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WO2024074935A1 - Système et procédure de guidage de repositionnement osseux - Google Patents

Système et procédure de guidage de repositionnement osseux Download PDF

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Publication number
WO2024074935A1
WO2024074935A1 PCT/IB2023/059538 IB2023059538W WO2024074935A1 WO 2024074935 A1 WO2024074935 A1 WO 2024074935A1 IB 2023059538 W IB2023059538 W IB 2023059538W WO 2024074935 A1 WO2024074935 A1 WO 2024074935A1
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WO
WIPO (PCT)
Prior art keywords
bone
guide
distal
proximal
wire
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IB2023/059538
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English (en)
Inventor
Chad Hollis
Daniel SAYGER
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Crossroads Extremity Systems LLC
Original Assignee
Crossroads Extremity Systems LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US17/938,289 external-priority patent/US20230043795A1/en
Application filed by Crossroads Extremity Systems LLC filed Critical Crossroads Extremity Systems LLC
Publication of WO2024074935A1 publication Critical patent/WO2024074935A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1775—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the foot or ankle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/14—Surgical saws
    • A61B17/15—Guides therefor
    • A61B17/151—Guides therefor for corrective osteotomy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/846—Nails or pins, i.e. anchors without movable parts, holding by friction only, with or without structured surface
    • A61B17/848—Kirschner wires, i.e. thin, long nails
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0642—Surgical staples, i.e. penetrating the tissue for bones, e.g. for osteosynthesis or connecting tendon to bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8897—Guide wires or guide pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/564—Methods for bone or joint treatment
    • A61B2017/565—Methods for bone or joint treatment for surgical correction of axial deviation, e.g. hallux valgus or genu valgus

Definitions

  • the present invention generally relates to surgical systems and procedures for correcting alignment between two bones or bone segments spanning a joint or an osteotomy, and particularly relates to surgical systems and procedures for correcting a bunion in a patient’s foot.
  • Bone misalignment and/or deformation can be a source of discomfort and reduced mobility in patients, particularly in a patient’s feet.
  • One particularly common foot disorder is a bunion.
  • Bunions are a progressive disorder, typically beginning with a leaning of the great toe. The leaning of the great toe may gradually change an angle of the bones and produce a characteristic bump on the medial side of the metatarsal near the joint of the metatarsal with the proximal phalanx.
  • the bunion is the prominence made of bone and at times an inflamed bursa.
  • Hallux valgus is the condition in which the great toe deviates from the normal position toward the direction of the second toe. Accordingly, the present invention is directed to surgical systems and procedures for correction of bunions, Hallux valgus, and for bone realignments more generally.
  • a method for correcting alignment between a first bone and a second bone by fusing a joint between the first bone and the second bone includes providing a first guide.
  • the first guide includes a first end portion with a first cannula aligned along a first axis.
  • a second end portion has a second cannula aligned along a second axis.
  • the first axis is non-parallel with the second axis.
  • the first axis is configured to intersect the first bone and the second axis is configured to intersect the second bone when the first and second bones are in a deformed configuration.
  • a first k-wire is inserted through the first cannula and into the first bone.
  • a second k-wire is inserted through the second cannula and into the second bone.
  • the first guide is removed from the first and second k-wires.
  • a second guide includes a first end portion with a first cannula.
  • a second end portion has a second cannula.
  • the first cannula is parallel with the second cannula.
  • the second guide slides over the first and second k-wires.
  • the first k-wire is received within the first cannula of the second guide and the second k-wire is received within the second cannula of the second guide.
  • the second guide acts on the first and second k-wires to re-align the first and second bones into a corrected configuration.
  • the method includes fixing the first and second bones in the corrected configuration and removing the second guide and the first and second k-wires from the first and second bones.
  • the method includes fixing the first and second bones in the corrected configuration includes inserting a first stabilizing wire into the first and second bones.
  • the method includes attaching a first end of a bone plate with the first bone and a second end of the bone plate with the second bone such that the first and second bones are retained in the corrected configuration. [0009] In another aspect, the method includes inserting a bone plate clip into the first and second bones.
  • the method includes resecting a first end of the first bone.
  • the first end portion of the first guide includes a third cannula aligned parallel with the first axis.
  • the method includes inserting a third k-wire into the first bone through the third cannula and resecting the first end of the first bone includes inserting a first resecting guide over the first and third k-wires to align the first resecting guide with the first end of the first bone.
  • the method includes resecting a first end of the second bone.
  • the second end of the first guide includes a fourth cannula aligned parallel with the second axis.
  • the method includes resecting the first end of the second bone.
  • the method includes inserting a second resecting guide over the second k-wire and a fourth k-wire inserted in the second bone to align the second resecting guide with the first end of the second bone.
  • the first bone is a metatarsal
  • the second bone is a medial cuneiform bone
  • the deformed configuration of the first and second bones includes a bunion
  • the corrected configuration of the first and second bones corrects the bunion.
  • the second guide adjusts an angle of the first bone in three orthogonal planes between the deformed configuration and the corrected configuration.
  • the second guide adjusts a position of the first bone in three orthogonal planes between the deformed configuration and the corrected configuration.
  • the method includes centering the first guide between the first bone and the second bone by inserting a centering k-wire through a centering cannula on the first guide.
  • the method includes removing the first guide from the first and second k-wires includes at least partially disassembling the first guide.
  • the method includes scanning the first bone and the second bone in the deformed configuration to render a 3D model thereof including a first virtual bone and a second virtual bone in a virtual deformed configuration, adjusting the first virtual bone and the second virtual bone in the 3D model to align the first virtual bone and the second virtual bone in a virtual corrected configuration, fixing a first virtual axis relative to the first virtual bone and fixing a second virtual axis relative to the second virtual bone in the virtual corrected configuration, the first virtual axis is parallel with the second virtual axis, and returning the first and second virtual bones to the virtual deformed configuration, the first and second virtual axes defining a correction factor therebetween in the virtual deformed configuration.
  • the method includes identifying a virtual resection plane where the first virtual bone and the second virtual bone overlap in the virtual corrected configuration, and fixing the first virtual axis relative to the first virtual bone includes aligning the first virtual axis parallel with the virtual resection plane.
  • the method includes forming the first guide based on the correction factor.
  • the correction factor includes a first virtual vector passing through a first virtual point in a virtual coordinate plane and a second virtual vector passing through a second virtual point in the virtual coordinate plane.
  • forming the first guide includes correlating the virtual coordinate plane with a coordinate plane of the first guide such that the first axis corresponds with the first virtual vector and the first virtual point and the second axis aligned corresponds with the second virtual vector and the second virtual point.
  • each of the correction factors includes a position vector and two direction vectors corresponding to the first and second axis of the respective guides within the plurality of guides.
  • the first guide is selected from a plurality of guides, each of the plurality of guides has a different angle between the first and second axes.
  • a method of manufacturing a kit for correcting alignment between a first bone and a second bone includes receiving a correction factor, the correction factor including a first virtual vector passing through a first virtual point in a virtual coordinate plane and a second virtual vector passing through a second virtual point in the virtual coordinate plane.
  • a first guide is formed based on the correction factor, the first guide including a first end portion having a first cannula aligned along a first axis and a second end portion having a second cannula aligned along a second axis.
  • the first axis corresponds to the first virtual vector and the first virtual point and the second axis corresponds to the second virtual vector and the second virtual point, the first and second axes is non-parallel.
  • the first guide is configured such that a first k-wire inserted through the first cannula intersects the first bone and a second k-wire inserted through the second cannula intersects the second bone in a deformed configuration.
  • the method includes receiving dimensions of a second guide, the second guide including a first end portion with a first cannula and a second end portion with a second cannula.
  • the first cannula is parallel with the second cannula.
  • the first guide is configured such that when sliding the second guide over the first and second k-wires, the first and second k-wires are received within the respective first and second cannula of the second guide and the second guide re-aligns the first and second bones into a corrected configuration.
  • the method includes receiving a scan of the first bone and the second bone in the deformed configuration to render a 3D model thereof including a first virtual bone and a second virtual bone in a virtual deformed configuration.
  • the first virtual bone and the second virtual bone are adjusted in the 3D model to align the first virtual bone and the second virtual bone in a virtual corrected configuration.
  • a first virtual axis is fixed relative to the first virtual bone and a second virtual axis is fixed relative to the second virtual bone in the virtual corrected configuration.
  • the first virtual axis is parallel with the second virtual axis.
  • the first and second virtual bones are returned to the virtual deformed configuration along with the first and second virtual axes defining the first and second virtual vectors and the first and second virtual points, respectively, of the correction factor.
  • the method includes identifying a virtual resection plane where the first virtual bone and the second virtual bone overlap in the virtual corrected configuration and fixing the first virtual axis relative to the first virtual bone includes aligning the first virtual axis parallel with the virtual resection plane.
  • a kit for correcting alignment between a first bone and a second bone by fusing a joint between the first bone and the second bone includes a first guide.
  • the first guide includes a first end portion with a first cannula aligned along a first axis and a second end portion with a second cannula aligned along a second axis.
  • the first axis is non-parallel with the second axis.
  • the first guide is configured such that inserting a first k-wire through the first cannula intersects the first bone and inserting a second k-wire through the second cannula intersects the second bone when the first and second bones are in a deformed configuration.
  • a second guide includes a first end portion with a first cannula and a second end portion with a second cannula. The first cannula can be parallel with the second cannula.
  • the second guide is configured such that when the first k-wire is fixed within the first bone and the second k-wire is fixed within the second bone in the deformed configuration, sliding the second guide over first and second k- wires, with the first and second k-wires is received within the respective first and second cannula of the second guide, re-aligns the first and second bones into a corrected configuration.
  • a stabilizing wire fixes the first and second bones in the corrected configuration by insertion into the first and second bones.
  • a bone plate with a first end configured to be attached with the first bone and a second end of the bone plate configured to be attached with the second bone retains the first and second bones in the corrected configuration.
  • a bone plate clip inserts into the first and second bones in the corrected configuration.
  • a first resecting guide aligns a resecting tool with a resection location on the first bone.
  • the first resecting guide includes first and second cannulas configured to be advanced over the first k-wire and a third k-wire, the third k-wire is parallel with the first k-wire.
  • a second resecting guide aligns the resecting tool with a resection location on the second bone.
  • a method for correcting alignment between a first bone and a second bone by fusing a joint between the first bone and the second bone includes aligning a first end portion of a first guide with the first bone.
  • the first end portion has a first cannula and a second cannula aligned in a first direction.
  • a first k-wire is inserted through the first cannula and into the first bone and a second k-wire through the second cannula and into the first bone.
  • a first end of the first bone is resected through a slot to form a first resected face. The slot aligns with the first end of the first bone by the first and second k-wires.
  • a third k-wire and a fourth k-wire insert through the first guide into the second bone.
  • a first end of the second bone is resected to form a second resected face.
  • a second guide slides over the first, second, third and fourth k-wires to adjust a position of the first and second bones such that the first and second resected faces abut in a corrected configuration.
  • the first and second bones are fixed in the corrected configuration.
  • the method includes fixing the first and second bones in the corrected configuration by inserting a stabilizing wire into the first and second bones.
  • the method includes fixing the first and second bones in the corrected configuration by attaching a first end of a bone plate with the first bone and a second end of the bone plate with the second bone such that the first and second bones are retained in the corrected configuration.
  • the method includes sliding the second guide over the first, second, third and fourth k-wires to translate the first resected face towards the second resected face.
  • the method includes sliding the second guide over the first, second, third and fourth k-wires to rotate alignment between the first bone and the second bone.
  • the third k-wire and the fourth k-wire are inserted into the second bone through a second end portion of the first guide including a third cannula and a fourth cannula.
  • the third and fourth cannula are aligned in a second direction.
  • the first end of the second bone is resected through the slot.
  • the slot is aligned with the first end of the second bone by the third and fourth k-wires.
  • the slot is on a resection guide including first and second apertures configured to align with the first and second k-wires.
  • the first bone is a metatarsal
  • the second bone is a medial cuneiform bone and the corrected configuration of the first and second bones corrects a bunion.
  • the second guide adjusts an angle of the first bone in three orthogonal planes between a deformed configuration and the corrected configuration.
  • the method includes removing the first guide from the first and second k-wires after resecting the first end of the second bone to form the second resected face.
  • the method includes removing the second guide and the first, second, third, and fourth k-wires from the first and second bones after fixing the first and second bones in the corrected configuration.
  • a method for correcting alignment between a first bone and a second bone by fusing a joint between the first bone and the second bone includes positioning a cutting guide in a first position proximate to a first end of the first bone, the cutting guide including a cutting slot and a first and second cannula through the cutting guide.
  • the cutting guide in the first position includes a first and second k-wire positioned through the first and second cannula and into the first bone.
  • a first end of the first bone is resected through the cutting slot to form a first resected face.
  • the cutting guide is removed from the first and second k-wires.
  • the cutting guide is positioned in a second position proximate to a first end of the second bone.
  • the cutting guide in the second position includes a third and fourth k-wires positioned through the first and second cannula and into the second bone.
