FR3136950A1 - Surgical instrumentation set for bone resection - Google Patents

Abstract

Surgical instrumentation assembly for bone resection The present invention relates to a surgical instrumentation assembly (1) for bone resection comprising: - a resection device (3) configured to be fixed to at least one bone of a joint, for example to a tibia and/or a talus of an ankle, the resection device (3) comprising a frame (5), - a positioning guide (9) intended to be fixed to the joint, - a viewing window positioning (11) configured to be connected to the frame (5), wherein the positioning guide (9) and the positioning window (11) are configured to allow, when the positioning guide (9) is attached to the joint , the cooperation of the positioning window (11) with the positioning guide (9), in order to position the resection device (3) relative to the bone in a fixation position. Figure for abstract: Fig. 18.

Description

Surgical instrumentation set for bone resection

The present invention relates to a set of surgical instrumentation for bone resection, for example for tibiotalar resection.

Arthrodesis is a surgical procedure which consists of permanently blocking a joint in order to make it stable and painless. Arthrodesis is a common procedure when no solution to preserve or replace the joint surfaces can be performed.

This procedure can be performed in particular for indications of osteoarthritis or trauma cases.

The difficulty in this type of surgical procedure consists of preparing the articular surfaces by resection of the damaged cartilage so as to create a uniform fit between the bone fragments with a view to their fusion by osteosynthesis.

This difficulty is all the more important as there are large anatomical variations, thus limiting the possibilities of assistance by instrumentation.

To carry out the resection, the practitioner can use several resection tools such as surgical cutters (by arthroscopy for example), curettes/rugins/gouges or an oscillating saw.

These different preparation options are all done freehand. This is therefore subject to a high level of uncertainty at the time of preparation and requires, most often, a long phase of surface adjustment.

A solution of the prior art to help the practitioner in adequately carrying out his bone resections is to use a set of surgical instrumentation comprising tools intended to attach to several portions of the bone of the joint. This allows effective stabilization of the tools but involves bulky instrumentation and additional incisions.

Furthermore, the adjustment of the position of the tooling relative to the joint is generally carried out by means of multiple mechanisms, complicating both the tooling and the adjustment step.

There is therefore a need to provide a simplified surgical instrumentation set.

• un dispositif de résection configuré pour être fixé à au moins un os d’une articulation, par exemple à un tibia et/ou un talus d’une cheville, le dispositif de résection comprenant un cadre,
• un guide de positionnement destiné à être fixé à l’articulation,
• une fenêtre de positionnement configurée pour être connectée au cadre,

dans lequel le guide de positionnement et la fenêtre de positionnement sont configurés pour permettre, lorsque le guide de positionnement est fixé à l’articulation, la coopération de la fenêtre de positionnement avec le guide de positionnement, afin de positionner le dispositif de résection par rapport à l’os selon une position de fixation.The invention aims in particular to overcome at least one of these drawbacks and concerns, according to a first aspect, a set of surgical instrumentation for bone resection, for example tibiotalar resection, the set comprising:

• a resection device configured to be fixed to at least one bone of a joint, for example to a tibia and/or a talus of an ankle, the resection device comprising a frame,
• a positioning guide intended to be fixed to the joint,
• a positioning window configured to be connected to the frame,

in which the positioning guide and the positioning window are configured to allow, when the positioning guide is fixed to the joint, the cooperation of the positioning window with the positioning guide, in order to position the resection device relative to to the bone according to a fixation position.

The surgical instrumentation assembly according to the invention allows effective stabilization of the assembly without involving bulky instrumentation and additional incisions.

The adjustment of the position of the tools in relation to the joint is carried out by means of a simple mechanism and makes it possible to provide a simplified surgical instrumentation set.

According to other characteristics of the invention, the surgical instrumentation assembly of the invention may comprise one or more of the following optional characteristics considered alone or in all technically possible combinations.

According to one characteristic, the resection device comprises an arm and in which the frame is connected to a first end of the arm.

According to one characteristic, the positioning window comprises a slot having a shape adapted to cooperate with the shape of the positioning guide. For example, the slot and the positioning guide being configured to allow, when the positioning guide is fixed to the joint, the insertion of a first end of the positioning guide through the slot by relative movement of the positioning window relative to the positioning guide, and moving the positioning window along at least a portion of the positioning guide.

According to one characteristic, the positioning window is configured to be connected to the frame in a removable manner and the assembly comprises at least one cutting window intended to be connected to the frame in a removable manner, the cutting window comprising at least one slot through through which a bone cutting element can pass.

According to one characteristic, the cutting window comprises a first slot and a second slot spaced from one another, through which the bone cutting element can pass.

According to one characteristic, the first slot extends at an inclined angle relative to the second slot.

According to one characteristic, the assembly includes a bone cutting element.

According to one characteristic, the bone cutting element is a saw blade.

According to one characteristic, the arm comprises the first end to which the frame is connected and a second free end.

• des premiers moyens de connexion disposés sur la portion centrale du cadre,
• des deuxièmes moyens de connexion, complémentaires des premiers moyens de connexion configurés pour coopérer avec les premiers moyens de connexion lorsque la fenêtre de positionnement est connectée au cadre.

According to one characteristic, the frame comprises a body, the body comprising a central portion from which extend two side tabs arranged to receive the positioning window, and in which the assembly comprises means for connecting the positioning window to the frame, the connection means comprising:

• first connection means arranged on the central portion of the frame,
• second connection means, complementary to the first connection means configured to cooperate with the first connection means when the positioning window is connected to the frame.

According to one characteristic, the second connection means comprise a return means intended to disengage the second connection means from the first connection means so as to disconnect the positioning window from the frame.

