Bone growth device

Abstract

An intramedullary bone growth nail device for moving a bone segment. The device including an elongated housing comprising having first and second ends configured to be fixed to bone segments. The device further including a drive system positioned within the elongated housing and including a gearbox, a motor, and a controller coupled to the motor. The drive system mechanically coupled to a transport mechanism which transports a moveable bone segment axially and adjacent the elongated housing.

Description

BONE GROWTH DEVICEREFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of U.S. Provisional Application No. 63 / 555.881, filed February 20, 2024, and U.S. Provisional Application No. 63 / 468,264, filed May 23, 2024, which are hereby incorporated by reference in the entirety.TECHNICAL FIELD

[0002] The present disclosure relates generally to the field of orthopedic surgery. More particularly, the present disclosure relates to the controlled growth of bones and bone segments in long bones in the treatment of trauma and / or deformities.BACKGROUND

[0003] Intramedullary and extramedullary rods are well known in orthopedic surgical procedures for treatments of fractures. These devices offer benefits over external fixation devices for reducing infection and decreasing recovery time. Intramedullary and extramedullary rods can also be used to correct limb inequality caused by congenital shortening, post-traumatic fractures, and other conditions that result in limb shortening. Many existing bone growth devices require an external control device to adjust the length. Still other employ complex mechanisms to achieve controlled distraction or compression. There exists a need for a bone growth device that is fully implanted, can be controlled via a remote externally communicating device and achieves precise, repeatable motion.SUMMARY

[0004] The various systems and methods of the present disclosure have been developed in response to the present state of the art, and in particular, in response to the problems and needs in the art that have not yet been fully solved by currently available metatarsal treatment systems and methods. The systems of the present disclosure may provide intramedullary and extramedullary devices for bone lengthening and bone growth.

[0005] In some embodiments, an intramedullary’ bone growth device may include a fixed length rod which includes first and second ends configured to attach to first and second bone segments.

[0006] In some aspects, the techniques described herein relate to a bone growth nail device including: a first end configured to be fixed to a first bone segment; a second end configured to be fixed to a second bone segment; an outer shell extending between the first and second end; a transport mechanism positioned mostly within the outer shell andconfigured to transport a third bone segment in an axial direction; and a drive system positioned within the outer shell and coupled to the transport mechanism including: a gearbox; a motor coupled to the gearbox; and a controller coupled to the motor and configured to control the motor.

[0007] In some aspects, the techniques described herein relate to a device, wherein the outer shell includes one or more first side apertures positioned adjacent a first end of the transport mechanism and one or more second side apertures positioned adjacent the second end of the transport mechanism. In some aspects, the techniques described herein relate to a device, wherein the transport mechanism includes: a threaded shaft coupled to the gearbox and configured to rotate; a nut threadably coupled to the shaft, wherein the nut is configured to move axially along the shaft as the shaft rotates; and a flexible tether fixed to the nut and disposed through the first and second apertures. In some aspects, the techniques described herein relate to a kit, including the device and a locking plate configured to be coupled to the third bone segment and the flexible tether. In some aspects, the techniques described herein relate to a kit, wherein the locking plate includes: a main plate position adjacent the bone segment surface; a conical protrusion extending from a bottom surface of the main plate, wherein the conical protrusion includes a central aperture; two locking fasteners disposed through the main plate and positioned in-line with the central aperture; a recess extending from the central aperture and accommodating the two locking fasteners. In some aspects, the techniques described herein relate to a kit, wherein the flexible tether is configured to be secured between the two locking fasteners and the recess. In some aspects, the techniques described herein relate to a device, wherein the transport mechanism includes: a second nut threadably coupled to the shaft; and a second flexible tether fixed to the second nut and configured to transport a fourth bone segment. In some aspects, the techniques descnbed herein relate to a kit, including the device, further including a first locking plate configured to be coupled to the third bone segment and the first flexible tether, and a second locking plate configured to be coupled to the second tether and the fourth bone segment. In some aspects, the techniques described herein relate to a device, wherein the first nut is threadably coupled to a first portion of the shaft which is threaded in a clockwise direction, wherein the second nut is threadably coupled to a second portion of the shaft which is threaded in a counter-clockwise direction. In some aspects, the techniques described herein relate to a device, wherein rotation of the shaft causes the first nut and the second nut to move toward each other. In some aspects, the techniques described herein relate to a device, wherein the first nut is threadablycoupled to a first portion of the shaft, wherein the second nut is threadably coupled to a second portion of the shaft which is threaded in the same direction, wherein the pitch / lead in the threads of the second portion of the shaft results in the second nut moving faster than the first nut and in the same direction. In some aspects, the techniques described herein relate to a device, wherein the second nut moves twice as fast as the first nut. In some aspects, the techniques described herein relate to a device, wherein the second portion of the shaft is twice as long as the first portion of the shaft. In some aspects, the techniques described herein relate to a device, wherein the first nut includes a channel in its outer surface configured to slidably receive the second flexible tether, wherein the second nut includes a channel in its outer surface configured to slidably receive the first flexible tether. In some aspects, the techniques described herein relate to a device, wherein the first nut further includes another channel in its outer surface configured to slidably receive a fourth flexible tether, wherein the second nut includes another channel in its outer surface configured to slidably receive a third flexible tether. In some aspects, the techniques described herein relate to a device, wherein the first tether includes one or more tether segments. In some aspects, the techniques described herein relate to a device, wherein the second tether includes one or more tether segments. In some aspects, the techniques described herein relate to a device, wherein outer shell includes one or more elongated grooves extending between the one or more first side apertures and the one or more second side apertures. In some aspects, the techniques described herein relate to a device, wherein the outer shell includes an elongated slot on a side opposite an elongated groove. In some aspects, the techniques described herein relate to a device, wherein the outer shell includes an elongated groove on one side within which the flexible tether is slidably disposed and an elongated slot on an opposite side within which the flexible tether is slidably disposed. In some aspects, the techniques described herein relate to a device, wherein the nut includes one or more protrusions on the side of the nut, the one or more protrusions including apertures through which the flexible tether passes, wherein the one or more protrusions are disposed within the elongated slot. In some aspects, the techniques described herein relate to a device, including a first pulley within the outer shell proximate to a first end of the outer shell and a second pully within the outer shell proximate to a second end of the outer shell, wherein the flexible tether passes around the first and second pulleys. In some aspects, the techniques described herein relate to a device, wherein the outer shell includes apertures proximate to the first and second pulleys through which the flexible tether passes. In some aspects, the techniques described herein relate to a kit, including the device and alocking screw configured to be coupled to the second bone segment and the flexible tether, the locking screw including: a head portion having a keyhole; and a shaft extending from the head, wherein an aperture extends through the keyhole and the shaft, the aperture including a conical portion and one or more chambers of varying sizes. In some aspects, the techniques described herein relate to a kit, wherein the flexible tether is configured to be secured to the locking screw. In some aspects, the techniques described herein relate to a kit, including the device, further including a first locking screw configured to be coupled to the second bone segment and the first flexible tether, and a second locking screw configured to be coupled to the second tether and the fourth bone segment. In some aspects, the techniques described herein relate to a kit, wherein the tether is secured to the locking screw by a locking clamp which is inserted into the aperture of the shaft. In some aspects, the techniques described herein relate to a device, further including a carriage positioned adjacent an external surface of the outer shell and attached to the tether, wherein the carriage moves along a grove in the outer shell in response to movement of the nut. In some aspects, the techniques described herein relate to a device, wherein the outer shell includes an elongated slot extending along a portion of the cylinder, wherein the portion of the outer shell is internally threaded. In some aspects, the techniques described herein relate to a device, wherein the transport mechanism includes: a shaft coupled to the drive system and configured to rotate; a carriage secured to the shaft and positioned within the elongated slot, wherein the carriage is configured to attach to the third bone segment; and two externally threaded nuts positioned on either side of the carriage, wherein the nuts are slidably coupled to the shaft, wherein the nuts are configured to engage with the threads of the outer shell and move axially along the shaft as the shaft rotates. In some aspects, the techniques described herein relate to a device, wherein the shaft is cylindrical with a flattened side. In some aspects, the techniques described herein relate to a device, wherein the carriage includes: a trolley portion which slidably couples with the shaft and has an aperture for the shaft to pass through; and an attachment portion which couples to the third bone segment. In some aspects, the techniques described herein relate to a device, wherein two externally threaded nuts include an aperture which engages the shaft such that the nuts rotate with the shaft. In some aspects, the techniques described herein relate to a device, wherein the transport mechanism includes: a threaded shaft coupled to the gearbox and configured to rotate; a nut threadably coupled to the shaft, wherein the nut is configured to move axially along the shaft as the shaft rotates; a first pulley positioned at the first end of the transport mechanism and positioned adjacent a first end of the threaded shaft; a secondpulley positioned at the second end of the transport mechanism and positioned adjacent a second end of the threaded shaft: a flexible tether fixed to the nut and threaded through the first and second apertures, wherein the flexible tether is further looped around the first and second pulleys; and a carriage fixed to the flexible tether and positioned exterior to the elongated housing, wherein the carriage is configured to attach to the third bone segment. In some aspects, the techniques described herein relate to a device, wherein the elongated housing includes a groove positioned between the one or more first side apertures and the one or more second side apertures. In some aspects, the techniques described herein relate to a device, wherein the carriage and tether move within the groove. In some aspects, the techniques described herein relate to a device, wherein the nut includes a channel which engages with an inward protrusion of the elongated housing and prevents rotation of the nut. In some aspects, the techniques described herein relate to a device, wherein flexible tether is fixed within an aperture in the nut. In some aspects, the techniques described herein relate to a device, wherein flexible tether is fixed within an aperture in the carriage. In some aspects, the techniques described herein relate to a device, wherein the first and second pulleys are angularly offset from the first and second apertures. In some aspects, the techniques described herein relate to a device, wherein the transport mechanism includes: a bevel drive coupled to the gearbox and configured to rotate; a first pulley coupled to the outer shell and in communication with the bevel drive, wherein the first pulley is positioned adjacent the first end of the outer shell and oriented axially adjacent the bevel drive; a second pulley coupled to a tensioner, wherein the second pulley is positioned adjacent the second end of the outer shell and oriented axially adjacent the bevel drive; a flexible tether threaded through the one or more first and second side apertures, wherein the flexible tether is further looped around the first and second pulleys; and a one or more carriages fixed to the flexible tether and positioned exterior to the elongated housing, wherein the carriage is configured to attach the movable bone segment. In some aspects, the techniques described herein relate to a device, wherein the one or more carriages are positioned on opposite sides of the elongated housing. In some aspects, the techniques described herein relate to a device, wherein the elongated housing includes one or more grooves positioned between the one or more first side apertures and the one or more second side apertures. In some aspects, the techniques described herein relate to a device, wherein the one or more carriages and the tether move within the groove. In some aspects, the techniques described herein relate to a device, wherein the one or more carriages include: a base portion with an aperture, wherein the tether extends through the aperture; a top portion including one ormore cutouts for attaching to the movable bone segment. In some aspects, the techniques described herein relate to a device, wherein the drive system further including a planetary system coupled to the gearbox. In some aspects, the techniques described herein relate to a device, wherein the planetary gear system includes: a first stage coupled to the gearbox and including a first sun gear; a second stage coupled to the first stage and including a plurality of planetary’ gears attached to a second sun gear; a third stage coupled to the second stage and including a second plurality of planetary gears attached to an adapter portion for connection with the transport mechanism; and a ring gear surrounding and contacting the planetary' gears of the second and third stages. In some aspects, the techniques described herein relate to a device, wherein the outer shell includes a key slot on one end which interacts with a medical tool. In some aspects, the techniques described herein relate to a device, wherein the first and second end include one or more fixation holes for securing to the first and second bone segments. In some aspects, the techniques described herein relate to a device, wherein the controller includes: one or more receiver coils configured to be activated via an air core transformer arrangement; and one or more capacitors configured to be charged by the one or more receiver coils. In some aspects, the techniques described herein relate to a device, wherein the controller is configured to control a speed at which the motor rotates. In some aspects, the techniques described herein relate to a device, wherein the controller is configured to control a gear ratio of the gearbox. In some aspects, the techniques described herein relate to a device, wherein the controller is configured to communicate wirelessly via one or more of Wifi, Bluetooth, RFID, and near-field magnetic induction (NFMI) communication. In some aspects, the techniques described herein relate to a device, wherein outer shell is partitioned into a first section which encompasses the drive system, and a second section which encompasses the transport mechanism. In some aspects, the techniques described herein relate to a device, wherein the tether is configured to attach to a moveable bone segment. In some aspects, the techniques described herein relate to a device, wherein the tether is tied directly to the moveable bone segment. In some aspects, the techniques described herein relate to a device, wherein the transport mechanism further includes one or more bearing seals positioned near ends of the shaft. In some aspects, the techniques described herein relate to a device, wherein the bone segments are positioned anywhere along the outer shell. In some aspects, the techniques described herein relate to a system for controlling growth of a bone including: a bone grow th nail device positioned between a first and second bone segment in a patient and attached to one or more moveable bone segments, the bone growth device including a control capsule; a padconfigured to activate the bone growth nail device through an air core transformer arrangement and wirelessly communicate with the control capsule; and a user device in communication with the pad.

[0008] In some aspects, the techniques described herein relate to a system, wherein the control capsule includes: a controller; a transmitter for transmitting data to the pad; a receiver for receiving data from the pad; one or more capacitors electrically connected to a drive system of the bone growth nail device; and one or more receiver coils electrically connected to the one or more capacitors, wherein the one or more receiver coils are activated through the air core transformer arrangement.

[0009] In some aspects, the techniques described herein relate to a system, wherein the patient pad includes: a control interface including: a control interface; a transmitter electrically connected to the control interface and configured to transmit data to the bone grow th device and user device; a receiver electrically connected to the control interface and configured to receive data from the bone growth device and user device; a battery electrically connected to the control interface; and one or more transformer coils electrically connected to the control interface and configured to charge the control capsule. In some aspects, the techniques described herein relate to a system, wherein the bone growth device and pad communicate via one or more of: radio frequency (RF), Bluetooth, Wi-Fi, cellular, near field communication (NFC), microwave, near-field magnetic induction (NFMI) communication, and / or infrared. In some aspects, the techniques described herein relate to a system, wherein a user controls, via the user device, a start and end of a therapy session. In some aspects, the techniques described herein relate to a system, wherein a user controls, via the user device, one or more of a distance to be moved, duration of session, or rate of movement of one or more bone segments. In some aspects, the techniques described herein relate to a system, wherein the bone growth nail device is configured to move each of the one or more bone segments 1mm a day. In some aspects, the techniques described herein relate to a system, wherein data transmitted and received between the bone growth device, pad. and user device includes therapy data includes the length of travel of the one or more bone segments, speed, length of time of each session, force, torque, errors encountered, date / time of each session, and temperature. In some aspects, the techniques described herein relate to a system, wherein the pad communicates the date to the bone growth device. In some aspects, the techniques described herein relate to a system, wherein a GUI of the user device displays the received data with one or moreof graphs, charts, or progress indicators. In some aspects, the techniques described herein relate to a system, wherein the GUI runs on an application on the user device.

[0010] In some aspects, the techniques described herein relate to a system, wherein the application provides tutorials indicators including patient milestones, overall therapy progress, therapy logging, sync status, patient diary, error messaging and resolution, and device health. In some aspects, the techniques described herein relate to a system, wherein the control interface indicates device activity such as presence of the bone growth device, status of the bone grow th device, and therapy session progress. In some aspects, the techniques described herein relate to a system, wherein the user device may indicate device activity' such as presence of the bone growth device, status of the bone growth device, and therapy session progress In some aspects, the techniques described herein relate to a system, wherein the pad is configured to wrap around the patient's leg. In some aspects, the techniques described herein relate to a system, wherein the pad is made of a flexible material configured to wrap around the patient. In some aspects, the techniques described herein relate to a system, wherein the pad includes one or more patches to block or reduce cross-talk between the pad and bone growth device. In some aspects, the techniques described herein relate to a system, wherein control interface or user device provides indications such as a connectivity' indicator, a pad status indicator such as on / off or charging, a pad battery level indicator, a bone growth device charging progress indicator, and / or an error indicator. In some aspects, the techniques described herein relate to a system, wherein the pad further includes a strap to wrap around the patient. In some aspects, the techniques described herein relate to a system, wherein the pad attaches to a limb cradle.

[0011] In some aspects, the techniques described herein relate to a method of performing bone transport therapy including: placing a pad adjacent a portion of a patient's body containing a bone growth nail; activating the pad; establishing a wireless connection between the pad and bone growth nail; transmitting to the bone growth nail, via a user device and pad, instructions including a therapy protocol to be implemented by the bone growth nail; charging, via an air core transformer arrangement with the pad. one or more capacitors of the bone growth nail; initiating bone transport, via the user device.

[0012] In some aspects, the techniques described herein relate to a method, further including indicating on the user device that connection has been made w ith the bone growth device. In some aspects, the techniques described herein relate to a method, further including stopping bone transport, via the user interface. In some aspects, the techniques described herein relate to a method, further including: receiving to the pad, therapy datafrom the bone grow th nail; and receiving to the user device, the therapy data from the pad. In some aspects, the techniques described herein relate to a method, further including displaying, via a user interface of the user device, the therapy data. In some aspects, the techniques described herein relate to a method, wherein the therapy data includes one or more of length of travel of the one or more bone segments, speed, length of time of each session, force, torque, errors encountered, date / time of each session, and temperature.

[0013] In some aspects, the techniques described herein relate to a method of installing a bone growth nail device including: reaming an intramedullary canal in first and second portions of a bone; inserting the nail into the intramedullary canal such that a first end of the nail is within the first portion of bone and a second end of the nail is within the second portion of bone, wherein the nail includes a flexible tether attached thereto including two free ends; resecting the first portion of bone into a first segment and a moveable bone segment; drilling one or more transverse holes into the moveable bone segment; routing the free ends of the tether through the transverse holes; securing the first end of the nail to the first bone segment and the second end of the nail to the second portion of bone with one or more fasteners; tensioning the one or more tethers; and securing tether to the moveable bone segment.

[0014] In some aspects, the techniques described herein relate to a method, further including folding the free ends of one or more tethers of the nail aw ay from the bone prior to insertion into the intramedullary canal. In some aspects, the techniques described herein relate to a method, further including removing unwanted portions of the bone. In some aspects, the techniques described herein relate to a method, further including tensioning the tethers prior to securing the tethers to the moveable bone segment. In some aspects, the techniques described herein relate to a method, wherein securing the tether to the moveable bone segment further includes: securing a locking plate to the moveable bone segment; threading the free ends of the tether through the locking plate; and w rapping the free ends of the tether around locking fasteners of the locking plate. In some aspects, the techniques described herein relate to a method, wherein securing the tether to the moveable bone segment further includes: installing a locking screw to the moveable bone segment; threading the free ends of the tether through the locking screw; inserting a locking clamp into the locking screw ; and fastening the tether to the locking clamp. In some aspects, the techniques described herein relate to a method, further including: resecting the second portion of resected bone to form a second moveable bone segment; drilling one or more transverse holes into the second moveable bone segment; and securing a second tether thatis atached to the nail to the second moveable bone segment. In some aspects, the techniques described herein relate to a method, further including removing excess tether. In some aspects, the techniques described herein relate to a method, wherein the nail includes: a drive system including: a gearbox; a motor coupled to the gearbox; and a controller coupled to the motor and configured to control the motor; a threaded shaft coupled to the gearbox and configured to rotate; and a nut threadably coupled to the shaft, wherein the nut is configured to move axially along the shaft as the shaft rotates, and wherein the flexible tether is coupled to the nut. In some aspects, the techniques described herein relate to a method, further including actuating the motor to cause the treaded shaft to rotate and thereby cause the movable bone segment to translate along the nail.

[0015] In some aspects, the techniques described herein relate to a bone growth device, including: a housing including an elongated slot; a first housing end including one or more fixation holes configured to receive one or more fasteners and configured to be atached to a first bone; a second housing end including one or more fixation holes configured to receive one or more fasteners and configured to be atached to a second bone; a threaded rod positioned within the housing; an actuator configured to rotate the treaded rod; and a bone segment transport element including a cylindrical hollow body with internal threads configured to mate with treads on the threaded rod, the bone segment transport element further including a protrusion on a side of the cylindrical hollow body positioned within the elongated slot, wherein the protrusion is configured to be atached to a third bone segment.

[0016] In some aspects, the techniques described herein relate to a device, wherein the protrusion includes one or more apertures. In some aspects, the techniques described herein relate to a device, wherein the protrusion is configured to be atached to the third bone segment using a fastener. In some aspects, the techniques described herein relate to a device, wherein the protrusion is coupled to a flexible tether which is configured to be atached to the third bone segment. In some aspects, the techniques described herein relate to a device, wherein the actuator includes one or more permanent magnet. In some aspects, the techniques described herein relate to a device, wherein the actuator includes a motor.

[0017] In some aspects, the techniques described herein relate to a bone grow th device, including: a housing including an elongated slot; a first housing end including one or more fixation holes configured to receive one or more fasteners and configured to be atached to a first bone; a second housing end including one or more fixation holesconfigured to receive one or more fasteners and configured to be attached to a second bone; a bone segment transport element including a cylindrical body and configured to travel within the housing along the length of the bone growth device, wherein the bone segment transport element is configured to be attached to a third bone segment; an actuator configured to rotate a gear, wherein rotation of the gear drives the bone segment transport element; and a flexible member coupled to the bone segment transport element and passing around a first pulley positioned proximate the first housing end and a second pully positioned proximate to the second housing end.

[0018] In some aspects, the techniques described herein relate to a device, wherein the bone segment transport element is configured to be attached to the third bone segment through the elongated slot. In some aspects, the techniques described herein relate to a device, wherein the flexible member is a flexible tether that is configured to be attached to the third bone segment. In some aspects, the techniques described herein relate to a device, wherein the actuator includes one or more permanent magnet. In some aspects, the techniques described herein relate to a device, wherein the actuator includes a motor.BRIEF DESCRIPTION OF THE DRAWINGS

[0019] Exemplary embodiments of the disclosure will become more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. Understanding that these drawings depict only exemplary embodiments and are, therefore, not to be considered limiting of the scope of the appended claims, the exemplary embodiments of the present disclosure will be described with additional specificity and detail through use of the accompanying drawings in which:

[0020] Figure 1A is a front view of a bone growth device connected to exemplary bone segments according to some embodiments.

[0021] Figure IB is a top view of the bone growth device shown in Figure 1 A connected to exemplary bone segments, according to some embodiments.

[0022] Figure 2A is a front view of the bone growth device shown in Figure 1 A and Figure IB, according to some embodiments.

[0023] Figure 2B through Figure 2F are front and top section view's of the bone growth device shown in Figure 2A, according to some embodiments.

[0024] Figure 3A is a front view of a bone growth device connected to exemplary bone segments according to some embodiments.

[0025] Figure 3B is a top view of the bone growth device shown in Figure 3A connected to exemplary bone segments, according to some embodiments.

[0026] Figure 4A is a front view of the bone growth device shown in Figure 3 A and Figure 3B, according to some embodiments.

[0027] Figure 4B and Figure 4C are front and top section views of the bone growth device shown in Figure 3 A, according to some embodiments.

[0028] Figure 5A is a front view of a bone growth device connected to exemplary bone segments according to some embodiments.

[0029] Figure 5B is a top view of the bone growth device shown in Figure 5A connected to exemplary bone segments, according to some embodiments.

[0030] Figure 6A is a front view of the bone growth device shown in Figure 5 A and Figure 5B, according to some embodiments.

[0031] Figure 6B through Figure 6E are front, side and isometric section views of the bone growth device shown in Figure 6A, according to some embodiments.

[0032] Figure 7A is a front view of a bone lengthening device connected to exemplary7bone segments according to some embodiments.

[0033] Figure 7B is a top view of the bone lengthening device shown in Figure 7A connected to exemplary bone segments, according to some embodiments.

[0034] Figure 8A is a front view of the bone growth device shown in Figure 7A and Figure 7B, according to some embodiments.

[0035] Figure 8B and Figure 8C are side and isometric section views of the bone growth device shown in Figure 8A, according to some embodiments.

[0036] Figure 9A is a front view of a bone growth device connected to exemplary bone segments according to some embodiments.

[0037] Figure 9B is a top view of the bone growth device shown in Figure 9A connected to exemplary bone segments, according to some embodiments.

[0038] Figure 10A is a front view of the bone growth device shown in Figure 9A and Figure 9B, according to some embodiments.

[0039] Figure 10B and Figure 10C are front and side section view s of the bone growth device shown in Figure 10A. according to some embodiments.

[0040] Figure 11 A is a front view of a bone growth device connected to exemplary bone segments according to some embodiments.

[0041] Figure 1 IB is atop view' of the bone growth device shown in Figure 11 A connected to exemplary' bone segments, according to some embodiments.

[0042] Figure 12A is a front view of the bone growth device shown in Figure 1 1A and Figure 1 IB, according to some embodiments.

[0043] Figure 12B through Figure 12D are isometric section views of the bone growth device shown in Figure 12A. according to some embodiments.

[0044] Figure 13A is a front view of a bone lengthening device connected to exemplary bone segments according to some embodiments.

[0045] Figure 13B is a top view of the bone lengthening device shown in Figure 13A connected to exemplary bone segments, according to some embodiments.

[0046] Figure 14A is a front view of the bone lengthening device shown in Figure 13A and Figure 13B, according to some embodiments.

[0047] Figure 14B and Figure 14C are front and isometric section views of the bone lengthening device shown in Figure 14A, according to some embodiments.

[0048] Figure 15A is a front view of a bone lengthening device connected to exemplary bone segments according to some embodiments.

