Surgical instrument assembly for bone resection

Abstract

The present invention relates to a surgical instrument assembly (1) for bone resection, comprising: a resection device (3) which is configured to be attached to at least one bone of a joint, for example to a tibia and / or a talus of an ankle, the resection device (3) comprising a frame (5), a positioning guide (9) which is intended to be attached to the joint, and a positioning window (11) which is configured to be connected to the frame (5), wherein the positioning guide (9) and the positioning window (11) are configured, when the positioning guide (9) is attached to the joint, to enable cooperation between the positioning window (11) and the positioning guide (9) in order to position the resection device (3) relative to the bone in an attachment position.

Description

Description Title of the invention: Set of surgical instruments for bone resection Technical Field

[0001] The present invention relates to a set of surgical instruments for bone resection, for example for tibiotalar resection. Previous technique

[0002] Arthrodesis is a surgical procedure that permanently fuses a joint to make it stable and pain-free. It is a common procedure when no other solution for preserving or replacing the joint surfaces is possible.

[0003] This procedure can be performed in particular in cases of osteoarthritis or trauma.

[0004] The difficulty in this type of surgical procedure lies in preparing the articular surfaces by resection of the damaged cartilage in order to create a uniform fit between the bone fragments for their fusion by osteosynthesis.

[0005] This difficulty is all the more significant because there are large anatomical variations, thus limiting the possibilities of assistance through instrumentation.

[0006] To perform the resection, the practitioner can use several resection tools such as surgical burrs (by arthroscopy for example), curettes / rugines / gouges or an oscillating saw.

[0007] These different preparation options are all done freehand. This therefore introduces a high level of uncertainty during preparation and most often requires a lengthy phase of surface adjustment.

[0008] A prior art solution to assist the practitioner in the proper execution of his bone resections is to use a set of surgical instrumentation including tools designed to be fixed to several portions of the bone of the joint. This allows for effective stabilization of the tooling but involves bulky instrumentation and additional incisions.

[0009] Furthermore, the adjustment of the tooling's position relative to the joint is generally achieved using multiple mechanisms, complicating both the tooling and the adjustment step.

[0010] Therefore, there is a need to provide a simplified set of surgical instruments. Description of the invention

[0011] The invention is notably aimed at overcoming at least one of these drawbacks and relates in a first aspect to a set of surgical instruments for bone resection, for example tibiotalar resection, the set comprising: a resection device configured to be fixed to at least one bone of a joint, for example to a tibia and / or a talus of an ankle, the resection device comprising a frame, a positioning guide intended to be fixed to the joint, a positioning window configured to be connected to the frame, in which the positioning guide and the positioning window are configured to allow, when the positioning guide is fixed to the joint, the cooperation of the positioning window with the positioning guide, in order to position the resection device relative to the bone in a fixed position.

[0012] The surgical instrumentation set according to the invention allows for effective stabilization of the assembly without involving bulky instrumentation and additional incisions.

[0013] The adjustment of the position of the tooling relative to the joint is achieved by means of a simple mechanism and makes it possible to provide a simplified set of surgical instrumentation.

[0014] According to other features of the invention, the surgical instrumentation set of the invention may include one or more of the following optional features considered alone or in all technically possible combinations.

[0015] According to one characteristic, the resection device includes an arm in which the frame is connected to a first end of the arm.

[0016] According to one feature, the positioning window includes a slot having a shape adapted to cooperate with the shape of the positioning guide. For example, the slot and the positioning guide being configured to allow, when the positioning guide is fixed to the joint, the insertion of a first end of the positioning guide through the slot by relative displacement of the positioning window with respect to the positioning guide, and the displacement of the positioning window along at least a portion of the positioning guide.

[0017] According to one feature, the positioning window is configured to be connected to the frame in a removable manner and the assembly includes at least one cutting window intended to be connected to the frame in a removable manner, the cutting window including at least one slot through which a bone cutting element can pass.

[0018] According to one characteristic, the cutting window includes a first slot and a second slot spaced apart, through which the bone cutting element can pass.

[0019] According to one characteristic, the first slit extends at an inclined angle relative to the second slit.

[0020] According to one feature, the set includes a bone cutting element.

[0021] According to one characteristic, the bone cutting element is a saw blade.

[0022] According to one characteristic, the arm includes the first end to which the frame is connected and a second free end.

[0023] According to one characteristic, the frame comprises a body, the body comprising a central portion from which extend two lateral legs arranged to receive the positioning window, and in which the assembly comprises means for connecting the positioning window to the frame, the connection means comprising: first connection means disposed on the central portion of the frame, second connection means, complementary to the first connection means configured to cooperate with the first connection means when the positioning window is connected to the frame.

[0024] According to one feature, the second means of connection include a recall means intended to disengage the second means of connection from the first means of connection so as to disconnect the positioning window from the frame.

[0025] According to one feature, the positioning window comprises a body and grasping means extending outward from the body, the grasping means being arranged so as to manipulate the positioning window by means of a user's thumb and forefinger.

[0026] According to one characteristic, the two slots of the cutting window, called the first cutting window, are spaced apart by a first distance and the assembly includes a second cutting window intended to be connected to the frame and comprising two slots being spaced apart by a second distance different from the first distance.

[0027] According to one feature, the positioning guide includes a blade.

[0028] According to a second aspect, the invention relates to a method of bone resection, for example tibiotalar resection, carried out by means of such a set of surgical instrumentation.

[0029] The process includes the following steps:

[0030] - fixing the positioning guide to the joint,

[0031] - cooperation between the positioning window and the positioning guide in order to position the resection device relative to the bone according to a fixation position.

