Anatomically adapted tarsometatarsal plate

Abstract

The bone plate can be used to fixate one or more bones. In some examples, the bone plate has first, second, third, and fourth fixation holes. The first and second fixation holes can be located in a distal body region of the bone plate and can be collinear with the bridge central longitudinal axis. The third and fourth fixation holes can be located in a proximal body region of the bone plate, the third fixation hole being collinear with the bridge central longitudinal axis and the fourth fixation hole being offset from the bridge central longitudinal axis by a first angle in a first plane and offset from the bridge central longitudinal axis by a second angle in a second plane.

Description

[Technical field]

[0001] cross reference This application claims the benefit of U.S. Provisional Patent Application No. 63 / 313,162, filed February 23, 2022, the entire contents of which are incorporated herein by reference.

[0002] The present disclosure relates generally to bone plates, and more particularly to bone plates for use in fixating reduced bones of the foot. [Background technology]

[0003] Bones in the human body, such as the bones of the foot, can be anatomically misaligned. For example, one common type of bone deformity is hallux valgus, a progressive foot deformity in which the first metatarsophalangeal joint is affected, often with significant functional disability and foot pain. The metatarsophalangeal joint is deviated outward, resulting in abduction of the first metatarsal while the phalanges are adducted. This often leads to the development of soft tissue and a bony prominence on the medial side of the foot, called hallux valgus.

[0004] Surgical intervention may be used to correct hallux valgus deformity. There are a variety of different surgical procedures to correct hallux valgus deformity, which may involve removing the abnormal bony enlargement of the first metatarsal and / or realigning the first metatarsal with respect to the adjacent metatarsals. In some procedures, a bone plate is used to fix the position of the first metatarsal after realignment. The bone plate may be applied across the tarsometatarsal joint between the first metatarsal and the medial cuneiform. The bone plate may hold the first metatarsal in a realigned position while the bone grows to form a fusion connection between the first metatarsal and the medial cuneiform. Summary of the Invention

[0005] In general, the present disclosure is directed to orthopedic bone plates, as well as related systems and surgical techniques utilizing such bone plates. In some embodiments, bone plates are used to fix the anatomically corrected position of a bone after a realignment procedure. Bone plates as disclosed herein can be geometrically tailored to provide a complementary anatomical fit to the surface anatomical structure of one or more particular bones to which the bone plate is intended to be engaged.

[0006] In some examples, a bone plate as disclosed herein can be applied to the metatarsals and cuneiform bones, for example, during a metatarsal fusion procedure. In one more specific example, the bone plate can be applied to the first metatarsal and medial cuneiform bones separated by a first tarsometatarsal joint. The bone plate can be geometrically tailored to provide a complementary anatomical fit to the surface anatomy of the first metatarsal and / or medial cuneiform bone. For example, the bone plate can be profiled to anatomically fit the first metatarsal and medial cuneiform bones. This can include configuring the bone plate to be angled by a first plane angle in a first plane to offset away from the joint space between the medial cuneiform and the second cuneiform bones, and / or angled by a second plane angle in a second plane to approximate the inclination at the dorsal surface of the medial cuneiform bone. This can provide an anatomically adapted bone plate for immobilizing the tarsometatarsal joint.

[0007] The anatomical fit provided by the exemplary bone plates disclosed herein can facilitate robust plate fixation in the target bone, for example, by reducing instances of improper fixation screw placement. For example, the anatomical fit provided by the bone plate can help prevent screw intrusion into the adjacent joint space (e.g., the joint space between the medial cuneiform and the second cuneiform) when installing the fixation plate, and / or can help avoid bone plate edge protuberance at the cuneiform (e.g., at the bevel at the dorsal surface of the medial cuneiform). This, in turn, can increase the robustness of the bone fixation provided by the bone plate, while also avoiding unnecessary damage to adjacent ligaments and reducing the profile of the bone plate extending out from the bone surface.

[0008] For example, in practice, the proximal lateral aspect of the medial cuneiform bone often exhibits a steep incline or change of direction where the medial cuneiform bone intersects with the adjacent intermediate cuneiform bone (e.g., defining the C1-C2 joint space). When using a straight bone plate without anatomical profiling as described herein, the most proximal fixation hole of the bone plate may be positioned at or on the proximal lateral edge of the medial cuneiform bone when the bone plate is positioned across the tarsometatarsal joint. When a fixation screw is then inserted through the most proximal fixation hole, the head of the screw may land in the C1-C2 joint space instead of the medial cuneiform bone. As described in some examples herein, by configuring the bone plate to wrap around the contour of the medial cuneiform bone, the fixation hole of the bone plate may be appropriately positioned over the medial cuneiform bone to help avoid intrusion into the C1-C2 joint space, improving fixation.

[0009] In one example, an anatomically adapted bone plate for a metatarsal fusion procedure is described. The bone plate includes a body, a first fixation hole, a second fixation hole, a third fixation hole, and a fourth fixation hole. The body includes a proximal body region configured to be positioned over a cuneiform bone, a distal body region configured to be positioned over a metatarsal bone, and a bridge extending between the proximal body region and the distal body region and configured to be positioned across a tarsometatarsal joint separating the metatarsal bone from the cuneiform bone. The bridge defines a bridge central longitudinal axis, the body has a width defining an extent of the bone plate transverse to the bridge central longitudinal axis, and the body includes an upper surface and a bone-facing surface opposite the upper surface. The first fixation hole and the second fixation hole are located in the distal body region and are positioned collinear with the bridge central longitudinal axis. The first and second fixation holes each extend through the body from the top surface to the bone-facing surface and are configured to receive a fixation screw therethrough. The third and fourth fixation holes are located in the proximal body region. The third fixation hole is positioned closer to the bridge than the fourth fixation hole. The third fixation hole is collinear with the bridge central longitudinal axis and the fourth fixation hole is offset from the bridge central longitudinal axis in a first plane by a first planar angle and offset from the bridge central longitudinal axis in a second plane by a second planar angle. The third and fourth fixation holes each extend through the body from the top surface to the bone-facing surface and are configured to receive a fixation screw therethrough.

[0010] In another example, a kit is described. The kit includes a first bone plate and a second bone plate. The first bone plate includes a body with four fixation holes, including a first fixation hole and a second fixation hole separated from a third fixation hole and a fourth fixation hole by a bridge. The first bone plate is configured to position the first fixation hole and the second fixation hole on the dorsal side of the metatarsal bone and the third fixation hole and the fourth fixation hole on the dorsal side of the cuneiform bone, the bridge crossing the dorsal side of the tarsometatarsal joint space between the metatarsal bone and the cuneiform bone. The first, second, and third fixation holes are aligned in a collinear line with the bridge, and the fourth fixation hole is angled medially in the transverse plane and rotated plantarly in the forehead plane relative to the first, second, and third fixation holes. The second bone plate includes a body with four fixation holes, including a first fixation hole and a second fixation hole separated from the third fixation hole and a fourth fixation hole by a bridge. The second bone plate is configured to position the first and second fixation holes on the medial side of the metatarsal and the third and fourth fixation holes on the medial side of the cuneiform, with the bridge crossing the medial side of the tarsometatarsal joint space between the metatarsal and cuneiform, the first, second and third fixation holes being aligned collinearly with the bridge, and the fourth fixation hole being angled dorsally in the sagittal plane and rotated laterally relative to the first, second and third fixation holes in the transverse plane.

[0011] In another example, a method of fixing a tarsometatarsal joint is described. The method includes positioning a bone plate over a portion of a metatarsal and over a portion of a cuneiform bone and across a tarsometatarsal joint separating the metatarsal from the cuneiform bone. Positioning the bone plate includes positioning a first fixation hole and a second fixation hole over the metatarsal bone and positioning a third fixation hole and a fourth fixation hole over the cuneiform bone with a bridge separating the second fixation hole from the third fixation hole extending across the tarsometatarsal joint. The first, second, and third fixation holes are disposed collinearly with a bridge central longitudinal axis defined by the bridge, and the fourth fixation hole is offset from the bridge central longitudinal axis in a first plane by a first planar angle and in a second plane by a second planar angle. The method also includes inserting fixation screws into the underlying metatarsal bone through each of the first and second fixation holes and into the underlying cuneiform bone through each of the third and fourth fixation holes.

[0012] The details of one or more examples are set forth in the accompanying drawings and the description below. Other features, objects, and advantages will become apparent from the description and drawings, and from the claims. [Brief description of the drawings]

[0013] [Figure 1A] 1A-1C are frontal views of the foot showing a normal first metatarsal position and an exemplary frontal plane rotational deviation position, respectively. [Figure 1B] 1A-1C are frontal views of the foot showing a normal first metatarsal position and an exemplary frontal plane rotational deviation position, respectively.

[0014] [Figure 2A] 1A-1D are top views of the foot showing normal first metatarsal position and an exemplary transverse plane deviation position, respectively. [Figure 2B] 1A-1D are top views of the foot showing normal first metatarsal position and an exemplary transverse plane deviation position, respectively.

[0015] [Figure 3A]1A-1C are lateral views of the foot showing normal first metatarsal position and an exemplary sagittal plane deviation position, respectively. [Figure 3B] 1A-1C are lateral views of the foot showing normal first metatarsal position and an exemplary sagittal plane deviation position, respectively.