  • a first end of the second bone is resected through the cutting slot to form a second resected face.
  • the cutting guide is removed from the third and fourth k-wires.
  • a second guide slides over the first, second, third and fourth k-wires.
  • the second guide adjusts a position of the first and second bones such that the first and second resected faces abut in a corrected configuration.
  • the first and second bones are fixed in the corrected configuration.
  • fixing the first and second bones in the corrected configuration includes inserting a stabilizing wire into the first and second bones.
  • fixing the first and second bones in the corrected configuration includes attaching a first end of a bone plate with the first bone and a second end of the bone plate with the second bone such that the first and second bones are retained in the corrected configuration.
  • sliding the second guide over the first, second, third and fourth k-wires translates the first resected face towards the second resected face.
  • sliding the second guide over the first, second, third and fourth k-wires rotates the first bone relative to the second bone to adjust an alignment therebetween.
  • Fig. 1 shows a top view of a patient’s foot in a deformed configuration
  • Fig. 2 A shows a front perspective view of the alignment guide
  • Fig. 2B shows a rear perspective view of the alignment guide
  • Fig. 3 A shows a front view of the alignment guide.
  • Fig. 3B shows a section view taken along the line 3B-3B of Fig. 3 A;
  • Fig. 4 shows an exploded view of the alignment guide
  • Fig. 5 shows an angle between cannula of the alignment guide
  • Fig. 6 shows a second angle between cannula of the alignment guide
  • Fig. 7 shows a third angle between cannula of the alignment guide
  • Fig. 8 shows an alignment guide aligned with a medial cuneiform bone and a metatarsal bone in the patient’s foot;
  • Fig. 9 shows insertion of a plurality of k-wires into the medial cuneiform bone and the metatarsal bone through the alignment guide;
  • Fig. 10A shows the removal of tubes of the alignment guide
  • Fig. 10B shows the removal of the alignment guide from the k-wires
  • FIG. 11 A is a perspective view of an alignment guide including a guide body and an insert in accordance with an alternative embodiment
  • FIG. 1 IB is another perspective view of the alignment guide illustrated in Fig. 11 A;
  • Fig. 12A is a perspective view of the guide body of Fig. 11A;
  • Fig. 12B is another perspective view of the guide body of Fig. 11A;
  • Fig. 12C is another perspective view of the guide body of Fig. 11A;
  • Fig. 12D is another perspective view of the guide body of Fig. 11A;
  • Fig. 12E is a side elevation view of the guide body of Fig. 11 A;
  • Fig. 12F is another side elevation view of the guide body of Fig. 11A;
  • Fig. 12G is a top plan view of the guide body of Fig. 11 A;
  • Fig. 12H is a bottom plan view of the guide body of Fig. 11 A;
  • Fig. 121 is a front elevation view of the guide body of Fig. 11A;
  • Fig. 12J is a rear elevation view of the guide body of Fig. 11A;
  • Fig. 13A is a perspective view of the insert of Fig. 11 A;
  • Fig. 13B is an exploded perspective view of the guide body and the insert of Fig. 11 A;
  • Fig. 14A is a perspective view showing insertion of a joint k-wire into a tarsometatarsal (TMT) joint;
  • Fig. 14B is a perspective view of the joint k-wire of Fig. 14 A;
  • Fig. 14C is an enlarged perspective view of a distal end portion of the joint k-wire of Fig. 14B;
  • Fig. 14D is a perspective view of a joint k-wire constructed in accordance with another example
  • Fig. 14E is a perspective view showing insertion of a guide body illustrated in Fig. 11 A onto the joint k-wire shown in Fig. 14A;
  • Fig. 14F is a perspective view showing the insert of Fig. 11 A inserted into the guide body of Fig. 14E, and k-wires driven through the alignment guide and into the patient’s foot;
  • Fig. 14G is a perspective view showing the insert removed from the guide body
  • Fig. 14H is a perspective view of the guide body removed from the patient’s foot;
  • Fig. 15 A shows a perspective view of a resection guide
  • Fig. 15B shows a front view of the resection guide
  • Figs. 16A shows the alignment guide removed
  • Figs. 16B shows installation of a first resection guide
  • FIG. 17 shows the installation of a second resection guide
  • Fig. 18A shows a perspective view of the correction guide
  • Fig. 18B shows a top view of the correction guide
  • Fig. 18C is a cross-sectional view of a correction guide in another example.
  • Figs. 19A shows a correction guide assembled over the plurality of k-wires to align the medial cuneiform bone and the metatarsal bone of the patient’s foot into a corrected configuration
  • Figs. 19B is another view showing the correction guide of Fig. 19A assembled over the plurality of k-wires to align the medial cuneiform bone and the metatarsal bone of the patient’s foot into a corrected configuration;
  • Fig. 20 shows the insertion of first and second fixing k-wires into the medial cuneiform bone and the metatarsal bone.
  • Fig. 21 shows the patient’s foot with the plurality of k-wires removed
  • Fig. 22 shows an exploded view of a bone plate assembly aligned with the medial cuneiform bone and the metatarsal bone in the corrected configuration
  • Fig. 23 shows a top view of a bone plate
  • Fig. 24 shows a side view of the bone plate
  • Fig. 25 shows the bone plate assembly assembled with the medial cuneiform bone and metatarsal bone in the corrected configuration
  • Fig. 26 shows a side view of the patient’s foot in the corrected configuration
  • Fig. 27 shows a method of calculating a correction factor using a virtual model
  • Fig. 28A shows the virtual model in a virtual deformed configuration
  • Fig. 28B shows the virtual model adjusted into a virtual corrected configuration
  • Fig. 28C shows fixing two virtual axes in a first virtual bone and a second virtual bone, respectively, in the virtual corrected configuration
  • Fig. 28D shows the virtual model returned to the virtual deformed configuration with the resultant orientation of the two virtual axes defining a correction factor for the virtual model
  • Fig. 29 shows a method of manufacturing an alignment guide based on the correction factor
  • Fig. 30A is a top perspective view of an auxiliary correction guide in one example
  • Fig. 30B is another top perspective view of an auxiliary correction guide of Fig. 30A;
  • Fig. 30C is another top perspective view of an auxiliary correction guide of Fig. 30A;
  • Fig. 30D is another top perspective view of an auxiliary correction guide of Fig. 30A;
  • Fig. 30E is a bottom perspective view of an auxiliary correction guide of Fig. 30A;
  • FIG. 3 OF is another bottom perspective view of an auxiliary correction guide of Fig. 30A;
  • Fig. 30G is another bottom perspective view of an auxiliary correction guide of Fig. 30A;
  • Fig. 3 OH is another bottom perspective view of an auxiliary correction guide of Fig. 30A;
  • Fig. 301 is a side elevation view of the auxiliary correction guide of Fig.
  • Fig. 30J is an opposite side elevation view of the auxiliary correction guide of Fig. 30A;
  • Fig. 30K is a top plan view of the auxiliary correction guide of Fig. 30A;
  • Fig. 30L is a bottom plan view of the auxiliary correction guide of Fig. 30A;
  • Fig. 30M is a front elevation view of the auxiliary correction guide of Fig. 30 A;
  • Fig. 30N is a rear elevation view of the auxiliary correction guide of Fig. 30 A;
  • Fig. 300 is a perspective view of an auxiliary correction guide that is a mirror image of the auxiliary correction guide of Figs. 30A-30N;
  • Fig. 31 A is a front elevation view of a correction guide assembled over a plurality of k- wires to align the medial cuneiform bone and the metatarsal bone of the patient’s foot into a corrected configuration;
  • Fig. 3 IB is a front elevation view of an auxiliary correction guide assembled over the plurality of k-wires of Fig. 31 A to positionally adjust the metatarsal bone with respect to the medial cuneiform bone from the corrected configuration to an adjusted configuration;
  • Fig. 32A shows a side view of another implementation of an alignment guide
  • Fig. 32B shows a top view of the alignment guide of Fig. 32A;
  • Fig. 33 shows an exploded view of the alignment guide of Fig. 32A;
  • Fig. 34A shows a perspective view of another implementation of a resection guide
  • Fig. 34B shows a front view of the resection guide of Fig. 34A
  • Fig. 35 shows alignment of the alignment guide of Fig. 32A with a patient’s foot.
  • Fig. 36 shows insertion of a plurality of k-wires into a medial cuneiform bone and a metatarsal bone through the alignment guide;
  • Fig. 37 shows a partial disassembly of the alignment guide
  • Fig. 38 shows the alignment guide removed and the installation of the resection guide of Figure 34A;
  • Fig. 39 shows a correction guide assembled over the plurality of k-wires to align the medial cuneiform bone and the metatarsal bone of the patient’s foot into a corrected configuration and the insertion of a fixing k-wire.
  • Fig. 40 shows a bone plate assembly assembled with the medial cuneiform bone and metatarsal bone in the corrected configuration.
  • Bunion correction or repair is a common surgery with over 100,000 surgeries performed annually in the US.
  • Many surgical procedures for bunion repair are invasive and painful, requiring an incision of several inches and a long period of convalescence, of up to 10-12 weeks.
  • Minimally invasive surgery has been performed in orthopedics for decades.
  • One common procedure is known as a Lapidus bunionectomy.
  • the bunion is corrected at the great toe by adjusting alignment at the first tarsometatarsal joint.
  • the metatarsal can also be stabilized using bone screws and/or a plate to facilitate fusion between the metatarsal and the medial cuneiform bone.
  • Fig. 1 shows a skeletal view of a patient’s foot 100 having one or more bones in an initial or deformed configuration 102.
  • the deformed configuration 102 can be a bunion, as illustrated.
  • the deformed configuration can be a post-traumatic malunion of a fracture, or other single bone deformity that can be corrected across an osteotomy.
  • the deformed configuration 102 can be a misalignment between a metatarsal 108 and a phalanx 112 of the patient’s great toe.
  • the metatarsal 108 can be at an angle with respect to the phalanx at 112.
  • a high degree of misalignment between the metatarsal 108 and the phalanx 112 can lead to severe pain and rubbing and discomfort and other problems in the patient’s foot 100. Accordingly, it can be beneficial to correct the alignment between the metatarsal 108 and the phalanx 112 of the great toe.
  • the patient’s foot 100 can further include a medial cuneiform bone 104.
  • the medial cuneiform bone 104 can be connected with a proximal end of the first metatarsal 108 (e.g., by one or more ligaments).
  • a tarsometatarsal (TMT) joint joins the medial cuneiform bone 104 to the first metatarsal 108.
  • TMT tarsometatarsal
  • FIG. 1-22 illustrate systems and methods of correcting alignment between the medial cuneiform bone 104 and the metatarsal 108.
  • proper alignment between the medial cuneiform bone 104 and the metatarsal 108 can correct alignment between the metatarsal 108 and the phalanx 112.
  • the deformed configuration 102 of the patient’s foot 100 can be corrected.
  • the present disclosure relates to systems and methods for correcting the deformed configuration 102.
  • the systems and methods described herein can be used more generally for correcting alignment between any two bones a patient’s body.
  • the system for correcting alignment in the patient’s foot 100 can include an alignment guide 200.
  • the alignment guide 200 can be formed of a rigid material.
  • the alignment guide 200 can include a first end portion 204.
  • the first end portion 204 can include one or more apertures 210a, 212a. Although two apertures are described and illustrated, more or fewer apertures can be included on the first end portion 204.
  • the apertures 210a, 212a can include internal threads 221, 222, respectively.
  • the apertures 210a, 212a can be chamfered on one or both sides of the alignment guide 200.
  • the apertures 210a, 212a can extend all the way through the alignment guide 200.
  • the apertures 210a, 212a can be aligned along respective axes 230, 232.
  • the axes 230, 232 can be parallel.
  • the axes 230, 232 can be converging.
  • the axes 230, 232 can be spaced apart a distance 204a.
  • the distance 204a can be based on a length of the medial cuneiform bone 104.
  • the alignment guide 200 can define at least one proximal cannula 213 (see Fig. 5), such as first and second proximal cannulas 210 and 212.
  • the first and second cannulas 210 and 212 can be referred to as first and second proximal cannulas, respectively.
  • the alignment guide 200 can include one or more removable tubes 240, 242.
  • the removable tubes 240 can include a first end 240a and a second end 240b.
  • the first end 240a can be received within the aperture 210a.
  • the removable tube 240 can include a threaded portion 244.
  • the threaded portion 244 can engage with the internal threads 221 of the aperture 210a.
  • the removable tubes 242 can include a first end 242a and a second end 242b.
  • the first end 242a can be received within the aperture 212a.
  • the removable tube 240 can include a threaded portion 246.
  • the threaded portion 246 can engage with the internal threads 222 of the aperture 212a.
  • the removable tube 240 can define the first cannula 210. When installed within the aperture 210a, the first cannula 210 can be aligned along the axis 230 of the aperture 210a.
  • the removable tube 242 can define the second cannula 212. When installed within the aperture 212a, the second cannula 212 can be aligned along the axis 232 of the aperture 212a.
  • the first and second cannulas 210 and 212 can define different diameters therethrough.
  • the cannula 212 can have a greater diameter than the cannula 210 (or vice- versa).
