CN117813059A

CN117813059A - Systems and methods for joint fusion

Info

Publication number: CN117813059A
Application number: CN202280050261.7A
Authority: CN
Inventors: M·坎贝尔; S·肖恩; D·赛格; M·C·霍利斯
Original assignee: Crossroads Extremity Systems LLC
Current assignee: Crossroads Extremity Systems LLC
Priority date: 2021-05-19
Filing date: 2022-05-19
Publication date: 2024-04-02

Abstract

Methods and apparatus are disclosed for resecting a joint between a first bone and a second bone to define a resected joint, approximating the first bone and the second bone to reduce the resected joint, and fixing the first bone and the second bone relative to each other. The resecting step may be performed using a cutting guide that is movable from a first orientation to cut the first bone to a second orientation to cut the second bone. The compressor block may be driven over temporary fixation members extending into the first and second bones to reduce the resected joint. The nail, along with or in combination with other fixation elements, may then permanently fix the first bone to the second bone.

Description

Systems and methods for joint fusion

Cross Reference to Related Applications

The present application claims priority from U.S. patent application Ser. No. 63/201,940, filed on Ser. No. 2021, 5, 19, 8, 16, 2021, 63/233,582, and U.S. patent application Ser. No. 63/364,943, filed on 18, 5, 2022, the disclosures of each of which are hereby incorporated by reference as if set forth in their entirety herein.

Technical Field

The present disclosure relates to medical devices, and more particularly to systems and methods for tarsometatarsal fusion.

Background

Tarsometatarsal joint fusion is a surgical procedure that fuses the cuneiform bone with the corresponding metatarsal bone in the midfoot. Fusion of the tarsometatarsal joints stiffens the joints to correct deformity in the tarsometatarsal region. Conventional methods involve cutting the cuneiform and metatarsal at the joint, reducing the gap created between the cuneiform and metatarsal, and fixing the cuneiform and metatarsal, for example, with a bone plate. Unfortunately, conventional methods have inconsistent incisions at the wedge and metatarsals, which can create unpredictable compression and alignment of the wedge and phalanges during final fixation (particularly at the second and third wedge and metatarsals).

Accordingly, there is a need for an improved method and apparatus that consistently produces a predictable incision and achieves subsequent reliable compression and alignment of the cuneiform bones and metatarsals prior to final fixation.

Drawings

Aspects and advantages of the embodiments provided herein are described with reference to the following detailed description, taken in conjunction with the accompanying drawings. Throughout the drawings, reference numerals may be repeated to indicate corresponding relationships between reference elements. The drawings are provided to illustrate exemplary embodiments described herein and are not intended to limit the scope of the disclosure.

FIG. 1 is a perspective view of a bone of a foot with bunions;

FIG. 2A is a perspective view of an exemplary cutting guide configured as a cutting guide and a pin guide for use in the corrective osteotomy procedure described herein;

FIG. 2B is another perspective view of the cutting guide of FIG. 2A;

FIG. 2C is a top plan view of the cutting guide of FIG. 2A;

FIG. 2D is a cross-sectional side view of the cutting guide of FIG. 2C taken along line 2D-2D;

FIG. 2E is a perspective view of an exemplary freehand pin guide for insertion of the orientation pin without the cutting guide of FIGS. 2A-2D;

FIG. 2F is a top plan view of the freehand pin guide of FIG. 2E;

FIG. 2G is a cross-sectional elevation view of the freehand pin guide of FIG. 2E;

FIG. 2H is a perspective view of an example of a cutting guide configured for use with the cutting guide and pin guide of the corrective osteotomy procedure described herein;

FIG. 2I is another perspective view of a cutting guide configured as the cutting guide and pin guide of FIG. 2H;

FIG. 2J is a top plan view of a cutting guide configured as the cutting guide and pin guide of FIG. 2H;

FIG. 2K is a cross-sectional elevation view of the cutting guide configured as the cutting guide and pin guide of FIG. 2J, taken along line 2K-2K;

FIG. 2L is a perspective view of an exemplary cutting guide configured as a cutting guide and a pin guide for use in a Lapidus bunion excision procedure described herein;

FIG. 2M is another perspective view of an exemplary cutting guide configured as the cutting guide and pin guide of FIG. 2L;

FIG. 2N is a top plan view of an exemplary cutting guide configured as the cutting guide and pin guide of FIG. 2L;

FIG. 3A is a perspective view of an exemplary linear taper configured for use in a Lapidus bunion excision procedure described herein;

FIG. 3B is another perspective view of the exemplary linear taper of FIG. 3A;

FIG. 3C is a side elevation view of the exemplary linear taper of FIG. 3A;

FIG. 3D is a perspective view of the outboard hook of the exemplary linear taper of FIG. 3A;

FIG. 3E is a perspective view of the inside hook of the exemplary linear taper of FIG. 3A;

FIG. 3F is a perspective view of a quick release insert of the exemplary linear taper of FIG. 3A;

FIG. 3G is a perspective view of the threaded shaft of the exemplary linear taper of FIG. 3A;

FIG. 3H is a perspective view of the exemplary linear taper of FIG. 3A including a shouldered pin;

FIG. 4A is a perspective view of an exemplary control handle configured for use in a Lapidus bunion excision procedure described herein;

FIG. 4B is another perspective view of the exemplary control handle of FIG. 4A;

FIG. 5A is a perspective view of an exemplary compressor block configured for use in a Lapidus bunion excision procedure described herein;

FIG. 5B is another perspective view of the exemplary compressor block of FIG. 5A;

FIG. 5C is a top plan view of the exemplary compressor block of FIG. 5A;

FIG. 5D is a cross-sectional elevation view of the exemplary compressor block of FIG. 5C taken along line 5D-5D;

FIG. 6A is a plan view of an exemplary bone plate configured for use in a Lapidus bunion resection procedure described herein;

FIG. 6B is a perspective view of the exemplary bone plate of FIG. 6A;

FIG. 6C is another perspective view of the exemplary bone plate of FIG. 6A;

FIG. 6D is an enlarged perspective view of a portion of the exemplary bone plate of FIG. 6A;

FIG. 6E is a perspective view of a cross screw configured for use with the bone plate of FIG. 6A;

FIG. 6F is a perspective view of a portion of the bone plate of FIG. 6D, showing the cross screw of FIG. 6E inserted therein;

FIG. 6G is a perspective view of the bone plate of FIG. 6D, showing the cross screw of FIG. 6E inserted therein;

FIG. 7A is a perspective view of an exemplary fixed angle cross screw drill guide configured for use in the Lapidus bunion resection procedure described herein;

FIG. 7B is another perspective view of the exemplary fixed angle cross screw drill guide of FIG. 7A;

FIG. 7C is yet another perspective view of the exemplary fixed angle cross screw drill guide of FIG. 7A;

FIG. 7D is a side elevation view of an exemplary variable angle cross screw drill guide configured for use in a Lapidus bunion resection procedure described herein;

FIG. 7E is a perspective view of the variable angle cross screw drill guide of FIG. 7D;

FIG. 7F is an end elevation view of the variable angle cross screw drill guide of FIG. 7D;

FIG. 8 is a perspective view of the bones of a human foot showing one of the steps of an exemplary Lapidus bunion excision procedure performed using the exemplary bunion excision device described herein, wherein the cutting guide of FIG. 2A is temporarily secured to the foot;

FIG. 9 is a perspective view of the human foot of FIG. 8, showing the insertion of a metatarsal pin through the cutting guide and into the first metatarsal, and also showing the saw blade cutting the base of the first metatarsal;

FIG. 10 is a perspective view of the human foot of FIG. 9, showing the temporary placement of the linear taper of FIG. 3A around the first and second metatarsals;

FIG. 11 is a perspective view of the human foot of FIG. 10 showing the control handle of FIG. 4A placed over the pin;

FIG. 12 is a perspective view of the human foot of FIG. 11, but with the control handle rotated;

FIG. 13 is a perspective view of the human foot of FIG. 12 showing a wedge pin inserted through the proximal pin hole of the cutting guide and into or through the first wedge, and a medial hook pin inserted through the medial hook pin hole of the linear taper and into or through the first metatarsal to fix the rotational position of the first metatarsal;

FIG. 14 is a perspective view of the human foot of FIG. 13 showing the insertion of a saw blade through the proximal slot of the cutting guide and configured to cut the base of the first wedge bone;

FIG. 15 is a perspective view of the human foot of FIG. 14, showing the cutting guide, linear taper and control handle removed;

FIG. 16 is a perspective view of the human foot of FIG. 15, showing the compressor block of FIG. 5A applied over the metatarsal pins and the cuneiform pins;

FIG. 17 is a perspective view of the human foot of FIG. 16 showing the insertion of a cross pin through one of the cross pin holes of the compressor block;

FIG. 18 is a perspective view of the human foot of FIG. 17, showing the metatarsal pins and the wedge pins removed;

FIG. 19 is a perspective view of the human foot of FIG. 18, showing the compressor block removed;

FIG. 20 is a perspective view of the human foot of FIG. 19, showing placement of the bone plate of FIG. 6A across the resected first tarsometatarsal joint;

FIG. 21 is a perspective view of the human foot of FIG. 20, showing the cross pin of FIG. 17 removed;

FIG. 22 is a perspective view of the human foot of FIG. 21 showing placement of the cross screw drill guide within the cross screw aperture of the bone plate;

FIG. 23 is a perspective view of the human foot of FIG. 22, showing the completed state of the Lapidus bunion excision shown in FIGS. 8-23;

FIG. 24 is a perspective view of the human foot of FIG. 22, showing an enlarged portion of the foot, with the first metatarsal being transparent to illustrate the internal placement of the screw;

FIG. 25 is a perspective view of the bones of a human foot showing steps of an exemplary Lapidus bunion excision procedure performed using the exemplary bunion excision device described herein, showing the cutting guide of FIG. 2H secured to the foot using metatarsal pins;

FIG. 26 is a perspective view of the foot of FIG. 25 showing the insertion of a saw blade through the slot of the cutting guide to cut the base of the first metatarsal;

FIG. 27 is a perspective view of the foot of FIG. 26, showing the saw blade and cutting guide removed;

FIG. 28 is a perspective view of the foot of FIG. 27 showing the cutting guide secured to the foot in a different position such that the same slot is aligned to cut the first wedge bone;

Fig. 29 is a perspective view of the foot of fig. 28, showing the insertion of a saw blade through the slot of the cutting guide 180 to cut the base of the first wedge bone, and further showing the linear taper attached to the foot and the control handle attached to the cutting guide;

FIG. 30A is a perspective view of an exemplary cutting guide configured as a re-cutting guide and a pin guide for use in a Lapidus bunion excision procedure described herein;

FIG. 30B is another perspective view of the re-cutting guide and pin guide of FIG. 30A;

FIG. 30C is a top plan view of the re-cutting guide and pin guide of FIG. 30A;

FIG. 31A is a perspective view of an exemplary realignment guide configured as a pin guide for frontal plane adjustment in a Lapidus bunion resection procedure described herein;

FIG. 31B is another perspective view of the realignment guide of FIG. 31A;

FIG. 31C is a cross-sectional elevation view of the realignment guide of FIG. 31B taken along line 31C-31C;

FIG. 32A is a perspective view of an exemplary realignment guide configured as a pin guide for frontal plane adjustment in a Lapidus bunion resection procedure described herein;

FIG. 32B is another perspective view of the realignment guide of FIG. 32A;

FIG. 32C is a top plan view of the realignment guide of FIG. 32A;

FIG. 33 is a perspective view of a bone of a human foot constructed similar to the construction of FIG. 15, showing steps of a re-cut portion of an exemplary Lapidus bunion excision procedure performed using an exemplary bunion excision device described herein, with metatarsal pins and/or wedge-shaped bone pins remaining in the foot;

FIG. 34 is a perspective view of the human foot of FIG. 33, showing the cutting guide of FIG. 30A placed over the metatarsal pins;

FIG. 35 is a perspective view of the human foot of FIG. 34 showing the insertion of the blade 836 through the slot of the cutting guide;

FIG. 36 is a perspective view of the bone of a human foot showing the steps of using the frontal plane realignment portion of the exemplary Lapidus bunion resection procedure of the exemplary bunion resection device described herein, wherein the foot is in the configuration shown in FIG. 15 or FIG. 33 and the realignment guide of FIG. 32A is installed;

FIG. 37 is a perspective view of the human foot of FIG. 36 with the realignment guide removed;

FIG. 38 is a perspective view of the human foot of FIG. 37 with the realignment guide replaced over the metatarsal pin and the wedge pin, with the metatarsal pin and the wedge pin inserted through a second pair of proximal pin holes of the realignment guide;

FIG. 39 is a perspective view of the bone of a human foot showing the steps of a frontal plane realignment portion of an exemplary Lapidus bunion excision procedure using the exemplary bunion excision device described herein, with the realignment guide of FIG. 31A mounted over the metatarsal pins;

FIG. 40 is a perspective view of the human foot of FIG. 39 with a first alternative metatarsal pin partially inserted into the first metatarsal through one of a pair of pin holes of the realignment guide;

FIG. 41 is a perspective view of the human foot of FIG. 40 with the proximal metatarsal pin removed from the first metatarsal;

FIG. 42 is a perspective view of the human foot of FIG. 41 with the first replacement metatarsal pin further inserted through the pin hole and the first metatarsal to a fully inserted position;

FIG. 43 is a perspective view of the human foot of FIG. 42, showing steps of an alternative procedure for the remaining metatarsal pins, wherein a second alternative metatarsal pin is partially inserted through the other of the pair of pin holes of the realignment guide;

FIG. 44 is a perspective view of the human foot of FIG. 43 with the remaining metatarsal pins removed;

FIG. 45 is a perspective view of the human foot of FIG. 44 with a second replacement metatarsal pin further inserted through the realignment guide;

FIG. 46 is a perspective view of the human foot of FIG. 45, showing the realignment guide removed from the foot;

FIG. 47 is a perspective view of the human foot of FIG. 46, with the first metatarsal rotated relative to the first wedge in the frontal plane;

FIG. 48 is a perspective view of the human foot of FIG. 47 with the compressor block mounted over the wedge pin and the replacement metatarsal pin;

FIG. 49A is a perspective view of another example of a cutting guide configured for use with the articulating fusion procedures described herein and a fixation guide;

FIG. 49B is another perspective view of the cutting guide of FIG. 49A;

FIG. 49C is a top plan view of the cutting guide of FIG. 49A;

FIG. 49D is a cross-sectional elevation view of the cutting guide of FIG. 49C taken along line 49D-49D;

FIG. 50A is a perspective view of another example of a cutting guide configured for use with the articulating fusion procedures described herein and a fixation guide;

FIG. 50B is a top plan view of the cutting guide of FIG. 50A;

FIG. 50C is a side elevational view of the cutting guide of FIG. 50A;

FIG. 50D is an end elevation view of the cutting guide of FIG. 50A;

FIG. 51A is a perspective view of another example of a compressor block configured for use in an arthrodesis procedure described herein;

FIG. 51B is another perspective view of the compressor block of FIG. 51A;

FIG. 51C is a top plan view of the compressor block of FIG. 51A;

FIG. 51D is a cross-sectional elevation view of the compressor block of FIG. 51C taken along line 51D-51D;

FIG. 51E is a cross-sectional elevation view of the compressor block of FIG. 51C taken along line 51E-51E;

FIG. 52A is a top plan view of another example of a compressor block configured for use in the arthrodesis procedure described herein;

FIG. 52B is a bottom plan view of the compressor block of FIG. 52A;

FIG. 52C is an end elevation view of the compressor block of FIG. 52A;

FIG. 52D is a perspective view of the compressor block of FIG. 52A;

FIG. 53A is a perspective view of a spacer configured for use between joints in the joint fusion procedure described herein;

FIG. 53B is a top plan view of the spacer of FIG. 53A;

FIG. 53C is a side elevational view of the spacer of FIG. 53A;

FIG. 54 is a perspective view of the bones of a human foot, showing steps of an exemplary fusion procedure of a tarsometatarsal (TMT) joint performed using the exemplary joint fusion device described herein, wherein the cutting guide of FIG. 49A is placed against first and second bones of a foot-defining joint;

FIG. 55 is a perspective view of the human foot of FIG. 54 showing the first and second temporary bone fixation elements inserted into the holes of the first portion of the cutting guide and into the first bone to temporarily fix the cutting guide to the foot, and further showing the saw blade positioned in the cutting slot of the cutting guide to cut the base of the first bone;

FIG. 56 is a perspective view of the human foot of FIG. 55, showing the cutting guide removed and repositioned in a second orientation with the first portion aligned with the second bone and the second portion aligned with the first bone, and further showing the temporary bone fixation element temporarily securing the second portion to the first bone;

FIG. 57 is a perspective view of the human foot of FIG. 56 showing the temporary bone fixation element extending through the first portion and into the second bone, and the saw blade in the cutting slot so as to cut the distal portion of the second bone;

FIG. 58 is a perspective view of the human foot of FIG. 57, showing the saw blade and cutting guide removed, with the temporary bone fixation element remaining inserted into the first and second bones, respectively;

FIG. 59 is a perspective view of the human foot of FIG. 58 showing the compressor block of FIG. 51 applied over a temporary bone fixation element, and the angled temporary fixation member inserted through the angled aperture of the compressor block through the compressed joint to temporarily fix the joint in place;