[0016] [Figure 4A] 1 illustrates one embodiment of a bone plate; [Figure 4B] 1 illustrates one embodiment of a bone plate; [Figure 4C] 1 illustrates one embodiment of a bone plate; [Figure 4D] 1 illustrates one embodiment of a bone plate;

[0017] [Diagram 5] FIG. 1 is a top view of one embodiment of a kit.

[0018] [Figure 6] 1 is a flow diagram of one embodiment of a surgical technique that includes positioning and fixing a bone plate.

[0019] [Figure 7A] 1 illustrates an embodiment of a first and second bone plate positioned and secured at the metatarsal and cuneiform bones and across the tarsometatarsal joint; [Figure 7B] 1 illustrates an embodiment of a first and second bone plate positioned and secured at the metatarsal and cuneiform bones and across the tarsometatarsal joint; [Figure 7C] 1 illustrates an embodiment of a first and second bone plate positioned and secured at the metatarsal and cuneiform bones and across the tarsometatarsal joint;

[0020] [Figure 8A] 1 illustrates another embodiment of a bone plate; [Figure 8B] 1 illustrates another embodiment of a bone plate;FIG. 2 is a side elevational view of a bone plate including a locking screw; [Figure 8C] 1 illustrates another embodiment of a bone plate;FIG. 2 illustrates an end elevational view of a bone plate including a locking screw;FIG.

[0021] [Figure 9A] 1 illustrates an additional embodiment of a bone plate;FIG. 2 is a front view of an end (e.g., proximal end) of a bone plate having a locking screw; [Figure 9B] 1 illustrates an additional embodiment of a bone plate;FIG. 2 is a side elevational view of a bone plate having a locking screw; [Figure 9C] 1 illustrates an additional embodiment of a bone plate;FIG. 2 is a top view of a bone plate having a locking screw;

[0022] In the following description and drawings, like reference numbers are used to refer to like elements. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0023] The present disclosure generally relates to bone plates and associated systems (e.g., kits), as well as techniques incorporating one or more such bone plates. In some examples, bone plates according to the present disclosure may be used to fix a repositioned bone during a surgical procedure, such as a metatarsal realignment and fusion procedure. In an exemplary application, the devices, systems, and techniques may be used during a surgical procedure performed on one or more bones, such as bone alignment, osteotomy, fusion procedure, fracture repair, and / or other procedures in which one or more bones may be set in a desired position. Such procedures may be performed on bones of, for example, the foot or hand, where the bones are relatively small compared to bones in other parts of the human anatomy (e.g., adjacent bones separated by joints or different parts of a single bone). In one example, a procedure utilizing the devices and / or techniques of the present disclosure may be performed to correct the alignment between a metatarsal (e.g., first metatarsal) and a cuneiform (e.g., medial cuneiform), such as hallux valgus correction. An example of such a procedure is the Lapidus procedure. In another example, the devices, systems, and / or techniques may be utilized to modify the position of one portion of a bone relative to another portion of the same bone, such as an osteotomy procedure (e.g., a metatarsal osteotomy procedure) in which a bone is cut into at least two different bones and one portion (e.g., a distal portion) is realigned relative to another portion (e.g., a proximal portion) of the same bone.

[0024] Preparation and fusion of two opposing bone portions, such as the metatarsal and cuneiform bones, may be performed in accordance with the present disclosure for a variety of clinical reasons and indications. Preparation and fusion of the metatarsal and cuneiform bones at the tarsometatarsal ("TMT") joint may be performed to treat hallux valgus and / or other bone and / or joint conditions.

[0025] Hallux valgus, also called hallux abductus valgus, is a complex progressive condition characterized by lateral deviation (valgus, abduction) of the great toe and medial deviation of the first metatarsophalangeal joint. Hallux valgus usually results in a progressive increase in the hallux adduction angle, i.e., the angle between the long axes of the first metatarsal and the proximal phalanges in the transverse plane. The increase in hallux adduction angle may tend to displace outward the plantar aponeurosis, which spans the first metatarsophalangeal joint from the metatarsal to the hallux, as well as the tendons of the intrinsic and extrinsic muscles. As a result, the sesamoid may also be displaced (e.g., laterally relative to the first metatarsophalangeal joint), resulting in subluxation of the joint between the sesamoid and the first metatarsal head. This may increase the pressure between the medial sesamoid and the crest of the first metatarsal head.

[0026] Although the techniques and devices are generally described herein in relation to the first metatarsal and medial cuneiform bones of the foot, these techniques and devices may be used in other adjacent bones (e.g., separated from one another by a joint) and / or adjacent bone portions (e.g., portions of the same bone separated from one another by a fracture or osteotomy). In various examples, the disclosed devices, systems, and / or techniques may be utilized in smaller bones of the foot, such as metatarsals (e.g., first, second, third, fourth, or fifth metatarsals), cuneiforms (e.g., medial, middle, lateral), cuboid, phalanges (e.g., proximal, middle, distal), and / or combinations thereof. The bones may be separated from one another by tarsometatarsal ("TMT") joints, metatarsophalangeal ("MTP") joints, or other joints. Thus, references herein to the first metatarsal and medial cuneiform bones may be substituted with other bone pairs as described herein. Furthermore, if a bone plate according to the present disclosure is intended to be used on a different bone or combination of bones other than the first metatarsal and medial cuneiform, the configuration of the bone plate (e.g., size, shape) may be adjusted to accommodate the particular bone or combination of bones being plated while following the bone plate configuration teachings outlined herein.

[0027] To further understand the exemplary devices and techniques of the present disclosure, the anatomy of the foot, along with exemplary misalignments that may occur and be corrected in accordance with the present disclosure, will first be described with respect to Figures 1-3. The bony misalignments may be caused by hallux valgus (bunion), natural growth deformities, and / or other conditions.

[0028] 1A and 1B are front views of a foot 200 showing a normal first metatarsal position and an exemplary rotational misalignment position in the frontal plane, respectively. FIGs. 2A and 2B are top views of a foot 200 showing a normal first metatarsal position and an exemplary transverse plane misalignment position, respectively. FIGs. 3A and 3B are side views of a foot 200 showing a normal first metatarsal position and an exemplary sagittal plane misalignment position, respectively. Although FIGs. 1B, 2B, and 3B each show a respective plane misalignment alone, in reality the metatarsals may be misaligned in any two of the three planes, or even all three. Thus, it should be understood that the depiction of a single plane of misalignment in each of FIGs. 1B, 2B, and 3B is for illustrative purposes, and that the metatarsals may be misaligned in multiple planes that are desirably corrected. Moreover, it should be understood that bone conditions treated in accordance with the present disclosure may not exhibit any of the exemplary misalignments described with respect to Figures 1B, 2B, and 3B, and the present disclosure is not limited in this respect.

[0029] 1A and 2A, a foot 200 is comprised of a number of bones including a first metatarsal 210, a second metatarsal 212, a third metatarsal 214, a fourth metatarsal 216, and a fifth metatarsal 218. The metatarsals are distally connected to a phalange 220, and more specifically, each is connected to a respective proximal phalange. The first metatarsal 210 is proximally connected to a medial cuneiform 222, the second metatarsal 212 is proximally connected to a middle cuneiform 224, and the third metatarsal 214 is proximally connected to a lateral cuneiform 226. The fourth metatarsal 216 and the fifth metatarsal 218 are proximally connected to a cuboid 228. The joints 230 between the metatarsals and the respective cuneiform bones (e.g., first metatarsal 210 and medial cuneiform 222) are referred to as tarsometatarsal ("TMT") joints. The joints 232 between the metatarsals and the respective proximal phalanges are called metatarsophalangeal joints. The angle 234 between adjacent metatarsals (e.g., first metatarsal 210 and second metatarsal 212) is referred to as the intermetatarsal angle ("IMA").

[0030] As mentioned above, FIG. 1A is a frontal plane view of a foot 200 showing a typical position of the first metatarsal 210. The frontal plane, also known as the coronal plane, is generally considered to be any vertical plane that divides the body into anterior and posterior parts. In the foot 200, the frontal plane is a vertically extending plane, perpendicular to an axis that extends from proximal to distal along the length of the foot. FIG. 1A shows the first metatarsal 210 in a typical rotational position in the frontal plane. FIG. 1B shows the first metatarsal 210 with a frontal plane rotational deformation characterized by a rotation angle 236 with respect to the ground, as indicated by line 238.

[0031] FIG. 2A is a top view of a foot 200 showing a typical position of the first metatarsal 210 in a transverse plane. The transverse plane, also known as the horizontal, axial, or anti-axial transverse plane, is considered to be any plane that divides the body into superior and inferior parts. In the foot 200, the transverse plane is a plane that extends horizontally and is perpendicular to an axis that extends dorsally to plantarly (top to bottom) across the foot. FIG. 2A shows the first metatarsal 210 with a typical IMA 234 in the transverse plane. FIG. 2B shows the first metatarsal 210 with a transverse plane rotational deformity characterized by a larger IMA caused by the distal end of the first metatarsal 210 pivoting medially relative to the second metatarsal 212.