[0049] Figure 15B is a top view of the bone lengthening device show n in Figure 15A connected to exemplary bone segments, according to some embodiments.

[0050] Figure 16A and Figure 16B are front section views of the bone lengthening device shown in Figure 15 A and Figure 15B, according to some embodiments.

[0051] Figure 17A is a front view of a bone growth device connected to exemplary7bone segments according to some embodiments.

[0052] Figure 17B is atop view of the bone growth device shown in Figure 17A connected to exemplary bone segments, according to some embodiments.

[0053] Figure 18A is a front view of the bone growth device shown in Figure 17A and Figure 17B, according to some embodiments.

[0054] Figure 18B through Figure 18F are front, side and isometric section views of the bone growth device shown in Figure 18A, according to some embodiments.

[0055] Figure 19A is a front view of a bone lengthening device connected to exemplary bone segments according to some embodiments.

[0056] Figure 19B is a top view' of the bone lengthening device show n in Figure 19A connected to exemplary bone segments, according to some embodiments.

[0057] Figure 20A is a front view of the bone lengthening device shown in Figure 19A and Figure 19B, according to some embodiments.

[0058] Figure 20B through Figure 20D are front and isometric section view s of the bone lengthening device shown in Figure 20A, according to some embodiments.

[0059] Figure 21 A shows various alternate front and sectioned views of the bone growth device shown in Figure 1 A and Figure IB, according to some embodiments.

[0060] Figure 21B shows various alternate front and sectioned views of a bone growth device incorporating a threaded rod actuation mechanism, according to some embodiments.

[0061] Figure 21C shows various alternate front and sectioned views of the bone growth device shown in Figure 5A and Figure 5B, according to some embodiments.

[0062] Figure 21D shows various alternate front and sectioned views of the bone growth device shown in Figure 7A and Figure 7B. according to some embodiments.

[0063] Figure 22A shows various alternate front and sectioned views of the bone growth device shown in Figure 18A and Figure 18B, according to some embodiments.

[0064] Figure 22B shows various alternate front and sectioned views of the bone growth device shown in Figure 11 A and Figure 1 IB, according to some embodiments.

[0065] Figure 22C show s various alternate front and sectioned views of the bone growth device shown in Figure 15A and Figure 15B, according to some embodiments.

[0066] Figure 23A is a section view of a bone growth device showing an actuator mechanism, according to some embodiments.

[0067] Figure 23B is an end view of the bone growth device shown in Figure 23A, according to some embodiments.

[0068] Figure 24A is a section view of a bone growth device showing an actuator mechanism, according to some embodiments.

[0069] Figure 24B is an end view of the bone growth device shown in Figure 24A, according to some embodiments.

[0070] Figure 25A is a section view7of a bone growth device showing an actuator mechanism, according to some embodiments.

[0071] Figure 25B is an end view of the bone growth device shown in Figure 25A, according to some embodiments.

[0072] Figure 26A is a front view of a bone growth device according to some embodiments.

[0073] Figure 26B is a top view of the bone growth device shown in Figure 26A, according to some embodiments.

[0074] Figure 27A through Figure 27D are front and isometric section views of the bone lengthening device shown in Figure 26 A, according to some embodiments.

[0075] Figure 28A is a section view of a bone growth device showing an alternate embodiment of a drive mechanism, according to some embodiments.

[0076] Figure 28B is an end view of the bone growth device shown in Figure 28A, according to some embodiments.

[0077] Figure 29A is an isometric view of a bone growth device body section according to some embodiments.

[0078] Figure 29B is an isometric view of a bone growth device assembly including a body section shown in Figure 29A according to some embodiments.

[0079] FIG. 30A is a perspective view of a bone growth device, according to some embodiments.

[0080] FIG. 30B is a perspective view of the bone growth device with the outer shell removed, according to some embodiments.

[0081] FIG. 30C is an exploded view of the bone growth device, according to some embodiments.

[0082] FIG. 30D is a side view of a portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0083] FIG. 30E is a side view of another portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0084] FIG. 31 A is a cross sectional view of the outer shell of FIG. 30B, according to some embodiments.

[0085] FIG. 3 IB is another cross-sectional view of the outer shell of FIG. 30B, according to some embodiments.

[0086] FIG. 32A is a perspective view of the nut of FIG. 30B, according to some embodiments.

[0087] FIG. 32B is a front facing view of the nut of FIG. 30B, according to some embodiments.

[0088] FIG. 32C is a right-side view of the nut of FIG. 30B, according to some embodiments.

[0089] FIG. 33A is a perspective view of the locking plate of FIG. 30B, according to some embodiments.

[0090] FIG. 33B is a top-down view of the locking plate of FIG. 30B, according to some embodiments.

[0091] FIG. 33C is a bottom up view of the locking plate of FIG. 30B, according to some embodiments.

[0092] FIG. 33D is a front side view of the locking plate of FIG. 30B, according to some embodiments.

[0093] FIG. 33E is a right-side view of the locking plate of FIG. 30B, according to some embodiments.

[0094] FIG. 34A is a perspective view of a bone growth device, according to some embodiments.

[0095] FIG. 34B is a perspective view of the bone growth device with the outer shell removed, according to some embodiments.

[0096] FIG. 34C is an exploded view of the bone growth device, according to some embodiments.

[0097] FIG. 34D is a side view of a portion of the bone grow th device with a transparent outer shell, according to some embodiments.

[0098] FIG. 34E is a side view of another portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0099] FIG. 35A is a cross sectional view of an outer shell, according to some embodiments.

[0100] FIG. 35B is another cross-sectional view of the outer shell of FIG. 35 A, according to some embodiments.

[0101] FIG. 36A is a perspective view of the first nut and second locking plate of FIG. 34B, according to some embodiments.

[0102] FIG. 36B is a perspective view of the nut of FIG. 34B, according to some embodiments.

[0103] FIG. 36C is a front facing view of the nut of FIG. 34B, according to some embodiments.

[0104] FIG. 36D is a side view of the nut of FIG. 34B, according to some embodiments.

[0105] FIG. 37A is a perspective view of a nut that is used in a bone growth device which utilizes four tethers, according to some embodiments.

[0106] FIG. 37B is a front view' of the nut of FIG. 37A, according to some embodiments.

[0107] FIG. 37C is a side view of the nut of FIG. 37A, according to some embodiments.

[0108] FIG. 38A is a perspective view of a bone growth device, according to some embodiments.

[0109] FIG. 38B is a perspective view of the bone growth device with the outer shell removed, according to some embodiments.

[0110] FIG. 38C is an exploded view of the bone growth device, according to some embodiments.

[0111] FIG. 38D is a side view of a portion of the bone growth device without an outer shell, according to some embodiments.

[0112] FIG. 38E is a side view of another portion of the bone growth device without an outer shell, according to some embodiments.

[0113] FIG. 38F is a close-up view of the first pulley of the bone growth device of FIG. 38A, according to some embodiments.

[0114] FIG. 38G is a close-up view of the second pulley of the bone growth device of FIG. 38A, according to some embodiments.

[0115] FIG. 39A is a cross-sectional view of the outer shell of the bone growth device of FIG. 38A, according to some embodiments.

[0116] FIG. 39B is another cross-sectional view of the outer shell, according to some embodiments.

[0117] FIG. 40A is a perspective view of the nut and carriage of the bone growth device of FIG. 38A, according to some embodiments.

[0118] FIG. 40B is a front facing view7of the nut of the bone growth device of FIG. 38A, according to some embodiments.

[0119] FIG. 40C is a right side view of the nut of the bone growth device of FIG. 38A, according to some embodiments.

[0120] FIG. 40D is a bottom up view of the nut of the bone growth device of FIG. 38A, according to some embodiments.

[0121] FIG. 40E is a top down view- of the nut of the bone growth device of FIG. 38A, according to some embodiments.

[0122] FIG. 41 A is a right side view of the carriage of the bone growth device of FIG. 38A, according to some embodiments.

[0123] FIG. 41B is a front facing view of the carriage of the bone growth device of FIG. 38A, according to some embodiments.

[0124] FIG. 41C is a top down view of the carriage of the bone growth device of FIG. 38A, according to some embodiments.

[0125] FIG. 41D is a bottom up view7of the carriage of the bone growth device of FIG. 38A, according to some embodiments.

[0126] FIG. 42A is a perspective view of a bone growth device, according to some embodiments.

[0127] FIG. 42B is a perspective view of the bone growth device with the outer shell removed, according to some embodiments.

[0128] FIG. 42C is an exploded view of the bone growth device, according to some embodiments.

[0129] FIG. 42D is a side view of a portion of the bone grow th device with a transparent outer shell, according to some embodiments.

[0130] FIG. 42E is a side view of another portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0131] FIG. 43A is a cross sectional view of the outer shell of FIG. 42B, according to some embodiments.

[0132] FIG. 43B is another cross-sectional view of the outer shell of FIG. 42B, according to some embodiments.

[0133] FIG. 44A is a perspective view? of the carriage of FIG. 42B, according to some embodiments.

[0134] FIG. 44B is a right side view of the carriage of FIG. 42B without nuts, according to some embodiments.

[0135] FIG. 44C is a front side view of the carriage of FIG. 42B without nuts, according to some embodiments.

[0136] FIG. 44D is a top down view of the carriage of FIG. 42B without nuts, according to some embodiments.

[0137] FIG. 44E is a bottom up view of the carriage of FIG. 42B without nuts, according to some embodiments.

[0138] FIG. 44F is a front view of a nut of FIG. 44A, according to some embodiments.

[0139] FIG. 44G is a perspective view of an alternative embodiment of the carriage of FIG. 44 A, according to some embodiments.

[0140] FIG. 45A is a perspective view' of a bone growth device, according to some embodiments.

[0141] FIG. 45B is a perspective view of the bone growth device with the outer shell removed, according to some embodiments.

[0142] FIG. 45C is an exploded view of the bone growth device, according to some embodiments.

[0143] FIG. 45D is a side view of a portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0144] FIG. 45E is a side view of another portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0145] FIG. 46A is a cross sectional view of the outer shell, according to some embodiments.

[0146] FIG. 46B is another cross-sectional view of the outer shell, according to some embodiments.

[0147] FIG. 47A is a right side view of the carriage of FIG. 45B. according to some embodiments.

[0148] FIG. 47B is a front side view of the carriage of FIG. 45B, according to some embodiments.

[0149] FIG. 47C is a top down view of the carriage of FIG. 45B. according to some embodiments.

[0150] FIG. 47D is a bottom up view of the carriage of FIG. 45B, according to some embodiments.

[0151] FIG. 48 is a perspective view of a patient pad wrapped around a patient's leg. according to some embodiments.

[0152] FIG. 49A is a front side view of the patent pad, according to some embodiments.

[0153] FIG. 49B is a perspective view of the patient pad with part of the cover material removed, according to some embodiments.

[0154] FIG. 49C is a back side view of the patient pad, according to some embodiments.

[0155] FIG. 49D is a perspective view of the patient pad coupled with an atachment band, according to some embodiments.

[0156] FIG. 49E is a perspective view of a limb cradle, according to some embodiments.

[0157] FIG. 49F is a top down view of the patient pad atached to the limb cradle, according to some embodiments.

[0158] FIGS. 50A is an illustration of a patient using a patient pad, according to some embodiments.

[0159] FIG. 50B is an illustration of a patient using a patient pad with a limb cradle, according to some embodiments.

[0160] FIGS. 50C is an illustration of a patient using a patient pad with an atachment band, according to some embodiments.

[0161] FIG. 51 A is a schematic diagram of a bone growth system, according to some embodiments.

[0162] FIG. 51B is another schematic diagram of a bone growth system, according to some embodiments.

[0163] FIG. 52A is an illustration of a patient interacting with a user device, according to some embodiments.

[0164] FIG. 52B is an illustration of a notification on the control interface and user device, according to some embodiments.

[0165] FIG. 53A is an example of the user interface of the bone growth system, according to some embodiments.

[0166] FIG. 53B is another example of the user interface of the bone growth system, according to some embodiments.

[0167] FIG. 53C is another example of the user interface of the bone growth system, according to some embodiments.

[0168] FIG. 53D is another example of the user interface of the bone growth system, according to some embodiments.

[0169] FIG. 54 is a circuit diagram of a drive system of the bone growth device, according to some embodiments.

[0170] FIG. 55A depicts one or more steps in a surgical process for installing a bone growth device, according to some embodiments.

[0171] FIG. 55B depicts one or more steps in a surgical process for installing a bone growth device, according to some embodiments.

[0172] FIG. 55C depicts one or more steps in a surgical process for installing a bone growth device, according to some embodiments.

[0173] FIG. 55D depicts one or more steps in a surgical process for installing a bone growth device, according to some embodiments.

[0174] FIG. 55E depicts one or more steps in a surgical process for installing a bone growth device, according to some embodiments.

[0175] FIG. 55F depicts one or more steps in a surgical process for installing a bone growth device, according to some embodiments.

[0176] FIG. 55G depicts one or more steps in a surgical process for installing a bone growth device, according to some embodiments.

[0177] FIG. 55H depicts one or more steps in a surgical process for installing a bone growth device, according to some embodiments.

[0178] FIG. 551 depicts one or more steps in a surgical process for installing a bone growth device, according to some embodiments.

[0179] FIG. 56 is a perspective view of a control capsule, according to some embodiments.

[0180] FIG. 57 is a perspective view of a bone grow th device, according to some embodiments.

[0181] FIG. 58A is a perspective view of a bone growth device, according to some embodiments.

[0182] FIG. 58B is a perspective view' of the bone growth device with the outer shell removed, according to some embodiments.

[0183] FIG. 58C is an exploded view of the bone growth device, according to some embodiments.

[0184] FIG. 58D is a side view of a portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0185] FIG. 58E is a side view of another portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0186] FIG. 59A is a top down view of the outer shell of FIG. 58A, according to some embodiments.

[0187] FIG. 59B is a bottom up view of the outer shell of FIG. 58 A, according to some embodiments.

[0188] FIG. 59C is a cross-sectional view of the outer shell of FIG. 58A, according to some embodiments.

[0189] FIG. 59D is another cross-sectional view of the outer shell of FIG. 58A, according to some embodiments.

[0190] FIG. 60A is a perspective view of the nut of FIG. 58 A, according to some embodiments.

[0191] FIG. 60B is a front view' of the nut of FIG. 58A, according to some embodiments.

[0192] FIG. 60C is a side view of the nut of FIG. 58A, according to some embodiments.

[0193] FIG. 60D is a top view' of the nut of FIG. 58A, according to some embodiments.

[0194] FIG. 61 A is a perspective view of a locking screw, according to some embodiments.

[0195] FIG. 61B is a top view of the locking screw of FIG. 61 A, according to some embodiments.

[0196] FIG. 61C is a bottom view of the locking screw of FIG. 61 A, according to some embodiments.

[0197] FIG. 61D is a side view of the locking screw of FIG. 61 A, according to some embodiments.

[0198] FIG. 6 IE is a side sectional view of the locking screw of FIG. 61 A, according to some embodiments.

[0199] FIG. 61F is a perspective view of a cable lock, according to some embodiments.

[0200] FIG. 61G is a perspective view of the cable lock of FIG. 61F positioned within the locking screw, according to some embodiments.DETAILED DESCRIPTION

[0201] Exemplar^' embodiments of the disclosure will be best understood byreference to the drawings, wherein like parts are designated by like numerals throughout. It will be readily understood that the components of the disclosure, as generally described and illustrated in the Figures herein, could be arranged and designed in a wide variety of different configurations. Thus, the following more detailed description of the embodiments of the apparatus, system, and method, as represented in Figures 1 through 61E, is not intended to limit the scope of the claims, as claimed, but is merely representative exemplary of exemplary embodiments.

[0202] The phrases “connected to,’’ “coupled to” and “in communication with” refer to any form of interaction between two or more entities, including mechanical, electrical, magnetic, electromagnetic, fluid, and thermal interaction. Two components may be functionally coupled to each other even though they are not in direct contact with each other. The term “abutting” refers to items that are in direct physical contact with each other, although the items may not necessarily be attached together. The phrase “fluid communication” refers to two features that are connected such that a fluid within one feature is able to pass into the other feature.

[0203] The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplar)'” is not necessarily to be construed as preferred or advantageous over other embodiments. While the various aspects of the embodiments are presented in drawings, the drawings are drawnto scale, but those of skill in the art will recognize that the dimensions of implants and instruments within the scope of the present disclosure may vary from those illustrated.

[0204] Figure 1 A is a front view of a bone growth device 100 and Figure IB is a top view of a bone grow th device 100 according to one embodiment. The bone growth device 100 may be designed to facilitate grow th of new bone betw een a first bone segment 101 and a second bone segment 102 via a third bone segment 103. The bone growth device 100 may include a first bone growth device end 130 and a second bone growth device end 135. The first bone growth device end 130 may include one or more first end fixation holes 113. The first end fixation holes 113 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the first bone growth device end 130 to a first bone segment 101. The second bone growth device end 135 may include one or more second end fixation holes 114. The second end fixation holes 114 may be configured to accommodate one or more fastening devices (not shown), such as a screw?or pin, configured to secure the second bone grow th device end 135 to a second bone segment 102.

[0205] A third bone segment 103 may be attached to a bone segment transport element 123 which may be configured to travel within an internal channel 104 along the length of the bone grow th device 100 at a rate conducive to achieving new7bone growth between the bone segments. As the anatomy of patients may vary, the bone growth device 100 may include a plurality of sizes, all with the same general profile and features.

[0206] Figure 2A is a front view7of a bone growth device 100. Figure 2B through Figure 2F are front and top section views of a bone grow th device 100. In one embodiment, the bone growth device 100 may have a slot 110 which may be generally along the axis of the bone growth device 100 and may be generally longer than it is wide. The bone growth device 100 may further include a bone segment transport element 123 which may be configured to attach to a third bone segment 103 through the slot 110. The bone segment transport element 123 may be configured to be securely connected to the third bone segment 103 via one or more fastening devices (not shown), such as a screw or pin. which may be placed though one or more transport element fixation holes 124.

[0207] In one embodiment, the bone growth device 100 may include an actuator 117. The actuator 117 may include one or more permanent magnets 118. The magnets 118 may be activated by a magnetic field generating device external to the patient (not shown). The magnetic field generating device may generate a magnetic force on the magnets 118 located within the actuator 117 to produce a rotational force in either a clockwise orcounter-clock-wise direction. The actuator 117 may be securely connected to a drive gear 116 such that any rotation of the actuator 117 is translated to rotation of the drive gear 116. The drive gear 116 may be a separate component or may be a feature incorporated on the actuator 117.

[0208] The drive gear 116 may be configured as a bevel gear and may be mated to a corresponding bevel style driven gear 115 such that rotation of the drive gear 116 may be translated to rotation of the driven gear 115. The gear ratios may be configured such that one rotation of the drive gear 116 may translate to one, greater than one, or less than one rotation of the driven gear 115. Further, the driven gear 115 may be configured to be connected to a drive pulley 125. The drive pulley 125 may be configured to transfer movement to the drive belt 111 when the driven gear 115 and drive pulley 125 are rotated. The drive belt 111 may further be connected to a pulley 112 which may be positioned at the opposite end of the drive belt 111 and may, in conjunction with the drive pulley 125, provide sufficient tension on the drive belt 111 to facilitate movement of the drive belt 111 and may allow the drive belt 111 to maintain continuous engagement with both the drive pulley 125 and the pulley 112.

[0209] The drive pulley 125 may be configured to be between either the first slot end 120 and the first bone growth device end 130 or betw een the second slot end 119 and the second bone growth device end 135. Further, the pulley 112 may be configured to be at the opposite end of the bone growth device 100 and between either the second slot end 1 19 and the second bone growth device end 135 or between the first slot end 120 and the first bone growth device end 130.

[0210] The bone growth device 100 may be secured to afirst bone segment 101 and a second bone segment 102 such that the distance between first and second bone segments 121 may be less than the overall length of the bone growth device 100. The bone segment transport element 123 may be securely attached to a third bone segment 103. The third bone segment 103 may be positioned such that the distance betw een second and third bone segments 122 may correlate to the desired bone growth distance. The bone growth device 100 may be configured such that the actuator 117 may essentially not change location along the length of the bone growth device 100 as the bone segment transport element 123 and a third bone segment 103 travel along the length of the bone growth device 100.

[0211] Figure 3A is a front view of a bone growth device 200 and Figure 3B is a top view of a bone growth device 200 according to one embodiment. The bone growthdevice 200 may be designed to facilitate growth of new bone between a first bone segment 201 and a second bone segment 202 via a third bone segment 203. The bone growth device 200 may include a first bone growth device end 230 and a second bone growth device end 235. The first bone growth device end 230 may include one or more first end fixation holes 213. The first end fixation holes 213 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the first bone growth device end 230 to a first bone segment 201. The second bone growth device end 235 may include one or more second end fixation holes 214. The second end fixation holes 214 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the second bone growth device end 235 to a second bone segment 202.

[0212] A third bone segment 203 may be attached to a bone segment transport element 223 which may be configured to travel within an internal channel 204 along the length of the bone grow th device 200 at a rate conducive to achieving new bone grow th between the bone segments. As the anatomy of patients may vary, the bone growth device 200 may include a plurality of sizes, all with the same general profile and features.

[0213] Figure 4A is a front view' of a bone growth device 200. Figure 4B and Figure 4C are front and top section view s of a bone growth device 200. In one embodiment, the bone growth device 200 may have a slot 210 which may be generally along the axis of the bone growth device 200 and may be generally longer than it is wide. The bone growth device 200 may further include a bone segment transport element 223 which may be configured to attach to a third bone segment 203 through the slot 210. The bone segment transport element 223 may be configured to be securely connected to the third bone segment 203 via one or more fastening devices (not shown), such as a screw or pin, which may be placed though one or more transport element fixation holes 224.

[0214] In one embodiment, the bone growth device 200 may include a compression spring 211. The compression spring 211 may be configured to include a spring base 217 that may be secured to either the first bone growth device end 230 or the second bone growth device end 235. The first end of the compression spring 211 may be configured to securely connect to the spring base 217 and the second end of the compression spring 211 may be configured to securely connect to the bone segment transport element 223. The compression spring 211 may be configured to exert a linear force on the bone segment transport element 223 that may cause the bone segment transportelement 223 to travel along the length of the bone growth device 200 at a rate conducive to achieving new bone growth between the bone segments.

[0215] The bone growth device 200 may be secured to a first bone segment 201 and a second bone segment 202 such that the distance between first and second bone segments 221 may be less than the overall length of the bone grow th device 200. The bone segment transport element 223 may be securely attached to a third bone segment 203. The third bone segment 203 may be positioned such that the distance between second and third bone segments 222 may correlate to the desired bone growth distance.

[0216] Figure 5A is a front view of a bone growth device 300 and Figure 5B is a top view of a bone growth device 300 according to one embodiment. The bone growth device 300 may be designed to facilitate growth of new bone between a first bone segment 301 and a second bone segment 302 via a third bone segment 303 and a fourth bone segment 304. The bone growth device 300 may include a first bone growth device end 330 and a second bone growth device end 335. The first bone growth device end 330 may include one or more first end fixation holes 313. The first end fixation holes 313 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin. configured to secure the first bone growth device end 330 to a first bone segment 301. The second bone growth device end 335 may include one or more second end fixation holes 314. The second end fixation holes 314 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the second bone growth device end 335 to a second bone segment 302.

[0217] A third bone segment 303 may be attached to a bone segment transport element 323 which may be configured to travel along the length of the bone growth device 300 at a rate conducive to achieving new bone growth between the bone segments. A fourth bone segment 304 may be attached to a bone segment transport element 323 which may be configured to travel along the length of the bone growth device 300 at a rate conducive to achieving new bone growth between the bone segments. As the anatomy of patients may vary, the bone growth device 300 may include a plurality of sizes, all with the same general profile and features.

[0218] Figure 6A is a front view' of a bone growth device 300. Figure 6B through Figure 6E are front, side and isometric section view s of a bone growth device 300. In one embodiment, the bone growth device 300 may include a linear gear 310 and one or more guide rails 315 which may be generally along the axis of the bone growth device 300. The bone growth device 300 may further include one or more bone segment transportelements 323 which may be configured to attach to a third bone segment 203 or fourth bone segment 304. The bone segment transport elements 323 may be configured to be securely connected to the third bone segment 303 or fourth bone segment 304 via one or more fastening devices (not shown), such as a screw or pin, which may be placed though one or more transport element fixation holes 324.

[0219] In one embodiment, the bone segment transport element 323 may include an actuation mechanism 345 which may include a ratchet driven rack in pinion gear mechanism. The actuation mechanism 345 may include a drive gear 336 that may be configured to be driven in a first rotational direction via a first ratchet arm 339. The first ratchet arm 339 may include a first magnet 337 and a first return spring 341. The first ratchet arm 339 may be configured such that when an external magnetic field is applied, the first ratchet arm 339 pivots about a first ratchet arm pivot axis 343 and results in rotation of the drive gear 336. When the external magnetic field is removed, the second return spring 342 may applied sufficient force on the second ratchet arm 340 to cause the second ratchet arm 340 to pivot about the second ratchet arm pivot axis 344 and return to the initial position.

[0220] Additionally, the actuation mechanism 345 may include a drive gear 336 that may be configured to be driven in a second rotational direction via a second ratchet arm 340. The second ratchet arm 340 may include a second magnet 338 and a second return spring 342. The second ratchet arm 340 may be configured such that when an external magnetic field is applied, the second ratchet arm 340 pivots about a second ratchet arm pivot axis 344 and results in rotation of the drive gear 336. When the external magnetic field is removed, the second return spring 342 may applied sufficient force on the second ratchet arm 340 to cause the second ratchet arm 340 to pivot about the second ratchet arm pivot axis 344 and return to the initial position.