  • the first and second cannulas 210 and 212 can define the same different diameters therethrough.
  • the first and second cannulas 210 and 212 can define varying diameters therethrough.
  • the alignment guide 200 can include a second portion 208.
  • the second end portion 208 can include at least one distal cannula 215 such as third and fourth cannulas 214 and 216.
  • the second portion 208 can define a distal end portion of the alignment guide 200, and the at least one cannula can define at least one distal cannula.
  • the third and fourth cannulas 214 and 216 can be defined through a body of the alignment guide 200 and/or through respect extensions 219, 218 thereof. Although two cannula are described and illustrated, more or fewer cannulas can be included on the second end portion 208.
  • the second end portion 208 can include removable inserts or removable portions (e.g., removable tubes) around the third and fourth cannula 214 and 216.
  • the third and fourth cannulas 214 and 216 can also be referred to as first and second distal cannulas 214 and 216 respectively.
  • the third and fourth cannulas 214 and 216 can extend all the way through the alignment guide 200 (e.g., including the extensions 218, 219).
  • the third and fourth cannulas 214 and 216 can define different diameters therethrough.
  • the third cannula 214 can have a greater diameter than the fourth cannula 216 (or vice-versa).
  • the third and fourth cannulas 214 and 216 can define the same different diameters therethrough.
  • the third and fourth cannulas 214 and 216 can define varying diameters therethrough.
  • the third and fourth cannula 214 and 216 can be aligned along respective parallel axes 234, 236.
  • the axes 234, 236 can be spaced apart a distance 208a.
  • the distance 204a can be based on a length of the metatarsal bone 108.
  • Figs. 5-7 shows the assembled alignment guide 200.
  • the first end portion 204 can define a position and orientation of a first set of cannula (e.g., cannula 210, 212).
  • the second end portion 208 can define a position and orientation of a second set of cannula (e.g., the third and fourth cannula 214 and 216).
  • the first set of cannula and the second set of cannula can be offset from each other and/or angled with respect to each other.
  • Fig. 5 shows an angle a between the axis 230 of the first cannula 210 and the axis 236 of the fourth cannula 216.
  • the angle a defines the relative orientation angle between the first set of cannula on the first end 204 and the second set of cannula on the second end 208.
  • the angle a can be defined in an z-x plane in a Cartesian coordinate system (having x, y, and z axes).
  • the cannula first 210 can include a point PA.
  • the point PA can be any fixed position along the first cannula 210.
  • the point PA can have an x, y, and z coordinate location in a Cartesian coordinate system (having x, y, and z axes).
  • the cannula 216 can include a point PB.
  • the point PB can be any fixed position along the fourth cannula 216.
  • the point PB can have an x, y, and z coordinate location in the Cartesian coordinate system.
  • the points PA and PB can define a relative position of the axes 230, 236 in the Cartesian coordinate system.
  • Fig. 6 shows an angle 0 between the axis 230 of the first cannula 210 and the axis 236 of the fourth cannula 216.
  • the angle 0 defines the relative orientation angle between the first set of cannula on the first end 204 and the second set of cannula on the second end 208 in a y-x plane.
  • Fig. 7 shows an angle y between the axis 230 of the first cannula 210 and the axis 236 of the fourth cannula 216.
  • the angle y defines the relative orientation angle between the first set of cannula on the first end 204 and the second set of cannula on the second end 208 in a y-z plane.
  • the relative positions of the points PA and PB and at least two of the relative angles a, 0, and y can define the axis of the cannula on the alignment guide 200.
  • Using the proper selection of the relative angles a, 0, and/or y, and/or the relative positions of the points PA and PB of the alignment guide 200 can be used to correctly align the bones in the patient’s foot 100, as described further below.
  • the alignment guide 200 can be aligned with the patient’s foot 100.
  • the first end portion 204 can be generally aligned with the medial cuneiform bone 104.
  • the second end portion 208 can be generally aligned with the metatarsal 108.
  • a plurality of temporary fixation elements such as k- wires 250 can be extended through respective cannula of the alignment guide 200. At least one of the k-wires can extend through a respective cannula and into the respective medial cuneiform 104, and at least another of the k-wires can extend through a respective cannula of the alignment guide 200 and into the metatarsal bone 108.
  • At least one proximal temporary fixation device such as at least one proximal k-wire, can be inserted through the at least one proximal cannula of the alignment guide 200 and into the cuneiform bone 104.
  • a first k-wire 252 can be driven through the cannula 210 and into the medial cuneiform 104.
  • the first k-wire 252 can be inserted at a first insertion point 254 on the medial cuneiform bone 104.
  • a second k-wire 256 can be driven through the cannula 212 and into the medial cuneiform bone 104.
  • the second k-wire 256 can be inserted through the medial cuneiform bone 104 at a second insertion point 258.
  • the first and second k-wires 252 and 256 can be referred to as first and second proximal k-wires respectively.
  • the first and second insertion points 254 and 258 can be referred to as proximal insertion points.
  • At least one distal temporary fixation device such as at least one distal k- wire, can be inserted through the at least one distal cannula of the alignment guide 200 and into the metatarsal 108.
  • a third k-wire 260 can be driven through the cannula 214 and into the metatarsal 108.
  • the third k-wire 260 can intersect and be inserted into the metatarsal 108 at a third insertion point 262.
  • a fourth k-wire 264 can be driven through the fourth cannula 216 and into the metatarsal 108.
  • the fourth k-wire 264 can be inserted into the metatarsal 108 at a fourth insertion point 266.
  • the third and fourth k-wires 260 and 264 can be referred to as first and second distal k-wires respectively.
  • the third and fourth insertion points 262 and 266 can be referred to as first and second distal insertion points respectively.
  • the alignment guide 200 can be positioned such that the first and second cannulas 210 and 212 and the third and fourth cannulas 214 and 216, and thus the first and second k-wires 252 and 256 and the third and fourth k-wire 260 and 264, extend medially from the medial cuneiform bone 104 and the first metatarsal 108, respectively.
  • the alignment guide 200 can be positioned such that the first and second cannulas 210 and 212 and the third and fourth cannulas 214 and 216, and thus the first and second k-wires 252 and 256 and the third and fourth k-wire 260 and 264, extend superiorly from the medial cuneiform bone 104 and the first metatarsal 108, respectively, as described below with respect to the alignment guide 300 (see Figs. 11A-14E).
  • the first and second k-wires 252, 256 can be parallel with each other, based on the parallel cannula 210, 212.
  • the third and fourth k-wires 260, 264 can be parallel with each other, based on the cannula 214, 216.
  • One or more of the insertion points 254, 258, 262, 266 e.g., at least one on each bone 104, 108) can be in predetermined locations on the patient’s foot.
  • the lengths of the extensions 218, 219 and/or the tubes 240, 242 can provide greater stability to the k-wires 250 that are received therein.
  • Diameters of the k-wires 250 can be sized according to the diameters of the respective cannula of the alignment guide 200 to ensure accurate insertion at angles into the bone 104, 108. Moreover, the k-wires 250 can be matched to the correct cannula based on different diameter sizes.
  • the first and second k-wires 252 and 256 can be referred to as proximal k- wires 251, and the third and fourth k-wires 260 and 264 can be referred to as distal k-wires 253 that are disposed distal of the proximal k-wires 251.
  • the first and second cannulas 210 and 212 of the alignment guide 200 can be referred to as proximal cannulas of the alignment guide.
  • the third and fourth cannulas 214 and 216 of the alignment guide can be referred to as distal cannulas of the alignment guide 200 that are disposed distal of the proximal cannulas of the alignment guide 200.
  • the proximal k-wires 251 are configured to be inserted into respective ones of the proximal cannulas 213 and into the cuneiform bone 104.
  • the distal k-wires 253 are configured to be inserted into respective ones of the distal cannulas and into the metatarsal 108. While the system can include two proximal k-wires 251 and two distal k-wires 253 in one example, it should be appreciated that the system can include any number of proximal and distal k-wires including at least one.
  • At least one proximal k- wire 251 can be inserted through at least one proximal cannula 213 and into the cuneiform bone 104, and at least one distal k-wire 253 can be inserted through at least one distal cannula 215 and into the metatarsal 108.
  • Fig. 10A-10B show removal of the tubes 240, 242 from the first end 204 of the alignment guide 200.
  • the first and second tubes 240, 242 are removed from the first end portion 204 to allow the alignment guide 200 to subsequently be removed from the plurality of k-wires 250 inserted within the medial cuneiform bone and metatarsal bone 108, also referred to as the proximal k-wires 251.
  • Fig. 10B shows the removal of the alignment guide 200 from the k-wires 250.
  • the alignment guide 200 can ride along the distal k-wires 253 as it is removed, while the clearance allows the alignment guide 200 to be removed from the proximal k-wires 252.
  • an alignment guide 300 can be constructed in accordance with an alternative embodiment.
  • the alignment guide 300 can include a guide body 301 and an insert 311 that is configured to be supported by the guide body 301.
  • the guide body 301 and the insert 311 can be formed of a rigid material.
  • the alignment guide 300 can define at least one proximal cannula and at least one distal cannula that are configured to receive respective temporary fixation elements, such as k-wires, that are secured to bones or bone segments, such as the medial cuneiform bone 104 and the first metatarsal 108, respectively at a predetermined relative position.
  • the at least one proximal cannula can be defined by the guide body 301, and the at least one distal cannula can be defined by the insert 311.
  • the at least one distal cannula can be defined by the guide body 301, and the at least one proximal cannula can be defined by the insert 311.
  • the temporary fixation elements can be alternatively constructed in any manner as desired.
  • the temporary fixation elements can define pins, nails, or the like.
  • the alignment guide 300 can include a guide body 301 that defines a bone-facing surface 303 and an outer surface 305 opposite the bone-facing surface 303.
  • the alignment guide has a first or proximal end portion 304 and a second or distal end portion 308.
  • the second end portion 308 extends distally from the first end portion 304.
  • the alignment guide 300 can include at least one proximal cannula, such as a first cannula 310 and a second cannula 312 that extend through the guide body 301 from the outer surface 305 to the bone-facing surface 303.
  • the first and second cannulas 310 and 312 can be referred to as first and second proximal cannulas.
  • the first and second cannulas 310 and 312 can extend through the first end portion 304.
  • the first and second cannulas 310 and 312 can be arranged such that the second cannula 312 is offset from the first cannula 310 in the distal direction.
  • the first and second cannulas 310 and 312 can extend through the guide body 301 along respective first and second central axes 330 and 332.
  • the central axes 330 and 332 can be parallel to each other as they extend in a direction from the outer surface 305 to the bone-facing surface 303 (also referred to as a bone-facing direction).
  • the central axes 330 and 332 can diverge from each other as they extend in the bone-facing direction.
  • the central axes 330 and 332 can converge toward each other as they extend in the bone-facing direction.
  • the cannulas 310 and 312 can be chamfered at either or both of the outer surface 305 and the bone-facing surface 303.
  • the central axes 330 and 332 can be spaced apart a distance 307 that is based on a length of the cuneiform bone 104. Therefore, the system can include a kit of alignment guides 300 having different distances 304 as desired.
  • the at least one proximal cannula is shown and described as including two cannulas, more or fewer cannulas can be defined by the at least one proximal cannula.
  • the first and second cannulas 310 and 312 can each be sized and configured to receive respective first and second k- wires 252 and 256 (see Fig. 14E).
  • the first and second cannulas 310 and 312 can define different diameters therethrough.
  • the first cannula 310 can have a greater diameter than the second cannula 312.
  • the second cannula 312 can have a greater diameter than the first cannula 310.
  • the first and second cannulas 310 and 312 can define the same diameters therethrough.
  • either or both of the first and second cannulas 310 and 312 can define varying diameters therethrough.
  • the first and second cannulas 310 and 312 can be defined by the guide body 301.
  • the first and second cannulas 310 and 312 can be defined by respective removable tubes of the alignment guide 300 that are inserted into respective apertures of the guide body 301. In both examples, it can be said that the alignment guide 300 defines the first and second cannulas 310 and 312.
  • the alignment guide 300 can further define at least one distal cannula such as third and fourth cannulas 314 and 316.
  • the third and fourth cannulas 314 and 316 can also be referred to as first and second distal cannulas.
  • the alignment guide 300 can define an aperture 313 that extends through the guide body 301 along the bone-facing direction.
  • the aperture 313 can extend through the second end portion 308 of the guide body 301.
  • the aperture 313 can be sized to receive the insert 311.
  • the insert 311 can be removably inserted into the aperture 313.
  • the aperture 313 can be open to a medial side of the second end portion 308 at an opening 315 that can extend laterally into the second end portion 308.
  • the aperture can extend from the outer surface 305 to the bone-facing surface 303.
  • Respective ends 371 that define the proximal and distal ends of the opening 315 can be disposed outboard of the cannulas of the insert 311, as will now be described.
  • the insert 311 can define an insert portion 368 and a seat portion 370.
  • the insert portion defines a bone- facing surface 371 of the insert 311, and the seat portion 370 can define an outer surface 373 of the insert 311 that is opposite the bone-facing surface 371.