FIG. 60 is a perspective view of the human foot of FIG. 59, showing the compressor block removed and the drill guide placed across the resected joint;

FIG. 61 is a perspective view of the human foot of FIG. 60 showing the pilot hole drilled through the drill guide, and showing the drill guide and temporary bone fixation element removed;

FIG. 62 is a perspective view of the human foot of FIG. 59 showing the compressor block removed and the reamer over one of the temporary bone fixation elements to create a pilot hole in accordance with an alternative embodiment;

FIG. 63 is a perspective view of the human foot of FIG. 62 showing a reamer placed over another one of the temporary bone fixation elements to create another pilot hole according to an alternative embodiment;

FIG. 64 is a perspective view of the human foot of FIG. 61 or FIG. 63 showing the applicator driving staples into the guide holes;

FIG. 65 is a perspective view of the human foot of FIG. 64, showing the release of staples from the applicator;

FIG. 66 is a perspective view of the bones of a human foot showing steps of a portion of an exemplary fusion procedure of a TMT joint performed using the exemplary joint fusion device described herein, showing the joint between a first bone and a second bone having been cut, and further showing first and second temporary bone fixation elements positioned in the first and second bones, respectively;

FIG. 67 is a perspective view of the human foot of FIG. 66 showing a bone plate placed over the temporary bone fixation element across the joint so as to cover respective portions of the first and second bones;

FIG. 68 is a perspective view of the human foot of FIG. 67 showing the insertion of a bone fastener through the bone plate and driven into one of the first and second bones;

FIG. 69 is a perspective view of the human foot of FIG. 68 showing the compressor block of FIG. 52A applied over the temporary bone fixation element toward the bone plate to move the first and second bones and closer together;

FIG. 70 is a perspective view of the human foot of FIG. 69 showing the second bone screw 2022 driven into the other of the first and second bones with respect to FIG. 68;

FIG. 71 is a perspective view of the human foot of FIG. 70, showing the compression block and temporary bone fixation elements removed;

FIG. 72 is a perspective view of the human foot of FIG. 71 showing the insertion of a nail through the nail hole of the bone plate;

FIG. 73A is a perspective view of an exemplary bone plate configured for use in the arthrodesis procedure described herein;

FIG. 73B is another perspective view of the bone plate of FIG. 73A;

FIG. 73C is a top plan view of the bone plate of FIG. 73A;

FIG. 73D is a bottom plan view of the bone plate of FIG. 73A;

FIG. 73E is a side elevational view of the bone plate of FIG. 73A;

FIG. 73F is an opposite side elevational view of the bone plate of FIG. 73A;

FIG. 73G is a distal end elevational view of the bone plate of FIG. 73A;

FIG. 73H is a proximal end elevational view of the bone plate of FIG. 73A; and is also provided with

Fig. 74 is a perspective view of the bones of the foot, illustrating the application of the exemplary bone plate of fig. 73A-73H.

Detailed Description

The following description relates to certain implementations for the purpose of describing innovative aspects of the present disclosure. However, one of ordinary skill in the art will readily recognize that the teachings herein could be applied in a variety of different ways.

Generally described, the systems, devices, and methods described herein provide improved methods and tools that may be used to perform Lapidus bunion resections with a desired accuracy. Some or all of the tools and/or components described herein may be provided in a kit, and may include a plurality of optional and/or interchangeable components that may be selected, positioned, secured, and/or used in a bunion excision procedure. Accordingly, the systems, devices, and methods described herein may allow a surgeon to perform a bunion resection or otherwise correct alignment of two or more misaligned bones or bone segments more effectively, efficiently, and/or precisely than is possible with conventional devices and procedures.

The embodiments described herein may be made of many different materials or combinations of materials. Nitinol, stainless steel, titanium, and/or other materials may have desirable material properties for certain components described herein. Stainless steel and/or titanium may not have shape memory or superelasticity, but may have mechanical properties for embodiments that may benefit from mechanical manipulation to achieve a variety of configurations. Still other materials, such as PEEK or other polymers, may also have material properties that are beneficial to the embodiments described herein. Combinations of materials may also be preferred. For example, a combination of nitinol and titanium (e.g., nitinol plate with titanium screws) may be the material of choice for some embodiments. Those skilled in the art are aware of typical materials and material combinations suitable for use in the present technology.

Fig. 1 is a perspective view of the bones of a foot 10 with bunions (also known as first metatarsal varus with associated thumb valgus). The foot 10 includes a first metatarsal 20 that is hinged at its proximal end to a first wedge 30 (also referred to as a medial wedge) at a first tarsometatarsal (TMT) joint 40. The distal end of the first metatarsal 20 is hinged with the phalanges 50 of the big toe. The inter-metatarsal angle is defined as the angle between the axis of one metatarsal relative to the second metatarsal in the anatomic transverse plane. Rotation is defined as axial rotation about the metatarsal axis in the plane of the anatomical face. The bunion as shown in fig. 1 is characterized by an increased angle and/or rotation of the first metatarsal 20 at the first TMT joint 40 such that the first metatarsal 20 extends away from the rest of the foot 10 or medially. When a bunion is present, the phalanges 50 of the big toe are generally angled inward or laterally toward the other phalanges 60, resulting in a characteristic bump at the metatarsophalangeal joint 70, which is the most prominent external indication of bunion. The raised metatarsophalangeal joint 70 may be further associated with a bladder or bone abnormality of the swollen bladder, which may cause discomfort, difficulty in putting on shoes, and other inconveniences to the person with bunions.

Referring to fig. 2A-7F, various devices and components are provided for a modified Lapidus bunion excision procedure for correcting the TMT joint deformity of fig. 1. Although the following description is made with reference to Lapidus bunion excision procedure, it is to be understood that the various devices and components described herein are not limited to such procedure and may be equally used in other orthopedic procedures as will be appreciated by those skilled in the art.

Fig. 2A-2D depict an exemplary cutting guide 100 configured as a cutting guide and a pin guide for the Lapidus bunion excision procedure described herein. Fig. 2A and 2B are upper and lower perspective views, respectively, of the cutting guide 100. Fig. 2C is a top plan view of the cutting guide 100. Fig. 2D is a side cross-sectional view of the cutting guide 100 taken along line 2D-2D in fig. 2C. The cutting guide 100 may be a single integrally formed component and may comprise metal, plastic, or other suitable material.

Cutting guide 100 generally includes a body 105, a proximal extension 110, a distal extension 115, and a paddle 120. The paddle 120 is sized and shaped to seat within a joint such as a TMT joint (e.g., between the first metatarsal and the first cuneiform bone), for example, after removal of soft tissue such as the joint capsule surrounding the joint. The relatively narrow and angled end portions of the paddle 120 may facilitate insertion of the paddle 120 into a joint. In some embodiments, the paddle 120 is integrally formed with the body 105.

The body 105 of the cutting guide 100 includes a distal slot 125 and a proximal slot 130. The distal slot 125 and the proximal slot 130 each pass through the entire thickness of the body 105 and are sized and shaped to act as positioning guides for a saw blade (or other cutting instrument, such as a drill) to facilitate accurate saw cuts on each side of the joint. For example, the distal slot 125 may be positioned at a predetermined distance relative to the distal plane of the paddle 120 to facilitate cutting the base of the first metatarsal when the paddle 120 is positioned within the first TMT joint. Similarly, the proximal slot 130 may be positioned on the opposite side (proximal plane) of the paddle to facilitate cutting of the first wedge bone. Distal slot 125 and proximal slot 130 may be identically or similarly shaped (e.g., may have identical lengths and/or widths) such that metatarsal and cuneiform bone cuts may be performed using the same or the same type of saw blade. In some embodiments, the distal slot 125 and the proximal slot 130 may be parallel to each other and/or to the paddle 120, or may be angled relative to the plane of the paddle 120. In some embodiments, a relatively wide tip segment 127 may be provided at the ends of the slots 125, 130 for placement of additional guide wires during cutting to prevent the blade from making too wide a cut when using the cutting guide 100.

The proximal pin hole 112 extends through the entire thickness of the cutting guide 100. One or both of the proximal pin holes 112 may be provided on the proximal extension 110 or within the body 105. Proximal pin bores 112 may each have a generally circular profile sized to receive a surgical pin or guide wire for temporarily securing the cutting guide to the foot. The proximal pin hole 112 serves as a guide so that two proximal pins or wires can be inserted at a predetermined spacing relative to each other and to the plane along which the first wedge bone is cut by the saw blade through the proximal slot 130. It should be understood that pins or wires are examples of temporary bone fixation elements as described herein. The proximal pin holes 112 extend in the vertical direction parallel to each other as shown in fig. 2D.

Distal pin hole 117 extends through the entire thickness of distal extension 115. Similar to the proximal pin holes 112, the distal pin holes 117 may each have a generally circular profile that is sized to receive a surgical pin or wire for temporarily securing the cutting guide to the foot, and may have the same diameter as the proximal pin holes 112. The distal pin hole 117 serves as a guide so that two distal pins or wires can be inserted at a predetermined spacing relative to each other and to the plane along which the first metatarsal is cut by the saw blade through the distal slot 125. The distal pin holes 117 extend in a vertical direction parallel to each other and to the proximal pin holes 112, as shown in fig. 2D. The plane intersecting the axis of the proximal pin bore 112 may be coplanar with the plane intersecting the axis of the distal pin bore 117. The combination of pin holes forms a linear array of holes spanning the TMT joint. The bottom or bone-facing surface of distal extension 115 may not be coplanar with the bottom or bone-facing surface of body 105 and/or proximal extension 110, which may allow cutting guide 100 to be placed closer to the bone while leaving room for the bony anatomy of the proximal metatarsal and medial cuneiform bones. Additional details are provided in U.S. patent No. 10,292,713, which is incorporated by reference herein.

In some embodiments, the body 105 of the cutting guide 100 further includes one or more additional openings, such as additional converging pin holes 107 and/or longitudinal apertures 109. If additional stability is desired during a bunion resection procedure, one or more additional pins or wires may be inserted using the converging pin holes 107. Longitudinal aperture 109 extends transverse to slots 125, 130 and may provide an opening to facilitate x-ray visualization and/or any other suitable surgical imaging procedure to confirm and/or monitor alignment of the cutting guide during a bunion resection procedure.

Fig. 2E-2G depict an exemplary freehand pin guide 150 that includes an array of pin holes spanning the TMT joint for directional pin insertion without the cutting guide 100 of fig. 2A-2D. In some bunion resection procedures, for example, if the cutting guide 100 is fitted inside a joint, the cutting guide 100 may not be used due to the preference of the surgeon, or for any other reason that causes a freehand joint to be cut instead of using the cutting guide 100. The freehand pin guide 150 generally includes a body 155 and a paddle 160. The proximal pin hole 165 and the distal pin hole 170 extend through the entire thickness of the body 155. The proximal pin holes 165 may have the same relative spacing as the proximal pin holes 112 of the cutting guide 100. Similarly, the distal pin hole 170 may have the same relative spacing as the distal pin hole 117 of the cutting guide 100. A handle attachment aperture 175, which may be threaded, is provided for attaching a side-mounted handle that may assist a user in placing the freehand pin guide 150. Similar to the proximal pin hole 112 and the distal pin hole 117 of the cutting guide 100, the proximal pin hole 165 and the distal pin hole 170 of the bare-handed pin guide 150 extend in parallel with each other in the vertical direction. However, the spacing of the proximal pin hole 165 and distal pin hole 170 of the freehand pin guide 150 from the paddle 160 is slightly less than the spacing of the proximal and distal pin holes 112, 117 of the cutting guide 100 relative to the paddle 120 to compensate for the freehand pin guide 150 that is applied after the cut has been made. Thus, as the cutting guide 100 has been used to perform a cut, the freehand pin guide 150 allows placement of a pin or wire after a freehand cut having the same spacing relative to the first TMT joint.

Fig. 2H-2K depict an exemplary reversible cutting guide 180 configured as a cutting guide and a pin guide for the Lapidus bunion excision procedure described herein. Fig. 2H and 2I are upper and lower perspective views, respectively, of the cutting guide 180. Fig. 2J is a top plan view of the cutting guide 180. Fig. 2K is a side cross-sectional view of the cutting guide 180 taken along line 2K-2K in fig. 2J. The cutting guide 180 may be a single integrally formed component and may comprise metal, plastic, or other suitable material. The cutting guide 180 is similar to the cutting guide 100 of fig. 2A-2D, but may be reversible and configured with a single slot 182 instead of the proximal slot 125 and the distal slot 130 of fig. 2A-2D.

The cutting guide 180 generally includes a body 105, a first extension 184, a second extension 188, and a paddle 120. The paddle 120 is sized and shaped to seat within a joint such as a TMT joint (e.g., between the first metatarsal and the first cuneiform bone), for example, after removal of soft tissue such as the joint capsule surrounding the joint. The relatively narrow and angled end portions of the paddle 120 may facilitate insertion of the paddle 120 into a joint. In some embodiments, the paddle 120 is integrally formed with the body 105.

The body 105 of the cutting guide 180 includes a single cutting slot 182. The slot 182 extends through the entire thickness of the body 105 and is sized and shaped to act as a positioning guide for a saw blade or other type of cutting instrument to facilitate accurate saw cuts on each side of the joint. For example, when the paddle 120 is positioned within a first TMT joint, the slot 182 may be positioned at a predetermined distance relative to the plane of the adjacent surface of the paddle 120 to facilitate cutting the base of the first metatarsal or first cuneiform bone, depending on the orientation of the cutting guide 180. In some embodiments, the slot 182 may be parallel to the paddle 120 or may be angled relative to the plane of the paddle 120. In some embodiments, a relatively wide tip segment 127 may be provided at the end of the slot 182 for placement of additional guide wires during cutting to prevent the blade from making too wide a cut when using the cutting guide 180.

The first pin hole 186 extends through the entire thickness of the cutting guide 180. One or both of the first pin bores 186 may be provided on the first extension 184 or within the body 105. The first pin holes 186 may each have a generally circular profile sized to receive a surgical pin or guide wire for temporarily securing the cutting guide to the foot. The first pin bore 186 serves as a guide so that two pins or wires may be inserted at a predetermined spacing relative to each other and relative to the second pin bore 190. The first pin holes 186 extend in the vertical direction in parallel with each other as shown in fig. 2K.

The second pin hole 190 extends through the entire thickness of the cutting guide 180. Similar to the first pin bore 186, the second pin bores 190 may each have a generally circular profile sized to receive a surgical pin or wire for temporarily securing the cutting guide 180 to the foot, and may have the same diameter as the first pin bore 186. The second pin hole 190 serves as a guide so that two distal pins or wires can be inserted relative to each other and to the plane along which the first metatarsal or first wedge is cut by the saw blade through the slot 182 at a predetermined spacing. The second pin holes 190 extend in a vertical direction parallel to each other and to the first pin holes 186, as shown in fig. 2K. The plane intersecting the axis of the first pin bore 186 may be coplanar with the plane intersecting the axis of the second pin bore 190. The combination of pin holes forms a linear array of holes spanning the TMT joint. The bottom or bone-facing surface of the second extension 188 may be coplanar or substantially coplanar with the bottom or bone-facing surface of the body 105 and/or the first extension 184, which may allow the cutting guide 180 to be placed across the TMT joint in either of two opposite orientations with the paddle 120 seated within the joint.

In some embodiments, the body 105 of the cutting guide 180 further includes one or more additional openings, such as additional converging pin holes 107 and/or longitudinal apertures 109. If additional stability is desired during a bunion resection procedure, one or more additional pins or wires may be inserted using the converging pin holes 107. Longitudinal aperture 109 extends transverse to slot 182 and may provide an opening to facilitate x-ray visualization and/or any other suitable surgical imaging procedure to confirm and/or monitor alignment of the cutting guide during a bunion resection procedure.

Fig. 2L-2N depict another exemplary reversible cutting guide 181 configured as a cutting guide and a pin guide for the Lapidus bunion excision procedure described herein. Fig. 2L and 2M are upper and lower perspective views, respectively, of the cutting guide 181. Fig. 2N is a top plan view of the cutting guide 181. The cutting guide 181 may be a single integrally formed component and may comprise metal, plastic, or other suitable material. The cutting guide 181 is similar to the cutting guide 180 of fig. 2H-2K, including a reversible configuration with a single slot 182.

The cutting guide 181 generally includes a body 105, a first extension 184, a second extension 188, and a paddle 120. The first and second extensions 184, 188 may include first and second pin bores 186, 190 as described above with reference to fig. 2H-2K. The paddle 120 is sized and shaped to seat within a joint such as a TMT joint (e.g., between the first metatarsal and the first cuneiform bone), for example, after removal of soft tissue such as the joint capsule surrounding the joint. The relatively narrow and angled end portions of the paddle 120 may facilitate insertion of the paddle 120 into a joint. In some embodiments, the paddle 120 is integrally formed with the body 105.

In the exemplary embodiment of fig. 2L-2N, the body 105 of the cutting guide 181 also includes one or more additional openings, such as additional converging pin holes 183, extending through the second extension 188. If additional stability is desired during a bunion resection procedure, one or more additional pins or leads may be inserted using the converging pin holes 183. Similar to the cutting guide 180 of fig. 2H-2K, the longitudinal aperture 109 extends transverse to the slot 182 and may provide an opening to facilitate x-ray visualization and/or any other suitable surgical imaging procedure to confirm and/or monitor alignment of the cutting guide during a bunion resection procedure.

