Patent Publication Number: US-2023136212-A1

Title: Minimally invasive tools, systems and methods

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority to U.S. Provisional Application No. 63/008,034, filed on Apr. 10, 2020, the entire contents of both which are incorporated herein by reference. 
    
    
     FIELD OF DISCLOSURE 
     The disclosed systems are directed to fixtures and guides for use in surgeries. More particularly, the disclosed systems are directed to fixtures and guides for use in minimally invasive surgical (MIS) procedures, including MIS for Charcot neuropathy procedures involving extremities such as the hand and foot. 
     BACKGROUND 
     Many minimally invasive surgeries (MIS) or surgical procedures, such as those involving bunions, osteotomies, and fusions, involve making cuts with burrs. Physicians or surgeons typically make these cuts without any guidance. As such, these procedures and the making of these cuts are typically considered to be an “art” as opposed to a science. Thus, the outcome of the surgery is largely dependent on the skill level of the surgeon and the ability to perform the surgery with consistency is difficult if not impossible. The disclosed systems are especially useful in planning for complex limb salvage procedures, such as fractures, non-unions, or deformities including Charcot neuropathy, which demand a high level of accuracy with reduced incisions. 
     SUMMARY 
     In some embodiments, a system includes a first tool having a base, a nut, and a tool guide. The base extends from a first end to a second end and includes at least one thread disposed along a length thereof. The first end includes a foot having a widthwise dimension that is greater than a diameter of the at least one thread. The nut is configured to be disposed along the length of the base and to engage at least one thread. The tool guide is configured to be slideably disposed along the length of the base and has a body including a flange portion. The flange portion defines an opening for receiving at least one of a pin and a cutting tool. Rotation of the first nut causes the nut to translate along the length of the base thereby causing the tool guide to move along the length of the base. 
     In some embodiments, a system includes a base plate formed from a radiolucent material. The base plate includes a first side and a second side. The first side of the base plate defines at least one first channel and at least one second channel. The at least one first channel extends along a length of the base plate in a first direction. The at least one second channel extends along a width of the based plate in a second direction, which is different from the first direction. The base plate further defines at least one first hole extending inwardly from the first side and at least partially overlapping the at least one first channel such that the hole is in communication with the at least one first channel. 
     A method includes securing a body part to a base plate formed from a radiolucent material; coupling at least one first tool to the base plate, the at least one tool configured for providing fluoroscopic guidance without physically contacting the body part; and performing a minimally invasive surgical procedure on the body part using the at least one first tool. 
     A system includes a base plate formed from a radiolucent material and a first tool. The base plate includes a first side and a second side. The first side of the base plate defines a first channel and a second channel that extend along a length of the base plate in a first direction. The first tool includes a first component including a first foot and a first body and a second component including a second foot and a second body. The first foot is sized and configured to be received in at least one of the first channel and the second channel defined by the base plate. The first body supports at least one first radiopaque member. The second foot is sized and configured to be received in at least one of the first channel and the second channel defined by the base plate. The second body supports at least one second radiopaque member. The at least one first radiopaque member of the first component and the at least one second radiopaque member are configured to provide a visual indication of proper alignment of the first component, second component, and a fluoroscope when the first component is disposed within one of the first and second channels and the second component is disposed within another of the first and second channels. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    is an isometric view of one example of a fixture in accordance with some embodiments; 
         FIG.  2    is an isometric view of one example of a base plate in accordance with some embodiments; 
         FIG.  3    is a lateral side view of the base plate illustrated in  FIG.  2    in accordance with some embodiments; 
         FIG.  4    is an end side view of the base plate illustrated in  FIG.  2    in accordance with some embodiments; 
         FIG.  5    is a top side plan view of the base plate illustrated in  FIG.  2    in accordance with some embodiments; 
         FIG.  6    is a bottom side plan view of the base plate illustrated in  FIG.  2    in accordance with some embodiments; 
         FIG.  7    is an isometric view of one example of a foot clamp in accordance with some embodiments; 
         FIG.  8    is an isometric view of a component of the foot clamp illustrated in  FIG.  7    in accordance with some embodiments; 
         FIG.  9    is a top side plan view of the foot clamp component illustrated in  FIG.  8    in accordance with some embodiments; 
         FIG.  10    is a bottom side plan view of the foot clamp component illustrated in  FIG.  8    in accordance with some embodiments; 
         FIG.  11    is an end view of the foot clamp component illustrated in  FIG.  8    in accordance with some embodiments; 
         FIG.  12    is a side view of the foot clamp component illustrated in  FIG.  8    in accordance with some embodiments; 
         FIG.  13    is an isometric view of another component of the foot clamp illustrated in  FIG.  7    in accordance with some embodiments; 
         FIG.  14    is a top side plan view of the foot clamp component illustrated in  FIG.  13    in accordance with some embodiments; 
         FIG.  15    is a bottom side plan view of the foot clamp component illustrated in  FIG.  13    in accordance with some embodiments; 
         FIG.  16    is an end view of the foot clamp component illustrated in  FIG.  13    in accordance with some embodiments; 
         FIG.  17    is a side view of the foot clamp component illustrated in  FIG.  13    in accordance with some embodiments; 
         FIG.  18    is a side view of an insert that may be used with the foot clamp illustrated in  FIG.  7    in accordance with some embodiments; 
