Patent Publication Number: US-2021177474-A1

Title: Fracture and nonunion rib implants

Description:
CLAIM OF PRIORITY 
     This application is a continuation of U.S. application Ser. No. 16/425,539, filed May 29, 2019, which claims the benefit of U.S. Provisional Patent Application Ser. No. 62/679,147, filed on Jun. 1, 2018, the benefit of priority of each of which is claimed hereby, and each of which is incorporated by reference herein in their entireties. 
    
    
     BACKGROUND 
     The present invention relates generally to apparatus and systems for rib implants. For patients with various rib injuries, surgeons sometimes install a plate to secure fractured rib portions to each other. In some cases, a nonunion of the rib sections may occur due to damaged rib portions or improper healing. In these cases, a portion of the rib may need to be removed. To regain anatomical integrity between the rib segments and to protect organs directly behind the ribcage, surgeons use donor tissue and/or plates and screws to bridge the void and to fasten the rib segments to each other. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document. 
         FIG. 1  shows an isometric view of a rib implant coupled to a rib cage of a patient, in accordance with an example of the present disclosure. 
         FIG. 2  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. 
         FIG. 3A  illustrates an isometric view of a fractured rib, in accordance with at least one example of this disclosure. 
         FIG. 3B  illustrates an isometric view of a rib implant, in accordance with at least one example of this disclosure. 
         FIG. 3C  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. 
         FIG. 4A  illustrates an isometric view of a fractured rib, in accordance with at least one example of this disclosure. 
         FIG. 4B  illustrates an isometric view of a fractured rib and a cut guide, in accordance with at least one example of this disclosure. 
         FIG. 4C  illustrates an isometric view of a resected rib, in accordance with at least one example of this disclosure. 
         FIG. 4D  illustrates an isometric view of a rib implant, in accordance with at least one example of this disclosure. 
         FIG. 4E  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. 
         FIG. 4F  illustrates an isometric view of a rib implant fastened to a rib, in accordance with at least one example of this disclosure. 
         FIG. 5  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. 
         FIG. 6  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. 
         FIG. 7A  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. 
         FIG. 7B  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. 
         FIG. 8  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. 
         FIG. 9  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. 
         FIG. 10  illustrates a schematic of a method, in accordance with at least one example of this disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     In some cases of a broken rib, surgeons use plates and screws to bridge the fracture and to secure rib segments to each other. However, these plates and fasteners can be palpable to a patient and in some cases may be prone to catching on nearby soft tissues, causing further discomfort. 
     This disclosure provides a solution to these issues through use of an implant that includes stems and a body that are insertable into an intramedullary canal of the ribs. An implant that is insertable into the intramedullary canal can help reduce palpability. Further, the implant can include one or more components made of porous material configured to promote bone ingrowth with can help effect fixation of the implant to the ribs. 
     In some other cases, a nonunion of rib sections may occur due to damaged rib portions or improper healing. In these cases, a portion of the rib may require removal. To regain anatomical integrity between the rib segments and to protect organs directly behind the ribcage, surgeons can use donor bones from a cadaver or donor bone from the patient (such as from the patient&#39;s femur). In some of these cases, surgeons may use plates and screws to bridge the void and to fasten the rib segments and donor materials to each other. However, these plates and fasteners can be palpable to a patient and can in some cases catch on nearby soft tissues causing further discomfort. Also, a gap may remain when plates are used to bridge the gap. Further, when patients require use of donor bone material from themselves, there may be associated pain and suffering. For example, a patient may donate femoral bone for a rib fracture repair. 
     This disclosure provides a solution to these issues through use of an implant that includes a body configured to provide a substantially natural transition between resected rib sections. The implant can also include one or more components made of porous material configured to promote bone ingrowth which can help effect fixation of the implant to the ribs. The implant can further include plates, flanges, and fasteners to further secure the implant to the rib portions. 
     As used herein, the terms “proximal” and “distal” should be given their generally understood anatomical interpretation. The term “proximal” refers to a direction generally toward the torso of a patient or base or handle of a tool, and “distal” refers to the opposite direction of proximal, i.e., away from the torso of a patient or toward the working end of the tool. 
       FIG. 1  shows an isometric view of a rib implant coupled to a rib cage of a patient, in accordance with an example of the present disclosure.  FIG. 1  shows rib cage  50  including ribs  52 A- 52 E and implant  100 . In some examples, rib cage  50  can be a rib cage of a human, such as a patient, where rib  52 E can be a fractured rib of rib cage  50 . In this example, rib implant  100  can be secured to adjacent ends of rib  52 E, which may be fractured and/or resected. Once secured to adjacent ends of rib  52 E, rib implant  100  can provide a bridge between rib portions. Further details of rib implant  100  are discussed below with respect to  FIG. 2 . 