[0032] The process according to the invention may comprise one or more of the following optional steps considered alone or in all technically possible combinations:

[0033] - insertion, when the positioning guide is fixed to the joint, of the first end of the positioning guide through the slot of the positioning window by relative displacement of the positioning window with respect to the positioning guide and displacement of the positioning window along at least a part of the positioning guide, the second end of the positioning guide being fixed to the joint;

[0034] - connecting the positioning window to the frame;

[0035] - fixing the resection device to a bone;

[0036] - removal of the joint positioning guide;

[0037] - disconnecting the frame positioning window, and connecting the cutting window to the frame;

[0038] - fixing the resection device to a second bone of the joint, before the step of connecting the cutting window to the frame;

[0039] - bone resection performed by passing the bone cutting element through slits in the cutting window;

[0040] - disconnection of the cutting window, called the first cutting window, from the frame and connection of the second cutting window to the frame, the two slots of the first cutting window being spaced apart by a first distance and the slots of the second cutting window being spaced apart by a second distance different from the first distance;

[0041] - bone resection performed by passing the bone cutting element through the slits of the second cutting window. Brief description of the drawings

[0042] [Fig. 1] Figure 1 is an illustration of a resection device of a set of surgical instruments according to the present invention comprising a frame and a means of manipulation.

[0043] [Fig. 2] Figure 2 represents a positioning window for the surgical instrumentation assembly according to the present invention.

[0044] [Fig. 3] Figure 3 represents means of connecting the positioning window to the frame of the surgical instrumentation assembly in the positioning according to the present invention.

[0045] [Fig. 4] Figure 4 represents the means of connecting the positioning window to the frame of the surgical instrumentation assembly in the window locking position according to the present invention.

[0046] [Fig. 5] Figure 5 represents the means of connecting the positioning window to the frame in the window placement position according to one embodiment of the invention.

[0047] [Fig. 6] Figure 6 represents the means of connecting the positioning window to the frame in the window locking position according to the variant embodiment of the invention.

[0048] [Fig. 7] Figure 7 represents a positioning guide for the surgical instrumentation assembly according to the present invention.

[0049] [Fig. 8] Figure 8 represents a cross-sectional window of the surgical instrumentation assembly according to the present invention.

[0050] [Fig. 9] Figure 9 represents the positioning window and the sectioning window of the instrumentation assembly superimposed on one another, with the positioning window visible through transparency.

[0051] [Fig. 10] Figure 10 shows two cross-sectional windows of the surgical instrumentation assembly according to the present invention.

[0052] [Fig. 11] Figure 11 represents bone resections performed using the cutting windows of Figure 10.

[0053] [Fig. 12] Figure 12 shows two cross-sectional windows of the surgical instrumentation set according to one embodiment of the invention.

[0054] [Fig. 13] Figure 13 represents a step in a bone resection procedure according to the present invention in which a joint line is determined.

[0055] [Fig. 14] Figure 14 represents a step in the bone resection process according to the present invention in which the positioning guide is fixed to a joint.

[0056] [Fig. 15] Figure 15 represents a step in the bone resection process according to the present invention in which a connection between the positioning window and the frame of the resection device is made.

[0057] [Fig. 16] Figure 16 represents a step in the bone resection process according to the present invention in which the positioning window is connected to the frame.

[0058] [Fig. 17] Figure 17 represents a step in the bone resection process according to the present invention in which the bone resection device cooperates with the positioning guide.

[0059] [Fig. 18] Figure 18 represents a step in the bone resection process according to the present invention in which the resection device is fixed to a bone.

[0060] [Fig. 19] Figure 19 represents a step in the bone resection procedure according to the present invention in which the resection device is fixed to the bone

[0061] [Fig. 20] Figure 20 represents a step in the bone resection procedure according to the present invention in which the positioning guide is removed from the joint.

[0062] [Fig. 21] Figure 21 represents a step in the bone resection procedure according to the present invention in which the positioning window is disconnected from the frame.

[0063] [Fig. 22] Figure 22 represents a step in the bone resection process according to the present invention in which the resection device is fixed to a second bone.

[0064] [Fig. 23] Figure 23 represents a step in the bone resection process according to the present invention in which a connection between the cutting window and the frame of the resection device is made.

[0065] [Fig. 24] Figure 24 represents a step in the bone resection process according to the present invention in which the cutting window is connected to the frame.

[0066] [Fig. 25] Figure 25 represents a step in the bone resection process according to the present invention in which a bone cut of a bone is made by means of a bone cutting element.

[0067] [Fig. 26] Figure 26 represents a step in the bone resection process according to the present invention in which a bone cut of a second bone is made by means of a bone cutting element.

[0068] [Fig. 27] Figure 27 represents a step in the bone resection process according to the present invention in which the cutting window is disconnected from the frame.

[0069] [Fig. 28] Figure 28 represents a step in the bone resection process according to the present invention in which the resection device is removed from the bones.

[0070] [Fig. 29] Figure 29 represents an example of arthrodesis performed by a plate and screw assembly. Description of the implementation methods

[0071] Other features and advantages of the invention will become apparent from the following non-limiting description and the attached figures which schematically illustrate several embodiments of the surgical instrumentation set according to the invention.

[0072] For the sake of simplicity, identical elements are identified by identical reference symbols across all figures.

[0073] A set of surgical instruments 1 is illustrated in Figure 18. The set includes:

[0074] - a resection device 3 comprising a frame 5, the resection device 3 is configured to be fixed to at least one bone 7 of a joint, for example to a tibia 7a and / or a talus 7b of an ankle,

[0075] - a positioning guide 9 intended to be fixed to the joint, and

[0076] - a positioning window 11 configured to be connected to frame 5.

[0077] The positioning guide 9 and the positioning window 11 are configured to allow, when the positioning guide 9 is fixed to the joint, the cooperation of the positioning window 11 with the positioning guide 9 in order to position the resection device 3 relative to the bone in a fixed position, when the positioning window is fixed to the frame 5.

[0078] The fixation position refers to the final position of the resection device in which the bone resection can be performed. Bone resection refers to a bone cut.

[0079] Positioning guide 9 and positioning window 11 ensure proper positioning of the resection device 3, including the frame 5, relative to the bone. Once the resection device 3 is positioned, it can be fixed to the bone and the bone resection can be performed. Positioning the resection device 3 using positioning guide 9 and positioning window 11 ensures that the bone resection will be carried out correctly.

