Patent Description:
In various orthopedic surgical procedures, it is necessary to align and secure two severed bone portions in a relatively fixed relationship to each other. For example, it is often necessary to establish such a secured relationship after a bone has been fractured as a result of either trauma caused by accidents, or physician intervention. To ensure that the bone can regenerate in the proper orientation and fuse the fracture, it is important that the bone portions be fixed (stabilized) in the desired position during bone regeneration.

<CIT> discloses a bone repair system and method for percutaneously fixing a first bone segment to a second bone segment, such as rib bone segments, in a body of a patient include drilling a first hole through the first bone segment and a second hole through the second bone segment, and feeding a first tether through the first hole and a second tether through the second hole, each tether having a proximal end and a distal end.

<CIT> discloses an apparatus for the correction of chest deformities including a rib implant for mounting to a rib, a sternal implant for mounting to a sternum, and a first elongate member. The rib implant includes a first aperture having a first axis. The sternal implant includes a second aperture having a second axis. The first elongate member has a first end adjustably received in the first aperture and a second end adjustably received in the second aperture
The present invention provides a system for surgically repairing a rib of a patient, as defined in claim <NUM>. Further optional features of the invention are defined in the dependent claims. Methods are described herein but the methods are not claimed.

Corresponding reference characters indicate corresponding parts throughout the several views. Elements in the drawings are not necessarily drawn to scale. The configurations shown in the drawings are merely examples, and should not be construed as limiting the scope of the inventive subject matter in any manner.

Although the present application discusses prostheses, systems and methods to stabilize a rib fracture or deformity, the present prostheses, systems and methods are also applicable to other bones such as the sternum, xyphoid, clavicle, costal cartilage, or other long bone of the body, for example. The following description is merely exemplary in nature and is in no way intended to limit the teachings, its application, or uses. Thus, it will become apparent to those skilled in the art that certain aspects of the present teachings have applicability to other surgical applications.

The present inventors contemplate benefits from using the disclosed apparatuses, systems and methods. For example, one or more of the brackets disclosed herein can be placed within the thoracic cavity and coupled to an anterior side the rib as part of a minimally invasive procedure (only using a small incision for delivery to the thoracic cavity and prosthesis installation). Thus, the present application recognizes apparatuses and systems for an intrathoracic procedure. Use of a minimally invasive procedure such as the intrathoracic procedure can improve patient recovery time and reduce surgical time. Furthermore, the disclosed apparatuses, systems and methods can reduce or eliminate the need for more invasive extra thoracic procedure where larger incisions are utilized, and cartilage is removed from one or more of the ribs. Extra thoracic rib fracture fixation involves plates and screws to rigidly fixate broken ribs. The procedure consists of making an incision through the soft tissue over the fracture to gain direct access to the rib. The soft tissue is further dissected to accommodate the length and width of the plate implant. The plate implant is then fixated to the rib with screws to stabilize the fracture. As discussed herein, the larger incision and dissection of the cartilage of the extra thoracic procedure can result in longer patient recovery time and increased time for performing the operation as compared with a minimally invasive procedure.

<FIG> shows a perspective post-operative anterior view of a human thorax <NUM> having an assembly <NUM> implanted therein. The assembly <NUM> can include at least one prosthesis <NUM> and one or more fasteners <NUM>. The anterior of the human thorax <NUM> can be formed by a sternum <NUM>, xyphoid <NUM>, manubrium <NUM>, costal cartilage, and ribs <NUM>. In addition, a clavicle <NUM> is shown connecting the sternum <NUM> to the scapula and humerus (neither shown). The human thorax <NUM> can define a thoracic cavity <NUM> within the human body under the ribs <NUM>, etc..