       FIG. 2  illustrates an isometric view of rib implant  100  secured to rib  52 E, in accordance with at least one example of this disclosure. Rib implant  100  can include body  102 , medial stem  104 , and lateral stem  106 . Also shown in  FIG. 2  is rib  52 E, which can include medial end  54  and lateral end  56 . Medial end  54  can include intramedullary canal  54 IM and medial end  56  can include intramedullary canal  56 IM. Also shown in  FIG. 2  are widths W 1  and W 2  and orientation indicators Medial and Lateral. 
     Rib implant  100  can be a rigid or semi-rigid member made of a single piece (or multiple pieces in some examples). Rib implant  100  can be made of solid biocompatible materials such as stainless steels, cobalt chromium, titanium, combinations thereof, or the like. In some examples, portions of rib implant  100  can be made of porous or semi-porous materials configured to promote bone ingrowth to enhance fixation (such as through osseointegration) of implant  100  to rib  52 E. 
     One porous material that can be used is OsseoTi™ porous metal from Zimmer Biomet™ (Warsaw, Ind.). OsseoTi can be made of Ti6Al4V and can have a porous structure that generally mimics a porous structure of human cancellous bone. Also, the porous material can be Trabecular Metal™, also from Zimmer Biomet. Such a material may be formed from a reticulated vitreous carbon foam substrate that can be infiltrated and coated with a biocompatible metal, such as tantalum, such as using a chemical vapor deposition (“CVD”) process in the manner disclosed in detail in U.S. Pat. No. 5,282,861. Also, the porous material can be Regenerex®, also from Zimmer Biomet. In other examples, other porous materials can be used. 
     Body  102  can be a rigid or semi-rigid member and can be sized to bridge medial end  54  and lateral end  56  of rib  52 E. In this example, body  102  can be sized to replace a portion of rib  52 E, such that body  102  abuts each of ends  54  and  56 , as shown in  FIG. 2 . In some examples, body  102  can be sized and shaped to match a size and a shape of each of rib portion  54  and rib portion  56  to create a substantially uniform bridge between the first end and the second end. In other examples, body  102  can be sized to be inserted into an intramedullary canal of rib  52 E, as discussed below with respect to  FIGS. 3A-3C . 
     Medial stem  104  can be a portion of rib implant  100  extending medially from a medial face of body  102 . Similarly, lateral stem  106  can be a portion of rib implant  100  extending laterally from a lateral face of body  102 . In some examples, medial stem  104  and lateral stem  106  can be of various sizes. In the example of  FIG. 2 , medial stem  104  and lateral stem  106  can have a width that is smaller than a width W 2 , which can be smaller than a width W 1  of body  102 . This can allow medial stem  104  to be insertable into intramedullary canal  54 IM and can allow lateral stem  106  to be insertable into intramedullary canal  56 IM, as shown in  FIG. 2 . In other examples, body  102  can have a width similar to that of W 2  so that body  102  can be inserted into both intramedullary canal  54 IM and intramedullary canal  56 IM. 
     In some examples, one or more of medial stem  104  and lateral stem  106  can include one or more barbs, or sharp directional projections, configured not to limit insertion of the stems into the intramedullary canals, and configured to engage the bone to help prevent back-out the stem from the rib portions. For example, a barb on medial stem  104  can help prevent back-out of medial stem  104  from rib portion  54 . 
     In some examples, one or more of medial stem  104  and lateral stem  106  can have consistent dimensions throughout a medial-to-lateral length of each of the medial stem  104  and lateral stem  106 , respectively. For example, when each of medial stem  104  and lateral stem  106  are substantially oval in geometric shape, each of medial stem  104  and lateral stem  106  can have a consistent width and height throughout the length. In other examples, either of of medial stem  104  and lateral stem  106  can be tapered throughout the medial-to-lateral length to help make insertion into intramedullary canal  541 M easier and to help ensure that each of medial stem  104  and lateral stem  106  can engage the bone of respective rib portions  54  and  56 . 
     In this example, body  102  can be made of solid biocompatible materials such as stainless steels, cobalt chromium, titanium, combinations thereof, or the like. Also, medial stem  104  and lateral stem  106  can each be made of, or coated with, porous or semi-porous materials configured to promote bone ingrowth to enhance fixation (such as through osseointegration), such as Trabecular Metal™, Regenerex®, or OsseoTi®, described above. In other examples, other porous materials can be used. 
     In operation of some examples, rib  52 E can be prepared to receive implant  100 . Preparations can include resecting rib  52 E, as discussed further below. When rib  52 E is ready to receive implant  100 , medial stem  104  can be inserted into intramedullary canal  541 M of rib portion  54  until a medial face of body  102  abuts a lateral face of rib portion  54 . In some examples, width wl can be sized to be substantially the same size as rib portions  54  and  56  to help limit translation of medial stem  104  and lateral stem  106  into respective intramedullary canals. Body  102  can help reduce palpability of implant  100  and catching of implant  100  on nearby soft tissues, by having width W 1  that is of similar size to rib portions  54  and  56 . 
