MIS ankle fusion plate and targeting guide system

Abstract

A system and methods are provided for an MIS ankle fusion plate and targeting guide for fixating the tibiotalar joint. The MIS ankle fusion plate comprises an upper portion that includes a tibial slot and cylindrical notches disposed on opposite edges of the upper portion. Tibial fixation holes are positioned above and below the tibial slot. The tibial fixation holes receive locking screws that fixate the fusion plate to the tibia. A lower portion of the fusion plate includes two talar fixation holes that receive locking screws to fixate the fusion plate to the talus. The targeting guide includes a plate guide portion for fixedly coupling with the fusion plate. Medial and lateral arms each join a targeting guide array with the plate guide portion. The targeting guide arrays are configured to support wire guides that facilitate establishing vectors for medial and lateral posterior fusion screws.

Description

MIS ANKLE FUSION PLATE AND TARGETING GUIDE SYSTEMPRIORITY

[0001] This application claims the benefit of and priority to U.S. Provisional Application, entitled “MIS Ankle Fusion Plate And Targeting Guide System,” filed on January 18, 2024, and having application serial number 63 / 622,191, the entirety of said application being incorporated herein by reference.FIELD

[0002] Embodiments of the present disclosure generally relate to securing bones together. More specifically, embodiments of the disclosure relate to a system and methods for a Minimally Invasive Surgery ankle fusion plate and targeting guide.BACKGROUND

[0003] A fusion bone plate implant may be utilized in conjunction with one or more fasteners so as to generate compression and stability at a bone interface. An implant coupled with fasteners generally serves to stabilize bones, or bone parts, relative to one another so as to promote bone fusion. In many applications, bone plates and fasteners are used to fuse bones, or bone parts, of the human body, such as bones in the foot, the ankle, the hand, the wrist, as well as various other portions of the body. Furthermore, during the course of certain medical procedures, a surgeon may immobilize one or more bones or the bone fragments by stabilizing the bones together in a configuration which approximates the natural anatomy. To this end, the surgeon may use fasteners to attach the bones to a bone plate implant so as to hold the bones in alignment with one another while they fuse together.SUMMARY

[0004] A system and methods are provided for an MIS ankle fusion plate and targeting guide for fixating the tibiotalar joint. The MIS ankle fusion plate comprises an upper portion that includes a tibial slot and cylindrical notches disposed on opposite edges of the upper portion. Tibial fixation holes are positioned above and below the tibial slot. The tibial fixation holes receive locking screws that fixate the fusion plate to the tibia. A lower portion of the fusion plate includes two talar fixation holes that receive locking screws to fixate the fusion plate to the talus. Thetargeting guide includes a plate guide portion for fixedly coupling with the fusion plate. Medial and lateral arms each join a targeting guide array with the plate guide portion. The targeting guide arrays are configured to support wire guides that facilitate establishing vectors for medial and lateral posterior fusion screws.

[0005] In an exemplary embodiment, an MIS ankle fusion plate comprises: an upper portion including a tibial slot; cylindrical notches disposed on opposite edges of the upper portion; a tibial fixation hole above and below the tibial slot; and a lower portion including two talar fixation holes.

[0006] In another exemplary embodiment, the tibial fixation holes are threaded holes configured to receive locking screws that fixate the MIS ankle fusion plate to the tibia. In another exemplary embodiment, the talar fixation holes are threaded holes configured to receive locking screws that fixate the MIS ankle fusion plate to the talus. In another exemplary embodiment, the tibial slot is configured to receive a non-locking screw into the tibia for eccentric compression.

[0007] In another exemplary embodiment, the cylindrical notches are configured to cooperate with an MIS targeting guide for positioning the MIS ankle fusion plate on the tibia. In another exemplary embodiment, the tibial fixation holes and the talar fixation holes are configured to receive non-locking cancellous screws that range in length between about 16mm and about 65mm.

