Patent Description:
In various surgical procedures there is a need to tension a tensioning member about a target bone or parts thereof. Surgical instruments are known which assist a surgeon in reliably and efficiently creating the required tension.

<CIT> discloses a closure system adapted to secure a first bone portion to a second bone portion. The closure system includes a band, a locking terminal, and a tensioning instrument. The band is adapted to be looped around the first and second bone portions. The locking terminal is adapted to fixedly engage a first portion of the band and selectively fixedly engage a second portion of the band. The tensioning instrument includes a body and a threaded rod. The threaded rod is received in the body and adapted to engage the band such that movement of the threaded rod relative to the body moves the second portion of the band relative to the first portion of the band.

<CIT> discloses a bone fixation system including at least one bone fixation member and a tensioning instrument. The bone fixation member includes a strap and a locking mechanism. The strap can be pulled through the locking mechanism so as to form a loop about a target bone so as to secure first and second bone segments in an approximated, compressed configuration. The tensioning instrument is configured to apply tension to the loop about the target bone. The tensioning instrument includes a tension assembly that is configured to secure a free end of the bone fixation member to the fixation instrument. The tension assembly is further configured to pull the free end so as to increase tension in the loop while the tension in the loop is less than a select tension.

<CIT> and <CIT> disclose further prior art, wherein <CIT> is the closest prior art.

Currently, surgical tensioning instruments are neither sufficiently easy to handle nor sufficiently reliable.

Accordingly, there is a need for a surgical tensioning instrument that is easy to handle and reliable. A surgical tensioning instrument according to the invention is provided in claim <NUM>.

The present disclosure provides a surgical tensioning instrument configured to apply a tension to a strap portion of a tensioning member about a target bone or parts thereof, with the tensioning member further including a locking portion configured to cooperate with the strap portion so as to maintain the tension in the tensioning member. The tensioning instrument comprises a clamping mechanism configured to secure the locking portion to the instrument, wherein the clamping mechanism comprises opposed clamping jaws, at least one of the clamping jaws being configured to be movable between a closed position, in which the locking portion is secured to the instrument, and an open position, in which the locking portion is released from the instrument. The clamping mechanism is operable to move the at least one of the clamping jaws from the closed position to the open position upon its operation.

The surgical tensioning instrument according to the invention is configured to apply a tension to a surgical tensioning member so as to tension a strap portion of the surgical tensioning member about a target bone or parts thereof, with the surgical tensioning member further including a locking portion configured to cooperate with the strap portion so as to maintain the tension in the surgical tensioning member. The surgical tensioning instrument comprises a body defining a front end and an opposed back end, and a grip movable relative to the body and configured to secure the strap portion of the surgical tensioning member to the surgical tensioning instrument. The instrument further comprises an actuator operatively coupled to the body and configured to move from an initial position toward a tensioning position in response to an applied force, thereby causing the grip to move in a tensioning direction. Further still, the instrument comprises a clamping mechanism configured to secure the locking portion of the surgical tensioning member to the surgical tensioning instrument, wherein the clamping mechanism comprises opposed clamping jaws at the front end of the body, at least one of the clamping jaws being configured to be movable between a closed position, in which the locking portion is secured to the surgical tensioning instrument, and an open position, in which the locking portion is released from the surgical tensioning instrument. The clamping mechanism is operable to move the at least one of the clamping jaws from the closed position to the open position upon its operation.

The at least one movable jaw may be hinged to the body and configured to pivot between the closed position and the open position. The clamping jaws may be symmetrically arranged in the closed position of the clamping mechanism.

The at least one movable jaw may have a central portion between two opposed end portions, and the central portion of the at least one movable jaw may be hinged to the body. The at least one movable jaw may have two opposed ends, a back end closer to the back end of the body and a front end closer to the front end of the body, wherein the front end of the jaw may be hook-shaped. In certain variants, the two clamping jaws may have front ends that are hook-shaped and facing each other. Hook-shaped may, for example, be understood as L-shaped or J-shaped.

The clamping mechanism may comprise a mechanical linkage of components configured to be movable in a direction towards the front end or in a direction towards the back end of the body. The clamping mechanism may be configured to turn a translatory, i.e., linear, movement of one of its components into a rotatory, i.e., pivoting, movement of another one of its components, such as at least one of the jaws.

The at least one movable jaw may be configured to cooperate with (e.g., may be connected to) a rod, which may be operable to move the at least one movable jaw from the closed position to the open position. The rod may only be movable in a translatory manner. The rod may be configured to cause a rotatory movement of the at least one movable jaw.

The rod may be configured to act as a push rod. A pushing movement of the rod may cause the at least one movable jaw to open. The pushing movement may be directed towards the front end of the body.

The rod may form part of the mechanical linkage. The mechanical linkage may comprise at least another rod. Two rods of the mechanical linkage may be connected directly to each other. These rods may be pivotably connected to each other via a joint (e.g., defining common hinge axis). Both rods may each extend along different longitudinal directions. Their longitudinal directions may be at an angle. The angle may be an obtuse angle.

