Ossicular fixation systems and methods

Abstract

The bone fixation system can be used to stabilize two bones that are intended to fuse together. The system includes a bone staple or clip that includes a crossbar and two legs. The system can include multiple screws or other additional implants configured to be embedded obliquely relative to the legs of the bone staple on either side of the interface between the two bones. The system can improve the fixation strength and / or stability of the two bones. The fixation system can be used, for example, for small bones such as bones of the foot or hand.

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Application No. 62 / 987,299, filed March 9, 2020, which is incorporated herein by reference in its entirety.

[0002] FIELD OF THE INVENTION The present disclosure relates to ossicular fixation systems, and more particularly, to implants, instruments, and methods for fixation of ossicular fractures. [Background technology]

[0003] There are many situations in which bones or bone fragments need to be fused, fused, or otherwise permanently connected. Some non-limiting examples include arthrodesis, corrective osteotomy, and / or fracture. Micromotion at the discontinuity between two bones or bone fragments can delay healing or union of the bones or bone fragments. Bones or bone fragments heal better and / or faster when stabilized with some mechanical load or stress across the discontinuity, such as when the bones or bone fragments are compressed together. The compressive force can reduce micromotion at the discontinuity of the bones or bone fragments. Summary of the Invention [Means for solving the problem]

[0004] The various systems and methods of the present disclosure have been developed in response to the current state of the art, and in particular in response to problems and needs in the art that are not fully resolved by currently available technology. The systems and methods of the present disclosure may provide techniques for ossicular fixation that result in more stable fixation, faster recovery, and / or improved patient outcomes.

[0005] In the present disclosure, an exemplary bone fixation system configured to be implanted across a bone discontinuity or across a joint between two bones may include at least one elongated implant and a clip including a first leg and a second leg, the clip further including a bridge connecting the first leg and the second leg at a first end of each of the first leg and the second leg, wherein a distance between second free ends of the first leg and the second leg opposite the first end is configured to increase when the clip changes from a first configuration to a second deformed configuration, and when moving to the second deformed configuration, the bridge elastically deforms such that the free ends of the first leg and the second leg move away from each other, and the at least one elongated implant and the first leg of the clip are configured to be implanted on a first side of the discontinuity or joint, and the at least one elongated implant is angled with the first leg of the clip.

[0006] In a configuration, the at least one elongate implant may include a first elongate implant and a second elongate implant, wherein the first elongate implant and a first leg of the clip may be configured to be implanted on a first side of the discontinuity or joint, and the second elongate implant and a second leg of the clip are configured to be implanted on a second side of the discontinuity or joint, and wherein the first elongate implant forms a first angle with the first leg of the clip and the second elongate implant forms a second angle with the second leg of the clip.

[0007] In the configuration, the first leg and second leg of the clip may have a length such that when implanted, the second free ends of the first leg and second leg terminate in the cancellous portion of the bone or bone section.

[0008] In the configuration, the at least one elongate implant may include a first thread and a second thread.

[0009] In a configuration, the first screw and the second screw may have a length such that when implanted, the first screw and the second screw are configured to achieve bicortical purchase.

[0010] In the configuration, the tips of the first screw and the second screw may be configured to protrude from the outer surface of the bone or bone portion when implanted.

[0011] In a configuration, the first screw and / or the second screw may be cannulated.

[0012] In a configuration, the first screw and / or the second screw may be non-cannulated.

[0013] In a configuration, the system may include a fixation plate configured to be coupled to the first screw and the second screw when implanted.

[0014] In the configuration, the at least one elongate implant may include a first leg and a second leg of a second clip, and the second clip may further include a bridge connecting the first ends of each of the first and second legs of the second clip, and the distance between the first ends of the first and second legs of the second clip and the second free ends of the first and second legs opposite the first ends of the first and second legs of the second clip may be configured to increase when the second clip changes from the free configuration to the deformed configuration.

[0015] In the configuration, the first leg and the second leg of the second clip may have a length such that when implanted, the second free ends of the first leg and the second leg of the second clip terminate in the cancellous portion of the bone or bone section.

[0016] In the configuration, the first angle may be the same as the second angle.

[0017] In the present disclosure, an exemplary bone fixation system configured to be implanted across a bone discontinuity or across a joint between two bones may include at least one elongated implant and a clip including a first leg and a second leg, the clip further including a bridge connecting the first leg and the second leg at a first end of each of the first leg and the second leg, wherein a distance between second free ends of the first leg and the second leg opposite the first end may be configured to increase when the clip changes from a first configuration to a second deformed configuration, and when moving to the second deformed configuration, the bridge may elastically deform such that the free ends of the first leg and the second leg move away from each other, and the at least one elongated implant and the first leg of the clip may be configured to be implanted on a first side of the discontinuity or joint, and the second leg of the clip is configured to be implanted on a second side of the discontinuity or joint.

[0018] In the configuration, the first leg and second leg of the clip may have a length such that when implanted, the second free ends of the first leg and second leg terminate in the cancellous portion of the bone or bone section.

[0019] In the configuration, the at least one elongate implant may include a screw.

[0020] The configuration has a length that can be configured so that the screw achieves bicortical engagement when implanted.

[0021] In the configuration, the tip of the at least one screw may be configured to protrude from the outer surface of the bone or bone portion when implanted.

[0022] In the configuration, the at least one second screw may be cannulated.

[0023] In the configuration, at least one screw may be non-cannulated.

[0024] In configurations, the system may include a fixation plate configured to be coupled to the at least one screw when implanted.

[0025] In the present disclosure, an exemplary drill guide configured to provide any of the configurations of the above-described systems may include a first pair of alignment holes configured to guide a drill bit to drill holes on either side of the discontinuity or joint to receive the first and second legs of the clip, and at least one second pair of alignment holes configured to guide a drill bit or a different drill bit or bone punch to form holes on either side of the discontinuity to receive the first and second elongated implants, or to guide the insertion of a k-wire on either side of the discontinuity to receive the first and second elongated implants.

[0026] In a configuration, the first pair of alignment holes and at least one second pair of alignment holes may be located on a single member.

[0027] In a configuration, at least one second pair of alignment holes may be offset a distance from the first pair of alignment holes.

[0028] In the configuration, the at least one second pair of alignment holes can be spaced a shorter distance apart than the first pair of alignment holes.

[0029] In a configuration, at least one of the second pair of alignment holes may be sized to receive a k-wire.

[0030] In a configuration, at least one of the second pair of alignment holes may be sized to drill holes configured to receive non-cannulated screws.

[0031] In the configuration, at least one of the second pair of alignment holes can be sized to receive a guide tube, and the guide tube can be configured to slidably receive a k-wire.

[0032] In the configuration, the first pair of alignment holes may be configured to guide a drill bit to drill the hole without traversing the discontinuity.

[0033] In the configuration, at least one second pair of alignment holes can be configured to guide a drill bit or other different drill bit or bone punch to form a hole or to guide the insertion of a k-wire without crossing the discontinuity.

[0034] In a configuration, the at least one second pair of alignment holes may include two or more pairs of alignment holes that are at different angles relative to the first pair of alignment holes.

[0035] In a configuration, the drill guide may include a pair of temporary fixation pins configured to be inserted through the first pair of alignment holes and drill holes in the bone or bone portion to receive the first and second legs of the clip prior to forming holes for receiving the first and second elongate implants or prior to inserting a k-wire.

[0036] In configuration, the kit may include any of the bone fixing systems described above and any of the drill guides described above.

[0037] In the present disclosure, an exemplary surgical guide system configured to assist in delivering any of the above-described systems may include a clip drill guide configured to be positioned across a discontinuity or joint, the clip drill guide including a first cannula configured to be positioned on a first side of the discontinuity or joint and a second cannula configured to be positioned on a second side of the discontinuity or joint; and an implant guide configured to be positioned on the first or second side of the discontinuity or joint, the implant guide including a plurality of implant positioning holes therethrough and a plurality of guide positioning holes therethrough, the plurality of implant positioning holes being spaced a distance from the plurality of guide positioning holes.

[0038] In the configuration, the first cannula and the second cannula are configured to guide the first clip leg hole and the second clip leg hole to drill without crossing a discontinuity or a joint.

[0039] The configuration includes a first temporary pin configured to be inserted through a first cannula and inserted into a first clip leg hole drilled through the first cannula in the bone or bone portion, and a second temporary pin configured to be inserted through a second cannula and inserted into a second clip leg hole drilled through the second cannula in the bone or bone portion.

[0040] In the configuration, a plurality of guide positioning holes extending through the implant guide are configured to slidably receive the first temporary pin and / or the second temporary pin.

[0041] In the configuration, the plurality of implant positioning holes are configured to receive a drilling device configured to form a first implant hole or a second implant hole in the bone or bone portion.

[0042] In the configuration, the first implant hole and / or the second implant hole are each configured to receive a non-cannulated screw.

[0043] In some configurations, the drilling device includes a drill bit or a bone punch.

[0044] In the configuration, the plurality of implant positioning holes are configured to receive k-wires.

[0045] In the configuration, the plurality of implant locating holes are configured to guide a drilling device or k-wire through the bone or bone portion without crossing a discontinuity or joint.

[0046] In the configuration, the plurality of implant positioning holes are positioned closer to the discontinuity or joint than the plurality of guide positioning holes.

[0047] In the configuration, the implant guide is arc-shaped, the plurality of implant positioning holes extend through the implant guide at various angles, and the plurality of guide positioning holes extend through the implant guide at various angles.

[0048] In configuration, the kit may include any of the bone fixing systems described above and any of the surgical guide systems described above.

[0049] In the present disclosure, an exemplary method of fixing bone portions defined by a bone discontinuity or fixing two bones across a joint includes delivering a first elongated implant to the bone or bone portion on a first side of the discontinuity or joint, delivering a second elongated implant to the bone or bone portion on a second side of the discontinuity or joint, and delivering a clip to the bone or bone portion, wherein a first leg of the clip is on the first side of the discontinuity or joint and a second leg of the clip is on the second side of the discontinuity or joint, and a bridge connecting first ends of the first leg and the second leg extends across the discontinuity or joint. the clip may be biased into a first configuration, the clip may be delivered in a second deformed configuration such that a distance between the free ends of the first and second legs of the clip is increased relative to the first configuration, the first elongated implant may be positioned between the first leg of the clip and the discontinuity or joint, the second elongated implant may be positioned between the second leg of the clip and the discontinuity or joint, the first elongated implant may form a first angle with the first leg of the clip, and the second elongated implant may form a second angle with the second leg of the clip.

[0050] In a configuration, the method may further include pre-drilling a hole in the bone or bone portion, the hole configured to receive the first elongate implant, the second elongate implant, and / or the first leg and the second leg of the clip.

[0051] In a configuration, pre-drilling the holes may include using a clip drill guide to locate holes for the first leg and second leg of the clip.

[0052] In a configuration, pre-drilling the holes can include using an implant guide to locate the holes for the first elongate implant and the second elongate implant.

[0053] In this configuration, the clip drill guide and implant guide may comprise an integrated device.

[0054] In the configuration, the implant guide may include a plurality of holes for selecting the first angle and / or the second angle.

[0055] In a configuration, the plurality of holes may include holes sized to deliver non-cannulated screws.

[0056] In a configuration, the first elongate implant and / or the second elongate implant may include a non-cannulated screw.

[0057] In a configuration, the plurality of holes may include holes sized for k-wires configured to deliver cannulated screws.

[0058] In a configuration, the first elongate implant and / or the second elongate implant may include a cannulated screw.

[0059] In the configuration, the holes for the first elongate implant and the second elongate implant can be offset from the hole to space the first leg and the second leg a distance apart.

[0060] In the configuration, the first angle and the second angle can be substantially the same such that the first elongate implant and the second elongate implant are approximately parallel to one another.

[0061] In a configuration, the first angle and the second angle can be different such that the first elongate implant and the second elongate implant are angled relative to one another.

[0062] In the configuration, each of the first elongate implant and the second elongate implant can have a length that is longer than the length of the first leg or the second leg such that the first elongate implant and the second elongate implant, respectively, are configured to achieve bicortical engagement.

[0063] In the configuration, the first elongate implant and / or the second elongate implant may be delivered such that a tip of the first elongate implant and / or the second elongate implant protrudes from an outer surface of the bone or bone portion.

[0064] In a configuration, delivering the first elongate implant and delivering the second elongate implant may include delivering a first leg and a second leg of a second clip.

[0065] In configuration, the discontinuity may include a fracture or resection line.

[0066] In the configuration, the clip may be delivered such that the first elongate implant and the first leg of the clip, and / or the second elongate implant and the second leg of the clip are separated by a distance.

[0067] In a configuration, the first elongate implant and the second elongate implant may be delivered prior to delivering the clip.

[0068] In a configuration, the first elongate implant and the second elongate implant may be delivered after delivering the clip.