     Once medial stem  104  is fully inserted into intramedullary canal  541 M, lateral stem  106  can be inserted into intramedullary canal  56 IM until a lateral face of body  102  contacts a medial face of rib portion  56 , limiting translation of lateral stem  106  into intramedullary canal  561 M and ensuring insertion of stem  104  into intramedullary canal  54 IM. In some examples, each of medial stem  104  and lateral stem  106  can engage each of intramedullary canal  541 M and intramedullary canal  561 M, respectively, in a press-fit (or interference fit) engagement. In these examples, width W 2  of each of medial stem  104  and lateral stem  106  can be sized to promote the press-fit engagement to secure implant  100  to rib portions  54  and  56  to provide support for rib  52 E. 
     After both of medial stem  104  and lateral stem  106  are secured within respective intramedullary canals, the procedure can be completed. Following the procedure, each of medial stem  104  and lateral stem  106 , being made of a porous material, can promote bone ingrowth from respective rib portions into medial stem  104  and lateral stem  106  to further secure medial stem  104  and lateral stem  106  to rib portions  54  and  56 , respectively. Because body  102  can be of a non-porous material, body  102  can help limit ingrowth of soft tissues into body  102 , to help increase patient comfort of implant  100 . 
     In other examples, each of medial stem  104  and lateral stem  106  can engage each of intramedullary canal  541 M and intramedullary canal  56 IM in other configurations, as discussed further in the examples below. Though installation of implant  100  is described above using the example of installing medial stem  104  first, lateral stem  106  can be installed first in some examples. In other examples, medial stem  104  and lateral stem  106  can be inserted simultaneously, such as when rib  52 E is a floating rib. 
       FIG. 3A  illustrates an isometric view of fractured rib  62 , in accordance with at least one example of this disclosure.  FIG. 3B  illustrates an isometric view of rib implant  300 , in accordance with at least one example of this disclosure.  FIG. 3C  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure.  FIGS. 3A-3C  are discussed together below. 
       FIGS. 3A-3C  show an example of a procedure of installing rib implant  300  in rib  62 . In some examples, implant  300  can be a splint configured to help fill a void between rib portions  64  and  66 . The previously discussed implants may be used in similar procedures.  FIG. 3A  shows rib  62 , which can include ends  64  and  66  with fracture  68  separating portions  64  and  66 .  FIGS. 3B and 3C  show implant  300 , which can include body  302 , medial stem  304 , lateral stem  306 , and fasteners  308  and  310 . Also shown in  FIGS. 3A-3C  are orientation indicators Medial and Lateral. 
     In the example of  FIGS. 3A-3C , implant  300  can be similar to implant  100  described above with respect to  FIGS. 1 and 2 , except that body  302  can be sized to have a width such that body  302  can be insertable into intramedullary canals of rib portions  64  and  66 . As shown in  FIG. 3C , body  302  can be fully inserted into intramedullary canals of rib portions  64  and  66  to create a splint between rib portions  64  and  66 . In this example, each of medial stem  304  and lateral stem  306  are also inserted into rib portions  64  and  66  and can made of porous materials, such as those described above with respect to  FIGS. 1 and 2 . 
     Body  302  can be made of either porous or non-porous materials. For example, body  302  can be made a porous or semi-porous material, such as Trabecular Metal™, Regenerex®, or OsseoTi®, described above. In some examples, body  302  can be non-porous, as described above with respect to  FIGS. 1 and 2  to help limit soft tissue attachment and to help reduce friction during insertion. In some examples, implant  300  can be made of a resorbable material, or a material configured to be absorbed by the body over time. In one example, the resorbable material can be Lactosorb® of Zimmer Biomet™ (Warsaw, Ind.). 
     In other examples, for example when a gap between rib portions  64  and  66  (fracture  68 ) is a small gap and when soft tissue attachment may be less of a concern, body  302  can be a made of a porous material, to help promote bone ingrowth into body  302  and implant  300  to help secure implant  300  to rib  62 . 
     In some examples, body  302  can be of the same width and height as medial stem  304  and lateral stem  306 , such that implant  300  (or the splint) can be of a consistent shape and size throughout an entire medial-to-lateral length of implant  300 . 
     In some examples, as shown in  FIG. 3C , fasteners  308  and  310  can be screws, bolts, rivets, or the like, configured to engage rib portions  64  and/or  66  and implant  300 . In one example, fastener  308  can engage rib portion  64  and body  302  and fastener  310  can engage rib portion  66  and body  302  to secure rib portions  64  and  66  to body  302 . In this way, fasteners  308  and  310  can help limit movement of implant  300  relative to rib portions  64  and  66 . Though  FIG. 3C  shows two of fasteners  308  and  310 , fewer fasteners, such as only fastener  308  or  310  can be used in some examples. In other examples, more fasteners can be used, such as 3, 4, 5, 6, 7, 8, 9, 10, or the like. In some example, pilot holes through rib portions  64  and/or  66  can be used and in other examples, pilot holes may not be used. Similarly, bores or holes in body  302  may or may not be used to receive fasteners  308  and  310 . 
