Surgical instrumentation and methods of use for implanting a prosthesis

Abstract

A tissue resection guide for use with a datum includes a base releasably engagable with the datum. The tissue resection guide has a first frame fixed relative to the base and the first frame has at least one integral first guide path that is sized and configured to at least partially capture and guide a first tissue resection tool relative to the first frame.

1 . A distractor comprising:
 a handle adjustable between an insertion position and a distraction position;   a datum securement attached to the handle and releasably engagable with a datum; and   a tissue engaging portion attached to the handle and movable with respect to the datum securement as the handle is adjusted between the insertion position and the distraction position.   
     
     
         2 . The distractor of  claim 1 , wherein the handle includes a first handle portion that extends from the datum securement and a second handle portion that extends from the tissue engaging portion. 
     
     
         3 . The distractor of  claim 2 , wherein the second handle portion is pivotable with respect to the first handle portion. 
     
     
         4 . The distractor of  claim 2 , wherein the first handle portion is releasably attached to the second handle portion. 
     
     
         5 . The distractor of  claim 2 , further comprising a proximal end and distal end,
 wherein the first handle portion is generally planar from the distal end to the proximal end.   
     
     
         6 . (canceled) 
     
     
         7 . The distractor of  claim 2 , wherein the second handle portion further comprises a grip portion opposite a tissue engaging portion and an inflection point between the tissue engaging portion and the grip portion wherein the second handle portion is attachable to the first handle portion proximate the inflection point. 
     
     
         8 . The distractor of  claim 2 , wherein the second handle portion includes a distal portion that is generally parallel the first handle portion when the distractor is in the insertion position and is not generally parallel to the first handle portion when the distractor is in the distraction position. 
     
     
         9 . The distractor of  claim 2 , further comprising:
 a ratchet extending between the first handle portion and the second handle portion.   
     
     
         10 . (canceled) 
     
     
         11 . The distractor of  claim 9 , wherein the ratchet is pivotably attached to the first handle portion. 
     
     
         12 . The distractor of  claim 9 , wherein the ratchet is detachable from the second handle portion. 
     
     
         13 . The distractor of  claim 1 , wherein the tissue engaging portion includes a paddle pivotably attached to the second handle portion. 
     
     
         14 . The distractor of  claim 13 , wherein the paddle is generally parallel with the handle in the insertion position. 
     
     
         15 . The distractor of  claim 13 , wherein the paddle is generally flush with the handle in the insertion position. 
     
     
         16 . The distractor of  claim 13 , wherein at least a portion of the paddle is sized and configured to extend over the datum and between a plurality of projections extending from the datum when the datum securement is engaged with the datum. 
     
     
         17 . The distractor of  claim 13 , wherein a proximal end of the paddle is heavier than the distal end of the paddle. 
     
     
         18 . The distractor of  claim 1 , wherein the datum securement includes an abutment member, the abutment member engagable with the datum and movable from a secured position to a released position. 
     
     
         19 . The distractor of  claim 1 , further comprising a datum lock configured to move the datum securement from a secured position to a released position. 
     
     
         20 . The distractor of  claim 19 , wherein the datum lock includes a rotatable nut that threadably engages a shaft extending from the datum securement. 
     
     
         21 . The distractor of  claim 1 , wherein the handle further comprises a grip portion having a plurality of indentations separated by columns that are oriented perpendicular to a longitudinal axis of the handle. 
     
     
         22 . A tissue resection guide for use with a datum comprising:
 a base releasably engagable with the datum and having a first frame fixed relative to the base, the first frame having at least one integral first guide path sized and configured to at least partially capture and guide a first tissue resection tool relative to the first frame.   
     
     
         23 . The tissue resection guide of  claim 22 , wherein the base further includes a second frame fixed relative to the base, the second frame having at least one integral second guide path sized and configured to at least partially capture and guide a second tissue resection tool relative to the first frame. 
     
     
         24 . The tissue resection guide of  claim 23 , wherein the second frame has an at least partially open sidewall. 
     
     
         25 . The tissue resection guide of  claim 24 , wherein the at least partially open sidewall includes two tapered and spaced apart side wall segments. 
     
     
         26 . The tissue resection guide of  claim 23 , wherein the base has a bottom surface engagable with the datum and a top surface opposite the bottom surface of the base, the at least one second guide path is at least partially closed proximate the top surface of the base and substantially open proximate the bottom surface of the base. 
     