The rod may at least partially extend through the body. The rod may be guided inside the body. The body may allow only a translatory movement of the rod. The rod may be surrounded by the body. The rod may be completely hidden within the body.

According to the invention, the clamping mechanism comprises a release button protruding from the body and configured to move at least one of the clamping jaws from the closed position to the open position. The release button may comprise a button through-hole, which may extend laterally through the button. The button through-hole may be oblong with a button through-hole back end that is closer to the back end of the body and a button through-hole front end that is closer to the front end of the body.

The button may be movable only linearly. The movement of the button may be limited in both directions, i.e., towards the front end of the body and towards the back end of the body, by means of a button guide, which may be at least one of rod-shaped, fixedly attached to the body and extending through the button through-hole. A portion of the button may always remain hidden in the body. A button spring may be located between the body and the button, and may bias the button into its initial position. In the initial position, the button may protrude (e.g., as far as possible) from the back end of the body, when the button is not being pushed into the body. In the initial position, the button through-hole front end of the button through-hole may contact the button guide. In a completely pushed position, the button through-hole back end of the button through-hole may contact the button guide.

The release button may be configured to actuate the rod. In particular, the button may be configured to push the rod towards the front end of the body and may, in some variants, be configured to pull the rod towards the back end of the body. The button may be directly connected to the rod. The button may be pivotably hinged to the rod. The button and the rod may be inserted into the body and their movement may be limited by the body to a translatory movement. The button and the rod may extend along different longitudinal directions. Their longitudinal directions may be at an angle. The angle may be an obtuse angle.

The at least one movable jaw may be pivotably guided in an elongated cut-out of the rod or of a component coupled to the rod. The cut-out may extend in a first plane, wherein the at least one movable jaw may be configured to move in a second plane from the closed position to the open position, and wherein the first plane may be parallel to the second plane.

The elongated cut-out may be curved such that self-opening of the at least one movable jaw from the closed position to the open position is avoided. The elongated cut-out may be straight or otherwise shaped, as long as there is one portion that is closer to the back end of the body and one portion that is closer to the front end of the body, i.e., as long as they have a portion that extends in a front end back end direction of the body.

The jaws may protrude laterally from the body. One of the jaws may be a fixed or stationary jaw. In other variants, all jaws are movable. The at least one movable jaw may protrude laterally from the body only in the open position. The jaws may be laterally within the body in the closed position of the clamping mechanism or in the closed position of the at least one movable jaw.

The clamping mechanism may be configured such that the closed position is held, when the clamping mechanism is not operated. The clamping mechanism may allow a force acting on the at least one movable jaw directly to close the at least one movable jaw but the clamping mechanism may prevent a force acting on the at least one movable jaw directly to open the at least one movable jaw. For that purpose, the elongated cut-out may be arranged such in the closed position of the clamping mechanism that the end of the jaw movably arrange therein is pressed against a lateral wall of the cut-out, i.e., a wall between the front end and the back end of the cut-out. In fact, as long as all or at least a majority, i.e., more than <NUM>%, of the force applied to the jaw directly for opening it is transmitted by pivoting the jaw about the body and exerted against the lateral wall of the cut-out, the direct opening of the jaw by a force acting directly on the free end of the jaw is avoided or made considerably more difficult. So, a force exerted on the at least one movable jaw for the purpose of self-opening causes the at least one movable jaw to push more towards a lateral wall of the elongated cut-out than in the elongation direction of the cut-out.

The release button may be configured to be pushed from an initial position into the body to move the at least one clamping jaw from the closed position to the open position. The button may be configured to return to its initial position upon release of the button to move the at least one clamping jaw from the open position to the closed position.

The clamping mechanism may be configured to actively move the opposed clamping jaws from the closed position to the open position upon its operation. The clamping mechanism may be configured to actively move the opposed clamping jaws from the open position to the closed position upon a lack of its operation.

There may further be provided a surgical tensioning system comprising the surgical tensioning member comprising the locking portion and the strap portion, and further comprising the surgical tensioning instrument. The at least one movable jaw may be configured to engage the locking portion of the surgical tensioning member in the closed position.

The engagement of the locking portion of the surgical tensioning member by the at least one movable jaw and another opposite movable or immovable jaw may cause the body of the surgical tensioning instrument to be fixedly attached to the locking portion of the surgical tensioning member.

The strap portion may be configured to be pulled through the locking portion along a first direction so as to form a loop about a target bone. The locking portion may be configured to prevent the strap portion from moving there through along a second direction opposite the first direction. In some variants, the strap portion defines a free end that may extend out of the locking portion.

The locking portion may include a locking plate and a locking head. The locking plate and locking head may be formed from different materials. The locking plate may be formed from metal and the locking head may be formed from a polymeric material. The locking plate may be configured to be attached to bone (e.g., via bone screws) and the locking head may be configured to engage the strap portion. The at least one movable jaw may be configured to engage the locking plate, or a portion thereof, in the closed position. The at least one movable jaw may be configured to engage the locking head of the locking portion of the surgical tensioning member in the closed position.