         FIG.  19    is a first end view of the insert illustrated in  FIG.  18    in accordance with some embodiments; 
         FIG.  20    is a second end view of the insert illustrated in  FIG.  18    in accordance with some embodiments; 
         FIG.  21    is an isometric view of a guidance tool in accordance with some embodiments; 
         FIG.  22    is a side view of the guidance tool illustrated in  FIG.  21    in accordance with some embodiments; 
         FIG.  23    is a bottom side view of the guidance tool illustrated in  FIG.  21    in accordance with some embodiments; 
         FIG.  24    is a top side view of the guidance tool illustrated in  FIG.  21    in accordance with some embodiments; 
         FIG.  25    is an end view of one example of a radiopaque element that may be used with the guidance tool illustrated in  FIG.  21    in accordance with some embodiments; 
         FIG.  26    is a side view of the radiopaque element illustrated in  FIG.  25    in accordance with some embodiments; 
         FIG.  27    is an isometric view of another example of a guide tool in accordance with some embodiments; 
         FIG.  28    is a side view of the guide tool illustrated in  FIG.  27    in accordance with some embodiments; 
         FIG.  29    is a bottom side view of the guide tool illustrated in  FIG.  27    in accordance with some embodiments; 
         FIG.  30    is a top side view of the guide tool illustrated in  FIG.  27    in accordance with some embodiments; 
         FIG.  31    is an end view of one example of a radiopaque member that may be used in connection with the guide tool illustrated in  FIG.  27    in accordance with some embodiments; 
         FIG.  32    is a side view of the radiopaque member illustrated in  FIG.  31    in accordance with some embodiments; 
         FIG.  33    is an isometric view of a fixation tool in accordance with some embodiments; 
         FIG.  34    is a side plan view of the fixation tool illustrated in  FIG.  33    in accordance with some embodiments; 
         FIG.  35    is another side plan view of the fixation tool illustrated in  FIG.  33    in accordance with some embodiments; 
         FIG.  36    is another side plan view of the fixation tool illustrated in  FIG.  33    in accordance with some embodiments; 
         FIG.  37    is an isometric view of one example of a guidance and fixation tool in accordance with some embodiments; 
         FIG.  38    is a top side plan view of the guidance and fixation tool illustrated in  FIG.  37    in accordance with some embodiments; 
         FIG.  39    is a bottom side plan view of the guidance and fixation tool illustrated in  FIG.  37    in accordance with some embodiments; 
         FIG.  40    is a rear view of the guidance and fixation tool illustrated in  FIG.  37    n accordance with some embodiments; 
         FIG.  41    is a side view of the guidance and fixation tool illustrated in  FIG.  37    in accordance with some embodiments; and 
         FIG.  42    is another side view of the guidance and fixation tool illustrated in  FIG.  37    in accordance with some embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     This description of the exemplary embodiments is intended to be read in connection with the accompanying drawings, which are to be considered part of the entire written description. 
     The disclosed systems, guides, fixtures, and tools advantageously enable improved surgical outcomes by providing a surgeon or other medical professional with fluoroscopic and/or actual physical guidance when performing MIS procedures. For example, the disclosed systems, guides, fixtures, and tools enable a surgeon to secure an extremity, such as a hand or foot, to a base plate and perform MIS procedures (e.g., Charcot neuropathy procedures) with the aid of fluoroscopy. Further, the disclosed tools and systems may be provided in a variety of sizes and/or shapes for performing various surgical techniques or cuts. For example, a guide or pair of guides may be provided in one or more sizes and provide guidance for providing one or more cuts at one or more angles. Advantageously, the disclosed tools and systems may provide guidance without the need for actually contacting the patient as described below. The selection of the one or more tools or systems (e.g., size and/or shape) may be made by a surgeon preoperatively (i.e., based on preoperative planning or imaging) or intraoperatively. The ability to guide cutting or drilling tools that limit the amount of patient contact contribute to a less invasive surgical procedure and faster recovery times. 
       FIG.  1    illustrates one example of a system or fixture for use in performing a MIS procedure. As shown in  FIG.  1   , the system or fixture includes a base plate  102  for supporting an extremity. Although base plate  102  is shown as being a foot plate, a person of ordinary skill in the art will understand that the disclosure is not so limited and that the base plate  102  could be used to support a hand, arm, wrist, or other extremity. In some embodiments, base plate  102  is formed from a rigid radiolucent material that may be sterilized. Examples of such materials include, but are not limited to, polyetheretherketone (PEEK), polyphenylsulfone (PPSU), polyacetal (POM-C), and polypropylene, to list only a few possibilities. Providing a radiolucent base plate  102  enables the extremity being supported by the base plate to be imaged using radiography from above (i.e., looking down onto the base plate). A person of ordinary skill in the art will appreciate that the base plate may also be formed from a radiopaque material in some embodiments. 
     Base plate  102  is shown in  FIGS.  2 - 6    having a generally rectangular shape, although one of ordinary skill in the art will understand that base plate  102  may have other shapes. As best seen in  FIGS.  2 ,  5 , and  6   , base plate  102  has a length that is greater than a width to accommodate a human foot, which typically is longer than it is wide. The thickness of base plate  102  may also vary, although the thickness of base plate  102  should have a sufficient thickness to be suitable rigid for supporting an extremity. 
     In some embodiments, base plate  102  defines at least one opening  104  ( FIGS.  2 ,  5 , and  6   ), which may serve as a handle for carrying the base plate  102 . The opening  104  may be positioned adjacent to a first side  106  and have a length that extends in a widthwise direction across base plate  102 . However, one of ordinary skill in the art will understand that opening  104  could be provided along one of the sides  108 ,  110  directly adjacent to side  106  or could be provided adjacent to side  112 , which is located opposite side  106 . 