     
         27 . The tissue resection guide of  claim 23 , wherein the at least one first guide path is raised upwardly further from the base in a direction generally normal to the top of the base than the at least one second guide path. 
     
     
         28 . The tissue resection guide of  claim 23 , wherein at least one of the first and second frames is oriented at an oblique angle relative a bottom surface of the base. 
     
     
         29 . The tissue resection guide of  claim 23 , wherein the second frame has an angle of inclination with respect to a bottom surface of the base greater than an angle of inclination of the first frame relative to the bottom surface of the base. 
     
     
         30 . The tissue resection guide of  claim 23 , wherein the at least one second guide path and a surface of the datum define a resection plane when the base is engaged with the datum. 
     
     
         31 . The tissue resection guide of  claim 22 , wherein the at least one guide path includes an enlarged end. 
     
     
         32 . The tissue resection guide of  claim 31 , wherein at least two enlarged ends are on opposite lateral sides of the first frame. 
     
     
         33 . The tissue resection guide of  claim 22 , wherein the at least one first guide path includes two substantially parallel longitudinal guide paths. 
     
     
         34 . The tissue resection guide of  claim 33 , wherein each of the two substantially parallel longitudinal guide paths has a longitudinal axis and an enlarged end, and wherein the longitudinal axes of adjacent longitudinal guide paths are spaced apart from one another by a distance that is less than a diameter of one of the enlarged ends. 
     
     
         35 . The tissue resection guide of  claim 22 , wherein the base has a bottom surface engagable with the datum and a top surface opposite the bottom surface of the base, the at least one first guide path is at least partially closed proximate the top surface of the base and substantially open proximate the bottom surface of the base. 
     
     
         36 . The tissue resection guide of  claim 35 , wherein the at least one first guide path is raised upwardly from the top surface of the base in a direction generally normal to the top surface of the base. 
     
     
         37 . The tissue resection guide of  claim 22 , wherein the first frame includes at least one viewing window extending through an outer surface of the first frame. 
     
     
         38 . The tissue resection guide of  claim 37 , wherein the first frame includes an alignment line on the outer surface that intersects with the at least one viewing window. 
     
     
         39 . The tissue resection guide of  claim 22 , wherein the at least one first guide path and a surface of the datum define a resection plane along which the tissue resection tool is guided when the base is engaged with the datum. 
     
     
         40 . A datum engagable with at least one tissue resection guide, the datum comprising:
 a bottom surface engagable with a tissue surface;   a first side surface extending upwardly from the bottom surface to define a first acute angle with the bottom surface;   a second side surface extending upwardly from the bottom surface to define a second acute angle with the bottom surface; and   a top surface connected to the first and second side surfaces and having a securement releasably engagable with the at least one tissue resection guide.   
     
     
         41 . The datum of  claim 40 , further comprising a third side surface extending upwardly from the bottom surface to define a third acute angle with the bottom surface. 
     
     
         42 . The datum of  claim 41 , further comprising a fourth side surface extending upwardly from the bottom surface to define an obtuse angle with the bottom surface. 
     
     
         43 . The datum of  claim 42 , wherein a width of the bottom surface measured between the first and fourth side surfaces is smaller than the length of the bottom surface measured between the first and second side surfaces. 
     
     
         44 . The datum of  claim 41 , wherein the third acute angle is smaller than the first and second acute angles. 
     
     
         45 . The datum of  claim 41 , wherein a fourth angle between the first side surface and the third side surface is less than a fifth angle between the second side surface and the third side surface. 
     
     
         46 . The datum of  claim 41 , wherein the third side surface is between the first and second side surfaces. 
     
     
         47 . The datum of  claim 41 , wherein the top surface is generally parallel to the bottom surface. 
     
     
         48 . The datum of  claim 41 , wherein the securement includes a threaded aperture. 
     
     
         49 . A method of implanting a prosthesis between first and second bones, the method comprising the steps of:
 resecting tissue from the first bone to expose a first resected tissue surface;   resecting tissue from the second bone to expose a second resected tissue surface;   attaching a datum to the second resected tissue surface;   attaching to the datum a first tissue resection guide configured to guide the first tissue resection tool;   further resecting tissue from the second bone with the first tissue resection tool while the first tissue resection tool is guided by the first tissue resection guide to expose a third resected tissue surface; and   placing the prosthesis in contact with the first and second resected tissue surfaces to operatively connect the first and second bones.   
     