[0080] The resection device 3 is illustrated in Figure 1.

[0081] In the present exposition, the resection device includes a frame 5.

[0082] The frame 5 includes a body 12 which includes a central portion 14 from which extend two lateral legs 16, 18.

[0083] Each of the legs 16, 18 comprises a first end 16', 18', proximal to the central portion 14 and a second end 16'', 18" distal to the central portion 14.

[0084] For example, the second distal ends 16", 18" are free.

[0085] For example, the central portion 14 and the two lateral legs 16, 18 can be arranged so that the two lateral legs 16, 18 extend a distance apart from each other, for example so that the second distal ends 16", 18" extend a distance apart from each other, for example so that the frame 5, for example the body 12, has a "U" shape.

[0086] Each of the legs 16, 18 may include a first part proximal to the central portion 14 and a second part distal to the central portion 14. Each of the legs may further include an intermediate part connecting the first proximal part and the second distal part.

[0087] For example, the distal parts of legs 16, 18 extend, relative to each other, a greater distance than the proximal parts of legs 16, 18 extend relative to each other.

[0088] For example, each of the first proximal parts of legs 16, 18 includes the first proximal end 16', 18', and each of the second distal parts of legs 16, 18 includes the second distal end 16", 18".

[0089] The frame 5 is configured to be fixed to at least one bone 7 of the joint, for example to the tibia 7a and / or the talus 7b of the ankle (figure 18).

[0090] In the present exposition, frame 5 allows the resection device to be fixed to at least one bone of the joint.

[0091] For this purpose, at least one opening 20 may be provided in the frame 5 so as to allow passage of a suitable fastening means through said at least one opening 20 to a bone of the joint so as to fix the frame 5 to the bone of the joint.

[0092] The fastening means is designed to anchor itself in the bone so as to fix the frame 5 to the bone.

[0093] Any suitable fastening means can be used. For example, the fastening means can be a pin 24 (fig. 27) such as a spherical positioning pin.

[0094] In the present exposition, the frame 5 can be fixed to both the tibia and the talus of the ankle joint (fig. 22).

[0095] For this purpose, an opening 20 is provided in each of the proximal ends 16', 18' and distal ends 16", 18" of the legs of frame 5. The openings in the proximal ends of the legs of frame 5 are configured to allow the passage of a pin 24 through each of these openings to a first bone, for example the tibia, so as to fix the frame to said first bone (Fig. 18). The openings in the distal ends of the legs of frame 5 are configured to allow the passage of a pin 24 through each of these openings to a second bone, for example the talus, so as to fix the resection device to said second bone (Fig. 22).

[0096] As illustrated in Figure 15, the side tabs 16, 18 of the frame 5 are arranged to receive the positioning window 11.

[0097] For example, the legs 16, 18 and the central portion 14 of the frame 5 define a housing 26, for example in the shape of a "U", intended to receive at least in part the positioning window 11.

[0098] The frame 5 can be supplied in different but appropriate sizes and shapes to provide adequate receiving housing for the positioning window 11.

[0099] Such a positioning window 11 is illustrated in figure 2.

[0100] The positioning window 11 is configured to be received in the housing 26 formed between the legs 16, 18 of the frame 5.

[0101] In the present exposition, the positioning window 11 comprises a body 28 comprising a first portion 30, called the upper portion, and a second portion 32, called the lower portion, opposed to each other, and between which extend two lateral legs 34, 36.

[0102] During the assembly of the positioning window 11 and the frame 5, the positioning window 11 can cooperate with the frame 5.

[0103] For this purpose, the upper portion 30 of the positioning window may have recesses 31 designed to abut against walls 140 of the frame 5 that project from the central portion 14 of the frame 5. For example, the openings 20 of the frame which are intended to receive the pins 24 can be provided in these walls 140 (fig. 1). In addition, the lower portion 32 of the positioning window 11 may include extensions 320 intended to come into contact with walls 180 of the frame 5, for example of the body 12, which protrude from the distal parts of the legs 16, 18 of the frame 5. For example, the openings 20 of the frame which are intended to receive the pins 24 may be provided in these walls 180 (fig. 1).

[0104] The upper portion 30, the lower portion 32 and the two lateral tabs 34, 36 of the positioning window define a space 38.

[0105] This space 38 allows for minimal visibility of the joint and the results of the preparatory steps. Space 38 also helps to limit contact between the positioning window 11 and the anterior surface of the tibia.

[0106] Positioning window 11 is configured to be connected to frame 5.

[0107] Configured to be connected to the frame means, for example, that the positioning window 11 is configured to be fixed to the frame 5, for example, attached to the frame 5.

[0108] For this purpose, the surgical instrumentation set 1 includes means for connecting the positioning window 11 to the frame 5.

[0109] For example the connection means are removable connection means so that the positioning window 11 is connected with the frame 5 in a removable manner.

[0110] As illustrated in Figures 3 and 4, the connection means include first connection means 40 arranged at the central portion 14 of the frame 5, and second connection means 42, complementary to the first connection means 40 configured to cooperate with the first connection means 40 when the positioning window 11 is connected to the frame 5 (Fig. 3).

[0111] For example, the first connection means 40 include an opening 40' delimited by a wall with a threaded hole. The opening 40' is formed in the central portion 14 of the frame 5. In the remainder of this description, this opening will be referred to as the threaded opening 40'.

[0112] Furthermore, the second connection means 42 include a knurled knob 42' configured to cooperate with said threading. For example, at least a portion of the knurled knob is configured to be screwed into the threaded opening 40'.

[0113] The wheel 42' comprises an upper part 42'a, allowing its manipulation, a central area 42'b and an end 42'c provided with a thread complementary to the tapping of the tapped opening 40' (fig. 3).

[0114] For example, the upper part 42'a and the central area 42'b each have a substantially cylindrical shape.