  • the insert can define third and fourth cannulas 314 and 316 that extend from the outer surface 373 to the bone-facing surface 371.
  • the third and fourth cannulas 314 and 316 can be referred to as first and second distal cannulas, respectively, when the aperture 313 that receives the insert 311 extends through the second end portion 308.
  • the insert 311 is illustrated and described as defining two cannulas, the insert 311 can define more or fewer cannulas as desired.
  • the third and fourth cannulas 314 and 316 can extend along respective third and fourth central axes 334 and 336, respectively, through the insert 311.
  • the third and fourth cannulas 314 and 316 can define different diameters therethrough.
  • the third cannula 314 can have a greater diameter than the fourth cannula 316.
  • the fourth cannula 316 can have a greater diameter than the third cannula 314.
  • the third and fourth cannulas 314 and 316 can define the same different diameters therethrough.
  • either or both of the third and fourth cannulas 314 and 316 can define varying diameters therethrough.
  • the central axes 334 and 336 can extend parallel to each other as they extend in a direction from the outer surface 373 to the bone-facing surface 371 (also referred to as a bone-facing direction).
  • the central axes 334 and 336 can diverge from each other as they extend in the bone- facing direction.
  • the central axes 334 and 336 can converge toward each other as they extend in the bone-facing direction.
  • the axes 334 and 336 can be spaced apart a longitudinal distance 309. The distance 309 can be based on a length of the metatarsal bone 108. Therefore, the kit of alignment guides 300 can have different distances 309 as desired.
  • the opening 315 to the aperture 313 can have a longitudinal distance greater than the distance 309 so as to accommodate the distal k- wires upon removal of the guide body 301 from the patient’s foot 100.
  • the at least one distal cannula is shown and described as including two cannulas, more or fewer cannulas can be defined by the at least one distal cannula.
  • the cannulas 314 and 316 can be chamfered at either or both of the outer surface 373 and the bone-facing surface 371.
  • the insert portion 368 of the insert 311 can define a shoulder 380.
  • the seat portion 370 can have a cross-sectional dimension perpendicular to the bone-facing direction that is greater than a corresponding cross-sectional dimension of the aperture 313.
  • the seat portion 370 is sized so that it is not insertable into or through the aperture 313 of the guide body 301 in the bone-facing direction.
  • the insert portion 368 is sized for insertion through the aperture 313 in the bone-facing direction. Therefore, the extent of the seat portion 370 that extends out with respect to the insert portion 368 in a direction perpendicular to the bone- facing direction can define the shoulder 380.
  • the insertion portion 368 can be inserted through the aperture 313 until the seat portion 370, and in particular the shoulder 380, abuts the outer surface 305 of the guide body 301.
  • the insert 311 can be inserted through the aperture 313 such that seat portion 370 sits atop the outer surface 305 of the guide body 301.
  • the insert portion 368 can extend through the guide body 301 to the bone-facing surface 371 which can be offset with respect to the bone-facing surface 303 of the guide body 301 in the bone-facing direction.
  • the insert portion 386 can have a height along the bone -facing direction that is greater than the height of the guide body 301 at the aperture 313. The height of the insert portion 386 can be measured from the shoulder 380 to the bone-facing surface 371 of the insert 311.
  • the height of the guide body 301 can be measured from the outer surface 305 to the bone-facing surface 303 of the guide body 301.
  • the height of the insert portion can be sized such that the bone-facing surface 371 at the insert portion 368 abuts the metatarsal 108 when the bone-facing surface 303 at the first end portion 304 abuts the cuneiform bone 104.
  • the alignment guide 300 can define the angle a between the central axis 330 of the first cannula 310 and the axis 236 of the fourth cannula 316 (see Fig. 5), the angle P between the axis 330 of the first cannula 310 and the axis 236 of the fourth cannula 316 (see Fig. 6), and the angle y between the axis 330 of the first cannula 310 and the axis 236 of the fourth cannula 316 (see Fig. 7).
  • the system can include a plurality of inserts that define different values of at least one of the angles a, 0, and y as desired.
  • the second or distal end portion 308 of the guide body 301 can be offset with respect to the first or proximal end portion 304 in the medial direction.
  • the guide body 301 can include an intermediate portion 317 that extends from the first end portion 304 to the second end portion 308.
  • the intermediate portion 317 extends from the distal end of the first end portion 304 to the proximal end of the second end portion 308.
  • the first and second end portions 304 and 308 and the intermediate portion 317 can be monolithic with each other so as to define a one-piece unitary body.
  • either or both of the first and second end portions 304 and 308 can be separate from the intermediate portion 317 and attached to the intermediate portion 317 in any suitable manner as desired.
  • the guide 300 can further include a joint alignment cannula 319 that extends through the guide body 301 at a location between the proximal cannulas and the aperture 313.
  • the joint alignment cannula 319 can extend through the intermediate portion 317.
  • the joint alignment cannula 319 can be disposed distal of the first and second cannulas 310 and 312.
  • the j oint alignment cannula 319 can extend from the outer surface 305 to the inner surface 303 along a respective central axis 321.
  • the central axis 321 can he on a common plane with the first and second central axes 330 and 332.
  • the central axis 321 can be oriented parallel with the first and second central axes 330 and 332. Alternatively, the central axis 321 can be angularly offset with respect to the first and second central axes 330 and 332 within the common plane.
  • the joint alignment cannula 319 can have a diameter that is different than the diameter of either or both of the first and second cannulas 310 and 312. For instance, the diameter of the joint alignment cannula 319 can be greater than the diameter of either or both of the first and second cannulas 310 and 312. Thus, a k-wire that fits through the joint alignment cannula 319 can be sized too big to fit through either of the first and second cannulas 310 and 312.
  • the diameter of the joint alignment cannula 319 can be equal to the diameter of the first and second cannulas 310 and 312.
  • the first end portion 304 can define a position and orientation of a first set of cannula (e.g., cannulas 310 and 312).
  • the second end portion 308 and the insert 311 can define a position and orientation of a second set of cannula (e.g., the third and fourth cannula 314 and 316).
  • the first set of cannula and the second set of cannula can be offset from each other and/or angled with respect to each other as described herein.
  • a joint k-wire 372 can be inserted into a joint 369 that is defined by medial cuneiform bone 104 and the first metatarsal 108 along a predetermined trajectory that is parallel to the joint 369.
  • the joint k-wire 372 can be driven along a direction from the dorsal side to the plantar side, such that the central axis of the joint k-wire extends along a declination angle of the joint 369.
  • the joint 369 can be referred to as the tarsometatarsal (TMT) joint.
  • the trajectory along which the joint k-wire 372 is inserted into the joint 369 can further be an inferior direction, or a combination of inferior and lateral directions.
  • Any suitable imaging source such as x-ray, can confirm that the joint k-wire is parallel with the joint. If not, the joint k-wire 372 can be manipulated and repositioned, or removed and reinserted until it has been confirmed to be oriented parallel to the joint 369.
  • the joint k-wire 372 has a shaft 375 that is elongate along a central axes 381.
  • the shaft 375 can have any suitable diameter between approximately 1 mm and approximately 4 mm, such as between approximately 2 mm and approximately 3 mm. In one example, the diameter can be approximately 2.5 mm. In one example, the diameter of the shaft 375 is greater than the diameter of the proximal and distal k-wires. Alternatively, the diameter of the shaft 375 can be equal to or less than the diameter of the proximal and distal k-wires.
  • the shaft 375 has a distal end portion 377 that can include one or more cutting teeth 379, such as a plurality of cutting teeth 379.
  • the cutting teeth 379 can be defined by recesses 381 that are created in the distal end portion 377 of the shaft 375.
  • the recesses 381, and thus the cutting teeth 379 can be circumferentially spaced about the shaft 375 and circumferentially aligned with each other.
  • the cutting teeth 379 can be elongate parallel to the central axis 378.
  • the cutting teeth 379 can be continuous along an entirety of their respective lengths or can be segmented as desired.
  • the cutting teeth 379 can extend along the shaft to a position proximal of the distal end portion 377 that is inserted into the joint 369.
  • the distal end portion 377 can terminate at a distal tip 385 that can be smooth and blunt. In one example, the distal tip 385 can be rounded. Alternatively, the distal tip can be flat or assume any suitable alternative shape as desired.
  • the joint k-wire 372 is driven distally such that the distal end portion 377 is inserted into the joint 369.
  • the joint k-wire 372, and in particular the distal end portion 377 can be rotated as the distal end portion 377 is inserted into the joint 369, such that the cutting teeth 379 cut into the distal end of the medial cuneiform 104 and the proximal end of the first metatarsal 108 that define the joint 369.
  • the joint k-wire 372 can be rotated after the distal end portion 377 has been inserted into the joint 369. It should be appreciated that once the joint k-wire 372 has been inserted into the joint 369, the joint 369 is maintained in tension.
  • the distal end of the medial cuneiform bone 104 and the proximal end of the first metatarsal 108 thereby apply a compressive retention force onto the joint k-wire 372 that retains the joint k-wire 372 in the joint 369 along the desired predetermined trajectory.
  • the joint k-wire 372 can include at least one helical thread at the outer surface of the shaft 375 that extends about the central axis of the joint k-wire 372 at a location distal of the cutting teeth 379.
  • the joint k-wire 372 can be rotated about its central axis as it is inserted into the joint, thereby advancing the joint k-wire 372 into the joint, such that the cutting teeth 379 cut into the distal end of the medial cuneiform 104 and the proximal end of the first metatarsal 108 as described above.
  • the cutting teeth 379 can be concentrically arranged. That is, the cutting teeth 379 can extend circumferentially about the central axis 378, and can be spaced from each other along a direction parallel with the central axis 378. The circumferential cutting teeth 379 can extend continuously about the central axis 378, or can be segmented as desired.
  • the recesses 381 can be disposed between respective adjacent cutting teeth 379 along the direction parallel with the central axis 378.
  • the cutting teeth 379 can cut into the distal end of the medial cuneiform 104 and the proximal end of the first metatarsal 108 that define the joint 369.
  • the joint k-wire 372 of Fig. 14D can be inserted with pure translational motion and no rotational motion.
  • the joint k-wire 372 of Fig. 14D can be rotated about the central axis 378 as it is inserted into the joint 369.
  • the joint k-wire 372 of Fig. 14D can include at least one helical thread at the outer surface of the shaft 375 at a location distal of the cutting teeth 379.
  • the joint k-wire 372 can be rotated about its central axis 378 as it is inserted into the joint, thereby advancing the joint k-wire 372 into the joint, such that the cutting teeth 379 cut into the distal end of the medial cuneiform 104 and the proximal end of the first metatarsal 108 as described above.
  • the alignment guide 300 can be placed adjacent the joint k-wire 372 such that the joint alignment cannula 319 is aligned with the joint k-wire 372.
  • the alignment guide 300 is then brought toward the patient’s foot 100, which causes the joint k-wire 372 to be inserted into the joint alignment cannula 319.
  • the joint alignment cannula 319 can be driven over the joint k-wire 372 as the alignment guide 300 is brought toward the patient’s foot.
  • the first and second cannulas 310 and 312 have a predetermined spacing with respect to the joint alignment cannula 319, Accordingly, when the joint k-wire 372 is disposed in the joint 369, the first and second cannulas 310 and 312 are aligned with the medial cuneiform bone 104, and the insert-receiving aperture 313 is aligned with the first metatarsal 108.
  • the insert 311 can be received in the aperture in the manner described above.
  • the alignment guide 300 can be positioned such that the first and second cannulas 310 and 312 are aligned with the medial cuneiform bone 104, and the third and fourth cannulas 314 and 316 are aligned with the first metatarsal 108.
  • the alignment guide 300 can be placed against the patient’s foot 100 such that the bonefacing surface 303 of the guide body 301 is disposed adjacent to or abuts the medial cuneiform bone 104, and the bone-facing surface 371 of the insert 311 is disposed adjacent to or abuts the first metatarsal 108.
  • a plurality of temporary fixation elements such as k- wires 250 can be extended through respective cannula of the alignment guide 300 and into the patient’s foot 100.
  • at least one of the k- wires can extend through a respective cannula of the alignment guide 300 and into the respective medial cuneiform 104, and at least another of the k- wires can extend through a respective cannula of the alignment guide 300 and the first metatarsal bone 108.
  • At least one proximal temporary fixation device such as at least one proximal k-wire, can be inserted through the at least one proximal cannula of the alignment guide 300 and into the medial cuneiform bone 104.
  • a first k-wire 252 can be driven through the first cannula 310 and into the medial cuneiform 104.
  • the first cannula 310 can be sized to guide the first k-wire 252 along the first central axis 330 as it is driven into the medial cuneiform bone 104.
  • a second k-wire 256 can be driven through the cannula 312 and into the medial cuneiform bone 104.
  • the second cannula 312 can be sized to guide the second k-wire 256 along the second central axis 332 as it is driven into the medial cuneiform bone 104.
  • the first and second k- wires 354 and 356 can be referred to as first and second proximal k- wires respectively.
