Distal bone suture button

Abstract

Suture buttons for securing two bones together are disclosed. The use of the suture buttons can allow surgeons to more easily and effectively perform suture button techniques, such as for repairing ankle syndesmosis injuries. The first suture button includes a pulley peg extending from the button head. The pulley peg can be positioned using a bone hole during installation of the first suture button, which can help protect the suture and reduce potential patient discomfort. The second suture button helps the second suture button rotate and be more easily positioned when deployed from a button insertion tool. Each of the provided first and second suture buttons can help reduce friction between the respective button and the suture during the installation procedure. The provided first and second suture buttons can be used together in a surgical procedure or individually with other suitable buttons or anchors.

Description

[Technical Field]

[0001] Priority claims This application claims priority to and the benefit of U.S. Application No. 17 / 017,056, filed September 10, 2020, which is incorporated herein by reference in its entirety.

[0002] This application relates generally to surgical procedures for holding two bones together. In particular, this application provides a suture button that allows surgeons and any other appropriate healthcare providers to more easily and effectively perform suture button techniques, such as for repairing syndesmotic injuries in the ankle. [Background technology]

[0003] In various instances, patients may sustain an injury that requires the fixation of a first, or proximal, bone to a second, or distal, bone to aid in the patient's recovery. Ankle joint injuries may be one such type of injury. The ankle joint is composed of two bones, the tibia and fibula, held together by the distal tibiofibular ligament. In some cases, for example, after an ankle injury, the ligament may be torn, leaving a gap between the tibia and fibula. If found to be torn or unstable, the ligament injury must be repaired to prevent ankle instability and subsequently reduce the risk of ankle osteoarthritis.

[0004] One method of securing a near bone to a far bone is the suture button technique. The suture button technique involves deploying a bone fixation construct including a first button connected to a second button with a suture. The suture can be tensioned to secure the near bone to the far bone. For example, to repair a ligament injury, the suture button technique involves two buttons holding the fibula (e.g., proximal) and tibia (e.g., distal) together and sutures connecting the two buttons through drilled bone holes in the fibula and tibia. The buttons are typically placed in place using a needle and pull-out suture or a button insertion tool.

[0005] However, typical buttons used in suture button technology have several drawbacks. The button must apply pressure to the proximal bone to tie down the suture while also allowing the suture ends to be pulled or tensioned to increase the tension between the proximal and distal buttons. As the suture is pulled or tensioned, it inevitably moves or slides relative to the two buttons. However, typical proximal buttons may be configured to create an unintended amount of friction between the button and the suture. For example, a typical proximal button may have multiple individual openings that serve different portions or ends of the suture. The individual openings may restrict the movement of the suture, potentially causing friction. In other cases, a typical proximal button may have suture openings sized such that the suture is similarly restricted and causes friction. Excessive friction can cause the suture to break, which can force the surgeon to redo the procedure or cause the suture to fail before the patient has recovered. Unintended amounts of friction can also make it more difficult for the surgeon to perform the procedure. For example, the suture can get caught on an edge while the surgeon is tensioning it.

[0006] In addition to the above, typical proximal bone buttons may unintentionally extend beyond the proximal bone after placement, which may cause greater patient discomfort than if the height of the proximal bone button were more consistent with the height of the proximal bone.

[0007] A button used to apply pressure to the distal bone may be adjusted to prevent the button from returning through the bone hole after it has been advanced through the bone hole. Adjusting the distal button may require deploying the distal button from the button insertion instrument, which causes the distal button to change orientation. However, typically, such deployment requires forcibly removing the distal button from the insertion instrument to provide the distal button with sufficient space to change orientation. In some cases, such as when tissue (e.g., skin) presses against the distal button and interferes with the distal button's orientation during the change, the amount of space required may make it difficult to deploy the distal button easily and effectively.

[0008] In addition to the above, the distal button ties down the sutures that connect the distal button to the proximal button. As tension is applied to the sutures to install the distal and proximal buttons, the sutures inevitably move relative to the distal button. A typical distal button can create more friction than desired between the typical distal button and the sutures. For example, many typical distal buttons include at least two holes through which the sutures move, creating friction between each hole and the suture. This typical configuration with at least two holes can also cause the suture to wrap around or kink on itself as it is loaded onto and deployed from the button insertion tool.

[0009] Therefore, what is desired is a proximal button that overcomes the above drawbacks. Additionally, what is desired is a distal button that overcomes the above drawbacks. Summary of the Invention

[0010] The suture buttons, systems, and methods disclosed in this disclosure generally relate to surgical procedures for holding two bones together. In particular, a suture button is disclosed that allows a surgeon or any other appropriate healthcare provider to more easily and effectively perform a suture button technique, such as for repairing a syndesmosis injury in the ankle. A first suture button is disclosed that is configured to interface with a proximal bone (e.g., the fibula bone) as part of a suture button technique to secure the proximal and distal bones. A second suture button is disclosed that is configured to interface with a distal bone (e.g., the tibia bone) as part of a suture button technique to secure the proximal bone to the distal bone. A surgeon can use both the provided first suture button and the provided second suture button when performing a suture button technique to repair a syndesmosis injury. Alternatively, a surgeon can use the provided first suture button with another appropriate suture button or anchor, or the provided second suture button with another appropriate suture button or anchor.

