Patent Publication Number: US-2023157708-A1

Title: Intramedullary fixation system for management of pelvic and acetabular fractures

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 15/952,093, filed Apr. 12, 2018, which is a continuation of U.S. patent application Ser. No. 14/300,752, filed Jun. 10, 2014, now abandoned, which is a continuation of U.S. patent application Ser. No. 14/357,917, filed on May 13, 2014, now U.S. Pat. No. 9,839,435, which is the U.S. National Stage Entry of International Application Serial No. PCT/CA2012/050808, filed Nov. 14, 2012, which claims benefit of U.S. Provisional Patent Application Ser. No. 61/559,609, filed Nov. 14, 2011, which are incorporated in their entirety herein by reference. 
    
    
     BACKGROUND 
       FIG.  1 A  depicts a frontal view of the skeletal structure forming the pelvic ring, and  FIGS.  1 B and  1 C  depict cross-sectional side views of the skeletal structure forming the pelvic ring. As shown in  FIGS.  1 A,  1 B and  1 C , the pelvic ring includes right and left ilium bones  105 ,  110 , the sacrum  115  and their associated ligamentous connections. The main connections are through and around the right and left sacrociliac joints  120 ,  125  at the posterior of the pelvis and the pubic symphysis  130  at the anterior of the pelvis. The pelvic ring is a key structural element of the skeletal system because it is a weight-bearing structure interposed between the upper body and the legs. As such, if a fracture occurs and it is untreated, the pelvic ring may not heal (nonunion) or may heal in a poor position (malunion). Nonunion can lead to chronic pain and an inability to walk. Malunion can result in a short leg or one which points in the wrong direction. Because of these problems, it is necessary to reposition to normal the fragments which have become displaced during the fracturing (reduction). Once the fragments are repositioned, it is necessary to hold them in place (fixation) until the healing of the fracture is complete. This process may take approximately 6 to 8 weeks. 
     Because the pelvic ring forms a ring structure, it cannot be disrupted in one place when a fracture occurs. Typically, a disruption, or “break,” occurs in both the posterior and anterior portions of the pelvic ring. The disruptions in the pelvic ring can be through one or more of the bones  105 ,  110 ,  115 , through the posterior sacrociliac joints  120 ,  125 , through the pubic symphysis  130  at the front, or any number of combinations of the above. If the acetabulum (a portion of each ilium bone  105 ,  110  forming the hip socket) is fractured, the smooth bearing surface of the acetabulum must be restored to as close to its original shape as possible in order to allow for proper movement at the hip. Once restored, the acetabulum must be held in the restored position until healing occurs. 
     Conventional treatment of a pelvic fracture includes reduction of the fracture fragments and fixation with plates and screws along the surface of the bone. However, placing a plate on the bone requires a significant operation with resulting high blood loss. In some cases, a straight intramedullary screw may be placed along a curved path. While the screw is less invasive, the fixation may be inadequate because the straight screw cannot be implanted very far into a curved bone. This may result in inadequate fixation. Moreover, the screw must be relatively small in diameter to avoid extending through the bone. Surgically speaking, implanting a screw such that it extends from the bone can result in significant hazard to the patient because it may puncture or otherwise impinge upon important vascular and nervous structures. 
     SUMMARY 
     This disclosure is not limited to the particular systems, devices and methods described, as these may vary. The terminology used in the description is for the purpose of describing the particular versions or embodiments only, and is not intended to limit the scope. 
     As used in this document, the singular forms “a,” “an,” and “the” include plural references unless the context clearly dictates otherwise. Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of ordinary skill in the art. Nothing in this disclosure is to be construed as an admission that the embodiments described in this disclosure are not entitled to antedate such disclosure by virtue of prior invention. As used in this document, the term “comprising” means “including, but not limited to.” 
     In an embodiment, a device for treating a fracture of a bone may include a flexible tube having a distal end and a proximal end, a stiffening mechanism within the flexible tube configured to cause the flexible tube to become rigid, and an actuator configured to cause the stiffening mechanism to cause the flexible tube to become rigid in response to the actuator being actuated. 
     In an embodiment, a method of treating a fracture of a bone may include inserting a guide wire including a bent section having a sharpened tip at a distal portion of the guide wire into an intramedullary space of the bone, forming a tunnel surrounding the guide wire in the bone, inserting a flexible device into the tunnel, and causing the flexible device to become rigid in the tunnel in order to fix a fracture of the bone. 
     In an embodiment, a device for treating a fracture of a bone may include a flexible tube having a distal end and a proximal end, a plurality of rods contained within the flexible tube, and an actuator configured to cause the plurality of rods to be fixed in place when actuated. 
     In an embodiment, a device for treating a fracture of a curved bone may include a flexible tube having a distal end and a proximal end, a spring contained within the flexible tube, an actuator configured to cause the spring to exert a normal force against an inner surface of the flexible tube in response to the actuator being actuated. 
     In an embodiment, a kit may include a flexible device comprising a flexible tube having a distal end and a proximal end, and an actuator configured to cause the stiffening mechanism to cause the flexible tube to become rigid in response to the actuator being actuated, and instructions for using the flexible device to fix a bone fracture. 
     In an embodiment, a device for treating a fracture of a bone may include a flexible tube having a distal end and a proximal end and including a series of slits configured to allow the flexible tube to flex, a high helix angle screw positioned at the distal end of the flexible tube, a plurality of bead segments, including a distal bead segment and a proximal bead segment, within the flexible tube configured to cause the flexible tube to become rigid, wherein each of the plurality of bead segments comprises a distal end, a proximal end and a bore, a cannula extending through the bore of each of the plurality of bead segments and having a distal end connected to the distal bead segment and a proximal end extending from the proximal end of the flexible tube, and a cap connected to the proximal end of the flexible tube and configured to permit the flexible tube to be rotated. 
