Surgical pin positioning lock

Abstract

A pin lock may be used to prevent a compressor-distractor from pushing off of a surgical pin as the compressor-distractor is actuated to move one bone relative to another bone. In some examples, the compressor-distractor is attached to a metatarsal with a first pin and to a cuneiform with a second pin. The pin lock can be inserted onto the first pin or the second pin, optionally with a second pin lock inserted onto the other pin. The compressor-distractor can then be actuated while the compressor-distractor is locked by the pin lock from moving up along the axial length of the first pin or the second pin.

Claims

1. A method comprising: attaching a compressor-distractor to a first bone portion by at least inserting a first pin through a first pin-receiving hole of the compressor-distractor and into the first bone portion; attaching the compressor-distractor to a second bone portion by at least inserting a second pin through a second pin-receiving hole of the compressor-distractor and into the second bone portion; and after attaching the compressor-distractor to the first bone portion and/or the second bone portion, inserting a pin lock onto the first pin or the second pin, the pin lock locking a position of the compressor-distractor along an axial length at least one of the first pin and the second pin.

2. The method of claim 1, further comprising: while the compressor-distractor is locked by the pin lock from moving up along the axial length of the first pin or the second pin, actuating the compressor-distractor to at least one of move the first bone portion toward the second bone portion and move the first bone portion away from the second bone portion.

3. The method of claim 1, wherein the first bone portion and the second bone portion are different portions of a same bone.

4. The method of claim 1, wherein the first bone portion is a metatarsal and the second bone portion is a cuneiform separated by a tarsal-metatarsal joint from the metatarsal.

5. The method of claim 1, wherein inserting the pin lock onto the first pin or the second pin comprises positioning the pin lock over an end of the first pin or an end of the second pin and sliding the pin lock down the axial length of the first pin or the second pin until the pin lock contacts the compressor-distractor.

6. The method of claim 1, wherein inserting the pin lock onto the first pin or the second pin comprises: actuating the pin lock to unlock a pin-receiving channel on the pin lock; inserting the first pin or the second pin through the unlocked pin-receiving channel; and releasing the pin lock to cause the pin lock to lock the pin lock.

7. The method of claim 1, wherein the pin lock comprises: a bearing retaining body defining a pin receiving hole extending axially therethrough, the bearing retaining body defining a bearing receiving cavity extending from an outer perimeter surface to the pin receiving hole and including a bearing contained therein; a piston defining at least one sidewall and a top wall which, collectively, form a cavity, the top wall of the piston defining a pin receiving hole extending therethrough, the at least one sidewall defining an inward taper over at least a portion of its length; and a biasing member, wherein the bearing retaining body is at least partially inserted into the cavity of the piston with the pin receiving hole of the bearing retaining body being axially aligned with the pin receiving hole extending through the top wall of the piston, the biasing member is positioned between the bearing retaining body and the top wall of the piston and configured to bias the bearing retaining body away from the top wall of the piston, and the piston is configured to move relative to the bearing retaining body, causing the inward taper on the at least one sidewall to move relative to the bearing and thereby causing the bearing to move into or out of the pin receiving hole.

8. The method of claim 7, further comprising a base defining at least one sidewall and a bottom wall which, collectively, form a cavity, the bottom wall of the base defining a pin receiving hole extending therethrough, wherein the base is positioned with the at least one sidewall of the base extending at least partially over the at least one sidewall of the piston, the pin receiving hole of the base is axially aligned with the pin receiving hole of the bearing retaining body and with the pin receiving hole extending through the top wall of the piston, and the bearing retaining body is positioned at least partially between the bottom wall of the base and the biasing member.

9. The method of claim 8, wherein inserting the pin lock onto the first pin or the second pin comprises: pushing the piston toward the base, inserting the first pin or the second pin through the pin receiving hole of the base, the pin receiving hole of the bearing retaining body, and the pin receiving hole extending through the top wall of the piston, and releasing the piston.

10. The method of claim 1, wherein the pin lock comprises a first arm and a second arm coupled to the first arm, the first arm defining a first opening, the second arm defining a second opening, the first arm and the second arm being biased away from each other to position the first opening out of axial alignment with the second opening and being configured to compress together to axially align the first opening with the second opening.

11. The method of claim 1, wherein: the first bone portion is a metatarsal and the second bone portion is a cuneiform separated by a tarsal-metatarsal joint from the metatarsal, while the compressor-distractor is locked by the pin lock from moving up along the axial length of the first pin or the second pin, actuating the compressor-distractor to at least one of move the first bone portion toward the second bone portion and move the first bone portion away from the second bone portion.

12. The method of claim 11, wherein actuating the compressor-distractor to at least one of move the metatarsal toward the cuneiform and move the metatarsal away from the cuneiform comprises: actuating the compressor-distractor to move the metatarsal away from the cuneiform, while the compressor-distractor is actuated to move the metatarsal away from the cuneiform, cleaning a space between the metatarsal and the cuneiform, and subsequently actuating the compressor-distractor to move the metatarsal toward the cuneiform.

13. A surgical pin positioning lock comprising: a bearing retaining body defining a pin receiving hole extending axially therethrough, the bearing retaining body defining a bearing receiving cavity extending from an outer perimeter surface to the pin receiving hole and including a bearing contained therein; a piston defining at least one sidewall and a top wall which, collectively, form a cavity, the top wall of the piston defining a pin receiving hole extending therethrough, the at least one sidewall defining an inward taper over at least a portion of its length; a biasing member; and a base defining at least one sidewall and a bottom wall, wherein the bearing retaining body is at least partially inserted into the cavity of the piston with the pin receiving hole of the bearing retaining body being axially aligned with the pin receiving hole extending through the top wall of the piston, the biasing member is positioned between the bearing retaining body and the top wall of the piston and configured to bias the bearing retaining body away from the top wall of the piston, the piston is configured to move relative to the bearing retaining body, causing the inward taper on the at least one sidewall to move relative to the bearing and thereby causing the bearing to move into or out of the pin receiving hole, and the bearing retaining body is positioned at least partially between the bottom wall of the base and the biasing member.

14. The lock of claim 13, wherein: the at least one sidewall and the bottom wall of the base, collectively form a cavity, the bottom wall of the base defining a pin receiving hole extending therethrough, the base is positioned with the at least one sidewall of the base extending at least partially over the at least one sidewall of the piston, and the pin receiving hole of the base is axially aligned with the pin receiving hole of the bearing retaining body and with the pin receiving hole extending through the top wall of the piston.

15. The lock of claim 14, wherein a bottom edge of the at least one sidewall of the piston is offset from the bottom wall of the base a distance ranging from 0.5 mm to 5 mm, when the piston is fully biased away from the base.

16. The lock of claim 13, wherein the bearing receiving cavity comprises a first bearing receiving cavity, and further comprising at least a second bearing receiving cavity and a third bearing receiving cavity, the first, second, and third bearing receiving cavities being spaced from each other about a perimeter of the bearing retaining body, and the bearing comprises a first bearing, and further comprising at least a second bearing and a third bearing, the first, second, and third bearings being contained in the first, second, and third bearing receiving cavities, respectively.

17. The lock of claim 13, wherein the pin receiving hole of the bearing retaining body and the pin receiving hole extending through the top wall of the piston are each circular and configured to receive a circular pin having a diameter ranging from 0.5 mm to 4 mm.

18. The lock of claim 13, wherein the inward taper of the at least one sidewall of the bearing retaining body is tapered at an angle ranging from 10 degrees to 45 degrees relative to a remainder of the sidewall.

19. The lock of claim 13, wherein the bearing receiving cavity is larger at the outer perimeter surface of the bearing retaining body than at the pin receiving hole such that the bearing can be inserted into the bearing receiving cavity from the outer perimeter surface of the bearing retaining body but cannot exit the bearing receiving cavity into the pin receiving hole.

Description

BRIEF DESCRIPTION OF DRAWINGS

(1) FIGS. 1A and 1B are front views of a foot showing a normal first metatarsal position and an example frontal plane rotational misalignment position, respectively.

(2) FIGS. 2A and 2B are top views of a foot showing a normal first metatarsal position and an example transverse plane misalignment position, respectively.

(3) FIGS. 3A and 3B are side views of a foot showing a normal first metatarsal position and an example sagittal plane misalignment position, respectively.

(4) FIG. 4 is a perspective view of an example compressor-distractor according to disclosure.

(5) FIG. 5 is a frontal plane view of the example compressor-distractor of FIG. 4 showing an example angular offset between pin-receiving holes.

(6) FIG. 6 is a sagittal plane view of the example compressor-distractor of FIG. 4 showing an example angular offset between pin-receiving holes.

(7) FIG. 7 is a side view of an example configuration of the compressor-distractor of FIG. 4.

(8) FIG. 8 is a perspective view of one example pin lock that can be used according to the disclosure.

(9) FIGS. 9-12 are views of another example pin lock that can be used according to the disclosure.

(10) FIG. 13 is a top plan view of an example bone preparation guide that can be used with a compressor-distractor and instrument defining a sliding surface.

(11) FIG. 14 is a perspective view of an example bone preparing guide, spacer, and tissue removing instrument check member that can be used with a compressor-distractor and instrument defining a sliding surface.

(12) FIG. 15 is a side perspective view of a foot depicting a bone preparation instrument inserted into a joint.

(13) FIG. 16 is a perspective view of a foot depicting a bone positioning guide on the foot prior to an alignment of a first metatarsal.

(14) FIG. 17 is a perspective view of a foot depicting a bone positioning guide on the foot after an alignment of a first metatarsal and with a spacer inserted into a joint space.

(15) FIG. 18 is a perspective view of a foot depicting a bone preparation guide positioned on the foot.

(16) FIG. 19 is a perspective view of a foot depicting a bone preparation guide on the foot with pins inserted through the bone preparation guide.

(17) FIG. 20 is a perspective view of a foot depicting a removal of a bone preparation guide.

(18) FIG. 21 is a perspective view of a foot depicting pins remaining in the foot following removal of a bone preparation guide.