[0011] Throughout this disclosure, the first suture button will be referred to as the fibula button and the second suture button will be referred to as the tibia button, although it will be appreciated that the provided first suture button and provided second suture button may be used to secure together multiple bones other than the fibula and tibia.

[0012] In view of the technical features described in this disclosure, which may be combined with any other aspect unless otherwise stated, in a first aspect of the present disclosure, a suture button insertion system includes, but is not limited to, a suture, a button insertion instrument, and a suture button. The button insertion instrument includes a shaft having an insertion tip, an ejector rod within the shaft, and a trigger. Acting the trigger causes the ejector rod to translate within the shaft. The suture button includes a support portion having an opening, a first wing extending from the support portion, and a second wing extending from the support portion on the opposite side of the first wing. The second wing includes a chamfered end. A suture is placed through the opening at the side of the button insertion instrument. The second wing is positioned within the insertion tip so that the chamfered end faces the side of the button insertion instrument where the suture is located.

[0013] In a second aspect of the present disclosure, which may be combined with any other aspect (e.g., the first aspect) unless otherwise stated, the suture button is a first suture button, and the system further includes a second suture button or anchor coupled to the first suture button by a suture.

[0014] In a third aspect of the present disclosure, which may be combined with any other aspect (e.g., the first or second aspect) unless otherwise stated, the chamfered end is chamfered at an angle of 20 to 60 degrees.

[0015] In a fourth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first or second aspect) unless otherwise stated, the chamfered end is chamfered at an angle equal to 30 degrees.

[0016] In a fifth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first to fourth aspects) unless otherwise stated, one opening in the support is centrally positioned relative to an axis extending through the first and second wings.

[0017] In a sixth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first to fourth aspects) unless otherwise stated, one opening in the support is positioned offset from the center with respect to an axis extending through the first and second wings.

[0018] In a seventh aspect of the present disclosure, which may be combined with any other aspect (e.g., the sixth aspect) unless otherwise stated, one opening positioned off-center in the support is positioned off-center toward the side of the button insertion device where the suture is located.

[0019] In an eighth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first to seventh aspects) unless otherwise stated, a plane extending across the entire length and width of the first and second wings is parallel to the central axis of one opening.

[0020] In a ninth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first to eighth aspects) unless otherwise stated, the insertion tip comprises at least one slit.

[0021] In a tenth aspect of the present disclosure, which may be combined with any other aspect (e.g., the ninth aspect) unless otherwise stated, a gap remains between the suture button and the button insertion instrument within at least one slit when the second wing is fully positioned within the insertion tip.

[0022] In an eleventh aspect of the present disclosure, which may be combined with any other aspect (e.g., the first to tenth aspects) unless otherwise stated, an inner surface of the insertion tip includes at least one recessed portion adjacent to at least one non-recessed portion. The second wing includes an upper surface and a lower surface, the upper surface including at least one recessed portion adjacent to at least one non-recessed portion. The at least one recessed portion of the insertion tip corresponds to the at least one non-recessed portion of the second wing, and the at least one non-recessed portion of the insertion tip corresponds to the at least one recessed portion of the second wing.

[0023] In a twelfth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first to eleventh aspects) unless otherwise stated, the pusher rod includes a flat end surface substantially perpendicular to a plane extending across the entire length and width of the first and second wings.

[0024] In a thirteenth aspect of the present disclosure, which may be combined with any other aspect (e.g., the second to twelfth aspects) unless otherwise stated, a suture button insertion method includes forming a bone hole through a first bone and a second bone. A button insertion tool is used to insert a suture button through the bone hole so that the suture button emerges from the other side of the bone hole. The button insertion tool includes a shaft having an insertion tip, an ejector rod within the shaft, and a trigger. Acting the trigger causes the ejector rod to translate within the shaft. The suture button includes a support having an opening, a first wing extending from the support, and a second wing extending from the support on a side opposite the first wing. The second wing includes a chamfered end. A suture is placed through the opening into a side of the button insertion tool. The second wing is positioned within the insertion tip during insertion so that the chamfered end faces the side of the button insertion tool where the suture is located. The method may include rotating the suture button toward the side of the button insertion tool where the suture is located by deploying the suture button from the button insertion tool, wherein deploying the suture button includes causing an ejector rod to force the suture button out of the insertion tip by moving a trigger.

[0025] In a fourteenth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first to thirteenth aspects) unless otherwise stated, when the trigger is actuated, the end of the pusher rod moves in parallel and exits the insertion tip.

[0026] In a fifteenth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first to fourteenth aspects) unless otherwise stated, the chamfered end of the suture button includes a near edge and a far edge relative to the pusher rod, and the pusher rod abuts the near edge when the pusher rod forces the suture button out of the insertion tip.

[0027] In a sixteenth aspect of the present disclosure, which may be combined with any other aspect (e.g., aspects 13 to 15) unless otherwise stated, the method may further include a step of determining a desired placement of the suture button by radiographic imaging before deploying the suture button.

[0028] In a seventeenth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first, third to seventh, and thirteenth aspects) unless otherwise stated, a suture button includes a support having an opening, a first wing extending from the support, and a second wing extending from the support on the opposite side of the first wing. The second wing includes an upper surface opposite the lower surface and a chamfered edge. The upper surface includes at least one recessed portion adjacent to a non-recessed portion. A plane extending over the entire length and width of the first and second wings is parallel to the central axis of the opening.

