Joint spacer systems and methods
In some examples, a method for preparing one or more bones involves inserting a spacer into a space defined between a first bone and a second bone, such as a joint space between a first metatarsal and medial cuneiform. A bone preparation guide can be aligned with opposed ends of the first bone and the second bone using the spacer as an alignment reference. For example, the bone preparation guide may include an opening such that the guide can be installed across the joint space with the spacer received in the opening. A clinician may use the bone preparation guide to guide a tissue removing instrument to cut or otherwise prepare the ends of the first bone portion and second bone portion.
1. A method of correcting a bunion deformity, the method comprising:
positioning a spacer integral with and extending downwardly from a bone preparation guide to define a unibody in a tarsometatarsal joint between a first metatarsal and a medial cuneiform, thereby positioning a cutting slot of the bone preparation guide over a portion of the first metatarsal to be cut or over a portion of the medial cuneiform to be cut;
guiding a cutting instrument through the cutting slot of the bone preparation guide to cut the first metatarsal or to cut the medial cuneiform;
moving the first metatarsal in a frontal plane and in a transverse plane to correct the bunion deformity; and
applying a fixation device to the first metatarsal and to the medial cuneiform across the tarsometatarsal joint to fixate a moved position of the first metatarsal.
2. The method of claim 1 , wherein:
positioning the spacer integral with and extending downwardly from the bone preparation guide in the tarsometatarsal joint comprises positioning the cutting slot of the bone preparation guide over the portion of the first metatarsal to be cut; and
guiding the cutting instrument through the cutting slot of the bone preparation guide comprises cutting the first metatarsal.
3. The method of claim 2 , wherein the bone preparation guide comprises a fixation aperture, and further comprising, prior to guiding the cutting instrument through the cutting slot of the bone preparation guide, inserting a pin through the fixation aperture to secure the bone preparation guide to the first metatarsal.
4. The method of claim 2 , wherein moving the first metatarsal in the frontal plane and in the transverse plane to correct the bunion deformity comprises moving the first metatarsal in the frontal plane and in the transverse plane after guiding the cutting instrument through the cutting slot of the bone preparation guide to cut the first metatarsal.
5. The method of claim 1 , wherein:
positioning the spacer integral with and extending downwardly from the bone preparation guide in the tarsometatarsal joint comprises positioning the cutting slot of the bone preparation guide over the portion of the medial cuneiform to be cut; and
guiding the cutting instrument through the cutting slot of the bone preparation guide comprises cutting the portion of the medial cuneiform.
6. The method of claim 5 , wherein the bone preparation guide comprises a fixation aperture, and further comprising, prior to guiding the cutting instrument through the cutting slot of the bone preparation guide, inserting a pin through the fixation aperture to secure the bone preparation guide to the medial cuneiform.
7. The method of claim 5 , wherein moving the first metatarsal in the frontal plane and in the transverse plane to correct the bunion deformity comprises moving the first metatarsal in the frontal plane and in the transverse plane before guiding the cutting instrument through the cutting slot of the bone preparation guide to cut the medial cuneiform.
8. The method of claim 1 , wherein:
the cutting slot comprises a first cutting slot and a second cutting slot;
positioning the spacer integral with and extending downwardly from the bone preparation guide in the tarsometatarsal joint comprises positioning the first cutting slot of the bone preparation guide over the portion of the first metatarsal to be cut and positioning the second cutting slot of the bone preparation guide over the portion of the medial cuneiform to be cut; and
guiding the cutting instrument through the cutting slot of the bone preparation guide comprises guiding the cutting instrument through the first cutting slot to cut the first metatarsal and guiding the cutting instrument through the second cutting slot to cut the medial cuneiform.
9. The method of claim 1 , wherein positioning the spacer integral with and extending downwardly from the bone preparation guide in the tarsometatarsal joint comprises positioning the bone preparation guide on a dorsal-medial side of a foot with the spacer extending partially but not fully into the tarsometatarsal joint.
