Osteotomy procedure for correcting bone misalignment
An osteotomy procedure may be performed to correct a misalignment of a bone, such as a bunion deformity. In some examples, the osteotomy procedure involves making a spherical-shaped cut transecting a first metatarsal, thereby forming a first metatarsal portion having a spherical-shaped projection and a second metatarsal portion having a spherical-shaped recess. The method further involves moving the second metatarsal portion in at least two planes relative to the first metatarsal portion, thereby adjusting an anatomical alignment of the second metatarsal portion.
1. A method comprising:
making a generally spherical-shaped cut with a cutting instrument transecting a first metatarsal bone, thereby forming a first metatarsal portion having a generally spherical-shaped projection and a second metatarsal portion having a generally spherical-shaped recess; and
moving the second metatarsal portion in at least two planes relative to the first metatarsal portion, thereby adjusting an anatomical alignment of the second metatarsal portion relative to the first metatarsal portion,
wherein moving the second metatarsal portion in at least two planes relative to the first metatarsal portion comprises rotating the second metatarsal portion relative to the first metatarsal portion in a frontal plane until a tibial sesamoid bone and a fibular sesamoid bone are on opposite sides of a sagittal plane of the first metatarsal bone when viewed from the frontal plane.
2. The method of claim 1 , wherein the first metatarsal portion is a proximal portion of the first metatarsal bone and the second metatarsal portion is a distal portion of the first metatarsal bone.
3. The method of claim 1 , wherein moving the second metatarsal portion in at least two planes relative to the first metatarsal portion comprises pivoting the second metatarsal portion laterally relative to the first metatarsal portion in a transverse plane.
4. The method of claim 3 , wherein pivoting the second metatarsal portion laterally relative to the first metatarsal portion in the transverse plane comprises reducing an intermetatarsal angle between the first metatarsal bone and a second metatarsal bone.
5. The method of claim 1 , further comprising, subsequent to moving the second metatarsal portion relative to the first metatarsal portion, fixing the first metatarsal portion with respect to the second metatarsal portion.
6. The method of claim 5 , wherein fixing the first metatarsal portion with respect to the second metatarsal portion comprises applying at least one of a bone plate, a pin, a screw, and a staple across a joint separating the first metatarsal portion from the second metatarsal portion.
7. The method of claim 6 , wherein applying the bone plate comprises applying a bone plate selected from the group consisting of a helical-shaped bone plate, a T-shaped bone plate, and an L-shaped bone plate.
8. The method of claim 1 , wherein the cutting instrument is a spherical-shaped cutting instrument having a diameter within a range from 6 millimeters to 30 millimeters.
9. The method of claim 8 , wherein the spherical-shaped cutting instrument has a radius of curvature that is constant across a cutting face of the spherical-shaped cutting instrument.
10. The method of claim 8 , wherein the spherical-shaped cutting instrument has a radius of curvature that varies by less than plus or minus 20 percent across a cutting face of the spherical-shaped cutting instrument.
11. The method of claim 4 , wherein reducing the intermetatarsal angle between the first metatarsal bone and a second metatarsal bone comprises reducing the intermetatarsal angle to between about 1 degree and about 5 degrees.
12. A method comprising:
making a generally spherical-shaped cut with a cutting instrument transecting a first metatarsal bone, thereby forming a distal metatarsal portion and a proximal metatarsal portion, one of which has a generally spherical-shaped projection and another of which has a generally spherical-shaped recess; and
moving the distal metatarsal portion in three planes, including a frontal plane, relative to the proximal metatarsal portion, thereby adjusting an anatomical alignment of the distal metatarsal portion relative to the proximal metatarsal portion,
wherein moving the distal metatarsal portion in the frontal plane comprises moving the distal portion relative to the first metatarsal portion in the frontal plane until a tibial sesamoid bone and a fibular sesamoid bone are on opposite sides of a sagittal plane of the first metatarsal bone when viewed from the frontal plane.
13. The method of claim 12 , further comprising inserting a guide pin into at least the distal metatarsal portion, wherein moving the distal metatarsal portion relative to the first metatarsal portion comprises moving the distal metatarsal portion via the guide pin.
14. The method of claim 13 , wherein inserting the guide pin comprises inserting a first guide pin into the distal metatarsal portion and inserting a second guide pin into the proximal metatarsal portion.
15. The method of claim 14 , wherein moving the distal metatarsal portion in multiple planes comprises visualizing the distal metatarsal portion and the proximal metatarsal portion under fluoroscopy and monitoring a position of one or more anatomical landmarks visible under fluoroscopy to control adjustment of the anatomical alignment.
16. The method of claim 15 , wherein the anatomical landmark comprises at least one of a plantar condyle the tibial sesamoid bone, and the fibular sesamoid bone.
17. The method of claim 12 , further comprising fixing the distal metatarsal portion with respect to the proximal metatarsal portion by applying at least one of a bone plate, a pin, a screw, and a staple across a joint separating the distal metatarsal portion from the proximal metatarsal portion.
18. The method of claim 17 , wherein fixing the distal metatarsal portion with respect to the proximal metatarsal portion comprises applying a bone plate.