[0115] To enable cooperation between the end 42'c of the wheel 42' and the threaded opening 40', an opening 44 is provided in the positioning window 11 (Fig. 2). The opening 44 is configured to allow passage of the end 42'c of the wheel 42' through said opening 44 of the positioning window to the threaded opening 40' of the frame 5 (Fig. 4).

[0116] For example, the opening 44 is provided in the upper portion 30 of the positioning window 11.

[0117] The opening 44 provided in the upper portion of the positioning window 11 is intended to be arranged opposite the threaded opening 40' of the frame 5 when the positioning window 11 cooperates with the frame 5.

[0118] The knob 42' can be manipulated via its upper part 42'a so that its threaded end 42'c passes through the opening 44 of the positioning window 11 (Fig. 4) and engages in the tapped opening 40' of the frame 5. The knob 42' can then be screwed in by rotating it so that the threads of the knob and the tapped opening 40' cooperate. This connects the positioning window 11 to the frame 5 (Fig. 4).

[0119] According to an embodiment illustrated in figures 5 and 6, the wheel 42' may include a return means 47. The return means 47 is intended to disengage the end having the thread 42'c of the wheel 42' from the frame 5 and in particular from the tapped opening 40' of the frame 5.

[0120] For example the return means is arranged on the central area 42'b of the wheel 42'.

[0121] As illustrated in figures 5 and 6, the return means 47 can be a spring 47', for example a compression spring.

[0122] Figure 6 illustrates assembly 1 according to the present exposition in which the wheel 42' is screwed into the threaded opening 40' of the frame 5. When screwing the wheel into the threaded opening 40', the wheel applies a stress on the spring 47' which goes from a free state (fig. 5) to a compressed state (fig. 6).

[0123] When the positioning window 11 is connected to the frame 5, the spring 47' is in a compressed state.

[0124] When the knurled knob 42' is unscrewed from the threaded opening 40', the knurled knob 42' no longer applies any force to the spring. The spring 47' relaxes and pulls the knurled knob 42' out of the threaded opening 40' so that the knurled knob 42' is disengaged from the threaded opening 40' (fig. 5).

[0125] This configuration makes it easier to disconnect the positioning window 11 and the frame 5.

[0126] The means of connection shown above (such as the knurled knob including the thread and tapped opening) are not limiting and any other means of connection, for example removable ones, may be used.

[0127] In the present exposition, the positioning window 11 includes gripping means 46 (fig.2) extending outward from the body 28 of the positioning window 11. The gripping means 46 are arranged so as to manipulate the positioning window 11 by means of a user's thumb and forefinger.

[0128] For example, the gripping means 46 are arranged so that each has a first face 46' arranged opposite each other and a second face 46" opposite the first face 46'. The second faces 46" are intended to receive a thumb or index finger of the user.

[0129] For example, the second 46" faces include a shape adapted to be manipulated by a thumb and forefinger of the user.

[0130] For example, the second 46" faces include a concave shape.

[0131] In the present exposition, the positioning window 11 includes two gripping means 46.

[0132] For example, a first gripping means 46 is arranged on a first leg 34 of the positioning window and a second gripping means 46 is arranged on a second leg 36 of the positioning window.

[0133] For example, the gripping means 46 are gripping lugs 460 that extend outward from the body of the positioning window. The gripping means are fixed relative to the body.

[0134] The gripping means allow easy manipulation of the positioning window 11, for example during the cooperation of the positioning window 11 and the frame 5 for the purpose of connecting the positioning window 11 to the frame 5.

[0135] When the positioning window 11 is connected to the frame 5, the positioning window 11 can be manipulated so that it cooperates with the positioning guide 9.

[0136] For this purpose, the positioning window 11 includes a slot 50 which has a shape adapted to cooperate with a shape of the positioning guide 9.

[0137] The slot 50 of the positioning window is provided in the lower portion 32 of the positioning window 11.

[0138] The lower portion 32 of the positioning window may include a wall 520 which extends outward from the lower portion 32 of the positioning window 11 and into which the slot 50 extends.

[0139] The 520 wall allows for improved guidance range of the positioning guide.

[0140] In the present exposition, the slot 50 and the positioning guide 9 are configured to permit, when the positioning guide 9 is fixed to the joint, the insertion of a first end 9' of the positioning guide 9 through the slot 50 by relative displacement of the positioning window 11 with respect to the positioning guide 9, and the displacement of the positioning window 11 along at least a part of the positioning guide 9.

[0141] Such a positioning guide 9 is illustrated in figure 7.

[0142] The positioning guide 9 is intended to be fixed to the joint (fig. 14).

[0143] We understand that the positioning guide is configured to anchor itself to a joint.

[0144] In the present presentation, the positioning guide 9 is intended to be inserted between the tibia 7a and the talus 7b, along an articular line "L" (fig. 13) which serves as an anatomical reference.

[0145] The joint line “L” corresponds to a line of bone fusion between the tibia 7a and the talus 7b.

[0146] In the case of the tibiotalar joint, the articular line "L" extends perpendicularly to the tibia 7a, in particular to the tibial crest 7a', so that the positioning guide extends perpendicularly to the tibia 7a, in particular to the tibial crest 7a'.

[0147] In the present exposition, the positioning guide 9 comprises a first end 9' and a second end 9'', opposite to the first end 9'.

[0148] The first end 9' is configured to fit into slot 50 of positioning window 11.

[0149] The second 9" end is intended to be attached to the joint.

[0150] The positioning guide 9 is configured so as to allow the positioning window 11 to move relative to the positioning guide 9. The positioning guide 9 is configured to allow the positioning window 11 to be guided from the first end 9' of the positioning guide 9 to the second end 9" of the positioning guide 9 fixed to the joint.

[0151] The positioning guide, once inserted into the slot of the positioning window, serves as a guide or slide for the positioning window.

[0152] The positioning guide may include a part for attaching the positioning guide to the joint and a part for guiding the positioning window.

