PERIPROSTHETIC HIP FRACTURE CABLING SYSTEM

Abstract

An improved fracture cabling system has one or more spacers. Each spacer has a longitudinal length extending along a body of the spacer. The body has an upper portion with an aperture configured to receive a wire or cable and a lower portion having one or more pairs of feet spaced by a longitudinal gap or groove. Each of the one or more pairs of feet is located on a lateral side of the spacer body and configured to contact a bone with a fracture. The gap is configured to be positioned over the fracture with each foot positioned on a side of the bone spaced from the fracture. The longitudinal length of the one or more spacers is preferably curved or arcuate. Each body of the one or more spacers has a leading end and a trailing end.

Claims

1. An improved fracture cabling system comprises: one or more spacers, each spacer has a longitudinal length extending along a body of the spacer, the body having an upper portion with an aperture configured to receive a wire or cable and a lower portion having one or more pairs of feet spaced by a longitudinal gap or groove, each of the one or more pairs of feet being located on a lateral side of the spacer body and configured to contact a bone with a fracture, wherein the gap is configured to be positioned over the fracture with each foot positioned on a side of the bone spaced from the fracture.

2. The fracture cabling system of claim 1 wherein the longitudinal length of the one or more spacers is curved or arcuate.

3. The fracture cabling system of claim 1 wherein each body of the one or more spacers has a leading end and a trailing end.

4. The fracture cabling system of claim 3 wherein the improved fracture binding comprises a plurality of spacers, each spacer abutting an adjacent spacer at the leading end or trailing end.

5. The fracture cabling system of claim 4 wherein each spacer has a leading end and a trailing end spaced arcuately between 15 degrees to 180 degrees.

6. The fracture cabling system of claim 4 wherein each spacer has a leading end and a trailing end spaced arcuately from 90 degrees to 180 degrees.

7. The fracture cabling system of claim 6 wherein the one or more spacers have a pair of sides, each side having the pairs of feet configured to engage the bone at longitudinally spaced locations, wherein the feet at the leading or trailing ends are partially rounded in shape and wherein the pairs of feet located from the ends are rounded in shape.

8. The fracture cabling system of claim 7 wherein each of the feet has a width of 3.0 mm to 4.0 mm or greater.

9. The fracture cabling system of claim 1 further comprises: a cable, the cable being inserted through the aperture of each of the one or more spacers and when tightened, secures each spacer in contact with the bone securely to set the fracture.

10. An improved bone stabilizing cabling system comprises: one or more spacers, each spacer has a longitudinal length extending along a body of the spacer, the body having an upper portion with an aperture configured to receive a wire or cable and a lower portion having one or more pairs of feet spaced by a longitudinal gap or groove, each of the one or more pairs of feet being located on a lateral side of the spacer body and configured to contact a bone in near proximity to a femoral head of the bone, wherein the gap is configured to be positioned over the bone with each foot positioned on a side of the bone spaced from the femoral head to stabilize and reinforce the bone.

11. The improved bone stabilizing cabling system of claim 10 wherein the longitudinal length of the one or more spacers is curved or arcuate.

12. The improved bone stabilizing cabling system of claim 10 wherein each body of the one or more spacers has a leading end and a trailing end.

13. The improved bone stabilizing cabling system of claim 12 wherein the improved fracture binding comprises a plurality of spacers, each spacer abutting an adjacent spacer at the leading end or trailing end.

14. The improved bone stabilizing cabling system of claim 13 wherein each spacer has a leading end and a trailing end spaced arcuately between 15 degrees to 180 degrees.

15. The improved bone stabilizing cabling system of claim 13 wherein each spacer has a leading end and a trailing end spaced arcuately from 90 degrees to 180 degrees.

16. The improved bone stabilizing cabling system of claim 15 wherein the one or more spacers have a pair of sides, each side having the pairs of feet configured to engage the bone at longitudinally spaced locations, wherein the feet at the leading or trailing ends are partially rounded in shape and wherein the pairs of feet located from the ends are rounded in shape.

17. The fracture cabling system of claim 16 wherein each of the feet has a width of 3.0 mm to 4.0 mm or greater.

18. The improved bone stabilizing cabling system of claim 10 further comprises: a cable, the cable being inserted through the aperture of each of the one or more spacers and when tightened, secures each spacer in contact with the bone securely to reinforce the bone.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0017] The patent or application file contains at least one drawing/photograph executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

[0018] The invention will be described by way of example and with reference to the accompanying drawings in which:

[0019] FIG. 1 is a perspective view of an exemplary embodiment of the improved fracture cabling device according to the present invention.

