Low-invasive rib fracture fixation method

Abstract

The implant assembly can be secured to a human rib and can include an implant, an anchor, and a bracket. The implant can include an elongated body engageable with a surface of the rib. The elongated body can define a first bore and a second bore, each extending at least partially through the body. The anchor can be at least partially insertable into a hole formed in the rib and at least partially insertable into the first bore. The bracket can be engaged with the implant and configured to pass at least a portion of the anchor, which can secure the bracket and suture anchor to the implant and the rib.

Description

[Technical Field]

[0001] (Priority Claim) This application claims the benefit of U.S. Provisional Patent Application No. 63 / 431,823, filed December 12, 2022, and also claims the benefit of U.S. Provisional Patent Application No. 63 / 530,842, filed August 4, 2023, the benefit of which is hereby claimed, and each application is incorporated herein by reference in its entirety. [Background technology]

[0002] Implants are commonly used in the medical field to strengthen a patient's bones. In some cases, implants can be attached to fractured bones. For example, if a patient has cracked or broken ribs, a surgeon may attach a plate that maintains rib alignment to promote proper healing. The plate can be fastened to the ribs on either side of the fracture to maintain proper rib alignment during healing. The plate can be secured to the ribs using fasteners. In some cases, the plate and fasteners can be removed from the patient after the fracture has healed. [Brief explanation of the drawings]

[0003] The drawings are not necessarily drawn to scale, and the same numerals may refer to similar components in different figures. The same numerals with different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, and not by way of limitation, various embodiments discussed in this document.

[0004] [Figure 1] FIG. 1 shows an isometric view of an implant assembly. [Figure 2] FIG. 2 shows a perspective view of the implant assembly. [Figure 3] FIG. 3 shows an isometric view of the implant assembly. [Figure 4A] FIG. 4A shows a perspective view of the implant assembly. [Figure 4B] FIG. 4B shows an enlarged perspective view of the implant assembly. [Figure 5] FIG. 5 shows an isometric view of the implant assembly. [Figure 6] FIG. 6 shows a perspective view of the implant assembly. [Figure 7] FIG. 7 shows an isometric exploded view of the implant assembly. [Figure 8A] FIG. 8A shows a cross-sectional view of the implant assembly. [Figure 8B] FIG. 8B shows a schematic diagram of a portion of the implant assembly. [Figure 8C] FIG. 8C shows a schematic diagram of a portion of the implant assembly. [Figure 9A] FIG. 9A shows an isometric view of a portion of an implant assembly. [Figure 9B] FIG. 9B shows an isometric view of a portion of the implant assembly. [Figure 10A] FIG. 10A shows an isometric view of a portion of an implant assembly. [Figure 10B] FIG. 10B shows an isometric view of a portion of the implant assembly. [Figure 11A] FIG. 11A shows a perspective view of a portion of an implant assembly. [Figure 11B] FIG. 11B shows a cross-sectional view of a portion of the implant assembly. [Figure 12A] FIG. 12A shows a side view of a portion of an implant assembly. [Figure 12B] FIG. 12B shows a cross-sectional view of a portion of the implant assembly. [Figure 13A] FIG. 13A shows a perspective view of a portion of an implant assembly. [Figure 13B] FIG. 13B shows a perspective view of a portion of the implant assembly. [Figure 14A] FIG. 14A shows an isometric view of a portion of an implant assembly. [Figure 14B]FIG. 14B shows an isometric view of a portion of the implant assembly. [Figure 15A] FIG. 15A shows an isometric view of a portion of an implant assembly. [Figure 15B] FIG. 15B shows an isometric view of a portion of the implant assembly. [Figure 15C] FIG. 15C shows an isometric view of a portion of the implant assembly. [Figure 16A] FIG. 16A shows an isometric view of a portion of an implant assembly. [Figure 16B] FIG. 16B shows an isometric view of a portion of the implant assembly. [Figure 16C] FIG. 16C shows an isometric view of a portion of the implant assembly. [Figure 16D] FIG. 16D shows an isometric view of a portion of the implant assembly. [Figure 16E] FIG. 16E shows an isometric view of a portion of the implant assembly. [Figure 17] FIG. 17 shows an isometric view of a portion of an implant assembly. [Figure 18] FIG. 18 shows an isometric view of a portion of the instrument assembly. [Figure 19] FIG. 19 shows an isometric view of a portion of the instrument assembly. [Figure 20] FIG. 20 shows an enlarged perspective view of the implant assembly. [Figure 21A] FIG. 21A shows an isometric view of a portion of an implant assembly. [Figure 21B] FIG. 21B shows an isometric view of a portion of the implant assembly. [Figure 21C] FIG. 21C shows an isometric view of a portion of the implant assembly. [Figure 22] FIG. 22 shows a perspective view of the implant assembly. [Figure 23] FIG. 23 shows a perspective view of the implant assembly. [Figure 24]FIG. 24 shows a perspective view of the implant assembly. Summary of the Invention [Problem to be solved by the invention]

[0005] In cases of rib fractures that require a plate to promote proper healing, fasteners can be used to secure the plate to the rib segments. For example, bone screws are often used to secure plates to rib segments. However, securing plates to rib segments using screws alone can be relatively time-consuming. Also, reduction of separated rib segments can be relatively difficult and time-consuming, and fasteners are not always useful in the reduction process.

[0006] The present application may include devices and methods for addressing these problems, which may include anchor assemblies, including anchors (such as suture anchors) and brackets (such as buttons or fasteners) for securing implants or plates to bone and allowing for faster reduction of separated rib segments compared to traditional methods involving screws and plates. The anchors may be manipulated intrathoracically or extrathoracically to quickly secure the implants to each rib segment after reduction, helping to reduce the time required to complete the procedure.

[0007] In the case of rib fractures that require a plate to promote proper healing, it may be desirable to place the plate intrathoracically to reduce palpability and improve comfort. In such cases, it is common to place the plate from the opposite side of the thoracic cavity. For example, an anterior rib fractured in the ventral portion can be accessed from the patient's posterior side. While there are many relative advantages to placing an implant in this manner, the procedure for placing the implant in this manner can be challenging. For example, aligning the rib plate with the fractured rib, maintaining alignment for drilling the rib, and securing the plate to the rib can be a difficult process. The present application may include devices and methods for addressing these issues, allowing for relatively rapid reduction of the rib portion and relatively rapid fixation of the implant to the bone using anchor assemblies.

[0008] The above discussion is intended to provide an overview of the subject matter of the present patent application. It is not intended to provide an exclusive or comprehensive description of the invention. The following discussion is included to provide further information regarding the present patent application. DETAILED DESCRIPTION OF THE INVENTION

[0009] FIG. 1 shows an isometric view of an implant assembly 100 installed within a rib 50 using an extrathoracic approach. FIG. 2 shows a perspective view of the implant assembly 100. FIGS. 1 and 2 are described together below. FIG. 1 also shows a fracture 52 in a rib 50. The rib 50 can include a first rib portion 54 and a second rib portion 56. FIG. 1 also shows extrathoracic and intrathoracic orientations.

[0010] Implant assembly 100 may include plate 102, anchor assemblies 104a and 104b, and fasteners 106a through 106n. Plate 102 may include body 107 and bores 108a and 108b. Body 107 may be curved to conform to the extrathoracic surface of rib 50. Bore 108 may be a circular bore or a slot that extends at least partially through body 107. Bores 108a and 108b may be configured to at least partially accommodate anchor assemblies 104a and 104b, respectively. Body 107 may be an elongated, rigid, or semi-rigid member. Body 107 may be made from a biocompatible material such as stainless steel, cobalt chromium, titanium (e.g., commercially available pure titanium (e.g., Grade 2) or titanium alloy), or a polymer such as polyetheretherketone (PEEK) or polyetherketoneketone (PEKK). Optionally, one or more components of the plate 102 or anchor assembly 104 may be made from one or more absorbable materials, such as lactosorb or other biodegradable polymers.

[0011] The anchor assembly 104a can include a bracket 110 and an anchor 112. The bracket 110 can be a button, a fastener, or the like. The bracket 110 can be rigid or semi-rigid and configured to engage the plate 102 or a portion of a bone. The anchor 112 is a flexible or non-rigid (or semi-rigid) component or group of components that can be manipulated to connect the anchor assembly 104 to a bone (e.g., a rib 50) and a plate (e.g., a plate 102).

[0012] 2, anchor 112 can include anchor sleeve 114 and suture 116. Brackets 106 and 110 can be made from one or more biocompatible materials: stainless steel, cobalt chrome, titanium (e.g., commercially available pure titanium or titanium alloys), polymer, polyetheretherketone (PEEK), or polyetherketoneketone (PEKK).

[0013] The anchor sleeve 114 or the suture 116 can be made from a relatively soft and flexible material, such as cotton, silk, nylon, or vicryl. The anchor sleeve 114 or the suture 116 can each optionally be formed from a braided material. The anchor sleeve 114 can be a sleeve defining a longitudinal bore extending at least partially therethrough. The anchor sleeve 114 is deformable from a first shape, shown in FIG. 2, to a second shape, shown in FIG. 1. The suture 116 can extend at least partially through the longitudinal bore of the anchor sleeve 114 to couple the sleeve 114 to the suture 116.

[0014] As shown in FIG. 1 , the anchor 112 is at least partially insertable into a hole formed in the first rib portion 54 and at least partially insertable into the bore 108a. The bore can be formed using a punch or drill. The underside of the bracket 110 is engageable with the implant body 107 and can be configured to pass at least a portion of the suture 116 through it. The anchor 112 can be inserted through the bore 108 and the rib 50, and the sleeve 114 can engage the underside of the rib 50. Once the anchor 112 is in place, the suture 116 can be actuated or manipulated to tighten the anchor 112 around the bracket 110, and the suture 116 can be actuated or manipulated (e.g., pulled) to deform the anchor sleeve 114 and secure the bracket 110 and anchor 112 to the implant and rib 50.

