Patent Publication Number: US-2019183710-A1

Title: Modular patient positioning system

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This is a division of U.S. patent application Ser. No. 15/015,109, entitled “MODULAR PATIENT POSITIONING SYSTEM”, filed Feb. 3, 2016, which is incorporated herein by reference. 
    
    
     FIELD OF DISCLOSURE 
     The disclosure is generally directed to the field of modular patient positioning systems (referred to herein as “MPPS”). In particular, the disclosure is directed to the field of MPPSs for use in orthopedic surgery and conveniently positioning or extending different body portions to be operated upon in different positions. The system of the current disclosure allows surgeons and operating room staff to use a reduced amount of hardware in combination with a foundational device to position, support, and improve the results of the surgical procedure. Moreover, small movements that can cause joint misalignment are preventable with the system. The modularity of the system also allows one system to be used for posterior or anterior hip surgery, knee surgery, extremity surgery, as well as a sit-up position for neck or shoulder surgery. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1A  shows a first exemplary embodiment of an MPPS, which comprises two separate pegboards and in a first configuration.  FIG. 1B  shows another exemplary embodiment of an MPPS that comprises one pegboard. 
         FIG. 2  shows the first exemplary embodiment of the MPPS of  FIG. 1A  in a second configuration. 
         FIG. 3A ,  FIG. 3B ,  FIG. 3C  show various exemplary ways that the MPPS of  FIG. 1A  may be used during surgery. 
         FIG. 4  shows how when the MPPS of  FIG. 1A  is in the second configuration, the patient&#39;s upper body is in a raised position that makes surgery on the upper portion of the patient&#39;s upper body easier. 
         FIG. 5A  and  FIG. 5B  show other exemplary embodiments of an MPPS; in these exemplary embodiments, pegs are shown for retaining a portion of a patient&#39;s body in an operating position. The embodiment of  FIG. 5A  is wider than the embodiment of  FIG. 5B . 
         FIG. 6  shows another embodiment of the MPPS; in this exemplary embodiment, the MPPS is for supporting a first part of the patient&#39;s upper body and providing unobstructed access to a second part of the patient&#39;s upper body, on which surgery is to be performed. 
         FIG. 7A ,  FIG. 7B  are rear views, showing how the exemplary embodiment of  FIG. 6  allows unobstructed access to either of the left or right side parts of the patient&#39;s upper body, on which surgery is to be performed. 
         FIG. 8  shows another exemplary embodiment of the MPPS; in this exemplary embodiment, an arm pegboard extends outwardly beyond side edges of the second pegboard and a surgical table. 
         FIG. 9A ,  FIG. 9B ,  FIG. 9C  show different exemplary ways in which additional pegboards, such as the arm pegboards of  FIG. 8 , may be connected to the rest of the MPPS. 
         FIG. 10A  and  FIG. 10B  show examples of performing arm surgeries with the exemplary embodiments of  FIG. 1A  and  FIG. 8  respectively. 
         FIG. 11A ,  FIG. 11B ,  FIG. 11C  show additional exemplary embodiments of the MPPS; in these exemplary embodiments, the MPPS includes an x-ray facilitating cut-out. 
         FIG. 12A ,  FIG. 12B , and  FIG. 12C  show another exemplary embodiment of the MPPS; in this exemplary embodiment, a generic positioning member for retaining a portion of the patient&#39;s body that is to be operated on in a desired surgical position using pegs as a supporting/holding mechanism is included. 
         FIG. 13  shows the exemplary generic positioning member of  FIGS. 12A, 12B, and 12C , in use positioning a patient body in a laterally upright configuration. 
         FIG. 14A-14C , show other exemplary embodiments of an MPPS, these exemplary embodiments including positioning members for use on surgery on different specific body parts. 
         FIG. 15A  and  FIG. 15B  show an exemplary embodiment of an MPPS for facilitating surgery on a patient&#39;s neck and/or shoulder area. 
         FIG. 16A  and  FIG. 16B  show additional exemplary embodiment of an MPPS. 
         FIG. 17  shows the exemplary embodiment of the MPPS of  FIG. 16  in a configuration for surgery on a portion of a patient&#39;s lower body and positioned on a surgical table, similar to  FIG. 3A ,  FIG. 3B , and  FIG. 3C . 