The engagement of the locking head or locking plate of the locking portion of the surgical tensioning member by the at least one movable jaw and another opposite movable or immovable jaw may cause the body of the surgical tensioning instrument to be fixedly attached to the locking head or to the locking plate of the locking portion of the surgical tensioning member.

The present disclosure further provides a surgical tensioning instrument configured to apply a tension to a surgical tensioning member so as to tension the surgical tensioning member about a target bone or parts thereof. The surgical tensioning instrument comprises a grip configured to secure a free end of the surgical tensioning member to the surgical tensioning instrument, with the grip being configured to move in a first direction so as to generate or increase tension in the surgical tensioning member. The instrument further comprises an actuator operatively coupled to the grip, the actuator configured to move from an initial position toward a tensioning position in response to an applied force, thereby causing the grip to move in the first direction. Further still, the instrument comprises a tension limiter connected between the actuator and the grip, wherein the tension limiter allows the grip to move in the first direction when the tension in the surgical tensioning member is less than a tension threshold, and prevents the grip from moving in the first direction when the tension in the surgical tensioning member reaches the tension threshold. The tension limiter comprises a tension limiter spring connected between the actuator and the grip, wherein movement of the actuator from the initial position toward the tensioning position causes the tension limiter spring to stretch, and the stretching of the tension limiter spring causes the tension limiter spring to bias the grip to move in the first direction under a biasing force.

The present disclosure further provides a surgical tensioning instrument configured to apply a tension to a surgical tensioning member so as to tension the surgical tensioning member about a target bone or parts thereof. The surgical tensioning instrument comprises a grip configured to secure a free end of the surgical tensioning member to the surgical tensioning instrument, a traveler that is connected to the grip such that the grip is configured to move in a first direction along with the traveler so as to generate or increase tension in the surgical tensioning member, and an actuator operatively coupled to the traveler, the actuator configured to move from an initial position toward a tensioning position in response to an applied force, thereby causing the traveler to move in the first direction. The instrument further comprises a tension limiter connected between the actuator and the traveler, wherein the tension limiter allows the traveler to move in the first direction when the tension in the surgical tensioning member is less than a tension threshold, and prevents the traveler from moving in the first direction when the tension in the surgical tensioning member reaches the tension threshold. The tension limiter comprises a tension limiter spring connected between the actuator and the traveler, wherein movement of the actuator from the initial position toward the tensioning position causes the tension limiter spring to stretch, and the stretching of the tension limiter spring causes the tension limiter spring to bias the traveler to move in the first direction under a biasing force.

When the tension in the surgical tensioning member reaches the tension threshold or exceeds the tension threshold, any further movement of the actuator towards the tensioning position may cause the tension limiter spring to stretch further and the traveler and/or grip to stop its movement in the first direction. In other words, the traveler and/or grip may remain stationary, while the actuator is moved towards the body.

The tension limiter spring may be enclosed by the actuator. The tension limiter spring may be partially or fully enclosed by the actuator. The tension limiter spring may be visible through the actuator. The tension limiter spring may be a helical spring.

The actuator may extend along a second direction and the tension limiter spring may extend in the second direction. Alternatively, the actuator and the tension limiter spring may extend longitudinally in parallel.

The surgical tensioning instrument may further comprise a tension limiter adjustment mechanism configured to provide an adjustability of the tension threshold by adjustment of an initial pre-stretch of the tension limiter spring. The adjustment mechanism may comprise an adjustable threaded connection configured to alter its longitudinal length.

The adjustment mechanism may be configured to adjust a distance between one part of the tension limiter spring, which is closer to the actuator, and another part of the tension limiter spring, which is closer to the grip and/or traveler. The adjustment mechanism may be configured to adjust a distance between one longitudinal end of the tension limiter spring, which is connected to the actuator, and an opposite longitudinal end of the tension limiter spring, which is connected to the grip and/or traveler. The adjustment mechanism may form a connection link between the tension limiter spring and the actuator. The term connection - as in the entire disclosure - may be refer to a direct or indirect (i.e., via another component) connection.

The surgical tensioning instrument may be a forceps type instrument. One shank of the forceps may be formed by a body of the surgical tensioning instrument and another shank of the forceps may be formed by the tensioning mechanism and/or by the actuator.

The grip may define a grip channel for insertion of a portion of the surgical tensioning member. The grip channel may be configured to lead the surgical tensioning member into a space between the actuator and the body of the surgical tensioning instrument. The grip channel may be formed by a space between the grip and the traveler. The grip channel may be formed on a side of the traveler opposite the body and/or the traveler pivot axis.

