Instrumentation for the percutaneous treatment of hallux valgus

Abstract

The invention relates to instrumentation for the percutaneous treatment of hallux valgus after making a distal cut (A) in the first metatarsal (B), the instrumentation comprising: - a securing pin (2); - at least one securing screw; - at least one retaining pin (3) for positioning the securing screws; and - a guide structure (6). The guide structure (6) comprises: - an intramedullary hook and a support structure, which are suitable for moving the head (D) of the first metatarsal; - first guide means, which are suitable for positioning the securing pin (2) in the head (D) of the first metatarsal; and - second guide means, which are suitable for positioning the retaining pins (3) through the base (H) of the first metatarsal and into the head (D) of the first metatarsal.

Description

[0001] Description

[0002] Title of the invention: Instrumentation for the percutaneous treatment of Hallux Valgus

[0003] Technical field of the invention

[0004] The present invention relates to the general technical field of surgical treatment of Hallus Valgus.

[0005] It relates more specifically to instruments or guides adapted to percutaneous osteosynthesis surgery for Hallus Valgus.

[0006] State of the art

[0007] Hallux valgus is an abnormal deviation of the big toe towards the outside. This deviation is accompanied by the appearance of a bony protrusion (generally called a "bunion") which may be more or less painful, on the inner edge of the forefoot, at the level of the joint between the metatarsal and the first phalanx of the big toe (metatarsophalangeal joint).

[0008] Manual surgical techniques have been developed to treat this pathology, using cutting tools, holding pins and fixing screws, but these are not easy to implement, particularly due to ergonomic issues and difficulties in managing all parameters with two hands (including displacement of bone segments, aiming of pins, etc.).

[0009] As described in documents US-11 980 396 or FR-3 117762, various instruments or guides have been developed to facilitate the surgical treatment of Hallux Valgus.

[0010] However, percutaneous techniques and known materials are not always easy for the practitioner to implement, and they generally do not allow for high precision in positioning the implants used.

[0011] Indeed, the percutaneous approach consists of performing the treatment through mini-incisions where the only control of the position of the implants is done by 2D fluoroscopic control (for a positioning that must be controlled in 3 dimensions).

[0012] Presentation of the invention

[0013] To overcome the aforementioned drawbacks of the prior art, the present invention proposes an instrumentation for the percutaneous treatment of Hallux Valgus of a foot whose toes extend in a plane of the foot P1, which treatment includes an operation to perform a distal cut of the first metatarsal to obtain:

[0014] - a first metatarsal head comprising an external medial head face and a head cutting face which extends into a spongy portion of the first metatarsal head, and

[0015] - a base of the first metatarsal comprising an external medial base, an internal lateral base, and a cutting base that extends into a spongy portion of the base of the first metatarsal,

[0016] which instrumentation includes, at least:

[0017] - a safety pin,

[0018] - at least one retaining pin,

[0019] - at least one fixing screw, and

[0020] - a guide structure equipped with a grip handle that extends into a guide head,

[0021] which guide structure is characterized in that the guide head comprises (a) an intramedullary hook adapted to penetrate said spongy base of the first metatarsal, and (b) a support structure adapted to apply support against said external medial face of the head when said intramedullary hook is inserted into said spongy base of the first metatarsal,

[0022] which guide structure includes first guiding means, adapted for positioning said securing pin in said head of first metatarsal by said external medial face of head, in or substantially in said plane of foot P1, in order to allow guiding the movement of said head of first metatarsal relative to said base of first metatarsal, in or substantially in said plane of foot P1, during support of said support structure, and which guide structure includes second guiding means, adapted for positioning said at least one retaining pin, by said external medial face of base, through said base of first metatarsal, and in said head of first metatarsal, preferably by said head cut face and said spongy part of head of first metatarsal,

[0023] at least one of which retaining pins is adapted to allow the positioning of said at least one fixation screw. Such a combination of features facilitates the surgeon's two-handed movement. It also increases the chances of correctly positioning the pins and therefore the fixation screws; and further saves time during the procedure.