     In an embodiment, a device for treating a bone may include a plurality of bead segments including a distal bead segment and a proximal bead segment where each of the plurality of bead segments comprises a distal end, a proximal end and a bore, a screw head in contact with a distal end of the distal bead segment, a stiffening cable extending through the bore of each of the plurality of bead segments, and a tensioning assembly in contact with a proximal end of the proximal bead segment. The tensioning assembly may be configured to cause the stiffening cable to cause the proximal end of each bead segment to engage a distal end of an adjacent bead segment. The stiffening cable may have a distal end connected to the screw head and a proximal end connected to the tensioning assembly. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         FIG.  1 A  depicts a frontal view of the skeletal structure forming the pelvic ring. 
         FIGS.  1 B and  1 C  depict cross-sectional side views of the skeletal structure forming the pelvic ring. 
         FIG.  2 A  depicts an exemplary device for treating a bone according to an embodiment. 
         FIG.  2 B  depicts interior portions of the exemplary device of  FIG.  2 A  according to an embodiment. 
         FIG.  3    depicts an exemplary expansion sleeve according to an embodiment. 
         FIG.  4    depicts an alternate exemplary expansion sleeve according to an embodiment. 
         FIG.  5    depicts an alternate exemplary expansion sleeve according to an embodiment. 
         FIG.  6    depicts an exemplary bead segment and flexible device incorporating a plurality of bead segments according to an embodiment. 
         FIG.  7    depicts a flow diagram for an exemplary method of treating a bone according to an embodiment. 
         FIG.  8    depicts an alternate exemplary device for treating a bone according to an embodiment. 
         FIGS.  9 A and  9 B  depict an external view and a cut-away view, respectively, of exemplary bead segments according to an embodiment. 
         FIGS.  10 A-D  depict points of contact between the exemplary bead segments of  FIGS.  9 A and  9 B . 
         FIG.  11    depicts a flexible device incorporating a plurality of bead segments according to an embodiment. 
         FIGS.  12 A and  12 B  depict an exploded view and a cut-away view of an exemplary tensioning assembly according to an embodiment. 
         FIG.  13    depicts an exemplary guide wire according to an embodiment. 
     
    
    
     DETAILED DESCRIPTION 
     The following term shall have, for the purposes of this application, the meaning set forth below. 
     The terms “fixing” or “to fix” refer to holding or setting something in place. In particular, a bone fracture may be fixed by causing a device placed across the point of fracture to become rigid, thereby stabilizing the bone on either side of the fracture. Additionally, the device itself may become fixed by making the device become rigid as a result of actuation of an actuator. 
       FIG.  2 A  depicts an exemplary device for treating a bone according to an embodiment.  FIG.  2 B  depicts interior portions of the exemplary device according to an embodiment. As shown in  FIGS.  2 A and  2 B , the device  200  may include a flexible tube  205 , a stiffening mechanism  210  and an actuator  215 . The flexible tube  205  may have a distal end  205   a  and a proximal end  205   b . The flexible tube  205  may include a plurality of slits, such as  206 , in an outer housing configured to allow the flexible tube to flex. In an embodiment, the flexible tube  205  may comprise stainless steel and/or nitinol. 
     The stiffening mechanism  210  may be located within the flexible tube  205  and may be configured to cause the flexible tube to become rigid. In an embodiment, the stiffening mechanism  210  may include a plurality of expansion sleeves. Exemplary expansion sleeves are disclosed in  FIGS.  3 - 5    and are discussed in further detail below. 
       FIG.  3    depicts an exemplary expansion sleeve according to an embodiment. As shown in  FIG.  3   , the expansion sleeve may include a jam nut  305  having expansion beads  310   a  and  310   b , cladding  315  covering at least a portion of the expansion beads, a plurality of expanding segments, such as  320 , and a bore  325 . The jam nut  305  may include an expansion bead  310   a  having a convex end and an expansion bead  310   b  having a concave end. Each of the expansion beads  310   a  and  310   b  may taper down in diameter from the convex/concave end to the other end of the bead. The convex expansion bead  310   a  of a first expansion sleeve and the concave expansion bead  310   b  of a second adjacent expansion sleeve are configured to enable the adjacent expansion sleeves to abut each other when the actuator  215  is actuated. The cladding  315  may be made of, for example and without limitation, silicone and may provide some compliance when the expansion sleeve  305  contacts the interior surface of the flexible tube  205 . The jam nut  305  may be actuated by causing the expansion beads  310   a  and  310   b  to be moved towards each other causing the cladding  315  to expand. As such, the expanding segments  320  may be configured to be in a non-actuated state against the cladding  315  when the jam nut  305  is not actuated. In contrast, when the jam nut  305  is actuated, the cladding  315  may force the expanding segments  320  to abut an interior surface of the flexible tube  205 . As such, the expanding segments  320  may cause the flexible tube  205  to become rigid when the jam nut  305  is in an actuated state. The bore  325  may be configured to receive a cannula, as discussed below. 
