Near bone suture button

Suture buttons are disclosed for fixing two bones together. The suture buttons may enable surgeons to more easily and effectively implement a suture button technique, such as to repair syndesmosis injuries in ankles. A first suture button includes a pulley peg extending from a button head. The pulley peg may be positioned with a bone hole upon installation of the first suture button, which may help protect suture and help reduce potential patient discomfort. The second suture button helps facilitate the second suture button flipping into place upon deployment from a button inserter. Each of the first and second provided suture buttons may help reduce friction between the respective buttons and suture during an installation procedure. The first and second provided suture buttons may be used together in a surgical procedure or individually with other suitable buttons or anchors.

BACKGROUND

In various instances, patients may suffer injuries that require securing a first or near bone to a second or far bone in order to help the patient recover from the injury. Injuries to the ankle joint may be one such type of injury. The ankle joint is composed of two bones, the tibia and fibula, which are held together by the distal tibiofibular syndesmosis. In some instances, such as after ankle injuries, the syndesmosis can be torn, leaving a gap between the tibia and fibula. Syndesmotic injuries should be repaired if found torn or unstable in order to prevent ankle instability and subsequently reduce the risk of ankle osteoarthritis.

One method to secure a near bone to a far bone is the suture button technique. The suture button technique includes deploying a bone-securing construct that includes a first button coupled to a second button with suture. The suture may be tensioned to secure the near bone to the far bone. For example, to repair syndesmotic injuries, the suture button technique involves two buttons that hold the fibula (e.g., near bone) and tibia (e.g., far bone) together with suture that connects the two buttons through a drilled bone hole in the fibula and tibia. The buttons are typically put into place with a needle and pull-through sutures or with a button inserter.

Typical buttons for use in the suture button technique, however, have a number of drawbacks. Buttons for applying pressure to the near bone must anchor suture while also enabling the suture's ends to be pulled or tensioned in order to increase tension in the suture between the near bone button and the far bone button. As the suture is pulled or tensioned it must move or slide relative to the two buttons. Typical near bone buttons, however, may be constructed such that an undesired amount of friction is generated between the near bone button and the suture. For instance, typical near bone buttons may have multiple individual openings for different portions or ends of suture. The individual openings may restrict movement of the suture, creating friction. In other instances, typical near bone buttons may have an opening for the suture sized such that the suture is similarly restricted, creating friction. If friction is too great it may cause damage to the suture that requires the surgeon to start the procedure over, or that may cause the suture to fail prior to the patient recovering. An undesired amount of friction may also make it more difficult for the surgeon to perform the procedure. For example, the suture may get caught on an edge while the surgeon is tensioning the suture.

In addition, typical near bone buttons may extend out from the near bone an undesired amount after installation. This may cause patients a greater level of discomfort than if the near bone button was more flush with the near bone.

Buttons for applying pressure to the far bone may be transported through a bone hole and then adjusted so that they do not travel back through the bone hole. Adjusting a far bone button may involve deploying the far bone button from a button inserter, the deployment causing the far bone button to alter its orientation. Typically, however, such deployment may involve forcing the far bone button away from the inserter to give the far bone button enough space to change it orientation. The amount of space needed may make it difficult in some instances to easily and effectively deploy the far bone button, such as when tissue (e.g., skin) pushes against the far bone button and resists its changing orientation.

In addition, far bone buttons anchor suture that couples a far bone button to a near bone button. The suture must move relative to the far bone button as the suture is tensioned to install the far bone button and near bone button. Typical far bone buttons may generate a greater than desired amount of friction between a typical far bone button and the suture. For instance, many typical far bone buttons include at least two holes through which the suture moves, with friction generated between each hole and the suture. Such typical configurations with at least two holes may also cause the suture to wrap around itself or twist when loaded into or deployed from a button inserter.

Accordingly, a near bone button that solves the above drawbacks is desired. Additionally, a far bone button that solves the above drawbacks is desired.