[0032] FIG. 3A is a side view of a foot 200 showing a typical position of the first metatarsal 210 in the sagittal plane. The sagittal plane is a plane parallel to the sagittal suture that divides the body into right and left halves. In the foot 200, the sagittal plane is a vertically extending plane, perpendicular to an axis extending from proximal to distal along the length of the foot. FIG. 3A shows the first metatarsal 210 with a typical rotational position in the sagittal plane. FIG. 3B shows the first metatarsal 210 with a sagittal plane rotational deformation characterized by a rotation angle 240 with respect to the ground as indicated by line 238.

[0033] Surgical techniques and instruments according to the present disclosure may be useful during procedures to correct misalignment of one or more bones, such as the metatarsal and opposing cuneiform bones, and / or to promote fusion of the metatarsal and cuneiform bones across the TMT joint. In some applications, the realignment procedure involves surgically accessing the TMT joint (e.g., from the medial and / or dorsal side of the foot). A clinician can insert a bone preparation instrument through the incision to prepare the end surfaces of one or both bones.

[0034] Before or after preparing one or both ends of the first metatarsal 210 and the medial cuneiform 222, the clinician can realign the metatarsal with respect to the cuneiform. The clinician can pivot the distal end of the first metatarsal 210 laterally toward the second metatarsal 212 to close the intermetatarsal angle between the first and second metatarsals. Additionally or alternatively, the clinician can rotate the first metatarsal 210 in the frontal plane to correct the frontal plane rotation of the metatarsal and / or move the first metatarsal 210 in the sagittal plane to correct the sagittal plane position of the metatarsal. Realignment of the first metatarsal 210 can be performed by the clinician freehand or with a bone positioning device to facilitate realignment. After the desired realignment in one or more planes, the clinician can fix the displaced position of the first metatarsal 210 by applying one or more fixation devices (e.g., one or more pins, plates, screws, staples, rods), at least one of which may be a bone plate as configured herein.

[0035] 4A, 4B, 4C, and 4D (collectively referred to as "FIG. 4") are different views of an embodiment of a bone plate 300 that can be used to fix bones, such as metatarsals and cuneiform bones, across the tarsometatarsal joint during a bone realignment procedure, such as a metatarsal realignment procedure. As described elsewhere herein, the bone plate 300 can be an anatomically adapted bone plate that is geometrically configured to fit the anatomical shape of one or more particular bones. As an example, the bone plate 300 can be anatomically adapted for a metatarsal fixation procedure such that the bone plate 300 includes one or more geometric features that are complementary to the anatomical shapes of the cuneiform bone (e.g., medial cuneiform) and / or metatarsal bone (e.g., first metatarsal). 4A is a top view of bone plate 300, FIG. 4B is a proximal end front view of bone plate 300, FIG. 4C is a side front view of bone plate 300, and FIG. 4D is a bottom view of bone plate 300. FIG.

[0036] As shown in FIG. 4 , the bone plate 300 can include a body 302. The body 302 can include a proximal body region 304, a distal body region 306, and a bridge 308. The proximal body region 304 can be configured to be positioned over a cuneiform bone, such as the medial cuneiform. The distal body region 306 can be configured to be positioned over a metatarsal bone, such as the first metatarsal. The bridge 308 can extend between the proximal body region 304 and the distal body region 308. The bridge 308 can be configured to be positioned across a tarsometatarsal joint that separates the metatarsal bone from the cuneiform bone. The bridge 308 can define a bridge central longitudinal axis 310. The body 302 can have a width 312 that defines an extent of the bone plate 300 transverse to the bridge central longitudinal axis 310. Additionally, the body 302 may include an upper surface 314 and a bone-facing surface 316 opposite the upper surface 314 .

[0037] The bone plate 300 may also include fixation holes. Generally, the body 302 may include at least one fixation hole extending through the proximal body region 304 and at least one fixation hole extending through the distal body region 306. In different examples, the body may include more fixation holes (e.g., two or more) extending through the proximal body region 304 and / or more fixation holes (e.g., two, three, or more) extending through the distal body region 306.

[0038] 4, the bone plate 300 includes a first fixation hole 318, a second fixation hole 320, a third fixation hole 322, and a fourth fixation hole 324. The first fixation hole 318 and the second fixation hole 320 can be located in the distal body region 306, and the first fixation hole 318 and the second fixation hole 320 can each extend through the body 302 from the top surface 314 to the bone-facing surface 316. As also shown for the illustrated embodiment, the second fixation hole 320 is positioned closer to the bridge 308 than the first fixation hole 318. The third fixation hole 322 and the fourth fixation hole 324 can be located in the proximal body region 304, and the third fixation hole 322 and the fourth fixation hole 324 can each extend through the body 302 from the top surface 314 to the bone-facing surface 316. As shown in the illustrated embodiment, the third fixation hole 322 is positioned closer to the bridge 308 than the fourth fixation hole 324. Each of the first fixation hole 318, second fixation hole 320, third fixation hole 322, and fourth fixation hole 324 may be configured to receive a fixation screw therethrough.

[0039] For the illustrated bone plate 300, first fixation hole 318, second fixation hole 320, third fixation hole 322, and fourth fixation hole 324 are the only fixation holes provided by bone plate 300. In other words, bone plate 300 has only two fixation holes on the proximal bone plate portion and only two fixation holes on the distal bone plate portion. Other numbers of fixation holes may be utilized in other bone plate embodiments.

[0040] As discussed above, the bone plate 300 can include one or more features to anatomically adapt the plate to one or more bones to which the bone plate 300 may be positioned and secured. As an example, the bridge 308 can be configured to be positioned across the tarsometatarsal joint that separates the metatarsal and cuneiform bones. The bridge 308 can have a length 326 that extends from an edge 321 of the second fixation hole 320 to an edge 323 of the third fixation hole 322. The length 326 of the bridge 308 can range from 5.0 mm to 15.0 mm, such as 5.5 mm to 14.5 mm, 6.0 mm to 14.25 mm, 6.0 mm to 11.0 mm, or 9.0 mm to 11.0 mm. The length 326 of the bridge 308 can have a midline 328 midway between the edge 321 of the second fixation hole 320 and the edge 323 of the third fixation hole 322. As another example, the body 302 can define a proximal length 330 extending from the midline 328 of the bridge 308 to a proximal edge 329 of the bone plate 300, for example, to position the proximal body region 304 over a metatarsal bone (e.g., the first metatarsal). The proximal length 330 can range from 8 to 20 mm, e.g., 12 to 20 mm, or 17 to 20 mm, and the proximal length 330 can be less than 18.5 mm, e.g., less than 18.0 mm, or less than 15.0 mm. Similarly, the body 302 can define a distal length 332 extending from the midline 328 of the bridge 308 to a distal edge 331 of the bone plate 300, for example, to position the distal body region 306 over a cuneiform bone (e.g., the medial cuneiform bone). The distal length 332 can range from 8 to 20 mm, e.g., from 12 to 20 mm, or from 15 to 18 mm. In some cases, the distal length 332 can be greater than the proximal length 330, such that the ratio of the distal length 332 divided by the proximal length 330 can be greater than 1.0, e.g., greater than 1.03, greater than 1.1, greater than 1.15, greater than 1.2, or greater than 1.25. The body 302 can also define an overall length 334 from the proximal edge 329 to the distal edge 331 that ranges from 16 to 50 mm, e.g., from 24 to 46 mm, or from 30 to 40 mm.

[0041] To further facilitate anatomical fit and fixation of the bone plate 300 in one or more bones, the bone plate 300 can include one or more intra-hole spacings to facilitate proper fixation screw placement in the target bone. For example, the distance between the first fixation hole 318 (e.g., a proximal edge 338 of the first fixation hole 318 closest to the second fixation hole 320) and the second fixation hole 320 (e.g., a distal edge 337 of the second fixation hole 320 closest to the first fixation hole 318) can define the first intra-hole spacing 336. The first intra-hole spacing 336 can range from 2 to 12 mm, e.g., 5 to 10 mm, 7 to 9 mm, or 3.25 to 4.50 mm, and the ratio of the first intra-hole spacing 336 to the length 326 of the bridge 308 can be at least 0.78. The first inter-hole spacing 336 can be configured to position each of the first fixation hole 318 and the second fixation hole 320 over a metatarsal (e.g., the first metatarsal). As another example, the distance between the third fixation hole 322 (e.g., the proximal edge 339 of the third fixation hole 322 closest to the fourth fixation hole 324) and the fourth fixation hole 324 (e.g., the distal edge 340 of the fourth fixation hole 324 closest to the third fixation hole 322) can define the second inter-hole spacing 341. The second inter-hole spacing 341 can range from 2 to 12 mm, e.g., from 5 to 10 mm or from 7 to 9 mm, and the ratio of the second inter-hole spacing 341 to the bridge length is at least 0.78. This second intra-hole spacing 341 can be configured to position each of the third fixation hole 322 and the fourth fixation hole 324 over a cuneiform bone (e.g., a medial cuneiform bone) in some applications with one or more other anatomical fitting features in the proximal body region 304 described later in this specification.

