a head of the implant such that the screw anchors the implant to the plate and a head of the screw is engaged with the plate.

The anchoring may include driving a screw through the jig and plate into a head of the implant. The anchoring may include driving a screw through the jig and plate and into a tail of the implant. The anchoring may include driving a screw through the jig and plate and into the bone interior.

The anchoring may include providing a plurality of screws. The anchoring may include driving each of the plurality of screws through a threaded hole defined by the jig. Each of the screws may engage the plate and a head of the implant.

The method may include sliding a washer onto a head of one of the cannulated screws. The method may include bending an eyelit of the washer to conform with the surface contour of the bone. The method may include suturing soft tissue to the eyelit of the washer.

The method may include decoupling an implant shaft from an implant tail.

The methods, which may involve the apparatus shown and described herein, may include a method for treating a bone having a bone surface and a bone interior.

The method for treating a bone having a bone surface and a bone interior may include making an incision in soft tissue covering the bone surface. The method may include placing a jig in direct contact with the bone surface. A bottom surface of the jig may complement the surface contour.

The jig may include a jig opening. The jig may include a guide extending away from the jig opening. The method may include driving a fixation element through a hole defined by the jig and into the bone interior. The method may include preparing an access hole on the surface. An access position for preparing the access hole may be defined by the jig opening.

The method may include inserting an implant through the guide, through the access hole and into the bone interior. The method may include radially expanding the implant to form a mesh cage. The method may include removing the jig from the bone surface prior to closing the incision. The method may include closing the incision.

The placing the jig may include aligning the bottom surface of the jig with the surface contour. The placing the jig may include complementarily seating the bottom surface of the jig with the surface contour.

The method may include inserting a drill through the guide to provide the access hole. The method may include inserting a cavity preparation device through the access hole. The method may include preparing a cavity in the bone interior. The method may include inserting the implant through the access hole and into the cavity.

After removing the jig, the method may include anchoring the implant to the bone. The anchoring may include driving screws through the jig and into the implant. The driving the screws may not anchor the jig to the bone.

After removing the jig from the bone, the method may include placing the plate onto the bone surface. The placing the plate may include positioning the plate so that a shaft of the implant extends through an opening defined by the plate. The placing the plate may include positioning the plate so that an opening defines by the plate abuts a tail of the implant.

The method may include anchoring the plate to the implant. The method may include decoupling the shaft from the implant prior to closing the incision.

After removing the jig from the bone, the method may include sliding a tube over a shaft attached to a tail of the implant until the plate abuts the bone surface. The tube may extend away from the plate at an oblique angle relative to a bottom surface of the plate. When the plate abuts the bone surface, the tube may be coaxially mounted on the tail of the implant. When the plate abuts the bone surface, the tube may be positioned in the bone interior.

The method may include anchoring the plate to the implant. After anchoring the plate to the implant, the method may include decoupling the shaft from the tail.

A method for identifying an access position on a bone is provided. The access position may identify a location on an outer surface of the bone for drilling a hole in the bone. The hole may be utilized for delivery of an implant into an implantation region inside the bone. The method may include positioning a tip of a fixation element inside the bone. The fixation element may be a target wire. The method may include sliding a base member over a length of the fixation element that is operatively external to the bone.

The method may include positioning a curved member that is slidably affixed to the base member. The positioning may include positioning the curved member such that an end of the curved member rests on an outside surface of the bone, thereby identifying the access position.

The fixation element may be inserted into the bone at an angle to a longitudinal axis of the bone. The angle may be between 30 degrees and 150 degrees.

The method may include sliding the curved member within a sleeve of the base member such that the end of the curved member moves along a circumference of a circle centered about the tip of the fixation element. The method may include sliding the curved member such that the end of the curved member sweeps out an arc of the circumference in a direction that is substantially proximal to distal with respect to a longitudinal axis of the bone.

When the bone is a humerus, the method may include positioning the tip of the fixation element inside a head of the humerus. When the bone is a humerus, the method may include inserting the fixation element into a head of the humerus in a direction that, with respect to the bone, is lateral to medial. When the bone is a humerus, the method may include comprising inserting the tip of the fixation element at a proximal end of a greater tuberosity of the humerus.

When the bone is a humerus, the method may include inserting the tip of the fixation element into a head of the humerus in a direction that, with respect to the bone, is lateral to medial. When the bone is a humerus, the may include inserting the tip of a fixation element into a head of the humerus in a direction that, with respect to the bone, is anterior to posterior.

A method for securing an implant positioned inside a bone is provided. The method may include driving a fixation element from outside the bone into the bone and into an implant positioned inside the bone. The method may include sliding a washer onto the fixation element. The washer may include a central aperture and an offset aperture.

The method may include sliding a cannulated bone anchor onto the fixation element. The method may include driving the cannulated anchor along the fixation element through the central aperture, into the bone and into the implant.

The method may include suturing a muscle, a ligament and/or a tendon to the washer. The method may include suturing a muscle, a ligament and/or a tendon by passing, threading or weaving the suture through one or more offset apertures of the washer.

The method may include bending the offset aperture of the washer. After bending the offset aperture, the method may include suturing a muscle, a ligament and/or a tendon to the washer. After bending the offset aperture, the method may include passing, threading or weaving the suture through one or more offset aperture of the washer.

The washer may include a plurality of offset apertures. The method may include passing, threading or weaving a surgical suture through the plurality of apertures. The method may include tying a suture to the washer. The washer may include an arcuate shaped member that defines an arc of an outer perimeter of the offset aperture. The method may include tying a surgical suture at a position on the arcuate shaped member.

The methods, which may involve the apparatus shown and described herein, may include a method for treating a bone having a bone surface and a bone interior. The method may include one or more steps from any other method disclosed herein.

The method may include making an incision in soft tissue covering the bone surface. The method may include sliding an implant delivery base through the incision.

The method may include seating a bottom surface of the implant delivery base complementarily against a surface contour. The bottom surface of the implant delivery base may complement the surface contour. The bone may define a longitudinal axis and include the surface contour. The surface contour may extend along the bone surface between two or more points at different elevations from the longitudinal axis.

After placing the implant delivery base on the bone surface, the method may include seating a reduction device on skin located around the incision. The seating may include sliding the reduction device along a post supported by the implant delivery base. The method may include driving a fixation element through the reduction device and into the bone. The reduction device may be used to attain reduction of the bone. The reduction device may be used to maintain reduction of the bone.

The method may include implanting an implant through a channel defined by the implant delivery base and into an interior of the bone. The method may include expanding the implant to form a mesh cage. The expanded implant may occupy a volume in the bone interior. The driving the fixation element through the reduction device may not transect the volume. The driving the fixation element through the reduction device may provide clearance for the expanded implant.

When the bone is a proximal humerus, the incision may be made at a deltoid insertion on a lateral aspect of the humerus.

The method may include driving a first fixation element through a first hole defined by the implant delivery base and into a first fragment of the bone. The method may include driving a second fixation element through a second hole defined by the implant delivery base and into a second fragment of the bone. The first fixation element and the second fixation element may not transect the volume.

The method may include driving a plurality of fixation elements through holes defined by the reduction device. Driving the plurality of fixation elements may provide clearance for the expanded implant in the bone interior.

The placing may include placing the bottom surface on the bone surface at predetermined distance from an anatomical feature defined by the bone. When the bone is a proximal humerus bone, the anatomical feature may include an articular surface of a greater tuberosity.

The method may include identifying a target site within the bone interior. Identifying the target site may include inserting a bushing into the channel. Identifying the target site may include driving a fixation element through the bushing and into the bone interior. Identifying the target site may include verifying that a tip of the fixation element is positioned at the target site.

The method may include removing the implant delivery base from the bone surface prior to closing the incision.

The methods, which may involve the apparatus shown and described herein, may include a method for treating a bone having a bone surface and a bone interior.

The method may include making an incision in soft tissue covering the bone surface. The method may include sliding the plate coupled to an implant delivery base through the incision. The method may include seating a bottom surface of the plate complementarily against a surface contour. The bottom surface of the plate may complement the surface contour. The bone may define a longitudinal axis. The bone may include the surface contour. The surface contour may extend along the bone surface between two or more points at different elevations from the longitudinal axis.

After placing the plate on the bone surface, the method may include seating a reduction device on skin located around the incision. The seating may include sliding the reduction device along a post supported by the implant delivery base. The method may include driving a fixation element through the reduction device and into the bone. The method may include driving a fixation element through the reduction device and into the bone.

The method may include implanting an implant through a channel defined by the implant delivery base and into an interior of the bone. The method may include expanding the implant to form a mesh cage. The expanded implant may occupy a volume in the bone interior. The fixation element may not transect the volume. Driving the fixation element may provide clearance for the expanded implant in the bone interior.

When the bone is a proximal humerus, the incision may be made at a deltoid insertion on a lateral aspect of the humerus.

The method may include driving a first fixation element through a first hole defined by the implant delivery base and into a first fragment of the bone. The method may include driving a second fixation element through a second hole defined by the implant delivery base and into a second fragment of the bone. The first fixation element and the second fixation element may not transect the volume.

The method may include driving a plurality of fixation elements through holes defined by the reduction device. Driving the plurality of fixation elements may provide clearance for the expanded implant in the bone interior.

The placing may include placing the bottom surface on the bone surface at predetermined distance from an anatomical feature defined by the bone. When the bone is a proximal humerus, the anatomical feature may include an articular surface of a greater tuberosity.

The method may include identifying a target site. The identifying may include inserting a bushing into the channel. The identifying may include driving a fixation element through the bushing and into the bone interior. The identifying may include verifying that a tip of the fixation element is positioned in a predetermined location within the bone interior.

The method may include anchoring the plate to the bone. The anchoring may include inserting a bushing into a screw hole defined by the reduction device. The anchoring may include advancing a screw through the bushing and into a hole defined by the plate.

The method may include anchoring the plate to the bone. The anchoring may include inserting a first bushing into a reduction device screw hole. The anchoring may include advancing a fixation element through the first bushing and into the plate screw hole. The anchoring may include replacing the first bushing with a second bushing. The anchoring may include advancing a cannulated screw along the fixation element and into the plate screw hole.

The method may include decoupling the implant delivery base from the plate prior to closing the incision.

The apparatus may include, and the methods may involve, apparatus for directing a fixation element into a bone. The apparatus may include a first bushing. The apparatus may include a second bushing. The second bushing may be configured to nest within the first bushing. The apparatus may include a third bushing. The third bushing may be configured to nest within the second busing.

The first bushing may include a cannulated longitudinal segment. The cannulated longitudinal segment may be externally threaded.

The second bushing may include a first cannulated longitudinal segment. The first cannulated longitudinal segment may have a first external diameter. The second bushing may include a second cannulated longitudinal segment. The second cannulated longitudinal segment may have a second external diameter. The second diameter may be greater than the first diameter.

The first cannulated longitudinal segment of the second bushing may be configured to fit within a cannulated longitudinal segment of the first bushing.

The second bushing may include a key. The key may be positioned between the first and second longitudinal segments of the second bushing. The first bushing may include a key seat. The key seat may be configured to receive the key when, in operation, the first cannulated segment of the second bushing is nested within the longitudinal segment of the first bushing.

In operation, when the key is seated in the key seat, the second bushing may be rotational fixed, about its longitudinal axis, with respect to the first bushing. The key may be hexagonally shaped. The key may have any suitable geometric shape. The keyseat may have a geometric shape that corresponds to the geometric shape of the key.

The second bushing may include a third cannulated longitudinal segment. The third cannulated segment may have a third external diameter. The third external diameter may be greater than the first or second external diameters.

The second bushing may include a longitudinal segment. The longitudinal segment of the second bushing may include a pair of kerfs. In operation, when a fixation element is inserted into the second bushing, the pair of kerfs may allow the longitudinal segment of the second bushing to expand about a central longitudinal axis of the second bushing. Pressure applied by the longitudinal segment may provide a friction fit that holds the fixation element in a position along the longitudinal axis of the second bushing.

The first bushing may be cannulated. The first bushing may have a first internal diameter. The second bushing may be cannulated. The second bushing may have a second internal diameter. The third bushing may be cannulated. The third bushing may have a third internal diameter. The first internal diameter may be greater than the second internal diameter. The second internal diameter may be greater than the third internal diameter.

The first bushing may be configured to receive a fixation element. The fixation element may be threaded. The fixation element maybe cannulated. For example, the fixation element may be a cannulated screw. The internal diameter of the first bush may be large enough to receive the cannulated screw. The internal diameter of the first bushing may be sized to direct a screw along a longitudinal axis defined by the first bushing.

The first bushing may include an externally threaded longitudinal segment. The externally threaded longitudinal segment of the first bushing may be configured to engage an internally threaded screw hole defined by the plate. The plate may be any suitable plate described herein. An external diameter of the first bushing may be sized such that the externally threaded segment of the first bushing may engage a screw hole defined by plates described herein.

The second bushing may be configured to receive a surgical drill. For example, the internal diameter of the second bushing may be large enough to receive an 8-millimeter drill. The internal diameter of the second bushing may be sized to direct a tool along a longitudinal axis defined by the second bushing. An external diameter of the second bushing may be sized such that the second bushing may be nested within the first bushing.

The third bushing may be configured to receive a fixation element. For example, an internal diameter of the third bushing may be sized to receive an unthreaded K-wire. The internal diameter of the third bushing may be sized to direct the fixation element along a longitudinal axis defined by the third bushing.

The third bushing may include a first longitudinal segment. The third bushing may include a second longitudinal segment. The third bushing may include a based longitudinal segment. A pair of kerfs may divide a length of the base longitudinal segment into the first longitudinal segment and the second longitudinal segment. The pair of kerfs may allow the first and second longitudinal segments to expand about a central longitudinal axis of the third bushing. The central longitudinal axis may be defined by the base longitudinal segment.

The first longitudinal segment may include a first semi-circular cross section. The second longitudinal segment may include a second semi-circular cross section.

The first longitudinal segment may define a first longitudinal axis. The second longitudinal segment may define a second longitudinal axis. In a first state, the first longitudinal axis may form a first angle with the central longitudinal axis. In the first state, the second longitudinal axis may form a second angle with the central longitudinal axis. The second angle may be equal or substantially equal to the first angle.

In a second state, the first longitudinal axis may form a third angle with the central longitudinal axis. In the second state, the second longitudinal axis may form a fourth angle with the central longitudinal axis. The fourth angle may be equal or substantially equal to the third angle. The third angle may be greater than the first angle. The fourth angle may be greater than the second angle.

The first state may correspond to state, when in operation, the third bushing is not nested within the second bushing. The second state corresponds to when the third bushing is nested within the second bushing. When the third bushing is not nested within the second bushing, the first and second longitudinal segments may be spaced from the central longitudinal axis by a greater distance than when the third bushing is nested within the second bushing. When the third bushing is nested within the second bushing, the internal diameter of the second bushing may compress the first and second longitudinal segments of the third bushing about a central longitudinal axis of the third bushing.

The first state may correspond to when, in operation, the third bushing is nested within the second bushing. The second state may correspond to when, in operation, the third bushing is nested within the second bushing and the first and second longitudinal segments are further compressed about the central longitudinal axis of the third bushing. For example, when the third bushing is nested within the second bushing the first and second longitudinal segments of the third bushing may apply outward pressure to the second bushing. The outward pressure may provide a friction fit that maintains the third bushing within the second bushing. Compressing the first and second longitudinal segments may reduce the pressure applied to the second bushing and allow the third bushing to be more easily removed from the second bushing.

Methods for directing a tool from an outside of a bone into the bone are provided. The tool may include a screw, K-wire, drill or any other suitable tool. Methods may include positioning a bushing with respect to the bone. The bushing may be positioned by threadedly engaging the bushing with the plate. The plate may be affixed to the bone.

Methods may include driving a first tool through the bushing into the bone. The bushing may direct the first tool into the bone along a longitudinal axis defined by the bushing. The first tool may be a K-wire. Methods may include separating a first component from the bushing. The first component may be separable from the bushing without removing the first tool from the bone.

Methods may include driving a second tool though the bushing into the bone. The bushing may direct the second tool into the bone along a longitudinal axis defined by the bushing. Driving the second tool through the bushing may expand a diameter of the second component.

Methods may include driving the second tool over the first tool. The second tool may include a drill. The second tool may be a cannulated drill. The cannulated drill may fit over the first tool. Methods may include separating a second component from the bushing. The second component may be separable from the bushing without removing the first tool from the bone.

Methods may include driving a third tool through the bushing into the bone. The bushing may direct the third tool into the bone along a longitudinal axis defined by the bushing. Methods may include driving the third tool over the first tool. The third tool may include a screw. The screw may be a cannulated screw. The cannulated screw may be driven through the bushing and over the first tool. Methods may include separating a third component of the bushing from the plate affixed to the bone.

Methods may include applying pressure to the first component before separating the first component from the bushing. The pressure may compress first and second longitudinal segments of the first component about a central longitudinal axis of the bushing. The pressure may decrease a diameter of the first component.

An exemplary method may include applying the jig to a surface of the bone. The jig may be applied while maintaining provisional reduction of the bone. The provisional reduction of the bone may be maintained manually. The provisional reduction may be maintained with fixation elements. A fixation element may pass through a positioning hole of the jig. The fixation element passing through the positioning hole may be used to align the jig with an anatomical landmark of the bone.

When the bone is a proximal humerus, a fixation element passing through the positioning hole may be used to position the jig with a top of a greater tuberosity. A fixation element may be used to position an anterior jig leg over a bicipital groove. The jig may include a transverse member and a longitudinal member extending away from the transverse member. Positioning the jig relative to the top of the greater tuberosity and/or the bicipital groove may position a center of the jig frame on the bone just lateral to an insertion of the pectoralis major tendon.

The method may include driving fixation elements through fixation element holes defined by the jig and into the humeral head. The method may include driving one or more temporary screws through screw holes defined by the jig and into the humeral head. A temporary screw may be non-locking. A temporary screw may have a length longer than a screw. A temporary screw may have a length longer than a locking screw. A temporary screw may be used to capture a bone fragment. A temporary screw may be used to apply a force to the captured bone fragment. A temporary screw may be used to stabilize a bone or a bone fragment. A temporary screw may be removed from the bone surface and replaced with a screw. A temporary screw may be replaced with a locking screw.

Proper alignment of the humeral head to the humeral shaft may be confirmed by a practitioner using fluoroscopy or any other suitable method. Fixation elements may be placed through the jig and into a humeral shaft. When proper alignment is confirmed, any fixation element external to the jig may be removed to avoid interfering with the preparation of bone interior for of the implant. A target wire may be inserted through the jig. A tip of the target wire may be advanced 3-5 mm from the articular surface of the humeral head. When proper placement of the tip of the target wire is confirmed, preparation of an access hole may commence.

Example Procedure

Set up operating room. Provide radiolucent fracture table or other suitable C-arm/table combination such that anterior/posterior (“AP”) and lateral images may be obtained without unnecessary patient movement or provisional fixation disruption. C-arm may be left in place during surgery. C-arm may be rotated to obtain AP and lateral images.

This example, which may include one or more of activities I-VII below, or one or more of their listed subactivies, or one or more activities that are not listed, may employ apparatus and methods shown in one or more ofFIGS. 4-84 and 96-108. This example is described using the jig. This example may be used with the plate or a plate and jig combination described herein.

I. Fracture Reduction and Provisional Stabilization

Apply jig while maintaining provisional reduction manually or with temporary reduction wires.Use 0.062 in. K-wire to align jig with top of greater tuberosity. Position anterior edge of jig adjacent to biceps tendon groove such that the center of the jig aligns slightly lateral to the pectoralis major insertion.Direct the 0.062″ K-wire toward the center, in lateral view, of the humeral head.Insert K-wires or temporary screws through jig into humeral head.Radiographically confirm proper alignment of humeral head to humeral shaft.Drill with 3 mm non-cannulated drill and place screw through distal hole in plate or insert K-wires through jig into humeral shaft.Remove any K-wires that may be external to jig that may interfere with site preparation and implant delivery.
II. Provide AccessPlace a bushing sized to receive a drill and a bushing sized to receive a K-wire into a guide included in the jig, the K-wire bushing being nested inside the drill bushing (see, for example,FIG. 65).Drive 2.0 or 2.5 mm K-wire through the wire guide bushing into humeral head.Radiographically confirm that tip of K-wire is located centrally within the humeral head (target site) in AP and lateral views.Remove wire guide bushing.Place 8.0 mm cannulated drill through drill guide bushing and advance drill slowly with spindle rotating at high speed to reach target location.
III. Site PreparationInsert the fully collapsed cavity preparation device into the drill guide bushing and advance the instrument to the target location.Radiographically confirm site preparation instrument position.Rotate the entire site preparation instrument three times.Slightly expand the site preparation instrument cutting flutes by rotating the site preparation instrument expansion knob clockwise ¼ turn (one click).Rotate the entire site preparation instrument three more times.Repeat: Expand flutes by one click and rotate the entire site preparation instrument three times until tactile or audible feedback is received and/or until radiography indicates that the cutting flutes are nearing the cortical wall. The site preparation instrument does not need to be fully expanded; the implant is effective in a wide range of diameters.Collapse the site preparation instrument by rotating the expansion dial counter-clockwise until it stops.Remove site preparation instrument from the access site.K-wires that interfere with the instrument may be removed.
IV. Cage Implant Delivery, Rotation, and LockingAdvance implant through drill guide bushing and up to target location. Deploy implant head by rotating delivery device knob clockwise.Attach implant rotation instrument to implant shaft.Manually rotate cage multiple times to properly seat cage.Confirm that release lever of implant rotation instrument is aligned with center of jig.Radiographically confirm expansion of cage.Tighten cage-locking screw to lock cage in expanded state.
V. Distal Targeting/Implant FixationAttach distal targeting apparatus to implant shaft.Confirm that cage-locking screw is fully advanced prior to drilling.Drill bicortically using 3.0 mm non-cannulated drillMeasure length for screw using graduations on drill.Insert 3.5 mm cannulated screw.
VI. Humeral Head ScrewsThread a drill guide bushing sized to receive a drill into a screw hole defined by the jig, the drill guide bushing including a K-wire bushing nested within an inner lumen of the drill guide bushing.Place 0.062″ K-wire through the K-wire bushing.Remove K-wire bushing.Measure length for screw using depth gauge.Drill near cortex with 2.9.mm cannulated drill.Remove drill guide bushing.Place 3.5 mm cannulated screw.
VII. Proximal Targeting/Fragment FixationAttach apparatus for directing fixation elements to implant shaft.Insert 0.062″ K-wires for through the apparatus for guiding cannulated screws into the implant head.Measure for screw length using depth gauge.Drill using 2.9 mm cannulated drill over K-wire.Insert 3.5 mm cannulated screws over the K-wires and through the cage to secure fragments. (Stacked suture washers may be used with any fragment screw for buttress of poor quality bone or attachment of suture. Two or more washers may be stacked.) Two bicortical screws across the fracture line may enhance biomechanical integrity. One suture per eyelet may be provided.Remove cage delivery tube utilizing 5/32″ hex driver.
VIII. Distal Screws and ClosureDrill, measure, and insert one or more distal 3.5 mm screws.Remove K-wires.Repair cuff attaching suture to suture washers and/or suture attachment points on optional plate.Close incisions.Perform post-operative protocols for surgical treatment of proximal humerus fractures.

The steps of illustrative methods may be performed in an order other than the order shown and/or described herein. Some embodiments may omit steps shown and/or described in connection with the illustrative methods. Some embodiments may include steps that are neither shown nor described in connection with the illustrative methods. Illustrative method steps may be combined. For example, one illustrative method may include steps shown in connection with another illustrative method.

Some embodiments may omit features shown and/or described in connection with the illustrative apparatus. Some embodiments may include features that are neither shown nor described in connection with the illustrative apparatus. Features of illustrative apparatus may be combined. For example, one illustrative embodiment may include features shown in connection with another illustrative embodiment.

Embodiments may involve some or all of the features of the illustrative apparatus and/or some or all of the steps of the illustrative methods.

The illustrative apparatus and therapeutic scenarios will now be described now with reference to the accompanying drawings in the Figures, which form a part hereof. It is to be understood that other embodiments may be utilized and that structural, functional and procedural modifications may be made without departing from the scope and spirit of the present disclosure.

For the sake of clarity, figures may illustrate therapeutic treatment of bones without showing fracture lines.

FIGS. 1 and 2illustrate steps that may be performed by using apparatus shown and described herein.

FIG. 1shows an illustrative procedure for inserting an implant in a bone such as bone B. The illustrative procedure shown inFIG. 1is shown using a jig and K-wires. The illustrative procedure may be used with any jig, plate, or jig and plate combination disclosed herein.

The illustrative procedure may include one of more of the steps shown inFIG. 1.

At steps100and101, a fracture may be reduced and stabilized by complementarily seating a jig on an anatomical landmark of bone B. The seating registers the jig holes to define K-wire trajectories that lead into bone B, but away from a volume in the interior of B that will be prepared for and occupied by the implant. The seating registers a target hole defined by the jig to the target site. A target hole may be registered to a target site when the target hole points in a direction that transects the target site. The seating places a large jig opening in position for reception of the implant. The K-wires position the various bone fragments (not shown) for later anchoring to the implant.

At step102, an implant location may be targeted. A hinged positioning device is registered, at the proximal end of the jig, to the target site. A distal limb of the positioning device points to a location for drilling of an access hole. A K-wire is inserted toward the target site.

At step103, an access site of the implant may be confirmed using a template (not shown).

At step104, a cannulated drill is inserted over the K-wire to access medullary space.

At step105, a cavity for receiving the implant may be prepared using a cavity preparation device.

At step106, the implant may be deployed in the cavity.

At step107, the implant may be seated in the cavity by rotating the implant. A handle may be attached to an implant shaft to effect the rotation. The implant may be locked in the expanded state.

At step108, apparatus for directing an anchor is attached to the implant shaft. This registers anchor direction features to the tail of the implant, in which there is disposed an anchor receiving feature.

At step109, the anchor direction apparatus is replaced by a guide for directing K-wires. The guide has a channel that parallels the center line of the implant so that K-wires may be driven toward the center of the implant at different angles relative to the shaft.

At step110the implant may be secured to the bone and/or fractured bone segments using one or more screws, plates and/or washers.

FIG. 2shows an illustrative procedure for inserting an implant in bone B. The illustrative procedure shown inFIG. 2is shown using a plate removably coupled to a jig. The jig may be positioned on a top face of the plate. The illustrative procedure may be used with any jig, plate, or jig and plate combination disclosed herein.

The illustrative procedure may include one of more of the steps shown inFIG. 2.

At step200, the fracture may be reduced and stabilized by complementarily seating a jig and a plate on an anatomical landmark of a bone such as bone B. The seating registers the jig holes to define K-wire trajectories that lead into bone B, but away from a volume in the interior of B that will be prepared for and occupied by the implant. The K-wires are shown is a skewed orientation to help fasten the jig to the bone. The seating registers a target hole defined by the jig to the target site. The seating places a large jig or plate opening in position for reception of the implant. The K-wires position the various bone fragments (not shown) for later anchoring to the implant.

At step200A, the view has been rotated to show a side view of the plate under the jig and a slanted guide, registered to the target site, that will receive instrumentation and the implant.

At step201, an implant location may be targeted. Bushings down-size the guide to fit a K-wire, which is inserted toward the target site. An access angle for implanting the implant into the interior may be confirmed using a template (not shown). Confirming the access angle may include inserting a bushing into a guide defined by the jig and advancing a K-wire through the guide and into an interior of the bone. If the access angle is undesirable, the K-wires may be removed and the guide and plate may be repositioned on the bone. If the access angle is undesirable, the bushing may be removed and replaced with an angled bushing. The angled bushing may have an oblique bore that modifies the access angle, relative to the guide central axis.

At step202, a drill is inserted to access medullary space. The drill may be inserted over the K-wire. Appropriate bushing may be provided for the drill.

At step203, a cavity for receiving the implant may be prepared using a cavity preparation device.

At step204, the implant may be deployed in the cavity.

At step205, the implant may be seated in the cavity by rotating the implant. A handle may be attached to an implant shaft to effect the rotation. The implant may be locked in the expanded state.

At step206, apparatus for directing an anchor is attached to the implant shaft. This registers anchor direction features to the tail of the implant, in which there is disposed an anchor receiving feature.

At step207A, K-wires may be driven through the implant head using the guide for directing K-wires. Anchors may be driven through the plate and the implant head.

At step207B the implant may be secured to the bone and/or fractured bone segments using one or more screws, plates and/or washers.