       FIG. 4A  illustrates an isometric view of rib  72 , in accordance with at least one example of this disclosure.  FIG. 4B  illustrates an isometric view of fractured rib  72  and cut guide  420 , in accordance with at least one example of this disclosure.  FIG. 4C  illustrates an isometric view of resected rib  72 , in accordance with at least one example of this disclosure.  FIG. 4D  illustrates an isometric view of rib implant  400 , in accordance with at least one example of this disclosure.  FIG. 4E  illustrates an isometric view of rib implant  400  secured to rib  72 , in accordance with at least one example of this disclosure.  FIG. 4F  illustrates an isometric view of rib implant  400  fastened to rib  72 , in accordance with at least one example of this disclosure. 
       FIGS. 4A-4E  show an example of a procedure of installing rib implant  400  in rib  72 . Any of the previously discussed implants may be used in similar procedures.  FIGS. 4A-4C, 4E, and 4F  show rib  72 , which can include rib portions  74  and  76  separated by fracture  77  ( FIGS. 4A and 4B ). Rib portion  74  can include resected end  78  and rib portion  76  can include resected end  80  ( FIGS. 4C, 4E, and 4F ). Cut guide  420  (shown in  FIG. 4B ) can be a part of a system including implant  400 , where cut guide  420  can include guides  422  (including slot  426 ) and  424  (including slot  428 ). Implant  400  (shown in  FIGS. 4D-4F ) can include body  402 , medial stem  404 , and lateral stem  406 . 
     As shown in  FIG. 4A , rib  72 , which can be a rib of a patient, can have fracture  77  separating ends  74  and  76 . As shown in  FIG. 4B , cut guide  420  can be positioned relative to rib  72 , for example, such that guide  422  is on a medial side of fracture  77  (aligned with a portion of rib portion  74 ) and guide  424  is on a lateral side of fracture  77  (aligned with a portion of rib portion  76 ). In some examples, when cut guide  420  is in a desired position, a blade or saw can be passed through opening  426  of guide  422  to resect rib portion  74  at a desired location. Similarly, the blade or saw can be passed through opening  428  of guide  424  to resect rib portion  76  at a desired location. After resection, rib portion  74  can have resected end  78  and rib portion  76  can have resected end  80 . In some examples, guides  422  and  424  can be sized and shaped to create resected ends  78  and  80 , respectively, so that resected ends  78  and  80  are better suited to receive implant  400 . 
     Implant  400  can be similar to implant  100  described above with respect to  FIGS. 1-2 , such that body  402  can be sized to have a width configured to engage resected ends  78  and  80 , respectively, of rib portions  74  and  76 . In some examples, substantially matching the width of body  402  to rib portions  74  and  76  (for example, by using cut guide  420  and/or by providing body  402  with a desired width) can help provide a relatively consistent profile across rib portion  74 , body  402 , and rib portion  76 , to help reduce palpability and to help provide a natural feel to a patient to help increase patient comfort. 
     As shown in  FIGS. 4E and 4F , each of medial stem  404  and lateral stem  406  can be inserted into rib portions  74  and  76  and can made of porous materials, such as those described above with respect to stems  104  and  106  of  FIGS. 1 and 2 , to help promote bone ingrowth. In some examples, body  402  can be made of either porous or non-porous materials. In this example, body  402  can be non-porous, as described above with respect to  FIGS. 1 and 2 , to help limit soft tissue attachment and to help reduce friction between body  402  and soft tissue. 
     Fasteners  408  and  410  are shown in  FIG. 4F , which can be screws, bolts, rivets, or the like. Though two fasteners are shown, a single fastener can be used in other examples. For example, only fastener  408  can be used to secure rib portion  74  to medial stem  404 . By keeping rib portion  76  free from lateral stem  406 , relatively small movement may occur following installation, which can help healing and proper setting, in some examples. In other examples, where it is desired that implant  400  not move at all (or move very little), two or more fasteners can be used to secure each of medial stem  404  and lateral stem  406  to rib portions  74  and  76 , respectively. In other examples, more than two fasteners can be used, such as 3, 4, 5, 6, 7, 8, 9, 10, or the like. 
     As shown in  FIG. 4F , fastener  408  can be sized to pass through rib portion  74 , through medial stem  404 , and into a portion of rib portion  74  but not extending beyond rib portion  74  (remaining within rib portion  74 ). In other examples, fastener  408  can be sized to extend partially into medial stem  404 . Fastener  410  can be sized similarly to fastener  408 , in some examples. 
       FIG. 5  illustrates an isometric view of rib implant  500  secured to rib  82 , in accordance with at least one example of this disclosure. Rib implant  500  can include stems and can also include plates extending medially and laterally, where the plates engage an outer surface of the rib for affixing the implant to the rib using fasteners. Any of the previously discussed implants can be modified to include plates. 
     Rib implant  500  can include body  502 , medial stem  504 , lateral stem  506 , medial plate  514 , and lateral plate  516 . Medial stem  504  can include stem bore  518  and lateral stem  506  can include stem bore  520 . Medial plate  518  can include plate bores  522  and  524  and lateral plate  520  can include plate bores  526  and  528 . Also shown in  FIG. 5  is rib  82  (including rib portions  84  and  86 ) and orientation indicators Medial and Lateral. 
