Lapidus System for Minimally Invasive Surgery

Abstract

The system includes a cutting guide having a base body configured to be secured to a first bone of a patient and a cutting slot block configured to provide guidance for cutting at least one of the first bone and a second bone of the patient. The cutting slot block is rotatably coupled to the base body. The cutting slot block is configured to rotate in a first rotational direction. The cutting guide includes a distal portion and a proximal portion.

Description

[Technical Field]

[0001] Priority claims This application claims priority to U.S. Provisional Patent Application No. 63 / 442,672, filed February 1, 2023, the entire contents of which are hereby incorporated by reference and relied upon. [Background technology]

[0002] The Lapidus procedure refers to a surgical procedure for the treatment of bunion deformities. Bunions are bony protrusions that form on the side of the big toe joint and can cause foot deformities. The Lapidus procedure involves correcting the foot structure by repositioning a poorly aligned first metatarsal bone to its proper position. Summary of the Invention [Problem to be solved by the invention]

[0003] The Lapidus procedure has traditionally required complete exposure of the first metatarsophalangeal (TMT) joint, which means that an incision at least 3.5 cm long is traditionally required to complete the Lapidus procedure, which can result in large scars, longer healing times, and a risk of infection. [Means for solving the problem]

[0004] The present disclosure provides novel, innovative systems and methods for minimally invasive rapidus surgery. In one example, a system according to the present disclosure may include a cutting guide having a base body configured to be secured to a first bone of a patient and a cutting slot block configured to provide guidance for cutting at least one of the first bone and a second bone of the patient. The cutting slot block may be rotatably coupled to the base body. The cutting slot block may be configured to rotate in a first rotational direction.

[0005] In one example, a method according to the present disclosure may include the steps of: securing a base body of a cutting guide to a first bone of a patient; positioning a cutting slot block at a first angle; cutting one of the first bone and the second bone by inserting a bone-cutting device through a slot in the cutting slot block at the first angle into an incision between the first bone and the second bone; rotating the cutting slot block to a second angle different from the first angle; and cutting one of the first bone and the second bone by inserting a bone-cutting device through the slot in the cutting slot block at the second angle into the incision.

[0006] Additional features and advantages of the disclosed system are described in, and will be apparent from, the following detailed description and figures. [Brief explanation of the drawings]

[0007] [Figure 1] FIG. 10 is a perspective view of a cutting guide according to an example embodiment of the present disclosure. [Figure 2] FIG. 2 is a top view of the cutting guide portion of FIG. 1. [Figure 3] FIG. 10 is a perspective view of a first repositioning guide block according to an example embodiment of the present disclosure. [Figure 4] FIG. 4 is a side view of the first repositioning guide block of FIG. 3. [Figure 5] FIG. 4 is a top view of the first repositioning guide block of FIG. 3; [Figure 6] FIG. 4 is a diagram of the first repositioning guide block of FIG. 3 applied to a human bone. [Figure 7] 4 is a view of both the cutting guide of FIG. 1 and the first repositioning guide block of FIG. 3 applied to a human bone. [Figure 8] FIG. 10 is a perspective view of a second repositioning guide block applied to a cutting guide according to an example embodiment of the present disclosure. [Figure 9] FIG. 9 is a top view of the second repositioning guide block and cutting guide of FIG. 8. [Figure 10]FIG. 9 is a side view of the second repositioning guide block and cutting guide of FIG. 8. [Figure 11] FIG. 9 is a view of the second repositioning guide block and cutting guide of FIG. 8 applied to a human bone. [Figure 12] FIG. 1 is a top view of the foot anatomy of a patient suffering from a bunion. [Figure 13] FIG. 1 is a top view of the foot anatomy of a patient suffering from a bunion. [Figure 14] FIG. 10 is a left front perspective view of a third repositioning guide block applied to a cutting guide according to an example embodiment of the present disclosure. [Figure 15] FIG. 15 is a right front perspective view of the third repositioning guide block and cutting guide of FIG. 14. [Figure 16] FIG. 15 is a perspective view of a third fixed block of the third repositioning guide block of FIG. 14. [Figure 17] FIG. 15 is a side view of the third fixed block of the third repositioning guide block of FIG. 14. DETAILED DESCRIPTION OF THE INVENTION

[0008] The present disclosure is directed to systems and methods for minimally invasive Lapidus surgery. As previously discussed, conventional Lapidus procedures can require incisions at least 3.5 cm long, which can have various problems, such as large scars, longer healing times, and the risk of infection. Furthermore, conventional devices for Lapidus procedures may only allow correction in a single plane (the sagittal plane), requiring the surgeon to manually perform corrections in other planes (e.g., the frontal and horizontal planes), which can require larger incision sizes and reduce the precision and repeatability of the procedure.

[0009]

[0006] Aspects of the present disclosure can address previously discussed problems with conventional Lapidus procedures. For example, aspects of the present disclosure provide a system having a cutting guide, a first repositioning guide, and / or a second repositioning guide, which allows for modification of a bone (e.g., the first metatarsal) in multiple planes (sagittal, frontal, and horizontal). Furthermore, because multiple planes can be modified using a system according to the present disclosure, the precision and repeatability of the Lapidus procedure can be improved.

[0010] Furthermore, the cutting guide according to the present disclosure may allow the surgeon to make two (non-parallel) cuts that may have nearly the same starting point, which may allow the Rapidus procedure to be performed with a smaller incision (e.g., about 3 mm) than traditional approaches (e.g., with an approximately 3 cm incision), which may reduce scar size, healing time, and risk of infection compared to traditional full exposure techniques.

[0011] 1 and 2 depict an example cutting guide 100 according to an example of the present disclosure. The cutting guide 100 may have a distal portion 102 and a proximal portion 104. The cutting guide 100 may include a base body 110 and a cutting slot block 120, for example, at or near the distal portion 102.

[0012] In some examples, the foundation body 110 can be secured to a patient's bone (e.g., the medial cuneiform bone). In some examples, the foundation body 110 can include a first fixation block 112. The first fixation block 112 can include a first fixation mechanism 114 for securing the foundation body 110 (including the first fixation block 112) to the patient's bone. In some examples, the first fixation mechanism can be one or more holes 114 formed in the first fixation block 112. The one or more holes 114 can be configured to receive bone fasteners. In some examples, the bone fasteners can be pins, screws, tacks, or K-wires. In other examples, the bone fasteners can be any other suitable fastening device capable of securing (temporarily or removably) the foundation body 110 / first fixation block 112 to the patient's bone. In some examples, the bone fasteners can include a hat that can prevent the bone fastener from penetrating the bone deeper than a predetermined length (to prevent unintentional penetration of another bone). In certain examples, the first fixation mechanism may be a fastener or any other suitable device capable of securing (temporarily or removably) the base body 110 / first fixation block 112 to the patient's bone (e.g., the medial cuneiform bone).

[0013] The cutting slot block 120 can be configured to provide a guide for cutting one or more bones of a patient (e.g., medial cuneiform, first metatarsal). The cutting slot block 120 can be rotatably coupled to the base body 110 / first fixation block 112. The cutting slot block 120 can include a rotation axis A1. The cutting slot block 120 can rotate in a first rotation direction 121, for example, about the rotation axis A1. In some examples, the first rotation direction 121 can be in a first plane. The first plane can be a horizontal plane or substantially parallel to a horizontal plane (e.g., when the cutting guide 100 is attached to a person's body).