[0069] In the configuration, the clip can be in the deformed configuration when the first elongate implant and the second elongate implant are delivered.

[0070] In the configuration, the first elongate implant and the second elongate implant can be delivered without crossing a discontinuity.

[0071] In the configuration, the clip can be delivered without the first leg and / or the second leg crossing the discontinuity.

[0072] In one configuration, the method includes positioning a clip drill guide across a discontinuity or joint, the clip drill guide including a first cannula positioned on a first side of the discontinuity or joint and a second cannula positioned on a second side of the discontinuity or joint; drilling a first clip leg hole through the first cannula; inserting a first temporary pin into the first clip leg hole through the first cannula; drilling a second clip leg hole through the second cannula; inserting a second temporary pin into the second clip leg hole through the second cannula; positioning the implant guide on the first side of the discontinuity or joint by sliding one of a plurality of guide positioning holes through the implant guide over the first temporary pin; and inserting a hole through one of a plurality of implant positioning holes through the implant guide. The method may further include forming a first implant hole by inserting a drilling device, wherein the plurality of implant positioning holes may be positioned closer to the discontinuity or joint than the plurality of guide positioning holes; positioning an implant guide on a second side of the discontinuity or joint by sliding one or another of the plurality of guide positioning holes over a second temporary pin; forming a second implant hole by inserting the drilling device or a second drilling device through one or another of the plurality of implant positioning holes; inserting the first implant into the first implant hole; inserting the second implant into the second implant hole; removing the first temporary pin and the second temporary pin; and inserting a first leg of a clip into the first clip leg hole and a second leg of the clip into the second clip leg hole.

[0073] In the configuration, the drilling device may include a drill bit.

[0074] In a configuration, the drilling device may include a bone punch.

[0075] In one configuration, the method includes positioning a first drill guide across the discontinuity or joint, the first drill guide including a first cannula positioned on a first side of the discontinuity or joint and a second cannula positioned on a second side of the discontinuity or joint; drilling a first clip leg hole through the first cannula; inserting a first temporary pin into the first clip leg hole through the first cannula; drilling a second clip leg hole through the second cannula; inserting the second temporary pin into the second clip leg hole through the second cannula; positioning the implant guide on the first side of the discontinuity or joint by sliding one of a plurality of guide positioning holes through the implant guide over the first temporary pin; and inserting a first implant guide wire through one of a plurality of implant positioning holes that may pass through the implant guide. the plurality of implant positioning holes are positioned closer to the discontinuity or joint than the plurality of guide positioning holes; positioning the implant guide on a second side of the discontinuity or joint by sliding one or another one of the plurality of guide positioning holes over a second temporary pin; inserting a second implant guide wire through the one or another one of the plurality of implant positioning holes; inserting a first implant into the bone or bone portion over the first implant guide wire; inserting a second implant into the bone or bone portion over the second implant guide wire; removing the first implant guide wire and the second implant guide wire; removing the first temporary pin and the second temporary pin; and inserting a first leg of the clip into the first clip leg hole and a second leg of the clip into the second clip leg hole.

[0076] In a configuration, the plurality of implant locating holes may have a smaller diameter than the plurality of guide locating holes.

[0077] In a configuration, the implant guide can be arc-shaped, with multiple implant positioning holes extending through the implant guide at various angles, and multiple guide positioning holes extending through the implant guide at various angles.

[0078] In the present disclosure, an exemplary method of fixing bone portions defined by a bone discontinuity or fixing two bones across a joint may include delivering at least one elongated implant to the bone or bone portion on a first side of the discontinuity or joint, and delivering a clip to the bone or bone portion, wherein a first leg of the clip is on the first side of the discontinuity or joint and a second leg of the clip is on a second side of the discontinuity or joint, and a bridge connecting first ends of the first leg and the second leg extends across the discontinuity or joint, wherein the clip may be biased into a first configuration, and wherein the clip may be delivered in a second deformed configuration such that a distance between the free ends of the first leg and the second leg of the clip is increased relative to the first configuration, and wherein the at least one elongated implant may be positioned between the first leg of the clip and the discontinuity or joint, and wherein the at least one elongated implant may be angled with the first leg of the clip.

[0079] In a configuration, the method may further include pre-drilling a hole in the bone or bone portion, the hole configured to receive the first leg and the second leg of the at least one elongate implant and / or clip.

[0080] In a configuration, pre-drilling the holes may include using a clip drill guide to locate holes for the first leg and second leg of the clip.

[0081] In a configuration, pre-drilling the holes may include using an implant guide to locate the holes for the at least one elongate implant.

[0082] In this configuration, the clip drill guide and implant guide may comprise an integrated device.

[0083] In configuration, the implant guide may include multiple holes for selecting angles.

[0084] In a configuration, the plurality of holes may include holes sized to deliver non-cannulated screws.

[0085] In a configuration, the at least one elongate implant may include a non-cannulated screw.

[0086] In a configuration, the plurality of holes may include holes sized for k-wires configured to deliver cannulated screws.

[0087] In a configuration, the at least one elongate implant may include a cannulated screw.

[0088] In the configuration, the hole for the at least one elongate implant may be offset from the hole to space the first leg a distance apart.

[0089] In the configuration, the at least one elongate implant may have a length such that the at least one elongate implant is configured to achieve bicortical engagement.

[0090] In the configuration, the at least one elongate implant may be delivered such that a tip of the at least one elongate implant protrudes from an outer surface of the bone or bone portion.

[0091] In configuration, the discontinuity may include a fracture or resection line.

[0092] In the configuration, the clip may be delivered such that the at least one elongate implant and the first leg of the clip are separated by a distance.

[0093] In a configuration, the at least one elongate implant may be delivered prior to delivering the clip.

[0094] In a configuration, the first elongate implant and the second elongate implant may be delivered after delivering the clip.

[0095] In the configuration, the clip can be in the deformed configuration when the first elongate implant and the second elongate implant are delivered.

[0096] In the configuration, the at least one elongate implant can be delivered without crossing the discontinuity.

[0097] In the configuration, the clip can be delivered without the first leg and / or the second leg crossing the discontinuity.

[0098] In one configuration, the method includes positioning a clip drill guide across a discontinuity or joint, the clip drill guide including a first cannula positioned on a first side of the discontinuity or joint and a second cannula positioned on a second side of the discontinuity or joint; drilling a first clip leg hole through the first cannula; inserting a first temporary pin through the first cannula into the first clip leg hole; drilling a second clip leg hole through the second cannula; inserting the second temporary pin through the second cannula into the second clip leg hole; and inserting one of a plurality of guide positioning holes through the implant guide into the first clip leg hole. The method may further include positioning an implant guide on a first side of the discontinuity or joint by sliding it over a temporary pin; forming an implant hole by inserting a drilling device through one of a plurality of implant positioning holes extending through the implant guide, the plurality of implant positioning holes being positionable closer to the discontinuity or joint than the plurality of guide positioning holes; inserting at least one elongated implant into the implant hole; removing the first temporary pin and the second temporary pin; and inserting a first leg of the clip into the first clip leg hole and a second leg of the clip into the second clip leg hole.

[0099] In the configuration, the drilling device may include a drill bit.

[0100] In a configuration, the drilling device may include a bone punch.

[0101] In one configuration, the method includes positioning a first drill guide across the discontinuity or joint, the first drill guide including a first cannula positioned on a first side of the discontinuity or joint and a second cannula positioned on a second side of the discontinuity or joint; drilling a first clip leg hole through the first cannula; inserting a first temporary pin through the first cannula and into the first clip leg hole; drilling a second clip leg hole through the second cannula; inserting the second temporary pin through the second cannula and into the second clip leg hole; and sliding one of a plurality of guide positioning holes through the implant guide over the first temporary pin. and inserting an implant guide wire through one of a plurality of implant positioning holes extending through the implant guide, the plurality of implant positioning holes being positionable closer to the discontinuity or joint than the plurality of guide positioning holes; inserting at least one elongated implant into the bone or bone portion over the implant guide wire; removing the implant guide wire; removing the first temporary pin and the second temporary pin; and inserting a first leg of a clip into the first clip leg hole and a second leg of the clip into the second clip leg hole.

[0102] In a configuration, the plurality of implant locating holes may have a smaller diameter than the plurality of guide locating holes.

[0103] In a configuration, the plurality of implant positioning holes can be sized to receive a guide tube, and the guide tube can be configured to slidably receive an implant guidewire.

[0104] In a configuration, the implant guide can be arc-shaped, with multiple implant positioning holes extending through the implant guide at various angles, and multiple guide positioning holes extending through the implant guide at various angles.

[0105] The foregoing summary is for purposes of illustration only and is not intended to be limiting. Other aspects, features, and advantages of the systems, devices, and methods, and / or other subject matter described herein, will become apparent in the teachings set forth below. This summary is provided to introduce a selection of concepts of the present disclosure. This summary is not intended to identify key features or essential features of the subject matter described herein. [Brief explanation of the drawings]

[0106] Various embodiments are shown in the accompanying drawings for purposes of illustration and should in no way be construed as limiting the scope of these examples. Various features of different disclosed embodiments can be combined to form additional embodiments, which are part of this disclosure. [Figure 1] 1 is a schematic diagram of a perspective view of an exemplary bone and fixation device implanted across the bone boundary. FIG. [Figure 2A] FIG. 2 is a perspective view of the fixation device of FIG. 1; [Figure 2B] FIG. 2 is a view of the fixation device of FIG. 1 in a free configuration. [Figure 2C] 2 is a view of the fixation device of FIG. 1 in a modified configuration; [Figure 2D] FIG. 2 is a side view of the fixation device of FIG. 1 in a free configuration. [Figure 2E] 2 is a side view of the fixation device of FIG. 1 in a modified configuration. [Figure 2F] 2 is a perspective view of an exemplary insertion tool coupled to the fixation device of FIG. 1. [Figure 3A] 2 is a perspective view of an exemplary bone portion and fixation system including the fixation device of FIG. 1 implanted across a discontinuity in the bone portion and multiple screws implanted on either side of the discontinuity; FIG. [Figure 3B]FIG. 3B is a side view of the bone and fixation system of FIG. 3A. [Figure 4A] 1 is a perspective view of an exemplary bone portion, which is a schematic diagram, and another fixation system including the fixation device of FIG. 1 implanted across a discontinuity in the bone portion and a plurality of cannulated screws implanted on either side of the discontinuity. [Figure 4B] FIG. 4B is a side view of the bone and fixation system of FIG. 4A. [Figure 5A] 4A-4B, in which the cannulated screws have a different insertion angle than shown in FIGS. 4A-4B. FIG. [Figure 5B] FIG. 5B is a side view of the bone and fixation system of FIG. 5A. [Figure 5C] 5B is another perspective view of the bone and fixation system of FIG. 5A. [Figure 6] 5A-5B are schematic side views of an exemplary bone, fixation system, and fixation plate. [Figure 7] 2 is a perspective view of an exemplary bone and fixation system including two fixation devices of FIG. 1 each implanted across a discontinuity in the bone. [Figure 8A] 3A-3B illustrate certain steps for implanting the fixation system of FIGS. 3A-3B. [Figure 8B] 3A-3B illustrate certain steps for implanting the fixation system of FIGS. 3A-3B. [Figure 8C] 3A-3B illustrate certain steps for implanting the fixation system of FIGS. 3A-3B. [Figure 8D] 3A-3B illustrate certain steps for implanting the fixation system of FIGS. 3A-3B. [Figure 8E] 3A-3B illustrate certain steps for implanting the fixation system of FIGS. 3A-3B. [Figure 8F] 3A-3B illustrate certain steps for implanting the fixation system of FIGS. 3A-3B. [Figure 8G] 3A-3B illustrate certain steps for implanting the fixation system of FIGS. 3A-3B. [Figure 8H] 3A-3B illustrate certain steps for implanting the fixation system of FIGS. 3A-3B. [Figure 8I] 3A-3B illustrate certain steps for implanting the fixation system of FIGS. 3A-3B. [Figure 9A] 5A-5C illustrate certain steps for implanting the fixation system of FIGS. 4A-5C. [Figure 9B] 5A-5C illustrate certain steps for implanting the fixation system of FIGS. 4A-5C. [Figure 9C] 5A-5C illustrate certain steps for implanting the fixation system of FIGS. 4A-5C. [Figure 9D] 5A-5C illustrate certain steps for implanting the fixation system of FIGS. 4A-5C. [Figure 10A] FIG. 2E is a perspective view of an exemplary drill guide for preparing bone for implantation of the fixation device of FIGS. 2A-2D. [Figure 10B] FIG. 7 is a perspective view of an exemplary drill guide for preparing bone for implantation of the screws shown in FIGS. 3A-6. [Figure 11A] 5A-5C illustrate certain steps for using an alternative drill guide for implanting the fixation system of FIGS. [Figure 11B] 5A-5C illustrate certain steps for using an alternative drill guide for implanting the fixation system of FIGS. [Figure 11C] 5A-5C illustrate certain steps for using an alternative drill guide for implanting the fixation system of FIGS. [Figure 11D] 5A-5C illustrate certain steps for using an alternative drill guide for implanting the fixation system of FIGS. [Figure 11E] 5A-5C illustrate certain steps for using an alternative drill guide for implanting the fixation system of FIGS. [Figure 12A] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12B] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12C] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12D] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12E] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12F] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12G] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12H] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12I] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12J] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. [Figure 12K] 5A-5C illustrate certain steps of using another alternative drill guide for implanting the fixation system of FIGS. DETAILED DESCRIPTION OF THE INVENTION

[0107] Various features and advantages of the systems, apparatus, and methods of the technology described herein will become more fully apparent from the following description of illustrated examples. These examples are intended to illustrate the principles of the disclosure, and the disclosure should not be limited solely to the described examples. In light of the principles disclosed herein, features of the illustrated examples may be modified, combined, removed, and / or substituted, as would be apparent to one skilled in the art.