[0015] Once the sutures 116 are at least partially tightened, the sutures 116 of anchor assemblies 104a and 104b can be used to align and reduce the first and second rib portions 54, 56. After reduction, the sutures 116 can be tensioned to secure the first and second rib portions 54, 56 to the plate 102. Once the anchors 112 are tensioned, excess sutures 116 can be trimmed. In this manner, the anchor assemblies can be used to quickly secure the plate 102 to the ribs 50.

[0016] FIG. 3 shows an isometric view of an implant assembly 300 attached to a rib 50 using a hybrid intrathoracic or intrathoracic approach. FIG. 4A shows a perspective view of the implant assembly 300. FIG. 4B shows a close-up view of the implant assembly 300. FIGS. 3-4B are described together below. FIG. 3 also shows a rib 50 including a fracture 52. The rib can include a first rib portion 54, a second rib portion 56, and a third portion 58. FIG. 3 also shows extrathoracic and intrathoracic orientations.

[0017] Implant assembly 300 is similar to implant assembly 100 described above, and elements having like reference numbers may be similarly configured. Implant assembly 300 may be configured for hybrid intrathoracic and intrathoracic approaches. Any of the implant assemblies described above or below may be modified to include the features of implant assembly 300.

[0018] The implant assembly 300 can include a plate 302 including a body 307 that can be curved to fit the intrathoracic surface of the rib 50. The body 307 can include bores (which can be slotted) configured to receive the anchor assemblies 304a-304c. Each anchor assembly 304 can include a bracket 310 and an anchor 312. Each suture anchor 312 can include an anchor sleeve 314, a suture 316, and a leader suture 318 including a tag 320. At least a portion of the suture 316 can pass through an opening 321 (shown in FIG. 4B ) in the anchor sleeve 314. The suture 316 can pass at least partially through a longitudinal opening in the anchor sleeve 314 and can also pass through the bracket 310. The leader suture 318 can be coupled to the anchor sleeve 314.

[0019] When assembled, plate 302 can be inserted into the thoracic cavity and engage rib 50. Anchor 312 can be at least partially inserted into a bore (similar to bore 108) in plate 302 from inside to outside the thoracic cavity and at least partially inserted into hole 60 formed in first rib portion 54. For example, leader suture 318 can be inserted through plate 302 and hole 60 and used to pull anchor sleeve 314 through body 307 and hole 60 without deforming it. The underside of bracket 310 can engage implant body 307.

[0020] Once the anchor sleeve 314 is inserted through the bore in the plate 302 and the hole 60 in the rib 50 (e.g., first rib portion 54), the sleeve 314 can engage the extrathoracic side of the rib 50. At this point, the tag 320 can be manipulated or actuated to release the leader suture 318 from the anchor sleeve 314, thereby removing the leader suture 318 from the anchor 312 (e.g., anchor sleeve 314).

[0021] This process can be repeated for each anchor assembly 304. The suture 316 is then actuated or manipulated (e.g., extrathoracically) to pretension (initial tightening) the anchor 312, engaging the bracket 310 to the plate 302, and at least partially deforming (e.g., compressing or precompressing, or changing shape or reducing size) the anchor sleeve 314 to engage the rib 50, such that the sleeve 314 and bracket 310 compress the plate 302 and rib 50. Once the anchor assembly 304 is tightened, it can be used to align and reduce the rib segments 54, 56, and 58.

[0022] Once rib sections 54, 56, and 58 are in place, sutures 316 can be further actuated or manipulated to tighten anchors 312 around brackets 310, and sutures 316 can be manipulated to deform anchor sleeves 314 and secure brackets 310 and anchors 312 to the implant and rib 50. Each anchor assembly 304 can be similarly manipulated to secure anchor assemblies 304a, 304b, and 304c to rib sections 54, 56, and 58, respectively, and to plate 302. Once anchors 312 are fully tightened, excess sutures 316 can be trimmed. In this manner, the anchor assemblies can be used to quickly secure plate 302 to rib 50.

[0023] Figure 5 shows an isometric view of implant assembly 500 attached to rib 50 using an intrathoracic approach. Figure 6 shows a perspective view of implant assembly 500. Figures 5 and 6 are described together below. Figure 5 also shows rib 50 including fracture 52. The rib can include first rib portion 54, second rib portion 56, and third portion 58. Figure 5 also shows extrathoracic and intrathoracic directional indications.

[0024] Implant assembly 500 is similar to the implant assemblies described above, and elements having like reference numbers may be similarly configured. Implant assembly 500 may be configured for an intrathoracic approach. Any of the implant assemblies described above or below may be modified to include the features of implant assembly 500.

[0025] More specifically, implant assembly 500 can use the same components as implant assembly 100 using a different plate (plate 502). Plate 502 can be rigid or semi-rigid and formed of a biocompatible material, but plate 502 can be configured to engage the intrathoracic surface of rib 50 and therefore have a similar curvature as plate 302. Plate 502 can include bores or slots 508a, 508b, and 508c, which can be configured to at least partially receive anchor assemblies 504a, 504b, and 504c, respectively.

[0026] During operation or installation of the implant assembly 500, the anchor 512 of the anchor assembly 504a can be inserted through the slot (e.g., slot 508a) and the hole in the rib 50, and the anchor sleeve 514 and suture 516 can be inserted at least partially from intrathoracic to extrathoracic. The suture 516 can be actuated or manipulated (e.g., intrathoracic) to at least partially tighten the anchor 512, engaging the bracket 510 with the intrathoracic surface of the body 507 of the plate 502 and securing the anchor assembly 504a to the first rib portion 54. This process can be repeated for anchor assemblies 504b and 504c and secured to rib portions 56 and 58, respectively. The suture 516 can be manipulated to align and reduce the rib portions 54-58. Once the rib portions are aligned as desired, the sutures 516 of each anchor assembly 504 can be tightened to secure the anchors 512 and brackets 510 of each anchor assembly 504 to the ribs 50 and plate 502 and manipulated to deform the sleeve 514. The sutures 516 can optionally be tensioned using tensioners, and the sutures 516 can be trimmed to remove excess material. The implant assembly 500 allows each of the above-described steps to be performed within the thoracic cavity.

[0027] Figure 7 shows an isometric exploded view of the implant assembly 100. Figure 7 also shows a rib 50 including a fracture 52, and shows rib segments 54 and 56. Figure 7 also shows extrathoracic and intrathoracic directional indications.

[0028] The implant assembly 100 can be consistent with the implant assemblies 100 described above. FIG. 7 shows further details of the implant assembly 100. For example, FIG. 7 shows that the body 107 can include multiple bores 122a through 122n, each configured to at least partially receive a fastener 106a through 106n therethrough to help secure the plate 102 to the rib 50. Although seven bores are shown, the plate 102 can include more or fewer bores, such as 1, 2, 3, 4, 5, 6, 8, 9, 10, 15, 20, etc. Optionally, one or more of the bores 122 can be threaded to at least partially receive a fastener therethrough.

[0029] Figure 7 also more clearly shows that slot 108 can be elongated (e.g., oval or stadium shaped). Figure 7 also shows that holes 60 through rib 50 can be positioned so that plate 102 can move along the surface of rib 50 (e.g., inward or outward) relative to holes 60, with bore 108 aligning with holes 60. This allows plate 102 to be positioned as needed for proper reduction of first rib portion 54 and second rib portion 56 and proper fixation of plate 102 to rib 50 after reduction.

[0030] 7 also shows the anchor assembly 104 in a tightened configuration with excess sutures 116 removed. In such a configuration, the anchor sleeve 114 can deform into a shape that prevents or limits migration through the holes 60. FIG. 7 also shows that the sutures 116 can connect the bracket 110 to the anchor sleeve 114, so that when the anchor assembly 104a is tightened, the anchor sleeve 114 can contact the rib 50 and the bracket 110 can contact the plate 102 to secure the anchor assembly 104 and plate 102 to the rib 50.

[0031] FIG. 8A shows a cross-sectional view of implant assembly 800. Implant assembly 800 may be similar to any of the implant assemblies described above. FIG. 8A shows in more detail how the anchor assemblies are connected. Any of the implant assemblies described above or below can be modified to include the features of implant assembly 800.

[0032] Implant assembly 800 can include an anchor assembly 804 including a bracket 810 and an anchor 812. The anchor 812 can include an anchor sleeve 814 and a suture 816. The bracket 810 can include a head 824 and a body 826, which together define a channel 827 that passes at least partially through the bracket 810 and can be configured to retain at least a portion of the suture 816. The anchor sleeve 814 can include a lumen 828 through which the suture 816 can pass.

[0033] As described in more detail below, the suture 816 can include multiple parts or portions, but may also be a single continuous suture. The suture 816 can include a first free end 830 and a second free end 832 that can be manipulated independently or manipulated together. The first free end 830 and the second free end 832 can be connected to form a free end 834. The suture 816 begins at the first free end 830, enters the bore or opening 846, passes through the channel 827, the suture 816 passes through the lumen 828, re-enters the channel 827, exits the channel 827 again, and can pass through the lumen 828 again before the second free end 832 exits the bracket 810 and connects to the first free end 830.

[0034] The suture 816 can be coupled and configured such that pulling the free end 834 in direction D (when the anchor sleeve 814 engages another surface, such as a rib) can cause the suture 816 to pull the bracket 810 in a direction opposite to direction D, pulling the anchor sleeve 814 in direction D, effectively shortening the loop between the bracket 810 and the anchor sleeve 814. The pulling action deforms the anchor sleeve 814 as the length of the suture 816 is shortened between the bracket 810 and the anchor sleeve 814, allowing the anchor assembly 804 to be used as an anchor.