[0042] Additionally, the width 312 of the body 302 can be configured to help facilitate anatomic fit and fixation of the bone plate 300 in one or more bones. For example, the width 312 of the body 302 can be greater at locations of the body 302 that define each of the first fixation hole 318, the second fixation hole 320, the third fixation hole 322, and the fourth fixation hole 324 than the width at the bridge 308. As another example, the width 312 of the body 302 can be less at longitudinal locations between the first fixation hole 318, the second fixation hole 320, the third fixation hole 322, and the fourth fixation hole 324 than the width 312 of the body 302 at locations of the body 302 that define the first fixation hole 318, the second fixation hole 320, the third fixation hole 322, and the fourth fixation hole 324. These widths 312 of the body 302 can provide an efficient profile for the bone plate 302 for placement on relatively small bones, such as the metatarsals and cuneiform bones of the foot, yet still provide fixation points for the bone plate 300 for robust fixation of the bone plate 300 to these relatively small bones.

[0043] The body 302 of the bone plate 300 may be flat or may include an arched profile along its length. For example, as best seen in FIG. 4C, the body 302 may be arched along at least a portion of the overall length 334, with the bone-facing surface 316 defining a concave profile and the upper surface 314 defining a convex profile. For example, the body 302 may be arched with an apex of the arched profile approximately at the center of the bridge 308, a low point approximately at the first fixation hole 318 in the distal body region 306, and a low point approximately at the fourth fixation hole 324 in the proximal body region 304. The body 302 may define an arched profile having a central radius R (e.g., at the center of the bridge 308) ranging from 20.0 mm to 25.0 mm, e.g., 21.0 mm to 24.0 mm, 22.0 mm to 23.0 mm.

[0044] To further help facilitate an anatomical fit of the bone plate 300 to one or more bones, the body 302 can define the bone plate 300 as an asymmetric bone plate. In particular, the bone plate 300 can be contoured to complement a target anatomical structure of one or more bones and / or adjacent joint spaces onto which the bone plate 300 may be positioned and secured. To complement the target anatomical structure, the bone plate 300 can include a fourth fixation hole 324 that is asymmetrically oriented relative to one or more other fixation holes (e.g., relative to each of the first fixation hole 318, the second fixation hole 320, and the third fixation hole 322). In particular, the bone plate 300 can include a fourth fixation hole 324 that is asymmetrically oriented such that the fourth fixation hole 324 complements a natural anatomical structure present in a cuneiform bone (e.g., present in the medial cuneiform bone) and / or a joint space between adjacent cuneiform bones (e.g., a joint space adjacent the medial cuneiform bone and the middle cuneiform bone). The asymmetric orientation of the fourth fixation hole 324 can thus help provide the bone plate 300 as an anatomically adapted bone plate that complements the native anatomy present in the cuneiform bone and takes into account the native anatomy in the cuneiform bone to help avoid inadvertent fixation screw placement in the joint space, with the fourth fixation hole 324 positioned to facilitate robust fixation screw fixation in that native anatomy.

[0045] 4, the fourth fixation hole 324 may be offset from the bridge central longitudinal axis 310, while the first fixation hole 318, the second fixation hole 320, and the third fixation hole 322 are located on the bridge central longitudinal axis 310. More specifically, in some instances, as best seen in FIG. 4A, each of the first fixation hole 318, the second fixation hole 320, and the third fixation hole 322 may be positioned collinear with the bridge central longitudinal axis 310, while the fourth fixation hole 324 is offset from the bridge central longitudinal axis 310 in two or more planes. As one such example, the first fixation hole 318 can have a geometric center 318A, the second fixation hole 320 can have a geometric center 320A, the third fixation hole 322 can have a geometric center 322A, and the fourth fixation hole 324 can have a geometric center 324A. The geometric center 324A of the fourth fixation hole 324 is offset from the bridge center longitudinal axis 310, but each of the geometric centers 318A of the first fixation hole 318, 320A of the second fixation hole 320, and 322A of the third fixation hole 322 are positioned substantially along the bridge center longitudinal axis 310.

[0046] The geometric centers 318A, 320A, and 322A positioned substantially along the bridge central longitudinal axis 310 can include geometric centers 318A, 320A, and 322A that are bisected by the bridge central longitudinal axis 310. Alternatively, the geometric centers 318A, 320A, and 322A positioned substantially along the bridge central longitudinal axis 310 can include geometric centers 318A, 320A, and 322A that more generally intersect the bridge central longitudinal axis 310 at some portion of the geometric centers 318A, 320A, and 322A, although the geometric centers 318A, 320A, and 322A do not necessarily need to be precisely aligned with one another. For example, geometric centers 318A, 320A, and 322A may each intersect with bridge central longitudinal axis 310 at some portion of geometric centers 318A, 320A, and 322A, but the true center of one or more of geometric centers 318A, 320A, and 322A is within 2%, 5%, 7%, 10%, 12%, 15%, 17%, 20%, 25%, 30%, 35%, or 40% of bridge central longitudinal axis 310.

[0047] As discussed above, the fourth fixation hole 324 may be offset from the bridge central longitudinal axis 310 in two or more planes. More specifically, the fourth fixation hole 324 may be offset from the bridge central longitudinal axis 310 in a first plane by a first planar angle and in a second plane by a second planar angle. For example, the geometric center 324A of the fourth fixation hole 324 may be offset from the bridge central longitudinal axis 310 in a first plane by a distance ranging from 0.25 to 10.0 mm, such as 0.5 to 7.0 mm or 1.0 to 4.0 mm. As another example, the geometric center 324A of the fourth fixation hole 324 may be offset from the bridge central longitudinal axis 310 in a second plane by an angle ranging from 1° to 50°, 5° to 40°, or 15° to 30°.

[0048] With respect to the offset orientation of the fourth fixation hole 324 by a first angle in the first plane, for example, the portion of the proximal body region 304 defining the fourth fixation hole 324 can include a bend in the body 302 that is offset in the first plane from the bridge central longitudinal axis 310 by a first planar angle 346. More specifically, as best seen in FIG. 4A , the fourth fixation hole 324 can define a first fourth fixation hole axis 325 along which the fourth fixation hole 324 extends generally between a distal edge 340 of the fourth fixation hole 324 and a proximal edge 343 of the fourth fixation hole 324. Also, the portion of the proximal body region 304 can include a bend in the body 302 at an orientation that offsets the first fourth fixation hole axis 325 from the bridge central longitudinal axis 310 in the first plane by the first planar angle 346. In certain applications of the bone plate 300 on one or more bones of the foot, the first plane may be, for example, a transverse plane, and the bend of the body 302 may be offset medially in the first plane from the bridge central longitudinal axis 310 by a first planar angle 346. In other examples where the bone plate 300 is applied to one or more bones of the foot, the first plane may be, for example, a sagittal plane, and the bend of the body 302 may be offset dorsally in the first plane from the bridge central longitudinal axis 310 by a first planar angle 346. By way of example, the first planar angle 346 may range from 1° to 50°, 5° to 40°, or 15° to 30°. Such ranges for the first planar angle 346, particularly 5° to 40° or 15° to 30°, may be useful in orienting the fourth fixation hole 324 (e.g., in the first plane) in a manner that takes into account the natural anatomy of the cuneiform bone, because the bend defined by the first planar angle 346 may serve to angle the fourth fixation hole 324 away from the joint space adjacent the cuneiform bone and / or toward a stable fixation surface on the cuneiform bone.

[0049] For example, with respect to an offset orientation of the fourth fixation hole 324 by a second angle in the second plane, the portion of the proximal body region 304 defining the fourth fixation hole 324 can include a twist of the body 302 that offsets the fourth fixation hole 324 from the bridge central longitudinal axis 310 in the second plane by the second planar angle 347. More specifically, as best seen in FIG. 4B , the fourth fixation hole 324 can define a second fourth fixation hole axis 327 along which the fourth fixation hole 324 extends through the body 302 from the top surface 314 to the bone-facing surface 316. Also, the portion of the proximal body region 304 can include a twist of the body 302 in an orientation that offsets the second fourth fixation hole axis 327 from the bridge central longitudinal axis 310 in the second plane by the second planar angle 347.

[0050] In certain applications of the bone plate 300 on one or more bones of the foot, the second plane may be, for example, a forehead plane, and torsion of the body 302 may offset the second fourth fixation hole axis 327 plantarly in the second plane from the bridge central longitudinal axis 310 by the second planar angle 347. In other examples where the bone plate 300 is applied to one or more bones of the foot, the second plane may be, for example, a transverse plane, and torsion of the body 302 may offset laterally in the second plane from the bridge central longitudinal axis 310 by the second planar angle 347. By way of example, the second planar angle 347 may range from 1° to 50°, 5° to 40°, or 15° to 30°. Such ranges for the second planar angle 347, particularly 5° to 40° or 15° to 30°, may be useful in orienting the fourth fixation hole 324 (e.g., in the second plane) in a manner that takes into account the natural anatomical structure of the cuneiform bone, such as contouring, because the twist defined by the second planar angle 347 may help to rotate the fourth fixation hole 324 in an orientation that complements the surface shape of the cuneiform bone to facilitate stable, more flush contact between the bone-facing surface 316 of the portion of the proximal body region 304 having the fourth fixation hole 324 and the underlying surface of the cuneiform bone.