According to one characteristic, the positioning window comprises a body and gripping means extending projecting from the body, the gripping means being arranged so as to manipulate the positioning window by means of a thumb and an index finger. 'an user.

According to one characteristic, the two slots of the cutting window, called the first cutting window, are spaced from one another by a first distance and the assembly comprises a second cutting window intended to be connected to the frame and comprising two slots being spaced from each other by a second distance different from the first distance.

According to one characteristic, the positioning guide comprises a blade.

According to a second aspect, the invention relates to a method of bone resection, for example tibiotalar resection, implemented by means of such a set of surgical instrumentation.

The process includes the steps of:

- fixing the positioning guide to the joint,

- cooperation between the positioning window and the positioning guide in order to position the resection device relative to the bone according to a fixation position.

The method according to the invention may comprise one or more of the following optional steps considered alone or in all technically possible combinations:

– insertion, when the positioning guide is fixed to the joint, of the first end of the positioning guide through the slot of the positioning window by relative movement of the positioning window relative to the positioning guide and movement of the positioning window along the at least part of the positioning guide, the second end of the positioning guide being fixed to the joint;

– connection of the positioning window to the frame;

- fixation of the resection device to a bone;

- removal of the joint positioning guide;

- disconnection of the positioning window from the frame, and connection of the cutting window to the frame;

- fixation of the resection device to a second bone of the joint, before the step of connecting the cutting window to the frame;

- bone resection carried out by passing the bone cutting element through slots in the cutting window;

- disconnection of the cutting window, called the first cutting window, from the frame and connection of the second cutting window to the frame, the two slots of the first cutting window being spaced from each other by a first distance and the slots of the second cutting window being spaced from each other by a second distance different from the first distance;

- bone resection carried out by passing the bone cutting element through the slots of the second cutting window.

There is an illustration of a resection device of a set of surgical instrumentation according to the present invention comprising a frame and a handling means.

There represents a positioning window of the surgical instrumentation assembly according to the present invention.

There represents means for connecting the positioning window to the frame of the surgical instrumentation assembly in the installation position according to the present invention.

There represents the means of connecting the positioning window to the frame of the surgical instrumentation assembly in the locking position of the window according to the present invention.

There represents the means of connecting the positioning window to the frame in the installation position of the window according to a variant embodiment of the invention.

There represents the means of connecting the positioning window to the frame in the locking position of the window according to the alternative embodiment of the invention.

There represents a guide for positioning the surgical instrumentation assembly according to the present invention.

There represents a cutting window of the surgical instrumentation assembly according to the present invention.

There represents the positioning window and the cutting window of the instrumentation assembly superimposed on each other, the positioning window being visible through transparency.

There represents two cutting windows of the surgical instrumentation assembly according to the present invention.

There represents bone resections carried out using the cutting windows of the .

There represents two cutting windows of the surgical instrumentation assembly according to a variant embodiment of the invention.

There represents a step of a bone resection method according to the present invention in which a joint line is determined.

There represents a step of the bone resection method according to the present invention in which the positioning guide is fixed to a joint.

There represents a step of the bone resection method according to the present invention in which a connection between the positioning window and the frame of the resection device is made.

There represents a step of the bone resection method according to the present invention in which the positioning window is connected to the frame.

There represents a step of the bone resection method according to the present invention in which the bone resection device cooperates with the positioning guide.

There represents a step of the bone resection method according to the present invention in which the resection device is fixed to a bone.

There represents a step of the bone resection method according to the present invention in which the resection device is fixed to the bone

There represents a step of the bone resection method according to the present invention in which the positioning guide is removed from the joint.

There represents a step of the bone resection method according to the present invention in which the positioning window is disconnected from the frame.

There represents a step of the bone resection method according to the present invention in which the resection device is attached to a second bone.

There represents a step of the bone resection method according to the present invention in which a connection between the cutting window and the frame of the resection device is made.

There represents a step of the bone resection method according to the present invention in which the cutting window is connected to the frame.

There represents a step of the bone resection method according to the present invention in which a bone cut of a bone is carried out by means of a bone cutting element.

There represents a step of the bone resection method according to the present invention in which a bone cut of a second bone is carried out by means of a bone cutting element.

There represents a step of the bone resection method according to the present invention in which the cutting window is disconnected from the frame.

There represents a step of the bone resection method according to the present invention in which the resection device is removed from the bones.

There represents an example of arthrodesis carried out by a pad and screw assembly.

Other characteristics and advantages of the invention will appear on reading the non-limiting description which follows and the appended figures which schematically illustrate several embodiments of the surgical instrumentation assembly according to the invention.

For the sake of simplification, identical elements are identified by identical reference signs throughout the figures.

A set of surgical instrumentation 1 is illustrated in . The set includes:

- a resection device 3 comprising a frame 5, the resection device 3 is configured to be fixed to at least one bone 7 of a joint, for example to a tibia 7a and/or a talus 7b of an ankle,

- a positioning guide 9 intended to be fixed to the joint, and

- a positioning window 11 configured to be connected to the frame 5.

The positioning guide 9 and the positioning window 11 are configured to allow, when the positioning guide 9 is fixed to the joint, the cooperation of the positioning window 11 with the positioning guide 9 in order to position the resection device 3 relative to the bone in a fixing position, when the positioning window is fixed to the frame 5.

By fixation position we mean the final position of the resection device in which the bone resection can be carried out. By bone resection we mean a bone cut.

