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Delete 		NXT-5PROV NXT-5, 6, 7, 8 Figure 5B is a perspective view of a medial bone plate 500b deployed on a long bone, according to one embodiment. The medial bone plate 500b may have many structures, features, and functions, operations, and configuration similar to that of the medial bone plate 500a described in relation to FIG. 5A, like parts are identified with the same reference numerals. Accordingly, the medial bone plate 500a may include a proximal end 502, distal end 504, body 506, one or more fastener openings 514, and a fixation feature 516. In the illustrated embodiment, the medial bone plate 500b differs from the medial bone plate 500a because the medial bone plate 500b has a lateral approach fastener opening 526. 107 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 In one embodiment, a lateral approach fastener opening 526 is a fastener opening configured to accept a lateral approach fastener 528. The lateral approach fastener opening 526 and lateral approach fastener 528 may be part of a lateral approach fastening system. A lateral approach fastening system can be any device, structure, apparatus, or system designed or configured to accept a fastener deployed from a lateral side of a long bone. 108 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 A lateral approach fastener opening 526 can be implemented in a variety of ways. In the illustrated embodiment, the lateral approach fastener opening 526 is a set of internal threads of an opening that are configured to engage external threads of lateral approach fastener 528 that passes through the long bone. Advantageously, the lateral approach fastener 528 is deployed from a lateral side of the long bone so as to avoid a neurovascular bundle or femoral artery near the medial side of the long bone. Those of skill in the art will recognize a variety of different designs for a lateral approach fastening system such as the example lateral approach fastener opening 526 and lateral approach fastener 528 presented here, each of which is considered within the scope of the present disclosure. 109 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 In certain embodiments, a lateral approach fastening system is one example of an opposite side approach fastening system. A opposite side approach fastening system is one that can include two components one on one side of a body part or section of tissue and one on an opposite of the body part or section of tissue. Opposite side approach fastening system can be used in relation to a medial-lateral axis, an anterior-posterior axis, a superior-inferior axis, a cephalad-caudal axis, and the like. 110 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 Figure 5C is a perspective view of a lateral approach fastener 528 for use with the medial bone plate of FIG. 5B, according to one embodiment. The lateral approach fastener 528 can include a head 530 and a shank 532. In one embodiment, the head 530 may be angled to engage with bone when deployed. The shank 532 can include two sets of threads, coarse threads 534 and fine threads 536. The coarse threads 534 may have a greater pitch to facilitate purchase of the threads in bone of the long bone. The fine threads 536 may include smaller pitch that matches the pitch of internal threads of a lateral approach fastener opening 526 to provide enhanced engagement and fixation with a medial bone plate 500b. 111 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 The handle 310 is used by an operator to manipulate the intramedullary nail 100 or intramedullary nail system 200 during deployment or retraction. The driver 320 can include external threads that engage with internal threads of a coupling 110/third coupling 220 to secure the driver 320 to the coupling 110/third coupling 220. Alternatively, the driver 320 can include a different engagement feature such as a friction fit, tabs, grooves, etc. for connecting to the coupling 110/third coupling 220 for the deployment or for a retraction. 78 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 Figure 2C is a perspective view of the adapter 204 of FIG. 2A, according to one embodiment. Figure 2C shows the second coupling 218, third coupling 220, and body 222 in more details. In certain embodiments, the second coupling 218, third coupling 220, and body 222 have a circular longitudinal cross section. Other shaped longitudinal cross sections can also be used. 68 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 As described above in relation to the offset section 116, the adapter 204 may include a hollow passage 228 that extends from the second coupling 218 to the third coupling 220 that may be used for deployment of the adapter 204 over a guide wire. Generally, the hollow passage 228 has a common diameter throughout the adapter 204 and may have a diameter that matches the diameter of a corresponding passage within the intramedullary nail 202. The length of second coupling 218, third coupling 220, and body 222 may vary depending on the amount of offset needed to clear a deployed arthroplasty implant, age, gender, size, and anatomical structure of a patient. 