One of the ribs <NUM> (rib 24A) has previously undergone a medical procedure to stabilize a fracture. As a result of the procedure, the assembly <NUM> has been implanted to stabilize the rib 24A. The prosthesis <NUM> can comprise a bracket <NUM> shaped as a plate. The bracket <NUM> can be configured to be fixedly attached the rib 24A. The one or more fasteners <NUM> can be configured to fixedly attach the bracket <NUM> to the rib 24A. The construction of the bracket <NUM> will be discussed and shown in further detail subsequently. The bracket <NUM> can be mounted to the rib 24A by the one or more fasteners <NUM>. As shown in <FIG>, the bracket <NUM> and the fasteners <NUM> have stabilized the fracture of the rib 24A.

Examples of the one or more fasteners <NUM> can include medical-grade screws, medical-grade nails, medical-grade staples, medical-grade posts, and others. According to some examples, the bracket <NUM> and/or one or more fasteners <NUM> can be made of a variety of bio-resorbable materials. One resorbable material of particular interest is marketed by Zimmer Biomet, Inc. (Warsaw, Indiana) under the tradename LACTOSORB®. LACTOSORB® is an absorbable co-polymer synthesized from all-natural ingredients: <NUM>% L-lactic acid and <NUM>% glycolic acid, and is substantially amorphous (i.e., without crystallinity), meaning that its degradation is uniform, precluding the crystalline release associated with degrading copolymers that have been associated with late inflammatory reactions. Furthermore, the LACTOSORB® copolymer ratio permits the polymer to retain most of its strength for six to eight weeks. Such a time period is appropriate for healing, but not so long as to raise concerns about long-term stress shielding of bone. In addition to LACTOSORB®, other resorbable materials may be used such as PLA, PGA, and others including various polymers, ceramics, etc..

The bracket <NUM> and/or one or more fasteners <NUM> may also be made from a variety of bio-compatible materials. These materials may not be resorbable. Examples of bio-compatible materials that may be used are the implantable plastics PEEK or PET. In addition to PEEK or PET, implantable surgical metals may also be used. Alloys that may be implanted are, but not limited to, stainless steel, titanium, or cobalt chrome molybdenum. Specifically, commercially pure titanium, listed as grade <NUM>, <NUM>, <NUM>, or <NUM> or titanium alloy such as titanium <NUM>-aluminum/<NUM>-vanadium may be used. The bracket <NUM> may be inelastically deformable so as to retain its shape once contoured to cooperate with the shape of the bone regions to be secured.

<FIG> shows a prospective view of the rib 24A with the fracture <NUM> in isolation prior to implantation of the assembly <NUM> of <FIG>. A surgeon optionally has placed indicia on the rib 24A indicating desired locations for the one or more fasteners <NUM> (<FIG>). The rib 24A has portions 32A and 32B, which have been aligned by the surgeon to reduce the fracture <NUM>.

<FIG> shows a perspective view of the rib 24A stabilized with an assembly 12A. The assembly 12A of <FIG> includes a first bracket 28A, a second bracket 28B and the one or more fasteners <NUM>. As shown in <FIG>, the first bracket 28A can interface with and be mounted to a first side <NUM> of the rib 24A. This first side <NUM> can be an anterior side of the rib 24A that interfaces with the thoracic cavity <NUM> of the patient. The first bracket 28A can be configured to be fixedly attached to the first side <NUM> of the rib 24A that faces the thoracic cavity <NUM> of the patient. The one or more fasteners <NUM> can be configured to fixedly attach the first bracket 28A to the rib 24A.

The second bracket 28B can interface with and be mounted to a second side <NUM> of the rib 24A. The second side <NUM> of the rib 24A can be a posterior side (an external or outward facing side) of the rib 24A. The second bracket 28B can be configured to be fixedly attached to the second side <NUM> of the rib 24A. The one or more fasteners <NUM> can be configured to fixedly attach the second bracket 28B to the rib 24A. The first bracket 28A and second bracket 28B can be generally aligned on opposing sides of the rib 24A so as to form a sandwich of the rib 24A. The bracket 28A and second bracket 28B can span the facture <NUM> so as to anchored by the one or more fasteners <NUM> to both the bone portion 32A and the bone portion 32B.

