Set of surgical instruments for bone resection

Abstract

Assembly of surgical instruments for bone resection. The present invention relates to an assembly of surgical instruments (1) for bone resection 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), in which 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. Figure for the abstract: Fig. 18.

Description

Description Title of the invention: Surgical instrumentation set for bone resection Technical field

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

[0002] = Arthrodesis is a surgical procedure which consists of permanently blocking an arti- culation in order to make it stable and painless. Arthrodesis is a common procedure when no solution for preserving or replacing the articular surfaces is available can be done.

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

[0004] — The difficulty in this type of surgical procedure consists in preparing the arti- cular by resection of the damaged cartilage so as to create a uniform fit between the bone fragments with a view to their fusion by osteosynthesis.

[0005] — This difficulty is all the more important since there are large ana- tomics, thus limiting the possibilities of assistance by instrumentation.

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

[0007] — These different preparation options are all done freehand. This makes therefore the subject of a high level of uncertainty at the time of preparation and requires, the more often, a long phase of surface adjustment.

[0008] = A prior art solution to assist the practitioner in the proper performance of his bone resections is to use a set of surgical instruments comprising a tool intended to be fixed on several portions of the bone of the articulation. This allows effective stabilization of the tool but involves a bulky instrumentation and additional incisions.

[0009] = Furthermore, the adjustment of the position of the tooling relative to the articulation is generally achieved by means of multiple mechanisms making it both complex the tooling and adjustment stage.

[0010] — There is therefore a need to provide a set of surgical instruments simplified. Statement of the invention