69 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 Figures 2D, 2E, 2F, and 2G are a distal end view, a proximal end view, a side view, and a side cross-section view respectively of the adapter of FIG. 2C, according to one embodiment. The adapter 204 has a distal end 230 and a proximal end 232. The first coupling 216 of the intramedullary nail 202 and the second coupling 218 and third coupling 220 of the adapter 204 serve to connect the intramedullary nail 202 with a driver (See FIG. 3A) for deployment/retraction of the intramedullary nail 202. 70 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 The first coupling 216 may use a variety of features and/or interfaces for making a coupling/connection between the multiple couplings and the driver. In the illustrated embodiment, the couplings 216, 218, 220 may each include an arrangement of one or more grooves 234 that accept one or more "tongues" or tabs 236 that may extend from another coupling 216, 218, 220 or driver of an inserter. The one or more grooves 234 may engage the one or more "tongues" or tabs 236 to permit the driver to force or move the intramedullary nail 202 longitudinally when deploying the intramedullary nail 202. The one or more grooves 234 may permit some torque forces to be applied to the couplings 216, 218, 220 to facilitate deployment of the intramedullary nail 202. In certain embodiments, the one or more grooves 234 may engage with the one or more "tongues" or tabs 236 in a friction fit such that the intramedullary nail 202 can be retracted as needed during a deployment procedure. In certain embodiments, the couplings 216, 218, 220 may engage each other and a driver such that retraction of the driver also retracts the couplings 216, 218, 220 and structures connected to the couplings 216, 218, 220. 71 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 Those of skill in the art will recognize that the features, functions, and advantages of the offset section 116 can be integrated into an intramedullary nail such as intramedullary nail 100, can be integrated into an adapter 204 such as the adapter 204 used with the example intramedullary nail 202 described above, can be integrated into an inserter used to insert an intramedullary nail into an intramedullary canal of a patient, or can be implemented in whole, or in part, in both the intramedullary nail and/or an adapter or an inserter. For example, in one embodiment, an adapter, or driver of an inserter, may include a second bend angled anteriorly from a longitudinal axis the intramedullary nail and a distal end of an intramedullary nail may include a first bend angled posteriorly from a longitudinal axis the intramedullary nail, with a suitable coupling between the first bend and the second bend. Each of these embodiments and other variations thereof are considered within the scope of the present disclosure. 72 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 Those of skill in the art will also recognize that the features, functions, and advantages of the offset section 116 are not limited to one or more bends in an anterior and/or posterior direction and can be used for prostheses, adapters, and/or instruments to provide one or more offset sections 116 that bend in other directions, including, but not limited to, medial/lateral, anterior/posterior, superior/inferior, cephalad/caudal, and the like. The offset section 116 enables use of prostheses in procedures to avoid existing tissue or structures that a surgeon desires to not disturb. 73 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 In certain embodiments, various names and/or labels may be used for the section 116 and/or an adapter 204 used with embodiments of the present disclosure. For example, the section 116 may also be referred to as an offset section, a detour section, a routing section, a rerouting section, an “S-shaped” section, or the like. Alternatively, or in addition, the section 116 may be referred to as an accessibility section or accommodation section because the section enables an operator to access the medullary cavity when an arthroplasty implant is deployed or because the section accommodates deployment of an intramedullary nail even when an arthroplasty implant is deployed. Alternatively, or in addition, the adapter 204 (or inserter driver) may also be referred to as an offset adapter, a detour adapter, a routing adapter, a rerouting adapter, an “S-shaped” adapter, or the like. Alternatively, or in addition, the adapter 204 may be referred to as an accessibility adapter or accommodation adapter because the adapter enables an operator to access the medullary cavity when an arthroplasty implant is deployed or because the adapter accommodates deployment of an intramedullary nail even when an arthroplasty implant is deployed. 