[0051] In some examples, as best seen in FIG. 4D , to further aid in conforming the bone plate 300 to the anatomy of one or more target bones, the bone plate 300 can include one or more recessed regions 350. The one or more recessed regions 350 can be configured to facilitate contouring of the bone plate 300. Thus, the one or more recessed regions 350 can be configured to facilitate additional bending and / or twisting of the bone plate 300 as desired by the clinician prior to placing the bone plate 300 in the region of the bone plate 300 where the recessed regions 350 are present. If included, the one or more recessed regions 350 can be located on the bone-facing surface 316. In use, for example, the clinician can insert a plate bender into different holes in the body 300 to bend the plate along its longitudinal axis to conform the plate to the anatomy of a particular patient undergoing a surgical procedure.

[0052] 4D , the bone plate 300 can include at least one recessed area 350 located longitudinally between the third and fourth fixation holes 322, 324 on the bone-facing surface 316. Additionally, since the at least one recessed area 350 can be located longitudinally between the third and fourth fixation holes 322, 324, the at least one recessed area 350 can also be located in a portion of the proximal body region 304 that is offset from the bridge central longitudinal axis 310. Thus, since the at least one recessed area 350 can be located longitudinally between the third and fourth fixation holes 322, 324, the at least one recessed area 350 can be located in a portion of the body 302 that includes a bend and twist of the body 302 that offsets the fourth fixation hole 324 from the bridge central longitudinal axis 310. In one particular example, longitudinally between the third fixation hole 322 and the fourth fixation hole 324, the bone-facing surface 316 can include one recessed region 350 extending radially inward from a first side of the body 302 and another recessed region 350 extending radially inward from an opposite second side of the body 302, with the raised region located radially between the two radially inward extending recessed regions 350.

[0053] To facilitate certain surgical procedures, kits can be provided that include one or more bone plates disclosed herein, which can be useful, for example, in fixating repositioned bones during surgical procedures such as metatarsal realignment and fusion procedures.

[0054] 5 is a top view of one embodiment of a kit 500. The kit 500 can include a first bone plate, such as bone plate 300, and a second bone plate 400. The kit 500 can also include a sterile container 505, in which the bone plate 300 and the bone plate 400 are located. In addition, as shown in the embodiment of FIG. 5, the kit 500 can further include one or more fixation screws 510 in the sterile container 505 along with the bone plate 300 and the bone plate 400. In general, the number of fixation screws in the kit can be equal to or greater than the number of fixation holes provided by the bone plate to be used during a surgical procedure (e.g., the number of fixation holes provided by the multiple bone plates when multiple plates are used during a surgical procedure). In one particular example, the kit 500 can include at least four fixation screws 510 in the sterile container 505, e.g., exactly four, at least eight, exactly eight, or even other numbers of fixation screws. The components within the sterile container 505 may be sealed within the sterile container 505 to maintain the sterility of those components while within the sterile container 505.

[0055] The bone plate 400 may be similar or the same as disclosed elsewhere herein with respect to the bone plate 300, except as noted herein. That is, the bone plate 400 may be similar or the same as the bone plate 300, except that the bone plate 400 may differ from the bone plate 300 in that the bone plate 400 includes a fourth fixation hole 424 that is offset from the bridge central longitudinal axis 410 in a different orientation than the fourth fixation hole 324. For example, the fourth fixation hole 424 of the bone plate 400 may be offset from the bridge central longitudinal axis 410 in an orientation that is a mirror image of the orientation in which the fourth fixation hole 324 of the bone plate 300 is offset from the bridge central longitudinal axis 310. The inclusion of such bone plate 300 and bone plate 400 can facilitate surgical procedures such as metatarsal realignment and fusion procedures, where fixation of one or more bones is desired at one or more of those bones, i.e., at two different locations having generally opposite anatomical surface topographies (as will be further described with reference to Figures 7A-7C). In some such instances, bone plate 400 itself may be a mirror image of bone plate 300.

[0056] 4, bone plate 300 can include a body 302 having four fixation holes, including first and second fixation holes 318, 320 separated from third and fourth fixation holes 322, 324 by a bridge 308. Bone plate 300 can be configured to position first and second fixation holes 318, 320 on the dorsal side of the metatarsals and third and fourth fixation holes 322, 324 on the dorsal side of the cuneiform bones, with bridge 308 crossing the dorsal side of the tarsometatarsal joint space between the metatarsals and the cuneiform bones (as seen in FIGS. 7A-7C). The first, second, and third fixation holes 318, 320, 322 can be aligned collinearly with the bridge 308, and the fourth fixation hole 324 can be angled medially in the transverse plane and rotated plantarly in the forehead plane relative to the first, second, and third fixation holes 318, 320, 322 (as seen in FIGS. 7A-7C).

[0057] The bone plate 400 includes a body 402 having four fixation holes, including a first fixation hole 418 and a second fixation hole 420 separated from a third fixation hole 422 and a fourth fixation hole 424 by a bridge 408. As described above, in some examples, the bone plate 400 can have the fourth fixation hole 324 offset from the bridge central longitudinal axis 310 in an orientation that is a mirror image of the orientation in which the fourth fixation hole 424 of the bone plate 300 is offset from the bridge central longitudinal axis 410. Thus, the bone plate 400 can be configured to position the third fixation hole 422 and the fourth fixation hole 424 on the medial side of the cuneiform bone, with the first fixation hole 418 and the second fixation hole 420 on the medial side of the metatarsal bone, and the bridge 408 crossing the medial side of the tarsometatarsal joint space between the metatarsal and the cuneiform bone. The first, second, and third fixation holes 418, 420, 422 can be aligned collinearly with the bridge 408, and the fourth fixation hole 424 can be angled dorsally in the sagittal plane and rotated outwardly relative to the first, second, and third fixation holes 418, 420, 422 in the transverse plane (as seen in Figures 7A-7C).

[0058] In some cases, bone plate 400 may be a mirror image of bone plate 300, as well as an offset orientation of fourth fixation hole 424. For example, bone plate 400 itself may be a mirror image of bone plate 300. In this example, bone plate 300 may be configured to wrap downward from the dorsal side of the cuneiform bone to the plantar side, while bone plate 400 may be configured to wrap upward from the medial side of the cuneiform bone to the dorsal side.

[0059] As previously described with respect to the bone plate 300, the bone plate 300 can have a portion of the proximal body region 304 that defines the fourth fixation hole 324, the portion including a plate bend of the body 302 that is offset in the first plane from the bridge central longitudinal axis 310 by a first planar angle. More specifically, the portion of the proximal body region 304 that includes the plate bend of the body 302 offsets the first fourth fixation hole axis 325 from the bridge central longitudinal axis 310 by the first planar angle in the first plane.

[0060] The bone plate 400 can include a bend in the body 402 that is a mirror image of the bend in the body 302 of the bone plate 300. The fourth fixation hole 424 can define a first fourth fixation hole axis 425 along which the fourth fixation hole 424 extends generally between a distal edge 440 of the fourth fixation hole 424 and a proximal edge 443 of the fourth fixation hole 424. A portion of the proximal body region 404 can also include a bend in the body 402 in an orientation that offsets the first fourth fixation hole axis 425 from the bridge center longitudinal axis 410 by a first planar angle 446 in a first plane. Compared to the bend in the body 302 of the bone plate 300, the portion of the proximal body region 404 of the body 402 of the bone plate 400, i.e., the portion including the plate bend in the body 402 that offsets the first fourth fixation hole axis 425 from the bridge central longitudinal axis 410 by the first planar angle in the first plane, may be a mirror image of the bend in the body 302 of the bone plate 300 by the first angle in the first plane. The first planar angle 446 may be in the angle range as described for the first planar angle 346 for the bone plate 300.

[0061] Also, as previously described with respect to bone plate 300, bone plate 300 can have fourth fixation hole 324 defining a second, fourth fixation hole axis 327 along which fourth fixation hole 324 extends through body 302 from top surface 314 to bone-facing surface 316. The portion of proximal body region 304 defining fourth fixation hole 324 can include a twist of body 302 that offsets second, fourth fixation hole axis 327 from bridge center longitudinal axis 310 in a second plane by a second planar angle.

[0062] The bone plate 400 can include a twist of the body 402 that is a mirror image of the twist of the body 302 of the bone plate 300. The fourth fixation hole 424 can define a second fourth fixation hole axis 427 (axis 427 is shown in FIG. 4B for reference in comparison to axis 327) along which the fourth fixation hole 424 extends through the body 402 from the top surface 414 to the bone-facing surface 416. Also, a portion of the proximal body region 404 can include a twist of the body 402 in an orientation that offsets the second fourth fixation hole axis 427 from the bridge center longitudinal axis 410 by a second planar angle 447 in a second plane. In comparison to the twist of the body 302 of the bone plate 300, the portion of the proximal body region 404 of the body 402 of the bone plate 400 includes a plate twist of the body 402 that offsets the second fourth fixation hole axis 427 from the bridge center longitudinal axis 410 by a second planar angle in the second plane, which may be a mirror image of the twist of the body 302 of the bone plate 300 by the second angle in the second plane. The second planar angle 447 may be in an angle range as described for the second planar angle 347 for the bone plate 300. Thus, in some examples, the bone plate 400 may include a bending of the body 402 and a twist of the body 402 that are mirror images of the bending of the body 302 and the twist of the body 302 of the bone plate 300, respectively.

