System and method for assisting with arrangement of a stock instrument with respect to a patient tissue

Patent metadata

Field	Value
Publication number	US-9254155-B2
Application number	US-201113282528-A
Country	US
Kind code	B2
Filing date	Oct 27, 2011
Priority date	Oct 29, 2010
Publication date	Feb 9, 2016
Grant date	Feb 9, 2016

Abstract

A stock instrument includes at least one guide interacting feature. A lower instrument surface of the stock instrument is placed into contact with the patient tissue. A guide has a lower guide surface contoured to substantially mate with at least a portion of an upper instrument surface of the stock instrument. A predetermined instrument orientation upon the patient tissue is defined, which is preselected responsive to preoperative imaging of the patient tissue. The guide and instrument are mated in a predetermined relative guide/instrument orientation wherein at least one guide interacting feature of the instrument is placed into engagement with at least one instrument guiding feature of the guide. The guide is moved into a predetermined guide orientation with respect to the patient tissue and concurrently the instrument is moved into a predetermined instrument orientation with respect to the patient tissue.

First claim

Having described the invention, we claim:

1. A method of arranging a stock instrument with respect to a patient tissue, the stock instrument including at least one guide interacting feature, the method comprising the steps of:
affixing a landmark to the patient tissue at a predetermined first landmark location;
placing a lower instrument surface of the stock instrument into contact with the patient tissue at a second location spaced apart from the predetermined first landmark location;
providing a guide having a lower guide surface contoured to mate with at least a portion of an upper instrument surface of the stock instrument, the upper and lower instrument surfaces being opposite surfaces of the stock instrument, an upper guide surface spaced longitudinally apart from the lower guide surface by a guide body, the guide also having at least one instrument guiding feature at a predetermined feature location with respect to the guide body and an orienting feature, the orienting feature comprising an arm extending from the upper guide surface, and the arm having a corresponding landmark engaging portion;
defining a predetermined orientation of the stock instrument on the patient tissue, the predetermined orientation being preselected responsive to preoperative imaging of the patient tissue;
placing the lower guide surface into mating contact with at least a portion of the upper instrument surface wherein the at least one guide interacting feature of the stock instrument is placed into engagement with the at least one instrument guiding feature of the guide, such that the guide and the stock instrument are engaged in fixed relative orientation and displaceable together as a guide assembly; and
moving the stock instrument into the predetermined orientation on the patient tissue by moving the guide assembly, while the lower instrument surface of the stock instrument remains in contact with the patient tissue at the second location, until the corresponding landmark engaging portion of the arm of the orienting feature abuts against the landmark affixed to the patient tissue, thereby immobilizing the guide assembly relative to the patient tissue at the predetermined orientation.

2. The method of claim 1 , including a step of securing the stock instrument in the predetermined orientation with respect to the patient tissue before removing the guide from engagement with the instrument.

3. The method of claim 2 , wherein the step of securing the stock instrument in the predetermined orientation includes the step of placing at least one guide pin through a corresponding securing feature in the stock instrument.

4. The method of claim 1 , wherein the step of moving the guide includes the steps of:
providing an orienting indicator to the orienting feature; and
repositioning the guide to bring the orienting indicator into a predetermined signaling relationship with the landmark.

5. The method of claim 1 , wherein a chosen one of the at least one guide interacting feature and the at least one instrument guiding feature is a protrusion and the other one of the at least one guide interacting feature and the at least one instrument guiding feature is a cavity, and the protrusion enters the cavity to engage the guide and the stock instrument in the mating contact.

6. The method of claim 1 , wherein the step of providing the guide includes at least one of the steps of:
custom-manufacturing the guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock instrument; and
modifying a stock guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock instrument.

7. The method of claim 6 , wherein the step of modifying the stock guide includes the step of providing a custom-manufactured orienting feature to the stock guide.

8. The method of claim 1 , wherein the predetermined first landmark location is chosen responsive to preoperative imaging of the patient tissue.

9. A method of arranging a stock instrument with respect to a patient tissue, the stock instrument including at least one guide interacting feature, the method comprising the steps of:
affixing at least one landmark to the patient tissue at a first landmark location;
placing a lower instrument surface of the stock instrument into contact with the patient tissue at a second location spaced apart from the first landmark location;
providing a guide having a lower guide surface contoured to mate with at least a portion of an upper instrument surface of the stock instrument, the upper and lower instrument surfaces being opposite surfaces of the stock instrument, an upper guide surface spaced longitudinally apart from the lower guide surface by a guide body, the guide having at least one instrument guiding feature at a predetermined feature location with respect to the guide body, the guide having an orienting feature, the orienting feature comprising an arm extending from the upper guide surface, the arm including a corresponding landmark engaging portion;
defining a predetermined orientation of the stock instrument on the patient tissue, the predetermined orientation being preselected responsive to preoperative imaging of the patient tissue;
placing the lower guide surface into mating contact with at least a portion of the upper instrument surface and engaging the guide and the stock instrument together to form a guide assembly wherein relative rotation between the guide and the stock instrument is prevented; and
moving the stock instrument into the predetermined orientation on the patient tissue by moving the guide assembly, while the lower instrument surface of the stock instrument remains in contact with the patient tissue at the second location, until the corresponding landmark engaging portion of the arm of the orienting feature abuts against the at least one landmark affixed to the patient tissue, thereby immobilizing the guide assembly relative to the patient tissue at the predetermined orientation.

10. The method of claim 9 , wherein moving the guide assembly further comprises rotating the guide assembly to bring an orienting indicator of the orienting feature into a predetermined signaling relationship with the at least one landmark.

11. The method of claim 9 , wherein the at least one landmark includes a pin and the corresponding landmark engaging portion includes a corresponding notch formed in the arm of the orienting feature.

12. The method as defined in claim 9 , wherein engaging the guide and the stock instrument together further comprises placing the at least one instrument guiding feature of the guide into engagement with at least one guide interacting feature of the stock instrument.

13. The method of claim 12 , wherein a chosen one of the at least one guide interacting feature and the at least one instrument guiding feature is a protrusion and the other one of the at least one guide interacting feature and the at least one instrument guiding feature is a cavity, and the protrusion enters the cavity to engage the guide and the instrument in the mating contact.

14. The method of claim 9 , further comprising custom-manufacturing the guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock instrument, the guide thereby being patient-specific.

15. The method of claim 9 , further comprising modifying a stock guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock instrument.

16. The method of claim 15 , further

Assignees

• Iannotti Joseph P
• Barsoum Wael K
• Bryan Jason A
• Cleveland Clinic Foundation

Inventors

• Iannotti Joseph P
• Barsoum Wael K
• Bryan Jason A

Classifications

• A61B17/1778

  for the shoulder · CPC title

• A61B2090/3916

  Bone tissue · CPC title

• A61B2034/107

  Visualisation of planned trajectories or target regions · CPC title

• A61B17/8872

  Instruments for putting said fixation devices against or away from the bone (A61B17/7074, A61B17/808 take precedence) · CPC title

• A61B17/88 Primary

  Osteosynthesis instruments;} Methods or means for implanting or extracting internal {or external} fixation devices {(A61B17/7074 takes precedence) · CPC title