[0035] Figure 8B shows a schematic view of a portion of an anchor assembly 804, similar to any of the anchor assemblies described above. Figure 8B shows how the suture 816 is connected or positioned.

[0036] 8B schematically illustrates suture 816. Suture 816 is generally a hollow-core suture, allowing 816 to pass through itself at certain locations. Suture 816 may include a first portion 836 including a first free end 830. Suture 816 may also include a second portion 838 including a second free end 832. First portion 836 may be the portion of suture 816 between lines P1-P1, and second portion 838 may be the portion of suture 816 between lines P2-P2. Suture 816 may include a third portion 840, which may be the portion of suture 816 between lines P3-P3, and fourth portion 842 may be the portion of suture 816 between lines P4-P4.

[0037] The suture 816 can define a lumen 844 that passes from the first free end 830 to the second free end 832. The third portion 840 can define a first end bore 846 and a first side bore 848. The fourth portion 842 can define a second end bore 850 and a second side bore 852. Optionally, the bores 846 and 850 can be a single bore.

[0038] The suture 816 can be coupled as follows: The first portion 836 can extend into the first end bore 846 and into the third portion 840 and lumen 844. The first portion 836 can extend from the first side bore 848 and lumen 844 and transition to the fourth portion 842 at lines P1 and P4. The first portion 836, the third portion 840, and the fourth portion 842 can together form a first loop. The fourth portion 842 can transition to the third portion 840 at lines P3 and P4. The third portion can transition to the second portion at lines P3 and P2. The fourth portion 842, the third portion 840, and the second portion 838 can together form a second loop. The second portion 838 can extend through the second side bore 852 to the lumen 844 and the fourth portion 842. Second portion 838 can exit lumen 844 through fourth portion 842 and second end bore 850 .

[0039] 8C shows a cross-sectional view of implant assembly 800C, which may include an anchor assembly 804 similar to anchor assembly 304 described above. FIG. 8C shows in more detail how the anchor assemblies are coupled. Any of the implant assemblies described above or below can be modified to include the features of implant assembly 800.

[0040] Implant assembly 800 can include an anchor assembly 804 including a bracket 810 and an anchor 812. Anchor 812 can include an anchor sleeve 814 and a suture 816. Bracket 810 can include a head 824 and a body 826, which together define a channel 827 that passes at least partially through bracket 810 and is configured to hold at least a portion of suture 816. Anchor sleeve 814 can include a lumen 828 through which suture 816 can pass.

[0041] As described in more detail below, the suture 816 can include multiple portions or sections, but can also be a single continuous suture. The suture 816 can include a first free end 830 and a second free end 832, which can be manipulated independently or together. The first free end 830 and the second free end 832 can be connected to form a free end 834. The suture 816 can begin at the first free end 830, enter the bore 846, pass through the lumen 828, and enter the channel 827. The suture 816 can be wrapped around the bracket 810, exit the channel 827, and re-enter the channel 828 to form a loop. Before the second free end 832 exits the first end bore 846 and connects to the first free end 830, the suture 816 can again pass through the channel 827, re-enter the lumen 828, and pass through the lumen 828 a second time to form a second loop.

[0042] The suture 816 is coupled and configured such that pulling the free end 834 in direction D (when the anchor sleeve 814 is engaged with another surface, such as a rib) may cause the suture 816 to pull the sleeve 814 in a direction opposite direction D, pulling the bracket 810 in direction D, effectively shortening the loop between the bracket 810 and the anchor sleeve 814. The pulling action may deform the anchor sleeve 814 as the suture 816 shortens between the bracket 810 and the anchor sleeve 814, allowing the anchor assembly 804 to be used as an anchor.

[0043] FIG. 9A shows an isometric view of a bracket 910 of an implant assembly. FIG. 9B shows an isometric view of a bracket 910 of an implant assembly. FIGS. 9A and 9B are described together below. The bracket 910 may be similar to the fasteners described above (e.g., bracket 110). The bracket 910 may include a relatively small protrusion. Any of the implant assemblies described above or below can be modified to include the features of the bracket 910.

[0044] The bracket 910 may include a cylindrical head 924 having a relatively small height and rounded edges. The bracket 910 may also include a protrusion 926 extending from one side of the head 924, e.g., from the base or top surface. The protrusion may be configured (e.g., sized or shaped) for at least partial insertion into any of the slots in the plates described above. The protrusion 926 may extend across a diameter (or chord) of the head 924 and define an edge 927 that is engageable with the slot in the plate. When inserted into the slot, the edge 927 of the protrusion 926 may engage the slot and limit rotation of the bracket 910 relative to the slot and plate.

[0045] The bracket 910 may also define a channel 928 configured to receive and retain a suture (e.g., suture 116) at least partially within the bracket 910. The channel 928 may include a first bore 952 and a second bore 954 configured to receive one or more loops of suture (described above). The bores 952 and 954 may be spaced apart from one another to retain a portion of the suture within the channel 928, allowing the bracket 910 to be drawn toward the plate and anchor (e.g., anchor sleeve 114) as the suture is manipulated to tighten the anchor assembly (e.g., implant assembly 100). The channel 928 may be at least partially recessed in the head 924 such that the extension of the suture above the top surface of the head 924 is limited.

[0046] FIG. 10A shows an isometric view of a bracket 1010 of an implant assembly. FIG. 10B shows an isometric view of a bracket 1010 of an implant assembly. FIGS. 10A and 10B are described together below. The bracket 1010 can be similar to the fasteners described above (e.g., bracket 110). The bracket 1010 can include a relatively large protrusion. Any of the implant assemblies described above or below can be modified to include the features of the bracket 1010.

[0047] The bracket 1010 is similar to the bracket 910 described above and may include a head 1024, a protrusion 1026, and a channel 1028. The bracket 1010 may also define bores 1052 and 1054. The bracket 1010 may include the protrusion 1026, which may be relatively cylindrical in shape with slots 1056 and 1058 extending along the length of the protrusion 1026. The protrusion 1026 may be inserted into a bore in the bone and may help limit movement of the rib relative to the plate (e.g., plate 102). The slots 1056 and 1058 may be configured to receive and retain at least a portion of a suture (e.g., suture 116) when the suture 116 is coupled to the bracket 1010.

[0048] FIG. 11A shows a perspective view of the bracket 1110 and anchor 1116 of the implant assembly 1100. FIG. 11B shows a cross-sectional view of the bracket 1110 of the implant assembly 1100. FIGS. 11A and 11B are described together below. The bracket 1110 can be similar to the fasteners (e.g., bracket 110) described above. The bracket 1110 can include barbs to limit suture movement. Any of the implant assemblies described above or below can be modified to include the features of the bracket 1110. Optionally, the anchor 1116 can vary in diameter along its length, which can help reduce engagement between the anchor 1116 and the bracket 1110 until the bracket 1110 approaches the bone and plate (e.g., plate 102).

[0049] The bracket 1110 is similar to the fasteners described above and may include a head 1124, a protrusion 1126, and a channel 1128. The bracket 1110 may include the protrusion 1126 and may include a barb 1160 (which may be a tooth or protrusion) configured to engage the anchor 1116 and limit movement of the anchor 1116 through the bracket 1110 in a single direction. That is, the bracket 1110 can be tightened onto the anchor 1116 but cannot loosen.

[0050] FIG. 12A shows a side view of the bracket 1210 of the implant assembly. FIG. 12B shows a cross-sectional view of the bracket 1210 of the implant assembly. FIGS. 12A and 12B are described together below. The bracket 1210 can be similar to the fasteners described above (e.g., bracket 110). The bracket 1210 can include a locking assembly to limit suture movement. Any of the implant assemblies described above or below can be modified to include the features of the bracket 1210.

[0051] Bracket 1210 is similar to the fasteners described above and can include a head 1224, a protrusion 1226, and a channel 1228. Head 1224 can include a notch 1262 configured to receive an instrument therein for removal or extraction of bracket 1210.

[0052] The protrusion 1226 can include an outer body 1264 and an inner body 1266. The inner body 1266 can extend at least partially into a tapered bore 1268 in the outer body 1264. The inner body 1266 can also be tapered so that it cannot pass completely through the tapered bore 1268.

[0053] The bracket 1210 can also include a biasing element 1270, which can be a spring, such as a compression spring. The biasing element 1270 can engage the head 1224 and the inner body 1266 to urge the inner body 1266 out of the tapered bore 1268. The head 1224 can also include a movable mechanism 1272, which can be, for example, a ball or ball bearing. The ball 1272 can be at least partially disposed within the inner body 1266 and can engage the tapered bore 1268 and extend into the channel 1228. During operation, the biasing element 1270 pushes the inner body 1266 to protrude from the tapered bore 1268, causing the movable mechanism 1272 to engage with the tapered bore 1268 and extend into the channel 1228, and the movable mechanism 1272 can engage with a suture (e.g., the suture 116) disposed within the channel 1228 and limit movement of the suture relative to the bracket 1210.

[0054] Optionally, the inner body 1266 can be moved further into the tapered bore 1268 to overcome the biasing element 1270, allowing the movable mechanism 1272 to move radially outward to release the suture within the channel 1228. In this manner, the bracket 1210 can function as a self-locking fastener that is releasable by movement of the inner body 1266 relative to the outer body 1264.