The first bracket 28A and second bracket 28B can be similarly constructed or can have a different construction from one another. The first bracket 28A can have an aperture <NUM> configured to receive a pivot pin of a delivery device as further discussed in reference to <FIG>. Referring now to <FIG>, the first bracket 28A can be thinner, equal, or thicker than the second bracket 28B. Both the first bracket 28A and second bracket 28B can include one or more apertures <NUM>. The one or more apertures <NUM> can be shaped and sized to receive the head or other portions the one or more fasteners <NUM> (<FIG>). The first bracket 28A and second bracket 28B can have an elongate length with the length much longer relative to the width and thickness dimensions. The one or more apertures <NUM> may be threaded or simply formed as non-threaded through holes. The one or more apertures <NUM> may be positioned symmetrically having bridge regions of the brackets 28A, 28B therebetween or may be arranged asymmetrically. Further, one or more apertures <NUM> may optionally include a circular or an oval countersink and may be internally threaded according to some examples. As shown in <FIG>, one of the one or more apertures (and consequently one of the one or more fasteners <NUM>) can be aligned with the fracture <NUM> while others of the apertures and the fasteners <NUM> can be positioned to align with the bone portion 32A and the bone portion 32B.

<FIG> show a system <NUM> according to an example of the present disclosure. The system <NUM> can include the one or more fasteners <NUM>, first bracket 28A (not shown in <FIG>), and the second bracket 28B as previously discussed but can further include a caddy <NUM> and a delivery device <NUM>. The delivery device <NUM> can include an actuator <NUM>, a shaft <NUM>, a tip <NUM> and a pivot pin <NUM>.

The caddy <NUM> can have one or more recesses configured to receive and retain the one or more fasteners <NUM> for delivery to adjacent the rib 24A by the delivery device <NUM> as shown in <FIG>. The second bracket 28B can be coupled to the caddy <NUM> such as on a bottom side so as to be placed to interface with the rib 24A as shown in <FIG>.

As shown in <FIG>, the first bracket 28A can be selectively coupled to the delivery device <NUM> by the pivot pin <NUM> at the tip <NUM>, which is received in the aperture <NUM> (<FIG>) of the first bracket 28A. The first bracket 28A can be detachable from the pivot pin <NUM> once assembly 12A is created by driving the fasteners <NUM> into the rib 24A to fixate the first bracket 28A to the bone.

<FIG> show the first bracket 28A can be configured to rotate on the pivot pin <NUM> from a first position (shown in <FIG>) to a second position (shown in <FIG>). More particularly, the first bracket 28A can be configured to pass through an incision <NUM> in the patient in the first position as shown in <FIG>. This first position can be at vertical or near vertical (within <NUM> degree of vertical) relative to the incision <NUM>. Put another way, the first position can align or substantially align the elongate length of the first bracket 28A with an axis A of the shaft <NUM> as shown in <FIG>. The first position can minimize or reduce the size of the incision <NUM> as the elongate length of the first bracket 28A is in the vertical or near vertical position and is thus minimized. In the first position, the first bracket 28A can pass into the thoracic cavity <NUM> as shown in <FIG>.

As shown in <FIG>, upon contacting the first side <NUM> of the rib 24A, the first bracket 28A can be configured to pivot relative to the shaft <NUM> on the pivot pin <NUM> of the delivery device <NUM> within the thoracic cavity <NUM> to the second position. In the second position, the first bracket 28A can interface with the first side <NUM> of the rib 24A along a major surface thereof such that the one or more apertures <NUM> are in position to receive the one or more fasteners <NUM>. Pivoting to the second position can be facilitated by a shape of an outer edge of an end of the first bracket 28A, which can be filleted, chamfered, rounded or the like.