(19) FIG. 22 is a perspective view of a foot showing an example compressor-distractor installed over pins positioned in bones of the foot.

(20) FIGS. 23 and 24 illustrate alternative pin lock configurations installed over a pin, sandwiching the compressor-distractor between the bones of the foot and the pin lock.

(21) FIG. 25 is a side perspective view of a foot depicting bone plates across a joint between first and second bones.

DETAILED DESCRIPTION

(22) In general, this disclosure is directed to devices and techniques that can be used during a surgical bone realignment procedure. In some examples, a system is described that includes a compressor-distractor device and a pin lock. The compressor-distractor device and the pin lock can be utilized together during a bone repositioning procedure. For example, during a bone repositioning procedure, a bone such as a metatarsal on a foot may be moved from an anatomically misaligned position to an anatomically aligned position with respect to another bone, such as an adjacent metatarsal. One end of the metatarsal and a facing end of adjacent cuneiform may be prepared, such as by cutting the ends of the metatarsal and adjacent cuneiform.

(23) To facilitate clean-up and compression between the two bone ends, the compressor-distractor device may be attached to both the metatarsal and cuneiform. The compressor-distractor device can then be actuated to move the metatarsal away from the cuneiform. This can open up the space between the two bone faces, for example, to allow the clinician to preform further cleanup and/or preparation on a bone face and/or to remove debris from the space between the two bone faces. In either case, the compressor-distractor device can be actuated to move the metatarsal toward the cuneiform, for example, to compress the two bone faces together for fixation.

(24) As the compressor-distractor device is actuated to move the bone ends toward and/or away from each other, the compressor-distractor may have a tendency to push up the pins holding the compressor-distractor to the metatarsal and the cuneiform instead of translating the movement force associated with actuation to the bones. This can cause incomplete movement between the two bone ends and/or cause the metatarsal to undesirability change orientation relative to the cuneiform.

(25) For these and other reasons, a pin lock according to the disclosure may be utilized with the compressor-distractor device. The pin lock may slide down the shaft of a pin connecting the compressor-distractor to an underlying bone, e.g. the pin connecting the compressor-distractor to the metatarsal and/or the pin connecting the compressor-distractor to the cuneiform. Once suitably positioned, the pin lock can be locked such that the position of the pin lock does not change along the length of the pin under the force conditions expected to be experienced during the procedure. The compressor-distractor can then be actuated to move the two bone ends relative to each other. If the compressor-distractor begins to move up the pin(s) holding the device to underlying bones in response to being actuated, the pin lock can limit the extent of movement. This can help ensure that the force of the compressor-distractor is translated through the pins to move the metatarsal and cuneiform towards and/or away from each other while minimizing the extent to which compressor-distractor shifts the orientation of the pins relative to each other, causing orientation changes between the metatarsal and cuneiform.

(26) A compressor-distractor used according to the present disclosure can have a variety of different configurations. In some examples, the compressor-distractor includes first and second engagement arms that define first and second pin-receiving holes, respectively. The first and second pin-receiving holes can receive pins that are inserted into adjacent bones being compressed and/or distracted. In this way, the pins inserted through the pin-receiving holes can function to attach to the compressor-distractor to the bones. The first and second pin-receiving holes can be parallel to each other, e.g., to facilitate sliding the compressor-distractor on and/or off the pins without adjusting the relative positioning of the pins. Alternatively, the first and second pin-receiving holes can be angled relative to each other. This may cause the pins and, correspondingly bones to which the pins are attached, to rotate as the compressor-distractor is placed over the pins.

(27) A pin lock according to the disclosure can likewise have a variety of different configurations. In general, any instrument that can lock about a perimeter of a pin used to connect a compressor-distractor to underlying bone can be used as a pin lock. As one example, a pin lock may be formed as a spring clip having two arms with pin holes formed in each of the arms. Pushing the two arms of the spring clip toward each other may cause the pin holes on each of the arms to align for sliding the spring clip on a pin. Releasing the compression force applied to the arms may cause the spring force provided by the clip to bias the two arms away from each other. This can increase frictional engagement between the arms of the spring clip and the pin, thereby locking the spring clip to the pin.

(28) As another example, the pin lock may be formed with a piston that moves relative to a bearing which, in turn, can contact a perimeter surface of the pin. The piston can be biased to push against the bearing, thereby causing the bearing to frictionally engage with the surface of the pin. Actuating the piston can allow the bearing to move away from the surface of the pin and/or apply less force to the surface of the pin, thereby releasing the lock from the pin.

(29) A system that includes a compressor-distractor and pin lock may be used during a surgical procedure in which one or more other surgical instruments are also used. For example, the compressor-distractor and pin lock may be used during a procedure in which a bone preparation guide is also deployed for preparing the bones that are to be subsequent distracted and/or compressed together using the compressor-distractor and pin lock. The bone preparation guide may be pinned to two different bone portions, which may be two different bones separated by a joint or two portions of the same bone (e.g., separated by a fracture or break). In either case, one end of the bone preparation guide may be pinned to one bone portion while another end of the bone preparation guide may be pinned to the other bone portion. The bone preparation guide may be pinned to the two bone portions using a pair of pins that extend parallel to each other through a pair of fixation apertures on the bone preparation guide, optionally along with one or more additional pins that may extend through one or more additional fixation apertures on the bone preparation guide that may be skewed or angled at a non-zero degree angle relative to the parallel pins. In some configurations, the bone preparation guide defines one or more slots through which a bone preparation instrument (e.g., cutting instrument) is inserted to prepare opposed end faces of the two bones. A pin lock may be installed on a pin (or multiple pin locks installed on multiple pins) holding the bone preparation guide to the underlying bones.

(30) In instances where a pin lock is used, the bone preparation guide may optionally be attached to underlying bones without utilizing any skewed or angled pins discussed above. The skewed or angled pins can help prevent the bone preparation guide from migrating dorsally up the parallel pins during bone preparation (e.g., cutting). By installing a pin lock over one or more of the parallel pins, the skewed or angled pins may be eliminated from the surgical procedure. This can reduce the complexity of the procedure and also avoid the creation of an additional hole or holes in the bone, which otherwise necessitates further healing.

(31) In either case, after utilizing the bone preparation guide to prepare the two bone portions, the clinician may remove any angled pins (e.g., non-parallel pins) inserted through the bone preparation guide into the bone portions, leaving the parallel-aligned pins (e.g., a pair of parallel pins) in the bone portions. The bone preparation guide can be slide or translated along the parallel-aligned pins until the fixation apertures of the bone preparation guide come off the distal ends of the pins. At this point, the bone preparation guide may be separated from the pins, leaving the pins in the bone portions. The compressor-distractor can then be installed over the pins by threading the parallel-aligned pins through the first and second pin-receiving holes of the compressor-distractor.

(32) After installing the compressor-distractor on the pins, the clinician may then install one or more pin locks on one or more pins holding the compressor-distractor to the bones. For example, the clinician may actuate the pin lock to place the pin lock in an unlocked configuration and then position the pin lock on a pin extending through the compressor-distractor to an underlying bone. With the pin lock held in an unlocked state, the clinician may translate the pin lock down the length of the pin until the pin lock is adjacent to, and optically in contact with, the compress-distractor. Once suitably positioned, the clinician may release the pin lock to lock the device along the length of the pin. In different examples, the clinician may apply a single pin lock (e.g., one lock on a pin extending into the metatarsal or one lock on a pin extending into the cuneiform) or may apply multiple pin locks (e.g., one lock on a pin extending into the metatarsal and one lock on a pin extending into the cuneiform).

(33) With the one or more pin locks suitably positioned and locked, the clinician can actuate the actuator to move the first and second engagement arms away from each other and, as a result, move the bone portions away from each other. This can provide an enlarged separation gap between the bone portions for cleaning the inter-bone space in anticipation for fixation. For example, the clinician may remove bone chips and/or tissue debris from the inter-bone space between the two bone portions, further cut or prepare an end face of one or both bone portions, or otherwise prepare for fixation. Additionally or alternatively, the clinician can actuate the compressor-distractor to move the bone ends toward each other, e.g., compressing the bone ends together for application of a bone fixation device.

(34) As generally noted, pin lock devices and techniques according to the disclosure can be used for correcting a misalignment of one or more bones. The disclosed devices and techniques can be implemented in a surgical procedure in which one bone portion is realigned relative to another bone portion. In some examples, the technique is performed on one or more bones in the foot or hand, where bones are relatively small compared to bones in other parts of the human anatomy. For example, the foregoing description generally refers to example techniques performed on the foot and, more particularly a metatarsal and cuneiform of the foot. However, the disclosed techniques may be performed on other bones, such as the tibia, fibula, ulna, humerus, femur, or yet other bone, and the disclosure is not limited in this respect unless otherwise specifically indicated. In some applications, however, the disclosed techniques are used to correct a misalignment between a metatarsal (e.g., a first metatarsal) and a second metatarsal and/or a cuneiform (e.g., a medial, or first, cuneiform), such as in a bunion correction surgery.

(35) FIGS. 1-3 are different views of a foot 200 showing example anatomical misalignments that may occur and be corrected according to the present disclosure. Such misalignment may be caused by a hallux valgus (bunion), natural growth deformity, or other condition causing anatomical misalignment. FIGS. 1A and 1B are front views of foot 200 showing a normal first metatarsal position and an example frontal plane rotational misalignment position, respectively. FIGS. 2A and 2B are top views of foot 200 showing a normal first metatarsal position and an example transverse plane misalignment position, respectively. FIGS. 3A and 3B are side views of foot 200 showing a normal first metatarsal position and an example sagittal plane misalignment position, respectively. While FIGS. 1B, 2B, and 3B show each respective planar misalignment in isolation, in practice, a metatarsal may be misaligned in any two of the three planes or even all three planes. Accordingly, it should be appreciated that the depiction of a single plane misalignment in each of FIGS. 1B, 2B, and 3B is for purposes of illustration and a metatarsal may be misaligned in multiple planes that is desirably corrected.