[0063] As described above, the kit 500 can include the fixation screws 510 in the sterile container 505. The fixation screws 510 can be locking and / or non-locking fixation screws. In examples where the fixation screws 510 are locking screws, each of the fixation screws 510 can include threads 511 in the screw head 512 of each of the fixation screws 510. Additionally, each of the first fixation hole 318, the second fixation hole 320, the third fixation hole 322, and the fourth fixation hole 324 of the bone plate 300 can include threads 311, and each of the first fixation hole 418, the second fixation hole 420, the third fixation hole 422, and the fourth fixation hole 424 of the bone plate 400 can include threads 411. The threads 311, 411 in the fixation holes of the bone plates 300, 400 may be complementary to the threads 511 in the head 512 of the fixation screws 510 such that the threads 511 can lockably engage with the respective threads 311, 411. Thus, the head 512 of each of the fixation screws 510 may be configured to lock into a respective one of the first fixation hole 318, the second fixation hole 320, the third fixation hole 322, and the fourth fixation hole 324 of the bone plate 300 and the first fixation hole 418, the second fixation hole 420, the third fixation hole 422, and the fourth fixation hole 424 of the bone plate 400.

[0064] FIG. 6 is a flow diagram of an embodiment of a method 600 that may include, among other steps, positioning and fixing a bone plate. As will be described, in one example, the method 600 may be used to prepare, realign, and fix the tarsometatarsal joint. Certain features of the method 600 will be described with reference to FIGS. 7A-7C. Additional details regarding exemplary surgical techniques, including exemplary instrumentation that may be used during the techniques, may be found in U.S. Pat. No. 9,622,805, issued April 18, 2017, entitled "BONE POSITIONING AND PREPARING GUIDE SYSTEMS AND METHODS," and U.S. Patent Application Publication No. 2020 / 0015856, published January 16, 2020, entitled "COMPRESSOR-DISTRACTOR FOR ANGULARLY REALIGNING BONE PORTIONS," the entire contents of each of which are incorporated herein by reference.

[0065] At step 610, the method 600 includes making an incision. The incision can be made through the skin, such as on the dorsal side of the foot, the medial side of the foot, or the dorsal-medial side of the foot. The incision can be made to provide surgical access to the TMT joint 230, which separates the first metatarsal 210 from the opposing medial cuneiform 222. To surgically access the joint, the patient can be placed in a supine position on an operating room table and given general anesthesia or monitored anesthesia care. Hemostasis can be obtained by applying a femoral or mid-sural tourniquet. In some instances, imaging of the foot can be used to assist the clinician in locating the TMT joint 230, and then the incision can be centered around the TMT joint 230 when cutting through the skin.

[0066] At step 620, the method 600 includes preparing the first metatarsal 210 and / or the medial cuneiform 222. With the TMT joint 230 exposed through the incision, the end surface of the first metatarsal 210 (e.g., the proximal end surface) and / or the end surface of the medial cuneiform 222 (e.g., the distal end surface) can be prepared. It should be noted that one or both of the end surfaces of the metatarsal and the cuneiform can be prepared before and / or after the metatarsal is moved relative to the cuneiform. Thus, unless otherwise stated, the order of bone preparation and / or movement is not limited. In general, the clinician can prepare the ends of each bone that forms the TMT joint 230 to promote fusion of the bone ends across the TMT joint following realignment. Bone preparation can include using a tissue removal instrument to apply force to the end surfaces of the bones to create a bleeding bone surface to promote subsequent fusion. Exemplary tissue removal instruments that can be used include, but are not limited to, saws, rotary excavators, rongeurs, reamer, osteotome, spatula, and the like. The tissue removal instrument can be applied to the end surface of a bone that is being prepared for removal of cartilage and / or bone. For example, the tissue removal instrument can be applied to the end surface to remove cartilage (e.g., all cartilage) down to the subchondral bone. Additionally or alternatively, the tissue removal instrument can be applied to cut, fenestrate, mortar, and / or otherwise reshape the end surface of the bone and / or to create a bleeding bone surface to promote fusion. When a cutting operation is performed to remove the end of the bone, the cut can be performed freehand and with the aid of a cutting guide having a guide surface positionable over the portion of the bone to be cut. When a bone preparation guide is used, the cutting instrument can be inserted against the guide surface of the bone preparation guide (e.g., between a slot defining between two guide surfaces) to guide the cutting instrument for removal of the bone.

[0067] In step 630, the method 600 includes moving the first metatarsal 210. As described above, the first metatarsal 210 can be moved before and / or after the first metatarsal 210 and / or the medial cuneiform 222 are prepared. Moving the first metatarsal 210 in step 630 can include moving the first metatarsal 210 in at least one plane. For example, the first metatarsal 210 can be moved at least in the transverse plane to close the IMA 234 between the first metatarsal 210 and the adjacent second metatarsal 212, and / or the forehead plane (e.g., to reduce a sesamoid bone that is substantially centered under the metatarsal). In some examples, the first metatarsal 210 can be moved in multiple planes, such as the transverse plane and / or the forehead plane and / or the sagittal plane (e.g., each of the transverse plane, the forehead plane, and the sagittal plane). The clinician may or may not utilize a bone positioning device to facilitate the movement of the bone portions. The moved position of the first metatarsal 210 may result in a realignment of the first metatarsal 210 relative to one or more other adjacent bones.

[0068] At step 640, the method 600 may include compressing one or more bones. In some embodiments, step 640 may be omitted depending on the realigned position of the first metatarsal 210. If step 640 is included, the prepared end surfaces of the bone portions of the first metatarsal 210 and the medial cuneiform 222 may be compressed together prior to securing one or more plates to the bones. A clinician may compress the end surfaces together using manual pressure and / or using a compression tool physically attached to both the first and second bone portions.

[0069] At step 650, the method 600 includes positioning a bone plate (e.g., a first bone plate) 300 over a portion of the first metatarsal 210 and over a portion of the medial cuneiform 222 and across the TMT joint 230 separating the metatarsal 210 from the cuneiform 222. For example, as shown in FIGS. 7A-7C, positioning the bone plate at step 650 may include positioning the bone plate 300. Positioning the bone plate 300 may include positioning a first fixation hole 318 and a second fixation hole 320 over the metatarsal 210 and positioning a third fixation hole 322 and a fourth fixation hole 324 over the cuneiform 222, with a bridge 308 separating the second fixation hole 320 from the third fixation hole 322 extending across the TMT joint 230. As previously described herein with respect to bone plate 300, the first, second, and third fixation holes 318, 320, 322 can be disposed collinearly with a bridge central longitudinal axis defined by bridge 308, and the fourth fixation hole 324 can be offset from the bridge central longitudinal axis by a first planar angle in a first plane and a second planar angle in a second plane. In some examples, positioning the bone plate 300 in step 650 can include positioning the distal body region 306 of the bone plate 300 on the metatarsal bone 210 and positioning the proximal body region 304 of the bone plate 300 on the cuneiform bone 222.

[0070] In step 660, the method 600 includes inserting a fixation screw 510 into the underlying metatarsal bone 210 through each of the first fixation hole 318 and the second fixation hole 320, and into the underlying cuneiform bone 222 through each of the third fixation hole 322 and the fourth fixation hole 324.

[0071] As shown in Figures 7A-7C, the bone plate 300 can be secured across the dorsal side of the metatarsal 210, the dorsal side of the cuneiform 222, and the dorsal side of the TMT joint 230 (e.g., the dorsal side of the joint space between the metatarsal 210 and the cuneiform 222). Also, as shown in Figures 7A-7C, the bone plate 300 can be positioned and secured to wrap from the dorsal side of the cuneiform 222 downward to the plantar side. In particular, the offset orientation of the fourth fixation hole 324 can generally wrap from the dorsal side of the cuneiform 222 downward to the plantar side. As seen in Figures 7A-7C, this feature provides the bone plate 300 with a suitable anatomical fit for the medial cuneiform 222. For example, the described bend in the body 302 of the plate 300 can position the fourth fixation hole 324 to be spaced away from the joint space between the cuneiform bone 222, the metatarsal bone 212, and the cuneiform bone 224. In this manner, the bend in the body 302 of the plate 300 can position the fourth fixation hole 324 to generally follow the shape of the cuneiform bone 222 to position the fourth fixation hole 324 on the cuneiform bone 222 and away from the joint space between the cuneiform bone 222, the metatarsal bone 212, and the cuneiform bone 224. Additionally, the described twist in the body 302 of the plate 300 can position the fourth fixation hole 324 to be generally flush with the dorsal surface 223 of the cuneiform bone 222, which slopes downwardly in a medial direction. Thus, these features of the bone plate 300 can facilitate an anatomical fit at the cuneiform bone 222 by generally tracking the natural surface contouring at the cuneiform bone 222 .

[0072] In some embodiments, the fixation screws may be inserted into the bone plate 300 in a particular order. As one such example, if the second fixation hole 320 is positioned closer to the bridge 308 than the first fixation hole 318 and the third fixation hole 322 is positioned closer to the bridge 308 than the fourth fixation hole 324, then the first fixation screw may be inserted through the second fixation hole 320 and the second fixation screw may be inserted through the third fixation hole 322. Then, after the first fixation screw is inserted through the second fixation hole 320 and the second fixation screw is inserted through the third fixation hole 322, the third fixation screw may be inserted through the first fixation hole 318 and the fourth fixation screw may be inserted through the fourth fixation hole 324. As another such example, if the second fixation hole 320 is positioned closer to the bridge 308 than the first fixation hole 318, and the third fixation hole 322 is positioned closer to the bridge 308 than the fourth fixation hole 324, then the first fixation screw can be inserted into the first fixation hole 318 and the second fixation screw can be inserted into the fourth fixation hole 324. Then, after the first fixation screw is inserted through the first fixation hole 318 and the second fixation screw is inserted through the fourth fixation hole 324, the third fixation screw can be inserted through the second fixation hole 320 and the fourth fixation screw can be inserted through the third fixation hole 322.