     Rib implant  500  can be similar to rib implants  100  and  400  discussed above in that body  502  can be sized to abut two resected ends of rib  82  to span rib portions  84  and  86 , such as to create a substantially uniform section of rib  82 . Rib implant  500  can differ, in one example, in that rib implant  500  can include medial plate  514  and lateral plate  516 . Medial plate  514  can extend medially from outer portion  502 A of body  502 . In some examples, medial plate  514  can be substantially parallel to medial stem  504 . Similarly, lateral plate  516  can extend laterally from outer portion  502 A of body  502 . In some examples, lateral plate  516  can be substantially parallel to lateral stem  506 . 
     In some examples, one or more of medial plate  514  and lateral plate  516  can have a peanut-shape from a top perspective with respect to  FIG. 5 . That is, for example, a width of medial plate  514  can be smaller between bores  522  and  524 . This reduced width can help allow for medial plate  514  to be bent or shaped to match a contour of rib portion  84 . Lateral plate  516  can be optionally similarly configured. 
     Bores  518  and  520  of medial stem  504  and lateral stem  506 , respectively, can be configured to receive a fastener (such as a screw, rivet, bolt, or the like) therethrough. Similarly, each of bores  522 ,  524 ,  526 , and  528  can be configured to receive a fastener (such as a screw, rivet, bolt, or the like) therethrough. In some examples, bore  522  of medial plate  514  can be substantially aligned or coaxial with bore  518  of stem  504  such that bores  522  and  518  can receive a common fastener therethrough. Bores  526  of lateral plate  516  and  520  of lateral stem  506  can be similarly aligned to receive a common fastener. Also, bore  524  of medial plate  514  can receive a fastener therethrough and bore  528  of lateral plate  516  can receive a fastener therethrough. Though two bores of each of medial plate  514  and lateral plate  516  are shown, each of medial plate  514  and lateral plate  516  can include fewer bores, such as one each, or more bores, such as 3, 4, 5, 6, 7, 8, 9, 10, or the like. 
     In some examples, one or more of bores  522 ,  524 ,  526 , and  528  can be threaded bores. In some examples, the threading of bores  522 ,  524 ,  526 , and  528  can allow for each of bores  522 ,  524 ,  526 , and  528  to receive locking fasteners (such as a locking screw or bolt) to secure to each of bores  522 ,  524 ,  526 , and  528  to help prevent back-out of each fastener from medial stem  504 , medial plate  514 , lateral stem  506 , and/or lateral plate  516 . 
     Rib implant  500  can also differ in that body  502  can include an outer portion  502 A and inner portion  502 B. In some examples, outer portion  502 A can be, for example, a non-porous biocompatible material, which can be selected to help prevent soft tissue adhesion and reduce friction between body  502  and soft tissues. Inner portion  502   b  can be comprised of a porous or semi-porous material, such as Trabecular Metal™, Regenerex®, or OsseoTi®, which can help promote bone ingrowth from rib portions  84  and  86  into inner portion  502 B to enhance fixation (such as through osseointegration). In this way, body  502  can promote fixation of implant  500  to rib  82  while helping to reduce unwanted adherence of soft tissue to outer portion  502 A of body  502 . 
       FIG. 6  illustrates an isometric view of rib implant  600  secured to rib  82 , in accordance with at least one example of this disclosure. Rib implant  600  can include plates extending medially and laterally, where the plates engage an outer surface of the rib for affixing the implant to the rib using fasteners. Any of the previously discussed implants can be modified to include plates. 
     Rib implant  600  can include body  602 , medial plate  614  (including bores  622  and  624 ) and lateral plate  616  (including bores  626  and  628 ). Rib implant  600  can be similar to rib implant  500 , except that rib implant  600  does not include stems. 
     In operation of some examples, body  602  can be positioned between rib portions  84  and  86  to create a substantially uniform bridge therebetween. In these examples, fasteners can be passed through bores  622 ,  624 ,  626 , and/or  628  to affix medial plate  614  and lateral plate  616  (and therefore implant  600 ) to rib portions  84  and  86 . 
     In the example of  FIG. 6 , body  602  can differ from body  502  in that body  602  can be made of only one material. For example, body  602  can be made of a non-porous material. Using only a single material for body  602  and plates  614  and  616  can help to reduce cost of implant  600 . 
       FIG. 7A  illustrates an isometric view of rib implant  700 A secured to rib  92 , in accordance with at least one example of this disclosure. Rib implant  700 A can include a body having a cylindrical shape that can be bent by a surgeon to match a patient&#39;s anatomy such as a contour of the rib. Rib implant  700 A can also include one or more tapered stems to help ensure engagement between the stem and the intramedullary canal of the rib. Rib implant  700 A can also include one or more flanges on either side of the body to help limit translation of rib implant. Any of the previously discussed implants can be modified to include one or more tapered stems, flanges, and/or a body having a cylindrical shape. 