[0011] — The invention aims in particular to overcome at least one of these drawbacks and relates according to 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 attached to at least one bone of an arti- culation, for example to a tibia and / or a talus of an ankle, the device resection including a frame, a positioning guide intended to be fixed to the joint, a positioning window configured to be connected to the frame, wherein the positioning guide and the positioning window are configured to allow, when the positioning guide is fixed to the joint, cooperation of the positioning window with the positioning guide, in order to position the resection device relative to the bone in a fixation position. The surgical instrumentation set according to the invention allows for effective stabilization of the set without involving bulky instrumentation and additional incisions. 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. According to other features of the invention, the surgical instrumentation assembly of the invention may comprise one or more of the following optional features considered alone or in all technically possible combinations. According to one feature, the resection device comprises an arm and wherein the frame is connected to a first end of the arm. According to one feature, the positioning window comprises a slot having a shape adapted to cooperate with the shape of the positioning guide. For example, the slot and the positioning guide are 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. According to one feature, the positioning window is configured to be removably connected to the frame and the assembly comprises at least one cutting window intended to be removably connected to the frame, the cutting window comprising at least one slot through which a bone cutting element can pass. According to one feature, the cutting window includes a first slot and a second slot spaced apart from each other, through which the bone cutting element can pass. According to one feature, the first slot extends at an inclined angle relative to the second slot. According to one feature, the assembly comprises a bone cutting element. According to one feature the bone cutting element is a saw blade. According to one feature, the arm comprises the first end to which the frame is connected and a second free end. According to one feature, the frame comprises a body, the body comprising a central portion from which extend two lateral tabs arranged to receive the positioning window, and wherein the assembly comprises means for connecting the positioning window to the frame, the connection means comprising: first connection means arranged on the central portion of the frame, second means of connection, complementary to the first means connection configured to cooperate with the first means of connection when the positioning window is connected to the frame. According to one feature, the second connection means comprise a return means intended to disengage the second connection means from the first connection means so as to disconnect the positioning window from the frame. According to one feature, the positioning window comprises a body and gripping means extending projecting from the body, the gripping means being arranged to manipulate the positioning window by means of a thumb and an index finger of a user. According to one feature, the two slots of the cutting window, called the first cutting window, are spaced from each other by a first distance and the assembly comprises a second cutting window intended to be connected to the frame and comprising two slots being spaced from each other by a second distance different from the first distance. According to one feature, the positioning guide includes a blade. According to a second aspect, the invention relates to a method of bone resection, for example tibiotalar resection, implemented by means of such a set of surgical instruments. The process includes the steps of: - fixing the positioning guide to the joint, - cooperation between the positioning window and the positioning guide in order to position the resection device relative to the bone in a fixation position. The method according to the invention may comprise one or more of the following optional steps considered alone or in any technically feasible combination: possible: — inserting, when the positioning guide is attached to the joint, 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 portion of the positioning guide, the second end of the positioning guide being attached to the joint; — connection of the positioning window to the frame; - fixing the resection device to a bone; - removal of the joint positioning guide; - disconnection of the positioning window from the frame, and connection of the cutting window to the frame; - fixing the resection device to a second bone of the joint, before the step of connecting the cutting window to the frame; - bone resection performed by passing the bone cutting element through slots in the cutting window; - disconnecting the cutting window, called the first cutting window, from the frame and connecting the second cutting window to the frame, the two slots of the first cutting window being spaced from each other by a first distance and the slots of the second cutting window being spaced from each other by a second distance different from the first distance; - bone resection performed by passing the bone cutting element through the slots of the second cutting window. Brief description of the drawings [Fig.1] [Fig.1] is an illustration of a resection device of a surgical instrumentation set according to the present invention comprising a frame and a manipulation means. [Fig.2] [Fig.2] represents a positioning window of the surgical instrumentation assembly according to the present invention. [Fig.3] [Fig.3] shows means for connecting the positioning window to the frame of the surgical instrumentation assembly in the placement position according to the present invention. [Fig.4] [Fig.4] shows the means for connecting the positioning window to the frame of the surgical instrumentation assembly in the window locking position according to the present invention. [Fig.5] [Fig.5] shows the means of connecting the positioning window to the frame in the window installation position according to a variant of carrying out the invention. [Fig.6] [Fig.6] shows the means for connecting the positioning window to the frame in the locking position of the window according to the variant embodiment of the invention. [Fig.7] [Fig.7] shows a positioning guide for the surgical instrumentation assembly according to the present invention. [Fig.8] [Fig.8] shows a sectional window of the surgical instrumentation assembly according to the present invention. [Fig.9] [Fig.9] shows