(36) With reference to FIGS. 1A and 2A, foot 200 is composed of multiple bones including a first metatarsal 210, a second metatarsal 212, a third metatarsal 214, a fourth metatarsal 216, and a fifth metatarsal 218. The metatarsals are connected distally to phalanges 220 and, more particularly, each to a respective proximal phalanx. The first metatarsal 210 is connected proximally to a medial cuneiform 222, while the second metatarsal 212 is connected proximally to an intermediate cuneiform 224 and the third metatarsal is connected proximally to lateral cuneiform 226. The fourth and fifth metatarsals 216, 218 are connected proximally to the cuboid bone 228. The joint 230 between a metatarsal and respective cuneiform (e.g., first metatarsal 210 and medial cuneiform 222) is referred to as the tarsometatarsal (TMT) joint. The joint 232 between a metatarsal and respective proximal phalanx is referred to as a metatarsophalangeal joint. The angle 234 between adjacent metatarsals (e.g., first metatarsal 210 and second metatarsal 212) is referred to as the intermetatarsal angle (IMA).

(37) As noted, FIG. 1A is a frontal plane view of foot 200 showing a typical position for first metatarsal 210. The frontal plane, which is also known as the coronal plane, is generally considered any vertical plane that divides the body into anterior and posterior sections. On foot 200, the frontal plane is a plane that extends vertically and is perpendicular to an axis extending proximally to distally along the length of the foot. FIG. 1A shows first metatarsal 210 in a typical rotational position in the frontal plane. FIG. 1B shows first metatarsal 210 with a frontal plane rotational deformity characterized by a rotational angle 236 relative to ground, as indicated by line 238.

(38) FIG. 2A is a top view of foot 200 showing a typical position of first metatarsal 210 in the transverse plane. The transverse plane, which is also known as the horizontal plane, axial plane, or transaxial plane, is considered any plane that divides the body into superior and inferior parts. On foot 200, the transverse plane is a plane that extends horizontally and is perpendicular to an axis extending dorsally to plantarly (top to bottom) across the foot. FIG. 2A shows first metatarsal 210 with a typical IMA 234 in the transverse plane. FIG. 2B shows first metatarsal 210 with a transverse plane rotational deformity characterized by a greater IMA caused by the distal end of first metatarsal 210 being pivoted medially relative to the second metatarsal 212.

(39) FIG. 3A is a side view of foot 200 showing a typical position of first metatarsal 210 in the sagittal plane. The sagittal plane is a plane parallel to the sagittal suture which divides the body into right and left halves. On foot 200, the sagittal plane is a plane that extends vertically and is perpendicular to an axis extending proximally to distally along the length of the foot. FIG. 3A shows first metatarsal 210 with a typical rotational position in the sagittal plane. FIG. 3B shows first metatarsal 210 with a sagittal plane rotational deformity characterized by a rotational angle 240 relative to ground, as indicated by line 238.

(40) A system and technique that utilizes a compressor-distractor and/or a pin lock according to the disclosure can be useful during a bone positioning procedure, for example, to correct an anatomical misalignment of a bones or bones. In some applications, the compressor-distractor can help establish and/or maintain a realignment between a metatarsal and an adjacent cuneiform. Additionally or alternatively, the compressor-distractor can facilitate clean-up and compression between adjacent bone portions between fixation. The pin lock can help hold the compressor-distractor at an appropriate position along the length of a pin or pins connecting the compressor-distractor to bone portions to be compressed and/or distracted.

(41) The metatarsal undergoing realignment may be anatomically misaligned in the frontal plane, transverse plane, and/or sagittal plane, as illustrated and discussed with respect to FIGS. 1-3 above. Accordingly, realignment may involve releasing the misaligned metatarsal for realignment and thereafter realigning the metatarsal in one or more planes, two or more planes, or all three planes. After suitably realigning the metatarsal, the metatarsal can be fixated to hold and maintain the realigned positioned.

(42) While a metatarsal can have a variety of anatomically aligned and misaligned positions, in some examples, the term anatomically aligned position means that an angle of a long axis of first metatarsal 210 relative to the long axis of second metatarsal 212 is about 10 degrees or less (e.g., 9 degrees or less) in the transverse plane and/or sagittal plane. In certain embodiments, anatomical misalignment can be corrected in both the transverse plane and the frontal plane. In the transverse plane, a normal IMA 234 between first metatarsal 210 and second metatarsal 212 is less than about 9 degrees. An IMA 234 of between about 9 degrees and about 13 degrees is considered a mild misalignment of the first metatarsal and the second metatarsal. An IMA 234 of greater than about 16 degrees is considered a severe misalignment of the first metatarsal and the second metatarsal. In some embodiments, methods and/or devices according to the disclosure are utilized to anatomically align first metatarsal 210 by reducing the IMA from over 10 degrees to about 10 degrees or less (e.g., to an IMA of 9 degrees or less, or an IMA of about 1-5 degrees), including to negative angles of about 5 degrees or until interference with the second metatarsal, by positioning the first metatarsal at a different angle with respect to the second metatarsal.

(43) With respect to the frontal plane, a normal first metatarsal will be positioned such that its crista prominence is generally perpendicular to the ground and/or its sesamoid bones are generally parallel to the ground and positioned under the metatarsal. This position can be defined as a metatarsal rotation of 0 degrees. In a misaligned first metatarsal, the metatarsal may be axially rotated between about 4 degrees to about 30 degrees or more. In some embodiments, methods and/or devices according to the disclosure are utilized to anatomically align the metatarsal by reducing the metatarsal rotation from about 4 degrees or more to less than 4 degrees (e.g., to about 0 to 2 degrees) by rotating the metatarsal with respect to the adjacent cuneiform.

(44) A compressor-distractor according to the disclosure may be useful to distract a misaligned metatarsal from an adjacent cuneiform to provide access to the end faces of the bones and/or tarsometatarsal joint. The compressor-distractor may also be useful to apply a compressive force to the metatarsal and adjacent cuneiform (e.g., after preparing the end faces of the bones) to press the bones together to facilitate fixation. Additionally or alternatively, the compressor-distractor may impart and/or maintain relative movement between the metatarsal and adjacent cuneiform, such as rotation and/or pivoting of one bone relative to the other bone. For example, the compressor-distractor may be configured with an angular offset between pin-receiving holes, which may be effective to move the metatarsal from an anatomically misaligned position to an anatomically aligned positon. As the compressor-distractor is translated over pins inserted into the metatarsal and cuneiform, the angular offset of the pin-receiving holes may cause the pins to move from being generally parallel to an angular alignment dictated by the pin-receiving holes. The resulting movement of the metatarsal relative to cuneiform caused by this movement can help position the metatarsal in an aligned position.

(45) In other configurations, however, the compressor-distractor may not move the metatarsal from an anatomically misaligned position to an anatomically aligned positon. Rather, the compressor-distractor may be configured to distract and compress a metatarsal relative to an adjacent cuneiform without performing rotating and/or pivoting the metatarsal relative to an adjacent cuneiform. For example, the compressor-distractor may have pin-receiving holes that are not angular offset relative to each other. In these implementations, the compressor-distractor can be attached and/or removed from the metatarsal relative and adjacent cuneiform without intended to rotate and/or pivot the metatarsal relative to the cuneiform.

(46) An example technique utilizing a compressor-distractor and pin lock will be described in greater detail below with respect to FIGS. 15-25. However, example compressor-distractor configurations that may be used according to the disclosure will first be described with respect to FIGS. 4-7. Further, example pin locks that may be used according to the disclosure will be described with respect to FIGS. 8-12.

(47) FIG. 4 is a perspective view of an example compressor-distractor 100 that can be used in systems and techniques according to disclosure. Compressor-distractor 100 is illustrated as having a first engagement arm 102 and a second engagement arm 104. Compressor-distractor 100 also includes an actuator 106 that is operably coupled to the first engagement arm 102 and the second engagement arm 104. Actuator 106 can be actuated to move the two engagement arms toward each other and away from each other to adjust a separation distance between the two arms. Further, as will be discussed in greater detail, each engagement arm may include at least one pin-receiving hole that is configured to receive a pin inserted into a bone.

(48) For example, first engagement arm 102 may include a first pin-receiving hole 108 and second engagement arm 104 may include a second pin-receiving hole 110. The first pin-receiving hole 108 can receive a first pin 112, while the second pin-receiving hole 110 can receive a second pin 114. The first pin 112 and second pin 114 can be inserted into different bones or bone portions being worked upon. In the case of a bone realignment procedure, for example, first pin 112 can be inserted into a metatarsal (e.g., first metatarsal 210) and second pin 114 can be inserted into a cuneiform (e.g., medial cuneiform 222). The pin-receiving holes can anchor compressor-distractor 100 to the bones being compressed and/or distracted via the pins inserted through the holes and into the underlying bones. In some configurations, the pin-receiving holes can be used to impart relative movement between one bone in which first pin 112 is inserted and another bone in which second pin 114 is inserted.

(49) For example, first pin-receiving hole 108 and second pin-receiving hole 110 may be angled relative to each other at a non-zero degree angle such that, when compressor-distractor 100 is inserted over a substantially parallel set of pins, the angled receiving holes cause the pins to move relative to each other to align with the pin-receiving holes. The direction and extent of movement imposed by the angled pin-receiving holes of compressor-distractor 100 may vary depending on the desired surgical application in which the compressor-distractor is being used. In the case of a misaligned metatarsal, such as a bunion procedure for instance, the pin-receiving holes may be angled to impart a frontal plane rotation and/or a sagittal plane translation. As a result, when compressor-distractor 100 is installed over pins position in the metatarsal and adjacent cuneiform, the angled pin-receiving holes may cause the metatarsal to rotate in the frontal plane relative to the cuneiform and/or translate in the sagittal plane (e.g., downwardly or plantarly) to help correct a misalignment of the metatarsal.