       FIG.  4    depicts an alternate exemplary expansion sleeve according to an embodiment. As shown in  FIG.  4   , expansion sleeve  405  may include expansion beads  410   a  and  410   b,  a retaining spring  415 , a plurality of expanding segments, such as  420 , and a bore  425 . The expansion sleeves may include an expansion bead  410   a  having a convex end and an expansion bead  410   b  having a concave end. Each of the expansion beads  410   a  and  410   b  may taper down in diameter from the convex/concave end to the other end of the bead. The convex expansion bead  410   a  of a first expansion sleeve and the concave expansion bead  410   b  of a second adjacent expansion sleeve are configured to enable the adjacent expansion sleeves to abut each other when the actuator  215  is actuated. The retaining spring  415  may provide some compliance when the expansion sleeve  405  contacts the interior surface of the flexible tube  205 . The expansion sleeve  405  may be actuated by causing the expansion beads  410   a  and  410   b  to be moved towards each other causing the expanding segments  420  to be pushed towards an inner surface of the flexible tube  205 . As such, the retaining spring  415  may be configured to restrain the expanding segments  420  when in a non-actuated state. In contrast, when the actuator  215  is actuated, the expanding segments  420  may be configured to abut an interior surface of the flexible tube  205 . In this way, the expanding segments  420  may cause the flexible tube  205  to become rigid when in an actuated state. The bore  425  may be configured to receive a cannula, as discussed below. 
       FIG.  5    depicts an alternate exemplary expansion sleeve according to an embodiment. As shown in  FIG.  5   , expansion sleeve  505  may include expansion beads  510   a  and  510   b,  one or more O-rings  515 , a plurality of expanding segments, such as  520 , and a bore  525 . The expansion sleeves may include an expansion bead  510   a  having a convex end and an expansion bead  510   b  having a concave end. Each of the expansion beads  510   a  and  510   b  may taper down in diameter from the convex/concave end to the other end of the bead. The convex expansion bead  510   a  of a first expansion sleeve and the concave expansion bead  510   b  of a second adjacent expansion sleeve are configured to enable the adjacent expansion sleeves to abut each other when the actuator  215  is actuated. The one or more O-rings  515  may provide some compliance when the expansion sleeve  505  contacts the interior surface of the flexible tube  205 . The expansion sleeve  505  may be actuated by causing the expansion beads  510   a  and  510   b  to be moved towards each other causing the expanding segments  520  to be pushed towards an inner surface of the flexible tube  205 . As such, the one or more Orings  515  may be configured to restrain the expanding segments  520  when in a non-actuated state. In contrast, when the actuator  215  is actuated, the expanding segments  520  may be configured to abut an interior surface of the flexible tube  205 . As such, the expanding segments  520  may cause the flexible tube  205  to become rigid when in an actuated state. The bore  525  may be configured to receive a cannula, as discussed below. 
     The expansion sleeves discussed in  FIGS.  3 - 5    are exemplary and are not meant to be limiting. Additional and/or alternate devices for forming expansion sleeves may be used within the scope of this disclosure. 
     Referring back to  FIG.  2   , the actuator  215  may be configured to cause the stiffening mechanism  210  to cause the flexible tube  205  to become rigid in response to the actuator being actuated. In an embodiment, the actuator  215  may include, for example and without limitation, a cap  220  connected to the proximal end of the flexible tube  205 . In an embodiment, the cap  220  may be configured to permit the flexible tube  205  to be rotated, thereby allowing the flexible tube to be inserted into a bone. The cap  220  may also be configured to cause the stiffening mechanism  210  to become rigid. For example, if the stiffening mechanism  210  comprises a plurality of expansion sleeves, the cap  220 , when rotated, may be configured to cause each of the plurality of expansion sleeves to abut an interior surface of the flexible tube  205 . 
     In an alternate embodiment, the actuator  215  may include a cannula  225  with a locking assembly  230 . The cannula  225  may extend through a bore in each of a plurality of expansion sleeves, such as  305 ,  405  or  505 . The cannula  225  may include a distal end connected to a distal expansion sleeve located at the distal end of the flexible tube  205  and a proximal end extending from the proximal end of the flexible tube. In an embodiment, the cannula  225 , when actuated, may cause the plurality of expansion sleeves  305 ,  405  or  505  to actuate, which may cause the flexible tube  205  to become rigid, as described above. The locking assembly  230  may be used to actuate the cannula  225 . For example, the locking assembly  230  may cause the cannula  225  to become tensioned. The locking assembly  230  may then be used to lock the cannula  225  in the actuated state. 
     In an alternate embodiment, the cannula  225  may extend through a bore in each of a plurality of bead segments, such as  605  in  FIG.  6   . Each of the bead segments  605  may further include a distal end and a proximal end. In an embodiment, the distal end of a bead segment  605  may be sized and shaped to be received by, receive or otherwise engage a proximal end of an adjacent bead segment in response to the cannula  225  being actuated. For example, the distal end of each bead segment  605  may be convex, and the proximal end of each bead segment may be concave. Conversely, the distal end and proximal end of each bead segment  605  may be concave and convex, respectively. Additional or alternate shapes for the distal and proximal ends of bead segments  605  may be used within the scope of this disclosure. 
     In an embodiment, each of the bead segments  605  may be about 8 mm in diameter and about 12 mm in length. In an embodiment, each of the bead segments  605  may be about 2 mm to about 15 mm in diameter. In an embodiment, each of the bead segments  605  may be about 5 mm to about 25 mm in length. Alternately sized bead segments  605  may also be used within the scope of this disclosure. 
     The cannula  225  may include a distal end connected to a distal bead segment located at the distal end of the flexible tube  205  and a proximal end extending from the proximal end of the flexible tube. In an embodiment, the cannula  225 , when actuated, may cause the plurality of bead segments  605  to actuate, which may cause the flexible tube  205  to become rigid. The locking assembly  230  may be used to actuate the cannula  225 . For example, the locking assembly  230  may cause the cannula  225  to become tensioned. The locking assembly  230  may then be used to lock the cannula  225  in the actuated state. 
     In an embodiment, a screw  235  may additionally be positioned at the distal end of the flexible tube  205 . The screw  235  may be used to enable the flexible tube  205  to be inserted into a bone. In an embodiment, the screw  235  may be a high helix angle screw. In an embodiment, the screw  235  may move a distance into a medium, such as a bone, that is approximately equal to its diameter when rotated one revolution. In other words, a screw  235  having a diameter of 12 mm may move forward approximately 12 mm when rotated once. 