     In some embodiments, base plate  102  also defines one or more first channels (e.g., channels  114 - 1 ,  114 - 2 ; collectively “channels  114 ”) for use in securing tools (described in greater detail below) to base plate  102 . As shown in  FIG.  5   , channels  114  extend from side  106  in a direction parallel to a longitudinal axis defined by base plate  102 . Base plate  102  may also define one or more second channels (e.g., channels  116 - 1 ,  116 - 2 ,  116 - 3 ; collectively “channels  116 ”). Channels  116  may extend in a widthwise direction from side  108  to side  110  such that channels  116  extend perpendicular to channels  114 . In some embodiments, the width of channels  114  and  116  is different; however, one of ordinary skill in the art will understand that the width of channels  114  and  116  may be the same. 
     Although channels  114  and  116  are shown as having a generally square cross-sectional geometry, one of ordinary skill in the art will understand that channels  114  and/or  116  may have other cross-sectional geometries. For example, channels  114  and/or  116  may include undercuts or dovetails to facilitate the securement of one or more tools to base plate  102 . 
     In some embodiments, channels  114 - 1 ,  114 - 2  respectively terminate at an enlarged hole  120 - 1 ,  120 - 2  (collectively, “enlarged holes  120 ” or “holes  120 ”), which extends through base plate  102 , i.e., from an upper side  122  to a lower side  124 . As described in greater detail below, holes  120  facilitate the placement or removal of one or more tools without having the slide the tools out via the opening of the channels  114  located at the side  106  of base plate  102 . 
     The number and type of tools that may be secured to base plate  102  may be of a variety of types and sizes depending on the type of MIS procedure. For example, the tools may include pin holders and fluoroscopic visualization tools, to list only a couple of examples. 
     One example of a foot clamp or guide  200 , which is also configured to receive one or more pins, is shown in  FIGS.  7 - 20   . As shown in  FIG.  7   , foot clamp  200  may include a first component  202  and a second component  220  each of which may be slideably coupled to base plate  102 . The slideable coupling of the components  202 ,  220  of foot clamp  200  advantageously enable feet of a wide variety of sizes to be secured to base plate  102 . The foot clamp  200  may incorporate positioning and size variations, which are designed for a single patient or a general range of patient sizes. 
     As best seen in  FIGS.  8 - 12   , component  202  includes a body  204  having a first contoured surface  206  that is curved to approximate the contours of a heel of a human foot. A flange  208  extends from base of the body  204  and includes features (e.g., an extension or dovetail) for engaging one or more of channels  116  defined by base plate  102 . In some embodiments, flange  208  defines a slot  210  that extends along a length of flange  208 . Slot  210  has a width that is dimensioned to receive a screw or other fixation device for securing component  202  to base plate  102  at a specific location. For example, in some embodiments, base plate  102  may include one or more threaded holes (holes  118 - 1 ,  118 - 2 ,  118 - 3 ,  118 - 4 ; collectively “holes  118 ”) for receiving the screw. Rotating the screw to advance the screw into one of the one or more holes hole defined by base plate  102  results in component  202  being pressed against base plate  102  to prevent or resist component  202  moving relative to base plate  102  as will be understood by one of ordinary skill in the art. 
     Component  202  also includes an extension block  212  extending from an upper surface of the body  204 . One or more holes (holes  214 - 1 ,  214 - 2 ; collectively “holes  214 ”) are defined by extension block  212 . Holes  214  extend entirely through extension block  212  and are dimensioned to receive a pin therein. In some embodiments, holes  214  extend parallel to one another, although one of ordinary skill in the art will understand that holes  214  may be otherwise positioned with respect to one another. The one or more pins may be inserted into the one or more holes  214  defined by extension block  212  to secure a foot or extremity to component  202  and thus to base plate  102  when component  202  is secured to base plate  102 . 
     As best seen in  FIGS.  13 - 17   , component  220  of foot clamp or guide  200  may have a similar structure to component  202  with the exception that component  220  is essentially a mirror image of component  202 . For example, component  220  includes a body  222  having a first contoured surface  224  that is curved to approximate the contours of a heel of a human foot. However, one of ordinary skill in the art will understand that components  202  and  202  may have different shapes such that they would not be considered mirror images of one another. 
     The body  222  of component  220  may also include a flange  226 . Like flange  208  of component  202 , the bottom surface of flange  226  may include one or more features (e.g., ribs or a dovetail)  234 - 1 ,  234 - 2  (collectively, “features  234 ” or “ribs  234 ”) sized and configured to engage one or more of channels  116  defined by base plate  102  as best seen in  FIG.  15   . In some embodiments, flange  226  defines a slot  228  that extends along a length of flange  226 . Slot  228  has a width that is dimensioned to receive a screw or other fixation device for securing component  220  to base plate  102  at a specific location. For example, as described above, base plate  102  may include a number of threaded holes  118  for receiving the screw or fixation device such that, upon rotating the screw to advance the screw into one of the one or more holes defined by base plate  102 , component  220  is pressed against base plate  102  to prevent or resist component  220  from moving relative to base plate  102 . 
     Component  220  may also include an extension block  230 , which extends from an upper surface of the body  222  of component  220 . Extension block  230  defines one or more holes ( 232 - 1 ,  232 - 2 ; collectively “holes  232 ”) each of which extends entirely through extension block  230  and being dimensioned to receive a pin therein. In some embodiments, holes  232  extend parallel to one another, although one of ordinary skill in the art will understand that holes  232  may be otherwise aligned with respect to one another. One or more pins may be inserted into one or more holes defined by extension block  230  to secure a foot or other extremity to component  220  and thus to base plate  102  when component  220  is secured to base plate  102 . 