  • the second cannula 312 and the second k-wire 256 can be disposed distal of the first cannula 310 and the first k-wire 252.
  • the first and second k-wires 252 and 256 can be referred to as proximal k-wires.
  • At least one distal temporary fixation device such as at least one distal k- wire, can be inserted through the at least one distal cannula of the alignment guide 300 and into the metatarsal 108.
  • a third k-wire 260 can be driven through the third cannula 314 and into the first metatarsal 108.
  • the third cannula 314 can be sized to guide the third k-wire 260 along the third central axis 334 (see Fig. 13 A) as it is driven into the first metatarsal 108.
  • a fourth k-wire 264 can be inserted through the fourth cannula 316 and into the first metatarsal 108.
  • the fourth cannula 316 can be sized to guide the fourth k-wire 264 along the fourth central axis 336 (see Fig. 13A) as it is driven into the first metatarsal 108.
  • the fourth cannula 316 and the fourth k-wire 264 can be disposed distal of the third cannula 314 and the third k-wire 260.
  • the third and fourth k-wires 260 and 264 can be referred to as first and second distal k-wires respectively that are disposed distal of the proximal k-wires.
  • the first and second k-wires 252 and 256 can be on opposite sides of the joint 369 with respect to the third and fourth k-wires 260 and 264.
  • the alignment guide 300 can be positioned such that the first and second cannulas 310 and 312 and the third and fourth cannulas 314 and 316, and thus the first and second k-wires 252 and 256 and the third and fourth k-wire 260 and 264, extend superiorly from the medial cuneiform bone 104 and the first metatarsal 108, respectively.
  • the alignment guide 300 can be positioned such that the first and second cannulas 310 and 312 and the third and fourth cannulas 314 and 316, and thus the first and second k-wires 252 and 256 and the third and fourth k-wire 260 and 264, extend medially from the medial cuneiform bone 104 and the first metatarsal 108, respectively.
  • the first and second k-wires 252 and 256 can be oriented parallel with each other, as defined by their trajectories along the respective first and second central axes 330 and 332.
  • the third and fourth k-wires 260 and 264 can be oriented parallel with each other, as defined by their trajectories along the respective third and fourth central axes 334 and 336.
  • Each of the k-wires 350 can be driven into the respective medial cuneiform bone 104 or the first metatarsal bone 108 at respective insertion points that can be predetermined on the patient’s foot.
  • the alignment guide 300 can be removed.
  • the insert 311 can be removed from the third and fourth k-wires 260 and 264 by moving the insert 311 away from the guide body, and thus away from the patient’s foot 100, along the k-wires 260 and 264 until the k-wires 260 and 264 have been removed from the insert 311.
  • Fig. 14E the insert 311 can be removed from the third and fourth k-wires 260 and 264 by moving the insert 311 away from the guide body, and thus away from the patient’s foot 100, along the k-wires 260 and 264 until the k-wires 260 and 264 have been removed from the insert 311.
  • the guide body 301 can then be removed from the k-wires 252, 256, 260, and 264 by moving the guide body 301 away from the patient’s foot 100. It should be appreciated that once the insert 311 is removed, the third and fourth k-wires 260 and 264 extend through the aperture 313, such that clearance exists between the guide body 301 and the third and fourth k-wires 260 and 264. In this regard, it is recognized that the first and second central axes 330 and 332 of the first and second k-wires 252 and 256 are angularly offset from the third and fourth central axes 334 and 336 of the third and fourth k-wires 260 and 264.
  • the guide body 301 is removed from the first and second cannulas 310 and 312 along the respective first and second central axes 330 and 332, and aperture 313 provides the clearance that allows the second end portion 308 to be removed from the third and fourth k-wires 260 and 264.
  • the third and fourth k-wires can extend out the opening 315 during removal of the guide body 301 from the patient’s foot.
  • the joint k-wire 372 can be removed from the joint 369 after the proximal and distal k-wires have been driven into the patent’s foot 100.
  • the joint k-wire 372 can be removed from the joint 369 before or after removal of the alignment guide 300.
  • the system for correcting alignment in the patient’s foot 100 can include a resection guide 404.
  • the resection guide 404 can align a resecting tool (not shown), such as a saw, a broach, or the like, with an end of the medial cuneiform bone 104 and/or an end of the metatarsal bone 108, respectively.
  • the resection guide 404 can include a cannulated portion 411.
  • the cannulated portion 411 can include one or more apertures 415, 417.
  • the resection guide 404 can include a plane portion 409.
  • the plane portion can include a slot 407 for aligning the resecting tool.
  • the apertures 415, 417 can interact with one or more k- wires (e.g., k-wires 250) or pins to align the plane portion 409 with the desired target location for the resection tool.
  • the plane portion 409 (e.g., a plane defining the slot 407) can be generally perpendicular with the cannulated portion 411 (e.g., an axis between the apertures 415, 417). In other implementations, the plane portion 409 can be angled with respect to the cannulated portion 411.
  • the apertures 415, 417 can extend through the cannulated portion 411.
  • the apertures 415, 417 can be sized to align with the k-wires or pins.
  • the slot 407 can extend through the plane portion 409.
  • the slot 407 can have a height and thickness sized to accommodate the cutting portion of the resection tool.
  • the slot 407 can have a depth sufficient to maintain alignment of the resection tool with the desired target location.
  • Figs. 16A-16B show usage of the first resection guide 404 to align a resection tool with a first inner end of the first cuneiform bone 104.
  • the cannulated portion 411 can be received over the first and second k-wire 252, 256 on the apertures 415, 417, respectively. This can align the plane portion (e.g., the slot 407) with the end of the first cuneiform bone 104.
  • a resection plane 104a can be cut into the first cuneiform bone 104 using a resecting tool through the slot 407.
  • the resection plane 104a can be aligned with the first and second k-wire 252, 256.
  • FIG. 17 shows usage of a second resection guide 408 to align a resection tool with a first inner end of the metatarsal bone 108.
  • the second resection guide 408 can include the same components as the resection guide 404 (e.g., a plane portion 409 and a cannulated portion 411).
  • the cannulated portion 411 of the second resection guide 408 can be received over the third and fourth k- wires 260, 264 on apertures 415, 417, respectively.
  • the third and fourth k-wires can align the plane portion 409 and a slot 407 with the end of the metatarsal bone 108.
  • a resection plane 108a can be cut into the metatarsal bone 108 using a resecting tool through the slot 407.
  • the resection plane 108a can be aligned with the third and fourth k-wires 260, 264.
  • the resection guide 404 can be used to form the resection plane 108a instead of the section resection guide 408.
  • the system for correcting alignment in the patient’s foot 100 can include a correction guide 500.
  • the correction guide 500 can align the bones in the patient’s foot 100 from the initial or deformed configuration into a corrected configuration 103 that is different than the initial or deformed configuration, as shown in Figs. 19A-19B, and reduces the deformity that is defined by the first metatarsal 108.
  • the correction guide can cause the first metatarsal 108 to move from the initial configuration to the corrected configuration by rotating the first metatarsal 108 relative to the medial cuneiform 108 and/or translating the first metatarsal 108 relative to an adjacent second metatarsal 109.
  • the correction guide 500 can define an inner bone-facing surface 501 and an opposite outer surface 503.
  • the correction guide 500 can include a first end portion 504.
  • the correction guide 500 can include at least one proximal cannula 513 such as first and second cannulas 510 and 512 that extend through the correction guide 500, and in particular through the first end portion 504.
  • the first and second cannulas 510 and 512 can correspond to the first and second k-wires 252 and 256, respectively, which have been previously driven at least into or through the medial cuneiform bone 104.
  • the first and second cannulas 510 and 512 can extend along respective first and second central axes 530 and 532, respectively.
  • the first and second central axes 530 and 532 can be parallel to each other, or can alternatively be oriented at any suitable angle relative to each other as desired.
  • the correction guide 500 can include a second end portion 508 that extends distally with respect to the first end portion 504.
  • the inner and outer surfaces 501 and 503 can be defined by the first end portion 504 and the second end portion 508.
  • the first and portion 504 and the second end portion 508 can define a single monolithic unitary structure.
  • the first and second end portions 504 and 508 can be positionally fixed with respect to each other.
  • the first end portion 504 can be referred to as a proximal end portion
  • the second end portion 508 can be referred to as a distal end portion.
  • the correction guide 500 can include at least one distal cannula 515 such as third and fourth cannulas 514 and 516 that extend through the correction guide 500, and in particular through the second end portion 508.
  • the third and fourth cannulas 514 and 516 can correspond to the third and fourth k-wires 260 and 264, respectively, which have been previously driven at least into or through the metatarsal bone 108.
  • the third and fourth cannulas 514 and 516 can extend along respective third and fourth central axes 534 and 536, respectively.
  • the third and fourth central axes 534 and 536 can be parallel to each other, or can alternatively be oriented at any suitable angle relative to each other as desired.
  • the first and second cannulas 510 and 512 can be referred to as proximal cannulas 513 of the correction guide 500, and the third and fourth cannulas 514 and 516 can be referred to as distal cannulas 515 of the correction guide that are spaced distally from the proximal cannulas 513.
  • the proximal k-wires 251 are configured to be driven into cuneiform bone 104 in the manner described above, and inserted into respective ones of the proximal cannulas 513.
  • the distal k-wires 253 are configured to be driven into the metatarsal 108 in the manner described above, and inserted into respective ones of the distal cannulas 515. While the system can include two proximal k-wires 251 and two distal k-wires 253 in one example, it should be appreciated that the system can include any number of proximal and distal k-wires including at least one. Thus, at least one proximal k-wire 251 can be inserted through at least one proximal cannula 513 and into the cuneiform bone 104, and at least one distal k-wire 253 can be inserted through at least one distal cannula 515 and into the metatarsal 108.
  • the proximal and distal cannulas 513 and 515 extend through the correction guide from the outer surface 503 to the inner surface 501.
  • the first cannula 510 can extend through the outer surface 503, such that the first central axis 530 extend through a point PC.
  • the point PC can have a position (x, y, z) in the Cartesian coordinate plane.
  • the fourth cannula 516 can extend through the outer surface 503, such that the fourth central axis 536 extend through a point PD that has a respective position (x, y, z) in the Cartesian coordinate plane.
  • the points PC and PD can define a relative position of the first and fourth central axes 530 and 536 in the Cartesian coordinate system.
  • the correction guide 500 can be received on the k- wires 250.
  • the at least one proximal k-wire 251 can be received within a respective at least one proximal cannula 513
  • the at least one distal k-wire 253 can be received within a respective at least one distal cannula 513.
  • the at least one proximal and distal k- wires 251 and 253 can be positioned in the cannulas of the correction guide 500 after having been driven into either of the alignment guides 200 and 300 and after subsequent removal of the alignment guide.
  • the k-wires 251 and 253 extend medially from the medial cuneiform 104 and the first metatarsal 108 as shown in Figs. 19A-19B.
  • the k-wires 251 and 253 can extend superiorly from the medial cuneiform 104 and the first metatarsal 108 as described above with respect to the alignment guide 300 (see Figs. 14C and 31 A).
  • the first and second central axes 530 and 532 can have a predetermined angular relationship with respect to the third and fourth central axes 534 and 536 from a view from the frontal plane.
  • the predetermined angular relationship can be a parallel relationship, such that the first and second central axes 530 and 532 are oriented parallel with the third and fourth axis 534 and 536.
  • the first and second central axes 530 and 532 can be aligned within the same plane as the third and fourth central axis 534 and 536.
  • a common plane can include each of the first and second central axes 530 and 532 along with the third and fourth central axes 534 and 536.
  • the first and second central axes 530 and 532 can be angularly offset with respect to the third and fourth central axes 534 and 536 with respect to a view from the frontal plane.
  • the correction guide 500 can align the metatarsal bone 108 relative to the medial cuneiform bone 104 as it is advances on the k-wires 250.
  • the first and second proximal k-wires 252 and 256 are received by the first and second proximal cannulas 510 and 512, respectively
  • the third and fourth distal k-wires 260 and 264 are received by the third and fourth distal cannulas 514 and 516, respectively.
  • the first and second k-wires 252 and 256 can be oriented along the first and second central axes 530 and 532, respectively, and the third and fourth k-wires 260 and 264 can be oriented along the third and fourth central axes 534 and 536, respectively.
  • the correction guide 500 thus causes the proximal k-wires to move to thereby assume the predetermined angular relationship with the distal k-wires.
  • the at least one distal k-wire moves relative to the at least one proximal k- wire, the at least one distal k-wire causes the first metatarsal 108 to correspondingly move with respect to the medial cuneiform bone 104 and the second metatarsal bone 109.
  • the correction guide 500 can cause the distal k-wires to rotate in the frontal plane, which in turn causes the metatarsal 108 to rotate in the frontal plane with respect to the cuneiform bone 104 in a direction of rotation.
  • the direction of rotation can be in the counterclockwise direction in the frontal plane (that is, from a view of the frontal plane in the proximal direction).
  • the correction guide 500 can therefore orient the distal k-wires 260 and 264, and thus the metatarsal bone 108 and the proximal phalanx 112, into the corrected configuration 103.