The traveler may be pivotably hinged to the grip. The grip may be pivotably hinged to the traveler about a grip pivot axis, preferably independently. The actuator may be pivotably hinged to the traveler about the same grip pivot axis but independently from the grip. A grip spring may be connected between the grip and the traveler and may bias the grip in an initial traveler position relative to the traveler. The grip may have one end portion that is hinged to the other end portion of the traveler via the grip pivot axis. The grip spring may extend between a central portion of the grip and a central portion of the traveler, may be connected at one end thereof to the grip via a connecting axis and at the other end thereof to the traveler, and may bias the grip away from the traveler, thereby opening the grip channel between a central protruding grip portion of the grip and the other end of the traveler for insertion of a surgical tensioning member. The traveler may include a stop for the grip, against which the grip may be biased by the grip spring to define a maximum width of the grip channel.

The actuator may have one end portion that is hinged to the grip by means of the connecting axis.

The actuator may be pivotably hinged to the grip. The actuator may be pivotably hinged directly at one end of the grip, for example to the grip pivot axis. The actuator may further be hinged indirectly, for example via the tension limiter spring at the other end of the grip.

The actuator may be pivotable about one axis and the grip may be pivotable about another axis, and both axes may be collinear. The resulting axis may be the grip pivot axis or the traveler pivot axis.

The actuator may pivot together with the grip and the traveler about the traveler pivot axis, when the tension in the surgical tensioning member is less than a tension threshold. When the tension in the surgical tensioning member is at or above the tension threshold, the grip and the traveler remain stationary, while the actuator pivots either about the connecting axis or about the grip pivot axis.

The surgical tensioning instrument may further comprise a body defining a surgical tensioning member contacting front end of the body and an opposed back end of the body. The front end and the back end of the body may define a longitudinal extension of the body.

The grip, the traveler and the actuator may be pivotably hinged to the body and may be configured to pivotably move in the first direction and towards the body. They may be hinged via the traveler and its traveler pivot axis.

The grip may be configured to move towards and away from the traveler to close and open the grip channel, wherein a grip spring may be connected between the grip and the traveler and may bias the grip away from the traveler and the grip channel into an open initial position.

The body may comprise an interface configured to temporary fix a locking portion of the surgical tensioning member to the body. Additionally, or in the alternative, the body may comprise a pulley configured to lead a free end of a strap portion of the surgical tensioning member extending through the locking portion towards the grip and/or grip channel.

The present disclosure further provides a surgical tensioning system comprising the surgical tensioning member including a locking portion and a strap portion, wherein the strap portion may be configured to be pulled through the locking portion along a third direction so as to form a loop about a target bone, and the locking portion may be configured to prevent the strap portion from moving there through along a fourth direction opposite the third direction. The strap portion may define a free end that may extend out the locking portion. The surgical tensioning system further comprises the surgical tensioning instrument, wherein the tension threshold may be below a breaking tension of the surgical tensioning member.

The foregoing summary, as well as the following detailed description, will be better understood when read in conjunction with the appended drawings. In the drawings:.

<FIG> illustrates a lateral cross-section view of a surgical tensioning instrument <NUM>, which here is a forceps type instrument.

The surgical tensioning instrument <NUM> comprises a body <NUM>, which extends longitudinally from a front end <NUM> to a back end <NUM>. Front end <NUM> and back end <NUM> of the body <NUM> can also be referred to as front portion and back portion of the body <NUM>, thereby not necessarily denoting a certain point but a portion of the body <NUM>.

The body <NUM> comprises a pulley <NUM>, which is rotatably hinged to the body <NUM> at the front end <NUM> thereof. As will be explained in greater detail below, the purpose of the pulley <NUM> is to guide a surgical tensioning member from the front end <NUM> towards the back end <NUM> of the body <NUM>.

The front end <NUM> of the body <NUM> comprises an interface <NUM> configured to temporarily and laterally enclose a locking portion of the surgical tensioning member. Thereby, the locking portion can temporarily be fixed to the body <NUM>, as will also be explained in greater detail below.

The surgical tensioning instrument <NUM> further comprises a clamping mechanism <NUM> and a tensioning mechanism <NUM>, which are both mounted to the body <NUM>. <FIG> illustrates a cross-section view of section A-A in <FIG> showing an open state of the clamping mechanism <NUM>. <FIG> illustrates a cross-section view in accordance with <FIG> but showing a closed state of the clamping mechanism <NUM>.

<FIG> will jointly be referred to in the following to describe the clamping mechanism <NUM> and the tensioning mechanism <NUM> of the surgical tensioning instrument <NUM>.

The clamping mechanism <NUM> of the surgical tensioning instrument <NUM> illustrated in <FIG> comprises a button <NUM> with a button through-hole <NUM>, a button guide <NUM>, a button spring <NUM>, a first rod <NUM>, a second rod <NUM> with two second rod through-holes <NUM>, and two clamping jaws <NUM>. The button <NUM>, also referred to as release button herein, comprises the button through-hole <NUM>, which extends laterally through the button <NUM>. The button through-hole <NUM> is oblong with a button through-hole back end that is closer to the back end <NUM> of the body <NUM> and a button through-hole front end that is closer to the front end <NUM> of the body <NUM>. The button <NUM> protrudes partially from the back end <NUM> of the body <NUM>, and is movable only linearly.

