# US 10,307,193 B2 · Sternal closure cerclage, plate implant and instrumentation > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,307,193 B2 - Document ID: US10307193B2 - Status: Granted - Kind: B2 - Application number: 15/815,783 - Filed: 2017-11-17 - Published: 2018-05-17 - Granted: 2019-06-04 - Earliest claimed: 2013-03-15 - Assignees: Zimmer Biomet CMF and Thoracic, LLC - Applicants: Zimmer Biomet CMF and Thoracic, LLC - Inventors: Saddy Garcia; Bryan Wilcox; Benjamin Witten - Web page: https://patentgrep.com/patent/US10307193B2 ## CPC - A61B 17/1789: {for the sternum} - A61B 17/0482: {Needle or suture guides (guides for drills, pins or wire A61B17/17; guides for puncturing needles A61B17/3403)} - A61B 17/0487: {Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks (suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122)} - A61B 17/06004: {Means for attaching suture to needle (tipping A61B17/06195)} - A61B 17/06066: {Needles, e.g. needle tip configurations} - A61B 17/06109: {Big needles, either gripped by hand or connectable to a handle} - A61B 17/062: Needle manipulators - A61B 17/1606: {of forceps type, i.e. having two jaw elements moving relative to each other} - A61B 17/1611: {the two jaw elements being integral with respective elongate shaft elements} - A61B 17/1642: {for producing a curved bore} - A61B 17/3403: {Needle locating or guiding means} - A61B 17/7053: {with parts attached to bones or to each other by flexible wires, straps, sutures or cables} - A61B 17/8076: {for the ribs or the sternum} - A61B 17/808: {Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms} - A61B 17/82: for bone cerclage {(apparatus for manipulating wires or straps A61B17/8861; wires, bands or straps other than cerclage A61B17/842)} - A61B 17/823: {for the sternum} - A61B 17/86: Pins or screws {or threaded wires; nuts therefor (A61B17/72 take precedence)} - A61B 17/8861: {Apparatus for manipulating flexible wires or straps (devices for inserting Kirschner wires A61B17/1697)} - A61B 17/8869: {Tensioning devices} - A61B 17/0466: {Suture bridges} - A61B 17/1728: {for holes for bone plates or plate screws} - A61B 17/683: {comprising bone transfixation elements, e.g. bolt with a distal cooperating element such as a nut} - A61B 2017/00734: {battery operated} - A61B 2017/0417: {T-fasteners} - A61B 2017/0496: {for tensioning sutures} - A61B 2017/06038: {soldered, brazed or welded} - A61B 2017/06057: {Double-armed sutures, i.e. sutures having a needle attached to each end} - A61B 2017/06071: {with an abrupt angle formed between two adjacent sections} - A61B 2017/0608: {J-shaped} - A61B 2017/06104: {interconnected at their distal ends, e.g. two hollow needles forming a loop for passing a suture} - A61B 2017/0619: {thermoplastic, e.g. for bonding, welding, fusing or cutting the suture by melting it} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract A system including a bone punch tool and a needle guide. The bone punch tool can include a support arm having a support arm proximal portion and a support arm distal portion, a pivot arm having a pivot arm proximal portion and a pivot arm distal portion, and an arcuate punch configured to punch through bone. The pivot arm distal portion can be pivotably coupled to the support arm distal portion, such that the pivot arm proximal portion is configured to be moved away from the support arm proximal portion to extend the arcuate punch into a punch position to punch an arcuate hole through bone. The needle guide can be configured to guide a needle through the arcuate hole. ## Claims ### Claim 1 A closure system for securing a first bone portion to a second bone portion, the closure system comprising: a bracket including a plurality of bracket apertures, the bracket configured to be secured to the first and second bone portions; a cerclage configured to extend around the first and second bone portions to secure the first bone portion to the second bone portion; and a plurality of fastener guides preloaded with fasteners, wherein the fastener guides are configured to be aligned with the bracket apertures, and the preloaded fasteners are configured to be driven through the bracket apertures into the first bone portion or the second bone portion. ### Claim 2 (depends on 1) The closure system of claim 1, wherein at least one fastener guide of the plurality of fastener guides comprises an elongated tube. ### Claim 3 (depends on 1) The closure system of claim 1, wherein each fastener guide of the plurality of fastener guides is connected to form a guide unit. ### Claim 4 (depends on 1) The closure system of claim 1, wherein the bracket fixedly engages a first end of the cerclage. ### Claim 5 (depends on 1) The closure system of claim 1, wherein a second end of the cerclage is configured to be moved relative to a first end of the cerclage to tension the cerclage. ### Claim 6 (depends on 1) The closure system of claim 1, wherein the bracket comprises a body and a plurality of legs extending from the body. ### Claim 7 (depends on 1) The closure system of claim 1, wherein at least a portion of the cerclage is configured to be received in an opening of the bracket. ### Claim 8 A closure system for securing a first bone portion to a second bone portion, the closure system comprising: a bracket including a plurality of bracket apertures, the bracket configured to be secured to the first and second bone portions; a cerclage configured to be looped around the first and second bone portions; and a plurality of fastener guides preloaded with fasteners, wherein the plurality of fastener guides are configured to be aligned with the plurality of bracket apertures, and the preloaded fasteners are configured to be driven through the bracket aperture into the first bone portion or the second bone portion. ### Claim 9 (depends on 8) The closure system of claim 8, wherein at least a portion of the cerclage is covered by an outer member. ### Claim 10 (depends on 9) The closure system of claim 9, wherein the outer member is molded over or formed integrally with the