the positioning window and the cutting window of the instrumentation assembly superimposed on each other, the positioning window being visible by transparency. [Fig.10] [Fig.10] shows two cutting windows of the surgical instrumentation assembly according to the present invention. [Fig.11] [Fig.11] represents bone resections performed using the cutting windows of [Fig.10]. [Fig.12] [Fig.12] represents two cutting windows of the surgical instrumentation assembly according to an alternative embodiment of the invention. [Fig.13] [Fig.13] represents a step of a bone resection method according to the present invention in which a joint line is determined. [Fig.14] [Fig.14] represents a step of the bone resection method according to the present invention in which the positioning guide is fixed to a joint. [Fig.15] [Fig.15] shows a step of the bone resection method according to the present invention in which a connection between the positioning window and the frame of the resection device is made. [Fig.16] [Fig.16] shows a step of the bone resection method according to the present invention in which the positioning window is connected to the frame. [Fig.17] [Fig.17] represents a step of the bone resection method according to the present invention in which the bone resection device cooperates with the positioning guide. [Fig.18] [Fig.18] shows a step of the bone resection method according to the present invention in which the resection device is attached to a bone. [Fig.19] [Fig.19] represents a step of the bone resection method according to the present invention in which the resection device is fixed to the bone [Fig.20] [Fig.20] represents a step of the bone resection method according to the present invention in which the positioning guide is removed from the joint. [Fig.21] [Fig.21] represents a step of the bone resection method according to the present invention in which the positioning window is disconnected from the frame. [Fig.22] [Fig.22] represents a step in the bone resection process according to the present invention wherein the resection device is attached to a second bone. [Fig.23] [Fig.23] shows a step of the bone resection method according to the present invention in which a connection between the cutting window and the frame of the resection device is made. [Fig.24] [Fig.24] shows a step of the bone resection method according to the present invention in which the cutting window is connected to the frame. [Fig.25] [Fig.25] shows a step of the bone resection method according to the present invention in which a bone cut of a bone is made by means of a bone cutting element. [Fig.26] [Fig.26] shows a step of the bone resection method according to the present invention in which a bone cut of a second bone is made by means of a bone cutting element. [Fig.27] [Fig.27] shows a step of the bone resection method according to the present invention in which the cutting window is disconnected from the frame. [Fig.28] [Fig.28] shows a step of the bone resection method according to the present invention in which the resection device is removed from the bones. [Fig.29] [Fig.29] represents an example of arthrodesis performed using a plate and screw assembly. Description of the embodiments Other characteristics and advantages of the invention will appear on reading the non-limiting description which follows and the appended figures which schematically illustrate several embodiments of the surgical instrumentation assembly according to the invention. For the sake of simplification, identical elements are identified by identical reference signs throughout the figures. A surgical instrument set 1 is illustrated in [Fig.18]. The set includes: - 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 Ja and / or a talus 7b of an ankle, - a positioning guide 9 intended to be fixed to the joint, and - a positioning window 11 configured to be connected to the frame 5. 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 fixation position, when the positioning window is fixed to the frame 5. The fixation position is the final position of the resection device in which the bone resection can be performed. Bone resection is defined as a bone cut. The positioning guide 9 and the positioning window 11 ensure proper positioning of the resection device 3 comprising the frame 5 relative to a bone. Once the resection device 3 is positioned, the resection device 3 can be secured to the bone and the bone resection can be performed. Positioning the resection device 3 via the positioning guide 9 and the positioning window 11 ensures that the bone resection will be performed properly. The resection device 3 is illustrated in [Fig.1]. In the present disclosure, the resection device comprises a frame 5. The frame 5 comprises a body 12 which comprises a central portion 14 from which two lateral legs 16, 18 extend. 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. For example, the second distal ends 16', 18'' are free. For example, the central portion 14 and the two lateral legs 16, 18 may be arranged so that the two lateral legs 16, 18 extend at a distance from each other, for example so that the second distal ends 16', 18' extend at a distance from each other, for example so that the frame 5, for example the body 12, has a "U" shape. Each of the legs 16, 18 may comprise a first portion proximal to the central portion 14 and a second portion distal to the central portion 14. Each of the legs may further comprise an intermediate portion connecting the first proximal portion and the second distal portion. For example, the distal portions of the legs 16, 18 extend from each other a distance greater than the distance at which the proximal portions of the legs 16, 18 extend from each other. For example, each of the first proximal portions of the legs 16, 18 includes the first proximal end 16', 18', and each of the second distal portions of the legs 16, 18 includes the second distal end 16°', 18°'. 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 ([Fig.18]). In the present disclosure, the frame 5 makes it possible to fix the resection device to said at least one bone of the joint. For this purpose, at least one opening 20 can be provided in the frame 5 so as to allowing passage of a suitable fixing means through said at least one opening 20 to a bone of the joint so as to fix the frame S to the bone of the joint. The fixation means is intended to anchor in the bone so as to fix the frame 5 to the bone. Any suitable fixation means may be used. For example, the fixation means may be a pin 24 ([Fig. 27]) such as a spherical positioning pin. In the present disclosure, the frame 5 may be fixed to both the tibia and the talus of the ankle joint ([Fig. 22]). 