[0024] Other non-limiting and advantageous features of the instrumentation according to the invention, taken individually or in all technically possible combinations, are as follows:

[0025] - the instrumentation includes two retaining pins designed to extend parallel to each other, and two fixing screws;

[0026] - the fixing screw(s) are preferably cannulated fixing screws, each adapted to cooperate with a retaining pin;

[0027] - the first guiding methods include a head light provided through the guide head;

[0028] - the guide head extends into a support arm, the end of which is equipped with the second guiding means, which support arm, which grip handle and which intramedullary hook extend in a guide plane P2, and which head lumen of said first guiding means is in the form of a flat slit which defines a slit plane P3 extending in said guide plane P2;

[0029] - the second means of guidance include at least one spindle guide mounted on a support base, which spindle guide is generally in the form of a tube comprising a longitudinal axis, suitable for receiving and guiding said or one of said retaining spindles;

[0030] - the guide pins are mounted mobile in rotation, on the support base, around their longitudinal axis, which guide pins include a drilling end, suitable for anchoring in the bone of the base of the first metatarsal;

[0031] - the spindle guide(s) are mounted removably on the support base;

[0032] - the support base is mounted on the distal end of a circular arc-shaped sliding structure mounted to slide in a channel provided at the end of the support arm, which sliding structure, guided in said channel, is movable in the guide plane P2;

[0033] - the guide structure includes removable locking means for the positioning of the slide structure in the slide; - said removable locking means include a clamping screw mounted on the slide and suitable for clamping said slide structure;

[0034] - the slide structure includes a marking defining a range of movement to prevent the retaining pin(s) from coming into contact with the intramedullary hook when positioned through the base of the first metatarsal;

[0035] - the first guiding means include a through slot formed in the proximal end of the slide structure and disposed in said slot plane P3;

[0036] - the support base includes a through hole, in the form of a tubular sleeve, for guiding a stabilizing guide pin, intended to be positioned in the cuneiform bone.

[0037] Of course, the different features, variants and embodiments of the invention can be combined with each other in various ways as long as they are not incompatible or mutually exclusive.

[0038] Detailed description of the invention

[0039] Furthermore, various other features of the invention become apparent from the attached description made with reference to the drawings which illustrate non-limiting embodiments of the invention and where:

[0040] [Fig. 1] is a perspective view, from a first angle, of an embodiment of instrumentation for the treatment of Hallux Valgus according to the invention;

[0041] [Fig. 2] shows the instrumentation of figure 1, viewed from a second angle; [Fig. 3] is a top view illustrating an initial stage of use of the instrumentation of figures 1 and 2, as part of a possible treatment of Hallux Valgus;

[0042] [Fig. 4], [Fig. 5], [Fig. 6], [Fig. 7], [Fig. 8], [Fig. 9] show different successive stages of a surgical intervention for the treatment of a Hallux Valgus, with the final result obtained in [Fig. 10],

[0043] Figures 1 and 2 illustrate a possible embodiment of an instrumentation 1 usable for the treatment of Hallux Valgus of a foot, comprising a foot plane P1, this treatment comprising (Figures 3 to 10) an operation to perform a distal cut A of the first metatarsal B of the big toe C to obtain:

[0044] - a first metatarsal head D comprising an external medial face of the head E and a head cutting face F which extends into a spongy portion of the first metatarsal head G, and

[0045] - a base of the first metatarsal H comprising an external medial face of base J, an internal lateral face of base K and a cutting face of base L which extends into a spongy part of the base of the first metatarsal M.

[0046] Figures 3 to 10 only show the bones, without the skin and muscles that cover them.

[0047] In the illustrated embodiment, the instrumentation 1 includes a locking pin 2, two retaining pins 3, a guide stabilizing pin 4, two fixing screws 5, and a guide structure 6.