The positioning guide 9 and the positioning window 11 ensure adequate positioning of the resection device 3 comprising the frame 5 in relation to a bone. Once the resection device 3 is positioned, the resection device 3 can be fixed to the bone and the bone resection can be performed. Positioning the resection device 3 via the positioning guide 9 and the positioning window 11 ensures that the bone resection will be carried out adequately.

The resection device 3 is illustrated in .

In this presentation, the resection device comprises a frame 5.

The frame 5 comprises a body 12 which comprises a central portion 14 from which two side legs 16, 18 extend.

Each of the legs 16, 18 comprises a first end 16', 18', proximal to the central portion 14 and a second end 16'', 18'' distal to the central portion 14.

For example, the second distal ends 16'', 18'' are free.

For example, the central portion 14 and the two side legs 16, 18 can be arranged so that the two side legs 16, 18 extend at a distance from each other, for example so that the second Distal ends 16'', 18'' extend at a distance from each other, for example so that the frame 5, for example the body 12, has a "U" shape.

Each of the legs 16, 18 may comprise a first part proximal to the central portion 14 and a second part distal to the central portion 14. Each of the legs may further comprise an intermediate part connecting the first proximal part and the second distal part.

For example, the distal parts of the legs 16, 18 extend, relative to each other, at a distance greater than the distance at which the proximal parts of the legs extend relative to each other. legs 16, 18.

For example, each of the first proximal parts of the legs 16, 18 comprises the first proximal end 16', 18', and each of the second distal parts of the legs 16, 18 comprises the second distal end 16'', 18''.

The frame 5 is configured to be fixed to at least one bone 7 of the joint, for example to the tibia 7a and/or to the talus 7b of the ankle ( ).

In the present presentation, the frame 5 makes it possible to fix the resection device to at least one bone of the joint.

For this purpose, at least one opening 20 can be provided in the frame 5 so as to allow passage of a suitable fixing means through said at least one opening 20 to a bone of the joint so as to fix the frame 5 to the joint bone.

The fixing means is intended to anchor in the bone so as to fix the frame 5 to the bone.

Any suitable fixing means can be used. For example, the fixing means can be a pin 24 ( ) such as a spherical positioning pin.

In the present discussion, the frame 5 can be attached to both the tibia and the talus of the ankle joint ( ).

For this purpose, an opening 20 is provided in each of the proximal ends 16', 18' and distal ends 16'', 18'' of the legs of the frame 5. The openings provided in the proximal ends of the legs of the frame 5 are configured to allow a passage of a pin 24 through each of these openings to a first bone, for example the tibia, so as to fix the frame to said first bone ( ). The openings provided in the distal ends of the legs of the frame 5 are configured to allow passage of a pin 24 through each of these openings to a second bone, for example the talus so as to fix the resection device to said second bone ( ).

As illustrated by , the side legs 16, 18 of the frame 5 are arranged so as to receive the positioning window 11.

For example, the legs 16, 18 and the central portion 14 of the frame 5 define a housing 26, for example in the shape of a “U”, intended to receive at least in part the positioning window 11.

The frame 5 can be provided in different but suitable sizes and shapes in order to provide adequate receiving accommodation for the positioning window 11.

Such a positioning window 11 is illustrated in .

The positioning window 11 is configured to be received in the housing 26 formed between the legs 16, 18 of the frame 5.

In the present presentation, the positioning window 11 comprises a body 28 comprising a first portion 30, called the upper portion, and a second portion 32, called the lower portion, opposite each other, and between which two lateral tabs extend. 34, 36.

When mounting the positioning window 11 and the frame 5, the positioning window 11 can cooperate with the frame 5.

For this purpose, the upper portion 30 of the positioning window may have recesses 31 intended to abut with walls 140 of the frame 5 which project from the central portion 14 of the frame 5. For example, the openings 20 of the frame which are intended to receive the pins 24 can be provided in these walls 140 ( ). In addition, the lower portion 32 of the positioning window 11 may comprise extensions 320 intended to abut with walls 180 of the frame 5, for example of the body 12, which project from the distal parts of the legs 16, 18 of the frame 5. For example, the openings 20 of the frame which are intended to receive the pins 24 can be provided in these walls 180 ( ).

The upper portion 30, the lower portion 32 and the two side tabs 34, 36 of the positioning window define a space 38.

This space 38 allows for a minimum of visibility of the articulation and the result of the preparatory stages. The space 38 also makes it possible to limit the contacts between the positioning window 11 and the anterior face of the tibia.

The positioning window 11 is configured to be connected to the frame 5.

By configured to be connected to the frame we mean for example that the positioning window 11 is configured to be fixed to the frame 5, for example secured to the frame 5.

For this purpose, the surgical instrumentation assembly 1 comprises means for connecting the positioning window 11 to the frame 5.

For example, the connection means are removable connection means so that the positioning window 11 is connected with the frame 5 in a removable manner.

As illustrated in Figures 3 and 4, the connection means comprise first connection means 40 arranged at the central portion 14 of the frame 5, and second connection means 42, complementary to the first connection means 40 configured to cooperate with the first connection means 40 when the positioning window 11 is connected to the frame 5 ( ).

For example, the first connection means 40 comprise an opening 40' delimited by a wall provided with a thread. The 40' opening is provided in the central portion 14 of the frame 5. In the remainder of the description, this opening will be called the 40' tapped opening.

Furthermore, the second connection means 42 comprise a wheel 42' configured to cooperate with said tapping. For example at least part of the wheel is configured to be screwed into the 40’ tapped opening.

The wheel 42' comprises an upper part 42'a, allowing its manipulation, a central zone 42'b and an end 42'c provided with a thread complementary to the tapping of the tapped opening 40' ( ).

For example, the upper part 42'a and the central zone 42'b each have a substantially cylindrical shape.