     Implant  700 A can include body  702 , medial stem  704 , lateral stem  706 , medial flange  724 , and lateral flange  726 . Also shown in  FIG. 7A  is rib  82 , which can include rib portions  84  and  86 . Rib portion  84  can include intramedullary canal  84 IM and rib portion  86  can include intramedullary canal  86 IM. Also shown in  FIG. 7A  are orientation indicators Medial and Lateral. 
     Body  702  can be a rigid or semi-rigid member having a substantially cylindrical geometric shape. Body  702  can be comprised of biocompatible materials that are relatively bendable, such as stainless-steel alloys, titanium alloys, and the like. 
     Medial flange  724  and lateral flange  726  can be flanges or end plates coupled to respective medial and lateral ends of body  702 . In some examples, medial flange  724  and lateral flange  726  can be formed of a single piece with body  702  and in other examples, medial flange  724  and lateral flange  726  can be secured to body  702 , such as through a welding process. Medial flange  724  and lateral flange  726  can be sized to abut respective rib portions  84  and  86  and to create a substantially uniform transition between medial flange  724  and lateral flange  726  and respective rib portions  84  and  86 . In some examples, medial flange  724  and lateral flange  726  can be sized to limit translation of implant  700  relative to rib  82  through contact between medial flange  724  and lateral flange  726  and rib portions  84  and  86 , respectively. 
     Stems  704  and  706  can extend medially and laterally, respectively, from medial flange  724  and lateral flange  726  and can taper as they extend away. In some examples, each of stems  704  and  706  can have multiple tapered portions of varying taper sizes and/or styles including Brown, Morse, Jarno, Jacobs, and the like tapers. In other examples, each of stems  704  and  706  can have a single taper. Each of stems the tapers of stems  704  and  706  can be sized and shaped to engage intramedullary canals  84 IM and  861 M, respectively, to ensure engagement between stems  704  and  706  and respective intramedullary canals  84 IM and  861 M. In some examples, each of stems  704  and  706  can be made of a porous or semi-porous material configured to promote ingrowth of rib portions  84  and  86  into stems  704  and  706 , respectively. Any of the porous materials discussed above can be used. 
     In operation of some examples, stem  704  can be inserted into rib portion  84  in a medial direction until flange  714  contacts a lateral end of rib portion  84  and/or until stem  704  contacts an inner width of cortical bone forming intramedullary canal  84 IM. Stem  706  can then be inserted into rib portion  86  in a similar manner. As in the examples discussed above, either of stems  704  and  706  can be inserted first and in some examples, stems  704  and  706  can be inserted simultaneously. Either prior to insertion of stems  704  and  706  or after insertion, body  702  can be bent, such as by a surgeon using a bending tool, such as a rod bender. Body  702  can be bent to help match a natural curvature of rib  82 , helping to improve respective alignment between stems  704  and  706  and intramedullary canals  84 IM and  86 IM, which can help improve comfort and can help secure implant  700  to rib  82 . 
       FIG. 7B  illustrates an isometric view of a rib implant secured to a rib, in accordance with at least one example of this disclosure. Rib implant  700  can include one or more plates and one or more fasteners extendable through the plates and into the rib. Any of the previously discussed implants can be modified to include one or more plates and/or fasteners. 
     Implant  700 B can include body  702 , medial stem  704 , lateral stem  706 , fasteners  708  and  710 , medial plate  714 , lateral plate  716 , medial flange  724 , and lateral flange  726 . Also shown in  FIG. 7A  is rib  82 , which can include rib portions  84  and  86 . Rib portion  84  can include intramedullary canal  84 IM and rib portion  86  can include intramedullary canal  861 M. Also shown in  FIG. 7B  are orientation indicators Medial and Lateral. 
     Implant  700 B can be similar to implant  700 A described above with respect to  FIG. 7A , except that implant  700 B can also include medial and lateral plates  714  and  716  and fasteners  708  and  710 . In some examples, medial plate  714  can extend medially from a substantially outer width or outer portion of medial flange  724 . Similarly, lateral plate  716  can extend medially from a substantially outer width or outer portion of lateral flange  726 . Each of medial and lateral plates  714  and  716  can include bores configured to receive fasteners therethrough. Fasteners  708  and  710  can be secured to medial and lateral plates  714  and  716  and to rib portions  84  and  86  in one or more ways. 
     As shown in  FIG. 7B , fastener  708  can extend through medial plate  714  into rib portion  84 . In some examples, fastener  708  can extend through cortical bone of rib portion  84  and into intramedullary canal  841 M In other examples, fastener  708  can extend through intramedullary canal  84 IM and into cortical bone on the opposite side of intramedullary canal  84 IM. In the example of  FIG. 7B , fastener  708  can be adjacent to medial stem  704  to help limit translation of implant  700  relative to rib  724 . In some examples, a bore in medial plate  714  can guide the placement of fastener  708  relative to medial stem  704 . 