[0029] In an eighteenth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first, third to seventh, thirteenth and seventeenth aspects) unless otherwise stated, the second wing has a first length that is longer than the second length, the first wing has a third length, and the first length and the third length are equal.

[0030] In a 19th aspect of the present disclosure, which may be combined with any other aspect (e.g., the 1st, 3rd, 4th, 13th, 17th and 18th aspects) unless otherwise stated, the support is centrally positioned relative to an axis extending through the first and second wings.

[0031] In a twentieth aspect of the present disclosure, which may be combined with any other aspect (e.g., the first, third, fourth, thirteenth, seventeenth, and eighteenth aspects) unless otherwise stated, the support is positioned off-center relative to an axis extending through the first and second wings.

[0032] Additional features and advantages of the disclosed method and apparatus will be described in, and will be apparent from, the following detailed description and figures. The features and advantages described herein are not all-inclusive, and in particular, many additional features and advantages will be apparent to those skilled in the art in view of the figures and description. Furthermore, it should be noted that the language used herein has been chosen primarily for ease of reading and for explanatory purposes, and not to limit the scope of the inventive subject matter. [Brief explanation of the drawings]

[0033] [Figure 1A] FIG. 1 shows a perspective view of a fibula button having a head with a circular opening, according to one embodiment of the present disclosure. [Figure 1B] FIG. 1 shows a perspective view of a fibula button having a head with a circular opening, according to one embodiment of the present disclosure.

[0034] [Figure 1C] FIG. 1 shows a perspective view of a fibula button having a pulley peg with rounded ends, according to one embodiment of the present disclosure.

[0035] [Figure 1D] FIG. 1 shows a perspective view of a fibula button having a head with a chamfered surface on the top surface of the head leading to an opening in the head, according to one embodiment of the present disclosure.

[0036] [Figure 1E] FIG. 1 shows a perspective view of a fibula button having a head with a chamfered surface on the underside of the head leading to an opening in the head, according to one embodiment of the present disclosure.

[0037] [Figure 2A] FIG. 1 illustrates a cross-sectional side view of a fibula button with a radiused pulley peg according to one embodiment of the present disclosure. [Figure 2B] FIG. 1 illustrates a cross-sectional side view of a fibula button with a radiused pulley peg according to one embodiment of the present disclosure.

[0038] [Figure 2C] FIG. 1 illustrates a cross-sectional side view of a fibula button having a non-radiused pulley peg according to one embodiment of the present disclosure.

[0039] [Figure 3A] 1 shows a perspective view of a tibial button according to one embodiment of the present disclosure. [Figure 3B] 1 illustrates a top view of a tibial button according to one embodiment of the present disclosure.

[0040] [Figure 3C] 1 shows a side view of a tibial button with an angled insertion instrument end according to one embodiment of the present disclosure. [Figure 3D] 10A shows a side view of a tibial button with an alternative angled insertion instrument end according to one embodiment of the present disclosure. FIG.

[0041] [Figure 3E] 1 illustrates a side view of a tibial button having an off-center opening according to one embodiment of the present disclosure. FIG.

[0042] [Figure 4A] 1 shows a side view of an example of a system including a button insertion instrument, a suture button, and a suture, according to one embodiment of the present disclosure. [Figure 4B] 1 shows a side view of another example of a system including a button insertion instrument, a suture button, and a suture, according to one embodiment of the present disclosure.

[0043] [Figure 5A] 1 illustrates a top view of a portion of an example button insertion tool device loaded with a fibula button, according to one aspect of the present disclosure.

[0044] [Figure 5B] 1A-1C show cross-sectional front views of example insertion tips of button insertion tools according to one embodiment of the present disclosure.

[0045] [Figure 6A]1 shows a perspective side view of a tibial button being loaded onto an insertion tip of a button insertion tool according to one embodiment of the present disclosure. FIG. [Figure 6B] 1 shows a perspective side view of a tibial button being loaded onto an insertion tip of a button insertion tool according to one embodiment of the present disclosure. FIG.

[0046] [Figure 6C] FIG. 6C shows a perspective side view of the button insertion instrument of FIG. 6B deploying the tibial button, according to one embodiment of the present disclosure. [Figure 6D] FIG. 6C shows a perspective side view of the button insertion instrument of FIG. 6B deploying the tibial button, according to one embodiment of the present disclosure.

[0047] [Figure 7] 1 shows a button insertion tool loaded with a fibula button and a tibial button and positioned through a bone hole to deliver the tibial button across the bone hole, according to one embodiment of the present disclosure.

[0048] [Figure 8] 1 shows an installed fibula button and tibial button securing the two bones together according to one embodiment of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0049] The suture buttons, systems, and methods disclosed herein generally relate to surgical procedures for holding two bones together. In particular, suture buttons are disclosed that allow surgeons and any other appropriate healthcare providers to more easily and effectively perform suture buttoning techniques, such as for repairing syndesmotic injuries in the ankle. In one example, a button insertion tool can be used by a surgeon to deploy the button. In such an example, a first suture button disclosed herein is configured to abut a proximal bone as part of a bone fixation structure. A second suture button disclosed herein is configured to be advanced through bone holes formed in the proximal and distal bones and then abut the distal bone as part of a bone fixation structure. Throughout this disclosure, the first suture button will be referred to as a fibula button and the second suture button will be referred to as a tibia button, although it should be understood that the provided first suture button and provided second suture button may be used to secure together any two bones other than the fibula and tibia.