SUMMARY

The presently disclosed suture button, system, and method generally relate to surgery techniques to hold two bones together. More specifically, suture buttons are disclosed that enable surgeons, or any other suitable healthcare provider, to more easily and effectively implement the suture button technique, such as to repair syndesmosis injuries in ankles. A first suture button is disclosed that is constructed to interface with a nearest bone (e.g., a fibula bone) as part of the suture button technique to secure a near bone and a far bone. A second suture button is disclosed that is constructed to interface with a farthest bone (e.g., a tibia bone) as part of the suture button technique to secure the near bone to the far bone. A surgeon may use both the provided first suture button and the provided second suture button when performing the suture button technique to repair a syndesmosis injury. Alternatively, a surgeon may use the provided first suture button with another suitable suture button or anchor, or may use the provided second suture button with another suitable suture button or anchor.

Throughout this disclosure, the first suture button will be referred to as a fibula button and the second suture button will be referred to as a tibia button, though it should be appreciated that the provided first suture button and the provided second suture button may be used to secure together bones other than the fibula and tibia.

In an example, a suture button for aiding in the fixation of two bones includes a head and a pulley peg. The suture button's head includes a top surface, a bottom surface, and a first opening extending through the head from the top surface to the bottom surface. The pulley peg is elongated from a first end to a second end. Each of the pulley peg's ends are connected to or integral with the head's bottom surface so as to form a second opening between the pulley peg and the head's bottom surface.

In an example, a system includes a first suture button or anchor, a second suture button, and a button inserter. The second suture button is coupled by suture to the first suture button or anchor. The second suture button includes a head and a pulley peg. The second suture button's head includes a top surface, a bottom surface, and a first opening extending through the head from the top surface to the bottom surface. The pulley peg is elongated from a first end to a second end. Each of the pulley peg's ends are connected to or integral with the head's bottom surface so as to form a second opening between the pulley peg and the head's bottom surface. The button inserter deploys the first suture button or anchor and the second suture button. A middle portion of the suture is positioned through the second suture button's second opening. Each of the suture's ends are positioned through the second suture button's first opening. Tensioning the suture's ends tensions the suture between the first suture button or anchor and the second suture button subsequent to deployment from the button inserter.

In an example, a method of securing two bones together includes forming a bone hole through a first bone and a second bone. A first suture button or anchor is then inserted, via a button inserter, through the bone hole such that the first suture button or anchor exits on the other side of the bone hole. The first suture button or anchor is coupled by suture to a pulley peg of a second suture button. The second suture button includes a head and a pulley peg. The second suture button's head includes a top surface, a bottom surface, and a first opening extending through the head from the top surface to the bottom surface. The pulley peg is elongated from a first end to a second end. Each of the pulley peg's ends are connected to or integral with the head's bottom surface so as to form a second opening between the pulley peg and the head's bottom surface. A middle portion of the suture is positioned through the second suture button's second opening. Each of the suture's ends are positioned through the second suture button's first opening.

The first suture button or anchor and the second suture button may be deployed from the button inserter. The ends of the suture may be tensioned such that the first suture button or anchor contacts the second bone and the second suture button contacts the first bone. The suture may then be secured.

DETAILED DESCRIPTION

The presently disclosed suture buttons, system, and method generally relate to surgery techniques to hold two bones together. More specifically, suture buttons are disclosed that enable surgeons, or any other suitable healthcare provider, to more easily and effectively implement the suture button technique, such as to repair syndesmosis injuries in ankles. In one example, a surgeon may use a button inserter to deploy the buttons. In such an example, a first presently disclosed suture button is adapted to contact the near bone as part of the bone-securing construct. A second presently disclosed suture button is adapted to be transported through a bone hole formed in the near bone and far bone and then to contact the far bone as part of the bone-securing construct. Throughout this disclosure, the first suture button will be referred to as a fibula button and the second suture button will be referred to as a tibia button, though it should be appreciated that the provided first suture button and the provided second suture button may be used to secure together any two bones other than the fibula and tibia.

A surgeon may use both the provided fibula button and the provided tibia button when performing the suture button technique, such as to repair a syndesmosis injury. Alternatively, a surgeon may use the provided fibula button with another suitable suture button or anchor, or may use the provided tibia button with another suitable suture button or anchor.