To allow cooperation between the end 42'c of the wheel 42' and the threaded opening 40', an opening 44 is provided in the positioning window 11 ( ). The opening 44 is configured to allow the end 42'c of the wheel 42' to pass through said opening 44 of the positioning window up to the threaded opening 40' of the frame 5 ( ).

For example, the opening 44 is provided in the upper portion 30 of the positioning window 11.

The opening 44 provided in the upper portion of the positioning window 11 is intended to be arranged opposite the tapped opening 40' of the frame 5 when the positioning window 11 cooperates with the frame 5.

The wheel 42' can be manipulated via its upper part 42'a so that its end provided with the thread 42'c passes into the opening 44 of the positioning window 11 ( ) and engages in the threaded opening 40' of the frame 5. The wheel 42' can then be screwed by rotating the wheel 42' so as to make the threading of the wheel and the tapping of the wheel cooperate. 40' tapped opening. This makes it possible to connect the positioning window 11 to the frame 5 ( ).

According to an embodiment illustrated in Figures 5 and 6, the wheel 42' may comprise a return means 47. The return means 47 is intended to disengage the end provided with the thread 42'c of the wheel 42' from the frame 5 and in particular the threaded opening 40' of frame 5.

For example, the return means is arranged on the central zone 42'b of the wheel 42'.

As illustrated in Figures 5 and 6, the return means 47 can be a spring 47', for example a compression spring.

There illustrates assembly 1 according to the present presentation in which the wheel 42' is screwed into the threaded opening 40' of the frame 5. When screwing the wheel into the threaded opening 40', the wheel applies a stress on the spring 47' which passes from a free state ( ) to a compressed state ( ).

When the positioning window 11 is connected to the frame 5, the spring 47' is in a compressed state.

When the wheel 42' is unscrewed from the threaded opening 40', the wheel 42' no longer applies stress to the spring. The spring 47' relaxes and drives the wheel 42' outside the tapped opening 40' so that the wheel 42' is disengaged from the tapped opening 40' ( ).

This configuration makes it easier to disconnect the positioning window 11 and the frame 5.

The connection means presented above (such as the wheel including the thread and the tapped opening) are not limiting and any other connection means, for example removable, can be used.

In the present presentation, the positioning window 11 comprises gripping means 46 ( ) extending projecting from the body 28 of the positioning window 11. The gripping means 46 are arranged so as to manipulate the positioning window 11 by means of a thumb and an index finger of a user.

For example, the gripping means 46 are arranged so that they each have a first face 46' arranged facing one another and a second face 46'' opposite the first face 46'. The second 46” faces are intended to receive a thumb or index finger of the user.

For example, the second 46” faces include a shape adapted to be manipulated by the user’s thumb and index finger.

For example, the second 46'' faces include a concave shape.

In the present presentation, the positioning window 11 comprises two gripping means 46.

For example, a first gripping means 46 is arranged on a first tab 34 of the positioning window and a second gripping means 46 is arranged on a second tab 36 of the positioning window.

For example, the gripping means 46 are gripping lugs 460 which extend projecting from the body of the positioning window. The gripping means are fixed in relation to the body.

The gripping means allow easy manipulation of the positioning window 11, for example during the cooperation of the positioning window 11 and the frame 5 with a view to connecting the positioning window 11 to the frame 5.

When the positioning window 11 is connected to the frame 5, the positioning window 11 can be manipulated so that it cooperates with the positioning guide 9.

For this purpose, the positioning window 11 comprises a slot 50 which has a shape adapted to cooperate with a shape of the positioning guide 9.

The slot 50 of the positioning window is provided in the lower portion 32 of the positioning window 11.

The lower portion 32 of the positioning window may comprise a wall 520 which extends projecting from the lower portion 32 of the positioning window 11 and into which the slot 50 extends.

The wall 520 makes it possible to improve the guiding range of the positioning guide.

In the present presentation, the slot 50 and the positioning guide 9 are configured to allow, when the positioning guide 9 is fixed to the joint, the insertion of a first end 9' of the positioning guide 9 through the slot 50 by relative movement of the positioning window 11 relative to the positioning guide 9, and the movement of the positioning window 11 along at least part of the positioning guide 9.

Such a positioning guide 9 is illustrated in .

The positioning guide 9 is intended to be fixed to the joint ( ).

We mean that the positioning guide is configured to anchor to a joint.

In the present presentation, the positioning guide 9 is intended to be inserted between the tibia 7a and the talus 7b, along a joint line “L” ( ) which serves as an anatomical reference.

The “L” joint line corresponds to a bone fusion line between the tibia 7a and the talus 7b.

In the case of the tibiotalar joint, the joint line "L" extends perpendicular to the tibia 7a, in particular to the tibial crest 7a', so that the positioning guide extends perpendicular to the tibia 7a, in particular to the tibial crest 7a'.

In the present presentation, the positioning guide 9 comprises a first end 9' and a second end 9'', opposite the first end 9'.

The first end 9' is configured to insert into the slot 50 of the positioning window 11.

The second 9” end is intended to be attached to the joint.

The positioning guide 9 is configured so as to allow the positioning window 11 to move relative to the positioning guide 9. The positioning guide 9 is configured to allow the positioning window 11 to be guided from the first end 9' from the positioning guide 9 to the second end 9'' of the positioning guide 9 fixed to the joint.

The positioning guide, once inserted into the positioning window slot, serves as a guide or slide for the positioning window.

The positioning guide may include a portion for securing the positioning guide to the joint and a portion for guiding the positioning window.