The caddy <NUM> can be configured to retain the one or more fasteners <NUM> and deliver the one or more fasteners <NUM> to a position adjacent the rib as shown in <FIG>. Once in the position of <FIG>, an end effector (example shown subsequently) can be configured to engage the one or more fasteners <NUM> to drive the one or more fasteners <NUM> from the caddy <NUM> and into the rib 24A to fixedly attach the first bracket 24A to the first side <NUM> of the rib 24A and the second bracket 24B to the second side <NUM> of the rib <NUM>.

<FIG> also show the caddy <NUM> moveably coupled to the delivery device <NUM>. The caddy <NUM> can translate along the shaft <NUM> of the delivery device <NUM> as facilitated by the actuator <NUM>. In particular, the actuator <NUM> can be rotated on threading along the shaft <NUM> distally from the position of <FIG> to the position of <FIG> to engage the second bracket 28B to the second side <NUM> of the rib 24A. The actuator <NUM> can force the caddy <NUM> coupled to the second bracket 28B to translate along a groove or other feature in the shaft <NUM>. Upon reaching the position of <FIG> with the second bracket 28B engaging the rib 24A, the delivery device <NUM> via the caddy <NUM> and the second bracket 28B can apply a force on second side <NUM> of the rib 24A. Additionally, the delivery device <NUM> can configured to engage the second bracket 28B against the second side <NUM> of the rib 24A while the first bracket 28A is engaged by the delivery device <NUM> with the first side <NUM> of the rib 24A. This arrangement can apply a clamp force CF on the rib 24A as shown in <FIG>. The second bracket 28B can then be configured to be fixedly attached to the second side <NUM> of the rib 24A. The one or more fasteners <NUM> can then be driven from the caddy <NUM>. Reviewing <FIG>, the one or more fasteners <NUM> can pass from the caddy <NUM> (not shown in <FIG>) and can be driven at least partially through the one or more apertures <NUM> of the second bracket 28B into the rib 24A. The one or more fasteners <NUM> can pass through the rib 24A and can be received in one or more apertures <NUM> of the first bracket 28A. The one or more fasteners <NUM> can mount the first bracket 28A and the second bracket 28B together against the rib 24A and hold together the assembly 12A. Upon forming the assembly 12A, the delivery device <NUM> can be decoupled from the first bracket 28A and can be removed from the thoracic cavity <NUM>.

<FIG> shows a perspective view of the rib 24A stabilized with an assembly 12B. The assembly 12B of <FIG> may be more desirably than the assembly 12A of <FIG> in certain situations where a minimally invasive procedure with only a relatively small incision is desirable. To help facilitate placement of the assembly 12B, the lungs can be partially deflated and scopes (not shown) are used through an incision (access port) to navigate and place components such as the first bracket 28A. The assembly 12B includes the first bracket 28A and the one or more fasteners <NUM> (<FIG>). Thus, the assembly 12B differs from the assembly 12A in that the assembly 12B includes only a single bracket (first bracket 28A). As shown in <FIG>, the first bracket 28A can interface with and be mounted to the first side <NUM> of the rib 24A. This first side <NUM> can interface with the thoracic cavity <NUM> of the patient. The first bracket 28A can be configured to be fixedly attached to the first side <NUM> of the rib 24A that faces the thoracic cavity <NUM> of the patient. The one or more fasteners <NUM> can be configured to fixedly attach the first bracket 28A to the rib 24A.

The first bracket 28A can be constructed in the manner previously described including in regards to bracket <NUM>. The first bracket 28A can be delivered to the first side <NUM> of the rib 24A in a manner as previously described in <FIG>. However, some differences from the technique of <FIG> in the delivery of the first bracket 28A and fixation of the first bracket 28A to the rib 24A are noted in the following passages and are shown in <FIG>.

<FIG> show a system 40A according to an example of the present disclosure. The system 40A can include the one or more fasteners <NUM> and the first bracket 28A, as previously discussed but can further include a caddy 42A and a delivery device 44A. The delivery device 44A can include the actuator <NUM> (only shown in <FIG>), the shaft <NUM>, the tip <NUM> and the pivot pin <NUM> in the manner previously described for the delivery device <NUM>. However, the delivery device 44A can additionally include a member 53A (<FIG>) not utilized with the previously described delivery device.

