Tarsal-metatarsal joint procedure utilizing fulcrum
A technique for correcting a bone deformity, such as a bunion, may be performed using a fulcrum. In some examples, the technique involves inserting a fulcrum between a first metatarsal that is anatomically misaligned with respect to a second metatarsal. The technique further includes preparing an end of the first metatarsal and preparing an end of a medial cuneiform opposing the end of the first metatarsal. In addition, a distal portion of the first metatarsal is moved toward the second metatarsal in a transverse plane, thereby pivoting a proximal portion of the first metatarsal about the fulcrum and reducing an intermetatarsal angle between the first metatarsal and the second metatarsal.
1. A method of correcting a bunion deformity comprising:
making an incision on a foot to provide access to a tarsal-metatarsal joint;
inserting a fulcrum between a first metatarsal and a second metatarsal;
moving the first metatarsal relative to a medial cuneiform to establish a moved position of the first metatarsal, wherein moving the first metatarsal relative to the medial cuneiform comprises moving the first metatarsal against the fulcrum; and
fixing the moved position of the first metatarsal relative to the medial cuneiform by inserting a fixation device across the tarsal-metatarsal joint.
2. The method of claim 1 , wherein moving the first metatarsal against the fulcrum comprises maintaining a separation distance between the first metatarsal and the second metatarsal during movement.
3. The method of claim 2 , wherein the second metatarsal contacts the fulcrum and the separation distance is a width of the fulcrum.
4. The method of claim 1 , wherein positioning the fulcrum between the first metatarsal and the second metatarsal comprises positioning the fulcrum between a proximal portion of the first metatarsal and a proximal portion of the second metatarsal.
5. The method of claim 4 , wherein
positioning the fulcrum between the proximal portion of the first metatarsal and the proximal portion of the second metatarsal comprises positioning the fulcrum between a base of the first metatarsal and a base of the second metatarsal, and
moving the first metatarsal relative to the medial cuneiform comprises moving the first metatarsal without shifting the base of the first metatarsal toward the base of the second metatarsal.
6. The method of claim 4 , wherein the proximal portion of the first metatarsal is a proximal-most third of the first metatarsal and the proximal portion of the second metatarsal is a proximal-most third of the second metatarsal.
7. The method of claim 1 , wherein moving the first metatarsal relative to the medial cuneiform comprises moving the first metatarsal relative to the medial cuneiform in a frontal plane, and moving the first metatarsal against the fulcrum comprises rotating the first metatarsal against the fulcrum.
8. The method of claim 1 , wherein moving the first metatarsal relative to the medial cuneiform comprises moving the first metatarsal relative to the medial cuneiform in a transverse plane, and moving the first metatarsal against the fulcrum comprises pivoting the first metatarsal against the fulcrum.
9. The method of claim 1 , wherein moving the first metatarsal relative to the medial cuneiform comprises moving the first metatarsal relative to the medial cuneiform in three planes.
10. The method of claim 1 , further comprising:
preparing an end of the first metatarsal; and
preparing an end of the medial cuneiform opposing the end of the first metatarsal.
11. The method of claim 10 , wherein:
preparing the end of the first metatarsal comprises preparing the end of the first metatarsal after moving the first metatarsal relative to the medial cuneiform, and
preparing the end of the medial cuneiform comprises preparing the end of the medial cuneiform after moving the first metatarsal relative to the medial cuneiform.
12. The method of claim 10 , wherein:
preparing the end of the first metatarsal comprises cutting the end of the first metatarsal; and
preparing the end of the medial cuneiform comprises cutting the end of the medial cuneiform.
13. The method of claim 12 , further comprising attaching a bone preparation guide to at least one of the first metatarsal and the medial cuneiform, wherein cutting the end of the first metatarsal comprises cutting the end of first metatarsal using the bone preparation guide, and cutting the end of the medial cuneiform comprises cutting the end of the medial cuneiform using the bone preparation guide.
14. The method of claim 10 , further comprising, after preparing the end of the first metatarsal and after preparing the end of the medial cuneiform but prior to fixing the moved position of the first metatarsal, provisionally fixing the moved position of the first metatarsal relative to the medial cuneiform.
15. The method of claim 1 , further comprising engaging a bone positioning guide with the first metatarsal, wherein moving the first metatarsal relative to the medial cuneiform comprises moving the first metatarsal with the bone positioning guide.
16. The method of claim 1 , wherein the fulcrum has a length extending from a leading end to a trailing end and tapers in thickness along at least a portion of the length from the trailing end to the leading end.
17. The method of claim 1 , wherein the fulcrum has a generally rectangular cross-sectional shape or a generally circular cross-sectional shape.
18. The method of claim 1 , wherein
the fulcrum has a body and a handle operatively connected to the body,
the handle projects at a non-zero degree angle from the body to define a tissue retraction space between the handle and the body, and
inserting the fulcrum between the first metatarsal and the second metatarsal comprises retracting tissue away from the tarsal-metatarsal joint with the handle.
19. The method of claim 1 , wherein inserting the fulcrum between the first metatarsal and the second metatarsal comprises positioning the first metatarsal in contact with a first face of the fulcrum and the second metatarsal in contact with a second face of the fulcrum, the first face having surface features different than the second face.
20. The method of claim 1 , wherein the fixation device comprises at least one of a bone plate and an intramedullary implant.