  • Reorientation of the metatarsal 108 relative to the medial cuneiform bone 104 can include rotation and/or translation of the metatarsal 108 in the Cartesian coordinate system (e.g., in three orthogonal planes).
  • the degree of rotation and/or translation of the metatarsal 108 can be determined based on the angles a, 0, and/or y, and/or any differences in the relative positions of the axes between the alignment guide 200 and the correction guide 500 (e.g., any differences in the relative positions defined by points A, B and points C, D).
  • the correction guide 500 can cause the at least one distal k-wire 253 to rotate in the frontal plane, for instance in a clockwise direction with respect to a view from the frontal plane.
  • the metatarsal 108 similarly rotates in the clockwise direction in the frontal plane. Because the first and second central axes 530 and 532 can be oriented parallel with respect to the third and fourth central axes 534 and 536, the correction guide 500 does not compress or distract the TMT joint 369 as it receives the proximal and distal k-wires 251 and 253.
  • the corrected configuration 103 can include one or more corrections to the alignment of the bones of the patient’s foot 100.
  • the metatarsal 108 can be generally aligned with the proximal phalanx 112 of the great toe.
  • the corrected configuration 103 can reduce or eliminate the bunion and/or hallux valgus deformity.
  • the resected face 104a of the medial cuneiform bone 104 can be abutted against the resected face 108a of the metatarsal bone 108. This abutment can promote the union or fusion of the metatarsal 108 with the medial cuneiform bone 104.
  • the predetermined angular relationship between the first and second axes 530 and 532 and the third and fourth central axes 534 and 536 can be an angular offset with respect to each other.
  • the first and second central axes 530 and 532 can converge toward the third and fourth central axes 534 and 536 as they extend in a direction from the outer surface 503 to the inner surface 501.
  • first and second central axes 530 and 532 can converge toward the third and fourth central axes 534 and 536 can converge toward each other along a longitudinal direction that includes the distal direction and proximal direction that is opposite the distal direction.
  • first and second central axes 530 and 532 can be aligned with each other and with the third and fourth central axes 534 and 536, for instance along the distal direction.
  • first and second central axes 530 and 532 can be coplanar with the third and fourth central axes 534 and 536, such that a common plane includes each of the central axes 530, 532, 534, and 536.
  • the correction guide 500 can compress the TMT joint 369 as it receives the proximal and distal k-wires 251 and 253 and is driven toward the cuneiform bone 104 and the metatarsal 108.
  • the correction guide 500 can be configured for a combination of realignment and compression of the cuneiform bone 104 and the metatarsal 108, and thus can be referred to as a “realignment and compressor block” (e.g., a RAC block).
  • first and second k-wires 252, 256 can be received within the first and second cannula 510 and 512, respectively, on the first end 504 of the correction guide 500
  • third and fourth k-wires 260 and 264 can be received within the third and fourth cannula 514 and 516, respectively, on the second end 508 of the correction guide 500
  • any number of k-wires in the cuneiform bone 104 and the metatarsal bone 108 can be inserted through respective cannulas of the correction guide as desired.
  • the medial cuneiform bone 104 can be fixed temporarily or permanently relative to the metatarsal 108 in the corrected configuration 103.
  • a first or proximal fixing k-wire 610 can be inserted into the medial cuneiform bone 104 and the metatarsal bone 108.
  • the first fixing wire 610 can extend through the resection faces 104a, 108a.
  • a second or distal fixing k-wire 612 can be inserted through the metatarsal 108 and into the medial cuneiform bone 104.
  • the second fixing k-wire 612 can be inserted through the resection planes 104a, 108a.
  • any temporary or permanent fixing means can be used for connecting the medial cuneiform bone 104 with the metatarsal bone 108 in the corrected configuration.
  • the medial cuneiform bone 104 and the metatarsal bone 108 can be screwed together, braced together, adhered together or otherwise connected together on a temporary or permanent basis.
  • the correction guide 500 can be removed from the plurality of the k-wires 250.
  • the plurality of k-wires 250 can be removed from the medial cuneiform bone 104 and/or the metatarsal bone 108.
  • the system for correcting alignment in the patient’s foot 100 can include a bone plate assembly 700.
  • the bone plate assembly 700 attach the medial cuneiform bone 104 and the metatarsal 108, as shown in Figs. 25-26.
  • the bone plate assembly 700 can include a bone plate 710.
  • the bone plate 710 can include a first end 704 and a second end 708.
  • the bone plate assembly 700 can include a bone clip 720.
  • the bone clip 720 can couple between the medial cuneiform bone 104 and the metatarsal bone 108.
  • the bone clip 720 can include a first prong 724 and second prong 728 connected by a transverse member 726.
  • the bone plate assembly 700 can include a plurality of fasteners 730 such as bone screws, pins or other fasteners known in the field of orthopedics.
  • Figs. 23-24 show further detail of the bone plate 710.
  • the bone plate 710 can be contoured to fit against the medial cuneiform bone 104 and the metatarsal bone 108.
  • the bone plate 710 can be made out of titanium, aluminum, steel, other suitable materials in the orthopedic field.
  • the first end 704 of the bone plate 710 can have a plurality of apertures 715, 716, 717.
  • the apertures 716, 717 can be sized to receiver the fasteners 730.
  • the aperture 715 can be sized to receive the prong 724 of the clip 720.
  • the second end 708 of the bone plate 710 can have a plurality of apertures 711, 712, 713.
  • the apertures 711, 712 can be sized to receive the fasteners 730.
  • the aperture 713 can be sized to receive the prong 728 of the clip 720.
  • the clip 720 can include a recess 719 for receiving, or at least partially receiving, the transverse member 726 of the clip 720.
  • FIGs. 25-26 show the bone plate assembly 710 assembled with the patient’s foot 100.
  • the first end 704 of the bone plate 710 can be attached with the medial cuneiform bone 104 by the fasteners 730.
  • the fasteners 730 can extend through the apertures 716, 717 and into the medial cuneiform bone 104.
  • the second end 708 of the bone plate 710 can be attached with the metatarsal bone 108.
  • the fasteners 730 can extend through the apertures 711, 712 and into the metatarsal bone 108.
  • the fasteners 730 can be received within respective intersection points 254, 258, 262, and/or 266 of the k-wires 250.
  • the fasteners can form new holes in the bones of the patient’s foot.
  • the clip 720 can span across the joint between the medial cuneiform bone 104 and the metatarsal bone 108.
  • the first prong 724 can be received within aperture 715 and into the metatarsal bone 108.
  • the second prong 728 can be received through the aperture 713 and into the medial cuneiform bone 104.
  • the prongs 724, 728 can be received within the respective intersections 258, 262.
  • the prongs 724, 728 can include a plurality of serrated edges for enhanced engagement features for attaching within the bones in the patient’s foot 100.
  • different alignment guides 200 can be used depending on the intended fixation means for the medial cuneiform bone 104 with the metatarsal bone 108.
  • the different alignment guides 200 can include cannula that align the k- wires 250 at different points in the bone to match apertures in the different fixation means.
  • Fig. 27 describes a process 800 for designing an alignment guide that customized to a patient’s unique anatomy. Although described herein in the context of a patient’s foot, the process 800 can be used for other parts of a patient’s body. The process 800 is further illustrated in Figs. 28A-28D.
  • a virtual model 840 of a patient’s foot is created.
  • the virtual model 840 can be based on a scan of a patient’s foot including a deformity, such as a bunion and/or Hallux valgus.
  • the scan used to create or render the virtual model 840 can be based on a CT, PET, X-ray, ultrasound, MRI, or other type of medical imaging scan.
  • the virtual model 840 can include virtual representations of the bones of the patient’s foot.
  • the virtual model 840 can include a virtual deformed configuration 802 of the patient’s bones.
  • the virtual model 840 can include a virtual first bone 804 and a virtual second bone 808.
  • the virtual first bone 804 can correspond to a medial cuneiform bone in the patient’s foot and the virtual second bone 808 can correspond to a metatarsal.
  • the virtual model 840 can be displayed to a user through a graphical user interface (e.g., on a computer).
  • the virtual model 840 can be manipulable by a user.
  • the virtual model 840 can approximate the natural connections (e.g., ligaments, cartilage, and/or muscles) between bones in the patient’s foot. Accordingly, movements of one virtual bone can alter the location of connected virtual bones.
  • the virtual bones of the model 840 can be freely moved and manipulated by a user. Accordingly, feasible re-positioning of the bones and resultant movements of connected virtual bones can be approximated based on the skill and knowledge of a user.
  • a user adjusts the configuration of first and second virtual bones 804, 808 into a virtual corrected configuration 803.
  • the virtual corrected configuration 803 can include correction of one or more deformities of the patient’s foot. Adjustment into the virtual corrected configuration 803 can include changing relative angles and positions between the first and second virtual bones 804, 808. Moreover, the virtual corrected configuration 803 can include one or more overlapping portions of the first and second virtual bones 804, 808.
  • One or more virtual resection planes 804a, 808a can be identified by a user to remove overlapping portions of the first and second virtual bones 804, 808 or otherwise adjust the lengths and dimensions thereof.
  • a first virtual axis 830 is added to intersect the first virtual bone 804.
  • a second virtual axis 836 is added to intersect the second virtual bone 808.
  • the first virtual axis 830 is fixed relative to the first virtual bone 804.
  • the second virtual axis 836 is fixed relative to the second virtual bone 808.
  • the first and second virtual axes 830, 836 can be aligned with the virtual model 840 at a location that is easily accessible during surgery of the patient’s foot.
  • the first and second virtual axes 830, 836 are parallel with each other.
  • the first and second virtual axes 830, 836 can be aligned with one or more of the virtual resection planes 804a, 808a.
  • the first virtual axis 830 extends through a point PG located in a virtual Cartesian coordinate system.
  • the second virtual axis 836 extends through a point PH located in the virtual Cartesian coordinate system.
  • the first and second virtual bones 804, 808 are returned to the original deformed configuration 802 of the model 840.
  • the first and second virtual axes 830, 836 are rotated to different angles and/or translated relative to each other into the deformed configuration 802 from the corrected configuration 803.
  • the first and second virtual axes 830, 836 can be defined as vectors passing through respective point PE and PF, respectively, within the virtual Cartesian coordinate system.
  • the relative positions of the first and second virtual axes 830, 836 in the deformed configuration 802 can be used to define a correction factor for an alignment guide.
  • the relative positions can include relative angles in two or more of the virtual Cartesian coordinate system planes (e.g., z-x, z-y, x-y).
  • the relative angles can correspond to the a, 0, and/or y angles in the alignment guide (e.g., alignment guide 200 or the like).
  • the relative positions of the first and second virtual axes 830 and 836 can be based on the respective points PE and PF.
  • the points PE and PF can correspond to the respective points PA and PB of the alignment guide (e.g., alignment guide 200 or the like).
  • the dimensions of the virtual model 840 can be used to form the correction factor of an alignment guide for use in surgery on the patient’s foot.
  • the relative positions of the first and second virtual axes 830, 836 in the corrected configuration 803 can be used to define dimensions of a correction guide.
  • the points PG and PH can correspond to the respective points PC and PD of the correction guide (e.g., correction guide 500 or the like).
  • the first and second virtual axes 830, 836 in the corrected configuration 803 can correspond to the parallel axes of the cannula in the correction guide.
  • the relative positions of the first and second virtual axes 830, 836 in the deformed configuration 802 can be used to define dimensions of a resection guide.
  • the dimensions can include an orientation of a slot (e.g., slot 407) in the resection guide.
  • the slot can be aligned parallel with one or more of the resection planes 804a, 808a.
  • the resection guide can also include one or more apertures aligned with the first and/or second virtual axes 830, 836 in the deformed configuration 802.
  • a user e.g., a surgeon
  • angles (a, 0, and/or y) and/or translations needed to correct the deformities in the patient’s foot 100 This description can be based on a user’s knowledge and experience and/or in conjunction with viewing a scan of the patient’s foot 100.
  • the user-provided information can indicate the alignment guide 200 needed during in surgery.
  • a user can be provided a kit with multiple alignment guides and select among a pre-determined set of alignment guides 200 that each correct different, but commonly seen deformations in a patient’s foot.
  • the alignment guide 200 can include multiple sets of cannula that correspond to different correction factors.
  • process 900 is a method of manufacturing a system for correcting alignment in the patient’s foot 100 based on a correction factor.
  • a manufacturer can receive a correction factor.
  • the correction factor can define one or more dimensions of an alignment guide (e.g., alignment guide 200).
  • the correction factor can be a CAD model, in some implementations.
  • the dimensions can include orientation and positioning of one or more cannula therethrough.
  • the correction factor can be based on the process 800 described above and/or user-provided information.
  • the correction factor can be customized to an individual patient’s foot.
  • the correction factor can be one of a standard set of commonly used correction factors.
  • the manufacturer can form the alignment guide based on the correction factor.
  • the manufacture can 3D print the alignment guide.
  • the manufacturer can receive dimensions for creating a correction guide.
  • the dimensions for the correction guide can be based on the process 800 described above or otherwise customized to an individual patient’s foot.