[0050] When a surgeon practices suture buttoning techniques, such as to repair syndesmosis injuries, the surgeon may use the provided fibula button and the provided tibia button. Alternatively, the surgeon may use the provided fibula button with another suitable suture button or anchor, or the provided tibia button with another suitable suture button or anchor.

[0051] In some cases, the provided fibular button configurations reduce friction between the fibular button and the sutures during placement compared to a typical proximal bone button by including a larger opening in the provided fibular button, allowing the sutures to pass through the larger opening without encountering the metal components of the fibular button. The provided fibular button may include a head and a pulley peg extending from the head. The head includes an opening, and the space between the pulley peg and the head is a second opening. The size of each opening is configured to allow multiple strands of suture to move freely through the opening. The sutures can move more freely through the larger opening, which reduces friction between portions of the suture and between the sutures and the fibular button. The provided fibular button may further include various curved, smooth, or chamfered surfaces to further reduce friction.

[0052] In some instances, the pulley pegs of the fibular button are sized to allow insertion into the bone holes. Inserting the pulley pegs into the bone holes helps lock the fibular button in place to a greater extent than if the fibular button were simply placed on the surface of the bone. Inserting the pulley pegs into the bone holes also allows the fibular button to contour more gently relative to the proximal bone than a typical proximal bone button. Additionally, once installed, the pulley pegs, when placed within the bone holes, allow the tensioned sutures to remain inside the bone rather than on the bone surface, where they would be more exposed to other tissues. Therefore, the fibular button can help reduce patient irritation or discomfort that may result from an installed button or sutures protruding from one of the patient's bones. The fibular button can also help protect tensioned sutures from future breakage. Additionally, by keeping the tensioned suture within the bone, the surgeon is able to cut the free end of the suture to bring it level with the surface of the fibular button, while eliminating the risk of cutting the tensioned suture.

[0053] The provided tibial button configurations reduce friction between the tibial button and the sutures during placement compared to typical distal buttons. For example, the provided tibial buttons include a single large opening through which the suture passes. The single large opening reduces the number of potential contact points between the tibial button and the sutures compared to typical buttons that include multiple openings for the sutures. The tibial button may also include various curved, smooth, or chamfered surfaces to further reduce friction. The provided tibial buttons further help prevent the sutures from wrapping around themselves when loading or deploying the tibial button onto or from the button insertion tool by directing the sutures to only one side of the button insertion tool.

[0054] The provided tibial button may also be configured to prevent rotation or lateral translation when loaded into the button insertion tool. The provided button insertion system can help facilitate rotation of the tibial button when deployed from the button insertion tool. The tibial button includes a chamfered end that faces the suture connecting the tibial button to a second button (e.g., a fibular button) when loaded into the button placement tool. The natural tendency of the tibial button to rotate toward the chamfered end, combined with tension from the suture, facilitates rotation of the tibial button in that direction. Furthermore, to deploy the tibial button, the button insertion tool may include a pusher rod that extends slightly beyond the tip of the button insertion tool to eject the tibial button from the tip where the tibial button is loaded. The rotation-facilitating aspect of the button insertion system allows the tibial button to rotate near the tip of the button insertion tool, using little space between them.

[0055] The proximity of the tibial button to pivot about the button insertion instrument and the manner in which the tibial button facilitates pivoting create a strong pivoting force that helps the tibial button overcome the counterforce of tissue (e.g., skin) that may hold the tibial button. Additionally, each of the above-described aspects can help increase the ease of deployment of the tibial button compared to at least some conventional button insertion systems by helping to ensure that the tibial button turns, or pivots, in a targeted or desired direction. Further advantages of the provided fibular button and the provided tibial button will become apparent from the following description of the figures.

[0056] 1A and 1B show perspective views of an example fibula button 100A. The example fibula button 100A includes a button head 102 and a pulley peg 108 extending from the button head 102. An opening 114 is formed between the button head 102 and the pulley peg 108. The button head 102 includes an upper surface 104 and a lower surface 110. In various embodiments, the upper surface 104 may be radiused to help prevent damage to surrounding tissue when the fibula button 100A is placed in a patient. In some embodiments, the lower surface 110 may be flat, as shown. The button head 102 also includes an opening 106 extending therethrough from the upper surface 104 to the lower surface 110. The opening 106 is sized to accommodate multiple strands of suture passing therethrough. In some cases, the size of the opening 106 may be large enough to allow placement of a suture knot within the opening 106. The top surface 104 may include a chamfered surface 116 leading to the opening 106. The chamfered surface 116 may help reduce friction between the button head 102 and the suture moving through the opening 106. In various cases, the cross section of the opening 106 may be circular, as shown.

[0057] In various embodiments, the pulley peg 108 extends from a first end 120 to a second end 122. The first end 120 and the second end 122 may be connected to or integral with the underside 110 of the button head 102. In some cases, the pulley peg 108 may include a flat surface 118 at each of its ends 120 and 122. The flat surface 118 can assist in guiding the suture through the opening 106. In some cases, the pulley peg 108 may include a flat surface 112 at each of its ends 120 and 122. In other cases, the pulley peg 108 may include a curved surface 124 at each of its ends 120 and 122, as illustrated in FIG. 1C as part of example fibula button 100B. The curved surface 124 can help reduce friction between the pulley peg 108 and the suture moving toward and through the opening 106 .