[0020] FIG. 2 is a top plan view of the device shown in FIG. 1.

[0021] FIG. 3 is a side view of the device shown in FIG. 1.

[0022] FIG. 4 is an end view of the device shown in FIG. 3.

[0023] FIG. 5 is a cross-sectional view of the device shown in FIG. 3 taken along section 5-5.

[0024] FIG. 6 is a cross-sectional view of the device shown in FIG. 3 taken along section 6-6.

[0025] FIG. 7 is a cross-sectional view of the device shown in FIG. 2 taken along section 7-7.

[0026] FIG. 8 is a side view of the exemplary embodiment of the spacer for improved bone fracture system.

[0027] FIG. 9 is a side view of a second embodiment of the spacer for improved bone fracture system.

[0028] FIG. 10 is a side view of a third embodiment of the spacer for improved bone fracture system.

[0029] FIG. 11 is a side view of a fourth embodiment of the spacer for improved bone fracture system.

[0030] FIG. 12 is a side view of the fourth embodiment with two spacers and a cable and cable crimp shown.

[0031] FIG. 13 is a side view of the fourth embodiment with two spacers and a cable and cable crimp shown.

[0032] FIG. 14 is a side view of the fourth embodiment with four spacers and a cable and cable crimp shown.

[0033] FIG. 15 shows a depiction of the device being placed on a bone.

[0034] FIG. 16 shows a second depiction of the device being placed on a femur bone next to the head of the femur and a cable without a spacer for comparison.

[0035] FIG. 17 shows an exemplary wire and crimp.

[0036] FIG. 18 shows an alternative exemplary wire with a ball end and a crimp.

[0037] FIG. 19 shows the device of the present invention in a complete encircling configuration approaching 360 degrees.

[0038] FIG. 20 is a photograph of a cable tensioned around a non-osteoporotic femur.

[0039] FIG. 21 is a photograph of a cable tensioned a cadaver femur with a total hip stem.

[0040] FIG. 22 is a photograph of a cable that has been passed through the present invention spacer, wrapped around a cadaver femur with a total hip stem, and tensioned to the cable manufacturer's recommended tension level.

[0041] FIG. 23 is a photograph of a cable that has been passed through the present invention spacer, wrapped around a cadaver femur, and tensioned to the cable manufacturer's recommended tension level.

DETAILED DESCRIPTION OF THE INVENTION

[0042] The present invention increases the contact area to bone such that the cable 40 is restricted from penetrating the bone 2 as the cable 40 is tensioned. This prevents additional fracturing of the bone 2. It also improves the mechanical strength of the fracture repair construct. FIG. 16 illustrates a comparison of an exemplary cable 40 alone and the cable 40 when coupled to the improved bone repair or stabilization device 10 with a spacer body 11. Improved distribution of contact forces between the tensioned cable 40 and the fractured bone 2 is shown.

[0043] Stainless Steel, titanium, or any other non-corrosive material, whether permanent or resorbable can be used to make the spacer body 11.

[0044] The present invention improves the repair of periprosthetic hip fractures. Currently a cable tensioned around a PPHF penetrates the proximal femur resulting in secondary femur fractures and loss of fixation of the periprosthetic fracture repair construct. The present invention limits and prevents cortical penetration of a tensioned cable. Thereby the fracture is stabilized, which permits fracture union.