       FIG.  13    depicts an exemplary guide wire  1300 . The guide wire may include a bent section  1305  having a sharpened tip  1310  at a distal portion  1315 . 
       FIG.  7    depicts a flow diagram for an exemplary method of treating a bone according to an embodiment. As shown in  FIG.  7   , a guide wire may be inserted  705  into an intramedullary space of a bone. An exemplary guide wire is shown in  FIG.  13   . Referring now to  FIG.  13   , the guide wire  1300  may include a bent section  1305  having a sharpened tip  1310  at a distal portion of the guide wire  1315 . The guide wire may be inserted  705  by rotating the guide wire to orient the bent section  1305  of the guide wire and selectively hammering the guide wire to cause the bent section to form a curved path in bone based on the orientation of the bent section. In an embodiment, inserting  705  the guide wire  1300  may include using a fluoroscope to determine the orientation of the bent section  1305  of the guide wire. In an embodiment, the guide wire  1300  may be attached to a hammer drill during insertion  705 . During insertion of the guide wire  1300 , a user may orient the bent tip  1305  so that it is positioned in the direction that the guide wire is to be inserted  705 . The hammer drill may then be activated to cause the guide wire  1300  to be inserted into the bone in such direction. In particular, the sharpened tip  1310  may be used to cause the hole to be formed in the bone. If the user determines that the direction of insertion  705  for the guide wire  1300  is to be changed, the guide wire may be re-oriented prior to further insertion of the guide wire. In an embodiment, a straight path may be approximated by inserting the guide wire  1300  in a succession of short curved paths that are substantially 180 degrees opposed to each other. As such, although the present method may be used to insert a guide wire  1300  into curved bone, such as at least a portion of a pelvic ring, a posterior column of an acetabulum or an anterior column of an acetabulum of a patient, the method may also be used to insert a guide wire into a substantially straight bone as well. 
     In an embodiment, the guide wire  1300  may include one or more of stainless steel and nitinol. In an embodiment, the guide wire  1300  may be about 1 mm to about 1.5 mm in diameter. It will be apparent to those of ordinary skill in the art that the guide wire  1300  may be of a different size depending upon the particular bone into which the guide wire is to be inserted and that the disclosed size range is merely exemplary. 
     A tunnel may be formed  710  surrounding the guide wire  1300  in the bone. In an embodiment, the tunnel may be formed  710  using a cannulated reamer with a flexible drive shaft that fits over and around the guide wire  1300 . The cannulated reamer may include a bore configured to receive the guide wire  1300 . As such, the guide wire  1300  may guide the direction of the cannulated reamer in forming  710  the space in the bone. 
     The cannulated reamer may be configured to have a diameter sufficient to allow a flexible device, such as at least one of the flexible tubes described in reference to  FIGS.  2 ,  6  and  8   , to be inserted  715  into the tunnel. In an embodiment, the cannulated reamer may be short enough to enable the reamer to form and follow a curved hole defined by the guide wire. 
     The flexible device may be caused  720  to become rigid when in the tunnel. In particular, the rigid flexible device may be used to treat a bone fracture. In an embodiment, the flexible device may be caused  720  to become rigid by operating an actuator and, in response to operating the actuator, rigidizing the flexible device from a flexible state to a more rigid state. For example, expansion sleeves, jam nuts and/or bead segments described above in reference to  FIGS.  3 - 6    may be used to abut against an interior surface of the flexible device causing the flexible device to hold its shape when actuated. In an embodiment, the expansion sleeves may include one or more of a spring, one or more jam nuts and one or more O-rings. In an embodiment, a flexible device may be caused  720  to become rigid by actuating a cannula extending through each of a plurality of expansion sleeves. In an alternate embodiment, a flexible device may be caused  720  to become rigid by rotating a cap located at a proximal end of the flexible device. 
       FIG.  8    depicts an alternate exemplary device for treating a bone according to an embodiment. As shown in  FIG.  8   , the device  800  may include a flexible tube  805 , a plurality of rods  810  contained within the flexible tube, and an actuator (not shown). The flexible tube  805  may include a distal end and a proximal end. In an embodiment, the flexible tube  805  may include a series of slits configured to allow the tube to flex. In an embodiment, the flexible tube  805  may include stainless steel and/or nitinol. 
     In an embodiment, the plurality of rods  810  may be affixed to each other at the distal end of the flexible tube  805  and/or affixed to the distal end of the flexible tube. The plurality of rods  810  may substantially or completely fill the flexible tube  805  such that the rods cannot substantially move with respect to each other inside the flexible tube. In particular, the rods  810  remain parallel to each other and are constrained from deflecting in a radial direction. In an embodiment, the plurality of rods  810  move axially as the flexible tube  805  is flexed. As such, a rod  810  positioned along the inside of a curve traverses a shorter distance that a rod positioned along the outside of the curve, where the relative lengths of the rods change as the curve is modified. 
     The actuator may be configured to cause the plurality of rods to be fixed in place when actuated. In an embodiment, the actuator may be configured to cause the plurality of rods  810  to be fixed in place by causing the plurality of rods to lock in place at the proximal end of the flexible tube  805 . If the plurality of rods  810  are locked together at the proximal end of the flexible tube  805 , any curve(s) in the tube may be fixed in place. 
     In an embodiment, the device  800  may further include a screw  815  positioned at the distal end of the flexible tube  805 . The screw  815  may be used to enable the flexible tube  805  to be inserted into a bone. In an embodiment, the screw  815  may be a high helix angle screw. In an embodiment, the screw  815  may move a distance into a medium, such as a bone, that is approximately equal to its diameter when rotated one revolution. In other words, a screw  815  having a diameter of 12 mm may move forward approximately 12 mm when rotated once. 