<FIG> shows the first bracket 28A can be selectively coupled to the delivery device 44A by the pivot pin <NUM>, which is received in the aperture <NUM> of <FIG> and <FIG>. The first bracket 28A can be detachable from the pivot pin <NUM> once assembly 12B is created. However, the arrangement of <FIG> differs from that of <FIG> in that the caddy 42A is additionally coupled to the pivot pin <NUM> at the tip <NUM>. The caddy 42A is pivotably mounted on the pivot pin <NUM> as further discussed herein. <FIG> and <FIG> show the first bracket 28A and the caddy 42A can be configured to rotate on the pivot pin <NUM> from a first position (shown in <FIG>) to a second position (shown in <FIG>). More particularly, the first bracket 28A and the caddy 42A can be configured to pass through the incision <NUM> in the patient in the first position as shown in <FIG>. This first position can be at vertical or near vertical (within <NUM> degree of vertical) relative to the incision <NUM>. Put another way, the first position can align or substantially align the elongate length of the first bracket 28A and the caddy 42A with an axis A of the shaft <NUM> as shown in <FIG>. The first position can minimize or reduce the size of the incision <NUM> as the elongate length (largest dimension) of the first bracket 28A and the caddy 42A is in the vertical or near vertical position. In the first position, the first bracket 28A and the caddy 42A can pass into the thoracic cavity <NUM> as shown in <FIG>.

As shown in <FIG> and <FIG>, upon contacting the first side <NUM> of the rib 24A, the first bracket 28A and the caddy 42A can be configured to pivot relative to the shaft <NUM> on the pivot pin <NUM> of the delivery device 44A within the thoracic cavity <NUM> to the second position. In the second position, the first bracket 28A can interface with the first side <NUM> of the rib 24A along a major surface thereof such that the one or more apertures <NUM> are in position to receive the one or more fasteners <NUM>.

The caddy 42A can be configured to retain the one or more fasteners <NUM> and deliver the one or more fasteners <NUM> to a position adjacent the first bracket 28A and the rib 24A as shown in <FIG> and <FIG>. Once in the position of <FIG> and <FIG>, an end effector (example shown subsequently in <FIG> and <FIG>) can be configured to engage the one or more fasteners <NUM> to drive the one or more fasteners <NUM> from the caddy 42A partially through the first bracket 28A and into the rib 24A to fixedly attach the first bracket 24A to the first side <NUM> of the rib 24A.

<FIG> shows the member 53A moveably coupled to the delivery device <NUM>. The member 53A can translate or otherwise move along the shaft <NUM> of the delivery device 44A as facilitated by the actuator <NUM>. In particular, the actuator <NUM> can be rotated on threading along the shaft <NUM> distally to the position of <FIG> to engage the first bracket 28A to the first side <NUM> of the rib 24A. The actuator <NUM> can force the member 53A to engage the rib 24A along the second side <NUM> and can apply a force on the second side <NUM> of the rib 24A. Additionally, the delivery device <NUM> can configured to engage the first bracket 28A against the first side <NUM> of the rib 24A while the member 53A is engaged by the delivery device 44A with the second side <NUM> of the rib 24A. This arrangement can apply a clamp force CF on the rib 24A as shown in <FIG>.

Turning to <FIG> and <FIG>, according to the invention, the system 40A is further expanded to include additional components. The first bracket 28A can be configured to be fixedly attached to the first side <NUM> of the rib 24A (<FIG>). Fixation can be performed with the driver <NUM> driving the one or more fasteners <NUM> such as shown in <FIG> and <FIG>. The driver <NUM> can include a body <NUM> (<FIG>), a shaft <NUM> and an end effector <NUM>. As shown in <FIG>, the end effector <NUM> can include a shaft coupling portion <NUM>, a body <NUM> and a drive head <NUM>.