[0014] In certain examples, the difference between the maximum and minimum angles of cutting slot block 120 can be at least 15°, at least 20°, at least 25°, at least 30°, or in a range from about 15° to about 40°, such as from about 15° to about 25°, from about 25° to about 35°, and / or from about 35° to about 40°. In other examples, the difference between the maximum and minimum angles of angle marking 134 can have any other suitable value (e.g., less than 15° or more than 40°).

[0015] The cutting slot block 120 may include a cutting slot guide 122 and a slot 127 defined by the cutting slot guide 122. In some examples, the slot 127 may be formed within or on the surface of the cutting slot guide 122. The slot 127 (in combination with the cutting slot guide 122) may provide a guide for a bone-cutting device. Examples of bone-cutting devices may include a burr drill, a blade, an osteotome, and a reciprocating saw. In some examples, the cutting slot guide 122 may include a first plate 123 and a second plate 124. A bottom portion of the first plate 123 and a bottom portion of the second plate 124 may be connected to each other through a connecting portion 125. The slot 127 may be defined by the first plate 123, the second plate 124, and the connecting portion 125. In other examples, the cutting slot block 120 / cutting slot guide 122 / slot 127 may have any other suitable shape / structure (e.g., one or more rods / pole / plates with or without one or more holes / slots / grooves) as long as it is capable of guiding a bone cutting device.

[0016] In one example, the cutting guide 100 may include a gauge block 130. The gauge block 130 may be configured to provide an indication of the angle of the cut slot block 120. The gauge block 130 may be used to measure the angle of the cut slot block 120. For example, the gauge block 130 may have angle markings 134 (e.g., from -10° to 30°). The angle markings 134 may be located on the top and / or side of the gauge block 130.

[0017] 1 and 2 , the maximum and minimum angles at angle marking 134 are shown as 30° and −10°, respectively, with the difference between these two angles being 40°. However, angle marking 134 can have any other suitable angle value. In certain examples, the difference between the maximum and minimum angles at angle marking 134 can be at least 15°, at least 20°, at least 25°, at least 30°, or in a range from about 15° to about 40°, such as from about 15° to about 25°, from about 25° to about 35°, and / or from about 35° to about 40°. In other examples, the difference between the maximum and minimum angles at angle marking 134 can have any other suitable value (e.g., less than 15° or more than 40°).

[0018] In some examples, the cutting guide 100 may further include a rotating arm 140. The rotating arm 140 may extend outward from the distal portion 102 (e.g., a rotation axis A1 of the cutting slot block 120), for example, to the proximal portion 104 of the cutting guide 100. The rotating arm 140 may rotate relative to the base body 110 / first fixation block 112 / gauge block 130. The rotating arm 140 may rotate about the rotation axis A1 in a first rotational direction 121. In some examples, the cutting slot block 120, the gauge block 130, and the rotating arm 140 may be connected to and rotate about the same hinge point / pin, which may serve as the rotation axis (e.g., rotation axis A1).

[0019] In some examples, the rotating arm 140 can be coupled to the cutting slot block 120. The rotating arm 140 can rotate the cutting slot block 120 relative to the base body 110 / first fixed block 112. That is, rotation of the rotating arm 140 can cause rotation of the cutting slot block 120. In other examples, rotation of the rotating arm 140 can be independent of rotation of the cutting slot block 120.

[0020] In some examples, the rotating arm 140 may include a first engagement structure 142. The first engagement structure 142 may be configured to engage and disengage the rotating arm 140 from the base body 110 / gauge block 130. The base body 110 / gauge block 130 may include a second engagement structure 132. The second engagement structure 132 may be configured to engage with the first engagement structure 142. In some examples, the first engagement structure 142 may be a (spring-loaded) blade, and the second engagement structure may be a plurality of notches. In other examples, the first engagement structure 142 and the second engagement structure 132 may have any other suitable structure (e.g., worm gear / threaded component-notches) that can be engaged / disengaged with each other.

[0021] In certain examples, the rotating arm 140 may further include a graspable device (e.g., a knob) 145 coupled to the first engagement structure 142. The first engagement structure 142 may be engaged / disengaged with the second engagement structure 132 via the graspable device 145. For example, when the graspable device 145 is pulled in one direction (e.g., toward the proximal portion 104 of the cutting guide 100), the first engagement structure 142 may be disengaged from the second engagement structure 132. When the graspable device 145 is pushed in a second direction opposite the first direction (e.g., toward the distal portion 102 of the cutting guide 100), the first engagement structure 142 may be engaged with the second engagement structure 132. In one example, the first engagement structure 142 may be spring loaded, and the graspable device 145 may automatically be pushed in the second direction when the force pulling the graspable device 145 in the first direction is removed.

[0022] In some examples, the first engagement structure 142 can serve as an indicator that can point to the angle marking 134. For example, as shown in FIG. 2, the first engagement structure 142 (e.g., a blade) can indicate the angle of the rotating arm 140 / cutting slot block 120 relative to the angle marking 134 (e.g., −10° in FIG. 2). In some examples, the indicator can be provided on the cutting slot block 120, the base body 110, or the rotating arm 140.

[0023] In some examples, the rotating arm 140 may include a locking mechanism. For example, if the graspable device 145 can be rotated a predetermined angle (e.g., 45° or 90°) in one direction (e.g., counterclockwise) while the first engagement structure 142 is engaged with the second engagement structure 132, the rotating arm 140 may be locked with the base body 110 / gauge block 130, and the graspable device 145 cannot be pulled in the first direction. To unlock the rotating arm 140, the graspable device 145 can be rotated a predetermined angle (e.g., 45° or 90°) in the other direction (e.g., clockwise). In this manner, the locking mechanism can lock the angle of the rotating arm 140 relative to the base body 110 / gauge block 130. As the rotating arm 140 rotates with the cutting slot block 120 , the locking mechanism of the rotating arm 140 can also lock the angle of the cutting slot block 120 relative to the base body 110 / gauge block 130 .

[0024] In some examples, the gauge block 130 may be part of the base body 110. In this case, the gauge block 130 may be integral with and / or permanently fixed to the first fixture block 112, as shown in FIGS.

[0025] In other examples, the gauge block 130 may be separate from the base body 110 / first fixed block 112. In some examples, the gauge block 130 may be coupled to / moved with the cut slot block 120. In this case, the rotating arm 140 may rotate independently of the cut slot block 120.

[0026] 3-5 illustrate a first repositioning guide block 200 according to an example embodiment of the present disclosure. In some examples, a system according to the present disclosure may further include the first repositioning guide block 200. The first repositioning guide block 200 can provide guidance for rotating a patient's bone (e.g., a first metatarsal bone), for example, in a second rotational direction 205. The second rotational direction 205 can be in a second plane. The second plane can be the frontal plane or substantially parallel to the frontal plane (e.g., when the first repositioning guide block 200 is attached to a person's body).

[0027] The first repositioning guide block 200 may include a first portion 202 and a second portion 204. In some examples, the first portion 202 may be curved. In other examples, the first portion 202 may have any other suitable shape (e.g., a straight rod with or without one or more bend points).