[0055] FIG. 13A shows a perspective view of a portion of implant assembly 1300. FIG. 13B shows a perspective view of a portion of implant assembly 1300. FIGS. 13A and 13B are described together below. Implant assembly 1300 can be similar to the implant assemblies described above (e.g., implant assembly 100). Implant assembly 1300 can include a toggle anchor for securing the anchor assembly to rib 50. Any of the implant assemblies described above or below can be modified to include the features of implant assembly 1300.

[0056] More specifically, the implant assembly 1300 can include an anchor assembly 1304 including an anchor 1310 coupled to a suture 1316. The anchor 1310 can be an elongated fastener having a rigid or semi-rigid body. For example, the anchor 1310 can have the shape of a cylinder or a hollow cylinder. The anchor 1310 can be sized or shaped so that it can be inserted with the suture 1316 through the hole 60 in the rib 50 when oriented with its axis aligned with the hole 60, as shown in FIG. 13A . Once the anchor 1310 is inserted completely through the hole 60, it can be rotated, with or without assistance, so that its axis is no longer aligned with the hole 60, as shown in FIG. 13B . The anchor assembly 1304 can then be tightened to pull the anchor 1310 against the surface of the rib 50 and restrict the anchor 1310 from reinserting the hole 60.

[0057] FIG. 14A shows an isometric view of a portion of implant assembly 1400. FIG. 14B shows an isometric view of a portion of implant assembly 1400. FIGS. 14A and 14B are described together below. Implant assembly 1400 can be similar to the implant assemblies described above (e.g., implant assembly 100). Any of the implant assemblies described above or below can be modified to include the features of implant assembly 1400.

[0058] 14A illustrates how fasteners can have heads with different profiles. For example, fastener 1410a can include a rounded head 1424a with a protruding projection 1426a, while fastener 1410b can include head 1424b that includes a notch 1462. Notch 1462 allows an instrument to engage head 1424 for adjustment, insertion, or extraction of fastener 1410b.

[0059] 14A and 14B also show that the plate 1402 can include a body 1407 defining a slot 1408 therein. The slot 1408 can include a step 1474, where the slot 1408 includes a counterbore that defines the step 1474. The slot 1408 can also include a bore 1476 extending through the body 1407. The slot 1408 can be configured to allow the protrusion 1426b to be insertable into and at least partially pass through the bore 1476, such that extension or insertion of the bracket 1410 is limited by engagement between the head 1424b and the step 1474. The step 1474 can be positioned or dimensioned such that when the fastener 1410b is fully inserted into 1408, the head 1424b does not extend beyond the outer surface of the body 1407.

[0060] Figure 15A shows an isometric view of the head of the implant assembly bracket 1510. Figure 15B shows an isometric view of the protrusion of the implant assembly bracket 1510. Figure 15C shows an isometric view of the implant assembly bracket 1510. Figures 15A-15C are described together below.

[0061] The bracket 1510 can be similar to the fasteners described above, such as bracket 110. The bracket 1510 can be an assembly of components. For example, the bracket 1510 can include a head 1524 as shown in FIG. 15A and a barrel 1526 as shown in FIG. 15B. The head 1524 can include a notch 1562 similar to the notch described above. The barrel 1526 can include a channel 1528 configured to pass at least a portion of the anchor therethrough.

[0062] Head 1524 can also include a threaded inner bore 1578, and 1526 can include a threaded outer bore 1580 that can be threaded into threaded inner bore 1578, as shown in FIG. 15C, to form 1510. Using notch 1562, head 1524 can be unscrewed from barrel 1526 after assembly for adjustment, modification, or extraction of bracket 1510.

[0063] Figure 16A shows an isometric view of plate 1602A of the implant assembly. Figure 16B shows an isometric view of plate 1602B of the implant assembly. Figure 16C shows an isometric view of plate 1602C of the implant assembly. Figure 16D shows an isometric view of plate 1602D of the implant assembly. Figure 16E shows an isometric view of plate 1602E of the implant assembly. Plates 1602A through 1602E are described together below.

[0064] Any of plates 1602A-1602E can be incorporated into any of the implant assemblies described above. Plates 1602 can be bendable by a user (e.g., a surgeon) during surgery, bendable during implantation (self-moldable), or provided pre-curved to fit the curvature of a patient's ribs. Plates 1602A-1602E may be of different shapes and sizes (e.g., length or width) with different characteristics for use in different procedures. Optionally, plate 1602 can be malleable or bendable in various directions and along multiple axes, allowing for patient-specific curvature of plate 1602. For example, plate 1602A can include an elongated body 1607A defining slots 1608, e.g., three slots. Plate 1608A is relatively flat and can be used in intrathoracic approach procedures where fasteners are not used. Optionally, plate 1602A can include one or more teeth, barbs, or protrusions 1609 configured to engage bone and limit movement of plate 1602 relative to the bone. Any of the plates described herein can include protrusions 1609.

[0065] The plate 1602B can include a body 1607B defining a plurality of slots 1608 (e.g., two slots) and can define a plurality of fastener bores 1622 (e.g., seven bores). The plate 1602B can include bores at the lateral ends of the body 1607B to help secure the plate 1602B to the ribs. Such a plate can be used in procedures using an extrathoracic approach involving one or more fractures.

[0066] The plate 1602C can include a body 1607C that defines a plurality of slots 1608 (e.g., two slots) and can define a plurality of fastener bores 1622 (e.g., seven bores). The plate 1602C can include all of the bores 1622 located between the slots 1608. Such a plate can be used in procedures using an extrathoracic approach involving one or more fractures.

[0067] The plate 1602D can include a body 1607D that defines a plurality of slots 1608 (e.g., four slots) and can define a plurality of fastener bores 1622 (e.g., six bores). The slots 1608 are relatively evenly spaced with the fastener bores 1622, allowing the plate 1602D to be used in an extrathoracic approach with multiple fractures.

[0068] The plate 1602E can include a body 1607E that defines a plurality of slots 1608 (e.g., three slots) and can define a plurality of fastener bores 1622 (e.g., two bores). The slots 1608 are relatively evenly spaced with the fastener bores 1622, allowing the plate 1602E to be used in an extrathoracic approach with multiple fractures.

[0069] Figure 17 shows an isometric view of an implant assembly inserter 1800. Figure 18 shows an isometric view of a portion of the inserter 1800. Figures 17 and 18 are described together below. The inserter 1800 can be used to form a hole in a bone, such as forming hole 60 in a rib 50, and to insert an implant assembly, such as inserting implant assembly 100 into hole 60, as described in more detail below.

[0070] The inserter 1800 can include a body 1882 coupled to a first handle 1884. The inserter 1800 can also include a second handle 1886 rotatably coupled to the body 1882 and coupled to an actuator 1888. The body 1882 can also include an arm 1890 defining a channel 1891. The arm 1890 can also include a retainer 1892 (or guide) defining a bore 1894. The channel 1891 can be configured to at least partially receive and retain a punch 1896. The inserter 1800 can also include a rod (or shaft) 1895 engageable or connectable to the punch 1896. Optionally, the punch 1896 can be coupled to the rod 1895 such that the punch 1896 can be disconnected from the rod 1895. Optionally, the rod 1895 and punch 1896 can be connected via a threaded engagement or one or more fasteners.

[0071] The punch 1896 can include a shaft 1897 and a tip 1898 configured to drill into bone. The shaft 1897 or the tip 1898 can at least partially define a slot 1899. The slot 1899 can be configured to receive and retain at least a portion of an anchor assembly (e.g., anchor assembly 104).

[0072] In operation, the anchor assembly is coupled to punch 1896, and punch 1896 can be inserted into channel 1891. Retainer 1892 can then be hooked around a rib and, optionally, around a plate (e.g., plate 102), with tip 1898 aligned with a channel (e.g., bore 108) in the plate. First handle 1884 and second handle 1886 can then be manipulated to actuate actuator 1888, forcing punch 1896 through channel 1891 and toward bone, forming a hole (e.g., bore 60) in the bone (e.g., rib 50) through which at least a portion of the anchor assembly can pass. Tip 1898 can optionally extend at least partially into bore 1894.

[0073] Once the hole is formed, the punch 1896 can be retracted using the first handle 1884 and the second handle 1886, or manually, and the punch 1896 can be removed from the newly formed hole. Optionally, the inserter 1800 can include a biasing member (e.g., a spring) engageable with the first handle 1884 and the second handle 1886 to urge the handles into a retracted position and automatically retract the second handle 1886 when the handles are released.

[0074] Due to the shape of slot 1899, when punch 1896 is retracted, the anchor assembly is released from punch 1896, with at least a portion of the anchor assembly (e.g., anchor sleeve 114) remaining on the opposite side of the hole and at least a portion of the suture (e.g., suture 116) passing through the hole. Following hole formation and anchor assembly insertion, the process can be repeated as needed, and anchor assemblies (such as those described above) can be used to reduce rib segments and secure plates to the ribs, as described above.

[0075] 19 shows an isometric view of an inserter punch 1996. The punch is similar to punch 1896 described above and can operate with inserter 1800. Punch 1996 can include a shaft 1997 and a tip 1998 configured to penetrate bone. Shaft 1997 or tip 1998 can at least partially define a slot 1999. Slot 1999 can be configured to receive and retain at least a portion of an anchor assembly (e.g., anchor assembly 104). Optionally, shaft 1997 can be cannulated or can include a cannula for at least partially accommodating at least a portion of the anchor assembly therein or therethrough.

[0076] 20 shows an enlarged view of implant assembly 2000, which may be similar to implant assembly 300 described above, but may include a tag woven into the anchor sleeve. Any of the implant assemblies described above or below may be modified to include the features of implant assembly 2000. Although only a portion of implant assembly 2000 is shown, implant assembly 2000 may include any of the brackets, plates, and other components of the implant assemblies described above or below.