[0108] Overview of Examples of Bone Fixation Systems The present disclosure describes improved systems and methods for stabilizing bones or bone fragments intended to be fused together while applying therapeutic levels of continuous mechanical load or stress across the discontinuity.

[0109] Bone staples or clips can apply a compressive force between two bone portions, at least stabilizing the two bone portions and helping to promote healing at the bone discontinuity. In the bone fixation systems disclosed herein, additional implants can be used in combination with clips to further increase the fixation strength of the system in the bone portions and / or improve healing of the fixed bone portions. When additional implants are used with clips on either side of the discontinuity (and, in some embodiments, without crossing the discontinuity) and implanted adjacent (e.g., immediately adjacent) to the clip legs at an angle to the clip legs, the crossing of the additional implants and clip legs can improve cortical engagement of the fixation system. The compressive force applied by the clip legs toward each other can be transferred to the more laterally inserted fixation device, applying a more evenly distributed compressive force across the discontinuity.

[0110] As described in more detail below, the additional implant may include one or more screws, such as fixation screws or compression screws, which may be cannulated or non-cannulated, fully threaded or partially threaded, and / or include a screwdriver head or be headless. In some implementations, a fixation plate may be used with the screws. In other implementations, the additional implant may include a second clip implanted at an angle relative to the first clip so that the legs of the first and second clips intersect when viewed from the side of the discontinuity. The second clip may have the same features as the first clip or different features.

[0111] 1, an exemplary bone staple or clip 102 may be used to stabilize two bone portions 10A, 10B that are partially or completely separated at a boundary or discontinuity 16. For example, the discontinuity 16 may be a fracture site, a resection site, or another bone-to-bone interface. The bone portions 10A, 10B may be portions of the same bone or different bones prior to forming the discontinuity 16. The clip 102 may be fabricated from titanium, stainless steel, polyetheretherketone (PEEK), nitinol, and / or other rigid or semi-rigid biocompatible materials, or combinations thereof.

[0112] As shown in FIGS. 2A-2E , the clip 102 can be formed as a single piece. In some embodiments, the clip can include a material such as Nitinol or other shape-memory material. The clip 102 can include bone-engaging legs 152, 154, which can be referred to as members or prongs. The bone-engaging legs 152, 154 can be connected by a bridge 150. The bone-engaging legs 152 extend from near a first end of the bridge 150. The bone-engaging legs 152 can include a first end attached to the bridge 150 and a second end that can be a free end. The bone-engaging legs 152 can have a substantially uniform thickness along substantially their entire length. In other implementations, the bone-engaging legs 152 can taper toward the free end. The bone-engaging legs 154 extend from near the second end of the bridge 150. The bone-engaging legs 154 can include a first end attached to the bridge 150 and a second end that can be a free end. The bone-engaging legs 154 may have a substantially uniform thickness along substantially their entire length. In other implementations, the bone-engaging legs 154 may be tapered toward the free end. The bone-engaging legs 152, 154 may include teeth 153, 155, respectively, or other grip-enhancing features. The teeth 153, 155 may improve bone bite and / or improve pullout strength of the clip 102 from the bone segments 10A, 10B shown in FIG. 1 . The teeth 153 and 155 may face each other. In other implementations, the teeth 153, 155 may be located on any one or more longitudinal or substantially longitudinally extending surfaces of the bone-engaging legs 152, 154.

[0113] The bridge 150 may include a first shoulder 156 and a second shoulder 158 at opposite ends thereof. The shoulders 156, 158 extend away from the connection points of the legs 152, 154 along the longitudinal axis of the bridge 150 (which may be generally transverse to the central longitudinal axis of the clip 102) and may each terminate at a free end of the bridge 150. In some implementations, the shoulders 156, 158 may include tabs, ears, protrusions, wings, retainers, or other retention members. Alternatively, the shoulders 156, 158 may extend generally transverse to the longitudinal axis of the bridge 150. In some embodiments, the bridge 150 may be symmetrical about the central longitudinal axis of the clip 102.

[0114] As further described in U.S. Patent Application Publication No. 2018 / 0317906, which is incorporated herein by reference in its entirety and is to be considered part of this disclosure, the clip 102 can change between a free configuration and a deformed configuration. In the absence of a resultant external force, the clip 102 can be in the free configuration, as shown in FIG. 2B . That is, the clip 102 can be biased into the free configuration. In the free configuration, the bridge 150 can have a bend with a concave surface facing the legs 152, 154. The free ends of the legs 152, 154 can be spaced a first distance D1 apart in the free configuration, as shown in FIG. 2B . As shown in FIGS. 2C and 2E , a force can be applied to, for example, reduce or otherwise change the curvature of the bridge 150 so that the clip 102 can be deformed. In the fully deformed configuration, the bridge 150 is elastically straight. As shown in FIG. 2C, the free ends of the bone-engaging legs 152, 154 are further separated to a second distance D2 in the free configuration that is greater than D1.

[0115] The clip 102 may be movable between a free configuration and a deformed configuration by an insertion tool 170, as shown in FIG. 2F. The insertion tool 170 may include a body 172 and a knob 173. The knob 173 may be at the proximal end of the insertion tool 170. An at least partially threaded shaft 174 may have a first end connected to the knob 173 and a second free end at or near the distal end of the insertion tool 170. The shaft 174 may be movable along the longitudinal axis of the insertion tool 170 by rotation of the knob 173. The insertion tool 170 may include a pair of jaws 176, 178 at the distal end near or adjacent the second free end of the shaft 174. The bridge 150 of the clip 104 may be positioned between the jaws 176, 178. The shoulders 156, 158 of the clip 104 may be engaged within respective members of the pair of jaws 176, 178. A second free end of shaft 174 may engage bridge 150. By axially translating shaft 174 relative to bridge 150 and securing shoulders 156, 158 within jaws 176, 178, bridge 150 may be bent or straightened between a free configuration and a deformed configuration.

[0116] Referring again to FIG. 1 , the bone-engaging legs 152, 154 of the clip 102 can have a length such that a free end of the bone-engaging legs 152, 154 is configured to terminate in the cancellous bone region 14 of the bone portions 10A, 10B, and another portion of the bone-engaging legs 152, 154 is configured to engage the cortical bone region 12 on one side of the bone portions 10A, 10B. As shown, the clip 102 does not have to engage the cortical bone region on the radially opposite side of the bone portions 10A, 10B. Fixation in the cancellous bone region is not as strong as fixation in the cortical bone region. For clarity, the cortical and cancellous bone regions are not shown in subsequent figures containing schematic diagrams of the bone portions. In some embodiments, the bone-engaging legs 152, 154 of the clip 102 can have a length such that at least one of the free ends of the bone-engaging legs 152, 154 achieves bicortical engagement.

[0117] 3A and 3B illustrate an exemplary fixation system 300 that can improve fixation and / or healing of bones 10A, 10B in cortical bone regions. The fixation system 300 can include a clip 102 in a modified configuration and one or more (e.g., two) screws 302, 304. In some implementations, the screws 302, 304 can be compression screws, which has its plain and ordinary meaning as understood by those skilled in the art. The screws 302, 304 can be non-cannulated. The screws 302, 304 can be threaded along substantially the entire length of their shafts. The screws 302, 304 can have lengths configured to achieve bicortical engagement in the bones 10A, 10B. As shown in FIG. 3B, the tips of the screws 302, 304 can slightly protrude from the outer surface of the bones 10A, 10B. In other embodiments, the tips of the screws do not protrude from the cortical surface of the bone. The term "bicortical engagement" has its plain and ordinary meaning as understood by those skilled in the art. The length of the screws 302, 304 may or may not be longer than the length of the legs 152, 154 of the clip 102.

[0118] As shown in FIG. 3A , the screw 302 can be on the same side of the discontinuity 16 as the bone-engaging leg 152, and the screw 304 can be on the same side of the discontinuity 16 as the bone-engaging leg 154. The bridge 150 of the clip 102 can span across the discontinuity 16. The screw 302 is between the discontinuity 16 and the bone-engaging leg 152. The screw 304 is between the discontinuity 16 and the bone-engaging leg 154. Preferably, there can be an interference between the bone-engaging leg 152 and the screw 302 and / or between the bone-engaging leg 154 and the screw 304. Optionally, the screws 302, 304 can be separated from the bone-engaging legs 152, 154, respectively, by a gap. The size of the gap can vary. The spacing of the screws 302, 304 relative to the legs 152, 154 can be anywhere from an interference to a gap of approximately 2 mm. The spacing can be based at least in part on the length and / or convergence angle of the legs 152, 154, which can be used to determine the amount of travel the legs 152, 154 have before receiving assistance from contact with the screws 302, 304.

[0119] As shown in FIGS. 3A and 3B , the screw 302 can be at a first angle relative to the bone-engaging leg 152, and the screw 304 can be at a second angle relative to the bone-engaging leg 154. The first and second angles can be the same or different. The respective angles between the screws 302, 304 and the bone-engaging legs 152, 154 can be varied depending on, for example, the adjacent anatomical structures, surgical exposure, and / or other factors. In some embodiments, the screws 302, 304 and the bone-engaging legs 152, 154 of the clip 102 do not cross the discontinuity. Not extending across the discontinuity 16 can be advantageous in bone fusion procedures where the amount of space available for a fixation device, such as a compression screw, at the discontinuity 16 (e.g., a fracture line) is limited, particularly in cortical bone space. In some implementations, the screws 302, 304 and / or the bone-engaging legs 152, 154 are implanted generally transversely relative to the bones 10A, 10B.

[0120] Compressive forces between the bone-engaging legs 152, 154 (due to deformation of the bridge 150 of the clip 102) that terminate in the cancellous bone region can be transmitted to the screws 302, 304 therebetween, which have bicortical bite and are angled with the legs 152, 154. This combination can provide more contact between the fixation system 300 and the cortical regions of the bones 10A, 10B. The screws 302, 304 can facilitate more even distribution of the compressive forces provided by the bone-engaging legs 152, 154 of the clip 102 across the discontinuity 16. Thus, the fixation system 300 can provide greater fixation strength and / or promote better stabilization of the bones 10A, 10B.

[0121] 4A-4B and 5A-5B illustrate an exemplary fixation system 400 that can improve fixation of the system 400 in cortical bone regions and / or healing of bones 10A, 10B. The system 400 can include a clip 102 in a modified configuration and one or more (e.g., two) screws 402, 404. In some implementations, the screws 402, 404 can be compression screws. The screws 402, 404 can be cannulated, including a channel 403 configured to receive a k-wire. The screws 402, 404 can be threaded along a portion of their shaft length. The threads can extend from the leading end of the screws 402, 404 toward the trailing end or driver head of the screws. The screws 402, 404 can have a length configured to achieve bicortical engagement in the bones 10A, 10B. 4B and 5B, the tips of the screws 402, 404 can protrude slightly from the outer surface of the bone portions 10A, 10B. In other embodiments, the tips of the screws do not protrude from the cortical surface of the bone. The length of the screws 302, 304 may or may not be longer than the length of the legs 152, 154 of the clip 102.

[0122] As shown in FIGS. 4A and 5A , the screw 402 can be on the same side of the discontinuity 16 as the bone-engaging leg 152, and the screw 404 can be on the same side of the discontinuity 16 as the bone-engaging leg 154. The bridge 150 of the clip 102 can span across the discontinuity 16. The screw 402 is between the discontinuity 16 and the bone-engaging leg 152. The screw 404 is between the discontinuity 16 and the bone-engaging leg 154. Preferably, there can be an interference between the bone-engaging leg 152 and the screw 402 and / or between the bone-engaging leg 154 and the screw 404. Optionally, the screws 402, 404 can be separated from the bone-engaging legs 152, 154, respectively, by a gap. The size of the gap can vary. The spacing of the screws 402, 404 relative to the legs 152, 154 can be anywhere from an interference to a gap of about 2 mm. The spacing can be based at least in part on the length and / or convergence angle of the legs 152, 154, which can be used to determine the amount of travel the legs 152, 154 have before receiving assistance from contact with the screws 402, 404.