In some instances, the provided fibula button construction reduces friction between the fibula button and suture during the installation of the fibula button as compared to typical near bone buttons by including large spaces in the provided fibula button through which suture can travel without encountering metal components of the fibula button. The provided fibula button may include a head and a pulley peg extending from the head. The head includes a single opening and the space between the pulley peg and the head is a second opening. Each of the openings is sized such that multiple strands of suture may move freely through the openings. Suture may move more freely through larger spaces, which reduces friction between portions of suture and between suture and the fibula button. The provided fibula button may additionally include various curved or smooth or chamfered surfaces to further reduce friction.

In some instances, the fibula button's pulley peg is sized such that it may be inserted within a bone hole. Inserting the pulley peg within a bone hole helps lock the fibula button in place to a greater degree than if the fibula button merely rested on a bone's surface. Inserting the pulley peg within the bone hole also enables the fibula button to be more flush to the near bone than typical near bone buttons. Additionally, the pulley peg being positioned within the bone hole upon installation enables tensioned suture to be maintained inside of the bone rather than on the bone surface where the suture would be more exposed to other tissues. The fibula button may therefore help decrease potential patient irritation or discomfort that may arise from an installed button or suture protruding from one of the patient's bones. The fibula button may also help protect the tensioned suture from potential damage. In addition, having the tensioned suture maintained within the bone enables a surgeon to cut the free ends of the suture flush to the fibula button's surface without the risk of cutting the tensioned suture.

The provided tibia button construction may reduce friction between the tibia button and suture during installation of the tibia button as compared to typical far bone buttons. For instance, the provided tibia button includes a single, large opening for suture to pass through. The single, large opening reduces the number of possible contact points between the tibia button and the suture as compared to typical buttons that include multiple openings for the suture. The tibia button may also include various curved or smooth or chamfered surfaces to further reduce friction. The provided tibia button further helps prevent the suture from winding about itself when the tibia button is loaded into or deployed from a button inserter by directing the suture to a single side relative to the button inserter.

The provided tibia button may also be configured such that it is prevented from rotating or laterally translating when loaded into a button inserter. The provided button insertion system may also help facilitate the tibia button flipping upon deployment from a button inserter. The tibia button includes a chamfered end that, when loaded into a button installer, faces towards the suture that couples the tibia button to a second button (e.g., a fibula button). The natural inclination of the tibia button to rotate towards the direction the chamfered end is facing in addition to tension from the suture facilitates the tibia button flipping in that direction. Further, to deploy the tibia button, the button inserter may include a pusher rod that extends just beyond the tip of the button inserter to push the tibia button out of the tip within which the tibia button is loaded. The flipping facilitation aspects of the button insertion system enable the tibia button to flip close to the button inserter tip with little space in between.

The closeness with which the tibia button flips to the button inserter, and the aspects that help facilitate the tibia button flipping, generate a strong flipping force that helps the tibia button overcome opposing forces from tissue (e.g., skin) that may push against the tibia button. Further, each of these aspects may help increase the ease of deploying the tibia button as compared to at least some typical button insertion systems by helping ensure the tibia button changes its orientation, or flips, in a target or desired direction. Additional advantages of the provided fibula button and the provided tibia button will be apparent from the following description of the figures.

FIGS.1A and1Billustrate perspective views of an example fibula button100A. The example fibula button100A includes a button head102and a pulley peg108extending from the button head102. An opening114is formed between the button head102and the pulley peg108. The button head102includes a top surface104and a bottom surface110. In various aspects, the top surface104may be rounded to help prevent damage to surrounding tissue when the fibula button100A is installed in a patient. In some aspects, the bottom surface110may be flat as illustrated. The button head102also includes an opening106that extends through the button head102from the top surface104to the bottom surface110. The opening106is sized such that it can accommodate multiple strands of suture moving through the opening106. In some instances, the opening106may be sized large enough such that a suture knot may be positioned within the opening106. The top surface104may include a chamfer116that leads to the opening106. The chamfer116may help reduce friction between the button head102and suture moving through the opening106. In various instances, the opening106may have a circular cross-section as illustrated.