[0221] Further, the first magnet 337 and the second magnet 338 may be configured with opposite polar orientations such that when an external magnetic field is applied to a bone segment transport element 323 the first ratchet arm 339 and the second ratchet arm 340 pivot in opposite directions. As a result, the external magnetic field may be altered to cause either clock-wise or counter-clock-wise rotation of the drive gear 336.

[0222] A bone segment transport element 323 may include a guide rail channel 316 which may be configured to slidably engage the linear gear 310. Additionally, a bone segment transport element may include one or more guide rail channels 316 which may be configured to slidably engage the one or more guide rails 315. A drive gear 336 may beconfigured to engage with a linear gear 310 such that rotation of the drive gear 336 may result in movement of the bone segment transport element 323 along the length of one or more guide rails 315 and along a linear gear channel 31 1.

[0223] The one or more bone segment transport elements 323 may be configured such that when an external magnetic field is simultaneously applied to the one or more bone segment transport elements 323, the one or more bone segment transport elements 323 travel in the same direction at the same rate along the one or more guide rails 315 and along a linear gear channel 311.

[0224] Alternately, the one or more bone segment transport elements 323 may be configured such that when an external magnetic field is simultaneously applied to the one or more bone segment transport elements 323. the one or more bone segment transport elements 323 travel in an opposite direction at the same rate along the one or more guide rails 315 and along a linear gear channel 311.

[0225] Alternately, the one or more bone segment transport elements 323 maybe configured such that an external magnetic field may be directed at only one bone segment transport element 323 at a time and the one bone segment transport element may move independently of other bone segment transport elements 323.

[0226] The bone grow th device 300 may be secured to a first bone segment 301 and a second bone segment 302 such that the distance between first and second bone segments 320 may be less than the overall length of the bone growth device 300. One or more bone segment transport elements 323 may be securely attached to a third bone segment 303 or a fourth bone segment 304. The third bone segment 303 may be positioned such that the distance between second and third bone segments 321 may correlate to a first desired bone growth distance. The fourth bone segment 304 may be positioned such that the distance betw een first and fourth bone segments 319 may correlate to a second desired bone growth distance. The distance between the third and fourth bone segments 322 may correlate to the total travel distance of the one or more bone segment transport elements 323.

[0227] Figure 7A is a front view of a bone lengthening device 400 and Figure 7B is a top view of a bone lengthening device 400 according to one embodiment. The bone lengthening device 400 may be designed to facilitate growth of new bone between a first bone segment 401 and a second bone segment 402 via a third bone segment 403. Additionally, the bone lengthening device 400 may be configured to increase the overall length on a bone by increasing the distance between first and second bone segments 420.The bone lengthening device 400 may include a first bone lengthening device end 430 and a second bone lengthening device end 435. The first bone lengthening device end 430 may include one or more first end fixation holes 413. The first end fixation holes 413 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the first bone lengthening device end 430 to a first bone segment 401. The second bone lengthening device end 435 may include one or more second end fixation holes 414. The second end fixation holes 414 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the second bone lengthening device end 435 to a second bone segment 402.

[0228] A third bone segment 403 may be attached to a bone segment transport element 423 which may be configured to travel along the length of the bone lengthening device 400 at a rate conducive to achieving new bone growth between the bone segments. As the anatomy of patients may vary, the bone lengthening device 400 may include a plurality7of sizes, all with the same general profile and features.

[0229] Figure 8A is a front view of a bone lengthening device 400. Figure 8B and Figure 8C are side and isometric section views of a bone lengthening device 400. In one embodiment, the bone lengthening device 400 may include a linear gear 410 and one or more guide rails 415 which may be generally along the axis of the bone lengthening device 400. The bone lengthening device 400 may further include a bone segment transport element 423 which may be configured to attach to a third bone segment 403. The bone segment transport element 423 may be configured to be securely connected to the third bone segment 403 via one or more fastening devices (not shown), such as a screw or pin, which may be placed though one or more transport element fixation holes 424.

[0230] In one embodiment, the bone segment transport element 423 may include an actuation mechanism 445 which may include a ratchet driven rack in pinion gear mechanism. The actuation mechanism 445 may include a drive gear 436 that may be configured to be driven in a first rotational direction via a first ratchet arm 439. The first ratchet arm 439 may include a first magnet 437 and a first return spring 441. The first ratchet arm 439 may be configured such that when an external magnetic field is applied, the first ratchet arm 439 pivots about a first ratchet arm pivot axis 443 and results in rotation of the drive gear 436. When the external magnetic field is removed, the second return spring 442 may applied sufficient force on the second ratchet arm 440 to cause the second ratchet arm 440 to pivot about the second ratchet arm pivot axis 444 and return to the initial position.

[0231] Additionally, the actuation mechanism 445 may include a drive gear 436 that may be configured to be driven in a second rotational direction via a second ratchet arm 440. The second ratchet arm 440 may include a second magnet 438 and a second return spring 442. The second ratchet arm 440 may be configured such that when an external magnetic field is applied, the second ratchet arm 440 pivots about a second ratchet arm pivot axis 444 and results in rotation of the drive gear 436. When the external magnetic field is removed, the second return spring 442 may applied sufficient force on the second ratchet arm 440 to cause the second ratchet arm 440 to pivot about the second ratchet arm pivot axis 444 and return to the initial position.

[0232] Further, the first magnet 437 and the second magnet 438 may be configured with opposite polar orientations such that when an external magnetic field is applied to a bone segment transport element 423 the first ratchet arm 439 and the second ratchet arm 440 pivot in opposite directions. As a result, the external magnetic field may be altered to cause either clock-wise or counter-clock-wise rotation of the drive gear 436.

[0233] A bone segment transport element 423 may include a guide rail channel 416 which may be configured to slidably engage the linear gear 410. Additionally, a bone segment transport element 423 may include one or more guide rail channels 416 which may be configured to slidably engage the one or more guide rails 415. A drive gear 436 may be configured to engage with a linear gear 410 such that rotation of the drive gear 436 may result in movement of the bone segment transport element 423 along the length of the guide rails 415.

[0234] A bone lengthening device 400 may include a first lengthening device portion 426 and a second lengthening device portion 427 that may be slidably connected to a first lengthening device portion 426. A second lengthening device portion may include one or more guide rail channels 416 configured to slidably connect to a guide rail 415 and a linear gear channel 411 configured to slidably connect to a linear gear 410.

[0235] Additionally, a second lengthening device portion may be configured to include an actuation mechanism 445, including: drive gear 436, first magnet 437, second magnet 438, first ratchet arm 439. second ratchet arm 440, first return spring 441. second return spring 442, first ratchet arm pivot axis 443 and second ratchet arm pivot axis 444.

[0236] The one or more bone segment transport elements 423 may be configured such that when an external magnetic field is simultaneously applied to the one or more bone segment transport elements 423. the one or more bone segment transportelements 423 travel in the same direction at the same rate along the one or more guide rails 415.

[0237] Alternately, the one or more bone segment transport elements 423 may be configured such that when an external magnetic field is simultaneously applied to the one or more bone segment transport elements 423, the one or more bone segment transport elements 423 travel in an opposite direction at the same rate along the one or more guide rails 415.

[0238] Alternately, the one or more bone segment transport elements 423 may be configured such that an external magnetic field may be directed at only one bone segment transport element 423 at a time and the one bone segment transport element may move independently of other bone segment transport elements 423.

[0239] A bone lengthening device 400 may be secured to a first bone segment 401 and a second bone segment 402 such that the distance between first and second bone segments 420 may be less than the overall length of the bone lengthening device 400. A bone segment transport element 423 may be securely attached to a third bone segment 403. The third bone segment 403 may be positioned such that the distance between second and third bone segments 421 may correlate to a first desired bone growth distance.

[0240] The bone lengthening device 400 may be configured such that, by applying an external magnetic field to a second lengthening device portion 427, the length of bone lengthening device 422 may increase resulting in an increase in the length of a patient’s bone.

[0241] Figure 9A is a front view of a bone growth device 500 and Figure 9B is a top view of a bone growth device 500 according to one embodiment. The bone growth device 500 may be designed to facilitate growth of new bone between a first bone segment 501 and a second bone segment 502 via a third bone segment 503. The bone grow th device 500 may include a first bone growth device end 530 and a second bone growth device end 535. The first bone growth device end 530 may include one or more first end fixation holes 513. The first end fixation holes 513 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the first bone growth device end 530 to a first bone segment 501. The second bone growth device end 535 may include one or more second end fixation holes 514. The second end fixation holes 514 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the second bone growth device end 535 to a second bone segment 502.

[0242] A third bone segment 503 may be attached to a bone segment transport element 523 which may be configured to travel within an internal channel 504 along the length of the bone growth device 500 at a rate conducive to achieving new bone growth between the bone segments. As the anatomy of patients may vary, the bone grow th device 500 may include a plurality' of sizes, all with the same general profile and features.

[0243] Figure 10A is a front view of a bone growth device 500. Figure 10B and Figure 10C are front and side section views of a bone growth device 500. In one embodiment, the bone growth device 500 may have a slot 510 which may be generally along the axis of the bone growth device 500 and may be generally longer than it is w ide. The bone growth device 500 may further include a bone segment transport element 523 which may be configured to attach to a third bone segment 503 through the slot 510. The bone segment transport element 523 may be configured to be securely connected to the third bone segment 503 via one or more fastening devices (not shown), such as a screw or pin, which may be placed though one or more transport element fixation holes 524.

[0244] In one embodiment, the bone growth device 500 may include an actuator 517. The actuator 517 may include one or more permanent magnets 516. The magnets 516 may be activated by a magnetic field generating device external to the patient (not shown). The magnetic field generating device may generate a magnetic force on the magnets 516 located within the actuator 517 to produce a rotational force in either a clock-wise or counter-clock-wise direction. The bone segment transport element 523 may be configured to include a ball portion 525. The ball portion 525 may be configured to slidably connect to a socket portion 526 included in the actuator 517.

[0245] In one embodiment, the bone growth device 500 may include an internal threaded portion 511. The internal threaded portion 511 may be configured to mate with an actuator threaded portion 518 such that any rotation of the actuator 517 is translated to linear motion of the bone segment transport element 523.

[0246] The bone growth device 500 may be secured to a first bone segment 501 and a second bone segment 502 such that the distance between first and second bone segments 521 may be less than the overall length of the bone growth device 500. The bone segment transport element 523 may be securely attached to a third bone segment 503. The third bone segment 503 may be positioned such that the distance betw een second and third bone segments 522 may correlate to the desired bone growth distance. The bone growth device 500 may be configured such that the actuator 517 travels along the length of thebone growth device 500 along with the bone segment transport element 523 and a third bone segment 503.

[0247] Figure 11 A is a front view of a bone growth device 600 and Figure 1 IB is a top view of a bone growth device 600 according to one embodiment. The bone growth device 600 may be designed to facilitate grow th of new bone betw een a first bone end 601 and a second bone end 602 via a bone segment 603. The bone growth device 600 may include a first bone growth device end 630 and a second bone growth device end 635. The first bone growth device end 630 may include one or more first end fixation holes 613. The first end fixation holes 613 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the first bone growth device end 630 to a first bone end 601. First bone growth device end 630 may be configured to securely attach to an external portion of first bone end 601. The second bone growth device end 635 may include one or more second end fixation holes 614. The second end fixation holes 614 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the second bone growth device end 635 to a second bone end 602. Second bone growth device end 635 may be configured to securely attach to an external portion of second bone end 602.

[0248] A bone segment 603 may be attached to a bone segment transport element 623 which may be configured to travel along the length of the bone growth device 600 at a rate conducive to achieving new bone growth between the bone segments. As the anatomy of patients may vary, the bone growth device 600 may include a plurality of sizes, all with the same general profile and features.

[0249] Figure 12A is a front view- of the bone growth device shown 600. Figure 12B through Figure 12D are isometric section views of a bone growth device 600. In one embodiment, the bone growth device 600 may have a slot 610 which may be generally along the axis of the bone growth device 600 and may be generally longer than it is w ide. The bone growth device 600 may further include a bone segment transport element 623 which may be configured to attach to a third bone segment 603. The bone segment transport element 623 may be configured to be securely connected to the third bone segment 603 via one or more fastening devices (not shown), such as a screw or pin, which may be placed though one or more transport element fixation holes 624.

[0250] In one embodiment, the bone growth device 600 may include an actuator 617. The actuator 617 may include one or more permanent magnets 616. The magnets 616 may be activated by a magnetic field generating device external to the patient (not shown).The magnetic field generating device may generate a magnetic force on the magnets 616 located within the actuator 617 to produce a rotational force in either a clock-wise or counter-clock-wise direction. The bone segment transport element 623 may be configured to include threaded hole 615. The threaded hole 61 may be configured to mate with a threaded rod 618. The threaded rod 618 may be securely connected to an actuator 617. Alternately, the threaded rod 618 may be a feature of an actuator 617. An actuator 617 may be configured such that any rotation of the actuator 617 is translated to linear motion of the bone segment transport element 623.

[0251] The bone growth device 600 may be secured to a first bone end 601 and a second bone end 602 such that the distance between first and second bone segments 621 may be less than the overall length of the bone growth device 600. The bone segment transport element 623 may be securely attached to a bone segment 603. A bone segment 603 may be positioned such that the distance between second and third bone segments 622 may correlate to the desired bone growth distance. The bone grow th device 600 may be configured such that the actuator 617 travels along the length of the bone growth device 600 along with the bone segment transport element 623 and a bone segment 603.

[0252] Figure 13A is a front view of a bone lengthening device 700 and Figure 13B is a top view of a bone lengthening device 700 according to one embodiment. The bone lengthening device 700 may be designed to facilitate growth of new bone between a first bone segment 701 and a second bone segment 702. The bone lengthening device 700 may include a first bone lengthening device end 730 and a second bone lengthening device end 735. The first bone lengthening device end 730 may include one or more first end fixation holes 713. The first end fixation holes 713 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the first bone lengthening device end 730 to a first bone segment 701 . First bone lengthening device end 730 may be configured to securely attach to an external portion of first bone segment 701. The second bone lengthening device end 735 may include one or more second end fixation holes 714. The second end fixation holes 714 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the second bone lengthening device end 735 to a second bone segment 702. Second bone lengthening device end 735 may be configured to securely attach to an external portion of second bone segment 702. As the anatomy of patients may vary, the bone growth device 700 may include a plurality of sizes, all with the same general profile and features.

[0253] Figure 14A is a front view of a bone lengthening device 700. Figure 14B and Figure 14C are front and isometric section views of a bone lengthening device 700. In one embodiment, the bone lengthening device 700 may include an actuator 717. The actuator 717 may include one or more permanent magnets 716. The magnets 716 may be activated by a magnetic field generating device external to the patient (not shown). The magnetic field generating device may generate a magnetic force on the magnets 716 located within the actuator 717 to produce a rotational force in either a clock-wise or counter-clockwise direction.

[0254] The first lengthening device portion 726 may be configured to include an internal linear gear 719. The linear gear 719 may be configured to mate with a drive gear 720. A drive gear 720 may be configured to mate with a threaded rod 718 such that rotation of the threaded rod 718 translates to rotation of the drive gear 720 which results in translation of the linear gear 719 and displacement of the first lengthening device portion 726. The threaded rod 718 may be securely connected to an actuator 717. Alternately, the threaded rod 718 may be a feature of an actuator 717. An actuator 717 may be configured such that any rotation of the actuator 717 is translated to linear motion of a first lengthening device portion 726 with respect to a second lengthening device portion 727 via a threaded rod 718, a drive gear 720 and a linear gear 719.

[0255] The bone lengthening device 700 may be secured to a first bone segment 701 and a second bone segment 702 such that the distance between first and second bone segments 721 may be less than the overall length of the bone lengthening device 700 and may correlate to the desired bone grow th distance. The bone lengthening device 700 may be configured such that the actuator 717 may essentially not change location along the length of the bone lengthening device 700 as length of the bone lengthening device 722 increases or decreases.

[0256] Figure 15A is a front view of a bone lengthening device 800 and Figure 15B is a top view of a bone lengthening device 800 according to one embodiment. The bone lengthening device 800 may be designed to facilitate growth of new bone between a first bone segment 801 and a second bone segment 802. The bone lengthening device 800 may include a first bone lengthening device end 830 and a second bone lengthening device end 835.

[0257] The first bone lengthening device end 830 may include a first bone connection portion 803. The first bone connection portion 803 may be configured to interface with the anatomy of a specific patient. The first bone connection portion 803 mayinclude one or more first bone connection fixation holes 813 and a first device attachment portion 805. The first bone connection fixation holes 813 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the first bone lengthening device end 830 to a first bone segment 801. First bone lengthening device end 830 may be configured to securely attach to an external portion of first bone segment 801 of a specific patient. The first device attachment portion 805 may be configured to include a threaded portion or other mechanism to securely attach a first bone connection portion 803 to a bone lengthening device 800.

[0258] The second bone lengthening device end 835 may include a second bone connection portion 804. The second bone connection portion 804 may be configured to interface with the anatomy of a specific patient. The second bone connection portion 804 may include one or more second bone connection fixation holes 814 and a second device attachment portion 806. The second bone connection fixation holes 814 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the second bone lengthening device end 835 to a second bone segment 802. Second bone lengthening device end 835 may be configured to securely attach to an external portion of second bone segment 802 of a specific patient. The second device attachment portion 806 may be configured to include a threaded portion or other mechanism to securely attach a second bone connection portion 804 to a bone lengthening device 800.

[0259] Figure 16A and Figure 16B are front section views of a bone lengthening device 800. In one embodiment, the bone lengthening device 800 may include an actuator 817. The actuator 817 may include one or more permanent magnets 816. The magnets 816 may be activated by a magnetic field generating device external to the patient (not shown). The magnetic field generating device may generate a magnetic force on the magnets 816 located within the actuator 817 to produce a rotational force in either a clock-wise or counter-clock-wise direction.

[0260] The first lengthening device portion 826 may be configured to include an internal linear gear 819. The linear gear 819 may be configured to mate with a drive gear 820. A drive gear 820 may be configured to mate with a threaded rod 818 such that rotation of the threaded rod 818 translates to rotation of the drive gear 820 which results in translation of the linear gear 819 and displacement of the first lengthening device portion 826. The threaded rod 818 may be securely connected to an actuator 817. Alternately, the threaded rod 818 may be a feature of an actuator 817. An actuator 817 may be configuredsuch that any rotation of the actuator 817 is translated to linear motion of a first lengthening device portion 826 with respect to a second lengthening device portion 827 via a threaded rod 818, a drive gear 820 and a linear gear 819.

[0261] The bone lengthening device 800 may be secured to a first bone segment 801 and a second bone segment 802 such that the distance between first and second bone segments 821 may be less than the overall length of the bone growth device 800 and may correlate to the desired bone growth distance. The bone growth device 800 may be configured such that the actuator 817 may essentially not change location along the length of the bone growth device 800 as length of the bone lengthening device 822 increases or decreases.

[0262] Figure 17A is a front view of a bone growth device 900 and Figure 17B is a top view of a bone growth device 900 according to one embodiment. The bone growth device 900 may be designed to facilitate growth of new bone between a first bone segment 901 and a second bone segment 902 via a third bone segment 903. The bone growth device 900 may include a first bone growth device end 930 and a second bone growth device end 935. The first bone growth device end 930 may include one or more first end fixation holes 913. The first end fixation holes 913 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the first bone growth device end 930 to a first bone segment 901. The second bone growth device end 935 may include one or more second end fixation holes 914. The second end fixation holes 914 may be configured to accommodate one or more fastening devices (not shown), such as a screws or pin, configured to secure the second bone grow th device end 935 to a second bone segment 902.

[0263] A third bone segment 903 may be atached to a bone segment transport element 923 which may be configured to travel within an internal channel 904 along the length of the bone grow th device 900 at a rate conducive to achieving new bone growth between the bone segments. As the anatomy of patients may vary, the bone growth device 500 may include a plurality of sizes, all with the same general profile and features.

[0264] Figure 18A is a front view of a bone growth device 900. Figure 18B through Figure 18F are front, side and isometric section views of a bone growth device 900. In one embodiment, the bone growth device 900 may have a slot 910 which may be generally along the axis of the bone growth device 900 and may be generally longer than it is wide. The bone growth device 900 may further include a bone segment transport element 923 which may be configured to atach to a third bone segment 903 through the slot 910.The bone segment transport element 923 may be configured to be securely connected to the third bone segment 903 via one or more fastening devices (not shown), such as a screw or pin, which may be placed though one or more transport element fixation holes 924.

[0265] In one embodiment, the bone growth device 900 may include an actuator917. The actuator 917 may include one or more permanent magnets 918. The magnets 918 may be activated by a magnetic field generating device external to the patient (not shown). The magnetic field generating device may generate a magnetic force on the magnets 918 located within the actuator 917 to produce a rotational force in either a clock-wise or counter-clock-wise direction. The actuator 917 may be configured to include a non-circular shaft 912. Alternately, a non-circular shaft 912 may be configured to be a separate component securely connected to an actuator 917.

[0266] The bone segment transport element 923 may be configured to include a connection portion 925. The connection portion 925 may be configured to slidably connect to a socket portion 926 included in the threaded element 915. The threaded element may further include an internal non-circular hole 927 configured to slidably connect to a non-circular shaft 912.

[0267] In one embodiment, the bone growth device 900 may include an internal threaded portion 911. The internal threaded portion 911 may be configured to mate with a threaded element 915 such that any rotation of the actuator 917 is translated to linear motion of the bone segment transport element 923.[026S] The bone growth device 900 may be secured to a first bone segment 901 and a second bone segment 902 such that the distance between first and second bone segments 921 may be less than the overall length of the bone growth device 900. The bone segment transport element 923 may be securely attached to a third bone segment 903. The third bone segment 903 may be positioned such that the distance betw een second and third bone segments 922 may correlate to the desired bone growth distance. The bone growth device 900 may be configured such that the actuator 917 may essentially not change location along the length of the bone growth device 900 as the bone segment transport element 923 and a third bone segment 903 travel along the length of the bone growth device 900.

[0269] Figure 19A is a front view' of a bone lengthening device 1000 and Figure 19B is a top view of a bone lengthening device 1000 according to one embodiment. The bone lengthening device 1000 may be designed to facilitate growth of new bone between a first bone segment 1001 and a second bone segment 1002. The bone lengthening device1000 may include a first bone lengthening device end 1030 and a second bone lengthening device end 1035. The first bone lengthening device end 1030 may include one or more first end fixation holes 1013. The first end fixation holes 1013 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the first bone lengthening device end 1030 to a first bone segment 1001. The second bone lengthening device end 1035 may include one or more second end fixation holes 1014. The second end fixation holes 1014 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the second bone lengthening device end 1035 to a second bone segment 1002. As the anatomy of patients may vary', the bone lengthening device 1000 may include a plurality of sizes, all with the same general profile and features.

[0270] Figure 20A is a front view of a bone lengthening device 1000. Figure 20B through Figure 20D are front and isometric section views of a bone lengthening device 1000. In one embodiment, the bone lengthening device 1000 may include an actuator 1017. The actuator 1017 may include one or more permanent magnets 1016. The magnets 1016 may be activated by a magnetic field generating device external to the patient (not shown). The magnetic field generating device may7generate a magnetic force on the magnets 1016 located within the actuator 1017 to produce a rotational force in either a clock- wise or counter-clock-wise direction.

[0271] A first lengthening device portion 1026 may be configured to include a connection portion 1023. The connection portion 1023 may be configured to slidably mate with a socket portion 1024 which may be included in a threaded element 1019. A threaded element 1019 may further include an external thread 1025.

[0272] A second lengthening device portion 1027 may be configured to include an internal threaded portion 1020 configured to mate with an external thread 1025 of a threaded element 1019. A threaded element 1019 may further include a non-circular hole 1028. A non-circular hole 1028 may be configured to be slidably connectable to a noncircular shaft 1018.

[0273] The non-circular shaft 1018 may be securely connected to an actuator 1017. Alternately, the non-circular shaft 1018 may7be a feature of an actuator 1017. An actuator 1017 may be configured such that any rotation of the actuator 1017 is translated to linear motion of a first lengthening device portion 1026 with respect to a second lengthening device portion 1027 via a non-circular shaft 1018 and a threaded element 1019.

[0274] The bone lengthening device 1000 may be secured to a first bone segment 1001 and a second bone segment 1002 such that the distance between first and second bone segments 1021 may be less than the overall length of the bone lengthening device 1000 and may correlate to the desired bone growth distance. The bone lengthening device 1000 may be configured such that the actuator 1017 may essentially not change location along the length of the bone lengthening device 1000 as length of the bone lengthening device 1022 increases or decreases.

[0275] Figure 23A is a section view of a bone growth device 2300 showing an alternate embodiment of an actuator mechanism 2317. Figure 23B is an end view of the bone growth device 2300 shown in Figure 23A. In one embodiment, the bone growth device 2300 may include an actuator mechanism 2317. The actuator mechanism 2317 may include one or more permanent magnets (not shown) encased within a non-magnetic material 2318 such as PEEK, carbon fiber, polycarbonate, polyamide or another polymer. The actuator mechanism 2317 may be activated by a magnetic field generating device external to the patient (not shown). The magnetic field generating device may be configured to oscillate a magnetic field source back and forth along a generally radial arc 2320 that is generally concentric to the actuator mechanism 2317. The generally radial arc 2320 may span approximately 90 degrees. The oscillations of the magnetic field generating device may be configured to produce a rotational force in the actuator mechanism 2417 in either a clock-wise or counter-clock-wise direction. The actuator mechanism 2317 may be configured to include a non-circular shaft 2312. Alternately, a non-circular shaft 2312 may be configured to be a separate component securely connected to an actuator mechanism 2317.

