Devices and less invasive techniques for treating lesser metatarsals of the foot
A variety of surgical procedures may be performed on the bones of the foot, such as on one or more lesser metatarsals of the foot positioned laterally of the first metatarsal. For example, a surgical procedure may involve cutting an end of one or both of a second metatarsal and an intermediate cuneiform and/or cutting an end of one or both of a third metatarsal and a lateral cuneiform. The tarsometatarsal joints defined be one or both sets of bones may be cut to treat an arthritic joint, metatarsus adductus, and/or other clinical condition. In any case, various surgical instruments can be utilized during a procedure to help increase the accuracy and repeatability of the procedure patient-to-patient, improving overall patient outcomes and making it less invasive. For example, one or more cut guides having tissue control features may be utilized during procedure.
1 . A less invasive technique for treating lesser metatarsals of a foot, the technique comprising:
making an incision through a skin of a patient;
positioning at least a portion of a bone cutting guide comprising a body extending lengthwise from a medial side to a lateral side through the incision;
retracting the skin along the incision to expose at least a portion of the bone cutting guide positioned over a first joint;
guiding a cutting instrument along a first guide surface of the bone cutting guide to prepare the first joint;
repositioning the skin along the incision to expose at least a portion of the bone cutting guide positioned over a second joint, thereby covering the portion of the first joint with the skin; and
guiding a cutting instrument along a second guide surface of the bone cutting guide to prepare the second joint.
2 . The technique of claim 1 , wherein the positioning of the skin along the incision is done using at least one of a skin feature on the medial side of the body of the bone cutting guide and a second skin feature on the lateral side of the body of the bone cutting guide.
3 . A minimally invasive technique for treating lesser metatarsals of a foot, the technique comprising:
making an incision through a skin of a patient;
positioning a portion of a bone cutting guide comprising a body extending lengthwise from a medial side to a lateral side through the incision, wherein the bone cutting guide comprises a medial side skin cutout feature and a lateral side skin cutout feature;
retracting the skin along the incision to expose at least a portion of a first bone under (a) a medial portion of the bone cutting guide with the skin positioned in the lateral side skin cutout feature or (b) a lateral portion of the bone cutting guide with the skin positioned in the medial side skin cutout feature;
guiding a cutting instrument along a first side guide surface of the bone cutting guide to cut the first bone;
repositioning the skin along the incision to expose at least a portion of a second bone under an other of (a) the medial portion of the bone cutting guide with the skin positioned in the lateral side skin cutout feature or (b) the lateral portion of the bone cutting guide with the skin positioned in the medial side skin cutout feature; and
guiding the cutting instrument along a second side guide surface of the bone cutting guide to cut the second bone.
4 . The minimally invasive technique of claim 3 , wherein positioning the portion of the bone cutting guide through the incision comprises positioning the medial side of the bone cutting guide under the skin, positioning the lateral side of the bone cutting guide under the skin, and positioning an intermediate portion of the bone cutting guide extending outwardly through the incision.
5 . The minimally invasive technique of claim 4 , wherein the medial side skin cutout feature is defined between the medial portion of the bone cutting guide and the intermediate portion of the bone cutting guide, and the lateral side skin cutout feature is defined between the lateral portion of the bone cutting guide and the intermediate portion of the bone cutting guide.
6 . The minimally invasive technique of claim 3 , wherein:
the medial portion of the bone cutting guide comprises an upper guide surface and a lower guide surface, with the medial side skin cutout feature defined between the upper guide surface and the lower guide surface; and
the lateral portion of the bone cutting guide comprises an upper guide surface and a lower guide surface, with the lateral side skin cutout feature defined between the upper guide surface and the lower guide surface.
7 . The minimally invasive technique of claim 3 , wherein the bone cutting guide comprises a medial side shelf positionable under the skin, a lateral side shelf positionable under the skin, and an intermediate portion positionable projecting outwardly through the incision between the medial side shelf and the lateral side shelf.
8 . The minimally invasive technique of claim 3 , wherein positioning the portion of the bone cutting guide through the incision comprises positioning a seeker of the bone cutting guide through the incision into a portion of both a second tarsometatarsal joint and a third tarsometatarsal joint.
9 . The minimally invasive technique of claim 3 , wherein making the incision comprises making the incision shorter than a length necessary to simultaneously expose both the first bone and the second bone.
10 . The minimally invasive technique of claim 3 , wherein making the incision comprises making the incision less than or equal to 5.0 mm.
11 . The minimally invasive technique of claim 3 , wherein:
the first bone is a second metatarsal or a third metatarsal; and
the second bone is an other of the second metatarsal or the third metatarsal.
12 . The minimally invasive technique of claim 11 , wherein:
retracting the skin along the incision to expose at least a portion of the first bone further comprises exposing at least a portion of a cuneiform separated from the first bone by a tarsometatarsal joint;
the first side guide surface is a first metatarsal side guide surface, and further comprising guiding the cutting instrument along a first cuneiform side guide surface of the bone cutting guide to cut the cuneiform separated from the first bone by the tarsometatarsal joint;
repositioning the skin along the incision to expose at least a portion of a second bone further comprises exposing at least a portion of a cuneiform separated from the second bone by a tarsometatarsal joint; and
the second side guide surface is a second metatarsal side guide surface, and further comprising guiding the cutting instrument along a second cuneiform side guide surface of the bone cutting guide to cut the cuneiform separated from the second bone by the tarsometatarsal joint.
13 . The minimally invasive technique of claim 3 , wherein retracting the skin along the incision to expose at least the portion of the first bone and guiding the cutting instrument along the first side guide surface of the bone cutting guide to cut the first bone comprises retracting the skin along the incision to expose at least the portion of the first bone and guiding the cutting instrument along the first side guide surface of the bone cutting guide to cut the first bone while the second bone remains at least partially covered with the skin.
14 . The minimally invasive technique of claim 3 , wherein repositioning the skin along the incision to expose at least the portion of the second bone and guiding the cutting instrument along the second side guide surface of the bone cutting guide to cut the second bone comprises retracting the skin along the incision to expose at least the portion of the second bone and guiding the cutting instrument along the second side guide surface of the bone cutting guide to cut the second bone while the first bone remains at least partially covered with the skin.
15 . The minimally invasive technique of claim 3 , further comprising:
adjusting a separation distance between the first bone and the second bone; and
fixating a moved position of the first bone and the second bone using one or more bone connectors.
16 . The minimally invasive technique of claim 15 , wherein the adjusting of the separation distance between the first bone and the second bone comprises correcting an alignment of the first bone in relation to the second bone in at least one plane.
17 . The minimally invasive technique of claim 3 , further comprising, prior to making the incision, positioning an incision guide over a joint locator pin, wherein the incision guide defines a length of the incision, and making the incision via the incision guide.