     In an embodiment, the device  800  may further include a sleeve (not shown) located within the flexible tube  805 . The sleeve may be configured to contain the plurality of rods  810 . In an embodiment, the actuator may be configured to cause the plurality of rods  810  to be fixed by causing the sleeve to apply a normal force towards a center of the sleeve in response to the actuator being actuated. As such, the sleeve may compress the plurality of rods  810  causing the rods to be incapable of movement, thereby causing the flexible tube  805  to become rigid. 
     In an embodiment, a device for treating a bone may include a flexible tube similar to one of the flexible tubes described above, a spring contained within the flexible tube and an actuator configured to cause the spring to exert a normal force against an inner surface of the flexible tube in response to the actuator being actuated. The normal force exerted by the spring may cause the flexible tube to become rigid. The flexible tube may include a series of slits configured to allow the tube to flex. The flexible tube may include stainless steel and/or nitinol. In an embodiment, a screw may be positioned at the distal end of the flexible tube. 
     In an embodiment, a bone-treating device may be manufactured in the following manner or by performing similar operations. A flexible tube may be formed of a flexible material, such as super-elastic nitinol or spring-tempered stainless steel. The flexible tube may include a plurality of slits to allow the tube to be axially flexible, but stiff in torsion. Alternately, a gooseneck wound spring may be used. In an embodiment, a screw may be attached to a distal end of the flexible tube, and a cap may be attached to a proximal end of the flexible tube. The cap may include a structure that permits the cap to be turned by a wrench. 
     A stiffening system is inserted into the flexible tube such that a distal end of the stiffening system is attached to a distal end of the flexible tube. The stiffening system includes a cannula connected at a distal end to the distal end of the flexible tube and a plurality of bead segments or expansion sleeves threaded along the cannula. Each of the bead segments or expansion sleeves includes a bore permitting the cannula to pass therethrough. The bead segments and expansion sleeves are described in greater detail in reference to  FIGS.  3 - 6   . 
     Alternately, the stiffening system includes a plurality of thin rods attached at a distal end of the flexible tube. In an embodiment, the thin rods may be inserted inside of a sleeve surrounding the thin rods that is configured to prevent the rods from moving when actuated. Alternately, the stiffening system may include a lock at the proximal end of the flexible tube that is used to lock the thin rods in place. 
     In an embodiment, a bone containing a device for treating the bone may include the bone, and a device comprising a tube having a distal end and a proximal end, a stiffening mechanism configured to cause the tube to remain in a rigid state. In an embodiment, the device may include a screw positioned at the distal end of the tube. 
     In an embodiment, the stiffening mechanism may include a plurality of bead segments including a distal bead segment. Each of the plurality of bead segments may include a distal end and a proximal end. The distal end of each bead segment of the plurality of bead segments, other than the distal bead segment, may receive the proximal end of an adjacent bead segment of the plurality of bead segments. In an embodiment, each of the bead segments may be about 8 mm in diameter and about 12 mm in length. In an embodiment, each of the bead segments may be about 2 mm to about 15 mm in diameter. In an embodiment, each of the bead segments may be about 5 mm to about 25 mm in length. Alternately sized bead segments may also be used within the scope of this disclosure. 
     In an alternate embodiment, the stiffening mechanism may include a plurality of expansion sleeves. An expansion sleeve may include, for example and without limitation, a spring, one or more jam nuts, and/or one or more O-rings. 
     The above-described devices and methods may be used to treat a bone fracture. For example, bone fragments at the point of a fracture may be repositioned into a proper alignment, and a device, such as one described above, may be inserted in order to fix the bone fracture to allow healing to complete. 
     Alternately, the above-described devices and methods may be used to prophylactically treat a bone in order to provide support. For example, a metastatic tumor may cause a weak spot in a bone. A device may be inserted to provide support for such a weak spot. As another example, a device may be inserted to support the posterior and anterior columns of the acetabulum for the management of a complex total hip replacement procedure or a revision of a previous total hip replacement. Additional uses of the devices and methods described herein may also be performed within the scope of this disclosure. 
     In an alternate embodiment, a device without a flexible tube may be manufactured for use as described above.  FIGS.  9 A and  9 B  depict an external view and a cut-away view, respectively, of exemplary bead segments according to an embodiment. As shown in  FIGS.  9 A and  9 B , the bead segments, such as  900 , may include a male surface  905  and a female (hollow) surface  910  and a bore. The bore of each bead segment may be configured to receive a stiffening cable or cannula as described above in reference to  FIGS.  3 - 6   . 
     The male surface  905  and the female surface  910  may have a shape that permits torque transfer from one bead segment to the next. For example, the male surface  905 , and the female surface  910  may have a spherical and at a proximal end and a conical cross-section at a distal end, as described further below in reference to  FIGS.  10 A-D . Alternate cross-sectional shapes may also be used for the male surface  905  and the female surface  910  within the scope of this disclosure. For example, other multisided shapes, such as square cross-sections, pentagonal cross-sections, hexagonal cross-sections, heptagonal cross-sections, octagonal cross-sections, spherical cross-sections, conical cross-sections or the like, may be used within the scope of this disclosure. 
     The shapes of the male surface  905  and the female surface  910  of adjacent bead segments may permit torque to be transmitted from one bead to the next to drive a distal screw (such as  1110  in  FIG.  11   ). In addition, the shapes of the male surface  905  and the female surface  910  of adjacent bead segments may enable the bead segments to pivot with respect to each other allowing the chain to form curved shapes. 