At steps208,208A and208B the implant may be secured to the bone. The implant may be secured to the bone by driving cannulated screws over the fixation elements positioned in step207and step207A. Step208may also include securing the implant to the bone and/or fractured bone segments using one or more screws, plates and/or washers. The implant may be secured to the bone by driving a screw through the bone and into the implant, driving a screw through the plate and into the implant and bone and/or driving a screw through the plate and into the bone.

FIG. 2Ashows bone B from in lateral projection. InFIG. 2A, bone B is a humerus. A proximal portion of the humerus is illustrated inFIG. 2A. For the purposes of the application, “proximal” may refer to a location closer to a patient's core, and “distal” may refer to a location further away from the patient's core. A proximal portion of the humerus may be referred to herein as the proximal humerus.

The proximal humerus may include greater tuberosity209, lesser tuberosity203, surgical neck207, head of humerus205and deltoid tuberosity201. BLis a longitudinal axis defined by the proximal humerus.

FIG. 2Bshows a view of the proximal humerus that is different from the view illustrated inFIG. 2A.

FIG. 2Cshows conceptually device D complementarily seated against contour C of an anatomical feature or landmark on bone B. Contour C may have a height z that varies in one or both of directions x and y. Device D has bottom surface S that complements contour C. The complementary seating dictates the placement of device D.

Gaps G may intervene between bottom surface S and contour C. S may be complementarily seated against C based on discrete points of contact P. The discrete points of contact may be spaced apart from each other.

Bottom surface S may be coincident with contour C. When bottom surface S is coincident with contour C, no gaps may intervene between bottom surface S and contour C.

FIG. 3shows illustrative anatomy in connection with which the apparatus and methods may be used.FIG. 3shows illustrative skeleton S. Skeleton S may include illustrative bones Siin which apparatus and methods in accordance with the principles of the invention may be used.

The apparatus and methods may be used in connection with “hollow” bones. The hollow bones may include cortical tissue. The hollow bones may include cancellous tissue. Cortical tissue may be referred to as “tissue.” Cancellous tissue may be referred to as “tissue.” Other matter in the interior of a bone may be considered “tissue.” The bone may be considered “tissue.”

The apparatus and methods may be used to create a space inside a bone. The bone may be any bone Si included in Table 5 below. The space may be a cavity. The tissue may be inside the bone. The space may be created by breaking up the tissue. The space may be created by removing the tissue from the bone. The space may be created as part of a therapeutic procedure. The apparatus and methods may displace tissue by imparting mechanical energy to the tissue, for example, through one or more of expanding motion, rotational motion, axial motion, compressive motion, cutting motion, and any other suitable motions.

The apparatus and methods may be used to deploy an implant in the space created inside the bone. The apparatus and methods may be used to anchor the implant to the bone. The implant may be any implant disclosed herein. The implant may be used together with any plate disclosed herein. The apparatus and methods disclosed herein may be used in any bone in the body.

Illustrative bones Si in which apparatus and methods in accordance with the principles of the invention may be used are included in Table 5 below. Table 5 may include a partial list of bones Si.

Apparatus and methods described above may be utilized in any bone Si included in Table 5 above, or any other bone in the human body.

Apparatus and methods illustrated in the figures are shown in reference to a bone ‘B’. The apparatus and methods described in respect to bone ‘B’ may be utilized in any bone Si included in Table 5 above, or any other bone in the human body.

FIG. 4shows illustrative jig400. Illustrative jig400may include transverse member408, first longitudinal member401and second longitudinal member403. Transverse member408, first longitudinal member401and second longitudinal member403may together define opening421. A plate may be positioned in opening421.

Jig400may include indicators419and indicators417. Indicators417may register to a first location on the bone surface for initiating a first access hole. Indicators419may register to a second location on the bone surface for initiating a second access hole.

Jig400may include a bottom surface (not shown). The bottom surface may conform to a surface contour of a bone. When the bottom surface of jig400is seated complementarily against the surface contour, target hole409may point in a direction. The direction may point to a target site. A target site may be a location in the bone interior where a physician may desire to position an end of an implant. The end of the implant may be an end of an implant head distal the physician when the implant is implanted in the bone.

Jig400may include positioning hole407. When the bottom surface is seated complementarily against the surface contour, positioning hole may point in a direction tangent to a greater tuberosity.

Jig400may include a first bottom surface. The first bottom surface may extend along at least a portion of a bottom face of longitudinal member401and along at least a portion of a bottom face of transverse member408. The first bottom surface may conform to a surface contour of a first bone, for example a left humerus or a right humerus. Jig400may also include a second bottom surface. The second bottom surface may extend along at least a portion of a bottom face of longitudinal member403and along at least a portion of a bottom face of transverse member408. The second bottom surface may conform to a surface contour of a second bone, for example a right humerus or a left humerus.

Jig400may include plurality of holes413. When the bottom surface of the jig is seated complementarily against the surface contour, each of the plurality of holes may point into an interior of the bone. Each of the plurality of holes may not point not into a volume occupied by an implant in the interior. The volume may be a volume occupied by the implant when the implant is positioned at the target site in the interior and radially expanded to form a mesh cage. The volume may be referred to alternately herein as an implantation region.

Jig400may include suture holes422. Jig400may include cleats415. Cleats415may be used to anchor suture lines to jig400. A physician may pass a suture through one or more suture holes422and then wrap the suture line around cleat415.

Jig400may include bushings (not shown). The bushings may be screwed or placed onto holes defined by the jig. Each of the bushings may be used to guide a fixation element through the jig and into an interior of a bone.

FIG. 5shows illustrative jig500. Illustrative jig500may include first transverse member507, second transverse member505, first longitudinal member501and second longitudinal member503. First transverse member507, second transverse member505, first longitudinal member501and second longitudinal member503may define hole509. Hole509may be used to access a plate positioned under jig500. Hole509may provide clearance for driving a screw into a bone B.

Second transverse member505, first longitudinal member501and second longitudinal member503may surround area502. A plate may be positioned in area502.

Second transverse member505may provide jig500with additional rigidity in comparison with jig400. Second transverse member may provide extra support along a bone when jig500is positioned on the bone.

Jig500may include indicators517, indicators519and indicators521. Jig500may include positioning hole513. Jig500may include target hole515. Jig500may include a plurality of holes511. InFIG. 500, bushings511are shown to be screwed into some of the holes511. Bushings511may assist a physician in guiding a fixation element through jig500and into a bone interior. Jig500may include suture holes523.

Jig500may include a bottom surface (not shown). The bottom surface may conform to a surface contour of a bone.

FIG. 6shows illustrative jig600. Illustrative jig600may include first transverse member617, second transverse member615, first longitudinal member611and second longitudinal member613. First transverse member617, second transverse member615, first longitudinal member611and second longitudinal member613may together define opening601. An access hole may be prepared at a portion of the bone defined by opening601.

Jig600may include target hole605and positioning hole607. Jig600may include a plurality of holes603.

Jig600may include a bottom surface (not shown). The bottom surface may conform to a surface contour of a bone.

FIG. 7shows illustrative jig600positioned on bone B. Bone B may be a humerus bone. Jig600may be positioned on a lateral aspect of the proximal humerus bone. Bone B may be a fractured bone having bone fragment707and bone fragment709. Jig600may be positioned over the fracture line defined by bone fragment707and bone fragment709.

The bottom surface of jig600may be seated complementarily against a surface contour defined by B. When the bottom surface of jig600is seated complementarily against the surface contour, head703of jig600may be positioned flush with a top of a greater tuberosity on bone B.

Fixation elements703may be driven through the plurality of holes defined by jig600and into an interior of bone B.FIG. 7illustrates exemplary trajectories of fixation elements703. The exemplary trajectories may facilitate the reduction of the broken bone segments. The exemplary trajectories may secure broken bone B. At least one fixation element is shown driven through the fracture, assisting in securing together both parts of bone B.

The exemplary trajectories may preserve an open or unobstructed region in the interior of bone B in which the implant can be inserted into the bone. Fixation elements703may penetrate the interior of bone B without penetrating volume705. Volume705may be a volume occupied in the interior of the bone by an implant when the implant is positioned at the target site and radially expanded to form a mesh cage. Volume705may be referred to alternately as an implantation region.

FIG. 8shows illustrative jig800positioned on bone B. InFIG. 8, bone B may be a proximal humerus. Bone B may have a fractured proximal humeral head. Bone B may include bone segment805and bone segment807.

Jig800may include a bottom surface (not shown) complementing a surface contour defined by bone B. InFIG. 8, the bottom surface may be seated complementarily against the surface contour.

Jig800may include target hole813. Target wire809may be driven through target hole813and into bone B. Tip811of target wire809may be positioned at a target site. The target site may be a location in bone B for implanting an implant.

Jig800may define a plurality of holes. InFIG. 8, fixation elements807are shown passing through the plurality of holes and into an interior of bone B. The plurality of holes may position fixation elements807in the interior but not in volume801. Volume801may be a volume occupied in the interior of the bone by an implant when the implant is positioned at the target site and radially expanded to form a mesh cage.

FIG. 9shows illustrative jig900positioned on bone B. InFIG. 9, bone B may be a proximal humerus. Bone B may have a fractured proximal humeral head.

Jig900may include a bottom surface (not shown) complementing a surface contour defined by bone B. InFIG. 9, the bottom surface may be seated complementarily against the surface contour.

A shape of jig900may provide a large supportive surface area on bone B while providing bone visibility during a surgical procedure. Driving fixation elements901through jig900on each side of the fracture may assist in securing the fracture during the surgical procedure.

Jig900may include distal leg member911and distal leg member913. Distal leg member911and distal leg member913may be positioned on either side of the proximal humeral shaft to allow for access to bone B through an access hole without obstructing the access hole. Indicators905may indicate an area on bone B for initiating a first access hole. Indicators905may indicate a second area on bone B for initiating a second access hole. A practitioner may initiate an access hole between indicators903. A practitioner may initiate an access hole between indicators905.

Jig900may define a plurality of holes. Jig900may define positioning hole909and target hole907.

InFIG. 9, fixation elements901are shown passing through the plurality of holes and into the interior of bone B. The plurality of holes may position fixation elements901in the interior but not in volume901. Volume901may be a volume occupied in the interior of the bone by an implant when the implant is positioned at a target site in the interior and radially expanded to form a mesh cage. The target site may be defined by a target wire passing through target hole907and into bone B.

FIG. 10shows illustrative therapeutic scenario1000. Scenario1000shows a targeting apparatus positioned on bone1025. Bone1025may include one or more features of bone B or any suitable bone shown inFIG. 3. Therapeutic scenario1000may include positioning the implant inside bone1025. Bone1025defines longitudinal axis LB. Bone1025may be a humerus or any other suitable bone shown inFIG. 3. Apparatus1000may be used to identify an access position for inserting the implant into an implantation region of bone1025.

Therapeutic scenario1000shows elongated base member1001. Therapeutic scenario1000shows elongated targeting member1003. Therapeutic scenario1000shows first swing arm1005. First swing arm1005is pivotally affixed to base member1001. First swing arm1005is pivotally affixed to base member1001. First swing arm1005may be pivotally affixed to base member1001at any suitable position along a longitudinal axis of base member1001.

First swing arm1005may include elongated body1013. First swing arm1005may include clevis1015. First swing arm1005may be pivotally affixed to base member1001by a pin (not shown) that passes through clevis1015and base member1001.

Targeting member1003may include one or more channels (not shown). Each channel may have a longitudinal axis. First swing arm1005may be pivotally affixed to targeting member1003by a pin that passes through targeting member1003, trough elongated portion1013of first swing arm1005and passes perpendicular to the longitudinal axis of the channel.

First swing arm1005is pivotally affixed to the targeting member1003. First swing arm1005may be positioned at any suitable position along a longitudinal axis of targeting member1003.

Therapeutic scenario1000shows second swing arm1007. Second swing arm1007may be pivotally affixed to base member1001. For example, second swing arm1007may be pivotally affixed to base member1001by a pin (not shown) that passes through aperture1017in base member1001. Aperture1017may be positioned at any suitable position along a longitudinal axis of base member1001.

Second swing arm1007may be pivotally affixed to targeting member1003. For example, second swing arm1007may be pivotally affixed to targeting arm1003by a pin (not shown) that passes through aperture1019in targeting arm1003. Aperture1019may be a positioned at any suitable position along a longitudinal axis of targeting arm1003.

Pivotal connections to base member1001and targeting member1003may position first swing arm1005parallel to second swing arm1007. Pivotal connection to first swing arm1005and second swing arm1007may position base member1001parallel to targeting member1003.

Base member1001may define a receptacle (shown in notch, but not numbered) that is configured to receive fixation element1023. The receptacle may extend along a longitudinal axis of base member1001.

A tip of fixation element1023may be positioned inside bone1025. The tip of fixation element1023when positioned inside bone1025may define a proximal end of the implantation region. The tip of fixation element1023may be positioned within bone1025using fluoroscopy or other suitable imaging techniques.

The receptacle defined by base member1001may be configured to receive fixation element1023at a position on fixation element1023that is operatively external to bone1025. Fixation element1023may include a K-wire. For example, fixation element1023may be a 0.062″ K-wire.

When fixation element1023is positioned on proximal end of bone1025and fixation element1023is positioned inside the receptacle of base member1001, first swing arm1005and second swing arm1007are configured to allow gravity to pull targeting member1003in a distal direction along axis LB.

Base member1001may include set screw1011. Set screw1011may be configured to lock base member1001to fixation element1023. Base member1001may be locked to fixation element1023after fixation element1023is inserted into bone1025. Fixation element1023may be inserted into bone1025at a position relative to an anatomical landmark of bone1025. For example, when bone1025is a humerus, fixation member1023may be positioned relative to a greater tuberosity of the humerus. Fixation member1023may be positioned relative to a head of the humerus.

Base member1001may be locked to fixation element1023after a suitable position of the tip of fixation element1023has been verified using a suitable imaging technique. A suitable position of the tip may be inside a head of a humerus. A suitable position of the tip may include a center of the humeral head in a lateral view.

When fixation element1023is positioned within the receptacle, targeting member1003, in operation, moves along a circumference CTSof a circle centered at the tip of fixation element1023. When base member1001is positioned on fixation member1023, swing arms1005and1007allow targeting member1003to move along circumference CTS.

When targeting member1003moves along circumference CTS, targeting member1003identifies access position1027at an intersection of circumference CTSand an outer surface bone1025. Access position1027may correspond to a position, on an outside surface of bone1025, for drilling an access hole into bone1025. The access hole may provide access to an interior of bone1025. The access hole may provide access to the implantation region.

Longitudinal axis LTSdefines angle γ, with respect to longitudinal axis LBof bone1025. Angle γ corresponds to an angle at which the implant will be positioned, relative to axis LBinside bone1025.

Targeting member1003may include indicator1009. Indicator1009may be positioned at a proximal end of targeting member1003. Indicator1009may be configured to indicate access position1027on bone1025at the intersection of the outer surface of bone1025circumference CTS. A length of the implant may correspond to a distance from a center of the circle to access position1027.

The receptacle defined by base member1001may be configured to position base member1003with respect to fixation element1023such that, in operation, indicator1009is positioned on circumference CTS.

Targeting member1003may include a first concave surface (not shown) that is configured to guide a drill into bone1025when the drill is oriented substantially perpendicular to axis LB. Targeting member1003may include a second concave surface (not shown) that is configured to guide a drill into bone1025at angle γ. Indicator1009may include the first and second concave surfaces.

Therapeutic scenario1000shows finger support1021. Pressure applied to finger support1021may hold indicator1009at access position1027.

FIG. 11shows illustrative therapeutic scenario1100. Scenario1100shows a targeting apparatus positioned on bone1125. Bone1125may include one or more features of Bone B or any suitable bone shown inFIG. 3. Apparatus shown in therapeutic scenario1100may be used to identify access position1113on an outer surface of bone1125. Access position1113indicates a position on bone1025for inserting an implant into an implantation region inside bone1125.

Therapeutic scenario1100shows base member1104. Base member1104may include first sleeve1105. First sleeve1105may be configured to slide over a length of fixation element1107that protrudes from bone1125.

Curved member1101may indicate access position1113when first sleeve1105is positioned over fixation element1107.

A tip of fixation element11107may be positioned inside bone1125. When first sleeve1105is positioned over fixation element1107, distal flute1109of curved member1101is positioned on circumference CTSof a circle centered at the tip1114of fixation element1107. Distal flute1109is oriented to guide a drill bit perpendicularly into the bone to initiate a hole. The angle of the drill bit can then be backed off to establish a trajectory along LTS.

Therapeutic scenario1100shows that fixation element1107is inserted into bone1125in a direction that is lateral-to-medial.

A distal end of curved member1101may include guide1110. Guide1110, when positioned against an outer surface of bone1125at access position1113, indicates an angular direction, along axis LTS, for drilling and for inserting the implant into bone1125.

When fixation element1107is inserted into sleeve1105, curved member1101may be configured to identify access position1113independent of a distance, along longitudinal axis LBof bone1125.

When fixation element1107is inserted into sleeve1105, curved member1101may be configured to identify access position1113independent of an angle between fixation element1107and longitudinal axis LTSof the implantation region.

Fixation element1107may be positioned at any suitable angle to longitudinal axis LB. For example, a longitudinal axis of fixation element1107may be positioned substantially perpendicular to LB. A longitudinal axis of fixation element1107may be positioned at an oblique angle to LB.

In operation, guide1110may define a longitudinal axis LTSof the implantation region based on a position of tip1114of fixation element1107inside the bone1125.

Bone1125may be a humerus. In operation, guide1110may define a longitudinal axis LTSof the implantation region that passes through a head of the humerus.

FIG. 12shows illustrative therapeutic scenario1200. Scenario1200shows a targeting apparatus positioned on bone1202. Therapeutic scenario1200shows apparatus that may have one or more features in common with apparatus shown in inFIG. 10.

Indicator1215may include concave guide surface1223. In operation, when base member1201is positioned on fixation element1231, indicator1215may be positioned on an outer surface of bone1202and identify an access position (such as access position1027shown inFIG. 10).

Surfaces1223and1225are the same or similar to surfaces present on indicator1009, and indicator1009may include such surfaces. Surface1223, as used inFIG. 10, can guide a drill that is aligned with member1003perpendicularly into the bone. After a starter hole is made, the drill bit can be backed off and angled along LTS. Surface1225, as used inFIG. 10, then guides the drill along LTS.

Indicator1215may include concave surface1223. When indicator1215is positioned at the access position, concave surface1223may be used to guide a surgical drill (not shown) into bone1202. The scenario may be a scenario in which member1213is not present and does not obstruct the drill. Concave surface1223may be configured to orient the surgical drill with respect to an outer surface of bone1202to reduce the likelihood that the surgical drill will slide off of bone1202. For example, concave surface1223may be configured to orient the surgical drill substantially perpendicular to LB.

Indicator1215may include concave surface1225. When indicator1215is positioned at an access position, concave surface1225is oriented to guide a surgical drill (not shown) into bone1202along axis LTS. Indicator1215may include a channel (not shown) that allows the surgical drill to be rotated, without removing the drill from bone1202, from being positioned in concave surface1223to being positioned in concave surface1225.

Therapeutic scenario1200shows gripper1221. Gripper1221is affixed to targeting member1211. Gripper1221may stabilize targeting member1211on an outside surface of bone1202. Gripper1221may stabilize targeting member1211on an outside surface of bone1202, when targeting member1211contacts the outside surface of bone1202. When bone1202is a humerus, gripper1221may be configured to stabilize targeting member1211on a humeral shaft of the humerus.

Gripper1221may include first projection1219. Gripper1221may include second projection1220. First projection1219is substantially parallel to second projection1220. First projection1219is spaced apart from second projection1220. First projection1219may be spaced apart from second projection1220by a distance. The distance may be greater than a width of targeting member1211. The distance may be less than or equal to a width of bone1202.

Gripper1221may be pivotally affixed to targeting member1211.

When targeting member1211contacts an outside surface of bone1202, first projection1219and second projection1220may be aligned with a longitudinal axis LTSof the implantation region.

Therapeutic scenario1200shows guide channel1217. Guide channel1217may be pivotally affixed to indicator1215. Guide channel1217may be pivotally affixed to indicator1215by a pin (not shown) that passes through aperture1229.

Guide channel1217may include an elongated concave surface. Guide channel1217may be configured such that, in operation, when targeting member1211contacts an outer surface of bone1202, guide channel1217defines longitudinal axis LTS. Axis LTSmay correspond to a longitudinal axis of the implantation region.

In operation, apparatus shownFIG. 12may define an access position (such as access position1027shown inFIG. 10) on an outer surface of bone1202. At the access position, guide channel1217defines longitudinal axis LTS. Guide channel1217may define axis LTSat any suitable angle β between LTSand fixation element1231. Apparatus shown inFIG. 12may be configured to define any suitable axis LTSthat passes through a center of a circle centered on a proximal end of bone penetrating1231inserted into bone1202. Guide channel1217may guide a drill or other tool into bone1202along axis LTS.

Therapeutic scenario1200shows angular stopping member1213. Angular stopping member1213may be pivotally affixed to guide channel1217. Guide channel1217may be pivotally affixed to angular stopping member1213by a pin (not shown) that passes through aperture1227. Angular stopping member1213is pivotally affixed to swing arm1207. Swing arm1207is pivotally affixed to targeting member1211. Swing arm1207may be pivotally affixed to targeting member1211by a pin (not shown) that passes through aperture1207.

Angular stopping member1213may be configured to support guide channel1217. For example, in operation, when base member1201is positioned on fixation element1231, targeting member1213may be configured to contact an outside surface of bone1202. In operation, angular stopping member1213may be configured to support guide channel1217at an angle between LBand LTS.

Angular stopping member1217may include first slot1208and a second slot (not shown) opposing slot1208. Swing arm1207is pivotally affixed to angular stopping member1213by a pin (not shown) that passes through swing arm1207and rests in the first and second opposing slots.

In operation, when targeting member1213contacts the outer surface of bone1202, movement of the pin in the first and second opposing slots adjusts an angle of guide channel1217relative to LB.

FIG. 13shows therapeutic scenario1300. Scenario1300shows a targeting apparatus positioned on bone1323. The targeting apparatus may be used to identify an access position on bone1323. A hole may be drilled at the access position. An implant may be deployed into an interior of bone1323through the hole drilled at the access position.

Target wire1315may be inserted into bone1323. A position to target wire1315inside bone1323may be verified using fluoroscopy or other imaging techniques. A proximal tip of target wire1315may correspond to a proximal end of an implantation region inside bone1323.

Jig1321may be placed on an outer surface of bone1323. Jig1321may be positioned on bone1323by inserting jig1321over a shaft of target wire1315. Target wire1315may be inserted into bone1323after jig1321is positioned on bone1323.

Fixation elements1317may pass through jig1321. Fixation elements1317may be inserted into one or more segments of bone1323. When bone1323is fractured, the segments may be defined by one or more fracture lines.

A targeting apparatus may be used to identify an access position on an outer surface of bone1323. The targeting apparatus may be configured to determine the access position based on a position of the proximal tip of target wire1315. The targeting apparatus may be configured to determine the access location independent of an orientation of a shaft of target wire1315.

Base member1301defines longitudinal axis LBM. The targeting apparatus may be configured to determine the access location independent of an angle between LBMand LB.

A targeting apparatus may include base member1301. Base member1301may define a receptacle (not shown). Target wire1315may fit into the receptacle and allow base member1310to slide over a shaft of target wire1315. Base member1301may be pivotally affixed to targeting member1306by swing arm1303and swing arm1307.

Targeting member1306may include passageway1309for clearance of swing arm1303. Targeting member1306may include passageway1311for clearance of swing arm1307.

Swing arms1303and1307include a plurality of holes. The holes may be used to pivotally affix swing arm1303or1307to targeting member1306at locations along axes LSA1and/or LSA2. The plurality of holes may allow adjustment of spacing between base member1301and targeting member1306. Spacing between base member1301and targeting member1306may be adjusted to account for differences in patient anatomy.

Swing arm1303may define axis LSA1. Swing arm1307may define axis LSA2. Swing arms1303and1307may be affixed to base member1301and to targeting member1306such that LSA1is substantially parallel to LSA2. Positioning LSA1parallel to LSA2may allow indicator1319at a proximal end of targeting member1306to move along a circumference of a circle centered at the proximal tip of target wire1315.

Indicator1319may identify the access location when indicator1319contacts an outer surface of bone1323. Indicator1319may fit into a groove of jig1321. At the access position, indictor1319may direct drill1313into bone1323. Indicator1313may direct drill1313into bone1323at an angle with LB. The angle may direct drill1313toward the proximal end of target wire1315.

FIG. 14shows illustrative jig1400positioned on bone B. Jig1400may include a bottom surface (not shown) complementing a surface contour defined by bone B. InFIG. 14, the bottom surface may be seated complementarily against the surface contour. When the bottom surface is seated complementarily against the surface contour, portion1415of jig1400may be positioned on top of a greater tuberosity.

Jig1400may include indicator1401and indicator1403. Indicator1401may indicate a position on bone B for initiating a first access hole. Indicator14013may indicate a position on bone B for initiating a second access hole. A distance between the first access hole and a target site may correspond to a first implant length. A distance between the second access hole and the target site may correspond to a second implant length. A practitioner may determine an implant length suitable for implanting in bone B. A practitioner may then determine which set of indicators corresponds to the selected implant length. The practitioner may then initiate an access hole between the selected set of indicators.

Fixation elements1413may be driven through jig1400and into bone B. Each of fixation elements1413may be driven through one of a plurality of holes defined by jig1400.

Jig1400may include a target hole. Target wire1409may be driven through the target hole. Tip1411of target wire1409may be located at the target site in bone B.

FIG. 14also shows illustrative access drill1313. Access drill1313may include distal protrusion1405. InFIG. 14, access drill1313is shown passing through the first access hole and into an interior of bone B. A practitioner may identify the first access hole using indicator1401on the reduction jig, using an access locating jig, using direct visualization or using x-ray fluoroscopy imaging.

Access drill1313may be used to start preparation of the first access hole. Tip1407of access drill1313is shown to be advanced up to the location of tip1411of target wire1409. Advancing access drill1313to the target site may create an initial path through the bone. This initial path may be used as a guide channel for subsequent surgical procedures disclosed herein.

A guide and/or a tissue protector (not shown) may be used in conjunction with the procedure illustrated inFIG. 14.

FIG. 15shows illustrative jig1500positioned on bone B. Jig1500may include a bottom surface (not shown) complementing a surface contour defined by bone B. InFIG. 15, the bottom surface may be seated complementarily against the surface contour.

Fixation elements1509may be driven through holes included in a plurality of holes defined by jig1500. Target wire1507may be driven through a target hole defined by jig1500and into an interior of bone B.

FIG. 15shows illustrative drill1501. Drill1501may be a drill larger than access drill1313. Drill1501may be used to remove cortical bone tissue in an interior of bone B. Drill1501may be used to remove cortical bone along the initial path defined by access drill1313. Drill1501may be used to enlarge the initial path.

Drill1501may be advanced along the initial path created by access drill1313by drilling over pin1511placed in the initial path. Drill1501may be advanced along the initial path created by access drill1313by over drilling over a drill similar to drill1313but without distal protrusion1405. Drill1501may be used to enlarge the initial path and create a path large enough for deployment of an implant in an unexpanded state.

Using drills with different widths may reduce the stress applied to cortical bone in bone B when creating the path. Additionally, using access drill1313prior to drill1501may enable a physician to change a trajectory of an initial path without compromising the cortical bone.

A guide and/or a tissue protector (not shown) may be used in conjunction with the procedure illustrated inFIG. 15.

FIG. 16shows illustrative jig1600positioned on bone B. Jig1600may include a bottom surface (not shown) complementing a surface contour defined by bone B. InFIG. 16, the bottom surface may be seated complementarily against the surface contour.

Fixation elements1605may be driven through holes included in a plurality of holes defined by jig1600. Fixation elements1605may pass through bushings1617coupled to the plurality of holes.

Target wire1609may be driven through a target hole defined by jig1600and into an interior of bone B. Tip1607of target wire1609may be positioned at a target site.

Jig1600may include a positioning hole. Fixation element1613may be driven through the positioning hole. Tip1615of fixation element1613may pass over a top of a greater tuberosity. Tip1615may be inserted so as to not violate a portion of the greater tuberosity and/or an articular surface of bone B.