(50) FIG. 5 is a frontal plane view of compressor-distractor 100 showing an example angular offset between first pin-receiving hole 108 and second pin-receiving hole 110. In this example, the two pin-receiving holes are angled relative to each other in the frontal plane by an angle 116. Angle 116 may be measured between two linear pins (e.g., first pin 112 and second pin 114) inserted through respective receiving holes in the perspective of the frontal plane. While the degree of angular offset between first pin-receiving hole 108 and second pin-receiving hole 110 may vary, in the case of a metatarsal realignment procedure, angle 116 may range from 2 to 20, such as from 6 to 15, or from 8 to 12, or approximately 10. The two pin-receiving holes may be offset in a direction that causes the metatarsal to rotate laterally as the compressor-distractor 100 is installed over first and second pins 112, 114. For example, when compressor-distractor 100 is positioned on the medial side of the foot, the first pin-receiving hole 108 may be angled to cause first pin 112 to rotate toward the lateral side of the foot relative to second pin 114.

(51) In addition to or in lieu of providing a fontal plane angulation, compressor-distractor 100 may be configured to impart sagittal plane rotation, when the compressor-distractor 100 is installed over first and second pins 112, 114. For example, when installed over substantially parallel first and second pins 112, 114 positioned in the metatarsal and cuneiform, respectively, the angulation of first and second pin holes 108, 110 may cause the metatarsal to rotate or flex plantarly (e.g., such that the distal end of the metatarsal is rotated plantarly about the TMT joint).

(52) FIG. 6 is a sagittal plane view of compressor-distractor 100 showing another example angular offset between first pin-receiving hole 108 and second pin-receiving hole 110. In this example, the two pin-receiving holes are angled relative to each other in the sagittal plane by an angle 118. Angle 118 may be measured between two linear pins (e.g., first pin 112 and second pin 114) inserted through respective receiving holes in the perspective of the sagittal plane. While the degree of angular offset between first pin-receiving hole 108 and second pin-receiving hole 110 may vary, in the case of a metatarsal realignment procedure, angle 118 may range from 5 to 12, such as from 7 to 10, or from 8 to 9, or approximately 8.5. The two pin-receiving holes may be offset in a direction that causes the metatarsal to rotate (e.g., downwardly or plantarly) in the sagittal plane as the compressor-distractor 100 is installed over first and second pins 112, 114.

(53) In general, features described as pin-receiving holes may be void spaces extending linearly through the body of compressor-distractor 100 and configured (e.g., sized and/or shaped) to pass a pin inserted into a bone therethrough. While the pin-receiving holes may have any polygonal (e.g., square, rectangle) or arcuate (e.g., curved, elliptical) shape, the pin-receiving holes may typically have a circular cross-sectional shape. In some examples, the pin-receiving holes have a diameter ranging from 0.1 mm to 10 mm, such as from 0.5 mm to 4 mm. The pin-receiving holes may have a length (e.g., extending through the thickness of first engagement arm 102 or second engagement arm 104) ranging from 5 mm to 50 mm, such as from 10 mm to 25 mm.

(54) Compressor-distractor 100 can have any suitable number of pin-receiving holes. In general, providing multiple pin-receiving holes on each side of the compressor-distractor 100 may be useful to provide alternative angulation or movement options for the clinician using the compressor-distractor. For example, compressor-distractor 100 may have a plurality of pin-receiving holes for use with first pin 112 and/or second pin 114. During a surgical procedure, the clinician may select a certain pin-receiving hole from the plurality of pin-receiving holes into which first pin 112 and/or second pin 114 are to be inserted. The clinician may select the pin-receiving hole combination based on the amount and direction of movement the clinician desires the first bone to move relative to the second bone upon installing the compressor-distractor over first and second pins 112, 114. After selecting the desired pin-receiving hole combination, the clinician can direct the distal end of first and second pins 112, 114 into the corresponding selected pin-receiving holes then translate compressor-distractor 100 from the distal end of the pins down towards the proximal end of the pins.

(55) It should be appreciated that while compressor-distractor 100 may have multiple pin-receiving holes for first pin 112 and/or second pin 114, the disclosure is not limited in this respect. In other configurations, compressor-distractor 100 may only have a single pin-receiving hole into which first pin 112 and/or second pin 114 can be inserted. In still other configurations, compressor-distractor 100 may have one or more pin-receiving hole(s) that rotate and/or slide within one or more slots to provide adjustable angulation, allowing the clinician to adjust the angular alignment of first and/or second pin-receiving holes 108, 110.

(56) In the example of FIG. 4, compressor-distractor 100 is illustrated as having two pin-receiving holes associated with first pin 112 and two pin-receiving holes associated with second pin 114. In particular, FIG. 4 illustrates first engagement arm 102 as having previously-described first pin-receiving hole 108 and second engagement arm 104 as having previously-described second pin-receiving hole 110. In addition, first engagement arm 102 is illustrated has having a third pin-receiving hole 120, while second engagement arm 104 has a fourth pin-receiving hole 122. First and second engagement arms 102, 104 may each have fewer pin-receiving holes (e.g., one) or more pin-receiving holes (e.g., three, four, or more).

(57) In some configurations, the third pin-receiving hole 120 is angled relative to the fourth pin-receiving hole 122 at a non-zero degree angle in a second plane different than a first plane in which first pin-receiving hole 108 is angled relative to second pin-receiving hole 110. For example, first pin-receiving hole 108 may be angled relative to second pin-receiving hole 110 in the frontal plane and/or sagittal plane. Third pin-receiving hole 120 may be parallel to second pin-receiving hole 110 in the frontal plane but angled relative to the second pin-receiving hole in the sagittal plane. Further, fourth pin-receiving hole 122 may be parallel to first pin-receiving hole 108 in the frontal plane but angled relative to the first pin-receiving hole in the sagittal plane. Third and fourth pin-receiving holes 120, 122 can be angled relative to each other and/or first and second pin-receiving holes 108, 110 at any of the angles discussed above. When configured as illustrated in FIG. 4, a clinician desiring both frontal plane and sagittal plane movement can use the first and second pin holes 108, 110. By contrast, when the clinician desires sagittal plane movement but not frontal plane movement, the clinician can use first and fourth pin-receiving hole 108, 122.

(58) As briefly discussed above, compressor-distractor 100 can open and close to compress and distract the bones to which to the compressor-distractor is secured. To facilitate movement, compressor-distractor 100 is illustrated as having an actuator 106. Actuator 106 is configured to control movement of first engagement arm 102 relative to second engagement arm 104. Actuator 106 may be implemented using any feature that provides controllable relative movement between the two engagement arms, such as rotary movement, sliding movement, or other relative translation. In some configurations, actuator 106 is configured to move first and second engagement arms 102, 104 at least 1 mm away from each other, such as a distance ranging from 1 mm to 45 mm, a distance ranging from 1 mm to 5 mm, or a distance ranging from 1 mm to 2.5 mm during distraction. Actuator 106 may be actuated during compression until the faces of the bones to which compressor-distractor 100 is attached are suitably compressed and/or the sidewall faces of first and second engagement arms 102, 104 contact each other.

(59) In the example of FIG. 4, actuator 106 is illustrated as including a shaft 124 connected to the first engagement arm 102 and the second engagement arm 104. Shaft 124 may be threaded and actuator 106 may further include a knob 126 coupled to the shaft. Rotation of knob 126 in one direction may cause first engagement arm 102 to move closer to second engagement arm 104, while rotation of the knob in the opposite direction can cause the first engagement arm to move away from the second engagement arm.

(60) To secure actuator 106 to compressor-distractor 100, the actuator may be fixedly connected to one of the arms. For example, shaft 124 of actuator 106 may be fixedly attached along its length to first engagement arm 102 and rotatable relative to the arm. As a result, when knob 126 is rotated, second engagement arm 104 may move along the length of shaft 124 towards and/or away from first engagement arm 102. This provides relative movement between the two arms while first engagement arm 102 remains in a fixed position relative to actuator 106.

(61) In FIG. 4, first engagement arm 102 is illustrated as extending from a distal end 128A to a proximal end 128B. Similarly, second engagement arm 104 is illustrated as extending from a distal end 130A to a proximal end 130B. Actuator 106 is positioned adjacent the proximal ends 128B, 130B of the first and second engagement arms 102, 104, respectively, such as the proximal half of the arms in the illustrated configuration. Offsetting actuator 106 from the pin-receiving holes may be useful, for example, to provide clearance for the clinician to manipulate the actuator when compressor-distractor 100 is inserted on pins installed in bones. In the case of a foot surgery, first and second engagement arms 102, 104 may have a length affective to position actuator 106 to be offset medially from the foot being operated on while first pin-receiving hole 108 is engaged with a first pin 112 inserted into a metatarsal and second pin-receiving hole 110 is engaged with a second pin 114 engaged with a cuneiform.

(62) To help stabilize first engagement arm 102 relative to second engagement arm 104 during movement along shaft 124, compressor-distractor 100 may also include one or more unthreaded shafts extending parallel to the threaded shaft. In FIG. 4, for example, actuator 106 has a first unthreaded shaft 132A and a second unthreaded shaft 132B (collectively referred to as unthreaded shaft 132). Unthreaded shaft 132 extends parallel to threaded shaft 124 and helps stabilize second engagement arm 104 as it moves along the threaded shaft towards and away from first engagement arm 102. Threaded shaft 124 is illustrated as extending through a threaded aperture in the sidewall of second engagement arm 104, while unthreaded shaft 132 is illustrated as extending through an unthreaded aperture in the sidewall of the engagement arm.

(63) First engagement arm 102 and second engagement arm 104 can have a variety of different sizes and shapes. In general, each engagement arm may define a length offsetting the pin-receiving holes from actuator 106. In some examples, distal end 128A of first engagement arm 102 defines a first pin block 134 and/or distal end 130A of second engagement arm 104 defines a second pin block 136. The pin blocks may be regions of the respective engagement arms defining pin-receiving holes and through which the pin-receiving holes extend. First and second pin blocks 134, 136 may have a thickness greater than a thickness of the remainder of the engagement arms. For example, as shown, pin blocks 134, 136 may extend downwardly (e.g., plantarly) from a remainder of the engagement arms and/or actuator 106.