[0153] The positioning guide 9 is configured so that when the second end 9" is fixed to the joint, i.e. interposed between the tibia 7a and the talus 7b along the joint line "L", the first end 9', which is then the only free end, can allow cooperation between the positioning window 11 and the positioning guide 9. This cooperation is achieved by relative displacement of the positioning window 11 with respect to the positioning guide so that the free end 9' of the positioning guide is inserted into the slot 50 of the positioning window 11.

[0154] The positioning guide 9 can be any suitable means to enable cooperation with the positioning window 11 so that the positioning window 11 can move from the free end 9' of the positioning guide 9, along at least a part of the positioning guide 9.

[0155] For example, positioning guide 9 can be a surgical instrument for cutting bones, resembling, for example, a pair of scissors.

[0156] For example, the positioning guide 9 may include a blade.

[0157] For example, positioning guide 9 could be a chisel or an osteotome.

[0158] The blade may include the first end 9', the second end 9'' and a central portion arranged between the first end 9', the second end 9''.

[0159] The positioning guide such as the blade 9 may include a flat surface, for example from its first end 9' to its second end 9" (fig. 7).

[0160] The positioning guide 9 is configured so that its dimensions are adjusted with the slot 50 of the positioning window 11.

[0161] The flat surface also allows the positioning guide 9 to comprise two parts; a part for fixing the positioning guide to the joint, formed by the second end 9'' and a part for guiding the positioning window once the positioning guide is inserted into the slot of the positioning window, formed by the central portion and the first end.

[0162] In operation, the positioning guide 9 is fixed via its second end 9” to the joint (fig. 14). For example, the positioning guide 9 is interposed between the tibia 7a and the talus 7b, for example along the joint line “L”.

[0163] The positioning window 11 is connected to the frame 5 (fig. 15, 16).

[0164] The positioning window 11 and the frame 5 are manipulated so that the first end 9' of the positioning guide is inserted into the slot 50 of the positioning window 11 (Fig. 17). The positioning window 11, which is connected to the frame 5, is moved relative to the positioning guide 9 until it comes into contact with the joint (Figs. 18, 19). The frame 5 is fixed to at least one bone of the joint, for example, the tibia (Fig. 19). Once the frame 5 is fixed to the bone, the positioning guide 9 is withdrawn from the joint and from the slot 50 of the positioning window (Fig. 20).

[0165] Positioning the positioning guide 9 in the center of the joint, between the tibia 7a and the talus 7b, allows this same centering to be transmitted to the frame 5 before the frame is fixed to the bone.

[0166] Therefore, the correct positioning of frame 5 in relation to the tibiotalar joint will ensure, during the bone cutting stage, that the cuts made are always centered on the joint line “L”.

[0167] To facilitate the handling of frame 5, the resection device 3 may include a handling means to which frame 5 is connected. The handling means may be any suitable means for manipulating frame 5, such as a handle or an arm.

[0168] In the present exposition, the means of manipulation is an arm 48 to which the frame 5 is connected.

[0169] One such arm 48 is illustrated in figure 1.

[0170] In the present exposition, the arm 48 comprises a first end 48' to which the frame is connected and a second end 48", opposite to the first end 48'.

[0171] According to one feature, the second 48" end is free.

[0172] By free end we mean an end without any means of connection to either the frame or the joint.

[0173] The means for fixing the resection device to the bone or bones of the joint are arranged on the frame only, which helps to reduce tissue damage while allowing ergonomic fixation.

[0174] The arm 48 includes a gripping portion 48"' arranged between the two ends 48', 48", the gripping portion is free.

[0175] According to the present exposition, the second end of the arm 48" may include a visual landmark 500 intended to allow alignment of the arm with a bone, for example the tibia and in particular the tibial crest 7a'.

[0176] This will ensure that the positioning guide 9 is correctly positioned in relation to the tibia and in particular the tibial crest 7a', that is to say perpendicular to the tibia.

[0177] Indeed, when the positioning guide 9 is fixed to the joint, it is possible that the positioning guide 9 is not perfectly aligned with the joint line "L" and therefore not perfectly perpendicular to the tibia. When the positioning window 11 cooperates with the positioning guide 9, it is possible to rotate the arm 48 slightly to the right and / or left so as to align the visual reference mark 500 with the tibia (Fig. 18). The movement of the arm 48 is transmitted to the frame 5 and to the positioning window 11, and thus to the positioning guide 9, which cooperates with the positioning window 11. In this way, the positioning guide 9 can be correctly aligned with the joint line and positioned perpendicular to the tibia, and in particular to the tibial crest 7a'.

[0178] Once the position of the positioning guide 9 has been adjusted using the arm 38, the frame 5 can be fixed to the bone.

[0179] The visual marker 500 can be any suitable marker such as a shape or a laser marking for example.

[0180] In the embodiment illustrated in Figure 1, the frame 5 and the arm 48 are formed as a single piece. It is understood that the frame 5 is formed from a single piece of material along with the arm 48.

[0181] In this embodiment, the knob 42' is connected to the arm 48; for example, the central area 42'b of the knob is housed in an additional recess 52 of the arm (Figs. 3, 4). For this purpose, the central part of the knob may include a threaded portion that allows it to be held in position within the additional recess 52. To install the knob, it must be inserted into the additional recess 52. This allows the means for attaching the positioning window 11 to the frame 5 to be grouped together, thus making the connection and disconnection of the positioning window 11 and the frame 5 efficient and quick.

[0182] The invention is not limited to such a configuration, for example the frame 5 and the arm 48 can be two pieces assembled by screwing or welding.

[0183] The frame 5 and the arm 48 can comprise any suitable material, for example the arm and the frame may comprise a metallic material.

[0184] In a preferred embodiment, the frame 5 and the arm 48 comprise a titanium alloy, for example, a TA6V alloy

[0185] According to one variant, the material can be stainless steel, for example type 17-4PH.

[0186] The invention is not limited to such a configuration, for example the frame 5 and the arm 48 may comprise a plastic material.

[0187] When the resection device 3 comprising the frame 5 and, for example, the arm 48 is adjusted and fixed to the bone, a bone resection can be performed on the joint.