Cavity preparation device1601may have a diameter. The diameter of cavity preparation device1601, when preparation device1601is unexpanded, may be equal to, lesser than, or slightly greater than, a diameter of drill1501. Cavity preparation device1601may be inserted through an access hole prepared on the surface of the bone by access drill1313and drill1501. Cavity preparation device1601may be advanced along the enlarged initial path created by drill1501.

Cavity preparation device1601may include one or more demarcations along a length of the device. Each demarcation may indicate a length. The length may be a distance between the demarcation and a tip of the cavity preparation device. Each demarcation may indicate a size and/or length of an implant. As the cavity preparation device is being inserted through the access hole, the demarcation visible next to the location at the surface of the access site hole on the bone may correlate to a size and/or length of an implant.

FIG. 17shows illustrative cavity preparation device1601positioned in bone B. InFIG. 17, broaching member1603has been expanded using a handle (not shown) coupled to an end of cavity preparation device1601.

Broaching member1603may be expanded in bone B. Broaching member1603may rotated in bone B. Broaching member1603may be simultaneously expanded and rotated in bone B. Movement of broaching member1603in bone B may form a cavity in bone B. Movement of broaching member1603in bone B may prepare a site in the interior of bone B for implantation of an implant.

Broaching member1603may create the cavity by displacing cancellous bone in bone B. Broaching member1603may create the cavity by cutting cancellous bone in the interior of bone B.

The cavity formed by broaching member may have a volume. The volume may be substantially equal to a volume of an implant head when the implant head is expanded to form a mesh cage. A physician may first select a size of an implant for implanting at the target site. The physician may then expand the broaching member to create a cavity having a size substantially equivalent to a size of the selected implant, when the selected implant is expanded.

Exemplary methods for preparing a cavity in the interior of bone B for implantation of an implant may include inserting a fully collapsed cavity preparation device through an access hole. The cavity preparation device may be cavity preparation device1601, a site preparation instrument, an expandable hand reamer or any other suitable cavity preparation device. The cavity preparation device may be manual or automated.

The cavity preparation device may be advanced through the access hole and along a channel or path previously created by one or more wires or drills. If a deviation from the prepared channel or path is desired, the method may include altering the path of the cavity preparation instrument from the prepared path to facilitate preparation of the cavity in a different, desired location.

The method may include advancing the cavity preparation device to a tip of a target wire positioned in the bone interior. The method may include advancing the cavity preparation device along an access wire. The method may include confirming the position of the cavity preparation device in the bone interior. The position may be confirmed fluoroscopically.

The method may include rotating the cavity preparation device. The cavity preparation device may be rotated any suitable number of times, such as once, twice, three times, five times, or any suitable number of times.

The method may include expanding a broaching member included in the cavity preparation device. The broaching member may be expanded by rotating an expansion knob coupled to an end of the cavity preparation device. The expansion knob may be rotated clockwise. The expansion knob may be rotated counterclockwise. Rotating the expansion knob may expand the broaching member. Rotating the expansion knob may slightly expand the broaching member. Rotating the expansion knob a predetermined amount may result in an audible feedback. For example, rotating the expansion knob ¼ of a turn, ½ a turn, or a full turn, may give off a clicking sound.

The method may include determining a size and/or location of the radial expansion of the broaching member using x-ray fluoroscopy imaging.

The method may include completing preparation of the cavity. A physician may complete the cavity preparation by turning the expansion knob a predetermined number of times and rotating the cavity preparation device a certain number of turns per each expansion knob click. A physician may use one or more of tactile feedback, audible feedback and/or fluoroscopy to determine if the cavity is the proper size. A physician may use one or more of tactile feedback, audible feedback and/or fluoroscopy to determine if the broaching member is nearing a cortical wall of the bone.

The cavity may be prepared when a volume of the cavity has a diameter that will facilitate the expansion of the implant into the interior of the bone.

A broaching member may need to be fully expanded to complete preparation of a cavity.

A broaching member may not need to be fully expanded to complete preparation of a cavity. This may be at least because a plurality of implants, each implant having a different diameter when expanded, may be implanted in the bone. Therefore, cavities of various sizes may be prepared, each cavity being suitable for implanting an implant having a different expanded diameter.

A tip of a target wire may remain at a target site during preparation of the cavity.

The method may include at least partially retracting the target wire during cavity preparation. The target wire may be retracted to enable a physician to fully expand the cavity preparation device.

After the cavity has been prepared, the method may include collapsing the broaching member. The broaching member may be completely collapsed. The broaching member may be collapsed by rotating the expansion knob counter-clockwise. The expansion knob may be rotated fully until it stops.

The method may include determining the size and location of the prepared cavity using x-ray fluoroscopy imaging.

After collapsing the broaching member, the method may include removing the cavity preparation device from the access site. The method may include removing any wires that interfere with the cavity preparation device.

Some, all or none of the bone cut or morselized by the broaching member may be removed from cavity.

The method may include removing cut bone or morselized bone may from the cavity. The method may also include adding material into the cavity. Exemplary material that may be added to the cavity may include bone graft or biological agents to facilitate healing. This material may be removed from, or added to, the cavity through a cannula in the cavity preparation device.

FIG. 18shows illustrative cavity preparation device1601positioned in bone B with broaching member1603in an expanded state. InFIG. 18, cavity preparation device1601is positioned in bone B without a jig fixed to a surface of bone B.

In some of these embodiments, provisional reduction of bone B may be performed by the physician without using a jig. In some of these embodiments, a physician may select a location on the bone surface for preparing an access hole and/or select an angle for drilling through the access hole without the assistance of one or more jigs.

FIG. 18shows illustrative handle1801coupled to broaching member1601. Handle1801, when rotated in a first direction, may expanded broaching member1603. Handle1801, when rotated in a second direction opposite the first direction, may collapse broaching member1603.

Handle1801may have a hard stop. The hard stop may prevent a physician from expanding the broaching member more than a predetermined amount.

FIG. 19shows illustrative cavity preparation device1601positioned in bone B with broaching member1603in an expanded state.

FIG. 20shows illustrative apparatus for delivering an implant in bone B. Delivering an implant may be referred to alternately herein as deploying an implant.

FIG. 20shows illustrative delivery device2001. Illustrative delivery device2001may include handle2003, pin2007, indentation2005and sheath2009. Implant2011may be positioned in sheath2009. Rotation of handle2003may retract sheath2009into delivery device2001. Retraction of shaft2009may expose implant2011. InFIG. 20, sheath2009is shown partially retracted. A portion of a head of implant2011has been exposed. The head of implant2011is illustrated in a partially expanded state.

A method for delivering an implant may include advancing a delivery device through an access hole and up to a tip of a target wire or a target site. When the delivery device is advanced, implant2011may be positioned in sheath2009. The method may include deploying the implant. The deploying may include rotating a knob of the delivery device. Rotation of the knob may retract sheath2009. Retraction of sheath2009may expose implant2011. A head of the implant, when exposed, may self-expand. When the implant is sufficiently exposed, delivery device2001may be removed from implant2011. Handle2003may include a piston for retracting sheath2009.

Implant2201may be deployed in bone B as follows. Implant2201may be positioned in a shaft of the delivery device. Implant2201may be positioned in the shaft of the delivery device with head2211in an unexpanded state. Implant2201may not be rigidly coupled to the delivery device.

FIG. 21shows illustrative apparatus for delivering an implant in bone B. The illustrative apparatus may include delivery device2001and illustrative reduction jig2100. InFIG. 21, illustrative reduction jig2011is fixed to bone B by fixation elements2103. Portion of a head of implant2011has been exposed by delivery device2001. The head of implant2011is illustrated in a partially expanded state. Jig2011may support to bone B during the deployment of implant2011.

FIG. 22shows illustrative implant2201implanted in bone B. Illustrative implant2201may include implant head2211, implant tail2207, and implant shaft2203. Implant shaft2203may include keyseat2205. Keyseat2205may be a laser-cut feature at an end of implant shaft2203.

FIG. 22shows illustrative implant2201with implant head2211fully expanded. InFIG. 22, a delivery device such as delivery device2001may be used to deploy implant2201in bone B.

Implant tail2207may include implant base2209. Implant tail2207may be coupled to implant base2209by a snap fit. The snap fit may provide rotational and axial locking. In other embodiments, implant tail2207may be welded to implant base2209, be of unitary construction with implant base2209, be of monolithic construction with implant base2209, or coupled to implant base2209in any other suitable fashion. Implant tail2207may include beveled end2215. Beveled end2215may conform to a surface contour of a bone when shaft2203is removed from implant tail2207.

Implant head2211may include proximal end2213. Proximal end2213may be positioned at the target site during deployment of implant2201. Proximal end2213may be positioned adjacent a tip of a target wire during deployment of implant2201.

FIG. 23shows illustrative implant2201implanted in bone B.FIG. 23also shows illustrative jig2301fixed to bone B by fixation elements2303.

FIG. 23shows how fixation elements2303driven through jig2301and into bone B provide clearance for implant2211.

FIG. 24shows illustrative implant2201deployed in bone B.FIG. 24also shows illustrative jig2401fixed to bone B by fixation elements2403.

FIG. 24shows how fixation elements2403driven through jig2401and into bone B provide clearance for implant2211.

FIG. 25shows illustrative rotation handle2500. Rotation handle2500may be configured to be releasably coupled to an end of an implant shaft. Rotation handle2500may removably couple to one or more laser cut features located at an end of the implant shaft. Rotation handle2500may include a mechanism for removably coupling to keyseat2205.

Rotation handle2500may include an internal spring mechanism. The internal spring mechanism may include a lever. The lever may pop into a window to facilitate coupling and decoupling rotation handle2500with an implant shaft.

When rotation handle2500is coupled to an implant shaft, rotation handle2500may allow for axial control of the implant. When rotation handle2500is coupled to an implant shaft, rotation handle2500may allow for rotational control of the implant.

Rotation handle2500may include opening2511. Opening2511may be shaped to receive an end of an implant shaft. Rotation handle2500may include lever2509. Lever2509, when lifted, may decouple an implant shaft from rotation handle2500.

A method for rotating an implant in a cavity may include attaching a rotation handle to a shaft of the implant. The method may include rotating the implant multiple times. Rotating the implant may assist in seating the implant in the cavity. Rotating the implant may further expand the head of the implant. Rotating the implant may further engage the head of the implant with surrounding tissue or bone. Rotating the implant may move cut up cancellous bone into the head of the implant. Rotating the implant may seat the tail of the implant inside the bone.

The method may also include ensuring that a release lever of the rotation handle is aligned with a center of a jig when rotation is complete. The method may also include confirming expansion of the implant head fluoroscopically. The method may also include tightening an implant locking screw to lock the cage in the expanded state.

Rotation handle2500may be used to move the head of the implant further into an interior the bone. Rotation handle2500may be used to further advance the head of the implant into the bone. The head of the implant may be further advanced into the bone to position the tail fully within a bone, or to ensure that the tail does not extend away from an outer surface of the bone. Rotation handle2500may be used to move the head of the implant away from an interior of the bone.

FIG. 28shows illustrative therapeutic scenario2800. Scenario2800shows apparatus for securing tail2813of implant2815to bone2827. Scenario2800shows a targeting apparatus that may be used for drilling to anchor receiving features of tail2813. The targeting apparatus may also be used to direct anchors through bone2827and through the anchor receiving features of tail2813.

The targeting apparatus may include bracket2801. Bracket2801may include end2805and end2803.

End2805may include collar2807. Collar2807receives an end of implant shaft2811. An end of implant shaft2811is affixed to tail2813. Implant shaft2811may be inserted concentrically into collar2807. Implant shaft2811may be tubular. Implant shaft2811may be locked to collar2807. Implant shaft2811may be locked to collar2807axially along axis LTS. Implant shaft2811may be locked to collar2807rotationally about axis LTS.

Guide tubes may include one or more flanges to prevent guide tubes from separating from bracket2801. For example, guide tube2817may include flanges2821and2819that may prevent guide tube2817from separating from bracket2801.

When implant shaft2811is engaged with collar2807, guide tube2817directs drill2825through bone2827and through a clearance hole (not shown) in tail2813. Guide tubes2817may direct an anchor through bone2817and through the clearance hole in tail2813.

When an end of implant shaft2811is engaged with tail2813, and an end of implant shaft2811is engaged with collar2807, guide tube2817may be aligned with a first clearance hole defined by tail2813. When an end of implant shaft2811is engaged with tail2813, and an end of implant shaft2811is engaged with collar2807, guide tube2823may be aligned with a second clearance hole defined by tail2813.

Collar2807may include a key (not shown) and implant shaft2811may include a keyseat (not shown). The key may be configured to be releasably seated in the keyseat when the implant shaft2811is inserted into collar2807. When the key is seated in the keyseat, implant shaft2811may be locked axially along LTS. When the key is seated in the keyseat, implant shaft2811may be locked rotationally about LTS.

Collar2807may include a keyseat and implant shaft2811may include a key.

Collar2807may include release2809. Release2809may release the key from the keyseat. Releasing the key from the keyseat may allow implant shaft2811to be disengaged from collar2807.

Collar2807may include a releasable key and a static key. For example, collar2807may include static key2829. Static key2829may protrude into a cannula defined by collar2807. Static key2829may not be visible on an exterior of collar2807. Implant shaft2811may include a slot (not shown) that may be configured to receive static key2829. Engagement of static key and the slot may be configured to align a releasable key with the keyseat.

Seating the key of collar2807in the keyseat of implant shaft2811may align one or more of guide tubes2817and2823with one or more clearance holes defined by tail2813.

Implant shaft2811may be configured for use with implants of different lengths. Implant shaft2811may include a first keyseat and a second keyseat (not shown). Seating the key of collar2807in the first keyseat may space collar2807a first distance apart from the proximal end of implant shaft2811. The first distance may align guide tube2817with a clearance hole defined by a tail affixed to an implant having a first length.

Engagement of the second keyseat in implant shaft2811with the key of collar2807may space collar2807a second distance from the proximal end of implant shaft2811. The second distance may align guide tube2823with a clearance hole defined by a tail affixed to an implant having a second length.

FIG. 29shows illustrative therapeutic scenario2900. Scenario2900shows jig2907positioned on bone2827. Jig2907positioned on bone2827based on positioning jig2907relative to one or more anatomical landmarks on bone2827. Jig2907is secured to bone2827by one or more fixation elements.

Scenario2900shows that bracket2801may include passageway2903. Passageway2903holds guide tube2817. Guide tube2817may be slidable in passageway2903. Passageway2903orients guide tube2817relative to bracket2801. For example, passageway2903may orient guide tube2817along a longitudinal axis defined by passageway2903.

Bracket2801may include passageway2901. Passageway2901may hold a guide tube, such as guide tube2823(shown inFIG. 28). Guide tube2823may be slidable in passageway2901. Passageway2903may be a first passageway and passageway2901may be a second passageway for holding a second guide tube (not shown). Passageways2901and2903may orient guide tubes relative to collar2807. Passageways2901and2903may orient guide tubes relative to clearance holes in an implant tail.

When collar2807is engaged with implant shaft2811, guide tube2817may be slidable in the passageway2903between bracket2801and bone2827.

End3005may include guide tube3003. Guide tube3003may be slidable with respect to bracket3001. Guide tube3003may be slidable along axis LGT. Gasket3009may provide a friction fit around guide tube3003. Gasket3009may hold a position of guide tube3003relative to bracket3001. Gasket3009may hold a position of guide tube3003along axis LGT.

Guide tube3003may include flange3011. Flange3011is positioned at a first end of guide tube3003. Guide tube3003may include flange3013. Flange3013is positioned at a second end of guide tube3003. Flanges3011and3013may prevent guide tube3003from sliding out of bracket3001.

Apparatus3003may include collar2807. Collar2807defines longitudinal axis LC. Bracket3001positions axis LCrelative to axis LGT. For example, bracket3001may position axis LCperpendicular to axis LGT. When a tubular shaft such as implant shaft2811(shown inFIG. 28) is engaged with collar2807, axis LGTmay be substantially perpendicular to a longitudinal axis LTS(shown inFIG. 28) defined by implant shaft2811.

Scenario3100shows implant shaft2811engaged with collar2807. An end of implant shaft2811is shown protruding from collar2811. In scenario3100, a slot3107is visible at the protruding end of implant shaft2811.

FIG. 32shows illustrative therapeutic scenario3200. Scenario3200shows apparatus for targeting anchors or screws that engage implant3219. The apparatus may be used to direct one or more of fixation elements, such as fixation elements3213) into bone3202and into implant3219.

The apparatus may direct an elongated fixation element from outside bone3202into bone3202and into a volume defined by a head of implant3219positioned inside bone3202.

Scenario3200shows implant shaft3209. Implant shaft3209may include one or more features of implant shaft2811shown inFIG. 28. Implant shaft3215may include keyseat3215. Keyseat3215may be configured to receive a key of collar2807(shown inFIG. 28).

Implant shaft3209defines longitudinal axis LTS. An end of implant shaft3209may be configured to engage a tail of implant3219. In operation, as shown in scenario3200, an end of implant shaft3209may be configured to extend outside of bone3202. Collar3207may be configured to slidably engage an end of implant shaft3209that extends outside of bone3202. Collar3207may slide along axis LTS. Collar3207may rotate about axis LTS.

Collar3207may be rigidly affixed to neck3205. Boom3201may be rotatably affixed to neck3205. Boom3201may be configured to rotate about axis LPB. Boom3201may include elongated passageway3203. When collar3207is slidably engaged with implant shaft3209, elongated passageway3203is positioned to direct fixation element3211from outside bone3202, into bone3202and into a volume defined by a head of implant3219. The volume defined by the head of implant3219may correspond to a volume of an expandable web of an implant.

When collar3207is slidably engaged with implant shaft3209, elongated passageway3203may be aligned along LTS. When elongated passageway3203is aligned with axis LTS, elongated passageway203may direct fixation member3211into the volume defined by the head of implant3219. When elongated passageway3203is aligned along LTS, elongated passageway3203may be configured to direct fixation member3211into the volume defined by the head of implant3219at or near a center longitudinal axis of implant3219.

The center longitudinal axis of implant3219may correspond to LTS. When elongated passageway3203is aligned along LTS, elongated passageway3203may direct fixation element3211into the volume defined by the head of implant319such that fixation element3211is deflected by center axis member3204of implant3219.

Rotating collar3207about axis LTSmay position elongated passageway3203about a perimeter of the head of implant3219. Pivoting boom3201about axis LPBmay allow boom3201to slide over an end of fixation element3211that is operationally external to bone3202.

After boom3201is removed from fixation element3211, boom3201may be repositioned about axis LTS. After boom3201is removed from fixation element3211, cannulated screws may be drilled over fixation element3211. Screws drilled over fixation element3211may secure bone3202to implant3219.

Pivoting boom3201about axis LPBmay also allow boom3201to be repositioned without being obstructed by the ends of fixation elements3213that are operatively external to bone3202. Boom3201may be repositioned by rotating collar3207about axis LTS.

FIG. 33shows illustrative therapeutic scenario3300. Apparatus shown in scenario3300may have one or more features of apparatus shown in scenario3200.

Scenario3300shows jig3311complementarily seated on bone3302. Jig3311may be secured to bone3302by one or more of fixation elements3313.

Collar3306may include trough3301. Collar3306may include trough3305. Kerf3303extends between trough3301and trough3305. Collar3306may include a pair of opposing kerfs. Collar3306may include an internal diameter that is less than an outer diameter of implant shaft3323. When collar3306slidably engages implant shaft3323, the opposing pair of kerfs may allow implant shaft3323to space trough3301apart from trough3305.

Spacing trough3301apart from trough3305may apply pressure to an outer surface of implant shaft3323. The pressure applied by troughs3301and3305may provide a friction fit that holds collar3306in a position about longitudinal axis LTS.

Scenario3300also shows boom3201. Boom3201is pivotable about pin3307. Scenario3300shows that passageway3203of boom3201may direct fixation element3317into head3309of an implant. Scenario330shows that passageway3203may receive, and thereby direct, fixation element3317at angle θ. Angle θ corresponds to an angle between length LPof passageway3203and fixation element3317. Length LP may allow a fixation element to be directed into head3309at a range of angles. An illustrative range may be 5°-175°. At any angle θ, passageway3203may direct a fixation element into head3309at or near axis LTS.

Scenario3300shows anchor3315. Anchor3315may be cannulated. Anchor3315may slide over fixation element3317. Fixation element3317may guide anchor3315into bone3302and into head3309at angle θ. Surgical washer3314may provide a surface area that is wider than a surface area of a head of anchor3315. The wider surface area of surgical washer3314may spread pressure applied to bone3302when buttressing anchor3315against an outer surface of bone3302. Surgical washer3314may also provide apertures for attachment of sutures.

FIG. 34shows illustrative surgical washer3400. Surgical washer3400may include central aperture3401. Central aperture may be defined by circumference3407. Surgical washer3400may include offset aperture3403. Offset aperture3403may be a first offset aperture. Surgical washer3400may include second offset aperture3405. Offset aperture3403may be a second offset aperture.

Offset aperture3403is spaced apart from central aperture3401at a position with respect to circumference3407. Offset aperture3405is spaced apart from central aperture3401at a position with respect to circumference3407.

Surgical washer3400may include solid material3402that joins offset apertures3405and3403to each other and to central aperture3401.FIG. 34shows that an offset aperture (e.g. offset aperture3403) and central aperture3401may form a “Figure eight” shape.

Offset apertures3405may provide eyelets for suturing tissue. For example, an anchor may be driven through central aperture3401. The anchor may secure surgical washer to a bone. Tissue such as tendon, ligaments and/or muscle in the vicinity of the bone may be sutured to one or more of offset apertures3405and3403. Sutures may be tied to an arcuate shaped member (e.g. solid material between inner circumference3406and arc3417) that defines, at least in part, an outer perimeter of offset aperture3405.

Surgical washer3400may include outer perimeter3413. Outer perimeter3413encloses apertures3401,3403and3405. Outer perimeter3413may define one or more of apertures3401,3403and3405. Surgical washer3400may include solid material3402between arc3419of inner offset circumference3420(defined by chord3421) and a length of outer perimeter3413enclosing arc3419.

Solid material3419may vary in thickness between an arc and a length of outer perimeter3413. For example, surgical washer3400may include a first thickness of solid material3402between arc3419and a first length of outer perimeter3413. Surgical washer3400may include a variable thickness of solid material3402between arc3409(defined by chord3411) and outer perimeter3413.

Outer perimeter3413defines height hgbetween offset apertures3403and3405. Surgical washer3400. A value of height hgmay determine a movability of length3417of outer perimeter2413with respect to inner circumference of3407of central aperture3401. Movability may allow an offset aperture to be bent about axis LW. For a given value of height hg, values higher than the given value may result in less movability than values lower than the given value.

Movability of a surgical washer may also be determined based on a shape of space3423between offset aperture3403and offset aperture3405. For example, if solid material reduces space3423, offset aperture may be less moveable.

Bending an offset aperture about axis LWmay allow a physician to position an offset aperture with respect to tissue. Bending an offset aperture about axis LWmay allow a physician to position an offset aperture with respect to tissue for threading a suture through an offset aperture. Axis LWmay be tangential to inner circumference3420and tangential to inner circumference3407.

FIG. 3400shows that within space3423, a first length of outer perimeter3417around offset aperture3405may be positioned convexly opposing a second length3415of outer perimeter3413.FIG. 34also shows that arc3409may be positioned convexly opposing a length of inner circumference3406surrounding offset aperture3405. Surgical washer3400may include solid material3402between convexly opposing arcs.

FIG. 35shows illustrative surgical washer3500. Surgical washer3500may include central aperture3501. Central aperture3501may receive an anchor that presses surgical washer3500between a head of the anchor and an outside surface of the bone. Surgical washer3500may spread pressure applied by a head of the anchor over a surface area of surgical washer3500.

An inner circumference3515of central aperture3501may define a first plane. An outer perimeter of surgical washer3500may define a second plane. The first plane may be spaced apart from the second plane.

Surgical washer3500may include offset apertures3503,3505,3507,3509,3511, and3513. Outer perimeter3502may define height hgof washer3500. Movability of an offset aperture relative to the central aperture may be determined based on height hg. A value of height hgrelative to outer perimeter3502may define a space between two offset apertures. For example, outer perimeter3502may define space3519between offset apertures3505and3503.

An offset aperture may be defined by an inner perimeter of the offset aperture. An inner perimeter may be circular, oblong, hexagonal or any other suitable shape. For example, offset aperture3511is defined by inner perimeter3517.

FIG. 36shows illustrative surgical washer3600. Surgical washer3600may include central aperture3601. Surgical washer may include offset apertures3603,3605,3607,3609and3611positioned around central aperture3601.

FIG. 36shows that two adjacent offset apertures may be spaced apart by groove3613. Groove3613may have height hg. Groove3613may have width wg. Movability of an offset aperture may be determined based on hgand wg. For example, if solid material reduces hgand/or wgand offset aperture may be less moveable.

FIG. 37shows illustrative apparatus3700. Apparatus3700may include an illustrative surgical washer positioned on an anchor. The anchor may include threaded shaft3701. The anchor may include head3705. The anchor may include cannula3707. Cannula3707may allow the anchor to slide over a fixation element. Threaded shaft3701passes through a central aperture of the surgical washer. The surgical washer also may include offset aperture3703. Sutures may be threaded through offset aperture3703.

FIG. 38shows illustrative apparatus3800. Apparatus3800may include surgical washer3802abutting head3815of anchor3807. Surgical washer3802may include offset apertures such as offset aperture3813. Adjacent offset apertures may be spaced apart from each other by groove3801. Groove3801is shallower than groove3613(shown inFIG. 36). Thus, offset apertures in surgical washer3600may be more deformable than offset apertures of surgical washer3802. Offset apertures of surgical washer3802may not be bendable.

Groove3801may be defined based on any suitable feature of surgical washer3802. For example, groove3801may be defined by one or more arcs. For example, groove3801may be defined based on arc3809. Arc3809may in turn be defined by chord3811.

Groove3801may be defined based on empty space between two adjacent and opposing arcs. For example, groove3801may be defined based on empty space between arc3805and opposing arc3804of an adjacent offset aperture.

Surgical washer3802may include a mid-section that extends between a circumference of a central aperture and an outer perimeter of the washer. The mid-section may be curved. For example, apparatus3800shows a surgical washer that is convex when positioned abutting head3815and viewed from head3815looking down a threaded shaft of anchor3807. Thus, when washer3802is buttressed (in the orientation shown inFIG. 38) against a bone by anchor3807, the curved mid-section spaces head3815apart from an outer surface of the bone. When washer3802is buttressed (in the orientation shown inFIG. 38) against a bone by anchor3807, the curved mid-section spaces a rim (not shown) around central aperture of washer3802apart from an outer surface of the bone.

A curved mid-section may flatten out before the outer perimeter of the washer. A curved mid-section may flatten out before the circumference of the central aperture. A flattened-out region of a mid-section may form a flange for dispersing pressure applied to a head of an anchor. A flattened-out region of a mid-section may form a flanged outer skirt that encircles a surgical washer.

FIG. 39shows illustrative apparatus3900. Apparatus3900may include surgical washer3902and anchor3905. Surgical washer3902may include a curved mid-section.FIG. 39shows washer3902positioned such that when surgical washer3902abuts head3903of anchor3905the curved mid-section is concave, when viewed from a head3903looking down a threaded shaft of anchor3905.

Surgical washer3902may be oriented on anchor3905as surgical washer3802is oriented on anchor3807(shown inFIG. 38). Surgical washer3802may be oriented on anchor3807(shown inFIG. 38) as surgical washer3902is oriented on anchor3905.

When washer3902is buttressed (in the orientation shown inFIG. 39) against a bone by anchor3905, the curved mid-section spaces offset aperture3901(and outer perimeter of washer3902) apart from an outer surface of the bone. Spacing offset aperture apart from the outer surface of the bone may allow sutures to be more easily threaded through the offset aperture than if the mid-section was planar.

When washer3902is buttressed (in the orientation shown inFIG. 39) against a bone by anchor3905, a rim of a central aperture of washer3902may be pressed against an outer surface of the bone.

FIG. 40shows illustrative view4000of apparatus3800(shown inFIG. 38).FIG. 40shows that a central aperture of washer3802may define first plane4005. An outer perimeter of washer3802may define second plane4007. A flanged or flattened out region of a mid-section of washer3802may define second plane4007.

View4000shows that first plane4005is spaced apart from second plane4007by distance4011. In operation, when anchor3807buttresses washer3802against an outer surface of a bone, distance4011may space head3815apart from the outer surface of the bone. First plane4005may be substantially parallel to second plane4007.