     The male surface  905  of each bead segment may include a narrowed neck  915  proximal to the ball to increase the bead-to-bead rotational angle. The narrowed neck  915  may further enable the open ends of the female surface  910  of an adjacent bead to be modified such that the male surface  905  of the bead cannot disengage. In an embodiment, the female surface  915  may be modified post-assembly in order to secure the connection. For example, a circlip may be added to a groove on the inside of the cavity of the female surface  915 . Alternately, the edge of the female surface  915  may be crimped or rolled such that the inner diameter of the female surface is reduced at the edge. In this manner, a string of bead segments may be kept in an interlocked arrangement even if a central stiffening cable (not shown) is broken. 
       FIGS.  10 A-D  depict points of contact between the exemplary bead segments of  FIGS.  9 A and  9 B . The male surface  905  and the female surface  910  of adjacent bead segments  900  have shapes that are capable of transmitting torque, such as hexagons.  FIGS.  10 A-D  identify details of how the male surface  905  and the female surface  910  of the adjacent bead segments  900  interact. The female surface  910  may be substantially straightsided with a cross-section that is similar in nature to the male surface  905  of the adjacent bead segment  900 . At the distal end of the female surface  910 , a cone shape having a circular cross-section may be used. The corners of the male surface  905  of the adjacent bead segment  900  may make point contact with the cone-shaped portion of the female surface  910 . This may cause localized points of high stress, which may lead to improved friction over line contact. In particular, the conical-shaped portion of the female surface  910  may permit improved friction as compared to a hexagonal prism because the hexagonal prism may not make even line contact around the male socket  905  as the adjacent bead segments  900  pivot with respect to each other. The described design may enable an interference fit, such as is shown in  FIG.  10 D , which may enable even higher friction as the point regions are distorted. 
       FIG.  11    depicts a flexible device incorporating a plurality of bead segments according to an embodiment. As shown in  FIG.  11   , the flexible device  1100  includes a plurality of bead segments, such as  1105 , a distal screw  1110 , a stiffening cable (not shown) inside the flexible device, and a tensioning assembly  1115 . Each bead segment  1105  may be substantially similar to any of the bead segments identified herein or any other bead segment possessing similar characteristics to a bead segment identified within the scope of this disclosure, without limitation. 
     The stiffening cable may be a multi-stranded wire that passes through the bead segments  1105 . The stiffening cable may be anchored at the distal screw  1110  at the distal end of the flexible device  1100  and at the tensioning assembly  1115  at a proximal end of the flexible device. In an embodiment, the stiffening cable may be anchored at each of the distal and proximal ends by thermal welding, soldering, gluing, welding a tapered collet in place or the like. 
     While the stiffening cable may be soldered to an anchor so that stress is distributed along an entire hole in which the stiffening cable is anchored such that the solder may wick throughout the hole, a mechanically suitable solder may not be biocompatible. In an embodiment, soldering the stiffening cable to a tapered collet may be used to avoid bioincompatibility within a patient. The collet may be fitted over a stiffening cable and then pressed into a conical hole, which distorts the collet into the cable. The collet may be welded in place at its outside edge so that the cable itself does not experience heating. In such an embodiment, the stiffening cable may receive substantially equal stress in each direction around the tapered collet. 
       FIGS.  12 A and  12 B  depict an exploded view and a cut-away view of an exemplary tensioning assembly  1115  according to an embodiment. As shown in  FIG.  12 A , the tensioning assembly  1115  may include a hex ball tensioner  1205 , a cable anchor  1210 , a tensioning sleeve  1215 , a collet  1220  and a lock nut  1225 . A stiffening cable may be located in the center of the tensioning assembly  1115 , but is not shown in  FIGS.  12 A and  12 B  to enable better viewing of the remaining components of the tensioning assembly. 
     In an embodiment, the stiffening cable may be secured with the tapered collet  1220  resting in the socket of the cable anchor  1210 . The tensioning sleeve  1215  may be threaded over the cable anchor  1210 . The cable anchor  1210  may have a square rod which slides in the hex ball tensioner  1205 . In operation, the cable anchor  1210  may be held in place by a user operated tool while the tensioning sleeve  1215  is threaded in. Threading in the tensioning sleeve  1215  may cause the cable anchor  1210  to be pushed out. A spline of the cable anchor  1210 , when held by a user such as a surgeon, may prevent the entire assembly from rotating while the tensioning sleeve  1215  is rotated by a second external tool. The lock nut  1225  may be applied. In an embodiment, the lock nut  1225  may have the same thread pitch inside and out. As such, the lock nut  1225  may be threaded into the bone as it threads onto the cable anchor  1210  without drawing the cable anchor out of the bone, such as the pelvis, into which it is inserted. Application of the tensioning assembly  1115  may cause the flexible device to become rigid within the patient in order to assist in fixing the bone. 
     EXAMPLE 1: Kit for Medical Use 
     A kit may be sold to physicians, surgeons or other medical professionals or medical institutions for use in treating a bone fracture. The kit includes a flexible device similar to those discussed above (e.g., device  200  or device  800 ). The kit may also include a hammer drill (or hammer drill attachment for a surgical drill) and a guide wire configured to be attached to the hammer drill (or hammer drill attachment). The guide wire includes a bent section having a sharpened tip at a distal portion of the guide wire. An exemplary guide wire is disclosed in  FIG.  13   . The kit may also include a cannulated reamer. The cannulated reamer includes a flexible drive shaft and a bore configured to receive the guide wire. The kit may further include instructions for using the flexible device to treat a bone fracture. In particular, the kit may include instructions for using the hammer drill, guide wire and/or cannulated reamer to insert the guide wire into a bone and to use the cannulated reamer to form a tunnel in the bone using the guide wire as a guide. The instructions for inserting the guide wire using the hammer drill may include instructions for rotating the guide wire into a particular orientation based on the direction of the hole to be formed and instructions for using the hammer drill to form the hole. 
