JP-2026075616-A - Independent surgical screw placement system with aiming jig

Abstract

[Problem] Independent surgical screw placement systems utilize aiming jigs. [Solution] The aiming jig has components and features that can be appropriately adjusted to prevent independent or off-plate screws from intersecting the nominal trajectories of other joint screws that secure the surgical plate to the foot in the relevant surgery. The aiming jig has a telescopic arm that can be adjusted to various potential trajectories for independent surgical screws until a desired trajectory for such independent screw is determined. [Selection Diagram] Figure 3

Inventors

• ジェシー ラッシュ
• リチャード シャインフィールド
• ギャレット ノートン
• ジェシカ サンドー

Assignees

• グローバス メディカル インコーポレイティッド

Dates

Publication Date

20260508

Application Date

20251021

Priority Date

20241022

Claims (20)

1. An independent surgical screw placement system for surgical procedures on the ankle joint, A surgical plate sized to cover and extend over the ankle joint, having a plurality of screw holes extending through the plate on its upper and lower surfaces and at spaced intervals on the plate; A plurality of articular screws, each receiving into the screw hole and adapted to be fixed to the ankle joint at the corresponding joint location, comprising a plurality of articular screws defining their respective nominal trajectories within the ankle joint, A system comprising: an aiming fixture that is removablely fixed to the plate, and is adapted to be adjustable to a user-selectable trajectory for the independent screw that does not intersect the nominal trajectory of the articulated screw.
2. The system according to claim 1, further comprising a connector disposed between the plate and the aiming jig, wherein the connector is keyed to adjust the angular orientation of the aiming jig relative to the plate.
3. The system according to claim 2, wherein the connector comprises a pilot pin that can be fitted into opposing pilot holes, and a screwable connection portion that can operate to fix the aiming jig to the plate when the pilot pin and the pilot hole are fitted together.
4. The aiming fixture includes an arm having a first end located on the plate, the arm extending from the plate to a second end, and the second end terminating within a housing. The screwable connection portion of the connector is disposed at the first end of the arm, The user-selectable trajectory of the independent screw is characterized by a plurality of angular parameters relative to the plate, The system according to claim 1, wherein the arm includes first and second nesting extension portions, the nesting extension portions being located between the first end and the second end of the arm and extending therefrom, the nesting extension portions being selectively movable and adjustable to position the housing at a user-selectable angle relative to the plate, the user-selectable angle constituting one of the parameters of the user-selectable trajectory of the independent screw.
5. The first nesting extension portion comprises a longitudinally extending rail having a longitudinally extending slot defined inside, and the second nesting extension portion defines a tongue portion that slidably receives within the slot. The rail has a plurality of stoppers defined adjacent to the slot and spaced apart in the longitudinal direction, The system according to claim 4, wherein the tongue includes a user-operable button, the button having a first position for engaging one of the selected stoppers for adjusting the rail and the tongue relative to each other, and the button having a second position for disengaging from the stoppers for the nesting extension portions to nest and extend relative to each other.
6. The system according to claim 5, wherein the nesting expandable portion comprises an arc-shaped portion extending from the connector toward the center.
7. The housing comprises a distal side and a proximal side, wherein the distal side is positioned to face and be movably close to the foot associated with the ankle joint when the procedure is performed, and the proximal side is positioned to be accessible to the user during the procedure. The housing further comprises at least one housing aperture extending through the side, The system according to claim 4, wherein the aiming fixture further comprises a k-wire tube that is removablely receivable through the housing aperture, the k-wire tube having a longitudinally extending k-wire bore sized to receive a k-wire.
8. The k-wire tube is selectively slidable in the proximal and distal directions relative to the housing to a desired position. The system according to claim 7, wherein the aiming jig includes a locking mechanism for adjusting the k wire tube to the desired position.
9. The locking mechanism comprises a longitudinally extending notch defined within the outer surface of the k wire tube, and the locking mechanism further comprises a shoulder defined within the k wire bore and a handle disposed at the proximal end of the k wire tube, wherein the handle is connected to the k wire tube such that rotation of the handle causes rotation of the notch within the bore relative to the shoulder. The system according to claim 8, wherein sufficient rotation of the handle relative to the shoulder portion selectively locks and unlocks the k-wire tube at the desired position, and the handle further includes a portion that indicates whether the corresponding k-wire tube is in the locked position or the unlocked position.
10. The system according to claim 7, further comprising three of the housing apertures, each of which has its own central axis, the axes being angled relative to one another to define an intersection point distally separated from the housing, and the housing being installable relative to the foot of the ankle joint after being inserted into the ankle joint during the procedure, such that the intersection point corresponds to the distal end of the independent screw.
11. The surgical plate comprises a dorsal plate, which is fixed to a first tarsometatarsal joint in connection with a Lisfranc injury repair procedure and is fitted to extend over and cover the first tarsometatarsal joint, the dorsal plate having a distal surface that can be brought toward the ankle joint during the procedure, and a proximal surface opposite to the distal surface and fitted to face away from the ankle joint when fixed to the ankle joint, The system according to claim 4, wherein the aiming fixture is adapted to position the housing above the central side of the ankle joint, and the aiming fixture is adapted to have the user-selectable trajectory starting from the central side.