[0008] In an exemplary embodiment, an MIS targeting guide for an ankle fusion plate comprises: a plate guide portion for coupling with the ankle fusion plate; a targeting guide screw for fixating the plate guide portion to the ankle fusion plate; a medial arm and a lateral arm each joining a targeting guide array with the plate guide portion; and a wire guide supported by each targeting guide array.

[0009] In another exemplary embodiment, the targeting guide screw includes a threaded portion configured to thread into a topmost tibial fixation hole of the ankle fusion plate. In another exemplary embodiment, the plate guide portion includes protruding axial bosses that are configured to be inserted into cylindrical notches of the ankle fusion plate. In another exemplary embodiment, the protruding axial bosses and the cylindrical notches are configured to simplify in- vivo aligning and positioning of the MIS targeting guide onto the ankle fusion plate.

[0010] In another exemplary embodiment, the medial arm and the lateral arm comprise a symmetrical guide that extends from the plate guide portion to each targeting guide array. In another exemplary embodiment, the medial arm and the lateral arm have the same shape but are reflections of one another across a midline of the symmetrical guide. In another exemplary embodiment, the symmetrical guide is configured to be used on both left feet and right feet, without limitation.

[0011] In another exemplary embodiment, each targeting guide array includes at least two through slots that are sized to allow passage of a K-wire. In another exemplary embodiment, each of the at least two through slots includes a series of rounded notches that are sized to hold a wire guide in place within the through slot. In another exemplary embodiment, the series of rounded notches are configured to facilitate establishing vectors for medial and lateral posterior fusion screws.

[0012] These and other features of the concepts provided herein may be better understood with reference to the drawings, description, and appended claims.BRIEF DESCRIPTION OF THE DRAWINGS

[0013] The drawings refer to embodiments of the present disclosure in which:

[0014] Figure 1 illustrates an exemplary embodiment of an MIS ankle fusion plate in accordance with the present disclosure;

[0015] Figure 2 illustrates an exemplary embodiment of a first configuration of the MIS ankle fusion plate of Fig. 1, according to the present disclosure;

[0016] Figure 3 illustrates an exemplary embodiment of a second configuration of the MIS ankle fusion plate of Fig. 1, according to the present disclosure;

[0017] Figure 4 illustrates an exemplary-use environment wherein proper bone resection and plate fitment are being verified by placing a trial plate onto the tibia and the talus in accordance with the present disclosure;

[0018] Figure 5 illustrates an exemplary-use environment wherein an exemplary embodiment of an MIS ankle fusion plate is provisionally fixated to the tibia and talus, according to the present disclosure;

[0019] Figure 6 illustrates an exemplary -use environment wherein a non-locking drill guide is used to direct a bone drill to drill a bone hole into the tibia in accordance with the present disclosure;

[0020] Figure 7 illustrates an exemplary-use environment wherein an exemplary embodiment of an MIS ankle fusion plate is fixated to the tibial by way of a non-locking fixation screw and fixated to the talus by way of the olive wire, according to the present disclosure;

[0021] Figure 8 illustrates an exemplary-use environment wherein an exemplary embodiment of an MIS targeting guide is fixated to an MIS ankle fusion plate and to the tibia to establish vectors for medial and lateral posterior fusion screws in accordance with the present disclosure;

[0022] Figure 9 illustrates an exemplary-use environment wherein the MIS targeting guide of Fig. 8 is removed from the patient after medial and lateral K-wires are placed, according to the present disclosure;

[0023] Figure 10 illustrates an exemplary -use environment wherein a cannulated drill is used to drill bone holes for external posterior screws as well as for fixation screws in accordance with the present disclosure;

[0024] Figure 11 illustrates an exemplary -use environment wherein an exemplary embodiment of an MIS ankle fusion plate is finally implanted, according to the present disclosure;

[0025] Figure 12 illustrates an exemplary embodiment of an MIS targeting guide in accordance with the present disclosure;

[0026] Figure 13 illustrates an isometric view of a symmetrical guide comprising the MIS targeting guide of Fig. 12 in accordance with the present disclosure;