In various aspects, the pulley peg108is elongated from a first end120to a second end122. The first end120and the second end122may be connected to or integral with the bottom surface110of the button head102. In some instances, the pulley peg108may include a flat surface118at each of its ends120and122. The flat surfaces118may help guide suture through the opening106. In some instances, the pulley peg108may include a flat surface112at each of its ends120and122. In other instances, the pulley peg108may include a curved surface124at each of its ends120and122, as illustrated inFIG.1Cas part of example fibula button100B. The curved surface124may help reduce friction between the pulley peg108and suture moving towards and through the opening106.

In various instances, the opening106may have suitable cross-sections other than circular. For example, the opening106may have a cross-section that is pill-shaped, rectangular with rounded corners, oval, or other suitable shapes.FIG.1Dillustrates an example fibula button100C with a button head102having an opening130with an elongated or pill-shaped cross-section. The pill-shaped cross section of the opening130may help reduce friction between suture strands and/or between suture strands and the button head102by providing additional space for the suture to move freely. For instance, ends of the suture strand(s) may move through the opening130while remaining outside of the outer bounds of the pulley peg108. Stated differently, the ends of the suture strand(s) do not have to move inward to a central opening (e.g., the opening106) which may cause friction between portions of the suture strand(s). In addition, the pill-shaped opening130may be large enough such that a suture knot may be positioned within pill-shaped opening130.

In various instances, the pill-shaped opening130may be substantially perpendicular to the pulley peg108as illustrated. Stated differently, the pill-shaped opening130includes a long end and a short end, and a plane extending through a central portion of the two ends120and122of the pulley peg108is substantially perpendicular to the long end. This substantially perpendicular configuration enables the pulley peg108to maintain a narrower width than if the ends120and122of the pulley peg108were on the outside of the long end of the opening130. The narrower width enables the pulley peg108to fit within a narrower bone hole.

In various instances, the innermost portion of the pulley peg108and an inner portion of the button head102(e.g., the portion forming the opening130) share a continuous surface132. Stated differently, the inner surface of the button head102that forms the opening130continues directly into the pulley peg108. This is in contrast to there being a space on the bottom surface110between the opening130and the ends120and122of the pulley peg108. Eliminating this space between the opening130and the ends120and122of the pulley peg108helps eliminate edges that may increase friction between suture and the fibula button100C.

In some aspects, the bottom surface of the provided fibula button's button head may include a chamfer leading to the button head's opening. For example,FIG.1Eillustrates an example fibula button100D in which the bottom surface110of the button head102includes a chamfer140leading to the opening130. The chamfer140may help reduce friction between the button head102and suture moving through the opening130.

FIGS.2A and2Billustrate respective side views, rotated ninety degrees with respect to one another, of the example fibula button100A. As will be discussed in more detail below, the pulley peg108is configured to secure suture (e.g., multiple suture strands and/or multiple portions of a single suture strand). For example, inFIG.2Ba free end of a suture strand may enter the opening114on one side and exit the opening114on the other side such that when both free ends of the suture strand are pulled away from the fibula button100A, the pulley peg108secures the suture strand. In other aspects of the present disclosure, the pulley peg108may take other suitable shapes extending outward from the bottom surface110that allow it to secure one or more suture strands. For example,FIG.2Cillustrates an example fibula button200that includes a pulley peg208. The pulley peg includes two legs202A and202B connected by a crossbar204. In some instances, the legs202A,202B and the crossbar204may be a single, integral component. In other instances, the crossbar204may be connected to the leg202A and to the leg202B.

The example fibula buttons100A,100B, or100C may be composed from any suitable medical-grade material capable of long-term contact with biological materials. For example, the fibula buttons100A,100B, or100C may be composed of nitinol.

FIGS.3A,3B, and3Cillustrate a perspective view, top view, and side view respectively of an example tibia button300A. The tibia button300A includes a support302having an opening308. The support302may include curved surfaces to reduce friction between suture and the support302during installation of the tibia button300A. In addition, the inclusion of a single opening308in the support302for each suture strand to move through during installation of the tibia button300A may help reduce friction between the suture and the tibia button300A as compared to typical suture buttons having multiple openings for different suture strands or different portions of a single suture strand. A wing304extends from the support302to a leading end310of the tibia button300A. A wing306extends from the support302to a chamfered end312of the tibia button300A. The wings304and306may have various suitable lengths with respect to the support302.