FIG. 41shows illustrative view4100of apparatus3900(shown inFIG. 39).FIG. 41shows that a central aperture of washer3902may define first plane4107. An outer perimeter of washer3902may define second plane4103. A flanged or flattened out region of a mid-section of washer3902may define second plane4013.

View4100shows that first plane4107is spaced apart from second plane4103by distance4105. In operation, when anchor3905buttresses washer3902against an outer surface of a bone, distance4105may space head3903apart from the outer surface of the bone. First plane4107may be substantially parallel to second plane4103.

FIG. 42shows illustrative therapeutic scenario4200.FIG. 42shows implant4207being rotated around implant shaft axis LTS. Implant shaft axis LTSmay be an implant central axis. Implant4207may be rotated to seat implant4207within bone4201. Implant4207may be rotated to incorporate bone matter into implant head of implant4207. Implant4207may be rotated by handle2400. Handle2400may be coupled to an end of implant shaft4203.

Scenario4200shows jig4211positioned on bone4201. Scenario4200shows fixation elements4213that releasably couple jig4211to bone4210. When bone4201is fractured, one or more of fixation elements4213may be inserted into segments of bone4201. Fixation elements4213may be used to position the segments and provisionally reduce the fracture. Scenario4200shows targeting wire4215. Jig4211may be positioned on bone4201based on an anatomical landmark on bone4201. Proper positioning of target wire4215in bone4201may be verified by fluoroscopy or other imaging techniques.

Target wire4215may be positioned such that a tip of target wire4215positioned in bone4210is positioned at a target site. Target wire4215may be positioned such that a tip of target wire4215positioned in bone4210defines end4217of an implantation region for implant4207. Implant4207may include tail4205. Tail4205may be affixed to implant shaft4203. Implant shaft4203may be used to manipulate implant4207after implant4207is deployed inside bone4201.

Implant shaft4203may define a longitudinal axis LTS. End4217of the implantation region may be at intersection of the proximal end of targeting wire4215and longitudinal axis LTS.

Tail4315may be affixed to implant shaft4307. A beveled end4308of implant shaft4307may fit onto or mate with the beveled end of tail4315. Beveled end4308may include one or more fingers4317. A finger such as4317may fit onto an indentation in an outer surface of tail4315.

Tail4315may include an internally threaded segment (threads not shown). Implant shaft4307may include flange4319. Flange4319is positioned inside the hollow implant shaft. Flange4319may be positioned at a proximal end of a non-beveled segment of implant shaft4307.

Scenario4300shows locking screw4305inside implant shaft4307. Locking screw4305may include a threaded segment (not shown) that slides past flange4319when locking screw4305is inserted into implant shaft4307. Locking screw may include a shoulder (not shown) that abuts flange4319when locking screw4305is inserted into implant shaft4307and threadedly engages the internally threaded segment of tail4315.

When locking screw4305threadedly engages the internally threaded segment of tail4315, locking screw4305axially locks implant shaft4307to tail4315. Implant shaft4307may include one or more fingers4317protruding from beveled end4307. Tail4315may include one or more indentations that are configured to mate with one or more fingers4317. When locking screw4305threadedly engages tail4315, one or more of fingers4317mate with the one or more indentations of tail4315. When the one or more fingers4317mate with the indentations, implant shaft4307may be rotational fixed with respect to tail4317.

Locking screw4305may be cannulated. A cannulated locking screw may allow a driver to be inserted through implant shaft4307, through locking screw4305, through tail4315and engage a locking mechanism of implant4311. The locking mechanism of implant4311may include a screw that locks a shape of implant4311. Rotating the locking mechanism inside implant4311may collapse implant4311. Collapsing implant4311may allow implant4311to be removed from bone4313.

When inserted into implant shaft4307, head4303of driver4301may be used to turn locking screw4305. Driver4301may be used to disengage locking screw from tail4315. Disengaging locking screw4305from tail4315may allow implant shaft4307to be removed from tail4315. Flange4319may prevent locking screw4305from falling out of implant shaft4307when implant shaft4307is removed from tail4315.

FIG. 44shows illustrative driver4400. Driver4400may be used to rotate locking screw4305when locking screw4305is inside implant shaft4307. Driver4400may include shaft4301. Driver4400may include head4303. Head may have a hexagonal shape or any other suitable shape for rotating locking screw4305(shown inFIG. 43).

FIG. 45shows illustrative implant4500implanted in bone B. InFIG. 45, screws4509are shown anchoring implant head4507to bone B. Some of screws4509may have washers4513coupled to heads of screws4509. InFIG. 45, screw4515is shown passing through a first hole in implant tail4503. Distal screw4517is shown passing through a second hole in implant tail4503.

FIG. 45illustrates possible trajectories of screws and washers passing through implant4500. The trajectories may be used to address fracture patterns. The trajectories may be used to provide fixation and stability to bone B for facilitating bone healing.

FIG. 47shows illustrative implant4700implanted in bone B.FIG. 47shows a plurality of screws anchoring implant head4721to bone B, anchoring both plate4701and implant head4721to bone B, anchoring implant tail and plate4701to bone B, and anchoring plate4701to bone B. One or more of the screws may include a washer4725.

Plate4800may include one or more slots for receiving sutures (not shown).

Plate4800may have a bottom surface. The bottom surface may complement a surface contour of a bone. When the bottom surface is seated complementarily against the surface contour, opening4827may define an area on the bone for preparing an access hole for accessing a target site in the bone. When the bottom surface is seated complementarily against the surface contour, target hole4811may point to the target site.

When the bottom surface is seated complementarily against the surface contour, indicators4823may register to a first access position on the bone for accessing the target site. The first access position may be an access position for an implant having a first length. When the bottom surface is seated complementarily against the surface contour, indicators4821may register to a second access position on the bone for accessing the target site. The second access position may be an access position for an implant having a second length. The first length may be different from the second length.

When the bottom surface is seated complementarily against the surface contour and an implant is expanded at the target site, screw holes4813and screw holes4809may point to an implant head. When the bottom surface is seated complementarily against the surface contour and an implant is expanded at the target site, a screw advanced slot4825may engage an implant tail. When the bottom surface is seated complementarily against the surface contour and an implant is expanded at the target site, a screw advanced through slot4815may engage an implant tail. When the bottom surface is seated complementarily against the surface contour and an implant is expanded at the target site, a screw advanced through slot4815may engage an implant head.

Slots4815and4825may be used for guiding a screw through plate4800and into an implant. Slots4815and4825may provide a physician with a range of access angles for driving the screw through slots4815and4825and into an implant. One or both of slots4815and4825may include one or more ridges. Each ridge may extend around the slot. One or more ridges may act as a locking feature for a screw.

Plate4900may have a bottom surface complementing a surface contour of a bone. When the bottom surface is seated complementarily against the surface contour, opening4915may define an area on the bone for preparing an access hole for accessing a target site in the bone. When the bone surface is seated complementarily against the surface contour, target hole4907may point to the target site.

Plate4900may define slot4913. Slot4913may extend away from opening4915. Slot4913may be partially circumscribed by plate4900. Slot4913may include one or more ridges. Each ridge defined by slot4813may extend around slot4913. The ridges may act as a locking feature for a screw.

Slot4913may be used for guiding a screw through plate4900and into an implant. Slot4913may provide a physician with a range of access angles for driving the screw through slot4913and into an implant.

Plate5000may have a bottom surface complementing a surface contour of a bone. When the bottom surface is seated complementarily against the surface contour, opening5013may define an area on the bone for preparing an access hole for accessing a target site in the bone. When the bottom surface is seated complementarily against the surface contour, target hole5003may point to the target site.

Plate5000may define slot5015extending away from opening5013. Slot5015may be used for guiding a screw through plate5000and into an implant. Slot5015may provide a physician with a range of access angles for driving the screw through opening5015and into an implant. Slot5015may include one or more ridges. The ridges may act as a locking feature for a screw.

The bottom surface of plate5000may conform to a surface contour of a left humerus. A proximal end of the plate (including screw holes5005) may be shaped to cover a greater area of a greater tuberosity of the left humerus compared to plate4800.

First plate5101may define suture holes5113. First plate5101may include one or more slots for receiving sutures (not shown). First plate5101may define target hole5117. First plate5101may define screw holes5118and screw hole5121. First plate5101may define a plurality of holes5119for receiving fixation elements.

First plate5101may define opening5109. Second plate5103may be positioned in opening5109. Second plate5103may be releasably coupled to first plate5101by screw5105. Second plate5103may define opening5107.

First plate5101may have a bottom surface complementing a surface contour of a bone. When the bottom surface is seated complementarily against the surface contour, opening5109may define an area on the bone for preparing an access hole for accessing a target site in the bone. When an implant is implanted through the access hole and into the bone, a tail of the implant may be positioned in opening5109. When the implant is implanted into the bone, a tail of the implant may also be positioned in opening5107. Plate5103may be positioned in opening5109after the implant is implanted into the bone. The positioning may include positioning an implant shaft in opening5107and sliding plate5103along the implant shaft and onto plate5101.

Each of plates4800,4900, and5100may define a bottom surface. The bottom surface of each of the plates may conform to a surface contour of a right bone and a left bone. The bottom surface may conform to a surface contour of a right proximal humerus and a left proximal humerus. Each of plates4800,4900, and5100may define a first bottom surface and a second bottom surface. The first bottom surface may conform to a surface contour of a right proximal humerus. The second bottom surface may conform to a surface contour of a left proximal humerus. The first bottom surface and the second bottom surface may define the same bottom surface. The first bottom surface may be different from the second bottom surface. A physician may use plate4800, plate4900, or plate5100for providing therapy to either a right humerus or a left humerus.

One or more of the screw holes defined by each of plates4800,4900,5000and5100may be threaded. Threaded screw holes may be shaped to receive screws having threaded heads. Threaded screw holes may provide a locking construct between the plates and the screws.

Tube5209may have an inner diameter. Tube5209may have an inner diameter slightly larger than a diameter of an implant tail.

After an implant has been implanted in a bone, bottom face5203of plate5200may be placed on a surface of bone. Placement of bottom surface5203of plate5200on a bone may include coaxially mounting tube5209onto an implant tail of the implant. Placement of plate5200on a bone may include sliding plate5200along the implant tail until bottom face5203of plate5200is seated on a surface of the bone. Slot5215and groove5211may facilitate the coupling of the implant tail to plate5200by defining an opening through which a screw may pass through slot5215and groove5211and into a bore defined by the implant tail.

FIG. 53shows illustrative plate5300. Plate5300may define screw hole5315and screw hole5313. Plate5300may include a top face5301. Plate5300may include bottom face5305. Plate5300may define opening5307. Tube5309may extend away from opening5307. Tube5309may extend away from opening5307at an angle oblique to a longitudinal axis of plate5300. Tube5309may include groove5311. Groove5311may facilitate the coupling of an implant tail to plate5300by providing an opening through which a screw may pass into a bore defined by an implant tail. A screw passed through groove5311and into an implant tail may couple tube5309and plate5300to the implant tail.

InFIG. 55, bushing5501is screwed onto a portion of threads5403. Bushing5501may be referred to herein as a first externally threaded tube.

FIG. 56shows illustrative apparatus5600. Illustrative apparatus5600may include plate5400and bushing5601. Bushing5605may be referred to herein as a second externally threaded tube.

A method for preparing a bone for implantation of an implant may include placing plate5400on a surface of the bone. The method may include anchoring plate5400to the bone by driving a screw through screw hole5407and/or slot5405. The method may include screwing bushing5501into threads5403. The method may include inserting a drill through opening5503to create an access hole. The method may include inserting a cavity preparation device through opening5503to prepare a cavity in the bone. The method may include passing an implant in an unexpanded form through opening5503and into the cavity. The method may include unscrewing bushing5501from plate5400after the implant is implanted in the cavity. The method may include supporting the implant after implantation. The method may include screwing bushing5601into threads5403. Screwing bushing5401into the inner threaded portion of plate5400may coaxially mount opening5605around a tail of the implant. Bushing5601may be placed on an implant shaft of the implant and slid along the implant shaft towards the bone surface. The implant shaft may be removed from an implant tail after bushing5601is coupled to plate5400.

FIG. 57shows illustrative plate5700. Plate5700may define screw holes5709, slot5707, slot5703and slot5701. Plate5700may define opening5705. When plate5700is placed on a bone, an access hole may be prepared in an area on the bone defined by opening5705.

One of more of slot5707, slot5703and slot5701may include one or more ridges. The ridges may engage a head of a screw. The ridges may act as a locking feature for a screw.

Plate5700may have a bottom surface complementing a surface contour of a bone. When the bottom surface is seated complementarily against the surface contour, opening5705may define an area on the bone for preparing an access hole for accessing a target site in the bone.

Plate5800may define opening5803. When plate5800is placed on a bone B, an access hole may be prepared in an area of the bone defined by opening5803.

Plate5800may have a bottom surface complementing a surface contour of a bone. When the bottom surface is seated complementarily against the surface contour, opening5803may define an area on the bone for preparing an access hole for accessing a target site in the bone.

FIG. 59shows illustrative plate5900. Plate5900may define suture holes5913. Plate5900may include one or more slots for receiving sutures. Plate5900may define screw hole5911, slot5907and slot5901. One or both of slot5907and slot5901may include one or more ridges. The ridges may act as a locking feature for a screw. Plate5900may define opening5903.

Plate5900may have a bottom surface complementing a surface contour of a bone. When the bottom surface is seated complementarily against the surface contour, opening5903may define an area on the bone for preparing an access hole for accessing a target site in the bone. When the bottom surface is seated complementarily against the surface contour, an access hole may be prepared in an area of the bone defined by opening5903. The access hole may be used to access a target site in the interior of the bone.

FIG. 60shows a bottom view of illustrative jig6000. Jig6000may define slot6003sized for receiving a screw. Jig6000may define opening6001for accessing a surface of a bone through the jig. Opening6001may be sized to provide clearance for an implant. Jig may define screw holes6007. Screw holes6007may be used by a practitioner to guide screws into a head of an expanded implant. Jig6000may define target hole6015. Jig6000may define positioning hole6013. Jig6000may include slot6005sized for receiving a screw.

Jig6000may include recess6009. Recess6009may be sized to receive a plate. A plate may be positioned in recess6009.

Jig6000may have a bottom surface complementing a surface contour of a bone. When the bottom surface is seated complementarily against the surface contour, opening6001may define an area on the bone for preparing an access hole for accessing a target site in the bone.

FIG. 61shows a side view of apparatus illustrated inFIG. 60.FIG. 61shows guide6101included in jig6000. Guide6101may extend away from opening6001. Guide6101may receive one or more bushings. Exemplary bushings that may be received by guide6101include bushings7015,7017,7019or7021(shown inFIG. 70). One or more devices may be inserted through guide6101, through opening6111and into a bone.

Guide6101may receive a fixation element. Guide6101may receive a drill. Guide6101may receive a cavity preparation device. Guide6101may receive an implant. Guide6101may receive a bushing sized to receive a fixation element. Guide6101may receive a bushing sized to receive a drill. Guide6101may receive a bushing sized to receive a cavity preparation device. Guide6101may receive a bushing sized to receive an implant.

Guide6101may define central axis Gc. When the bottom surface is jig6000is seated complementarily against the surface contour, central axis Gcmay point towards a target site. When the bottom surface is jig6000is seated complementarily against the surface contour, central axis Gcmay point in a direction that does not transect the target site.

FIG. 62shows a top view of apparatus illustrated inFIG. 60.

FIG. 63shows illustrative jig6309. Jig6309may be releasably coupled to bone B by distal screw6313. Distal screw6313may have one or more features in common with distal screw6507(illustrated inFIG. 65). Fixation elements6315may pass through jig6309and into an interior of bone B. Fixation element6317may pass through positioning hole6319defined by jig6309.

Jig6309may define slot6302. In operation, slot6302may be used by a practitioner to pass a screw into a tail of an expanded implant (not shown). Each of bushing6321and bushing6322may be releasably coupled to a screw hole defined by jig6309. Each of bushings6321may be used to guide a screw through jig6309and into an interior of bone B. When a screw is positioned in bone B, a bushing used to drive the screw into bone B may be removed.

Jig6309may include guide6311. Illustrative drill6301may be inserted through guide6311. Drill6301may include demarcations6307. Tip6323of drill6301may be advanced to a target site in bone B. Drill6301may be used to prepare an access hole in bone B.

FIG. 64shows a different view of apparatus illustrated inFIG. 63. InFIG. 64, illustrative plate6401is positioned in a recess defined by jig6309.

FIG. 65shows illustrative jig6501seated on bone B. Fixation elements6509pass through holes defined by jig6501and into bone B. Fixation element6511passes through a positioning hole located on jig6501. A distal end of jig6501is releasably coupled to bone B by distal screw6507.

Distal screw6507may be a removable screw. Distal screw6507may be a non-locking screw. Distal screw6507may be inserted through plate6502coupled to a bottom of jig6501and into bone B. Distal screw6507may be inserted through plate6502and into bone B during preliminary reduction of bone B. Distal screw6507may be used to stabilize bone B. Distal screw6507may be used to position plate6502onto bone B. Distal screw6507may be removed from bone B after reduction is obtained. Distal screw6507may be replaced with a screw such a locking screw after an implant is implanted in bone B. Distal screw6507may have a length longer than a length of the screw.

Insert6517is nested within a lumen defined by insert6515. Insert6515may be sized to receive a drill, cavity preparation device and an implant. Insert6515may define a first insert central axis. The insert central axis may point towards a target site. Insert6517may be sized to receive a fixation element. Fixation element6519is shown passing through insert6517and into bone B. Tip6521of fixation element6519is positioned at a target site in bone B. Insert6517may define a second insert central axis. The second insert central axis may be coaxial with the first insert central axis. The second insert central axis may point to the target site. Insert6517may guide a target wire to the target site. Insert6515may guide one or more of a drill, cavity preparation device and an implant to the target site.

FIG. 66shows a perspective view of apparatus illustrated inFIGS. 63 and 64. Distal screw6313may have one or more features in common with distal screw6507.

FIG. 67shows an outline of illustrative implants6703,6705and6707positioned in a central location in an interior of bone B. Bone B may be a humerus bone. A humeral head of bone B may define central axis Bc.

InFIG. 67, a proximal end of each of implants6703,6705and6707is positioned at target site6701. Each of implants6703,6705and6707has a unique length. Additionally, each of implants6703,6705and6707defines a unique central axis. Implant6707defines central axis6709. Implant6705defines central axis6711. Implant6703defines central axis6713. As shown inFIG. 67, a tail of each of implants6703,6705and6707extends through a surface of bone B at a unique location. Thus, each implant would necessitate preparation of an access hole at a different location on bone B for deployment at target site6701.

When a practitioner is selecting a size of an implant for implanting at target site6701in bone B, each sized implant may require preparation of an access hole at a different location on bone B.

FIG. 68shows an outline of illustrative implants6803,6805and6807positioned in an interior of bone B. Bone B may be a humerus bone. A humeral head of bone B may define a central axis Bc.

InFIG. 68, a proximal end of each of implants6803,6805and6807is positioned at target site6801. Each of implants6803,6805and6807has a unique length. Additionally, each of implants6803,6805and6807defines a unique central axis. Implant6807defines central axis6809. Implant6805defines central axis6811. Implant6803defines central axis6813. As shown inFIG. 68, a tail of each of implants6803,6805and6807extends through a surface of bone B at a unique location. Thus, each implant would necessitate preparation of an access hole at a different location on bone B for deployment at target site6801.

When a practitioner is selecting a size of an implant for implanting at target site6801in bone B, each sized implant may require preparation of an access hole at a different location on bone B.

FIG. 69shows an outline of illustrative implants6903,6905and6907positioned in an interior of bone B. Bone B may be a humerus bone. A humeral head of bone B may define a central axis Bc.

InFIG. 69, a proximal end of each of implants6903,6905and6907is positioned at target site6901. Each of implants6903,6905and6907has a unique length. Additionally, each of implants6903,6905and6907defines a unique central axis. Implant6907defines central axis6909. Implant6905defines central axis6911. Implant6903defines central axis6913. As shown inFIG. 69, a tail of each of implants6903,6905and6907extends through a surface of bone B at a unique location. Thus, each implant would necessitate preparation of an access hole at a different location on bone B for deployment at target site6901.

When a practitioner is selecting a size of an implant for implanting at target site6901in bone B, each sized implant may require preparation of an access hole at a different location on bone B.

FIG. 70shows illustrative apparatus including plate7001and jig7003. Plate7001may be releasably coupled to a bone (not shown) by distal screws7005. Distal screws7005may have one or more features in common with distal screw6507. Screw7023may releasably couple jig7003to plate7001.

Jig7003may define screw hole7011. Bushing7009may be screwed onto a screw hole defined by jig7003. Each of fixation element7009and fixation element7007may pass through a first hole defined by jig7003, through a second hole defined by plate7001, and into an interior of a bone (not shown).

FIG. 70shows illustrative insert7015, illustrative insert7017, illustrative insert7019and illustrative insert7021. An end of each of the inserts sized to be received by guide7013may define an outer shape. The outer shape may be sized to fit into an inner surface of guide7013.

FIG. 71shows a cross sectional view of apparatus illustrated inFIG. 70.

Each of the outer shapes may be sized to fit into an inner surface of guide7013. A portion of the outer shapes may define a central axis. The central axis of the outer shapes may be parallel to a central axis of guide7013.

Each lumen may define a lumen central axis. A lumen central axis defined by each of guides7015,7017and7021may not be parallel to the central axis of guide7013. A lumen central axis defined by guide7019may be parallel to the central axis of guide7013.

When insert7019is inserted into guide7013, insert7019may guide a device along a central axis defined by guide7013and into a bone B. When one of inserts7015,7017or7021are inserted into guide7013, apparatus advanced through the inserts may be advanced along an access angle different from the central axis of guide7013. The access angle may be the angle defined by the lumen of the insert. A physician may use inserts7015,7017,7019and7021as apparatus for selecting or modifying an access angle for accessing a bone through an opening defined by plate7001.

In embodiments where the inner lumen has a cylindrical shape, the inner lumen may be referred to alternatively as an inner cylindrical surface. An inner lumen axis may be referred to alternatively as an insert inner central axis.

FIG. 72shows illustrative apparatus including jig7201, plate7203and implant7200. Plate7203may be releasably coupled to a bottom of jig7201.

InFIG. 72, fixation element7205, fixation element72011and fixation element7215may pass through jig7201and into an interior of bone B. A hole defined by jig7201to receive fixation element7211may define a first direction. A hole defined by jig7201to receive fixation element7215may define a second direction. The second direction may be divergent from the first direction.

Fixation element7207may pass through a positioning hole defined by jig7201. Fixation element7207may be seated on a top of a greater tuberosity of bone B. Jig7201may include guide7213. Shaft7209of implant7200may extend through guide7213.

FIG. 73shows a side view of apparatus illustrated inFIG. 72.

FIG. 74shows illustrative apparatus including plate7401and implant7409. InFIG. 74, implant has been deployed in bone B so that implant tail7411is positioned in opening7403defined by plate7401.

Plate7401may include screw hole7405. Driving a screw through distal screw hole7405may releasably couple an end of plate7401to bone B. Plate7401may define screw holes7413. Passing a screw through one of screw holes7413may guide the screw through the plate, through a surface of bone B and into an implant head of implant7409. InFIG. 74, fixation elements7407are shown passing through plate7401and into an interior of bone B.

Fixation elements7503may pass through plate7501and into an interior of bone B. Distal screws7507may releasably couple a portion of plate7501to bone B. Distal screws7507may have one or more features in common with distal screw6507. Drill7517may pass through opening7505of plate7501and drill into bone B. InFIG. 75, tip7519of drill7517is shown advancing along trajectory7521in an interior of bone B.

Member7509may nest into plate7501. Opening7403of plate7501may aide in guiding and stabilizing drill7517during penetration of the cortical wall. A skive angle on tube member7509may also help facilitate drilling in a desired direction.

Screws7615may anchor plate7601to head7617of implant7600. Screws7615may pass through screw holes defined by plate7601and into head7617. Screw7621may anchor an end of plate7601to bone B. Screws7613and7611may anchor implant tail7619to bone B. Implant7600may be deployed in bone B so that implant tail7619is positioned in opening7603defined by plate7601.

InFIG. 77, screws7711may anchor implant head7701to first plate7705. Second plate7707may be anchored to both first plate7705and implant tail7721by screw7715. Screw7715is illustrated as passing through slot7717defined by second plate7707. Second plate is anchored to first plate7705and bone B by screw7719.

FIG. 78shows illustrative apparatus including plate7811, first jig7815and second jig7809. Plate7811may be releasably coupled to bone B by distal screw7805. Distal screw7805may have one or more features in common with distal screw6507. Fixation elements7807may pass through first jig7815and into bone B. Fixation elements7817may pass through second jig7809and into bone B.

InFIG. 78, illustrative drill7801is shown advanced through guide7803included in second jig7809and into bone B. Tip7813of drill7801is shown positioned at a target site for implanting an implant in bone B.

FIG. 79shows a side view of a portion of the apparatus illustrated inFIG. 78

FIG. 80shows a top view of apparatus illustrated inFIG. 78. InFIG. 80, fixation element8001is shown passing through a positioning hole defined by first jig7815. Fixation element8001passes over, and is seated on, a top of a greater tuberosity defined by bone B. InFIG. 80, plate7811and first jig7815are shown positioned on a lateral surface adjacent the bicipital groove.

FIG. 81shows illustrative apparatus including plate8101and jig8103. Plate may be releasably coupled to bone B by distal screw8107. Distal screw8107may have one or more features in common with distal screw6507. Jig8103and plate8101may be secured to bone B by fixation elements8105passing through jig8103and into bone B.

Plate8201may be anchored to bone B by screw8209. Distal crew8209may be seated in slot8207. Distal screw8209may have one or more features in common with distal screw6507. Plate8201may define slot8213. A screw may be inserted through hole8213after an implant is implanted in bone B. Plate8201may define opening8203. Opening8203may be used for one or more of preparation of an access hole, cavity preparation and implant deployment.

Second jig8322may include insert8319. Insert8319may be inserted into guide8301. First bushing8321may be placed in insert8319. Path8311may illustrate an angle and a diameter defined by an inner surface of insert8319extending along an inner surface of bone B. Second bushing8315may be screwed into a screw hole defined by second jig8322(not shown).

Jig8403may include a transverse member and a longitudinal member. Plate8401may be positioned adjacent jig8403. Plate8401may be positioned adjacent8403. Plate8401may not physically contact jig8403.

Jig8403may define a plurality of holes sized receiving fixation elements. Jig8403may define a targeting hole and/or a positioning hole. Plate8401may define holes sized for receiving fixation elements. Plate8401may define holes for receiving screws. Plate8401may be placed on the bone after jig8403is used to gain access to an interior of the bone. Plate8401may be placed on the bone prior to accessing an interior of the bone.

FIG. 85shows illustrative apparatus8500. Apparatus8500may be used for percutaneous delivery of an implant into bone8515. Percutaneous delivery of an implant may utilize a relatively small incision compared to typical surgical techniques for fracture repair. For example, percutaneous delivery may allow for an incision that is smaller in size and less traumatic than a deltopectoral incision or a deltoid split incision.

Percutaneous implant delivery using apparatus8500includes apparatus such as implant delivery base8501and plate8509. Implant delivery base8501and plate8509may be positioned underneath the skin (on the bone surface) during the implantation procedure. Percutaneous implant delivery may also utilize apparatus such as reduction device8505. Reduction device8505may be moved along post8503. Reduction device8505may be moved along post8503to be positioned on the skin during the implantation procedure. Reduction device8515may be releasably coupled to post8503. Reduction device8515may be secured to post8503after implant delivery base8501is positioned on bone8515.

Reduction device8505may direct one or more fixation elements8510, from a location above the skin, to a desired location in an interior of bone8515. Bone8515may be obscured by skin and soft tissue during the procedure. After placing implant delivery base8501on a bone, a practitioner may assess the placement. A practitioner may assess the placement by driving fixation elements8510into a bone and confirming the position of fixation elements8510in the interior. If fixation elements8510are placed in a desirable location, the practitioner may further reduce a bone fracture of bone8515and prepare to initiate an access hole in the bone through the channel. If fixation elements are not placed in a desirable location, the practitioner may remove fixation elements8510from the bone and reposition reduction device8505on the surface. When the bone is a proximal humerus, the desirable placement location in the bone may be a calcar region.