In <FIG>, the body <NUM> can be configured for gripping and actuation of a motor or other motive device by the surgeon. The body <NUM> can be coupled to the shaft <NUM>. The shaft <NUM> can extend distally from the body <NUM> to the end effector <NUM>. The shaft <NUM> can include internal components (e.g., an internal shaft acting as a driver - not shown) configured to rotate or otherwise move to drive the drive head <NUM> to rotate or otherwise actuate the end effector <NUM> as a driver. The shaft <NUM> can be part of an existing drive tool with the end effector <NUM> specifically configured for the deployment below the rib(s) as discussed and illustrated herein.

As shown in <FIG>, the end effector <NUM> can have a fixed pre-defined shape, and thus, is not extendible, retractable or otherwise configured to change in shape or extent. The shape of the end effector <NUM> can be U-shape. The U-shape arrangement of the end effector <NUM> can allow the end effector <NUM> to pass through a small incision yet be able to be moved under the rib (or other bone for deployment). The end effector <NUM> can be manipulated in position via manipulation (e.g., rotational turning) of the shaft <NUM>. Thus, the end effector <NUM> may not be manipulatable independently of the shaft <NUM> for repositioning according to some examples.

The shaft coupling portion <NUM> can be configured to couple with the shaft <NUM>. This coupling can be via receptacle, interlocking male/female or other connection as known in the art. The body <NUM> of the end effector <NUM> can extend substantially laterally from the shaft coupling portion <NUM> and shaft <NUM> such that the driver head <NUM> is offset from an axis A of the shaft <NUM>. The shape of the end effector <NUM> is that of a U from the shaft coupling portion <NUM> along the body <NUM> to the drive head <NUM>. Driver head <NUM> can be pointed back in a general direction proximally toward the body <NUM> of the driver <NUM>. Put another way, the driver head <NUM> can have a rotational axis RA that is substantially aligned (up to within <NUM> degrees of alignment or exactly aligned) with but offset from the axis A of the shaft <NUM>. The driver head <NUM> can extend from the body <NUM> back in a direction proximally substantially parallel (up to within <NUM> degrees of parallel or exactly parallel) with and along the axis A of the shaft <NUM>.

As best shown in <FIG>, the end effector <NUM> can be configured to drive the one or more fasteners <NUM> into the rib 24A. To do so, the end effector <NUM> can utilize a plurality of spur gears <NUM> as shown in <FIG>. The plurality of spur gears <NUM> can be used to maintain correct rotation output when used with existing drivers. The embodiment disclosed here has three spur gears meshed together although different numbers of spur gears are contemplated. When a forward drive button is active, the fastener <NUM> is rotated in the forward direction. A reverse drive button can also be utilized to reverse the one or more fasteners if needed. In particular, the one or more fasteners <NUM> can then be driven from the caddy 42A (not shown in <FIG> and <FIG>) partially through the first bracket 28A and into the rib 24A. The one or more fasteners <NUM> can mount the first bracket 28A against the rib 24A forming the assembly 12B of <FIG>. Upon forming the assembly 12A, the delivery device 44A including the caddy 42A (now empty of the one or more fasteners <NUM>) can be decoupled from the first bracket 28A and the driver device 44A and the caddy 42A can be removed from the thoracic cavity <NUM>.

<FIG> show a first bracket 128A according to a further example. The first bracket 128A can include a first portion <NUM> and a second portion <NUM>. The first portion <NUM> and the second portion <NUM> can be separable from one another. The first portion <NUM> and the second portion <NUM> can each include at least one aperture <NUM> therethrough. The first portion <NUM> and the second portion <NUM> can be selectively joined by a ratchet <NUM>. The ratchet <NUM> allows for compressive fixation to the rib or other bone. The ratchet <NUM> can include a male portion <NUM> and a mating female portion <NUM>. The male portion <NUM> can be progressively inserted into the female portion <NUM> to facilitate increased compression. Retraction of the male portion <NUM> from the female portion <NUM> can reduce compression. Due to the ratchet <NUM>, the elongate length of the bracket <NUM> can be adjustable.