[0028] First portion 202 may include an elongated slot 210. Elongated slot 210 may be provided to receive a bone fastener. The bone fastener may be inserted into elongated slot 210 (and ultimately percutaneously into the patient's bone) and moved along elongated slot 210 in a second rotational direction 205. Elongated slot 210 may include a first elongated surface 212 and a second elongated surface 214 opposite first elongated surface 212. First elongated surface 212 and / or second elongated surface 214 may include a plurality of grooves 213 / 215 configured to receive the bone fastener. Grooves 213 / 215 may be sized to securely receive the bone fastener or may be smaller than the bone fastener. In this manner, the patient's bone (e.g., the first metatarsal) may be rotated for modification in a second plane (the frontal plane) and / or temporarily fixed in a desired position during surgery.

[0029] In one example, the second portion 204 of the first repositioning guide block 200 can include one or more holes 220. The one or more holes 220 can be provided to receive bone fasteners. For example, the bone fasteners can be inserted into the one or more holes 220 of the second portion 204 and ultimately inserted, for example, percutaneously, into one or more bones (e.g., the second metatarsal and / or the third metatarsal) of the patient. In this manner, the first repositioning guide block 200 can be stably fixed to the patient's body / bones (other than the bone, such as the first metatarsal, that is intended to be corrected / rotated).

[0030] FIG. 6 illustrates the first repositioning guide block 200 of FIG. 3 applied to a human bone. The skin of the foot has been omitted from FIG. 6 for illustrative purposes only. As shown in FIG. 6 , a first bone fastener 271 can pass through the hole 220 in the second portion 204 of the first repositioning guide block 200 and can be inserted, for example, into the second metatarsal 430 to temporarily secure the first repositioning guide block 200 to the patient's body (e.g., foot). A second bone fastener 272 can pass through the elongated slot 210 and can be inserted into the first metatarsal 420 positioned next to the medial cuneiform 410. A lateral portion of the second bone fastener 272 can be inserted into or positioned around the grooves 213 / 215 formed in the (first / second) elongated surfaces to temporarily secure the second bone fastener 272 (and ultimately the first metatarsal) in a desired position during surgery.

[0031] FIG. 7 illustrates the cutting guide 100 of FIG. 1 and the first repositioning guide block 200 of FIG. 3 applied to a human bone. As shown in FIG. 7, the first bone fastener 171 and the second bone fastener 172 can pass through holes 114 formed on / in the foundation body 110 / first fixation block 112 and can be inserted, for example, into the medial cuneiform bone 410 to temporarily fixate the foundation body 110 / first fixation block 112 to the patient's body (e.g., foot). At this time, the cutting slot block 120 can be positioned adjacent to the joint between the medial cuneiform bone 410 and the first metatarsal bone 420. The first and second bone fasteners 171 / 172 can be positioned so that they do not intersect with each other or the joint.

[0032] 8-10 show a second repositioning guide block 300 applied to a cutting guide 100 according to an example embodiment of the present disclosure. In FIGS. 8-10, the first engagement structure 142 of the cutting guide 100 can be a worm gear / threaded component, and the second engagement structure 132 of the cutting guide 100 can be a plurality of notches. In this case, the rotating arm 140 can include a separate support portion 146 (instead of having the first engagement structure 142 serve as the support portion). Most of the configurations / features / characteristics of the cutting guide 100 in FIGS. 8-10 can be similar and / or the same as those previously described in connection with the cutting guide of FIGS. 1-2, and therefore, repeated description can be omitted.

[0033] In some examples, the system may further include a second repositioning guide block 300. The second repositioning guide block 300 may be removably coupled to the cutting guide 100 (e.g., the rotation arm 140). The second repositioning guide block may be provided to rotate a patient's bone (e.g., the first metatarsal). In some examples, the second repositioning guide block 300 may rotate the patient's bone (e.g., the first metatarsal) in a third rotational direction 302. The third rotational direction 302 may be in a first plane (e.g., a horizontal plane). In some examples, the third rotational direction 302 may be the same as the first rotational direction 121. In other examples, the third rotational direction 302 may be different from the first rotational direction 121.

[0034] The second repositioning guide block 300 may comprise a second arm 310 that is removably coupled to the cutting guide 100 (e.g., the rotating arm 140). In FIGS. 8-10 , the second repositioning guide block 300 is coupled to the rotating arm 140 of the cutting guide 100, but the second repositioning guide block 300 may be coupled to any other suitable portion of the cutting guide 100. The second arm 310 may comprise a first end portion 312, a second end portion 314 opposite the first end portion 312, and an intermediate portion 316 between the first end portion 312 and the second end portion 314. In some examples, the cutting guide 100 may be positioned near the first end portion 312 or the intermediate portion 316 of the second arm 310.

[0035] In some examples, the second arm 310 may include a slot 318. The slot 318 may define a path / length along which the second repositioning guide block 300 may translate / rotate relative to the cutting guide 100 (e.g., the rotation arm 140). In some examples, the slot 318 may extend from the first end portion 312 to the middle portion 316 of the second arm 310. In other examples, the slot 318 may extend from the first end portion 312 to any other suitable portion of the second arm 310 (e.g., the second end portion 314), or may only be formed in the first end portion 312.

[0036] In some examples, a fastener 305 may be provided and inserted into the slot 318 to couple the second repositioning guide block 300 (e.g., second arm 310) with the cutting guide 100 (e.g., rotating arm 140). In some examples, the cutting guide 100 / rotating arm 140 may include a hole configured to receive the fastener. The fastener 305 may have a threaded engagement with the hole.

[0037] In one example, the fastener 305 can include a first portion having a width smaller than the width of the slot 318 and a second portion 307 having a width larger than the width of the slot 318. When the first portion is inserted into the slot 318 and ultimately into the hole in the cutting guide 100 (e.g., the rotation arm 140), the second portion 307 can press against the second arm 310, thereby temporarily securing the second repositioning guide block 300 (e.g., the second arm 310) to the cutting guide 100.

[0038] In some examples, the fastener 305 may also include a graspable device 308 (e.g., a knob). The graspable device 308 can be turned in one direction (e.g., clockwise) to secure the second repositioning guide block 300 to the cutting guide 100. When a user wishes to move the second repositioning guide block 300 relative to the cutting guide 100, for example, along the slot 318, the graspable device 308 can be turned in the other direction (e.g., counterclockwise). In this manner, the second repositioning guide block 300 can be locked / unlocked with the cutting guide 100. The second repositioning guide block 300 can be fully disengaged from the cutting guide 100 when the graspable device 308 is fully turned in this direction and removed from the cutting guide 100.

[0039] In some examples, the second repositioning guide block 300 may further include a second fixation block 320. The second fixation block 320 may be disposed on the second end portion 314 of the second arm 310. The second fixation block 320 may include a second fixation mechanism 322 for securing the second fixation block 320 to a patient's bone (e.g., the first metatarsal). In some examples, the second fixation mechanism 322 may be one or more holes formed in the second fixation block 320. The one or more holes may be configured to receive bone fasteners. In other examples, the second fixation mechanism 322 may be a fastener or any other suitable device capable of securing (temporarily or removably) the second repositioning guide block 300 / second fixation block 320 to a patient's bone (e.g., the first metatarsal). The second fixation block 320 may be percutaneously secured to the patient's bone.

[0040] In one example, the second fixing block 320 may include a base fixing block 321, a first protrusion 323, and a second protrusion 325. The first protrusion 323 and the second protrusion 325 may extend from the base fixing block 321.