Fig. 3A-3H depict an exemplary linear taper 200 configured for use in the Lapidus bunion excision procedure described herein. Referring to fig. 3A to 3C, the linear taper 200 includes an inner hook 205, a threaded shaft 210, an outer hook 215, and a handle 220. As will be described in greater detail with reference to fig. 10-14, the linear taper 200 is adapted to apply a correction in the transverse plane during the Lapidus bunion resection procedure by moving the first and second metatarsals closer together, thereby reducing the inter-metatarsal angle, and to maintain the desired correction in the frontal plane when the pin is placed within the medial hook pin hole 209.

The inboard hook 205 includes a coupling aperture 206 sized and shaped to couple to a first end 212 of the threaded shaft 210. In some embodiments, the inner hook 205 may be fixedly coupled to the threaded shaft 210 such that the inner hook 205 is neither rotatable nor translatable relative to the threaded shaft 210. Medial hook 205 includes a curved engagement surface 207 configured to abut the medial side of the foot. One or more medial hook pin holes 209 extend from the engagement surface 207 through the entire thickness of the medial hook 205 so that a pin may be placed through the medial hook 205 to temporarily secure the medial hook 205 to the toe.

The outboard hook 215 includes a coupling aperture 216 that is sized and shaped to receive the threaded shaft 210 therethrough. The outer hook 215 may have a smooth inner surface with a diameter at least as large as the full diameter of the threaded shaft 210 such that the outer hook 215 may translate along the threaded shaft 210 without rotation. Other features of the coupling aperture may include a non-cylindrical profile such that when the outer hook 215 is assembled to the threaded shaft 210, the non-cylindrical profile prevents the outer hook 215 from rotating about the axis of the threaded shaft 210. The lateral hook 215 includes a curved engagement surface 217 configured to rest against the lateral side of a bone, such as the second metatarsal. In some embodiments, the engagement surface 217 may be inserted through a cutout, for example, between the second toe and the third toe, such that the engagement surface 217 may be placed against the lateral side of the foot for lateral plane correction. For example, the engagement surface 217 may be placed against the lateral side of the second metatarsal or any other lateral side of the foot.

In various embodiments, the components of the linear taper 200 may comprise various materials. For example, the handle 220, threaded shaft 210, inner hook 205, and/or outer hook 205 may comprise a metal, plastic, or polymeric material, or the like. In some embodiments, the medial hook 205 and/or the lateral hook 215 may comprise a radiolucent material. Advantageously, the radiolucent material may be at least partially transmissive to x-rays or other radiation associated with medical imaging to facilitate imaging of foot bones while applying linear taper 200. Exemplary radiolucent materials suitable for medial hook 205 and/or lateral hook 215 include carbon fibers, polymeric materials, and/or composite materials, such as carbon fiber reinforced polymers.

The handle 220 includes one or more gripping features 222, such as knurling, to facilitate grasping by a user while rotating the handle 220. Threaded aperture 224 extends longitudinally through handle 220. The internal threads of threaded bore 224 are sized and spaced to engage the external threads of threaded shaft 210. In some embodiments, only a portion of the threaded aperture 224 is threaded, e.g., wherein any remaining length is drilled to a larger diameter to allow the threaded shaft 210 to pass completely through. Thus, the internal threads of threaded aperture 224 allow handle 220 to translate along threaded shaft 210 to a desired position by rotating handle 220 about threaded shaft 210. Thus, when a user wishes to reduce the spacing between the inner and outer hooks 205, 215, the user twists the handle 220 clockwise about the threaded shaft 210 such that the handle 220 pushes the outer hook 215 along the threaded shaft 210 toward the inner hook 205. Friction between the internal threads of threaded aperture 224 and the external threads of threaded shaft 210 prevents outer hook 215 and handle 220 from being pushed outward away from inner hook 205 unless handle 220 is twisted.

Fig. 3D shows an alternative embodiment of the outboard hook 215. In the alternative lateral hook 215 of fig. 3D, the engagement surface 217 includes one or more bone engagement features 218 configured to provide improved grip on the lateral side of the second metatarsal during Lapidus bunion resection. In some cases, the bone engagement feature 218 may reduce the probability that the lateral hook 215 slides upward away from the second metatarsal during or after the decrease in the inter-metatarsal angle in the lateral plane.

Fig. 3E-3G illustrate quick release features that may be incorporated at the inside hooks of the linear taper 200. In the quick release embodiment of the linear taper 200, the fixedly coupled inner side hooks 205 of fig. 3A-3C are replaced with quick release inner side hooks 235. Quick release inner hook 235 includes an aperture 236 that is large enough to slidably receive threaded shaft 210. The quick release insert 237 may be inserted into the upper portion of the quick release inside hook 235. The quick release insert 237 has a coupling aperture 239 that includes a locking portion 238 that is configured to interlock with the recess 214 near the first end 212 of the threaded shaft 210. Thus, when the quick release insert 237 is in the raised position shown in fig. 3E, the locking portion 238 engages within the recess 214 to fixedly couple the quick release inboard hook 235 to the threaded shaft.

When it is desired to remove the linear taper 200 from the foot, the quick release insert 237 is pushed downward in direction 240. As the quick release insert 237 moves downward, the locking portion 238 disengages from the notch 214 in the threaded shaft 210 such that the entire quick release inner hook can slide in the longitudinal direction 242 relative to the threaded shaft 210. For example, with quick release medial hook 235 secured to bone, threaded shaft 210 may be removed through coupling aperture 216 of lateral hook 215, and lateral hook 215 may be removed substantially vertically from the foot. The medial hook 205 may then be released and easily removed from the foot.

Referring now to fig. 3H, in some embodiments, a shouldered pin 260 may be used in conjunction with the linear taper 200. While any type of pin may be used, the shouldered pin 260 may advantageously prevent damage to the skin on the inside of the foot when the linear taper 200 is used. The shouldered pin 260 includes a tip 262 into the foot and a shoulder 264 extending radially outward from the sides of the shouldered pin 260. The shoulder 264 is preferably larger than the medial hook pin hole 209 such that the shoulder 264 prevents the shouldered pin 260 from sliding outward through the medial hook pin hole 209. Thus, when the shouldered pin 260 is inserted into the medial side of the first metatarsal and the linear taper 200 is manipulated to reduce the inter-metatarsal angle of the foot, the lateral force exerted by the medial hook 205 is transferred to the first metatarsal via the shoulder 264, rather than through the skin along the engagement surface 207, thereby reducing the likelihood of compression and/or damage to the skin of the foot. In some embodiments, the shouldered pin 260 may be used in conjunction with the quick release inside hook 235 depicted in fig. 3E-3G.

Fig. 4A and 4B depict an exemplary control handle 300 configured for use in the Lapidus bunion excision procedure described herein. As will be described in greater detail with reference to fig. 11-14, the linear taper 200 is adapted to apply a correction in the frontal plane or other plane during a Lapidus bunion resection procedure by rotating the first metatarsal relative to the first wedge bone. Control handle 300 is only one example of a handle that may be attached to cutting guide 100. Those skilled in the art will appreciate that various attachments may be made between the control handle and the cutting guide 100 without departing from the scope of the present technique.

The control handle 300 includes a handle 305 and an engagement portion 310 connected to the handle. The apertures 312 in the engagement portion 310 and/or the pin guides 314 disposed in the apertures 312 are spaced apart to receive pins placed in the first metatarsal according to the spacing of the distal pin holes 117 or 170 of the cutting guide 100 or freehand pin guide 150. The spacing of the apertures 312 also corresponds to the spacing of the proximal pin bores 112 or 165. The space 316 within the pin guide 314 is suitably large to receive a surgical pin or guide wire.

Fig. 5A-5D depict an exemplary compressor block 400 configured for use in the Lapidus bunion excision procedure described herein. As will be appreciated from the following description, compressor block 400 may be configured for a combination of realignment and compression of the first and second bones, and thus may be referred to as a "realignment and compression block" (e.g., an RAC block). Fig. 5A and 5B are upper and lower perspective views, respectively, of the compressor block 400. Fig. 5C is a top plan view of compressor block 400. Fig. 5D is a side cross-sectional view of compressor block 400 taken along line 5D-5D in fig. 5C. As will be described in greater detail, with reference to fig. 16-18, the compression block 400 is configured to help compress and secure the resected joint that has been cut or severed freehand using the cutting guide 100.

The compressor block 400 includes a body 405 having a proximal pin bore 410 and a distal pin bore 415 extending therethrough. The proximal pin bores 410 are spaced relative to one another by the same spacing as the proximal pin bores 112, 165 of the cutting guide 100 and the freehand pin guide 150. Similarly, the distal pin holes 415 are spaced apart relative to one another by the same spacing as the distal pin holes 117, 170 of the cutting guide 100 and the freehand pin guide 150. However, the proximal pin hole 410 and the distal pin hole 415 are each positioned closer to the center of the compressor block 400 than the proximal pin holes 112, 165 and the distal pin holes 117, 170 of the cutting guide 100 and the freehand pin guide 150. In addition, as shown in the cross-sectional view of fig. 5D, the proximal pin hole 410 and the distal pin hole 415 are not parallel and are disposed at a converging angle such that they are relatively closer together at the bottom edge 407 of the compressor block 400. Thus, as the compressor block 400 slides down over the pins, the parallel pins threaded into the proximal and distal ports 410, 415 are compressed closer together, as shown in fig. 15-16. A handle attachment aperture 425, which may be threaded, is provided for attaching a side-mounted handle, which may assist a user in sliding the compressor block 400 downward to compress a pin or wire passing through the compressor block 400.

The compressor block 400 also includes a widened section 409 that includes a cross pin hole 420. As shown in fig. 5A and 5B, each cross pin hole 420 extends downwardly and inwardly from the outer edge of the widened section 409 such that a pin or wire inserted into the cross pin hole 420 is spaced relatively closer to the centerline of the compressor block 400 from the bottom edge 407 of the compressor block 400. As shown in fig. 16-18, the cross pin holes 420 are aligned such that when the compressor block 400 is used in conjunction with the cutting guide 100 or freehand pin guide 150 at the first TMT joint, the compressor block 400 brings the cut faces of the resected first TMT joint into contact with each other and a pin inserted through either cross pin hole 420 will extend at an angle through the interface of the compressed joint to temporarily maintain contact at the articular faces until the first cuneiform bone or first metatarsal bone can be secured by a plate or other securing member.

Fig. 6A-6G depict an exemplary bone plate 500 and cross screw 530 configured for use in the Lapidus bunion resection procedure described herein. Bone plate 500 and/or cross screw 530 may be formed from various metals or alloys. For example, the bone plate may be formed of titanium, shape memory alloys (such as nitinol), and the like.

Bone plate 500 is sized and shaped to be applied across the resected first TMT joint. Accordingly, bone plate 500 includes a body 505 that includes a nail aperture 510, a wedge bone screw aperture 515, a metatarsal screw aperture 520, and a cross screw aperture 525. The nail aperture 510 includes two holes 512 sized and shaped to receive two legs of a bone nail such that one of the legs seats within a first wedge bone adjacent the wedge bone screw aperture 515 and the other leg seats within a first metatarsal adjacent the metatarsal screw aperture 520 and the cross screw aperture 525.

Each of the staple apertures 510 and screw apertures 515, 520, 525 are shaped to include countersunk holes to reduce movement of the staples and/or screws seated therein. In addition, the countersink may allow the nail or screw applied therein to not extend significantly above the outer surface of the body 505 of the bone plate 500. Because of the angle at which the cross screw must be applied in the cross screw aperture 525, the cross screw aperture 525 has an oval shape (e.g., corresponding to a cylindrical profile along the screw path through the cross screw aperture 525) when viewed perpendicular to the bone plate 500, and includes a shelf 527 that occupies about half of the perimeter of the cross screw aperture 525. The shelf 527 is shaped to engage the head of the cross screw when inserted at a pre-drilled angle such that the cross screw securely engages the bone plate 500 and seats within the countersink.

Fig. 6D is an expanded partial view of bone plate 500, showing cross screw aperture 525 and shelf 527 in detail. Fig. 6E shows an exemplary cross screw 530 configured to seat within cross screw aperture 525, including a head 532 and a threaded shaft 534. As shown in fig. 6D, taken perpendicular to the axis of the cross screw path, the shelf 527 may be inclined or tapered such that the inner edge of the shelf 527 is higher relative to the outer edge of the shelf 527 intersecting the inner wall of the cross screw aperture 525. As shown in fig. 6E, the head 532 of the cross screw 530 has an undercut shelf 537. In this embodiment, the shelf 537 tapers downwardly as the diameter increases. Thus, as shown in fig. 6F and 6G, when the cross screw 530 is inserted through the cross screw aperture 525, the undercut shelf 537 of the head 532 of the cross screw 530 engages the upwardly tapered shelf 527 of the bone plate 500 such that the bone screw 530 is seated in the bone at a desired angle.

Fig. 7A-7F depict an exemplary cross screw drill guide configured for use in conjunction with bone plate 500 when a cross screw is applied through cross screw aperture 525. Fig. 7A-7C depict an exemplary fixed angle cross screw drill guide 600. Fig. 7D-7F depict an exemplary variable angle cross screw drill guide 650 that allows a surgeon to select an angle within a range of angles for insertion of a cross screw.

The fixed angle cross screw drill guide 600 includes a body 605 and a tip 615. The longitudinal bore 610 extends through the entire length of the body 605. The diameter of the longitudinal bore 610 may be selected such that a drill bit sized appropriately to drill a pilot hole for a cross screw may fit through the longitudinal bore 610. In some embodiments, the diameter of the longitudinal bore 610 may be selected such that a k-wire or other guiding structure may fit through the longitudinal bore 610 such that the guide may be removed and a tubular drill bit may be used to drill the pilot hole. Tip 615 includes a shelf-engaging surface 627 and a toe 629. Toe portion 629 and shelf engagement surface 627 are shaped such that toe portion 629 may seat within cross screw aperture 525 with shelf engagement surface 627 seated against shelf 527 of cross screw aperture 525. The oval shape of the cross screw aperture 525 defines a single stable orientation for seating the tip 615 of the fixed angle cross screw drill guide 600 therein. The fixed angle cross screw drill guide 600 facilitates consistent and reproducible application of cross screws at a predetermined suitable angle to prevent recurrence of bunions. In addition, the fixed angle cross screw drill guide 600 may force the drill bit into the bone at a location concentric with the radius of curvature of the shelf 527 of the bone plate 500 (e.g., because the screw is still able to pass through the bone plate 500 even if the hole is drilled incorrectly). In addition, the angular cross screw drill guide 600 is fixed to prevent the cross screw from interfering with the staple legs, prevent the cross screw from passing through the TMT joint, and angle the cross screw toward the base of the second metatarsal or second wedge.

The variable angle cross screw drill guide 650 similarly includes a body 655 and a tip 665, and an aperture 660 extending through the body 655. The tip 665 has the same shape as the tip 615 of the fixed angle cross screw drill guide 600, including a shelf engagement surface 677 and a toe 679, such that the oval shape of the cross screw aperture 525 similarly defines a single stable orientation for seating the tip 665 of the variable angle cross screw drill guide 650 therein. The variable angle cross screw drill guide 650 has a generally wedge-shaped body 655 surrounding a wedge-shaped slot 662 in communication with an aperture 660. Wedge slot 662 accommodates a range 652 of drilling angles through aperture 660. Thus, while the oval shape of the cross screw aperture 525 defines a single seated orientation of the variable angle cross screw drill guide 650, the wedge slot 662 allows the surgeon to select various angles within a predetermined plane. The available drilling paths may range from a first extreme path perpendicular or nearly perpendicular to bone plate 500 to a second extreme path at a smaller angle relative to bone plate 500. Depending on the geometry of the skeletal structure of the individual foot, the variable angle cross screw drill guide 650 may allow the surgeon to select a cross screw trajectory, for example, into the second metatarsal or the second wedge as desired.

With reference to fig. 8-24, an exemplary Lapidus bunion resection using certain devices described herein will be described. While the procedure of fig. 8-24 shows a particular implementation of Lapidus bunion resections using a particular subset of the devices described herein, it should be appreciated that the components and steps shown and described with reference to fig. 8-24 may likewise be applied in a different order and/or in a different combination of components to correct bunions.

Fig. 8-24 depict the bones of the foot 10 initially having bunions. Similar to the foot 10 of fig. 1, the foot 10 includes a first metatarsal 20 that is angled and rotated relative to the first wedge 30 at the first TMT joint 40 such that the big toe has an undesirable medial concavity and an increased angle between the metatarsals. As shown in fig. 8, the procedure may begin by placing and temporarily securing the cutting guide 100 of fig. 2A-2D. Prior to placement of the cutting guide, the surgeon may prepare the first TMT joint 40 by making an incision (such as a dorsi-medial incision) to expose the first TMT joint 40 and resecting soft tissue surrounding the joint (such as a joint capsule or other soft tissue) to expose the first TMT joint 40 and create a space in which the paddles 120 (fig. 2A-2D) of the cutting guide 100 may be seated.