74 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 The intramedullary nail 100, offset section 116, intramedullary nail 202, and/or adapter 204 may be made from a variety of materials. In one embodiment, the materials used have sufficient flexibility to enable the intramedullary nail 100 or intramedullary nail system 200 to be deployed into the intramedullary canal either retrograde or antegrade. For example, in one embodiment, intramedullary nail 100, offset section 116, intramedullary nail 202, and/or adapter 204 may be made from a shape memory alloys such as Nitinol. Accordingly, such components may bend during deployment and then return to an original shape after deployment. 75 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 Figure 3A is a perspective view of an inserter 300a connected to one of the intramedullary nail 100 of FIG. 1A or the intramedullary nail 202 and adapter 204 of FIG. 2A deployed within a long bone, such as a femur 102, according to one embodiment. The inserter 300a is a tool or instrument that enables and/or facilitates deployment and/or retraction of the intramedullary nail 100 and/or intramedullary nail system 200 (e.g., intramedullary nail 202 and adapter 204). 76 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 Figure 3B is a perspective view of an inserter 300a and one of the intramedullary nail of FIG. 1A and/or the intramedullary nail system of FIG. 2A, according to one embodiment. The inserter 300a is disconnected from the intramedullary nail of FIG. 1A and/or the intramedullary nail system of FIG. 2A. The inserter 300a may include a handle 310, a driver 320, and a guide 330. 77 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 Those of skill in the art will recognize that the intramedullary nail 202 adapter 204 and adapter 204 can be adapted to engage a first coupling 216 at a proximal end 206 and/or the distal end 208. Alternatively, or in addition, the intramedullary nail 100 can be manufactured with the section 116 on either or both the proximal end 106 and/or the distal end 104. In this manner the benefits of an offset section 116 can be gained on either end of the intramedullary nail 100 or intramedullary nail 202 or on both ends. 67 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 In one embodiment, the driver 320 includes a threaded distal end 322, a shaft 324, and a thumb-screw 326. The threaded distal end 322, shaft 324, and thumb-screw 326 can be used to connect the driver 320 to the coupling 110/third coupling 220. The thumb-screw 326 is connected to the shaft 324 such that rotation of the thumb-screw 326 about the longitudinal axis of the shaft 324 turns the threaded distal end 322 to engage or disengage with the coupling 110/third coupling 220. The thumb-screw 326 can be rotated by an operator. 79 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 In the illustrated embodiment, the driver 320 includes a straight shaft 324 and straight driver 320. However, as described above, different features of the section 116 and/or adapter 204 may be coupled, connected, or integrated into the driver 320 of the inserter 300a. For example, the distal end 322 may include an adapter 204 with two bends 224, 226 as described above that engage a first coupling 216 of an intramedullary nail 202. In another example, the distal end 322 may include a bend such as second bend 226 and an adapter 204 or an intramedullary nail 202 may include a first bend 224. Such variations on the position and location of the bends 118/120/224/226 between the driver 320, an adapter 204, and an intramedullary nail 202/100 are within the scope of this present disclosure. 80 Added by DJM 8 2021 8/16/21, 12:00 AM
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Delete 		NXT-5PROV NXT-5, 6, 7, 8 The guide 330 provides a visual indicator for a surgeon or other user regarding where features of an intramedullary nail 100 or intramedullary nail system 200 are physically during deployment or retraction. In one embodiment, the guide 330 includes a section 332 and a shaft 334. The section 332 and shaft 334 may extend from the inserter 300a parallel to, and aligned with, the section 116 and shaft 108/210 of the intramedullary nail 100 or intramedullary nail system 200. Similarly, the section 332 and shaft 334 may include openings 336 positioned in alignment with openings 132 of the intramedullary nail 100 or intramedullary nail system 200. In this manner, a surgeon can visually see the progression and position of the intramedullary nail 100 or intramedullary nail system 200 and/or adapter 204 within the patient during a deployment or retraction. 81 Added by DJM 8 2021 8/16/21, 12:00 AM

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