Reduction jig8505may define holes8517. The holes may be sized to receive fixation elements. The holes may point into the interior of bone8515but not into an implantation region of an implant.

Plate8509may define a bottom surface. The bottom surface may conform to a contour of bone8515. Implant delivery base8501may define a bottom surface. The bottom surface may conform to a contour of bone8515.

Implant delivery base8501may include top surface8521. Top surface8521may define two bores. Each bore may extend through an interior of implant delivery base8501. Fixation elements8510are shown extending through the bores. Fixation elements8510may releasably couple apparatus8500to bone8515.

Implant delivery base8501may define channel8507. Channel8507may extend through implant delivery base8501at an angle oblique to an implant delivery base bottom surface. Channel8507may be configured to receive bushing8513.

Implant delivery base8501may define a bottom surface (not shown). The bottom surface may conform to a surface contour of bone8515. The bottom surface may conform to a portion of a top face of plate8509. Implant delivery base8501may be coupled to plate8509by any suitable coupling mechanism, such as a screw mechanism, a snap fit mechanism, or any other coupling mechanism known to those skilled in the art.

When apparatus8500is seated complementarily on the surface contour, a central axis defined by channel8507may point to a target site. When the bottom surface is seated complementarily on the surface contour, a central axis defined by bushing8515may point to a target site. Implant delivery base8501may conform to a portion of a top surface of plate8509. Implant delivery base8501may include a recess shaped to receive plate8509.

Post8503may be fixedly attached to implant delivery base8501. Post8503may be releasably coupled to implant delivery base8501. Post8503may be secured to implant delivery base8501after implant delivery base8501is positioned on bone8515.

Reduction jig8505may be slidably affixed to post8503. In operation, a physician may position reduction device8505on the surface of the skin above bone8515after apparatus8500is seated complementarily on a surface contour of bone8515. Reduction jig8505may be adjustable along post8503. Reduction jig8505may slidable to account for differences in anatomy of patients. For example, different patients may have different thicknesses of soft tissue between a surface of bone8515and the patient's skin.

One or more of fixation elements8510may be driven through holes8517in reduction device8505to hold segments of a fracture together. Holes in reduction device8505may be perpendicular to a longitudinal axis of bone8515. Holes that are perpendicular to a longitudinal axis of bone8505may allow reduction device8505to be moved along post8503in order to position reduction device8505on the skin of a patient. Holes in reduction device8505may transect reduction device8505at right angles. Holes that are transect reduction jig at right angles may allow reduction device8505to be moved along post8503in order to position reduction device8505on the skin of a patient.

Reduction jig8505may include groove8520. Groove8520may be sized to provide clearance for an anchoring guide to guide a screw into the bone or into a plate positioned on the bone. Groove8520may be sized to provide clearance for driving a target wire into bone8515. Groove8520may allow apparatus8500to be positioned relative to the target wire. Targeting apparatus (such as the targeting apparatus shown inFIG. 12or the targeting apparatus shown inFIG. 11) may be used to position the target wire.

After making the incision, a physician may slip plate8509into the incision and position plate8509onto the surface of bone8515. Implant delivery base8501may be coupled to the plate prior to the plate being positioned on the bone. Implant delivery base8501may be coupled to the plate after the plate is positioned on the bone. Fixation elements8510may be driven through implant delivery base8501to secure it to bone8515. Fixation elements8510may be used to reduce a fracture of bone8515(not shown). Reduction device8505may be coupled to post8505. Reduction device may be seated on skin extending around the incision. Fixation elements8510may be driven through reduction device8505to reduce the fracture of bone8515. Fixation elements8510may target specific anatomical locations such as a calcar region of the humerus. One or more fixation elements may be driven through aperture8519. A threaded K-wire with a nut may be driven through aperture8519and used to provide compressional force to the bone.

After stabilizing the fracture, bushing8513may be inserted into channel8507. Any fixation elements positioned in aperture8519may be removed from the bone. Bushing8513may be fixedly attached to guide8507. Bushing8513may be inserted into guide8507.

A fixation element may be driven through a fixation element bushing (not shown) nested in bushing8513. The fixation element may be used to determine if an access angle defined by bushing8513is desirable. The fixation element may be used to determine a longitudinal axis of an implantation region where an implant will reside inside bone8515. The orientation of the fixation element and, specifically, the location of a tip of the fixation element in the interior of bone8515may be verified using fluoroscopy or other imaging techniques.

If the position of a tip of the fixation element inserted through guide8513is desirable, the fixation element bushing may be removed. The target wire may be replaced with a drill. The target wire may be over drilled with a cannulated drill. After drilling, a cavity inside bone8509may be prepared using a cavity preparation device. After preparing the cavity, an implant may be inserted through guide8513and advanced towards the target site. When the implant is positioned at the target site, an implant head of the implant may be expanded to form a mesh cage.

FIG. 86shows illustrative apparatus8600. Apparatus8600may be used for percutaneous delivery of an implant into a bone such as bone8515(shown inFIG. 85). Apparatus8600may include implant delivery base8601. A bottom surface of implant delivery base8601may conform to a surface contour of a bone.

Apparatus8600may include post8609. Post8609may extend away from top surface8621of implant delivery base8601. Post8609may be releasably coupled to implant delivery base8601. Post8609may be fixedly attached to implant delivery base8601.

Apparatus8600may include reduction device8611. Reduction device8611may be slidably coupled to post8609. Reduction device8611may be removably coupled to post8609. Reduction device8611may define a plurality of holes for driving fixation elements into a bone. Holes defined by reduction device8611may transect reduction device8611at a right angle.

Implant delivery base8601may include slot8607. Slot8607may facilitate the coupling or insertion of a screw through slot8607and into an implant tail after the implant is implanted in an interior of the bone.

Percutaneous implant delivery may not utilize a plate such as plate8509. After making the incision, a physician may slip implant delivery base8601into the incision and seat the bottom surface on the bone. Fixation elements may then be driven through bores8603and8605and into the bone, coupling implant delivery base8601to the bone. Fixation elements may be driven through reduction device8611and into the bone.

Bushing8613may be inserted into a channel defined by implant delivery base8601. Bushing8613may be fixedly attached to implant delivery base8601. When the bottom surface of the implant delivery base is seated complementarily on the surface contour, bushing8613may point towards a target site.

Reduction device8611may define aperture8615. Fixation elements may be driven through aperture8615and into a bone. Screws may be driven through aperture8615and into a bone. Aperture8615may allow apparatus8600to be positioned over anchors or fixation elements previously inserted into holes in a plate such as plate8509.

FIG. 87shows illustrative apparatus8700. Apparatus8700may include implant delivery base8701. Implant delivery base8701may be used alone for percutaneous implant delivery. Implant delivery base8701may be used with plate8725for percutaneous delivery.

Implant delivery base8701may define channel8705. Bushing8707may be removably coupled to channel8705. Bushing8707may be fixedly coupled to channel8705.

Implant delivery base8701may define bores8709and8711. Bores8709and8711may extend through the implant delivery base at an angle oblique to a bottom surface of the implant delivery base. Bore8709may define a central axis. The central axis may pass through slot8713and into a bore defined by a bottom face of implant delivery base8701. Bore8711may define a central axis. The central axis may pass through a slot (not shown) and into a bore defined by a bottom face of implant delivery base8701.

Implant delivery base8701may include holes8715. Holes8715may be used to couple implant delivery base8701to plate8725. Driving a screw or fixation element through holes8715and into holes defined by plate8725and positioned under holes8715may releasably couple implant delivery base8701with plate8725.

Apparatus8700may include post8717extending away from implant delivery base8701. Post8717may extend away from top surface8703of implant delivery base8701. Apparatus8700may include reduction device8719. Reduction device8719may be slidably coupled to post8717. Reduction device8719may define holes8723. Holes8723may be sized for receiving fixation elements. Reduction device8719may define aperture8721. Aperture8721may be sized for receiving fixation elements. Aperture8721may be sized for receiving screws. Reduction device8719may include groove8720.

Groove8720may be sized to provide clearance for an anchoring guide to guide a screw into the bone or into a plate positioned on the bone. Groove8720may be sized to provide clearance for driving a target wire into a bone. Groove8720may allow apparatus to be positioned relative to the target wire. A targeting apparatus (such as the apparatus shown inFIG. 12or the apparatus shown inFIG. 11) may be used to position the target wire.

FIG. 88shows illustrative therapeutic scenario8800. Apparatus shown in therapeutic scenario8800may be used for percutaneous delivery of an implant (not shown) into bone8515. Implant delivery base8819may be slipped onto a surface of bone8815through a relatively small incision. Reduction device8825may be slidably engaged with post8835.

Reduction device may define screw holes8823. Screw holes8823may correspond to screw holes8837defined by implant delivery base8819. A central axis one of screw holes8823may be coaxial with a central axis of a screw hole defined by implant delivery base8819. One or more of screw holes8823may be threaded. One or more of screw holes8823may not be threaded. Screw holes8823may be positioned above screw holes defined by a plate coupled to a bottom surface of implant delivery base8819(not shown).

Screw holes8823may receive a fixation element. Screw holes8823may receive a screw. Screw holes8823may be receive a bushing sized for receive a fixation element. Screw holes8823may receive a bushing sized for receiving a screw. InFIG. 88, bushing8827and bushing8831are positioned in two of screw holes8823.

InFIG. 88, fixation element8802is advanced through bushing8827and into the interior of bone8815. Fixation element8802may be a threaded K-wire. Fixation element8802may include threaded portion8806and threaded tip8811. Nut8801is positioned on fixation element8802. Nut8801may be internally threaded. A practitioner may screw nut8801onto threaded portion8802of fixation element8802. Nut8801, when screwed onto fixation element8802, may provide compressional force to bone8815. Nut8801may be used to draw a fragment of bone8815towards implant delivery base8819.

Fixation element8804may be a threaded K-wire. Fixation element8804may include threaded portion8807and threaded tip8808. A nut screwed onto fixation element8804may provide compressional force to bone8815.

Post8835may be cannulated. A fixation element such as fixation element8806may be driven through post8835and into bone8815to obtain provisional reduction of a fracture of a bone. Fixation element8806may include threaded portion8805and threaded tip8813. Fixation element8806may remain in post8835until the bone is stabilized. Fixation element8806may be removed from post8835before a bushing is inserted through a channel defined by implant delivery base8819. Shoulder8809may define an outer surface of the channel.

In operation, a practitioner may use one, two, three or more fixation elements such as fixation element8802, fixation element8804and fixation element8806to reduce a fractured bone. Fixation elements received by screw holes8806may remain in a bone while a bone fracture of bone8815(now shown) is being reduced. Once reduction is obtained, additional fixation elements such as fixation elements8823may be driven through holes8833defined by reduction device and into bone8815. When the bone is stabilized, fixation elements disposed through screw holes8806may be removed from the bone.

Implant delivery base8819may include a channel extending through an interior of implant delivery base8819. The channel may support a bushing (not shown).

Implant delivery base8819may include first bore8841. First bore8841may be positioned on shoulder8809. First bore8841may extend through the implant delivery base at an angle oblique to an implant delivery base longitudinal axis. First bore8841may form a notch on shoulder8809. Implant delivery base8819may include a second bore having the same geometrical properties as the first8841bore disposed on an opposite side of shoulder8809. When fixation elements are advanced through both first bore8841and the second bore, and into the bone, implant delivery base8819may be releasably coupled to bone8815. A practitioner may confirm the placement of the fixation elements. Proper placement of the fixation elements within a bone may indicate proper placement of implant delivery base8819on the bone. When the bone is a proximal humerus, proper placement may be a location in a calcar region of the bone.

Implant delivery base8819may define third bore8843. Third bore may be disposed on shoulder8809. Third bore8843may extend through the implant delivery base at an angle perpendicular to a longitudinal axis of implant delivery base8819. The implant delivery base may define a fourth bore having the same geometrical properties as third bore8843and disposed on an opposite side of shoulder8809. Advancing fixation elements through both third bore8843and the fourth bore and into the bone may enhance the coupling of implant delivery base8819to bone8815.

Implant delivery base8819may include longitudinal member8840. Longitudinal member8840may not include shoulder8809. Longitudinal member8840may define screw holes8837. Screw holes8837may be positioned above screw holes defined by a plate coupled to a bottom of implant delivery base8819(not shown). When implant delivery base8819is positioned on a bone, screw holes8837may point to an implantation region occupied by an implant (not shown).

Reduction device8825may be positioned at any suitable position along post8835. Reduction device8825may be slidably coupled to post8835. For example, in operation, reduction device8825may be positioned abutting the skin of a patient. Positioning (and re-positioning) reduction device8835may enable a physician to achieve a satisfactory reduction of a fracture.

Reduction device8825may include hole sets8833. Each of hole sets8883may correspond to a different size implant. Holes spaced a first distance away from a central axis of reduction device8825may form a first hole set. Holes spaced a second distance away from the central axis of reduction device8825may form a second hole set. The first hole set may correspond to a first implant defining a first volume, when expanded. The second hole set may correspond to a second implant defining a second volume, when expanded. Implant size may be determined based on a length of an implant. Implant size may be determined based on a volume of an implant, when expanded. Hole sets8833may be used to position fixation element8821such that fixation element8821provides clearance for an implant and does not engage the implant.

After positioning fixation elements through one or more of hole sets8833and after implantation of the implant in bone8815, a portion of reduction device8825may be removed. The portion of the reduction device that may be removed is shown inFIG. 88Aat step8814B. Targeting apparatus (such as apparatus3000, shown inFIG. 30) may then be positioned on an implant shaft of the implant.

A releasable key of the targeting apparatus may engage keyseat8803. A static key of the targeting apparatus may engage slot8805. When positioned on implant shaft8801, the targeting apparatus may be used to drive an anchor into clearance hole8813in tail8811. Cannulated anchors may be driven over fixation element8821and into a head of implant8817.

FIG. 88Ashows an illustrative method for inserting an implant in a bone using a percutaneous approach. The illustrative method may include one or more of the steps shown inFIG. 88A. The steps shown inFIG. 88Amay be performed in an order different from the order shown inFIG. 88A. The steps may be performed using apparatus and methods disclosed in herein, such as apparatus and methods illustrated inFIGS. 85-88.

Step8802and step8802A may include reducing a bone. The reduction may include guiding a fixation element through the cannulated post and guiding a fixation element through a screw hole defined by the reduction device. The fixation elements may be guided into the bone using a bushing coupled to the cannulated post and through a bushing coupled to the reduction device.

The reduction may include driving a first fixation element through first bore8841and into the bone at an angle that is oblique to a longitudinal axis of the bone. The reduction may include driving a second fixation element through a second bore and into the bone at an angle that is oblique to the longitudinal axis of the bone. The second bore may be disposed on an opposite side of a shoulder relative to first bore8841. The shoulder may be defined by an outer surface of a channel. The channel may extend through an interior of the implant delivery base.

The reduction may include driving a third fixation element through third bore8843and into the bone at an angle that is perpendicular to the longitudinal axis of the bone. The reduction may include driving a fourth fixation element into a fourth bore and into the bone in a direction perpendicular to the longitudinal axis of the bone. The fourth bore may be disposed on an opposite side of the shoulder relative to third bore8843

Step8804and step8804A may include stabilizing the bone. Stabilizing the bone may include driving fixation elements through bores defined by a top surface of the implant delivery base. Fixation elements driven through the bores may transect the bone at an angle oblique to a bone longitudinal axis. After the bone is stabilized, step8804may include removing the fixation element positioned in the cannulated post.

The stabilizing may include driving a first fixation element through first bore8841and into the bone in a direction oblique to the longitudinal axis of the bone. The stabilizing may include driving a second fixation element through a second bore and into the bone in direction oblique to the longitudinal axis of the bone. The second bore may be disposed on an opposite side of the shoulder relative to first bore8841.

The stabilizing may include driving a third fixation element through third bore8843and into the bone in a direction perpendicular to the longitudinal axis of the bone. The stabilizing may include driving a fourth fixation element into a fourth bore and into the bone in a direction perpendicular to a longitudinal axis of the bone. The fourth bore may be disposed on an opposite side of the shoulder relative to third bore8843.

Step8806may include driving a fixation element through a fixation element bushing nested inside a drill bushing. The fixation element bushing may be nested in a drill bushing. The fixation element bushing may be seated in a channel defined by the implant reduction base. A tip of the fixation element may be advanced through the fixation element bushing and towards a target site. Step8806may include removing the fixation element positioned in a screw hole defined by the reduction device.

Step8808may include removing the fixation element bushing from the drill bushing and advancing a drill through the drill bushing and into the bone interior.

Step8810may include preparing an interior of the bone for implantation of an implant. The preparing may include inserting a cavity preparing device through the drill bushing and into the bone interior. Step8812may include deploying an implant in the prepared cavity, rotating the implant in the prepared cavity and locking the implant head in the expanded shape. Step8814may include securing the implant to the bone. A device for driving screws into a tail of the implant may be coupled to an implant shaft. The device may be used to drive screws into an implant tail. Step8816and8816A may include fragment fixation. Fragment fixation may include fixing fragments of the bone to the implant head using screws. The screws may be cannulated.

FIG. 92shows an illustrative operational view of jig8901registered to implant9000. InFIG. 92, jig8901is registered to implant9000by engagement of pins8911and8913with jig8901. Engaging pins8911and8913with jig8901may align jig8901with implant9000. Aligning jig8901with implant9000may ensure that a member drilled through bushing8907or bushing8909passes into a hole defined by tail9003of implant9000. InFIG. 92, screw9201is shown anchoring implant9000to bone B. Drill9203is shown passing through bushing8909and through a hole defined by tail9003of implant9000. The hole defined by tail9003may be hole9007(shown above inFIG. 90).

FIG. 92Ashows an illustrative antegrade procedure for implanting an implant in a bone. The bone may be proximal humerus bone or any suitable bone shown above inFIG. 3. An antegrade procedure may be a therapeutic procedure performed in a direction normal to a path of blood circulation. The illustrative procedure shown inFIG. 92Amay be performed in any other suitable bone in the human body.

The illustrative procedure may include one of more of the steps shown inFIG. 92A. The procedure may include step9202for accessing and preparing the bone for implantation of the implant.

The procedure may include step9204for deploying and locking the implant. Step9204may include deploying the implant outside of a bone in free space. Step9204may include locking the implant to a desired expansion diameter. Locking the implant may include constraining a diameter of a head of the implant to a desired diameter. Locking the implant may include constraining a head of the implant to a desired contour. Locking the implant may include engaging a locking screw with a locking mechanism of the implant to limit expansion/collapsing of the implant head. Step9204may include inserting pins into the implant. The pins may be inserted into the implant using a jig such as jig8901.

The procedure may include step9206which represents inserting the implant into a fractured bone. The implant may be inserted into the bone with or without a jig such as jig8901. In embodiments where the implant is inserted into a humerus with a fixation element, such as a pin, pre-positioned in the implant head, step9206may include positioning one or more of the pins to protrude from a fracture in the humerus between the greater and lesser tuberosity of the humerus. The procedure may include step9208which represents stabilizing the bone and reducing the fractured bone as appropriate.

The procedure may include step9210for securing the implant to the bone. Step9210may include driving one or more fixation elements through the bone and into the implant. The procedure may include step9212for securing the implant to the bone by driving one or more screws through the bone and into the implant head. Step9212may also include driving one or more screws through the bone and into the implant tail. The screws may be cannulated and may be driven into an implant component by driving the screw over a previously positioned fixation element. An implant component may include a head, tail, hub, base, locking mechanism or any other suitable implant component.

When the implant is positioned in the bone with one or more pins protruding from the implant, step9210may include reapplying the jig to the protruding pins. Embodiments may include removing the pins and driving fixation elements through the screw holes defined by the jig. Step9212may include driving cannulated screws over the fixation elements and into the implant. Driving screws through screw holes defined by the jig, may be used to anchor the implant to the bone.

FIG. 93shows illustrative apparatus9300. Apparatus9300includes implant head9301. Implant base9303may couple head9301to tail9305. Tail9305may be snap-fit into Implant base9303. Locking screw9321may be used to lock expansion of head9301. Locking screw9321may lock an expansion of head9301by threadedly engaging one or more components (not shown) of an implant.

Tail9305includes internal threads9308. Locking screw9309may threadedly engage internal threads9308. Tail9305defines emplacement axis LE. Axis LE may be defined by a pair of opposing clearance holes in tail9305.

A beveled end of tail9305may mate with a beveled end9315of implant shaft9311. Beveled end of tail9305may allow tail9305to be positioned at or below an outer surface of a bone when head9301is positioned inside the bone. Beveled end9315of implant shaft9311includes fingers9317and9319. Fingers9317and9319may fit into indentations (not shown) in tail9305. Fitting fingers9317and9319into the indentation in tail9305may rotational lock tail9305with respect to implant shaft9311.

Implant shaft9311may be axially locked with respect to tail9305by locking screw9309. Locking screw9309may be inserted into implant shaft9311until a head of locking screw9309abuts flange9313. Flange9313may reduce an inner diameter of implant shaft9311. A threaded segment of locking screw9309may be sized to pass through flange9313. For example, major diameter of locking screw9309may be less than the diameter of implant shaft9311reduced by flange9313. A threaded segment of locking screw9309may threadedly engage internal threads9308in tail9305.

When locking screw9309is positioned within implant shaft9311, threaded engagement locking screw9309and internal threads9308may position beveled end9315of implant shaft9311against a beveled end of tail9305. Threaded engagement of locking screw9309and internal threads9308may position fingers9319and9317in indentations on tail9305.

Tail9305includes clearance hole9307. After positioning head9301inside a bone, locking screw9309and implant shaft9311may be removed from tail9305. Removing locking screw9309and implant shaft9311from tail9305may expose clearance hole9307. An anchor may be driven through clearance hole9307and into the bone to stabilize a position of head9301.

FIG. 94shows illustrative apparatus9400. Apparatus9400shows that a head of an implant (such as head9301shown inFIG. 93) may include outer mesh9401and inner mesh9403. Outer mesh9401may be self-expanding. Inner mesh9403may be self-expanding. A head of an implant may include one, three or more mesh layers. Locking screw9321may be utilized to lock outer mesh9401and/or inner mesh9403in an expanded state. Inner mesh9403may be “free floating” and expand up to a maximum limit allowed by a diameter of outer mesh9401. In such embodiments, inner mesh9403may not be locked. When outer mesh9401and/or inner mesh9403are locked, locking screw9321may not obstruct emplacement axis LE.

Locking screw9309includes threaded end9411. Locking screw9309includes unthreaded end9405. Threaded end9411may have diameter that is less than a diameter of unthreaded end9405. Threaded end9411may slide past flange9313and engage internal threads9308of tail9305.

Unthreaded end9405may include a first segment having a first diameter. Unthreaded end9405may include a second segment having a second diameter. The first diameter may be less than the second diameter. For example, the first segment may slide past flange9313. The second segment may not slide past flange9313.

Apparatus9400shows tail9305locked to implant shaft9311by locking screw9309. When tail9305is locked to implant shaft9311, movement of implant shaft9311may adjust a position of implant head9301(shown inFIG. 93) inside a bone. When tail9305is locked to implant shaft9311, implant shaft9311may be used as a point of reference for inserting fixation elements into an implant component such as implant head9301or tail9305.

FIG. 95shows illustrative apparatus9500. Apparatus9500includes outer mesh9503and inner mesh9501.FIG. 95shows that outer and inner meshes may be constructed to provide different expansion shapes and therapeutic properties (compare to inner and outer meshes shown inFIG. 94).

Apparatus9500shows locking screw9321engaged with internal threads9417in a locked configuration. When locking screw9321is in a locked configuration, clearance hole9505is not obstructed by locking screw9321. Clearance hole9505may be one of a pair of clearance holes that define an emplacement axis (such as axis LE shown inFIG. 93). Clearance hole9505and an associated emplacement axis may be positioned such that they are not obstructed even when locking screw9321is in an unlocked position (e.g., not threadedly engaged with threads9417).

Implant component9504(which may be an extension of tail9305) may fit into implant base9303. Implant component9504may be snap-fit into implant base9303. For example, detent9519of implant base9303may be biased to engage an indentation, such as indentation9521in implant component9504. Tail9305also includes indentations9513and9511. Indentations9513and9511may mate with a finger protruding from an implant shaft. For example, indentation9317may mate with finger9317(shown inFIG. 93).

Screw9607and screw9609are shown anchoring implant tail9605to bone9601in a diaphyseal region of bone9601. Screws9607and9609are shown passing through a metaphasis region of bone9601.

Implant9600may be advanced into bone9601through an access hole prepared at an access site. The access site may be an access site prepared at an anterior side of bone9601. In other embodiments, an implant may be advanced into a proximal tibia from a medial side of the proximal tibia. An implant may be advanced into a proximal tibia from either a medial side of the proximal tibia or the lateral side of the proximal tibia.

FIG. 96shows implant9600positioned centrally within an interior of bone9601. However, in other embodiments, an implant may be positioned laterally or medially within an interior of a bone. For example, an implant may be positioned laterally within a head of a proximal tibia to support a fractured lateral condyle. An implant may be positioned medially within a head of a proximal tibia to support a fractured medial condyle.

Implant9700may be implanted in an interior of a proximal portion of the tibia (“proximal tibia”). Implant9700may be anchored to bone9701and plate9707.

InFIG. 97, screws9709are shown anchoring implant head9703to bone9601and to plate9707. Screws9709may be inserted medially, pass through the plate and extend underneath lateral condyle9704.

Implant9700may be advanced into bone9701through an access hole prepared at an access site. The access site may be an access site prepared at an anterior side of bone9701. In other embodiments, an implant may be advanced into a proximal tibia from a medial side of the proximal tibia. An implant may be advanced into a proximal tibia from either a medial side of the proximal tibia or the lateral side of the proximal tibia.

FIG. 97illustrates implant9700positioned centrally within an interior of bone9701. An implant may be positioned laterally or medially within an interior of the proximal tibia. An implant may be positioned laterally, with respect to a longitudinal axis of bone, within a head of a proximal tibia to support a fractured lateral condyle. An implant may be positioned medially, with respect to a longitudinal axis of bone, within a head of a proximal tibia to support a fractured medial condyle.

InFIG. 97A, plate9723is affixed to a first side of bone9721using a plurality of screws9725,9727and9729. The first side may be a medial side. The first side of the bone is opposite a second side of the bone. The second side may be a lateral side. InFIG. 97A, an access hole was prepared on the second side for advancing the implant through the surface of the bone and into the interior.

Screws9725may pass through plate9723and through a head of implant9720. Screws9727may pass through plate9723and into a tail of implant9720. Screws9729may pass through plate9723and advance along a width of bone9721.

FIG. 97Aillustrates implant9720positioned centrally within an interior of bone9721. Implant9720may be positioned laterally or medially within an interior of the proximal tibia. Implant9720may be positioned laterally, with respect to a longitudinal axis of bone, within a head of a proximal tibia to support a fractured lateral condyle. Implant9720may be positioned medially, with respect to a longitudinal axis of bone, within a head of a proximal tibia to support a fractured medial condyle.

FIG. 98shows illustrative implant9800positioned inside bone9801. Bone9801may be a tibia. Implant9800may be implanted in an interior of a proximal portion of the tibia (“proximal tibia”). Implant9800may be anchored to bone9801and plate9805. Plate9805may be positioned on a medial portion of bone9801.

InFIG. 98, plate9805is illustrated as having a substantially rectangular outer perimeter. Plate9805may be referred to as a longitudinal member. A plate anchored to an implant positioned within a proximal tibia may be wider than plate9805.

A plate anchored to an implant positioned within in a tibia may include a longitudinal member and a semi-circular transverse member extending away from the longitudinal member. The semi-circular transverse member may extend away from an end of the longitudinal member and wrap around an anterior or posterior portion of a metaphysis region of the tibia. The semi-circular transverse member may extend away from an end of the longitudinal member and wrap around an anterior or posterior portion of a diaphysis region of the tibia.

A plate anchored to an implant implanted in a proximal tibia may include a longitudinal member and a transverse member extending away from the longitudinal member. The transverse member may wrap around an anterior or posterior portion of a metaphysis region of the tibia. The transverse member may extend away from an end of the longitudinal member and wrap around an anterior or posterior portion of a diaphysis region of the tibia.

FIG. 99shows implant9900positioned within bone9901. Bone9901may be a tibia. InFIG. 99, implant9900is shown positioned in a distal region of the tibia (“distal tibia”). Screw9911and screw9913are shown anchoring implant tail9905to bone9901. Screws9911and9913may be positioned in a diaphysis region of bone9901.