[0045] The strength of any bone is directly proportional to how much of a load it bears from day-to-day. This process is very similar to muscle size and strength. Working out, exercising and lifting weights will result in increased muscle mass and strength. The same principle applies to bone. Normally, human bone is very tough and feels hard to the touch. Osteoporosis, is one circumstance whereby bone loses its strength. Another situation where bone becomes weaker is when it contains a metal implant. The femur or thigh bone on the occasion of a hip replacement has a metal stem placed in the upper portion of it. When this hip stem sits in the upper femur for a period of time, the surrounding bone weakens. This weakening is due to stress shielding. The process of stress shielding simply means that the metal stem bears all of the load with standing and it shields the adjacent bone from the stresses or work of standing. This may at first sound like a favorable process, except the bone that is shielded from stress will weaken slowly over time. The end result is twofold. First, the hip stem may loosen. Secondly, a peri-prosthetic femur fracture (PPFF) will occur more easily in the upper part of the thigh bone. Repair of a PPFF is challenged by the presence of the hip stem. The hip stem limits passage of screws across the width of the broken bone because the hip stem is in femoral canal. The best option at this point to fix a PPFF is to use cables. Except, the bone is weak and any cable tightened around the bone will simply cut into the bone and lose the ability to hold a fracture in place until it heals. A simplistic analogy would be to imagine a warm knife cutting through butter. The cables that are currently available for PPFF repairs are commonly only 1.7 mm in width or diameter, typically between 1.6 mm and 2.0 mm in width or diameter. This narrow width or diameter is part of the problem and why cables around a PPFF do not provide any fixation. The solution this invention offers is to pass a spacer 11 with feet 20 that are wider than the cable 40 over the cable 40, preferably by passing the cable 40 through an aperture in the spacer 11. The feet 20 are twice the width or diameter of a cable 40. The spacer 11 has two feet fore or leading and two feet after or trailing. Every foot 20 has a diameter or width twice the width of a cable 40. Accordingly, for a cable diameter of 1.5 mm to 2.0 mm, each foot will have a width of 3.0 mm to 4.0 mm or greater. Therefore, the two fore or leading feet offer four times the surface area of a cable 40. Likewise, the two after or trailing feet 20 offer four times the surface area of a cable 40. This increased surface area of the feet 20 on the cable spacer 11 improves the fixation of a cable 40 tensioned around a stress shielded bone 2 because the cable 40 cannot cut into the weakened bone 2. A simplistic analogy would be to imagine trying to pass a spoon through butter.

[0046] These features are explained in reference to the detailed drawings. In some embodiments, the spacer 11 is a single piece structure with an arcuate or curved shape to fit about an exterior surface of the bone 2. This single piece structure typically extends about 90 degrees to 180 degrees, but can extend from 15 degrees to 180 degrees, preferably 30 degrees or 45 degrees to 180 degrees. In other embodiments, the spacer 11 has a short circumferential arc of say 30 degrees to 60 degrees or 15 degrees to 90 degrees and can be stacked in a plurality of such spacers 11 around a cable 40 to create a variety of circumferential or arcuate lengths extending around the bone 2 to completely encircle the bone 2 up to 360 degrees if so desired. Normally this encirclement can be less than that to achieve the desired protection of the bone 2.

[0047] With reference to FIG. 1, a perspective view of the device 10 of the present invention is illustrated. The device 10 has the spacer body 11, the spacer body has a leading end 12 and a trailing end 14. Positioned on the inner circumferential arc of the spacer body 11 are a plurality of feet 20. The feet 20 at a leading end 12 and the feet 20 at a trailing end 14 are approximately half the length of the feet 20 as illustrated in the intermediate position at the midpoint of the arc of the spacer 11.

[0048] With reference to FIG. 2, a plan view of the spacer body 11 of the device 10 is illustrated showing the leading end 12 and the trailing end 14 with the plurality of feet 20. The feet 20 as shown are on both sides of the device 10 at lateral extremes.

[0049] With reference to FIG. 3. A view of the spacer body 11 of the device 10 is illustrated. As shown, the device 10 extends about an arc θ, as illustrated θ is a circumferential arc. It can be made as a single radius of curvature or a plurality of curvatures. The important aspect is that the arc θ extends angularly about 90 degrees as illustrated in this embodiment. As shown, a ¼ angle θ is shown between the intermediate foot 20 and the spacer body 11. The feet 20 at the trailing and leading ends 12, 14 are approximately half the extension of the intermediate feet. The intermediate feet are a full rounded curvature whereas the leading and trailing end feet 20 are cut at those ends and represent about half the circumferential or longitudinal length of the intermediate feet 20. In other words, the intermediate feet 20 will be twice the amount of contact area with regard to the bone 2 when assembled whereas the leading and trailing end feet are approximately half the length.

[0050] Importantly, with reference to FIG. 4, when looking at an end view of the spacer 11 of the device 10 shows the leading end 12 feet 20 spaced by a gap 24. The gap 24 spaces the feet 20 in pairs about the longitudinal or arcuate length of the spacer body 11. As illustrated, these feet 20 have a radius of curvature 20R, as discussed earlier this radius of curvature 20R is approximately, in this example, 3.4 mm in diameter which is approximately twice that of the 1.7 mm diameter of the cable 40 to which it will be attached. As further illustrated in FIG. 4, an aperture 30 is shown that has a rounded or circular shape for receiving a cable 40. At the 6 o'clock position or lower portion of this aperture 30 is a slotted opening 32 that communicates with aperture 30. This slotted opening 32 is narrow and provides a way of localizing the cable when it is inserted through the aperture 30. This central narrow slotted opening 32 secures the cable 40 in such a fashion that it cannot translate or shift left or right, but is always centered even upon tensioning of the device 10 which will be discussed later.