In various instances, the wing306may be configured to engage with a button inserter tip such that the wing306does not slide or otherwise move away from the button inserter tip until the tibia button300A is deployed. For instance, the wing306may include recesses314A,314B. The wing306may include the recesses314A,314B on a single side or on opposing sides (e.g., on the opposing side not illustrated). The non-recessed portion(s) of the wing306may correspond to a recess or recesses in the button inserter tip such that when the wing306is slid within the button inserter tip, lateral movement of the tibia button (e.g., perpendicular to the long axis of the tibia button300A) is prevented with respect to the button inserter.

The chamfered end312of the wing306includes a chamfer at an angle316. In various examples, the angle316may be equal to thirty degrees. In other examples, the wing306may be chamfered at another suitable angle316, such as between 15-60 degrees. For instance,FIG.3Dillustrates an example tibia button300B having a wing306with a chamfered end312at an angle316of forty-five degrees. The advantages that the chamfered end312may provide for the presently disclosed tibia button will be discussed in more detail in connection withFIGS.6A to6D.

In various examples, such as those illustrated inFIGS.3A to3D, the support302and the opening308through the support302may be centered relative to the wings304and306. In other examples, the support302and/or the opening308may be off-center relative to the wings304and306. For instance,FIG.3Eillustrates an example tibia button300C having a support302and an opening308that is off-center from an axis320of the wings304and306. The support302and the opening308may be off-center towards the longer side of the wing306(e.g., due to the chamfered end312) to help the tibia button300C flip into place during installation, as will be described in more detail below. In other examples, the support302may be centered while the opening308is off-center. In some instances, the support302and the opening308may be centered along the axis320such that the wing304and the wing306have equal lengths. In other instances, the support302and/or the opening308may be off-center along the axis320. When the support302is off-center along the axis320, either the wing304or the wing306may have a longer length than the other.

The example tibia buttons300A,300B, or300C may be composed from any suitable medical-grade material capable of long-term contact with biological materials. For example, the fibula buttons300A,300B, or300C may be composed of nitinol.

The remaining disclosure will make reference to the example fibula button100A and the example tibia button300A. The remaining disclosure, however, may apply equally to the example fibula buttons100B and100C, the example tibia buttons300B and300C, and any other suitable fibula buttons and/or tibia buttons consistent with the present disclosure.

In some instances, the provided fibula button100A and/or the provided tibia button300A may be used with a needle and pull-through suture technique. In other instances, the fibula button100A and/or the tibia button300A may be used in conjunction with a button inserter that deploys the fibula button100A and/or the tibia button300A for installation in a patient. The fibula button100A may be used in conjunction with the tibia button300A in a surgical procedure. The fibula button100A and the tibia button300A may alternatively be used independently of one another in a surgical procedure. For instance, the fibula button100A may be used with a suitable anchor or suture button other than the tibia button300A. In another instance, the tibia button300A may be used with a suitable anchor or suture button other than the fibula button100A.

FIG.4Aillustrates an example button inserter400that may be used in conjunction with the presently disclosed fibula button100A and/or tibia button300A and method. The example button inserter400may include a handle402, a support protrusion404, a trigger406, a shaft414, a pusher rod408, a resilient member412(e.g., a spring), and a button deployer430. The button deployer430may include a suture bollard410and a button post416. In the example, the tibia button300A is removably engaged with the shaft414. For example, a portion of the tibia button300A may be positioned within an insertion tip432at the end of the shaft414such that the tibia button300A is constrained rotationally and laterally, as will be described in more detail in connection withFIGS.6A to6D. In the illustrated loaded configuration of the example button inserter400, tension in the suture418may secure the tibia button300A in place along a long axis of the button inserter400. In some examples, the pusher rod408extends from the button deployer430, through the inside of the shaft414, to make contact with the tibia button300A.

The suture418may be a flexible material, e.g., suture or suture tape. In some instances, the suture418may be a single strand of suture that is arranged to couple the fibula button100A to the tibia button300A. In other instances, the suture418may be multiple strands of suture that are arranged to couple the fibula button100A to the tibia button300A. In at least one instance, the suture418can be an adjustable or non-adjustable loop. In at least one instance, the combination of the suture418, the tibia button300A, and the fibula button100A can be an adjustable, knotless button/loop construct. The knotless button/loop construct may be self-locking.

