Method and Device for Stabilizing Joints With Limited Axial Movement

Abstract

An apparatus for stabilizing a joint with low relative motion during orthopedic surgery. The apparatus includes a press-fit fastener body and a coupler. The press-fit fastener body has a proximal end and a distal end and is configured to be press-fit into a tunnel in a first bone member. The coupler is located on or is part of the press-fit fastener body and is configured to receive at least one flexible element trailing from at least one suture anchor. At least a portion of the suture anchors are located within a second bone member.

1 . A method of stabilizing joints with limited axial movement comprising:
 inserting at least one suture anchor into a first bone member, wherein an at least one flexible element having a first end and a second end is attached to the at least one suture anchor at the first end of each of the at least one flexible element, the at least one flexible element spanning a space between the first bone member and a second bone member and passing through a tunnel in the second bone member and an intermediate bone member, the intermediate bone member being located between the first and second bone member;   securing the at least one flexible element to a fastener configured to be press-fit into the tunnel in the second bone member;   inserting the fastener into the tunnel in the second bone member; and   adjusting the at least one flexible member to a desired tension, thereby securing the first bone member to the second bone member.   
   
   
       2 . A method according to  claim 1  further comprising drilling a hole through at least the first bone member, the second bone member, and the intermediate bone member. 
   
   
       3 . A method according to  claim 1 , wherein the first bone member is a scaphoid bone, the second bone member is triquetrum bone, and the intermediate bone is a lunate bone. 
   
   
       4 . A method according to  claim 1 , wherein the first, second, and intermediate bone members are bone fragments. 
   
   
       5 . A method according to  claim 1 , wherein inserting the fastener into the tunnel in the second bone member creates a press-fit. 
   
   
       6 . A method according to  claim 1 , wherein inserting the at least one suture anchor includes inserting the at least one suture anchor such that the at least one suture anchor is beneath the surface of the first bone member, thereby avoiding abrasion of soft tissue and cartilage. 
   
   
       7 . A method according to  claim 1 , wherein inserting the fastener includes inserting the fastener such that the fastener is beneath the surface of the second bone member, thereby avoiding abrasion of soft tissue and cartilage. 
   
   
       8 . A method according to  claim 1 , wherein securing the at least one flexible element occurs before inserting the fastener and adjusting the at least one flexible member. 
   
   
       9 . A method according to  claim 1 , wherein inserting the fastener occurs before securing the at least one flexible element and adjusting the at least one flexible member. 
   
   
       10 . A method according to  claim 1 , wherein adjusting the at least one flexible member occurs before securing the at least one flexible element and inserting the fastener. 
   
   
       11 . A method for stabilizing joint with limited axial movement comprising:
 making an incision on a first site of the joint, the incision being proximal to a first bone member;   drilling a guidewire through the first bone member, a second bone member, and into a third bone member, the second bone member being located between the first and third bone members;   preparing a bone tunnel through the first and second bone members and into the third bone member;   securing a suture anchor within the third bone member, the suture anchor having a flexible member extending through the bone tunnel and the second bone member and spanning a space between the first and third bone members, the flexible member having a first end and a second end, the first end being secured to the suture anchor;   inserting a press-fit fastener into the first bone member, the press-fit fastener creating a press-fit between the press-fit fastener and the bone tunnel; and   securing the second end of the suture anchor to the press-fit fastener.   
   
   
       12 . A method according to  claim 11 , further comprising dissecting soft-tissue from the joint, thereby exposing the first bone member. 
   
   
       13 . A method according to  claim 11 , wherein securing the suture anchor within the third bone member includes:
 placing the suture anchor over the guide wire; and   advancing the suture anchor along the guidewire until the suture anchor is secured within a portion of the bone tunnel within the third bone member and beneath a proximal cortex of the third bone member.   
   
   
       14 . A method according to  claim 11 , further comprising removing the guide wire prior to inserting the press-fit fastener. 
   
   
       15 . A method according to  claim 11 , further comprising adjusting the at least one flexible member to a desired tension, thereby securing the first bone member to the third bone member. 
   
   
       16 . A method according to  claim 11 , wherein the first bone member is a scaphoid bone, the second bone member is a lunate bone, and the third bone member is a triquetrum bone. 
   
   
       17 . A method for stabilizing joint with limited axial movement comprising:
 making an incision on a first incision site of the joint, the first site being proximate to a first bone member;   drilling a guidewire through the first bone member, a second bone member, and a third bone member, the second bone member being located between the first and third bone members;   making a second incision on a second incision site of the joint, the second site being proximate to the third bone member;   creating a bone tunnel through the first, second, and third bone members;   passing a flexible element through the bone tunnel such that the flexible element extends from the first incision to the second incision and passes through the first, second, and third bone members;   inserting a first fastener into the third bone member through the second incision, the first fastener creating a press-fit within the third bone member;   securing a first end of the flexible element to the first fastener;   inserting a second fastener into the first bone member through the first incision, the second fastener creating a press-fit within the first bone member; and   securing a second end of the flexible element to the second fastener.   
   
   
       18 . A method according to  claim 17 , wherein the first and second fasteners are tapered and the first and second fasteners are inserted into the first and third bone members such that a direction of the first fastener's taper opposes a direction of the second fastener's taper. 
   
   
       19 . A method according to  claim 17 , wherein passing the flexible element through the bone tunnel includes:
 affixing the flexible element to an eyelet located on the guidewire; and   drawing the flexible element through the bone tunnel using the guidewire.   
   
   
       20 . A method according to  claim 17 , wherein the guidewire extends through the joint and the second incision site is located at an exit site of the guidewire. 
   
   
       21 . A method according to  claim 18 , wherein the flexible element is a soft tissue graft implant. 
   
   
       22 . A method according to  claim 21 , wherein the soft tissue graft implant is reinforced with a suture. 
   
   
       23 . A method according to  claim 17 , further comprising:
 dissecting soft-tissue from the joint at the first incision, thereby exposing the first bone member; and   dissecting soft-tissue from the joint at the second incision, thereby exposing the third bone member.   
   
   
       24 . A method according to  claim 17 , further comprising removing the guide wire prior to inserting the first and second press-fit fasteners. 
   
   
       25 . A method according to  claim 17 , wherein the first and second ends of the flexible element are secured to the first and second fasteners by positioning the first and second ends within the press-fit areas created between the first and second fasteners and the bone tunnel. 
   
   
       26 . A method according to  claim 17 , wherein the first bone member is a scaphoid bone, the second bone member is a lunate bone, and the third bone member is a triquetrum bone. 
   
   
       27 . A method according to  claim 17 , wherein at least one of the first and second fasteners include surface features that improve fixation within the first and third bone members. 
   
   
       28 . A method according to  claim 27 , wherein the surface features include at least one selected from the group consisting of threads, ribs, back cutting threads, and grooves. 
   
   
       29 . A method according to  claim 28 , wherein the surface features include threads and the at least one of the first and second fasteners are inserted into the bone members by rotating. 
   
   
       30 . A method according to  claim 28 , wherein the surface features include ribs and the at least one of the first and second fasteners are inserted into the bone members by tapping the at least one of the first and second fasteners with a hammer.