[0051] With reference to FIG. 5, a cross sectional view better illustrates the aperture 30 and slot 32. As can be seen, a cable 40 when positioned through the opening 30 will tend to center itself on the slot 32 and upon tensioning will tightly secure the device 10. As further shown the feet 20 has a radius of curvature 20R as discussed. As shown, this radius of curvature 20R is approximately twice that of the size of the typical cable 40. This is important as when the device 10 or spacer body 11 is pressed tightly against the bone 2, the objective is to have a larger contact area so it reduces bone penetration while providing contact with the bone 2 in this spaced orientation. As can be appreciated, the gap 24 between the feet 20 as illustrated provide a space. This effectively means that when the spacer body 11 is positioned over a fracture, the feet 20 can straddle the fracture if so desired, in such a fashion that they will provide contact on both sides of the fracture without necessarily having to lie directly into the broken bone pieces. This further facilitates the use of this device in such a fashion that it can secure and better provide a contact region that is less damaging to the bone 2, particularly a fractured bone.

[0052] With reference to FIG. 6, an end view of the device 10 is shown with a cross section showing the aperture 30 and the slotted opening 32 communicating with the aperture 30. The spacer body 11 is further illustrated from an underside view. In the underside view the feet 20 are shown in this section 6-6.

[0053] With reference to FIG. 7, a cross sectional view of the device 10 as taken along the circumferential length of the spacer body 11. This spacer body 11 greatly shows how the aperture 30 extends through the leading end 12 through to the trailing end 14 as does the slotted opening 32 at the bottom of the aperture which centrally localizes the cable 40 such that it will securely fit always in the bottom of the aperture 30. As illustrated, the feet 20 at the leading and trailing ends 12, 14 are approximately half the circumferential or longitudinal length of the intermediate foot 20.

[0054] With reference to FIG. 8, a first embodiment of the invention device 10 is shown. In this embodiment the angle θ.sub.1 is approximately 90 degrees. The distance from the end to the center of the feet 20 at the intermediate location is approximately 45 degrees on either side from the leading 12 or trailing end 14.

[0055] In a second embodiment shown in FIG. 9, the device 10 is shown wherein the spacer body 11 extends 120 degrees. In this embodiment θ.sub.2 is 120 degrees. As shown half of θ.sub.2 is approximately 60 degrees. This is the dimension that extends from the leading or trailing feet 20 to a mid-portion of the intermediate feet 20.

[0056] With reference to FIG. 10, a third embodiment device 10 is shown where the spacer body 11 extends a full 180 degrees longitudinally. In this embodiment, as illustrated, the leading end 12 and trailing end 14 each have the feet 20 adjacent the end half the size of the three intermediate feet 20 in this embodiment. The angle θ.sub.3 is shown at 180 degrees. The distance between adjacent feet along the circumferential length is approximately ¼ θ.sub.3 or 45 degrees in this embodiment.

[0057] With reference to FIG. 11, a fourth embodiment device 10 is shown. This embodiment is smaller in circumferential length than the other embodiments illustrated. In this embodiment, the leading end 12 and trailing end 14 have the feet 20, but there are no intermediate feet 20. In this embodiment the angle 04 is approximately 45 degrees as illustrated. This 45 degree angle extends from the leading end 12 to the trailing end 14 along the circumferential length of the spacer body 11.

[0058] As illustrated in FIG. 12, when the spacer 11 of the fourth embodiment is stacked about a cable 40, two spacers 11 can be used to create a 90 degree device. When stacked the leading end 12 and the trailing end 14 of an adjacent spacer 11 will abut and when tensioned because of the slotted opening 32 in the aperture 30 that causes the cable 40 to tension and always be centered, the abutting leading 12 and trailing end 14 feet in combination will create full size or rounded bone contacting feet similar to the intermediate feet 20 of other embodiments. While the bone 2 is not always at the proper radius of curvature, the advantage of using stacked or a plurality of spacers 11 to tension the cable 40 provides feet 20 for maintaining contact tightly against the bone 2 such that there is not gap or space between the spacers 11.

[0059] With reference to FIG. 13, an embodiment 5 is illustrated wherein the spacer body 11 extends approximately 60 degrees or angle θ.sub.5 by stacking two of these spacer bodies 11 together, an angle is achieved of 205 or 120 degrees.