Screws10013are shown anchoring implant tail10005to a diaphysis region of bone10001. Screw10015is shown anchoring plate10009to a diaphysis region of bone10001. Screw10007is shown anchoring implant head10003to lateral malleolus10017of the distal tibia.

FIG. 101shows implant10100implanted into bone10101. Bone10101may be a calcaneus bone. Implant10100may be positioned in bone10101such that implant head10103supports articular surface10117of bone10101. Implant10111may be implanted in bone10101through the Achilles tendon at the base of tuberosity.

Washer10111may be coupled to screw10109. Washer10111may distribute load applied to bone10101by a head of screw10109. Washer10111may space a head of screw10119apart from an outer surface of bone10101.

Washer10113may be coupled to a head of screw10117. Washer10113may distribute load applied to bone10101by a head of screw10117. Washer10113may space a head of screw10117apart from an outer surface of bone10101.

Washer10217may be coupled to a head of screw10215. Washer10213may be coupled to a head of screw10211. Washer10217and washer10213are shown positioned on a lateral surface of calcaneus bone10201.

Screw10215may support an articular surface of bone10201.

FIG. 102shows a pattern of screws anchoring implant10200to bone10201that is representational of a screw pattern that may be used by a practitioner to support a calcaneus fracture. Any other suitable screw pattern may be used to anchor implant10200to bone10201.

Any pattern of screws shown herein for anchoring an implant to a bone is for illustrative purposes only. Any other suitable pattern of screws may be used to anchor an implant to a bone.

FIG. 103shows illustrative plate10300. Plate10300may include a bottom face (shown below inFIG. 104). The bottom face may include a bottom surface. The bottom surface may conform to a surface contour of a bone. The surface contour may be defined by an outer surface of a bone.

Plate10300may define plurality of holes10311. Each of the plurality of holes10311may be sized to receive a fixation element.

Plate10300may define screw hole10305. When a bottom surface of plate10300is seated complementarily on a surface contour of a bone, screw hole10305may be configured to position a bushing for directing a screw, or direct a screw, in a direction. The direction defined by screw hole10305may direct a screw into an interior of the bone but not into an implantation region occupied by an implant when the implant is positioned within the bone.

Plate10300may define screw holes10301and10303. Screw holes10301and10303may each be configured to10305may be configured to direct a screw in a direction. The directions defined by screw holes10301and10303may intersect an implantation region when a bottom surface of plate10300is seated complementarily on a bone surface. The direction defined by screw hole10301may diverge from a direction defined by screw hole10303. In other embodiments, the direction defined by screw hole10301may converge with a direction defined by screw hole10303.

Plate10300may define screw hole10307and screw hole10309. Screw holes10307and10309may define directions that direct screws into an implantation region when a bottom surface of plate10300is seated complementarily on a bone surface. The direction defined by screw hole10307may converge with a direction defined by screw hole10309. The direction defined by screw hole10307may diverge from a direction defined by screw hole10309.

Plate10300defines screw hole10313and screw hole10315. Screw holes10313and10315may define directions that direct screws into an implantation region when a bottom surface of plate10300is seated complementarily on a bone surface. A direction defined by screw hole10313may diverge from a direction defined by screw hole10315. The direction defined by screw hole10313may converge with a direction defined by screw hole10315.

Plate10300may be configured to be coupled to a jig such as jig10500(shown below inFIG. 105). Plate10300, as shown inFIG. 103, defines bore10302. Bore10302may be threaded. Bore10302may be configured to receive a screw. The screw may be a screw inserted into a bore defined by a jig, advanced through the jig and into bore10302, coupling plate10300to the jig.

Plate10300may define opening10319. When a bottom surface of plate10300is seated complementarily on a surface contour of a bone, opening10319may define an access position. An access hole may be prepared at the access position through opening10319. Plate10300also includes locking slot10317. A locking slot may be defined by the plate. InFIG. 103, locking slot10317is partially defined by plate10300and extends away from opening10319. Locking slot10317also intersects opening10319. Locking slot10317may be shaped to engage a head of a screw.

Plate10300may define screw holes10321. When a bottom surface of plate10300is seated complementarily on a surface contour of a bone, screw holes10321may point into an interior of the bone but not into the implantation region.

FIG. 104shows bottom face10401of plate10300. Some or all of bottom face10401may define a bottom surface configured to conform to a surface contour of a bone.

FIG. 105shows illustrative jig10500. Jig10500may be configured to be seated on, and coupled to, a position on a top face of a plate, such as plate10300(shown inFIG. 103). Jig10500may define positioning hole10501.

Jig10500may define aperture10503. Aperture10503may include threaded openings10505and10507for receiving a bushing. A fixation element advanced through a bushing coupled to threaded opening10505may be advanced in a first direction. A fixation element advanced through a bushing coupled to threaded opening10507may be advanced in a second direction. The first direction may be divergent from the second direction. The first direction may be convergent with the second direction.

Jig10500may define screw hole10511and screw hole10509. Screw hole10511may define a first direction. Screw hole10509may define a second direction. The first direction may be convergent with the second direction. The first direction may be divergent from the second direction.

Jig10500may define bore10502. Bore10502may extend though jig10500. Bore10502may be threaded. When jig10500is seated on a plate such as plate10300, a screw advanced through bore10502and into a hole in the plate positioned underneath bore10502(such as bore10302illustrated inFIG. 103) may releasably couple jig10500to the plate.

Jig10500may include aperture10521. Aperture10521may define opening10525for receiving a first bushing and opening10527for receiving a second bushing. Opening10525may be an open channel that has an arcuate perimeter. Opening10527may be an open channel that has an arcuate perimeter.

A fixation element advanced through the first bushing may be directed along a first direction. A fixation element advanced through the second bushing may be directed along a second direction. The first direction may diverge from the second direction. The first direction may be convergent with the second direction.

Jig10500may include guide10519. Guide10519may extend away from opening10517defined by jig10500. Guide10519may be shaped to receive bushings inserted into guide10519. Guide10519may receive a bushing shaped to receive a target wire. Guide10519may receive a bushing shaped to receive a drill. Guide10519may receive a bushing shaped to receive a cavity preparation device. Guide10519may receive a bushing shaped to receive an unexpanded implant.

Guide10519may include slot10523. Slot10523may mate with a protrusion extending away from a bushing inserted into guide10519. The mating of slot10523with a protrusion of a bushing may secure the bushing within guide10519.

Guide10519may define opening10515. A practitioner may advance a fixation element through opening10515to provisionally reduce a fracture. For example, a practitioner may advance a threaded member coupled to a nut into a bone fragment. The nut may rest on an outer surface of opening10515. The nut may be used to provide compression to the bone fragment.

Jig10500may define a plurality of holes sized for receiving fixation elements. The plurality of holes may include holes10513and10527. Holes10527may be positioned adjacent a bottom portion of guide10519. Fixation elements driven though bores10513and10527when jig10500is coupled to a plate seated complementarily on a bone surface may releasably couple jig10500to the bone. When jig10500is coupled to a plate seated on a bone, bores10513and10527may point into an interior of the bone but not into an implantation region.

Jig10500may also include channels10530. Each of channels10530may be defined by a perimeter of jig10500. A fixation element may be guided through one of channels10530and into a hole defined by a plate coupled to the jig. The hole in the plate may be sized for receiving the fixation element. Channel10530may define an arcuate cross section.

FIG. 106shows bottom face10601of jig10500. A contour of a first portion of bottom face10601may conform to a contour of a portion of a top face of a plate such as plate10300. A second portion of bottom face10601may extend away from a plate (such as plate10300) when jig10500is coupled to the plate. For example, when jig10500is coupled to plate10300, the first portion of bottom face10601may rest on plate10300and the second portion of bottom face10601may not come into contact with plate10300.

FIG. 107AandFIG. 107Bshow illustrative bushing10701. Longitudinal segment10707of bushing10701defines longitudinal axis LB. Bushing10707includes flanged end10703. Bushing10707includes flanged end10704. In an equilibrium state, kerf10711spaces flanged end10703apart from flanged end10704. Flanged end10703may be mounted on longitudinal segment10706. Longitudinal segment10706may define longitudinal axis LF1. Flanged end10704may be mounted on longitudinal segment10708. Longitudinal segment10708may define longitudinal axis LF2. Longitudinal segment10706may have a semi-circular cross section in a plane that is normal to LF1. Longitudinal segment10708may have a semi-circular cross section in plane that is normal to LF2.

FIG. 107Ashows bushing10701in an equilibrium state. In an equilibrium state, longitudinal axis LF1may form an angle B with respect to axis LB. In an equilibrium state, longitudinal axis LF1may form an angle A with respect to axis LB.

Bushing10701includes longitudinal segment10707that defines longitudinal axis LB. Longitudinal segment1707may be cannulated. Longitudinal segment1707may define a circular cross section in a plane normal to LB.

Longitudinal segment10719may be cannulated such that it is configured to receive longitudinal segment10707of bushing10701. Longitudinal segment10715may be cannulated such that it is configured to receive longitudinal segments10708and10706(shown inFIG. 107A). A cannula running through longitudinal segment10719may be narrower than a cannula running though longitudinal segment10715. Bushing10703may include a cannula that is large enough to receive a surgical drill.

Longitudinal segment10719may include kerf10718. Kerf10718may be one of two or more kerfs in longitudinal segment10719. In operation, when a tool is inserted into cannula10721, the one or more kerfs may allow longitudinal segment10719to expand about longitudinal axis LB1. Expansion of longitudinal segment10719may provide a friction fit, along axis Lb1for a tool inserted into cannula10721. When longitudinal segment10719is nested within longitudinal segment10723, pressure applied by expansion of the longitudinal segment10719may provide a friction fit that holds longitudinal segment10719with respect to longitudinal segment10723.

When bushing10701is inserted into cannula10721of bushing10703, flanged end10713and longitudinal segment10715may compress longitudinal segment10703and longitudinal segment10704about longitudinal axis LB1. Thus, when bushing10701is positioned within bushing10703, angles A and B may be smaller than in the equilibrium state (shown above inFIG. 107A). When bushing10701is positioned within bushing10703, longitudinal segments10706and10708may exert pressure on longitudinal segment10713and/or longitudinal segment10715. The exerted pressure may provide a friction fit for bushing10701within bushing10703.

Bushing10705may include one or more kerfs such as kerf10730. The one or more kerfs may allow bushing10705to be formed into a tapered shape along longitudinal axis LB2. The one or more kerfs may define two or more longitudinal segments, such as longitudinal segments10740,10741,10742and10743.

In an equilibrium state (when bushings10705and10703are not nested) longitudinal segments10740,10741,10742and10743may be inwardly biased toward axis LB2. In the equilibrium state, a diameter of cannula10729may narrow along axis LB2when moving from threaded segment10725toward a hexagonal cross section of cannula10729.

Bushing10703may be nested within bushing10705. When bushing10703is nested in bushing10705, longitudinal segment10719may expand longitudinal segments10740,10741,10742and10743outward from axis LB2. When bushing10703is nested in bushing10705, longitudinal segments10740,10741,10742and10743may apply pressure to longitudinal segment10719of bushing10703. The pressure may provide a friction fit that maintains a nested position of bushing10703within bushing10705.

Bushing10705may include one kerf. For example, kerf10730may be the only kerf in bushing10705. When kerf10730is the only kerf, longitudinal segments10740,10741,10742and10743may form a unitary longitudinal segment. When kerf10730is the only kerf and bushing10703is nested in bushing10705, the unitary longitudinal segment may apply pressure to longitudinal segment10719of bushing10703. The pressure may provide a friction fit that maintains a nested position of bushing10703within bushing10705.

Bushing10705defines cannula10729. Cannula10729may include different cross sections along longitudinal axis LB2. For example,FIG. 107Bshows that cannula10729may include a hexagonal cross section at or near an end of longitudinal segments10740,10741,10742and10743. The hexagonal cross section may be configured to mate with hexagonal protrusions10717of bushing10703. When bushing10703is inserted into bushing10705, a mating of the hexagonal cross section and hexagonal protrusions may lock bushings10703and10705rotationally, with respect to each other, about axis LB1and/or LB2.

As shown by10702, Bushing10701may be nested within bushing10703. As shown by10712, bushing10703may be nested within bushing10705. Bushings10701,10703and10705may form nested bushing10801(shown inFIG. 108). Nested bushing10801may be fixed to jig10500. Narrow gauge instruments, such as K-wires, may be directed into a bone through cannula10709in bushing10701. Bushing10701may direct such instruments into a bone in a direction along axis LB. Bushing10701, when affixed to a jig, may direct instruments into an implantation region within a bone.

After positioning an instrument using bushing10701, bushing10701may be separated from bushing10703. Separating bushing10701from bushing10703may expose cannula10721of bushing10703. Cannula10721may have a diameter that is larger than the diameter of cannula10709. Cannula10721may be configured to receive larger gauge instruments than those that would fit into cannula10709. Cannula10721may be sized to receive a drill. The drill may be a cannulated drill that is configured to slide over the K-wire positioned using bushing10701. Cannula10721may direct an instrument along longitudinal axis LB1.

Bushing10703may be separated from bushing10705. Separating bushing10703from bushing10705may expose cannula10729. Cannula10729may have a diameter that is larger than the diameter of cannula10721. Cannula10729may be configured to received larger gauge instruments than those that would fit into cannula10721. Cannula10729may be sized to receive an anchor or screw. Cannula10729may direct an anchor or screw along longitudinal axis LB2. The anchor or screw may be a cannulated and configured to slide over the K-wire positioned using bushing10701.

Bushing10705may be removed from jig10500.

FIG. 108shows exemplary apparatus. The apparatus shown inFIG. 108includes jig10500releasably coupled to plate10300. The apparatus shown inFIG. 108also includes bushings10701,10703and10705coupled together to form nested bushing10801. InFIG. 108, bushings10701,10703and10705are coupled together to form nested bushing10800and are seated on a screw hole defined by jig10500. Threaded segment10725of bushing10705may threadedly engage a screw hole in jig10500.

FIG. 109shows an illustrative method for inserting an implant in a bone. The illustrative method may include one or more of the steps shown inFIG. 109. The steps shown inFIG. 109may be performed in an order different from the order shown inFIG. 109. The steps may be performed using apparatus and methods disclosed herein. The steps may be performed using any plate, jig, or plate and jig combination disclosed herein.

Step10901may include reducing and stabilizing a fractured bone. Step10903may include confirming an access angle. Step10905may include drilling. The drilling may form an access hole towards a target site. Step10907may include prepping an interior of the bone for implantation of the implant. Prepping the interior may include creating a cavity within the bone. Step10909may include deploying the implant in the cavity. The deploying may include expanding the implant. The implant may be self-expanding. Step10911may include rotating and locking the deployed implant. Step10913may include fixing the implant to the bone. The fixing the implant may include fixing a tail of the implant to the bone. Step10915may include driving screws through the bone and into a head of the implant. Step10915may be performed for any suitable bone. In some of the embodiments where the bone is a proximal humerus, the screws may be driven through a humeral head and into a head of the implant. Step10917may include securing fragments of the bone. The securing the fragments of the bone may include securing fragments of the bone to the implant head by driving fixation elements through the bone and into the implant head. Step10919may include securing the implant to the bone.

FIG. 110shows an illustrative method for inserting an implant in a bone. The illustrative method may include one or more of the steps shown inFIG. 110. The steps shown inFIG. 110may be performed in an order different from the order shown inFIG. 110. The steps may be performed using apparatus and methods disclosed herein. The steps may be performed using any plate, jig, or plate and jig combination disclosed herein.

Step11001may include reducing and stabilizing a fractured bone. Step11003may include confirming an access angle. Step11005may include drilling. The drilling may be performed to form an access hole towards a target site. Step11007may include prepping an interior of the bone for implantation of the implant. Prepping the interior may include creating a cavity within the bone. Step11009may include deploying the implant in the cavity. Step11011may include rotating and locking the deployed implant. Step11013may include securing fragments of the bone. The securing the fragments of the bone may include securing fragments of the bone to the implant head by driving fixation elements through the bone and into the implant head. Step11015may include fixing the implant to the bone. The fixing the implant may include fixing a tail of the implant to the bone. Step11017may include securing the implant to the bone.

FIG. 111shows an illustrative method for inserting an implant in a bone. The illustrative method may include one or more of the steps shown inFIG. 111. The steps shown inFIG. 111may be performed in an order different from the order shown inFIG. 111. The steps may be performed using apparatus and methods disclosed herein. The steps may be performed using any plate, jig, or plate and jig combination disclosed herein.

Step11101may include reducing and stabilizing a fractured bone. Step11103may include target and access. Target and access may include driving a target wire through a target hole and towards a target site. Step11105may include using a side cut drill to create an access hole on the bone and driving a target wire through the access hole and towards the target site. The target wire may be used as a guide pin. Step11107may include drilling through the access hole and towards the target site. Step1109may include prepping an interior of the bone for implantation of the implant. Prepping the interior may include creating a cavity within the bone. Step11111may include deploying the implant in the cavity. Step11113may include rotating and locking the deployed implant. Step11115may include may include fixing the implant to the bone. The fixing the implant may include fixing a tail of the implant to the bone. Step1117may include securing fragments of the bone. The securing the fragments of the bone may include securing fragments of the bone to the implant head by driving fixation elements through the bone and into the implant head. Step11119may include securing the implant to the bone.

FIG. 112shows an illustrative therapeutic scenario with illustrative apparatus implanted in bone B. The apparatus may include plate11201and implant11203. The apparatus may also include implant delivery base11207, post11205and reduction device11209.

The apparatus illustrated inFIG. 112may be used for the percutaneous delivery of implant11203into an interior of bone B. The apparatus illustrated inFIG. 112may be used to deliver implant11203into an interior of bone B using a minimally invasive method, such as a method including splitting the deltoid muscle. The apparatus illustrated inFIG. 112may be used to deliver implant11203into an interior of a bone using an open procedure.

Implant delivery base11207may be used alone for percutaneous delivery of implant11203in bone B. Implant delivery base11207may be used with plate11201for percutaneous delivery of implant11203in bone B.

Implant delivery base11207may have one or more features in common with the implant delivery bases illustrated inFIGS. 85-88A. Post11205may have one or more features in common with the posts illustrated inFIGS. 85-88A. Reduction device11209may have one or more features in common with the reduction devices illustrated inFIGS. 85-88A.

The implant delivery bases illustrated inFIGS. 85-88Amay have one or more features in common with implant delivery base11207. The posts illustrated inFIGS. 85-88Amay have one or more features in common with post11205. The reduction devices illustrated inFIGS. 85-88Amay have one or more features in common with reduction device11209.

Plate11203may be positioned complimentarily on a surface of bone B.

Implant delivery base11207may be nested in opening11231defined by plate11201. Implant delivery base11207may be seated in opening11231defined by plate11201. A bottom surface of implant delivery base11207may be seated on a surface of bone B. A bottom surface of implant delivery base11207may be seated in opening11231. A bottom surface of implant delivery base11207may be seated on a face of plate11201. A first portion of a bottom surface of implant delivery base11207may be seated on a surface of bone B and a second portion of a bottom surface of implant delivery base11207may be seated on a surface of plate11201. One or more features of implant delivery base11207may snap into plate11201. Plate11201may include a slot shaped to receive a protrusion on a bottom face of implant delivery base11207.

Implant delivery base11207may define channel11243. Channel11243may be sized to receive implant11203in an unexpanded state. Channel11243may be sized to receive a bushing (not shown). The bushing may be sized to receive implant11203in an unexpanded state. The bushing may be sized to receive a drill. The bushing may be removably coupled to channel11243.

Implant delivery base11207may define bore11223. Implant delivery base11207may define a second bore (not shown) opposite bore11223across a channel longitudinal axis. Fixation element11229may pass through bore11223. Fixation element11227may pass through the second bore. Bore11223and the second bore may extend through implant delivery base11207at an angle oblique to a bottom surface of implant delivery base11207. Bore11223may define a central axis. Fixation element11229may pass through a hole defined by plate11201and into the interior of bone B. Fixation element11227may pass through a hole defined by plate11201and into the interior of bone B. The passing of fixation elements11227and11229through implant delivery base11207and through plate11201may couple implant delivery base11207to plate11201. The passing of fixation elements11227and11229through implant delivery base11207, through plate11201and into bone B may couple implant delivery base11207to plate11201and to bone B.

A central axis defined by channel11243may be non-parallel to a central axis defined by bore11223and a central axis defined by the second bore. A first central axis defined by bore11223and a second central axis defined by the second bore may point into the interior of bone B, but not into a volume occupied by implant11203in the interior when implant11203is advanced through the channel, into the interior, positioned at a target site, and radially expanded to form a mesh cage.

Implant delivery base11207may include hole11219and hole11225. Implant delivery base11207may include a second hole opposite hole11219across a base longitudinal axis. Implant delivery base11207may include a third hole opposite hole11225across a base longitudinal axis. When implant delivery base11207is coupled to plate11201, hole11219may be coaxial with hole11233and the second hole, and hole11225may be coaxial with hole11235and the third hole. A practitioner may removably couple implant delivery base11207to plate11201during the therapeutic procedure by passing a screw through hole11219and hole11233. A practitioner may removably couple implant delivery base11207to plate11201during the therapeutic procedure by passing a screw through11225and hole11235.

Implant delivery base11207may include post11205extending away from a top surface of implant delivery base11207. Post11205may be cannulated to define inner lumen11217. Inner lumen11217may be sized to receive a drill. Inner lumen11217may be sized to receive a screw. In operation, when implant delivery base11207is coupled to plate11201and implant11203is positioned in bone B, a screw advanced through lumen11217may engage a hole defined by a tail of implant11203.

Implant delivery base11207may include reduction device11209. Reduction device11209may be removably coupled to post11205. Reduction device11209may be snapped onto post11205. Reduction device11209may be removed from post11205using handle11211.

Reduction device11209may define hole11215, hole11241, hole11239and hole11221. Holes defined by reduction device11209may be sized to receive fixation elements such as k-wire11235, k-wire11237and screws (not shown). Holes defined by reduction device11209may be sized to receive a bushing (not shown). Each of holes11215,11241,11239and11221may point to a volume defined by implant11203when the implant is positioned at the target site in bone B and expanded to form a mesh cage.

Reduction device11209may define slit11213. Slit11213may run from an end of reduction device11209along a central axis of reduction device11209. Slit11213may extend through one or more holes defined by reduction device11209. A practitioner may drive k-wires into the bone and subsequently slide reduction device over the k-wires by axially sliding an opening defined by slit11213along the k-wires.

Arms of reduction device11209extending circumferentially about bone B may have any suitable length and width to target desired anatomy of bone B.

FIG. 113shows illustrative rod11301. Rod11301may include tapered segment11319. Tapered segment11319may displace tissue in a bone as rod11301is inserted into the bone.

Rod11301may include anchor receiving feature11315. Anchor receiving feature11315may define a first central longitudinal axis (not shown). The first central longitudinal axis may be oblique to the central longitudinal axis of rod11301. An anchor driven through anchor receiving feature11315may secure rod11301to a bone.

Rod11301may include anchor receiving feature11313. Anchor receiving feature11315may define a second central longitudinal axis (not shown). The second central longitudinal axis may be oblique to the central longitudinal axis of rod11301. An anchor driven through anchor receiving feature11313may secure rod11301to the bone.

A first planar surface (not shown) may include the first central longitudinal axis. A second planar surface (not shown) may include the second central longitudinal axis. The first planar surface may be parallel to the second planar surface.

Rod11301may include anchor receiving feature11311. Anchor receiving feature11311may define a third central longitudinal axis (not shown). An anchor driven through anchor receiving feature11311may secure rod11301to the bone. The third central longitudinal axis may intersect the first and the second planar surfaces.

Rod11301may include anchor receiving feature11309. Anchor receiving feature11309may define a fourth central longitudinal axis (not shown). An anchor driven through anchor receiving feature11309may secure rod11301to the bone. The fourth central longitudinal axis may intersect the first and the second planar surfaces. The fourth central longitudinal axis may be parallel to the third central longitudinal axis defined by anchor receiving feature11311. The fourth central longitudinal axis may intersect the third central longitudinal axis defined by anchor receiving feature11311.

Rod11301may include guide surface11305. A segment of rod11301that includes guide surface11305may be a guide segment. Guide surface11305may guide tools into the bone. Guide surface11305may guide tools into the bone through aperture11306. Aperture may be defined by ring-shaped segment11312. Exemplary tools may include a k-wire, drill, reamer and/or implant. The drill may be any suitable drill, such as drill1501(shown inFIG. 15). The reamer may be any suitable reamer, such as reamer1601(shown inFIGS. 16-19). The implant may be the implant, such as implant9720(shown inFIG. 97A).

Guide surface11305may be configured to support the implant tail of the implant.

Rod11301may include threaded segment11307. Threaded segment11307may threadedly engage an extension rod (not shown) that extends along central longitudinal rod axis LR. A force may be applied to the extension rod to drive rod11301into a bone. The extension rod may be threadedly disengages from rod11301after rod is11301is positioned in the bone. Appling the force to the extension rod may mitigate a risk of deforming rod11301while inserting rod11301into the bone.

Rod11301may include anchor receiving feature11309. Anchor receiving feature11309may receive an anchor that is driven through the implant tail (not shown). The anchor received by anchor receiving feature11309may secure the implant tail to the bone. The anchor received by anchor receiving feature11309may secure rod11301to the bone. The anchor received by anchor receiving feature11309may secure the implant to rod11301.

Rod11301may include elongated extension member11303. Extension member11303may have a length. The length of extension member11303may extend parallel to, or substantially parallel to, a central longitudinal axis of rod13301. An outer surface of rod11301may be tubular and define a cylindrical surface. An outer surface of extension member11303may be coextensive with the cylindrical surface. An outer surface of extension member11303may be coextensive with a portion of the cylindrical surface. An inner surface of extension member11303may be coextensive with an inner surface of ring-shaped segment11312.

An “outer” surface may be a surface of extension member13303, rod11301or ring-shaped segment11312that is more distant from a central longitudinal axis of rod11301. An “inner” surface may be a surface of extension member extension member13303, rod11301or ring-shaped segment11312that is closer to the central longitudinal axis of rod11301. A thickness of extension member13303, rod11301or ring-shaped segment11312may be a distance between the inner and outer surfaces.

An outer surface of extension member11303may be planar, or substantially planar. An inner surface of extension member11303may be planar, or substantially planar.

Extension member11303may have a thickness. The thickness may extend between inner and outer surfaces of extension member11303. The thickness of extension member11303may vary along the length of extension member11303. The thickness of extension member11303may be less than a diameter of the cylindrical surface defined by rod11301. A thickness of elongated extension member11303may less than a radius of the cylindrical surface defined by rod11301. An outside surface of extension member11303may not completely encircle aperture11306. A thickness of elongated extension member11303may not obscure aperture11306. A thickness of elongated extension member11303may not obscure a trajectory defined by guide surface11305.

An outside surface of extension member11303may not completely encircle ring-shaped segment11312. A thickness of ring-shaped segment11312may vary along a central longitudinal axis of rod11301. A thickness of ring-shaped segment11312may vary to accommodate the trajectory defined by guide surface11305. The thickness of ring-shaped segment11312may vary about a central longitudinal axis defined by guide surface11305. The thickness of ring-shaped segment11312may vary along the central longitudinal axis defined by guide surface11305. The thickness of ring-shaped segment11312may vary about a central longitudinal axis defined by rod11301. The thickness of ring-shaped segment11312may vary along the central longitudinal axis defined by rod11301.

Ring-shaped segment11312may be thick at or near a joint with extension member11303. Increased thickness at the joint may provide more robust support for extension member11303.

An outer surface of extension member11303may have an arc length that is less than a circumferential length of the cylindrical surface defined by rod11301. Elongated extension member11303may define a planar surface area. When rod11301is positioned inside a bone, elongated extension member11303may be positioned between a central longitudinal axis of the bone and cortical bone. When rod11301is positioned inside a bone, elongated extension member11303may be positioned between a central longitudinal axis of rod11301and an outer surface of rod13301.

Extension member11303may include mating feature11321. Mating feature11321may mate with a corresponding mating feature (not shown) in an extension rod (not shown). Mating feature11321may position the extension rod such a central longitudinal axis of the extension rod is perpendicular to, or substantially perpendicular, to axis LR.

Extension member11303may include anchor receiving feature11317. Anchor receiving feature11317may be configured to receive an anchor that locks rod11301to an extension rod. Anchor receiving feature11317may be threaded.