The movement of the button <NUM> is limited in both directions, i.e., towards the front end <NUM> of the body <NUM> and towards the back end <NUM> of the body <NUM>, by means of the button guide <NUM>. The latter is rod-shaped, fixedly attached to the body <NUM> and extends through the button through-hole <NUM>. Therefore, a portion of the button <NUM> always remains hidden in the body <NUM>. The button spring <NUM> is located between the body <NUM> and the button <NUM>, and biases the button <NUM> into its initial position. In the initial position, the button <NUM> protrudes as far as possible from the back end <NUM> of the body <NUM>, when the button <NUM> is not being pushed into the body <NUM>. In the initial position, the button through-hole front end of the button through-hole <NUM> contacts the button guide <NUM>. Here in <FIG>, the button <NUM> is in a partially pushed state. In this partially pushed state, the button <NUM> is in a position, where the button through-hole back end of the button through-hole <NUM> is closer to the button guide <NUM> than the button through-hole front end of the button through-hole <NUM>.

With continued reference to <FIG>, the first rod <NUM> comprises a back end, which is hinged to the button <NUM> and extends longitudinally further through the body <NUM> towards the front end <NUM> of the body <NUM>. An opposite front end of the first rod <NUM> is hinged to a back end of the second rod <NUM>, which extends longitudinally even further through the body <NUM> towards the front end <NUM> of the body <NUM>. An opposite front end of the second rod <NUM> comprises symmetrically curved second rod through-holes <NUM>, also referred to as elongated cut-outs, which extend in a common plane. Back ends of the curved second rod through-holes <NUM> are closer to each other as well as closer to the back end <NUM> of the body <NUM> than front ends of the curved second rod through-holes <NUM>, which are further apart from each other. Of course, the second rod through holes <NUM> may be straight or otherwise shaped, as long as they have one portion that is closer to the back end <NUM> of the body <NUM> and one portion that is closer to the front end <NUM> of the body <NUM>, i.e., as long as they have a portion that extends in a front end <NUM> to back end <NUM> direction.

With reference to <FIG>, <FIG> and <FIG>, the clamping jaws <NUM> extend longitudinally even further through the body <NUM> and are closest to the front end <NUM> of the body <NUM>. Back ends of the clamping jaws <NUM> are pivotably guided in the second rod through-holes <NUM>, their central portions are hinged to the body <NUM>, and their front ends are hook-shaped i.e., L-shaped), and free to be able to secure a surgical tensioning member. Here in <FIG>, the clamping jaws <NUM> are in their open position. <FIG> shows that open position, where the back ends of the clamping jaws <NUM> are at the back ends of the curved second rod through-holes <NUM>. <FIG> shows the closed position of the clamping jaws <NUM>, where the back ends of the clamping jaws <NUM> are at the front ends of the curved second rod through-holes <NUM>. <FIG> and <FIG> also show the symmetrical arrangement of the clamping jaws <NUM> in both, their open and closed position.

Of course, instead of two, there may be provided just one movable clamping jaw <NUM> and one corresponding second rod through-hole <NUM>. The other clamping jaw may be immovably fixed to the body <NUM> and even form part of the interface <NUM> of the body <NUM>. Moreover, more than two clamping jaws <NUM> may be provided (e.g., two pairs of opposing clamping jaws).

When the button <NUM> is pushed, the button <NUM> is moved from its initial position - protruding as far as possible from the back end <NUM> of the body <NUM> - further into the body <NUM> and against the biasing force of the button spring <NUM>. The linear movement of the button <NUM> is transmitted through the first rod <NUM> to the second rod <NUM>. The second rod <NUM> is moved towards the clamping jaws <NUM> such that the back ends of the clamping jaws <NUM> are brought closer together at the back ends of the curved second rod through-holes <NUM> and the front ends of the clamping jaws <NUM> are spaced further apart to assume their largest distance X from each other, see <FIG>.

When the button <NUM> is released, the button spring <NUM> returns the button <NUM> to its initial position - protruding as far as possible from the back end <NUM> of the body <NUM>. The button <NUM> pulls the first rod <NUM> and, thereby, the second rod <NUM> to their initial positions, wherein the second rod <NUM> pulls away from the clamping jaws <NUM> and the back ends of the clamping jaws <NUM> are moved to the front ends of the curved second rod through-holes <NUM>, where they are spaced further apart. This causes the front ends of the clamping jaws <NUM> to be brought closer together to assume their smallest distance x from each other, see <FIG>. This initial state, i.e., closed state, of the clamping jaws <NUM> and of the clamping mechanism <NUM> is held reliably against an opening force, which may act on the front end of the clamping jaws <NUM> trying to pivot the clamping jaws <NUM> around their central portions in order to open the front ends of the clamping jaws <NUM>. Such an opening force on the front end of the clamping jaws <NUM> causes the back ends of the clamping jaws <NUM> to push against an inner lateral wall of the second rod through-holes <NUM> between the front and back ends of the curved second rod through-holes <NUM>, see <FIG>.