[0060] When the cable 40 is passed through the opening 30, the cable 40 can be crimped together by a crimping device 50 that allows one end of the cable 42 to be positioned in the crimping device 50 and the other end 41 to be inserted through another opening in the cable crimping device 50. Therefore, when tensioned and crimped, the embodiments will be held in positioned tightly against the bone 2.

[0061] In FIG. 14 another embodiment is illustrated wherein the four spacer bodies 11 are stacked along a cable 40. These four spacer bodies 11 have an approximate angle θ.sub.4 of 45 degrees. Stacking four of the θ.sub.4 spacers circumferentially about the cable 40 allows for a 180 degree device 10 to be created. Again, as illustrated, the crimping device 50 that holds the cable ends 41, 42. What happens the end 42 in the embodiment shown can have a bulbous end. This is not required, however, it provides an additional feature to make it easier for the surgeon to tension the cable 40.

[0062] With reference to FIGS. 15 and 16, the device 10 of the present invention is shown. In FIG. 15, the device 10 is shown with the 45 degree radius spacer 11 shown in FIG. 1. In this device 10 the cable 40 is shown being passed through the spacer body 11 and the tools 100 are shown pulling the cable 40 in such a fashion that they fit about the bone 2. As shown, the bone 2 has an enlarged femur head 4 and the encircling device 10 having a spacer 11 are shown slightly below this enlarged head 4 so they can stabilize the bone 2. FIG. 16 further illustrates a comparison of the spacer device 10 when tensioned about the bone 2 affixed to a bone 2 close to the femur head 4. For comparison purposes in FIG. 16, a cable wire 40 without the spacer device body 11 is shown to show how narrow the cable wire 40 is and how prone it is to penetrate into a weakened bone. Therefore, the use of the present invention 10 provides stabilizing feet 20 that are spaced out not only along a circumferential arc but also spaced laterally such that it provides a stability factor such that the device 10 will not tip and provides a contact area of each foot 20 that is larger approximately double that of a typical wire width. And by using pairs of feet 20 along this circumferential arc, the device 10 is stabilized and provides much less bone penetrating potential compared to just a single cable wire.

[0063] Alternatively, in the prior art, flat devices are commonly employed. However, these flat devices are limited in that they provide a flat surface around which the bone 2 is to be accommodated whereas the feet provide an arcuate shape that better contacts the bone 2 locally and provides a superior contact point that is stabilized due to the fact that the aperture 30 for receiving the cable 40 has a slot 32 that centralizes the cable 40 in such a fashion that it cannot shift. This allows the radially inner portion of the spacer 11 to be stabilized by effective use of pairs of feet 20 on each lateral side of the device 10.

[0064] With reference to FIG. 17, a typical cable 40 is shown with a crimping device 50. This is provided simply to illustrate how the crimping device 50 works wherein pairs of openings 52 are provided, each opening 52 to receive an end of the cable 40. This simplifies the procedure for the surgeon.

[0065] As further illustrated in FIG. 18, one of the ends 42 of a cable 40 is illustrated with a bulbous end. This further facilitates the tensioning procedure in that the crimping device 50 can be slid to the bulbous end 42 so that when the cerclage cable wire 40 is tightened against the bone 2 with the device 10 in place, it can be held easily in position. The surgeon only has to deal with the one end of the cable 40 to feed it through the crimping device 50 and tension it into the aperture 52. Upon crimping, the cable 40 will no longer move.

[0066] With reference to FIG. 19, it is possible to use the device 10 in such a fashion that it completely encircles the bone 2 approximately 360 degrees. While this is not necessarily required in all circumstances, it provides a wonderful view of how the use of a plurality of spacer bodies 11 can be positioned in such a fashion that it can extend from as low as 90 degrees to as high as 360 degrees.

[0067] The photographs of FIGS. 20-23 show cables 40 alone and cables 40 with the spacer 11 of the present invention used on periprosthetic fractures. The photograph of FIG. 20 shows a cable 40 tensioned around a non-osteoporotic femur bone 2. Note the cable 40 has constricted the overlying soft tissues, but the cable 40 has not penetrated the cortex as is seen in FIG. 21. In FIG. 21, a cable 40 was tensioned just proximal to the lesser trochanter of a cadaver femur 2 with a total hip stem. The tip of the cable is pointing to where the cable 40 penetrated the femur 2. The photographs of FIG. 22 shows a cable 40 has been passed through the new spacer 11, wrapped around a cadaver femur 2 with a total hip stem, and tensioned to the cable manufacturer's recommended tension level. Compare this to FIG. 21 and note how the spacer 11 prevents cable 40 penetration. The photograph of FIG. 23 shows a cable 40 has been passed through the new spacer 11, wrapped around a cadaver femur 2, and tensioned to the cable manufacturer's recommended tension level. Compare this figure to FIG. 21 and note how the spacer 11 prevents cable 40 penetration.

