System and technique for metatarsal realignment with reduced incision length
A metatarsal correction procedure may be performed so as to minimize the length of the surgical incision created during the procedure. A variety of different instruments and/or techniques and facilitate the minimal incision procedure. In some examples, a technique involves making a comparatively small surgical incision to access a tarsometatarsal joint. A metatarsal and a cuneiform separated by the tarsometatarsal joint can be prepared. In addition, the metatarsal can be moved relative to the cuneiform using a bone positioning device having a metatarsal engagement member positioned in contact with the skin of the patient on a medial side of the metatarsal. After moving the metatarsal, a fixation device can be installed across the tarsometatarsal joint to cause fusion. In some examples, a plate holder is attached to a U-shaped bone plate to facilitate plating across the joint through the comparatively small incision.
1. A method of performing a minimal incision metatarsal correction procedure, the method comprising:
preparing an end of a metatarsal;
preparing an end of a cuneiform separated from the metatarsal by a tarsometatarsal joint;
moving the metatarsal relative to the cuneiform using a bone positioning device comprising a metatarsal engagement member and a tip, the metatarsal engagement member being positioned in contact with a skin of a patient covering a medial side of the metatarsal and the tip being positioned on a lateral side of a different metatarsal, wherein moving the metatarsal comprises applying a force via the bone positioning device to the skin of the patient covering the medial side of the metatarsal to move the metatarsal in a transverse plane to close an intermetatarsal angle between the metatarsal and an adjacent metatarsal and to rotate the metatarsal in a frontal plane, the metatarsal rotating relative to the metatarsal engagement member; and
after moving the metatarsal relative to the cuneiform, causing the metatarsal to fuse to the cuneiform.
2. The method of claim 1 , further comprising:
making an incision between the different metatarsal and a laterally-adjacent metatarsal;
inserting the tip of the bone positioning device through the incision; and
positioning the tip in contact with the lateral side of a different metatarsal.
3. The method of claim 2 , wherein:
the metatarsal is a first metatarsal;
the cuneiform is a medial cuneiform;
the different metatarsal is a second metatarsal; and
the laterally-adjacent metatarsal is a third metatarsal.
4. The method of claim 1 , wherein the metatarsal engagement member defines a concave surface configured to contact the skin of the patient covering the medial side of the metatarsal, the concave surface is formed by a pair of sidewalls, and the metatarsal engagement member defines a length extending in a dorsal to plantar direction that is at least 28 mm.
5. The method of claim 1 , wherein moving the metatarsal relative to the cuneiform using the bone positioning device comprises engaging a mechanism that moves the metatarsal engagement member and the tip relative to each other.
6. The method of claim 5 , wherein the mechanism comprises at least one of a ratchet and a threaded shaft.
7. The method of claim 1 , wherein causing the metatarsal to fuse to the cuneiform comprises installing at least one of a plate, a pin, a screw, and a staple across the tarsometatarsal joint between the metatarsal and the cuneiform.
8. The method of claim 1 , wherein causing the metatarsal to fuse to the cuneiform comprises installing a U-shaped plate across the tarsometatarsal joint.
9. The method of claim 8 , wherein the U-shaped plate comprises:
a first metatarsal-side fixation hole, a second metatarsal-side fixation hole, a first cuneiform-side fixation hole, and a second cuneiform-side fixation hole;
the first metatarsal-side fixation hole is spaced from the first cuneiform-side fixation hole by a bridge;
the second metatarsal-side fixation hole is angularly offset relative to the bridge; and
the second metatarsal-side fixation hole is angularly offset relative to the bridge.
10. The method of claim 9 , wherein installing the U-shaped plate across the tarsometatarsal joint comprises positioning the bridge across the tarsometatarsal joint with the first metatarsal-side fixation hole and the first cuneiform-side fixation hole positioned plantarly relative to the second metatarsal-side fixation hole and the second cuneiform-side fixation hole.
11. The method of claim 8 , wherein installing the U-shaped plate across the tarsometatarsal joint comprises installing the U-shaped plate on a medial side of the metatarsal and the cuneiform, and further comprising installing a second plate on a dorsal side of the metatarsal and the cuneiform.
12. The method of claim 1 , wherein causing the metatarsal to fuse to the cuneiform comprises installing a plate across the tarsometatarsal joint, and further comprising attaching a plate holder to the plate and using the plate holder to position the plate over the metatarsal and the cuneiform while installing the plate.
13. The method of claim 12 , wherein the plate holder comprises an instrument configured to at least one of grasp an external surface of the plate and be inserted into a fixation hole of the plate.
14. The method of claim 12 , wherein the plate comprises a U-shaped plate that includes a first fixation hole with a first drill guide inserted into the first fixation hole and a second fixation hole with a second drill guide inserted into the second fixation hole, wherein the plate holder comprises a forceps with converging angled tips configured to be positioned against an external surface of the first drill guide and the second drill guide.
15. The method of claim 1 , further comprising making an incision through the skin to access the tarsometatarsal joint between the metatarsal and the cuneiform, wherein the incision has a length less than 6 cm.
16. The method of claim 1 , further comprising:
making an incision through the skin to access the tarsometatarsal joint between the metatarsal and the cuneiform, and
prior to making the incision, imaging at least a portion of the metatarsal and the cuneiform to identify a location of the tarsometatarsal joint.
17. The method of claim 16 , further comprising positioning a radio-identifiable marking line on an incision guide on the location of the tarsometatarsal joint to designate an incision location.
18. The method of claim 1 , wherein:
preparing the end of the metatarsal comprises preparing the end of the metatarsal with a bone preparation guide, and/or
preparing the end of the cuneiform comprises preparing the end of the cuneiform with the bone preparation guide.
19. The method of claim 18 , wherein the bone preparation guide comprises at least one guide surface configured to be positioned over at least one of the metatarsal and the cuneiform.
20. The method of claim 19 , wherein the at least one guide surface comprises a first guide surface configured to guide a cutting instrument across the metatarsal and a second guide surface configured to guide the cutting instrument across the medial cuneiform, and further comprising:
a first facing surface spaced from the first guide surface to define a first cutting slot between the first guide surface and the first facing surface, and
a second facing surface spaced from the second guide surface to define a second cutting slot between the second guide surface and the second facing surface.
21. The method of claim 18 , further comprising attaching the bone preparation guide to at least one of the metatarsal and the cuneiform by inserting at least one fixation pin into at least one fixation pin receiving aperture of the bone preparation guide and into the at least one of the metatarsal and the cuneiform.
22. The method of claim 1 , wherein:
preparing the end of the metatarsal comprises at least one of cutting and fenestrating the end of the metatarsal, and
preparing the end of the cuneiform comprises at least one of cutting and fenestrating the end of the cuneiform.
23. The method of claim 1 , further comprising, after moving the metatarsal relative to the cuneiform and prior to causing the metatarsal to fuse to the cuneiform, provisionally fixating the position of the metatarsal relative to the cuneiform.
24. The method of claim 1 , wherein the metatarsal is a first metatarsal and the cuneiform is a medial cuneiform.