The positioning guide 9 is configured so that when the second end 9'' is fixed to the joint, that is to say interposed between the tibia 7a and the talus 7b along the joint line "L", the first end 9', which is then the only free end, can allow cooperation between the positioning window 11 and the positioning guide 9. This cooperation is achieved by relative movement of the positioning window 11 relative to the positioning guide so that the free end 9' of the positioning guide fits into the slot 50 of the positioning window 11.

The positioning guide 9 can be any suitable means to allow cooperation with the positioning window 11 so that the positioning window 11 can move from the free end 9' of the positioning guide 9, along at least part of the positioning guide 9.

For example, the positioning guide 9 can be a surgical instrument for cutting bones, resembling for example a scissor.

For example, the positioning guide 9 may include a blade.

For example, the positioning guide 9 can be a chisel or an osteotome.

The blade may comprise the first end 9', the second end 9'' and a central portion arranged between the first end 9', the second end 9''.

The positioning guide such as the blade 9 may comprise a flat surface, for example from its first end 9' to its second end 9'' ( ).

The positioning guide 9 is configured so that its dimensions are adjusted with the slot 50 of the positioning window 11.

The flat surface further allows the positioning guide 9 to comprise two parts; a part intended for fixing the positioning guide to the joint, formed by the second end 9'' and a part intended to guide the positioning window once the positioning guide inserted into the slot of the positioning window, formed through the central portion and the first end.

In operation, the positioning guide 9 is fixed via its second end 9'' to the joint ( ). For example, the positioning guide 9 is inserted between the tibia 7a and the talus 7b, for example along the joint line “L”.

The positioning window 11 is connected to the frame 5 ( , 16).

The positioning window 11 and the frame 5 are manipulated so that the first end 9' of the positioning guide is inserted into the slot 50 of the positioning window 11 ( ). The positioning window 11 which is connected to the frame 5 is moved relative to the positioning guide 9 until it comes into contact with the joint ( , 19). The frame 5 is fixed to at least one bone of the joint, for example to the tibia ( ). Once the frame 5 is fixed to the bone, the positioning guide 9 is removed from the joint and the slot 50 of the positioning window ( ).

Positioning the positioning guide 9 in the center of the joint, between the tibia 7a and the talus 7b makes it possible to transmit this same centering to the frame 5 before fixing the frame to the bone.

As a result, the correct positioning of frame 5 in relation to the tibiotalar joint will make it possible, during the bone cutting stage, to guarantee that the cuts made are always centered on the “L” joint line.

In order to facilitate the manipulation of the frame 5, the resection device 3 may comprise a manipulation means to which the frame 5 is connected. The handling means can be any suitable means for manipulating the frame 5, such as a handle or an arm.

In the present presentation, the manipulation means is an arm 48 to which the frame 5 is connected.

Such an arm 48 is illustrated in .

In the present presentation, the arm 48 comprises a first end 48' to which the frame is connected and a second end 48'', opposite the first end 48'.

According to one characteristic, the second 48” end is free.

By free end we mean an end devoid of means of connection to both the frame and the joint.

The means for fixing the resection device to the bone or bones of the joint are arranged on the frame only, which helps reduce tissue damage while allowing ergonomic fixation.

The arm 48 comprises a gripping portion 48''' arranged between the two ends 48', 48'', the gripping portion is free.

According to the present presentation, the second end of the arm 48'' may include a visual marker 500 intended to allow alignment of the arm with a bone, for example the tibia and in particular the tibial crest 7a'.

This will ensure that the positioning guide 9 is correctly positioned in relation to the tibia and in particular the tibial crest 7a', that is to say perpendicular to the tibia.

Indeed, when fixing the positioning guide 9 on the joint, it is possible that the positioning guide 9 is not completely aligned with the joint line “L” and therefore that it is not completely perpendicular to the tibia. . When the positioning window 11 cooperates with the positioning guide 9, it is possible to rotate the arm 48 slightly to the right and/or to the left so as to align the visual marker 500 with the tibia bone ( ). The movement of the arm 48 is transmitted to the frame 5 and to the positioning window 11 and therefore to the positioning guide 9 which cooperates with the positioning window 11. In this way, the positioning guide 9 can be aligned correctly with the joint line and arranged perpendicular to the tibia and in particular the tibial crest 7a'.

Once the position of the positioning guide 9 has been adjusted by means of the arm 38, the frame 5 can be fixed to the bone.

The visual marker 500 can be any suitable marker such as a shape or a laser marking for example.

In the embodiment illustrated in , the frame 5 and the arm 48 are formed in one piece. We understand that the frame 5 came from one piece with the arm 48.

In this embodiment, the wheel 42' is connected to the arm 48, for example the central zone 42'b of the wheel is housed in a complementary housing 52 of the arm ( , 4). For this purpose, the central part of the wheel may include a threaded portion which allows it to be held in position in the complementary housing 52. To put the wheel in place, it must be inserted into the complementary housing 52. This makes it possible to have the means for fixing the positioning window 11 to the frame 5 grouped together and thus make the connection and disconnection of the positioning window 11 and the frame 5 efficient and rapid.

The invention is not limited to such a configuration, for example the frame 5 and the arm 48 can be two parts assembled by screwing or welding.

The frame 5 and the arm 48 may comprise any suitable material, for example the arm and the frame comprise a metallic material.

In a preferred embodiment, the frame 5 and the arm 48 comprise a titanium alloy, for example, a TA6V alloy

According to a variant, the material can be stainless steel, for example type 17-4PH.

The invention is not limited to such a configuration, for example the frame 5 and the arm 48 may comprise a plastic material.

When the resection device 3 comprising the frame 5 and, for example, the arm 48 is adjusted and fixed to the bone, a bone resection can be carried out on the joint.