(64) In FIG. 4, first engagement arm 102 is illustrated as having a same length as second engagement arm 104. As a result, distal end 128A of the first engagement arm is parallel with the distal end 130A of the second engagement arm. In other configurations, one engagement arm may be longer than the other engagement arm to provide an offset. For example, first engagement arm 102 may be longer than second engagement arm 104, e.g., causing the first engagement arm to extend farther laterally when applied to a foot being operated upon than second engagement arm 104. This configuration may be useful during bunion correction procedures to impart transverse plane movement (e.g., rotation) of the metatarsal relative to the cuneiform to close the IM angle.

(65) Compressor-distractor 100 may be fabricated from any suitable material or combination of materials, such as metal (e.g., stainless steel) and/or polymeric materials. In some configurations, compressor-distractor 100 is fabricated from a radiolucent material such that it is relatively penetrable by X-rays and other forms of radiation, such as thermoplastics and carbon-fiber materials. Such materials are useful for not obstructing visualization of bones using an imaging device when the bone positioning guide is positioned on bones.

(66) Compressor-distractor 100 can have a variety of different configurations, and a compressor-distractor according to the disclosure is not limited to the example configuration illustrated with respect to FIGS. 3-6. For example, FIG. 7 illustrates a side view of an alternative configuration of compressor-distractor 100 in which first engagement arm 102 and second engagement arm 104 are curved upwardly away from first and second pin blocks 134, 136. The curvature of the arms can position actuator 106 out of the surgical site, removing a visual obstruction to help the clinician perform the surgical technique.

(67) As mentioned above, a compressor-distractor according to some implementations of the disclosure may not be configured with angled pin-receiving holes and/or may have parallel pin-receiving holes that are utilized in lieu of angled pin-receiving holes also presented on the compressor-distractor. FIG. 7 is a perspective illustration of another example configuration of compressor-distractor 100 deployed in an example surgical technique attached to foot 200. Like reference numerals in FIG. 7 reference to like elements discussed above with respect to FIGS. 1-6.

(68) Example systems and techniques according to the present disclosure may utilize a pin lock, which can be positioned along the length of first pin 112 and/or second pin 114, sandwiching compressor-distractor 100 between a bone to which it is attached and the pin stop. In general, any instrument that can lock partially or fully about a perimeter of a pin used to connect a compressor-distractor to underlying bone can be used as a pin lock.

(69) FIG. 8 is a perspective view of one example pin lock that can be used according to the disclosure. In this example, pin lock 300 is illustrated in the form of a spring clip that includes a first arm 302 and a second arm 304 coupled to the first arm. A biasing element 306 biases the first arm away from the second arm. Pin lock 300 is illustrated in the form of a spring clip, or flat spring where first arm 302 and second arm 304 are integrally joined together in a V-shape. In other examples, first arm 302 may be joined to second arm 304 by a compression spring, a torsion spring, or yet other biasing element.

(70) When configured as shown in FIG. 8, first arm 302 can define a first opening 308 and second arm 304 can divine a second opening 310. first opening 308 and second opening 310 may be sized to receive a pin (e.g., first pin 112, second pin 114). Accordingly, first opening 308 and second opening 310 may have a size and shape corresponding to the size and shape of pin to be inserted therethrough, including any of the sizes and shapes discussed above with respect to the pin receiving holes on compressor distractor 100.

(71) Biasing element 306 can bias first arm 302 away from second arm 304, e.g., such that the arms are not parallel to each other but angled relative to each other. This can result in first opening 308 being out of axial alignment with second opening 310, when the arms are pushed away from each other by biasing element 306. A clinician can compress first arm 302 and second arm 304 together, causing first opening 308 to align with second opening, e.g., such that the two openings are substantially co-linear about their geometric centers. When compressed together to align first opening 308 with second opening 310, pin lock 300 can then be inserted over a pin, e.g., by inserting the distal end of the pin through the aligned holes and advancing the pin lock down along the length of the pin to a desired location. By subsequently releasing the compressive force pushing first arm 302 and second arm 304 together, biasing element 306 can bias the arms away from each other, thereby applying a force biasing first opening 308 away from second opening 310. This can result in frictional engagement between pin lock 300 and the outer surface of the pin inserted therethrough, thereby locking the pin lock on the pin.

(72) FIGS. 9-11 are views of another example pin lock 350 that can be used according to the disclosure. FIG. 9 is an exploded perspective view of pin lock 350. FIG. 10 is a side sectional view of pin lock 350 shown in a locked position. FIG. 11 is a side sectional view of pin lock 350 shown in an unlocked position. Finally, FIG. 12 is a side view of pin lock 350 shown inserted on an example pin, which for purposes of illustration is denoted as first pin 112 but can be any pin as described herein.

(73) In the illustrated example, pin lock 350 is shown as including a bearing retaining body 352, a piston 354, and a biasing member 356. Bearing retaining body 352 defines a pin receiving hole 358 extending axially therethrough (e.g., along a length of the body through which pin 112 can be inserted). Piston 354 is formed by at least one sidewall 360 and a top wall 362. The sidewall 360 and top wall 362 collectively define a cavity 364 into which biasing member 356 can be inserted and bearing retaining body 352 can be partially or fully inserted into.

(74) To provide a releasable locking function, pin lock 350 can include at least one bearing 366. For example, bearing retaining body 352 may include a bearing receiving cavity 368 extending from an outer perimeter surface 370 of the bearing retaining body to the pin receiving hole 358 extending through the bearing retaining body. Bearing 366 can be inserted into the bearing receiving cavity. In some configurations, bearing receiving cavity extends generally perpendicularly through bearing retaining body 352 relative to the direction pin receiving hole 358 extends through the body. In either case, bearing receiving cavity 368 may include intersect with pin receiving hole 358 such that bearing 366 can extend at least partially through bearing receiving cavity 368 and into pin receiving hole 358 to apply pressure to pin 112.

(75) Bearing receiving cavity 368 may have a substantially constant cross-sectional area (e.g., diameter) across the thickness of bearing retaining body 352 to pin receiving hole 358. In other implementations, bearing receiving cavity 368 is larger at the outer perimeter surface 370 of bearing retaining body 352 than at the pin receiving hole 358. For example, bearing receiving cavity 368 may be larger than a diameter of bearing 366 at the outer perimeter surface 370 such that the bearing can be inserted into the bearing receiving cavity from the outer perimeter surface of the bearing retaining body. However, bearing receiving cavity 368 may have a diameter smaller than the diameter of bearing 366 at pin receiving hole 358, allowing the bearing to project partially into the pin receiving hole but preventing the bearing from exiting bearing receiving cavity into the pin receiving hole.

(76) In some examples, pin lock includes multiple bearings 366 positioned in multiple bearing receiving cavities. The multiple bearings may be arrayed at different locations about the perimeter of bearing retaining body 352, e.g., such as substantially equidistant from each other about the perimeter of the bearing retaining body. In the illustrated example, bearing retaining body 352 includes three bearings (first, second, and third bearings) positioned 120 degrees from each other around the perimeter of the bearing retaining body in corresponding bearing receiving cavities (first, second, third bearing receiving cavities). However, bearing retaining body 352 may include fewer or more bearings without departing from the scope of the disclosure.

(77) As noted, piston may be defined by at least one sidewall 360 and a top wall 362. The top wall 362 of piston can also include a pin receiving hole 372 extending through the wall surface. When pin lock 350 is assembled, pin receiving hole 372 extending through piston 354 can be axially aligned with pin receiving hole 358 extending through bearing retaining body 352, e.g., such that the geometric centers of pin receiving hole 358 and pin receiving hole 372 are co-linear for inserting a linear pin 112 through both receiving holes.

(78) To lock and unlock pin lock 350, sidewall 360 of piston 364 may include a taper 374 over at least a portion of its length. For example, sidewall 360 may taper toward the distal end of the sidewall but may be on tapered as a sidewall is closer to top wall 362. Taper 374 defined by sidewall 360 may press against bearing 366 when pin lock 350 is in a locked position, in turn causing bearing 366 to push into pin receiving hole 358 and against any pin 112 inserted therethrough.

(79) By contrast, when pin lock 350 is in an unlocked position, taper 374 may be offset from bearing 366 such that the bearing is positioned in plane with a portion of sidewall 360 that does not include a taper. As a result, bearing 366 may have more room to travel out through the outer perimeter 370 of bearing retaining body 352 before contacting sidewall 360 then when taper 374 is pressed against the bearing. This can reduce the force applied by sidewall 360 to bearing 366 which, in turn, can reduce the force applied by the bearing to pin 112. In some implementations, bearing 366 can even move out of pin receiving hole 358.

(80) The angle 400 of taper relative to a reminder of the sidewall 360 may vary in different implementations. In some examples, angle 400 ranges from 5 degrees to 75 degrees, such as from 10 degrees to 45 degrees. This can provide progressive increase or decrease in the amount of force applied to bearing 366 as piston 354 is actuated up or down, respectively. In other examples, taper 374 may not be a gradual taper with respect to a remainder of the sidewall 360 but instead may be a sharp taper (e.g., a cliff transition or 90 degree step) relative to a reminder of the sidewall.

(81) When assembled as shown in the illustrated example, biasing member 356 may be positioned inside of cavity 364 defined by piston 354. Biasing member 356 may contact an interior surface of top wall 362 of piston 354 and a top surface of bearing retaining body 352. Biasing member 356 may bias or push bearing retaining body 352 away from piston 354 to cause taper 374 to be in contact with bearing 366 in a resting position. A clinician may apply hand force to compress piston 354 toward bearing retaining body 352 (and/or a base 380 discussed below) to actuate the piston, overcoming the force of biasing member 356 (e.g., compressing the biasing member) to move taper 374 out of alignment with bearing 366. In general, biasing member 356 may be any type of spring or other structure that provides biasing characteristics similar to spring, such as a helical coil spring, a torsion spring, a twin spring, or other spring-like structure.