[0077] The implant assembly 2000 can include an anchor assembly 2004 that can include a bracket and an anchor 2012. The anchor 2012 can include an anchor sleeve 2014, a suture 2016, and a leader suture 2018 that includes a tag 2020. At least a portion of the suture 2016 can pass through one or more openings in the anchor sleeve 2014. The suture 2016 can pass at least partially through a longitudinal opening in the anchor sleeve 2014 and can also pass through the bracket. The leader suture 2018 can be coupled to the anchor sleeve 2014, such as by being woven into the anchor sleeve 2014 at a link 2023. Optionally, the leader suture 2018 can be combined with the anchor sleeve 2014.

[0078] In some example operations, the leader suture 2018 is inserted through the holes in the plate and rib and can be used to pull the anchor sleeve 2014 through the plate and hole without deforming it. Because the leader suture 2018 is connected to the end (or a portion near the end) of the anchor sleeve 2014, the anchor sleeve 2014 can pass through the plate and bone hole without folding in half, which reduces engagement and friction when passing the anchor 2012 through the plate and bone, helping to improve deployment speed.

[0079] Once the anchor sleeve 2014 is inserted through the bore in the plate and the hole in the rib (e.g., first rib portion 54), the sleeve 2014 can engage the extrathoracic side of the rib 50. At this point, the tag 2020 can be actuated or manipulated to release the leader suture 2018 from the anchor sleeve 2014, removing the leader suture 2018 from the anchor 2012 (e.g., anchor sleeve 2014).

[0080] Figure 21A shows an isometric view of the anchor 2112 of the implant assembly 2. Figure 21B shows an isometric view of the anchor 2112 of the implant assembly. Figure 21C shows an isometric view of the anchor 2112 of the implant assembly. The anchor 2112 is similar to the anchors described above and may include deployable tabs. Any of the systems described above or below can be modified to include the functionality of the anchor 2112.

[0081] The anchor 2112 can include deployable tabs 2150 configured to deploy radially outward after insertion of the anchor 2112 through the bone and plate. The tabs 2150 can engage the bone or plate after deployment and help compress the bone and plate. The anchor 2112 can optionally include a threaded shank.

[0082] Figure 22 shows a perspective view of an implant assembly 2200 installed in a rib 50 using a hybrid intrathoracic or intercostal approach for an intrathoracic plate. Figure 22 also shows that the rib 50 includes a fracture 52. The rib can include a first rib portion 54 and a second rib portion 56. Figure 22 also shows an incision 62.

[0083] Implant assembly 2200 is similar to the implant assemblies described above, such as implant assembly 300 (or other assemblies), and elements having similar reference numbers may be similarly configured. Implant assembly 2200 may be configured for a hybrid intrathoracic or intrathoracic approach to installing an intrathoracic plate. Any of the implant assemblies described above or below may be modified to include the functionality of implant assembly 2200.

[0084] Implant assembly 2200 can include a plate 2202 including a body 2207 that can be curved to conform to the intrathoracic or internal surface of rib 50. Body 2207 can also include a bore (which can be formed as a slot) configured to at least partially accommodate anchor assemblies 2204a and 2204b. Each anchor assembly 2204a and 2204b can include a bracket 2210a and 2210b and an anchor 2212a and 2212b, respectively. Anchors 2212 are suture anchors and can each include an anchor sleeve 2214 (e.g., anchor sleeves 2214a and 2214b) and a suture 2216 (e.g., sutures 2216a and 2216b). At least a portion of suture 2216 can pass through an opening in anchor sleeve 2214 (similar to opening 321 shown in FIG. 4B ). The suture 2216 passes at least partially through a longitudinal opening in the anchor sleeve 2214 and may also pass through the bracket 2210 .

[0085] Leader suture 2218a can be coupled to anchor sleeve 2214a, and leader suture 2218b can be coupled to anchor sleeve 2214b. Optionally, tags 2220 (e.g., 2220a and 2220b) can be coupled to leader suture 2218a and leader suture 2218b, respectively, and the tags can be manipulated or pulled to release leader suture 2218 from its respective anchor sleeve 2214. Tags 2220 can be similar to tag 320 (or others described above). Optionally, suture 2216a can be coupled to leader suture 2218a, and suture 2216b can be coupled to leader suture 2218b, allowing suture 2216 and anchor sleeve 2214 to be pulled through hole 60 without deformation.

[0086] In operation or assembly, a first hole 60 can be formed in the first rib portion 54 and a second hole 60 can be formed in the rib portion 56, for example, by drilling holes through the first rib portion 54 and the rib portion 56. Additionally, an incision 62 can be made at a location or portion near the rib 50, for example, near the fracture 52. Leader suture 2218a and suture 2216a are inserted through bracket 2210a (which can optionally be pre-assembled) and implant or plate 2202, and leader suture 2218b and suture 2216b are inserted through bracket 2210b and implant or plate 2202 until anchor 2212 and anchor sleeve 2214 pass through plate 2202. Leader sutures 2218a and 2218b and sutures 2216a and 2216b can then be inserted through incision 62 into the patient's chest cavity, through holes 60 in first rib section 54 and rib section 56, respectively, and exit the chest cavity. Optionally, multiple holes 60 can be created to allow for the use of multiple anchor assemblies within a single slot of plate 2202.

[0087] Optionally, a snare can be inserted into the thoracic cavity through the first bore, exit the thoracic cavity through the incision 62, grasp the free end 2230a with forceps (or a similar instrument), and use the snare to pull the free end 2230a through the incision and the hole 60 in the rib portion 54, and the free end 2230b through the incision and the hole 60 in the rib portion 56.

[0088] Once leader suture 2218 and suture 2216 have at least partially passed through hole 60, plate 2202 can be inserted through incision 62 and engaged with the internal or intrathoracic portion of first rib portion 54 and rib portion 56, e.g., the portion spanning fracture 52. Brackets 2210a and 2210b can also be inserted through the incision and engaged with plate 2202. After insertion through incision 62 (or while plate 2202 is being inserted), plate 2202 can be rotated so that the curvature of plate 2202 matches the internal or intrathoracic curvature of rib 50.

[0089] The anchor sleeves 2214 of anchor assembly 2204 can each be similar to the anchor sleeves described above (e.g., similar to anchor sleeve 814 of implant assembly 800C). The anchor sleeves 2214 can each define a longitudinal bore passing at least partially therethrough, with first anchor sleeve 2214a and second anchor sleeve 2214b each being deformable from a first shape to a second shape. A suture 2216a can then pass at least partially through the longitudinal bore to couple anchor sleeve 2214a to suture 2216a. Similarly, suture 2216b can pass at least partially through the longitudinal bore to couple anchor sleeve 2214b to suture 2216b.

[0090] When plate 2202 and anchor assemblies 2204a and 2204b are in position relative to rib 50, tag 2220 can be manipulated or pulled to release leader suture 2218 from each anchor sleeve 2214 prior to deformation of anchor sleeve 2214. Suture 2216a can then be manipulated to fasten first anchor assembly 2204a to implant 2202 and rib portion 54, and suture 2216b can be manipulated to fasten second anchor assembly 2204b to implant 2202 and rib portion 56. Once the anchor assemblies are fastened, free end 2230a can be manipulated to transform anchor sleeve 2214a from a first shape to a second shape and fasten anchor assembly 2204a to implant 2202 and rib portion 54. Similarly, the free end 2230b can be manipulated to transform the anchor sleeve 2214b from a first shape to a second shape to fasten the anchor assembly 2204b to the implant 2202 and the rib portion 56.

[0091] Either before, after, or partially after deformation of the anchor sleeves, the sutures 2216a and 2216b can be used to approximate or reduce the first rib portion 54 and the second rib portion 56. After reduction, the anchor sleeves 2214a and 2214b can be fully deformed to tighten the anchor assemblies 2204a and 2204b, if desired.

[0092] Optionally, the suture 2216 of either anchor assembly can be inserted into the washer 2231 before tightening or deformation. For example, the free end 2230b can be inserted into the washer 2231 and the anchor sleeve 2214b can be threaded through the washer 2231, thereby engaging the washer 2231 with the outer surface or extrathoracic portion of the rib portion 56. The anchor sleeve 2214b can then be tightened or deformed to engage the washer 2231, positioning the washer 2231 between the deformed anchor sleeve 2214b and the rib portion 56. This helps to reduce pressure on the rib portion 56 near the hole 60 and limit pullout of the anchor sleeve 2214b during or after tightening. Optionally, an open washer can be placed around the suture 2216 so that the suture 2216 does not need to pass through the washer 2231.

[0093] Once the anchor sleeve 2214 is deformed, a tensioner can be applied to the first and second anchor assemblies to tighten the anchor assemblies to a desired force or pressure. Optionally, the tensioner can be used to tighten the first and second anchor assemblies multiple times. After tightening, the first suture 2216a and the second suture 2216b can be trimmed near the first anchor sleeve 2214a and the second anchor sleeve 2214b, respectively.

[0094] Such a procedure can provide a minimally invasive process for repairing fractured ribs while placing an intrathoracic plate without having to deflate or "descent" the lungs for access.

[0095] 23 shows a perspective view of an implant assembly 2300 installed on a rib 50 for installing an extrathoracic plate or implant using an intercostal approach. FIG. 23 also shows that the rib 50 includes a fracture 52. The rib can include a first rib portion 54, a second rib portion 56, and a third portion 58.

[0096] Implant assembly 2300 may be similar to the implant assemblies described above, such as implant assemblies 100 or 500 (or other assemblies), and elements having like reference numbers may be similarly configured. Implant assembly 2300 may include leader sutures 2318 attached to each anchor sleeve. Implant assembly 2300 may be configured for an intercostal approach for an extrathoracic plate. Any of the implant assemblies described above or below may be modified to include the features of implant assembly 2300.