To carry out the bone resection, the positioning window 11 can be disconnected from the frame 5 and can be replaced by a cutting window 54.

Such a cutting window 54 is illustrated in . The cutting window 54 is part of the resection device.

The cutting window 54 is configured to be received in the housing 26 formed between the legs 16, 18 of the frame 5.

The cutting window 54 comprises a body 56 comprising a first portion 58, called the upper portion, and a second portion 60, called the lower portion, opposite each other and between which two lateral legs 62, 64 extend.

When assembling the cutting window 54 and the frame 5, the cutting window 54 can cooperate with the frame 5.

For this purpose, the upper portion 58 of the cutting window 54 may have recesses 580 intended to abut with the walls 140 projecting from the central portion 14 of the frame 5 and in which the openings 20 are formed, and the portion lower 60 of the cutting window 54 may include extensions 600 intended to abut with the walls 180 projecting from the distal parts of the legs 16, 18 of the frame 5.

The upper portion 58, the lower portion 60 and the two side tabs 62, 64 of the cutting window 54 define a space 66.

This space allows for a minimum of visibility of the articulation and the result of the preparatory stages. The space also makes it possible to limit contact between the cutting window and the anterior surface of the tibia.

The cutting window 54 is configured to be connected to the frame 5.

For this purpose, the means of connection of the cutting window 54 to the frame 5 are the same as those described and used to allow the connection of the positioning window 11 to said frame 5 (tapped opening 40' in frame 5 and wheel 42 ', for example fixed to arm 48).

To allow cooperation between the end 42'c of the wheel 42' and the threaded opening 40', an opening 68 is provided in the cutting window 54 ( ). The opening 68 is configured to allow the end 42'c of the wheel 42' to pass through said opening 68 of the cutting guide window up to the threaded opening 40' of the frame 5.

For example, the opening 68 is provided in the upper portion 58 of the cutting window 54.

The opening 68 provided in the upper portion 58 of the cutting window 54 is intended to be arranged opposite the tapped opening 40' of the frame 5 when the cutting window 54 cooperates with the frame 5.

The wheel 42' can be manipulated so that its end provided with the thread 42'c passes into the opening 68 of the upper portion 58 of the cutting window 54 and engages in the threaded opening 40' of the frame 5. The wheel 42' can then be screwed so as to connect the cutting window 54 to the frame 5.

In the present presentation, the cutting window 54 comprises gripping means 70 extending projecting from the body 56 of the cutting window 54. The gripping means 70 are arranged so as to manipulate the cutting window 54 by means of 'a user's thumb and index finger.

The gripping means 70 allow easy handling of the cutting window 54, for example when inserting the cutting window 54 into the housing 26 of the frame 5 with a view to its connection to the frame 5.

For example, the gripping means 70 are arranged so that they each have a first face 70' arranged facing one another and a second face 70'' opposite the first face 70'. Each of the second 70” faces is intended to receive a thumb or index finger of the user.

For example, the second 70” faces include a shape adapted to be manipulated by the user’s thumb and index finger.

For example, the second 70” faces include a concave shape.

In the present presentation, the cutting window 54 comprises two gripping means 70. These gripping means 70 are gripping lugs 720 which extend projecting from the body of the cutting window 54.

For example, a first gripping pin 720 is arranged on a first tab 62 of the cutting window 54 and a gripping pin 720 is arranged on a second tab 64 of the cutting window 54.

When the cutting window 54 is connected to the frame 5, the cutting window 54 can be used to perform bone resections in the joint.

The cutting window 54 comprises for this purpose at least one slot 74a, 74b through which a bone cutting element 76 ( , 26) can pass.

Said at least one slot 74a, 74b of the cutting window is configured to allow passage of the bone cutting element 76 and to guide the bone cutting element as it passes through said at least one slot.

The bone cutting element 76 is intended to cut a bone.

The bone cutting element 76 may be any element suitable for cutting a bone. For example, the bone cutting element 76 may be a saw blade, for example an oscillating saw blade.

In the present presentation, said at least one slot 74a, 74b of the cutting window 54 is provided in the lower portion 60 of the cutting window 54 ( ).

The lower portion 60 of the cutting window may comprise a wall 78 which projects from the window of the cutting guide 54 and into which said at least one slot 74a, 74b extends.

Wall 78 makes it possible to increase the guiding range. The higher the slots 74a, 74b are, the less play there will be during the cutting step using the bone cutting element.

In the example shown in , the cutting window comprises a first slot 74a and a second slot 74b spaced from one another.

When the cutting window 54 is connected to the frame 5, the slots 74a, 74b are intended to be arranged on either side of the joint line "L" so that the bone cutting element can pass through each of the slots 74a, 74b for cutting the tibia 7a and the talus 7b respectively.

The bone cuts are made by passing the bone cutting element, for example a saw blade, through the respective slots 74a, 74b of the cutting window. The cutting window is connected to the frame 5 for which the appropriate position has been previously adjusted and centered with respect to the joint line via the positioning window 11 and the positioning guide 9 ( ).

The cutting window 54 is thus characterized by the presence of slots distributed on either side of the centering position defined by the positioning guide 9 and the positioning window ( ).

According to a first variant not illustrated, a first slot 74a and a second slot 74b are separated respectively by an identical distance e1 and e2 with respect to a centering line 0, which correspond to the joint line or bone fusion line given by the positioning guide and positioning window.

According to a second variant illustrated in , the distances e1 and e2 are different. For example, the distance e1 of the first slot 74a relative to the centering line 0 is greater than the distance of the second slot 74b relative to the centering line 0. Conversely, the distance e1 of the first slot 74a relative to the centering line 0 is less than the distance e2 of the second slot 74b relative to the centering line 0. This makes it possible to choose the cutting amplitude for each of the bones.