[0123] As shown in FIGS. 4A and 4B , the screw 402 can be at a first angle relative to the bone-engaging leg 152, and the screw 404 can be at a second angle relative to the bone-engaging leg 154. The first angle and the second angle can be different. As shown in FIGS. 5A and 5B , the screws 402, 404 can have substantially the same angle relative to the bone-engaging legs 152, 154. The threads 402, 404 can be substantially parallel. In the implementation shown in FIGS. 5A-5B , the system 400 can be substantially symmetrical about the plane of the discontinuity 16. The respective angles between the screws 402, 404 and the bone-engaging legs 152, 154 can be varied depending on, for example, adjacent anatomical structures, surgical exposure, and / or other factors.

[0124] In some embodiments, the screws 402, 404 and bone-engaging legs 152, 154 do not cross the discontinuity 16. Not extending across the discontinuity 16 can be advantageous in bone fusion procedures where the amount of space, particularly cortical bone space, available for fixation devices such as compression screws at the discontinuity 16 (such as a fracture line) is limited. In some implementations, the screws 402, 404 and / or bone-engaging legs 152, 154 are implanted generally transversely relative to the bones 10A, 10B.

[0125] Compressive forces between the bone-engaging legs 152, 154 (due to deformation of the bridge 150) that terminate in the cancellous region can be transmitted to the screws 402, 404 therebetween, which have bicortical bite and are angled with the legs 152, 154. This combination can provide more contact between the fixation system 300 and the cortical regions of the bones 10A, 10B. The screws 402, 404 can facilitate more even distribution of the compressive forces provided by the bone-engaging legs 152, 154 of the clip 102 across the discontinuity 16. Thus, the fixation system 400 can provide greater fixation strength and / or promote faster healing of the bones 10A, 10B.

[0126] FIG. 6 illustrates an exemplary fixation system 600 that can improve fixation of the system 600 in the cortical bone region and / or healing of the bones 10A, 10B. The fixation system 600 can incorporate any of the features of the system 400 described above. The system 600 can include a modified configuration of the clip 102, multiple (e.g., two) screws 402, 404, and a fixation plate 602. The screws 402 and 404 can include driver heads 405 having an outer diameter larger than the outer diameter of the screw shafts. As shown in FIG. 6 , when the screws 402, 404 are implanted substantially parallel to one another, the heads 405 of the screws 402, 404 can engage with their respective openings in the fixation plate 602. Alternatively, the screws 402, 404 can be implanted at an angle to one another and on either side of the discontinuity 16 while being between the bone-engaging legs 152, 154. The fixation plate 602 can improve bone reduction and therefore promote better fixation of the bone portions 10A, 10B.

[0127] FIG. 7 illustrates an exemplary fixation system 700 that can improve fixation and / or healing of bones 10A, 10B in cortical bone regions. The fixation system 701 can include the first clip 102 (having elastic or superelastic properties) described above inserted into a deformed configuration and a substantially rigid second clip 105 (e.g., not elastic). The legs 172, 174 of the second clip 105 can be substantially parallel or at another fixed angle relative to each other. The second clip 105 can have a bridge 170 that is shorter than the bridge 150 of the first clip 102. As shown in FIG. 7B, the bridges 150, 170 of the first clip 102 and the second clip 105 each extend across the discontinuity 16. The bone-engaging legs 172, 174 of the second clip 105 can be located between the bone-engaging legs 152, 154 of the first clip 102. The bone-engaging legs 152, 154 of the first clip 102 can be angled relative to the bone-engaging legs 172, 174 of the second clip 105. The respective angles between the bone-engaging legs 172, 174 and the bone-engaging legs 152, 154 can be varied depending on, for example, the adjacent anatomical structures, surgical exposure, and / or other factors. In some embodiments, the bone-engaging legs 152, 154 of the first clip 102 and the bone-engaging legs 172, 174 of the second clip 105 do not cross the discontinuity 16. In some implementations, the bone-engaging legs 152, 154 of the first clip 102 and / or the bone-engaging legs 172, 174 of the second clip 105 are embedded generally transversely relative to the bones 10A, 10B. In some embodiments, the bone-engaging legs 172, 174 of the second clip 105 are longer than the bone-engaging legs 152, 154 of the first clip 102. In some embodiments, the bone-engaging legs 172, 174 of the second clip 105 are long enough to achieve bicortical engagement.

[0128] In some embodiments, the compressive force between the bone-engaging legs 152, 154 of the first clip 102 (due to deformation of the bridge 150) can be transferred to the rigid bone-engaging legs 172, 174. The fixation of the bone-engaging legs 172, 174 of the second clip 105 in the cortical regions of the bones 10A, 10B, combined with the fixation of the bone-engaging legs 152, 154 of the first clip 102 in the cortical regions of the bones 10A, 10B, improves overall cortical engagement. This combination can result in more contact between the fixation system 701 and the cortical regions of the bones 10A, 10B and greater, more evenly distributed compressive forces across the discontinuity 16, leading to improved fixation strength and / or faster healing of the bones 10A, 10B.

[0129] The fixation system may include the clip 102 in the deformed configuration and other arrangements of additional implants configured to increase the cortical bite of the system and / or intersect the legs 152, 154 of the clip 102 to more evenly distribute the compressive force across the discontinuity 16 and / or increase the compressive force across the discontinuity 16. The additional implants may include, for example, cannulated and non-cannulated screws, multiple tacks, multiple unthreaded nails, a second bone staple without a deformed configuration, etc.

[0130] Exemplary Tools and Methods for Implanting Particular Fastening Systems Exemplary methods for implanting the fixation systems 300, 400 shown in Figures 3A-3B, 4A-4B, and 5A-5C are described below. Those skilled in the art will appreciate from this disclosure that the fixation systems disclosed herein can be implanted with other methods and / or delivery devices. While not all steps are shown here for brevity, those skilled in the art will appreciate that such steps may be included based on this disclosure. These methods and / or delivery devices may also be used, in whole or in part, to deliver other examples of fixation systems.

[0131] As shown in FIGS. 8A-8I , a method for fixing bone portions across a discontinuity using fixation system 300 may include one or more of the following steps. As shown in FIG. 8A , a first drill guide 800 may be positioned across discontinuity 16 relative to the outer surface of bone portions 10A, 10B. Drill guide embodiments disclosed herein can aid in properly positioning screws relative to the legs of a clip. First drill guide 800 may include two alignment openings 802, 804 configured to be aligned relative to bone portions 10A, 10B on either side of discontinuity 16. Openings 802, 804 may extend into channels along posts 812, 814, respectively. Posts 812, 814 may have predetermined lengths. In some implementations, openings 802, 804 may be aligned approximately transversely and / or symmetrically relative to discontinuity 16. First drill guide 800 may include a handle 806. The handle 806 can be aligned with a portion of the first drill guide 800, including the posts 812, 814. In some embodiments, the handle 806 is angled relative to a portion of the first drill guide 800, including the posts 812, 814, to allow easier access to the bone portions 10A, 10B, for example, when the portion must navigate through a narrow gap or sharp corner to reach the bone portions 10A, 10B. The handle 806 can allow for easier alignment of the alignment openings 804, 806 with the outer surface of the bone portions 10A, 10B. The channels of the first drill guide 800 can receive and guide a drilling device for drilling holes in bone. The drilling device can include a drill bit, punch, reamer, broach, or other suitable device for drilling holes in bone.

[0132] As shown in FIGS. 8A and 8B , when a first reamer or drill bit 820 is inserted into one of the openings 802, 804 of the first drill guide 800, the length of the posts 812, 814 can be configured to guide the first drill bit 820 to move along a line extending generally diametrically through the cortical regions of the bone portions 10A, 10B, but not necessarily through the bone portions 10A, 10B, to drill through or blind holes in both cortices. Throughout this disclosure, the drill bit is shown drilling through holes in the bone portions 10A, 10B, although the drill bit can alternatively drill closed holes. In some implementations, as shown in FIGS. 8B-8C , the bone portions 10A, 10B are shown as transparent for clarity, and the first drill bit 820 can drill through holes through the bone portions 10A, 10B. In other implementations, the first drill bit 820 can drill a blind hole through the bone portions 10A, 10B. The blind hole can have a depth such that the hole is bicortical or terminates in the cancellous portion of the bone. As shown in FIGS. 8B and 10A, the bone-contacting ends of the posts 812, 814 can terminate in multiple tips 813 rather than a continuous ring. As shown in FIG. 8B, gaps between the tips 813 allow visual confirmation that the first drill bit 820 is contacting the outer surface of the bone portions 10A, 10B.

[0133] As shown in FIG. 8B , after drilling a hole in the bone portion 10B through the opening 804, a temporary fixation pin 824 can be inserted into the opening 804 of the first guide 800 and into the bone portion 10B through the hole drilled by the first drill bit 820. The first drill bit 820 can then be used to form the aforementioned bore in the bone portion 10A through the opening 802, thereby inserting the temporary fixation pin 822 into the opening 802 and the bone portion 10A. As shown in FIG. 8C , the temporary fixation pins 822, 824 can be inserted into the openings 802, 804 of the first drill guide 800 and the holes (e.g., through-holes) in the bone portions 10A, 10B formed by the first drill bit 820. The temporary fixation pins 822, 824 can temporarily and removably couple a second drill guide 830 to one of the bone portions 10A, 10B, as described below. Each of the holes drilled by the first drill bit 820 may be sized to slidably receive a temporary fixation pin 822, 824.

[0134] As shown in FIG. 8D , first drill guide 800 can be removed after temporary fixation pins 822, 824 have been inserted into bones 10A, 10B, respectively. As shown in FIG. 8D , second drill guide 830 can be placed against the outer surface of bone 10A or 10B, such as bone 10B (or the surgical procedure can begin with bone 10A). Second drill guide 830 can have a surface that is placed against the outer surface of bone 10A, 10B. The surface can optionally be generally inwardly curved or concave. Second drill guide 830 can optionally have multiple (e.g., 2, 3, 4, 5, 6, or more) first channels 831 extending from the concave surface through the height of second drill guide 830 to the opposite surface of second drill guide 830. The plurality of first channels 831 may be substantially aligned and spaced (e.g., at uniform or varying intervals) along the length of the second drill guide 830. The first channels 831 are sized to fit over the temporary fixation pins 822, 824 when the second drill guide 830 is placed against the bones 10A, 10B. A user can adjust which first channels 831 fit over the temporary fixation pins 822, 824, as shown in FIG. 8D (using a first channel 831 at or near the center of the second drill guide 830 along the length of the second drill guide 830) and FIG. 8E (using a first channel 831 on one side of the second drill guide 830 along the length of the second drill guide 830).

[0135] The second drill guide 830 may optionally include a plurality (e.g., 2, 3, 4, 5, 6, or more) of second channels 833 extending from the concave surface through the height of the second drill guide 830 to the opposite surface of the second drill guide 830. Alternatively, the second plurality of channels 833 may be replaced by a groove including an infinite number of channel positions. The plurality of second channels 833 may be substantially aligned and spaced (e.g., at uniform or varying intervals) along the length of the second drill guide 830. As shown in FIG. 8D , the plurality of second channels 833 may optionally follow the concave surface such that the plurality of second channels 833 intersect and / or pass through the centerline of the arc of the concave surface at a known distance below the bone-contacting surface of the second drill guide 830. This configuration ensures that, for all combinations of channels 831 and 833, except when the user selects one of channels 831 and one of channels 833 that are immediately adjacent to each other across the width of the second drill guide 830, the screws 302, 304 pass through the bone-engaging legs 152, 154 of the clip 102 before reaching the depth of the free ends of the bone-engaging legs 152, 154. In this case, the screws 302 or 304 are embedded approximately parallel to the legs 152 or 154 of the clip. A plane passing through the axes of the plurality of first channels 831 can be approximately parallel to a plane passing through the axes of the plurality of second channels 833. The two planes can be adjacent to each other across the width of the second drill guide 830 and can be separated such that each of the plurality of first channels 831 is separated from the nearest or adjacent second channel 833 by a predetermined distance. As described above, the size of the predetermined distance can be varied in different drill guides to increase or decrease contact between the clip 102 and the screws 302, 304. In some embodiments, the second channels 833 can be positioned adjacent to each of the first channels 831 across the width of the second drill guide 830. In other embodiments, the number of first channels 831 and second channels 833 need not be the same. In some embodiments, the second channels 833 can be staggered with the first channels 831 instead of being adjacent to each other across the width of the second drill guide 830.