[0097] The implant assembly 2300 can include a plate 2302 including a body 2307 that can be curved to fit the extrathoracic or external surface of the rib 50. The body 2307 can also include bores (which may be formed as slots or slots) configured to receive anchor assemblies 2304a and 2304b. Each anchor assembly 2304a and 2304b can include a bracket 2310a and 2310b and an anchor 2312a and 2312b, respectively. The anchors 2312 are suture anchors and can each include an anchor sleeve 2314 (e.g., anchor sleeves 2314a and 2314b) and a suture 2316 (e.g., sutures 2316a and 2316b). At least a portion of the suture 2316 can pass through an opening in the bracket 2310. Each suture 2316 can also pass at least partially through a longitudinal opening in the respective anchor sleeve 2314. Leader suture 2318a can be coupled to anchor sleeve 2314a, and leader suture 2318b can be coupled to anchor sleeve 2314b. Optionally, a tag 2320 (e.g., 2320a) can be coupled to each of leader suture 2318a and leader suture 2318b such that manipulating or pulling the tag can release leader suture 2318 from its respective anchor sleeve 2314. Tag 2320 can be similar to tag 320 (or others described above).

[0098] During operation or assembly, a first hole 60 can be formed in the first rib portion 54 and a second hole 60 can be formed in the rib portion 56 by drilling holes through the first rib portion 54 and the rib portion 56. Additionally, an incision 62 can be formed at a location or portion near the rib 50, for example, near the fracture 52. Leader suture 2318a can be inserted through bracket 2310a and implant or plate 2302, and leader suture 2318b can be inserted through bracket 2310b and implant or plate 2302, for example, until anchor 2312 and anchor sleeve 2314 pass through plate 2302 (which may optionally be pre-assembled).

[0099] Leader sutures 2318a and 2318b may be inserted through holes 60 in first rib portion 54 and rib portion 56, respectively, enter the thoracic cavity, and then exit the thoracic cavity through incision 62. Optionally, a snare or forceps may be inserted into incision 62 to grasp leader suture 2318 and pull it through incision 62.

[0100] After (or before) the leader suture 2318 has at least partially passed through the incision 62 (optionally when the suture sleeve has passed through the incision 62), the plate 2302 can be inserted through the incision (e.g., a separate incision in addition to the incision 62 that provides access to the rib 50) and engaged with the outer or extrathoracic portions of the first rib portion 54 and the rib portion 56 so as to span the fracture 52. Additionally, brackets 2310a and 2310b can be inserted through the incision and engaged with the plate 2302, and optionally inserted at least partially into the holes 60. Optionally, the brackets 2310 can be pre-assembled with the plate 2302. At this point, the anchor sleeve 2314 can be moved or positioned on the extrathoracic side of the rib 50.

[0101] The anchor sleeves 2314 of the anchor assembly 2304 may each be similar to the anchor sleeves described above (e.g., similar to the anchor sleeve 814 of the implant assembly 800). The anchor sleeves 2314 may each define a longitudinal bore passing at least partially therethrough, with the first anchor sleeve 2314a and the second anchor sleeve 2314b each being deformable from a first shape to a second shape. The suture 2316a may then pass at least partially through the longitudinal bore to couple the anchor sleeve 2314a to the suture 2316a. Similarly, the suture 2316b may pass at least partially through the longitudinal bore to couple the anchor sleeve 2314b to the suture 2316b. The tag 2320 may be manipulated or pulled to release the leader suture 2318 from each anchor sleeve 2314 prior to deformation of the anchor sleeves 2314.

[0102] When the plate 2302 and anchor assemblies 2304a and 2304b are in position relative to the plate and rib 50, the suture 2316a can be manipulated to fasten the first anchor assembly 2304a to the implant 2302 and rib portion 54, and the suture 2316b can be manipulated to fasten the second anchor assembly 2304b to the implant 2202 and rib portion 56. Once the anchor assemblies are fastened, the free end 2330a can be manipulated to transform the anchor sleeve 2314a from a first shape to a second shape to fasten the anchor assembly 2304a to the implant 2302 and rib portion 54. Similarly, the free end 2330b can be manipulated to transform the anchor sleeve 2314b from a first shape to a second shape to fasten the anchor assembly 2304b to the implant 2302 and rib portion 56.

[0103] Either before, after, or with partial deformation of the anchor sleeves, the sutures 2316a and 2316b can be used to approximate or reduce the first and second rib portions 54 and 56. If desired, the anchor sleeves 2314a and 2314b can be fully deformed after reduction to tighten the anchor assemblies 2304a and 2304b.

[0104] Optionally, before fastening or deformation and after removal of leader suture 2320, leader suture 2318 of either anchor assembly can be inserted through washer 2331. For example, leader suture 2318b can be inserted through washer 2331, with anchor sleeve 2314a passing through washer 2331, so that washer 2331 engages the interior surface or intrathoracic portion of rib portion 54. Optionally, after removal of leader suture 2318b, washer 2331 can be passed over anchor sleeve 2314b. The anchor sleeve 2314b can then be fastened or deformed to engage washer 2331, so that washer 2331 is positioned between the deformed anchor sleeve 2314a and rib portion 54. This relieves pressure on rib portion 54 near hole 60 and helps limit pullout of anchor sleeve 2314b during or after fastening.

[0105] Once the anchor sleeve 2314 is deformed, tensioners can be applied to the first and second anchor assemblies to tighten the anchor assemblies to a desired force or pressure. After tightening, the first and second sutures 2316a and 2316b can be trimmed near the first and second anchor sleeves 2314a and 2314b, respectively.

[0106] Such a procedure can provide a minimally invasive process for repairing fractured ribs while placing an extrathoracic plate without having to deflate or "descent" the lungs for access.

[0107] FIG. 24 shows a perspective view of an implant assembly 2400 attached to a rib 50 using a hybrid intrathoracic or intrathoracic approach. FIG. 24 also shows that the rib 50 includes a fracture 52. The rib can include a first rib portion 54, a second rib portion 56, a third rib portion 58, and a fourth rib portion 59. FIG. 24 also shows extrathoracic and intrathoracic orientations. FIG. 24 illustrates how the devices and methods described herein can be used to secure a plate to the opposite side of the rib 50, such as with a stacking or rail loading technique.

[0108] 24 shows how a first plate 2402a is secured to the outer thoracic sides of the first rib segment 54 and rib segment 56 spanning the first fracture 52, a second plate 2402b is secured to the outer thoracic sides of the third rib segment 58 and fourth rib segment 59 spanning the second fracture 52, and a third plate 2402c is secured to the inner thoracic sides of the rib segment 56 and third segment 58 spanning the third fracture 52. In this manner, multiple plates can be used to repair multi-segment or multi-fractured ribs using a relatively small number of holes.

[0109] For example, anchor assembly 2404a (including bracket 2410a, anchor sleeve 2414a, and washer 2431a) can be secured to first plate 2402a and first rib portion 54 through a bore in first rib portion 54. Anchor assembly 2404b (including bracket 2410b, anchor sleeve 2414b, and washer 2431b) can be secured to rib portion 56, first plate 2402a, and third plate 2402c through a bore in rib portion 56. Anchor assembly 2404c (including bracket 2410c, anchor sleeve 2414c, and washer 2431c) can be secured to rib portion 58, second plate 2402b, and third plate 2402c through a bore in rib portion 58. Anchor assembly 2404d (including bracket 2410d, anchor sleeve 2414d, and washer 2431d) can then be secured to third plate 2402c and fourth rib portion 59 through a bore in fourth rib portion 59. In this manner, three plates or implants can be secured to four rib segments using only four anchor assemblies, optionally without the use of screws.

[0110] Notes and Examples The following non-limiting examples detail particular aspects of the present subject matter that solve the problems and provide the benefits discussed herein.

[0111] Example 1 is an implant assembly fixable to a human rib, the implant including an elongated body engageable with a surface of the rib, the elongated body defining a first bore and a second bore, each extending at least partially through the body; an anchor at least partially insertable into a hole formed in the rib and at least partially insertable into the first bore; and a bracket engageable with the implant and configured to be received through at least a portion of the anchor, the anchor being operable (or deployable) to secure the bracket and anchor to the implant and the rib.

[0112] In Example 2, the subject matter of Example 1 optionally includes the anchor comprising: an anchor sleeve defining a longitudinal bore extending at least partially therethrough, the anchor sleeve being deformable from a first shape to a second shape; and a suture extending at least partially through the longitudinal bore and connecting the sleeve to the suture, the suture including first and second free ends manipulated to deform the anchor sleeve to the second shape.

[0113] In Example 3, the subject matter of Example 2 optionally includes the suture comprising a first portion including a first free end and a second portion including a second free end, the first free end and the second free end being coupled to one another and operable to deform the anchor sleeve to the second shape.

[0114] In Example 4, the subject matter of Example 3 optionally includes: the suture defining a lumen therethrough; the suture including a third portion defining a first end bore and a first side bore; and the suture including a fourth portion defining a second end bore and a second side bore. the first portion extends into the first end bore and the third portion and the lumen; the first portion transitions into the fourth portion; the first portion, the third portion, and the fourth portion together form a first loop; the fourth portion transitions into the third portion; the third portion transitions into the second portion; the fourth portion, the third portion, and the second portion together form a second loop; the second portion extends through the second side bore to the lumen and the fourth portion; the second portion passes through the second end bore, exits the lumen, and connects to the first portion; and the first free end and the second free end are operable to adjust the size of the first loop and the size of the second loop.

[0115] In Example 5, the subject matter of Example 4 may optionally include the first free end and the second free end extending through the bracket and operable to deform the anchor sleeve and adjust the dimensions of the first loop and the second loop.