[0058] In various instances, the cross-section of the opening 106 may be any suitable cross-section other than circular. For example, the cross-section of the opening 106 may be pill-shaped, rectangular with rounded corners, oval, or any other suitable shape. FIG. 1D shows an example fibula button 100C having a button head 102 with an opening 130 that is elongated or pill-shaped in cross-section. The pill-shaped cross-section of the opening 130 can help reduce friction between the suture strands and / or between the suture strands and the button head 102 by providing additional space for the suture to move freely. For example, the ends of one or more suture strands can move through the opening 130 with other portions outside the outermost boundary of the pulley peg 108. In other words, there is no need for the ends of one or more suture strands to move inward toward a central opening (e.g., opening 106), which could cause friction between portions of one or more suture strands. Additionally, the pill-shaped opening 130 can be large enough to allow placement of a suture knot within the pill-shaped opening 130 .

[0059] In various instances, the pill-shaped opening 130 may be substantially perpendicular to the pulley peg 108, as shown. In other words, the pill-shaped opening 130 includes a long end and a short end, with a plane extending through a central portion of the two ends 120 and 122 of the pulley peg 108 being substantially perpendicular to the long end. This substantially perpendicular configuration allows the pulley peg 108 to be narrower than if the ends 120 and 122 of the pulley peg 108 were outside the long end of the opening 130. The narrower width allows the pulley peg 108 to fit into a narrower bone hole.

[0060] In various instances, the innermost portion of the pulley peg 108 and the inner portion of the button head 102 (e.g., the portion forming the opening 130) share a continuous surface 132. In other words, the inner surface of the button head 102 that forms the opening 130 continues directly into the pulley peg 108. This contrasts with the presence of a space on the underside 110 between the opening 130 and the ends 120 and 122 of the pulley peg 108. Eliminating this space between the opening 130 and the ends 120 and 122 of the pulley peg 108 helps eliminate edges that could increase friction between the suture and the fibula button 100C.

[0061] In some embodiments, the underside of the button head of the provided fibula button may include a chamfered surface that connects to the opening in the button head. For example, FIG. 1E shows an example fibula button 100D in which the underside 110 of the button head 102 includes a chamfered surface 140 that connects to the opening 130. The chamfered surface 140 can help reduce friction between the button head 102 and the suture that passes through the opening 130.

[0062] 2A and 2B each show a side view of an example fibula button 100A, rotated 90 degrees relative to one another. As described in more detail below, the pulley peg 108 is configured to secure a suture (e.g., multiple suture strands and / or multiple portions of a single suture strand). For example, in FIG. 2B, the free ends of the suture strands can enter one side of the opening 114 and exit the other side of the opening 114, such that the pulley peg 108 secures the suture strand when both free ends of the suture strand are pulled away from the fibula button 100A. In other aspects of the present disclosure, the pulley peg 108 may take other suitable shapes extending outward from the underside 110, allowing one or more suture strands to be secured by the pulley peg 108. For example, FIG. 2C shows an example fibula button 200 including a pulley peg 208. The pulley peg includes two legs 202A and 202B connected by a crossbar 204. In some cases, legs 202A, 202B and crossbar 204 may be a single, integral piece. In other cases, crossbar 204 may be connected to legs 202A and 202B.

[0063] The example fibula button 100A, 100B, or 100C may be constructed from any suitable medical-grade material capable of prolonged contact with biological matter. For example, the fibula button 100A, 100B, or 100C may be constructed from Nitinol.

[0064] 3A, 3B, and 3C show perspective, top, and side views, respectively, of an example tibial button 300A. The tibial button 300A includes a buttress 302 having an opening 308. The buttress 302 may include a curved surface to reduce friction between the suture and the buttress 302 during placement of the tibial button 300A. Additionally, the buttress 302 includes a single opening 308 for movement of the suture strand during placement of the tibial button 300A, which helps reduce friction between the suture and the tibial button 300A compared to typical suture buttons that have multiple openings for different suture strands or different portions of a single suture strand. Wings 304 extend from the buttress 302 to a tip 310 of the tibial button 300A. Wings 306 extend from the buttress 302 to a chamfered end 312 of the tibial button 300A. The wings 304 and 306 may have various suitable lengths relative to the support 302 .

[0065] In various instances, the wings 306 may be configured to engage with the button insertion tool tip to prevent the wings 306 from sliding or otherwise separating from the button insertion tool tip until the tibial button 300A is deployed. For example, the wings 306 may include recesses 314A, 314B. The wings 306 may include recesses 314A, 314B on one side or on both sides (e.g., opposite sides not shown). One or more non-recessed portions of the wings 306 may correspond to one or more recesses in the button insertion tool tip so that lateral movement of the tibial button relative to the button insertion tool (e.g., movement perpendicular to the long axis of the tibial button 300A) is prevented as the wings 306 slide within the button insertion tool tip.

[0066] The chamfered ends 312 of the wings 306 include chamfered surfaces at an angle 316. In various examples, the angle 316 may be equal to 30 degrees. In other examples, the wings 306 may be chamfered at another suitable angle 316, such as between 15 and 60 degrees. For example, FIG. 3D illustrates an example tibial button 300B having wings 306 with chamfered ends 312 at an angle 316 of 45 degrees. The benefits that the chamfered ends 312 can have on the tibial buttons disclosed herein are described in more detail in conjunction with FIGS. 6A-6D.