With reference to <FIG>, the tensioning mechanism <NUM> of the surgical tensioning instrument <NUM> comprises a traveler <NUM> with a traveler pivot axis <NUM> and a traveler spring <NUM>, a grip <NUM> with a grip pivot axis <NUM>, a grip spring <NUM>, a a connecting axis <NUM>, a grip channel <NUM>, an actuator <NUM>, and a tension limiter <NUM> with a stretchable tension limiter spring <NUM> and a tension limiter adjustment mechanism <NUM>.

The traveler <NUM> has one end portion that is hinged to the body <NUM> via the traveler pivot axis <NUM>. The traveler spring <NUM> extends between a central portion of the traveler <NUM> and the body <NUM>, and biases the traveler <NUM> against the body <NUM>.

The grip <NUM> has one end portion that is hinged to the other end portion of the traveler <NUM> via a grip pivot axis <NUM>. The grip spring <NUM> extends between a central portion of the grip <NUM> and the central portion of the traveler <NUM>, is connected at one end thereof to the grip <NUM> via the connecting axis <NUM> and at the other end thereof to the traveler <NUM>, and biases the grip <NUM> away from the traveler <NUM>, thereby opening the grip channel <NUM> between a central protruding grip portion of the grip <NUM> and the other end of the traveler <NUM> for insertion of a surgical tensioning member. The traveler <NUM> includes a stop for the grip <NUM>, against which the grip <NUM> is biased by the grip spring <NUM> to define a maximum width of the grip channel <NUM>.

The actuator <NUM> has one end portion that is hinged to the grip <NUM> by means of the connecting axis <NUM>.

The tension limiter spring <NUM>, here in form of a helical coil spring extending through the actuator <NUM>, has one end portion that is connected to the other end portion of the grip <NUM>. Therefore, the central protruding grip portion of the grip <NUM> is located between two end portions of the grip <NUM>. The other end portion of the tension limiter spring <NUM> is connected to the other end portion of the actuator <NUM> only via the tension limiter adjustment mechanism <NUM>, which is an adjustable threaded connection capable of length adjustment to pre-tension the tension limiter spring <NUM>. Of course, the tension limiter adjustment mechanism <NUM> can be omitted and the other end portion of the tension limiter spring <NUM> may be connected directly to the other end portion of the actuator <NUM>. Moreover, other stretchable spring types may be used instead of a coil spring.

In the initial state of the tensioning mechanism <NUM>, the actuator <NUM> and the body <NUM> are the furthest apart, and the grip channel <NUM> is the largest.

When the actuator <NUM> is pivoted from its initial state, see <FIG>, <FIG> and <FIG>, towards the body <NUM>, it first pivots about the grip pivot axis <NUM> in unison with the grip <NUM>, which causes the grip channel <NUM> to become smaller and eventually the central protruding grip portion of the grip <NUM> to abut the traveler <NUM>, either directly by contacting the traveler <NUM> or indirectly via a surgical tensioning member inserted into and/or through the grip channel <NUM>, see <FIG>. If a surgical tensioning member is inserted into the grip channel <NUM>, the further movement of the grip <NUM> depends on whether or not the tension necessary to further tighten the surgical tensioning member is below, or at or above a tension threshold set at the tension limiter <NUM>. Both possibilities shall be described in the following:.

Below the tension threshold, the actuator <NUM> continues pivoting towards the body <NUM>, while continuing pressing the central protruding grip portion of the grip <NUM> against the traveler <NUM>, but now pivoting the grip <NUM> and traveler <NUM> about the traveler pivot axis <NUM> and against the biasing force of the traveler spring <NUM>. Thereby, the distance between the front end <NUM> of the body <NUM> and the grip channel <NUM> is increased, which causes a further tensioning the surgical tensioning member <NUM> about the sternum halves, see <FIG>.

At or above the tension threshold, the actuator <NUM> continues pivoting towards the body <NUM>, while continuing pressing the central protruding grip portion of the grip <NUM> against the traveler <NUM>, but now pivoting alone, i.e., only the actuator <NUM> and the tension limiter <NUM>, about the connecting axis <NUM> and stretching the tension limiter spring <NUM>. Since the grip <NUM> and the traveler <NUM> remain stationary, the distance between the front end <NUM> of the body <NUM> and the grip channel <NUM> is maintained, which causes no further tensioning of a surgical tensioning member gripped in the grip channel <NUM> and which causes a maintenance of the tension in the surgical tensioning member, see <FIG>.

As soon as the actuator <NUM> is no longer actively pivoted towards the body <NUM> and released, the tension limiter spring <NUM>, the grip spring <NUM> and the traveler spring <NUM> return the tensioning mechanism <NUM> back to its initial state.

<FIG> will be referred to in the following to describe the process of using the surgical tensioning instrument <NUM> for a clamping and/or a tensioning.