[0116] In Example 6, the subject matter of any one or more of Examples 4 to 5 may optionally include the bracket defining a bracket bore extending at least partially therethrough, and the suture extending at least partially through the bracket bore to secure the anchor to the bracket.

[0117] In Example 7, the subject matter of any one or more of Examples 4 to 6 may optionally include that the first free end and the second free end extend through the anchor sleeve and are operable to deform the anchor sleeve and adjust the dimensions of the first loop and the second loop.

[0118] In Example 8, the subject matter of Example 7 can optionally include the anchor including a leader coupled to the anchor sleeve and insertable through the hole in the rib and the bore in the implant to retract the anchor sleeve through the hole in the rib and the bore in the implant.

[0119] In Example 9, the subject matter of Example 8 can optionally include wherein the anchor includes a tag coupled to the reader and operable to release the leader from the anchor sleeve.

[0120] In Example 10, the subject matter of any one or more of Examples 1 to 9 may optionally include the first bore of the implant defining a longitudinal slot extending along the elongated body of the implant, and at least one of the anchor and the bracket being movable along the longitudinal slot to move the anchor and the bracket relative to the implant.

[0121] In Example 11, the subject matter of Example 10 may optionally include that the bracket includes a head and a protrusion, the head being engageable with the surface of the implant, and the protrusion being at least partially insertable into the slot to limit rotation of the bracket relative to the implant.

[0122] In Example 12, the subject matter of Example 11 can optionally include the second bore of the implant defining a second longitudinal slot extending along the elongate body of the implant.

[0123] In Example 13, the subject matter of Example 12 may optionally include the protrusion comprising a barrel threadably engageable with the bracket, the barrel at least partially insertable into the longitudinal slot, the barrel defining a barrel bore configured to accommodate at least a portion of the anchor.

[0124] In Example 14, the subject matter of Example 13 can optionally include, wherein the barrel includes a protrusion extending at least partially into the barrel bore, the protrusion configured to engage the anchor to allow movement relative to the barrel in a first direction and restrict movement of the anchor in a second direction opposite the first direction.

[0125] Example 15 is a method for securing an implant to a human bone, the method including: loading a first anchor assembly into an inserter; engaging the implant with a first rib portion; forming a first hole in the first rib portion using the inserter; inserting the first anchor assembly at least partially through the first bore; removing the inserter from the first hole; inserting a first bracket of the first anchor assembly at least partially into the first bore of the implant; and manipulating a first suture of the first anchor assembly to fasten the first anchor assembly to the implant and the first rib portion.

[0126] In Example 16, the subject matter of Example 15 can optionally include inserting the anchor while the inserter creates the first hole.

[0127] In Example 17, the subject matter of any one or more of Examples 15 to 16 may optionally include loading a second anchor assembly into an inserter, engaging the implant and the second rib portion, forming a second hole in the second rib portion, inserting the second anchor assembly at least partially through the second hole, removing the inserter from the second bore, inserting a second bracket of the second anchor assembly into the second hole in the implant, and manipulating a second suture of the second anchor assembly to fasten the second anchor assembly to the implant and the second rib portion.

[0128] In Example 18, the subject matter of Example 17 can optionally include reducing the first and second rib portions using the first and second anchor assemblies.

[0129] In Example 19, the subject matter of Example 18 can optionally include tensioning the first anchor assembly and the second anchor assembly using a tensioner and trimming the first suture and the second suture near the first bracket and the second bracket, respectively.

[0130] Example 20 is a method for securing an implant to a human bone, the method including forming a first hole in a first rib portion, inserting at least a portion of a first anchor assembly at least partially through the first hole using an inserter, removing the inserter from the first hole, engaging the first rib portion with the implant, inserting a first bracket of the first anchor assembly at least partially into the first hole of the implant, and manipulating a first suture of the first anchor assembly to fasten the first anchor assembly to the implant and the first rib portion.

[0131] In Example 21, the subject matter of Example 20 optionally further includes inserting the first anchor assembly at least partially through the first hole portion, which may include pulling the leader suture through the first hole portion and the first bore to retract the first anchor assembly at least partially through the first hole portion.

[0132] In Example 22, the subject matter of Example 21 can optionally include pulling a tag coupled to the leader suture to release the leader suture from the first anchor.

[0133] In Example 23, the subject matter of any one or more of Examples 20 to 22 may optionally include forming a second hole in a second portion of the rib, inserting at least a portion of a second anchor assembly at least partially through the second hole using an inserter, removing the inserter from the second hole, engaging the implant with the second rib portion, inserting a second bracket of the first suture anchor assembly at least partially into the second bore of the implant, and manipulating a second suture of the first anchor assembly to fasten the second anchor assembly to the implant and the second rib portion.

[0134] In Example 24, the subject matter of Example 23 may optionally include reducing the first and second rib portions using the first and second anchor assemblies, tensioning the first and second anchor assemblies using a tensioner, and trimming the first and second sutures.

[0135] Example 25 is a method of securing an implant to a patient's bone, the method including: forming a first hole in a first rib portion; creating an incision near the first rib portion; inserting a first suture of a first anchor assembly through the incision into the patient's chest cavity and out of the chest cavity through a first bore inside the first rib portion; inserting an implant through the incision and engaging with the interior of the first rib portion; inserting a first bracket of the first anchor assembly through the incision and engaging with the implant, the first suture being connected to the first bracket; and manipulating the first suture of the first anchor assembly to tighten the first anchor assembly to the implant and the first rib portion.

[0136] In Example 26, the subject matter of Example 25 may optionally include inserting a first anchor sleeve of a first anchor assembly through the implant, through the incision, and through at least the first hole, the first anchor sleeve defining a longitudinal bore at least partially therethrough, the first anchor sleeve being deformable from a first shape to a second shape, a first suture passing at least partially through the longitudinal bore to couple the first anchor sleeve to the first suture, and manipulating a free end of the first suture to deform the first anchor sleeve to the second shape to engage with the first rib portion and fasten the first anchor assembly to the implant and the first rib portion.

[0137] In Example 27, the subject matter of Example 26 may optionally include inserting the first suture and first anchor sleeve through the washer after passing through the first hole, engaging the deformed first anchor sleeve with the washer, and engaging the washer with the first rib portion.

[0138] In Example 28, the subject matter of any one or more of Examples 26 to 27 may optionally include forming a second hole in the second rib portion, inserting a second suture of the second anchor assembly through the incision into the thoracic cavity and out of the thoracic cavity through the second hole inside the second rib portion, engaging an implant with the inside of the second rib portion, inserting a second bracket of the second anchor assembly through the incision and engaging it with the implant, the second suture being coupled to the second bracket, and manipulating the second suture of the second anchor assembly to tighten the second anchor assembly to the implant and the second rib portion.

[0139] In Example 29, the subject matter of Example 28 can optionally include reducing the first rib portion and the second rib portion using the first anchor assembly and the second anchor assembly.

[0140] In Example 30, the subject matter of any one or more of Examples 28 to 29 may optionally include inserting a second anchor sleeve of a second anchor assembly through the implant, through the incision, and through at least the second hole, the second anchor sleeve defining a longitudinal bore at least partially therethrough, the second anchor sleeve being deformable from a first shape to a second shape, a second suture extending at least partially through the longitudinal bore, coupling the second anchor sleeve to the second suture, and manipulating a free end of the second suture to deform the second anchor sleeve to the second shape and fasten the second anchor assembly to the implant and the second rib portion.

[0141] In Example 31, the subject matter of Example 30 may optionally include tensioning the first anchor assembly and the second anchor assembly using a tensioner and trimming the first suture and the second suture near the first anchor sleeve and the second anchor sleeve, respectively.

[0142] In Example 32, the subject matter of any one or more of Examples 25 to 31 may optionally include inserting a snare into the thoracic cavity through the first bore and out of the thoracic cavity through the incision, grasping a first suture with the snare, and outgoing the first suture through the incision and out of the first bore, and using the snare to pull the first suture through the incision and the first bore.

[0143] Example 33 is a method of securing an implant to a patient's bone, the method including forming a first bore in a first rib portion, creating an incision near the first rib portion, inserting a first suture of a first anchor assembly through the first bore into the patient's chest cavity and out of the chest cavity through the incision, engaging an exterior of the first rib portion with the implant, inserting a first bracket of the first anchor assembly at least partially through the implant, the first suture being coupled to the first bracket, and manipulating the first suture of the first anchor assembly to fasten the first anchor assembly to the implant and the first rib portion.

[0144] In Example 34, the subject matter of Example 33 optionally includes inserting a first anchor sleeve of a first anchor assembly through the implant and the first bore, the first anchor sleeve defining a longitudinal bore extending at least partially therethrough and deformable from a first shape to a second shape, a first suture passing at least partially through the longitudinal bore to couple the first anchor sleeve to the first suture, and manipulating a free end of the first suture to deform the first anchor sleeve to the second shape and engage the first rib portion to fasten the first anchor assembly to the implant and the first rib portion.

[0145] In Example 35, the subject matter of Example 34 optionally includes inserting the first suture and the first anchor sleeve through the first bore and then through the washer, and engaging the washer with the deformed first anchor sleeve such that the washer engages the first rib portion.

[0146] In Example 36, the subject matter of any one or more of Examples 34 to 35 optionally includes forming a second bore in the second rib portion; inserting a second suture of a second anchor assembly through the second bore in the thoracic cavity and exiting the thoracic cavity through the incision; engaging an outer portion of the second rib portion with the implant; at least partially inserting a second bracket of the second anchor assembly into the implant and connecting the second suture to the second bracket; and manipulating the second suture of the second anchor assembly to fasten the second anchor assembly to the implant and the second rib portion.