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 the frame 5. The openings provided in the proximal ends of the legs of the frame 5 are configured to allow 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 provided in the distal ends of the legs of the frame S are configured to allow 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]). As illustrated in [Fig. 15], the side legs 16, 18 of the frame 5 are arranged to receive the positioning window 11. 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. The frame 5 may be provided in different but suitable sizes and shapes to provide adequate receiving housing for the positioning window 11. Such a positioning window 11 is illustrated in [Fig.2]. The positioning window 11 is configured to be received in the housing 26 formed between the legs 16, 18 of the frame 5. In the present disclosure, 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, opposite each other, and between which two lateral tabs 34, 36 extend. When mounting the positioning window 11 and the frame 5, the positioning window 11 can cooperate with the frame 5. For this purpose, the upper portion 30 of the positioning window may have recesses 31 intended to come into abutment with walls 140 of the frame 5 which 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 may 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 abutment with walls 180 of the frame 5, for example of the body 12, which project 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 can be provided in these walls 180 ([Fig.1]). The upper portion 30, the lower portion 32 and the two side tabs 34, 36 of the positioning window define a space 38. This space 38 allows for a minimum of visibility of the joint and the result of the preparatory steps. Space 38 also allows for limiting contact between the positioning window 11 and the anterior face of the tibia. The positioning window || is configured to be connected to frame 5. By configured to be connected to the frame is meant for example that the positioning window 11 is configured to be fixed to the frame 5, for example secured to the frame 5. For this purpose, the surgical instrumentation assembly 1 comprises means for connecting the positioning window 11 to the frame 5. 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. As illustrated in Figures 3 and 4, the connection means comprise 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] >» For example, the first connection means 40 comprise a 40” opening delimited by a wall provided with a thread. The 40° opening is provided in the central portion 14 of the frame 5. In the remainder of the description, this opening will be called the 40' threaded opening. Furthermore, the second connection means 42 comprise a 42” wheel configured to cooperate with said tapping. For example, at least a portion of the wheel is configured to be screwed into the 40° tapped opening. The wheel 42' comprises an upper part 42'a, allowing its manipulation, a central Zone 42°b and an end 42°c provided with a thread complementary to the tapping of the tapped opening 40° ([Fig.3]). For example, the upper portion 42'a and the central area 42'b each have a substantially cylindrical shape. To allow cooperation between the end 42'c of the wheel 42' and the 40° threaded opening, 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” in said opening 44 of the positioning window up to the 40° threaded opening of the frame 5 ([Fig.4]). For example, the opening 44 is provided in the upper portion 30 of the positioning window 11. 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. The wheel 42” can be manipulated via its upper part 42"a so that its end provided with the 42°c thread passes into the opening 44 of the positioning window 11 ([Fig.4]) and engages in the 40° threaded opening of the frame 5. The wheel 42” can then be screwed by rotating the wheel 42' so as to make the thread of the wheel and the thread of the 40' threaded opening cooperate. This makes it possible to connect the positioning window 11 to the frame 5 ([Fig.4]). According to an embodiment illustrated in Figures 5 and 6, the wheel 42” can comprise a return means 47. The return means 47 is intended to disengage the end provided with the 42”c thread of the wheel 42' from the frame S and in particular from the 40° threaded opening of the frame 5. For example, the return means is arranged on the central zone 42b of the wheel 42 As illustrated in Figures 5 and 6, the return means 47 may be a spring 47', for example a compression spring. [Fig.6] illustrates the assembly 1 according to the present disclosure in which the wheel 42' is screwed into the 40° threaded opening of the frame 5. When screwing the wheel into the 40' threaded opening, the wheel applies a stress to the 47° spring which passes from a free state ([Fig.5]) to a compressed state ([Fig.6]). When the positioning window 11 is connected to the frame 5, the spring 47" is in a compressed state. When the 42° knob is unscrewed from the 40” threaded opening, the 42° knob no longer applies stress to the spring. The 47° spring relaxes and drives the 42° knob out of the 40° threaded opening so that the 42° knob is disengaged from the 40° threaded opening ([Fig.5]). This configuration makes it easier to disconnect the positioning window 11 and the frame 5. The connection means presented above (such as the wheel comprising the thread and the tapped opening) are not limiting and any other connection means, for example removable, can be used. In the present disclosure, the positioning window 11 comprises means of gripping means 46 ([Fig.2]) extending projecting 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 thumb and an index finger of a user. For example, the gripping means 46 are arranged so that they each have a first face 46' arranged opposite one another and a second face 46'' opposite the first face 46'. The second faces 46” being intended to receive a thumb or an index finger of the user. For example, the second 46° faces include a shape adapted to be manipulated by the user's thumb and index finger. For example the second 46'' faces include a concave shape. In the present disclosure, the positioning window 11 comprises two gripping means 46. 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. For example, the gripping means 46 are gripping lugs 460 which extend projecting from the body of the positioning window. The gripping means are fixed relative to the body. The gripping means allow easy manipulation of the positioning window 11, for example when the positioning window 11 and the frame 5 cooperate with each other for the purpose of connecting the positioning window 11 to the frame 5. 