     To facilitate the use of fluoroscopy, the holes  214 ,  232  defined by components  202 ,  220 , respectively, may be sized and configured to receive inserts  240  as best seen in  FIGS.  18 - 20   . In some embodiments, inserts  240  includes a body  242  longitudinally extending from a first end  244  to a second end  246 . Body  242  also may include a shoulder  248  at second end  246 . Shoulder  248  has a diameter that is greater than a diameter of the rest body  242 , including first end  244 . A hole  250  extends through the entirety of body  242  parallel to and, in some embodiments, aligned with a central longitudinal axis defined by body  242 . Hole  250  is dimensioned to receive a pin or other fixation device and/or surgical tool (e.g., a drill or burr) as will be understood by one of ordinary skill in the art. Inserts  240  may be press fit (or be dimensioned to have another type of fit) into holes  214 ,  232  defined by components  202 ,  220  except that shoulder  248  has a diameter that prevents shoulder  248  from being received within holes  214 ,  232 . The hole  250  may incorporate positioning and size variations which are designed for a single patient or a general range of patient sizes. In some embodiments, inserts  240  are formed from a radiopaque material to provide for fluoroscopic guidance and visualization; however, one of ordinary skill in the art will understand that insert  240  may be formed entirely or partially from a radiopaque material. 
       FIGS.  21 - 24    illustrate one example of a first visualization tool  300  that may be used with base plate  102  in accordance with some embodiments. The visualization tool  300  may incorporate positioning and size variations, which are designed for a single patient or a general range of patient sizes. 
     Visualization tool  300  includes a foot  302  that is sized and configured to engage channels  114  to secure visualization tool  300  to base plate  102 . Foot  302  may have a complementary shape to the cross-sectional geometry of channels  114 . For example, if channels  114  include a dovetail shape or undercut, then foot  302  may have a complementary dovetail shape or include extensions for being received within the undercut. Although not shown, foot  302  may include a spring loaded detent, a hole for receiving a screw, or other locking mechanism for securing visualization tool  300  to a specific location along the length of channel  114 . Foot may also include a radiopaque member  328  for providing a visualization/alignment check in combination with radiopaque member  320  as discussed below. 
     Visualization tool  300  also includes a stem  304  extending from foot  302  and terminating at body  310 . For reasons described in greater detail below, foot  302 , stem  304 , and body  310  may be formed from a radiolucent material. In some embodiments, stem  304  includes one or more bends  306 ,  308  or curves for providing a bowed shape to visualization tool  300 . Providing visualization tool  300  with a bowed shape increases the amount of area (e.g., clearance) between the extremity fixed to base plate  102  and the stem  304  of visualization tool  300  while at the same time enabling body  310  to be at least partially disposed over the extremity or body part when the extremity or body part is secured to base plate  102 . 
     As best seen in  FIG.  24   , body  310  may include one or more radiopaque members  312 - 1 ,  312 - 2  (collectively “radiopaque members  312 ) embedded within and/or otherwise attached to or supported by body  310 . In some embodiments, radiopaque members  312  comprise elongate rods and each of which extend from a first end  314  to a second end  316 . Radiopaque members are shown as being supported by body  310  such that their longitudinal axes are arranged non-perpendicular and non-parallel with respect to one another, although one of ordinary skill in the art will understand that the rods may aligned such that they are perpendicular or parallel to one another depending on the surgical procedure in which they will be used. Radiopaque members  312  advantageously provide a surgeon with visual guidance when tool  300  is used with fluoroscopy. 
     As will be understood by one of ordinary skill in the art, the radiopaque members  312  may define “go”/“no go” areas (e.g., areas in which a surgeon make cuts or should not make cuts) or otherwise provide guidance for making a cut. For example, in the embodiment shown in  FIGS.  21 - 24    and as best seen in  FIG.  24   , the area  318  located between radiopaque members  312  may be the “go” area and the areas located outside of radiopaque members  312  may be the “no go” area. 
     In some embodiments, body  310  of tool  300  also supports another radiopaque member  320 . As best seen in  FIGS.  25 - 26   , radiopaque member  320  has a hollow cylindrical shape extending from a first end  322  to a second end  324  and defining a central opening  326 . A central axis defined by the central opening  326  is positioned perpendicular to the longitudinal axes defined by radiopaque members  312  such that radiopaque member  320  may be used to ensure that the fluoroscope is aligned properly with base plate  102 . For example, when the fluoroscope is aligned properly with alignment tool  300  (and thus with base plate  102 ), then the radiopaque member  320  will appear to be a circle when viewed using fluoroscope. If the fluoroscope is misaligned with alignment tool  300  (and thus with base plate  102 ), then the radiopaque member  320  will appear to be non-circular when viewed using the fluoroscope. Further, when visualization tool includes a radiopaque member  328  in foot  302 , the combination of radiopaque members  320 ,  328  may have the appearance of a bullseye (or other shape or appearance) to indicate the fluoroscope is properly aligned with the tool  300 . 
     Although not shown in  FIGS.  21 - 24   , body  310  may also define one or more holes or slots sized and configured to receive a drill, burr, or other surgical tool. For example, body  310  may include any number of holes or slots such that tool  300  may be used as a drill and/or cutting guide in addition to providing visual guidance. The body  310  may incorporate positioning and size variations which are designed for a single patient or a general range of patient sizes. 
       FIGS.  27 - 30    illustrate one example of a second visualization tool  400  that may be used with base plate  102  in accordance with some embodiments. Visualization tool  400  may be similar to visualization tool  300 . For example, visualization tool  400  may include a foot  402  for securing visualization tool  400  to base plate  102 . Like foot  302  of tool  300 , foot  402  of visualization tool  400  may have a complementary shape to the shape of channels  114  to facilitate engagement and securement of foot  402  in a channel  114 . Tool  402  may include a spring-loaded detent, a hole for receiving a screw, or other locking mechanism for securing visualization tool  400  to a specific location along the length of channel  114 . In some embodiments, foot  402  includes a radiopaque member  428  for providing a visualization/alignment check in combination with radiopaque member  420  as described below. 