[0048] The retaining pins 3 are adapted to allow the positioning of the fixing screws 5. They are intended to extend parallel to each other.

[0049] The fixing screws 5 are preferably cannulated fixing screws (i.e., including an axial longitudinal orifice), each adapted to cooperate with a retaining pin 3.

[0050] The guide structure 6 includes a grip handle 7 which extends into a guide head 8.

[0051] For its part, guide head 8 includes:

[0052] - an intramedullary hook 9 (shaped like a pointed structure) adapted to penetrate the spongy base of the first metatarsal M, via the basic cutting face L, and

[0053] - a support structure 10, adapted to apply support against the external medial face of head E when the intramedullary hook 9 is inserted into the spongy base of the first metatarsal M.

[0054] The guide structure 6 also includes first guide means 11, adapted for positioning the securing pin 2 in the head of the first metatarsal D by the external medial face of the head E, in or substantially in the plane of the foot P1, in order to allow guidance of the movement of said head of the first metatarsal D relative to the base of the first metatarsal H, in or substantially in said plane of the foot P1, during support of said support structure 10.

[0055] And the guide structure 6 further includes second guide means 12 adapted for the positioning of the two retaining pins 3, through the external medial face of base J, through the base of first metatarsal H, and in the head of first metatarsal D through the head cutting face F and said spongy part of head of first metatarsal G.

[0056] The first guiding means 11 include a head light 13 provided through the guide head 8.

[0057] The guide head 8 extends into a support arm 14, the end of which is equipped with the second guiding means 12 detailed later in the description.

[0058] The support arm 14, the grip handle 7 and the intramedullary hook 9 extend in a guide plane P2.

[0059] As can be seen in Figures 1 and 2, the head light 13 of the first guiding means 11 is in the form of a flat slit which defines a slit plane P3 extending into the guide plane P2.

[0060] The head light 13 passes through the guide head 8 from the support structure 10 to the opposite face of the guide head 8.

[0061] This head light 13 opens into the support structure 10 in the form of a first elongated slot 13a, and into the opposite face of the guide head 8 in the form of a second elongated slot 13b.

[0062] The length of the second elongated slit 13b is greater than the length of the first elongated slit 13a; thus, the head light 13 flares out in the guide head 8 from the first elongated slit 13a to the second elongated slit 13b.

[0063] The second guiding means 12 comprise two guide pins 15 mounted on a support base 16 itself mounted at the distal end 17 of a circular arc slide structure 18.

[0064] Each spindle guide 15 is generally in the form of a tube comprising a longitudinal axis 19, suitable for receiving and guiding a retaining spindle 3.

[0065] The spindle guides 15 are mounted to slide, and free to rotate about their longitudinal axis 19, in cylindrical sleeves 16a, 16b of the support base 16; and they are preferably mounted in a totally removable manner in these cylindrical sleeves 16a, 16b.

[0066] As will be seen later in the description, sliding in the cylindrical sleeves 16a, 16b allows the pin guides 15 to adapt to different morphologies and corrections.

[0067] The guide pins 15 advantageously include a drill end 20, suitable for anchoring itself in the bone of the base of the first metatarsal H, by a manual rotation maneuver, in the manner of a hand drill.

[0068] The slide structure 18 is mounted to slide in a slide 21 provided at the end of the support arm 14. It is guided in the slide 21 and movable in the guide plane P2.

[0069] As can be seen in the attached figures, removable locking means 22 are provided to fix the positioning of the slide structure 18 in the slide 21.

[0070] These removable locking means 22 include a clamping screw 23 mounted on the slide 21 and suitable for clamping the slide structure 18 for locking it in position.

[0071] The general arc-shaped form of the slide structure 18 is adapted so that its center aims at the head of the first metatarsal D, thus giving the trajectory of the retaining pin 3 which will receive the fixing screw 5. The deployment of the slide structure 18 allows the surgeon to choose the entry point of the pins 3 (and then the screws 5).