[0041] In some examples, the second repositioning guide block 300 may further include a compression member 330. The compression member 330 may be disposed between the second arm 310 and the second fixation block 320. The compression member 330 may be configured to move the second fixation block 320 relative to the second arm 310 in a fourth direction 335 between an anterior position (e.g., toward the medial cuneiform bone) and a posterior position (e.g., away from the medial cuneiform bone). In some examples, the fourth direction 335 may be in a third plane. The third plane may be a sagittal plane or substantially parallel to the sagittal plane (e.g., when the second repositioning guide block 300 is attached to a person's body).

[0042] In one example, the compression portion 330 may include a screw fastener 332. The second arm 310 may include a through hole, for example at the second end portion 314, configured to receive the compression portion 330. The through hole in the second arm 310 may be in threaded engagement (e.g., having an internal thread) with the compression portion 330. In this case, rotation of the screw fastener 332 can move the screw fastener 332 between a forward position and a rearward position relative to the second arm 310. In other examples, the compression portion 330 can be moved back and forth by any other suitable technique (e.g., simply pushing or pulling the compression portion 330 back and forth).

[0043] The compression portion 330 may have a middle portion and an end portion. The second arm 310 may be connected to the middle portion of the compression portion 330 through a hole in the second end portion 314, and the second fixing block 320 may be connected to the end portion of the compression portion 330 through a first protrusion 323 and a second protrusion 325. The first protrusion 323 and the second protrusion 325 may be permanently coupled to the compression portion 330. Therefore, the second fixing block 320 can move together with the compression portion 330 in the fourth direction 335 (when the compression portion 330 is rotated).

[0044] In one example, the compression portion 330 may include a driver engagement recess 334. In this case, the compression portion 330 may be turned / rotated through a driver configured to engage with the driver engagement recess 334, thereby translating between a forward position and a rearward position.

[0045] FIG. 11 illustrates the second repositioning guide block 300 and cutting guide 100 of FIGS. 8-10 applied to a human bone. In FIG. 11, the skin of the foot has been omitted for illustrative purposes only. As shown in FIG. 11, one or more bone fasteners 171 / 172 can be passed through one or more holes 114 formed on / in the foundation body 110 / first fixation block 112, for example, inserted into the medial cuneiform bone to temporarily fixate the foundation body 110 / first fixation block 112 to the patient's body (e.g., foot). The cutting slot block 120 can then be positioned adjacent to the joint between the medial cuneiform bone and the first metatarsal bone.

[0046] In Figure 11, the second repositioning guide block 300 is coupled to the cutting guide 100 (e.g., rotating arm 140). As shown in Figure 11, one or more bone fasteners 371 can pass through one or more holes formed on / in the second fixation block 320, for example, to be inserted into the first metatarsal bone to temporarily fixate the second repositioning guide block 300 / second fixation block 320 to the patient's body (e.g., foot).

[0047] In one example, a first method for minimally invasive rapidus surgery may be provided. The first method may include securing a foundation body 110 of a cutting guide 100 to a first bone (e.g., a medial cuneiform bone) of a patient. In one example, the foundation body 110 may be secured to the first bone of the patient by percutaneously inserting bone fasteners through holes 114 in the foundation body 110 and into the first bone.

[0048] In some examples, the first method may further include positioning the cutting slot block 120 at a first angle (e.g., 0° or any other suitable angle). In some examples, the cutting slot block 120 may be temporarily fixed at the first angle by locking the position of the cutting slot block 120 via the rotating arm 140 (e.g., the graspable device 145). In some examples, the first angle may be marked as a reference point.

[0049] Thus, one of a first bone (e.g., medial cuneiform bone) and a second bone (e.g., first metatarsal bone) can be cut at a first angle by inserting a bone-cutting device (e.g., a burr drill) through slot 127 of cutting slot block 120 into an incision formed between the first and second bones (hereinafter, the "first cut"). In one example, cutting slot block 120 can be locked at the first angle during the first cut and unlocked after the first cut.

[0050] FIG. 12 is a top view of the anatomy of a patient's foot suffering from a bunion. As shown in FIG. 12, a first incision 510 can be made, for example, on the lateral side of the foot, near the joint between a first bone 520 (e.g., the medial cuneiform) and a second bone 530 (e.g., the first metatarsal). In some examples, the first cut can be made along a line 540, for example, across the first bone 520 (e.g., the medial cuneiform) and, in some cases, across the second bone 530 (in addition to the first bone 520). In some examples, the line 540 of the first cut can be substantially parallel to the joint line between the first bone 520 and the second bone 530. In some examples, the first cut can be intended to trim a surface on the first bone 520 (e.g., the medial cuneiform) down to a bleeding bone surface to prepare the first bone 520 for fusion.

[0051] The cutting slot block 120 can then be rotated to a second angle different from the first angle, and one of the first bone 520 and the second bone 530 can be cut by inserting a bone-cutting device into the incision through the slot 127 of the cutting slot block 120 at the second angle (hereinafter, the "second cut"). In one example, the cutting slot block 120 can be temporarily fixed at the second angle by locking the position of the cutting slot block 120 via the rotating arm 140 (e.g., the graspable device 145). The slot 127 can be aligned with the hinge rotation axis A1 so that the angle of the cutting slot block 120 can be adjusted for the (first / second) cut through the same small incision 510.

[0052] In certain examples, the size of the first incision 510 can range from about 3 mm to about 10 mm, such as, for example, from about 3 mm to about 5 mm, from about 5 mm to about 7 mm, from about 7 mm to about 9 mm, and / or from about 9 mm to about 10 mm. In other examples, the incision 510 can have any other suitable size (less than 3 mm or greater than 10 mm).

[0053] The difference between the second angle and the first angle can be in a range of about 10° to about 25°, such as about 10° to about 15°, about 15° to about 20°, or about 20° to about 25°. In other examples, the difference between the second angle and the first angle can have any other suitable range (e.g., less than about 10° or more than about 25°).

[0054] In some examples, a second cut may be made along line 550 to cut second bone 530. First cut line 540 may include a first end near incision 510 and a second end opposite the first end. Second cut line 550 may include a first end near incision 510 and a second end opposite the first end. In some examples, the distance between the first end of first cut line 540 and the first end of second cut line 550 may be less than the distance between the second end of first cut line 540 and the second end of second cut line 550. In some examples, the first end of first cut line 540 and the first end of second cut line 550 may meet at the same point. That is, the first cut and the second cut may have the same (or nearly the same) starting point. In one example, the first end of the first cutting line 540 and the first end of the second cutting line 550 can be positioned within the slot 127 of the cutting guide 100 and / or at the rotation axis A1.

[0055] In certain examples, the distance between the first end of the first cut line 540 and the first end of the second cut line 550 can be less than (or half the size of) the size of the first incision 510. For example, the distance between the first end of the first cut line 540 and the first end of the second cut line 550 can be less than 3 mm, less than 2 mm, less than 1.5 mm, less than 1 mm, less than 0.5 mm, less than 0.3 mm, or less than 0.1 mm.

[0056] The portions of the first bone 520 and / or the second bone 530 cut by the bone-cutting device may be removed. For example, the bone 532 cut by the first and second cuts can be removed. In some examples, the portions of the first bone 520 and / or the second bone 530 cut by the bone-cutting device can be wedge-shaped, as shown in FIG. 12 .