In the loaded configuration of the example button inserter400, the fibula button100A may be held against the button post416by tension in the suture418. The suture418may be wrapped around the suture bollard410prior to deployment. A surgeon, or any other suitable healthcare provider, may use the example button inserter400to insert the tibia button300A through tunnels in a first bone and a second bone (e.g., a fibula and a tibia) and may deploy the tibia button300A by activating the trigger406in the direction of the illustrated arrow. The fibula button100A may be deployed by translating the button inserter400away from the patient. The suture418may then be tensioned and secured to install the deployed fibula button100A and tibia button300A.

As an alternative to the button inserter400,FIG.4Billustrates an example button inserter440that may be used in conjunction with the presently disclosed fibula button100A and/or tibia button300A and method. The example button inserter440includes a handle442, a support protrusion444, a trigger446, an inner rod508(FIG.5), a resilient member512(FIG.5), a shaft452, and a button deployer530(FIG.5). The button deployer530may include a suture bollard448and a button post450. In the example, the tibia button300A is removably engaged with an insertion tip432of the shaft414in the same or similar manner as with the example button inserter400described above. The example button inserter440is configured similarly to the example button inserter400. A user may activate the trigger446by pulling it in the direction of the illustrated arrow to deploy the tibia button300A. The fibula button100A may be deployed by translating the button inserter440away from the patient.

FIG.5Ashows a top view of a portion of the example button inserter440. The example fibula button100is held against the button post450by tension in the suture418. In some examples, the button post450includes two separate posts with suitable space in between for the pulley peg108, as illustrated. This enables the suture418to be secured by the pulley peg108while also enabling the free ends of the suture418to be pulled through the opening106.

FIG.5Billustrates a cross-sectional front view of an example insertion tip432of the button inserter400or440. The insertion tip432may include a slit502between a first end504A and a second end504B. When a tibia button300A is positioned within the slit502, the tibia button300A is prevented from rotating about its long axis. In some instances, the first end504A may include a recess506. The recess506may correspond to or line up with a non-recessed portion of the tibia button300A (e.g., seeFIG.3A) such that the wing306of the tibia button300A may be inserted within the insertion tip432. For instance, the recess506may have a rounded cross-section as illustrated, a squared cross-section, or other suitable shape. The tibia button300A is accordingly prevented from moving laterally along a short axis of the button inserter400or440by the non-recessed portion of its wing306positioned within the recess506of the insertion tip432. In instances in which the wing306of the tibia button300A includes recesses314A and314B on opposing sides, the second end504B of the insertion tip432may include a recess as well. In addition, the recess506of the insertion tip432prevents the tibia button300A from rotating about its short axis.

It should be appreciated that the button inserters400and440are merely examples of button inserters that may be used to deploy the fibula button100A and/or the tibia button300A. Any suitable button inserter may be used to deploy the fibula button100A and/or the tibia button300A that is compatible with the advantages of the fibula button100A and/or the tibia button300A as described herein.

FIGS.6A and6Billustrate perspective side views of alternate configurations of the tibia button300A loaded within the insertion tip432of a button inserter (e.g., the button inserter400). In the configuration600A shown inFIG.6A, the tibia button300A is positioned with in the insertion tip432such that the chamfered end312is facing a first direction (e.g., towards the top of the page). In the configuration600B shown inFIG.6B, the tibia button300A is positioned within the insertion tip432such that the chamfered end312is facing opposite of the first direction (e.g., towards the bottom of the page). In each of the configurations600A and600B, the chamfered end312is facing towards the suture418. The chamfered end312facing towards the suture418helps facilitate the tibia button300A flipping into place in a desired direction once the tibia button300A is deployed. For instance, in the configuration600A, the tibia button300A flips in the direction of the arrow602upon deployment. Conversely, in the configuration600B, the tibia button300A flips in the direction of the arrow604upon deployment.