         FIG. 18A ,  FIG. 18B ,  FIG. 18C ,  FIG. 18D ,  FIG. 18E  show the exemplary embodiment of the MPPS of  FIG. 16  in positions for conducting surgery on one of a patient&#39;s legs ( FIG. 18A ), a patient&#39;s knee ( FIG. 18B ), and/or both of a patient&#39;s legs ( FIG. 18C ).  FIGS. 18C and 18D  show the use of a leg positioner for flexing, e.g., a knee, during surgery thereon. 
         FIG. 19A ,  FIG. 19B , and  FIG. 19C , show the exemplary embodiments of  FIGS. 18A, 18B, and 18C , respectively in side view. 
         FIG. 20  shows the exemplary embodiment of the MPPS of  FIG. 16A  in a configuration for performing surgery on an upper portion of a patient&#39;s body. 
         FIG. 21A  and  FIG. 21B  are rear views similar to those of  FIG. 7A  and  FIG. 7B , respectively, where different portions of the patient&#39;s upper body are supported and different portions of the patient&#39;s upper body are unobstructed for surgery thereon. 
         FIG. 22  is a rear view, similar to the rear views of  FIG. 21A  and  FIG. 21B , but showing where the MPPS is configured to support substantially the entire upper body. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     It will be appreciated that for simplicity and clarity of illustration, numerous specific details are set forth in order to provide a thorough understanding of the embodiments described herein. However, it will be understood by those of ordinary skill in the art that the embodiments described herein can be practiced without these specific details. In other instances, methods, procedures and components have not been described in detail so as not to obscure the related relevant feature being described. Also, the description is not to be considered as limiting the scope of the embodiments described herein. The drawings are not necessarily to scale and the proportions of certain parts have been exaggerated to better illustrate details and features of the present disclosure. Similar reference numerals are used to refer to structures similar to the various exemplary embodiments. 
     The embodiments shown and described above are only examples. Therefore, many such details are neither shown nor described. Even though numerous characteristics and advantages of the present technology have been set forth in the foregoing description, together with details of the structure and function of the present disclosure, the disclosure is illustrative only, and changes may be made in the detail, especially in decorative and structural matters of shape, size and arrangement of the parts within the principles of the present disclosure up to, and including the full extent established by the broad general meaning of the terms used in the claims. It will therefore be appreciated that the embodiments described above may be modified within the scope of the claims. 
       FIG. 1A  shows a first exemplary embodiment of a modular patient positioning system (“MPPS”)  10  and in a first configuration. This exemplary embodiment of the MPPS  10  includes at least first pegboard  25  and second pegboard  30 . Typically, though not necessarily, the first pegboard  25  and the second pegboard  30  are generally the same size. The first pegboard  25  and the second pegboard  30  have peg holes  35  therein, for reasons discussed below. The at least first pegboard  25  and second pegboard  30  may be connected together, such that the first pegboard  25  and second pegboard  30  can be rotated relative to each other between different configurations. In the exemplary embodiment of the MPPS of  FIG. 1A ; the first pegboard  25  and second pegboard  30  are connected together by a hinge  50 . Hinge  50  may comprise a removable hinge pin  51 . However, as exemplified in  FIG. 16B , hinges are not necessary. 
     In a first configuration, as shown in  FIG. 1A , the first pegboard  25  and second pegboard  30  lie along a common plane. In  FIG. 1B , the MPPS comprises a single pegboard. 
     In a second configuration, as shown in  FIG. 2 , the first pegboard  25  and second pegboard  30  lie along different planes at an angle α. The second configuration allows for different parts of a patient&#39;s body to be positioned and supported in different planes. The second configuration usually includes one pegboard lying flat (e.g. substantially horizontally) or parallel to a top surface of a surgical table and the other pegboard being at a positive or negative angle α relative to the flat pegboard (see discussions of  FIGS. 3A-3C  below). For ease of reference and not intended to be limiting in any way, this disclosure will refer to the “second pegboard” as the pegboard that is raised or lowered, as discussed further below. 
       FIGS. 3A-3C  show various exemplary ways by which the second pegboard  30  can be supported in a raised position relative to the first pegboard  25 . 
     As shown in  FIG. 3A , the MPPS  10  may be supported on (by) a surgical/operating table T (schematically shown). First pegboard  25  may be clamped to a first, typically fixed-positioned part T 1  of the surgical table T by a clamp C. The second pegboard  30  is supported in the raised position by a rotatable portion T 2  of the surgical table T and may or may not be clamped to rotatable portion T 2 . 