     A stem  404  extends from foot  402  to body  410  and includes bends or curves  406 ,  408  along its length. Foot  402 , stem  404 , and body  410  may be formed from a radiolucent material such that foot  402 , stem  404 , and body  410  are essentially transparent under fluoroscopy. The bends or curves  406 ,  408  provide clearance between the stem  404  and an extremity or body part secured to base plate  102 . 
     Body  410  may include one or more radiopaque members  412 - 1 ,  412 - 2  (collectively, “radiopaque members  412 ”) supported by body  410 . Radiopaque members  412  may be implemented as elongate rods each of which extends from a first end  414  to a second end  416 ; however, a person of ordinary skill in the art will understand that radiopaque members  412  may be implemented in other configurations. Like radiopaque members  312 , radiopaque members  412  may be positioned relative to one another such that their longitudinal axes are arranged non-perpendicular and non-parallel, although one of ordinary skill in the art will understand that the radiopaque members  412  may be otherwise positioned relative to one another. Further, radiopaque members may be used to provide a surgeon with visual guidance for making free-hand cuts or may identify “go”/“no go” areas. In the embodiment shown in  FIG.  27   , for example, the area  418  between radiopaque members  412  may be a “go” area and the area outside of radiopaque members  412  may be a “no go” area. 
     Body  410  may also support additional radiopaque members beyond radiopaque members  412 . For example, body  410  supports radiopaque member  420 , which is shown as a hollow cylinder in  FIGS.  31  and  32   . As best seen in  FIG.  32   , radiopaque member  420  extends from a first end  422  to a second end  424  and defines a central opening  426  therethrough. A central axis defined by the central opening  426  is positioned perpendicular to the longitudinal axes defined by radiopaque members  412  such that radiopaque member  420  may be used to ensure that the fluoroscope is aligned properly with base plate  102 . For example, when the fluoroscope is aligned properly with alignment tool  400  (and thus with base plate  102 ), then the radiopaque member  420  will appear to be a circle when viewed using fluoroscope. If the fluoroscope is misaligned with alignment tool  400  (and thus with base plate  102 ), then the radiopaque member  420  will appear to be non-circular when viewed using the fluoroscope. Further, in embodiments in which foot  402  also includes a radiopaque member  428 , the combination of radiopaque members  420 ,  428  may have the appearance of a bullseye (or other shape or appearance) to indicate the fluoroscope is properly aligned with the tool  400 . As best seen in  FIGS.  29  and  30   , in some embodiments the radiopaque member  428  located in the foot  402  is not disposed directly beneath the radiopaque member  420  located in body  410 . Consequently, the fluoroscope must be positioned at an angle (e.g., non-parallel) relative to a planar surface of the base plate  102  for the radiopaque members  420 ,  428  to align properly with one another. A person of ordinary skill in the art will understand that the angle may vary. 
     Although not shown in  FIGS.  27 - 30   , body  410  may also define one or more holes or slots sized and configured to receive a drill, burr, or other surgical tool. For example, body  410  may include any number of holes or slots such that tool  400  may be used as a drill and/or cutting guide in addition to providing visual guidance. 
       FIGS.  33 - 36    illustrate one example of a fixation tool  500  that may be used in connection with base plate  102  in accordance with some embodiments. Fixation tool  500  is configured to be secured to base plate  102  and hold one or more pins to secure an extremity or other body part to base plate  102 . 
     Tool  500  includes a base  502  extending from a first end  504 , at which a foot  506  is located, to a second end  508 . In some embodiments, base  502  includes one or more sections of threads  510  along its length. For example, in some embodiments, base  502  of tool  500  is threaded entirely along its length while in some embodiments base  502  includes one or more discrete sections of threads. Foot  506  is sized and configured to engage channels  114  defined by base plate  102  and to secure tool  500  to a specific location along a length a channel  114 . For example, if channels  114  include a dovetail shape or have an undercut, then foot  506  may have a complementary dovetail shape or include extensions for being received within the undercut. Further, the foot  506  of tool  500  may include a spring-loaded detent, a hole for receiving a screw, or other locking mechanism for securing tool  500  to a specific location along the length of channel  114 . 
     In some embodiments, end  508  defines a hole  512  for receiving a dowel pin  514  therethrough. Base  502  may define a second hole  516  disposed along a length therefore for receiving a second dowel pin  518 . As described in greater detail below, pins  514 ,  518  may act as a stop to maintain tool  500  in an assembled configuration. 
     One or more nuts  520 - 1 ,  520 - 2  (collectively, “nuts  520 ”) may be threadably coupled to the threads  510  of base  502 . Nuts  520  may have a generally cylindrical shape with one or more cutouts or recesses  522  to facilitate a user grasping or otherwise engaging nuts  520  in order to rotate nuts  520  about the base  502 . As described in greater detail below, rotating nuts  520  relative to base  502  causes nuts  520  to move along a longitudinal axis defined by base  502 . 
     A tool guide  530  may also be provided and position between nuts  520  along the length of base  502 . In some embodiments, tool guide  530  includes a body  532  having a generally circular outer shape and a flange portion  534  extending therefrom. Flange portion  534  may include a pair of spaced-apart flanges  536 - 1 ,  536 - 2  (collectively, “flanges  536 ”) as best seen in  FIG.  36   . Each flange  536  may define a respective hole or slot  538  that is dimensioned to receive a fixation or cutting tool, such as a drill or a burr, therethrough in a slideable manner. 