[0067] In various examples, such as those illustrated in FIGS. 3A-3D, the buttress 302 and the opening 308 therethrough may be centered between the wings 304 and 306. In other examples, the buttress 302 and / or the opening 308 may be positioned off-center between the wings 304 and 306. For example, FIG. 3E illustrates an example tibial button 300C having a buttress 302 and opening 308 with a centerline that is offset from the axis 320 of the wings 304 and 306. The centerlines of the buttress 302 and opening 308 may be offset toward the longer side of the wing 306 (e.g., longer due to the chamfered end 312) to aid in rotating the tibial button 300C into place during installation. This is described in more detail below. In other examples, the buttress 302 may be centered while the opening 308 is off-center. In some cases, support 302 and opening 308 may be centered along axis 320 such that the length of wing 304 is equal to the length of wing 306. In other cases, support 302 and / or opening 308 may be off-center along axis 320. When support 302 is off-center along axis 320, the length of either wing 304 or wing 306 may be longer than the other.

[0068] The exemplary tibial button 300A, 300B, or 300C may be constructed from any suitable medical-grade material capable of long-term contact with biological matter. For example, the tibial button 300A, 300B, or 300C may be constructed from Nitinol.

[0069] The following disclosure describes example fibula button 100A and example tibia button 300A, although the following disclosure may equally apply to example fibula buttons 100B and 100C, example tibia buttons 300B and 300C, and any other suitable fibula and / or tibia buttons consistent with this disclosure.

[0070] In some instances, the provided fibular button 100A and / or the provided tibial button 300A may be used in conjunction with a needle and retraction suture procedure. In other instances, the fibular button 100A and / or the tibial button 300A may be used in conjunction with a button insertion instrument that deploys the fibular button 100A and / or the tibial button 300A for placement in a patient. The fibular button 100A may be used in conjunction with the tibial button 300A in a surgical procedure. Alternatively, the fibular button 100A and the tibial button 300A may be used independently in a surgical procedure. For example, the fibular button 100A may be used in conjunction with a suitable anchor or suture button that is different from the tibial button 300A. In other instances, the tibial button 300A may be used in conjunction with a suitable anchor or suture button that is different from the fibular button 100A.

[0071] FIG. 4A illustrates an example button insertion tool 400 that can be used with the fibular button 100A and / or tibial button 300A and methods disclosed herein. The example button insertion tool 400 may include a handle 402, a support protrusion 404, a trigger 406, a shaft 414, a pusher rod 408, a resilient member 412 (e.g., a spring), and a button deployment portion 430. The button deployment portion 430 may include a suture bollard 410 and a button post 416. In this example, the tibial button 300A removably engages with the shaft 414. For example, a portion of the tibial button 300A may be positioned within an insertion tip 432 at the end of the shaft 414 so that the button 300A is rotationally and laterally constrained. This will be described in more detail with respect to FIGS. 6A-6D. In the loaded configuration of the example button insertion tool 400 shown, the tibial button 300A can be secured in place along the longitudinal axis of the button insertion tool 400 by tension in the suture 418. In some examples, the pusher rod 408 extends from the button deployment portion 430 through the interior of the shaft 414 and abuts the tibial button 300A.

[0072] The suture 418 may be a flexible material, such as a suture or suture tape. In some cases, the suture 418 may be a single strand of suture arranged to connect the fibula button 100A to the tibial button 300A. In other cases, the suture 418 may be multiple strands of suture arranged to connect the fibula button 100A to the tibial button 300A. In at least one case, the suture 418 may be an adjustable or non-adjustable loop. In at least one case, the combination of the suture 418, the tibial button 300A, and the fibula button 100A may be an adjustable knotless button / loop structure. The knotless button / loop structure may be a self-locking structure.

[0073] In the loaded configuration of the example button insertion tool 400, the fibular button 100A can be held against the button post 416 by tension on the suture 418. The suture 418 can be wound around the suture bollard 410 prior to deployment. A surgeon or any other appropriate healthcare provider can use the example button insertion tool 400 to insert the tibial button 300A through tunnels in the first and second bones (e.g., the fibula and tibia) and deploy the tibial button 300A by moving the trigger 406 in the direction of the arrow shown. The fibular button 100A can be deployed by translating the button insertion tool 400 away from the patient. The suture 418 can then be tensioned and secured to place the deployed fibular button 100A and tibial button 300A in place.

[0074] As an alternative to the button insertion tool 400, FIG. 4B illustrates an example button insertion tool 440 that can be used with the fibular button 100A and / or tibial button 300A and methods disclosed herein. The example button insertion tool 440 includes a handle 442, a support protrusion 444, a trigger 446, an inner rod 508 ( FIG. 5 ), a resilient member 512 ( FIG. 5 ), a shaft 452, and a button deployment portion 530 ( FIG. 5 ). The button deployment portion 530 may include a suture bollard 448 and a button post 450. In this example, the tibial button 300A removably engages with the insertion tip 432 of the shaft 414 in the same or similar manner as with the example button insertion tool 400 described above. The example button insertion tool 440 is configured similarly to the example button insertion tool 400. A user can deploy the tibial button 300A by pulling the trigger 446 in the direction of the arrow shown. The fibular button 100A can be deployed by translating the button insertion tool 440 away from the patient.