[0072] Figure 2 shows the presence of a marking 24 on one of the faces of the slide structure 18.

[0073] As explained later in the description, this marking 24 defines a range of possible movement of the slide structure 18 in the slide 21, which prevents the retaining pins 3 from coming into contact with the intramedullary hook 9, when they are positioned through the base of the first metatarsal H.

[0074] The proximal end 25 of the slide structure 18 includes a through slot 26 which is an integral part of the first guide means 11 adapted for positioning the locking pin 2. The through slot 26 is disposed in the slot plane P3 and in the guide plane P1, opposite the head light 13. Its length is greater than that of the second elongated slot 13b.

[0075] This through slot 26 is intended to cooperate with the head light 13 during the positioning of the securing pin 2.

[0076] They allow the guidance of the safety pin 2 in the slot plane P3 and the guide plane P1.

[0077] As we will see later in the description, they allow in particular the movement of the head of the first metatarsal D without constraining the securing pin 2 and thus avoid any rotational disturbance during the operative maneuver (while the surgeon is levering, the head of the first metatarsal can move laterally and is secured in its rotational and dorsoplantar linear component).

[0078] The height (or width) of the head light 13 and the height (or width) of the through slot 26 are slightly greater than the diameter of the securing pin 2.

[0079] As can be seen in figures 1 and 2, the first guiding means 11 and the second guiding means 12 are arranged to guide in a convergent or approximately convergent manner, on the one hand the securing pin 2, and, on the other hand, the retaining pins 3, on an area of ​​the head of the first metatarsal D.

[0080] On the other hand, it is also noted that the support base 16 includes a through orifice, in the form of a tubular sleeve 27, for guiding the stabilizing guide pin 4, intended to be positioned in the cuneiform bone N.

[0081] Surgical technique

[0082] A possible surgical technique for the percutaneous treatment of Hallux Valgus of a foot, using the instrumentation 1 described above, is detailed in figures 3 to 10.

[0083] An initial step in the treatment involves making a distal cut A internal to the first metatarsal B, as illustrated in Figure 3.

[0084] Next, the practitioner positions the guide structure 6, through skin incisions, by inserting the intramedullary hook 9 into the cancellous base of the first metatarsal M, through the base cutting face L, the guide plane P2 being placed in the foot plane P1 (figure 3). The support structure 10 is supported against the external medial face of the head E, and this insertion of the intramedullary hook 9 into the cancellous base of the first metatarsal M initiates a lateral displacement of the head of the first metatarsal D towards the 2nd metatarsal and opens the angle between the first and second metatarsals (figure 3).

[0085] The practitioner can then insert the securing pin 2 into the head of the first metatarsal D, on the side of the external medial face of the head E, guided by the first guiding means 11 of the guide structure 6. (figure 4).

[0086] The securing pin 2 then passes through the through slot 26 of the proximal end 25 of the slide structure 18, and through the head lumen 13, for its guidance in the guide plane P2 and in the foot plane P1, until it reaches the head of the first metatarsal D by the external medial face of the head E.

[0087] Preferably, the locking pin 2 is positioned perpendicular or approximately perpendicular to the second metatarsal, taking into account its subsequent movements related to the displacement of the head of the first metatarsal D

[0088] The practitioner has the option to adjust the safety pin 2 on the aforementioned angular sector, corresponding to the lengths of the through slot 26 and the head lumen 13.

[0089] Next, the practitioner can unlock the arc-shaped slide structure 18 by disengaging the clamping screw 23, and can continue moving the first metatarsal head D using the handle 7 of the guide structure 6, as illustrated in Figure 5.

[0090] This movement is achieved by pivoting the guide structure 6, using the handle 7, in the guide plane P1:

[0091] - with the support structure 10 in contact with the head of the first metatarsal D, and - with the end of the guide head 8 which carries the intramedullary hook 9 in contact with the basic cutting face L.