     As noted above, tool guide  530  may be positioned between nuts  520 . Nuts  520  may be used to position tool guide  530  and, consequently, a tool passing through tool guide  530 , along the length of base  502  in a position selected by a user. For example, rotating the nuts  520  in a first direction may cause the nuts  520 , and thus the tool guide  530 , to translate along the length of the base  502  in one direction (e.g., upwardly away from foot  506 ), and rotating the nuts  520  in a second or opposite direction may cause the nuts  520 , and thus the tool guide  530 , to translate along the length of the base  502  in an opposite direction (e.g., downwardly toward foot  506 ). When the desired position of the tool guide  530  has been achieved, then the nuts  520  are rotated in opposite directions relative to one another to “lock” the tool guide  530  in place. 
       FIGS.  37 - 42    illustrate one example of a guidance and fixation tool in accordance with some embodiments. In some embodiments, guidance and fixation tool  600  includes a first component  602 , e.g., a guidance component, and a second component  612 , e.g., a fixation component. Guidance component  602  includes a foot  604  coupled to a stem  606 , which in turn is coupled to a body  608 . Foot  604  is sized and configured to engage channels  114  defined by base plate  102  and to secure component  602  to a specific location along a length a channel  114 . For example, if channels  114  include a dovetail shape or have an undercut, then foot  602  may have a complementary dovetail shape or include extensions for being received within the undercut. Further, the foot  604  of component  602  may include a spring-loaded detent, a hole for receiving a screw, or other locking mechanism for securing component  602  to a specific location along the length of channel  114 . 
     In some embodiments, body  608  may define a hole  610  as best seen in  FIGS.  40  and  42   . Body  608  may be formed from a radiolucent material and, although not shown in the figures, one of ordinary skill in the art will understand that body  608  may support one or more radiopaque elements. For example, body  608  may include one or more embedded radiopaque elements that provide for fluoroscopic guidance and/or targeting in combination with radiopaque elements  628  supported by component  612  as described below. 
     Component  612  includes a body  614  defining one or more holes  616 - 1 ,  616 - 2  (collectively, “holes  616 ”) sized and configured to receive a fixation element therethrough. In some embodiments, holes  616  may be sized and configured to receive a radiopaque insert, such as radiopaque insert  240 , described above, and/or a cutting tool or burr. Body  614  may also define a hole  618  sized and configured to receive a radiopaque element, such as a radiopaque member  320  described above. 
     Component  612  also includes a flange  620  extending from body  614  and defining a slot  622  ( FIGS.  37 - 39   ). Slot  622  may be sized and configured to receive a fixation device, such as a screw or bolt, for securing slot  622  to base plate  102 . As best seen in  FIGS.  39  and  41   , flange  620  also includes one or more ribs  624 - 1 ,  624 - 2  (collectively, “ribs  624 ”) extending from bottom surface  626  of flange  620 . In some embodiments, as shown in  FIG.  39   , ribs  624  may be disposed on either side of and extend parallel to slot  622 . Ribs  624  are sized and configured to be received within channels  116  defined by base plate  102 . As best seen in  FIG.  42   , body  614  may also define a plurality of holes or include a plurality of radiopaque elements serving as targeting guides  628 - 1 ,  628 - 2 ,  628 - 3 ,  628 - 4  (collectively, “targeting guides  628 ”) that may be seen using fluoroscopy. For example, in some embodiments, the radiopaque element  610  of component  602  may be aligned with the radiopaque elements  628  of component  612  when the components  602 ,  612  are properly aligned with each other and the fluoroscope is properly aligned with the components  602 ,  612 . 
     Method of Use 
     As noted above, the various tools and components may be used as a system in support of various minimally invasive surgical procedures. For example, in some embodiments the various tools and components may be used in performing a MIS procedure associated with a foot as described below. However, one of ordinary skill in the art will understand that the tools and components may be used to perform MIS procedures associated with a hand, wrist, or other extremity. 
     In some embodiments, a fixture  100  may be formed using the base plate  102  and a foot clamp or guide  200 . For example, the components  202 ,  220  of foot clamp  200  are coupled to the foot plate  102  by aligning the extension or dovetail of the respective component  202 ,  220  with one of the channels  116  defined by base plate  102 . A screw, bolt, or other fixation device may be inserted through the slot  210  defined by component  202  and through slot  228  defined by component  220  and into a hole  118  defined by foot plate  102  to secure the components  202 ,  220  to base plate  102 . As will be understood by one of ordinary skill in the art, the screws, bolts, or other fixation devices may be tightened such that the components  202 ,  220  of foot clamp  200  may still be moved relative to base plate  102 . 
     A patient&#39;s foot may be placed on the base plate  102  and the foot clamp  200  may be adjusted, e.g., by sliding the components  202 ,  220  of foot clamp  200  relative to base plate  102 , until the surgeon or practitioner has achieved the desired positioning. Once the desired positioning has been achieved, the screws, bolts, or other fixation devices may be tightened to secure the foot clamp  200  to base plate  102  and one or more pins may be inserted through the holes  250  defined by the radiopaque inserts  240  of components  202 ,  220  and into the foot of a patient. 
     With the foot secured to base plate  102  by way of the pins inserted through the foot clamp  200 , any number of MIS procedures may be performed. In some embodiments, such procedures may be performed with fluoroscopic aids. For example, one or more of tools  300  and/or  400  may be coupled to the base plate  102  to provide fluoroscopic guidance. Tool(s)  300  and/or  400  may be coupled to the base plate  102  by inserting a foot, e.g., foot  302  or foot  402 , into a channel  114  either through the opening along the side  106  of base plate  102  or via a hole  120 . 