Using mating feature11321and anchor receiving feature11317, an extension rod may be securely affixed to rod11301. A force, applied to the extension rod may drive rod11301into the bone. The extension rod may be disengaged from rod11301after rod is11301is positioned in the bone. Mating feature11321may mitigate a risk of deforming rod11301while inserting rod11301into the bone.

Edge11310of extension member11303may be a mating feature. A first protrusion (e.g., of an extension rod) may be configured to mate with mating feature11321. A depth of mating feature11321may be less than a thickness of extension member11303. A second protrusion (e.g., of the extension rod) may be configured to abut edge11310. Edge11310may touch the second protrusion. Edge11310may contact the second protrusion when a force is applied to the second protrusion (e.g., via the extension rod). Edge11310may have a thickness that is the same as, or different from, a thickness of extension member11301. Edge11301may have a thickness that is at least equal to a depth of mating feature11321.

Extension member11303may include mating feature11308. Mating feature11308may mate with a corresponding mating feature (not shown) in an extension rod (not shown). Mating feature11308may position the extension rod such a central longitudinal axis of the extension rod is parallel to, or substantially parallel to, axis LR. Mating feature11308may define a track for receiving a corresponding feature of the extension rod.

FIG. 114shows another view of rod11301.FIG. 114shows that extension member11303does not obstruct aperture11306. Tools guided by guide surface11305(shown inFIG. 113) may pass through aperture11306and into the bone without being obstructed by extension member11303. Extension member11303may not obstruct an expansion of an implant inside the bone.

FIG. 115shows illustrative therapeutic scenario1501. Scenario11501shows rod11301positioned inside bone B. Bone B may be any suitable bone. Exemplary bones may include a humerus and femur. Scenario11501shows implant11503positioned inside bone B. Implant11503may be inserted into bone B using guide surface11305(shown inFIG. 113). Scenario11501shows implant11503in an expanded state. Scenario11501shows that extension member11303does not obstruct expansion of implant11503.

Scenario11501shows another view of mating feature. Scenario11501shows anchor11507positioned in anchor receiving features11315,11313and11311. Anchor11507may be received by anchor receiving feature11309(shown inFIG. 113).

FIG. 116shows rod11301positioned relative to extension rod11601. A central longitudinal axis LRof rod11301may be positioned perpendicular to, or substantially perpendicular to, a central longitudinal axis LERof extension rod11601.

When internal bore11611is positioned relative to anchor receiving feature11317, an anchor (not shown) may be driven through internal bore11611into anchor receiving feature11317. The anchor may be inserted into extension rod11601via opening11607. The anchor may threadedly engage anchor receiving feature11317. Threaded engagement of the anchor and anchor receiving feature11317may lock extension rod11601to rod11301. Extension rod11601may be locked to rod11301such that LRis perpendicular to, or substantially perpendicular to, LER. Extension rod11601may be locked to rod11301before rod11301is positioned inside a bone.

When extension rod11601is locked relative to rod11301mating feature11613may be securely mated to mating feature11321. For example, mating feature11601may be received by mating feature11321. When mating feature11601is securely mated to mating feature11321, a force applied to extension rod11601may be transferred to rod11301without deforming extension member11303or any other component of rod11301.

When rod11301is secured to extension rod11601, pass-through11605may be aligned with central longitudinal axis L11311of anchor receiving feature11311. Extension rod11601may remain affixed to rod11301after rod11301is positioned inside a bone. Tools may be inserted through pass-through11605. The tools may be used to position an anchor, from an outside of the bone, within anchor receiving feature11311.

When rod11301is secured to extension rod11601, pass-through11603may be aligned with central longitudinal axis L11309of anchor receiving feature11309. Extension rod11601may remain affixed to rod11301after rod11301is positioned inside a bone. Tools may be inserted through pass-through11603. The tools may be used to position an anchor, from an outside of the bone, within anchor receiving feature11309. For example, pass-through11603may be used to position anchor11507that secures implant11503.

Extension rod11601may include rib11609. Rib11609may secure targeting tools relative to extension rod11601. The targeting tools may be used to direct one or more anchors into rod11301when rod11301is positioned inside the bone. The targeting tools may be used to direct one or more anchors into implant11503(shown inFIG. 115) when implant11503is positioned inside the bone.

Rib11609may include one or more cut-outs.FIG. 116shows that rib11609includes cut-out11602.FIG. 116shows that rib11609includes cut-out11604. A cut-out may receive a set screw affixed to targeting tools (not shown). Targeting tools may include a feature that mates with rib11609. Targeting tools may be secured to extension rod11601by mating with rib11609. A set screw may be driven into cut-outs11602and/or11604in rib11609. Driving a set screw into cut-outs11602and/or11604may provide additional stability to targeting tools secured to rod11301.

Extension rod11601may be unlocked and removed from rod11301. Extension rod11601may be unlocked and removed from rod11301after rod11301is securely positioned inside a bone.

FIG. 116shows clearance axis LC1. Clearance axis LC1may represent space for positioning of a tool (e.g., drill or implant) inside a bone. Axis LC1may be parallel to an outer surface of rod11301.FIG. 116also shows clearance axis LC2. Clearance axis LC2may represent space for positioning of a tool (e.g., drill or implant) inside a bone. LC1, LC2and an inner surface of extension member11303may collectively define a clearance plane PCfor positioning of a tool (e.g., drill or implant) inside a bone.

Clearance may include space for an expandable implant (such as implant11503, shown inFIG. 115) to fully expand inside a bone. Clearance may include space for an expandable implant to fully expand inside the bone. Clearance may include space for an expandable implant to fully expand inside the bone when the implant is inserted into the bone at an angle, relative to a longitudinal axis of the bone. The angle may be defined by guide surface11305(shown inFIG. 113). Clearance may include space for an expandable implant to be therapeutically positioned within the bone. A therapeutic position for an implant may include a position, within the bone, that allows a practitioner to repair a fracture of the bone by securing one or more segments of the bone to the implant. An illustrative therapeutic position for an implant is shown inFIG. 115.

FIG. 117shows illustrative therapeutic scenario11700. Scenario11700shows extension rod11705. Extension rod11705may have one or more features in common with extension rod11601(shown inFIG. 116). Scenario11700shows rod11701. Rod11701may have one or more features in common with rod11301(shown inFIG. 113). Scenario11700shows extension rod11705affixed to rod11701. Rod11701is positioned inside bone B. Extension rod11705extends out of bone B.

Scenario11700shows targeting tool11707affixed to extension rod11705. Set screw11709may be used to secure targeting tool11707to extension rod11705. Targeting tool11707may include anchor receiving features11717. Targeting tool1707may include anchor receiving feature11719. When targeting tool11707is affixed to extension rod11705, anchor receiving features11717and11719may be positioned to direct one or more anchors into target locations on rod11701and/or within bone B.

Target tool11701may include guide segment11715. When targeting tool11701is affixed to extension rod11705, and extension rod is affixed to rod11701, guide segment11715may be positioned to direct tool11713into guide surface11305(shown inFIG. 113). Tool11713may be used to deploy implant11711inside bone B.

FIG. 118shows illustrative therapeutic scenario11800. Scenario11800shows extension rod11705affixed to rod11701. Rod11701is positioned inside bone B. Extension rod11705extends out of bone B. Scenario11800shows that when rod11701is positioned inside bone B, extension rod11705may be used to position tools11801and11803from an outside of bone B, relative to rod11701inside bone B. Scenario11800shows that when rod11701is positioned inside bone B, extension rod11705may be used to position tools11801and11803from an outside of bone B, relative to implant11711inside bone B.

For example, scenario11800shows that guide tube11801may be positioned within pass-through11805of extension rod11705. Pass-through11805may include one or more features of pass-through11605(shown inFIG. 116). Positioning guide tube11801within the pass-through may allow drill11803to be positioned within guide tube11801and be aligned with an anchor receiving feature of rod11701. For example, drill11803may create a pilot hole for an anchor that is received by anchor receiving feature11311(shown inFIGS. 113 and 115).

Extension rod11705may include pass-through11807. Pass-through11807may include one or more features of pass-through11603(shown inFIG. 116). Pass-through11807may position a drill or other tool relative to anchor receiving feature11309(shown inFIGS. 113 and 116). When positioned relative to anchor receiving feature11309, the drill may create a pilot hole for anchor11811. Pass-through11807may be used to position anchor11811.

FIG. 119shows illustrative therapeutic scenario11900. Scenario11900shows extension rod11907affixed to rod11903. Extension rod11907may include one or more features of extension rod11601(shown inFIG. 116). Rod11903may include one or more features of rod11301(shown inFIG. 116). Rod11903is positioned inside bone B. Extension rod11907extends out of bone B.

Scenario11900shows that when rod11903is positioned inside bone B, targeting tool11901may be affixed to extension rod11907. Targeting tool11901may be affixed to extension rod11907such that the targeting tools11901are positioned outside of bone B. When targeting tool11901is affixed to extension rod11907. Guide surfaces of targeting tool11901may be aligned with anchor receiving features, positioned inside bone B, of rod11903and/or implant11905.

Targeting tool11901may include one or more guide surfaces. For example, targeting tool11901may include guide surfaces that position tools11909,11915,11913,11911and11911. The one or more guide surfaces may direct a k-wire, anchor, drill, reamer wires, guide tubes or other tool into anchor receiving features of rod11903after rod11903is inside bone B. The one or more guide surfaces may direct a k-wire, anchor, drill, reamer, wires, guide tubes or other tool into anchor receiving features of implant11905after implant11905is inside bone B. Anchor receiving features of implant11905may include anchor receiving features in the implant tail of implant11905. Anchor receiving features of implant11905may include anchor receiving features in the implant head of implant11905.

Guide surfaces of targeting tool11901may be aligned with anchor receiving features of rod11903and/or implant11905when rod11701is positioned inside bone B, extension rod11705may be used to position tools11801and11803from an outside of bone B, relative to implant11711inside bone B.

FIG. 120shows rod12000. Rod12000may include one or more features of rod11301(shown inFIG. 113). Rod11301may include one or more features of rod12000.

Rod12000may be tubular. Rod12000may include rod body12006. Rod body12006may include a length that defines a cylindrical surface. For example, rod body12006may define cylindrical surface12010. Rod body12006may include a length that defines a cylindrical surface.

An outer surface of rod body12006may define axes LOS1and Lose. Axes LOS1and Lose may be parallel to a central longitudinal axis of rod12000.

Rod12000may include anchor receiving feature12005. Anchor receiving feature12005may define a first central longitudinal axis (not shown). The first central longitudinal axis may be oblique to the central longitudinal axis of rod12000. An anchor driven through anchor receiving feature12005may secure rod12000to a bone, such as bone B (shown inFIG. 115). An anchor may be driven through anchor receiving feature12005at an angle defined by the intersection of central longitudinal axis of anchor receiving feature12005and central longitudinal axis of rod12000.

Rod12000may include anchor receiving feature12003. Anchor receiving feature12003may define a second central longitudinal axis (not shown). The second central longitudinal axis may be oblique to a central longitudinal axis of rod12000. An anchor driven through anchor receiving feature12003may secure rod12000to a bone, such as bone B (shown inFIG. 115). An anchor may be driven through anchor receiving feature12003at an angle defined by the intersection of central longitudinal axis of anchor receiving feature12003and central longitudinal axis of rod12000.

A first planar surface (not shown) may include the first central longitudinal axis defined by anchor receiving feature12005. A second planar surface (not shown) may include the second central longitudinal axis defined by anchor receiving feature12003. The first planar surface may be parallel to the second planar surface.

The axes defined by anchor receiving features12005and12003may direct anchors into a bone at different angles with respect to a central longitudinal axis of rod12000. The axes defined by anchor receiving features12005and12003may direct anchors into a bone within parallel planar surfaces. Driving anchors into a bone at different angles and in parallel surfaces may decrease stress risers in the bone. The stress risers may be due to threaded engagement of the anchors with the bone.

An anchor may include a head. The head may not pass through anchor receiving feature12005or12003. The stress risers may be due to threaded engagement of the anchors with the bone and a bracing of the anchor head against an outer surface of rod12000. The stress risers may be due to threaded engagement of the anchors with the bone and a bracing of the anchor head against an outer surface of the bone.

Rod12000may include guide surface12001. A segment of rod12000that includes guide surface12001may be a guide segment. Guide surface12001may guide tools into the bone. Guide surface12001may guide tools into the bone through aperture12002. Guide surface12001may guide tools into the bone at an angle that is oblique to a central longitudinal axis of rod12000. Exemplary tools may include a k-wire, drill, reamer and/or implant. The drill may be any suitable drill, such as drill1501(shown inFIG. 15). The reamer may be any suitable reamer, such as reamer1601(shown inFIGS. 16-19). The implant may be any suitable implant, such as implant9720(shown inFIG. 97A).

Rod12000may include anchor receiving feature12007. Anchor receiving feature12007may define a third central longitudinal axis (not shown). The third central longitudinal axis may be oblique to a central longitudinal axis of rod12000. An anchor driven through anchor receiving feature12007may secure rod12000to the bone. The third central longitudinal axis may intersect the first and the second planar surfaces.

Rod12000may include anchor receiving feature12009. Anchor receiving feature12009may define a fourth central longitudinal axis (not shown). An anchor driven through anchor receiving feature12009may secure rod12000to the bone. The fourth central longitudinal axis may intersect the first and the second planar surfaces. The fourth central longitudinal axis may intersect the first and the second planar surfaces.

The fourth central longitudinal axis defined by anchor receiving feature12009may be parallel to the third central longitudinal axis defined by anchor receiving feature12007. The fourth central longitudinal axis defined by anchor receiving feature12009may intersect the third central longitudinal axis defined by anchor receiving feature12007.

Anchor receiving features12007and12009may receive anchors that secure rod12000to a bone. Anchor receiving features12007and12009may receive anchors that secure an implant to the bone. Anchor receiving features12007and12009may receive anchors that secure a tail of the implant to rod12000and the bone.

Rod12000may include elongated extension member12004. Extension member12004may include mating feature12011and mating feature12012. Mating features12011and12012may mate with corresponding mating features (not shown) in an extension rod (not shown). Mating features12011and12012may position the extension rod such that a central longitudinal axis of the extension rod is perpendicular to, or substantially perpendicular to, a central longitudinal axis of rod12000.

Rod12000include cannulated segment12014. Cannulated segment12014may be threaded. For example, a threaded tool (e.g., screw or extension rod) may be threadedly inserted into cannulated segment12014via aperture12013. A tool that engages cannulated segment12014may be positioned such a central longitudinal axis of the tool is parallel to, or substantially parallel to, a central longitudinal axis of rod12000.

Cannulated segment12014may have a width (or diameter) that is less than a width (or diameter) of rod12000. The difference in width (or diameter) may allow a tool to slide over cannulated segment12014without increasing an overall width (or diameter) of rod12000. A tool that slides over cannulated segment12014may also threadedly engage cannulated segment12014via aperture12013.

Elongated extension member12004may include anchor receiving feature12017. Anchor receiving feature12017may be configured to receive an anchor that locks rod12000to an extension rod (not shown). Anchor receiving feature12017may be threaded.

An extension rod may include mating features that mate with mating feature12011and/or mating feature12012. For example, mating features12011and12012may include depressions in a surface of rod12000. An extension rod may include one or more protrusions that fit into the depressions. When mating features of an extension rod are joined to mating features12011and12012, a guide surface of the extension rod may be positioned over anchor receiving feature12017. An anchor may be driven through the extension rod into anchor receiving feature12017and securely affixed the extension rod to rod12000.

A force, applied to the extension rod may drive rod12000into the bone. The extension rod may be disengaged from rod12000after rod is12000is positioned in the bone. Mating features12011and12012may mitigate a risk of deforming rod12000when applying the force to the extension rod and inserting rod12000into the bone.

FIG. 121shows another view of rod12000.FIG. 121shows that elongated extension member12004may include an outer surface area that is less than an outer surface area of rod body12006. For example, rod body12006may define a cylindrical surface. In some embodiments, rod body12006may define a cylindrical surface.

Rod body12006may have an outer surface area that is larger than an outer surface area of elongated extension member12004. Less outer surface area may provide elongated extension member12004with clearance for tools inserted into a bone via guide surface12001and aperture12002.

Clearance may include space for an expandable implant to fully expand inside the bone. Clearance may include space for an expandable implant to fully expand inside the bone. Clearance may include space for an expandable implant to fully expand inside the bone when the implant is inserted into the bone at an angle, relative to a longitudinal axis of the bone, defined by guide surface12001. Clearance may include space for an expandable implant to be therapeutically positioned within the bone. A therapeutic position for an implant may include a position, within the bone, that allows a practitioner to repair a fracture of the bone by securing one or more segments of the bone to the implant.

FIG. 121shows that cannulated segment12014is spaced apart from aperture12012by a length of elongated member12004.FIG. 121shows that cannulated segment12014may include an outer surface area that is larger than an outer surface area of elongated extension member12004.FIG. 121also shows that cannulated segment12014may include an outer surface area that is smaller than an outer surface area of rod body12006.

FIG. 122shows another view of rod12000.FIG. 122shows that rod body12006defines outer surface axes LOS3and LOS4. Guide surface12001(shown inFIG. 120) may form angle α with axis LOS3. A slope of guide surface12001may be defined by tan(α). Ring-shaped segment12201may bridge between guide surface12001and elongated extension member12004. Ring-shaped segment12201may form angle β with LOS3. A central longitudinal axis (not shown) of rod12000may pass through ring-shaped segment12201.

FIG. 122shows clearance axis LC1. Axis LC1may be an extension of outer surface axis LOS4defined by rod body12006. Ring-shaped segment12201may define angle γ with clearance axis LC1. Angle γ may be different from angle β. Angle γ may be equal to angle β.

Clearance axis LC1may represent space for positioning of a tool (e.g., drill or implant) inside a bone. Axis LC1may be parallel to an outer surface axis LOS.FIG. 122also shows clearance axis LC2. Clearance axis LC2may also represent space for positioning of a tool (e.g., drill or implant) inside a bone. LC1, LC2and an inner surface of extension member12004may collectively define a clearance plane PCfor positioning of a tool (e.g., drill or implant) inside a bone. Clearance plane PCmay provide space for positioning the tool inside a bone after the tool is inserted into the bone via aperture12002defined by ring-shaped element12201.

After rod12301is affixed to extension rod12303, a force may be applied to extension rod120303. The force may drive rod12301into bone B. The force may drive rod12301into bone B without deforming rod12301. Scenario12300shows that rod12301may be driven into bone B through an articular surface of bone B.

After rod12301is positioned inside bone B, a first length of extension rod12303may be positioned inside bone B. After rod12301is positioned inside bone B, a second length of extension rod12303may be positioned outside bone B.

Targeting tools may be affixed to the second length of extension rod12303that extends outside of bone B. Scenario12300shows targeting tool12307affixed to extension rod12303. Targeting tool may be a jig that includes apertures and guide surfaces. The apertures and guide surface may direct tools (e.g., drill, reamer, k-wire, guide tube, anchor) into targeted positions on rod12301. Such targeted positions may include anchor receiving features in rod12301.

For example, scenario12300shows tools12315and12317passing through aperture12311, through bone B and into an anchor receiving feature of rod12301. Scenario12300also shows tools12321and12323passing through aperture12319, through bone B and into an anchor receiving feature of rod12301.

Targeting tool12307may include aperture12313. Aperture12313and an associated guide surface (not shown) may direct tools through bone B and on to guide surface12305. Guide surface12305may include one or more features of guide surface12001(shown inFIG. 120).

Targeting tool12307may include apertures12309. Apertures12309may be associated with guide surfaces that direct tools into bone B. Apertures12309may be associated with guide surfaces that direct tools into an implant positioned inside bone B. Apertures12309may be associated with guide surfaces that direct tools into rod12301after rod12301is positioned inside bone B.

Extension rod12303may be removed from bone B after rod12301is secured to bone B. Extension rod12303may be removed from bone B after a fracture in bone B has been repaired.

Implant12403may pass through aperture12313and aperture12002(shown inFIG. 120) in a collapsed state. Implant12403may be expanded inside bone B. Elongated extension member12302of rod12301may provide clearance for expansion of implant12403inside bone B. Elongated extension member12302of rod12301may provide clearance for positioned of collapsed or expanded implant12403inside bone B.

Anchor12405may pass through a tail of implant12403. Anchor12405may be directed into implant12403and rod12301using guide surfaces associated with one or more of apertures12309in target tool12307. Anchor12409may be directed into bone B and into rod12301using a guide surface associated with aperture12311. Anchor12407may be directed into bone B and into rod12301using a guide surface associated with aperture12319.

Apparatus12500may include an elongated member removably coupled to the implant. The elongated member may include sleeve12505, anchoring base12507and end12511. End12511may be tapered.

Anchoring base12507may include a hollow mesh structure defining a plurality of openings12509. Anchoring base12507may extend between sleeve12505and end12511.

Openings12509may be sized to receive anchors for fixing anchoring base12507to a bone B. The anchors may be screws. A practitioner may drive a screw into anchoring base12507without using a jig to register the anchor to an opening12509.

Apparatus12500may be positioned in a bone. Apparatus12500may be positioned in a shaft of a bone. Apparatus12500may be positioned along a neck of a bone such that the implant head extends into a head of the bone. Apparatus12500may be positioned in any other suitable location in a bone.

FIG. 126shows a cross-sectional view of apparatus illustrated inFIG. 125taking along lines126-126.FIG. 126shows implant tail12603positioned in sleeve12505.FIG. 126also shows threaded member12601fixed to sleeve12505. Threaded member12601extends along a sleeve longitudinal axis and is spaced radially apart from the sleeve12505to define an annular space. Tail12603is seated in the annular space. Threaded member12601is shown engaged with an inner threaded portion of tail12603to couple the elongated member to the implant.

Apparatus12700may include an elongated member removably coupled to the implant. The elongated member may include sleeve12707. InFIG. 127, sleeve12707is illustrated as transparent to show implant tail12705and threaded member12715positioned in sleeve12707.

The elongated member may include threaded member12715. Threaded member12715may be fixed to the sleeve and extend along a sleeve longitudinal axis. Threaded member12715may be spaced radially apart from sleeve12707to define an annular space.

The elongated member may include end12713and an anchoring base extending between sleeve12707and end12713. The anchoring base may define slots12709and12711. End12713may be tapered.

Apparatus12700may be positioned in a bone. Apparatus12700may be positioned in a shaft of a bone. Apparatus12700may be positioned along a neck of a bone such that the implant extends into a head of the bone. Apparatus12700may be positioned in any other suitable location in the bone.

FIG. 128shows a cross-sectional view of apparatus illustrated inFIG. 127taking along lines128-128.FIG. 128shows threaded member12715engaged with an inner threaded portion of tail12705to couple the elongated member to the implant.

FIG. 129shows illustrative apparatus12901positioned in bone B. Apparatus12901may include first implant head12905and first implant base12915coupled to first implant head12905. Apparatus12901may include second implant head12907and second implant base12913coupled to second implant head12907. First implant head12905may have one or more features in common with the implant head. Second implant head12907may have one or more features in common with the implant head.

First implant head12905may be expandable. Second implant head12907may be expandable. One or both of implant head12905and12907may be expanded in bone B. One or both of implant head12905and12907may be expanded prior to positioning in bone B. One or both of implant head12905and12907may not be expandable.

First implant head12905and second implant head12907may self-expand in the bone after being removed from a sheath. First implant head12905and second implant head12907may be manually expandable. A practitioner may insert apparatus12901in the bone prior to expansion of first implant head12905and second implant head12907. A practitioner may insert apparatus12901in the bone after the expansion of first implant head12905and/or second implant head12907.

First implant head12905may have a first volume. Second implant head12907may have a second volume. The first volume may be equal to the second volume. A shape defined by an outer face of first implant head12905may be the same as, or different from, a shape defined by an outer face of second implant head12907.

Apparatus12901may include shaft12909. Shaft12909may be straight. Shaft12909may include one or more bent sections (not shown) to position implant head12905and implant head12907in desirable anatomical positions in a bone.

Shaft12909may be an implant tail. Shaft12909may be an intramedullary rod. Shaft12909may be a cannulated tube. Shaft12909may be a solid tube.

Shaft12909may extend between first implant base12915and second implant base12913. Shaft12909may couple the first implant head12905to second implant head12907. A first end of shaft12909may be coupled to first implant base12915. A second end of shaft12909may be coupled to second implant base12915. Shaft12909may be rigidly coupled to one or both of first implant base12915and second implant base12913. Shaft12909may be configured to be coupled to one or both of first implant base12915and second implant base12913by threads, snap-fit, friction fit, or any other suitable attachment mechanism described herein or known to those skilled in the art.

Shaft12909may define one or both of holes12911. Shaft12909may define additional holes extending through shaft12909. Holes12911may be sized to receive an anchor such as a screw. Shaft12909may define a mesh structure extending circumferentially around some or all of a central axis of shaft12909. Shaft12909may define one or more slots.

FIG. 130shows illustrative apparatus13001positioned in bone B. Apparatus13001may include first implant head13003and second implant head13005. First implant head13003may have one or more features in common with the implant head. Second implant head13005may have one or more features in common with the implant head.

First implant head13003may be expandable. Second implant head13005may be expandable. First implant head13003and second implant head13005may self-expand in bone B after being removed from a sheath. First implant head13003and second implant head13005may be manually expandable. A practitioner may insert apparatus13001in bone B prior to expansion of first implant head13003and second implant head13005. A practitioner may insert apparatus13001in bone B after expansion of first implant head13003and/or second implant head13005.

Base13007may be a first base. Base13007be rigidly fixed to first implant head13003. Second implant head13005may be rigidly fixed to a second base. The second base may be coupled to an inner face of base13007by threads, snap fit, friction fit, or any other suitable attachment mechanism described herein or known to those skilled in the art.

A practitioner may advance one or more screws into first implant head13003and second implant head13005. A practitioner may advance screws into one or both of first and second implant heads without using a jig.

FIG. 131shows illustrative apparatus13100positioned in bone B. Apparatus13100may include implant head13103. Implant head13103may have one or more features in common with the implant head. Implant head13103may be expandable. Implant head13103may be expanded in bone B. Implant head13103may be expanded prior to positioning in bone B. Implant head13101may be advanced, in an unexpanded state, through rod13101after rod13101is implanted in bone B and subsequently expanded in bone B. Implant head13103may not be expandable.

Apparatus13100may include member13101. Member13101may be an intramedullary rod13101. Intramedullary rod13101may be coupled to, and extend away from, implant head13103. Intramedullary rod13101may be cannulated. An end of intramedullary rod13101may be coupled to implant head13103. The end of intramedullary rod1310may define an opening in which implant head13101is seated. A portion of implant head13103may be positioned in intramedullary rod13101. A portion of an implant base fixed to implant head13103may be positioned in intramedullary rod13101. An implant base fixed to implant head13103may be positioned in intramedullary rod13101. A portion of an implant tail fixed to implant head13103may be positioned in intramedullary rod13101. An implant tail fixed to implant head13103may be positioned in intramedullary rod13101.

Implant head13103and intramedullary rod13101may be, together, monolithic. Implant head13103may be fixedly coupled to intramedullary rod13101. Implant head13103may be removably coupled to intramedullary rod13101. A portion of rod13101may extend through implant head13103. An end of rod13101may mate with an end of implant head13103.

Implant head may be configured to be coupled to intramedullary rod13101by threads, snap fit, friction fit, or any other suitable attachment mechanism described herein or known to those skilled in the art. Intramedullary rod13101may be cannulated. Coupling implant head13103to rod13101may include positioning implant head13103, the implant base and/or the implant tail in the cannula. Intramedullary rod13101may define an opening. Coupling implant head13103to rod13101may include positioning implant head13103, the implant base and/or the implant tail in the opening.

Implant head13103may extend away from a base. The base may be fixedly coupled to intramedullary rod13101. The base may be configured to be coupled to intramedullary rod13101by threads, snap fit, friction fit, or any other suitable attachment mechanism described herein or known to those skilled in the art. Intramedullary rod13101may be cannulated. Coupling the base to rod13101may include positioning the base in the cannula. Intramedullary rod13101may define an opening. Coupling the base to rod13101may include positioning the base in the opening.

Implant head13103may include an implant tail. The implant tail may pass through the intramedullary rod. The implant tail may be fixedly coupled to the intramedullary rod. The implant tail may be unitary with the intramedullary rod. The tail may be configured to be coupled to intramedullary rod13101by threads, snap fit, friction fit, or any other suitable attachment mechanism described herein or known to those skilled in the art.