     EXAMPLE 2: Medical Device Using Expansion Sleeves 
     A flexible device for treating a bone includes a nitinol flexible tube having a plurality of slits configured to allow the flexible device to flex, a plurality of expansion sleeves contained within the flexible tube, and a cannula configured to actuate the bead segments. The cannula, when actuated, may cause each expansion sleeve to expand and abut an inner surface of the flexible tube, thereby causing the flexible device to become rigid. An exemplary medical device using expansion sleeves is disclosed in  FIG.  2   . 
     EXAMPLE 3: Expansion Sleeve with Silicone Cladding 
     An expansion sleeve includes a jam nut having expansion beads, silicone cladding covering at least a portion of the expansion beads, a plurality of expanding segments and a bore configured to receive a cannula. Adjacent expansion beads are configured to engage each other based on the size and shape of their adjacent surfaces when actuated. For example, adjacent surfaces may be convex and concave. Each of the expansion beads may taper down in diameter from an exposed surface to an internal surface of the bead. The jam nut is actuated by causing the expansion beads to be moved towards each other, which, in turn, causes the cladding to expand. As such, the expanding segments are configured to be in a non-actuated state against the cladding when the jam nut is not actuated. In contrast, when the jam nut is actuated, the cladding forces the expanding segments to abut an interior surface of the flexible tube. As such, the expanding segments cause the flexible tube to become rigid when the jam nut is in an actuated state. 
     EXAMPLE 4: Expansion Sleeve with Retaining Spring 
     An expansion sleeve includes expansion beads, a retaining spring, a plurality of expanding segments and a bore configured to receive a cannula. Adjacent expansion beads are configured to engage each other based on the size and shape of their adjacent surfaces when actuated. For example, adjacent surfaces may be convex and concave. The expansion sleeve is actuated by causing the expansion beads to be moved towards each other causing the expanding segments to be pushed towards an inner surface of the flexible tube. As such, the retaining spring is configured to restrain the expanding segments when in a nonactuated state. In contrast, when the actuator is actuated, the expanding segments are configured to abut an interior surface of the flexible tube. In this way, the expanding segments cause the flexible tube to become rigid when in an actuated state. 
     EXAMPLE 5: Expansion Sleeve with O-Rings 
     An expansion sleeve includes expansion beads, one or more O-rings, a plurality of expanding segments, and a bore configured to receive a cannula. Adjacent expansion beads are configured to engage each other based on the size and shape of their adjacent surfaces when actuated. For example, adjacent surfaces may be convex and concave. The expansion sleeve is actuated by causing the expansion beads to be moved towards each other causing the expanding segments to be pushed towards an inner surface of the flexible tube. As such, the one or more O-rings are configured to restrain the expanding segments when in a non-actuated state. In contrast, when the actuator is actuated, the expanding segments are configured to abut an interior surface of the flexible tube. As such, the expanding segments cause the flexible tube to become rigid when in an actuated state. 
     EXAMPLE 6: Medical Device Using Bead Segments 
     A flexible device for treating a bone includes a stainless steel flexible tube having a plurality of slits configured to allow the flexible device to flex, a plurality of bead segments contained within the flexible tube, and a cannula configured to actuate the bead segments. The cannula, when actuated, may cause each bead segment to engage adjacent bead segments, thereby stiffening the bead segments and causing the flexible device to become rigid. An exemplary medical device using bead segments is disclosed in  FIG.  6   . 
     EXAMPLE 7: Medical Device Using Rods 
     A flexible device includes a flexible tube, a sleeve within the flexible tube and a plurality of rods contained within the sleeve. The rods are configured to be connected to a distal end of the flexible tube and to bend as the flexible tube is flexed. The sleeve, when actuated, is configured to compress the rods together to restrict their movement in a lateral direction (i.e., in the proximal or distal directions with respect to the flexible tube). An exemplary medical device using rods is disclosed in  FIG.  8   . 
     In the above detailed description, reference is made to the accompanying drawings, which form a part hereof. In the drawings, similar symbols typically identify similar components, unless context dictates otherwise. The illustrative embodiments described in the detailed description, drawings, and claims are not meant to be limiting. Other embodiments may be used, and other changes may be made, without departing from the spirit or scope of the subject matter presented herein. It will be readily understood that the aspects of the present disclosure, as generally described herein, and illustrated in the Figures, can be arranged, substituted, combined, separated, and designed in a wide variety of different configurations, all of which are explicitly contemplated herein. 
     The present disclosure is not to be limited in terms of the particular embodiments described in this application, which are intended as illustrations of various aspects. Many modifications and variations can be made without departing from its spirit and scope, as will be apparent to those skilled in the art. Functionally equivalent methods and apparatuses within the scope of the disclosure, in addition to those enumerated herein, will be apparent to those skilled in the art from the foregoing descriptions. Such modifications and variations are intended to fall within the scope of the appended claims. The present disclosure is to be limited only by the terms of the appended claims, along with the full scope of equivalents to which such claims are entitled. It is to be understood that this disclosure is not limited to particular methods, reagents, compounds, compositions or biological systems, which can, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting. 
     With respect to the use of substantially any plural and/or singular terms herein, those having skill in the art can translate from the plural to the singular and/or from the singular to the plural as is appropriate to the context and/or application. The various singular/plural permutations may be expressly set forth herein for sake of clarity. 