(82) In some implementations, bearing retaining body 352 and piston 354 are movable relative to each other but also interlocked to prevent their separation in a resting state. For example, bearing retaining body 352 and piston 354 may have overlapping edge lips or other interfering features that limit the range of travel between the two components.

(83) In other examples, including the illustrated example, pin lock 350 may also include a base 380. Base may define at least one sidewall 382 and a bottom wall 384. Sidewall 382 and bottom wall 384 can, collectively, form a cavity 386. Further, bottom wall 384 may include a pin receiving hole 388 extending through the wall surface. When pin lock 350 is assembled, pin receiving hole 372 extending through piston 354 can be axially aligned with pin receiving hole 358 extending through bearing retaining body 352 and further axially aligned with pin receiving hole 388 extending through 380, e.g., such that the geometric centers of pin receiving hole 358, pin receiving hole 372, and pin receiving hole 388 are co-linear for inserting a linear pin 112 through both receiving holes.

(84) Bearing retaining body 352 can be retained against base 380, e.g., such that a bottom portion of the bearing retaining body is in contact with and supported by bottom wall 384. Sidewall 382 of base 380 may extend up over at least a portion of sidewall 360 of piston 354. Accordingly, bearing retaining body 352 may be at least partially constrained within the joint cavity space formed by cavity 364 of piston 354 and cavity 386 formed by base 380. As shown, however, a portion of bearing retaining body 352 may or may not also project out beyond base 380 and/or piston 354 (and other, non-illustrated, implementations). Sidewall 382 may include a lip or ledge 390 that can engage with a corresponding lip or ledge 392 on sidewall 360 of piston, limiting a range of travel between the two components. In general, the range of travel may be sufficient to allow bearing 366 to move into and out of contact with taper 374 of sidewall 360. In some examples, the bottom edge of sidewall 360 is offset from bottom wall 384 of base 380 a distance ranging from 0.5 mm to 5 mm, when the piston is fully biased away from the base by biasing member 356.

(85) Features described as at least one sidewall in connection with pin lock 350 may be implemented using any number of sidewalls interconnected together. The specific number of sidewalls utilized may vary depending on the shape of the feature. For example, a body with a circular cross-sectional shape may be formed of a single sidewall whereas a body with a square or rectangular cross-sectional shape may be defined by four interconnected sidewalls.

(86) Further, it should be appreciated that the descriptive terms top and bottom with respect to the configuration and orientation of components described herein are used for purposes of illustration based on the orientation in the figures. The arrangement of components in real world application may vary depending on their orientation with respect to gravity. Accordingly, unless otherwise specified, the general terms first and second may be used interchangeably with the terms top and bottom with departing from the scope of disclosure.

(87) A system that includes a compressor-distractor and pin lock according to the disclosure may be used as part of a surgical procedure in which at least two pins are inserted into different bones or different portions of the same bone. The at least two pins may or may not be inserted in generally parallel alignment and/or the pins may be realigned during the surgical procedure so as to be substantially parallel (e.g., prior to installation of compressor-distractor 100). The two pins may be substantially parallel in that the pins are positioned side-by-side and have substantially the same distance continuously between the two pins in each of the three planes (e.g., the distance varies by less than 10%, such as less than 5% across the lengths of the pins in any given plane, with different continuous distances in different planes). Compressor-distractor 100 can be inserted over the parallel pins by threading the parallel pins into the pin-receiving holes of the device. If the pin-receiving holes of compressor-distractor 100 are parallel, the compressor-distractor can be inserted over the pins without changing the position of the pins. By contrast, if the pin-receiving holes of compressor-distractor 100 are angled, inserting the compressor-distractor over the pins can cause the pins to move from a substantially parallel alignment to an angled alignment dictated by the angulation of the pin-receiving holes.

(88) In either case, compressor-distractor 100 may then be used to distract the bone portions into which the pins are inserted (e.g., by actuating actuator 106 to draw the bone portions away from each other) and/or compress the bone portions into which the pins are inserted (e.g., by actuating actuator 106 to move the bone portions towards each other). Pin lock 300 and/or 350 can be positioned over first pin 112 and/or second pin 114, fixing compressor-distractor 100 along an axial length of the pin between the pin lock and a bone portion. Compressor-distractor 100 may be attached to a bone portion being compressed (e.g., a distracted metatarsal) and an adjacent stationary bone (e.g., a lateral-most metatarsal to the distracted metatarsal). Compressor-distractor 100 can compress two separated bone portions toward and/or against each other.

(89) In some examples, compressor-distractor 100 and/or pin lock 300/350 is used as part of a metatarsal realignment procedure in which a metatarsal is realigned relative to an adjacent cuneiform and/or metatarsal in one or more planes, such as two or three planes. Additional details on example bone realignment techniques and devices with which compressor-distractor 100 and pin lock 300/350 may be used are described in U.S. Pat. No. 9,622,805, titled BONE POSITIONING AND PREPARING GUIDE SYSTEMS AND METHODS, filed on Dec. 28, 2015 and issued Apr. 18, 2017, and U.S. Pat. No. 9,936,994, titled BONE POSITIONING GUIDE, filed on Jul. 14, 2016 and issued on Apr. 10, 2018, and US Patent Publication No. 2017/0042599 titled TARSAL-METATARSAL JOINT PROCEDURE UTILIZING FULCRUM, filed on Aug. 14, 2016. The entire contents of each of these documents are hereby incorporated by reference.

(90) The pins over which compressor-distractor 100 is installed may be used to pin and/or guide another medical instrument used during the surgical technique. For example first and second pins 112, 114 may be used to pin a first medical instrument to the bones or bone portions being operated upon. The medical instrument can be removed over the parallel pins, leaving the pins inserted into the bone or bone portions, and compressor-distractor 100 subsequently placed over the pins.

(91) For example, in the case of a metatarsal realignment procedure, first and second pins 112, 114 may be used to pin a bone preparation guide to a foot being operated upon. The bone preparation guide can be used to prepare an end face of a metatarsal and an adjacent end face of a corresponding cuneiform. The bone preparation guide can be taken off the first and second pins and compressor-distractor 100 installed on the pins. Compressor-distractor 100 can be manipulated to open the joint space between the metatarsal and cuneiform, e.g., to facilitate joint cleanup, and/or manipulated to compress the two bones together for fixation.

(92) FIG. 13 illustrates an example bone preparation guide 150 that may be used as part of a surgical procedure involving compressor-distractor 100 and pin lock 300. In some examples, bone preparation guide 150 includes a body 154 defining a first guide surface 160 to define a first preparing plane and a second guide surface 164 to define a second preparing plane. A tissue removing instrument (e.g., a saw, rotary bur, osteotome, etc., not shown) can be aligned with the surfaces to remove tissue (e.g., remove cartilage or bone and/or make cuts to bone). The first and second guide surfaces 160, 164 can be spaced from each other by a distance, (e.g., between about 2 millimeters and about 10 millimeters, such as between about 4 and about 7 millimeters). In the embodiment shown, the first and second guide surfaces are parallel, such that cuts to adjacent bones using the guide surfaces will be generally parallel.

(93) In some configurations, as shown in FIG. 13, a first facing surface 166 is positioned adjacent the first guide surface 160 and/or a second facing surface 168 is positioned adjacent the second guide surface 164. In such configurations, the distance between the first guide surface and the first facing surface defines a first guide slot, and the distance between the second guide surface and the second facing surface defines a second guide slot. Each slot can be sized to receive a tissue removing instrument to prepare the bone ends. The first and second slots may be parallel or skewed. In the illustrated example, the facing surfaces each contain a gap, such that the surface is not a single, continuous surface. In other embodiments, the facing surfaces can be a single, continuous surface lacking any such gap.

(94) An opening 170 can be defined by the body 154 between the first and second guide surfaces. The opening can be an area between the guide surfaces useful for allowing a practitioner to have a visual path to bones during bone preparation and/or to receive instruments. In the configuration shown, the opening extends across the body and a distance from a surface 172 opposite of the first facing surface 166 to a surface 174 opposite of the second facing surface 168.

(95) The illustrated bone preparation guide also includes a first end 176 extending from the body 154 in a first direction and a second end 178 extending from the body in a second direction. The second direction can be different than the first direction (e.g., an opposite direction). As shown, each of the first end and the second end can include at least one fixation aperture 180 configured to receive a fixation pin to secure the bone preparation guide to an underlying bone. For example, first end 176 of bone preparation guide 150 may define a first fixation aperture through which first pin 112 (FIG. 4) is inserted and the second and 178 of bone preparation guide 150 may define a second fixation aperture through which second pin 114 (FIG. 4) is inserted. These two fixation apertures may be may be parallel aligned, such that first and second pins 112, 114 extend through the holes parallel to each other. The first end 176 and/or the second end 178 of bone preparation guide 150 may also defined one or more additional fixation apertures that are angled (at a non-zero degree angle) or otherwise skewed relative to the two parallel fixation apertures.

(96) In use, a clinician may insert the two pins (e.g., parallel pins) through fixation apertures 180 and may optionally insert one or more angled pins through the one or more angled fixation apertures. This combination of parallel and angled pins may prevent bone preparation guide 150 from being removed from the underlying bones being worked upon. The clinician may or may not insert one or more pin locks 300/350 over one or more pins used to attached the bone preparation guide to bone. When the clinician has completed using the bone preparation guide, the angled pin or pins may be removed leaving the two parallel pins inserted into the underlying bones. The one or more pin locks, if used, can also be unlocked and removed from the pins. Bone preparation guide 150 can be slid or otherwise moved up and off the parallel pins and compressor-distractor 100 thereafter inserted down over the pins. Accordingly, reference to compressor-distractor 100 being attached by inserting a pin through a pin-receiving hole includes implementations where the compressor-distractor is positioned over bone and a pin is inserted through the pin-receiving hole of the compressor-distractor into underlying bone as well as implementations where the pin is first inserted into the bone and the pin-receiving hole of the compressor-distractor is then aligned over the pin and the compressor-distractor is pushed down the pin toward the underlying bone.

