Bunion repair method and tool assembly

Abstract

A system and method for the surgical correction of a bunion deformity allows for correction of a bunion deformity. The method includes: drilling a hole across a first metatarsal and through a second metatarsal; placing a tube from outside the first metatarsal through the hole across the first and second metatarsals; pushing a first button through the tube until the first button exits the tube through a medial side of the second metatarsal; flipping the first button to engage the first button against the second metatarsal and applying a lateral tension on the suture strand; manually pushing the first metatarsal and the second metatarsal together to correct intermetatarsal angular deformity; pulling free ends of the suture strand of the suture-button construct to advance a second button of the suture-button construct and to engage the second button against the first metatarsal; and securing the second button against the first metatarsal.

Claims

1. A bunion repair tool assembly, comprising: a drill bit having an axial through bore for guiding the drill bit over a wire to drill through first and second metatarsals, forming a drilled bore; a tube sized to be inserted into the drilled bore spanning between the first and second metatarsals; a first plate connected to a length of suture or FIBER WIRE, the first plate having a profile to fit through the tube in one orientation and to be larger than the drilled bore in another orientation at the second metatarsal; a pusher sized to push the first plate from a base end of the tube, through the tube to exit out of the distal end of the tube; and a second plate for being connected to the length of suture or FIBER WIRE and being sized to be larger than the drilled bore at the first metatarsal.

2. The assembly according to claim 1, wherein the drill bit has a drill portion and a base portion, the drill portion has a diameter of about 4 mm, and a drill length of about 80 mm and the axial through bore has a diameter of about 1.2 mm and extends from an open tip end to an open base end.

3. The assembly according to claim 1, wherein the pusher includes a handle, a pushing shank with a diameter of about 1.3 mm and a length of about 100 mm.

4. The assembly according to claim 1, wherein the first plate includes two holes for receiving a suture or FIBER WIRE, and a curved face which allows the plate to fit comformably against the second metatarsal.

5. The assembly according to claim 1 wherein the second plate includes two holes for receiving a suture or FIBER WIRE.

6. The assembly according to claim 1 wherein the tube has a length of about 90 mm and a diameter of about 3.9 mm.

7. The assembly according to claim 1, wherein the first plate is oblong-shaped having at least two apertures.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 is an exploded view of a tool assembly used to perform a method of the present invention;

(2) FIG. 2A is an enlarged perspective view of a first button or plate shown in FIG. 1;

(3) FIG. 2B is an elevation view of the first button or plate shown in FIG. 1;

(4) FIG. 2C is an end view of the first button or plate shown in FIG. 1;

(5) FIG. 2D is a plan view of the first button or plate shown in FIG. 1;

(6) FIG. 3A is an enlarged perspective view of a second button or plate shown in FIG. 1;

(7) FIG. 3B is an elevation view of the second button or plate shown in FIG. 1;

(8) FIG. 3C is an end view of the second button or plate shown in FIG. 1;

(9) FIG. 3D is a plan view of the second button or plate shown in FIG. 1;

(10) FIG. 4A is a schematic outline of a skeletal foot showing a bunion to be repaired;

(11) FIG. 4B is a schematic outline of the skeletal foot of FIG. 4A during a first step of bunion repair;

(12) FIG. 4C is a schematic outline of the skeletal foot of FIG. 4A during a second step of bunion repair;

(13) FIG. 4D is a schematic outline of a skeletal foot of FIG. 4A during a third step of bunion repair;

(14) FIG. 4E s a schematic outline of a skeletal foot of FIG. 4A during a fourth step of bunion repair;

(15) FIG. 4F is a schematic outline of a skeletal foot of FIG. 4A during fifth, sixth and seventh steps of bunion repair;

(16) FIG. 4G is a schematic outline of a skeletal foot of FIG. 4A showing an eighth and ninth steps of bunion repair; and

(17) FIG. 4H is a sectional view taken generally along line 4H-4H of FIG. 4G.

DETAILED DESCRIPTION

(18) While this invention is susceptible of embodiment in many different forms, there are shown in the drawings, and will be described herein in detail, specific embodiments thereof with the understanding that the present disclosure is to be considered as an exemplification of the principles of the invention and is not intended to limit the invention to the specific embodiments illustrated.

(19) U.S. Pat. No. 7,875,058 is herein incorporated by reference to the extent that it does not contradict the disclosure herein.

(20) FIG. 1 illustrates a tool assembly 20 that is used to perform a bunion repair method of the present invention.

(21) The assembly 20 includes a drill bit 24, a pusher 26, a first button or plate 28, a second button or plate 30, and a tube 32.

(22) The drill bit 24 has a drill portion 34 and a base portion 36. The drill portion 34 has a diameter D1 of about 4 mm, and a drill length L1 of about 80 mm.

(23) An axial through bore 38 has a diameter of about 1.2 mm and extends from an open tip end 42 to an open base end 44.