[0027] Figure 14 illustrates a front view of the symmetrical guide of Fig. 13, according to the present disclosure;

[0028] Figure 15 illustrates a first close-up view of an exemplary embodiment of a plate guide portion that includes axial bosses configured to align an MIS ankle fusion plate, according to the present disclosure;

[0029] Figure 16 illustrates a second close-up view of the plate guide portion and MIS ankle fusion plate shown in Fig. 15 in accordance with the present disclosure;

[0030] Figure 17 illustrates an exemplary embodiment of a plate guide portion attached to an MIS ankle fusion plate by way of a targeting guide screw, according to the present disclosure;

[0031] Figure 18 illustrates a cross-sectional view of the plate guide portion and the MIS ankle fusion plate coupled by way of the targeting guide screw of Fig. 17 in accordance with the present disclosure; and

[0032] Figure 19 illustrates an exemplary embodiment of a targeting guide array that comprises an MIS targeting guide in accordance with the present disclosure.

[0033] While the present disclosure is subject to various modifications and alternative forms, specific embodiments thereof have been shown by way of example in the drawings and will herein be described in detail. The present disclosure should be understood to not be limited to the particular forms disclosed, but on the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the present disclosure.DETAILED DESCRIPTION

[0034] In the following description, numerous specific details are set forth in order to provide a thorough understanding of the present disclosure. It will be apparent, however, to one of ordinary skill in the art that the MIS ankle fusion plate and targeting guide system and methods disclosed herein may be practiced without these specific details. In other instances, specific numeric references such as “first screw,” may be made. However, the specific numeric reference should not be interpreted as a literal sequential order but rather interpreted that the “first screw” is different than a “second screw.” Thus, the specific details set forth are merely exemplary. The specific details may be varied from and still be contemplated to be within the spirit and scope of the present disclosure. The term “coupled” is defined as meaning connected either directly to the componentor indirectly to the component through another component. Further, as used herein, the terms “about,” “approximately,” or “substantially” for any numerical values or ranges indicate a suitable dimensional tolerance that allows the part or collection of components to function for its intended purpose as described herein.

[0035] In general, the present disclosure describes a system and methods for an MIS ankle fusion plate and targeting guide for fixating the tibiotalar joint. The MIS ankle fusion plate comprises an upper portion that includes a tibial slot and cylindrical notches disposed on opposite edges of the upper portion. Tibial fixation holes are positioned above and below the tibial slot. The tibial fixation holes receive locking screws that fixate the fusion plate to the tibia. A lower portion of the fusion plate includes two talar fixation holes that receive locking screws to fixate the fusion plate to the talus. The targeting guide includes a plate guide portion for fixedly coupling with the fusion plate. Medial and lateral arms each join a targeting guide array with the plate guide portion. The targeting guide arrays are configured to support wire guides that facilitate establishing vectors for medial and lateral posterior fusion screws.

[0036] Figure 1 illustrates an exemplary embodiment of an MIS ankle fusion plate 100 (hereinafter, “fusion plate 100”). The fusion plate 100 is configured to address ankle fusion of the tibia and the talus (tibiotalar joint). The fusion plate 100 generally is anatomically contoured and includes optimized plate hole trajectories for robust bone thread purchase. As described herein, the fusion plate 100 is configured to be implanted using a mini-open, straight anterior approach, wherein five screw holes are used for positioning the plate 100 across the anterior tibiotalar joint.

[0037] As shown in Fig. 1, the upper portion of the fusion plate 100 includes a tibial slot 104 and a tibial fixation hole 108 above and below the tibial slot 104. The tibial fixation holes 108 are threaded holes configured to receive locking screws 112 (see Figs. 2-3) that fixate the fusion plate 100 to the tibia. Cylindrical notches 110 are disposed on opposite edges of the fusion plate 100 and are configured to cooperate with a targeting guide (discussed hereinbelow) for positioning the fusion plate 100 on the tibia. The lower portion of the fusion plate 100 includes talar fixation holes 116. The talar fixation holes 116 are threaded holes configured to receive locking screws, as discussed in connection with Figs. 2-3, that fixate the fusion plate 100 to the talus. The tibial slot 104 is configured to receive a non-locking screw 118 into the tibia for eccentric compression.