In either the configuration600A or600B, the configuration of the tibia button300A enables the suture418to be to the side of the insertion tip432and button inserter shaft, rather than the suture418winding around the button inserter shaft or around the tibia button300A itself. In addition, the tibia button300A and the insertion tip432may be constructed such that a gap606remains between the tibia button300A and the insertion tip432when the tibia button300A is fully inserted. The gap606is radiolucent and is therefore visible under x-ray. The gap606may help a surgeon guide how far the button inserter must be inserted before deploying the tibia button300A.

FIGS.6C and6Dfurther illustrate the configuration600B to show an example of the tibia button300A flipping into place upon deployment.FIG.6Cillustrates that the pusher rod408of the example button inserter400translates to push the tibia button300A out of the insertion tip432. For instance, activating the trigger406of the button inserter400may translate the pusher rod408. In various instances, the pusher rod408may extend beyond the end of the insertion tip432when the trigger406is fully depressed, which may help ensure that the tibia button300A is fully separated from the button inserter400and pushed all the way out of the insertion tip432. Ensuring that the tibia button300A is fully separated from the button inserter400may allow for easier deployment when installation of the tibia button300A involves pushing against resisting tissue (e.g., skin). In addition, the end of the pusher rod408that contacts the tibia button300A may be flat, as illustrated, such that it only contacts the nearest portion of the chamfered end312. The space between the flat end of the pusher rod408and the chamfered end312of the tibia button300A allows space for the tibia button300A to rotate or flip.

Upon the tibia button300A being pushed all the way out of the insertion tip432, tension in the suture418causes the tibia button300A to flip to the side of the suture418(e.g., in the direction of the arrow604). The chamfered surface312of the tibia button300A and the minimal contact between the pusher rod408and the chamfered surface312help facilitate the tibia button300A flipping towards the side of the suture418. Facilitating the tibia button300A flipping in a desired or target direction may help reduce complications during a surgical procedure that may arise by the tibia button300A flipping in an undesired direction, which may potentially cause the suture418to tangle or get pinched. The provided flipping facilitation of the present disclosure also enables the tibia button300A to flip very close to the insertion tip432, which can increase the ease of deploying the tibia button300A.FIG.6Dshows the flipped tibia button300A.

As indicated, the fibula button100A and the tibia button300A may be utilized as part of the suture-button technique to secure two bones together. For example, a method of ankle syndesmosis repair (with or without ankle fracture) may include drilling a bone hole through a patient's fibula and tibia. A button inserter (e.g., the button inserter400) may be loaded with the tibia button300A and the fibula button100A. A surgeon may transport the tibia button300A through the bone hole via the button inserter.FIG.7illustrates the tibia button300A transported through a bone hole706in a fibula bone702and a tibia bone704via the button inserter400. Suture418couples the tibia button300A to the fibula button100A. A surgeon may then deploy the tibia button300A and the fibula button100A, such as by activating the trigger406on the button inserter400and then translating the button inserter400away from the patient. In some instances, the tibia button300A may deploy first, and then the fibula button100A may be deployed once the tibia button300A is in position.

Upon deployment, the tibia button300A flips as described above and contacts the surface of the tibia bone704. The surgeon may remove the button inserter400from the bone hole706. The surgeon may tension the suture418(e.g., cinch an adjustable construct) to position the fibula button100A and secure it against the lateral surface of the fibula bone702. Once the tibia button300A and the fibula button100A are in position, the suture418may be secured, such as by a knot or via a knotless button-loop construct. The free ends of the suture418may be trimmed to remove excess material.FIG.8illustrates an installed fibula button100A and tibia button300A coupled by suture418and securing the fibula bone702to the tibia bone704. The pulley peg108of the fibula button100A is fully within the bone hole706, which enables solely the button head102of the fibula button100A to protrude from the surface of the fibula bone702. In some instances, a knot of suture418may be positioned within the opening106of the fibula button100A.

The examples and embodiments disclosed herein are to be construed as merely illustrative and not a limitation of the scope of the present disclosure in any way. It will be apparent to those having skill in the art that changes may be made to the details of the above-described embodiments without departing from the underlying principles discussed. In other words, various modifications and improvements of the embodiments specifically disclosed in the description above are within the scope of the appended claims. For example, any suitable combination of features of the various embodiments described is contemplated.