[0073] At step 670, the method 600 includes positioning a second bone plate 400 over a portion of the first metatarsal 210 and over a portion of the medial cuneiform 222 and across the TMT joint 230 separating the metatarsal 210 from the cuneiform 222. The second bone plate 400 may be a mirror image of the bone plate 300. Positioning the bone plate 400 may include positioning a first fixation hole 418 and a second fixation hole 420 over the metatarsal 210 and positioning a third fixation hole 422 and a fourth fixation hole 424 over the cuneiform 222, with a bridge 408 separating the second fixation hole 420 from the third fixation hole 422 that extends across the TMT joint 230. As previously described herein with respect to bone plate 400, the first, second, and third fixation holes 418, 420, 422 can be disposed collinearly with a bridge central longitudinal axis defined by bridge 408, and the fourth fixation hole 424 can be offset from the bridge central longitudinal axis by a first planar angle in a first plane and a second planar angle in a second plane. In some examples, positioning the bone plate 400 in step 670 can include positioning the distal body region 406 of the bone plate 400 on the metatarsal bone 210 and positioning the proximal body region 404 of the bone plate 400 on the cuneiform bone 222.

[0074] In step 680, the method 600 includes inserting a fixation screw 510 into the underlying metatarsal bone 210 through each of the first fixation hole 418 and the second fixation hole 420, and into the underlying cuneiform bone 222 through each of the third fixation hole 422 and the fourth fixation hole 424.

[0075] As shown in FIGS. 7A-7C, the bone plate 400 can be secured across the medial side of the metatarsal 210, the medial side of the cuneiform 222, and the medial side of the TMT joint 230 (e.g., the dorsal side of the joint space between the metatarsal 210 and the cuneiform 222). As also shown in FIGS. 7A-7C, the bone plate 400 can be positioned and secured to wrap around the dorsal side of the cuneiform 222 from the medial side upwards. In particular, the offset orientation of the fourth fixation hole 424 can generally wrap around the dorsal side of the cuneiform 222 from the medial side upwards. As seen in FIGS. 7A-7C, this feature provides the bone plate 400 with a suitable anatomical fit for the medial cuneiform 222 and / or one or more adjacent tendons. For example, as best seen in FIG. 7C , a tendon called the tibialis anterior tendon 700 can sweep across the medial side of the cuneiform bone 222 and block access to the fixation surfaces at the cuneiform bone 222. The configuration of the bone plate 400, including the described bend and twist of the body 402, can provide an anatomical fit at the cuneiform bone 222 that diverges the fourth fixation hole 424 from the bridge central longitudinal axis in a dorsal direction along the cuneiform bone 222 and laterally away from the tendon 700, thereby reducing interference caused by the tendon 700, which in turn helps reduce instances of damage to the tendon 700 during a surgical procedure using the bone plate 400. Additionally, the configuration of bone plate 400, including the described bend and twist of body 402, can position fourth fixation hole 424 to generally follow the shape of cuneiform bone 222 medially to position fourth fixation hole 424 on cuneiform bone 222 in an orientation that generally follows and is generally flush with the slope at the medial surface of cuneiform bone 222. Thus, these features of bone plate 400 can facilitate an anatomical fit at cuneiform bone 222 by generally following the natural surface contouring at cuneiform bone 222 and generally diverging from the natural adjacent tendon trajectories.

[0076] In some embodiments, the fixation screws may be inserted into the bone plate 400 in a particular order. As one such example, if the second fixation hole 420 is positioned closer to the bridge 408 than the first fixation hole 418, and the third fixation hole 422 is positioned closer to the bridge 408 than the fourth fixation hole 424, then the first fixation screw may be inserted through the second fixation hole 420 and the second fixation screw may be inserted through the third fixation hole 422. Then, after the first fixation screw is inserted through the second fixation hole 420 and the second fixation screw is inserted through the third fixation hole 422, the third fixation screw may be inserted through the first fixation hole 418 and the fourth fixation screw may be inserted through the fourth fixation hole 424. As another such example, if the second fixation hole 420 is positioned closer to the bridge 408 than the first fixation hole 418, and the third fixation hole 422 is positioned closer to the bridge 408 than the fourth fixation hole 424, then the first fixation screw can be inserted through the first fixation hole 418 and the second fixation screw can be inserted through the fourth fixation hole 424. Then, after the first fixation screw is inserted through the first fixation hole 418 and the second fixation screw is inserted through the fourth fixation hole 424, the third fixation screw can be inserted through the second fixation hole 420 and the fourth fixation screw can be inserted through the third fixation hole 422.

[0077] 8A-8C show another embodiment of a bone plate 800. Fig. 8A is a perspective view of the bone plate 800, Fig. 8B is a side elevational view of the bone plate 800 including a locking screw 510, and Fig. 8C is an end elevational view of the bone plate 800 including a locking screw 510.

[0078] The bone plate 800 may include a body 802 including a proximal body region 804 configured to be positioned over a cuneiform bone (e.g., medial cuneiform bone), a distal body region 806 configured to be positioned over a metatarsal bone (e.g., first metatarsal bone), and a bridge 808 extending between the proximal body region 804 and the distal body region 806. The bridge 808 is configured to be positioned across a tarsometatarsal joint (e.g., first metatarsal joint) that separates the metatarsal bone from the cuneiform bone. The bridge 808 defines a bridge central longitudinal axis 810. The body 802 has a width that defines an extent of the bone plate 800 transverse to the bridge central longitudinal axis 810. The body 802 includes an upper surface 814 and a bone-facing surface 816 opposite the upper surface.

[0079] The body 802 may include a plurality of fixation holes. In the illustrated embodiment, the body 802 includes a first fixation hole 818 and a second fixation hole 820 located in the distal body region 806, each of the first fixation hole 818 and the second fixation hole 820 being aligned with the bridge central longitudinal axis 810. The first fixation hole 818 and the second fixation hole 820 each extend through the body 802 from the top surface 814 to the bone-facing surface 816, each of the first fixation hole 818 and the second fixation hole 820 configured to receive a fixation screw 510 therethrough. Also, in the illustrated embodiment, the body 802 includes a third fixation hole 822 and a fourth fixation hole 824 located in the proximal body region 804, each of the third fixation hole 822 and the fourth fixation hole 824 being aligned with the bridge central longitudinal axis 810. Thus, with respect to bone plate 800, each of first, second, third, and fourth fixation holes 818, 820, 822, and 824 can intersect bridge central longitudinal axis 810. Third fixation hole 822 and fourth fixation hole 824 each extend through body 802 from top surface 814 to bone-facing surface 816, and each of third fixation hole 822 and fourth fixation hole 824 is configured to receive a fixation screw 510 therethrough.

[0080] The fourth fixation hole 824 can have a profile that is different from the profile of each of the first, second, and third fixation holes 818, 820, and 822. In particular, the fourth fixation hole 824 can have a first angled profile 819 relative to the profile of each of the first, second, and third fixation holes 818, 820, and 822. For example, the portion of the body 802 that defines the fourth fixation hole 824 can have a non-uniform height that creates the first angled profile 819. As best seen in FIG. 8A , the portion of the body 802 that defines the fourth fixation hole 824 can have a first body side 855 and an opposing second body side 856. The first body side 855 can have a first height 857 and the second body side 856 can have a second height 858 that is different from the first height 857. In the illustrated embodiment, the first height 857 is greater than the second height 858, however, in other embodiments, the second height 858 may be greater than the first height 857.

[0081] This difference, at the height at the opposite side 855, 856 of the portion of the body 802 defining the fourth fixation hole 824, can at least partially create a first angled profile 819 that can result in a first angled trajectory of a fixation screw inserted through the fourth fixation hole 824 relative to a fixation screw inserted through each of the first, second, and third fixation holes 818, 820, and 822. In particular, the fourth fixation hole 824 defines a fourth fixation hole axis 827 along which the fourth fixation hole 824 extends through the body 802 from the upper surface 814 to the bone-facing surface 816, and the third fixation hole 822 defines a third fixation hole axis 829 along which the third fixation hole 822 extends through the body 802 from the upper surface 814 to the bone-facing surface 816. 8C, the fourth fixation hole axis 827 is tilted in a first plane at a first planar angle relative to the third fixation hole axis 829. Specifically, the fourth fixation hole axis 827 may be tilted in the frontal plane at an angle 831 ranging from 1° to 20°, 5° to 15°, or 7° to 12° relative to the third fixation hole axis 829.