[0188] To perform the bone resection, the positioning window 11 can be disconnected from the frame 5 and can be replaced by a cutting window 54.

[0189] Such a cutting window 54 is illustrated in figure 8. The cutting window 54 is part of the resection device.

[0190] The cutting window 54 is configured to be received in the housing 26 formed between the tabs 16, 18 of the frame 5.

[0191] The cutting window 54 includes a body 56 comprising a first portion 58, called the upper portion, and a second portion 60, called the lower portion, opposed to each other and between which extend two lateral legs 62, 64.

[0192] When assembling the cutting window 54 and the frame 5, the cutting window 54 can cooperate with the frame 5.

[0193] For this purpose, the upper portion 58 of the cutting window 54 may have recesses 580 intended to butt against the walls 140 projecting from the central portion 14 of the frame 5 and in which the openings 20 are provided, and the lower portion 60 of the cutting window 54 may include extensions 600 intended to butt against the walls 180 projecting from the distal parts of the legs 16, 18 of the frame 5.

[0194] The upper portion 58, the lower portion 60 and the two lateral tabs 62, 64 of the cutting window 54 define a space 66.

[0195] This space allows for minimal visibility of the joint and the results of the preparatory steps. The space also helps to limit contact between the cutting window and the anterior surface of the tibia.

[0196] The cutting window 54 is configured to be connected to frame 5.

[0197] For this purpose, the means of connecting the cutting window 54 to the frame 5 are the same as those described and used to allow the connection of the positioning window 11 to said frame 5 (tapped opening 40' in the frame 5 and knob 42', for example fixed to the arm 48).

[0198] To allow cooperation between the end 42'c of the wheel 42' and the tapped opening 40', an opening 68 is provided in the cutting window 54 (Fig. 8). The opening 68 is configured to allow passage of the end 42'c of the wheel 42' through said opening 68 of the cutting guide window to the tapped opening 40' of the frame 5.

[0199] For example, the opening 68 is provided in the upper portion 58 of the cutting window 54.

[0200] The opening 68 in the upper portion 58 of the cutting window 54 is intended to be arranged opposite the tapped opening 40' of the frame 5 when the cutting window 54 cooperates with the frame 5.

[0201] The knob 42' can be manipulated so that its end with the thread 42'c passes into the opening 68 of the upper portion 58 of the cutting window 54 and engages in the tapped opening 40' of the frame 5. The knob 42' can then be screwed in so as to connect the cutting window 54 to the frame 5.

[0202] In the present exposition, the cutting window 54 includes gripping means 70 extending outward from the body 56 of the cutting window 54. The gripping means 70 are arranged so as to manipulate the cutting window 54 by means of a user's thumb and forefinger.

[0203] The gripping means 70 allow easy handling of the cutting window 54, for example when inserting the cutting window 54 into the housing 26 of the frame 5 in order to connect it to the frame 5.

[0204] For example, the gripping means 70 are arranged so that each has a first face 70' arranged opposite each other and a second face 70" opposite the first face 70'. Each of the second faces 70" is intended to receive a thumb or index finger of the user.

[0205] For example, the second 70" faces include a shape adapted to be manipulated by a thumb and forefinger of the user.

[0206] For example, the second 70" faces include a concave shape.

[0207] In the present exposition, the cutting window 54 includes two gripping means 70. These gripping means 70 are gripping lugs 720 which extend projecting from the body of the cutting window 54.

[0208] For example, a first gripping lug 720 is arranged on a first leg 62 of the cutting window 54 and a gripping lug 720 is arranged on a second leg 64 of the cutting window 54.

[0209] When the cutting window 54 is connected to the frame 5, the cutting window 54 can be used to perform bone resections in the joint.

[0210] The cutting window 54 includes for this purpose at least one slot 74a, 74b through which a bone cutting element 76 (fig. 25, 26) can pass.

[0211] Said at least one slot 74a, 74b of the cutting window is configured to permit passage of the bone cutting element 76 and to guide the bone cutting element as it passes through said at least one slot.

[0212] The bone cutting element 76 is intended for cutting a bone.

[0213] The bone cutting element 76 can be any suitable element for cutting bone. For example, the bone cutting element 76 can be a saw blade, for example, an oscillating saw blade.

[0214] In the present exposition, said at least one slot 74a, 74b of the cutting window 54 is provided in the lower portion 60 of the cutting window 54 (fig. 8).

[0215] The lower portion 60 of the cutting window may include a wall 78 which extends outward from the cutting guide window 54 and in which said at least one slot 74a, 74b extends.

[0216] The wall 78 increases the guiding span. The higher the slots 74a, 74b are, the less play there will be during the cutting step using the bone cutting element.

[0217] In the example shown in Figure 8, the cutting window includes a first slot 74a and a second slot 74b spaced apart from each other.

[0218] When the cutting window 54 is connected to the frame 5, the slots 74a, 74b are intended to be arranged on either side of the joint line "L" so that the bone cutting element can pass through each of the slots 74a, 74b to cut the tibia 7a and the talus 7b respectively.

[0219] Bone cuts are made by passing the bone cutting element, for example a saw blade, through the respective slots 74a, 74b of the cutting window. The cutting window is connected to the frame 5, for which the appropriate position has been previously set and centered with respect to the joint line via the positioning window 11 and the positioning guide 9 (Figure 9).

[0220] The cutting window 54 is thus characterized by the presence of slots distributed on either side of the centering position defined by the positioning guide 9 and the positioning window (figure 9).

[0221] According to a first variant not illustrated, a first slot 74a and a second slot 74b are separated respectively by an identical distance el and e2 with respect to a centering line 0, which corresponds to the articular line or bone fusion line given by the positioning guide and the positioning window.

[0222] According to a second variant illustrated in Figure 9, the distances el and e2 are different. For example, the distance el of the first slot 74a from the center line 0 is greater than the distance of the second slot 74b from the center line 0. Conversely, the distance el of the first slot 74a from the center line 0 is less than the distance e2 of the second slot 74b from the center line 0. This allows the cutting amplitude to be chosen for each bone.