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. For this purpose, the positioning window 11 comprises a slot 50 which has a shape adapted to cooperate with a shape of the positioning guide 9. The slot 50 of the positioning window is provided in the lower portion 32 of the positioning window 11. The lower portion 32 of the positioning window may comprise a wall 520 which projects from the lower portion 32 of the positioning window 11 and into which the slot 50 extends. The 520 wall improves the guidance range of the positioning guide. In the present disclosure, the slot 50 and the positioning guide 9 are configured to allow, when the positioning guide 9 is attached 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 portion of the positioning guide 9. Such a positioning guide 9 is illustrated in [Fig.7]. The positioning guide 9 is intended to be fixed to the joint ([Fig.14]). We mean that the positioning guide is configured to anchor to a joint. In this presentation, the positioning guide 9 is intended to be inserted between the tibia 7a and the talus 7b, according to an articular line “L” ([Fig.13]) which serves as an anatomical reference. The joint line “L” corresponds to a line of bony fusion between the tibia 7a and the talus 7b. In the case of the tibiotalar joint, the articular line "L" extends perpendicular to the tibia 7a, in particular to the tibial crest 7a', so that the positioning guide extends perpendicular to the tibia 7a, in particular to the tibial crest 7a'. In the present disclosure, the positioning guide 9 comprises a first end 9° and a second end 9°, opposite the first end 9°. The first end 9° is configured to fit into the slot 50 of the positioning window 11. The second end 9' is intended to be fixed to the joint. The positioning guide 9 is configured 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. The positioning guide, once inserted into the slot of the positioning window, serves as a guide or slide for the positioning window. The positioning guide may include a portion for attaching the positioning guide to the joint and a portion for guiding the positioning window. 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 articular 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. The positioning guide 9 may 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. operation 9, along at least a portion of the positioning guide 9. For example, the positioning guide 9 may be a surgical instrument for cutting bones, resembling, for example, a chisel. For example, the positioning guide 9 may include a blade. For example, the positioning guide 9 can be a chisel or an osteotome. The blade may comprise the first end 9”, the second end 9°' and a central portion arranged between the first end 9', the second end 9°. The positioning guide such as the blade 9 may comprise a flat surface, for example from its first 9° end to its second 9° end ([Fig.7]). The positioning guide 9 is configured so that its dimensions are adjusted with the slot 50 of the positioning window 11. The flat surface further allows the positioning guide 9 to comprise two parts; a part intended for fixing the positioning guide to the joint, formed by the second end 9°” and a part intended to guide 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. 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 inserted between the tibia 7a and the talus 7b, for example along the joint line “L”. The positioning window 11 is connected to the frame 5 ([Fig.15], 16). 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 ([Fig. 18], 19). The frame 5 is fixed to at least one bone of the joint, for example to the tibia ([Fig. 19]). Once the frame 5 is fixed to the bone, the positioning guide 9 is removed from the joint and from the slot 50 of the positioning window ([Fig. 20]). 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 fixing the frame to the bone. Therefore, the correct positioning of frame 5 in relation to the tibiotalar joint will allow, during the bone cutting stage, to guarantee that the cuts made are always centered on the joint line “L”. In order to facilitate manipulation of the frame 5, the resection device 3 may comprise a manipulation means to which the frame 5 is connected. The manipulation means may be any suitable means for manipulating the frame 5, such as a handle or an arm. In the present disclosure, the manipulation means is an arm 48 to which the frame 5 is connected. Such an arm 48 is illustrated in [Fig.1]. In the present disclosure, the arm 48 comprises a first end 48' to which the frame is connected and a second end 48”, opposite the first end 48, According to one feature, the second 48” end is free. A free end means an end without any means of connection to either the frame or the joint. The means for securing the resection device to the bone or bones of the joint are arranged on the frame only, thereby reducing tissue damage while allowing ergonomic fixation. The arm 48 comprises a gripping portion 48°' arranged between the two ends 48', 48”, the gripping portion is free. According to the present disclosure, the second end of the arm 48°' may comprise a visual marker 500 intended to allow alignment of the arm with a bone, for example the tibia and in particular the tibial crest 7a>. This will ensure that the positioning guide 9 is correctly positioned relative to the tibia and in particular the tibial crest 7a', i.e. perpendicular to the tibia. Indeed, when fixing the positioning guide 9 on the joint, it is possible that the positioning guide 9 is not completely aligned with the articular line "L" and therefore that it is not completely perpendicular to the tibia. When the positioning window 11 cooperates with the positioning guide 9, it is possible to slightly pivot the arm 48 to the right and / or to the left so as to align the visual marker 500 with the tibia bone ([Fig. 18]). The movement of the arm 48 is transmitted to the frame S and to the positioning window 11 and therefore 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 articular line and arranged perpendicular to the tibia and in particular the tibial crest 7a'. Once the position of the positioning guide 9 has been adjusted by means of the arm 38, the frame 5 can be fixed to the bone. The visual marker 500 can be any suitable marker such as a shape or laser marking for example. In the embodiment illustrated in [Fig. 1], the frame 5 and the arm 48 are formed in one piece. It is understood that the frame 5 is integral with the arm 48. In this embodiment, the wheel 42' is connected to the arm 48, for example the central zone 42'b of the wheel is housed in a complementary housing 52 of the arm ([Fig.3], 4). For this purpose, the central part of the wheel may comprise a threaded portion which allows it to be held in position in the complementary housing 52. To put the wheel in place, it must be inserted into the complementary housing 52. This allows the means for fixing the positioning window 11 to the frame 5 to be grouped together and thus makes the connection and disconnection of the positioning window 11 and the frame 5 efficient and rapid. The invention is not limited to such a configuration, for example the frame 5 and the arm 48 can be two parts assembled by screwing or welding. The frame 5 and the arm 48 may comprise any suitable material, for example the arm and the frame comprise a metallic material. In a preferred embodiment, the frame 5 and the arm 48 comprise a titanium alloy, for example, a TA6V alloy. Alternatively, the material may be stainless steel, for example type 17-4PH. The invention is not limited to such a configuration, for example the frame 5 and the arm 48 may comprise a plastic material. 