[0057] In some examples, cartilage and any tissue that may prevent healing between the remaining first and second bones may be removed during or before removing the cut bone 532. In some examples, one or more additional incisions are provided. For example, a second incision 515 may be made on the dorsal / superior side of the foot. The surgeon may perform irrigation through the second incision 515 to clean debris and any removed material. The size of the second incision 515 may be the same as or similar to the size of the first incision 510. The second incision 515 may be made to protect soft tissue (e.g., blood vessels, tendons, muscles) that should not be cut / removed during the first / second cut. For example, a blocking device may be provided through the second incision 515 to prevent a bone-cutting device (e.g., a burr drill) from cutting soft tissue that needs to be protected.

[0058] In one example, after the severed bone (e.g., wedge 532) is removed, the distal end of the second bone 530 may be pulled back toward the third bone 560 (e.g., the second metatarsal) so that the second bone 530 is aligned with the other bone (e.g., the other metatarsal). During this process, and / or through a separate process, the remaining portion 534 of the second bone 530 may be pushed closer to the first bone 520 and fused together (e.g., the first metatarsal is screwed, plated, or fixed to the medial cuneiform bone via any suitable means, such as pins, internal nails, or staples) so that the two bones are united to form one new, non-articular bone. The body can then begin the healing process, which can cause the two bones to grow together.

[0059] In one example, before securing the foundation body 110 to the first bone of the patient, the cutting guide can be placed along the first bone 520, bone fasteners can be inserted into the joint between the first bone 520 and the second bone 530, and the bone fasteners can then be positioned in the slots 127 of the cutting slot block 120 to ensure proper alignment of the cutting guide 100 / cutting slot block 120 with the joint. This can help the surgeon visualize the rest of the joint that they cannot see from the incision 510 and set / adjust the angle of the cutting slot block 120.

[0060] In certain examples, the method may further include, prior to securing the foundation body 110 to the first bone of the patient, securing the first repositioning guide block 200 to a third bone of the patient (e.g., the second metatarsal 560 or the third metatarsal 570) using a first bone fastener by percutaneously inserting the first bone fastener through the hole 220 in the second portion 204 of the first repositioning guide block 200 and into the third bone. The first repositioning guide block 200 may be configured to provide guidance for rotating the second bone 530 of the patient (e.g., the first metatarsal) in the second rotational direction 205.

[0061] A second bone fastener may then be percutaneously inserted through the elongated slot 210 in the first portion 202 of the first repositioning guide block 200 and into the second bone 530. The second bone 530 may be rotated in a second rotational direction 205 using the second bone fastener. For example, the second bone 530 may be rotated along the elongated slot 210 about the axis of the second bone 530, for example, in a second plane (e.g., the coronal plane) using the second bone fastener. After modification of the second bone 530 in the second plane, a side of the second bone fastener can be placed into one of the grooves 213 / 215 in the first / second elongated surfaces 212 / 214 of the elongated slot 210 to prevent rotation of the second bone 530 in the second rotational direction 205 in the second plane (or, when the grooves 213 / 215 are sized smaller than the bone fastener, the elongated slot 210 clamps the bone fastener from both sides). This can prevent the second bone 530 from rotating back to its original position after modification of the second bone 530 in the second plane. Modification in the second plane can be completed before the first and second cuts.

[0062] In one example, a second method for minimally invasive rapidus surgery may be provided. The second method may include securing the foundation body 110 of the cutting guide 100 to a first bone (e.g., the medial cuneiform bone) of the patient. In one example, the foundation body 110 may be secured to the first bone of the patient by percutaneously inserting bone fasteners through the holes 114 in the foundation body 110 and into the first bone.

[0063] 13 , in a second method, a first cut 540 may be made, for example, along a line 540 across a second bone 530 (e.g., a first metatarsal). In some examples, the line 540 of the first cut may be substantially parallel to the joint line between the first bone 520 and the second bone 530. In some examples, the first cut 540 may be intended to cut away a surface on the second bone 530 (e.g., a first metatarsal) to a bleeding bone surface to prepare the second bone 530 for fusion.

[0064] In a second method, a second cut 540 may be made along a line 550 to cut a first bone 520 (e.g., the medial cuneiform bone). The first cut line 540 may include a first end near the incision 510 and a second end opposite the first end. The second cut line 550 may include a first end near the incision 510 and a second end opposite the first end. In some examples, the distance between the first end of the first cut line 540 and the first end of the second cut line 550 may be less than the distance between the second end of the first cut line 540 and the second end of the second cut line 550. In some examples, the first end of the first cut line 540 and the first end of the second cut line 550 may meet at the same point. That is, the first cut and the second cut may have the same (or nearly the same) starting point. In one example, the first end of the first cutting line 540 and the first end of the second cutting line 550 can be positioned within the slot 127 of the cutting guide 100 and / or at the rotation axis A1.

[0065] The portion of the first bone 520 and / or the second bone 530 cut by the bone cutting device may be removed. For example, the bone 522 cut by the second cut 550 can be removed.

[0066] In one example, after the severed bone (e.g., bone 522) is removed, the second bone 530 may be pulled back toward the third bone 560 (e.g., the second metatarsal) so that the second bone 530 is aligned with the other bone (e.g., the other metatarsal). During this process, and / or through a separate process, the second bone 530 may be pushed closer to the first bone 520 and fused together (e.g., the first metatarsal is screwed, plated, or fixed to the medial cuneiform bone via any suitable means, such as pins, internal nails, or staples) so that the two bones are united to form one new, non-articular bone.

[0067] Most of the other / additional steps, processes, and / or features of the second method for minimally invasive rapidus surgery may be similar and / or the same as those previously described with respect to the first method (e.g., the distance between the first end of the first cutting line 540 and the first end of the second cutting line 550, additional incisions, steps prior to fixing the base body 110), and therefore redundant descriptions may be omitted.

[0068] If the first metatarsal is not corrected in the frontal plane, bone misalignment problems can occur. For example, two small bones called sesamoid bones are located below the first metatarsal, and if the metatarsal is corrected only in the horizontal plane, these bones can be misaligned, which can cause significant imbalance in the underlying soft tissue around the toes. This can also lead to various other bunion-related problems. Embodiments of the present disclosure can provide a method for correcting frontal plane rotation, for example, using the first repositioning guide block 200 (and the third repositioning guide block 600, discussed in detail below), which can ensure that the sesamoid bones are positioned below and behind the articulation with the phalanges.

[0069] In one example, before securing the first repositioning guide block 200 to the third bone, soft tissue release may be performed through the incision 510 inside the joint between the first bone 520 and the second bone 530 to completely free the joint. The released soft tissue may include ligaments that may hold the first and second bones together. Portions of this soft tissue may be cut or removed to allow the second bone 530 to move to correct its angle / position. This soft tissue release may detach the second bone 530 from the first bone 520, completely freeing the space between the two bones to prepare them for fusion. The soft tissue release may be performed through a scalpel or any other suitable sharp device. After the soft tissue release, the connection between the first bone 520 and the second bone 530 may be loosened but may still be held together to some extent through muscles and tendons. In some instances, a distraction device may be used to loosen the connection between the first bone and the second bone.