12. The system according to claim 11, wherein the screw holes extend forward, and the aiming jig can be detachably fixed to at least one location on the back plate behind at least one of the screw holes.
13. The arm of the aiming jig comprises an arm tube at the first end of the arm and a support shaft movably received within the arm tube. The arm tube and the support shaft each have a proximal and distal end, and are coaxial with respect to the longitudinal axis of the arm tube. The screwable connection portion comprises a threaded shaft disposed at the distal end of the support shaft and extending longitudinally from the distal end of the support shaft, and the screwable connection portion further comprises a corresponding threaded bore formed in the back plate at a location behind a plurality of the threaded holes. The pilot pin is disposed on the distal end of the arm tube and extends longitudinally and distally from the arm tube. The pilot hole is formed on the proximal surface of the back plate adjacent to the threaded bore of the screwable connection portion. The pilot pin and the threaded shaft extend parallel to each other, so that when the arm tube is fixed to the dorsal plate, it extends perpendicularly from the proximal surface of the dorsal plate. When the telescopic extension portion of the arm is connected to the plate, it extends radially and outward in an arc shape from the longitudinal axis of the arm tube. The system according to claim 12, wherein the relative locations of the threaded bore in the back plate and the pilot hole in the back plate determine the angular orientation of the arm of the aiming fixture with respect to the plate.
14. The system according to claim 13, further comprising a user-operable support handle connected to the proximal end of the support shaft, for screwing the threaded support of the support shaft into the threaded bore of the plate.
15. The rail and the slot are located on one of the arched portions, and the tongue and the user-operable button are located on the other of the arched portions such that the second end of the arm retracts and contracts through a range of positions angled with respect to the reference plane of the plate, The system according to claim 6, wherein the slot extends sufficiently so that the angled position range extends from 60° to 120° with respect to the reference plane associated with the plate.
16. A process for inserting independent surgical screws into ankle joints outside a plate, wherein the plate has an upper and lower surface having screw holes extending through the plate in spaced-out locations covering a surgical area, the plate has articular screws extending through the screw holes for fixing the plate to the ankle joint, the articular screws defining respective nominal trajectories within the ankle joint, the surgical area having an outer edge, the outer edge defining a boundary zone extending outward from the upper surface of the plate and spreading into the same space as the outer edge, and the process is, Adjust a first location spaced apart from the upper surface of the plate and located outside the boundary zone, and define a first angular orientation relative to the plate, which corresponds to a first potential trajectory of the independent screw for insertion outside the plate, Determining whether the first potential trajectory constitutes a first available trajectory by avoiding all of the nominal trajectories of the articular screw, If the first potential trajectory does not necessarily avoid all of the nominal trajectories of the articular screw, adjust the first spaced location to adjust the second location spaced from the upper surface of the plate, located outside the boundary zone, and define the second angular orientation relative to the plate, which corresponds to the second potential trajectory of the independent screw for insertion outside the plate. Determining whether the second potential trajectory constitutes a second available trajectory by avoiding all of the nominal trajectories of the articular screw, If it is determined that one of the potential trajectories constitutes the available trajectory, The steps include advancing the k-wire into the ankle joint along the available trajectory, and then removing the k-wire from the ankle joint, The steps include advancing the drill into the ankle joint along the available trajectory to form a bore sized to receive the independent screw into the ankle joint, and then removing the drill, A process comprising the steps of: advancing the independent screw into the bore along the available track to insert the independent screw out of the plate.
17. A step of determining the intersection point in the ankle joint corresponding to the endpoint of the independent screw to be inserted, If the second potential trajectory is not determined to constitute an available trajectory, the steps include rotating the second angular orientation to a different angle with respect to the intersection point in order to define a third angular orientation which corresponds to a third potential trajectory for inserting the independent screw outside the plate, The process according to claim 16, further comprising the step of determining whether the third potential trajectory avoids all of the nominal trajectories of the articular screw.
18. The step of rotating the second angular orientation includes selecting a potential rotational position relative to the intersection point from three rotational positions available at the first and second locations relative to the intersection point, The steps include determining whether the selected potential rotational position constitutes an available trajectory by avoiding all of the nominal trajectories of the articulated screw, If so, the process according to claim 17, comprising the step of adjusting the available trajectory for subsequent insertion of the independent screw.
19. The process according to claim 16, wherein, during the step of advancing the k-wire, the k-wire is physically prevented from moving away from the available trajectory, thereby maintaining the resulting pilot hole formed within the nominal range of the k-wire.
20. The process according to claim 16, further comprising the step of adjusting the spaced portion of the ankle joint toward the foot to define an adjacent portion that is movably close to the tissue adjacent to the ankle joint.