  • the manufacturer can form the correction guide based on the received dimensions.
  • the manufacture can 3D print the correction guide.
  • the final configuration 103 (see Fig. 19A) of the metatarsal 108 and/or the proximal phalanx 112 with respect to the cuneiform bone 104 as produced by the correction guide 500 may be undesirable or otherwise sub-optimal as determined during the surgical procedure. Accordingly, once the bones in the patient’s foot 100 have been repositioned to the corrected configuration 103, it may be desirable to further positionally adjust the metatarsal 108 with respect to the cuneiform bone 104 to an adjusted configuration 105 (see Figs. 31B and 32B). [0236] Accordingly, referring now also to Figs.
  • the system can include an auxiliary correction guide 620 that is configured to positionally adjust the metatarsal 108 with respect to the cuneiform bone 104 from the corrected configuration 103 to the adjusted configuration 105.
  • the auxiliary correction guide 620 can include an auxiliary correction guide body 622 that is formed of a rigid material, and can include a first or proximal end portion 624 and a second or distal end portion 626 that extends out with respect to the first end portion 624.
  • the guide body 622 can further include an offset intermediate portion 628 that extends from the first end portion 624 to the second end portion 626.
  • first and second end portions 624 and 626 are monolithic with the offset intermediate portion 628 so as to define include a monolithic unitary structure.
  • first and second end portions 624 and 626 can be separate from the offset intermediate portion 628 and attached to the intermediate portion 628 in any suitable manner as desired.
  • the auxiliary correction guide body 622 and thus the auxiliary correction guide 620, defines a bone-facing surface 623 and an outer surface 625 opposite the bone-facing surface 623.
  • the bone-facing surface 623 at the first end portion 624 is configured to face the medial cuneiform bone 104
  • the bone-facing surface 623 at the second end portion 626 is configured to face the first metatarsal 108.
  • the auxiliary correction guide 620 can define at least one proximal cannula and at least one distal cannula that are configured to receive respective temporary fixation elements, such as k- wires, that were previously secured to the medial cuneiform bone 104 and the first metatarsal 108.
  • the auxiliary correction guide 620 can be coupled to the k- wires after the medial cuneiform bone 104 and the first metatarsal 108 have been moved to the corrected configuration, and is configured to move either or both of the medial cuneiform bone 104 and the first metatarsal 108 from the corrected configuration to the adjusted configuration.
  • the at least one proximal cannula can extend through the guide body 301, and in particular the first end portion 624, from the outer surface 625 to the bone-facing surface 623.
  • the at least one distal cannula can extend through the guide body 301, and in particular the second end portion 626, from the outer surface 625 to the bone-facing surface 623.
  • the at least one proximal cannula can include a first cannula 630 and a second cannula 632 that extend through the guide body 622 from the outer surface 625 to the bone-facing surface 623.
  • the first and second cannulas 630 and 632 can be referred to as first and second proximal cannulas.
  • the first and second cannulas 630 and 632 can extend through the first end portion 624.
  • the first and second cannulas 630 and 632 can be arranged such that the second cannula 632 is offset from the first cannula 630 in the distal direction.
  • the first and second cannulas 630 and 632 can extend through the guide body 622 along respective first and second central axes 634 and 636.
  • the central axes 634 and 636 can be parallel to each other as they extend in a direction from the outer surface 625 to the bone-facing surface 623 (also referred to as a bone-facing direction).
  • the central axes 634 and 636 can diverge from each other as they extend in the bone-facing direction.
  • the central axes 634 and 636 can converge toward each other as they extend in the bone-facing direction.
  • the cannulas 630 and 632 can be chamfered at either or both of the outer surface 625 and the bone-facing surface 623.
  • the central axes 634 and 636 can be spaced apart a distance 307 that can be the same distance as the distance along which the first and second central axes 530 and 532 of the correction guide 500 (see Figs. 18A-18B) are spaced from each other. Therefore, the first and second cannulas 630 and 632 can receive the first and second k-wires 252 and 256 that were previously received by the correction guide 500.
  • first and second cannulas 630 and 632 can be defined by the guide body 622.
  • first and second cannulas 630 and 632 can be defined by respective removable tubes or inserts that can be inserted into the guide body 622.
  • the auxiliary correction guide 620 defines the first and second cannulas 630 and 632.
  • the auxiliary correction guide 620 can further define at least one distal cannula such as third and fourth cannulas 638 and 640.
  • the third and fourth cannulas 638 and 640 can also be referred to as first and second distal cannulas.
  • the third and fourth cannulas 638 and 640 extend through the guide body 622 from the outer surface 625 to the bone-facing surface 623.
  • the third and fourth cannulas 638 and 640 can extend through the second end portion 626.
  • the fourth cannula 640 can be spaced from the third cannula 638 in the distal direction.
  • the third and fourth cannulas 638 and 640 can extend through the guide body 622 along respective third and fourth central axes 642 and 644.
  • the cannulas 638 and 640 can be chamfered at either or both of the outer surface 625 and the bone-facing surface 623.
  • the central axes 642 and 644 can extend parallel to each other as they extend in a direction from the outer surface 625 to the bone-facing surface 623 (also referred to as a bone-facing direction).
  • the central axes 642 and 644 can diverge from each other as they extend in the bone-facing direction.
  • the central axes 642 and 644 can converge toward each other as they extend in the bonefacing direction.
  • the central axes 642 and 644 can be spaced apart a distance that can be the same distance as the distance along which the third and fourth central axes 534 and 536, respectively, of the correction guide 500 (see Figs. 18A-18B) are spaced from each other. Therefore, the third and fourth cannulas 638 and 640 can receive the third and fourth k- wires 252 and 256 that were previously received by the correction guide 500 (see Figs. 18A-18B).
  • the second end portion 626 can be laterally offset with respect to the first end portion 624.
  • the intermediate portion 628 can be offset so as to jog laterally as it extends from the first end portion 624 to the second end portion 626.
  • the third and fourth cannulas 638 and 640 can be offset laterally with respect to the first and second cannulas 630 and 632.
  • the first and second central axes 634 and 636 can he on a first plane, and the third and fourth central axes 642 and 644 can lie on a second plane that is angularly offset with respect to the first plane.
  • the third and fourth central axes 642 and 644 can converge at an angle 0 (see Fig.
  • the auxiliary correction guide 620 can receive the k- wires which causes the first metatarsal 108 to similarly rotate an amount equal to the angle 0 in the counterclockwise direction in the frontal plane relative to the medial cuneiform bone 104.
  • the angle 0 can be selected as desired, for instance in a range of angles from 1 degree up to and including 40 degrees.
  • the angle can be provided on the auxiliary correction guide 620, for instance at the outer surface 625. Further, a designation whether the auxiliary correction guide 620 is for use on the right foot or the left foot can also be provided, for instance, at the outer surface 625.
  • the third and fourth central axes 642 and 644 can be offset with respect to the first and second central axes 634 and 636 in the lateral direction by an offset distance D (see Fig. 30M).
  • the first and second central axes 634 and 636 can intersect each other directly and/or with respect to the frontal view at a point of convergence that is spaced from the bone-facing surface 623 in the bone facing direction.
  • the point of convergence can be spaced from the bone-facing surface 623 in the bone facing direction approximately 16mm, which is approximately the central axis of the average anatomical first TMT joint (e.g., when the first TMT joint is approximately 32mm tall).
  • the distal end portion 626 can be rotated relative to the proximal end portion 624, thereby creating the angle 0 and the distance D.
  • the third and fourth central axes 642 and 644 at the bone- facing surface 623 can be offset with respect to the first and second central axes 634 and 636 in the medial direction.
  • the distance D can define an offset in the medial direction.
  • the auxiliary correction guide 620 can be configured to receive the k-wires which causes the first metatarsal to translate toward or away from the second metatarsal.
  • the auxiliary correction guide 620 is illustrated showing the angle 0 as the counterclockwise angle described above, and the offset distance D as a lateral offset.
  • the auxiliary correction guide 620 can alternatively define the angle 0 without the offset distance D.
  • the auxiliary correction guide 620 can define the offset distance D without the angle 0.
  • the auxiliary correction guide 620 can define either or both of the offset distance D and the angle 0.
  • the auxiliary correction guide 620 can define the offset distance D alone or in combination with the angle 0.
  • the auxiliary correction guide 620 can define the angle 0 alone or in combination with the offset distance D.
  • an auxiliary correction guide 620’ can be provided that is a mirror image of the illustrated auxiliary correction guide 620 of Figs. 3A- 3N about the longitudinal direction (which includes the proximal direction and the distal direction).
  • the auxiliary correction guide can define either or both of the angle 0 as a clockwise angle, and the distance D as a medial offset.
  • the third and fourth central axes 642 and 644 can extend in a direction that is rotated clockwise relative to the first and second central axes 634 and 636 with respect to a view of the frontal plane in the proximal direction.
  • the offset distance D can be a medial offset, whereby at the bone-facing surface 623, the third and fourth central axes 642 and 644 are offset with respect to the first and second central axes 634 and 636 in the medial direction by an offset distance D.
  • the system can include a kit of auxiliary correction guides 620 and 620’, each including guides that have at least one different parameter than at least one other of the guides.
  • the at least one parameter can be defined by either or both of the angle 0 and the distance D.
  • a select one of the auxiliary correction guides 620 can be selected for use based on the desired correction of the patient’s foot.
  • auxiliary correction guide 620 is shown and described as including two cannulas, respectively, more or fewer cannulas can be defined by auxiliary correction guide 620 as desired.
  • a correction guide such as the correction guide 500 has been placed over the k-wires 252, 256, 260, and 264 so as to align the bones in the patient’s foot 100 into the corrected configuration 103 in the manner described above with respect to Figs. 9A-9B.
  • the first metatarsal 108 rotates in a first direction of rotation to the corrected configuration 103, such that the first metatarsal 108 defines a first rotational position R1 with respect to the medial cuneiform bone 104.
  • the first direction of rotation DR1 can be a counterclockwise direction with respect to a view of the frontal plane (that is, a view oriented in the proximal direction at the frontal plane).
  • first metatarsal 108 translates in a first direction of translation DTI to the corrected configuration so as to define a first translational position that is spaced from the adjacent second metatarsal 109 by a first distance DI .
  • first direction of translation can be with respect to the second metatarsal 109.
  • first direction of translation can be toward the second metatarsal 109.
  • first direction of translation can be a translational direction with respect to the medial cuneiform bone 104.
  • the first phalanx 112 can also move toward the second phalanx 115 to the corrected configuration.
  • the bones in the patient’s foot can benefit from further correction. For instance, it may be desired to move the first metatarsal 108 from the corrected configuration to an adjusted configuration. Moving the first metatarsal 108 from the corrected configuration to the adjusted configuration can rotate the first metatarsal 108 from the first rotational position R1 to a second rotational position R2 that is angularly offset with respect to the first rotational position R1. As shown in Fig.
  • the first metatarsal 108 can be further rotated in the first direction of rotation DR1 to a second rotational position R2 that is angularly offset with respect to the first rotational position R1.
  • the first direct of rotation can be defined by the counterclockwise direction in the frontal plane.
  • moving the first metatarsal 108 from the corrected configuration to the adjusted configuration can translate the first metatarsal 108 from the first translational position to a second translational position that is spaced from the second metatarsal 109 by a second distance D2 that is different than the first distance DI. For instance, as shown in Fig.
  • the first metatarsal 108 can be further translated in the first direction of translation, such that the second distance D2 can be less than the first distance DI. As described above, the first direction of translation of the first metatarsal 108 can be toward the adjacent second metatarsal 109.
  • the correction guide 500 can be removed from the k-wires in the manner described above, and the auxiliary correction guide 620 can be installed.
  • the correction guide 500 can be referred to as a first correction guide.
  • auxiliary correction guide 620 can be installed over the k-wires, such that the first and second k-wires 252 and 256 are received in the first and second cannulas 630 and 632, respectively, and the third and fourth k-wires 260 and 264 are received in the third and fourth cannulas 638 and 640.
  • the diameters of the cannulas 630 and 632 and the third and fourth cannulas 638 and 630 are approximately equal to those of the k-wires 252, 256, 260, and 264, respectively. Further, as described above, in one example, the third and fourth central axes 642 and 644 of the third and fourth cannulas 638 and 640 are rotated counterclockwise relative to the first and second central axes 634 and 636 of the first and second cannulas 630 and 632 with respect to a view of the frontal plane.
  • the third and fourth central axes 642 and 644 of the auxiliary correction guide 620 are offset laterally relative to the third and fourth central axes 534 and 536 with respect to a view of the frontal plane in the proximal direction.
  • the auxiliary correction guide 620 when the auxiliary correction guide 620 is installed such that the k-wires are received in the cannulas of the auxiliary correction guide 620, the auxiliary correction guide 620 can cause the distal k-wires to rotate in the first direction of rotation with respect to the proximal k-wires, which in turn causes the metatarsal 108 to rotate in the first direction of rotation with respect to the cuneiform bone 104 in the counterclockwise direction to the second rotational position R2.