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. 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. Such a cutting window 54 is illustrated in [Fig.8]. The cutting window 54 is part of the resection device. The cutting window 54 is configured to be received in the housing 26 formed between the legs 16, 18 of the frame 5. The cutting window 54 comprises a body 56 comprising a first portion 58, called the upper portion, and a second portion 60 called the lower portion, opposite each other and between which two lateral tabs 62, 64 extend. When mounting the cutting window 54 and the frame 5, the cutting window 54 can cooperate with the frame 5. For this purpose, the upper portion 58 of the cutting window 54 may have recesses 580 intended to come into abutment with the walls 140 projecting from the central portion 14 of the frame 5 and in which the openings 20 are formed, and the lower portion 60 of the cutting window 54 may comprise extensions 600 intended to come into abutment with the walls 180 projecting from the distal parts of the legs 16, 18 of the frame 5. The upper portion 58, the lower portion 60 and the two side legs 62, 64 of the cutting window 54 define a space 66. This space allows for a minimum of visibility of the articulation and the result preparatory steps, The space also helps to limit contact between the cutting window and the anterior face of the tibia. The cutting window 54 is configured to be connected to the frame 5. For this purpose, the means for 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 (threaded opening 40' in the frame S and wheel 42”, for example fixed to the arm 48). To allow cooperation between the 42°c end of the wheel 42' and the threaded opening 40”, an opening 68 is provided in the cutting window 54 ( [Fig.8]). The opening 68 is configured to allow passage of the 42°c end of the wheel 42” in said opening 68 of the cutting guide window up to the threaded opening 40* of the frame 5. For example, the opening 68 is provided in the upper portion 58 of the cutting window 54, The opening 68 provided in the upper portion 58 of the cutting window 54 is intended to be arranged opposite the 40° threaded opening of the frame 5 when the cutting window 54 cooperates with the frame 5. The 42” wheel can be manipulated so that its end provided with the 42' thread c passes through the opening 68 of the upper portion 58 of the cutting window 54 and engages in the 40° threaded opening of the frame 5. The 42° wheel can then be screwed so as to connect the cutting window 54 to the frame 5. In the present disclosure, the cutting window 54 comprises gripping means 70 extending projecting 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 thumb and an index finger of a user. 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 for the purpose of connecting it to the frame 5. For example, the gripping means 70 are arranged so that they each have a first face 70° arranged opposite one another and a second face 70' opposite the first face 70”. Each of the second faces 70” is intended to receive a thumb or an index finger of the user. For example, the second 70” laces include a shape adapted to be manipulated by the user's thumb and index finger. For example, the second 70” faces include a concave shape. In the present disclosure, the cutting window 54 comprises two gripping means 70. These gripping means 70 are gripping lugs 720 which extend projecting from the body of the cutting window 54. 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. 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. The cutting window 54 comprises for this purpose at least one slot 74a, 74b through which a bone cutting element 76 ([Fig.25], 26) can pass. Said at least one slot 74a, 74b of the cutting window is configured to allow passage of the bone cutting element 76 and to guide the bone cutting element during its passage in said at least one slot. The bone cutting element 76 is for cutting a bone. The bone cutting element '76 may be any element suitable for cutting bone. For example, the bone cutting element 76 may be a saw blade, for example, an oscillating saw blade. In the present disclosure, 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]). The lower portion 60 of the cutting window may comprise a wall 78 which projects from the window of the cutting guide 54 and into which said at least one slot 74a, 74b extends. The wall 78 allows the guide range to be increased. The higher the slots 74a, 74b are, the less play there will be during the cutting step using the bone cutting element. In the example shown in [Fig.8], the cutting window comprises a first slot 74a and a second slot 74b spaced apart from each other. 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 articular 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. 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 ([Fig.9]). 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 ([Fig.9]). According to a first variant not illustrated, a first slot 74a and a second slot 74b are separated respectively by a distance e1 and e2 identical with respect to a centering line O, which corresponds to the articular line or bone fusion line given by the positioning guide and the positioning window. According to a second variant illustrated in [Fig.9], the distances el and e2 are different. For example, the distance el of the first slot 74a relative to the centering line 0 is greater than the distance of the second slot 74b relative to the centering line 0. Conversely, the distance el of the first slot 74a relative to the centering line 0 is less than the distance e2 of the second slot 74b relative to the centering line 0. This makes it possible to choose the cutting amplitude for each of the bones. In an embodiment illustrated in [Fig. 10], the surgical instrumentation assembly may comprise the cutting window 54 as previously described, called the first cutting window and a second cutting window 54° intended to be connected to the frame 5 and comprising two slots 74a', 74b°. The 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 the talus respectively. 