[0147] In Example 37, the subject matter of Example 36 optionally includes reducing the first and second rib portions using the first and second anchor assemblies.

[0148] In Example 38, the subject matter of any one or more of Examples 36 to 37 optionally includes inserting a second anchor sleeve of a second anchor assembly through the implant and the second bore, the second anchor sleeve defining a longitudinal bore extending at least partially therethrough and deformable from a first shape to a second shape, a second suture passing at least partially through the longitudinal bore to couple the second anchor sleeve to the second suture, and manipulating a free end of the second suture to deform the first anchor sleeve to the second shape and engage the second rib portion to fasten the second anchor assembly to the implant and the second rib portion.

[0149] In Example 39, the subject matter of Example 38 optionally includes reducing the first and second rib portions using the first and second anchor assemblies, tensioning the first and second anchor assemblies using a tensioner, and trimming the first and second sutures.

[0150] In Example 40, the subject matter of any one or more of Examples 33 to 39 optionally includes inserting a first anchor assembly at least partially through the first bore, which may include pulling a leader suture coupled to the first suture through the first bore and the implant, and pulling the first anchor assembly at least partially through the first bore.

[0151] In Example 41, the subject matter of Example 40 optionally includes pulling a tag coupled to the leader suture to release the leader suture and the tag from the first anchor assembly.

[0152] In Example 42, the device or method of any one or any combination of Examples 1 to 41 can be optionally configured so that all of the described elements or options can be used or selected.

[0153] The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "examples." Such examples may include elements in addition to those shown or described. However, the inventors also contemplate examples in which only those elements shown or described are provided. Furthermore, the inventors also contemplate examples using any combination or permutation of the elements (or one or more aspects thereof) shown or described. This may be with respect to the particular example (or one or more aspects thereof) or with respect to any other example (or one or more aspects thereof) shown or described herein.

[0154] In the event of a conflict in usage between this specification and a document incorporated by reference, the usage in this specification shall control. In this document, the terms "comprises" and "in which" are used as the plain English equivalents of the respective terms "comprising" and "in which." Also, in the claims that follow, the terms "comprises" and "comprising" are open-ended, meaning that systems, devices, articles, compositions, formulations, or processes that include elements in addition to the elements listed after such term in a claim are considered to be within the scope of that claim.

[0155] In this document, the terms "a" or "an" are used, as is common in patent documents, to include one or more, regardless of other instances or uses of "at least one" or "one or more." In this document, the term "or" is used to refer to a non-exclusive "or," such that "A or B" includes "A but not B," "B but not A," and "A and B," unless otherwise indicated. In this document, the terms "comprises" and "in which" are used as the plain English equivalents of the respective terms "comprising" and "in which." Also, in the following claims, the terms "comprising" and "wherein" are open-ended, meaning that systems, devices, articles, compositions, formulations, or processes that include elements in addition to the elements listed after such term in a claim are considered to be within the scope of that claim. Furthermore, in the following claims, the terms "first," "second," "third," etc. are used merely as labels and are not intended to impose numerical requirements on their objects.

[0156] The above description is intended to be illustrative, not limiting. For example, the above examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments may be utilized by those of ordinary skill in the art after reviewing the above description. The Abstract is provided to comply with 37 CFR §1.72(b) to enable the reader to quickly grasp the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to simplify the disclosure. This should not be construed as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may reside in fewer than all features of a particular disclosed embodiment. Accordingly, the following claims are incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as an embodiment, and it is intended that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full range of equivalents to which such claims are entitled.

Claims

1. 1. An implant assembly securable to a human rib, comprising: an implant including an elongated body engageable with a surface of the rib, the elongated body defining a first bore and a second bore, each extending at least partially therethrough; an anchor at least partially insertable into a hole formed in the rib, the anchor at least partially insertable into the first bore; a bracket engageable with the implant and configured to receive at least a portion of the anchor therein, the anchor being operable to secure the bracket and anchor to the implant and the rib; An implant assembly comprising:

2. The anchor is an anchor sleeve defining a longitudinal bore extending at least partially therethrough, the anchor sleeve being deformable from a first shape to a second shape; a suture extending at least partially through the longitudinal bore and joining the sleeves, the suture including first and second free ends manipulable to deform the anchor sleeve into the second shape; and The implant assembly of claim 1 , comprising:

3. The suture is a first portion including the first free end and a second portion including the second free end, the first free end and the second free end coupled to one another and operable to deform the anchor sleeve to the second shape; The implant assembly of claim 2 .

4. the suture defines a lumen extending therethrough; the suture includes a third portion defining a first end bore and a first side bore; the suture includes a fourth portion defining a second end bore and a second side bore; the first portion extends into the first end bore, the third portion, and the lumen; the first portion transitions into the fourth portion; the first portion, the third portion, and the fourth portion together form a first loop; the fourth portion transitions into the third portion, and the third portion transitions into the second portion; the fourth portion, the third portion, and the second portion together form a second loop; the second portion extends through the second side bore to the lumen and to the fourth portion; the second portion extends out of the lumen through the second end bore and connects with the first portion; The implant assembly of claim 3 , wherein the first free end and the second free end are manipulable to adjust the size of the first loop and the size of the second loop.

5. 5. The implant assembly of claim 4, wherein the first free end and the second free end extend through the bracket, and the first free end and the second free end are operable to deform the anchor sleeve and adjust the size of the first loop and the size of the second loop.

6. 6. The implant assembly of claim 4 or claim 5, wherein the bracket defines a bracket bore extending at least partially therein, and the suture extends at least partially through the bracket bore to secure the anchor to the bracket.

7. 7. The implant assembly of claim 4, wherein the first free end and the second free end extend through the anchor sleeve, and the first free end and the second free end are operable to deform the anchor sleeve and adjust the size of the first loop and the size of the second loop.

8. 8. The implant assembly of claim 7, wherein the anchor comprises a leader coupled to the anchor sleeve and insertable through the hole in the rib and the bore in the implant to pull the anchor sleeve through the hole in the rib and the bore in the implant.

9. The implant assembly of claim 8 , wherein the anchor comprises a tag coupled to the leader and operable to release the leader from the anchor sleeve.

10. 10. The implant assembly of claim 1, wherein the first bore of the implant defines a longitudinal slot extending along the elongated body of the implant, and at least one of the anchor and the bracket is movable along the longitudinal slot to move the anchor and the bracket relative to the implant.

11. 11. The implant of claim 10, wherein the bracket includes a head and a protrusion, the head being engageable with a surface of the implant and the protrusion being at least partially insertable into the slot to limit rotation of the bracket relative to the implant.

12. The implant of claim 11 , wherein the second bore of the implant defines a second longitudinal slot extending along the elongated body of the implant.

13. 13. The implant of claim 12, wherein the protrusion comprises a barrel threadable into the bracket, the barrel at least partially insertable into the longitudinal slot, the barrel defining a barrel bore configured to accommodate at least a portion of the anchor therethrough.

14. 14. The implant of claim 13, wherein the barrel includes a protrusion extending at least partially into the barrel bore, the protrusion configured to engage the anchor to allow movement of the anchor in a first direction relative to the barrel and to limit movement of the anchor in a second direction opposite the first direction relative to the barrel.

15. 1. A method of securing an implant to a human bone of a patient, comprising: forming a first hole in the first rib portion; making an incision near the first rib portion; inserting a first suture of a first anchor assembly through the first hole into the patient's chest cavity and out through the incision; engaging an outer portion of the first rib portion with an implant; inserting a first bracket of the first anchor assembly at least partially through the implant and coupling the first suture to the first bracket; manipulating the first bracket of the first anchor assembly to fasten the first anchor assembly to the implant and the first rib portion; A method comprising:

16. inserting a first anchor sleeve of the first anchor assembly through the implant and the first hole, the first anchor sleeve defining a longitudinal bore extending at least partially therethrough, the first anchor sleeve being deformable from a first shape to a second shape, and the first suture extending at least partially through the longitudinal bore to couple the first anchor sleeve to the first suture; manipulating a free end of the first suture to deform the first anchor sleeve to the second shape to engage the first rib portion and fasten the first anchor assembly to the implant and the first rib portion; 16. The method of claim 15, comprising:

17. inserting the first suture and the first anchor sleeve through the first hole and then into a washer; engaging the deformed first anchor sleeve with the washer and engaging the washer with the first rib portion; 17. The method of claim 16, comprising:

18. forming a second hole within the second rib portion; inserting a second suture of a second anchor assembly through the second hole in the chest cavity and out of the chest cavity through the incision; engaging an outer portion of the second rib portion with the implant; inserting a second bracket of the second anchor assembly at least partially into the implant and coupling the second suture to the second bracket; manipulating the second suture of the second anchor assembly to fasten the second anchor assembly to the implant and the second rib portion; 18. The method of claim 16 or claim 17, comprising:

19. reducing the first and second rib portions using the first and second anchor assemblies; 20. The method of claim 18, comprising:

20. inserting a second anchor sleeve of the second anchor assembly through the implant and the second hole, the second anchor sleeve defining a longitudinal bore extending at least partially therethrough, the second anchor sleeve being deformable from a first shape to a second shape, and the second suture extending at least partially through the longitudinal bore to couple the second anchor sleeve to the second suture; manipulating a free end of the second suture to deform the first anchor sleeve to the second shape to engage the second rib portion and clamp the second anchor assembly to the implant and the second rib portion; reducing the first and second rib portions using the first and second anchor assemblies; and tensioning the first anchor assembly and the second anchor assembly using a tensioner; trimming the first suture and the second suture; 20. The method of claim 18 or claim 19, comprising:

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