[0075] 5A shows a top view of a portion of an example button insertion tool 440. An example fibula button 100 is held against a button post 450 by tension in the suture 418. In some examples, the button post 450 includes two separate posts as shown, with adequate space between them for the pulley peg 108. This allows the suture 418 to be secured by the pulley peg 108 while also allowing the free end of the suture 418 to be pulled through the opening 106.

[0076] FIG. 5B shows a cross-sectional front view of an example insertion tip 432 of the button insertion tool 400 or 440. The insertion tip 432 may include a slit 502 between a first end 504A and a second end 504B. When the tibial button 300A is positioned within the slit 502, the tibial button 300A is prevented from rotating about its longitudinal axis. In some cases, the first end 504A may include a recess 506. The recess 506 may correspond to a non-recessed portion of the tibial button 300A (see, e.g., FIG. 3A ) so that the wings 306 of the tibial button 300A can be inserted into the insertion tip 432. That is, the recess 506 may be aligned with a non-recessed portion. For example, the recess 506 may have a round cross-section as shown, a square cross-section, or any other suitable shape. Thus, the non-recessed portions of the wings 306 of the tibial button 300A are positioned within the recesses 506 of the insertion tip 432, preventing lateral movement of the tibial button 300A along the minor axis of the button insertion tool 400 or 440. In instances where the wings 306 of the tibial button 300A include recesses 314A and 314B on both sides, the second end 504B of the insertion tip 432 may also include a recess. Additionally, the recesses 506 of the insertion tip 432 prevent the tibial button 300A from rotating about its minor axis.

[0077] It should be understood that button insertion instruments 400 and 440 are merely examples of button insertion instruments that may be used to deploy fibular button 100A and / or tibial button 300A. Any suitable button insertion instrument consistent with the effects of fibular button 100A and / or tibial button 300A as described herein may be used to deploy fibular button 100A and / or tibial button 300A.

[0078] 6A and 6B show perspective side views of compatible configurations of a tibial button 300A loaded into the insertion tip 432 of a button insertion tool (e.g., button insertion tool 400). In configuration 600A shown in FIG. 6A, the tibial button 300A is positioned within the insertion tip 432 with the chamfered end 312 facing in a first direction (e.g., toward the top of the page). In configuration 600B shown in FIG. 6B, the tibial button 300A is positioned within the insertion tip 432 with the chamfered end 312 facing in the opposite direction from the first direction (e.g., toward the bottom of the page). In each of configurations 600A and 600B, the chamfered end 312 faces toward the suture 418. Having the chamfered end 312 facing toward the suture 418 helps facilitate the desired rotation and placement of the tibial button 300A into place after the tibial button 300A is deployed. For example, in configuration 600A, when the tibial button 300A is deployed, it rotates in the direction of arrow 602. Conversely, in configuration 600B, when the tibial button 300A is deployed, it rotates in the direction of arrow 604.

[0079] In either configuration 600A or 600B, the configuration of the tibial button 300A allows the suture 418 to be toward the side of the insertion tip 432 and button insertion instrument shaft, preventing the suture 418 from wrapping around the button insertion instrument shaft or the tibial button 300A itself. Additionally, the tibial button 300A and insertion tip 432 may be configured such that a gap 606 remains between the tibial button 300A and the insertion tip 432 when the tibial button 300A is fully inserted. The gap 606 is radiolucent and therefore visible in x-rays. The gap 606 can assist the surgeon in determining how far the button insertion instrument must be inserted before deploying the tibial button 300A.

[0080] 6C and 6D further illustrate a configuration 600B to illustrate an example tibial button 300A that rotates into place during deployment. FIG. 6C illustrates the pusher rod 408 of the example button insertion tool 400 translating to push the tibial button 300A out of the insertion tip 432. For example, the pusher rod 408 can be translated by actuating the trigger 406 of the button insertion tool 400. In various instances, fully depressing the trigger 406 can cause the pusher rod 408 to extend beyond the end face of the insertion tip 432, which can help ensure that the tibial button 300A is fully separated from the button insertion tool 400 and fully ejected from the insertion tip 432. In cases where pushing on tissue (e.g., skin) is required to place the tibial button 300A, ensuring that the tibial button 300A is fully separated from the button insertion tool 400 can allow for easier deployment. Additionally, the end face of the pusher rod 408 that abuts the tibial button 300A may be flat, as shown, so that the end face abuts only the closest portion of the chamfered end 312. The space between the flat end face of the pusher rod 408 and the chamfered end 312 of the tibial button 300A provides room for the tibial button 300A to rotate or pivot.

[0081] Once the tibial button 300A is fully pushed out of the insertion tip 432, tension in the suture 418 urges the tibial button 300A to rotate toward the suture 418 (e.g., in the direction of arrow 604). The chamfered surface 312 of the tibial button 300A and minimal contact between the pusher rod 408 and the chamfered surface 312 help facilitate rotation of the tibial button 300A toward the suture 418. Enabling the tibial button 300A to rotate in a desired or targeted direction can help reduce complications during the surgical procedure that may result from the tibial button 300A rotating in an unintended direction, which may cause the suture 418 to become tangled or pinched. Additionally, the rotation facilitation provided by the present disclosure allows the tibial button 300A to rotate very close to the insertion tip 432, thereby improving the ease of deployment of the tibial button 300A. Figure 6D shows the tibial button 300A rotated.