[0092] Such a displacement is carried out over a distance adapted to the correction sought.

[0093] It can be done over a few millimeters, until only a small contact remains between the base cutting face L and the head cutting face F (see figure 5). It is also possible to move the head of the first metatarsal D even further to eliminate this contact (displacement of more than 100%).

[0094] Such a displacement opens the angle between the first and second metatarsals, and causes a desired lateral displacement of the head of the first metatarsal D towards the second metatarsal.

[0095] It should be noted that this leverage effect medials the proximal part of the metatarsal, an important component that "locks" the cuneometatarsal joint. This "crowbar" effect, which pulls on the diaphysis and pushes the head, helps to limit the risk of recurrence.

[0096] During this movement, the securing pin 2 can pass through the through slot 26 and the head light 13, to avoid or at least limit its stresses.

[0097] The pin guides 15 are inserted into their respective receiving sleeves 16a, 16b of the support base 16 (Figure 6), and the slide structure 18 is moved so that its distal end, fitted with the support base 16, comes into contact or is practically in contact with the foot (Figure 6). The drilling end 20 of the pin guides 15 is in contact or is practically in contact with the base of the first metatarsal H.

[0098] In this position, the longitudinal axis 19 of the pin guides 15 is oriented towards the cutting face of the head F, and here aligned or practically aligned with the head of the first metatarsal D and the first phalanx O of the big toe.

[0099] The position of the slide structure 18 is locked by tightening the clamping screw 23. It is necessary to ensure that the locking of the slide structure 18 in the slide 21 is carried out within the permissible range by the marking 24.

[0100] The drill ends 20 of the guide pins 15 can anchor themselves in the bone of the base of the first metatarsal H, by their manual rotation, in the manner of a hand burr (figure 7).

[0101] It is also possible to fix the position of the guide structure 6 with a locking pin 2 inserted into the tubular sleeve 27 of the support base 16.

[0102] As can be seen in Figure 8, the orientation of the cylindrical opening of the sleeve 27 is adapted so that the securing pin 2 is implanted in the cuneiform bone N of the foot. The practitioner can then insert the retaining pins 3 into the pin guides 15, and push them in (for example by means of a pin-passer) to pass through the base of the first metatarsal H (from the external medial face of the base J), ​​and penetrate into the head of the first metatarsal D, through the head cutting face F (Figures 8 and 9).

[0103] The placement of the retaining pins 3 can be checked by fluoroscopy; the pin guides 15 are removed and the surgery is finalized, for example, by following the classic surgical techniques.

[0104] In particular, the cannulated fixation screws 5 are positioned on the retaining pins 3, then implanted in the bone by screwing to secure the base of the first metatarsal H and the head of the first metatarsal D, as illustrated in Figure 10. The operation is completed by cutting the distal bone fragment P, for example according to a cutting plane schematically represented by the dotted line 28 in Figure 9.

[0105] Such instrumentation 1 according to the invention makes it easier and more precise for the surgeon to treat Hallux Valgus.