[0223] In an embodiment illustrated in Figure 10, the surgical instrumentation set may include the cutting window 54 as previously described, referred to as the first cutting window, and a second cutting window 54' intended to be connected to the frame 5 and comprising two slots 74a', 74b'.

[0224] Slots 74a', 74b' of the second cutting window are intended to be arranged on either side of the tibiotalar joint and are configured so that a bone cutting element can pass through each of them to cut the tibia and talus respectively.

[0225] The second cutting window 54' differs from the first cutting window 54 in that the two slots 74a, 74b of the first cutting window are spaced apart from each other by a first distance "dl" and the two slots 74a', 74b' of the second cutting window 54' are spaced apart from each other by a second distance "d2" different from the first distance "dl".

[0226] For example, the second distance "d2" between the slots 74a', 74b' of the second cutting window 54' is greater than the distance "dl" between the slots 74a, 74b of the first cutting window 54 (fig. 10).

[0227] The second 54' cutting window can be used in cases where the amplitude of the cut made with the first cutting window was not sufficient.

[0228] In these embodiments, each of the slots 74a, 74b, 74a', 74b' is, for example, fixedly provided in the cutting guides 54, 54'. In other embodiments, more than two cutting windows with variable distances between the slots may be used. In embodiments not shown, it is, for example, possible to provide a single cutting guide 54 with slots whose positions can be adjusted by means of a suitable mechanism to modify the distance between the slots.

[0229] As an indication and in no way limiting, the distance "dl, d2" between the slots 74a, 74b, 74a', 74b' may be between 3 and 10 mm.

[0230] A visualization of the sections made using the first section window 54 and the second section window 54' on the tibia and talus is shown in Figure 11.

[0231] In the embodiments of figures 8 to 11, the first slit and the second slit 74a, 74b, 74a', 74b' of the section window(s) as previously described extend parallel to each other.

[0232] According to an embodiment illustrated in Figure 12, the first slot 74a, 74'a of the cutting window(s) as previously described extends at an angle 'a' inclined relative to the second slot 74b, 74b'. This allows for correction of the foot's orientation. The angle 'a' is defined in a plane orthogonal to the insertion direction of the positioning guide.

[0233] In this presentation, angle "a" is between 5 and 10 degrees, preferably angle "a" is equal to 5 degrees.

[0234] In other embodiments not shown, the positioning window 11 can be permanently connected to the frame 5. In this embodiment, the positioning window is also a cutting window and includes both a slot configured to allow passage of the positioning guide and two slots configured to allow passage of a bone cutting element. In this embodiment, the slots configured to allow passage of the bone cutting element must be separated from the slot configured to allow passage of the positioning guide.

[0235] A bone resection procedure, for example tibio-talar, using the surgical instrumentation set as previously described and which includes the steps of fixing a positioning guide 9 to a joint, and cooperation between a positioning window 11 and the positioning guide 9 in order to position a resection device relative to a bone according to a fixation position, is illustrated in figures 13 to 29.

[0236] As illustrated in Figure 13, the process includes a step in which an articulated line "L" is determined.

[0237] The joint line “L” corresponds to a line of bone fusion between bones of a joint, for example the tibia 7a and the talus 7b.

[0238] To do this, a tibial window is created via the positioning guide 9 so as to achieve a collapse of the tibial crest.

[0239] Following this step, the positioning guide 9 is inserted between the tibia and the talus.

[0240] Figure 14 illustrates the positioning guide 9 which is fixed to the joint, between the tibia 7a and the talus 7b.

[0241] As illustrated in Figure 15, the process includes a step in which the positioning window 11 is connected to the frame 5.

[0242] The positioning window 11 can be manipulated via the input lugs 460 of the positioning window 11.

[0243] The positioning window 11 is received at least in part in the housing 26 formed between the tabs 16, 18 of the frame 5. The positioning window 11 and the frame 5 cooperate so that the recesses 31 and the extensions 320 of the positioning window 11 come into contact with the respective walls 170, 180 of the frame 5.

[0244] The positioning window 11 can be connected to the frame 5, for example by screwing a knob 42' into a threaded opening 40' provided in the frame 5.

[0245] Figure 16 illustrates the positioning window 11 when connected to frame 5.

[0246] Figure 17 illustrates a step in which the positioning window 11 and the frame 5 are manipulated so that the first end 9' of the positioning guide is inserted into the slot 50 of the positioning window 11.

[0247] The positioning window 11 which is connected to the frame 5 is then moved relative to the positioning guide 9 to a portion of the joint anchoring means until it comes into contact with the joint (fig. 18, 19).

[0248] In the present method, the positioning window 11 is moved from the free end 9' of the positioning guide until the frame 5 comes into contact with a bone, for example, an anterior face of the tibia.

[0249] In the steps of the illustrated process, frame 5 is connected to arm 48.

[0250] In this embodiment, the positioning window 11 is moved via the arm 48.

[0251] The procedure may include a step in which a practitioner ensures the correct perpendicularity of the positioning guide 9 with the tibia 7a in the sagittal plane (visualization of the positioning guide 9) and in the frontal plane (alignment of the visual landmark 500 on the arm 48 with the tibial crest 7a).

[0252] The position of the arm 48 can be modified so as to align the positioning guide 9 with the tibial crest 7a.

[0253] Figure 18 illustrates a step in the process in which the frame 5 is fixed to a first bone, for example to the tibia 7a.

[0254] The fixation can be achieved by means of pins 24 which pass through the openings 20 of the frame 5 and are then inserted into the tibia 7a.

[0255] Frame 5 can be fixed to the tibia by means of two pins 24.

[0256] As illustrated in Figure 20, the process includes a step in which the positioning guide 9 is removed from the joint.

[0257] As illustrated in Figure 21, the process includes a step in which the positioning window 11 is disconnected from the frame 5, for example by unscrewing the knob 42' from the threaded opening 40' of the frame 5.