(97) In some examples as shown in FIG. 13, bone preparation guide 150 can also include a first adjustable stabilization member 182 engaged with the first end 176 and/or a second adjustable stabilization member 184 engaged with the second end 178. Each of the members can be threaded and engage a threaded aperture defined by the ends. The elevation of each end can be adjusted with respect to a bone by adjusting the stabilization member. In some embodiments, as shown, the stabilization members are cannulated such that they can receive a fixation pin.

(98) With reference to FIG. 14, bone preparation guide 150 may include or be used with a spacer 188 that extends downward from the body 154. Spacer 188 may be configured to be placed into a joint (e.g., within the TMT joint). In some embodiments, the spacer 188 is selectively engageable with the body of the bone preparation guide and removable therefrom. The spacer can have a first portion 190 configured to extend into a joint space and a second portion 192 engageable with the body 154. In the embodiment shown, the spacer can be received within opening 170, such that the spacer extends from the body in between the first and second guide surfaces. Such a spacer can be useful for positioning the body at a desired position with respect to a joint and for properly positioning the guide with respect to bones to be cut in more than one plane (e.g., three planes selected from more than one of a frontal plane, a transverse plane, and a sagittal plane). The distance between the spacer and the first guide surface can define a length of tissue removal (e.g., bone or cartilage to be cut) from a first bone, and the distance between the spacer and the second guide surface can define a length of tissue removal (e.g., bone or cartilage to be cut) from a second bone.

(99) As also shown in FIG. 14, bone preparation guide 150 may include or be used with a tissue removal location check member 194. Tissue removal check member 194 may be engageable with the body 154 and configured to extend to a first bone and a second bone. The tissue removal location check member can have a first portion 196 configured to extend into contact with first and second bones and a second portion 198 engageable with the body. In the embodiment shown, the tissue removal check member 194 is configured to extend in the body 154 at both the first and second guiding surfaces. The tissue removal location check member 194 may be useful for allowing a practitioner to see where a tissue removing instrument guided by the surfaces will contact the bone to be prepared.

(100) Bone preparation facilitated by bone preparation guide 150 can be useful, for instance, to facilitate contact between leading edges of adjacent bones, separated by a joint, or different portions of a single bone, separated by a fracture, such as in a bone alignment and/or fusion procedure. A bone may be prepared using one or more bone preparation techniques. In some applications, a bone is prepared by cutting the bone. The bone may be cut transversely to establish a new bone end facing an opposing bone portion. Additionally or alternatively, the bone may be prepared by morselizing an end of the bone. The bone end can be morselized using any suitable tool, such as a rotary bur, osteotome, or drill. The bone end may be morselized by masticating, fenestrating, crushing, pulping, and/or breaking the bone end into smaller bits to facilitate deformable contact with an opposing bone portion.

(101) During a surgical technique utilizing compressor-distractor 100 and pin lock 300/350, a bone may be moved from an anatomically misaligned position to an anatomically aligned position with respect to another bone. Further, both the end of the moved bone and the facing end of an adjacent end may be prepared for fixation. In some applications, the end of at least one of the moved bone and/or the other bone is prepared after moving the bone into the aligned position. In other applications, the end of at least one of the moved bone and/or the other bone is prepared before moving the bone into the aligned position.

(102) Movement of one bone relative to another bone can be accomplished using one or more instruments and/or techniques. In some examples, bone movement is accomplished using a bone positioning device that applies a force to one bone at a single location, such that the bone both translates and rotates in response to the force. This may be accomplished, for example, using a bone positioning guide that includes a bone engagement member, a tip, a mechanism to urge the bone engagement member and the tip towards each other, and an actuator to actuate the mechanism. Additionally or alternatively, bone movement may be accomplished using compressor-distractor 100 by imparting movement to one bone relative to another bone as the compressor-distractor is positioned on substantially parallel pins, causing the pins to move out of their substantially parallel alignment and resulting in movement of the underlying bones in one plane (e.g., frontal plane, sagittal plane, transverse plane), two or more planes, or all three planes. As yet a further addition or alternative, a clinician may facilitate movement by physically grasping a bone, either through direct contact with the bone or indirectly (e.g., by inserting a K-wire, grasping with a tenaculum, or the like), and moving his hand to move the bone.

(103) Regardless of the how movement is accomplished, a surgical technique may or may not utilize a fulcrum. A fulcrum may provide a structure about which rotation and/or pivoting of one bone relative to another bone occurs. The fulcrum can establish and/or maintain space between adjacent bones being moved, preventing lateral translation or base shift of the bones during rotation and/or pivoting. For example, to help avoid the proximal-most base of the first metatarsal 210 from shifting toward the proximal-most base of the second metatarsal 212, a clinician can insert the fulcrum in the notch between first metatarsal 210 and second metatarsal 212 at the base of the metatarsals (e.g., adjacent respective cuneiform) before moving the first metatarsal. The fulcrum can provide a point about which first metatarsal 210 can rotate and/or pivot while helping minimize or avoid base compression between the first metatarsal and the second metatarsal. In addition, use of the fulcrum may cause first metatarsal 210 and medial cuneiform 222 to be better angled relative to guide slots positioned over the end faces of the bones, providing a better cut angle through the guide slots than without use of the fulcrum. This can help reduce or eliminate unwanted spring-back, or return positioning, of first metatarsal 210 after initial realignment of the metatarsal.

(104) When used, the clinician can insert the fulcrum between first metatarsal 210 and second metatarsal 212 (or other adjacent bones, when not performing a metatarsal realignment) at any time prior to moving the first metatarsal (e.g., by actuating a bone positioning guide or otherwise manipulating the bone). In different embodiments, the fulcrum can be inserted between first metatarsal 210 and second metatarsal 212 before or after inserting joint spacer 188 and/or placing bone preparation guide 150 over the joint being operated upon. In one embodiment, the clinician prepares the joint being operated upon to release soft tissues and/or excise the plantar flare from the base of the first metatarsal 210. Either before or after installing an optional bone positioning guide over adjacent bones, the clinician inserts the fulcrum at the joint between the first metatarsal and the second metatarsal. The clinician can subsequently actuate bone positioning guide 10 (e.g., when used). As distal portion of first metatarsal can move toward the second metatarsal in the transverse plane to close the IMA, thereby pivoting a proximal portion of the first metatarsal about the fulcrum and reducing the IMA between the first metatarsal and the second metatarsal. While use of a fulcrum can minimize or eliminate base compression between adjacent bones being operated upon, in other embodiments, the described systems and techniques can be implemented without using a fulcrum.

(105) An example method for preforming a bone alignment procedure utilizing a compressor-distractor and instrument defining a sliding surface according to the disclosure will now be described with respect to FIGS. 15-25 depicting a foot 200 having a first metatarsal 210, a medial cuneiform 222, and a second metatarsal 212. Unless otherwise indicated, the example steps described can be carried out in any order and need not be performed in the order described.

(106) After customary surgical preparation and access, a bone preparation instrument 296 can be inserted into the joint (e.g., first tarsal-metatarsal joint) to release soft tissues and/or excise the plantar flare from the base of the first metatarsal 210, as shown in FIG. 15. Excising the plantar flare may involve cutting plantar flare off the first metatarsal 210 so the face of the first metatarsal is generally planar. This step helps to mobilize the joint to facilitate a deformity correction. In some embodiments, the dorsal-lateral flare of the first metatarsal may also be excised to create space for the deformity correction (e.g., with respect to rotation of the first metatarsal). In certain embodiments, a portion of the metatarsal base facing the medial cuneiform can be removed during this mobilizing step.

(107) An incision can be made and, if a bone positioning instrument is going to be used, a tip 50 of a bone positioning guide 10 inserted on the lateral side of a metatarsal other than the first metatarsal 210, such as the second metatarsal 212. As shown in FIG. 16, the tip can be positioned proximally at a base of the second metatarsal 212 and a third metatarsal 294 interface. A surface of a bone engagement member 40 can be placed on the proximal portion of the first metatarsal 210. In some embodiments, the bone engagement member engages a medial ridge of the first metatarsal 210. As shown, the body 20 of the positioning guide can be generally perpendicular to the long axis of the second metatarsal 212.

(108) To help avoid a base shift, a clinician can insert a fulcrum in the notch between first metatarsal 210 and second metatarsal 212 at the base of the metatarsals (e.g., adjacent respective cuneiform) before actuating bone positioning guide 10 or otherwise moving the first metatarsal relative to the medial cuneiform. The fulcrum can provide a point about which first metatarsal 210 can rotate and/or pivot while helping minimize or avoid base compression between the first metatarsal and the second metatarsal.

(109) In applications utilizing bone positioning guide 10, the actuator on the bone positioning guide can be actuated to reduce the angle (transverse plane angle between the first metatarsal and the second metatarsal) and rotate the first metatarsal about its axis (frontal plane axial rotation). The first metatarsal 210 can be properly positioned with respect to the medial cuneiform 222 by moving the bone engagement member 40 bone positioning guide with respect to the tip 50 of the bone positioning guide. In some embodiments, such movement simultaneously pivots the first metatarsal with respect to the cuneiform and rotates the first metatarsal about its longitudinal axis into an anatomically correct position to correct a transverse plane deformity and a frontal plane deformity. Other instrumented and/or non-instrumented approaches can be used to adjustment position of first metatarsal 210 relative to medial cuneiform 222. Thus, other applications utilizing compressor-distractor 100 and a pin lock may be performed without utilizing bone positioning guide 10.

(110) Independent of whether bone positioning guide 10 is used, an example technique may include positioning joint spacer 188 within the joint between first metatarsal 210 and medial cuneiform 222, as illustrated in FIG. 17. Bone preparation guide 150 can be placed over the joint spacer 188 as shown in FIG. 18 and engaged with the joint spacer to set a position and orientation of the bone preparation guide relative to the joint. In other embodiments, bone preparation guide 150 is placed on the bones without using joint spacer 188 to aid with positioning.