Once the joint is ready, the cutting guide 100 is placed by seating the paddle 120 (not visible in fig. 8) within the first TMT joint 40 such that the proximal extension 110 is disposed adjacent or against the first wedge 30 and the distal extension 115 is disposed adjacent or against the first metatarsal 20. The paddle 120 is inserted into the first TMT joint 40 such that the cutting guide 100 is oriented along the axis of the first metatarsal 20. The alignment of the cutting guide 100 may be confirmed under fluoroscopy or other suitable imaging techniques before proceeding.

When the cutting guide 100 has been placed and properly aligned, the cutting guide 100 is temporarily secured relative to the first metatarsal 20 by inserting two metatarsal pins 802 or wires through the distal pin holes 117 of the distal extension 115 and into or through the first metatarsal 20. The metatarsal pin 802 or lead, as well as any of the other pins or leads described in the following description, may be, for example, a Kirschner wire ("K-wire") or any other suitable type of wire or pin that may be placed in bone to secure the cutting guide 100.

Continuing to fig. 9, once the metatarsal pin 802 or lead is inserted, the base of the first metatarsal 20 is cut using a saw blade 804 inserted through the distal slot 125 of the cutting guide 100.

Referring to fig. 10, a linear taper 200 may be temporarily placed around the first and second metatarsals 20, 25. In some embodiments, a cut is made between the second toe and the third toe transverse to the second metatarsal 25 to accommodate insertion of the lateral hook 215 such that the engagement surface 217 contacts the lateral side of the second metatarsal 25. The engagement surface 207 of the medial hook 205 is placed against the medial side of the foot adjacent the first metatarsal 20 and the handle 220 of the linear taper 200 can be rotated clockwise relative to the threaded shaft 210 until the handle 220 contacts the lateral hook 215. The initial placement of the linear taper 200 may be a temporary placement without the need to initially insert any pins through the inside hooks 205.

Continuing to fig. 11, control handle 300 may be further placed by inserting metatarsal pins 802 through spaces 316 within pin guides 314 of control handle 300. Referring to fig. 12, the control handle 300 may then be rotated in the frontal plane to correct rotation about the axis of the first metatarsal 20. For example, when a clockwise rotation 806 is imparted to the control handle 300, torque applied to the control handle 300 is transferred via the metatarsal pin 802 such that the first metatarsal of the big toe and the phalanges 50 rotate 808 clockwise. In addition, any necessary adjustment of the joint in the sagittal plane may be manually applied at this time. In some embodiments, other corrections may also be applied using control handle 300, such as applying torque in the lateral plane to reduce the inter-metatarsal angle. When the frontal and sagittal planes have been properly corrected using the control handle 300, the surgeon may then proceed to adjust the position of the first metatarsal 20 in the transverse plane.

Referring collectively to fig. 12 and 13, a linear taper 200 may be used to correct the transverse plane. In some implementations, the medial hook pin 816 is inserted through one of the medial hook pin holes 209 and into or through the first metatarsal 20 to fix the rotational position of the first metatarsal 20 in the frontal plane (e.g., in the frontal plane correction previously applied using the control handle 300). The medial hook pin may be a shouldered pin such that lateral pressure applied by the medial hook 205 is applied directly to the first metatarsal 20 through the pin shoulder, rather than through the skin along the medial hook engagement surface 207.

The lateral plane correction may be applied by rotating the handle 220 of the linear taper 200 with or without the insertion of the medial hook pin 816. For example, a clockwise rotation 810 of the handle 220 reduces the distance along the threaded axis between the medial hook 205 and the lateral hook 215, thereby moving the medial hook 205 laterally with respect to the lateral hook 215 in a direction 812. Thus, the medial hook 205 applies a lateral force to the first metatarsal 20 in the lateral plane, resulting in a corresponding lateral movement 814 of the first metatarsal 20 in the lateral plane.

At this stage, misalignment of the first TMT joint 40 has been addressed. With continued reference to fig. 13, two wedge bone pins 818 or wires are inserted through the proximal pin holes 112 of the cutting guide and into or through the first wedge bone 30. The wedge pin 818 or wire temporarily secures the cutting guide 100 relative to the first wedge 30. At this point, the four pins 802 and 814 form an array that establishes and/or locks the surgeon's desired correction.

Continuing to fig. 14, once the wedge pin 818 or wire is inserted, the base of the first wedge 30 is cut using a saw blade 820 inserted through the proximal slot 130 of the cutting guide 100. Cutting the base of the first wedge 30 completes the resection of the first TMT joint 40. Referring to fig. 15, the cutting guide 100, the linear taper 200, and the control handle 300 are removed from the foot 10. The control handle 300 may be removed by sliding upward until the control handle is free of the metatarsal pins 802 or wires. The cutting guide 100 may be similarly removed by sliding the cutting guide 100 upward until it is free of metatarsal pins 802 or leads and cuneiform pins 818 or leads. The linear taper 200 is removed by removing the medial hook pin 816 and lifting the medial hook 205 and the lateral hook 215 away from the foot 10. In some embodiments, a quick release inside hook 235 may be used to facilitate removal of the linear taper. After removal of the cutting guide 100, linear taper 200 and control handle 300, a completely non-articulating first TMT joint remains with the metatarsal pin 802 or guide wire and the wedge pin 818 or guide wire held in place. At this point, the surgeon may further use any desired means to distract and further prepare the joint for fusion. It should be appreciated that the pins 802 in the metatarsal 20 and 818 in the wedge 30 may return to their initial orientations, which are the relative orientations of the misalignment between the metatarsal and the wedge.

Referring now to fig. 16, the compressor block 400 is applied over the metatarsal pins 802 or leads and the wedge pins 818 or leads. Preferably, the metatarsal pin 802 or wire is shorter or longer than the wedge pin 818 or wire (e.g., about the height of the compressor block 400 or greater, as shown in fig. 16). In the example of fig. 16, the compressor block 400 is applied by first threading the proximal pin bore 410 onto the relatively long wedge pin 818 or wire, and then threading the distal pin bore 415 onto the relatively short metatarsal pin 802 or wire. As described above with reference to fig. 5A-5D, unlike the pin holes of the cutting guide 100, the pin holes of the compressor block 400 are slightly closer together and taper inwardly, making it possible that it may be difficult to attempt to insert all four pins or wires through the compressor block 400 at the same time.

Sliding the compressor block 400 down over the wedge pin 818 or lead and the metatarsal pin 802 or lead will pull the metatarsal pin 802 or lead closer to the wedge pin 818 or lead due to the angle of convergence of the proximal pin hole 410 and the distal pin hole 415. Thus, application of the compressor block 400 moves the first metatarsal 20 in the direction 822 toward the first wedge 30, bringing the cutting surface of the first metatarsal 20 into contact with the cutting surface of the first wedge 30. The angled holes cause rotation of the pin in the sagittal plane, causing the plantar side of the joint to be compressed. This may be desirable because compression on only the dorsal aspect of the bone may in some cases cause plantar spacing of the joint, which is undesirable for fusion. Furthermore, application of the compressor block 400 aligns the pins 802 and 818 in a single plane corresponding to the plane of the cutting guide, which thus returns the alignment of the metatarsals and the wedge to the desired aligned position.

Continuing to fig. 17, a cross pin 824 is then inserted through one of the cross pin holes 420 such that the cross pin 824 passes through the compressed joint to temporarily secure the joint in place. As shown in fig. 18, the metatarsal pin 802 or guide wire and the wedge pin 818 or guide wire are removed. As shown in fig. 19, the compressor block 400 may then be removed by sliding the compressor block outward along the cross pin 824, which remains in place to fix the joint until the bone plate 500 can be applied. Any number of cross pin hole tracks may be applied to the compression block 400 to place the cross wires. Although cross pin 824 is shown as being inserted distally and extending proximally into the joint, in other embodiments, compression block 400 may have a cross pin hole 420 located proximally instead of, or in addition to, the distal side. In such embodiments, the cross pin 824 would be inserted from the proximal end of the compression block 400 and would extend distally through the joint.

Referring to fig. 20, the bone plate 500 is placed across the resected first TMT joint 40 when the joint is secured in place by the cross pin 824. The pilot holes are drilled as needed. To fix the first metatarsal 20 relative to the first wedge 30, a nail 826 is placed at the nail hole 510, a metatarsal screw 828 is placed at the metatarsal screw hole 520, and a wedge screw 830 is placed at the wedge screw hole 515. The pin 826, metatarsal screw 828 and wedge screw 830 may be placed in any order; however, it is preferable to place the peg 826 and metatarsal screw 828 prior to placement of the cross screw 834. As shown in fig. 21, when the first metatarsal 20 and the first wedge 30 have been secured using the bone plate 500, the cross pin 824 is no longer required and can be removed. The pin 826 may be made of a shape memory material. In some embodiments, the staple 826 is held in a deformed configuration in which the staple legs are substantially parallel during insertion through the plate 500. After insertion, the staple 826 may be allowed to relax toward a non-deformed configuration with the legs angled toward one another. Thus, after insertion, the staple 826 provides a compressive force across the TMT joint 40. More details about the plate-staple system can be found in U.S. patent No. 10,299,842, which is incorporated herein by reference in its entirety. Further details regarding staples suitable for use as described herein can be found in U.S. publication No. 2018/0317906, which is incorporated herein by reference in its entirety.

Continuing to fig. 22, a cross screw drill guide is placed within the cross screw aperture 525 of the bone plate 500. Although the fixed angle cross screw drill guide 600 of fig. 7A-7C is shown in fig. 22, the procedure may be implemented using the variable angle cross screw drill guide 650 of fig. 7D-7F as well. Cross screw drill guide 600 is seated in cross screw aperture 525 by seating shelf engagement surface 627 (or shelf engagement surface 677, if a variable angle cross screw drill guide 650 is used) against shelf 527 of cross screw aperture 525. A drill bit 832 is inserted through the cross screw drill guide 600 and rotated to drill a pilot hole for a cross screw within the cross screw aperture 525. The drill 832 and cross screw drill guide 600 are removed and a cross screw 834 is placed at the cross screw aperture 525, completing the Lapidus bunion excision procedure.

Fig. 23 and 24 illustrate the completion of Lapidus bunion excision in accordance with the present technique. Fig. 24 is an enlarged view of a portion of the foot, with the first metatarsal 20 shown in a transparent manner to illustrate the internal placement of the cross screw 834. As shown in fig. 23 and 24, the first metatarsal 20 is fixed in a desired orientation relative to the first wedge 30 with a reduced metatarsal angle relative to the second metatarsal 25 by the bone plate 500, the nail 826, the metatarsal screw 828 and the wedge screw 830.

Advantageously, cross screw 834 further has the function of preventing future recurrence of bunions. Since the foot may still experience daily pressure that may lead to recurrence of bunions, the cross screw 834 anchors the first metatarsal 20 to the second metatarsal 25 or the second wedge 35, depending on the geometry of the foot and the angle of insertion of the cross screw 834. Thus, the Lapidus bunion resections of fig. 8-24 advantageously outperform merely repairing bunions by providing additional structural connection to the more laterally disposed bones of the midfoot to prevent recurrence.

With reference to fig. 25-29, a portion of an alternative Lapidus bunion excision using certain devices herein will be described. The portion of the Lapidus bunion resection shown in fig. 25-29 provides an alternative method of performing a first metatarsal and first cuneiform bone cut using the single slot cut guide 180 shown in fig. 2H-2K. Thus, as will be described in greater detail below, a portion of the Lapidus bunion excision shown in fig. 25-29 may be used in conjunction with portions of the Lapidus bunion excision shown in fig. 8-24 and/or with other bunion excision procedures. Although the procedure of fig. 25-29 shows a particular implementation of Lapidus bunion resections using a particular subset of the devices described herein, it should be appreciated that the components and steps shown and described with reference to fig. 25-29 may likewise be applied in a different order and/or in a different combination of components to correct bunions.

As shown in fig. 25, the procedure may begin by placing and temporarily securing the cutting guide 180 of fig. 2H-2K to the foot 10. Similar to the starting configuration of fig. 8, the first TMT joint 40 may be prepared by making an incision (such as a dorsi-medial incision) to expose the first TMT joint 40 and resecting soft tissue surrounding the joint (such as an articular capsule or other soft tissue) to expose the first TMT joint 40 and create a space in which the paddles 120 (fig. 2H-2K) of the cutting guide 180 may be seated.

Once the joint is ready, the cutting guide 180 is placed by seating the paddle 120 (not visible in fig. 25) within the first TMT joint 40 such that the first extension 184 is disposed adjacent or against the first wedge 30 and the second extension 188 is disposed adjacent or against the first metatarsal 20. The paddle 120 is inserted into the first TMT joint 40 such that the cutting guide 180 is oriented along the axis of the first metatarsal 20 with the slot 182 positioned above the first metatarsal 20. Alternatively, in some embodiments, the cutting guide 180 may be oriented with the slot 182 positioned over the first wedge 30, and a bunion resection may be performed such that the first wedge 30 is cut before the first metatarsal 20. The alignment of the cutting guide 180 may be confirmed under fluoroscopy or other suitable imaging techniques before proceeding.

When the cutting guide 180 has been placed and properly aligned, the cutting guide 180 is temporarily secured relative to the first metatarsal 20 by inserting one or more metatarsal pins 802 or wires through the second pin holes 190 of the second extension 188 and into or through the first metatarsal 20. The metatarsal pin 802 or guide wire, as well as any of the other pins or wires described in the following description, may be, for example, a Kirschner wire ("K-wire") or any other suitable type of wire or pin that may be placed in bone to secure the cutting guide 180. Although two metatarsal pins 802 or wires are shown in this example, the cutting guide 180 may be suitably stable and stable when held in place by the paddle 120 and a single metatarsal pin 802 or wire.

Continuing to fig. 26, once the metatarsal pin 802 or lead is inserted, the base of the first metatarsal 20 is cut using a saw blade 804 inserted through a slot 182 of the cutting guide 180.

Referring to fig. 27 and 28, after cutting the base of the first metatarsal 20, the cutting guide 180 may be reoriented so that the same slot 182 may be used to guide the cutting of the first wedge 30 that later occurs in the Lapidus bunion resection procedure. The cutting guide 180 may be removed by sliding the cutting guide 180 upward until the second pin hole 190 is free of the metatarsal pins 802 or leads, as shown in fig. 27. At this stage, the resected portion of bone from the first metatarsal 20 (or from the first wedge 30 if the first wedge 30 is cut first) may be removed from the foot 10. The cutting guide 180 may then be inverted (e.g., rotated 180 degrees about an axis parallel to the metatarsal pins 802 or leads). The metatarsal pin 802 or wire may then be inserted through the first pin hole 186, and the cutting guide 180 may be moved down the metatarsal pin 802 or wire until the paddle 120 again seats within the first TMT joint 40, as shown in fig. 28. In some embodiments, the first pin hole 186 and the second pin hole 190 have different spacing about the center of the paddle 120. For example, the first pin hole 186 may be closer to the paddle 120 by a distance equal to the bone thickness removed by the first cut such that flipping the cutting guide 180 causes the paddle 120 to seat firmly against the cutting surface of the first metatarsal 20.

In the configuration of fig. 28, the second hole 190 is disposed above the first wedge 30 due to the eversion of the cutting guide 180, and the slot 182 is positioned to guide the cutting of the first wedge 30 rather than the first metatarsal 20. According to the condition shown in fig. 28, a Lapidus bunion excision procedure may be performed substantially as shown and described with reference to fig. 10-13 to correct the position of the first metatarsal 20 and phalanges 50 in the frontal and lateral planes. In the same procedure as described with reference to fig. 13, two wedge bone pins 818 or wires are inserted through the second pin holes 190 of the cutting guide 180 and into or through the first wedge bone 30. The wedge pin 818 or wire temporarily secures the cutting guide 180 relative to the first wedge 30. At this point, the four pins 802 and 814 form an array that establishes and/or locks the surgeon's desired correction.

Referring now to fig. 29, the slot 182 is now positioned on the cuneiform bone side of the first TMT joint 40 as the cutting guide 180 is flipped over after the first metatarsal 20 is cut. Thus, after correction of bunions and placement of the wedge pin 818 or wire in at least the frontal plane and/or the lateral plane, the slot 182 is positioned to guide cutting of the first wedge 30. It should be appreciated that prior to driving the wedge pin 818 into the wedge 30, the anchor mechanism of the foot may be engaged by dorsiflexing the thumb, which thereby compresses the paddle 120 against the wedge 30 (see fig. 2A). Compression of the paddle 120 against the wedge 30 may ensure that the slot 182 is aligned with a portion of the wedge 30 at a location that ensures that a sufficient segment is cut from the wedge 30.

Once the wedge pin 818 or wire is inserted, the base of the first wedge 30 is cut using the saw blade 820 inserted through the slot 182 of the cutting guide 180. Cutting the base of the first wedge 30 completes the resection of the first TMT joint 40. The cutting guide 180, linear taper 200, and control handle 300 may then be removed from the foot 10 by the same or similar operations as those described above with reference to fig. 15. After removal of the cutting guide 180, linear taper 200, and control handle 300, the first TMT joint 40 remains completely un-articulated with the metatarsal pin 802 or guide wire and the cuneiform pin 818 or guide wire held in place. At this point, the surgeon may further use any desired means to distract and further prepare the joint for fusion. The remainder of the Lapidus bunion excision procedure can then be performed substantially as shown and described with reference to fig. 16-24.