     
         50 . The method of  claim 49 , further comprising:
 attaching a second tissue resection guide on the datum; and   forming a fourth resected tissue surface by further resecting tissue from the second bone using the second tissue resection guide to guide a second tissue resection tool.   
     
     
         51 . The method of  claim 50 , wherein the third resected tissue surface is adjacent to a first side of the datum and the fourth resected tissue surface is adjacent to a second side of the datum. 
     
     
         52 . The method of  claim 51 , wherein the third resected tissue surface is generally aligned with the first side of the datum and the fourth resected tissue surface is generally aligned with the second side of the datum. 
     
     
         53 . The method of  claim 49 , wherein resecting the first bone further comprises:
 applying a second tissue resection tool to the first bone along a second tissue resection guide fixed relative to the first bone.   
     
     
         54 . The method of  claim 53 , further comprising:
 determining the position of the second tissue resection guide based upon the position of a spacer guide attached to the second tissue resection guide.   
     
     
         55 . The method of  claim 49 , further comprising:
 fixing the second bone relative to the first bone prior to resecting tissue from the second bone to expose the second resected tissue surface.   
     
     
         56 . The method of  claim 49 , further comprising:
 aligning a feature of the first tissue resection tool with a feature of the first tissue resection guide to achieve a predetermined resection depth.   
     
     
         57 . The method of  claim 49 , further comprising:
 positioning the datum on the second resected tissue surface with a distractor; and   moving the first bone away from the second bone with the distractor.   
     
     
         58 . The method of  claim 49 , further comprising:
 placing a window trial over the second resected tissue surface and third resected tissue surfaces to evaluate the size and shape of the second resected tissue surface and the third resected tissue surface.   
     
     
         59 . The method of  claim 49 , further comprising:
 positioning a barrel cut guide against the first resected tissue surface;   inserting a drill bit through an aperture in the barrel cut guide; and   drilling a cavity into the first bone using the drill bit, the cavity receiving a portion of the prosthesis.   
     
     
         60 . The method of  claim 49 , wherein the first bone is the tibia and the second bone is the talus. 
     
     
         61 . The method of  claim 49 , wherein the first and second resected tissue surfaces are comprised of bone. 
     
     
         62 . A tissue resection kit comprising:
 a datum engagable with a tissue surface; and   a first tissue resection guide having:
 a first base releasably engagable with the datum and having a first frame fixed relative to the first base, the first frame having at least one integral first guide path sized and configured to at least partially capture and guide a first tissue resection tool relative to the first frame. 
   
     
     
         63 . The tissue resection kit of  claim 62 , wherein the first base includes a third frame fixed relative to the first base, the third frame having at least one integral third guide path sized and configured to at least partially capture and guide a third tissue resection tool relative to the first frame. 
     
     
         64 . The tissue resection kit of  claim 62 , wherein the at least one first guide path and a surface of the datum define a resection plane along which the tissue resection tool is guided when the first base is engaged with the datum. 
     
     
         65 . The tissue resection kit of  claim 62 , further comprising:
 a second tissue resection guide having:
 a second base releasably engagable with the datum and having a second frame fixed relative to the second base, the second frame having at least one integral second guide path sized and configured to at least partially capture and guide a second tissue resection tool relative to the second frame. 
   
     
     
         66 . The tissue resection kit of  claim 62 , further comprising:
 a distractor releasably engagable with the datum, the distractor configured to displace a first bone relative to a second bone while positioning the datum onto a surface of the first bone.   
     
     
         67 . The tissue resection kit of  claim 62 , further comprising:
 a window trial engagable with the tissue surface, the window trial having the general shape and configuration of a prosthesis and having one or more apertures for viewing the tissue surface.   
     
     
         68 . An alignment guide for attaching one or resection guides to a bone, the alignment guide comprising:
 an elongated member having a first end, a second end and a longitudinal axis extending between the first and second ends;   a first securement proximate the first end and configured to releasably connect with the bone;   an attachment block proximate the second end and having a second securement configured to releasably connect to the bone; and   a grip tool releasably connectable to the attachment block and generally perpendicular to the attachment block in an engaged position.   
     
     
         69 . The alignment guide of  claim 68 , further comprising:
 an elongated alignment member attached to the elongated member and spaced laterally from and generally parallel to the longitudinal axis.