  • the cannulas of the auxiliary correction guide 620 can cause the distal k-wires to translate laterally with respect to the proximal k-wires in the first direction of translation, which causes the first metatarsal 108 to correspondingly translate in the first direction of translation toward the second metatarsal 109 from the first translational position to the second translational position so as to define the second distance D2 from the second metatarsal 109 that is less than the first distance DI .
  • the first phalanx 112 can also move toward the second phalanx 115 to the from the configuration to the adjusted configuration.
  • the auxiliary correction guide 620 can compress the TMT joint 369 as it receives the proximal and distal k-wires 251 and 253 and is driven toward the cuneiform bone 104 and the metatarsal 108.
  • the auxiliary correction guide 620 can be configured for a combination of realignment and compression of the cuneiform bone 104 and the metatarsal 108, and thus can be referred to as an auxiliary “realignment and compressor block” (e.g., an auxiliary RAC block).
  • the first or proximal fixing k-wire 610 can then be inserted into the medial cuneiform bone 104 and the metatarsal bone 108, and the second or distal fixing k-wire 612 can be inserted through the metatarsal 108 and into the medial cuneiform bone 104 as described above with respect to Fig. 20-21, and the auxiliary correction guide 620 can be removed from the k-wires.
  • any suitable bone plate or bone plate assembly such as the bone plate assembly 700 shown in Fig. 26 can be implanted in the manner described above with respect to Figs. 22-26.
  • the auxiliary correction guide 620’ of Fig. 300 can be installed over the k- wires such that the k-wires are received in the respective cannulas.
  • the auxiliary correction guide 620’ can move the distal k-wires, and thus first metatarsal 108, to an adjusted configuration whereby the first metatarsal 108 is rotated clockwise with respect to the medial cuneiform bone 104 to the second rotational position.
  • auxiliary correction guide 620’ can cause the distal k-wires to rotate in a second direction of rotation opposite the first direction of rotation with respect to the proximal k-wires, which correspondingly causes the first metatarsal 108 to rotate in the second direction of rotation with respect to the medial cuneiform bone 104.
  • the first metatarsal 108 is translated away from the adjacent second metatarsal 109 such that the first metatarsal 108 is spaced from the adjacent second metatarsal a second distance that is greater than the first distance DI .
  • the auxiliary correction guide 620 can cause the distal k- wires to translate in a second direction translation that is opposite the first direction of translation, which correspondingly causes the first metatarsal 108 to translate in the second direction of translation with respect to the first metatarsal 109.
  • Figs. 32A-32B illustrate another possible configuration for an alignment guide 1000.
  • the alignment guide 1000 can include the same features and functionalities of the alignment guide 200 described above, including some of the differences noted below.
  • the alignment guide 1000 can include a first portion 1004 and a second portion 1008.
  • the first portion 1004 can be releasably connectable with the second portion 1008.
  • the first portion 1004 can include a handle 1004a.
  • the handle portion 1004a can include an aperture therethrough.
  • the handle portion 1004a can function to enable a user to easily hold the alignment guide 1000 in place during use.
  • the first portion 1004 of the alignment guide 1000 can include at least one proximal cannula 1013, such as first and second cannulas 1010 and 1012 extending therethrough.
  • the cannulas 1010 and 1012 can extend through the first portion 1004.
  • the cannulas 1010 and 1012 can extend along respective central axes 1020 and 1022.
  • the central axes 1020 and 1022 can be parallel to each other.
  • the cannulas 1010 and 1012 can be referred to as first and second proximal cannulas.
  • the second portion 1008 can include at least one distal cannula 1015, such as third and fourth cannulas 1014 and 1016.
  • the cannulas 1014 and 1016 can extend through the second portion 1008.
  • the cannulas 1014 and 1016 can extend along central axes 1024 and 1026, respectively.
  • the central axes 1014 and 1016 can be parallel with each other.
  • the axes 1020 and 1022 can be nonparallel with the axes 1024 and 1026.
  • the cannulas 1014 and 1016 can be referred to as first and second distal cannulas, respectively, that are disposed distal of the proximal cannula 1013.
  • the alignment guide 1000 can include a centering cannula 1009 that can receive a k-wire that extends into the TMT joint between the medial cuneiform bone 104 and the metatarsal 108, thereby aligning a predetermined location of the alignment guide 1000 with the tarsometatarsal joint. Accordingly, the at least one proximal cannula 1013 can be aligned with the medial cuneiform bone 104, and the at least one distal cannula 1015 can be aligned with the metatarsal 108.
  • the centering cannula 1009 can be disposed between the at least one proximal cannula 1013 and the at least one distal cannula 1015.
  • the centering cannula 1009 can be disposed in an intermediate portion that extends between the first and second portions 1004 and 1008, or can be disposed in either of the first and second portion 1004 and 1008.
  • the first portion 1004 can be connectable with the second portion 1008 by an attachment mechanism 1006.
  • the attachment mechanism 1006 can be a thumbscrew.
  • the attachment mechanism 1006 can include a threaded end 1006a.
  • the attachment mechanism 1006 can extend through an aperture 1006b in the first portion 1004.
  • the attachment mechanism 1006 can extend through an aperture 1006c in the second portion 1008.
  • At least one of the apertures 1006b, 1006c can be internally threaded to couple with the threaded end 1006a.
  • the first and second portions 1004, 1008 can be coupled together by the attachment mechanism 1006.
  • the second portion 1008 can include a recess 1008a.
  • the first portion 1004 can include a projection portion 1004b.
  • the projection portion 1004b can be received within the recessed portion 1008a.
  • the recess/protrusion arrangement can enhance the stability of the coupling between the first portion 1004 and the second portion 1008.
  • Figs. 34A-34B show another implementation of a resection guide 1100.
  • the resection guide 1100 can be structured similarly to the resection guide 404 described above, including some of the differences noted herein.
  • the resection guide 1100 can include a first portion 1111.
  • the first portion 1111 can include one or more apertures 1115 and 1117 extending therethrough.
  • the first portion 1111 can be coupled with a planar portion 1109.
  • the planar portion 1109 can include a slots 1107 therein.
  • the slot 1107 can be sized to allow a resection tool to extend therethrough for resecting a bone of a patient's body (e.g., the patient’s foot 100).
  • the planar portion 1109 can include a curved shape to allow the slot 1107 to be placed closer to and/or in contact with the patient's body. This can reduce error associated with the process of resecting a bone.
  • Fig. 35 shows one method of using the alignment guide 1000 in a procedure for correcting alignment between two bones in a patient's body.
  • the alignment guide 1000 can be used to correct alignment of a medial cuneiform bone 104 and a metatarsal bone 108 in a patient's foot 100.
  • the process shown in Figs. 35-40 is similar to and can include any of the steps and details described above in the process shown in Figs. 1-26.
  • the centering cannula 1009 can align the alignment guide 1000 at the tarsometatarsal joint between the medial cuneiform bone 104 and the metatarsal 108.
  • a k- wire (not shown) can extend through the centering cannula 1009 and into the space between the medial cuneiform bone 104 and the metatarsal 108.
  • the first end 1004 of the alignment guide 1000 can be generally aligned with the medial cuneiform bone 104.
  • the second end 1008 of the alignment guide 1000 can be generally aligned with the metatarsal 108. As shown further in Fig.
  • a plurality of temporary fixation element such as k-wires 1300 can be inserted through the respective cannula of the alignment guide 1000 and into the medial cuneiform bone 104 and the metatarsal bone 108.
  • At least one proximal k-wire 1301 such as first k-wire 1310 can be inserted through the cannula 1010 and into the medial cuneiform bone 104.
  • the at least one proximal k-wire 1301 can further include a second k-wire 1312 that can be inserted through the cannula 1012 and into the medial cuneiform bone 104.
  • At least one distal k-wire 1303 such as a third k-wire 1314 can be inserted through the cannula 1014 and into the metatarsal 108.
  • the at least one distal k-wire 1303 can further include a fourth k-wire 1316 that extends through the cannula 1016 into the metatarsal 108.
  • the k- wires 1300 can extend along respective axes of the cannula of the alignment guide 1000. Accordingly, the alignment guide can define the intersection angles of the k- wires 1300.
  • the first and second k- wires 1310 and 1312 can be referred to as first and second proximal k- wires
  • the third and fourth k- wires 1314 and 1316 can be referred to as first and second distal k-wires that are disposed distal of the proximal k-wires.
  • the proximal k-wires are configured to be inserted into respective ones of the proximal cannulas 1013 and into the cuneiform bone 104.
  • the distal k-wires are configured to be inserted into respective ones of the distal cannulas 1015 and into the metatarsal 108.
  • the system can include two proximal k-wires and two distal k-wires in one example, it should be appreciated that the system can include any number of proximal and distal k-wires including at least one.
  • at least one proximal k-wire 1301 can be inserted through at least one proximal cannula 1013 and into the cuneiform bone 104
  • at least one distal k-wire 1303 can be inserted through at least one distal cannula 1015 and into the metatarsal 108.
  • the first portion 1004 of the alignment guide 1000 can be removed from the second portion 1008.
  • the attachment mechanism 1006 can be removed from between the first portion 1004 and the second portion 1008.
  • the first portion 1004 can be removed from the K wires 1300.
  • the second portion 1008 can be removed from the k- wires 1300.
  • the resection guide 1100 can be slid over the k-wires 1300.
  • the planar portion 1109 can be aligned with one or both of the medial cuneiform bone 104 and/or the metatarsal 108.
  • a resection tool 1400 can be inserted through the slot 1107 to form resection planes 104a, and/or 108a on the respective medial cuneiform bone 104 and metatarsal 108. As described above, this can facilitate alignment of the medial cuneiform bone 104 and the metatarsal 108 in a corrected configuration 103.
  • a correction guide 1500 can be slid over the k-wires 1300.
  • the correction guide 1500 can be constructed as described with respect to the correction guide 500 of Figs. 18A-20.
  • the correction guide 1500 can include a plurality of cannula extending along respective central axes that can be parallel with each other or can converge toward each other as described above.
  • the k- wires 1300 can be received in the respective cannulas of the collection guide 1500. This can realign and adjust positions of the medial cuneiform bone 104, metatarsal 108 and/or the proximal phalanx 112 to define the corrected configuration 103 of the patient's foot 100.
  • a fixing k-wire 1600 (or similar mechanism) can be inserted to fix the positions of the first metatarsal 108 and the medial cuneiform bone 104.
  • a bone plate assembly 1700 similar to the bone plate assembly 700, can be attached to the medial cuneiform bone 104 and the metatarsal 108 to maintain the relative positions of the two bones in the corrected configuration 103.
  • Conditional language such as “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain examples include or do not include, certain features, elements, and/or steps. Thus, such conditional language is not generally intended to imply that features, elements, and/or steps are in any way required for one or more examples.
  • the terms “approximately,” “about,” and “substantially,” may refer to an amount that is within less than or equal to 10% of the stated amount.
  • the term “generally” as used herein represents a value, amount, or characteristic that predominantly includes or tends toward a particular value, amount, or characteristic.
  • the term “generally parallel” can refer to something that departs from exactly parallel by less than or equal to 20 degrees. All ranges are inclusive of endpoints. Summary

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Abstract

La présente invention concerne un système chirurgical et une procédure chirurgicale pour corriger une déformation entre des premier et second os à l'aide d'un guide d'alignement basé sur un facteur de correction. Le guide d'alignement est utilisé pour insérer un ou plusieurs fils de Kirschner dans chacun des premier et second os dans une configuration déformée. Un guide de correction est passé le long des fils de Kirschner pour tourner et/ou translater le premier os par rapport au second os pour créer la configuration corrigée. Un guide de correction auxiliaire peut être passé le long des fils de Kirschner pour faire tourner et/ou translater davantage le premier os par rapport au second os pour passer de la configuration corrigée à une configuration ajustée.
PCT/IB2023/059538 2022-10-05 2023-09-26 Système et procédure de guidage de repositionnement osseux Ceased WO2024074935A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US17/938,289 2022-10-05
US17/938,289 US20230043795A1 (en) 2019-07-26 2022-10-05 Bone repositioning guide system and procedure

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WO2024074935A1 true WO2024074935A1 (fr) 2024-04-11

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20210022879A1 (en) * 2019-07-26 2021-01-28 Crossroads Extremity Systems, Llc Bone repositioning guide system and procedure
US20210251670A1 (en) * 2020-02-19 2021-08-19 Crossroads Extremity Systems, Llc Systems and methods for lapidus repair of bunions
FR3117762A1 (fr) * 2020-12-18 2022-06-24 Novastep Guide chirurgical réutilisable pour la chirurgie par ostéosynthèse notamment de l’hallux valgus

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20210022879A1 (en) * 2019-07-26 2021-01-28 Crossroads Extremity Systems, Llc Bone repositioning guide system and procedure
US20210251670A1 (en) * 2020-02-19 2021-08-19 Crossroads Extremity Systems, Llc Systems and methods for lapidus repair of bunions
FR3117762A1 (fr) * 2020-12-18 2022-06-24 Novastep Guide chirurgical réutilisable pour la chirurgie par ostéosynthèse notamment de l’hallux valgus

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