In an embodiment illustrated in , the surgical instrumentation assembly may comprise the cutting window 54 as previously described, called the first cutting window and a second cutting window 54' intended to be connected to the frame 5 and comprising two slots 74a', 74b'.

The slots 74a', 74b' of the second cutting window are intended to be arranged on either side of the tibiotalar joint and are configured so that a bone cutting element can pass through each of them. it to cut the tibia and the talus respectively.

The second cutting window 54' differs from the first cutting window 54 in that the two slots 74a, 74b of the first cutting window are spaced from each other by a first distance "d1" and the two slots 74a', 74b' of the second cutting window 54' are spaced from each other by a second distance "d2" different from the first distance "d1".

For example the second distance "d2" between the slots 74a', 74b' of the second cutting window 54' is greater than the distance "d1" between the slots 74a, 74b of the first cutting window 54 ( ).

The second cutting window 54' can be used in the event that the amplitude of the cut made with the first cutting window was not sufficient.

In these embodiments, each of the slots 74a, 74b, 74a’, 74b’ is for example fixedly provided in the cutting guides 54, 54’. In other embodiments, more than two cutting windows including variable distances between the slots can be used. In embodiments not illustrated, it is for example possible to propose a single cutting guide 54 which has slots whose positions can be adjusted by means of a mechanism adapted so as to modify the distance between the slots.

Indicatively and in no way limiting, the distance “d1, d2” between the slots 74a, 74b, 74a’, 74b’ may be between 3 and 10 mm.

A visualization of the cuts made using the first cutting window 54 and the second cutting window 54' on the tibia and the talus is presented in .

In the embodiments of Figures 8 to 11, the first slot and the second slot 74a, 74b, 74a', 74b' of the cutting window(s) as previously described extend parallel one in relation to the other.

According to an embodiment illustrated in , the first slot 74a, 74'a of the cutting window(s) as previously described extends at an angle "α" inclined relative to the second slot 74b, 74b'. This allows you to correct the orientation of the foot. The angle “α” is defined in a plane orthogonal to the direction of insertion of the positioning guide.

In this presentation, the angle “α” is between 5 and 10 degrees, preferably the angle “α” is equal to 5 degrees.

In other embodiments not shown, the positioning window 11 may be permanently connected with the frame 5. In this embodiment, the positioning window is also a cutting window and includes both a slot configured to allow passage of the positioning guide and two slots configured to allow passage of a bone cutting element. In this embodiment, the slots configured to allow passage of the bone cutting element must be spaced apart from the slot configured to allow passage of the positioning guide.

A method of bone resection, for example tibiotalar using the surgical instrumentation assembly as previously described and which comprises the steps of fixing a positioning guide 9 to a joint, and of cooperation between a window of positioning 11 and the positioning guide 9 in order to position a resection device relative to a bone according to a fixation position, is illustrated in Figures 13 to 29.

As illustrated by , the method includes a step in which a joint line “L” is determined.

The joint line “L” corresponds to a bone fusion line between the bones of a joint, for example the tibia 7a and the talus 7b.

To do this, a tibial window is created via the positioning guide 9 so as to collapse the tibial crest.

Following this step, the positioning guide 9 is inserted between the tibia and the talus.

There illustrates the positioning guide 9 which is fixed to the joint, between the tibia 7a and the talus 7b.

As illustrated by , the method includes a step in which the positioning window 11 is connected to the frame 5.

The positioning window 11 can be manipulated via the gripping lugs 460 of the positioning window 11.

The positioning window 11 is received at least partly in the housing 26 formed between the legs 16, 18 of the frame 5. The positioning window 11 and the frame 5 cooperate so that the recesses 31 and the extensions 320 of the positioning window positioning 11 come into contact with the respective walls 170, 180 of the frame 5.

The positioning window 11 can be connected to the frame 5, for example by screwing a wheel 42' into a threaded opening 40' provided in the frame 5.

There illustrates positioning window 11 when connected to frame 5.

There illustrates a step in which the positioning window 11 and the frame 5 are manipulated so that the first end 9' of the positioning guide is inserted into the slot 50 of the positioning window 11.

The positioning window 11 which is connected to the frame 5 is then moved relative to the positioning guide 9 up to a portion of the joint anchoring means until it comes into contact with the joint ( , 19).

In the present method, the positioning window 11 is moved from the free end 9' of the positioning guide until the frame 5 comes into contact with a bone, for example an anterior face of the tibia.

In the steps of the method illustrated, the frame 5 is connected to an arm 48.

In this embodiment, the positioning window 11 is moved via the arm 48.

The method may include a step in which a practitioner ensures the correct perpendicularity of the positioning guide 9 with the tibia 7a in the sagittal plane (visualization of the positioning guide 9) and in the frontal plane (alignment of the visual mark 500 on the arm 48 with the tibial crest 7a).

The position of the arm 48 can be modified so as to align the positioning guide 9 with the tibial crest 7a.

There illustrates a step of the method in which the frame 5 is fixed to a first bone, for example to the tibia 7a.

Fixation can be achieved by means of pins 24 which pass through the openings 20 of the frame 5 then are inserted into the tibia 7a.

Frame 5 can be fixed on the tibia by means of two pins 24.

As illustrated by , the method includes a step in which the positioning guide 9 is removed from the joint.

As illustrated by , the method comprises a step in which the positioning window 11 is disconnected from the frame 5, for example by unscrewing the wheel 42' from the threaded opening 40' of the frame 5.