Referring to fig. 30A-32C, various additional devices and components are provided for a modified Lapidus bunion excision procedure for correcting the TMT joint deformity of fig. 1. The devices and components of fig. 30A-32C may be used to perform additional optional steps in the Lapidus bunion resection procedure described herein, such as additional bone removal and/or additional rotational correction of the frontal plane prior to fixation. Although the following description is made with reference to Lapidus bunion excision procedure, it is to be understood that the various devices and components described herein are not limited to such procedure and may be equally used in other orthopedic procedures as will be appreciated by those skilled in the art.

Fig. 30A-30C depict a cutting guide 900 configured as a re-cutting guide and a pin guide for the Lapidus bunion excision procedure described herein. In some Lapidus bunion resection procedures, the surgeon may desire to remove additional bone from the first metatarsal and/or the first wedge bone at the first TMT joint during the procedure. For example, the edges of the first metatarsal and/or first wedge forming the TMT joint may have different levels of concavity in different individuals, such that some of the first metatarsal and/or first wedge may need to resect more bone in order to reach a plane that exposes the inner bone over the entire cross-section of the cut area.

Fig. 30A and 30B are upper and lower perspective views, respectively, of the cutting guide 900. Fig. 30C is a top plan view of the cutting guide 900. The cutting guide 900 may be a single integrally formed component and may comprise metal, plastic, or other suitable material. The cutting guide 900 may be sized and shaped for use in conjunction with (e.g., subsequent to) another cutting guide, such as the cutting guide 181 of fig. 2L-2N.

The cutting guide 900 generally includes a body 910, an extension 920, and a paddle 930. The extension 920 may have a similar or identical size and shape to the second extension 188 of the cutting guide 181, and may include pin holes 922 having a pitch corresponding to the pitch of the second pin holes 190 of the cutting guide 181. Body 910 includes slot 912. For example, the paddle 930 is sized and shaped to seat within a joint such as a TMT joint.

To achieve the desired re-cutting function, the spacing between the slot 912 and the pin hole 922 of the cutting guide 900 is closer than the corresponding spacing in the associated cutting guide for the initial joint cut. For example, in a kit including the cutting guide 900 and the cutting guide 181 (fig. 2L-2N), the distance between the slot 912 and the closer pin hole 922 is shorter than the distance between the slot 182 of the cutting guide 180 and the closer second pin hole 190. Thus, after cutting with the cutting guide 181 that passes through the pin extending through the second pin aperture 190, the cutting guide 181 may be removed and the cutting guide 900 may be placed over the same pin that passes through the pin aperture 922 such that the slot 912 defines a cutting plane that is closer to the pin for re-cutting. The use of the cutting guide 900 as a re-cutting guide will be described in more detail with reference to fig. 33-35.

Fig. 31A-31C depict an exemplary realignment guide 1000 configured as a pin guide for frontal plane adjustment in the Lapidus bunion resection procedure described herein. Fig. 31A and 31B are upper and lower perspective views, respectively, of the realignment guide 1000. Fig. 31C is a side cross-sectional view of the realignment guide 100 taken along line 31C-31C in fig. 31B. The realignment guide 1000 includes a body 1010 having two or more pairs of pin holes therethrough. The body 1010 is generally wedge-shaped and may be integrally formed of metal, plastic, or other suitable material.

In the example realignment guide 1000 of fig. 31A-31C, the body 1010 includes four pairs of pin holes 1012, 1014, 1016, and 1018. Each pair of pin holes 1012, 1014, 1016, 1018 may be parallel and the pin hole pairs oriented in a converging configuration. Each pair of pin holes 1012, 1014, 1016, 1018 may be spaced apart by a distance corresponding to the pin hole spacing of an associated cutting guide (e.g., cutting guide 180, 181, 900, etc.). Thus, the pin holes 1012, 1014, 1016, 1018 may be used to perform further frontal plane correction by being placed over an existing pair of pins and serving as a guide for placing a second pair of similarly spaced parallel pins placed at a predetermined angular offset about the phalanges relative to the existing pair of pins. The purpose of the realignment guide 100 will be described in more detail with reference to fig. 39-48.

Fig. 32A-32C depict an exemplary realignment guide 1020 configured as a pin guide and compression block for frontal plane adjustment in the Lapidus bunion resection procedure described herein. Fig. 32A and 32B are upper and lower perspective views, respectively, of the realignment guide 1020. Fig. 32C is a top plan view of the realignment guide 1020. The realignment guide 1020 may be integrally formed from metal, plastic, or other suitable material. The realignment guide 1020 may have a shape substantially similar to the compressor block 400 and may serve as both a realignment guide and a compressor block in operation.

The realignment guide 1020 includes a body 1025 having two pairs of proximal pin holes 1030, 1032 and two pairs of distal pin holes 1035, 1037. Similar to the proximal and distal pin holes 410, 415 of the compressor block 400, the proximal and distal pin holes 1030, 1032, 1035, 1037 converge toward the middle of the realignment guide 1020. The widened section 1040 may include cross pin holes 1042 for additional stabilization and/or temporary fixation while the permanent fixation device is placed. As will be described in greater detail with reference to fig. 36-38, the realignment guide 1020 may be used to effect additional frontal plane correction of the first metatarsal without the need to insert additional pins into the bone.

Fig. 33-35 are perspective views of the bones of foot 10 sequentially illustrating the re-cutting portion of an exemplary Lapidus bunion resection procedure performed using the exemplary bunion resection device described herein. The re-cut portion of the Lapidus bunaesitiectomy shown in fig. 33-35 may be performed at any time after the first metatarsal 20 and/or the first cuneiform 30 have been initially cut (where further bone removal is required). For example, in some procedures, the surgeon may examine the cut ends of the first metatarsal 20 and/or the first wedge 30 and determine that additional bone should be removed due to the concavity or desired spacing of the bone. Thus, as will be described in more detail below, a portion of the Lapidus bunion excision shown in fig. 33-35 may be used in combination with any of the other Lapidus bunion excision protocols described herein.

As shown in fig. 33, the re-cut portion may begin with the foot 10 in a configuration similar to that of fig. 15. In the configuration of fig. 33, a cutting guide (e.g., cutting guide 100, cutting guide 180, cutting guide 181, etc., as described elsewhere herein) may have been used to remove a portion of the first metatarsal 20 and/or the first cuneiform bone 30. The metatarsal pins 802 and/or the wedge pins 818 may remain in the foot 10 after the cutting guide for initial cutting of the first metatarsal 20 and/or the first wedge 30 is removed. In the exemplary re-cut portion shown in fig. 33-35, it is desirable to remove an additional portion of the first metatarsal 20 facing the first TMT joint 40.

Continuing to fig. 34, a cutting guide 900 configured as a re-cutting guide is placed by inserting the metatarsal pin 802 through the pin hole 922 of the cutting guide 900 and sliding the cutting guide 900 onto the metatarsal pin 802 until the cutting guide 900 seats against the previously cut surface of the first metatarsal 20. In this configuration of fig. 34, because the cutting guide 900 is spaced closer together relative to the cutting guides 100, 180, 181, the slots 912 of the cutting guide 900 are aligned closer to the metatarsal pins 802 than the end of the first metatarsal 20 facing the TMT joint. Once the cutting guide 900 is placed, the base of the first metatarsal 20 can be re-cut using a saw blade 836 inserted through a slot 912 of the cutting guide 900. The remainder of the Lapidus bunion excision procedure can then be performed substantially as shown and described with reference to fig. 16-24 or as described elsewhere herein. It should be appreciated that the re-cutting described above may be equally applied to the first metatarsal 20 or the first cuneiform 30. If a re-cut is required, another RAC block configured to provide additional compression may be used in the manner described above.

Fig. 36-38 are perspective views of the bone of foot 10, sequentially illustrating the frontal planar realignment portion of an exemplary Lapidus bunion resection procedure using realignment guide 1020 shown in fig. 32A-32C. The frontal plane realignment portion of the Lapidus bunaectomy shown in fig. 36-38 may be performed at any time after the first metatarsal 20 and the first cuneiform 30 have been cut and prior to fixation, as described elsewhere herein. When the realignment guide 1020 is configured as both a pin guide and a compression block for frontal plane realignment, the realignment portion shown in fig. 36-38 may be performed in place of (e.g., before or after) the compression portion of the Lapidus bunkerectomy as shown in fig. 16-18. For example, in some procedures, the surgeon may perform an initial frontal plane correction, and may then determine (such as when initially assembling the compression block as shown in fig. 16) that further correction or realignment of the first metatarsal 20 in the frontal plane is required.

The frontal plane realignment begins with the foot 100 in the configuration shown in fig. 15 or 33 as described above, wherein the metatarsal pin 802 remains in the first metatarsal 20 and the wedge pin 818 remains in the first wedge 30 after cutting the bone using the cutting guide described herein. When the realignment guide 1020 is placed by inserting the metatarsal pin 802 through the first pair of distal pin holes 1035 and inserting the wedge-shaped bone pin 818 through the first pair of proximal pin holes 1030, the realignment portion continues to the configuration shown in fig. 36. When the metatarsal pins 802 and the wedge pins 818 are disposed within pairs of holes on the same side of the realignment guide 1020 as shown in fig. 36, the realignment guide 1020 functions similarly to the compression block 400, compressing the cut ends of the first metatarsal 20 and the first wedge 30 without applying any frontal plane realignment. At the stage shown in fig. 36, the surgeon may determine that the initial frontal plane adjustment is insufficient and that the first metatarsal 20 should be realigned by further clockwise rotation to achieve the desired alignment.

As shown in fig. 37 and 38, the realignment guide 1020 is removed from the foot 10 (fig. 37) and replaced over the wedge pin 818 and metatarsal pin 802. However, upon replacement of the realignment guide 1020, the wedge-shaped bone pin 818 is inserted through a second pair of proximal pin holes 1032 that are angularly displaced relative to the first pair of proximal pin holes 1030. The metatarsal pin 802 is inserted through the same first pair of distal pin holes 1035 previously inserted therethrough in fig. 36. Thus, replacement of the realignment guide 1020 effects further clockwise rotational adjustment of the first metatarsal 20 and compresses the TMT joint 40 for fixation. Alternatively, counterclockwise adjustment may be performed by reinserting the wedge-shaped bone pin 818 through the same first pair of proximal pin holes 1030 and inserting the metatarsal pin 802 through the second set of distal pin holes 1037. After realignment as shown in fig. 36-38, the Lapidus bunion resection procedure may be performed to fix the bone of the TMT joint 40, for example, as shown and described with reference to fig. 17-24. As shown in fig. 18 to 20, a cross pin 824 for temporary fixation may be inserted through any one of the cross pin holes 1042.

Fig. 39-48 are perspective views of the bones of the foot, sequentially illustrating the frontal planar realignment portion of an exemplary Lapidus bunion resection procedure using the realignment guide 1000 shown in fig. 31A-31C. The frontal plane realignment portion of the Lapidus bunaectomy shown in fig. 39-48 may be performed at various stages of the procedure, for example, prior to placement of the compression block, as shown in fig. 16. In some embodiments, the frontal realignment portion of the Lapidus bunion resection shown in fig. 39-48 may be performed after the initial placement of the compression block 400 indicates that more or less frontal plane correction is required prior to fixation. As will be described in greater detail, the realignment using the realignment guide 1000 differs from the realignment using the realignment guide 1020 (e.g., fig. 36-38) in that the realignment guide 1000 guides the placement of a second pair of metatarsal pins that are rotationally displaced relative to the original pair of metatarsal pins, which may then be used in conjunction with the compression block 400 to complete the frontal plane realignment.

The frontal plane realignment begins with the foot 100 in the configuration shown in fig. 15 or 33 as described above, wherein the metatarsal pin 802 remains in the first metatarsal 20 and the wedge pin 818 remains in the first wedge 30 after cutting the bone using the cutting guide described herein. When the realignment guide 1000 is placed by inserting the metatarsal pins 802 through the first pair of pin holes 1012 of the realignment guide 1000, the realignment portion continues to the configuration shown in fig. 39. In this configuration, the other three pairs of pin holes 1014, 1016, 1018 define pin placement positions that are realigned for three incremental clockwise frontal planes. Alternatively, if a counter-clockwise frontal plane realignment is desired, the realignment guide 1000 will be placed by inserting the metatarsal pin 802 through the fourth pair of pin holes 1018 such that the other three pairs of pin holes 1012, 1014, 1016 will define a pin placement position for counter-clockwise frontal realignment.

After placement of the realignment guide 1000, the process continues to fig. 40 when the first replacement metatarsal pin 803a is partially inserted into the first metatarsal 20 through one of the pair of pin holes 1016. Because of the convergence of the paths of the pin holes 1012, 1014, 1016, 1018 within the first metatarsal 20, full insertion of the replacement metatarsal pin 802 while remaining inserted may not be possible or desirable. Thus, the first replacement metatarsal pin 803a may be only partially inserted such that the first replacement metatarsal pin 803a does not strike the corresponding metatarsal pin 802. Preferably, the first replacement metatarsal pin 803a extends sufficiently into the bone to maintain the position and orientation of the realignment guide 1000 relative to the first metatarsal 802 with one of the metatarsal pins 802 removed.

Continuing to fig. 41, a proximal metatarsal pin 802 corresponding to the first replacement metatarsal pin 803a is removed from the first metatarsal 20. In this configuration, the partially inserted first replacement metatarsal pin 803a and the retained metatarsal pin 802 are sufficient to maintain the position and orientation of the realignment guide 1000 relative to the first metatarsal. As shown in fig. 42, the first replacement metatarsal pin 803a may then be further inserted through the pin hole 1016 and the first metatarsal to a fully inserted position, with the realignment guide 1000 acting as a pin placement guide for the first replacement metatarsal pin 803 a.

Continuing to fig. 43-45, a similar replacement procedure is performed for the retained metatarsal pins 802. As shown in fig. 43, a second replacement metatarsal pin 803b is partially inserted into the other pin bore through the pair of pin bores 1016. As shown in fig. 44, the remaining metatarsal pin 802 is removed to allow the second replacement metatarsal pin 803b to be fully inserted. As shown in fig. 45, a second replacement metatarsal pin 803b is further inserted through the realignment guide 1000.

Continuing to fig. 46, the realignment guide 1000 is removed from the foot 10 such that the replacement metatarsal pins 803a, 803b remain in the first metatarsal 20 at the same spacing, but are angularly displaced relative to the removed metatarsal pin 802. As shown in fig. 47, the first metatarsal 20 is then rotated relative to the first wedge 30 in the frontal plane to a final orientation in which the replacement metatarsal pins 803a, 803b are aligned with the wedge pins 818. After this final frontal plane realignment process, a compression block, such as compression block 400, may then be placed over the wedge pin 818 and replacement metatarsal pins 803a, 803b to compress the TMT joint 40 for immobilization, as shown in fig. 48. For example, as shown and described with reference to fig. 17-24, the Lapidus bunion excision procedure may proceed to end.

Referring now to fig. 49A-49D, a bone fixation kit may include an exemplary cutting guide 1100, which may be configured as a cutting guide and a temporary fixation guide for joint fusion procedures, particularly for fusion of TMT joints (e.g., fusion of a second TMT joint or a third TMT joint). As will be described, the cutting guide 1100 may be configured to guide a cutting instrument to resect a first bone on one side of a joint and then be repositioned to guide the cutting instrument to resect a second bone on an opposite side of the joint.

The cutting guide 1100 generally includes a body 1105 defining a first portion 1110 and a second portion 1115 opposite the first portion 1110 in a longitudinal direction L. The first portion 1110 may be said to be spaced apart from the second portion 1115 in a first direction. Conversely, the second portion 1115 can be said to be spaced apart from the first portion 1110 in the first direction. The first direction and the second direction may be oriented along the longitudinal direction L. The first portion 1110 and the second portion 1115 of the body may define respective first and second portions of the cutting guide 1100. The cutting guide 1100 may also include a paddle 1120 extending from the body 1105 in a transverse direction T that is substantially perpendicular to the longitudinal direction L. The first portion 1110 may extend from the paddle 1120 in a first direction and the second portion 1115 may extend from the paddle 1120 in a second direction. The cutting guide 1100 may be a single integrally formed component and may comprise metal, plastic, or other suitable material.

The paddle 1120 may be sized and shaped to seat within the joint between the first and second bones (e.g., between the metatarsal bones and the cuneiform or cuboid bones) after removal of soft tissue such as the joint capsule surrounding the joint. At least a portion of the paddle 1120 may taper inwardly as it extends to its free end 1121 so as to define a tapered free end 1121. For example, the paddle 1120 may define opposing first and second longitudinal facing surfaces 1123a, 1123b. The first longitudinal facing surface 1123a may face a first direction and the second longitudinal facing surface 1123a may face a second direction. In one example, the first longitudinal-facing surface 1123a may be substantially planar as it extends from the main body 1105 to the free end 1121. At least a portion (such as a distal portion) of the second longitudinal facing surface 1123b may taper toward the first longitudinal facing surface 1123a as it extends to the free end 1121. The tapered free end 1121 may facilitate insertion of the paddle 1120 into a joint. As described above, the paddle 1120 may be integral with the body 1105. In other examples, the paddle 1120 may be separate from the main body 1105 and fixed to the main body 1105.

