Tarsal-metatarsal joint procedure utilizing compressor-distractor and instrument providing sliding surface
A compressor-distractor device may be used during a surgical procedure, such as a surgical procedure to correct a bunion deformity. In some examples, the compressor-distractor includes first and second engagement arms having first and second pin-receiving holes, respectively. The first and second pin-receiving holes may be angled relative to each other. The compressor-distractor may also include an actuator operatively coupled to the first and second engagement arms. In some example uses, a clinician may pin a first surgical device to a patient's bones use a pair of parallel pins. After removing the surgical device over the parallel pins, the clinician may thread the parallel pins through the angled first and second pin-receiving holes of the compressor-distractor, causing the bones to move relative to each other. Thereafter, the clinician may actuate the actuator on the compressor-distractor to move the bones towards and/or away from each other.
1. A method comprising:
attaching a compressor-distractor to a first metatarsal;
attaching the compressor-distractor to a medial cuneiform;
inserting an instrument defining a sliding surface between the first metatarsal and a second metatarsal; and
actuating the compressor-distractor to move the first metatarsal toward the medial cuneiform, thereby causing the first metatarsal to slide across the sliding surface of the instrument as the first metatarsal is moved toward the medial cuneiform.
2. The method of claim 1 , wherein the instrument 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.
3. The method of claim 1 , wherein the instrument has a generally rectangular cross-sectional shape or a generally circular cross-sectional shape.
4. The method of claim 1 , wherein the instrument has a body and a handle operatively connected to the body, and the handle projects at a non-zero degree angle from the body to define a tissue retraction space between the handle and the body.
5. The method of claim 1 , further comprising actuating the compressor-distractor to move the first metatarsal away from the medial cuneiform.
6. The method of claim 5 , wherein inserting the instrument between the first metatarsal and a second metatarsal comprises inserting the instrument after actuating the compressor-distractor to move the first metatarsal away from the medial cuneiform but prior to actuating the compressor-distractor to move the first metatarsal toward the medial cuneiform.
7. The method of claim 5 , wherein actuating the compressor-distractor to move the first metatarsal toward the medial cuneiform comprises moving an end of the first metatarsal generally axially toward an opposed end of the medial cuneiform, causing at least one of the end of the first metatarsal and a lateral side of the first metatarsal to slide across the sliding surface of the instrument as the first metatarsal is moved toward the medial cuneiform.
8. The method of claim 5 , further comprising, while the compressor-distractor is actuated to move the first metatarsal away from the medial cuneiform, cleaning a space between the first metatarsal and the medial cuneiform, and
wherein actuating the compressor-distractor to move the first metatarsal toward the medial cuneiform comprises moving the first metatarsal toward the medial cuneiform until the first metatarsal is compressing against the medial cuneiform.
9. The method of claim 5 , where actuating the compressor-distractor to move the first metatarsal away from the medial cuneiform comprises moving the first metatarsal away from the medial cuneiform a distance ranging from 1 millimeter to 2.5 millimeters.
10. The method of claim 1 , wherein inserting the instrument between the first metatarsal and a second metatarsal comprises positioning the instrument between a lateral portion of the first metatarsal and a medial portion of the second metatarsal.
11. The method of claim 1 , wherein the instrument further functions as a fulcrum, and further comprising, prior to attaching the compressor-distractor to the first metatarsal and the medial cuneiform, moving a distal portion of first metatarsal toward the second metatarsal in a transverse plane, thereby pivoting a proximal portion of the first metatarsal about the instrument and reducing an intermetatarsal angle between the first metatarsal and the second metatarsal.
12. The method of claim 1 , wherein:
the compressor-distractor comprises a first engagement arm, a second engagement arm, and an actuator operatively coupled to the first engagement arm and the second engagement arm,
attaching the compressor-distractor to the first metatarsal comprises attaching the first engagement arm to the first metatarsal;
attaching the compressor-distractor to the medial cuneiform comprises attaching the second engagement arm to the medial cuneiform; and
actuating the compressor-distractor to move the first metatarsal toward the medial cuneiform comprises engaging the actuator operatively coupled to the first engagement arm and the second engagement arm to move the first engagement arm toward the second engagement arm.
13. The method of claim 12 , wherein the actuator comprises a shaft connected to the first engagement arm and the second engagement arm.
14. The method of claim 1 , wherein attaching the compressor-distractor to the first metatarsal and attaching the compressor-distractor to the medial cuneiform comprises:
inserting a first pin into the first metatarsal;
inserting a second pin into the medial cuneiform;
positioning the first pin through a first pin-receiving hole of a first engagement arm of the compressor-distractor; and
positioning the second pin through a second pin-receiving hole of a second engagement arm of the compressor-distractor.
15. The method of claim 14 , further comprising
prior to inserting the first pin and the second pin, positioning a first fixation aperture of a bone preparation guide over the first metatarsal and a second fixation aperture of the bone preparation guide over the medial cuneiform, the first and second fixation apertures being parallel to each other,
wherein inserting the first pin and the second pin comprises inserting the first pin through the first fixation aperture of the bone preparation guide into the first metatarsal and the second pin through the second fixation aperture of the bone preparation guide into the medial cuneiform.
16. The method of claim 1 , further comprising moving the first metatarsal from a first position with respect to the second metatarsal to a second position with respect to the second metatarsal by applying a force to the first metatarsal, the force moving the first metatarsal in at least one plane.
17. The method of claim 16 , wherein moving the first metatarsal from the first position to the second position comprises moving the first metatarsal prior to attaching the compressor-distractor to the first metatarsal and to the medial cuneiform.
18. The method of claim 1 , further comprising:
moving the instrument defining the sliding surface with the first metatarsal as the first metatarsal is moved toward the medial cuneiform via actuation of the compressor-distractor.
19. A method comprising:
attaching a compressor-distractor to a first metatarsal;
attaching the compressor-distractor to a medial cuneiform;
actuating the compressor-distractor to move the first metatarsal away from the medial cuneiform; and
inserting an instrument defining a sliding surface between the first metatarsal and a second metatarsal.
20. The method of claim 19 , wherein the instrument 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.
21. The method of claim 19 , wherein the instrument has a generally rectangular cross-sectional shape or a generally circular cross-sectional shape.
22. The method of claim 19 , wherein inserting the instrument between the first metatarsal and a second metatarsal comprises inserting the instrument after actuating the compressor-distractor to move the first metatarsal away from the medial cuneiform.
23. The method of claim 19 , further comprising, while the compressor-distractor is actuated to move the first metatarsal away from the medial cuneiform, cleaning a space between the first metatarsal and the medial cuneiform.
24. The method of claim 19 , where actuating the compressor-distractor to move the first metatarsal away from the medial cuneiform comprises moving the first metatarsal away from the medial cuneiform a distance ranging from 1 millimeter to 2.5 millimeters.
25. The method of claim 19 , wherein inserting the instrument between the first metatarsal and a second metatarsal comprises positioning the instrument between a lateral portion of the first metatarsal and a medial portion of the second metatarsal.