<FIG> and <FIG> show an alternative surgical tensioning instrument <NUM>, which differs from the previous in that, at or above the tension threshold, pivoting is not about the connecting axis <NUM> but about the connecting axis <NUM>, since the actuator <NUM> has one end portion that is hinged to the grip <NUM> by means of the grip pivot axis <NUM> to pivot independently from the grip <NUM> and the traveler <NUM> about the grip pivot axis <NUM>.

In the exemplary surgical scenario of <FIG>, two sternum halves are to be secured together (top illustration; which of course does not limit usability of the surgical tensioning instrument <NUM>). For this purpose, a surgical tensioning member <NUM> is placed on at least one of the two sternum halves (middle illustration). Then, a tight loop is formed about them by means of a strap portion <NUM> of the surgical tensioning member <NUM>. For this purpose, the free end <NUM> of the strap portion <NUM> is pulled around the two sternum halves and passed through a locking portion <NUM> of the surgical tensioning member <NUM> (bottom illustration) in the manner of a conventional zip tie. The locking portion <NUM> comprises a locking head <NUM>, which is configured to secure the strap portion <NUM> to the locking portion <NUM>, and a locking plate <NUM>, which provides engagement holes <NUM> for securing the locking plate <NUM> via fasteners, such as screws, to at least one of the two sternum halves. Of course, this process can be applied to any target bone or parts thereof, not just to the shown sternum halves.

In some variants, the locking plate <NUM> is made from metal (e.g., from titanium). In such or other variants, the strap portion <NUM> and the locking head <NUM> may form an integral (e.g., injection molded) polymeric component coupled to the locking plate <NUM>. In still further variants, the entire member <NUM> is made as an injection molded component, with the engagement holes <NUM> optionally being defined by metallic, ring-shaped inserts.

In <FIG>, the surgical tensioning instrument <NUM> is approaching the surgical tensioning member <NUM> from a direction towards the strap portion <NUM> protruding from the locking head <NUM>. The surgical tensioning member <NUM> is in the initial state, where the button <NUM> is not being pushed and the clamping jaws <NUM> are in their closed position. The free end <NUM> (not visible) of the strap portion <NUM> is inserted into the grip channel <NUM>, see <FIG>.

In <FIG>, the surgical tensioning instrument <NUM> is contacting the locking portion <NUM> such that the interface <NUM> holds the locking portion <NUM> laterally to avoid lateral displacement of the front end <NUM> of the body <NUM> relative to the surgical tensioning member <NUM>. Here, the button <NUM> is pushed and the clamping jaws <NUM> are open - as in <FIG> and <FIG>. The free end <NUM> of the strap portion <NUM> has passed through and protrudes from the grip channel <NUM>, wherein the grip channel <NUM> leads the strap portion <NUM> into a space between the actuator <NUM> and the body <NUM>.

In <FIG>, while pressing the front end <NUM> of the body <NUM> against the locking portion <NUM>, the button <NUM> is released and the clamping jaws <NUM> are closed - as in <FIG> - to lock on to the locking portion <NUM>, in particular to the locking head <NUM>. Now the surgical tensioning instrument <NUM> is fixedly attached to the surgical tensioning member <NUM> and cannot be pulled away from it. Instead of locking to the locking head <NUM>, the locking may occur to the locking plate <NUM>.

<FIG> shows a lateral view of the configuration and state shown in <FIG>. This view will better illustrate the next steps in the process, since it better shows the further tensioning of the strap portion <NUM>, which protrudes from the locking head <NUM>, is guided by the pulley <NUM> towards the grip channel <NUM> and passes through the grip channel <NUM>.

In <FIG>, the actuator <NUM> is pulled in the direction of the shown clockwise direction indicated by a curved arrow towards the body <NUM> and pivots together with the grip <NUM> about the grip pivot axis <NUM> against the force of the grip spring <NUM>. Thereby, the grip channel <NUM> is closed and the strap portion <NUM> is gripped between the grip <NUM> and the still stationary traveler <NUM>.

In <FIG>, the actuator <NUM> is pulled further towards the body <NUM> with the strap portion <NUM> gripped. When the tension in the surgical tensioning member <NUM> looped about the sternum halves is less than a tension threshold, the actuator <NUM> pivots together with the grip <NUM> and the traveler <NUM> about the traveler pivot axis <NUM>. Thereby, the strap portion <NUM> is pulled towards the back end <NUM> of the body <NUM> to further tension the surgical tensioning member <NUM> about the two sternum halves.

In <FIG>, the actuator <NUM> is also pulled further towards the body <NUM> with the strap portion <NUM> gripped. When the tension in the surgical tensioning member <NUM> reaches or exceeds the tension threshold, the actuator <NUM> pivots about the connecting axis <NUM>, while the grip <NUM> and the traveler <NUM> remain stationary, i.e. the grip <NUM> does not pivot further about the grip pivot axis <NUM> and the traveler does not pivot further about the traveler pivot axis <NUM>. Instead, the tension limiter spring <NUM> is stretched. Thereby, the strap portion <NUM> is not pulled further towards the back end <NUM> of the body <NUM> and the tension of the surgical tensioning member <NUM> about the two sternum halves is not increased further.