[0276] The bone segment transport element 2323 may be configured to include an internal portion in which the threaded element 2315 may be rotatably captive such that, as the threaded element 2315 is rotated, the position of a bone segment transport element 2323 along the length of the central portion of the bone growth device 2300 is changed.

[0277] Figure 24A is a section view of a bone growth device 2400 showing an alternate embodiment of an actuator mechanism 2417. Figure 24B is a section view of the bone growth device 2400 shown in Figure 24A. In one embodiment, the bone growth device 2400 may include an actuator mechanism 2417. The actuator mechanism 2417 may include one or more permanent magnets (not shown) encased within a non-magnetic material 2418 such as PEEK, carbon fiber, polycarbonate, polyamide or other polymer. The actuator mechanism 2417 may be activated by a magnetic field generating device externalto the patient (not shown). The magnetic field generating device may be configured to oscillate a magnetic field source back and forth along a generally linear path 2420 that is generally along the axis of an actuator mechanism 2417. The generally linear path 2420 may have a length generally similar to the length of an actuator mechanism 2417. The oscillations of the magnetic field generating device may be configured to produce a rotational force in an actuator mechanism 2417 in either a clock-wise or counter-clock-wise direction. The actuator mechanism 2417 may be configured to include a non-circular shaft 2412. Alternately, anon-circular shaft 2412 may be configured to be a separate component securely connected to an actuator mechanism 2417.

[0278] The bone segment transport element 2423 may be configured to include an internal portion in which the threaded element 2415 may be rotatably captive such that, as the threaded element 2415 is rotated, the position of a bone segment transport element 2423 along the length of the central portion of the bone growth device 2400 is changed.

[0279] Figure 25A is a section view of a bone grow th device 2500 showing an alternate embodiment of an actuator mechanism 2517. Figure 25B is a section view of the bone growth device 2500 shown in Figure 25A. In one embodiment, the bone growth device 2500 may include an actuator mechanism 2517. The actuator mechanism 2517 may include one or more permanent magnets (not shown) encased within a non-magnetic material 2318 such as PEEK, carbon fiber, polycarbonate, polyamide or other polymer. The actuator mechanism 2517 may be activated by a magnetic field generating device external to the patient (not shown). The magnetic field generating device may be configured to oscillate a magnetic field source back and forth along a generally radial arc 2520 that is generally perpendicular to the axis of the actuator mechanism 2517. The generally radial arc 2520 may span approximately 90 degrees and be centered at a center point of oscillation 2530. The oscillations of the magnetic field generating device may be configured to produce a rotational force in the actuator mechanism 2517 in either a clock- wise or counter- clock-wise direction. The actuator mechanism 2517 may be configured to include a noncircular shaft 2512. Alternately, a non-circular shaft 2512 may be configured to be a separate component securely connected to an actuator mechanism 2517.

[0280] The bone segment transport element 2523 may be configured to include an internal portion in which the threaded element 2515 may be rotatably captive such that, as the threaded element 2515 is rotated, the position of a bone segment transport element 2523 along the length of the central portion of the bone growth device 2500 is changed.

[0281] Figure 26A is a front view of a bone growth device 2600 and Figure 26B is a top view of a bone growth device 2600 according to one embodiment. The bone growth device 2600 may be designed to facilitate grow th of new bone between two bone segments. The bone growth device 2600 may include a first bone growth device end 2645 and a second bone growth device end 2650. The first bone growth device end 2645 may include one or more first end fixation holes 2613. The first end fixation holes 2613 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin. configured to secure the first bone growth device end 2645 to a first bone segment. The second bone growth device end 2650 may include one or more second end fixation holes 2614. The second end fixation holes 2614 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the second bone growth device end 2650 to a second bone segment.

[0282] In one embodiment, the bone growth device 2600 may have a slot 2610 which may be generally along the axis of the bone growth device 2600 and may be generally longer than it is wide. The bone growth device 2600 may further include a bone segment transport element 2623 which may be configured to attach to a third bone segment (not shown) through the slot 2610. The bone segment transport element 2623 may be configured to be securely connected to the third bone segment (not show n) via one or more fastening devices (not shown), such as a screw or pin, which may be placed though one or more transport element fixation holes 2624.

[0283] Figure 28A is a section view of a bone growth device 2600 showing an alternate embodiment of a drive mechanism. Figure 28B is an end view of the bone growth device 2600 shown in Figure 28 A. In one embodiment, the bone growth device 2600 may include an actuator mechanism 2617. The actuator mechanism 2617 may include one or more permanent magnets (not shown) encased within a non-magnetic material 2618 such as PEEK, carbon fiber, polycarbonate, polyamide or other polymer. An external magnetic field generating device may generate a magnetic force on the magnets located within the actuator mechanism 2617 to produce a rotational force in either a clock-wise or counter- clock-wise direction. The actuator mechanism 2617 may be configured to include a noncircular shaft 2612. Alternately, a non-circular shaft 2612 may be configured to be a separate component securely connected to an actuator mechanism 2617. The actuator mechanism 2617 may further include a non-circular socket end 2670, such as a hex or square. The non-circular socket end 2670 may be configured to receive a mating tool (notshown) that may facilitate manual rotation of the actuator mechanism 2617 to adjust the location of the bone segment transport element 2623.

[0284] The bone growth device 2600 may include a plurality of body sections 2640 as shown in Figure 29A and Figure 29B. The body sections 2640 may be configured such that tw o or more body sections 2640 may be secured to each other and may form the central portion of the bone growth device 2600. The two or more body sections may include a recessed channel 2675. The recessed channel 2675 may facilitate a clean weld line, solder line or adhesive line to secure the two or more body sections 2640 to each other. Additionally, when the tw o or more body sections 2640 are secured to each other they may create a continuous internal thread 2660. The internal thread 2660 may be configured to mate with a threaded element 2615 such that any rotation of the actuator mechanism 2617 is translated to linear motion of the bone segment transport element 2623. The internal thread 2660 may be configured to mate with an external thread 2665 of a threaded element 2615 as shown in Figure 27A through Figure 27D. A threaded element 2615 may further include a non-circular hole 2627. A non-circular hole 2627 may be configured to be slidably connectable to a non-circular shaft 2612. The bone segment transport element 2623 may be configured to include an internal portion in wftich the threaded element 2615 may be rotatably captive such that, as the threaded element 2615 is rotated, the position of a bone segment transport element 2623 along the length of the central portion of the bone growth device 2600 is changed.

[0285] The bone growth device as described in the preceding figures is designed to facilitate new bone growth between a first bone segment and a second bone segment. This is achieved through incremental movement of one or more movable bone segments between the first and second bone segments, as described above in FIGS. 1A- 29B. As used herein, these movable bone segments may be referred to as a third bone segment, a fourth bone segment etc., or as a napkin ring. The drive systems as described in the below' description (i.e. 3002, 3402, 3802, 4202, 4502, 5802) may be utilized in the bone growth devices described above in FIGS. 1A-29B.

[0286] FIG. 30A is a perspective view of a bone growth device, according to some embodiments. FIG. 30B is a perspective view of the bone growth device with the outer shell removed (for illustration purposes), according to some embodiments. FIG. 30C is an exploded view- of the bone growth device, according to some embodiments. FIG. 30D is a side view of a portion of the bone growth device with a transparent outer shell,according to some embodiments. FIG. 30E is a side view of another portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0287] The bone growth device 3000 includes a first end piece 3010, a second end piece 3008, a drive system 3002, and a transport mechanism 3004, and an outer shell 3006. The first end piece 3010 is coupled to a first end of the outer shell 3006 and the second end piece 3008 is coupled to a second end of the outer shell 3006. The drive system 3002 is positioned within the outer shell 3006 and adjacent the first end piece 3010. In some embodiments, the first end piece 3010 and the second end piece 3008 may be formed integral with the outer shell 3006. The transport mechanism 3004 is positioned within the outer shell 3006 and adjacent the second end piece 3008. The drive system 3002 and the transport mechanism 3004 are positioned adjacent one another and mechanically coupled.

[0288] The drive system 3002 includes a control capsule 3014, a motor 3018 / 3020, and a gearbox 3028. According to some embodiments, 3020 may be an additional gearbox. The control capsule 3014 is electrically connected to the motor 3018. The motor 3018 is mechanically coupled to the gearbox 3028. According to some embodiments, the drive system includes additional components. The control capsule 3014 is positioned between the first end piece 3010 and an encoder 3016 which may form part of the motor. The control capsule 3014 may be coupled to each. The first end piece 3010 may seal the electrical components within the 3006 to prevent contamination. The encoder 3016 is positioned between the control capsule 3014 and the motor 3018. A bearing 3021, washer 3022, and key 3024 are coupled to the motor 3018 and extend from the motor 3018 in a distal direction. The key 3024 is coupled to a dynamic seal 3026 (e.g. coupler) which is positioned distally to the motor 3018. The dynamic seal 3026 is coupled to the gearbox 3028. The gearbox 3028 is positioned distally to the dynamic seal 3026. According to some embodiments, the drive system 3002 may be the same as the drive systems described in other figures (i.e. 3402, 3802, 4202, 4502, 5802).

[0289] The transport mechanism 3004 includes a shaft 3012, a nut 3038, and a tether 3032. According to some embodiments, the transport system includes further components. A proximal end of the shaft 3012 is coupled to the gearbox 3028. A bearing seal 3030 is coupled to the shaft 3012 and gearbox 3028 and prevents fluids or other contaminants from entering the gearbox 3028. A roller bearing 3036 (e.g. bushing) is coupled to the shaft 3012 near a proximal end of the shaft 3012. The second end piece 3008 is positioned adjacent the shaft 3012 and the roller bearing 3036. The nut 3038 is connected to the shaft 3012 and configured to move along a shaft 3012 in a proximal or distaldirection. This connection may be a threaded connection such that when the shaft rotates, the nut 3038 moves axially along the shaft. The tether is coupled with the nut 3038 such that when the nut 3038 moves, tether 3032 also moves. The tether 3032 is configured to be coupled to a locking plate 3034 such that movement of tether 3032 results in movement of the locking plate 3034. The locking plate 3034 is positioned outside of the outer shell 3006 and configured to be coupled to the moveable bone segment. Thus, movement of the tether results in movement of the bone segment.

[0290] The first end piece 3010 and second end piece 3008 are cylindrical in shape and have rounded ends which extend away from the outer shell 3006. In other embodiments, the first end piece 3010 and second end piece 3008 may have flat, pointed, or open ends. The first end piece 3010 and second end piece 3008 have second ends which are cylindrical in shape and smaller in diameter than the outer shell 3006. This allows part of the first end piece 3010 and second end piece 3008 to fit within the outer shell and help secure the parts together. The first end piece 3010 and second end piece 3008 may each include one or more fixation holes 3045. The fixation holes 3045 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin. configured to secure the bone growth device to a first bone segment and second bone segment respectively. Each of the one or more fixation holes 3045 of the first end piece 3010 or second end piece 3008 may be oriented orthogonal to the outer shells axis. In some embodiments, the one or more fixation holes are oriented orthogonal to one another.

[0291] The control capsule 3014 allows for the control of the drive system 3002 and therefore the transport mechanism 3004, and communication with external devices. Further, the control capsule 3014 provides power to the drive system 3002. According to some embodiments, the control capsule 3014 is the control capsule (i.e. 5614) as described in FIG. 56. The encoder 3016 may electrically couple with the control capsule 3014 and the motor 3018. The encoder 3016 counts the rotations of the motor shaft and may be used to determine how far the one or more bone segments have traveled. The motor 3018 receives power and commands from the control capsule 3014. In some embodiments, the motor 3018 is a brushless DC motor. The gearbox 3028 may receive a rotational output of the motor 3018 via the key 3024 and dynamic seal 3026. The dynamic seal 3026 prevents contaminants from passing between the gearbox 3028 and the motor 3018. In some embodiments, the gearbox 3028 may be a planetary gearbox. In some embodiments, the gearbox 3028 may include a ring gear.

[0292] The shaft 3012 is coupled to the gearbox 3028 such that the proximal end of the shaft positioned within a slot of the gearbox 3028. As the gearbox 3028 receives the rotational output of the motor, the slot rotates which in turn causes the shaft 3012 to rotate. The gearbox 3028 is configured to rotate the shaft 3012 in either a clockwise or counter-clockwise direction. As a result of the shaft 3012 rotation, the nut 3038 moves in either the proximal or distal direction.

[0293] The outer shell 3006 includes a first side-facing opening 3040 which is located near a proximal end of the outer shell 3006 and a second side-facing opening 3042 located near a distal end of the outer shell 3006. The openings are aligned in a straight line. The tether 3032 is comprised of a flexible material, such as for example, suture material, flexible metal wire, etc. The tether 3032 is looped through the first opening 3040 and the second opening 3042. The tether 3032 includes a first end and a second end. When in use, the first and second ends of the tether 3032 are threaded through the third bone segment 3003. The third bone segment 3003 is positioned on the outer shell 3006. The first and second end of the tether 3032 can then be further secured to the bone segment 3003. such as by use of the locking plate 3034. which may be mounted on the third bone segment 3003. Thus, as the nut 3038 moves along the shaft 3012, the tether 3032 moves with it and causes the third bone segment 3003 to move. For example, if the nut 3038 moves in the proximal direction this would result in the third bone segment 3003 and locking plate 3034 moving in the distal direction and vice versa. The bone growth device 3000 is designed to move the third bone segment 3003 in either the proximal or distal direction. The third bone segment 3003 need not be positioned between the first opening 3040 and the second opening 3042. Rather, it may be positioned anywhere along the bone growth device 3000 and then pulled along the bone growth device 3000 from the tension in the tether 3032 as the nut moves. The ability to place the one or more moveable bone segments anywhere along the bone growth device is one of the benefits of utilizing a bone growth device with a tether having free ends. As such, the bone growth devices described in FIGS. 34 A and 58 A may be utilized in this manner.

[0294] Using a flexible tether is beneficial as it takes advantage of the full extent of travel of the third bone segment 3003. For example, as the tether 3032 has free ends and is not fixed to a carriage, the free ends can easily be moved to the location of the third bone segment 3003, which may be located at any position along the bone growth device 3000. When setting the initial starting point of the third bone segment 3003. a surgeon need only move the free ends of the tether 3032 to the location of the third bone segment 3003 alongthe bone growth device 3000 and then fasten the tether 3032 to the third bone segment 3003. There is no need to activate the motor 3018 to position a carriage at the desired location. This reduces the amount of time it takes to secure the third bone segment 3003 and also reduces the number of steps required to achieve the nail starting position. Also, this allows the device to achieve a bone transport equal to the full travel of the nut 3038 along the shaft 3012.

[0295] FIG. 31A is a cross sectional view of the outer shell of FIG. 30B, according to some embodiments. FIG. 3 IB is another cross-sectional view of the outer shell of FIG. 30A, according to some embodiments.

[0296] In some embodiments, the outer shell 3006 has an outside diameter which is constant. The outer shell 3006 includes a first receiving portion 3108 located at the proximal end and a second receiving portion 31 16 located at the distal end. The outer shell 3006 may further include a first segment 3110, which extends from the first receiving portion 3108, and a second segment 3114, which extends from the second receiving portion 3116. The first segment 3110 and second segment 3114 are separated by an annular partition 3112. The annular partition 3112 includes an access port 3122 which allows communication between the two compartments formed by the first and second segments 3110, 3114. The outer shell 3006 further includes a groove 3124 located on an external surface of the outer shell 3006. The groove 3124 is elongate in shape and extends from the first opening 3040 to the second opening 3042.

[0297] The first receiving portion 31 8 is configured to receive a portion of the first end piece 3010. The second receiving portion 3116 is configured to receive a portion of the second end piece 3008. The first segment 3110 and the second segment 3114 may have a smaller internal diameter than the first receiving portion 3108 and the second receiving portion 3116. In other embodiments, the internal diameter of the outer shell 3006 is constant. The drive system 3002 is positioned within the first compartment in the first segment 3110. The transport mechanism 3004 is positioned within the second compartment in the second segment 3114. The proximal end of the shaft 3012 passes through the access port 3122 to interface with the gearbox 3028 in the first compartment within the first segment 3110.

[0298] The groove 3124 accommodates the tether 3032. This helps the tether 3032 to stay properly oriented between the first opening 3040 and the second opening 3042. The groove 3124 further reduces the amount of contact between the tether 3032 and thepatient. This helps to prevent the tether from being squeezed between the nail and the canal of the bone as the bone growth device 3000 operates.

[0299] FIG. 32A is a perspective view of the nut of FIG. 30B, according to some embodiments. The nut 3038 is shown coupled to the shaft 3012 and the tether 3032. FIG. 32B is a front facing view of the nut 3038, according to some embodiments. FIG. 32C is a right-side view of the nut 3038, according to some embodiments The nut 3038 is cylindrical in shape. The nut 3038 includes a front end 3202 and a back end (not shown) w hich mirrors the front end. An internally threaded aperture 3206 extends axially from the front end 3202 to the back end. The threaded aperture 3206 is configured to engage with the threads of the shaft 3012. A tether aperture 3204 is located adjacent to the threaded aperture 3206 and extends from the front end 3202 to the back end. The tether aperture 3204 receives and couples to the tether 3032. As the shaft 3012 rotates, the tether 3032 exerts a lateral force on the nut 3038 which prevents the nut 3038 from rotating with the shaft. As a result, the threaded aperture 3206 engages with the threads of the shaft 3012, which causes the nut 3038 to move axially along the shaft 3012. This in turn causes the tether 3032 to move along the shaft which results in the third bone segment 3003 attached to the tether 3032 to move along the outer shell 3006. According to some embodiments, the tether 3032 may be press fit w ithin the aperture 3204. According to some embodiments, an adhesive may be used to secure the nut 3038 to the tether 3032. According to some embodiments, the tether 3032 may be coupled with the nut 3038 via mechanical crimp, collet, or clamp. According to some embodiments, this may include a crimped ferrule. According to some embodiments, the tether 3032 may be molded into the nut 3038. According to some embodiments, the tether 3032 may be tied (e.g. looped around) the nut 3038.

[0300] FIG. 33A is a perspective view of the locking plate of FIG. 30B, according to some embodiments. As shown, the tether 3032 extends from the first opening 3040 along the groove 3124 toward the locking plate 3034. The tether extends through the movable bone segment (e.g. 3003 not shown) and through the locking plate 3034.

[0301] FIG. 33B is a top-down view of the locking plate, according to some embodiments. FIG. 33C is a bottom up view of the locking plate, according to some embodiments. FIG. 33D is a front side view of the locking plate, according to some embodiments. FIG. 33E is a right-side view of the locking plate, according to some embodiments. Axes (i.e. X. Y, Z) have been added to the figures to further define the locking plate 3034.

[0302] The locking plate 3034 generally resembles a rectangular prism with filleted edges. The locking plate 3034 includes a top surface 3302, a bottom surface 3326, a front surface 3310, a back surface 3308, a right side surface 3304, and a left side surface 3306. The left side surface 3306 and right side surface 3304 are oriented parallel to one another and aY-axis as shown. The back surface 3308 and the front surface 3310 are bowed inward such that the surfaces face away from each other. The back surface 3308 faces the Y+ direction while the front surface 3310 faces the Y- direction. Further, the top surface 3302 and bottom surface 3326 are both bowed in a Z- direction and oriented parallel each other as shown in FIG. 33E.

[0303] The locking plate 3034 further includes a conical protrusion 3328, a pass-through aperture 3312. a first locking fastener 3322 (e.g. screw), a second locking fastener 3320 (e.g. screw), ancillary apertures 3324a-d, and a central recess 3318. The conical protrusion 3328 extends from the bottom surface 3326 in the Z- direction. There is a chamfer where the conical protrusion 3328 meets the bottom surface 3326. The conical protrusion 3328 is widest near the chamfer and tapers in the Z- direction to a flat top. The pass-through aperture 3312 extends through the conical protrusion 3328 and the top surface 3302. The pass-through aperture 3312 is positioned at the centroid of the top surface 3302 and extends along the Z axis. The first locking fastener 3322 is positioned between the pass-through aperture 3312 and the left side surface 3306. The second locking fastener 3320 is positioned between the pass-through aperture 3312 and the right side surface 3304. The first and second locking fasteners 3322, 3320 are oriented to be axially parallel with the pass-through aperture 3312. Further, the centroid of the first and second locking fasteners 3322, 3320 are aligned with the X axis. The first and second locking fasteners 3322. 3320 each include a head piece and a shank. The head piece extends from the top surface 3302 while the shank extends from the bottom surface 3326. The ancillary apertures 3324a, 3324b, 3324c, and 3324d extend through the top and bottom surface 3302, 3326 in the direction of the Z axis. The ancillary aperture 3324a is positioned between the back surface 3308, the left side surface 3306, and the first locking fastener 3322. The ancillary aperture 3324b is positioned between the back surface 3308. the right side surface 3304. and the second locking fastener 3320. The ancillary aperture 3324c is positioned between the front surface 3310, the left side surface 3306, and the first locking fastener 3322. The ancillary aperture 3324d is positioned between the front surface 3310, the right side surface 3304. and the second locking fastener 3320. The ancillary aperture 3324a and the ancillary aperture 3324b are aligned in the X direction. The ancillary aperture 3324a and the ancillaryaperture 3324c are aligned in the Y direction. The ancillary aperture 3324d and the ancillary aperture 3324c are aligned in the X direction. The ancillary aperture 3324d and the ancillary aperture 3324b are aligned in the Y direction. The central recess 3318 is located on the top surface 3302 and resembles a barbel shape. The central recess 3318 extends from the pass- through aperture 3312 along the X axis and expands to accommodate the first and second locking fasteners 3322, 3320. The barbel shaped ends of the central recess 3318 are concentric with the head piece of the first and second locking fasteners 3322. 3320. A first gap 3316 is provided between the central recess 3318 and the first nut 3322. A second gap 3314 is provided between the central recess 3318 and the second locking fastener 3320.

[0304] In use, the locking plate 3034 is designed to be secured to a movable bone segment. A hole may be drilled through the movable bone segment and the conical protrusion 3328 inserted. The bottom surface 3326 is designed to rest on an outer surface of a movable bone segment. The curved shape of the bottom surface 3326 is designed to accommodate the curvature of the moveable bone segment. The shanked portion of the first and second locking fasteners 3322, 3320 and the conical protrusion 3328 help to grip the bone and prevent slippage between the locking plate 3034 and the movable bone segment. In some embodiments, holes may be drilled to accommodate first and second locking fasteners 3322, 3320. The ancillary' apertures 3324a-d may serve as potential anchoring points for screws or other means to further secure the locking plate 3034 to the bone segment. The chamfered edges and smooth surfaces of the top. front, back, left, and right help to decrease friction between the locking plate 3034 and the patient as the segment is moved.

[0305] After the locking plate 3034 has been secured to the movable bone segment, the tether 3032 is inserted through the hole in the bone segment and through the pass-through aperture 3312 in the Z+ direction. The ends of the tether 3032 are then secured to the first and second locking fasteners 3322, 3320. The ends of the tether 3032 may be inserted into the first gap 3316 and the second gap 3314 and wrapped around the locking fasteners 3322, 3320. The first and second locking fasteners 3322, 3320 may then be tightened to secure the tether 3032 in place. After securing the tether, any excess tether remaining may' be cut off. The central recess 3318 is designed to accommodate the tether 3032 such that friction between the tether 3032 and external tissue is mitigated during bone transport.

[0306] In alternative embodiments, the ends of the tether 3032 may be secured to the movable bone segment using any suitable means, including tying the tether 3032 tothe movable bone segment or using one or more bone anchors, plates, staples, or other hardware.

[0307] FIG. 34A is a perspective view of a bone growth device, according to some embodiments. FIG. 34B is a perspective view of the bone grow th device with the outer shell removed, according to some embodiments. FIG. 34C is an exploded view of the bone growth device, according to some embodiments. FIG. 34D is a side view of a portion of the bone growth device with a transparent outer shell, according to some embodiments. FIG. 34E is a side view of another portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0308] In FIG. 34A, the bone growth device 3400 is shown attached to a third bone segment 3403a and a fourth bone segment 3403b. According to some embodiments, the bone segments are moved toward each other. According to some embodiments, the bone segments may move in the same direction.

[0309] The bone growth device 3400 includes a first end piece 3410, a second end piece 3408, a drive system 3402, and a transport mechanism 3404, and an outer shell 3406. The first end piece 3410 is coupled to a first end of the outer shell 3406 and the second end piece 3408 is coupled to a second end of the outer shell 3406. In some embodiments, the first end piece 3410 and the second end piece 3408 may be formed integral with the outer shell 3406. The drive system 3402 is positioned within the outer shell 3406 and adjacent the first end piece 3410. The transport mechanism 3404 is positioned within the outer shell 3406 and adjacent the second end piece 3008. The drive system 3402 and the transport mechanism 3404 are positioned adjacent one another and mechanically coupled.

[0310] The drive system 3402 includes a control capsule 3414, a motor 3418 / 3420, and a gearbox 3428. According to some embodiments, 3420 may be an additional gearbox. The control capsule 3414 is electrically connected to the motor 3018. The motor 3418 is mechanically coupled to the gearbox 3428. According to some embodiments, the drive system includes further components. The control capsule 3414 is positioned between the first end piece 3410 and an encoder 3416 which may form part of the motor. The control capsule 3414 may be coupled to each. The first end piece 3010 may seal the electrical components within the 3006 to prevent contamination. The encoder 3416 is positioned betw een the control capsule 3414 and the motor 3418. A bearing 3421, washer 3422. and key 3424 are coupled to the motor 3418 and extend from the motor 3418 in a distal direction. The key 3424 is coupled to a dynamic seal 3426 (e.g. coupler) is positioneddistally to the motor 3418. The dynamic seal 3426 is coupled to the gearbox 3428 which is positioned distally to the dynamic seal 3426. According to some embodiments, the drive system 3402 may be the same as the drive systems described in other figures (i.e. 3002, 3802, 4202, 4502, 5802).