The body 1105 of the cutting guide 1100 defines a bone-facing surface 1105a and an outer surface 1105b opposite the bone-facing surface 1105a along the transverse direction T, and may include a cutting slot 1125 extending through the body 1105 of the cutting guide 1100 along the transverse direction T. The cutting slot 1125 may be elongated along a lateral direction a perpendicular to each of the longitudinal direction L and the transverse direction T. The cutting slot 1125 may pass through the body 1105 from the outer surface 1105b to the bone facing surface 1105a. The cutting slot 1125 is sized and shaped to function as a positioning guide for receiving a saw blade or other cutting instrument to facilitate sequential precision cutting of each of the first and second bones on opposite sides of the joint. For example, the cutting slot 1125 may be positioned at a predetermined spaced distance relative to the paddle 1120 in the longitudinal direction (and in particular in the first direction). Thus, the paddle 1120 may be positioned in the joint in a first orientation such that the cutting slot 1125 is aligned with the base of the first bone (i.e., the portion facing the joint). Thus, the cutting guide 1100 may receive a cutting instrument that facilitates cutting the base of the first bone when the paddle 1120 is positioned within the joint. In this regard, the first direction may define a distal direction, whereby the first bone is positioned distal to the second bone. Once the first bone is cut, the cutting slot 1125 may be removed from the joint and repositioned in the second orientation, whereby the cutting slot 1125 is aligned with the second bone when the paddle 1120 is disposed in the joint. The reversible cutting guide may be placed across the posterior side of the joint in a second orientation. Thus, the cutting guide 1100 may receive a cutting instrument that facilitates cutting a distal portion of the second bone (i.e., the portion facing the joint) when the paddle 1120 is positioned within the joint with the cutting guide 1100 in the second orientation. In this regard, the first direction may define a proximal direction opposite the distal direction.

The width of the cutting slot 1125 may be greater than the width of the paddle 1120. The cutting slot may also be parallel to at least one of the first and second longitudinal facing surfaces 1123a, 1123b of the paddle 1120, or parallel to the direction in which the paddle 1120 extends from the body 1105. In other examples, the cutting slot 1125 may be angled relative to at least a portion of each of the first and second longitudinal facing surfaces 1123a, 1123b of the paddle 1120. In some embodiments, the cutting slot 1125 may define an enlarged distal portion 1127, the opposite lateral ends of which may be configured to receive a stop member such as a wire (e.g., a Kirschner wire or K-wire) when cutting the first and/or second bones, so as to prevent the cutting blade from making an excessively wide incision in the cutting slot 1125. In particular, the stop member abuts the cutting instrument so as to limit travel of the cutting instrument in the cutting slot 1125 to an area not blocked by the stop member.

The cutting guide 1100 may define a first primary temporary bone fixation aperture 1112 extending through the body 1105 from the outer surface 1105b to the bone facing surface 1105a. In particular, the first primary temporary bone fixation aperture 1112 may extend through the first portion 1110 of the body 1105 in the transverse direction T. The first primary temporary bone fixation aperture 1112 may have a substantially circular cross-sectional profile sized to receive a temporary bone fixation element, such as a K-wire or pin, that temporarily secures the cutting guide 1100 to a corresponding underlying bone, as described further below. The first primary temporary bone fixation hole 1112 serves as a guide for a temporary bone fixation element that may be inserted through the hole 1112 and into the underlying bone at a predetermined spacing relative to the paddle 1120 and/or relative to the plane along which the underlying bone is cut by the cutting instrument through the cutting slot 1125. Depending on the orientation of the cutting guide, the underlying bone may be defined by either the first bone or the second bone. Although the example cutting guide 1100 of fig. 49A-50B includes a single first primary temporary bone fixation hole 1112, in some embodiments, the cutting guide 1100 may include a plurality of first primary temporary bone fixation holes 1112 to provide additional stability. For example, the cutting guide 1100 may include two or more first primary temporary bone fixation holes 1112 aligned along a centerline of the cutting guide 1100 perpendicular to the cutting slot 1125. The at least one first primary temporary bone fixation hole 1112 may be aligned along a longitudinal centerline of the guide 1100 (e.g., transverse to the plane of the cutting slot 1125).

The first portion 1110 may also include one or more first auxiliary temporary bone fixation holes 1111 that extend through the body 1105 from the outer surface 1105b to the bone facing surface 1105a. In particular, the first auxiliary temporary bone fixation hole 1111 may extend through the first portion 1110 of the main body 1105 in the lateral direction T. The first auxiliary temporary bone fixation aperture 1111 may have a substantially circular cross-sectional profile sized to receive a temporary bone fixation element, such as a K-wire or pin, which temporarily secures the cutting guide 1100 to the underlying bone, as described further below. In some examples, the first auxiliary temporary bone fixation hole 1111 may be offset from the first main temporary bone fixation hole 1112 by a predetermined distance in the first direction. The first auxiliary temporary bone fixation hole 1111 may also be disposed at an outer side with respect to the first main temporary bone fixation hole 1112 in the lateral direction L.

The temporary bone fixation holes 1111 and 1112 may extend parallel to one another or may be angularly offset relative to one another, defining non-parallel trajectories as they extend through the main body 1105. For example, the first auxiliary temporary bone fixation holes 1111 may be angularly offset relative to each other. In one example, they may converge toward each other as they extend through the bone plate body 1105 in a direction from the outer surface 1105b toward the bone-facing surface 1105a. In particular, the first auxiliary temporary bone fixation holes 1111 may be spaced farther apart from each other at the outer surface 1105b than they are at the bone facing surface 1105a. Temporary fixation members extending through the converging apertures 1111 and into the corresponding underlying bone may provide additional stability as desired.

The cutting guide 1100 may define a second temporary bone fixation aperture 1117 extending through the body 1105 from the outer surface 1105b to the bone-facing surface 1105a. In particular, the second temporary bone fixation aperture 1117 may extend through the second portion 1110 of the body 1105 in the transverse direction T. The second temporary bone fixation aperture 1117 may have a substantially circular cross-sectional profile sized to receive a temporary bone fixation element, such as a K-wire or pin or other structure, which temporarily secures the cutting guide 1100 to a corresponding underlying bone, as described further below. The second temporary bone fixation hole 1117 may have the same diameter as the first temporary bone fixation holes 1111 and 1112.

The second temporary bone fixation hole 1117 serves as a guide for a temporary bone fixation element that can be inserted through the hole 1117 and into the underlying bone at a predetermined spacing relative to the paddle 1120 and/or relative to the plane along which the underlying bone is cut by the cutting instrument through the cutting slot 1125. Depending on the orientation of the cutting guide, the underlying bone may be defined by either the first bone or the second bone. It should be appreciated that the respective underlying bones of the first temporary bone fixation holes 1111 and 1112 may be defined by one of the first bone and the second bone, and the respective underlying bone of the second temporary bone fixation hole 1117 may be defined by the other of the first bone and the second bone. The second temporary bone fixation hole 1117 may be aligned along a centerline of the cutting guide 1100.

The second aperture 1117 may extend parallel to one or more of the first apertures 1111 and 1112 until fully extended. Thus, the central axes of the first and second temporary bone fixation holes 1112, 1117 may lie on a common plane. In one example, the common plane may be defined by a longitudinal direction L and a transverse direction T. Although the example cutting guide 1100 of fig. 49A-50B includes a single second temporary bone fixation hole 1117, in some embodiments, the cutting guide 1100 may include a plurality of second temporary bone fixation holes 1117 to provide additional stability as desired. For example, the cutting guide 1100 may include two or more second temporary bone fixation holes aligned along a longitudinal centerline of the cutting guide 1100 oriented perpendicular to the cutting slot 1125.

The bone-facing surface 1105a of the body 1105 may be a plane that spans the second portion 1115 and/or the first portion 1110. Alternatively, the bone-facing surface 1105a of the second portion 1115 and/or the first portion 1110 may not be coplanar with the other of the first portion 1110 and the second portion 1115, which may in some cases allow the cutting guide 1100 to be placed closer to the first bone or the second bone while leaving room for the bony anatomy of the first bone and the second bone. Additional details are provided in U.S. patent No. 10,292,713, which is incorporated by reference herein.

The cutting guide 1110 may also include one or more apertures 1109 extending through the body 1105 from the outer surface 1105b to the bone-facing surface 1105 a. The aperture 1109 may be elongated in the longitudinal direction a or in any suitable alternative direction as desired. Thus, the aperture 1109 may define an elongated opening at either or both of the bone-facing surface 1105a and the outer surface 1105 b. The aperture 1109 may define an area free of the cutting guide material 1110 to facilitate X-ray visualization and/or any other suitable surgical imaging procedure to confirm and/or monitor the orientation and alignment of the cutting guide 1110 during surgery. In some examples, the aperture 1109 may intersect the cutting slot 1125 and may further intersect the paddle 1120 as desired.

Referring now to fig. 50A-50D, a bone fixation kit may include an alternative cutting guide 1200, which may be configured as a cutting guide and temporary fixation guide for joint fusion procedures, particularly for fusion of TMT joints (e.g., fusion of a second TMT joint or a third TMT joint). The cutting guide 1200 may be generally configured as described above with respect to the cutting guide 1100 of fig. 49A-49D, and for clarity and convenience, reference numerals of the cutting guide 1200 corresponding to like elements of the cutting guide 1100 have been increased by 100. Thus, the above description of the cutting guide 1100 applies to the cutting guide 1200 with equal efficacy and effect, unless otherwise noted.

Thus, the cutting guide 1200 includes a body 1205 defining a first end 1210 and a second end 1215 opposite the first end along a longitudinal direction. The cutting guide 1200 also includes paddles 1220 extending from the body 1205 in the transverse direction T and sized and shaped to seat within the joint between the first and second bones (e.g., between the metatarsals and the cuneiform or cuboid bones) after removal of soft tissue such as the joint capsule surrounding the joint. At least a portion of paddle 1220 may be tapered at its free end 1221 to facilitate insertion into a joint. The paddles 1220 may be integrally formed with the body 1205 or separate from and attached to the body 1205. The body 1205 may define a bone-facing surface 1205a and an outer surface 1205b opposite the bone-facing surface 1205a along a transverse direction T.

The cutting guide 1200 includes a slot 1225 extending through the body 1205 from the outer surface 1205b to the bone facing surface 1205a. The slot 1225 may be elongated in the lateral direction a. The slot 1225 may receive a cutting instrument to facilitate precise cutting of the first and second bones on opposite sides of the joint as described above. The cutting slot 1225 may have enlarged end segments 1227 at opposite lateral ends of the cutting slot 1225 that may be used to place additional temporary fixation members during cutting to prevent the cutting instrument from making too wide an incision in the cutting slot 1225.

The cutting guide 1200 may also include a stop bore 1229 extending through the body 1205 in the longitudinal direction L or in a direction angularly offset relative to the longitudinal direction L. The stop hole 1229 may intersect the slot 1225. The stop holes 1229 may be spaced apart from each other in the lateral direction a. The stop holes 1229 may be configured to receive a corresponding stop member, such as a temporary fixation member or other structure that limits the range of motion of the cutting instrument in the slot 1225. In particular, a stop member disposed in the stop hole 1229 may abut the cutting instrument in the slot 1225 to limit travel of the cutting instrument in the cutting slot 1225 to an area of the cutting slot 1225 that is not blocked by the stop member. The stop hole 1229 may be disposed inwardly relative to the enlarged end segment 1227 relative to the lateral direction a such that a stop member disposed in the stop hole 1229 further limits the useful width of the cutting slot 1225 along the lateral direction a relative to a stop member that may be received in the enlarged end segment 1227. As shown, the cutting guide 1200 does not include more apertures 1109 described above with respect to the cutting guide 1100 shown in fig. 49A-49D, but may include one or more of the apertures 1109 if desired. Further, if desired, the cutting guide 1100 may include a stop hole 1229.

The cutting guide 1200 includes a first primary temporary bone fixation hole 1212 that extends from the outer surface 1205b through the first portion 1210 of the body 1205 to the bone-facing surface 1205a, as described above with respect to the first primary temporary bone fixation hole 1112 of the cutting guide 1100 of fig. 49A-49D. The cutting guide 1200 may also include one or more first auxiliary temporary bone fixation holes 1211 extending through a first portion of the body 1205 from the outer surface 1205b to the bone facing surface 1205a, as described above with respect to the first auxiliary temporary bone fixation holes 1111 of the cutting guide 1100 of fig. 49A-49D. The cutting guide 1200 may include at least one second temporary bone fixation hole 1217 extending from the outer surface 1205b through the second portion 1215 of the body 1205 to the bone-facing surface 1205a along the transverse direction T. The second temporary bone fixation hole 1217 may be as described with respect to the second temporary bone fixation hole 1117 of the cutting guide 1100 of fig. 49A-49D. The stopper hole 1229 may be provided outside with respect to all the temporary fixing holes 1217, 1211, 1212, and 1213 in the lateral direction a as needed.

The cutting guide 1200 may also include one or more first offset temporary bone fixation holes 1213 extending from the outer surface 1205b through the first portion 1210 of the body 1205 to the bone facing surface 1205a. During operation, if desired, one of the first offset temporary bone fixation holes 1213 may be used in place of the first primary temporary bone fixation hole 1212 to compensate for the inclination and/or angulation of bones such as the metatarsal bones. For example, in some implementations, a first primary temporary wedge bone fixation hole 1212 may be used to place a lead and/or drill for a nail hole in the wedge bone, and after flipping the cutting guide 1200 over, one of the first offset temporary bone fixation holes 1213 may be used to place a lead and/or drill for a nail hole in the corresponding metatarsal. Thus, the subsequently inserted staples for securing the wedge-like bones to the metatarsal will be offset as desired. The proximal pin holes 1211, 1212 and the offset proximal pin hole 1213 may extend parallel to each other along the transverse direction T, or may be skewed in non-parallel trajectories.

Referring now to fig. 51A-51E, a bone fixation kit may also include an example compressor block 1400 configured for use in the joint fusion procedure described herein. In some embodiments, compressor block 1400 may be configured for a combination of realignment and compression of a first bone and a second bone (e.g., an RAC block). In particular, the compressor block 1400 may be used to align the first and second bones after the first and second bones have been cut by bare hands or using the cutting guide 1100 or 1200 or any suitable alternative cutting guide. The compressor block 1400 may also be used to pull the first and second bones toward each other. Accordingly, the compression block 1400 is configured to help compress and secure the resected joint that has been cut or resected freehand using the cutting guide 1100.

The compressor block 1400 includes a block body 1405 having a bone-facing surface 1404 and an outer surface opposite the bone-facing surface 1404 along a lateral direction T. The outer surface 1402 and/or bone-facing surface 1404 may be planar or alternatively shaped as desired. The block body 1405 defines a proximal end 1405a and a distal end 1405b opposite the proximal end along the longitudinal direction L. Thus, the mass body 1405 and the compressor mass 1400 define a distal direction from the proximal end 1405a toward the distal end 1405b, and a proximal direction from the distal end 1405b toward the proximal end 1405 a. The proximal and distal directions may be oriented in the longitudinal direction L. The block body 1405, and thus the compressor block 1400, may define a proximal portion 1403 and a distal portion 1407 opposite the proximal portion along the longitudinal direction L. Thus, the distal direction may be defined as the direction from the proximal portion 1403 toward the distal portion 1407, and the proximal direction may be defined as the direction from the distal portion 1407 toward the proximal portion 1403. Proximal portion 1403 may define a proximal end 1405a and distal portion 1407 may define a distal portion 1405b. Distal portion 1407 may be wider than proximal portion 1403 along lateral direction a.

Compressor block 1400 may include a first or proximal temporary bone fixation aperture 1410 that extends from outer surface 1402, through block body 1405, to bone facing surface 1404. In particular, proximal temporary bone fixation holes 1410 extend through proximal portion 1403 of block body 1405. The proximal temporary bone fixation hole 1410 may extend through the body from the outer surface to the bone-facing surface at a first angle less than 90 degrees relative to each of the outer surface and the bone-facing surface. Compressor block 1400 may also include a second or distal temporary bone fixation aperture 1415 extending through block body 1405 from outer surface 1402 to bone facing surface 1404. In particular, a distal temporary bone fixation aperture 1415 extends through a distal portion 1407 of the block body 1405. The distal temporary bone fixation hole 1415 can extend through the block body 1405 from the outer surface to the bone-facing surface at a first angle relative to the outer surface and the bone-facing surface.

The proximal and distal temporary bone fixation holes 1410, 1415 may be spaced apart from each other along the longitudinal direction L by a first distance that is less than a second distance along which the first and second primary temporary bone fixation holes 1112, 1117 are spaced apart from each other along the longitudinal direction L. Further, either or both of the proximal and distal temporary bone fixation holes 1410, 1415 may be spaced apart from the longitudinal center of the compressor block 1400 by a respective distance that is less than the respective distances by which the first and second primary temporary bone fixation holes 1112, 1117 are spaced apart from the longitudinal center of the cutting guide 1100.