Description

This disclosure generally relates to systems and devices associated with orthopedic procedures, and more particularly to systems for arranging screws related to surgical plates associated with such surgical procedures. In various surgical procedures involving the ankle joint, including the Lisfranc joint and the first tarsometatarsal (TMT) joint, independent screws or external screws positioned outside the associated plates and their associated articular screws are frequently used. One challenge in positioning such independent screws outside the associated plates is avoiding articular screws that should or already be positioned through the associated plates. It is desirable to have surgical systems and related methods to improve the placement of independent screws in relation to orthopedic surgery. In one suitable embodiment, this disclosure relates to an independent surgical screw placement system for surgical procedures in the ankle joint, etc. The system first includes a suitable surgical plate sized to cover and extend over the joint in question, such as the ankle joint. Thus, the surgical plate has a top and bottom surface, and a plurality of screw holes positioned to allow the plate to be fixed to adjacent bones, joints, or combinations thereof by plate or joint screws. Multiple articular screws are advanceable into the aforementioned screw holes for fixation to the ankle joint at the corresponding articular location. In this disclosure, the articular screws define their respective nominal orbits at the ankle joint, and the system features provisions for arranging independent surgical screws outside the plate and without intersecting the nominal orbits of the articular screws. The desired arrangement of the independent screws is achieved with the assistance of a aiming fixture, which is removablely fixed to the plate. In certain embodiments, the independent surgical screw placement system utilizes a connector located between the aforementioned plate and the aiming fixture. This connector may be equipped with features for keying or adjusting the angular orientation of the aiming fixture relative to the plate, for the purpose of later assisting in the desired non-interfering placement of the independent surgical screws. For example, certain embodiments may have the connector in the form of a pilot pin that can mate with opposing pilot holes. Once the pilot pin and pilot holes are mated, the screwable connection can be operated to secure the aiming fixture to the plate. In further embodiments, the aiming fixture includes an arm. One end of the arm is located near the plate. The arm extends upward from this first end, i.e., upward from the plate, and then extends either centrally or laterally, depending on the desired trajectory for an independent screw, to terminate at a second end. Thus, the second end of the arm is spaced apart from the plate. The housing is fixed to the second end of the aiming fixture. A screwable connector portion is provided at the first end opposite the arm, for part of its connection. The aiming fixture is characterized by being adjustable by the user to create a user-determined trajectory for an independent screw, preferably a trajectory that does not intersect with the nominal trajectory of any jointed screw. To this end, the arm may include first and second telescopic sections that can be selectively moved and adjusted to position the housing at an angle selected by the user relative to the plate. Such an angle selected by the user is one of the parameters of the user-determined trajectory of the independent screw. In a further embodiment, the housing includes three housing apertures, each extending between opposing proximal and distal sides. The proximal side is accessible by a surgeon or other user, while the distal side is movably positioned in close proximity to the joint being operated on, such as one of the ankle joints. The k-wire tube is also part of the surgical placement system described above and can be placed in any one of the apertures of the housing. Each aperture has its own central axis and is oriented to define an intersection point corresponding to the distal end of an independent screw that can be potentially inserted along a user-determined trajectory. The embodiments described above and their features will be better understood by referring to the description and drawings herein. This is a perspective view of an independent surgical screw placement system shown for an ankle joint undergoing a surgical procedure. This is a partial side view showing multiple articular screws within the ankle joint and their corresponding nominal trajectories, as well as independent screws that avoid such nominal trajectories. This is a partially exploded perspective view of an embodiment of an independent surgical screw placement system. Figure 3 is a further exploded view of the independent surgical screw placement system. This is a perspective view of a portion of the indep