[0136] Bones may have irregularities in their outer surfaces, which for simplicity are not shown in the schematic illustration of bone portions 10A, 10B. By using separate drill guides to drill holes for screws and clips in the bone portions, respectively, first drill guide 800 or second drill guide 830 can better conform to the contours of the outer surface of the bone portion and more easily adjust to irregularities in different portions of the bone surface.

[0137] As shown in FIG. 8E , the second channel 833 can be sized to slidably receive a drilling device 840 (such as a drill bit, bone punch, reamer, broach, or other such device), which can be the same size as the first drill bit 820 or a different size, larger or smaller than the first drill bit 820. The second drill guide 830 can have a height such that the second channel 833 is long enough to guide the second drill bit 840 substantially through the cortical regions of both bone portions 10A, 10B. In some embodiments, the second drill bit 840 can drill holes in the bone portions 10A, 10B. In some implementations, as shown in FIG. 8E , the second drill bit 840 can be inserted into the second channel 833 farthest from the first channel 831 into which the temporary fixation pin 824 was inserted. In other implementations, a different second channel 833 can be used.

[0138] As shown in FIG. 8F , the temporary fixation pin 824 and second drill bit 840 can be removed from the bone portion 10B after the desired holes have been drilled. A second drill guide 830 can be rotated 180° about its radial axis to mate with the inserted temporary fixation pin 822 and provide a guide for drilling holes on the opposite side of the discontinuity 16 in the bone portion 10A. During use, the second drill guide 830 can be oriented so that each of the second channels 833 is closer to the discontinuity 16 than the nearest first channel 831. As shown in FIGS. 8F and 10B , the second drill guide 830 can include an undercut portion 832 on the side where the first channel 831 is located, which is shorter than the side where the second channel 833 is located. The undercut portion 832 allows for better visual confirmation of the position of the temporary fixation pins 832, 834 when a hole is drilled into the bone portions 10A, 10B through one of the second channels 833. As shown in FIG. 8F, a second drill bit 840 can be used to drill a hole in the bone portion 10B through a second channel 833 that is closer to the first channel 831 into which the temporary fixation pin 822 is inserted than the distance between the first channel 831 and the second channel 833 used to form a hole in the bone portion 10B as shown in FIG. 8E.

[0139] As shown in FIG. 8G , the temporary fixation pin 822 and second drill bit 804 can be removed from the bone portion 10A after the desired holes have been drilled. The bone portion 10A can have a first hole 122 formed by the first drill bit 820 and a second hole 112 formed by the second drill bit 840. The bone portion 10B can have a first hole 124 formed by the first drill bit 820 and a second hole 114 formed by the second drill bit 840. The first hole 122 forms a first angle with the second hole 112. The first hole 124 forms a second angle with the second hole 114. The first angle and the second angle are different in some implementations, as shown in FIG. 8G . The first hoes 112, 122 and second hoes 114, 124 may also be in the same plane (ie, the first angle and / or the second angle may be 0 degrees).

[0140] 8H, the second holes 112, 114 can be sized to threadably receive screws 302, 304, respectively. The screws 302, 304 can be implanted with a screwdriver 305. A screwdriver 305 is shown for each screw 302, 304, and although the screws 302, 304 can be delivered simultaneously or sequentially, in some implementations, a single screwdriver 305 can be used to deliver the screws 302, 304 sequentially in any order.

[0141] In some implementations, as shown in FIG. 8I , after the screws 302, 304 are delivered, the clip 102 in the deformed configuration can be delivered with the insertion tool 170. The first holes 122, 124 can be sized so that the bone-engaging legs 152, 154 (hidden in the figure) of the clip 102 have a friction fit with the first holes 122, 124. The insertion tool 170 can be removed after substantially the entire length of the bone-engaging legs 152, 154 are embedded in the bones 10A, 10B. Removal of the insertion tool 170 causes the legs 152, 154 to compress toward each other as the clip 102 relaxes toward its free configuration, resulting in compression across the discontinuity 16. As the legs 152, 154 begin to converge, they can contact the screws 302, 304 to distribute the compressive load.

[0142] As shown in FIGS. 9A-9E, a method of using fixation system 400 to fixate bone portions across discontinuity 16, as shown in FIGS. 4A-4B, may include one or more of the following steps. Those skilled in the art should understand from the disclosure herein that some steps described with reference to and shown in FIGS. 8A-8I, e.g., 8A-8C, apply to methods of delivering fixation system 400, but for brevity, these steps are not shown or described again in the description providing fixation system 400. As shown in FIG. 9A, after a first drill guide 800 and a first drill bit 820 are used to drill holes (through or blind) in bone portions 10A, 10B on either side of discontinuity 16 to receive temporary fixation pins 822, 824, a second wire guide 930 can be placed against the outer surface of bone portion 10A or 10B, such as bone portion 10B shown in FIG. 9A (in other embodiments, the surgery can begin with bone portion 10A). The second wire guide 930 may have any of the features of the second drill guide 830, except that the diameter of the second channel 933 is smaller than the diameter of the second channel 833 of the second drill guide 830. Identical or similar features of the second drill guide 830 and the second wire guide 930 share the same last two digits. Therefore, for brevity, not all features of the second wire guide 930 will be described. The second channel 933 may be sized to slidably fit over a k-wire 940. In some implementations, as shown in FIG. 9A , the k-wire 940 may be inserted into the second channel 933 furthest from the first channel 931, through which the temporary fixation pin 824 is inserted along the length of the second wire guide 930.

[0143] As shown in FIG. 9B , the temporary fixation pin 824 can be removed from the bone 10B, leaving the k-wire 940 in place. The second wire guide 930 can be rotated 180° about its radial axis to couple with the inserted temporary fixation pin 822 and provide a guide for inserting a second k-wire 942 on the opposite side of the discontinuity 16 in the bone 10A. During use, the second wire guide 930 can be oriented so that each of the second channels 933 is closer to the discontinuity than the nearest first channel 931. The second wire guide 930 can include an undercut 932 on the side where the first channel 931 is located, which is shorter than the side where the second channel 933 is located. The undercut 932 allows for better visual confirmation of the position of the temporary fixation pins 822, 824 when a hole is drilled into the bone 10A, 10B through one of the second channels 933. A second k-wire 942 can be inserted (e.g., by impacting using a mallet or other method) into the bone portion 10B through the second channel 933. As shown in FIG. 9A, the circumferential spacing between the second channel 933 receiving the second k-wire 942 and the temporary fixation pin 822 can be selected to be smaller than the circumferential spacing between the first k-wire 940 and the temporary fixation pin 824, such that the angle between the second k-wire 942 and the temporary fixation pin 822 can be smaller than the angle between the first k-wire 940 and the temporary fixation pin 824, as shown in FIG.

[0144] As shown in FIG. 9C , the temporary fixation pin 822 can be removed from the bone portion 10A, leaving the k-wires 940, 942 in the bone portions 10B, 10A, respectively. The bone portion 10A can have a first hole 122 (through or blind) formed by the first drill bit 820. The bone portion 10B can have a second hole 124 (through or blind) formed by the first drill bit 820. The first hole 122 forms a first angle with the second k-wire 942. The second hole 124 forms a second angle with the K-wire 940. The first and second angles are different in some implementations, as shown in FIG. 9C . The cannulated screws 402, 404 can be slid over the k-wires 940, 942 and implanted using a cannulated screwdriver 405. A screwdriver 405 is shown for each screw 402, 404, and the screws 402, 404 can be delivered simultaneously or sequentially, although in other embodiments a single cannulated screwdriver 405 can be used to deliver the screws 402, 404 sequentially in any order. After the screws 402, 404 are implanted, the k-wires 940, 942 can be removed.

[0145] 9D , after the screws 402, 404 are delivered, the clip 102 in the deformed configuration can be delivered with the insertion tool 170. The first holes 122, 124 can be sized so that the bone-engaging legs 152, 154 (hidden in the figure) of the clip 102 mate with the first holes 122, 124. After substantially the entire length of the bone-engaging legs 152, 154 are embedded in the bones 10A, 10B, the insertion tool 170 can be removed. Removal of the insertion tool 170 causes the legs 152, 154 to compress toward each other as the clip 102 relaxes toward its free configuration, resulting in compression across the discontinuity 16. As the legs 152, 154 begin to converge, they can contact the screws 402, 404 to distribute the compressive load.

[0146] 11A-11E, a method of using fixation system 400 to fixate bone portions across a discontinuity 16, as shown in FIGS. 3A-5C, may include one or more of the following steps. Those skilled in the art should understand that although some steps described with reference to and shown in FIGS. 8A-8I and 9A-9D may apply to methods of delivering fixation system 400, with reference to FIGS. 11A-11E, for the sake of brevity, these steps will not be shown or described again.

[0147] A third drill guide 1100, as shown in FIGS. 11A-11C, can replace the first drill guide 800 and second drill guide 830 or second wire guide 930. The third drill guide 1100 can be used to drill holes configured for the legs 152, 154 of the clip 102, as shown in FIG. 11B, and then insert k-wires 940, 942 after temporary fixation pins 822, 824 temporarily attach the third drill guide 1100 to both bones 10A, 10B, as shown in FIG. 11C. The third drill guide 1100 can combine features of the first drill guide 800 and second wire guide 930 (or second drill guide 830 if non-cannulated screws 302, 304 are used) described herein. Features of the first, second, and third guides 820, 830, 930, 1100 share the same last two digits. Thus, for the sake of brevity, not all features of the third drill guide 1100 will be described. The third drill guide 1100 can advantageously simplify and / or reduce surgical procedures because the same instrument is used to drill all of the holes in the bones 10A, 10B.

[0148] The third drill guide 1100 may include a pair of first channels 1131 that may be sized to guide the first drill bit 820 through drilling holes in the bone portions 10A, 10B to receive the temporary fixation pins 822, 824. The drill guide 1100 may include a first plurality (e.g., three or more) of second channels 1133 and a second plurality (e.g., three or more) of second channels 1133. Alternatively, the second plurality of channels 1133 may be replaced by grooves including an infinite number of channel positions. Each of the plurality of second channels 1133 may be aligned or substantially aligned. The first and second plurality of second channels 1133 may be separated by a gap. The first and second plurality of second channels 1133 may be disposed on two substantially parallel tabs 1136, respectively. The spacing of the second channels on the two tabs 1136 may be the same or different. The two tabs 1136 can be offset relative to the first channel 1131 so that the second channel 1133 is closer to the discontinuity 16 than the first channel 1131. In some embodiments, the first and second pluralities of second channels 1133 can be aligned in pairs, as shown in FIGS. 11A-11C. In use, the first and second channels 1131 and 1133 can be positioned approximately symmetrically about the discontinuity 16, as shown in FIGS. 11A-11C. K-wires 940, 942 can be inserted into the second channels 1133 on either side of the discontinuity 16 so that the k-wires 940, 942 are parallel (as shown in FIG. 11C) or angled relative to each other (as shown in FIG. 9B). In an alternative embodiment, the second channels 1133 are used as guides for drilling holes for non-cannulated screws to create the fixation system 300 shown in FIGS. 3A and 3B.

[0149] As shown in FIG. 11D , the temporary fixation pins 822, 824 and the third drill guide 1100 can be removed from the bone portions 10A, 10B, leaving the k-wires 940, 942 in the bone portions 10B, 10A, respectively. The bone portion 10A can have a first hole 122 formed by the first drill bit 820. The bone portion 10B can have a second hole 124 formed by the first drill bit 820. The first hole 122 is at the same angle relative to the k-wire 942 as the angle between the second hole 124 and the K-wire 940. The angle can be different if the user selects a different second channel 1133 or if the second channel 1133 is replaced with a groove as described above. The cannulated screws 402, 404 can be slid over the k-wires 940, 942 and implanted using a cannulated screwdriver 405. A screwdriver 405 is shown for each screw 402, 404, and the screws 402, 404 can be delivered simultaneously or sequentially, although in other embodiments a single cannulated screwdriver 405 can be used to deliver the screws 402, 404 sequentially in any order. After the screws 402, 404 are implanted, the k-wires 940, 942 can be removed.

[0150] 11E, after the screws 402, 404 are delivered, the clip 102 in the deformed configuration can be delivered with the insertion tool 170. The first holes 122, 124 can be sized so that the bone-engaging legs 152, 154 (hidden in the figure) of the clip 102 have a friction fit with the first holes 122, 124. After substantially the entire length of the bone-engaging legs 152, 154 are embedded in the bones 10A, 10B, the insertion tool 170 can be removed. Removal of the insertion tool 170 causes the legs 152, 154 to compress toward each other as the clip 102 relaxes toward its free configuration, resulting in compression across the discontinuity 16. As the legs 152, 154 begin to converge, they can contact the screws 402, 404 to distribute the compressive load.