[0082] Additionally, the fourth fixation hole 824 can have a second tilted profile 817 relative to the profiles of each of the first, second, and third fixation holes 818, 820, and 822. The second tilted profile 817 can tilt the fourth fixation hole 824 by a second planar angle in a second plane different from the first plane. For example, a portion of the body 802 in the proximal body region 804 and longitudinally between the fourth fixation hole 824 and the third fixation hole 822 can create the second tilted profile 817. In the illustrated embodiment, the portion of the longitudinal body 802 in the proximal body region 804 between the fourth fixation hole 824 and the third fixation hole 822 creates the second tilted profile 817 by increasing the height 859 relative to the height of the body 802 at the bridge 808 and the longitudinal height between the second fixation hole 820 and the first fixation hole 818.

[0083] The second tilted profile 817 can result in a second tilted trajectory for a fixation screw inserted through each of the first, second, and third fixation holes 818, 820, and 822 that is different from the first tilted trajectory resulting from the first tilted profile 819 for a fixation screw inserted through the fourth fixation hole 824. In particular, as described above, the fourth fixation hole 824 defines a fourth fixation hole axis 827 along which the fourth fixation hole 824 extends through the body 802 from the upper surface 814 to the bone-facing surface 816, and the third fixation hole 822 defines a third fixation hole axis 829 along which the third fixation hole 822 extends through the body 802 from the upper surface 814 to the bone-facing surface 816. 8B, the fourth fixation hole axis 827 is tilted in the second plane at a second planar angle relative to the third fixation hole axis 829. Specifically, the fourth fixation hole axis 827 may be tilted in the sagittal plane at an angle 833 ranging from 1° to 20°, 5° to 15°, or 7° to 12° relative to the third fixation hole axis 829.

[0084] The angled profile 817, 819 of the fourth fixation hole 824 can help the bone plate 800 to conform to the native bone anatomy in which the bone plate 800 may be positioned and secured. For example, in applications in which the bone plate 800 is configured to have a proximal body region 804 positioned in a cuneiform bone (e.g., the medial cuneiform bone), the angled profile 817, 819 of the fourth fixation hole 824 can be configured to angle a fixation screw inserted through the fourth fixation hole 824 away from the joint space adjacent the cuneiform bone. This, in turn, can facilitate more robust fixation of the proximal body region 804 in the cuneiform bone.

[0085] 9A-9C show additional embodiments of a bone plate 900. In particular, FIG. 9A illustrates an end (e.g., proximal) front view of a bone plate 900 having a locking screw 510, FIG. 9B is a side front view of the bone plate having the locking screw 510, and FIG. 9C is a top view of the bone plate having the locking screw 510.

[0086] The illustrated embodiment of the bone plate 900 can include a fixation hole (e.g., a third fixation hole) 918 and a fixation hole (e.g., a fourth fixation hole) 927 on the same side of the bridge of the bone plate 900. Each of the fixation holes 918 and 927 can define a fixation screw axis extending therethrough along which the fixation screw 510 extends when positioned in the respective fixation hole 918, 927. As shown here, the fixation hole 918 can be configured to define a fixation screw axis that is parallel (e.g., substantially parallel) to at least the fixation screw axis defined by the fixation hole 927 such that the fixation screws 510 extending therethrough are generally parallel to one another when positioned in the fixation holes 918, 927. Additionally, the bone plate surface 924 of the bone plate 900 that defines the fixation hole 927 can be angled relative to the bone plate surface that defines the fixation hole 918. For example, the bone plate surface 924 defining the fixation hole 927 may be inclined at an angle ranging from 5° to 50°, e.g., ranging from 10° to 40°, ranging from 15° to 35°, or ranging from 20° to 25°, relative to the bone plate surface defining the fixation hole 918. This angularly inclined orientation of the bone plate surface 924 defining the fixation hole 927 relative to the bone plate surface defining the fixation hole 918 can help prevent the fixation screw 510 from being inserted in an unintended anatomical location, for example, helps prevent the fixation screw 510 from being inserted into the space between the cuneiform bones, while still maintaining conformance of the bone plate surface to the anatomical geometry / shape of the first cuneiform bone (e.g., in both a dorsal and medial direction at the first cuneiform bone).

[0087] Bone plates as described herein may be used alone or in combination with one or other bone fixation devices to fixate the joint between opposing bone portions for fusion. Other types of bone fixation devices that can be used include, but are not limited to, bone screws (e.g., compression bone screws), bone plates (e.g., having a different configuration than the anatomically configured bone plates as described herein), bone staples, external fixators, pins (e.g., intramedullary implants), and / or combinations thereof. Bone plates according to the present disclosure may be attached before or after one or more other bone fixation devices (if used) are placed on the bone portions to be fixed.

[0088] Various examples have been described. These and other examples are within the scope of the following claims.

Claims

1. 1. An anatomically adapted bone plate, comprising: a body including a proximal body region configured to be positioned on a first bone, a distal body region configured to be positioned on a second bone, and a bridge extending between the proximal body region and the distal body region, the bridge defining a bridge central longitudinal axis, the body having a width defining an extent of the bone plate transverse to the bridge central longitudinal axis, the body including an upper surface and a bone-facing surface opposite the upper surface; a first fixation hole and a second fixation hole located in the distal body region and positioned collinearly with the bridge central longitudinal axis, the first fixation hole and the second fixation hole each extending through the body from the upper surface to the bone-facing surface and configured to receive a fixation screw therethrough; and third and fourth fixation holes located in the proximal body region, the third fixation hole positioned closer to the bridge than the fourth fixation hole, the third fixation hole being collinear with the bridge central longitudinal axis and the fourth fixation hole being offset from the bridge central longitudinal axis by a first planar angle in a first plane and a second planar angle in a second plane, the third fixation hole and the fourth fixation hole each extending through the body from the top surface to the bone-facing surface and configured to receive the fixation screw therethrough.

2. 2. The bone plate of claim 1, wherein the first bone is a cuneiform bone and the second bone is a metatarsal bone, and the bridge is configured to be positioned across a tarsometatarsal joint separating the metatarsal bone from the cuneiform bone.

3. The bone plate of claim 2 , wherein the metatarsal is a first metatarsal, the cuneiform is a medial cuneiform, and the tarsometatarsal joint is a first tarsometatarsal joint.

4. The bone plate of claim 1 or 2, wherein the first, second, third, and fourth fixation holes are the only fixation holes provided by the bone plate.

5. the second fixation hole is positioned closer to the bridge than the first fixation hole, the bridge defining a length extending from an edge of the second fixation hole to an edge of the third fixation hole, the length of the bridge having a midline halfway between the edge of the second fixation hole and the edge of the third fixation hole; 3. The bone plate of claim 1, wherein the body defines a proximal length extending from the midline of the bridge to a proximal edge of the bone plate, the proximal length being less than 19 mm.

6. The body defines a distal length extending from the midline of the bridge to a distal edge of the bone plate; the body defines an overall length from the proximal edge to the distal edge ranging from 30 to 40 mm; the length of the bridge ranges from 9.0 mm to 15.0 mm; the proximal length ranges from 17 to 20 mm; the distal length ranges from 15 to 18 mm; the geometric center of the fourth fixation hole is offset in the first plane from the bridge central longitudinal axis by a distance ranging from 1 to 4 mm; 3. The bone plate according to claim 1 or 2.

7. 7. The bone plate of claim 6, wherein the geometric center of the fourth fixation hole is offset in the second plane from the bridge central longitudinal axis by an angle ranging from 5° to 40°, and the geometric center of the fourth fixation hole is offset in the second plane from the bridge central longitudinal axis to configure the fourth fixation hole to receive the fixation screw therethrough and maintain the fixation screw in an orientation that is substantially parallel to at least one other fixation screw received in the bone plate.

8. a portion of the proximal body region defining the fourth fixation hole includes a bend in the body that is offset from the bridge central longitudinal axis in the first plane by the first planar angle; the fourth fixation hole defines a fourth fixation hole axis along which the fourth fixation hole extends through the body from the upper surface to the bone-facing surface; the portion of the proximal body region defining the fourth fixation hole includes a body twist that offsets the fourth fixation hole axis from the bridge central longitudinal axis in the second plane by the second planar angle.

3. The bone plate according to claim 1 or 2.

9. The bone plate of claim 8 , wherein the first plane is a transverse plane and the second plane is a frontal plane.

10. The bone plate of claim 8, wherein the first angle ranges from 1° to 50° and the second angle ranges from 1° to 50°.

11. 9. The bone plate of claim 8, wherein the bent portion of the body is offset in a medial direction from the bridge central longitudinal axis in the first plane by the first planar angle.

12. 9. The bone plate of claim 8, wherein the twisting of the body offsets the fourth fixation hole axis from the bridge central longitudinal axis in the second plane by the second plane angle in a plantar direction.

13. the bridge defines a length extending from an edge of the second fixation hole to an edge of the third fixation hole; a distance between the first fixation hole and the second fixation hole defines a first inter-hole spacing; a ratio of the first intra-hole spacing to the length of the bridge is at least 0.78; 3. The bone plate according to claim 1 or 2.

14. 3. The bone plate of claim 1, wherein the body is arched along its length with the bone-facing surface defining a concave profile and the upper surface defining a convex profile.

15. 3. The bone plate of claim 1, wherein the width of the body is greater at positions on the body defining each of the first, second, third, and fourth fixation holes than at the bridge, and / or the width of the body is smaller at longitudinal positions between the first, second, third, and fourth fixation holes than at the positions on the body defining the first, second, third, and fourth fixation holes.

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