[0311] The transport mechanism 3404 includes a shaft 3412, a first nut 3438a, a second nut 3438b, a first tether 3432a, and a second tether 3432b. According to some embodiments, the transport system includes additional components. A proximal end of the shaft 3412 is coupled to the gearbox 3428. A bearing seal 3430 is coupled to the shaft 3412 and gearbox 3428 and prevents fluids or other contaminants from entering the gearbox 3428. A roller bearing 3436 (e.g. bushing) is coupled to the shaft 3412 near a proximal end of the shaft 3412. The second end piece 3408 is positioned adjacent the shaft 3412 and the roller bearing 3436. The first and second nuts 3438a,b are connected to the shaft 3412 and configured to move along a the shaft in a proximal or distal direction. This connection may be a threaded connection such that when the shaft rotates, the nuts 3438a, b move. The first tether 3432a is coupled with the first nut 3438a such that when the nut 3438 moves, tether 3432 also moves. The second tether 3432b is coupled with the second nut 3438b such that when the second nut 3438b moves, the second tether 3432b also moves. The first tether 3432a is configured to be coupled to a first locking plate 3434a such that movement of first tether 3432a results in movement of the first locking plate 3434a. The second tether 3432b is configured to be coupled to a second locking plate 3434b such that movement of second tether 3432b results in movement of the second locking plate 3434b. The first and second locking plates 3434a, b are positioned outside of the outer shell 3406.

[0312] The first end piece 3410 and second end piece 3408 are cylindrical in shape and have rounded ends which extend away from the outer shell 3406. In other embodiments, the first end piece 3410 and second end piece 3408 may have flat, pointed, or open ends. The first end piece 3410 and second end piece 3408 have a second end which is cylindrical in shape and smaller in diameter than the outer shell 3406. This allows part of the first end piece 3410 and second end piece 3408 to fit within the outer shell and help secure the parts together. The first end piece 3410 and second end piece 3408 may each include one or more fixation holes 3445. The fixation holes 3445 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the bone growth device to a first bone segment and second bone segment respectively. Each of the one or more fixation holes 3445 of the first end piece3410 or second end piece 3408 may be oriented orthogonal to the outer shells axis. In some embodiments, the one or more fixation holes are oriented orthogonal to one another.

[0313] The control capsule 3414 allows for the control of the drive system 3402 and therefore the transport mechanism 3404, and communication with external devices. Further, the control capsule 3414 provides power to the drive system 3402. According to some embodiments, the control capsule 3414 is the control capsule (i.e. 5614) as described in FIG. 56. The encoder 3416 may electrically couple with the control capsule 3414 and the motor 3418. The encoder 3416 counts the rotations of the motor shaft and may be used to determine how far the one or more bone segments have traveled. The motor 3418 receives power and commands from the control capsule 3414. In some embodiments, the motor 3418 is a brushless DC motor. The gearbox 3428 may receive a rotational output of the motor 3418 via the key 3424 and dynamic seal 3426 (e.g., coupler). The dynamic seal 3426 prevents contaminants from passing between the gearbox 3428 and the motor 3418. In some embodiments, the gearbox 3428 may be a planetary gearbox. In some embodiments, the gearbox 3428 may include a ring gear.

[0314] The shaft 3412 is coupled to the gearbox 3428 such that the proximal end of the shaft positioned within a slot of the gearbox 3428. The shaft 3412 includes a first threaded portion 3443a and a second threaded portion 3443b which may be threaded opposite the first threaded portion 3443a. For example, the first threaded portion 3443a may be threaded clockwise while the second threaded portion 3443b may be threaded counter-clockwise, or vice versa. Further, he threaded portions 3443a,b may differ in terms of the pitch / lead of each portion such that the nuts 3438a, b travel at different speeds. Further, the threaded portions 344a,b may differ in overall length as the distance each nut 3438a, b travels will differ due to the different speeds of each nut 3438a, b. As the gearbox 3428 receives the rotational output of the motor, the slot rotates which in turn cause the shaft 3412 to rotate. The gearbox 3428 is configured to rotate the shaft 3412 in either a clockwise or counter-clockwise direction. As a result of the shaft 3412 rotation, the nuts 3438a, b move in either the proximal or distal direction. Further, because of the difference in thread direction of the first and second threaded portions 3443a, b. the first and second nuts 3438a,b may move in opposite directions, i.e. away from each other or toward each other.

[0315] The outer shell 3406 includes a first side-facing opening 3440a, a second side-facing opening 3440b, a third side-facing opening 3440c, and a fourth side-facing opening 3440b. These openings 3440a-d are oriented axially adjacent to the proximal anddistal directions. The first and second openings 3440a, b are located at opposite ends of the outer shell 3406 and positioned in alignment. The third and fourth openings 3440c, d are located at opposite ends of the outer shell 3406 and positioned in alignment. The first tether 3432a is looped through the first opening 3440a and the second opening 3440b. The second tether 3432b is looped through the third opening 3440c and the fourth opening 3440d.

[0316] The tethers 3432a, b are comprised of a flexible material. Each tether 3432a, b includes a first end and a second end. When in use. the third bone segment 3403a and fourth bone segment 3403b are positioned along the bone growth device. The first and second ends of the first tether 3432a are threaded through the third bone segment 3403a and the first locking plate 3434a. The ends of the tether can then be secured to the first third bone segment 3403a. The first and second ends of the second tether 3432b are threaded through the fourth bone segment 3403b and the second locking plate 3434b. The ends of the tether can then be secured to the fourth bone segment 3403b.

[0317] As the first nut 3438a moves along the shaft 3412, the first tether 3432 moves with it and causes the third bone segment 3403a to move. For example, if the first nut 3438a moves in the distal direction this would result in the third bone segment 3403a and first locking plate 3434a moving in the proximal direction and vice versa. Further, as the second nut 3438b moves in the proximal direction this would result in the fourth bone segment 3403b and first locking plate 3434b moving in the distal direction and vice versa. Thus, given the setup as shown in FIGS. 34A-E. rotation of the shaft 3412 would cause the third bone segment 3403a to move in the proximal direction and the fourth bone segment 3403b to move in the distal direction toward each other.

[0318] According to some embodiments, the bone segments may move in the same direction. For example, the third bone segment 3403 a and the fourth bone segment 3403b may be positioned adjacent one another and then moved along the bone growth device 3400 in the same direction. According to some embodiments, the bone segments may be spaced apart by a distance (e.g. 1 mm) and the rate of travel of one of the bone segments may be greater than the rate of travel of the other bone segment. According to some embodiments, this difference in the rate (i.e. distraction rate) of travel may be double. For example, the third bone segment 3403a and fourth bone segment 3403b may be positioned near an end of the bone grow th device. The third bone segment 3403a may be moved at a rate of 1mm per day while the fourth bone segment 3403b may move at a rate of 2mm per day in the same direction. Such a setup allows for osteogenesis to occur between the third bone segment 3403a and fourth bone segment 3403b at a rate of 1mm aday in addition to osteogenesis with either the first and second bone segments. In order to accommodate movement of the bone segments in the same direction, the first threaded portion 3443a and second threaded portion 3443b of the shaft 3412 may be threaded in the same direction. The threaded portions 3443a,b however may differ in terms of the pitch / lead such that the nuts 3438a, b travel at different speeds. Further, the threaded portions 344a,b may differ in overall length as the distance each nut travels will differ due to the different speeds of each nut. In some embodiments, the length of one of the threaded portions 3443a,b is double the length of the other threaded portion. Further, the nuts may be positioned to both start on the same side of the threaded portions 3443a, b. For example, in an embodiment where both bone segments move in the proximal direction, the fourth bone segment 3403b and third bone segment 3403a may be placed near the distal end of the bone growth device, while the second nut 3438b may be positioned at a proximal end of the second threaded portion 3443b. Thus, both nuts 3438a, b would have space to move along the shaft 3412 in the distal direction while the bone segments moved in the proximal direction.

[0319] The bone growth device 3400 is designed to move the third bone segment 3403a and fourth bone segment 3403b in either the proximal or distal direction with equal or differing speed and force. One of the benefits of utilizing two bone segments is that it essentially doubles growth rate of the bone.

[0320] FIG. 35A is a cross sectional view of the outer shell, according to some embodiments. FIG. 35B is another cross-sectional view of the outer shell, according to some embodiments.

[0321] In some embodiments, the outer shell 3406 has an outside diameter which is constant. The outer shell 3406 includes a first receiving portion 3508 located at the proximal end and a second receiving portion 3516 located at the distal end. The outer shell 3406 further includes a first segment 3510 which extends from the first receiving portion 3508, and a second segment 3514 which extends from the second receiving portion 3516. The first segment 3510 and second segment 3514 are separated by an annular partition 3512. The annular partition 3512 includes an access port 3522 which allows communication between the two compartments formed by the first and second segments 3510, 3514. The outer shell 3406 further includes a first groove 3524a and a second groove 3524b located on an external surface of the outer shell 3406. The grooves 3524a,b are elongate in shape. The first groove 3524a extends from the first opening 3440a to the second opening 3440b. The second groove 3524b extends from the third opening 3440c tothe fourth opening 3440d. According to some embodiments, the first and second grooves 3524a, 3524b are positioned on opposite sides of the outer shell 3406. According to some embodiments, the first and second grooves 3524a, 3524b are positioned such that they are less than 180 degrees apart.

[0322] The first receiving portion 3508 is configured to receive a portion of the first end piece 3410. The second receiving portion 3516 is configured to receive a portion of the second end piece 3408. The first segment 3510 and the second segment 3514 may have a smaller internal diameter than the first receiving portion 3508 and the second receiving portion 3516. In other embodiments, the internal diameter of the outer shell 3406 is constant. The drive system 3402 is positioned within the first compartment in the first segment 3510. The transport mechanism 3404 is positioned within the second compartment in the second segment 3514. The proximal end of the shaft 3412 passes through the access port 3522 to interface with the gearbox 3428 in the first compartment 3510.

[0323] The grooves 3524a, b are designed to accommodate the tethers 3432a, b.This helps the tethers 3432a.b to stay properly oriented as they span between the openings 3440a-d. The grooves 3524a, b further reduces the amount of contact between the tethers 3432a, b and the patient. This helps to prevent the tether from being squeezed between the nail and the canal of the bone as the bone grow th device 3400 operates.

[0324] FIG. 36A is a perspective view of the first nut and second locking plate of FIG. 34B, according to some embodiments. The first nut 3438a is shown coupled to the shaft 3412 and the first tether 3432a. For more detail on the first or second locking plate see the description of FIG. 33A-E.

[0325] FIG. 36B is a perspective view- of the nut, according to some embodiments. FIG. 36C is a front facing view of the nut, according to some embodiments. FIG. 36D is a side view of the nut, according to some embodiments. The first nut 3438a is cylindrical in shape. The first nut 3438a includes a front end 3602 and a back end (not shown). An internally threaded aperture 3606 extends axially from the front end 3602 to the back end. The threaded aperture 3606 is configured to engage with the threads of the shaft 3412. A tether aperture 3604 is located to the side of the threaded aperture 3606 and extends from the front end 3602 to the back end. The tether aperture 3604 receives and couples to the first tether 3432a. A tether channel 3605 extends axially from the front end 3602 to the back end. The tether channel 3605 is U-shaped and designed to allow the second tether 3432b to pass through the nut 3438 without interference. According to some embodiments, the tether channel 3605 is positioned opposite the tether aperture 3604.According to some embodiments, the tether channel 3605 is positioned less than 180 degrees apart from the tether aperture 3604. The second nut 3438b may be identical to the first nut 3438a. The second nut 3438b may have threads which are opposite the first nut 3438a. According to some embodiments, the position of the tether channel 3605 in the second nut 3438b is inverse to the position of the tether channel 3605 of the first nut 3438a.

[0326] As the shaft rotates, the tethers exerts a lateral force on the nuts, which prevents the nuts from rotating with the shaft. As a result, the threaded apertures or each nut engage with the threads of the shaft which causes each nut to move axially along the shaft. This in turn causes each tether to move along the shaft which results in each bone segment attached to each tether to move along the outer shell. According to some embodiments, the tether 3432 may be press fit within the aperture 3604. According to some embodiments, an adhesive may be used to secure the nut to the tether 3432. According to some embodiments, the tether 3432 may be coupled with the nut 3438a via mechanical crimp, collet, or clamp. According to some embodiments, this may include a crimped ferrule. According to some embodiments, the tether 3432 may be molded into the nut 3438a. According to some embodiments, the tether 3432 may be tied (e.g. looped around) the nut 3438a.

[0327] FIG. 37A is a perspective view of a nut that is used in a bone growth device which utilizes four tethers, according to some embodiments. When using four tethers, two tethers are coupled to each of two nuts and each of two mobile bone segments. This permits balancing of the load on the mobile bone segment. FIG. 37B is a front view of the nut, according to some embodiments. FIG. 37C is a side view of the nut, according to some embodiments. The nut 3738 is similar in design as the nut described in the previous embodiment, i.e. 3438a. The nut 3738 includes a front end 3702 and aback end (not shown) and athreaded aperture 3706. The nut 3738 further comprises two tether apertures 3704a,b and two tether channels 3705a, b.

[0328] FIG. 38 A is a perspective view of a bone grow th device, according to some embodiments. FIG. 38B is a perspective view of the bone growth device with the outer shell removed, according to some embodiments. FIG. 38C is an exploded view of the bone growth device, according to some embodiments. FIG. 38D is a side view of a portion of the bone growth device without an outer shell, according to some embodiments. FIG. 38E is a side view of another portion of the bone growth device without an outer shell, according to some embodiments.

[0329] The bone growth device 3800 includes a drive system 3802, a transport mechanism 3804, and an outer shell 3806. The drive system 3802 is positioned within the outer shell 3806. The transport mechanism 3804 is positioned mostly within the outer shell 3806. The drive system 3802 and the transport mechanism 3804 are positioned adjacent one another and mechanically coupled.

[0330] The drive system 3802 includes a control capsule 3814. a motor 3818, and a gearbox 3828. The control capsule 3814 is electrically connected to the motor 3818. The motor 3818 is mechanically coupled to the gearbox 3828. According to some embodiments, the drive system includes additional components. The control capsule 3814 is positioned between a first end piece 3816 and the motor 3818. The control capsule 3814 may be coupled to each. The first end piece 3816 may seal the electrical components within the 3806 to prevent contamination. The drive system 3802 may further include an encoder. According to some embodiments, the drive system 3802 may be the same as the drive systems described in other figures (i.e. 3002, 3402, 4202, 4502, 5802).

[0331] The transport mechanism 3804 includes a shaft 3812, a nut 3838, a tether 3832. a first pulley 3815a, a second pulley 3815b. and a carnage 3834. According to some embodiments, the transport system includes additional components. A proximal end of the shaft 3812 is coupled to the gearbox 3828. A first bushing 3830 and a seal 3837 are coupled to the shaft 3812 and gearbox 3828 to prevent fluids or other contaminants from entering the gearbox 3828. A second bushing 3836 is coupled to the shaft 3812 near a distal end of the shaft 3812 and serves as the second end piece. The first and second pulleys 3815a,b are coupled to the outer shell 3806. The nut 3838 is connected to the shaft 3812 and configured to move along a shaft 3812 in a proximal or distal direction. This connection may be a threaded connection such that when the shaft rotates, the nut 3838 moves. The tether is coupled with the nut 3838 such that when the nut 3838 moves, the tether 3832 also moves. The tether 3832 is configured to be coupled to the carriage 3834 such that movement of tether 3832 results in movement of the carriage 3834. The carriage 3834 is positioned outside of the outer shell 3806.

[0332] The control capsule 3814 allows from the control of the drive system 3802 and transport mechanism 3804, and communication with external devices. Further, the control capsule 3814 provides power to the drive system 3802. According to some embodiments, the control capsule 3814 is the control capsule (i.e. 5614) as described in FIG. 56. The motor 3818 receives power and commands from the control capsule 3814. In some embodiments, the motor 3818 is a brushless DC motor. The gearbox 3828 receives arotational output of the motor 3818. The gearbox and motor are interlocked so as to prevent contaminants from passing between the gearbox 3828 and the motor 3818. In some embodiments, the gearbox 3828 may be a planetary gearbox. In some embodiments, the gearbox 3828 may include a ring gear.

[0333] The shaft 3812 is coupled to the gearbox 3828 via a key. As the gearbox 3828 receives the rotational output of the motor, the key rotates which in turn cause the shaft 3812 to rotate. The gearbox 3828 is configured to rotate the shaft 3812 in either a clockwise or counter-clockwise direction. As a result of the shaft 3812 rotation, the nut 3838 moves in either the proximal or distal direction. The shaft 3812 includes a distal portion, a proximal portion, and a middle portion. The proximal and distal portions are smaller in diameter than the middle portion. The drive system 3802 causes the shaft 3812 to rotate. The first pulley 3815a is coupled adjacent to the proximal portion of the shaft and the second pulley 3815b is coupled adjacent to the distal portion of the shaft.

[0334] The outer shell 3806 includes a first opening 3840 which is located near a proximal end of the outer shell 3806 and a second opening 3842 located near a distal end of the outer shell 3806. The openings are aligned in a straight line. The tether 3832 is comprised of a flexible material. The tether 3832 is looped through the first opening 3840 and the second opening 3842, and around both pulleys 3815a, b. Further, the tether 3832 is fixed to the carriage 3834 and the nut 3838. The carriage 3834 is positioned between the first opening 3840 and the second opening 3842 and is configured to attach to a movable bone segment. Thus, as the nut 3838 moves along the shaft 3812, the tether 3832 moves with it and causes the carriage 3834 to move. For example, if the nut 3838 moves in the proximal direction this would result in the carriage 3834 moving in the distal direction and vice versa. The bone growth device 3800 is designed to move the bone segment in either the proximal or distal direction.

[0335] FIG. 38F is a close-up view of the first pulley, according to some embodiments. FIG. 38G is a close-up view of the second pulley, according to some embodiments. The first and second pulleys 3815a, b are coupled such that an axis of rotation of each pulley is orthogonal to the axis of rotation of the shaft. This allows for the tether to rotate each pulley as the nut 3838 moves along the shaft. Further, each pulley is angularly offset from the openings 3840,3842 in the outer shell 3806.

[0336] FIG. 39A is a cross-sectional view of the outer shell of FIG. 38B, according to some embodiments. FIG. 39B is another cross-sectional view of the outer shell, according to some embodiments.

[0337] The outer shell 3806 resembles an elongated hollow cylinder. A plurality of fixation holes 3839 traverse the outer shell 3806 and are located at a proximal and distal end of the 3806. The fixation holes 3839 are designed to accommodate one or more fastening devices (not shown), such as a screw or pin and to secure the bone growth device to a first bone segment and second bone segment respectively. The one or more fixation holes 3839 may be positioned orthogonal to the axis of the outer shell. In some embodiments, the one or more fixation holes are oriented parallel to one another. In some embodiments, the one or more fixation holes are oriented orthogonal to one another.

[0338] The outer shell 3006 further includes an indented portion which spans linearly between the first opening 3840 and the second opening 3842. This indented portion includes an inward protrusion 3925 on the internal surface of the outer shell 3806 and a groove 3924 on an external surface of the outer shell 3806. The groove 3924 and inward protrusion 3925 are elongate in shape and extend from the first opening 3840 to the second opening 3842. The groove 3924 accommodates the tether 3832 and the carriage 3834. This helps the tether 3832 and carriage 3834 to stay properly oriented between the first opening 3840 and the second opening 3842. The groove 3924 further reduces the amount of contact of both the carriage 3834 and tether 3832 with the patient. This helps to prevent the tether from being squeezed between the nail and the canal of the bone as the bone growth device 3800 operates.

[0339] FIG. 40A is a perspective view of the nut and carriage of FIG. 38B, according to some embodiments. The nut 3838 is shown coupled to the shaft 3812 and the tether 3832. FIG. 40B is a front facing view of the nut, according to some embodiments. FIG. 40C is a right side view of the nut, according to some embodiments. FIG. 40D is a bottom up view of the nut. according to some embodiments. FIG. 40E is a top down view of the nut, according to some embodiments. The nut 3838 is generally cylindrical in shape. The nut 3838 includes a front end 4002 and a back end (not shown). A threaded aperture 4006 extends axially from the front end 4002 to the back end. The threaded aperture 4006 is configured to engage with the threads of the shaft 4012. A channel 4005 extends axially from the front end 4002 to the back end. The channel 4005 is U shaped and designed to accommodate the inward protrusion 3925 of the outer shell 3806. A tether aperture 4004 is located to the side of the threaded aperture 4006 and extends from the front end 4002 to the back end. The tether aperture 4004 receives and couples to the tether 4032. As the shaft 4012 rotates, the tether 4032 exerts a lateral force on the trolley 4038 which prevents the nut 4038 from rotating with the shaft. The channel 4005 and inward protrusion 3925 furtherprevent rotation of the nut 4038. As a result, the threaded aperture 4206 engages with the threads of the shaft 3812 which cause the nut 3838 to move axially along the shaft 3812. This in turn causes the tether 3832 to move along the shaft which results in the carriage attached to the tether 3832 to move along the outer shell 3806. According to some embodiments, the tether 3832 may be press fit within the aperture 4004. According to some embodiments, an adhesive may be used to secure the nut 3838 to the tether 3832. According to some embodiments, the tether 3832 may be coupled with the nut 3838 via mechanical crimp, collet, or clamp. According to some embodiments, this may include a crimped ferrule. According to some embodiments, the tether 3832 may be molded into the nut 3838. According to some embodiments, the tether 3832 may be tied (e.g. looped around) the nut 3838.

[0340] FIG. 41 A is aright side view of the carriage 3834 of FIG. 38B, according to some embodiments. FIG. 41B is a front facing view of the carriage 3834, according to some embodiments. FIG. 41C is a top dow n view of the carriage 3834, according to some embodiments. FIG. 41D is a bottom up view of the carriage 3834, according to some embodiments. The carriage 3834 includes a lower portion 4102 and an upper portion 4104. The lower portion 4102 includes an elongated curvature which extends axially. The elongated curved portion extend upw ards at a front and back end to meet the upper portion 4104. A tether aperture 4106 extends axially through the lower portion 4102. The upper portion 4104 extends axially between the front and back ends and has a slight curvature about the tether aperture 4106. Generally speaking, the carriage may resemble a boat shape with a capped top. Both the upper and lower portions 4102,4104 include smooth surfaces which reduce friction as the carriage 3834 moves. The shape of the carriage 3834 allow s it to slide axially along the groove 3924 of the outer cylinder. In some embodiments, a curvature of the lower portion 4102 matches a curvature of the groove 3924. The carriage 3834 is configured to attach to the tether 3832. Accordingly, the tether 3832 (not showTi)is fixed to the aperture 4106 According to some embodiments, the tether 3832 may be press fit within the aperture 4106. According to some embodiments, an adhesive may be used to secure the carriage 3834 to the tether 3832. According to some embodiments, the tether 3832 may be coupled with the carriage 3834 via a mechanical crimp, collet, or clamp. According to some embodiments, this may include a crimped ferrule. According to some embodiments, the tether 3832 may be molded into the carriage 3834. According to some embodiments, the tether 3832 may be tied (e.g. looped around) the carriage 3834. The carriage 3834 is further configured to attach to the movable bone segment. Accordingly,the carriage 3834 may include features that permit attaching the movable bone segment to the carriage 3834 (not shown). According to some embodiments, a wire or screw is threaded into the carriage 3834 which attached to the moveable bone segment.

[0341] FIG. 42A is a perspective view of a bone growth device, according to some embodiments. FIG. 42B is a perspective view of the bone grow th device with the outer shell removed, according to some embodiments. FIG. 42C is an exploded view of the bone growth device, according to some embodiments. FIG. 42D is a side view of a portion of the bone grow th device with a transparent outer shell, according to some embodiments. FIG. 42E is a side view of another portion of the bone growth device with a transparent shell, according to some embodiments.

[0342] The bone growth device 4200 includes a first end piece 4210. a second end piece 4208, a drive system 4202, a transport mechanism 4204, and an outer shell 4206. The first end piece 4210 is coupled to a first end of the outer shell 4206 and the second end piece 4208 is coupled to a second end of the outer shell 4206. In some embodiments, the first end piece 4210 and the second end piece 4208 may be formed integral with the outer shell 4206. The drive system 4202 is positioned within the outer shell 4206 and adjacent the first end piece 4210. The transport mechanism 4204 is mostly positioned within the outer shell 4206 and positioned adjacent the second end piece 4208. The drive system 4202 and the transport mechanism 4204 are positioned adjacent one another and mechanically coupled.