In <FIG>, which shows the alternative surgical tensioning instrument <NUM> in the same state as the previous surgical tensioning instrument <NUM> in <FIG>, the actuator <NUM> pivots about the grip pivot axis <NUM>, while the grip <NUM> and the traveler <NUM> remain stationary, i.e. the grip <NUM> does not pivot further about the grip pivot axis <NUM> and the traveler does not pivot further about the traveler pivot axis <NUM> shown in <FIG>.

As has become apparent from the above description of an exemplary embodiment, the clamping mechanism <NUM> is easy, intuitive and reliable to use. After being fixedly attached to the surgical tensioning member <NUM>, the surgical tensioning instrument <NUM> can easily be removed from the member <NUM> by actively opening the at least one clamping jaw <NUM>. Thereby, undesired (e.g., pulling) forces on the surgical tensioning member <NUM> that may occur in an (uncontrollable) passive opening of the clamping jaws can be avoided. In some variants, the clamping mechanism <NUM> can be opened by an operator's hand while holding the surgical tensioning instrument <NUM> for tensioning of the surgical tensioning member <NUM>, e.g., by the operator's thumb, in the exemplary embodiment, or any other finger of the tensioning hand already holding the surgical tensioning instrument <NUM>. In some configurations, the clamping mechanism <NUM> further allows a force acting on the at least one movable clamping jaw <NUM> directly to close it, but prevents a force acting on the jaw <NUM> directly to open it. Thereby, an accidental opening of the at least one clamping jaw <NUM> can be prevented.

As has also become apparent from the above description of an exemplary embodiment, the tensioning mechanism <NUM> is easy, intuitive and reliable to use. The tension limiter spring <NUM> being configured to stretch longitudinally upon operation of the tensioning mechanism <NUM> may in some implementations at the same time compress in a direction orthogonal to its longitudinal extension. This means that the tension limiter spring <NUM> requires less space in a direction orthogonal to its longitudinal extension when the tensioning mechanism <NUM> is operated compared to when the tensioning mechanism <NUM> is not operated. Thereby, tension limiter spring <NUM> can be integrated in a slimmer actuator <NUM>, for example, which already extends longitudinally a significant amount to be comfortable for an operator's hand, compared to a tension limiter spring that is compressed longitudinally upon operation of the tensioning mechanism. This ability of the tension limiter spring <NUM> to compress in a direction orthogonal to its longitudinal extension upon operation further allows the space between the actuator <NUM> and the body <NUM> to be increased, which can provide a larger range of motion for the tensioning operation, where the actuator <NUM> is moved in the first direction and towards the body <NUM>. In case the tension limiter spring <NUM> breaks or is otherwise impaired, the operator would immediately notice its failure, since the actuator <NUM> could then be moved towards the body <NUM> without any resistance from the tension limiter spring <NUM>, thereby rendering an uncontrolled tensioning of the surgical tensioning member <NUM> impossible. As such, operational safety can be increased.

Claim 1:
A surgical tensioning instrument (<NUM>; <NUM>) configured to apply a tension to a surgical tensioning member (<NUM>) so as to tension a strap portion (<NUM>) of the surgical tensioning member (<NUM>) about a target bone or parts thereof, the surgical tensioning member (<NUM>) further including a locking portion (<NUM>) configured to cooperate with the strap portion (<NUM>) so as to maintain the tension in the surgical tensioning member (<NUM>), the surgical tensioning instrument (<NUM>; <NUM>) comprising:
a body (<NUM>) defining a front end (<NUM>) and an opposed rear end (<NUM>);
a grip (<NUM>) movable relative to the body (<NUM>) and configured to secure the strap portion (<NUM>) of the surgical tensioning member (<NUM>) to the surgical tensioning instrument (<NUM>; <NUM>);
an actuator (<NUM>) operatively coupled to the body (<NUM>) and configured to move from an initial position toward a tensioning position in response to an applied force, thereby causing the grip (<NUM>) to move in a tensioning direction; and
a clamping mechanism (<NUM>) configured to secure the locking portion (<NUM>) of the surgical tensioning member (<NUM>) to the surgical tensioning instrument (<NUM>; <NUM>), wherein the clamping mechanism (<NUM>) comprises opposed clamping jaws (<NUM>) at the front end (<NUM>) of the body (<NUM>), at least one of the clamping jaws (<NUM>) being configured to be movable between a closed position, in which the locking portion (<NUM>) is secured to the surgical tensioning instrument (<NUM>; <NUM>), and an open position, in which the locking portion (<NUM>) is released from the surgical tensioning instrument (<NUM>; <NUM>);
wherein the clamping mechanism (<NUM>) is operable to move the at least one of the clamping jaws (<NUM>) from the closed position to the open position upon its operation;
characterized in that
the clamping mechanism (<NUM>) comprises a release button (<NUM>) protruding from the body (<NUM>) and configured to move the at least one of the clamping jaws (<NUM>) from the closed position to the open position.