[0151] 12A-12K, another exemplary method of using fixation system 400 to fix bone portions across a discontinuity 16, as shown in FIGS. 3A-5C, may include one or more of the following steps: One skilled in the art should understand that several steps described with reference to and shown in FIGS. 8A-8I, 9A-9D, and 11A-11E may apply to methods of delivering fixation system 400, but with reference to FIGS. 12A-12K, for the sake of brevity, these steps will not be shown or described again.

[0152] Fourth drill guide 1200, as shown in FIGS. 12A-12F, can replace first drill guide 800 and second drill guide 830 or second wire guide 930, or can replace third drill guide 1100. Fourth drill guide 1200 can have any of the features of third drill guide 1110, with differences described with reference to FIGS. 12A-12F. Features of the first guide, second guide, third guide, and fourth guides 800, 830, 930, 1100, 1200 share the same last two digits. Therefore, for the sake of brevity, not all features of third drill guide 1200 will be described.

[0153] The fourth drill guide 1200 may include a pair of first channels 1231 that may be sized to guide the first drill bit 820 through the bone portions 10A, 10B to receive the temporary fixation pins 822, 824. The fourth drill guide 1200 may include a first tab 1236 and a second tab 1236 extending from each of the two first channels 1231. The first and second tabs 1236 may be substantially parallel to one another. Each tab 1236 may include a second channel 1233. Each second channel 1233 may include an open groove 1235 (e.g., as more clearly shown in FIG. 12C ) extending along the longitudinal axis of the second channel 1233. The open groove 1235 may have a width that is at least greater than the outer diameter of the k-wires 940, 942. The two tabs 1136 may be offset relative to the first channel 1231 such that the second channel 1233 is closer to the discontinuity 16 than the first channel 1231 .

[0154] As shown in FIG. 12A , the bone-contacting end of the fourth drill guide 1200 (including the first channel 1231) can terminate in multiple tips 1213 rather than a continuous ring. During use, the first channel 1231 and the second channel 1233 can be arranged approximately symmetrically about the discontinuity 16. As shown in FIG. 12B , the fourth drill guide 1200 can be used to drill holes configured for the legs 152, 154 of the clip 102 through the first channel 1231. Temporary fixation pins 822, 824 can be placed in the holes drilled by the first drill bits 822, 824 (not shown in FIG. 12B ) guided by the first channel 1231.

[0155] 12C-12E, the guide tube 1240 can be used to guide the insertion of the k-wires 940, 942 into the bones 10A, 10B through the second channel 1233. The guide tube 1240 can help prevent skiving of the k-wires 940, 942 by docking the bearing surfaces of the k-wires 940, 942 directly to the surfaces of the bones 10B, 10A. The fourth drill guide 1200 and guide tube 1240 can be used to insert the k-wires 940, 942 after the temporary fixation pins 822, 824 temporarily couple the fourth drill guide 1200 to both of the bones 10A, 10B.

[0156] As shown in FIG. 12C , a guide tube 1240 can be inserted into one of the second channels 1233. The guide tube 1240 can include a post having an outer diameter sized to be slidably received by the second channel 1233. The guide tube 1240 can include a cannula 1242 sized to slidably receive one of the k-wires 940, 942. In some embodiments, the guide tube 1240 can include a ribbed portion configured to be easily manipulated by hand to slide into and / or out of the second channel 1233. As shown in FIG. 12D , the k-wire 940 can be inserted into the cannula 1242 of the guide tube 1240. The k-wire 940 can be driven into the bone 10B.

[0157] As shown in FIG. 12E, the guide tube 1240 can be removed, leaving the k-wire 940 in the second bone portion 10B. Also, as shown in FIG. 12E, the guide tube 1240 (or a second guide tube 1240) can be inserted into the other second channel 1233, and a k-wire 942 can be pushed into the bone portion 10A through the cannula 1242 of the second guide tube 1240. The k-wires 940, 942 can be inserted into the second channels 1233 on either side of the discontinuity 16 so that the k-wires 940, 942 are parallel. Alternatively, the second channels 1233 can be positioned non-symmetrically about the discontinuity 16, such that the k-wires 940, 942 are angled relative to each other (as shown in FIG. 9B). As shown in FIG. 12F, the second guide tube 1240 can be removed from the second channel 1233, leaving only the k-wire 942 in the bone portion 10A.

[0158] 12G, the fourth drill guide 1200 can be removed from the temporary fixation pins 822, 824 and k-wires 940, 942 that remain in the bones 10B, 10A, respectively. The open grooves 1235 in the second channels 1233 allow the fourth drill guide 1200 to be removed from the temporary fixation pins 822, 824 by passing the k-wires 940, 942 therethrough and sliding the fourth drill guide 1200 along the length of the temporary fixation pins 822, 824. That is, the open grooves 1235 allow the fourth drill guide 1200 to be removed directly from the temporary fixation pins 822, 824, even though the k-wires 940, 942 and the temporary fixation pins 822, 824 are pointing in different (non-parallel) directions.

[0159] As shown in FIG. 12H, the temporary fixation pins 822, 824 have been removed, and the clip 102 in the deformed configuration can be delivered with the insertion tool 170. The legs 152, 154 of the clip 102 can be inserted into the holes previously occupied by the temporary fixation pins 822, 824. The insertion tool 170 can hold the clip 102 in the deformed configuration as described above until the insertion tool 170 is disengaged from the clip 102. As shown in FIG. 12I, the cannulated screw 402 can be implanted by engaging the insertion tool 170 with the clip 102 and sliding it over the k-wire 942 using the cannulated screwdriver 405. The k-wire 942 can be removed from the bone 10A after the screw 402 is implanted. As shown in FIG. 12J, with the insertion tool 170 still engaged with the clip 102, the cannulated screw 404 can be slid over the k-wire 940 and implanted using the cannulated screwdriver 405. After the screws 404 are implanted, the k-wires 940 can be removed. A dedicated screwdriver 405 can be used for each screw 402, 404 to deliver the screws 402, 404. In other embodiments, a single cannulated screwdriver 405 can be used to deliver the screws 402, 404 sequentially in any order.

[0160] 12K, the insertion tool 170 can be removed after the screws 402, 404 are embedded in the bones 10A, 10B. Removal of the insertion tool 170 causes the legs 152, 154 to compress toward each other as the clip 102 relaxes toward its free configuration, resulting in compression across the discontinuity 16. As the legs 152, 154 begin to converge, they can contact the screws 402, 404 to distribute the compressive load.

[0161] In some fracture fixation instances, where bone quality is relatively poor due to, for example, osteoporosis, trauma, or other reasons, force transmission from the clip legs 152, 154 to the bone portions 10A, 10B can be lost due to the soft cancellous bone collapsing under force from the clip legs 152, 153. Therefore, by placing the screws 402, 404 in the bone portions 10A, 10B immediately adjacent to the legs 152, 153, the screws 402, 404 can bicortically engage the higher quality cortical "shell" of the bone (e.g., stronger than cancellous bone). Fixation forces can be transmitted from the clip legs 152, 154 to the screws 402, 404 and ultimately to the high quality cortical bone. The transmission of fixation forces can maintain the compression value of the clip legs 152, 154.

[0162] Specific Terms Orientation terms used herein, such as "superior," "inferior," "proximal," "distal," "longitudinal," "lateral," and "end," are used in the context of the illustrated examples. However, the present disclosure should not be limited to the illustrated orientations. Indeed, other orientations are possible and within the scope of the present disclosure. It should be understood that circular terms, such as diameter or radius, used herein do not require a perfectly circular structure, but rather should apply to any suitable structure having a cross-sectional area that can be measured from side to side. General shape terms, such as "circular," "cylindrical," "semicircular," "semi-cylindrical," or related or similar terms, need not strictly adhere to the mathematical definition of a circle, cylinder, or other structure, but can encompass structures that reasonably approximate.

[0163] Conditional language such as "can," "could," "potential," or "might" is generally intended to convey that a particular embodiment may or may not include certain features, elements, and / or steps, unless expressly stated otherwise or understood otherwise within the context in which it is used. Thus, conditional language is generally not intended to imply that features, elements, and / or steps are in some way required.

[0164] Unless otherwise stated, connective language such as the phrase "at least one of X, Y, and Z" is understood in the context as it is commonly used to convey that an item, term, etc. can be either X, Y, or Z. Thus, such connective language is generally not intended to imply that at least one of X, at least one of Y, and at least one of Z must be present in a particular embodiment.

[0165] As used herein, the terms "approximately," "about," and "substantially" refer to an amount that is close to a stated amount and still performs a desired function or achieves a desired result. For example, in some embodiments, as the context indicates, the terms "approximately," "about," and "substantially" can refer to an amount that is within 10% or less of a stated amount. As used herein, the term "approximately" refers to a value, amount, or characteristic that primarily comprises or tends toward a particular value, amount, or characteristic. As an example, in certain embodiments, as the context indicates, the term "approximately parallel" can refer to no more than 20 degrees away from exactly parallel. All ranges are inclusive of their endpoints.

[0166] conclusion Several exemplary embodiments of implant systems and methodologies are disclosed. Although the present disclosure is described with respect to certain exemplary embodiments and uses, other embodiments and other uses, including embodiments and uses that do not provide all of the features and advantages described herein, are also within the scope of the present disclosure. Components, elements, features, operations, or steps may be arranged or performed in ways different from those described, and components, elements, features, operations, or steps may be combined, integrated, added, or removed in various examples. All possible combinations and subcombinations of the elements and components described herein are intended to be included in the present disclosure. No single feature or group of features is necessary or essential.

[0167] Any portion of any of the steps, processes, structures, and / or apparatus disclosed or illustrated in one example of the present disclosure may be combined with or used in place of any other portion of any of the steps, processes, structures, and / or apparatus disclosed or illustrated in a different example or flow diagram. The embodiments described herein are not intended to be separate and distinct from one another. Several combinations, variations, and implementations of the disclosed features are within the scope of the present disclosure.

[0168] Although operations may be shown in the figures or described in the specification in a particular order, such operations need not be performed in the particular order shown or sequential order, or even all operations need to be performed, to achieve desirable results. Other operations not described or illustrated may be incorporated into the example methods and processes. For example, one or more additional operations may be performed before, after, simultaneously with, or between any of the described operations. Furthermore, in some implementations, operations may be rearranged or reordered. Also, the separation of various components in the above implementations should not be understood as requiring such separation in all implementations, and it should be understood that the described components and systems may generally be integrated together in a single product or packaged in multiple products. Furthermore, several implementations are within the scope of the present disclosure.

[0169] Furthermore, although exemplary embodiments have been described, any embodiments having equivalent elements, modifications, omissions, and / or combinations are also within the scope of this disclosure. Moreover, although certain aspects, advantages, and novel features are described herein, not all such advantages are necessarily achieved in accordance with a particular embodiment. For example, some embodiments within the scope of this disclosure may achieve one advantage or group of advantages as taught herein, but need not achieve other advantages taught or suggested herein. Furthermore, some examples may achieve advantages different from those taught or suggested herein.

[0170] Several embodiments are described with reference to the drawings. While the drawings are drawn and / or shown to scale, such scale should not be considered limiting, as dimensions and proportions other than those shown are contemplated and within the scope of the disclosed invention. Distances, angles, and the like are merely illustrative and do not necessarily bear an exact relationship to the actual dimensions and layout of the devices shown. Components may be added, removed, and / or rearranged. Furthermore, certain features, aspects, methods, properties, characteristics, qualities, attributes, elements, etc., associated with various embodiments herein may be used in all other embodiments described herein. Furthermore, any method described herein may be implemented using any apparatus suitable for performing the recited steps.

[0171] For purposes of summarizing the disclosure, certain aspects, advantages, and features of the invention have been described herein. Not all advantages, or any such advantages, will necessarily be achieved in accordance with any particular embodiment of the invention disclosed herein. No aspect of the disclosure is necessary or essential. In many instances, the devices, systems, and methods may be configured differently than shown in the drawings or description herein. For example, various functions provided by the illustrated modules may be combined, rearranged, added, or deleted. In some implementations, additional or different processors or modules may perform some or all of the functionality described in the description and with reference to the illustrated embodiments. Many variations in implementation are possible based on the disclosure herein. Any feature, structure, step, or process disclosed herein may be included in any embodiment.

[0172] In sum, various examples of implant systems and related methods are disclosed. The disclosure extends beyond the specifically disclosed embodiments to other alternative embodiments and / or other uses of the embodiments, as well as certain modifications and equivalents thereof. Moreover, the disclosure expressly contemplates that various features and aspects of the disclosed embodiments can be combined with or substituted for one another. Accordingly, the scope of the disclosure should not be limited by the particularly disclosed embodiments above, but should instead be determined solely by a fair reading of the following claims.