[0343] The drive system 4202 includes a control capsule 4214, a motor 4218 / 4220, a magnetic coupler 4225, and a gearbox 4228. According to some embodiments, 4220 may be an additional gearbox. The control capsule 4214 is electrically connected to the motor 4218. The motor 4218 is mechanically coupled to the magnetic coupler 4225. The magnetic coupler 4225 is magnetically coupled to the gearbox 4228. Alternatively, instead of a magnetic coupler 4225, the motor 4218 is directly mechanically coupled to the gearbox 4228 as described in the embodiments above. According to some embodiments, the drive system includes additional components. The control capsule 4214 is positioned between the first end piece 4210 and an encoder 4216 which may form part of the motor. The control capsule 4214 may be coupled to each. The first end piece 4210 may seal the electrical components within the 4206 to prevent contamination. The encoder 4216 is positioned between the control capsule 4214 and the motor 4218. A bearing 4221, washer 4222. and key 4224 are coupled to the motor 4218 and extend from the motor 4218 in a distal direction. The key 4224 is coupled to the magnetic coupler 4225 which ispositioned distal to the motor 4218. Alternatively, the key 4224 is mechanically coupled to the gearbox 4228. The gearbox 4228 is positioned distal to the magnetic coupler 4225 and is spaced apart so that it does not touch the magnetic coupler 4225. The gearbox 4228 may include a second magnetic coupler which interacts with the first magnetic coupler. The magnetic coupler 4225 is magnetically coupled to the gearbox 4228 such that rotational energy from the magnetic coupler 4225 is transferred to the gearbox 4228 via a magnetic field. Alternatively, no magnetic coupler 4225 is used and the key 4224 is mechanically coupled to the gearbox 4228. According to some embodiments, the drive system 4202 may be the same as the drive systems described in other figures (i.e. 3002, 3402, 3802, 4502. 5802).

[0344] The transport mechanism 4204 includes a shaft 4212 and a carriage4238. According to some embodiments, the transport system includes additional components. A proximal end of the shaft 4212 is coupled to the gearbox 4228. A bearing seal 4230 is coupled to the shaft 4212 and gearbox 4228 and prevents fluids or other contaminants from entering the gearbox 4228. A roller bearing 4236 (e.g. bushing) is coupled to the shaft 4212 near a distal end of the shaft 4212. The second end piece 4208 is positioned adjacent the shaft 4212 and the roller bearing 4236. The carriage 4238 is connected to the shaft 4212 and configured to move along a shaft 4212 in a proximal or distal direction. The carriage 4238 contains two externally threaded nuts 4246a, b that can freely slide along the shaft 4212. The nuts 4246a, b can freely rotate relative to the rest of the carriage 4238. The nuts contain an internal flat surface that contacts a flat surface on the outer surface of the shaft 4212. When the shaft 4212 rotates, the flat surface on the shaft 4212 transfers rotational force to the nuts on the carriage, which then rotate relative to the carriage 4238. The outer shell 4206 of the nail has internal threads that engage with the external threads of the carriage nuts. Thus, when the shaft 4212 and the nuts rotate, the threaded engagement causes the carriage 4238 to move axially along the shaft 4212.

[0345] The first end piece 4210 and second end piece 4208 are cylindrical in shape and have rounded ends which extend away from the outer shell 4206. In other embodiments, the first end piece 3010 and second end piece 3008 may have flat, pointed, or open ends. The first end piece 4210 and second end piece 4208 have a second end which is cylindrical in shape and smaller in diameter than the outer shell 4206. This allows part of the first end piece 4210 and second end piece 4208 to fit within the outer shell and help secure the parts together. The first end piece 4210 and second end piece 4208 may each include one or more fixation holes 4245. The fixation holes 4245 may be configured toaccommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the bone growth device to a first bone segment and second bone segment respectively. Each of the one or more fixation holes 4245 of the first end piece 4210 or second end piece 4208 may be oriented orthogonal to the outer shells axis. In some embodiments, the one or more fixation holes are oriented orthogonal to one another.

[0346] The control capsule 4214 allows from the control of the drive system 4202 and transport mechanism 4204, and communication with external devices. Further, the control capsule 4214 provides power to the drive system 4202. According to some embodiments, the control capsule 4214 is the control capsule (i.e. 5614) as described in FIG. 56. The encoder 4216 may electrically couple with the control capsule 4214 and the motor 4218. The encoder 4216 counts the rotations of the motor shaft and may be used to determine how far the one or more bone segments have traveled. The motor 4218 receives power and commands from the control capsule 4214. In some embodiments, the motor 4218 is a brushless DC motor. The gearbox 4228 may receive a rotational output of the motor 4218 via the key 4224. In some embodiments, the gearbox 4228 may be a planetary gearbox. In some embodiments, the gearbox 4228 may include a ring gear system.

[0347] The shaft 4212 is coupled to the gearbox 4228 such that the proximal end of the shaft is positioned within a slot of the gearbox 4228. As the gearbox 4228 receives the rotational output of the motor, the slot rotates which in turn cause the shaft 4212 to rotate. The gearbox 4228 is configured to rotate the shaft 4212 in either a clockwise or counterclockwise direction. As a result of the shaft 4212 rotation, the carriage 4238 moves in either the proximal or distal direction. The carriage 4238 is configured to attach to a moveable bone segment and transport it. The bone growth device 4200 is designed to move the third bone segment 4203 in either the proximal or distal direction with equal speed and force. According to some embodiments, a second carriage containing a second set of externally threaded nuts may be placed at an opposite end of the shaft 4212 in order to transport a fourth bone segment. The second set of nuts may be threaded in the opposite direction as nuts 4246a, b thus allowing the second carriage to move in the opposite direction as carriage 4238.

[0348] FIG. 43A is a cross sectional view of the outer shell of FIG. 42B, according to some embodiments. FIG. 43B is another cross-sectional view of the outer shell, according to some embodiments.

[0349] In some embodiments, the outer shell 4206 has an outside diameter which is constant. The outer shell 4206 includes a first receiving portion 4308 located at aproximal end and a second receiving portion 4316 located at a distal end. The outer shell 4206 includes a first segment 4310 which extends from the first receiving portion 4308, a second segment 4314 which extends from the second receiving portion 4316, and a third segment 4311 which is positioned between the first and second segments 4310,4314. The second segment 4314 and the third segment 4311 are separated by an annular partition 4312. The first segment 4310 and third segment are separated by a solid partition 4313. The annular partition 4312 includes an access port 4322 which allows communication between the two compartments formed by the second and third segments 4314, 4311. The outer shell 4206 further includes a transport channel 4324 cutout. The cutout may be C- shaped. The transport channel 4324 extends axially between the annular partition 4312 and second receiving portion 4316. The transport channel 4324 accommodates the carriage 4238 as it moves along the shaft 4212. According to some embodiments, the outer shell 4206 does not include the solid partition 4313.

[0350] The first receiving portion 4308 is configured to receive a portion of the first end piece 4210. The second receiving portion 4316 is configured to receive a portion of the second end piece 4208. The first section 4310 and the second section 4314 may have a smaller internal diameter than the first receiving portion 4308 and the second receiving portion 4316. In other embodiments, the internal diameter of the outer shell 4206 is constant. The second segment 4314 of the outer shell 4206 is internally threaded (not shown). The drive system 4202 is positioned within the compartments formed by the first and third segments 4310,431 1. For example, the gearbox 4228 may be positioned in the third segment 4311 while the rest of the drive system 4202 may be positioned in the first segment 4310. The transport mechanism 4204 is positioned mostly within the second segment 4314. The proximal end of the shaft 4212 passes through the access port 4322 to interface with the gearbox 4228 and bearing seal 4230 in the third segment 4311.

[0351] FIG. 44A is a perspective view of the carriage of FIG. 42B, according to some embodiments. FIG. 44B is a right side view of the carriage without nuts, according to some embodiments. FIG. 44C is a front side view of the carriage without nuts, according to some embodiments. FIG. 44D is atop down view of the carriage without nuts, according to some embodiments. FIG. 44E is a bottom up view of the carriage without nuts, according to some embodiments. The carriage 4234 includes a trolley portion 4402, which slidably couples with the shaft 4212, and an attachment portion 4404, which couples to a moveable bone segment. The carriage 4234 also include two rotatable externally threaded nuts 4246a, b as described above. The attachment portion 4404 extends vertically from thetrolley portion 4402. The trolley portion 4402 is cylindrical in shape and includes a front surface and a back surface A trolley aperture 4406 extends through the trolley portion 4402 and accommodates the shaft 4212. The trolley aperture 4406 is circular in shape which allows the shaft 4212 to rotate within the aperture without rotating the trolley portion 4402. The attachment portion 4404 is arc shaped and concentric with the trolley portion 4402. The attachment portion 4404 is positioned adjacent to the trolley portion 4402 and extends axially from the front and back sides of the trolley portion 4402. One or more cutouts 4412 bisect the attachment portion 4404. The cutout 4412 is U-shaped and oriented orthogonal to the shaft aperture. The carriage 4438 is designed to couple to a moveable bone segment. The cutout 4412 may serve as an attachment point.

[0352] FIG. 44F is a front view of a nut of FIG. 44A, according to some embodiments. The nut 4246a is cylindrical in shape. An outer surface of the nut 4246a is threaded. The nut 4246a includes a nut aperture 4248 which extends axially. The shape of the aperture 4248 is circular with a flattened side. This resembles the cross sectional shape of the shaft 4212 which is designed to fit within the aperture. The shape of the aperture ensures that the nut 4246a rotates with the shaft 4212. The nut 4246b may be identical to the nut 4246a.

[0353] FIG. 44G is a perspective view of an alternative embodiment of the carriage of FIG. 44A, according to some embodiments. The carriage 4458 is substantially the same as the carriage described in FIGS. 44A-E and utilizes the described nuts. The carriage includes a trolley portion 4452, an attachment portion 4404, and nuts, e.g. 4246a, b. The attachment portion 4404 includes a cutout channel 4462. The trolley portion 4452 is semicylindrical in shape and includes an open channel positioned opposite the attachment portion 4404. This allows for the carriage 4458 to be clipped onto and removed from the shaft 4212 through the transport channel 4324.

[0354] FIG. 45A is a perspective view of a bone growth device, according to some embodiments. FIG. 45B is a perspective view of the bone grow th device with the outer shell removed, according to some embodiments. FIG. 45C is an exploded view of the bone growth device, according to some embodiments. FIG. 45D is a side view of a portion of the bone grow th device with a transparent outer shell, according to some embodiments. FIG. 45E is a side view of another portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0355] The bone growth device 4500 includes a first end piece 4510. a second end piece 4508, a drive system 4502, a transport mechanism 4504, and an outer shell 4506.The first end piece 4510 is coupled to a first end of the outer shell 4506 and the second end piece 4508 is coupled to a second end of the outer shell 4506. In some embodiments, the first end piece 4510 and the second end piece 4508 may be formed integral with the outer shell 4506. The drive system 4502 is positioned within the outer shell 4506 and adjacent the transport mechanism 4504. The transport mechanism 4504 is mostly positioned within the outer shell 4506 and surrounds the drive system 4502. The drive system 4502 and the transport mechanism 4504 are mechanically coupled.

[0356] The drive system 4502 includes a control capsule 4514, a motor 4518 / 4520, and a gearbox 4528. According to some embodiments, 4520 may be an additional gearbox. The control capsule 4514 is electrically connected to the motor 4518. The motor 4518 is mechanically coupled to the gearbox 4528. According to some embodiments, the drive system includes additional components. The control capsule 4514 is positioned adjacent an encoder 4516 to which it may be coupled. The encoder 4516 is positioned between the control capsule 4514 and the motor 4518. The encoder may form part of the motor. The first end piece 4510 may seal the electrical components within the 4506 to prevent contamination A bearing 4521, washer 4522. and key 4524 are coupled to the motor 4518 and extend from the motor 4518 in a distal direction. The key 4524 is coupled to a dynamic seal 4526 (e.g. coupler) which is positioned distal to the motor 4518. The dynamic seal 4526 is coupled to the gearbox 4528 which is positioned distal to the dynamic seal 4526. According to some embodiments, the drive system 3002 may be the same as the drive systems described in other figures (i.e. 3002, 3402, 3802, 4202, 5802).

[0357] The transport mechanism 4504 includes a bevel drive 4552, a first pulley 4515a, a second pulley 4515b, a tensioner 4550, a tether 4532, a first carriage 4534a, and a second carriage 4534b. The bevel drive 4552 is positioned distal to the drive system 4502. The bevel drive 4552 is coupled to the gearbox 3428. The first pulley 4515a is coupled to the bevel drive 4552. A first pin 4551a couples the first pulley 4515a to the outer shell 4506. The tensioner 4550 and the second pulley 4515b are positioned proximal to the drive system 4502. The tensioner 4550 is coupled with the second pulley 4515b. A second pin 4551b couples the second pulley 4515b to the outer shell 4506. The tether 4532 is coupled with the first pulley 4515a and the second pulley 4515b. The first carriage 4534a and the second carriage 4534b are coupled to the tether 4532 and positioned on opposite sides of the outer shell 4506.

[0358] The first end piece 4510 and second end piece 4508 are cylindrical in shape and have rounded ends which extends away from the outer shell 4506. In otherembodiments, the first end piece 3010 and second end piece 3008 may have flat, pointed, or open ends. The first end piece 4510 and second end piece 4508 may be permanently fixed to the outer shell 4506. In some embodiments, the end pieces are removably attached to the outer shell 4506. The first end piece 4510 and second end piece 4508 may each include one or more fixation holes 4545. The fixation holes 4545 may be configured to accommodate one or more fastening devices (not shown), such as a screw or pin, configured to secure the bone growth device to a first bone segment and second bone segment respectively. Each of the one or more fixation holes 4545 of the first end piece 4510 or second end piece 4508 may be oriented orthogonal to the outer shells axis. In some embodiments, the one or more fixation holes are oriented orthogonal to one another.

[0359] The control capsule 4514 allows for the control of the drive system 4502 and transport mechanism 4504, and communication with external devices. Further, the control capsule 4514 provides power to the drive system 4502. According to some embodiments, the control capsule 4514 is the control capsule (i.e. 5614) as described in FIG. 56. The encoder 4516 may electrically couple with the control capsule 4514 and the motor 4518. The encoder 4516 counts the rotations of the motor shaft and may be used to determine how far the one or more bone segments have traveled. The motor 4518 receives power and commands from the control capsule 4514. In some embodiments, the motor 4518 is a brushless DC motor. The gearbox 4528 may receive a rotational output of the motor 4518 via the key 4524. The dynamic seal 4526 prevents contaminants from passing between the gearbox 3428 and the motor 3418. In some embodiments, the gearbox 4528 may be a planetary' gearbox. In some embodiments, the gearbox 3028 may include a ring gear system.

[0360] The bevel drive 4552 is coupled to the gearbox 4528 such that the proximal end of the bevel drive 4552 is positioned within a slot of the gearbox 4528. The bevel drive 4552 further includes a flanged portion which helps to prevent contaminants from entering the gearbox. A beveled portion of the bevel drive 4552 contacts a beveled portion of the first pulley 4515a. As the gearbox 3428 receives the rotational output of the motor, the slot rotates which in turn cause the bevel drive 4552 to rotate. The gearbox 3428 is configured to rotate the bevel drive 4552 in either a clockwise or counter-clockwise direction. As a result of the bevel drive 4552 rotation, the first pulley 4515a rotates, which in turn causes the tether 4532 to move and the second pulley 4515b to rotate. As the tether 4532 moves, the carriages 4534a, b move. The carriages 4534a, b are configured to attach to moveable bone segments. Thus movement of the carriages 4534a, b results in movement ofthe bone segments. The bone growth device 4500 is designed to move the bone segments in either the proximal or distal direction with equal speed and force.

[0361] The outer shell 4506 includes a first opening 4540a, a second opening 4540b, a third opening 4540c, and a fourth opening 4540b. These openings 4540a-d are oriented axially adjacent to the proximal and distal directions. The first and second openings 4540a, b are located near opposite ends of the outer shell 4506 and positioned in alignment. The third and fourth openings 4540c.d are located near opposite ends of the outer shell 4506 and positioned in alignment. The tether 4532 is looped through each of the openings and around each of the pulleys 4515a, b. The tether 4532 is comprised of a flexible material. The tensioner 4550 ensures that the tether 4532 has adequate tension by exerting a force on the second pulley 4515b in the proximal direction. The tensioner includes a compressed spring, piston, or other actuation mechanism to exert the force on the second pulley 4515b.

[0362] FIG. 46A is a cross sectional view of the outer shell, according to some embodiments. FIG. 46B is another cross-sectional view of the outer shell, according to some embodiments.

[0363] In some embodiments, the outer shell 4506 has an outside diameter which is generally constant. The outer shell 4506 may be coupled to the first end piece 4510 located near the distal end and second end piece 4508 located near the proximal end. The outer shell 4506 further includes a first compartment 4610 positioned adjacent the first end piece 4510, and a second compartment 4614 positioned adjacent the second end piece 4508. The first compartment 4610 and second compartment 4614 are separated by a partition 4612. The drive system 4502, bevel drive 4552, and first pulley 4515a are positioned within the first compartment 4610. The tensioner 4550 and second pulley 4515b are positioned within the second compartment 4614.

[0364] The outer shell 4506 further includes a first groove 4624a and a second groove 4624b located on an external surface of the outer shell 4506. The grooves 4624a, b are elongate in shape. The first groove 4624a extends from the first opening 4540a to the second opening 4540b. The second groove 4624b extends from the third opening 4540c to the fourth opening 4540d.The grooves 4624a,b are designed to accommodate the tethers 4532a, b and the carriages 4534a, b. This helps the tethers 4532a, b to stay properly oriented as they span between the openings 4540a-d. The grooves 4524a, b further reduces the amount of contact of the tethers 4532a, b and carriages 4534a,b with the patient. This helpsto prevent the tether from being squeezed between the nail and the canal of the bone as the bone growth device 4500 operates.

[0365] FIG. 47A is a right side view of the carriage of FIG. 45B, according to some embodiments. FIG. 47B is a front side view of the carriage, according to some embodiments. FIG. 47C is a top down view of the carriage, according to some embodiments. FIG. 47D is a bottom up view of the carriage, according to some embodiments.

[0366] The carriage 4534 (e.g. 4534a,b) includes a base portion 4702, a top portion 4704, a front surface 4710, a back surface (not shown), a tether aperture 4712, a top surface, a first cutout 4706, and a second cutout 4708. The base portion 4702 is cylindrical in shape and extends between the front surface 4710 and back surface. The tether aperture 4712 extends axially from the front surface 4710 to the back surface through the base portion 4702. The top portion 4704 extends vertically from the base portion 4702 and tapers to the top surface 4714. The top portion 4704 further includes a right side surface and a left side surface (not shown) which are parallel to the tether aperture 4712. The top portion 4704 has an arc shape which extends along the base portion 4702. The first and second cutouts 4706,4708 are positioned on the top portion 4704 and are orthogonal to the tether aperture 4712. The first and second cutouts 4706,4708 extend between the right side surface and left side surface. The first and second cutouts 4706,4708 are semi-circular in shape. The carriage 4534 is designed to attach to a moveable bone segment. The first and second cutouts 4706,4708 act as attachment points and may be utilized as clips. For example, a wire (e.g. Kirschner wire) may be inserted into the bone segment and axially aligned to pass through the first and second cutouts 4706 / 4708 which secures the bone segment to the carriage 4534. According to some embodiments, the tether 4532 may be press fit within the tether aperture 4712. According to some embodiments, an adhesive may be used to secure the carriage 4534 to the tether 4532. According to some embodiments, the tether 4532 may be coupled with the carriage 4534 via a mechanical crimp, collet, or clamp. According to some embodiments, this may include a crimped ferrule. According to some embodiments, the tether 4532 may be molded into the carriage 4534. According to some embodiments, the tether 4532 may be tied (e.g. looped around) the carriage 4534.

[0367] FIG. 48 is a perspective view of a patient pad 4802 wrapped around a patient's leg and interfacing with a bone growth device 4800, according to some embodiments. The patient pad 4802 is a charging and communication device which interacts with the bone growth device 4800 (e.g. devices of FIGS. 1-29A, 3000, 3400, 3800,4200, 4500, 5700, 5800as described herein). The patient pad 4802 is configured to identify and connect with such devices in order to begin a therapy session where the bone growth device 4800 is activated and bone transport is conducted. The patient pad 4802 establishes a connection with the bone growth device 4800 that allows for the transfer of power to the bone grow th device 4800 and the transfer of data between the bone growth device 4800 and patient pad 4802. The patient pad 4802 can further indicate activity status of the device and therapy progress.

[0368] FIG. 49A is a front side view of the patient pad, according to some embodiments. The patient pad 4802 is generally rectangular in shape and made of a flexible material which allows the pad to conform to a patient’s anatomy. The patient pad 4802 includes a control interface 4904 positioned centrally on a front side. The control interface 4904 is surrounded by a plurality of LED lights 4905 which may indicate device activity such as presence and alignment of the bone growth device, status of the bone growth device, and therapy session progress. In some embodiments, the control interface 4904 indicates the device activity. FIG. 49B is a perspective view of the patient pad with part of the cover material removed, according to some embodiments. As shown, the control interface 4904 includes a display 4920, a battery 4922, and a circuit board 4918. Positioned to either side of the control interface 4904 are transformer coils 4906a, b w hich are electrically connected to the control interface 4904. FIG. 49C is a back side view of the patient pad. according to some embodiments. As shown, the back of the patient pad 4802 includes patches 4924 w hich encapsulate the coils 4906a,b. The material of the patient pad 4802 is soft in order to promote the comfort of the patient.

[0369] The coils 4906a, b wirelessly charge the bone growth device that is implanted in the patient via an air core transformer arrangement that is magnetic resonant coupled. According to some embodiments, the bone growth device is charged through magnetic induction. The transformer coils 4906a,b further wirelessly communicate with the bone growth device. For example, during a therapy session the transformer coils 4906a, b would be maintained in close proximity to the bone growth device 4800 to allow optimal energy transfer and communication. This may be achieved by positioning the patient pad 4802 against the skin or thin clothing of the patient. Further, the patient pad 4802 may be positioned so that it is oriented in proper alignment with the bone grow th device 4800 to optimize the charging.

[0370] The control interface 4904 may provide audible or tactile indicators to the patient. These indications may include a connectivity indicator, a pad status indicatorsuch as on / off or charging, a pad batery level indicator, a bone growth device charging progress indicator, and / or an error indicator. Further, an optional user interface application may offer therapy progress details and visualizations. In some embodiments, the application may include detailed information on the indicators presented on the control interface 4904. This may include detailed error descriptions and troubleshooting guidance.

[0371] In use, the patient pad 4802 is placed on a portion of a patient’s body which contains the bone growth nail. In some embodiments the patient pad 4802 is wrapped around the portion of the patient’s body. The patient pad 4802 is activated via the control interface 4904 or a user device which is in communication with the patient pad 4802. Next, the control interface 4904 then indicates that connection has been made with the bone growth device 4800. A user may then confirm a therapy protocol when connection between devices is established. The patient pad 4802 then supplies power to the transformer coils 4906a, b which charge receiver coil in the control capsule (i.e. 5614). Once the control capsule is charged sufficiently, bone transport may begin.

[0372] As the patient pad 4802 is activated and power transfer begins, data communication between both devices is activated. This data transfer allows for the patient pad 4802 to indicate activity status and therapy progress. Data exchange between both devices may be interleaved in time with power transfer. Further power transfer to the control capsule may be optimally implemented at a high duty cycle, whereas data communication may be accomplished at lower duty cycle. Charging may be limited by proximity distance between the patient pad 4802 and the bone growth device 4800 and any atenuating materials may extend the charging duration.

[0373] FIG. 49D is a perspective view of the patient pad coupled with an atachment band, according to some embodiments. The atachment band 4908 helps to secure the patient pad 4802 to the patient. The atachment band 4908 may be adjustable to accommodate patient size. In some embodiments, the patient pad 4802 may include Velcro. The atachment band 4908 allows for the patient pad 4802 to be atached when in a vertical orientation.

[0374] FIG. 49E is a perspective view of a limb cradle, according to some embodiments. A limb cradle 4910 includes a contoured surface which is designed to hold the patient pad 4802 and also cradle a limb of a patient. The contoured surface includes one or more adhesive patches 4912 which help to secure the patient pad 4802 in place. The contoured surface also includes a cutout 4914 which accommodates the control interface 4904 of the patient pad 4802. FIG. 49F is a top down view of the patient pad atached tothe limb cradle, according to some embodiments. As shown, the patient pad 4802 is positioned face down such that the control interface 4904 is positioned within the cutout 4914. According to some embodiments, the limb cradle 4910 may further be configured to charge the patient pad 4802. In some embodiments, this may be done through wireless induction charging or through an air core transformer arrangement.

[0375] In use, the patient pad 4802 is attached to the limb cradle 4910. A patient then rests a limb which contains a bone growth device on the limb cradle 4910 and patient pad 4802 before beginning a bone grow th therapy session. The limb cradle 4910 helps to hold the patient’s limb still during the therapy session while also providing comfort.

[0376] FIGS. 50 A is an illustration of a patient using a patient pad, according to some embodiments. FIG. 50B is an illustration of a patient using a patient pad with a limb cradle, according to some embodiments. FIGS. 50C is an illustration of a patient using a patient pad with an attachment band, according to some embodiments.

[0377] FIG. 51A and FIG. 5 IB are schematic diagrams of a bone growth system 5100. according to some embodiments. The bone growth system 5100 includes a patient pad 5104 which is in communication with a receiver 5102 of a bone growth device (e.g. part of control capsule 5614), and an application 5106 run on a user device. Communication and information flow between the patient pad 5104 and receiver 5102 is dynamic and goes both ways. The patient pad 5104 includes a controller, a transmitter, a receiver, a charger, a battery, and a voltage regulator. According to some embodiments, the controller may include one or more CPU or processor boards, computer displays, touch screens and interface hardware. The transmitter is configured to communicate via one or more forms of wireless communication including but not limited to radio frequency (RF), Bluetooth, Wi-Fi, cellular, near field communication (NFC), microwave, near-field magnetic induction (NFMI) communication, and / or infrared. The application 5106 on the user device dynamically communicates with the patient pad 5104. In various embodiments, the application 5106 may be run on a laptop, computer or mobile device such as a tablet or mobile phone. In some embodiments, the application 5106 may be partially integrated into the patient pad 5104.