[0070] In some instances, bone fasteners such as K-wires may be used for temporary fixation of the joint after the second bone 530 has been repositioned and pressed against the first bone 520. For example, tacks / pins may first be used to secure the cutting guide 100 to the first bone 520, and the tacks / pins may be replaced with K-wires that may intersect the joint for temporary fixation before removing the cutting guide 100. With the joint fixed, the first repositioning guide block 200 and any associated bone fasteners may be removed. Fixation of the first bone 520 and the second bone 530 may be completed by placing tubular screws over the K-wires used for temporary fixation, placing solid screws percutaneously, inserting one or more small plates (e.g., smaller than the incisions 510 / 515) through the small incisions 510 / 515, and / or any other suitable fixation method.

[0071] In some examples, the cutting guide 100 can be used in conjunction with the second repositioning guide block 300 to modify the alignment of the second bone 530. The second repositioning guide block 300 can be used to translate or rotate the second bone (e.g., the first metatarsal) in a first plane (e.g., the horizontal plane) and / or a third plane (e.g., the sagittal plane).

[0072] The second arm 310 of the second repositioning guide block 300 can be removably coupled to the cutting guide 100 (e.g., the rotating arm 140), and the second fixation block 320 of the second repositioning guide block 300 can be percutaneously fixed to a second bone 530 of the patient.

[0073] After the second cut, the cutting slot block 120 / rotation arm 140 can be at a second angle. At this time, the second repositioning guide block 300 can be locked with the translation arm 140 / cutting guide 100. In this locked state, the translation arm 140 / cutting guide 100 can be rotated to a third angle, for example, for correction of the second bone in a first plane (e.g., the horizontal plane). In some examples, the third angle can be the same or similar to the first angle.

[0074] In one example, the second bone 530 can be moved back and forth along the longitudinal axis of the second bone 530 using the compression portion 330 of the second repositioning guide block 300. The second bone 530, coupled to the compression portion 330 via the second fixation block 320, can be pushed toward the first bone 520 by pushing the compression portion 330 forward for correction in a third plane (sagittal plane).

[0075] 14-15 show a third repositioning guide block 600 applied to the cutting guide 100 according to an example embodiment of the present disclosure. The third repositioning guide block 600 may be a combination of the first repositioning guide block 200 and the second repositioning guide block 300, and / or may be capable of providing the functions provided by the first repositioning guide block 200 and the second repositioning guide block 300. In FIGS. 14-15, the first engagement structure 142 of the cutting guide 100 may be a worm gear / threaded component, and the second engagement structure 132 of the cutting guide 100 may be a plurality of notches. Most of the configurations / features / characteristics of the cutting guide 100 in FIGS. 14-15 may be similar and / or the same as those previously described in connection with the cutting guides of FIGS. 1, 2, and 8-10, and therefore, redundant description may be omitted.

[0076] 14-15, in some examples, the third repositioning guide block 600 can be mounted to the cutting slot block 120 of the cutting guide 100. For example, one of the third repositioning guide block 600 and the cutting slot block 120 can have a passageway, and the other can have a section that fits within the passageway. The third repositioning guide block 600 can translate relative to the cutting slot block 120 (e.g., dorsal / plantar translation 602 and / or a fourth rotational direction in the horizontal plane 605). In some examples, the third repositioning guide block 600 can be translated by a threaded mechanism.

[0077] In one example, the third repositioning guide block 600 may include a third arm 610 and a third fixation block 620. The third arm 610 may extend away from the cutting slot block 120. Referring to FIG. 16 , the third fixation block 620 may include a through hole or passageway 630 configured to receive the third arm 610. The third fixation block 620 may be movable along the third arm 610 between a forward position and a rearward position. For example, the third fixation block 620 may include a threaded component held in a manner that provides a threaded engagement with the third arm 610. In this case, rotation of the threaded component may move the third fixation block 620 relative to the third arm 610 between the forward position and the rearward position.

[0078] In some examples, the third fixation block 620 may include a third fixation mechanism 622 for securing the third fixation block 620 to a patient's bone (e.g., the first metatarsal). In some examples, the third fixation mechanism 622 may be one or more holes formed in the third fixation block 620. The one or more holes may be configured to receive bone fasteners. In other examples, the third fixation mechanism 622 may be a fastener or any other suitable device that can secure (temporarily or removably) the third repositioning guide block 600 / third fixation block 620 to a patient's bone (e.g., the first metatarsal). The third fixation block 620 may be percutaneously secured to the patient's bone.

[0079] As shown in FIGS. 14-17 , in some examples, the third fixation block 620 can include an elongated slot 640 configured to receive a bone fastener. In some examples, the elongated slot 640 can be the same as or similar to the elongated slot 210 of the first repositioning guide block. In some examples, the elongated slot 640 can be tapered, with an opening at one end that is larger than the bone fastener and a gap between the opposing surfaces that is smaller than the bone fastener at the other end of the slot. The bone fastener can be inserted into the elongated slot 640 at an end of the slot width (ultimately percutaneously into the patient's bone) and moved along the elongated slot 640 in the second rotational direction 205. The elongated slot 640 can include a first elongated surface 642 and a second elongated surface 644 opposite the first elongated surface 642. The first elongated surface 642 and / or the second elongated surface 644 may include a plurality of grooves 643 / 645 configured to receive bone fasteners. The surfaces of the elongated slots bear against the bone fasteners such that the grooves 643 / 645 prevent detorsion of the bone fasteners in the second rotational direction 205. Once the bone is rotated along the second rotational direction 205 to a desired position, another bone fastener is placed percutaneously through another hole in the third repositioning guide block 600 to fix the rotation of the bone relative to the third repositioning guide block 600 in the second rotational direction 205.

[0080] In one example, the third arm 610 can define a first longitudinal axis, and the elongated slot 640 can define a second longitudinal axis. The second longitudinal axis of the elongated slot 640 can be perpendicular to the first longitudinal axis of the third arm 610. Using the elongated slot 640 of the third repositioning guide block 600, the user can correct rotation in the frontal plane, which can ensure that the sesamoid bones are posterior to and below articulation with the phalanges.

[0081] Aspects of the present disclosure can guide a surgeon in making (wedge-shaped) osteotomies using a bone-cutting device (e.g., a burr drill) through a small incision for minimally invasive surgery (MIS), particularly for multi-planar Rapidus procedures. The cutting guide 100 according to the present disclosure allows the surgeon to make two cuts that may have nearly the same starting point, which can enable minimally invasive surgery with smaller incisions (e.g., about 3 mm) than traditional approaches (e.g., with approximately a 3 cm incision), thereby resulting in smaller scars, shorter soft tissue healing times, and a lower risk of infection compared to traditional full-exposure techniques.

[0082] Compared to other minimally invasive techniques in the related art, aspects of the present disclosure can allow for a greater degree of angular correction by enabling a wedge osteotomy instead of a single-plane bone cut. Furthermore, this approach to wedge osteotomy allows the surgeon to intraoperatively select the angle of the wedge cut based on, for example, the anatomy, allowing for intermetatarsal angle correction of greater than 20°. In certain examples, aspects of the present disclosure can be used for any near (wedge) osteotomy (e.g., metatarsal, metacarpal, phalangeal, tibia, radius, humerus).

[0083] Embodiment Various aspects of the subject matter described herein are set forth in the following numbered embodiments.