     The tool(s)  300  and/or  400  may be slid along a channel  114  until its desired position is achieved. As will be understood by one of ordinary skill in the art, the position of the tool(s)  300 ,  400  relative to the foot may be checked using fluoroscopy. For example, a fluoroscope may be used to determine whether the radiopaque members  312  of tool  300  and/or radiopaque members  412  of tool  400  are in the desired position relative to the bones of the foot. The radiopaque member  320  of tool  300  and/or radiopaque member  420  of tool  400  should appear as a circle (and not an oval or other shape) to ensure that the fluoroscope is properly positioned relative to the base plate  102  and tools  300 ,  400 . Further, as discussed above, the radiopaque members  320 ,  328  or radiopaque members  420 ,  428  may have the appearance of a bullseye (or other shape or appearance) to indicate the fluoroscope is properly aligned with the tool(s)  300 ,  400 . 
     The surgeon or other practitioner may further use fluoroscopy during the surgical procedure. For example, as discussed above, tools  300 ,  400  may be used to guide a surgeon or practitioner in making bony cuts, drilling a hole, or identifying go/no go areas. One of ordinary skill in the art will appreciate that tools  300 ,  400  may provide a surgeon or practitioner with fluoroscopic aid in a number of other ways. 
     In some embodiments, a fixture  100  may be formed using the base plate  102  and one or more fixation tools  500 . For example, one or more fixation tools  500  may be coupled to the base plate  102  by sliding a foot  506  into a channel  114  via the opening formed along side  106  of base plate  102  or via hole  120 . 
     A foot hand or other body part may be placed in contact with the base plate  102  and then pins or other fixation elements may be inserted through the hole or slot  538  defined by the flange portion  534  of tool guide  530 . In some embodiments, prior to inserting the pin or fixation element into the body part, the height of the hole or slot  538  relative to the upper surface  122  of base plate  102  may be adjusted by rotating nuts  520  such that nuts  520  translate along the length (e.g., longitudinal axis) of base  502 . The translation of nuts  520  along the length of base  502  causes tool guide  530  to move along the length of the base  502 . In some embodiments, once the desired height of hole or slot  538  has been achieved, the nuts  520  may be rotated in opposite direction to fix the position of the tool guide  530  along the length of base  502 . 
     With the foot secured to base plate  102  by way of the pins inserted through one or more fixation tools  500 , any number of MIS procedures may be performed. In some embodiments, such procedures may be performed with fluoroscopic aids. For example, as described above, one or more of tools  300  and/or  400  may be coupled to the base plate  102  to provide fluoroscopic guidance. Tool(s)  300  and/or  400  may be coupled to the base plate  102  by inserting a foot, e.g., foot  302  or foot  402 , into a channel  114  either through the opening along the side  106  of base plate  102  or via a hole  120 . 
     The tool(s)  300  and/or  400  may be slid along a channel  114  until its desired position is achieved. Providing two areas of access to channels  114 , i.e., via hole  120  and the opening of channels  114  at the side  106 , advantageously enables one or more tool(s)  300 ,  400  to be added to the base plate  102  even with one or more fixation tools  500  already being coupled to the base plate  102 . 
     As will be understood by one of ordinary skill in the art, the position of the tool(s)  300 ,  400  relative to the foot may be checked using fluoroscopy. For example, a fluoroscope may be used to determine whether the radiopaque members  312  of tool  300  and/or radiopaque members  412  of tool  400  are in the desired position relative to the bones of the foot. The radiopaque member  320  of tool  300  and/or radiopaque member  420  of tool  400  should appear as a circle (and not an oval or other shape) to ensure that the fluoroscope is properly positioned relative to the base plate  102  and tools  300 ,  400 . 
     The surgeon or other practitioner may further use fluoroscopy during the surgical procedure. For example, as discussed above, tools  300 ,  400  may be used to guide a surgeon or practitioner in making bony cuts, drilling a hole, or identifying go/no go areas. One of ordinary skill in the art will appreciate that tools  300 ,  400  may provide a surgeon or practitioner with fluoroscopic aid in a number of other ways. 
     In some embodiments, a fixture  100  may be formed using the foot plate  102 , a foot clamp or guide  200 , and one or more fixation tools  500 . For example, as described above, the components  202 ,  220  of foot clamp  200  may be coupled to the foot plate  102  by aligning the extension or dovetail of the respective component  202 ,  220  with one of the channels  116  defined by base plate  102 . A screw, bolt, or other fixation device may be inserted through the slot  210  defined by component  202  and through slot  228  defined by component  220  and into a hole  116  defined by foot plate  102  to secure the components  202 ,  220  to base plate  102 . In some embodiments, the screws, bolts, or other fixation devices may be tightened such that the components  202 ,  220  of foot clamp  200  may still be moved relative to base plate  102 . 
     A patient&#39;s foot may be placed on the base plate  102  and the foot clamp  200  may be adjusted, e.g., by sliding the components  202 ,  220  of foot clamp  200  relative to base plate  102 , until the surgeon or practitioner has achieved the desired positioning. Once the desired positioning has been achieved, the screws, bolts, or other fixation devices may be tightened to secure the foot clamp  200  to base plate  102  and one or more pins may be inserted through the holes  250  defined by the radiopaque inserts  240  of components  202 ,  220  and into the foot of a patient. 
     Fixation tools  500  may be used to further secure the foot to the base plate  102 . As described above, a fixation tool  500  may be placed into engagement with the base plate  102  by sliding foot  504  into a channel  114  either by way of the opening formed along side  106  or via a hole  120 . The fixation tool is slid along channel  114  until the desired position is achieved relative to the foot, and then pins or other fixation elements may be inserted through the hole or slot  538  defined by the flange portion  534  of tool guide  530 . In some embodiments, prior to inserting the pin or fixation element into the body part, the height of the hole or slot  538  relative to the upper surface  122  of base plate  102  may be adjusted by rotating nuts  520  such that nuts  520  translate along the length (e.g., longitudinal axis) of base  502 . The translation of nuts  520  along the length of base  502  causes tool guide  530  to move along the length of the base  502 . In some embodiments, once the desired height of hole or slot  538  has been achieved, the nuts  520  may be rotated in opposite direction to fix the position of the tool guide  530  along the length of base  502 . 
