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:
using a guide surface of a cutting guide to guide a cutting instrument to cut a first metatarsal, the cutting instrument cutting the first metatarsal into a proximal metatarsal portion and a distal metatarsal portion;
inserting a guide pin into the distal metatarsal portion;
moving the distal metatarsal portion in at least a frontal plane and a transverse plane relative to the proximal metatarsal portion, to correct bunion deformity by adjusting an alignment of the distal metatarsal portion relative to the proximal metatarsal portion, wherein moving the distal metatarsal portion comprises moving the distal metatarsal portion in at least the frontal plane by applying a rotational force to the guide pin; and
fixating an adjusted position of the distal metatarsal portion relative to the proximal metatarsal portion by applying at least one fixation device.
2. The method of claim 1 , wherein moving the distal metatarsal portion in the frontal plane comprises rotating the distal metatarsal portion until a tibial sesamoid bone and a fibular sesamoid bone are on opposite sides of a sagittal plane when viewed from the frontal plane.
3. The method of claim 1 , wherein moving the distal metatarsal portion in the transverse plane comprises shifting the distal metatarsal portion laterally in the transverse plane.
4. The method of claim 1 , wherein moving the distal metatarsal portion in the transverse plane comprises pivoting the distal metatarsal portion laterally in the transverse plane.
5. The method of claim 1 , wherein moving the distal metatarsal portion in at least the frontal plane and the transverse plane further comprises moving the distal metatarsal portion in a sagittal plane.
6. The method of claim 1 , wherein fixating the adjusted position of the distal metatarsal portion relative to the proximal metatarsal portion by applying at least one fixation device comprises 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.
7. The method of claim 1 , wherein fixating the adjusted position of the distal metatarsal portion relative to the proximal metatarsal portion by applying at least one fixation device comprises applying at least one bone plate across a joint separating the distal metatarsal portion from the proximal metatarsal portion.
8. The method of claim 7 , wherein the at least one bone plate comprises 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.
9. The method of claim 1 , wherein using the guide surface of the cutting guide to guide the cutting instrument to cut the first metatarsal, the cutting instrument cutting the first metatarsal into the proximal metatarsal portion and the distal metatarsal portion comprises making at least one of a planar cut, a generally spherical-shaped cut, and a crescentic-shaped cut transecting the first metatarsal.
10. The method of claim 1 , wherein cutting the first metatarsal into a proximal metatarsal portion and a distal metatarsal portion comprises making a planar cut transecting the first metatarsal.
11. The method of claim 1 , further comprising, prior to using the guide surface of the cutting guide, aligning the cutting guide relative to the first metatarsal.
12. The method of claim 1 , wherein the cutting guide comprises a seeker, and aligning the cutting guide comprising inserting the seeker into a tarsometatarsal joint between the first metatarsal and a medial cuneiform.
13. The method of claim 1 , wherein inserting the guide pin into the distal metatarsal portion comprises inserting the guide pin into the distal metatarsal portion after cutting the first metatarsal into the proximal metatarsal portion and the distal metatarsal portion.
14. The method of claim 13 , wherein the guide pin comprises a distal guide pin and further comprising inserting a proximal guide pin into the proximal metatarsal portion.
15. The method of claim 14 , wherein moving the distal metatarsal portion 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 distal metatarsal portion.
16. A method comprising:
positioning a guide surface of a cutting guide over a portion of a first metatarsal to be cut, the cutting guide comprising a seeker offset a distance from the guide surface, wherein positioning the guide surface of the cutting guide over the portion of the first metatarsal to be cut comprises inserting the seeker into a joint defined by an end of the first metatarsal;
guiding a cutting instrument along the guide surface to cut the first metatarsal into a proximal metatarsal portion and a distal metatarsal portion;
inserting a guide pin into the distal metatarsal portion;
moving the distal metatarsal bone portion in at least a frontal plane and a transverse plane relative to the proximal metatarsal bone portion, to correct bunion deformity by adjusting an alignment of the distal metatarsal portion relative to the proximal metatarsal portion, wherein moving the distal metatarsal portion comprises moving the distal metatarsal portion in at least the frontal plane by applying a rotational force to the guide pin; and
fixating an adjusted position of the distal metatarsal portion relative to the proximal metatarsal portion by applying at least one fixation device.
17. The method of claim 16 , wherein moving the distal metatarsal portion in the transverse plane comprises shifting the distal metatarsal portion laterally in the transverse plane.
18. The method of claim 16 , wherein moving the distal metatarsal portion in the transverse plane comprises pivoting the distal metatarsal portion laterally in the transverse plane.
19. The method of claim 16 , wherein guiding the cutting instrument along the guide surface to cut the first metatarsal into the proximal metatarsal portion and the distal metatarsal portion comprises making at least one of a planar cut, a generally spherical-shaped cut, and a crescentic-shaped cut transecting the first metatarsal.
20. The method of claim 1 , wherein inserting the guide pin comprises inserting the guide pin such that the guide pin projects out of a medial-dorsal quadrant of the distal metatarsal portion.
21. The method of claim 1 , wherein using the guide surface of the cutting guide to guide the cutting instrument to cut the first metatarsal, the cutting instrument cutting the first metatarsal into the proximal metatarsal portion and the distal metatarsal portion comprises making a planar cut across the first metatarsal parallel to the frontal plane.
22. The method of claim 16 , wherein moving the distal metatarsal portion 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 distal metatarsal portion.