<FIG> shows an assembly <NUM> of the first bracket 128A with a second bracket 128B joined by one or more fasteners <NUM>. The second bracket 128B can be positioned on an opposing side of the rib 24A from the first bracket 128A. For example, the second bracket 128B can be on the first side <NUM> of the rib 24A as previously discussed and the first bracket 128A can be on the second side <NUM>. The one or more fasteners <NUM> may be bone screws but can also be fixation posts according to some examples. The fixation posts can have a head coupled to the second bracket 128B. The head of the fixation posts can slide along slots (<FIG>) of the second bracket 128B.

<FIG> shows an example of the second bracket 128B, which can include one or more slots <NUM> configured to receive the one or more fasteners <NUM> and allow for movement of the one or more fasteners <NUM> (<FIG>) along an elongate length of the second bracket 128B. This can allow for adjustment of the elongate length of the assembly <NUM> (<FIG>), in particular, the first bracket 128A using the ratchet <NUM> (<FIG>) as previously discussed.

The techniques described herein relate to a system, including a delivery tool configured to couple with the first rib bracket and position the first rib bracket relative to the rib, wherein the first rib bracket is configured to pass through an incision in the patient in a first position and pass into the thoracic cavity, and wherein upon contacting the first side of the rib, the first rib bracket is configured to pivot relative to a shaft of the delivery tool within the thoracic cavity to a second position.

The techniques described herein relate to a system, wherein the delivery tool is configured to couple with the caddy, wherein the caddy is configured to pass through the incision in the patient with the first rib bracket and pass into the thoracic cavity, wherein the caddy is configured to pivot with the first rib bracket relative to the shaft of the delivery tool within the thoracic cavity.

The techniques described herein relate to a system, wherein optionally the delivery tool is configured to engage a second side of the rib that opposes the first side of the rib while the first rib bracket is engaged with the first side of the rib to apply a clamp force on the rib.

The techniques described herein relate to a system, wherein the end effector has a shaft coupling portion configured to couple with a shaft of the driver, and wherein a body of the end effector extends substantially laterally from a shaft coupling portion such that a head of the end effector is offset from a rotational axis of the shaft and the head of the end effector extends back in a proximal direction spaced from the shaft.

The techniques described herein relate to a system, wherein the head has a rotational axis that is substantially aligned with but offset from the rotational axis of the shaft, and the head extends from the body back in a direction substantially parallel with and along the rotational axis of the shaft.

The techniques described herein relate to a system, wherein optionally the delivery tool is configured to couple with the caddy and is configured to translate the caddy to a position adjacent a second side of the rib that opposes the first side of the rib.

The techniques described herein relate to a system, further including a second rib bracket configured to be fixedly attached to the second side of the rib, wherein the delivery tool is configured to engage the second rib bracket against the second side of the rib while the first rib bracket is engaged with the first side of the rib to apply a clamp force on the rib.

The techniques described herein relate to a system, wherein optionally at least the first rib bracket includes a first part and a second part, and wherein optionally the first rib bracket has a ratchet mechanism that connects the first part to the second part.

The techniques described herein relate to a system for surgically repairing a rib of a patient, the system optionally including: a first rib bracket configured to be fixedly attached to a first side of the rib that faces a thoracic cavity of the patient; one or more fasteners configured to fixedly attach the first rib bracket to the rib; a delivery tool configured to couple with the first rib bracket and position the first rib bracket relative to the rib within the thoracic cavity; and a caddy configured to retain the one or more fasteners and deliver the one or more fasteners to a position adjacent the rib and the first rib bracket.