[0258] Figure 22 illustrates a step in the process in which the frame 5 is fixed to a second bone, for example to the talus 7b.

[0259] The fixing can be achieved by means of pins 24 which pass through the openings 20 of the frame 5 and are then inserted into the slope 7b.

[0260] Frame 5 can be fixed to embankment 7b by means of two pins 24.

[0261] As illustrated in Figure 23, the method includes a step in which a cutting window 54 is connected to the frame 5; for example, the cutting window can be manipulated via the gripping lugs 720 of the cutting window 54. For example, the cutting window 54 is received at least partially in the recess 26 formed between the tabs 16, 18 of the frame 5. The cutting window and the frame 5 cooperate so that the recesses 580 and the extensions 600 of the cutting window 54 come into contact with the respective walls 170, 180 of the frame 5.

[0262] The cutting window 54 can be connected to the frame by screwing a knob 42' into the threaded opening 40' provided in the frame 5.

[0263] Figure 24 illustrates the cutting window 54 when connected to the frame 5.

[0264] When the cutting window 54 is connected to the frame 5, the two slots 74a, 74b are arranged respectively on either side of the articular line "L". One slot 74a is arranged opposite the tibia and one slot 74b is arranged opposite the talus 7b.

[0265] With reference to Figure 25, the process may include making a bone cut using a bone cutting element.

[0266] In a first step, a bone cutting element, such as an oscillating saw blade, passes through a first slot 74a so as to effect a resection of a first bone, for example the tibia 7a.

[0267] As illustrated in Figure 26, the process includes a second step in which the oscillating saw blade passes through the second slot 74b so as to effect a resection of a second bone, for example the talus 7b.

[0268] In cases where the extent of the bone resection performed is too small, the procedure may include a step in which the cutting window 54 is disconnected from the frame 5 and replaced by a second cutting window 54' in which the distance The distance between the two slots 74a', 74b' is greater than the distance between the two slots 74a, 74b of the previous cutting window 54. This allows more material to be removed.

[0269] Once the bone cut has been made, the cutting window 54 is disconnected from the frame 5 by unscrewing the knob 42' (fig. 27).

[0270] Then pins 24 are removed from bones 7a, 7b in order to remove resection device 3 (fig. 28).

[0271] Figure 28 illustrates the 80, 82 tibiotalar resection performed.

[0272] As illustrated in Figure 29, the bone resection procedure can be followed by arthrodesis, for example by means of a plate / screw assembly 84.

Claims

Claims

1. Surgical instrumentation assembly (1) for bone resection, for example tibiotalar resection, the assembly (1) comprising: a resection device (3) configured to be fixed to at least one bone of a joint, for example to a tibia and / or a talus of an ankle, the resection device (3) comprising a frame (5), a positioning guide (9) intended to be fixed to the joint, a positioning window (11) configured to be connected to the frame (5), wherein the positioning guide (9) and the positioning window (11) are configured to allow, when the positioning guide (9) is fixed to the joint, the cooperation of the positioning window (11) with the positioning guide (9), in order to position the resection device (3) relative to the bone according to a fixing position.

2. An assembly (1) according to claim 1 wherein the resection device (3) comprises an arm (48) and wherein the frame (5) is connected to a first end (48') of the arm (48).

3. An assembly according to any one of claims 1 to 2 wherein the positioning window (11) comprises a slot (50) having a shape adapted to cooperate with the shape of the positioning guide (9), for example the slot (50) and the positioning guide^) being configured to allow, when the positioning guide (9) is fixed to the joint, the insertion of a first end of the positioning guide (9) through the slot (50) by relative displacement of the positioning window (11) with respect to the positioning guide (9), and the displacement of the positioning window (11) along at least a portion of the positioning guide (9).

4. An assembly (1) according to any preceding claim wherein the positioning window (11) is configured to be connected to the frame (5) in a removable manner and wherein the assembly comprises at least one cutting window (54) intended to be connected to the frame (5) in a removable manner, the cutting window (54) comprising at least one slot (74a, 74b) through which a bone cutting element can pass.

5. An assembly (1) according to the preceding claim wherein the cutting window (54) comprises a first slot (74a) and a second slot (74b) spaced apart from each other, through which the bone cutting element can pass.

6. Assembly (1) according to the preceding claim in which the first slot (74a) extends at an inclined angle (a) relative to the second slot (74a).

7. An assembly (1) according to one of claims 4 to 6 wherein the assembly (1) comprises a bone cutting element (76) such as a saw blade.

8. An assembly according to claim 2 wherein the arm (48) comprises the first end (48') to which the frame (5) is connected and a second free end (48").

9. An assembly (1) according to any one of the preceding claims wherein the frame (5) comprises a body (12), the body (12) comprising a central portion (14) from which extend two lateral tabs (16, 18) arranged to receive the positioning window (11), and wherein the assembly (1) comprises means for connecting the positioning window to the frame, the connection means comprising: first connection means (40) arranged on the central portion (14) of the frame (5) second connection means (42), complementary to the first connection means (40) configured to cooperate with the first connection means (40) when the positioning window (11) is connected to the frame (5).

10. Assembly (1) according to the preceding claim in which the second connection means (42) comprise a return means (47) intended to disengage the second connection means (42) from the first connection means (40) so as to disconnect the positioning window (11) from the frame (5).

11. An assembly (1) according to any preceding claim wherein the positioning window (11) comprises a body (28) and gripping means (46) extending projecting from the body, the gripping means (46) being arranged to manipulate the positioning window by means of a thumb and index finger of a user.

12. Assembly (1) according to claim 5 wherein the two slots (74a, 74b) of the cutting window (54), called the first cutting window, are spaced from each other by a first distance (dl) and wherein the assembly (1) comprises a second cutting window (54') intended to be connected to the frame (5) and comprising two slots (74a', 74b') being spaced from each other by a second distance (d2) different from the first distance (dl).

13. An assembly according to any preceding claim, wherein the positioning guide (9) comprises a blade.

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