10. The method of claim 1 , wherein the fixation device comprises one or more of a compressing bone screw, a plate, a staple, and an intramedullary implant.
11. The method of claim 1 , further comprising moving the first metatarsal in a sagittal plane to correct the bunion deformity.
12. The method of claim 1 , further comprising compressing a cut end of the first metatarsal together with a cut end of the medial cuneiform prior to applying the fixation device.
13. The method of claim 1 , wherein:
positioning the spacer integral with and extending downwardly from the bone preparation guide in the tarsometatarsal joint comprises positioning the cutting slot of the bone preparation guide over the portion of the first metatarsal to be cut; and
guiding the cutting instrument through the cutting slot of the bone preparation guide comprises cutting the first metatarsal; and
further comprising flipping the bone preparation guide 180 degrees and positioning the cutting slot of the bone preparation guide over the portion of the medial cuneiform to be cut; and
guiding the cutting instrument through the cutting slot of the bone preparation guide to cut the medial cuneiform.
14. A method of correcting a bunion deformity, the method comprising:
positioning a spacer integral with and extending downwardly from a bone preparation guide to define a unibody in a tarsometatarsal joint between a first metatarsal and a medial cuneiform, thereby positioning a cutting slot of the bone preparation guide over a portion of the first metatarsal to be cut;
inserting a pin through a fixation aperture of the bone preparation guide and into the first metatarsal to secure the bone preparation guide to the first metatarsal;
guiding a cutting instrument through the cutting slot of the bone preparation guide to cut the first metatarsal to form a cut end of the first metatarsal;
moving the first metatarsal in a frontal plane and in a transverse plane to correct the bunion deformity;
cutting the medial cuneiform to form a cut end of the medial cuneiform;
compressing the cut end of the first metatarsal together with the cut end of the medial cuneiform;
applying a fixation device to the first metatarsal and to the medial cuneiform across the tarsometatarsal joint to fixate a moved position of the first metatarsal.
15. The method of claim 14 , wherein moving the first metatarsal in the frontal plane and in the transverse plane to correct the bunion deformity comprises moving the first metatarsal in the frontal plane and in the transverse plane after guiding the cutting instrument through the cutting slot of the bone preparation guide to cut the first metatarsal but prior to cutting the medial cuneiform.
16. The method of claim 14 , wherein:
the cutting slot comprises a first cutting slot and a second cutting slot;
positioning the spacer integral with and extending downwardly from the bone preparation guide in the tarsometatarsal joint comprises positioning the first cutting slot of the bone preparation guide over the portion of the first metatarsal to be cut and positioning the second cutting slot of the bone preparation guide over the portion of the medial cuneiform to be cut; and
cutting the medial cuneiform to form the cut end of the medial cuneiform comprises guiding the cutting instrument through the second cutting slot of the bone preparation guide to cut the medial cuneiform to form the cut end of the medial cuneiform.
17. The method of claim 14 , further comprising moving the first metatarsal in a sagittal plane to correct the bunion deformity.
18. The method of claim 14 , wherein positioning the spacer integral with and extending downwardly from the bone preparation guide in the tarsometatarsal joint comprises positioning the bone preparation guide on a dorsal-medial side of a foot with the spacer extending partially but not fully into the tarsometatarsal joint.
19. The method of claim 14 , wherein the fixation device comprises one or more of a compressing bone screw, a plate, a staple, and an intramedullary implant.
20. The method of claim 14 , further comprising, after guiding the cutting instrument through the cutting slot of the bone preparation guide to cut the first metatarsal, flipping the bone preparation guide 180 degrees and positioning the cutting slot of the bone preparation guide over a portion of the medial cuneiform to be cut, wherein cutting the medial cuneiform to form the cut end of the medial cuneiform comprises guiding the cutting instrument through the cutting slot of the bone preparation guide to cut the medial cuneiform to form the cut end of the medial cuneiform.
21. The method of claim 14 , further comprising, prior to applying the fixation device, provisionally fixating the moved position of the first metatarsal.