Implant head13103may be coupled to rod13101using apparatus and methods illustrated and described in reference the elongated member including the sleeve. Rod13101may include the sleeve and the threaded member extending along a central axis of the rod. Implant head13103may be coupled to rod13101using apparatus and methods illustrated and described in reference toFIG. 125. Implant head13103may be coupled to rod13101using apparatus and methods illustrated and described in reference toFIG. 127.

Implant head13103may be coupled to a distal end of a screw. The screw may pass through the intramedullary rod. The screw may be fixedly coupled to an end cap positioned on an end of the intramedullary rod opposite the end of the rod to which implant head13103is coupled. The screw may be unitary with the intramedullary rod.

Member13101may be the implant tail. Member13101may be the implant shaft. Member13101may be the implant tail coupled to the implant shaft. Member13101may be a screw. A portion of implant head13103may be positioned in the screw.

A practitioner may advance one or more screws into implant head13103. A practitioner may advance screws into implant head13103without using a jig. A practitioner may anchor a distal end of a screw in a head of bone B by advancing the distal end of the screw into implant head13103.

FIG. 132shows illustrative apparatus13200positioned in bone B. The apparatus may include implant head13203(mesh structure not shown). Implant head13203may have one or more features in common with the implant head. Implant head13203may be expandable. Implant head13203may be expanded in bone B. Implant head13203may be expanded prior to positioning in bone B. Implant head13203may not be expandable.

Intramedullary rod13201may have one or more features in common with intramedullary rod13101. Intramedullary rod13201may be coupled to implant head13203. The coupling of implant head13203to rod13201may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

FIG. 132also shows illustrative fixation members13205and13207. Fixation member13205may be a screw. Fixation member13207may be a screw. Fixation members13205and13207are shown extending through a neck of bone B and into a head of bone B. A distal end of fixation member13205is anchored in implant head13203. A distal end of fixation member13207is anchored in implant head13203.

FIG. 133shows illustrative apparatus13300including intramedullary rod13301positioned in bone B. Apparatus13300may also include implant head13303(mesh structure not shown). Implant head13303may be fixedly coupled to an end of intramedullary rod13303. Implant head13303may be coupled to an end of intramedullary rod13303.

Implant head13303may have one or more features in common with the implant head. Implant head13303may be expandable. Implant head13303may be expanded prior to positioning in bone B. Implant head may be expanded in bone B. Implant head13303may not be expandable.

Intramedullary rod13303may have one or more features in common with intramedullary rod13101. Intramedullary rod13303may be coupled to implant head13301. The coupling of implant head13301to rod13303may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Implant head13303may have an outer face shaped in the pseudo-conical shape illustrated inFIG. 133.

Implant head13303may be positioned adjacent an articular surface of bone B. A shape of implant head13303may support an articular surface of bone B.

Implant head13303may be coupled to a first end of rod13303. Rod13303may include a second implant head (not shown) coupled to a second end of rod13303, opposite the first end. Rod13303may include one or more additional implant heads (not shown) coupled to rod13303along a length of rod13303.

FIG. 134shows illustrative apparatus13400positioned in bone B. Apparatus13400may include implant head13403. Implant head13403may have one or more features in common with the implant head. Implant head13403may be expandable. Implant head13403may be expanded inside bone B. Implant head13403may be expanded prior to positioning in bone B. Implant head13403may not be expandable.

Apparatus13400may include intramedullary rod13401. Intramedullary rod13401may have one or more features in common with intramedullary rod13101. Intramedullary rod13401may be coupled to implant head13403. The coupling of implant head13403to rod13401may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Apparatus13400may include plate13405. A bottom surface of plate13405may be positioned on bone B. Rod13401may extend through plate13405. Rod13401may extend through an opening in plate13405, rod13401may fixed to plate13405, and rod13401may be coupled to plate13404in any other suitable way using known apparatus and methods. Rod13401and plate13405may together be monolithic. Bi-cortical screws13407may be advanced through plate13405and across a width of a shaft of bone B.

FIG. 135shows illustrative apparatus13500positioned in bone B. Apparatus13500may include implant head13507. Implant head13507may have one or more features in common with the implant head. Implant head13507may be expandable. Implant head13507may be expanded inside bone B. Implant head13507may be expanded prior to positioning in bone B. Implant head13507may not be expandable.

Apparatus13500may include intramedullary rod13503. Intramedullary rod13503may have one or more features in common with intramedullary rod13101. Intramedullary rod13503may be coupled to implant head13507. The coupling of implant head13507to rod13503may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Apparatus may include intramedullary rod13501. Intramedullary rod13501may be extend through an opening in intramedullary rod13503and be fixed to rod13503using one or more screws, intramedullary rod13501may be fixedly attached to rod13503, and intramedullary rod13501may be coupled to intramedullary rod13503in any other suitable way known apparatus and methods.

Bone B may be a femur bone. A first end of rod13501may be positioned adjacent a greater trochanter of the femur. A length of rod13501may extend along a length of the femur. A second end of rod13501may be positioned in a femur shaft. Implant head13507may be positioned in a head of the femur. Rod13101may extend along a neck of the femur.

FIG. 136shows illustrative apparatus positioned in bone B. Apparatus13600may include implant head13607(mesh structure not shown). Implant head13607may have one or more features in common with the implant head. Implant head13607may be expandable. Implant head13607may be expanded inside bone B. Implant head13607may be expanded prior to positioning in bone B. Implant head13607may not be expandable.

Apparatus13600may include intramedullary rod13603. Intramedullary rod13603may have one or more features in common with intramedullary rod13101. Intramedullary rod13603may be coupled to implant head13607. The coupling of implant head13607to rod13603may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Bone B may be a femur bone. A first end of rod13601may be positioned adjacent a greater trochanter of the femur. A length of rod13601may extend along a length of the femur. A second end of rod13601may be positioned in the femur shaft. Implant head13607may be positioned in a head of the femur and extend along a neck of the femur.

FIG. 137shows illustrative apparatus13700for implanting into a bone such as a humerus, a femur, or any other suitable bone in the body. Apparatus13700may include implant head13705(mesh structure not shown). Implant head13705may have one or more features in common with the implant head. Apparatus13700may include implant head13707(mesh structure not shown). Implant head13707may have one or more features in common with the implant head.

Apparatus13700may include intramedullary rod13703. Intramedullary rod13703may have one or more features in common with intramedullary rod13101. Intramedullary rod13703may be coupled to implant head13705. The coupling of implant head13705to rod13703may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above. Intramedullary rod13703may be coupled to implant head13707. The coupling of implant head13707to rod13703may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

FIG. 138shows illustrative apparatus13800for implanting into a bone such as a humerus, a femur, or any other suitable bone in the body. Apparatus13800may include implant head13805(mesh structure not shown). Implant head13805may have one or more features in common with the implant head. Implant head13805may include a first sphere-shaped portion13807and a second cylindrically-shaped portion13809.

Apparatus13800may include intramedullary rod13803. Intramedullary rod13803may have one or more features in common with intramedullary rod13101. Intramedullary rod13803may be coupled to implant head13805. The coupling of implant head13805to rod13803may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

FIG. 139shows illustrative apparatus13900positioned in bone B. Apparatus13900may include implant head13905(mesh structure not shown). Implant head13905may have one or more features in common with the implant head. Implant head13905may be expandable. Implant head13905may be expanded inside bone B. Implant head13905may be expanded prior to positioning in bone B. Implant head13905may not be expandable.

Apparatus13900may include intramedullary rod13903. Intramedullary rod13903may have one or more features in common with intramedullary rod13101. Intramedullary rod13903may be coupled to implant head13905. The coupling of implant head13905to rod13903may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Apparatus may include intramedullary rod13901. Intramedullary rod13901may be coupled to intramedullary rod13903as described atFIG. 135, above. Rod13901may define first hole13911and second hole13913. First hole13911may define a central axis that points to implant head13905. Second hole13913may define a central axis that points to implant head13905. When implant head13905has not yet been expanded, first hole13911and second hole13913may each point to a volume that will be occupied by implant head13905when expanded in bone B.

A distal tip of fixation element13909, when advanced through first hole13911and into a head of bone B, may be anchored in implant head13905. A distal tip of fixation element13907, when advanced through second hole13913and into a head of bone B, may be anchored in implant head13905.

FIG. 140shows illustrative apparatus14000for implanting into a bone such as a humerus, a femur, or any other suitable bone. Apparatus14000may include implant head14005(mesh structure not shown). Implant head14005may have one or more features in common with the implant head. Implant head14005may be expandable. Implant head14005may be expanded inside the bone. Implant head14005may be expanded prior to positioning in the bone. Implant head14005may not be expandable. Apparatus14000may include intramedullary rod14003. Intramedullary rod14003may have one or more features in common with intramedullary rod13101. Intramedullary rod14003may be coupled to implant head14005. The coupling of implant head14005to rod14003may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Apparatus may include intramedullary rod14001. Intramedullary rod14001may be coupled to intramedullary rod14003as described atFIG. 135, above. Rod14001may define hole14009. Hole14009may define a central axis that points to implant head14005. When implant head14005has not yet been expanded, hole14009may point to a volume that will be occupied by implant head14005when expanded in the bone. A distal tip of fixation element14007, when advanced through first hole14009and into the bone, may be anchored in implant head14005.

FIG. 141shows illustrative apparatus14100for implanting into a bone such as a humerus, a femur, or any other suitable bone. Apparatus14100may include implant head14105(mesh structure not shown). Implant head14105may have one or more features in common with the implant head. Implant head14105may be expandable. Implant head14105may be expanded inside the bone. Implant head14105may be expanded prior to positioning in the bone. Implant head14105may not be expandable. Apparatus14100may include intramedullary rod14103. Intramedullary rod14103may have one or more features in common with intramedullary rod13101. Intramedullary rod14103may be coupled to implant head14105. The coupling of implant head14105to rod14103may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Apparatus may include intramedullary rod14101. Intramedullary rod14101may be coupled to intramedullary rod14103as described atFIG. 135, above. Rod14101may define hole14109. Hole14109may define a central axis that points to implant head14105. When implant head14105has not yet been expanded, hole14109may point to a volume that will be occupied by implant head14105when expanded in the bone. A distal tip of fixation element14107, when advanced through first hole14109and into the bone, may be anchored in implant head14105.

FIG. 142shows illustrative apparatus14200for implanting into a bone such as a humerus, a femur, or any other suitable bone. Apparatus14200may include implant head14205(mesh structure not shown). Implant head14205may have one or more features in common with the implant head. Implant head14205may be expandable. Implant head14205may be expanded inside the bone. Implant head14205may be expanded prior to positioning in the bone. Implant head14205may not be expandable. Apparatus14200may include intramedullary rod14203. Intramedullary rod14203may have one or more features in common with intramedullary rod13101. Intramedullary rod14203may be coupled to implant head14205. The coupling of implant head14205to rod14203may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Apparatus may include intramedullary rod14201. Intramedullary rod14201may be coupled to intramedullary rod14203as described atFIG. 135, above. Rod14201may define a hole (not shown). The hole may define a central axis that points to implant head14205. When implant head14205has not yet been expanded, the hole may point to a volume that will be occupied by implant head14205when expanded in the bone. A distal tip of fixation element14207, when advanced through first hole14209and into the bone, may be anchored in implant head14205.

FIG. 143shows illustrative apparatus14300or implanting into a bone such as a humerus, a femur, or any other suitable bone. Apparatus14300may include implant head14305(mesh structure not shown). Implant head14305may have one or more features in common with the implant head. Implant head14305may be expandable. Implant head14305may be expanded inside the bone. Implant head14305may be expanded prior to positioning in the bone. Implant head14305may not be expandable. Apparatus14300may include intramedullary rod14303. Intramedullary rod14303may have one or more features in common with intramedullary rod13101. Intramedullary rod14303may be coupled to implant head14305. The coupling of implant head14305to rod14303may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Apparatus may include intramedullary rod14301. Intramedullary rod14301may be coupled to intramedullary rod14303as described atFIG. 135, above. Rod14301may define first hole14311and second hole14313. First hole14311may define a central axis that points to implant head14305. Second hole14313may define a central axis that points to implant head14305. When implant head14305has not yet been expanded, first hole14311and second hole14313may each point to a volume that will be occupied by implant head14305when expanded in bone B. A distal tip of fixation element14309, when advanced through first hole14311and into the bone, may be anchored in implant head14305. A distal tip of fixation element14307, when advanced through second hole14313and into the bone, may be anchored in implant head14305.

FIG. 144shows illustrative apparatus14400positioned in bone B. Apparatus14400may include implant head14405(mesh structure not shown). Implant head14405may have one or more features in common with the implant head. Implant head14405may be expandable. Implant head14405may be expanded inside the bone. Implant head14405may be expanded prior to positioning in the bone. Implant head14405may not be expandable. Apparatus14400may include intramedullary rod14403. Intramedullary rod14403may have one or more features in common with intramedullary rod13101. Intramedullary rod14403may be coupled to implant head14405. The coupling of implant head14405to rod14403may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above. Apparatus may include intramedullary rod14401. Intramedullary rod14401may be coupled to intramedullary rod14403as described atFIG. 135, above. Rod14401may define one or more holes at an end of rod14401. Screws14407may pass through the holes at the end of rod14401. Bone B may be a femur bone. A length of intramedullary rod14401may extend along a length of the femur bone.

FIG. 145shows illustrative apparatus14500positioned in bone B. Apparatus14500may include implant head14505(mesh structure not shown). Implant head14505may have one or more features in common with the implant head. Implant head14505may be expandable. Implant head14505may be expanded inside the bone. Implant head14505may be expanded prior to positioning in the bone. Implant head14505may not be expandable. Apparatus14500may include intramedullary rod14503. Intramedullary rod14503may have one or more features in common with intramedullary rod13101. Intramedullary rod14503may be coupled to implant head14505. The coupling of implant head14505to rod14503may have one or more features in common with the coupling of intramedullary rod13101to implant head13103as described atFIG. 131, above.

Apparatus14500may include intramedullary rod14501. Intramedullary rod14501may be coupled to intramedullary rod14503as described atFIG. 135, above. Apparatus14500may include implant head14507(mesh structure not shown). Implant head14507may have one or more features in common with the implant head. Implant head14507may be expandable. Implant head14507may be expanded inside the bone. Implant head14507may be expanded prior to positioning in the bone. Implant head14507may not be expandable. Intramedullary rod14501may have one or more features in common with intramedullary rod13101. Intramedullary rod14501may be coupled to implant head14507. The coupling of implant head14507to rod14501may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above. One or more bi-cortical screws14509may pass through bone B and implant head14507. One or more bi-cortical screws14509may pass through bone B, implant head14507and rod14501. One or more screws14509may pass through bone B and implant head14507. One or more screws14509may pass through bone B, implant head14507and rod14501.

Bone B may be a femur bone. A length of intramedullary rod14501may extend along a length of the femur bone. Implant head14507may be positioned adjacent lateral and/or medial epicondyles of the femur bone.

FIG. 146shows illustrative apparatus14600for positioning in a bone such as a femur, a humerus, or any other suitable bone. Apparatus14600may include implant head14605(mesh structure not shown), implant head14607(mesh structure not shown) and implant head14609(mesh structure not shown). Implant heads14605,14607and14609may each have one or more features in common with the implant head. One or more of implant heads14605,14607and14609may be expandable. One or more of implant heads14605,14607and14609may be expanded inside the bone. One or more of implant heads14605,14607and14609may be expanded prior to positioning in the bone. One or more of implant heads14605,14607and14609may not be expandable.

Apparatus14600may include intramedullary rod14603. Intramedullary rod14603may have one or more features in common with intramedullary rod13101. Intramedullary rod14603may be coupled to implant head14605. The coupling of implant head14605to rod14603may have one or more features in common with the coupling of intramedullary rod13101to implant head13103as described atFIG. 131, above. Apparatus14600may include intramedullary rod14601. Intramedullary rod14601may be coupled to intramedullary rod14603as described atFIG. 135, above. Intramedullary rod14601may have one or more features in common with intramedullary rod13101. Intramedullary rod14601may be coupled to implant head14607and implant head14609. The coupling of implant head14607to rod14607and14609may have one or more features in common with the coupling of intramedullary rod13101to implant head13103described atFIG. 131, above.

Screws14611may be advanced through implant head14609. Screws14611may be advanced through implant head14609and rod14601. Additional screws (not shown) may be advanced through implant head14607and implant head14605. One or more screws may be advanced through both implant head14607and implant head14605.

FIG. 147shows illustrative implant14701including implant head14705and implant tail14703positioned in a bone B. Implant14701may have one or more features in common with the implant. Implant head14705may have one or more features in common with the implant head. Implant tail14703may have one or more features in common with the implant tail.

Bone B may be a calcaneus. Access site ‘1’ may be used by a practitioner to access the interior of the calcaneus. Access site ‘1’ may be positioned at a posterior portion of the calcaneus. Access site ‘1’ may be below the Achilles' tendon termination. Access site ‘1’ may be a primary access site. A practitioner may form a secondary access site on a lateral side of a posterior facet of the calcaneus bone. The secondary access site may be access site ‘2’. The secondary access site may be used by the practitioner to visualize the sinus relative to the talus. Implant head14705may be positioned in the calcaneus and expanded such that first portion14707of implant head14705is adjacent a sinus tarsi space. Implant head14705may be positioned in the calcaneus and expanded such that a second portion14709of implant head14705is adjacent a distal facet of the calcaneus. The distal facet may be a bottom surface of the calcaneus. The distal facet may be a sole of the foot.

FIG. 148shows illustrative implant14801including implant head14805and implant tail14803positioned in a bone B. Implant14801may have one or more features in common with the implant. Implant head14805may have one or more features in common with the implant head. Implant tail14803may have one or more features in common with the implant tail.

Bone B may be a calcaneus. Access site ‘1’ may be used by a practitioner to access the interior of the bone. Access site ‘1’ may be located at a posterior heel location on the calcaneus. Access site ‘1’ may be formed through a split made in the Achilles' tendon. Access site ‘1’ may be a primary access site. A practitioner may form a secondary access site on a lateral side of a posterior facet of the calcaneus bone. The secondary access site may be access site ‘2’. The secondary access site may be used by the practitioner to visualize the sinus relative to the talus. Implant head14805may be positioned in the calcaneus and expanded such that a portion14807of implant head14805is adjacent the distal facet of the calcaneus.

FIG. 149shows illustrative implant14901including implant head14905and implant tail14903positioned in a bone B. Implant14901may have one or more features in common with the implant. Implant head14905may have one or more features in common with the implant head. Implant tail14903may have one or more features in common with the implant tail.

Bone B may be a calcaneus. Access site ‘1’ may be used by a practitioner to access the interior of the bone. Access site ‘1’ may be formed through the distal facet of the calcaneus. The implant, when placed in the calcaneus, may define a central axis. The central axis may be perpendicular to the distal facet. Access site ‘1’ may be a primary access site. A practitioner may form a secondary access site on a lateral side of a posterior facet of the calcaneus bone. The secondary access site may be access site ‘2’. The second access site may be used by the practitioner to visualize the sinus relative to the talus. Implant head14905may be positioned in the calcaneus and expanded such that hub14907of implant head14905is adjacent the talus.

FIG. 150shows a cross-sectional view of illustrative apparatus15000. Apparatus15000may be implanted in the calcaneus or any other suitable bone. Apparatus15000may include first mesh15001and second mesh15003. First mesh15001may define a longitudinal axis and may be expandable about the axis. Second mesh15003may be expandable about the axis between the axis and first mesh15001.

First mesh15001and second mesh15003may together form the implant head of the implant. First mesh15001and second mesh15003may be configured to be longitudinally fixed to a central axis member that lies along the axis.

First mesh15001may have a first thickness. Second mesh15003may have a second thickness greater than the first thickness. The first thickness may be in the range 0.010 in. to 0.020 in. The second thickness may be in the range of 0.015 in. to 0.040 in.

First mesh15001may have a first stress-strain modulus corresponding to compression of the first mesh along a direction not parallel to the axis. Second mesh15003may have a second stress-strain modulus corresponding to compression of the second mesh along the direction. The second modulus may be greater than the first modulus.

First mesh15001may have a tear-drop shape. Second mesh15003may have a bulbous shape that has a shorter length, along a central axis of the implant, than first mesh15001.

FIG. 151shows illustrative apparatus15100. Apparatus15100may be implanted in the calcaneus bone or any other suitable bone. Apparatus15100may include a first mesh cage15101(mesh not shown), second mesh cage15103(mesh not shown), first elongated member15105and second elongated member15107.

First mesh cage15101may have one or more features in common with the implant head. Second mesh cage15103may have one or more features in common with the implant head.

FIG. 152shows illustrative apparatus15200. Apparatus15200may be implanted in the calcaneus or any other suitable bone. The apparatus may include mesh cage15201. Mesh cage15201may have one or more features in common with the implant head. Mesh cage15201may be expandable. Mesh cage15201may not be expandable. Mesh cage may extend between hub15211and base15213.

Mesh cage15203may include first bulbous section15201, second bulbous section15205and tapered section15207. Tapered section may define an outside diameter less than an outside diameter of implant base15209.

A side profile of mesh cage15201may differ from the front profile of mesh cage15201illustrated inFIG. 152.

FIG. 153shows illustrative apparatus15300. Apparatus15300may include implant head15301and implant tail15305. Implant head15301may have one or more features in common with the implant head. Implant tail may have one or more features in common with the implant tail. Implant head15301may be fixed to an end of central axis member15303. Implant head15301may be expandable.

Implant head15301may be manually expanded from a collapsed state to an expanded state. Implant head15301may self-expand to a first volume. Implant head15301may be manually expanded from the first volume to a second volume. Implant head15301may be manually expanded by insertion of rod15307into implant tail15305. Rod15307may have an inner threaded portion configured to mate with externally threaded end15309. When the inner threaded portion of rod15307mates with threaded end15309of central axis member15303and the rod15307is turned, central axis member15303may be advanced towards implant tail end15311. As central axis member15303advances towards end15311, implant head15301may be expanded.

Implant tail15305may be smooth. The smooth tail may allow for micromovement of the implant.

FIG. 154shows a cross-sectional view of the implant shown inFIG. 153taken along lines154-154. The cross-sectional view does not include rod15307.

Implant head15502may have one or more features in common with the implant head. Elongated support15504may have one or more features in common with central axis member15303(shown inFIG. 153). Implant tail15506may have one or more features in common with the implant tail.

Implant tail15506may include anchor receiving hole15510.

Elongated support15504may engage implant head15502at hub15508. Support15504may be engaged with hub15508prior insertion of implant head15502in a bone. For example, support15504may be engaged with hub15508at a factory or by a physician in a clinical setting. Support15504may be engaged with hub15508after insertion of implant head15502in a bone. For example, implant head15502may be placed in the bone and self-expanded or be expanded by an actuator.

A practitioner may select implant head15502from two or more implant heads, each head, when expanded, defining a different volume. A practitioner may select elongated support15506from two or more elongated supports, each elongated support defining a different length. A practitioner may select implant tail15506for coupling to elongated support15506. The practitioner may select implant tail15506from a group of implant tails, each implant tail having a different length and/or defining a different angle.

Implant head15502may not be expanded when a practitioner couples implant head15502to elongated support15502. Implant head15502may be expanded when a practitioner couples implant head15502to elongated support15502.

FIG. 156shows in partial cross section a partial view of illustrative implant assembly15600that may have one or more features in common with assembly15500(shown inFIG. 155). Implant head15602may include expandable mesh15604(shown schematically). Implant head15602may have one or more features in common with the implant head. Implant head15604may be fixed to base15608. Base15608may define opening15610. Opening15610may receive elongated support15612. Implant tail15614may extend from elongated support15612. Implant tail15614may have one or more features in common with the implant tail.

Bushing15616may provide clearance for threaded rod15618. Rod15618may threadingly engage axial member15620. Threaded rod15618may adjust an axial gap (not shown) between bushing15616and axial member15620. The axial gap may be changed to change the extent of expansion of mesh15604. Threaded rod15618may lock the gap to lock mesh15604in a state of expansion. Threaded rod15618may lock the gap to lock mesh15604in a collapsed state. Set screw15622may be tightened against rod15618to prevent rod15618from rotating. Set screw15622may be cannulated to allow access to head15624of rod15618.

Bushing15616may include catches15626. Catches15626may include recesses in bushing15616. Catches15626may catch latches15628. Latches15628may include protrusions15630. Protrusions15630may have an equilibrium state in which they rest at a radius from the axis of elongated support15612that is smaller than the radius of opening15610. During insertion of elongated support15612into base15608, elongated support15612may displace protrusions15630radially outward until catches15626align with protrusions15630. Protrusions15630may then elastically relax into catches15626.

Base15608may include arms (not shown) to resiliently support protrusions15630. The arms may be defined by voids or slots in base15608. The arms may be cantilevered. Mesh15604may be biased to expand radially outward from the axis of elongated support15612. The bias may urge elongated support15612to exit opening15610. This may increase a force of engagement of catches15626with protrusions15630. The engagement may be frictional. The engagement may be an interference engagement. For example, protrusions15630may be shaped to nest in a beveled edge (not shown) of catches15626.

FIG. 157shows illustrative flange15702in axial member15620. When implant head15602is joined to elongated support15612, protrusions15630may ride over flange15702before nesting in catches15626. Flange15702may provide sufficient resistance to implant head15602to reduce the likelihood of inadvertent engagement with catches15626. Arrows A show the direction of motion of implant head15602relative to elongated support15612during “snapping on” of implant head15602to elongated support15612.

FIG. 158shows illustrative implant assembly15800. Assembly15800may include the implant. The implant may include implant head15802. The implant may include elongated support15804. The implant may include implant tail15806. Assembly15800may include keyed plate15808.

Implant head15802may have one or more features in common with the implant head. Elongated support15804may have one or more features in common with central axis member15303(shown inFIG. 153). Implant tail15806may have one or more features in common with the implant tail. Keyed plate15808may have one or more features in common with the plate.

Implant head15802may include an expandable mesh anchoring substrate (expandable mesh not shown).

Plate15808may include clearance hole15810. Hole15810may be large enough to permit the passage of implant head15802in a collapsed state. Hole15810may be large enough to permit the passage of a diameter of implant head15802in the collapsed state. Hole15810may be large enough to permit the passage of diameter15812of elongated support15804. The diameter may be a “primary” diameter.

Implant tail15806may include grooves15816on opposite sides of tail15806. Groove15816may have a height that is sufficient to accommodate thickness15818. Grooves15816may have depth such that tail15806has a minor diameter15820such that tail15806can slide into slot15814. Grooves15816may have a length15822to be constrained by walls15824of slot15814with sufficient moment to prevent rotation of tail15806about a normal (not shown) to plate15808. Grooves15816may have a length15822to be constrained by walls15824of slot15814with sufficient moment to prevent rotation of tail15806about a longitudinal axis of support15804.

Anchor receiving holes may be used to fix plate15808to the bone. Tail15806may be seated sufficiently snuggly in slot15814, when plate15808is fixed to the bone, so that plate15808prevents or reduces rotation of the implant about the longitudinal axis of the implant. Tail15806may be seated sufficiently snuggly in slot15814, when plate15808is fixed to the bone, so that plate15808prevents or reduces rotation of the implant with respect to plate15808.

Tail15806may be seated sufficiently snuggly in slot15814, when plate15808is fixed to the bone, so that plate15808prevents or reduces translation of the implant along the longitudinal axis of the implant.

Tail15806may be seated sufficiently snuggly in slot15814, when plate15808is fixed to the bone, so that plate15808prevents or reduces translation of the implant with respect to plate15808. Plate15808may include a set screw (not shown) or other fixation device to lock tail15806in slot15814. One or more set screws may traverse plate15808at a position along slot15814, and contact tail15806at one or both of grooves15816.

Elongated support15804may include one or more anchor passing holes15828.

Anchor passing holes15828may receive an anchor engaged with implant head15802. A practitioner may pass one or more anchors through implant head15802and into anchor passing holes15828.

FIG. 159shows the implant in clearance hole15810prior to insertion in slot15814.

A practitioner may insert implant tail15802into slot15814after the implant is positioned in the bone by sliding plate15808along a surface of the bone.

When implant tail15802is positioned in slot15814, a practitioner may secure the implant to the bone using screws. The screws may pass through plate15802and into the bone. The screws may pass through the bone and into the implant. The screws may pass through plate15802and the implant.

Thus, apparatus and methods for bone fracture repair have been provided. Persons skilled in the art will appreciate that the present invention can be practiced by other than the described examples, which are presented for purposes of illustration rather than of limitation.