Claims

Demands

1. Instrumentation (1) for the percutaneous treatment of Hallux Valgus of a foot whose toes extend in a plane of the foot (P1), which treatment includes an operation to perform a distal cut (A) of the first metatarsal (B) to obtain: - a first metatarsal head (D) comprising an external medial head face (E) and a head cutting face (F) which extends into a spongy portion of the first metatarsal head (G), and - a base of the first metatarsal (H) comprising an external medial base face (J), an internal lateral base face (K) and a cutting base face (L) which extends into a spongy base part of the first metatarsal (M), which instrumentation (1) comprises: - a locking pin (2), - at least one retaining pin (3), - at least one fixing screw (5), and - a guide structure (6) equipped with a gripping handle (7) which extends into a guide head (8), characterized in that said guide head (8) comprises: (a) an intramedullary hook (9) adapted to penetrate said spongy base of first metatarsal (M), and (b) a support structure (10), adapted to apply support against said external medial face of head (E) when said intramedullary hook (9) is inserted into said spongy base of first metatarsal (M), which guide structure (6) includes first guiding means (11), adapted for positioning said securing pin (2) in said head of first metatarsal (D) by said external medial face of head (E), in or substantially in said foot plane (P1), in order to allow guidance of the movement of said head of first metatarsal (D) relative to said base of first metatarsal (H), in or substantially in said foot plane (P1), during support of said support structure (10), and which guide structure (6) includes second guiding means (12), adapted for positioning said at least one retaining pin (3), by said external medial face of base (J), through said base of first metatarsal (H), and in said head of first metatarsal (D), which at least one retaining pin (3) is adapted to permit the positioning of said at least one fixing screw (5).

2. Instrumentation according to claim 1, characterized in that it comprises two retaining pins (3) intended to extend parallel to each other, and two fixing screws (5).

3. Instrumentation according to any one of claims 1 or 2, characterized in that the fixing screw or screws (5) are cannulated fixing screws, each adapted to cooperate with a retaining pin (3).

4. Instrumentation according to any one of claims 1 to 3, characterized in that the first guiding means (11) comprise a head light (13) provided through the guide head (8).

5. Instrumentation according to claim 4, characterized in that the guide head (8) extends into a support arm (14) the end of which is equipped with the second guiding means (12), which support arm (14), which grip handle (7) and which intramedullary hook (9) extend in a guide plane (P2), and which head light (13) of said first guiding means (11) is in the form of a flat slit which defines a slit plane (P3) extending into said guide plane (P2).

6. Instrumentation (1) according to any one of claims 1 to 5, characterized in that said second guiding means (12) comprise at least one spindle guide (15) mounted on a support base (16), which spindle guide (15) is generally in the form of a tube comprising a longitudinal axis (19), suitable for receiving and guiding said or one of said retaining spindles (3).

7. Instrumentation (1) according to claim 6, characterized in that the guide pins (15) are mounted movably for rotation on the support base (16) about their longitudinal axis (19), which guide pins (15) comprise a drill end (20), adapted to anchor itself in the bone at the base of the first metatarsal (H).14

8. Instrumentation (1) according to any one of claims 6 or 7, characterized in that the spindle guide(s) (15) are removably mounted on the support base (16).

9. Instrumentation (1) according to any one of claims 6 to 8, taken as dependent on claim 5, characterized in that the support base (16) is mounted on the distal end of a circular arc slide structure (18), itself mounted to slide in a channel (21) formed at the end of the carrier arm (14), which slide structure (18), guided in said channel (21), is movable in said guide plane (P2).

10. Instrumentation (1) according to claim 9, characterized in that the guide structure (6) includes removable locking means (22) for the positioning of the slide structure (18) in the slide (21).

11. Instrumentation (1) according to claim 10, characterized in that said removable locking means (22) comprise a clamping screw (23) mounted on the slide (21) and adapted to clamp said slide structure (18).

12. Instrumentation (1) according to any one of claims 9 to 11, characterized in that the slide structure (18) comprises a marking (24) defining a range of movement to prevent the retaining pin(s) (3) from coming into contact with the intramedullary hook (9) during their positioning through the base of the first metatarsal (H).

13. Instrumentation (1) according to any one of claims 9 to 12, taken dependently from claim 5, characterized in that the first guiding means (11) comprise a through slot (26) formed in the proximal end of the slide structure (18) and disposed in said slot plane (P3).

14. Instrumentation (1) according to any one of claims 6 to 13, characterized in that the support base (16) includes a through orifice (27), in the form of a tubular sleeve, for guiding a guide stabilizing pin (4), intended to be positioned in a cuneiform bone (N).

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