     As also shown in  FIG. 7B , fastener  710  can extend through lateral plate  716  (such as through a bore of lateral plate  716 ) and into lateral stem  706 . In some example, fastener  710  can extend through lateral stem  706 . In either example, fastener  710  can help secure implant  700 B to rib  82 . 
     In some examples, bores in plates  714  and  716  can be recessed (similar to those of implant  600  so that fasteners  708  and  710  can be substantially flush relative to medial and lateral plates  714  and  716  to help reduce palpability of fasteners  708  and  710 . 
       FIG. 8  illustrates an isometric view of rib implant  800  secured to rib  92 , in accordance with at least one example of this disclosure. The example of  FIG. 8  can be similar to those discussed above where implant  800  is secureable to rib  92 , except that implant  800  is a multi-piece assembly. Implant  800  can include stem  802 , stem  804 , and coupler  806 . Also shown in  FIG. 8  is rib  92  having rib portions  94  and  96 . Also shown in  FIG. 8  are orientation indicators Medial and Lateral. 
     Each of stems  802  and  804  can be rigid or semi-rigid members comprised of biocompatible materials. In some examples, each of stems  802  and  804  can include a portion insertable into a rib portion, where the insertable portion can be made of a porous or semi-porous material configured to promote bone ingrowth. Each of stems  802  and  804  can be similarly sized (or can be of different sizes in some examples) and can be sized and shaped for engagement with coupler  806 . Coupler  806  can be a rigid or semi-rigid member configured to receive each of stems  802  and  804  therein and configured to secure each of stems  802  and  804  thereto such as through a clamping, threaded, or locking mechanism. In some examples, coupler  806  can slide over one or more of stems  802  and  804  for positioning of coupler  806 . 
     The multi-piece assembly of implant  800  can allow for individual insertion of stems  802  and  804  where a small gap (or fracture) between rib portions  94  and  96  is desired (or exists) and a single piece implant is difficult to secure within intramedullary canals of rib portions  94  and  96 . 
       FIG. 9  illustrates an isometric view of rib implant  900  secured to rib  92 , in accordance with at least one example of this disclosure. The example of  FIG. 9  can be similar to the example of  FIG. 8  discussed above, such that the member coupling the multi-piece assembly of implant  900  is a fastener, such as a screw or bolt. 
     Implant  900  can include medial stem  902 , lateral stem  904 , and coupler  906 . Medial stem  902  can include female end  908  and bore  910 . Lateral stem  904  can include male end  912  and bore  914 . 
     Each of stems  902  and  904  can be similar to those discussed above, except that medial stem  902  can include female end  908  located at a lateral portion of medial stem  902 , where female end  908  can be configured to receive male end  912  of lateral stem  904  therein to secure lateral stem  904  within medial stem  902 . Once lateral stem  904  is inserted into medial stem  902 , fastener  906  can be passed through bore  910  of medial stem  902  and bore  914  of lateral stem  904  to further secure medial stem  902  and lateral stem  904 . In some examples, fastener  906  can be excluded, such as where male end  912  and female end  908  engage in a threaded (or otherwise locking) fashion. 
     The multi-piece assembly of implant  900  can allow for insertion of stems  902  and  904  where a small gap (or fracture) between rib portions  94  and  96  is desired (or exists) and a single piece implant is difficult to secure within intramedullary canals of rib portions  94  and  96 . 
       FIG. 10  illustrates a schematic of method  1000 , in accordance with at least one example of this disclosure. Method  1000  can be a method of securing an implant to a rib of a patient. The steps or operations of method  1000  are illustrated in a particular order for convenience and clarity; many of the discussed operations can be performed in a different sequence or in parallel without materially impacting other operations. Method  1000  as discussed includes operations performed by multiple different actors, devices, and/or systems. It is understood that subsets of the operations discussed in method  1000  attributable to a single actor, device, or system could be considered a separate standalone process or method. 
     Method  1000  can begin at step  1002  where rib portions can be resected, such as rib portions  74  and  76  of  FIGS. 4A-4F . In some examples, a resection may not be performed, such as with the steps shown in  FIGS. 3A-3C . At step  1004 , a first stem can be inserted into a first rib portion. For example, stem  104  can be inserted into rib portion  54 , as shown in  FIG. 2 . At step  1006 , a second stem can be inserted into a second rib portion. For example, stem  106  can be inserted into rib portion  56 , as shown in  FIG. 2 . 
     At step  1008 , a body of the implant can be inserted into the ribs. For example, body  302  can be inserted into rib portions  64  and  66 . In some examples where the body does abut the rib portions (as shown in  FIG. 2 ), step  1008  may not be performed. At step  1010  the implant can be secured to the ribs. For example, fasteners  408  and  410  can be secured to rib portions  74  and  76  and medial and lateral stems  404  and  406  to secure implant  400  to rib  72 . 
     EXAMPLES 
     The following, non-limiting examples, detail certain aspects of the present subject matter to solve the challenges and provide the benefits discussed herein, among others. 