[0038] It is contemplated that the fusion plate 100 can be provided in one universal size and shape, but with two different bone screw configurations. Figure 2 illustrates an exemplary embodiment of a first configuration 120 of the fusion plate 100 while Fig. 3 illustrates an exemplary embodiment of a second configuration 124 of the fusion plate 100. In the first configuration 120, shown in Fig. 2, the tibial fixation holes 108 and the talar fixation holes 116 are configured to receive locking screws 112 having a 4.5mm diameter. In some embodiments, the first configuration 120 is compatible in both the tibial fixation holes 108 and the talar fixation holes 116 with a 5.0mm non-locking cancellous screw that ranges in length between about 16mm and about 65mm. The tibial slot 104 is configured to receive a non-locking screw 118 having a 4.5mm diameter.

[0039] In the second configuration 124 of Fig. 3, the tibial fixation holes 108 are configured to receive locking screws 112 having a 4.5mm diameter, and the tibial slot 104 is configured to receive a non-locking screw 118 having a 4.5mm diameter. Unlike the first configuration 120, in the second configuration 124, the talar fixation holes 116 are configured to receive locking screws 112 having a 3.5mm diameter. In some embodiments, the first configuration 124 is compatible in the tibial fixation holes 108 with the abovementioned 5.0mm non-locking cancellous screw while the talar fixation holes 116 are compatible with only the locking screws 112 having the 3.5mm diameter.

[0040] Moreover, it is contemplated that, in some embodiments, the fusion plate 100 may be configured to be compatible with any of locking, non-locking, and variable angle locking screws, having diameters of 3.5mm or 4.5mm, without limitation. In some embodiments, both the first and second configurations 120, 124 of the fusion plate 100 may be configured to be compatible with the 5.0mm cancellous screw for instances of poor-quality bone.

[0041] Figures 4-11 illustrate an exemplary-use environment wherein an ankle joint is by way of the fusion plate 100 shown in Figs. 1-3. As shown in Fig. 4, after ankle joint surface preparation, proper bone resection and plate fitment can be verified by placing a trial plate 128 onto the tibia 132 and the talus 136. As shown in Fig. 5, the fusion plate 100 may be provisionally fixated to the tibia and talus 132, 136 by way of olive wires 140. It is contemplated that proper orientation and / or alignment of the fusion plate 100 can be verified by way of fluoroscopy.

[0042] Following proper positioning of the fusion plate 100, the non-locking screw 118 can be used to fixate the fusion plate 100 to the tibia 132. As shown in Figs. 6-7, a non-locking drill guide 144 can be used to direct a bone drill 148 through the tibial slot 104 to drill a bone hole into the tibia 132. Once the bone hole is drilled, the non-locking screw 118 can then be driven through the tibial slot 104 into the bone hole in the tibia 132. As shown in Fig. 7, the fusion plate 100 remains fixated to the talus 136 by way of the olive wire 140.

[0043] Next, an MIS targeting guide 160 (hereinafter, “targeting guide 160”) can be coupled with the fusion plate 100 to assist with ankle alignment and stabilization, as shown in Figs. 8-9. As will be appreciated, a surgeon may begin by aligning the foot 152 (see Fig. 9) and ankle joint such that the ankle is neutral with respect to dorsiflexion and planter flexion, and then verify the degree of external rotation and hindfoot valgus. With the foot 152 properly aligned, the targeting guide 160 can be placed onto the fusion plate 100 by using a targeting guide screw 156.