[0068] Fractures of the femur after a total knee or a total hip replacement procedure are common. These fractures are called periprosthetic fractures (PPF). They are increasing in frequency due to the steady increase in adult joint reconstruction procedures performed annually. There are two significant challenges in repairing a PPF. First, the joint replacement implants interfere with application of fracture repair implants, such as plates and screws. As a result, metal cables are used. Normally, in non-osteoporotic bone cables provide adequate circumferential placement around a femur without cable penetration as shown in the photograph of FIG. 20. Secondly, cables applied on bone near joint replacement implants do not hold well. Poor fixation by cables near a joint replacement implant is because the bone is osteoporotic due to stress shielding as shown in the photograph of FIG. 21. Essentially, the bone adjacent to a hip or knee joint replacement is too weak and soft to provide adequate fixation with a metal cable to stabilize a PPF.

[0069] The inventor of the present invention has directly observed cables penetrating femurs applied in PPFF repairs. He studied this phenomenon further by obtaining 24 cadaver femurs that had a hip arthroplasty stem in place for a minimum of 6 months. In every cadaveric femur specimen, the cable penetrated the femoral bone when tensioned to the cable manufacturer's recommended tension level as shown in FIG. 21. In an attempt to limit cable penetration in stress shielded femurs, the inventor made the spacer 11 according to the present invention to pass over the cable 40 before cable tensioning as shown in FIGS. 22 and 23. The present invention device 10 improves upon his previous patented cable spacer as described in U.S. Pat. No. 9,387,024 B2 issued Jul. 12, 2016. This new device also protects the periosteal blood vessels via limited contact design. This implant improves upon the limited contact concept by widening the limited contact points of the spacer. The widened contact points distribute the tensioning forces of the cable as it is tightened. This prevents cable penetration into a stress shielded femur.

[0070] It is believed that the improved device 10 will distribute the loads against the bone 2 in such a fashion that bone repair of a fracture or stabilization of a weakened bone as in a hip replacement can be achieved without inducing any further fractures to the bone 2. This greatly enhances the procedure and makes it more likely for a favorable outcome for those who receive hip or knee replacements. These and other attributes of the present invention are as claimed in the claims as presented hereinafter.

[0071] The radius of curvature in conjunction with the fore and aft feet provide limited contact of a cable around a femoral bone. This is similar to the previously published spacer

[0072] The improved fore and aft feet design prevents cable penetration or cortical fracture in stress shielded femurs. This is a new feature and different than the published spacer. Ironically, the published spacer is all about limited contact, whereas this new spacer adds contact area slightly to distribute tensioning forces to prevent cable penetration and cortical fracture in stress shielded femurs.

[0073] Periprosthetic femur fractures (PPFF) near hip or knee replacements are common. PPFF have osteoporotic bone from stress shielding which limits the use of cables for fixation of a PPFF. Stress shielding is a bone remodeling process. Femoral bone stress shielding occurs within 6 months of a joint reconstruction procedure. When a metal implant is placed in the femur for a joint reconstruction procedure, it shields the adjacent bone from weight bearing loads. This is stress shielding. In response to decreased loads to bone adjacent to a total joint implant, the bone becomes less dense or osteoporotic. This can lead to fractures. The fractures are difficult to treat because the bone is weaker and less able to hold metal fracture repair implants such as plates, screws, or cables. We have observed that metal cables 40 penetrate the femur bone, and fracture stress shielded PPFF as shown in FIG. 21. The present invention avoids this complication.

[0074] Variations in the present invention are possible in light of the description of it provided herein. While certain representative embodiments and details have been shown for the purpose of illustrating the subject invention, it will be apparent to those skilled in this art that various changes and modifications can be made therein without departing from the scope of the subject invention. It is, therefore, to be understood that changes can be made in the particular embodiments described, which will be within the full intended scope of the invention as defined by the following appended claims. The surgical access window described herein encompasses the dimensions presented and any and all variations applicable to the methods and surgical technique described directly or indirectly intended with this device.