     It will be understood by those within the art that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). While various compositions, methods, and devices are described in terms of “comprising” various components or steps (interpreted as meaning “including, but not limited to”), the compositions, methods, and devices can also “consist essentially of” or “consist of” the various components and steps, and such terminology should be interpreted as defining essentially closed-member groups. It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to embodiments containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations. In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). In those instances where a convention analogous to “at least one of A, B, or C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, or C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). It will be further understood by those within the art that virtually any disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms. For example, the phrase “A or B” will be understood to include the possibilities of “A” or “B” or “A and B.” 
     In addition, where features or aspects of the disclosure are described in terms of Markush groups, those skilled in the art will recognize that the disclosure is also thereby described in terms of any individual member or subgroup of members of the Markush group. 
     As will be understood by one skilled in the art, for any and all purposes, such as in terms of providing a written description, all ranges disclosed herein also encompass any and all possible subranges and combinations of subranges thereof. Any listed range can be easily recognized as sufficiently describing and enabling the same range being broken down into at least equal halves, thirds, quarters, fifths, tenths, etc. As a non-limiting example, each range discussed herein can be readily broken down into a lower third, middle third and upper third, etc. As will also be understood by one skilled in the art all language such as “up to,” “at least,” and the like include the number recited and refer to ranges which can be subsequently broken down into subranges as discussed above. Finally, as will be understood by one skilled in the art, a range includes each individual member. Thus, for example, a group having 1-3 cells refers to groups having 1, 2, or 3 cells. Similarly, a group having 1-5 cells refers to groups having 1, 2, 3, 4, or 5 cells, and so forth. 
     Various of the above-disclosed and other features and functions, or alternatives thereof, may be combined into many other different systems or applications. Various presently unforeseen or unanticipated alternatives, modifications, variations or improvements therein may be subsequently made by those skilled in the art, each of which is also intended to be encompassed by the disclosed embodiments. 
     Example Embodiments 
     Example 1 includes a device, comprising: segments forming a flexible body having first and second body ends and being configurable in a curved shape; at least one axial opening formed in the segments; flexible members disposed in at least one of the at least one axial opening, each flexible member configured to move relative to at least one of the segments along an axial direction as the flexible body is being manipulated into a curved shape; and a mechanism disposed at one of the first and second body ends and being configurable to prohibit the flexible members from moving relative to one another to lock the flexible body in a curved shape. 
     Example 2 includes the device of Example 1 wherein at least one of the segments includes a segment end that is engaged with a segment end of another one of the segments. 
     Example 3 includes the device of any of Examples 1-2 wherein at least one of the segments includes first and second segment ends having approximately a same shape. 
     Example 4 includes the device of any of Examples 1-3 wherein at least one of the segments includes a segment end having a portion that is disposed within a portion of a segment end of another one of the segments. 
     Example 5 includes the device of any of Examples 1-4 wherein at least one of the at least one axial opening extends through a respective center of each of the segments. 
     Example 6 includes the device of any of Examples 1-5 wherein the flexible members comprise respective rods. 
     Example 7 includes the device of any of Examples 1-6 wherein at least one of the flexible members is configured to move relative to at least another of the flexible members along the axial direction as the flexible body is being manipulated into a curved shape. 
     Example 8 includes the device of any of Examples 1-7 wherein the mechanism is configurable to prohibit the flexible members from moving along the axial direction relative to the segments to lock the flexible body into a curved shape. 
     Example 9 includes the device of any of Examples 1-8, further comprising a screw disposed at another of the first and second body ends and configured to secure the flexible body to a bone. 
     Example 10 includes the device of any of Examples 1-9 wherein the mechanism is configurable to lock the flexible body in a curved shape while at least a portion of the flexible body is disposed inside of a bone. 
     Example 11 includes the device of any of Examples 1-10 wherein the mechanism is configurable to lock the flexible body in a curved shape without changing the curved shape. 
     Example 12 includes the device of any of Examples 1-11 wherein the flexible members span a length of the flexible body. 
     Example 13 includes the device of any of Examples 1-12 wherein the mechanism is configured to transition from one of prohibiting the flexible members from moving relative to one another and allowing the flexible members to move relative to one another to the other of prohibiting the flexible members from moving and allowing the flexible members to move without changing a shape of the flexible body. 
     Example 14 includes the device of any of Examples 1-13 wherein at least one of the flexible members is configured to support, at least partially, a load imposed upon one or more of the segments while the flexible body is locked in a curved shape. 
     Example 15 includes a method, comprising: manipulating a flexible body into a curved shape, the flexible body including segments and at least one axial opening through the segments from one end of the flexible body to another end of the flexible body; and locking the flexible body in the curved shape by prohibiting flexible members that are disposed within at least one of the at least one axial opening from moving relative to one another. 
     Example 16 includes the method of Example 15 wherein manipulating the flexible body includes moving at least one of the flexible members along at least one of the at least one axial opening relative to at least one of the segments. 
     Example 17 includes the method of any of Examples 15-16 wherein manipulating the flexible body includes moving at least one of the flexible members along at least one of the at least one axial opening relative to at least one other of the flexible members. 
     Example 18 includes the method of any of Examples 15-17 wherein locking the flexible body in the curved shape further comprises prohibiting the flexible members from moving relative to the segments. 
     Example 19 includes the method of any of Examples 15-18 wherein manipulating the flexible body into a curved shape includes moving at least one of the segments relative to an adjacent one of the segments while the at least one of the segments and the adjacent one of the segments are in contact with one another. 
     Example 20 includes the method of any of Examples 15-19 wherein locking the flexible body in the curved shape includes locking the flexible body without changing the curved shape. 
     Although specific embodiments have been illustrated and described herein, it will be appreciated by those of ordinary skill in the art that any arrangement, which is calculated to achieve the same purpose, may be substituted for the specific embodiments shown. Therefore, it is manifestly intended that this invention be limited only by the claims and the equivalents thereof.