(24) The pusher includes a handle 46, a pushing shank 48 with a diameter D2 of about 1.3 mm and a length L2 of about 100 mm.

(25) The tools shown in FIG. 1 are preferably composed of titanium, although other materials are possible.

(26) FIGS. 2A-2D illustrate the first plate 28. The polate 28 includes two holes 28a, 28b for receiving a suture or FIBER WIRE. The plate 28 has a curved face 28c which allows the plate to fit comformably against the second metatarsal 104b. The plate 28 includes curved sides 28d, 28e. The holes 28a, 28b, are recessed in a groove 28f in the curved face 28c.

(27) FIGS. 3A-3D illustrate the second plate 30. The plate 30 includes two holes 30a, 30b for receiving a suture or FIBER WIRE.

(28) Advantageous dimensions (in mm) for the two plates are shown in FIGS. 2A-3D, although the invention is not limited to any particular dimensions.

(29) The tube 32 has a length L3 of about 90 mm and a diameter D3 of about 3.9 mm with a wall thickness of about 0.25 mm.

(30) FIG. 4A illustrates a skeletal foot 100 having a first toe 102, a second toe 104, and a third toe 106. The bones of the toes include cuneiforms 102a, 104a, 106a; metatarsals 102b, 104b, 106b; and proximal phalanxes 102c, 104c, 106c. FIG. 4A shows that the first metatarsal 102b has been adversely rotated over time outwardly about the interface 102bb between the first metatarsal 102b and the first cuneiform 102a to form an outward projection or bunion 102d. To repair the bunion it is important to straighten the offset angle 102e in the transverse plane between the metatarsal axis 102f and the phalanx axis 102g, and reduce the angle 104e in the transverse plane between the first metatarsal axis 102f and the second metatarsal axis 104f.

(31) As shown in FIG. 4B the first metatarsal 102b has been rotated clockwise about the interface 102bb, and the metatarsal axis 102f has been substantially aligned with the phalanx axis 102g and the offset angle 102e has been reduced to near zero. A surgical method described in FIGS. 4B-4G will hold the bones in the desired position as shown in FIG. 4B.

(32) In a first step, a K-wire 103 is inserted by a driver through the first metatarsal 102b, spans between the first metatarsal 102b and the second metatarsal 104b and is inserted through the second metatarsal bone 104b. The K-wire 103 can have a diameter of about 0.045 inches.

(33) Then, as shown in FIG. 4C, in a second step, the drill bit 24, having the through bore 38 is placed coaxially over the K-wire, and with the K-wire acting as a guide, cuts a bore 110 (FIG. 4D) through the first and second metatarsals over the K-wire. The drill bit 24 is driven by a drill (not shown), having a drill chuck 25.

(34) FIG. 4D illustrates the K-wire 103 remaining in the bore 110 through the first and second metatarsal bones, once the drill bit 24 has been retracted in a third step.

(35) As shown in FIG. 4E, a tube 32, in a fourth step, has been inserted over the K-wire 103 and through the bore 110. The tube 32 fits tightly within the first and second metatarsal 102b, 104b and spans therebetween.

(36) FIG. 4F illustrates the K-wire 103 has been removed in a fifth step, and first plate 28 has sutures or FIBER WIRE 114 threaded through the holes 28a, 28b. In a sixth step, the plate 28 with trailing FIBER WIRE 114 is entered into an open end 120 of the tube 32. The pusher 26 is used to push the plate 28 through the tube 32 from the open end 120 and out of the opposite open end 124. Once the plate 28 emerges from the opposite open end 124, the tube is withdrawn in a seventh step.

(37) As shown in FIGS. 4G and 4H, as the tube is withdrawn, or after the tube is withdrawn, in an eighth step, the plate 28 is rotated approximately 90° so that the plate 28 will brace against the second metatarsal 104b and cannot be pulled back through the bore 110 as the tube is withdrawn. Also, once the tube 32 is withdrawn, in a ninth step, the second plate 30 is placed against an outside of the first metatarsal 102b as sutures are drawn tight to the second plate 30. The sutures 114, under tension, hold the first metatarsal 102b in position with respect to the second metatarsal 104b to prevent the first metatarsal from rotating counterclockwise about the interface 102bb.

(38) Although the plates 28, 30 are described to be installed adjacent to the second metatarsal 104b and the first metatarsal 102b respectively, depending on conditions, the plate 28 could be used against the first metatarsal 102b with the plate 30 used against the second metatarsal 104b, or two plates 30, 30 could be used against the two metatarsals 102b, 104b or two plates 28, 28 could be used against the two metatarsals 102b, 104b.

(39) FIG. 4H shows the plates 28, 30 against the metatarsals but also indicates that the k-wire, the bore and the tube are all placed though a center line of the thickness of the metatarsals 102b, 104b.

(40) From the foregoing, it will be observed that numerous variations and modifications may be effected without departing from the spirit and scope of the invention. It is to be understood that no limitation with respect to the specific apparatus illustrated herein is intended or should be inferred.