[0378] The patient pad 5104 provides power to the bone growth device and controls the therapy. The bone growth system 5100 allows for a patient specific therapy to be prescribed and applied to a patient. For example, a clinician may input the therapy protocol into the application 5106. The therapy protocol includes parameters which relates to the operation of the bone growth device and may include a particular distance to bemoved, duration of session, or rate of movement of one or more bone segments. The therapy may also relate to the frequency of therapy sessions or the total amount of therapy sessions. The therapy may be performed intermittently and applied daily to the patient. In some embodiments, the patient may be trained on the operation of the patient pad 5104 and application 5106 such that they may start and stop the therapy sessions independently. While the battery may be charged intermittently, it can provide several days’ worth of therapy on a single charge. Further, the control processor of the patient pad 5104 may store the therapy parameters and be capable of functioning autonomously to operate the bone growth device as prescribed. The rate of bone movement in bone grow th device is typically around 1 mm per day. In some embodiments which utilize two movable bone segments, this rate is typically doubled to 2 mm per day (i.e., each movable bone segment moves about 1 mm per day).

[0379] Data transferred from the patient pad 5104 to the receiver 5102 may include medical data such as the therapy protocol and therapy session information. Data transferred from the receiver 5102 to the patient pad 5104 may include session data including the length of travel of the bone segment, speed, length of time of each session, force, torque, errors encountered, date / time of each session, and temperature. The patient pad 5104 stores the received data and wirelessly communicates (e.g. via Bluetooth) this data to the application 5106. The data is then displayed in the application and can be accessed by the patient or an authorized user such as a clinician or technician. The application may graphically represent the received data in a variety of formats including charts, graphs, and progress indicators. The application may further provide tutorials indicators including patient milestones, overall therapy progress, therapy logging, sync status, patient diary, error messaging and resolution, and device health. The user interface / displays provided on the patient pad and an application on a handheld device (e.g., smart phone) are depicted in FIGS. 52A-52B and FIGS. 53A-D.

[0380] FIG. 52A is an illustration of a patient interacting with a user device, according to some embodiments. The patient has a patient pad 4802 positioned on the patient’s left thigh which is communicating with a bone nail device in the patient’s femur. The control interface 4904 displays data related to the bone growth nail and therapy session. The user is controlling the patient pad 4802 and bone growth nail via the user device 5106 (e.g. application running on the user device). A graphical user interface 5202 displays data related to the therapy session, patient pad 4802, bone growth device, and related patient health information and therapy scheduling. FIG. 52B is an illustration of a notification onthe control interface and user device, according to some embodiments. A device alert notification is shown on the control interface 4904 and the corresponding alert is shown within the graphical user interface 5202 of the application / user device 5106.

[0381] FIG. 53A is an example of the user interface of the bone growth system, according to some embodiments. FIG. 53B is another example of the user interface of the bone growth system, according to some embodiments. FIG. 53C is another example of the user interface of the bone growth system, according to some embodiments. FIG. 53D is another example of the user interface of the bone growth system, according to some embodiments. As shown, the user interface of the application allows the patient to track bone therapy progress and keep a dynamic schedule of upcoming and past bone therapy sessions. The user interface may include indications of bone growth progress broken down per session, per day, per week, per month, overall, etc. The user interface may display the bone growth graphically over time. The user interface may provide reminders to the patient. The user interface may provide information to the client such as information on the therapy, information on symptoms they may be experiencing, and explanations to frequently asked questions. The user interface may provide the ability- to track and record symptoms and mood and report them to the patient’s physician. The user interface may provide the user the abil i ty to log sessions and calendar upcoming sessions.

[0382] FIG. 54 is a circuit diagram of a drive system of the bone growth device, according to some embodiments. An internal receiving receiver coil collects energy from an external transmitting transformer coil (i.e. transmitter of the patient pad) which is rectified in diodes (D1-D4) and stored in bulk capacitance (C). Energy may be stored as one or more high-density supercapacitors in parallel, or alternatively, in a battery with a high-density lithium chemistry. The stored energy, or voltage, may be regulated to lower voltage and may be distributed to control circuits and motor drive circuits as shown. The control circuits may be integrated into a microcontroller with internal memory and an analog-to-digital converter.

[0383] The motor drive circuits may operate at higher available voltage and may require most of the available stored energy. Digital signals to a driver control the power transistors (six shown in H-Bridge configuration) that operate the motor. The motor may be a three-phase brushless DC motor with three hall sensors. According to some embodiments, a brushed DC motor, a stepper, or another AC motor alternative could be used. The three hall sensors provide rotational position and velocity signals back to controlcircuits. In some embodiments, this could be implemented with alternative sensors or sensor-less (back-EMF) motor control.

[0384] FIGS. 55A-H depict steps in a surgical process for installing a bone growth device (e.g. 3000 or 3400), according to some embodiments. In step one, as shown in FIG. 55A, the bone growth device 5500, or nail, is prepared for placement within a reamed intramedullary canal 5504 of a bone 5502. As shown, the free ends of the tethers 5506 are folded and positioned away from the bone 5504 prior to insertion. The bone growth device 5500 is axially aligned with the reamed canal 5504. In some embodiments, the free ends of the tethers 5506 may be placed tow ard the bone 5502 prior to insertion. In some embodiments, the free ends may be placed into the bone 5502 before insertion of the bone growth device 5500. In step two, as shown in FIGS. 55B-C, the bone growth device 5500 is inserted into the reamed canal 5504 of the bone 5502. FIG. 55C shows the orientation and configuration of the tethers 5506 as the bone growth device 5500 is fully inserted into the reamed canal 5504. As shown, this is done prior to resection of the bone 5502. However, in some embodiments, resection may occur before the bone growth device 5500 is inserted. In step three, as shown in FIG. 55D, the bone 5502 is resected and any unwanted portions of the bone are removed. During this step, a napkin ring (e.g. intercalary resection) 5503 and / or 5507 is cut from a section of bone and transverse holes 5508 are drilled into the napkin ring 5503 which extend orthogonal to the bone growth device 5500. In some embodiments, this step may occur before step two. In some embodiments, a second napkin ring 5507 is also cut. In step four, as shown in FIG. 55E, the free ends of the tethers 5506 are routed through the traverse holes 5508 in the napkin ring. In some embodiments, this step may occur before step two. In step five, as shown in FIG. 55F, the free ends of the tether 5506 are separated and prepared for tensioning. Ideally, the nail 5500 is positioned such that the napkin ring 5503 or 5507 is located adjacent the first or second bone segments 5501, 5505. If there is a second napkin ring 5507 (e.g. see 3400) the nail 5500 may be positioned such that each napkin ring is located at either end of the bone growth device 5500 and adjacent the first and second bone segments 5501.5505. In step six, the proximal and distal ends of the nail 5500 are secured to the bone segments 5501,5505 using one or more bone screws (not shown). This step may also be performed earlier in the procedure. In step seven, as shown in FIG. 55G, locking plates 5510 (e.g. 3034) are installed onto the napkin ring. FIG. 55H depicts the second napkin ring and second locking plates 5512. In step eight, as shown in FIG. 551, the free ends of the tethers 5506 are tensioned and secured to the locking plates 5510 and / or 5512. The free ends may be wrapped around the lockoutnuts of the locking plates 5510 / 5512. The locking fasteners may then be tightened to secure the free ends of the tether 5506 in place. According to some embodiments, any excess tether 5506 may be removed. Alternatively, the excess tether 5506 may be retained to be used in the event of a revision of resetting of the nail 5500.

[0385] FIG. 56 is a perspective view of a control capsule 5614, according to some embodiments. The control capsule 5614 includes a controller which allows for the control of the motor as described herein. The control capsule 5614 further includes a transmitter and a receiver which allow for communication with an external device (e.g. patient pad). The controller, transmitter, and receiver are part of a control and communication component 5620 of the control capsule 5614. The transmitter and receiver are configured to communicate via one or more forms of wireless communication including but not limited to radio frequency (RF), radio frequency identification (RFID), Bluetooth, Wi-Fi, cellular, near field communication (NFC), microwave, near-field magnetic induction (NFMI) communication, and / or infrared. The controller, transmitter, and receiver may be positioned on a flex board 5506. The flex board 5616 may be coupled to the motor and / or gearbox. The control capsule 5614 may further include one or more capacitors 5618 arranged on the flex board. The one or more capacitors 5618 are electrically connected to one or more receiver coils 5622 which surround the capacitors 5618, flex-board 5616, and controller 5620. Each receiver coil 5622 may include a plurality of coils which are configured to activate via the air core transformer arrangement. The air core transformer arrangement may be magnetic resonance coupled. In some embodiments, the coils may be activated via magnetic induction. Once activated the one or more receiver coils 5622 charge the one or more capacitors 5618. In some embodiments, the one or more receiver coils 5622 are wrapped in a proximal / distal direction (e.g. FIG. 58A-B). In some embodiments, the control capsule 5614 includes three receiver coils. The flex board includes circuitry such that the controller may communicate with the other components of the control capsule 5 14 (i.e. capacitors, receiver coils, transmitter) and the drive system of the bone growth device. In some embodiments, the controller is a microcontroller. The flex board is connected to the motor and conveys power and instructions from the other components of the control capsule 5614. As shown, part of the receiver coils 5622 have been removed for illustrative purposes.

[0386] FIG. 57 is a perspective view of a bone growth device, according to some embodiments. The bone growth device 5700 is substantially similar to the bonegrowth device of FIG. 30A (i.e. 3000). However, in this embodiment, the tether is attached to a carriage (e.g., 4534, see FIG. 47A) instead of a locking plate.

[0387] FIG. 58A is a perspective view of a bone growth device, according to some embodiments. FIG. 58B is a perspective view of the bone grow th device with the outer shell removed, according to some embodiments. FIG. 58C is an exploded view of the bone growth device, according to some embodiments. FIG. 58D is a side view of a portion of the bone growth device with a transparent outer shell, according to some embodiments. FIG. 58E is a side view of another portion of the bone growth device with a transparent outer shell, according to some embodiments.

[0388] The bone growth device 5800 includes a drive system 5802, a transport mechanism 5804, and an outer shell 5806. The drive system 5802 is positioned within the outer shell 5806 and adjacent the transport mechanism 5804. The transport mechanism 5804 is mostly positioned within the outer shell 5806 and surrounds the drive system 5802. The drive system 5802 and the transport mechanism 5804 are mechanically coupled.

[0389] The drive system 5802 includes a control capsule 5814, a motor 5818, a gearbox 5828, and a planetary gear system 5827. The control capsule 5814 is electrically connected to the motor 5818. The motor 5818 is mechanically coupled to the gearbox 5828. The gearbox 5852 is mechanically connected to the planetary gear system 5827. According to some embodiments, the drive system includes additional components. According to some embodiment, the drive system includes an encoder. The control capsule 5814 is positioned adjacent the motor 5818 to which it may be coupled. A plug seal 581 is positioned proximal to the control capsule 5814. The plug seal 5816 may seal the electrical components within the 5806 to prevent contamination A bearing, washer, and key may be coupled to the motor 5818 and extend from the motor 5818 in a distal direction to mechanically couple to the gearbox 5828. The gearbox 5828 may additionally include a bearing, washer, and key which extend from in the distal direction to mechanically couple to the planetary gear system 5827. The planetary gear system 5827 may include a first stage5860. a second stage 5861, a third stage 5863, and a ring gear 5862. The first stage 5860 includes an adapter which couples to the gearbox 5828. The first stage 5860 also includes an elongated sun gear fixed to the adapter. The elongated sun gear extends axially in the distal direction and mechanically couples with the second stage 5861. The second stage 5861 includes a first carrier with a plurality' of planetary gears rotationally attached thereto. The elongated sun gear of the first stage 5860 contacts the planetary gears of second stage5861. The second stage 5861 also includes a second elongated sun gear attached to thecarrier and extending axially in the distal direction. The second sun gear mechanically couples with the third stage 5863. The third stage 5863 includes a second carrier with a second plurality of planetary gears rotationally attached thereto. These planetary gears interact with the second sun gear. The third stage 5863 further includes a second adapter extending in the distal direction. The second adapter couples the planetary gear system 5827 to the transport mechanism 5804. The ring gear 5862 surrounds the second stage 5861. and portions of the first stage 5860 and third stage 5863. The ring gear 5862 is fixed to the outer shell 5806 such that it does not move. A pin may be inserted through the outer shell 5806 and into a notch of the ring gear 5862 to hold it in place. The ring gear 5862 includes internal sprockets which interact with the planetary gears of the second and third stages 5861,5863. Thus, the rotational movement from the motor 5818 is passed to the gearbox 5828 and planetary gear system 5827 to reach the transport mechanism 5804. According to some embodiments, the drive system 5802 may be the same as the drive systems described in other figures (i.e. 3002, 3402, 3802, 4202, 4502).

[0390] The transport mechanism 5804 includes a first pulley 5815a, a second pulley 5815b, a tensioner 5850, a nut 5834, a shaft 5812. and a tether 5832. A proximal end of the shaft 5812 may be coupled to the planetary gear system 5827. For example, aportion of the shaft 5812 is inserted into a key portion of the third stage 5 63. A pin may be inserted through the shaft 5812 and third stage 5863 to lock the shaft 5812 in place. One or more ring seals 5837 are positioned on the shaft adjacent the third stage 5863. A first bushing 5830 is positioned on the shaft 5812 and distal to the one or more ring seals 5837. A second bushing is coupled to a distal end of the shaft 5812. The nut 5834 is rotatably coupled to the shaft 5812 and configured to move along the shaft 5812 in the proximal or distal direction. This connection may be a threaded connection such that when the shaft rotates, the nut 5812 moves axially along the shaft. The tether is coupled with the nut 5812 such that when the nut 5812 moves, tether 5832 also moves. The tether 5832 is coupled with the first pulley 5815a and the second pulley 5815b. The first pulley 5815a is positioned distal to the second bushing 5836 near a distal end of the outer shell 5806. The second pulley 5815b is positioned proximal to the plug 5816 and near a proximal end of the outer shell 5806. The first and second pulleys 5815a,b are oriented orthogonal to the axis of rotation of the shaft 5812. The second pulley 5815b is coupled to the tensioner 5850. One or more ring seals 5837 may be positioned on the tensioner 5850. Pins may be used to couple the first and second pulleys 5815a.b to the outer shell 5806. The tensioner 5850 and the second pulley 5815b are positioned proximal to the drive system 5802. Thus, movement of nut5838 causes the tether 5832 to move about the first and second pulleys 5815a, b and further cause them to rotate. The tether 5832 may be configured to be coupled directly to a movable bone segment (e.g. 3003). According to some embodiments, the tether 5832 may be coupled to a locking plate or locking screw (e.g. 3034, 6102) which is coupled to the moveable bone segment. Thus, movement of the nut 5838 results in movement of the bone segment. The bone growth device 5800 is designed to move the bone segment in either the proximal or distal direction with equal speed and force.

[0391] The control capsule 5814 allows for the control of the drive system 5802 and transport mechanism 5804, and communication with external devices. Further, the control capsule 5814 provides power to the drive system 5802. According to some embodiments, the control capsule 5814 is the control capsule (i.e. 5614) as described in FIG. 56. The control capsule 5814 and the motor 5818 are connected via circuitry and cables (e.g. flex board). The motor 5818 receives power and commands from the control capsule 5814. In some embodiments, the motor 5818 is a brushless DC motor. In some embodiments, the gearbox 5828 may be a planetary gearbox. In some embodiments, the gearbox 3028 may include a ring gear.

[0392] The outer shell 5806 includes a first opening 5840a, a second opening 5840b, a third opening 5840c, and a fourth opening 5840b. These openings 5840a-d are oriented axially adjacent to the proximal and distal directions. The first and second openings 5840a, b are located near opposite ends of the outer shell 5806 and positioned in alignment. The third and fourth openings 5840c, d are located near opposite ends of the outer shell 5806 and positioned in alignment. The tether 5832 is looped through each of the openings and around each of the pulleys 5815a, b. The tether 5832 is comprised of a flexible material. The tensioner 5850 ensures that the tether 5832 has adequate tension by exerting a force on the second pulley 5815b in the proximal direction. The tensioner includes a compressed spring, piston, or other actuation mechanism to exert the force on the second pulley 5815b.

[0393] FIG. 59A is a top down view of the outer shell, according to some embodiments. FIG. 59B is a bottom up view of the outer shell, according to some embodiments. FIG. 59C is a cross-sectional view of the outer shell, according to some embodiments. FIG. 59D is another cross-sectional view of the outer shell, according to some embodiments.

[0394] The outer shell 5806 resembles an elongated hollow cylinder. The outer shell 5806 includes a first segment 5910 and a second segment 5908. The first segment-SO-5910 is positioned proximal to the second segment 5908. In some embodiments, the second segment 5908 has a larger diameter than the first segment 5910. In some embodiments, the diameter of the first and second segments are equal such that the diameter of the outer shell 5806 is constant. A plurality of fixation holes 5845 traverse the outer shell 5806 and are located at a proximal and a distal end of the outer shell 5806. The fixation holes 5845 are designed to accommodate one or more fastening devices (not shown), such as a screw or pin and to secure the bone growth device to a first bone segment and second bone segment respectively. The one or more fixation holes 5845 may be positioned orthogonal to the axis of the outer shell. In some embodiments, the one or more fixation holes 5845 are oriented parallel to one another. In some embodiments, the one or more fixation holes are oriented orthogonal to one another. In some embodiments, the one or more fixation holes are laterally offset from one another.

[0395] In some embodiments, the first segment 5910 has a larger internal diameter than the second segment 5914. According to some embodiments, the internal diameter of each segment is equal such that the internal diameter of the outer shell 5806 is constant. A first compartment within the first segment 5910 is open at the proximal end of the outer shell 5806. A second compartment within the second segment 5914 is open to the first compartment. This allows for the internal components of the bone growth device 5800 (e.g. drive system and transport mechanism) to be loaded into the outer shell 5806. In other embodiments, the proximal end of the outer shell 5806 may be closed and have a flat, rounded, or pointed shape. The second compartment may be open at the distal end of the outer shell 5806. In other embodiments, the distal end of the outer shell 5806 may be closed and have a flat, rounded, or pointed shape. The internal diameter of the second compartment narrows near the distal end of the outer shell 5806. The shaft, 5812 nut, second bushing 5836, and first pulley 5815a are positioned in the second compartment. The second pulley 5815b is positioned in the narrow^ portion of the second compartment adjacent the first opening 5840a and third opening 5840c. The drive system 5802 and the rest of the transport mechanism 5804 is positioned in the first compartment.

[0396] The outer shell 5806 further includes a first groove 5924a and a second groove 5924b located on an external surface of the outer shell 5806. The grooves 5924a,b are elongate in shape. The first groove 5924a extends from the first opening 5840a toward the second opening 5840b. A cutout 5940 (e.g.. a slot) positioned on the second segment 5914 divides the first groove 5924a into two separate portions. The cutout 5940 is aligned with the first and second openings 5840a, b. The first portion of the first groove 5924a ispositioned on the first segment 5910. The second portion of the first groove 5924a is positioned between the cutout 5940 and first opening 5840a. In other words, the first groove 5924a, extending from the second opening 5840b transitions to the cutout 5940 upon reaching the second segment 5914, and then transitions back into the first groove 5924a before reaching the first opening 5840a. The portion of the first groove 5924a adjacent the first opening 5840a helps to add rigidity to the outer shell 5806. The second groove 5924b extends from the third opening 5840c to the fourth opening 5840d. The grooves 5924a.b are designed to accommodate the tethers 5832a, b. This helps the tether 5832a,b to stay properly oriented as they span between the openings 5840a-d. The grooves 5824a, b further reduces the amount of contact of the tether 5832a, b with the patient. This helps to prevent the tether from being squeezed between the nail and the canal of the bone as the bone growth device 5800 operates. The cutout 5940 accommodates the nut 5838 as it travels along the shaft 5812. The cutout 5940 further reduces the amount of contact of both the nut 5838 and tether 5832 with the patient.

[0397] A proximal end of the outer shell 5806 further includes key slot 5942. The key slot 5942 is rectangular in shape. The key slot 5942 is designed to assist in the insertion of the bone growth device 5800 into a canal of bone. For example, the key slot 5942 can interface with a surgical tool which allows the surgeon to push and / or twist the bone growth device 5800 into the bone.

[0398] FIG. 60A is a perspective view of the nut of FIG. 58 A, according to some embodiments. FIG. 60B is a front view of the nut, according to some embodiments. FIG. 60C is a side view of the nut, according to some embodiments. FIG. 60D is atop view of the nut, according to some embodiments.

[0399] The nut 5834 includes a nut portion 6002, which slidably couples with the shaft 5812, and a tether portion 6004, which couples to the tether 5832. The nut 5834 further includes a front surface 6010, a back surface (not shown), a threaded aperture 6006, a tether aperture 6007, and a cutout 6011. The nut portion 6002 is cylindrical in shape and extends between the front surface 6010 and back surface. The threaded aperture 6006 extends axially from the front surface 6010 to the back surface through the nut portion 6002. The threaded aperture 6006 engages with the shaft 5812 such rotation of the shaft 5812 results in movement of the nut 5834. The tether portion 6004 extends vertically from the nut portion 6002 and is rectangular in shape. The cutout 6011 bisects the tether portion 6004 into two separate portions. The cutout 6011 is rectangular in shape. The tether 5832 extends through the tether aperture 6007 and passes through the cutout 6011. According tosome embodiments, the tether 5832 may be press fit within the tether aperture 6007. According to some embodiments, an adhesive may be used to secure the nut 5834 to the tether 5832.

[0400] In use, the nut 5834 moves along the shaft 5812 as the shaft rotates. This results in movement of the tether 5832, which is attached to the nut 5834. The tether portion 6004 of the nut 5834 extends to fit within the cutout 5940 of the outer shell 5806. This cutout 5940 serves to guide the nut 5834. The cutout 5940 also assists to propel the nut 5834 along the nail by preventing the nut 5834 from rotating with the shaft 5812.

[0401] FIG. 61A is a perspective view of a locking screw, according to some embodiments. FIG. 61B is a top view of the locking screw, according to some embodiments. FIG. 61C is a bottom view of the locking screw, according to some embodiments. FIG. 60D is a side view of the locking screw, according to some embodiments. FIG. 61E is a side sectional view of the locking screw, according to some embodiments.

[0402] A locking screw 6102 may be used with any of the embodiments of the bone growth devices described herein. In particular, it may be used in lieu of a locking plate (e.g. 3034). The locking screw 6102 includes ahead 6104 and a shaft 6106. The shaft 6106 may be threaded. The head 6104 includes a keyhole 6108. The keyhole 6108 is rectangular in shape with semicircular ends. The keyhole 6108 extends partially into the locking screw 6102. A center 6907 of the keyhole 6108 expands radially and forms part of an aperture which transverses through the locking screw 6102. The aperture is additionally made up of a first radial chamber 6109, a cylindrical portion 6110, a second radial chamber 6111, and a conical portion 6112. The first radial chamber 6109 is posited adjacent the center 6107. The cylindrical portion 6110 is positioned adjacent the first radial chamber 6109. The second radial chamber 6111 is positioned adjacent the cylindrical portion 61 10. The conical portion 6112 is positioned adjacent the second radial chamber 6111. The second radial chamber 6111 may be larger than the first radial chamber 6109. In some embodiments, the first radial chamber 6109 and the second radial chamber 6111 may be ellipsoid in shape.

[0403] In use, the locking screw 6102 is screwed into a reamed canal of a moveable bone segment. The keyhole 6108 may be used to tighten the locking screw 6102 in place. Tether ends are inserted through the bone segment and into the locking screw 6102 through the conical portion 6112. The tethers may be threaded through the aperture completely such that they extend from the keyhole 6108. The tethers may then be tensioned and tied off. According to some embodiments, the internal chambers of the locking screw6102 receive a male tapered piece that is tensioned upward and locked into the locking screw. This helps to clamp the tether between the locking screw and the internal taper.

[0404] FIG. 61 F is a perspective view of a cable lock, according to some embodiments. FIG. 61 G is a perspective view of the cable lock of FIG. 61 F positioned in the locking screw, according to some embodiments. A cable lock 6120 may be inserted into the locking screw 6102 in order to assist securing the tether to the locking screw 6102. The cable lock 6120 includes an aperture 6128 positioned at one end, and a clamp 6130 positioned at the other end. The cable lock 6120 further includes several protrusions 6136. The clamp includes a flange 6132 and a recess 6134. The cable lock 6120 is made of a flexible material such that the clamp portion 6130 may be forced to close. In use, the cable lock 6120 is inserted into the locking screw 6102 through the conical portion 6112. The several protrusions 6136 engage with the second radial chamber 6111 or first radial chamber 6109 of the locking screw 6102 to hold the cable lock 6120 in place. Further, the conical portion 6112 interacts with the clamp portion 6130 forcing the clamp to close as it is inserted. The tether may be tied of to the cable lock 6120 (e g. the clamp portion 6130 and / or aperture 6128). The tether may further be clamped within the clamp portion 6130 and between the flange 6132 and recess 6134.

[0405] The various components of the bone grow th devices described herein can be made from various materials including plastic, rubber, composites, metals such as aluminum, steel, titanium etc., and other medical grade surgical materials commonly used in the industry. According to some embodiments, the tether may be UHMWPE braid or braided stainless steel or titanium.

[0406] While certain embodiments have been described, these embodiments have been presented by way of example only and are not intended to limit the scope of the disclosure. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms. Furthermore, various omissions, substitutions and changes in the systems and methods described herein may be made without departing from the spirit of the disclosure. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the disclosure.