[0044] As shown in Fig. 8, the targeting guide screw 156 can be threaded and tightened into the topmost tibial fixation hole 108 (see Fig. 1) to fixate the targeting guide 160 to the fusion plate 100 and the tibia 132. With the targeting guide 160 secured in place, posterior medial and lateral K-wires 164 can be inserted through wire guides 168 and placed across the tibiotalar joint 176 using targeting guide arrays 172 comprising the targeting guide 160. In general, the wire guides 168 are positioned in the targeting guide arrays 172 according to anatomical requirements and surgeon preference. In some embodiments, the K-wires 164 have a diameter of about 2.0mm and a length of about 9”, without limitation.

[0045] Once the medial and lateral K-wires 164 are placed, the targeting guide 160 can be removed from the patient, as shown in Fig. 9. The targeting guide 160 can be removed by sliding the wire guides 168 off the K-wires 164 and then unscrewing the targeting guide screw 156 from the fusion plate 100. Slots in the targeting guide arrays 172 allow the K-wires 164 to remain in place as the targeting guide 160 is removed, as described herein.

[0046] As shown in Figs. 10-11, once the targeting guide 160 and the wire guides 168 are removed, a cannulated drill 148 (see Fig. 6) can be used to drill a bone hole to an appropriate diameter and depth in preparation for each external posterior screw 180 as well as for the fixation screws 112. The posterior screws 180 may be CoLag compression and / or fully threaded screws,as desired. As shown in Fig. 11 , the posterior screws 180 can be placed into the prepared posterior holes across the tibiotalar joint 176. Final implantation of the fusion plate 100 can be accomplished by driving fixation screws 112 into prepared bone holes in the tibia 132 and the talus 136. More specifically, the upper portion of the fusion plate 100 is fixated to the tibia 132 by using a driver 184 to implant fixation screws 112 (tibial fixation screws 188 in Fig. 11) into the tibial fixation holes 108 (see Fig. 1) of the fusion plate 100. The lower portion of the fusion plate 100 is fixated to the talus 136 by using the driver 184 to implant fixation screws 112 (talar fixation screws 192 in Fig. 11) into the talar fixation holes 116 (see Fig. 1) of the fusion plate 100.

[0047] Figure 12 illustrates an exemplary embodiment of targeting guide 160, in accordance with the present disclosure. The targeting guide 160 is configured to operate in conjunction with the fusion plate 100 and to establish vectors for the medial and lateral posterior fusion screws 180 (see Fig. 11) to address ankle fusion of the tibia 132 and the talus 136. As shown in Fig. 12, the targeting guide 160 includes a plate guide portion 200 that is joined with two targeting guide arrays 172 by way of a symmetrical guide 204.

[0048] As best shown in Figs. 17-18, the plate guide portion 200 is configured to fixedly couple with the fusion plate 100 by way of the targeting guide screw 156. The targeting guide screw 156 is a generally elongated member having a threaded portion 208 that is configured to thread into the topmost tibial fixation hole 108 of the fusion plate 100, as shown in Fig. 18. Thus, the targeting guide screw 156 threads into the tibial fixation hole 108 similarly to a locking fixation screw 112 (see Fig. 1). Further, as best shown in Figs. 15-16, the plate guide portion 200 includes protruding axial bosses 212 that are configured to be inserted into cylindrical notches 100 of the fusion plate 100. The axial bosses 212 and the notches 110 are configured to simplify in-vivo aligning and positioning of the targeting guide 160 onto the fusion plate 100, as shown in Fig. 8.

[0049] Figures 13-14 illustrate an exemplary embodiment of the symmetrical guide 204, according to the present disclosure. The symmetrical guide 204 comprises a first arm 216 and a second arm 220 that each extends from the plate guide portion 200 to a targeting guide array 172. The first and second arms 216, 220 have the same shape, but are effectively reflections of one another across a midline of the symmetrical guide 204. Thus, the symmetrical guide 204 is configured to be used on both left feet and right feet, without limitation.