[0084] Embodiment 1. A system comprising a cutting guide, the cutting guide comprising: a base body configured to be secured to a first bone of a patient; and a cutting slot block configured to provide guidance for cutting at least one of the first bone and a second bone of the patient and rotatably coupled to the base body, the cutting slot block configured to rotate in a first rotational direction, and the cutting guide comprising a distal portion and a proximal portion.

[0085] Embodiment 2. The system of embodiment 1, wherein the first bone comprises a medial cuneiform bone.

[0086] Embodiment 3. The system of embodiments 1-2, wherein the second bone comprises a first metatarsal.

[0087] Embodiment 4. The system of embodiments 1-3, wherein the cutting guide further comprises a gauge block configured to indicate the angle of the cutting slot block.

[0088] Embodiment 5. The system of embodiment 4, wherein the difference between the maximum and minimum angles of the cutting slot blocks is at least 15°.

[0089] Embodiment 6. The system of embodiments 1-5, wherein the foundation body comprises a first fixation block, the first fixation block comprising a first fixation mechanism for fixing the foundation body to a first bone of the patient.

[0090] Embodiment 7. The system of embodiment 6, wherein the first fixation mechanism comprises at least one of a fastener and a hole configured to receive a bone fastener.

[0091] Embodiment 8. The system of any one of embodiments 1 to 7, wherein the cutting slot block comprises a cutting slot guide and a slot formed in or on the cutting slot guide.

[0092] Embodiment 9. The system of embodiments 1-8, wherein the cutting guide further comprises a rotating arm coupled to the cutting slot block and configured to rotate the cutting slot block relative to the base body, the rotating arm extending outward from the axis of rotation of the cutting slot block.

[0093] Embodiment 10. The system of embodiment 9, wherein the rotating arm comprises a first engagement structure configured to engage the rotating arm with the base body and disengage the rotating arm from the base body.

[0094] Embodiment 11. The system of embodiment 10, wherein the base body comprises a second engagement structure configured to be engaged with the first engagement structure.

[0095] Embodiment 12. The system of embodiment 11, wherein the first engagement structure comprises a blade and the second engagement structure comprises a notch.

[0096] Embodiment 13. The system of embodiments 10-12, wherein the rotating arm includes a locking mechanism configured to lock the angle of the cutting slot block relative to the base body.

[0097] Embodiment 14. The system of any one of embodiments 1 to 13, further comprising a first repositioning guide block configured to provide a guide for rotating a second bone of the patient in a second rotational direction.

[0098] Embodiment 15. The system of embodiment 14, wherein the first repositioning guide block comprises a first portion having an elongated slot.

[0099] Embodiment 16. The system of embodiment 15, wherein the first portion is curved.

[0100] Embodiment 17. The system of embodiments 15-16, wherein the elongated slot comprises a first elongated surface and a second elongated surface opposite the first elongated surface, and at least one of the first elongated surface and the second elongated surface comprises a plurality of grooves.

[0101] Embodiment 18. The system of any of embodiments 14-17, wherein the first repositioning guide block comprises a second portion having one or more holes configured to receive bone fasteners.

[0102] Embodiment 19. The system of any one of embodiments 1 to 18, further comprising a second repositioning guide block removably coupled to the rotation arm and configured to rotate a second bone of the patient.

[0103] Embodiment 20. The system of embodiment 19, wherein the second repositioning guide block is configured to rotate a second bone of the patient in a first rotational direction.

[0104] Embodiment 21. The system of embodiments 19-20, wherein the second repositioning guide block comprises a second arm detachably coupled to the rotating arm, the second arm having a first end portion at the cutting guide portion and a second end portion opposite the first end portion, and a second fixation block disposed at the second end portion, the second fixation block having a second fixation mechanism for fixing the second fixation block to a second bone of the patient.

[0105] Embodiment 22. The system of embodiment 21, wherein the second fixation mechanism comprises at least one of a fastener and a hole configured to receive a bone fastener.

[0106] Embodiment 23. The system of embodiments 21-22, wherein the second repositioning guide block further comprises a compression portion configured to move the second fixation block between a forward position and a rearward position relative to the second arm.

[0107] Embodiment 24. The system of embodiment 23, wherein the compression portion comprises a screw fastener.

[0108] Embodiment 25. The system of embodiments 23-24, wherein the compression portion has a driver engagement recess.

[0109] Embodiment 26. The system of embodiments 23 to 25, wherein the compression portion is disposed between the second arm and the second fixation block.

[0110] Embodiment 27. The system of any one of embodiments 19 to 26, wherein the second repositioning guide block is configured to move relative to the rotating arm.

[0111] Embodiment 28. The system of embodiments 1 to 27, wherein the cutting slot block is positioned in the distal portion of the cutting guide.

[0112] Embodiment 29. A method of using the system of embodiments 1 to 28, comprising the steps of: fixing a base body of the cutting guide to a first bone of a patient; positioning a cutting slot block at a first angle; and cutting at least one of the first bone and the second bone by inserting a bone cutting device through a slot in the cutting slot block into an incision between the first bone and the second bone at the first angle; rotating the cutting slot block to a second angle different from the first angle; and cutting at least one of the first bone and the second bone by inserting a bone cutting device through the slot in the cutting slot block into the incision at the second angle.

[0113] Embodiment 30. The method of embodiment 29, further comprising the step of removing a portion of the first bone and / or the second bone cut by the bone cutting device.

[0114] Embodiment 31. The method of embodiment 30, wherein the portion of the first bone or the second bone cut by the bone cutting device is wedge-shaped.

[0115] Embodiment 32. The method of any one of embodiments 29 to 31, wherein the incision size ranges from about 3 mm to about 10 mm.

[0116] Embodiment 33. The method of embodiments 29-32, further comprising locking the cutting slot block at a first angle.

[0117] Embodiment 34. The method of any one of embodiments 29-33, wherein the foundation body is secured to the first bone of the patient by percutaneously inserting bone fasteners through the holes in the foundation body and into the first bone.

[0118] Embodiment 35. The method of embodiments 29-34, further comprising the steps of: prior to securing the foundation body to the first bone of the patient, positioning a cutting guide along the first bone; inserting a bone fastener or other thin, straight device into the joint between the first bone and the second bone; and positioning the bone fastener in the slot of the cutting slot block to ensure proper alignment with the joint.

[0119] Embodiment 36. The method of embodiments 29 to 35, further comprising the steps of: before fixing the foundation body to the first bone of the patient, percutaneously inserting a first bone fastener into the third bone through a hole in the second portion of the first repositioning guide block, thereby fixing the first repositioning guide block to the third bone of the patient using the first bone fastener, the first repositioning guide block being configured to provide a guide for rotating the second bone of the patient in a second rotational direction; percutaneously inserting a second bone fastener into the second bone through an elongated slot in the first portion of the first repositioning guide block, and rotating the second bone in the second rotational direction using the second bone fastener; and positioning a side of the second bone fastener into or around one of the grooves in the first or second elongated surface of the elongated slot to prevent rotation of the second bone in the second rotational direction.

[0120] Embodiment 37. The method of embodiment 36, wherein the third bone includes at least one of the second metatarsal and the third metatarsal.

[0121] As used herein, "about," "approximately," and "substantially" are understood to refer to numbers in a numerical range, such as, for example, a range of -10% to +10% of the stated value, preferably a range of -5% to +5% of the stated value, more preferably a range of -1% to +1% of the stated value, and most preferably a range of -0.1% to +0.1% of the stated value. Furthermore, these numerical ranges should be interpreted as providing support for claims directed to any number or subset of numbers in that range. For example, a disclosure of 1 to 10 should be interpreted as supporting ranges of 1 to 8, 3 to 7, 1 to 9, 3.6 to 4.6, 3.5 to 9.9, etc.