[0407] Features, materials, characteristics, or groups described in conjunction with a particular aspect, embodiment, or example are to be understood to be applicable to any other aspect, embodiment or example described in this section or elsewhere in this specification unless incompatible therewith. All of the features disclosed in this specification (including any accompanying claims, abstract and drawings), and / or all of thesteps of any method or process so disclosed, may be combined in any combination, except combinations where at least some of such features and / or steps are mutually exclusive. The protection is not restricted to the details of any foregoing embodiments. The protection extends to any novel one, or any novel combination, of the features disclosed in this specification (including any accompanying claims, abstract and drawings), or to any novel one, or any novel combination, of the steps of any method or process so disclosed.

[0408] Furthermore, certain features that are described in this disclosure in the context of separate implementations can also be implemented in combination in a single implementation. Conversely, various features that are described in the context of a single implementation can also be implemented in multiple implementations separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations, one or more features from a claimed combination can, in some cases, be excised from the combination, and the combination may be claimed as a subcombination or variation of a subcombination.

[0409] Moreover, while operations may be depicted in the drawings or described in the specification in a particular order, such operations need not be performed in the particular order shown or in sequential order, or that all operations be performed, to achieve desirable results. Other operations that are not depicted or described can be incorporated in the example methods and processes. For example, one or more additional operations can be performed before, after, simultaneously, or between any of the described operations. Further, the operations may be rearranged or reordered in other implementations. Those skilled in the art will appreciate that in some embodiments, the actual steps taken in the processes illustrated and / or disclosed may differ from those shown in the figures. Depending on the embodiment, certain of the steps described above may be removed, others may be added. Furthermore, the features and attributes of the specific embodiments disclosed above may be combined in different ways to form additional embodiments, all of which fall within the scope of the present disclosure. Also, the separation of various system components in the implementations described above should not be understood as requiring such separation in all implementations, and it should be understood that the described components and systems can generally be integrated together in a single product or packaged into multiple products. For example, any of the components for an energy storage system described herein can be provided separately, or integrated together (e.g., packaged together, or attached together) to form an energy storage system.

[0410] For purposes of this disclosure, certain aspects, advantages, and novel features are described herein. Not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, for example, those skilled in the art will recognize that the disclosure may be embodied or carried out in a manner that achieves one advantage or a group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein.

[0411] Conditional language, such as “can.” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements, and / or steps. Thus, such conditional language is not generally intended to imply that features, elements, and / or steps are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without user input or prompting, whether these features, elements, and / or steps are included or are to be performed in any particular embodiment.

[0412] Conjunctive language such as the phrase “at least one of X, Y, and Z,” unless specifically stated otherwise, is otherwise understood with the context as used in general to convey that an item, term, etc. may be either X, Y, or Z. Thus, such conjunctive language is not generally intended to imply that certain embodiments require the presence of at least one of X, at least one of Y, and at least one of Z.

[0413] Language of degree used herein, such as the terms “approximately,” “about,” “generally,” and “substantially” as used herein represent a value, amount, or characteristic close to the stated value, amount, or characteristic that still performs a desired function or achieves a desired result. For example, the terms “approximately”, “about”, “generally,” and “substantially” may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, and within less than 0.01% of the stated amount, depending on the desired function or desired result.

[0414] The scope of the present disclosure is not intended to be limited by the specific disclosures of preferred embodiments in this section or elsewhere in this specification and may be defined by claims as presented in this section or elsewhere in this specification or as presented in the future. The language of the claims is to be interpreted broadly based on the language employed in the claims and not limited to the examples described in the present specification or during the prosecution of the application, which examples are to be construed as non-exclusive.

[0415] The headings provided herein, if any, are for convenience only and do not necessarily affect the scope or meaning of the devices and methods disclosed herein.

[0416] Alternative Embodiments1.

[0417] An intramedullary bone grow th device comprising: a fixed length rod comprising: a first end configured to attached to a first bone segment; a second end configured to attached to a second bone segment; an internal channel substantially along the axis of the rod and configured to receive a transport element; and a slot that has a shorter length than the rod and is essentially along the axis of the rod; a configured to move the transport element along the length of the rod; and a transport element configured to attach to a third bone segment through the slot.2.

[0418] An intramedullar)’ bone growth device comprising: a fixed length rod comprising: a first end configured to attached to a first bone segment; a second end configured to attached to a second bone segment; a middle portion that has a shorter length than the rod, is substantially along the axis of the rod and is configured to receive one or more transport elements; and one or more magnetically driven actuation mechanisms configured to move along the middle portion of the rod with the one or more transport elements; and one or more transport element configured to attach to additional bone segments.3.

[0419] An intramedullary extendable bone growth device comprising: a first rod portion rod comprising: a first end configured to attached to a first bone segment: and a second end configured to slidably connect to a second rod portion; a second rod portion comprising: a first end configured to attach to a second bone segment; a second end configured to slidably connect to a first rod portion; and a middle portion that is substantially along the axis of the second rod portion and is configured to receive a transport element; a magnetically driven actuation mechanism configured to move along the middle portion of the second rod portion with the transport element; and a transport element configured to attach to a third bone segment.4.

[0420] An intramedullary bone growth device comprising: a fixed length rod comprising: a first end configured to attached to a first bone segment; a second end configured to attached to a second bone segment; and an internal channel substantially along the axis of the rod and configured to receive a transport element; a magnetically driven actuation mechanism configured to move the transport element along the length of the rod; and a transport element configured to attach to a third bone segment.5.

[0421] An extramedullary' bone grow th device comprising: extendable length rod comprising: a first end configured to attached to a first bone segment: a second end configured to attached to a second bone segment; an internal channel substantially along the axis of the rod; and a configured to modify the overall length of the extendable length rod.6.

[0422] A bone growth device comprising: an extendable length rod comprising: a first bone connection portion configured to attach to a first bone segment; a second bone connection portion configured to attach to a second bone segment; [an internal channel substantially along the axis of the rod; and a magnetically driven actuation mechanism configured to modify the overall length of the extendable length rod.7.

[0423] The bone growth device of embodiment 6, wherein each of the first bone connection portion and the second bone connection portion are configured to interface with the anatomy of a specific patient.8.

[0424] A bone growth nail device comprising : an elongated housing comprising: a first end configured to be fixed to a first bone segment; and a second end configured to be fixed to a second bone segment; a drive system positioned within the elongated housing and comprising: a gearbox; a motor coupled to the gearbox; and a controller coupled to the motor and configured to control the motor; and a transport mechanism positioned mostly within the elongated housing and mechanically coupled to the drive system, the transport mechanism configured to transport a third bone segment axially adjacent the elongated housing

Claims

WHAT IS CLAIMED IS:

1. A bone growth nail device comprising: a first end configured to be fixed to a first bone segment; a second end configured to be fixed to a second bone segment; an outer shell extending between the first and second end; a transport mechanism positioned mostly within the outer shell and configured to transport a third bone segment in an axial direction; and a drive system positioned within the outer shell and coupled to the transport mechanism comprising: a gearbox; a motor coupled to the gearbox; and a controller coupled to the motor and configured to control the motor.

2. The device of claim 1, wherein the outer shell comprises one or more first side apertures positioned adjacent a first end of the transport mechanism and one or more second side apertures positioned adjacent the second end of the transport mechanism.

3. The device of claim 2, wherein the transport mechanism comprises: a threaded shaft coupled to the gearbox and configured to rotate; a nut threadably coupled to the shaft, wherein the nut is configured to move axially along the shaft as the shaft rotates; and a flexible tether fixed to the nut and disposed through the first and second apertures.

4. A kit, comprising the device of claim 3 and a locking plate configured to be coupled to the third bone segment and the flexible tether.

5. The kit of claim 4, wherein the locking plate comprises: a main plate position adjacent the bone segment surface; a conical protrusion extending from a bottom surface of the main plate, wherein the conical protrusion comprises a central aperture; two locking fasteners disposed through the main plate and positioned in-line with the central aperture; a recess extending from the central aperture and accommodating the two locking fasteners.

6. The kit of any one of claims 4 or 5, wherein the flexible tether is configured to be secured between the two locking fasteners and the recess.

7. The device of claim 3, wherein the transport mechanism comprises: a second nut threadably coupled to the shaft; and a second flexible tether fixed to the second nut and configured to transport a fourth bone segment.

8. A kit, comprising the device of claim 7, further comprising a first locking plate configured to be coupled to the third bone segment and the first flexible tether, and a second locking plate configured to be coupled to the second tether and the fourth bone segment.

9. The device of claim 7, wherein the first nut is threadably coupled to a first portion of the shaft which is threaded in a clockwise direction, wherein the second nut is threadably coupled to a second portion of the shaft which is threaded in a counter-clockwise direction.

10. The device of claim 9, wherein rotation of the shaft causes the first nut and the second nut to move toward each other.

11. The device of claim 7, wherein the first nut is threadably coupled to a first portion of the shaft, wherein the second nut is threadably coupled to a second portion of the shaft which is threaded in the same direction, wherein the pitch / lead in the threads of the second portion of the shaft results in the second nut moving faster than the first nut and in the same direction.

12. The device of claim 11, wherein the second nut moves twice as fast as the first nut.

13. The device of claim 11 , wherein the second portion of the shaft is twice as long as the first portion of the shaft.

14. The device of claim 7, wherein the first nut comprises a channel in its outer surface configured to slidably receive the second flexible tether, wherein the second nut comprises a channel in its outer surface configured to slidably receive the first flexible tether.

15. The device of claim 11, wherein the first nut further comprises another channel in its outer surface configured to slidably receive a fourth flexible tether, wherein the second nut comprises another channel in its outer surface configured to slidably receive a third flexible tether.

16. The device of any one of claims 3, 7 or 9-15, wherein the first tether comprises one or more tether segments.

17. The device of any one of claims 7 or 9-16, wherein the second tether comprises one or more tether segments.

18. The device of claims 1-3, 7, or 9-17, wherein outer shell comprises one or more elongated grooves extending between the one or more first side apertures and the one or more second side apertures.

19. The device of claim 18, wherein the outer shell comprises an elongated slot on a side opposite an elongated groove.

20. The device of claim 3, wherein the outer shell comprises an elongated groove on one side within which the flexible tether is slidably disposed and an elongated slot on an opposite side within which the flexible tether is slidably disposed.

21. The device of claim 20, wherein the nut comprises one or more protrusions on the side of the nut, the one or more protrusions comprising apertures through which the flexible tether passes, wherein the one or more protrusions are disposed within the elongated slot.

22. The device of any one of claims 19-21, comprising a first pulley within the outer shell proximate to a first end of the outer shell and a second pully within the outer shell proximate to a second end of the outer shell, wherein the flexible tether passes around the first and second pulleys.

23. The device of claim 22, wherein the outer shell comprises apertures proximate to the first and second pulleys through which the flexible tether passes.

24. A kit, comprising the device of any one of claims 2 to 3 and a locking screw configured to be coupled to the second bone segment and the flexible tether, the locking screw comprising: a head portion having a keyhole; and a shaft extending from the head, wherein an aperture extends through the keyhole and the shaft, the aperture including a conical portion and one or more chambers of varying sizes.

25. The kit of claim 24, wherein the flexible tether is configured to be secured to the locking screw.

26. A kit. comprising the device of claim 25, further comprising a first locking screw configured to be coupled to the second bone segment and the first flexible tether, and a second locking screw configured to be coupled to the second tether and the fourth bone segment.

27. The kit of claim 24, wherein the tether is secured to the locking screw by a locking clamp which is inserted into the aperture of the shaft.

28. The device of claim 18, further comprising a carriage positioned adjacent an external surface of the outer shell and attached to the tether, wherein the carriage moves along a grove in the outer shell in response to movement of the nut.

29. The device of claim 1, wherein the outer shell comprises an elongated slot extending along a portion of the cylinder, wherein the portion of the outer shell is internally threaded.

30. The device of claim 29, wherein the transport mechanism comprises: a shaft coupled to the drive system and configured to rotate; a carriage secured to the shaft and positioned within the elongated slot, wherein the carriage is configured to attach to the third bone segment; and two externally threaded nuts positioned on either side of the carriage, wherein the nuts are slidably coupled to the shaft, wherein the nuts are configured to engage with the threads of the outer shell and move axially along the shaft as the shaft rotates.

31. The device of claim 30, wherein the shaft is cylindrical with a flattened side.

32. The device of any one of claims 30 to 31, wherein the carriage comprises: a trolley portion which slidably couples with the shaft and has an aperture for the shaft to pass through; and an attachment portion which couples to the third bone segment.

33. The device of any one of claims 30 to 32, wherein two externally threaded nuts include an aperture which engages the shaft such that the nuts rotate with the shaft.

34. The device of claim 2, wherein the transport mechanism comprises: a threaded shaft coupled to the gearbox and configured to rotate; a nut threadably coupled to the shaft, wherein the nut is configured to move axially along the shaft as the shaft rotates; a first pulley positioned at the first end of the transport mechanism and positioned adjacent a first end of the threaded shaft; a second pulley positioned at the second end of the transport mechanism and positioned adjacent a second end of the threaded shaft; a flexible tether fixed to the nut and threaded through the first and second apertures, wherein the flexible tether is further looped around the first and second pulleys: and a carriage fixed to the flexible tether and positioned exterior to the elongated housing, wherein the carriage is configured to attach to the third bone segment.

35. The device of claim 34, wherein the elongated housing comprises a groove positioned between the one or more first side apertures and the one or more second side apertures.

36. The device of any one of claims 34 to 35, wherein the carriage and tether move within the groove.

37. The device of any one of claims 34 to 36, wherein the nut comprises a channel which engages with an inward protrusion of the elongated housing and prevents rotation of the nut.

38. The device of any one of claims 34 to 37, wherein flexible tether is fixed within an aperture in the nut.

39. The device of any one of claims 34 to 38, wherein flexible tether is fixed within an aperture in the carriage.

40. The device of any one of claims 34 to 39, wherein the first and second pulleys are angularly offset from the first and second apertures.

41. The device of claim 2, wherein the transport mechanism comprises: a bevel drive coupled to the gearbox and configured to rotate; a first pulley coupled to the outer shell and in communication with the bevel drive, wherein the first pulley is positioned adjacent the first end of the outer shell and oriented axially adjacent the bevel drive; a second pulley coupled to a tensioner, wherein the second pulley is positioned adjacent the second end of the outer shell and oriented axially adjacent the bevel drive; a flexible tether threaded through the one or more first and second side apertures, wherein the flexible tether is further looped around the first and second pulleys; and a one or more carriages fixed to the flexible tether and positioned exterior to the elongated housing, wherein the carriage is configured to attach the movable bone segment.

42. The device of claim 41, wherein the one or more carriages are positioned on opposite sides of the elongated housing.

43. The device of any one of claims 41 to 42, wherein the elongated housing comprises one or more grooves positioned between the one or more first side apertures and the one or more second side apertures.

44. The device of any one of claims 41 to 43, wherein the one or more carriages and the tether move within the groove.

45. The device of any one of claim 41 to 44, wherein the one or more camages comprise: a base portion with an aperture, wherein the tether extends through the aperture; a top portion including one or more cutouts for attaching to the movable bone segment.

46. The device of any one of claims 1-3, 7, 9-23, or 28-45, wherein the drive system further comprising a planetary system coupled to the gearbox.

47. The device of claim 46, wherein the planetary gear system comprises: a first stage coupled to the gearbox and including a first sun gear; a second stage coupled to the first stage and including a plurality of planetary gears attached to a second sun gear; a third stage coupled to the second stage and including a second plurality of planetary gears attached to an adapter portion for connection with the transport mechanism; and a ring gear surrounding and contacting the planetary gears of the second and third stages.

48. The device of any one of claims 1-3. 7, 9-23, or 28-47, wherein the outer shell comprises a key slot on one end which interacts with a medical tool.

49. The device of any one or claims 1-3, 7, 9-23, or 28-48, wherein the first and second end comprise one or more fixation holes for securing to the first and second bone segments.

50. The device of any one of claims 1-3, 7, 9-23, or 28-49, wherein the controller comprises: one or more receiver coils configured to be activated via an air core transformer arrangement; and one or more capacitors configured to be charged by the one or more receiver coils.

51. The device of any one of claims 1-3, 7, 9-23, or 28-50, wherein the controller is configured to control a speed at which the motor rotates.

52. The device of any one of claims 1-3, 7. 9-23. or 28-51. wherein the controller is configured to control a gear ratio of the gearbox.

53. The device of any one of claims 1-3, 7, 9-23, or 28-52, wherein the controller is configured to communicate wirelessly via one or more of Wifi, Bluetooth, RFID, and nearfield magnetic induction (NFMI) communication.

54. The device of claims 1-3, 7, 9-23, or 28-53, wherein outer shell is partitioned into a first section which encompasses the drive system, and a second section which encompasses the transport mechanism.

55. The device of any one of claims 1-3, 7. 9-23, or 28-54, wherein the tether is configured to attach to a moveable bone segment.

56. The device of claim 55, wherein the tether is tied directly to the moveable bone segment.

57. The device of any one of claims 1-3, 7. 9-23. or 28-56, wherein the transport mechanism further comprises one or more bearing seals positioned near ends of the shaft.

58. The device of any one of claims 1-3, 7, or 9-23, wherein the bone segments are positioned anywhere along the outer shell.

59. A system for controlling growth of a bone comprising: a bone growth nail device positioned between a first and second bone segment in a patient and attached to one or more moveable bone segments, the bone grow th device comprising a control capsule; a pad configured to activate the bone growth nail device through an air core transformer arrangement and wirelessly communicate with the control capsule; and a user device in communication with the pad.

60. The system of claim 59, wherein the control capsule comprises: a controller; a transmitter for transmitting data to the pad; a receiver for receiving data from the pad; one or more capacitors electrically connected to a drive system of the bone growth nail device; and one or more receiver coils electrically connected to the one or more capacitors, wherein the one or more receiver coils are activated through the air core transformer arrangement.

61. The system of any one of claims 59 to 60, wherein the patient pad comprises: a control interface comprising: a control interface;a transmitter electrically connected to the control interface and configured to transmit data to the bone growth device and user device; a receiver electrically connected to the control interface and configured to receive data from the bone growth device and user device; a battery electrically connected to the control interface; and one or more transformer coils electrically connected to the control interface and configured to charge the control capsule.

62. The system of any one of claims 59 to 61, wherein the bone growth device and pad communicate via one or more of: radio frequency (RF), Bluetooth, Wi-Fi, cellular, near field communication (NFC), microwave, near-field magnetic induction (NFMI) communication, and / or infrared.

63. The system of any one of claims 59 to 62, wherein a user controls, via the user device, a start and end of a therapy session.

64. The system of any one of claims 59 to 63, wherein a user controls, via the user device, one or more of a distance to be moved, duration of session, or rate of movement of one or more bone segments.

65. The system of any one of claims 59 to 64, wherein the bone growth nail device is configured to move each of the one or more bone segments 1mm a day.

66. The system of any one of claims 59 to 65. wherein data transmitted and received between the bone growth device, pad. and user device includes therapy data includes the length of travel of the one or more bone segments, speed, length of time of each session, force, torque, errors encountered, date / time of each session, and temperature.

67. The system of any one of claims 59 to 66, wherein the pad communicates the date to the bone growth device.

68. The system of any one of claims 59 to 67, wherein a GUI of the user device displays the received data with one or more of graphs, charts, or progress indicators.

69. The system of any one of claim 68, wherein the GUI runs on an application on the user device.

70. The system of claim 69. wherein the application provides tutorials indicators including patient milestones, overall therapy progress, therapy logging, sync status, patient diary, error messaging and resolution, and device health.

71. The system of any one of claims 61 to 70, wherein the control interface indicates device activity such as presence of the bone growth device, status of the bone growth device, and therapy session progress.

72. The system of any one of claims 61 to 71, wherein the user device may indicate device activity such as presence of the bone growth device, status of the bone growth device, and therapy session progress.

73. The system of any one of claims 61 to 72, wherein the pad is configured to wrap around the patient’s leg.

74. The system of any one of claims 61 to 73, wherein the pad is made of a flexible material configured to wrap around the patient.

75. The system of any one of claims 61 to 74, wherein the pad includes one or more patches to block or reduce crosstalk between the pad and bone grow th device.

76. The system of any one of claims 61 to 75, wherein control interface or user device provides indications such as a connectivity indicator, a pad status indicator such as on / off or charging, a pad battery level indicator, a bone growth device charging progress indicator, and / or an error indicator.

77. The system of any one of claims 61 to 76, wherein the pad further includes a strap to wrap around the patient.

78. The system of any one of claims 61 to 77, wherein the pad attaches to a limb cradle.

79. A method of performing bone transport therapy comprising: placing a pad adj acent a portion of a patient’ s body containing a bone growth nail; activating the pad; establishing a wireless connection between the pad and bone growth nail; transmitting to the bone growth nail, via a user device and pad, instructions including a therapy protocol to be implemented by the bone growth nail; charging, via an air core transformer arrangement with the pad, one or more capacitors of the bone growth nail; initiating bone transport, via the user device.

80. The method of claim 79, further comprising indicating on the user device that connection has been made with the bone growth device.

81. The method of any one of claims 79 to 80, further comprising stopping bone transport, via the user interface.

82. The method of any one of claims 79 to 81, further comprising: receiving to the pad, therapy data from the bone growth nail; and receiving to the user device, the therapy data from the pad.

83. The method of claim 82, further comprising displaying, via a user interface of the user device, the therapy data.

84. The method of any one of any one of claims 82 to 83, wherein the therapy data comprises one or more of length of travel of the one or more bone segments, speed, length of time of each session, force, torque, errors encountered, date / time of each session, and temperature.

85. A method of installing a bone growth nail device comprising: reaming an intramedullary canal in first and second portions of a bone; inserting the nail into the intramedullary canal such that a first end of the nail is within the first portion of bone and a second end of the nail is within the second portion of bone, wherein the nail comprises a flexible tether attached thereto comprising two free ends; resecting the first portion of bone into a first segment and a moveable bone segment; drilling one or more transverse holes into the moveable bone segment; routing the free ends of the tether through the transverse holes; securing the first end of the nail to the first bone segment and the second end of the nail to the second portion of bone with one or more fasteners; tensioning the one or more tethers; and securing tether to the moveable bone segment.

86. The method of claim 85, further comprising folding the free ends of one or more tethers of the nail away from the bone prior to insertion into the intramedullary canal.

87. The method of any one of claims 85 to 86, further comprising removing unwanted portions of the bone.

88. The method of any one of claims 85 to 87, further comprising tensioning the tethers prior to securing the tethers to the moveable bone segment.

89. The method of any one of claims 85 to 88, wherein securing the tether to the moveable bone segment further comprises: securing a locking plate to the moveable bone segment; threading the free ends of the tether through the locking plate; and wrapping the free ends of the tether around locking fasteners of the locking plate.

90. The method of any one of claims 85 to 88, wherein securing the tether to the moveable bone segment further comprises:installing a locking screw to the moveable bone segment; threading the free ends of the tether through the locking screw; inserting a locking clamp into the locking screw; and fastening the tether to the locking clamp.

91. The method of any one or claims 85 to 90, further comprising: resecting the second portion of resected bone to form a second moveable bone segment; drilling one or more transverse holes into the second moveable bone segment; and securing a second tether that is attached to the nail to the second moveable bone segment.

92. The method of any one of claim 85 to 91, further comprising removing excess tether.

93. The method of any one of claims 85 to 92, wherein the nail comprises: a drive system comprising: a gearbox; a motor coupled to the gearbox; and a controller coupled to the motor and configured to control the motor; a threaded shaft coupled to the gearbox and configured to rotate; and a nut threadably coupled to the shaft, wherein the nut is configured to move axially along the shaft as the shaft rotates, and wherein the flexible tether is coupled to the nut.

94. The method of claim 93, further comprising actuating the motor to cause the treaded shaft to rotate and thereby cause the movable bone segment to translate along the nail.

95. A bone growth device, comprising: a housing comprising an elongated slot; a first housing end comprising one or more fixation holes configured to receive one or more fasteners and configured to be attached to a first bone; a second housing end comprising one or more fixation holes configured to receive one or more fasteners and configured to be attached to a second bone: a threaded rod positioned within the housing; an actuator configured to rotate the treaded rod; anda bone segment transport element comprising a cylindrical hollow body with internal threads configured to mate with treads on the threaded rod, the bone segment transport element further comprising a protrusion on a side of the cylindrical hollow body positioned within the elongated slot, wherein the protrusion is configured to be attached to a third bone segment.

96. The device of claim 95. wherein the protrusion comprises one or more apertures.

97. The device of claim 95 or 96, wherein the protrusion is configured to be attached to the third bone segment using a fastener.

98. The device of any one of claims 95 to 97, wherein the protrusion is coupled to a flexible tether which is configured to be attached to the third bone segment.

99. The device of any one of claims 95 to 98, wherein the actuator comprises one or more permanent magnet.

100. The device of any one of claims 95 to 99, wherein the actuator comprises a motor.

101. A bone growth device, comprising: a housing comprising an elongated slot; a first housing end comprising one or more fixation holes configured to receive one or more fasteners and configured to be attached to a first bone; a second housing end comprising one or more fixation holes configured to receive one or more fasteners and configured to be attached to a second bone; a bone segment transport element comprising a cylindrical body and configured to travel within the housing along the length of the bone growth device, wherein the bone segment transport element is configured to be attached to a third bone segment; an actuator configured to rotate a gear, wherein rotation of the gear drives the bone segment transport element; and a flexible member coupled to the bone segment transport element and passing around a first pulley positioned proximate the first housing end and a second pully positioned proximate to the second housing end.

102. The device of claim 101, wherein the bone segment transport element is configured to be attached to the third bone segment through the elongated slot.

103. The device of claim 101 or 102, wherein the flexible member is a flexible tether that is configured to be attached to the third bone segment.

104. The device of any one of claims 101 to 103, wherein the actuator comprises one or more permanent magnet.

105. The device of any one of claims 101 to 104, wherein the actuator comprises a motor.

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