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 from each other by a first distance "dl" and the two slots 74a', 74b° of the second cutting window 54' are spaced from each other by a second distance "d2" different from the first distance "dl". For example, the second distance “d2” between the slots 74a', 74b° of the second cutting window 54' is greater than the distance “d1” between the slots 74a, 74b of the first cutting window 54 ([Fig.10]). The second cutting window 54' can be used in the event that the amplitude of the cut made with the first cutting window was not sufficient. In these embodiments, each of the slots 74a, 74b, 74a', 74b* is for example fixedly arranged in the cutting guides 54, 54”. In other embodiments, more than two cutting windows comprising variable distances between the slots can be used. In embodiments not illustrated, it is for example conceivable to provide a single cutting guide 54 which has nits whose positions can be adjusted by means of a suitable mechanism so as to modify the distance between the slots. 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. A visualization of the cuts made using the first 54° cutting window and the second 54° cutting window on the tibia and talus is shown in [Fig.11]. In the embodiments of Figures 8 to 11, the first slot and the second slot 74a, 74b, 74a', 74b' of the cutting window(s) as previously described extend parallel to each other. According to an embodiment illustrated in [Fig. 12], the first slot 74a, 74'a of the cutting window(s) as previously described extends at an angle "Δ" inclined relative to the second slot 74b, 74b°. This makes it possible to correct the orientation of the foot. The angle "Φ" is defined in a plane orthogonal to the direction of insertion of the positioning guide. In this disclosure, the angle "à" is between 5 and 10 degrees, preferably the angle "à" is equal to 5 degrees. In other embodiments not shown, the positioning window 11 may 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 spaced from the slot configured to allow passage of the positioning guide. A method of bone resection, for example tibiotalar, using the surgical instrumentation set as previously described and which comprises 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 fixing position, is illustrated in figures 13 to 29. As illustrated in [Fig.13], the method includes a step in which a joint line "L" is determined. The joint line "L" corresponds to a line of bony fusion between bones in a joint, for example the tibia 7a and the talus 7b. To do this, a tibial window is created using the positioning guide 9 so as to collapse the tibial crest. Following this step, the positioning guide 9 is inserted between the tibia and the talus. [Fig.14] illustrates the positioning guide 9 which is fixed to the joint, between the tibia 7a and the talus 7b. As illustrated in [Fig.15], the method comprises a step in which the positioning window 11 is connected to the frame 5. The positioning window 11 can be manipulated via the gripping pins 460 of the positioning window 11. The positioning window 11 is received at least in part in the housing 26 formed between the legs 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. The positioning window 11 can be connected to the frame 5, for example by screwing a wheel 42 into a threaded opening 40' provided in the frame 5. [Fig.16] illustrates the positioning window 11 when connected to the S frame. [Fig.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. 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). 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. In the illustrated method steps, the frame 5 is connected to an arm 48. In this embodiment, the positioning window 11 is moved via the arm 48. The method may comprise 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 reference mark 500 on the arm 48 with the tibial crest 7a). The position of the arm 48 can be modified so as to align the positioning guide 9 with the tibial crest 7a. [Fig.18] illustrates a step of the method in which the frame 5 is fixed to a first bone, for example to the tibia 7a. 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. The frame 5 can be fixed to the tibia by means of two pins 24. As illustrated in [Fig.20], the method comprises a step in which the positioning guide 9 is removed from the joint. As illustrated in [Fig.21], the method comprises a step in which the positioning window 11 is disconnected from the frame 5, for example by unscrewing the 42° wheel from the threaded opening 40' of the frame 5. [Fig.22] illustrates a step of the method in which the frame 5 is fixed to a second bone, for example to the talus 7b. Fixing can be achieved by means of pins 24 which pass through the openings 20 of frame 5 then which are inserted into the slope 7b. Frame 5 can be fixed to the slope 7b by means of two pins 24. As illustrated in [Fig. 23], the method comprises 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 in part in the housing 26 formed between the legs 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. The cutting window 54 can be connected to the frame by screwing a 42” wheel into the 40°' threaded opening provided in the frame 5. [Fig.24] illustrates the cutting window 54 when connected to the frame 5. 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”. A slot 74a is arranged facing the tibia and a slot 74b is arranged facing the talus 7b. With reference to [Fig.25] the method may comprise making a bone cut using a bone cutting element. In a first step, a bone cutting element, such as an oscillating saw blade, passes through a first slot 74a so as to perform a resection of a first bone, for example the tibia 7a. As illustrated in [Fig.26], the method comprises a second step in which the oscillating saw blade passes through the second slot 74b so as to perform a resection of a second bone, for example the talus 7b. In the case where the amplitude of the bone resection carried out is too small, the method may comprise 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 between the two slots 74a', 74b', is greater than the distance between the two slots 74a, 74b of the previous cutting window 54. This makes it possible to remove more material. Once the bone cut has been made, the cutting window 54 is disconnected from the frame 5 by unscrewing the 42° wheel ([Fig.27]). Then the pins 24 are removed from the bones 7a, 7b in order to remove the resection device 3 ([Fig.28]). [Fig.28] illustrates the tibiotalar resection 80, 82 performed. As illustrated in [Fig.29], the bone resection procedure can be continued with arthrodesis, for example using a plate / screw assembly 84.