[0122] Throughout this specification, references to "various aspects," "an aspect," "an example," "an other example," "in some cases," or "one aspect" mean that a particular feature, structure, or characteristic described in connection with an aspect is included in at least one example. Thus, appearances of the phrases "various aspects," "an aspect," "particular embodiment," "an example," "other example," "particular other embodiment," "in some cases," or "in one aspect" in various places throughout this specification do not necessarily all refer to the same aspect. Furthermore, a particular feature, structure, or characteristic illustrated or described in connection with an example may be combined, in whole or in part, with a feature, structure, or characteristic of one or more other aspects, without limitation.

[0123] When terms such as "on," "above," "below," "below," and "next to" are used to describe a positional relationship between two parts, one or more parts may be located between the two parts unless these terms are used in conjunction with the terms "directly" or "directly." Similarly, as used herein, "coupled," "mountable," "attached," "connectable," "connected," or any similar term may include directly or indirectly coupled, directly or indirectly attachable, directly or indirectly attached, directly or indirectly connectable, and directly or indirectly connected.

[0124] It should be understood that at least some of the figures and descriptions herein have been simplified to show elements relevant for a clear understanding of the disclosure, while excluding other elements for purposes of clarity. However, one of ordinary skill in the art will recognize that these and other elements may be desirable. However, because such elements are well known in the art and because they do not facilitate a better understanding of the disclosure, a discussion of such elements is not provided herein.

[0125] The terminology used herein is intended only to describe specific embodiments and is not intended to be limiting of the present disclosure. As used herein, the singular forms "a," "an," and "the" are intended to include the plural unless otherwise indicated. It is further understood that the terms "comprising" and / or "including," as used herein, specify the presence of stated features, integers, steps, operations, elements, and / or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and / or groups thereof. As used herein, "at least one of X or Y" or "at least one of X and Y" should be interpreted as X, Y, or X and Y.

[0126] It should be understood that various changes and modifications to the examples described herein will be apparent to those skilled in the art. Such changes and modifications can be made without departing from the spirit and scope of the present subject matter and without diminishing its intended advantages. It is therefore intended that such changes and modifications be covered by the appended claims. [Explanation of symbols]

[0127] 100 Cutting guide 102 Distal portion 104 Proximal part 110 Basic body 112 First Fixed Block 114 First fixing mechanism, hole 120 Cutting Slot Block 121 First rotation direction 122 cutting slot guide 123 First Board 124 Second Board 125 Connection part 127 Slots 130 gauge block 132 Second engagement structure 134 Angle mark 140 Rotating arm, translating arm 142 First engagement structure 145 Graspable Device 146 Instruction section 200 First repositioning guide block 202 First Part 204 Second Part 205 Second rotation direction 210 Long and narrow slot 212 First elongated surface 213, 215 groove 214 Second elongated surface 220 holes 271 First Bone Fastener 272 Second Bone Fastener 300 Second repositioning guide block 302 Third Rotation Direction 305 Fasteners 307 Second Part 308 Graspable Device 310 Second Arm 312 first end portion 314 Second end portion 316 Middle part 318 Slots 320 Second Fixed Block 321 Foundation fixing block 322 Second Fixing Mechanism 323 First protrusion 325 Second protrusion 330 Compression area 332 Screw fastener 334 Driver engagement recess 335 The Fourth Direction 371 Bone fastener 410 Medial cuneiform bone 420 First metatarsal 430 Second metatarsal 510 First incision 515 Second incision 520 First Bone 522 severed bones 530 Second Bone 532 Cut bone, wedge 534 Remaining part of second bone 530 540 First cutting line 550 Second cutting line 560 Third bone, second metatarsal 570 Third metatarsal 600 Third repositioning guide block 602 Dorsalis / Plantarsal Translation 605 Fourth Rotation Direction 610 Third Arm 620 Third Fixed Block 622 Third Fixing Mechanism 630 Through hole, passage 640 Long and narrow slot 642 First elongated surface 644 Second elongated surface 643, 645 groove A1 rotation axis

Claims

1. a foundation body configured to be secured to a first bone of the patient; a cutting slot block rotatably coupled to the base body, the cutting slot block configured to provide guidance for cutting at least one of the first bone and the second bone of the patient; A cutting guide comprising: The system includes a cutting guide, wherein the cutting slot block is configured to rotate in a first rotational direction, and the cutting guide includes a distal portion and a proximal portion.

2. The system of claim 1 , wherein the first bone comprises a medial cuneiform bone and the second bone comprises a first metatarsal bone.

3. The system of claim 1 , wherein the cutting guide further comprises a gauge block configured to indicate an angle of a cutting slot block.

4. The system of claim 3 , wherein the difference between the maximum and minimum angles of the cutting slot block is at least 15°.

5. 4. The system of claim 3, wherein the foundation body comprises a first fixation block, the first fixation block comprising a first fixation mechanism for securing the foundation body to the first bone of the patient.

6. The system of claim 5 , wherein the first fixation mechanism comprises at least one of a fastener and a hole configured to receive a bone fastener.

7. The cutting slot block is a cutting slot guide; a slot formed in or on the cutting slot guide; The system of claim 1 , comprising:

8. 2. The system of claim 1, wherein the cutting guide further comprises a rotating arm coupled to the cutting slot block and configured to rotate the cutting slot block relative to the base body, the rotating arm extending outward from an axis of rotation of the cutting slot block.

9. The rotating arm is a first engagement structure configured to engage the pivot arm with the base and disengage the pivot arm from the base; a second engagement structure configured to engage with the first engagement structure; The system of claim 8 , comprising:

10. The system of claim 9 , wherein the first engagement structure comprises a blade and the second engagement structure comprises a notch.

11. The system of claim 9 , wherein the rotating arm comprises a locking mechanism configured to lock the angle of the cutting slot block relative to the foundation body.

12. The system of claim 1 , further comprising a repositioning guide block removably coupled to the rotation arm and configured to rotate the second bone of the patient.

13. The system of claim 12 , wherein the repositioning guide block is configured to rotate the second bone of the patient in the first rotational direction.

14. The repositioning guide block is a second arm removably coupled to the rotating arm, the second arm having a first end portion at the cutting guide and a second end portion opposite the first end portion; a second fixation block disposed on the second end portion, the second fixation block including a second fixation mechanism for securing the second fixation block to the second bone of the patient; The system of claim 12, comprising:

15. The system of claim 14 , wherein the second fixation mechanism comprises at least one of a fastener and a hole configured to receive a bone fastener.

16. 15. The system of claim 14, wherein the repositioning guide block further comprises a compression portion configured to move the second fixation block between a forward position and a rearward position relative to the second arm.

17. The system of claim 16 , wherein the compression portion comprises a screw fastener and / or a driver engagement recess.

18. 17. The system of claim 16, wherein the compression member is disposed between the second arm and the second fixation block.

19. The system of claim 12 , wherein the repositioning guide block is configured to move relative to the rotating arm.

20. The system of claim 1 , wherein the cutting slot block is disposed in the distal portion of the cutting guide.

Images