Tarsal-metatarsal joint procedure utilizing fulcrum

Abstract

A technique for correcting a bone deformity, such as a bunion, may be performed using an instrument. The technique may include preparing an end of a first metatarsal and preparing an end of a medial cuneiform opposing the end of the first metatarsal. The technique may also include moving the first metatarsal relative to the medial cuneiform. The technique can involve inserting the instrument between a first metatarsal and a second metatarsal.

1 . A method comprising:
 preparing an end of a first metatarsal;   preparing an end of a medial cuneiform opposing the end of the first metatarsal;   inserting an instrument between the first metatarsal and a second metatarsal adjacent to the first metatarsal to set a spacing between the first metatarsal and the second metatarsal corresponding to a thickness of the instrument; and   fixing a position of the first metatarsal relative to the medial cuneiform by inserting a fixation device across a tarsal-metatarsal joint.   
     
     
         2 . The method of  claim 1 , wherein the thickness of the instrument is within a range from 1 mm to 12 mm. 
     
     
         3 . The method of  claim 2 , wherein the instrument has a width within a range from 5 mm to 15 mm. 
     
     
         4 . The method of  claim 1 , further comprising selecting the instrument from a kit comprising a plurality of instruments each configured to be inserted between the first metatarsal and the second metatarsal to set the spacing between the first metatarsal and the second metatarsal, each of the plurality of instruments varying from each other of the plurality of instruments in the thickness. 
     
     
         5 . The method of  claim 4 , wherein the plurality of instruments include a first instrument having a first thickness and a second instrument having a second thickness, and the second thickness is at least 1 mm thicker than the first thickness. 
     
     
         6 . The method of  claim 1 , further comprising moving the first metatarsal relative to the medial cuneiform in a transverse plane. 
     
     
         7 . The method of  claim 6 , wherein moving the first metatarsal relative to the medial cuneiform in the transverse plane comprises moving the first metatarsal to a position parallel to the second metatarsal. 
     
     
         8 . The method of  claim 6 , wherein moving the first metatarsal relative to the medial cuneiform comprises moving the first metatarsal by applying a force to the first metatarsal with a bone positioning guide. 
     
     
         9 . The method of  claim 6 , wherein moving the first metatarsal relative to the medial cuneiform comprises applying a force compressing a base of the first metatarsal toward a base of the second metatarsal. 
     
     
         10 . The method of  claim 6 , wherein:
 the instrument is a fulcrum; and   moving the first metatarsal relative to the medial cuneiform in the transverse plane comprises pivoting the first metatarsal about the fulcrum.   
     
     
         11 . The method of  claim 6 , further comprising moving the first metatarsal relative to the medial cuneiform in a frontal plane. 
     
     
         12 . The method of  claim 1 , wherein inserting the instrument between the first metatarsal and the second metatarsal comprises moving a base of the first metatarsal away from a base of the second metatarsal a distance corresponding to the thickness of the instrument. 
     
     
         13 . The method of  claim 1 , wherein inserting the instrument between the first metatarsal and the second metatarsal comprises inserting the instrument between a proximal-most third of the first metatarsal and a proximal-most third of the second metatarsal. 
     
     
         14 . The method of  claim 1 , wherein inserting the instrument between the first metatarsal and the second metatarsal comprises inserting the instrument between a proximal base of the first metatarsal and a proximal base of the second metatarsal. 
     
     
         15 . The method of  claim 1 , wherein inserting the instrument between the first metatarsal and the second metatarsal comprises inserting the instrument after preparing the end of the first metatarsal and after preparing the end of the medial cuneiform. 
     
     
         16 . The method of  claim 1 , wherein:
 preparing the end of the first metatarsal comprises cutting the end of the first metatarsal; and   preparing the end of the medial cuneiform comprises cutting the end of the medial cuneiform.   
     
     
         17 . The method of  claim 1 , wherein the fixation device comprises one or more of a compressing bone screw, a bone plate, a bone staple, and an intramedullary implant. 
     
     
         18 . A method comprising:
 selecting an instrument from a kit comprising a plurality of instruments each configured to be inserted between a first metatarsal and a second metatarsal adjacent to the first metatarsal to set a spacing between the first metatarsal and the second metatarsal, each of the plurality of instruments varying from each other of the plurality of instruments in a thickness;   moving the first metatarsal relative to a medial cuneiform in a transverse plane; and   inserting the instrument between the first metatarsal and the second metatarsal to set the spacing between the first metatarsal and the second metatarsal in the transverse plane corresponding to the thickness of the instrument selected.   
     
     
         19 . The method of  claim 18 , wherein moving the first metatarsal relative to the medial cuneiform in the transverse plane comprises moving the first metatarsal to a position parallel to the second metatarsal with the spacing set by the thickness of the instrument selected. 
     
     
         20 . The method of  claim 18 , wherein moving the first metatarsal relative to the medial cuneiform in the transverse plane comprises moving the first metatarsal relative to the medial cuneiform in the transverse plane after inserting the instrument between the first metatarsal and the second metatarsal. 
     
     
         21 . The method of  claim 18 , further comprising:
 preparing an end of the first metatarsal;   preparing an end of the medial cuneiform; and   fixing a moved position of the first metatarsal relative to the medial cuneiform by inserting a fixation device across a tarsal-metatarsal joint.   
     
     
         22 . The method of  claim 21 , wherein:
 preparing the end of the first metatarsal comprises preparing the end of the first metatarsal after moving the first metatarsal relative to the medial cuneiform; and   preparing the end of the medial cuneiform comprises preparing the end of the medial cuneiform after moving the first metatarsal relative to the medial cuneiform.   
     
     
         23 . The method of  claim 21 , wherein:
 preparing the end of the first metatarsal comprises cutting the end of the first metatarsal; and   preparing the end of the medial cuneiform comprises cutting the end of the medial cuneiform.   
     
     
         24 . The method of  claim 18 , wherein the thickness of the plurality of instruments is within a range from 1 mm to 12 mm. 
     
     
         25 . The method of  claim 24 , wherein the plurality of instruments include a first instrument having a first thickness and a second instrument having a second thickness, and the second thickness is at least 1 millimeter thicker than the first thickness. 
     
     
         26 . The method of  claim 18 , wherein moving the first metatarsal relative to the medial cuneiform comprises moving the first metatarsal by applying a force to the first metatarsal with a bone positioning guide. 
     
     
         27 . The method of  claim 18 , wherein moving the first metatarsal relative to the medial cuneiform comprises applying a force compressing a base of the first metatarsal toward a base of the second metatarsal. 
     
     
         28 . The method of  claim 18 , wherein:
 the instrument is a fulcrum; and   moving the first metatarsal relative to the medial cuneiform in the transverse plane comprises pivoting the first metatarsal about the fulcrum.   
     
     
         29 . The method of  claim 18 , further comprising moving the first metatarsal relative to the medial cuneiform in a frontal plane. 
     
     
         30 . The method of  claim 18 , wherein inserting the instrument between the first metatarsal and the second metatarsal comprises inserting the instrument between a proximal-most third of the first metatarsal and a proximal-most third of the second metatarsal.