The techniques described herein relate to a system, wherein optionally the first rib bracket, when mounted to the delivery tool, is configured to pass through an incision in the patient in a first position and pass into the thoracic cavity, and wherein upon contacting the first side of the rib, the first rib bracket is configured to pivot relative to a shaft of the delivery tool within the thoracic cavity to a second position.

The techniques described herein relate to a system, wherein optionally the delivery tool is configured to couple with the caddy, wherein the caddy is configured to pass through the incision in the patient with the first rib bracket and pass into the thoracic cavity, wherein the caddy is configured to pivot with the first rib bracket relative to the shaft of the delivery tool within the thoracic cavity.

The techniques described herein relate to a system, further optionally including a second rib bracket configured to be fixedly attached by the one or more fasteners to the second side of the rib, wherein the delivery tool is configured to engage the second rib bracket against the second side of the rib while the first rib bracket is engaged with the first side of the rib to apply a clamp force on the rib.

The techniques described herein relate to a system, further optionally including a driver having an end effector configured to drive the one or more fasteners into the rib; and whereby the end effector is configured to engage the one or more fasteners to drive the one or more fasteners from the caddy and into the rib to fixedly attach the first rib bracket to the first side of the rib.

The techniques described herein relate to a system, optionally the end effector has a shaft coupling portion configured to couple with a shaft of the driver, wherein a body of the end effector extends substantially laterally from a shaft coupling portion such that a head of the end effector is offset from a rotational axis of the shaft, and wherein the head has a rotational axis that is substantially aligned with but offset from the rotational axis of the shaft, and the head extends from the body back in a direction substantially parallel with and along the rotational axis of the shaft.

The techniques described herein relate to a method, which is not claimed, of surgically repairing a rib of a patient optionally including: forming an incision adjacent the rib to access a thoracic cavity of the patient; inserting a first rib bracket into the thoracic cavity via the incision; positioning the first rib bracket to engage a first side of the rib that faces the thoracic cavity; and driving one or more fasteners through the bracket and into the rib to fixedly attach the first rib bracket to the rib.

The techniques described herein relate to a method, which is not claimed, wherein optionally positioning the first rib bracket to engage the first side of the rib that faces the thoracic cavity includes rotating the first rib bracket from a position that allows passage of the first rib bracket through the incision to a second position to interface with the first side of the rib.

The techniques described herein relate to a method, which is not claimed, further optionally including retaining the one or more fasteners with a caddy and positioning the caddy adjacent the first rib bracket.

The techniques described herein relate to a method, which is not claimed, wherein optionally positioning the caddy adjacent the first rib bracket includes rotating the caddy with the first rib bracket from a position that allows passage of the caddy and first rib bracket through the incision to the second position where the first rib bracket interfaces with the first side of the rib.

The techniques described herein relate to a method, which is not claimed, further optionally including engaging a second side of the rib that opposes the first side of the rib while the first rib bracket is engaged with the first side of the rib to apply a clamp force on the rib.

The techniques described herein relate to a method, which is not claimed, wherein optionally the second side of the rib is engaged with a second rib bracket.

The techniques described herein relate to a method, which is not claimed, wherein optionally driving one or more fasteners through the bracket and into the rib to fixedly attach the first rib bracket to the rib is performed with a driver head that accesses the thoracic cavity of the patient to engage the one or more fasteners.

Claim 1:
A system (<NUM>, 40A) for surgically repairing a rib of a patient, the system comprising:
a first rib bracket (28A, 128A) configured to be fixedly attached to a first side of the rib that faces a thoracic cavity of the patient;
one or more fasteners (<NUM>, <NUM>) configured to fixedly attach the first rib bracket to the rib;
a driver (<NUM>) having an end effector (<NUM>) configured to drive the one or more fasteners into the rib; and
a caddy (<NUM>, 42A) configured to retain the one or more fasteners and deliver the one or more fasteners to a position adjacent the rib whereby the end effector is configured to engage the one or more fasteners to drive the one or more fasteners from the caddy and into the rib to fixedly attach the first rib bracket to the first side of the rib.