Further, when the proximal and distal temporary bone fixation holes 1410, 1415 extend in an inward direction from the outer surface 1402 to the bone-facing surface 1404, they may be non-parallel and/or disposed at converging angles. Accordingly, the respective openings of the proximal and distal temporary bone fixation holes 1410, 1415 at the outer surface 1402 may be spaced apart from one another by a first distance, and the respective openings of the proximal and distal temporary bone fixation holes 1410, 1415 at the bone facing surface 1404 may be spaced apart from one another by a second distance that is less than the first distance. Thus, as will be described in greater detail below, temporary fixation members inserted through the proximal and distal apertures 1410, 1415 are urged closer together by the compressor block 1400 as the compressor block 1400 slides downward over temporary fixation members received in respective ones of the proximal and distal apertures 1410, 1415, as described in greater detail below with respect to fig. 58-59. The temporary fixing members may be parallel to each other before the compressor block 1400 is slid on the temporary fixing members.

Compressor block 1400 may also include handle attachment apertures 1425 extending through block body 1405. The handle attachment aperture 1425 is configured or arranged to attach a handle that can assist a user in sliding the compressor block 1400 downward on temporary securing members that pass through respective ones of the apertures 1410, 1415 of the compressor block 1400. The handle attachment aperture 1425 may be threaded to threadably mate with the handle. In one example, handle attachment aperture 1425 extends through proximal portion 1403 in lateral direction a, but it should be appreciated that handle attachment aperture 1425 may extend through any suitable location of block body 1405 in any suitable direction as desired.

The compressor block 1400 also includes a stationary portion 1406 and at least one inclined aperture, such as a pair of inclined apertures 1420, extending through the stationary segment 1406. In some examples, fixation segment 1406 may be defined by distal portion 1407 of block body 1405. In one example, when the inclined hole 1420 extends in a proximal direction to a second opening at the bone-facing surface 1404, the inclined hole extends in an inward direction (defined as a direction from the outer surface 1402 toward the bone-facing surface 1404) from a corresponding first opening at the distal end 1405 b. Thus, when compressor block 1450 is aligned on the first and second temporary fixation members proximate to the joint, the respective central axes of inclined holes 1420 can extend along respective linear paths diagonally through the joint, and the joint can be secured by inserting the inclined temporary fixation members through the inclined holes and through the joint.

It should be appreciated that the first opening may alternatively be defined by the outer surface 1402 or the outboard side surface, as desired. The inclined holes 1420 may be adjacent to each other along the lateral direction a. The temporary fixation members may be inserted into first openings in the inclined bores 1420, through the respective inclined bores 1420, and out the second end so as to be spaced from the bone facing surface 1404 of the compressor block 1400. It should be appreciated that the temporary fixation member as described herein may include a K-wire, pin, or any suitable alternative structure suitable for temporary attachment to bone. The inclined holes 1420 may be aligned with each other along the lateral direction a. During operation, the compressor block 1400 causes either or both of the resected first and second bones to progress toward the other of the first and second bones until the first and second bones are placed in contact with each other or with a spacer disposed in the compressed joint. The temporary fixation member inserted through either of the inclined holes 1420 in the manner described above will extend through the first and second bones at an angle through the compression joint to temporarily maintain the position of the first and second bones until the first and second bones can be fixed by the plate or other permanent fixation element.

Referring now to fig. 52A-52D, in some embodiments, fixation segment 1406 may include temporary bone fixation slots 1452 instead of angled holes 1420. In particular, the bone fixation slot 1452 can be defined by a base 1453a and an interior side surface 1453b that is spaced apart from one another and extends from the base 1453 a. Side surfaces 1453b extend from base 1453 a. The side surfaces 1453b may be spaced apart from each other in the lateral direction a. The base 1453a may taper inwardly as it extends in a proximal direction from the distal surface 1405b until the base 1453a intersects the bone facing surface 1404. The base 1453a may intersect the bone facing surface 1404 at a location distal of the distal temporary bone fixation aperture 1415 at the opening at the bone facing surface 1404. The bone fixation slot 1452 may receive a temporary fixation member that extends across the joint between the first bone and the second bone after the bones have moved toward each other as described above with respect to the inclined hole 1420. However, temporary bone fixation slot 1452 is configured to receive a temporary fixation member that extends through the joint along a different trajectory, while inclined hole 1420 receives a temporary fixation member that extends through the joint along a fixation trajectory defined by the central axis of inclined hole 1420. Further, because temporary fixation slots 1452 open to bone-facing surface 1405b, slots 1452 may allow compression block 1450 to be removed from the underlying bone while the temporary fixation member remains inserted into the bone through one or both of slots 1452.

Referring to fig. 53A-53C, the bone fixation kit may further include a spacer 1500 configured to be inserted into a gap between the first bone and the second bone after the first bone and the second bone have been cut. Thus, the spacer 1500 may be placed in the gap between the respective first and second resected surfaces between the first and second bones, respectively. Thus, the first bone and the second bone may be fused against the spacer 1500. The spacer 1500 may be sized and shaped to position the first and second bones in a desired resected position relative to each other. In some embodiments, the spacer 1500 may have a suitable thickness to serve as a surrogate for the removed joint tissue, such as to maintain a pre-existing length of rays of the foot. In some embodiments, the thickness may be selected to correspond to the thickness of tissue removed from the first bone and the second bone by the cutting instrument. Spacer 1500 may include opposing faces 1505 and 1510. One of the faces 1505 and 1510 may define a distal or first bone-facing face, and the other of the faces 1505 and 1510 may define a proximal or second bone-facing face. In some examples, the opposing faces 1505 and 1510 may be planar. In various embodiments, the opposing faces 1505 and 1510 may or may not be parallel to each other. For example, the non-parallel opposing faces 1505 and 1510 may allow the spacer 1500 to be used as a wedge-shaped insert for corrective conditions such as metatarsal adduction (MTA). The spacer may define an outer perimeter 1515 extending between the opposing faces 1505 and 1510. The outer perimeter 1515 may be generally oval or rectangular in shape, or may define any suitable alternative shape as desired. The bone fixation kit may include a plurality of spacers 1500 of different sizes, shapes, and/or thicknesses from one of the faces 1505 and 1510 to the other of the faces 1505 and 1510 to fit within different gaps having different sizes and shapes. The spacer 1500 may comprise a substantially rigid or resilient material. For example, the spacer 1500 may comprise plastic, gel, foam, metal, or other suitable material as desired. In addition, faces 1505 and 1510 of spacer 1500 may include bone-conducting bone growth material and/or bone growth openings to enhance bone fusion.

Referring now to fig. 54-65, a surgical fusion procedure of the joint between the first bone 21 and the second bone 23 will now be described. In one example, the first bone 21 and the second bone 23 define bones of the human foot 10. For example, the first bone 21 may define a metatarsal, such as a second metatarsal or a third metatarsal, and the second bone 23 may define a wedge-like bone, such as a second wedge-like bone or a third wedge-like bone, respectively, such that the joint defines a tarsometatarsal (TMT) joint. However, it should be understood that the first bone 21 and the second bone 23 may define any anatomical bone as desired. Alternatively, the first bone 21 and the second bone 23 may instead define bone segments of the same bone.

As shown in fig. 54-55, the process may begin by placing and temporarily securing a cutting guide 1100 to one or both of the first bone 21 and the second bone 23. Prior to placement of the cutting guide, the surgeon may prepare the joint by making an incision (such as a dorsi-medial incision) to expose the joint and resecting soft tissue surrounding the joint (such as a joint capsule or other soft tissue) to expose the joint and create a space in which the paddles 1112 of the cutting guide 1100 may be seated.

With particular reference to fig. 54, once the joint is ready, the cutting guide 1100 is placed by seating the paddle 1120 (see fig. 49A) in the joint between the first bone 21 and the second bone 23 in a first orientation such that the first portion 1110 is disposed adjacent or against the first bone 21 and the second portion 1115 is disposed adjacent or against the second bone 23. In particular, the cutting guide 1100 may be placed on the dorsal side of the joint in a first orientation. When in the first orientation, the cutting slot 1125 may be aligned with the base of the first bone 21. The paddle 1120 is inserted into the joint such that the longitudinal centerline of the cutting guide 1100 is oriented generally along the axis of the first bone 21. The alignment of the cutting guide 1100 may be confirmed under fluoroscopy or other suitable imaging techniques before proceeding.

Continuing to fig. 55, when the cutting guide 1100 is placed and properly aligned in the first orientation, whereby the first portion 1110 is aligned with the first bone 21, the second portion 1115 is aligned with the second bone 23, and the cutting slot 1125 is aligned with the base or proximal portion of the first bone 21, the cutting guide 1100 may be temporarily secured to the first bone 21. In particular, the first primary temporary bone fixation member 1801 can be inserted through the first primary temporary bone fixation aperture 1112 and into or through the first bone 21. The first primary temporary bone fixation member 1801 and all temporary bone fixation members described herein may be K-wires or alternate wires, pins, screws, nails, or any suitable bone fixation member as desired. The bone fixation member may be threaded and configured to be threadably grasped into the underlying bone, or may be smooth and unthreaded as desired. The auxiliary temporary bone fixation member 1802 may be inserted through one of the first auxiliary temporary bone fixation holes 1111 and into or through the first bone 21. It should be appreciated that temporary bone fixation member 1802, referred to herein as an adjunct, may be used to fix cutting guide 1100 to underlying first bone 21 without first primary temporary bone fixation member 1801. Optionally, another temporary bone fixation member may be inserted through the second temporary bone fixation aperture 1117 and into or through the second bone 23.

It should be appreciated that when two temporary bone fixation members are used to temporarily fix the cutting guide 1100 to either or both of the underlying bones 21 and 23, the cutting guide 1100 is fixed in place. Thus, while fixation of the cutting guide 1100 is described with respect to insertion of the first and second temporary bone fixation members 1801, 1802, any two temporary bone fixation members may temporarily fix the cutting guide 1100 in a first orientation relative to the first bone 21.

With continued reference to fig. 55, once temporary bone fixation members 1801 and 1802 have been inserted into first bone 21 and/or second bone, the base of first bone 21 may be cut. In particular, the cutting instrument 1824 may be inserted through the cutting slot 1125 of the cutting guide 1100 and into the underlying first bone 21 to cut the base of the first bone 21. The cutting instrument may be configured as a saw blade or any suitable instrument as desired.

Referring now to fig. 56, the cutting instrument 1824 may then be removed from the cutting guide 1100, and the cutting guide 1100 may be removed from the temporary fixation members 1801 and 1802. The position of the cutting guide 1100 may then be reversed to a second orientation opposite the first orientation, whereby the first portion 1110 is aligned with the second bone 23 and the second portion 1115 is aligned with the first bone 21. The cutting slot 1125 may be aligned with a base or distal portion of the second bone 23. The bone pin 1802 may be removed from the first bone 21 prior to placing the cutting guide 1100 in the second orientation against the underlying first bone 21 and second bone 23. The second temporary bone fixation aperture 1117 of the second portion 1115 may receive the first temporary bone fixation member 1801 when the cutting guide 1100 is placed adjacent to or against the underlying first bone 21 and second bone 23. In other words, the second portion 1115 may be placed over the first temporary bone fixation member 1801. Another temporary bone fixation member 1803 may be inserted through the first primary temporary bone fixation aperture 1112 and into or through the underlying second bone 23. Yet another temporary bone fixation member 1804 may be inserted through a selected one of the first auxiliary temporary bone fixation holes 1111 and into or through the second bone 23. A selected one of the first auxiliary temporary bone fixation holes 1111 may be selected as the hole 1111 that is optimally aligned with the underlying second bone 23. The temporary bone fixation member 1804 may extend parallel to the temporary bone fixation member 1803, or may be angularly offset relative to the temporary bone fixation member 1803.

Once the temporary bone fixation member has been inserted through the cutting guide 1100 and into the underlying first bone 21 and second bone 23, the base of the second bone 23 may be cut. In particular, the cutting instrument 1824 may be inserted through the cutting slot 1125 of the cutting guide 1100 and into the underlying second bone 21 to cut the base of the second bone 21. Accordingly, the joint between the first bone 21 and the second bone 23 may be resected by cutting the first bone 21 and the second bone 23, thereby creating a resected joint 47 between the first bone 21 and the second bone 23 (see fig. 58). It should be appreciated that cutting the first and second bones 21, 23 enlarges the joint therebetween and presents respective first and second resected surfaces of the first and second bones 21, 23.

The cutting guide 1100 may then be removed, as shown in fig. 58. Prior to removing the cutting guide 1100 from the bone, particularly when the temporary bone fixation member 1804 is angularly offset relative to the temporary bone fixation member 1803, the temporary bone fixation member 1804 may be removed from the underlying second bone 23 and cutting guide 1100. When the resection guide 1100 is removed, the temporary bone fixation members 1801 and 1803 may remain fixed to the first bone 21 and the second bone 23. The spacer 1500 may be inserted into the resected joint 47 between the first bone 21 and the second bone 23 created by cutting the first bone 21 and the second bone 23, respectively. The spacer 1500 may be fitted between resected first and second faces of the first and second bones 21, 23, respectively. The spacer 1500 may be sized relatively similar to the resected surface of the first bone 21 or the second bone 23 as described above. The spacer 1500 may prevent over-compression of the first bone 21 and the second bone 23 during future compression steps. In particular, the spacer 1500 may act as a stop member that contacts the first and second resected surfaces and prevents the first and second bones 21, 23 from traveling too close together. In some embodiments, the spacer 1500 may be omitted.

Once the first and second bones 21, 23 have been cut and the spacer 1500 has been inserted, the first and second bones 21, 23 may be compressed toward one another, if desired. In particular, referring now to fig. 59, a compressor block 1400 may be applied over temporary bone fixation members 1801 and 1803, which may now be referred to as distal and proximal temporary bone fixation members, respectively. Temporary bone fixation members 1801 and 1803 may extend parallel to one another prior to application of compressor block 1400. When the compressor block 1400 is applied, the distal temporary bone fixation aperture 1415 may receive a temporary bone fixation member 1801 inserted or inserted through (referred to as at least inserted into) the first bone 21, and the proximal temporary bone fixation aperture 1410 may receive a temporary bone fixation member 1803 inserted or inserted through (referred to as at least inserted into) the second bone 23. The temporary bone fixation member 1801 may be shorter or longer than the temporary bone fixation member 1803 (e.g., about the height of the compressor block 1400 or greater, as shown in fig. 59). The height of the compressor block may be measured in a lateral direction from the bone-facing surface to the opposite outer surface (see fig. 51A). In the example of fig. 59, the compressor block 1400 may be applied to the temporary bone fixation members 1801 and 1803 by first screwing the proximal temporary bone fixation hole 1410 onto the temporary bone fixation member 1803 and by inserting the temporary bone fixation member 1801 into the distal temporary bone fixation hole 1415.

As described above, unlike the pin holes of the cutting guide 1100, the proximal and distal temporary bone fixation holes 1410, 1415 taper inwardly toward each other in the longitudinal direction as they extend from the outer surface of the cutting guide to the bone-facing surface. In particular, prior to sliding compressor block 1400 along temporary bone fixation members 1801 and 1803 toward resected joint 47, temporary bone fixation members 1803 and 1801 may be inserted into respective proximal and distal temporary bone fixation holes at the bone-facing surface, respectively. Sliding compression block 1400 over temporary bone fixation members 1801 and 1803 toward underlying first bone 21 and second bone 23 draws temporary bone fixation member 1801 proximally toward temporary bone fixation member 1803 due to the convergence angle defined by proximal temporary bone fixation hole 1410 and distal temporary bone fixation hole 1415 (referred to as converging temporary bone fixation holes).

Because the temporary bone fixation member 1801 is fixed to the first bone 21, application of the compressor block 1400 moves the first bone 21 proximally toward the second bone 23, which thereby reduces the size of the resected joint 47. When the spacer 1500 is disposed in the resected joint 47, the resected faces of the first and second bones 21, 23 contact respective faces of the spacer 1500 (or each other if no spacer is used) to an approximated position. In addition, converging temporary fixation holes 1410 and 1415 causes temporary fixation members 1801 and 1803 to rotate and translate in the sagittal plane such that the plantar side of resected joint 47 is compressed. This may be desirable because in some cases, compression only on the dorsal aspect of bones 21 and 23 may result in plantar clearance of resected joint 47, which is undesirable for fusion.

Once the bones 21 and 23 have been approximated, the inclined temporary fixation member 1805 is inserted through one of the inclined holes 1420 such that the inclined temporary fixation member 1805 travels inwardly as it travels proximally through the first bone 21, across the resected joint 47 and into the second bone 23. Thereby, the inclined temporary fixation members 1805 temporarily fix the first bone 21 and the second bone 23 in place in their approximated positions. The temporary bone fixation member 1801 and temporary bone fixation member 1803 may then be removed from the underlying bones 21 and 23 and from the compressor block 1400. The compressor block 1400 may then be removed by sliding the compressor block outward along the angled temporary fixation members 1805, which remain in place to temporarily fix the joint. Alternatively, if the compressor block 1400 includes the temporary bone fixation slot 1452 of fig. 52A-52D, the compressor block 1400 may be removed from the first and second bones 21, 23 by moving the compressor block 1400 away from the bones such that the angled temporary fixation members 1805 exit the slot 1452 from the opening at the bone-facing surface of the compressor block 1400. Any number of inclined hole tracks may be applied to compression block 1400 for placement of the inclined temporary bone fixation members.