(111) As depicted in FIG. 19, one or more fixation pins can be inserted into apertures of the bone preparation guide 150 to secure the guide to the first metatarsal 210 and the medial cuneiform 222. The fixation pins inserted into the apertures of bone preparation guide 150 includes a first fixation pin 112 and second fixation pin 114. The first and second fixation pins 112, 114 may be inserted in substantially parallel alignment. The first and second fixation pins 112, 114 may project at least 25 mm above the surface of the bones into which the pins are inserted, such as at least 50 mm, or at least 75 mm. One or more additional pins can be inserted at an angle or in a converging orientation to help prevent movement of the bone preparation guide 150 during a tissue removing step. After insertion of the pins, the spacer 188 (if used) can optionally be removed in embodiments having a selectively engageable spacer. Also, after insertion of the pins, one or more pin locks 300/350 may be inserted over one or more pins to help lock the bone preparation guide 150 to the bone to be cut.

(112) In some applications, the end of the first metatarsal 210 facing the medial cuneiform 222 can be prepared with a tissue removing instrument 296 guided by a guide surface of bone preparation guide 150 (e.g., inserted through a slot defined by a first guide surface and a first facing surface). In some embodiments, the first metatarsal 210 end preparation is done after at least partially aligning the bones, e.g., by actuating bone positioning guide 10 or otherwise moving the first metatarsal but after preparing the end of first metatarsal 210. In other embodiments, the first metatarsal 210 end preparation is done before the alignment of the bones, e.g., by preparing the end of the first metatarsal 210 before installing compressor-distractor 100 and a pin lock.

(113) In addition to preparing the end of first metatarsal 210, the end of the medial cuneiform 222 facing the first metatarsal 210 can be prepared with the tissue removing instrument 296 guided by a guide surface of bone preparation guide 150 (e.g., inserted through a slot defined by a second guide surface and a second facing surface). In some embodiments, the medial cuneiform 222 end preparation is done after the alignment of the bones. In yet other embodiments, the medial cuneiform 222 end preparation is done before the alignment of the bones. In embodiments that include cutting bone or cartilage, the cuneiform cut and the metatarsal cut can be parallel, conforming cuts. In some examples, a saw blade can be inserted through a first slot to cut a portion of the medial cuneiform and the saw blade can be inserted through a second slot to cut a portion of the first metatarsal.

(114) Any pin locks and/or angled/converging pins can be removed and the bone preparation guide 150 can be lifted off the substantially parallel first and second pins 112, 114, as shown in FIG. 20. This can leave a pair of substantially parallel first and second pins 112, 114 positioned in first metatarsal 210 and medial cuneiform 220, as shown in FIG. 21.

(115) Compressor distractor can be inserted on substantially parallel first and second pins 112, 114 as shown in FIG. 22. For example, the clinician can position compressor-distractor 100 so the bottom side of first pin-receiving hole 108 is positioned over first pin 112 and the bottom side of second pin-receiving hole 110 is positioned over second pin 114. The clinician can then slide compressor-distractor 100 down over the pins toward the underlying bones, e.g., until the bottom side of the compressor-distractor is adjacent to or in contact with the underlying bones. The clinician may adjust the spacing between first engagement arm 102 and second engagement arm 104 by actuating actuator 106 until the separation distance corresponds to the spacing between first and second pins 112, 114, before installing the compressor-distractor down over the pins. If first pin-receiving hole 108 is angled relative to second pin-receiving hole 110, the process of inserting compressor-distractor 100 on the pins can cause first and second pins 112, 114 to shift from their substantially parallel alignment to a nonparallel alignment corresponding to the angular position of the pin-receiving holes. By contrast, when first pin-receiving hole 108 is parallel to second pin-receiving hole 110, the process of inserting compressor-distractor 100 on the pins may not cause first and second pins 112, 114 to shift substantially from their parallel alignment.

(116) In applications where bone positioning guide 10 is utilized, the bone positioning guide may be removed before or after bone preparation guide 150 is removed and compressor-distractor 100 is installed. In either case, in some examples, a temporary fixation device such as an olive pin, k-wire, or other fixation structure may be used to maintain the position of the underlying bones (e.g., first metatarsal 210 relative to medial cuneiform 222) while bone preparation guide 150 is removed and compressor-distractor 100 is installed.

(117) With compressor-distractor 100 attached to underlying bones (e.g., first metatarsal 210 and medial cuneiform 222) by first pin 112 and second pin 114, a pin lock can be inserted over first pin 112 and/or second pin 114. FIG. 23 illustrates an example implementation where a single pin lock 350 is inserted onto first pin 112. To install a pin lock (e.g., pin lock 350), the clinician may actuate the pin lock from a natural resting position in which the pin lock is locked to an unlocked position. For example, the clinician may press piston 354 toward bearing retaining body 352 and/or base 380. This may release the force pushing bearing 366 into pin receiving hole 358.

(118) The clinician can position the pin receiving hole defined axially through pin lock 350 over a distal end of first pin 112 (or a different pin in different examples). While optionally holding the pin lock in an unlocked position, the clinician can slide pin lock 350 down over the pin 112 toward compressor-distractor 100. In some examples, the clinician pushes the pin lock down until the pin lock contacts the top surface of the compressor-distractor. For example, the clinician may press pin lock 350 against compressor-distractor 100, e.g., until the compressor-distractor is pressing against bone on the opposite end of the pin block. Once suitably positioned, the clinician can actuate pin lock 350 to lock the pin lock, e.g., by releasing piston 354. This can cause bearing 366 to press against 112, proving frictional interference that inhibits relative movement between the pin and pin lock.

(119) FIG. 24 illustrates an example alternative implementation where pin lock 300 is inserted onto second pin 114. To install pin lock, the clinician may similarly actuate the pin lock from a natural resting position in which the pin lock is locked to an unlocked position. For example, the clinician may press first arm 302 toward second arm 304. This may align first pin hole 308 with second pin hole 310. The clinician can position the pin receiving hole defined axially through the aligned first pin hole 308 and second pin hole 310 over a distal end of second pin 114 (or a different pin in different examples). While optionally holding the pin lock in an unlocked position, the clinician can slide pin lock 300 down over the pin 112 toward compress-distractor 100. In some examples, the clinician pushes the pin lock down until the pin lock contacts the top surface of the compressor-distractor. For example, the clinician may press pin lock 300 against compressor-distractor 100, e.g., until the compressor-distractor is pressing against bone on the opposite end of the pin block. Once suitably positioned, the clinician can actuate pin lock 300 to lock the pin lock, e.g., by releasing the compressive force applied to first arm 302 and second arm 304. This can cause the arms to bias away from each other, proving frictional interference against pin 114 that inhibits relative movement between the pin and pin lock.

(120) With compressor-distractor 100 pinned to underlying bones (e.g., first metatarsal 210 and medial cuneiform 222) and locked, actuator 106 may be actuated to distract the underlying bones. For example, the clinician may turn knob 126 to cause second engagement arm 104 to move away from first engagement arm 102, opening or enlarging a gap between the underlying bones. When pin to first metatarsal 210 and medial cuneiform 222, the clinician can actuate actuator 106 to open the TMT joint. While in this example application compressor-distractor 100 is described as being attached to first metatarsal 210 and medial cuneiform 222 to distract the two bones (e.g., followed by subsequent compression), alternative implementations may involve manual distraction of the bones. In these alternatives, the clinician may attach compressor-distractor 100 to first metatarsal 210 and medial cuneiform 222 after distracting the two bone portions, e.g., and only utilize the compression feature of compressor-distractor 100 without utilizing the distraction feature.

(121) In either case, with the underlying bones distracted, the clinician may clean or otherwise prepare the space between the bones and/or the end face of one or both bones. The clinician may clean the space by removing excess cartilage, bone, and/or other cellular debris that may natively exist or may have been created during the bone preparation step that may inhibit infusion.

(122) The clinician may also actuate actuator 106 to compress the bones together for permanent fixation infusion. The clinician may turn knob 126 to cause second engagement arm 104 to move toward first engagement arm 102, for example until the end faces of the underlying bones contact each other and/or a compressive force is applied through pins 112, 114 to the end faces. While in this example application compressor-distractor 100 is described as being used to compress the two bones, alternative implementations may involve manual compression of the bones or compression using a different instrument. In these alternatives, the clinician may attach compressor-distractor 100 to first metatarsal 210 and medial cuneiform 222 to distract the two bone portions, e.g., and only utilize the distraction feature of compressor-distractor 100 without utilizing the compression feature.

(123) With the end faces pressed together via compressor-distractor 100, the clinician may provisionally or permanently fixate the bones or bones portions together. For example, one or more bone fixation devices can be applied across the joint and to the two bones to stabilize the joint for fusion, such as two bone plates positioned in different planes. FIG. 25 illustrates an example fixation device arrangement that includes a first bone plate 400 positioned on a dorsal-medial side of the first metatarsal and medial cuneiform and a second bone plate 410 positioned on a medial-plantar side of the first metatarsal and the medial cuneiform. In other embodiments, second bone plate 410 can be a helical bone plate positioned from a medial side of the cuneiform to a plantar side of the first metatarsal across the joint space. The plates can be applied with the insertion of bone screws. Example bone plates that can be used as first bone plate 400 and/or second bone plate 410 are described in US Patent Publication No. US2016/0192970, titled Bone Plating System and Method and filed Jan. 7, 2016, which is incorporated herein by reference. Other types in configurations of bone fixation devices can be used, and the disclosure is not limited in this respect.

(124) Compressor-distractor devices and pin locks, along with associated techniques and systems, have been described. In some examples, a compressor-distractor and pin lock according to the disclosure is included in a disposable, sterile kit that includes associated surgical instrumentation, such as bone positioning guide and/or a preparation guide described herein. Other components that may be included within the sterile kit include bone fixation devices, bone fixation screws, pins for insertion into pin-receiving holes, and the like.

(125) Various examples have been described. These and other examples are within the scope of the following claims.