Claims

Demands

1. Set of surgical instruments (1) for osscus resection, by Example: tibiotalar resection, the set (1) comprising: a resection device (3) configured to be attached to the minus 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), in which the positioning guide (9) and the positioning window operation (11) are configured to allow, when the po- guide positioning (9) is fixed to the joint, the cooperation of the window of positioning (11) with the positioning guide (9), in order to po- position the resection device (3) relative to the bone according to a fixing position.

2. Assembly (1) according to claim 1 wherein the device of resection (3) includes an arm (48) and in which the frame (5) is connected to a first end (48') of the arm (48).

3. Assembly according to any one of claims 1 to 2 in which the positioning window (11) includes 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 (9) being configured to allow, when the positioning guide (9) is fixed to the joint, the insertion of one end of the guide positioning (9) through the slot (50) by relative displacement of the positioning window (11) relative to the positioning guide (9), and the movement of the positioning window (11) along the less a part of the positioning guide (9).

4. Together (1) according to any one of the preceding claims in which the positioning window (11) is configured to be connected to the frame (5) in a removable manner and in which the assembly includes 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 cutting element bone can pass through.

5. Assembly (1) according to the preceding claim in which the window of cut (54) includes a first slot (74a) and a second slot (74b) spaced apart, through which the cutting element bone can pass through.

6. Set (1) according to the preceding claim in which the first slit (74a) extends at an inclined angle (œ) with respect to the second slot (74a).

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

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

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

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

11. Together (1) according to any one of the preceding claims in which the positioning window (11) comprises a body (28) and grasping means (46) extending outward from the body, the gripping means (46) being arranged so as to manipulate the window positioning by means of a user's thumb and forefinger.

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 apart from each other by a first distance (d1) and in which the assembly (1) includes a second cutting window (54') intended to be connected to the frame (5) and comprising two slots (74a', 74b”) being spaced apart from each other by a second different distance (d2) of the first distance {d1).

13. Together according to any one of the preceding claims, in which the positioning guide (9) includes a blade.