There illustrates a step of the method in which the frame 5 is fixed to a second bone, for example to the talus 7b.

Fixing can be carried out by means of pins 24 which pass through the openings 20 of the frame 5 then which are inserted into the embankment 7b.

The frame 5 can be fixed on the embankment 7b by means of two pins 24.

As illustrated by , the method comprises a step in which a cutting window 54 is connected to the frame 5, for example the cutting window can be manipulated via the gripping lugs 720 of the cutting window 54. For example the cutting window 54 is received at least partly in the housing 26 formed between the legs 16, 18 of the frame 5. The cutting window and the frame 5 cooperate so that the recesses 580 and the extensions 600 of the cutting window 54 come into contact with the respective walls 170, 180 of frame 5.

The cutting window 54 can be connected to the frame by screwing a wheel 42' into the tapped opening 40' provided in the frame 5.

There illustrates the cutting window 54 when connected to the frame 5.

When the cutting window 54 is connected to the frame 5, the two slots 74a, 74b are arranged respectively on either side of the joint line “L”. A slot 74a is arranged facing the tibia and a slot 74b is arranged facing the slope 7b.

In reference to the the method may include performing a bone cut using a bone cutting element.

In a first step, a bone cutting element, such as an oscillating saw blade passes through a first slot 74a so as to carry out a resection of a first bone, for example the tibia 7a.

As illustrated in , the method comprises a second step in which the oscillating saw blade passes through the second slot 74b so as to carry out a resection of a second bone, for example the talus 7b.

In the case where the amplitude of the bone resection carried out is too low, the method may include a step in which the cutting window 54 is disconnected from the frame 5 and replaced by a second cutting window 54' in which the distance between the two slots 74a', 74b', is greater than the distance between the two slots 74a, 74b of the previous cutting window 54. This allows more material to be removed.

Once the bone cut has been made, the cutting window 54 is disconnected from the frame 5 by unscrewing the wheel 42' ( ).

Then the pins 24 are removed from the bones 7a, 7b in order to remove the resection device 3 ( ).

There illustrates the tibiotalar resection 80, 82 performed.

As illustrated by , the bone resection procedure can continue with an arthrodesis, for example by means of a plate/screw assembly 84.

Claims (13)

Surgical instrumentation set (1) for bone resection, for example tibiotalar resection, the set (1) comprising:

• a resection device (3) configured to be fixed to at least one bone of a joint, for example to a tibia and/or a talus of an ankle, the resection device (3) comprising a frame (5),
• a positioning guide (9) intended to be fixed to the joint,
• a positioning window (11) configured to be connected to the frame (5),

in which the positioning guide (9) and the positioning window (11) are configured to allow, when the positioning guide (9) is fixed to the joint, the cooperation of the positioning window (11) with the guide positioning device (9), in order to position the resection device (3) relative to the bone in a fixation position. Assembly (1) according to claim 1 in which the resection device (3) comprises an arm (48) and in which the frame (5) is connected to a first end (48') of the arm (48). Assembly according to any one of claims 1 to 2 in which the positioning window (11) comprises a slot (50) having a shape adapted to cooperate with the shape of the positioning guide (9), for example the slot (50) and the positioning guide (9) being configured to allow, when the positioning guide (9) is fixed to the joint, the insertion of a first end of the positioning guide (9) through the slot (50) by relative movement of the positioning window (11) relative to the positioning guide (9), and moving the positioning window (11) along at least part of the positioning guide (9). Assembly (1) according to any one of the preceding claims in which the positioning window (11) is configured to be connected to the frame (5) in a removable manner and in which the assembly comprises at least one cutting window (54) intended to be removably connected to the frame (5), the cutting window (54) comprising at least one slot (74a, 74b) through which a bone cutting element can pass. Assembly (1) according to the preceding claim in which the cutting window (54) comprises a first slot (74a) and a second slot (74b) spaced from one another, through which the bone cutting element can pass. Assembly (1) according to the preceding claim in which the first slot (74a) extends at an inclined angle (α) relative to the second slot (74a). Assembly (1) according to one of claims 4 to 6 in which the assembly (1) comprises a bone cutting element (76) such as a saw blade. Assembly according to claim 2 in which the arm (48) comprises the first end (48') to which the frame (5) is connected and a second free end (48''). Assembly (1) according to any one of the preceding claims in which the frame (5) comprises a body (12), the body (12) comprising a central portion (14) from which two lateral tabs (16) extend , 18) arranged to receive the positioning window (11), and in which the assembly (1) comprises means for connecting the positioning window to the frame, the connection means comprising:

• first connection means (40) arranged on the central portion (14) of the frame (5)
• second connection means (42), complementary to the first connection means (40) configured to cooperate with the first connection means (40) when the positioning window (11) is connected to the frame (5).

Assembly (1) according to the preceding claim in which the second connection means (42) comprise return means (47) intended to disengage the second connection means (42) from the first connection means (40) so as to disconnect the positioning window (11) of the frame (5). Assembly (1) according to any one of the preceding claims in which the positioning window (11) comprises a body (28) and gripping means (46) extending projecting from the body, the gripping means (46) being arranged to manipulate the positioning window by means of a thumb and index finger of a user. Assembly (1) according to claim 5 in which the two slots (74a, 74b) of the cutting window (54), called the first cutting window, are spaced from one another by a first distance (d1) and in which the assembly (1) comprises a second cutting window (54') intended to be connected to the frame (5) and comprising two slots (74a', 74b') being spaced from one another by a second distance (d2) different from the first distance (d1). Assembly according to any one of the preceding claims, in which the positioning guide (9) comprises a blade.