     With the foot secured to base plate  102  by way of the pins inserted through foot clamp  200  and one or more fixation tools  500 , any number of MIS procedures may be performed. In some embodiments, such procedures may be performed with fluoroscopic aids. For example, as described above, one or more of tools  300  and/or  400  may be coupled to the base plate  102  to provide fluoroscopic guidance. Tool(s)  300  and/or  400  may be coupled to the base plate  102  by inserting a foot, e.g., foot  302  or foot  402 , into a slot  114  either through the opening along the side  106  of base plate  102  or via a hole  120 . 
     The tool(s)  300  and/or  400  may be slid along a slot  114  until its desired position is achieved. Providing two areas of access to slots  114 , i.e., via hole  120  and the opening of slots  114  at the side  106 , advantageously enables one or more tool(s)  300 ,  400  to be added to the base plate  102  even with one or more fixation tools  500  already being coupled to the base plate  102 . 
     As will be understood by one of ordinary skill in the art, the position of the tool(s)  300 ,  400  relative to the foot may be checked using fluoroscopy. For example, a fluoroscope may be used to determine whether the radiopaque members  312  of tool  300  and/or radiopaque members  412  of tool  400  are in the desired position relative to the bones of the foot. The radiopaque member  320  of tool  300  and/or radiopaque member  420  of tool  400  should appear as a circle (and not an oval or other shape) to ensure that the fluoroscope is properly positioned relative to the base plate  102  and tools  300 ,  400 . 
     The surgeon or other practitioner may further use fluoroscopy during the surgical procedure. For example, as discussed above, tools  300 ,  400  may be used to guide a surgeon or practitioner in making bony cuts, drilling a hole, or identifying go / no go areas. One of ordinary skill in the art will appreciate that tools  300 ,  400  may provide a surgeon or practitioner with fluoroscopic aid in a number of other ways. 
     In some embodiments, a fixture  100  may be formed using the base plate  102  guidance and fixation tool  600  and one or more fixation tools  500 . For example, component  602  of tool  600  may be coupled to base plate  102  by sliding foot  604  into a channel  114  defined by base plate  102 . Component  612  may be coupled to base plate  102  by inserting ribs  624  into channels  116  defined by base plate  102 . A screw, bolt, or other fixation device may be inserted into slot  622  defined by the flange  620  of component  612  and into a hole  118  to secure component  612  to base plate  102 . 
     A body part (e.g., hand, foot, wrist) may be secured to the base plate  102  via tool  600  by inserting one or more fixation elements, such as a pin or k-wire, through holes  616  defined by body  614  of component  612 . As noted above, an insert  240  may be disposed within holes  616  and a fixation element may be inserted through insert  240  into the body part. 
     If desired, one or more fixation tools  500  may be used to further secure the body part to the base plate  102 . As described above, a fixation tool  500  may be placed into engagement with the base plate  102  by sliding foot  504  into a channel  114  either by way of the opening formed along side  106  or via a hole  120 . The fixation tool is slid along channel  114  until the desired position is achieved relative to the foot, and then pins or other fixation elements may be inserted through the hole or slot  538  defined by the flange portion  534  of tool guide  530 . In some embodiments, prior to inserting the pin or fixation element into the body part, the height of the hole or slot  538  relative to the upper surface  122  of base plate  102  may be adjusted by rotating nuts  520  such that nuts  520  translate along the length (e.g., longitudinal axis) of base  502 . The translation of nuts  520  along the length of base  502  causes tool guide  530  to move along the length of the base  502 . In some embodiments, once the desired height of hole or slot  538  has been achieved, the nuts  520  may be rotated in opposite direction to fix the position of the tool guide  530  along the length of base  502 . 
     With the body part secured to base plate  102 , any number of MIS procedures may be performed. In some embodiments, such procedures may be performed with fluoroscopic aids, such as one or more of tools  300  and/or  400 . As described above, tool(s)  300  and/or  400  may be coupled to the base plate  102  by inserting a foot, e.g., foot  302  or foot  402 , into a slot  114  either through the opening along the side  106  of base plate  102  or via a hole  120 . 
     The tool(s)  300  and/or  400  may be slid along a slot  114  until its desired position is achieved. Providing two areas of access to slots  114 , i.e., via hole  120  and the opening of slots  114  at the side  106 , advantageously enables one or more tool(s)  300 ,  400  to be added to the base plate  102  even with one or more fixation tools  500  already being coupled to the base plate  102 . 
     As will be understood by one of ordinary skill in the art, the position of the tool(s)  300 ,  400  relative to the foot may be checked using fluoroscopy. For example, a fluoroscope may be used to determine whether the radiopaque members  312  of tool  300  and/or radiopaque members  412  of tool  400  are in the desired position relative to the bones of the foot. The radiopaque member  320  of tool  300  and/or radiopaque member  420  of tool  400  should appear as a circle (and not an oval or other shape) to ensure that the fluoroscope is properly positioned relative to the base plate  102  and tools  300 ,  400 . 
     The surgeon or other practitioner may further use fluoroscopy during the surgical procedure. For example, as discussed above, tools  300 ,  400  may be used to guide a surgeon or practitioner in making bony cuts, drilling a hole, or identifying go/no go areas. One of ordinary skill in the art will appreciate that tools  300 ,  400  may provide a surgeon or practitioner with fluoroscopic aid in a number of other ways. 
     Although the invention has been described in terms of exemplary embodiments, it is not limited thereto. Rather, the appended claims should be construed broadly, to include other variants and embodiments of the invention, which may be made by those skilled in the art without departing from the scope and range of equivalents of the invention.