[0173] [Embodiment] (1) A bone fixation system configured to be implanted across a bone discontinuity or across a joint between two bones, comprising: at least one elongated implant; a clip including a first leg and a second leg, the clip further including a bridge connecting the first leg and the second leg at first ends of the first leg and the second leg, wherein a distance between second free ends of the first leg and the second leg opposite the first end increases when the clip changes from a first configuration to a second deformed configuration, and when moving to the second deformed configuration, the bridge elastically deforms such that the free ends of the first leg and the second leg move away from each other; The at least one elongated implant and the first leg of the clip are configured to be implanted into a first side of the discontinuity or the joint, and the at least one elongated implant is angled with the first leg of the clip. (2) The system of embodiment 1, wherein the at least one elongated implant includes a first elongated implant and a second elongated implant, wherein the first elongated implant and the first leg of the clip are configured to be implanted on the first side of the discontinuity or the joint, and the second elongated implant and the second leg of the clip are configured to be implanted on the second side of the discontinuity or the joint, and wherein the first elongated implant forms a first angle with the first leg of the clip and the second elongated implant forms a second angle with the second leg of the clip. (3) A system as described in embodiment 1 or 2, wherein the first leg and the second leg of the clip have a length such that when implanted, the second free ends of the first leg and the second leg end in the spongy portion of the bone or bone portion. (4) A system described in any one of embodiments 1 to 3, wherein the at least one elongated implant includes a first screw and a second screw. (5) The system of embodiment 4, wherein the first screw and the second screw have lengths such that when implanted, the first screw and the second screw are configured to achieve bicortical engagement.

[0174] (6) A system described in embodiment 4 or 5, wherein the tips of the first screw and the second screw are configured to protrude from the outer surface of the bone or bone portion when implanted. (7) A system described in any one of embodiments 4 to 6, wherein the first screw and / or the second screw are cannulated. (8) A system described in any one of embodiments 4 to 7, wherein the first screw and / or the second screw are non-cannulated. (9) A system described in any one of embodiments 4 to 8, including a fixation plate configured to be coupled to the first screw and the second screw when implanted. (10) The system described in any one of embodiments 1 to 3, wherein the at least one elongated implant includes a first leg and a second leg of a second clip, the second clip further including a bridge connecting the first leg and the second leg of the second clip at first ends of the first leg and the second leg of the second clip, and the distance between second free ends of the first leg and the second leg of the second clip opposite the first ends of the first leg and the second leg of the second clip is configured to increase when the second clip changes from a free configuration to a deformed configuration.

[0175] (11) The system of embodiment 10, wherein the first leg and the second leg of the second clip have a length such that when implanted, the second free ends of the first leg and the second leg of the second clip terminate in the spongy portion of the bone or bone section. (12) A system according to any one of embodiments 1 to 11, wherein the first angle is the same as the second angle. (13) A bone fixation system configured to be implanted across a bone discontinuity or across a joint between two bones, comprising: at least one elongated implant; a clip including a first leg and a second leg, the clip further including a bridge connecting the first leg and the second leg at first ends of the first leg and the second leg, wherein a distance between second free ends of the first leg and the second leg opposite the first end increases when the clip changes from a first configuration to a second deformed configuration, and when moving to the second deformed configuration, the bridge elastically deforms such that the free ends of the first leg and the second leg move away from each other; The at least one elongated implant and the first leg of the clip are configured to be implanted into a first side of the discontinuity or the joint, and the second leg of the clip is configured to be implanted into a second side of the discontinuity or the joint. (14) The system of embodiment 13, wherein the first leg and the second leg of the clip have a length such that when implanted, the second free ends of the first leg and the second leg terminate in the spongy portion of the bone or bone portion. (15) The system described in embodiment 13 or 14, wherein the at least one elongated implant includes a screw.

[0176] (16) The system of embodiment 15, wherein the screw has a length configured to achieve bicortical engagement when implanted. (17) The system described in embodiment 15 or 16, wherein the tip of the at least one screw is configured to protrude from the outer surface of the bone or bone portion when implanted. (18) The system described in any one of embodiments 15 to 17, wherein the at least one second screw is cannulated. (19) The system described in any one of embodiments 15 to 18, wherein the at least one screw is non-cannulated. (20) A system described in any one of embodiments 15 to 19, including a fixation plate configured to be coupled to the at least one screw when implanted.

[0177] (21) A method of fixing bone segments defined by a discontinuity in the bone or fixing two bones across a joint, comprising: delivering a first elongated implant to a bone or bone portion on a first side of the discontinuity or the joint; delivering a second elongated implant to a bone or bone portion on a second side of the discontinuity or joint; delivering a clip to the bone or bone portion, wherein a first leg of the clip is on the first side of the discontinuity or the joint, a second leg of the clip is on the second side of the discontinuity or the joint, and a bridge connecting first ends of the first leg and the second leg extends across the discontinuity or the joint, wherein the clip is biased into a first configuration and the clip is delivered in a second deformed configuration such that a distance between free ends of the first leg and the second leg of the clip is increased relative to the first configuration; the first elongate implant is positioned between the first leg of the clip and the discontinuity or the joint, and the second elongate implant is positioned between the second leg of the clip and the discontinuity or the joint; The method, wherein the first elongate implant is at a first angle with the first leg of the clip and the second elongate implant is at a second angle with the second leg of the clip. (22) The method of embodiment 21, further comprising pre-drilling holes in the bone or bone portion, the holes configured to receive the first elongate implant, the second elongate implant, and / or the first leg and the second leg of the clip. (23) The method of embodiment 22, wherein pre-drilling the holes includes using a clip drill guide to position the holes for the first leg and the second leg of the clip. (24) The method of embodiment 22 or 23, wherein pre-drilling the holes includes using an implant guide to position the holes for the first elongate implant and the second elongate implant. (25) The method described in embodiment 24, wherein the clip drill guide and the implant guide form an integrated device.

[0178] (26) The method described in embodiment 24 or 25, wherein the implant guide includes a plurality of holes for selecting the first angle and / or the second angle. (27) The method of embodiment 26, wherein the plurality of holes includes holes sized to deliver non-cannulated screws. (28) The method of embodiment 27, wherein the first elongate implant and / or the second elongate implant comprises a non-cannulated screw. (29) The method of embodiment 26, wherein the plurality of holes includes holes sized for k-wires configured to deliver cannulated screws. (30) The method of embodiment 29, wherein the first elongated implant and / or the second elongated implant comprises a cannulated screw.

[0179] (31) A method according to any one of embodiments 24 to 30, wherein the holes for the first elongate implant and the second elongate implant are offset from the hole, spacing the first leg and the second leg apart by a distance. (32) The method of any one of embodiments 21 to 31, wherein the first angle and the second angle are substantially the same such that the first elongated implant and the second elongated implant are approximately parallel to each other. (33) The method of any one of embodiments 21 to 31, wherein the first angle and the second angle are different such that the first elongate implant and the second elongate implant are angled relative to each other. (34) The method of any one of embodiments 21 to 33, wherein each of the first elongate implant and the second elongate implant has a length greater than the length of the first leg or the second leg, such that the first elongate implant and the second elongate implant are configured to achieve bicortical engagement, respectively. (35) The method of embodiment 24, wherein the first elongate implant and / or the second elongate implant are delivered such that a tip of the first elongate implant and / or the second elongate implant protrudes from the outer surface of the bone or bone portion.

[0180] (36) The method of embodiment 21 or 22, wherein delivering the first elongate implant and delivering the second elongate implant includes delivering a first leg and a second leg of a second clip. (37) The method of any one of embodiments 21 to 36, wherein the discontinuity comprises a fracture or resection line. (38) The method of any one of embodiments 21 to 37, wherein the clip is delivered such that the first elongate implant and the first leg of the clip, and / or the second elongate implant and the second leg of the clip, are separated by a distance. (39) The method of any one of embodiments 21 to 38, wherein the first elongate implant and the second elongate implant are delivered before delivering the clip. (40) The method of any one of embodiments 21 to 38, wherein the first elongate implant and the second elongate implant are delivered after delivering the clip.

[0181] (41) The method of embodiment 40, wherein the clip is in a deformed configuration when the first elongate implant and the second elongate implant are delivered. (42) The method of any one of embodiments 21 to 41, wherein the first elongate implant and the second elongate implant are delivered without crossing the discontinuity. (43) The method of any one of embodiments 21 to 42, wherein the clip is delivered without the first leg and / or the second leg crossing the discontinuity. (44) Positioning a clip drill guide across the discontinuity or the joint, the clip drill guide including a first cannula positioned on the first side of the discontinuity or the joint and a second cannula positioned on the second side of the discontinuity or the joint; drilling a first clip leg hole through the first cannula; inserting a first temporary pin through the first cannula and into the first clip leg hole; drilling a second clip leg hole through the second cannula; inserting a second temporary pin through the second cannula and into the second clip leg hole; positioning the implant guide on the first side of the discontinuity or the joint by sliding one of a plurality of guide positioning holes through the implant guide over the first temporary pin; forming a first implant hole by inserting a drilling device through one of a plurality of implant positioning holes extending through the implant guide, the plurality of implant positioning holes being positioned closer to the discontinuity or the joint than the plurality of guide positioning holes; positioning the implant guide on the second side of the discontinuity or the joint by sliding the one or another of the plurality of guide positioning holes over the second temporary pin; forming a second implant hole by inserting the drilling device or a second drilling device through the one or another of the plurality of implant positioning holes; inserting the first implant into the first implant hole; inserting the second implant into the second implant hole; removing the first temporary pin and the second temporary pin; 22. The method of claim 21, comprising inserting the first leg of the clip into the first clip leg hole and inserting the second leg of the clip into the second clip leg hole. (45) The method of claim 44, wherein the drilling device includes a drill bit.

[0182] (46) The method of embodiment 44, wherein the drilling device comprises a bone punch. (47) Positioning a first drill guide across the discontinuity or the joint, the first drill guide including a first cannula positioned on the first side of the discontinuity or the joint and a second cannula positioned on the second side of the discontinuity or the joint; drilling a first clip leg hole through the first cannula; inserting a first temporary pin through the first cannula and into the first clip leg hole; drilling a second clip leg hole through the second cannula; inserting a second temporary pin through the second cannula and into the second clip leg hole; positioning the implant guide on the first side of the discontinuity or the joint by sliding one of a plurality of guide positioning holes through the implant guide over the first temporary pin; inserting a first implant guide wire through one of a plurality of implant positioning holes extending through the implant guide, the plurality of implant positioning holes being positioned closer to the discontinuity or the joint than the plurality of guide positioning holes; positioning the implant guide on the second side of the discontinuity or the joint by sliding the one or another of the plurality of guide positioning holes over the second temporary pin; inserting a second implant guidewire through the one or another of the plurality of implant positioning holes; inserting the first implant over the first implant guidewire into the bone or bone portion; inserting the second implant over the second implant guidewire into the bone or bone portion; removing the first implant guidewire and the second implant guidewire; removing the first temporary pin and the second temporary pin; 22. The method of claim 21, comprising inserting the first leg of the clip into the first clip leg hole and inserting the second leg of the clip into the second clip leg hole. (48) A method described in any one of embodiments 44 to 47, wherein the plurality of implant positioning holes have a smaller diameter than the plurality of guide positioning holes. (49) A method described in any of embodiments 44 to 48, wherein the implant guide is arc-shaped, the multiple implant positioning holes penetrate the implant guide at various angles, and the multiple guide positioning holes penetrate the implant guide at various angles. (50) A method of fixing bone segments defined by a discontinuity in the bone or fixing two bones across a joint, comprising: delivering at least one elongated implant to the bone or bone portion on a first side of the discontinuity or the joint; delivering a clip to the bone or bone portion, wherein a first leg of the clip is on the first side of the discontinuity or the joint, a second leg of the clip is on the second side of the discontinuity or the joint, and a bridge connecting first ends of the first leg and the second leg extends across the discontinuity or the joint, wherein the clip is biased into a first configuration and the clip is delivered in a second deformed configuration such that a distance between free ends of the first leg and the second leg of the clip is increased relative to the first configuration; the at least one elongate implant is positioned between the first leg of the clip and the discontinuity or the joint; The method, wherein the at least one elongate implant is angled with the first leg of the clip.

[0183] (51) The method of embodiment 50, further comprising pre-drilling a hole in the bone or bone portion, the hole configured to receive the at least one elongated implant and / or the first leg and the second leg of the clip. (52) The method of embodiment 51, wherein pre-drilling the holes includes using a clip drill guide to position the holes for the first leg and the second leg of the clip. (53) The method of embodiment 51 or 52, wherein pre-drilling the holes includes using an implant guide to position the holes for the at least one elongated implant. (54) The method described in embodiment 53, wherein the clip drill guide and the implant guide form an integrated device. (55) The method described in embodiment 53 or 54, wherein the implant guide includes a plurality of holes for selecting the angle.