cerclage. ### Claim 11 (depends on 8) The closure system of claim 8, wherein the cerclage is configured to be tensioned around the first and second bone portions to secure the first bone portion to the second bone portion. ### Claim 12 (depends on 11) The closure system of claim 11, wherein the fasteners are configured to be driven through the bracket apertures into the first or second bone portion to secure the tensioned cerclage between the bracket and the first or second bone portion. ### Claim 13 (depends on 8) The closure system of claim 8, wherein the bracket defines a window configured to receive a cutting device for cutting the cerclage. ### Claim 14 (depends on 8) The closure system of claim 8, wherein the bracket includes: a body and a plurality of fastener-receiving portions, wherein a bottom surface of the body is raised relative to a bottom surface of at least one leg of the fastener-receiving portions. ### Claim 15 A method, comprising: looping a cerclage around first and second bone portions, the cerclage configured to be tensioned to adjoin the first bone portion to the second bone portion; positioning a bracket over the first and second bone portions, the bracket comprising a plurality of bracket apertures; aligning a plurality of fastener guides with the plurality of bracket apertures, wherein each of the plurality of fastener guides comprises an elongated tube and includes a preloaded fastener, wherein the plurality of fastener guides are connected to form a guide unit in a shape corresponding to a shape of the bracket; and driving the plurality of preloaded fasteners through the bracket apertures and into the first or second bone portion. ### Claim 16 (depends on 15) The method of claim 15, further comprising: passing a second end of the cerclage through an opening in the bracket. ### Claim 17 (depends on 15) The method of claim 15, further comprising: tensioning the cerclage by moving a second end of the cerclage relative to the first end of the cerclage. ### Claim 18 (depends on 15) The method of claim 15, further comprising: removing the plurality of fastener guides from the bracket without releasing tension of the cerclage or removing the fasteners. ### Claim 19 (depends on 15) The method of claim 15, further comprising: inserting a cutting device through a window defined by the bracket to cut the cerclage. ### Claim 20 (depends on 15) The method of claim 15, wherein the bracket includes a body, wherein a bottom surface of the body is raised relative to a bottom of at least one of the plurality of bracket apertures. ### Claim 21 A closure system for securing a first bone portion to a second bone portion, the closure system comprising: a bracket including a plurality of bracket apertures, the bracket configured to be secured to the first and second bone portions; and a guide unit including a plurality of fastener guides preloaded with fasteners, wherein each fastener guide of the plurality of fastener guides comprises an elongated tube, wherein a shape of the guide unit corresponds to a shape of the bracket and the fastener guides are configured to align with the bracket apertures, and wherein the preloaded fasteners are configured to be driven through the bracket apertures into the first bone portion or the second bone portion. ### Claim 22 (depends on 21) The closure system of claim 21, further comprising: a cerclage configured to extend around the first and second bone portions to secure the first bone portion to the second bone portion. ### Claim 23 (depends on 21) The closure system of claim 21, wherein the bracket comprises a body and a plurality of legs extending from the body, the plurality of bracket apertures being respectively positioned in the plurality of legs. ### Claim 24 (depends on 1) The closure system of claim 1, wherein at least a portion of the cerclage is configured to extend beneath a raised portion of the bracket. ### Claim 25 A closure system for securing a first bone portion to a second bone portion, the closure system comprising: a bracket including a plurality of bracket apertures, the bracket configured to be secured to the first and second bone portions; and a guide unit including: a plurality of fastener guides; and a plurality of fasteners; wherein each of the plurality of fastener guides is preloaded with a fastener of the plurality of fasteners; wherein each of the plurality of fastener guides is configured to be aligned with a respective one of the plurality of bracket apertures such that a shape of the guide unit corresponds to a shape of the bracket; wherein each of the plurality of preloaded fasteners is configured to be driven out of the guide unite and through the bracket aperture into the first bone portion or the second bone portion to secure the bracket to the first and second bone portions. ### Claim 26 (depends on 25) The closure system of claim 25, further comprising: a cerclage configured to be looped around the first and second bone portions. ### Claim 27 (depends on 26) The closure system of claim 26, wherein at least a portion of the cerclage is covered by an outer member that is molded over or formed integrally with the cerclage. ### Claim 28 (depends on 25) The closure system of claim 25, wherein the cerclage is configured to be tensioned around the first and second bone portions to secure the first bone portion to the second bone portion. ### Claim 29 (depends on 25) The closure system of claim 25, wherein the fasteners are configured to be driven through the bracket apertures into the first or second bone portions to secure the cerclage between the bracket and the first and second bone portions. ### Claim 30 (depends on 25) The closure system of claim 25, wherein the bracket defines a window configured to receive a cutting device for cutting the cerclage. ### Claim 31 (depends on 25) The closure system of claim 25, wherein the bracket includes: a body and a plurality of legs extending from the body, wherein a bottom surface of the body is raised relative to a bottom surface of at least one leg of the plurality of legs.