     Example 1 is a rib implant securable to first and second rib portions of a rib, the rib implant comprising: a body the body including a first end and an opposite second end, the body configured to span a first rib portion of a rib at the first end and a second rib portion of the rib at the second end; a first porous stem extending from the first end of the body, the first porous stem insertable into a first intramedullary canal of the first rib portion; and a second porous stem extending from the second end of the body opposite the first porous stem, the second porous stem insertable into a second intramedullary canal of the second rib portion to secure, together with the first porous stem, the first rib portion and the second rib portion. 
     In Example 2, the subject matter of Example 1 optionally includes wherein the body is comprised of a porous material configured to promote bone ingrowth. 
     In Example 3, the subject matter of any one or more of Examples 1-2 optionally include wherein the body is comprised of a resorbable material. 
     In Example 4, the subject matter of any one or more of Examples 1-3 optionally include wherein one or more of the body, the first porous stem, and the second porous stem is comprised of Lactosorb. 
     In Example 5, the subject matter of any one or more of Examples 1-4 optionally include wherein the first porous stem is comprised of a porous material configured to promote bone ingrowth. 
     In Example 6, the subject matter of any one or more of Examples 1-5 optionally include wherein one or more of the body, the first porous stem, and the second porous stem is comprised of a material selected from a group consisting of Trabecular metal, Regenerex, and OsseoTi. 
     In Example 7, the subject matter of any one or more of Examples 1-6 optionally include wherein the body is comprised of a solid material and is sized and shaped to match a size and a shape of each of the first rib portion and the second rib portion to create a substantially uniform bridge between the first rib portion and the second rib portion. 
     In Example 8, the subject matter of any one or more of Examples 1-7 optionally include wherein the first porous stem is configured to create an interference fit with the first intramedullary canal. 
     In Example 9, the subject matter of any one or more of Examples 1-8 optionally include a fastener extendable through the first stem to secure the first stem to the first rib portion. 
     In Example 10, the subject matter of any one or more of Examples 1-9 optionally include a plate extending from the body substantially parallel to the first stem, the plate configured to engage a face of the first rib portion. 
     In Example 11, the subject matter of Example 10 optionally includes wherein the plate includes a plate bore and the first stem includes a stem bore substantially coaxial with the plate bore. 
     In Example 12, the subject matter of any one or more of Examples 1-11 optionally include a fastener extendable through the plate bore and the stem bore to secure the first stem and the plate to the first rib portion. 
     In Example 13, the subject matter of anyone or more of Examples 1-12 optionally include wherein the body comprises a substantially cylindrical rod. 
     In Example 14, the subject matter of Example 13 optionally includes wherein the rod is bendable to match a curvature of a rib of a patient. 
     In Example 15, the subject matter of any one or more of Examples 13-14 optionally include a flange secured to the body between the body and the first stem. 
     In Example 16, the subject matter of any one or more of Examples 13-15 optionally include wherein at least one of the first stem and second stem comprises a tapered extension. 
     Example 17 is a rib implant system comprising: an implant securable to a first rib portion of a rib and a second rib portion of the rib, the implant comprising: a body the body including a first end and an opposite second end, the body configured to span a first rib portion of a rib at the first end and a second rib portion of the rib at the second end; a first porous stem extending from the first end of the body, the first porous stem insertable into a first intramedullary canal of the first rib portion; and a second porous stem extending from the second end of the body opposite the first porous stem, the second porous stem insertable into a second intramedullary canal of the second rib portion to secure, together with the first porous stem, the first rib portion and the second rib portion. 
     In Example 18, the subject matter of Example 17 optionally includes a cut guide configured to guide resection of the first rib portion and the second rib portion so that the rib implant is positionable therebetween. 
     In Example 19, the subject matter of any one or more of Examples 17-18 optionally include a fastener securable to the first rib portion and the first stem to secure the rib implant to the first rib portion. 
     Example 20 is a rib implant securable to a medial rib portion of a rib and a lateral rib portion of the rib, the rib implant comprising: a first porous stem including a medial portion and a lateral portion, the medial portion insertable into a first intramedullary canal of the medial rib portion; and a second porous stem including a medial portion and a lateral portion, the lateral portion insertable into a lateral intramedullary canal of the lateral rib portion, the lateral portion of the first porous stem securable to the medial portion of the second porous stem to secure the medial rib portion and the lateral rib portion. 
     In Example 21, the subject matter of Example 20 optionally includes wherein the medial portion of the second porous stem is insertable into the lateral portion of the first porous stem. 
     In Example 22, the subject matter of any one or more of Examples 20-21 optionally include a coupler securable to the medial portion of the second porous and the lateral portion of the first porous stem. 
     In Example 23, the system, device, or method of anyone of or any combination of Examples 1-22 is optionally configured such that all elements or options recited are available to use or select from. 
     ADDITIONAL NOTES 
     The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein. 
     In the event of inconsistent usages between this document and any documents so incorporated by reference, the usage in this document controls. 
     In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects. 
     The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.