[0082] As described, the fibula button 100A and tibial button 300A can be utilized as part of a suture-button procedure to secure two bones together. For example, an ankle syndesmosis repair method (with or without an ankle fracture) may include drilling bone holes through the patient's fibula and tibia. A button insertion tool (e.g., button insertion tool 400) can be loaded with the tibial button 300A and fibula button 100A. A surgeon can use the button insertion tool to deliver the tibial button 300A through the bone holes. FIG. 7 shows the tibial button 300A being delivered through the bone holes 706 in the fibula bone 702 and the tibia bone 704 by the button insertion tool 400. The tibial button 300A is attached to the fibula button 100A with sutures 418. The tibial button 300A and the fibular button 100A can then be deployed by the surgeon actuating the trigger 406 of the button insertion tool 400 and then translating the button insertion tool 400 away from the patient, etc. In some cases, the tibial button 300A may be deployed first, and then the fibular button 100A may be deployed after the tibial button 300A is in place.

[0083] Once deployed, the tibial button 300A rotates as described above to abut the surface of the tibia bone 704. The surgeon can remove the button insertion tool 400 from the bone hole 706. The surgeon can apply tension to the sutures 418 (e.g., tighten the adjustable structure) to position the fibula button 100A and secure the fibula button 100A against the lateral surface of the fibula bone 702. Once the tibial button 300A and fibula button 100A are in place, the sutures 418 can be secured with a knot, secured via a knotless button-and-loop structure, or the like. The free ends of the sutures 418 can be trimmed to remove excess material. Figure 8 shows the installed fibula button 100A and tibial button 300A joined by the sutures 418, securing the fibula bone 702 to the tibia bone 704. The pulley peg 108 of the fibula button 100A resides completely within the bone hole 706, allowing only the button head 102 of the fibula button 100A to protrude from the surface of the fibula bone 702. In some instances, the knot of the suture 418 can be placed within the opening 106 of the fibula button 100A.

[0084] The examples and embodiments disclosed herein should be construed as merely illustrative and in no way limit the scope of the present disclosure. It will be apparent to those skilled in the art that changes can be made to the details of the above-described embodiments without departing from the basic principles described. In other words, various modifications and improvements of the embodiments specifically disclosed in the above description are within the scope of the appended claims. For example, any suitable combination of features of the various embodiments described is contemplated.

Claims

1. Sutures and a button insertion tool including a shaft having an insertion tip, a push rod within the shaft, and a trigger; a support having a single opening; a first wing extending from the support; and a second wing extending from the support directly opposite the first wing, the second wing including a chamfered end; a suture button including: Equipped with the suture is placed through the single opening to one side of the button insertion tool; the second wing is positioned within the insertion tip so that the beveled end faces toward the side of the button insertion tool on which the suture resides; Actuation of the trigger causes the pusher rod to translate within the shaft, thereby forcing the suture button out of the insertion tip; the pusher rod includes a flat end surface substantially perpendicular to a transverse plane extending through the first and second wings; the chamfered end of the suture button includes a near edge and a far edge relative to the pusher rod, and the pusher rod is configured such that the flat end surface of the pusher rod abuts only the near edge when the pusher rod forces the suture button out of the insertion tip, such that a space exists between the pusher rod and the chamfered end to allow the suture button to rotate or turn. Suture button insertion system.

2. The suture button insertion system of claim 1 , wherein the suture button is a first suture button, and the suture button insertion system further comprises a second suture button or anchor coupled to the first suture button by the suture.

3. The suture button insertion system of claim 1 , wherein the chamfered end is chamfered at an angle of 20 to 60 degrees relative to a plane perpendicular to the direction in which the second wing extends.

4. The suture button insertion system of claim 1 , wherein the chamfered end is chamfered at an angle equal to 30 degrees relative to a plane perpendicular to the direction in which the second wing extends.

5. The suture button insertion system of claim 1 , wherein the single opening in the support has a central axis that intersects with an axis extending through the first and second wings.

6. The suture button insertion system of claim 1 , wherein the single opening in the support has a central axis that is offset from an axis extending through the first and second wings.

7. The suture button insertion system of claim 6 , wherein the central axis of the single opening in the support is positioned offset from the axis toward the side of the button insertion instrument on which the suture resides.

8. The suture button insertion system of claim 1 , wherein a plane extending across the entire length and width of said first and second wings is parallel to a central axis of said single opening.

9. The suture button insertion system of claim 1 , wherein the insertion tip includes at least one slit.

10. 10. The suture button insertion system of claim 9, wherein a gap remains between the suture button and the button insertion instrument within the at least one slit when the second wing is fully positioned within the insertion tip.

11. the inner surface of the insertion tip includes at least one recessed portion adjacent to at least one non-recessed portion; the second wing includes an upper surface and a lower surface, the upper surface including at least one recessed portion adjacent to at least one non-recessed portion; the at least one recessed portion of the insertion tip corresponds to the at least one non-recessed portion of the second wing; the at least one non-recessed portion of the insertion tip corresponds to the at least one recessed portion of the second wing; The suture button insertion system of claim 1 .

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