Although the oblique temporary bone fixation hole 1420 (see fig. 51D) is shown disposed at the distal portion 1470 of the compression block 1400 in one example, the oblique temporary bone fixation hole 1420 may alternatively be disposed at the proximal portion 1403 and thus may extend inwardly as it extends distally. Accordingly, the oblique temporary fixation member 1805 may be driven to insert through the oblique temporary bone fixation aperture 1420 and driven inwardly as it extends distally through the second bone 23, the resected joint 47, and into the first bone 21 to secure the first and second bones 21, 23 in their approximated position.

Referring now to fig. 60-61, when the resected joint 47 is secured in place by the angled temporary fixation member 1805, the drill guide 1900 may be placed across the resected joint 47. The drill guide 1900 may have a first leg 1901 and a second leg 1902 that may be placed adjacent to or against the first bone 21 and the second bone 23, respectively. The drill guide 1900 may define a through hole 1903 extending through the legs 1901 and 1902. First and second guide holes 1922 and 1923 are drilled through-holes 1903 into first and second bones 21 and 23, respectively. In particular, a drill 1910 is driven through the through holes 1903 of the first and second legs 1901 and 1902 to create guide holes 1922 and 1923. In some examples, the guide holes may be aligned with apertures created by insertion of temporary bone fixation members 1801 and 1803. Drilling guide 1900 is further described in U.S. patent application No. 2018/0353172, which is incorporated by reference herein in its entirety.

Alternatively, as shown in fig. 62-63, the first and second guide holes 1922 and 1923 may be prepared by driving a hollow reamer 1930 over the temporary bone fixation members 1801 and 1803 and into the underlying first and second bones 21 and 23. Temporary bone fixation members 1801 and 1803 may then be removed. At this point, it should be appreciated that because the resected joint 47 is secured by the angled temporary bone fixation member 1805 (see fig. 59), the temporary bone fixation members 1801 and 1803 may remain in the first bone 21 and the second bone 23 during removal of the compressor block 1400. Alternatively, the temporary bone fixation members 1801 and 1803 may be removed from the first bone 21 and the second bone 23 prior to removal of the compressor block 1400, and reinserted into the bones 21 and 23 after the compressor block 1400 has been removed. Once the guide holes 1922 and 1923 have been formed, the temporary bone fixation members 1801 and 1803 may be removed from the first and second bones.

Next, referring to fig. 64-65, in order to permanently fix the first bone 21 relative to the second bone 23, a peg 1946 may be inserted across the resected joint. The term "permanent" means that fixation remains after the surgical procedure is completed. The nail 1946 can be clamped and tensioned using an applicator 1940 as shown and described in U.S. patent application No. 2018/0353172. The first leg 1947 of the nail 1946 may be inserted into the first bone 21 through the first guide hole 1922. The second leg 1949 of the nail 1946 may be inserted into the second bone 23 through the second guide hole 1923. Crossbar 1951 may extend across resected joint 47 from first leg 1947 to second leg 1949. The applicator 1940 may then release the spike 1946. Because the legs 1947 and 1949 of the nail 1946 may be elastic, when the applicator 1940 is removed, the legs are drawn together, which allows the nail 1946 to compress the resected joint 47. Nail 1946 is further described in U.S. patent publication No. 2018/0317906, which is incorporated herein by reference in its entirety. Alternatively or additionally, the resected joint 47 may be fixed using bone plates and/or cross screws or any other desired fixation device suitable for fixing the first bone 21 relative to the second bone 23. Bone plate and nail systems may be found in U.S. patent No. 10,299,842, which is incorporated by reference herein in its entirety.

Fig. 66-72 depict the joint 40 between the first bone 20 and the second bone 30. Here, the joint 40 is depicted in the bone of the foot 10. Fig. 66-72 illustrate an exemplary procedure for joint fusion including a bone plate in combination with a nail, as compared to the procedure of fig. 54-65. However, it should be understood that the process of FIGS. 66-72 may also be practiced with bone plates alone, without the inclusion of nails as a bone fixation device.

In the initial configuration of fig. 66, the joint 40 is ready for fixation, such as by cutting the facing ends of the bones 20 and 30 (e.g., using any of the cutting guides described herein). Bone pins 2002, 2004 are positioned partially within bones 20 and 30, respectively. For example, the initial configuration of fig. 66 may correspond to the configuration shown in fig. 58. Although not shown in fig. 66-72, a spacer such as spacer 1500 may be used in conjunction with the process of fig. 66-72.

Turning to fig. 67, a bone plate 2010 may be placed across joint 40 such that bone plate 2010 covers a portion of bones 20 and 30. Distal screw aperture 2012 is positioned over a portion of bone 20 and proximal screw aperture 2014 is positioned over a portion of bone 30. The middle portion of the bone plate 2010 includes a nail hole 2016 that is sized and shaped to receive a nail therethrough. In alternative embodiments, the staple aperture 2016 may have other configurations, such as an elongated open slot adapted to receive other components (such as non-staple compression plates, etc.).

As shown in fig. 68, a first bone screw 2020 may be driven into bone 30 through proximal screw aperture 2014 to initially secure bone plate 2010 to foot 10. In the configuration shown in fig. 68, bone plate 2010 is fixed relative to bone 30 but remains movable relative to bone 20 such that a compression block may be applied prior to fixing bone plate 2010 to bone 20, as shown in fig. 69. In alternative embodiments, the first bone screw 2020 may be driven into the bone 20 through the distal screw aperture 2012 instead of the proximal screw aperture 2014.

Fig. 69 depicts the application of compression block 1450 on bone pins 2002, 2004, similar to the application of compressor block 1400 in fig. 59. Sliding the compressor block 1450 downward over the bone pins 2002, 2004 draws the bone pins 2002, 2004 closer together due to the convergence angle of the pin holes 1410, 1415 of the compressor block 1450, causing the bones 20 and 30 to move closer together and into contact with each other or with the spacer if used. In some alternative embodiments, the first bone screw 2020 may be driven into the bone 20 or 30 after the compression block 1450 is applied to the bone pins 2002, 2004, rather than before the compression block is applied.

As shown in fig. 70, a second bone screw 2022 may be driven into bone 20 through distal screw aperture 2012, while compression block 1450 retains bone pins 2002 and 2004, thereby maintaining the desired compression of bones 20 and 30. Insertion of the second bone screw 2022 secures the bones 20 and 30 in the desired configuration. Compression block 1450 and bone pins 2002, 2004 may then be removed from foot 10, as shown in fig. 71. With continued reference to fig. 72, the nails 1926 may then be inserted through the nail holes 2016 of the bone plate 2010 (e.g., after preparation and/or drilling of the nails using a process such as that shown in fig. 60-63) such that the bones 20 and 30 are fixed relative to one another by the nails 1926, bone screws 2020 and 2022, and the bone plate 2010.

Fig. 73A-73E depict an exemplary bone plate 550 configured for use in the arthrodesis procedure described herein. Bone plate 500 may be formed from various metals or alloys. For example, the bone plate may be formed of titanium, shape memory alloys (such as nitinol), and the like. As will be described in greater detail, bone plate 550 may be configured to fix two adjacent rays of the foot.

Bone plate 550 is sized and shaped to be applied across. Thus, bone plate 550 includes two generally parallel bodies 555 connected by a bridge 557. Body 555 and bridge 557 may comprise a single integrally formed part. Each body 555 includes a staple aperture 560, a proximal screw aperture 565, and a distal screw aperture 570. Each of the nail apertures 560 includes two holes 562 sized and shaped to receive two legs of a bone nail such that one of the legs seats within a proximal bone, such as a wedge bone adjacent a corresponding proximal screw aperture 565, and the other leg seats within a distal bone, such as a corresponding metatarsal bone adjacent a corresponding distal screw aperture 570.

Each of the pin aperture 560 and the screw apertures 565, 570 are shaped to include a countersink to reduce movement of the pin and/or screw seated therein. In addition, the countersink may allow the nail or screw applied therein to not extend significantly above the outer surface of the body 555 of the bone plate 550. Bone-facing surface 551 of bone plate 550 may be substantially smooth. In addition, the bone plate 550 may be curved, as shown in fig. 73A-73E, to match the curvature of the bones of the midfoot. For example, as shown in fig. 73D and 73E, the bone plate 550 may have a concave curvature about both the longitudinal axis and the lateral axis.

Fig. 74 is a perspective view of the bones of foot 10, illustrating an exemplary placement of bone plate 550. As shown in fig. 74, bone plate 550 may be used to fix both the second ray and the third ray of foot 10. For example, one body 555 of the bone plate 550 secures the second wedge 35 to the second metatarsal 25, and another body 555 of the bone plate 550 secures the third wedge 37 to the third metatarsal 27, such that the bridge 557 stabilizes the second ray and the third ray of the foot relative to each other. In some embodiments, both the second and third TMT joints of the foot 10 may have been resected and prepared using any of the cutting guides described herein, or only one of the second and third TMT joints may have been resected. For example, bone plate 550 may be used to provide additional stability to the resected and immobilized joint by fixing the joint to another unresectable joint.

Each of the bodies 555 is secured to its corresponding wedge bone 35 or 37 and its corresponding metatarsal 25 or 27 by a proximal bone screw 2024 passing through a proximal screw aperture 565, a distal bone screw 2026 passing through a distal screw aperture 570, and a bone screw 2028 passing through a screw aperture 560, such that each bone screw 2028 spans the TMT joint.

The embodiments described herein are exemplary. Modifications, rearrangements, substitutions processes, etc. may be made to these embodiments and still be encompassed within the teachings set forth herein. Depending on the embodiment, certain acts, events, or functions of any of the methods described herein can be performed in a different order, may be added, combined, or eliminated altogether (e.g., not all described acts or events are necessary for the practice of the methods). Moreover, in some embodiments, acts or events may be performed concurrently, rather than sequentially.

The phrases "connected to," "coupled to," and "in communication with … …" refer to any form of interaction between two or more entities, including mechanical, electrical, magnetic, electromagnetic, fluid, and thermal interactions. The two components may be functionally coupled to each other even though they are not in direct contact with each other. The term "contiguous" refers to items that are in direct physical contact with each other, although items may not necessarily be attached together.

Unless specifically stated otherwise or otherwise understood within the context of use, conditional language such as "may," "capable," "possible," "for example," etc., as used herein are generally intended to convey that certain embodiments include but other embodiments do not include certain features, elements, and/or states. Thus, such conditional language is not generally intended to imply that features, elements and/or states are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without author input or prompting, whether these features, elements and/or states are included in or are to be performed in any particular embodiment. The terms "comprising," "including," "having," "involving," and the like are synonymous and are used inclusively in an open-ended fashion and do not exclude additional elements, features, acts, operations, etc. Moreover, the term "or" is used in its inclusive sense (rather than in its exclusive sense) such that when used, for example, to connect a series of elements, the term "or" refers to one, some, or all of the series of elements.

Unless specifically stated otherwise, disjunctive language such as the phrase "at least one of X, Y or Z" is understood herein in the context as generally used to present an article, term, etc., may be X, Y or Z or any combination thereof (e.g., X, Y and/or Z). Thus, such disjunctive language is generally not intended, and should not imply that certain embodiments require the presence of at least one X, at least one Y, or at least one Z, respectively.

An article of manufacture such as "a" or "an" should generally be construed to include one or more of the described items unless specifically stated otherwise. Thus, a device such as the phrase "configured to … …" is intended to include one or more of the recited devices. Such one or more of the recited devices may also be collectively configured to perform the recited recitation. For example, "a processor configured to execute statements A, B and C" may include a first processor configured to execute statement a in combination with a second processor configured to execute statements B and C.

While the above detailed description has shown, described, and pointed out novel features as applied to illustrative embodiments, it will be understood that various omissions, substitutions, and changes in the form and details of the device or algorithm illustrated may be made without departing from the spirit of the disclosure. As will be recognized, certain embodiments described herein may be embodied within a form that does not provide all of the features and benefits set forth herein, as some features may be used or practiced separately from others. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.

Claims

1. A method of fusing joints, the method comprising:

inserting a first temporary bone fixation member into a first bone at a first distance from a joint between the first bone and a second bone;

resecting the joint to produce a resected joint, the resecting step comprising:

cutting a base of the first bone adjacent to the joint; and

cutting a base of a second bone adjacent to the joint;

inserting a second temporary bone fixation member into the second bone at a second distance relative to the resected joint;

compressing the joint using a compressor block such that the resected surface of the first bone moves toward the resected surface of the second bone; and

after the compressing step, the first bone is permanently fixed to the second bone across the resected joint.

2. The method of claim 1, wherein the first bone is a metatarsal, the second bone is a cuneiform bone or a cuboid, and the joint is a tarsometatarsal joint.

3. The method of claim 1, further comprising placing a reversible cutting guide in a first orientation across the joint, the reversible cutting guide comprising:

a body having a first portion and an opposing second portion;

A primary temporary bone fixation hole extending through the first portion of the body;

a second temporary bone fixation hole extending through the second portion of the body parallel to the first temporary bone fixation hole; and

a cutting slot extending through the body between the first and second temporary bone fixation holes.

4. The method of claim 3, further comprising inserting an auxiliary bone fixation member into the first bone through an auxiliary bone fixation hole extending through the first portion of the reversible cutting guide.

5. The method of claim 3, wherein in the first orientation, the cutting slot is aligned with the base of the first bone, and the resecting step further comprises cutting the base of the first bone through the slot.

6. The method of claim 5, wherein the reversible cutting guide further comprises a paddle extending from the body between the first portion and the second portion of the cutting guide; and the method further comprises inserting the paddle into the joint.

7. The method of claim 5, further comprising removing the reversible cutting guide from the first orientation and placing the reversible cutting guide across the joint in a second orientation opposite the first orientation.

8. The method of claim 7, wherein in the second orientation, the primary temporary bone fixation member extends through the second temporary bone fixation hole and into a first bone, and the second temporary bone fixation member extends through the primary temporary bone fixation hole and into the second bone.

9. The method of claim 8, further comprising inserting another temporary bone fixation member into the second bone through a third temporary bone fixation of the first portion when the cutting guide is in the second orientation.

10. The method of claim 7, wherein in the second orientation, the cutting slot is aligned with the base of the second bone, and the resecting step includes cutting the base of the second bone through the cutting slot.

11. The method of claim 7, wherein the paddle is inserted into a joint and the primary temporary bone fixation hole defines a second distance relative to the joint when the cutting guide is in the second orientation.

12. The method of claim 1, further comprising inserting a spacer into the resected joint between the first bone and the second bone prior to compressing the joint.

13. The method of claim 1, wherein the compressor block comprises:

a block body having a bone-facing surface and an opposing outer surface;

a proximal temporary bone fixation hole extending through the body from the outer surface to the bone facing surface at a first angle less than 90 degrees relative to the top and bottom surfaces; and

a distal temporary bone fixation hole extending through the body from the outer surface to the bone facing surface at the first angle relative to the outer surface and the bone facing surface, wherein the proximal bone fixation hole and the distal bone fixation hole converge as they extend from the outer surface to the bone facing surface.

14. The method of claim 13, wherein compressing the joint comprises:

inserting a proximal temporary bone fixation member into the proximal temporary bone fixation aperture at the bone-facing surface;

inserting a distal temporary bone fixation member into the distal temporary bone fixation hole at the bone-facing surface;

Sliding the compressor block along the proximal and distal temporary bone fixation members toward the joint.

15. The method of claim 14, wherein the compressor block further comprises an angled bore extending therethrough, the angled bore defining a linear path through the joint when the compressor block is aligned on the temporary bone fixation member proximate the joint, and the method further comprises inserting an angled temporary fixation member through the angled bore and through the joint.

16. The method of claim 15, further comprising removing the oblique temporary fixation member after permanently fixing the first bone to the second bone.

17. The method of claim 1, wherein the step of permanently fixing the first bone to the second bone comprises placing a nail over the joint such that a first leg of the nail is inserted into the first bone and a second leg of the nail is inserted into the second bone.

18. The method of claim 17, wherein placing the staples comprises:

positioning a guide leg of a drill guide over the first bone;

Pre-drilling a first pilot hole in the first bone through a first pilot leg;

positioning a second guide leg of the drill guide over the second bone;

pre-drilling a second pilot hole in the second bone through the second pilot leg; and

the first leg of the staple is inserted into the first guide hole and the second leg of the staple is inserted into the second guide hole.

19. The method of claim 18, wherein placing the staples further comprises:

the temporary bone fixation member is removed and the guide hole is pre-drilled at the insertion location of the temporary bone fixation member.

20. The method of claim 1, wherein placing the peg comprises:

pre-drilling a first pilot hole in the first bone above the first temporary bone fixation member using a hollow reamer;

pre-drilling a second pilot hole in the second bone above the second temporary bone fixation member using the hollow reamer;

21. The method of claim 1, wherein a bone plate and a plurality of bone screws are used to fix the joint, and wherein at least one bone screw of the plurality of bone screws is a cross screw extending at an angle less than 90 degrees relative to the bone plate.

22. The method of claim 1, comprising, prior to compressing the joint:

sliding the bone plate over the first pin and the second pin; and

a first screw is inserted into the first bone or the second bone through a first aperture in the bone plate.

23. The method of claim 22, comprising inserting a second screw through a second aperture in the bone plate into the other of the first bone or the second bone after compressing the joint.

24. The method of claim 23, comprising inserting a compression pin through the bone plate.