Bi-planar instrument for bone cutting and joint realignment procedure
A technique for correcting a bone deformity, such as a bunion, may be performed using an instrument that defines a spacer body connected to a fulcrum. The spacer body portion of the instrument can be inserted into a joint space between opposed bone ends. The fulcrum body can be inserted between adjacent metatarsals. An angle set between the spacer body and fulcrum body can help properly position both features within different joint spaces for ensuring that subsequent steps of the surgical procedure are properly performed and instrumentation is appropriately aligned.
1. A method for correcting an alignment of a bone in a foot and preparing bones for fusion, the method comprising:
inserting a unitary instrument comprising a spacer body connected to a fulcrum body between bones of a foot by inserting the spacer body into a joint space between a metatarsal and an opposed cuneiform and simultaneously inserting the fulcrum body between the metatarsal and an adjacent metatarsal,
preparing an end of the metatarsal using a bone preparation guide aligned with the spacer body to guide a bone preparation instrument;
preparing an end of the opposed cuneiform using the bone preparation guide to guide the bone preparation instrument; and
moving the metatarsal relative to the adjacent metatarsal in at least a transverse plane, thereby pivoting the metatarsal about the fulcrum body and reducing an intermetatarsal angle between the metatarsal and the adjacent metatarsal.
2. The method of claim 1 , wherein the spacer body is connected to the fulcrum body with a bridge member.
3. The method of claim 2 , wherein inserting the unitary instrument comprises positioning the bridge member against a proximal-lateral corner of the metatarsal.
4. The method of claim 1 , wherein the spacer body is fixedly connected to the fulcrum body.
5. The method of claim 1 , wherein an angle defined between the spacer body and fulcrum body is within a range from 60 degrees to 120 degrees.
6. The method of claim 1 , further comprising adjusting an angle defined between the spacer body and fulcrum body.
7. The method of claim 6 , wherein the spacer body is hingedly attached to the fulcrum body, and adjusting the angle defined between the spacer body and fulcrum body comprises rotating the spacer body relative to the fulcrum body about a hinged connection.
8. The method of claim 6 , wherein adjusting the angle defined between the spacer body and fulcrum body comprises bending a malleable section of material connecting the spacer body to the fulcrum body.
9. The method of claim 1 , wherein inserting the spacer body into the joint space comprises inserting a first portion of the spacer body into the joint space with a second portion of the spacer body extending above the joint space, and further comprising aligning the bone preparation guide with the second portion of the spacer body.
10. The method of claim 9 , wherein the second portion of the spacer body is sized smaller than a receiving opening of the bone preparation guide into which the second portion of the spacer body is inserted, and further comprising moving the bone preparation guide in at least one plane relative to the spacer body, with the spacer body inserted into the receiving opening.
11. The method of claim 10 , wherein the second portion of the spacer body further comprises a shelf extending outwardly from at least one a front face and a rear face of the spacer body, the shelf restricting movement between the bone preparation guide and the spacer body.
12. The method of claim 1 , wherein the bone preparation guide is permanently connected to the spacer body, and inserting the spacer body into the joint space comprises positioning the bone preparation guide over the metatarsal and the opposed cuneiform.
13. The method of claim 1 , further comprising a handle projecting at a non-zero degree angle away from the fulcrum body, wherein inserting the fulcrum body further comprises retracting tissue laterally away from an incision providing access to the metatarsal and the adjacent metatarsal and holding the tissue away from the incision in a tissue retraction space formed between the handle and the fulcrum body.
14. The method of claim 1 , wherein:
the metatarsal is a first metatarsal,
the opposed cuneiform is a medial cuneiform, and
the adjacent metatarsal is a second metatarsal.
15. The method of claim 1 , further comprising removing at least the spacer body from the joint space, compressing a prepared end of the metatarsal against a prepared end of the opposed cuneiform, and fixating the prepared end of the metatarsal to the prepared end of the opposed cuneiform.
16. The method of claim 15 , wherein removing at least the spacer body further comprises removing the fulcrum body connected to the spacer body.
17. The method of claim 15 , wherein fixating the prepared end of the metatarsal to the prepared end of the opposed cuneiform comprises inserting a fixation member across a tarsometatarsal joint.
18. The method of claim 1 , wherein preparing the end of the metatarsal and preparing the end of the opposing cuneiform comprises preparing one or both of the end of the metatarsal and the end of the opposing cuneiform after moving the metatarsal relative to the adjacent metatarsal.
19. The method of claim 1 , further comprising applying at least one fixation device across the joint space between a prepared end of the metatarsal and a prepared end of the opposed cuneiform.
20. The method of claim 19 , wherein the at least one fixation device comprises a bone plate.
21. The method of claim 1 , wherein the spacer body and fulcrum body are fabricated as separate components that are subsequently connected together to form the unitary instrument.