[0050] Figure 19 illustrates an exemplary embodiment of a targeting guide array 172 in accordance with the present disclosure. The targeting guide array 172 includes at least two through slots 224 that are sized to allow passage of a K-wire 164. A series of rounded notches 228 is disposed in each through slot 224. The rounded notches 228 are sized to hold a wire guide 168 in place within the through slot 224. The series of rounded notches 228 enable the surgeon to establish vectors for the medial and lateral posterior fusion screws 180 (see Fig. 11) to address ankle fusion of the tibia 132 and the talus 136, as described herein.

[0051] While the MIS ankle fusion plate and targeting guide system and methods have been described in terms of particular variations and illustrative figures, those of ordinary skill in the art will recognize that the MIS ankle fusion plate and targeting guide system is not limited to the variations or figures described. In addition, where methods and steps described above indicate certain events occurring in certain order, those of ordinary skill in the art will recognize that the ordering of certain steps may be modified and that such modifications are in accordance with the variations of the MIS ankle fusion plate and targeting guide system. Additionally, certain of the steps may be performed concurrently in a parallel process, when possible, as well as performed sequentially as described above. To the extent there are variations of the MIS ankle fusion plate and targeting guide system, which are within the spirit of the disclosure or equivalent to the MIS ankle fusion plate and targeting guide system found in the claims, it is the intent that this patent will cover those variations as well. Therefore, the present disclosure is to be understood as not limited by the specific embodiments described herein, but only by scope of the appended claims.

Claims

CLAIMSWhat is claimed is:

1. An MIS ankle fusion plate, comprising: an upper portion including a tibial slot; cylindrical notches disposed on opposite edges of the upper portion; a tibial fixation hole above and below the tibial slot; and a lower portion including two talar fixation holes.

2. The ankle fusion plate of claim 1, wherein the tibial fixation holes are threaded holes configured to receive locking screws that fixate the MIS ankle fusion plate to the tibia.

3. The ankle fusion plate of claim 1, wherein the talar fixation holes are threaded holes configured to receive locking screws that fixate the MIS ankle fusion plate to the talus.

4. The ankle fusion plate of claim 1, wherein the tibial slot is configured to receive a nonlocking screw into the tibia for eccentric compression.

5. The ankle fusion plate of claim 1, wherein the cylindrical notches are configured to cooperate with an MIS targeting guide for positioning the MIS ankle fusion plate on the tibia.

6. The ankle fusion plate of claim 1, wherein the tibial fixation holes and the talar fixation holes are configured to receive non-locking cancellous screws that range in length between about 16mm and about 65mm.

7. An MIS targeting guide for an ankle fusion plate, comprising: a plate guide portion for coupling with the ankle fusion plate; a targeting guide screw for fixating the plate guide portion to the ankle fusion plate; a medial arm and a lateral arm each joining a targeting guide array with the plate guide portion; and a wire guide supported by each targeting guide array.

8. The targeting guide of claim 7, wherein the targeting guide screw includes a threaded portion configured to thread into a topmost tibial fixation hole of the ankle fusion plate.

9. The targeting guide of claim 7, wherein the plate guide portion includes protruding axial bosses that are configured to be inserted into cylindrical notches of the ankle fusion plate.

10. The targeting guide of claim 9, wherein the protruding axial bosses and the cylindrical notches are configured to simplify in-vivo aligning and positioning of the MIS targeting guide onto the ankle fusion plate.

11. The targeting guide of claim 7, wherein the medial arm and the lateral arm comprise a symmetrical guide that extends from the plate guide portion to each targeting guide array.

12. The targeting guide of claim 11, wherein the medial arm and the lateral arm have the same shape but are reflections of one another across a midline of the symmetrical guide.

13. The targeting guide of claim 12, wherein the symmetrical guide is configured to be used on both left feet and right feet, without limitation.

14. The targeting guide of claim 7, wherein each targeting guide array includes at least two through slots that are sized to allow passage of a K-wire.

15. The targeting guide of claim 14, wherein each of the at least two through slots includes a series of rounded notches that are sized to hold a wire guide in place within the through slot.

16. The targeting guide of claim 7, wherein the series of rounded notches are configured to facilitate establishing vectors for medial and lateral posterior fusion screws.

Images