[0184] (56) The method of embodiment 55, wherein the plurality of holes includes holes sized to deliver non-cannulated screws. (57) The method of embodiment 56, wherein the at least one elongated implant comprises a non-cannulated screw. (58) The method of embodiment 55, wherein the plurality of holes includes holes sized for k-wires configured to deliver cannulated screws. (59) The method of embodiment 58, wherein the at least one elongated implant comprises a cannulated screw. (60) A method according to any one of embodiments 53 to 59, wherein the hole for the at least one elongated implant is offset from the hole, spacing the first leg a certain distance apart.

[0185] (61) The method described in any of embodiments 50 to 60, wherein the at least one elongated implant has a length such that the at least one elongated implant is configured to achieve bicortical engagement. (62) The method of embodiment 61, wherein the at least one elongate implant is delivered such that the tip of the at least one elongate implant protrudes from the outer surface of the bone or bone portion. (63) The method of any one of embodiments 50 to 62, wherein the discontinuity comprises a fracture or resection line. (64) The method of any one of embodiments 50 to 63, wherein the clip is delivered such that the at least one elongate implant and the first leg of the clip are spaced a distance apart. (65) The method of any one of embodiments 50 to 64, wherein the at least one elongated implant is delivered before delivering the clip.

[0186] (66) The method of any one of embodiments 50 to 64, wherein the at least one elongated implant is delivered after delivering the clip. (67) The method of embodiment 66, wherein the clip is in a deformed configuration when the first elongate implant and the second elongate implant are delivered. (68) The method of any one of embodiments 50 to 67, wherein the at least one elongate implant is delivered without crossing the discontinuity. (69) The method of any one of embodiments 50 to 68, wherein the clip is delivered without the first leg and / or the second leg crossing the discontinuity. (70) Positioning a clip drill guide across the discontinuity or the joint, the clip drill guide including a first cannula positioned on the first side of the discontinuity or the joint and a second cannula positioned on the second side of the discontinuity or the joint; drilling a first clip leg hole through the first cannula; inserting a first temporary pin through the first cannula and into the first clip leg hole; drilling a second clip leg hole through the second cannula; inserting a second temporary pin through the second cannula and into the second clip leg hole; positioning the implant guide on the first side of the discontinuity or the joint by sliding one of a plurality of guide positioning holes through the implant guide over the first temporary pin; forming an implant hole by inserting a drilling device through one of a plurality of implant positioning holes extending through the implant guide, the plurality of implant positioning holes being positioned closer to the discontinuity or the joint than the plurality of guide positioning holes; inserting the at least one elongated implant into the implant cavity; removing the first temporary pin and the second temporary pin; 51. The method of embodiment 50, comprising inserting the first leg of the clip into the first clip leg hole and inserting the second leg of the clip into the second clip leg hole.

[0187] (71) The method of claim 70, wherein the drilling device includes a drill bit. (72) The method of embodiment 70, wherein the drilling device comprises a bone punch. (73) Positioning a first drill guide across the discontinuity or the joint, the first drill guide including a first cannula positioned on the first side of the discontinuity or the joint and a second cannula positioned on the second side of the discontinuity or the joint; drilling a first clip leg hole through the first cannula; inserting a first temporary pin through the first cannula and into the first clip leg hole; drilling a second clip leg hole through the second cannula; inserting a second temporary pin through the second cannula and into the second clip leg hole; positioning the implant guide on the first side of the discontinuity or the joint by sliding one of a plurality of guide positioning holes through the implant guide over the first temporary pin; inserting an implant guide wire through one of a plurality of implant positioning holes extending through the implant guide, the implant positioning hole being positioned closer to the discontinuity or the joint than the guide positioning holes; inserting the at least one elongate implant over the implant guidewire into the bone or bone portion; removing the implant guidewire; removing the first temporary pin and the second temporary pin; 51. The method of embodiment 50, comprising inserting the first leg of the clip into the first clip leg hole and inserting the second leg of the clip into the second clip leg hole. (74) A method described in any one of embodiments 70 to 73, wherein the plurality of implant positioning holes have a smaller diameter than the plurality of guide positioning holes. (75) The method of embodiment 73, wherein the plurality of implant positioning holes are sized to receive a guide tube, and the guide tube is configured to slidably receive the implant guide wire.

[0188] (76) A method described in any of embodiments 70 to 75, wherein the implant guide is arc-shaped, the multiple implant positioning holes penetrate the implant guide at various angles, and the multiple guide positioning holes penetrate the implant guide at various angles. (77) A drill guide configured to deliver the system of any one of claims 1 to 20, comprising: a first pair of alignment holes configured to guide a drill bit to drill holes on either side of the discontinuity or the joint to receive the first leg and the second leg of the clip; and at least one second pair of alignment holes configured to guide the drill bit or a different drill bit or bone punch to form holes on either side of the discontinuity to receive the first elongated implant and the second elongated implant, or to guide the insertion of a k-wire on either side of the discontinuity to receive the first elongated implant and the second elongated implant. (78) A drill guide according to embodiment 77, wherein the first pair of alignment holes and the at least one second pair of alignment holes are arranged in a single member. (79) The drill guide of embodiment 77 or 78, wherein the at least one second pair of alignment holes is offset a distance from the first pair of alignment holes. (80) The drill guide of embodiment 79, wherein the at least one second pair of alignment holes are spaced apart by a shorter distance than the first pair of alignment holes.

[0189] (81) A drill guide according to any one of embodiments 77 to 80, wherein at least one of the second pair of alignment holes is sized to receive a k-wire. (82) A drill guide according to any one of embodiments 77 to 80, wherein the at least one second pair of alignment holes is sized to drill holes configured to accept non-cannulated screws. (83) A drill guide according to any one of embodiments 77 to 80, wherein the at least one second pair of alignment holes is sized to receive a guide tube, and the guide tube is configured to slidably receive a k-wire. (84) A drill guide according to any one of embodiments 77 to 83, wherein the first pair of alignment holes are configured to guide the drill bit to drill a hole without crossing the discontinuity. (85) A drill guide described in any of embodiments 77 to 84, wherein the at least one second pair of alignment holes is configured to guide the drill bit or the other different drill bit or bone punch to form a hole or to guide the insertion of the k-wire without crossing the discontinuity.

[0190] (86) A drill guide according to any one of embodiments 77 to 85, wherein the at least one second pair of alignment holes includes two or more pairs of alignment holes that are angled differently relative to the first pair of alignment holes. (87) A drill guide according to any of embodiments 77 to 86, including a pair of temporary fixation pins configured to be inserted through the first pair of alignment holes and the drilled holes in the bone or bone portion to receive the first and second legs of the clip before forming the holes for receiving the first and second elongated implants or before inserting a k-wire. (88) A kit comprising a bone fixing system according to any one of embodiments 1 to 9 and a drill guide according to any one of embodiments 77 to 87. (89) A surgical guide system configured to assist in the delivery of the system of any one of embodiments 1 to 20, comprising: a clip drill guide configured to be positioned across the discontinuity or the joint, the clip drill guide including a first cannula configured to be positioned on the first side of the discontinuity or the joint and a second cannula configured to be positioned on the second side of the discontinuity or the joint; an implant guide configured to be positioned on the first side or the second side of the discontinuity or the joint, the implant guide including a plurality of implant positioning holes extending therethrough and a plurality of guide positioning holes extending therethrough, the plurality of implant positioning holes being spaced a distance from the plurality of guide positioning holes. (90) The system of embodiment 89, wherein the first cannula and the second cannula are configured to guide the first clip leg hole and the second clip leg hole to open without crossing the discontinuity or the joint.

[0191] (91) The system of embodiment 89 or 90, comprising: a first temporary pin configured to be inserted through the first cannula and inserted into a first clip leg hole drilled through the first cannula in the bone or bone portion; and a second temporary pin configured to be inserted through the second cannula and inserted into a second clip leg hole drilled through the second cannula in the bone or bone portion. (92) The system of embodiment 91, wherein the plurality of guide positioning holes extending through the implant guide are configured to slidably receive the first temporary pin and / or the second temporary pin. (93) A system described in any of embodiments 89 to 92, wherein the plurality of implant positioning holes are configured to receive a drilling device configured to form a first implant hole or a second implant hole in the bone or bone portion. (94) The system described in embodiment 93, wherein the first implant hole and / or the second implant hole are each configured to receive a non-cannulated screw. (95) The system of embodiment 93 or 94, wherein the drilling device includes a drill bit or a bone punch.

[0192] (96) A system described in any of embodiments 89 to 92, wherein the plurality of implant positioning holes are configured to receive k-wires. (97) A system described in any of embodiments 93 to 96, wherein the plurality of implant positioning holes are configured to guide the drilling device or the k-wire through the bone or bone portion without crossing the discontinuity or the joint. (98) A system described in any of embodiments 89 to 97, wherein the plurality of implant positioning holes are positioned closer to the discontinuity or the joint than the plurality of guide positioning holes. (99) A system described in any of embodiments 89 to 98, wherein the implant guide is arc-shaped, the multiple implant positioning holes penetrate the implant guide at various angles, and the multiple guide positioning holes penetrate the implant guide at various angles. (100) A kit comprising a bone fixing system according to any one of embodiments 1 to 20 and a surgical guide system according to any one of embodiments 89 to 99.

Claims

1. 1. A bone fixation system configured to be implanted across a bone discontinuity or across a joint between two bones, comprising: at least one elongated implant; a clip including a first leg and a second leg, the clip further including a bridge connecting the first leg and the second leg at first ends of the first leg and the second leg, wherein a distance between second free ends of the first leg and the second leg opposite the first end increases when the clip changes from a first configuration to a second deformed configuration, and when moving to the second deformed configuration, the bridge elastically deforms such that the second free ends of the first leg and the second leg move away from each other; the at least one elongate implant and the first leg of the clip are configured to be implanted into the first side of the discontinuity or the joint, and the at least one elongate implant is angled with the first leg of the clip in a plane perpendicular to a direction in which a longitudinal axis of the bridge extends when the clip is in the second deformed configuration; a bridge having no hole through which the at least one elongated implant is inserted, and a base end of the at least one elongated implant is positioned away from the bridge; the at least one elongated implant is positioned between the discontinuity or the joint and the first leg of the clip, and when the at least one elongated implant and the first leg of the clip are implanted into the first side of the discontinuity or the joint, an intermediate portion of the first leg of the clip in a direction in which the first leg extends is in contact with an intermediate portion of the at least one elongated implant in a direction in which the at least one elongated implant extends; the bridge does not have a hole through which the at least one elongated implant is inserted, and a base end of the at least one elongated implant is positioned away from the bridge.

2. the at least one elongate implant includes a first elongate implant and a second elongate implant, the first elongate implant and the first leg of the clip configured to be implanted on the first side of the discontinuity or the joint, the second elongate implant and the second leg of the clip configured to be implanted on a second side of the discontinuity or the joint, the first elongate implant forming a first angle with the first leg of the clip and the second elongate implant forming a second angle with the second leg of the clip; 2. The system of claim 1, wherein the first elongated implant is positioned between the discontinuity or joint and the first leg of the clip, and the first leg of the clip is in contact with the first elongated implant when the first elongated implant and the first leg of the clip are implanted on a first side of the discontinuity or joint, and the second elongated implant is positioned between the discontinuity or joint and the second leg of the clip, and the second leg of the clip is in contact with the second elongated implant when the second elongated implant and the second leg of the clip are implanted on a second side of the discontinuity or joint.

3. 3. The system of claim 1 or 2, wherein the first leg and the second leg of the clip have a length such that when implanted, the second free ends of the first leg and the second leg terminate in a spongy portion of the bone or bone section.

4. The system of any one of claims 1 to 3, wherein the at least one elongate implant includes a first screw and a second screw.

5. 5. The system of claim 4, wherein the first screw and the second screw have lengths such that when implanted, the first screw and the second screw are configured to achieve bicortical engagement.

6. The system of claim 4 or 5, wherein the tips of the first screw and the second screw are configured to protrude from an outer surface of the bone or bone portion when implanted.

7. The system according to any one of claims 4 to 6, wherein the first screw and / or the second screw are cannulated.

8. The system according to any one of claims 4 to 7, wherein the first screw and / or the second screw are non-cannulated.

9. The system of any one of claims 4 to 8, comprising a fixation plate configured to be coupled to the first screw and the second screw when implanted.

10. 4. The system of claim 1, wherein the at least one elongate implant includes a first leg and a second leg of a second clip, the second clip further including a bridge connecting the first leg and the second leg of the second clip at first ends of the first leg and the second leg of the second clip, respectively, and wherein a distance between the second free ends of the first leg and the second leg of the second clip opposite the first ends of the first leg and the second leg of the second clip is configured to increase when the second clip changes from a free configuration to a deformed configuration.

11. 11. The system of claim 10, wherein the first leg and the second leg of the second clip have a length such that when implanted, the second free ends of the first leg and the second leg of the second clip terminate in a spongy portion of the bone or bone section.

12. The system of claim 2 , wherein the first angle is the same as the second angle.

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