     As shown in  FIG. 3B , the MPPS  10  may be supported on (by) a surgical/operating table T (schematically shown). First pegboard  25  may be clamped to a first, typically fixed-positioned part T 1  of the surgical table T by a clamp C. The second pegboard  30  is moved into the raised position and supported in the raised position by a support member S, such as a bar, frame, or wedge, between the top of the surgical table and an underside of the second pegboard  30 . 
     As shown in  FIG. 3C , the MPPS  10  may be supported on (by) a surgical/operating table T (schematically shown). First pegboard  25  may be clamped to a first, typically fixed-positioned part T 1  of the surgical table T by a clamp C. The second pegboard  30  is moved into the raised position and supported in the raised position by hinge pin  51  comprising a locking hinge pin. 
     The ability for the first pegboard  25  and second pegboard  30  to rotate relative to each other and receive pads/cushions and pegs makes it easier for a doctor to position different patient&#39;s in different body positions using pegs, pegboards, and pads to perform surgery on, for example, upper portions U of a patient&#39;s body P. For example, as shown in  FIG. 4 , when the MPPS is in the second configuration: the first pegboard  25  lies substantially flat on a surgical table T and the second pegboard  30  is rotated upward and away from the plane of the first pegboard  25 . In this second configuration, the patient&#39;s lower body L lies generally flat on the first pegboard  25  substantially parallel with the surgical table T and the patient&#39;s upper body U is supported at a raised angle α above the plane of the first pegboard, to present the patient&#39;s upper body U in a raised position that makes surgery on an upper portion U of the patient&#39;s upper body U easier. 
     Thus, when the part of the patient&#39;s upper body U to be operated on comprises a shoulder, a doctor may use pads/cushions and pegs (see discussion about  FIGS. 5B, 5B , below) to specifically position different patient&#39;s in different body positions using pegs. This reduces doctor fatigue during the surgical procedure and maintains desired patient positioning. 
     The angle α at which the second pegboard supports the patient&#39;s upper body relative to the plane of the first pegboard can vary, but generally depends on the heights of the surgical table and the doctor, so that the area of the patient to be operated on is at a position where the surgeon need not lean over the patient, stand in any awkward postures, etc. 
     As shown in  FIG. 5A  and  FIG. 5B , one or more pegs  85  may be inserted into peg holes  35  and protrude outwardly to retain a portion of the patient&#39;s upper body U in a desired surgical position. 
     As shown in the exemplary embodiment of  FIG. 1 , the first pegboard  25  and second pegboard  30  are generally identical in structure, allowing ease of installation and replacement of broken parts. However, the first pegboard  25  and second pegboard  30  need not be identical in structure. 
     For example, as shown in  FIG. 6 , the second pegboard  30  is L-shaped having a narrow portion  31  and a wide portion  32 . Wide portion  32  includes the hinge portion of second pegboard  30 . The first pegboard  25  is generally rectangular and equal in width to the wide portion  32  of the second pegboard  30 . Thus, the hinge portion of wide portion  32  of the second pegboard  30  can be conveniently connected to the hinge portion of the first pegboard  25  by the hinge pin  51 . 
     As shown in the rear views of  FIG. 7A  and  FIG. 7B , the narrow portion  31  of the second pegboard  30  supports a first part of the patient&#39;s upper body U 1  and provides unobstructed access to a second part of the patient&#39;s upper body U 2 , on which surgery is to be performed. For example, as shown in rear view  FIG. 7A , the patient&#39;s left shoulder is supported by narrow portion  31  of the second pegboard  30  and the patient&#39;s right shoulder is unobstructed for surgery. As shown in rear view  FIG. 7B , the second, L-shaped pegboard may be disconnected from the first pegboard, reversed in configuration, and then reconnected to the first pegboard, whereby the second, L-shaped pegboard may be positioned to provide unobstructed access to the left side of the patient&#39;s upper body. 
     MPPS  10  can be used to raise or lower a patient&#39;s legs for surgery thereon, rather than the upper body by merely reversing the positioning of the first pegboard portion and the second pegboard portion. This is described in more detail below. For example, as described below, raising or lowering the second pegboard portion can be used to flex or relax a patient&#39;s knee or hip. 
     In another exemplary embodiment, as shown in  FIG. 8 , the MPPS  10  may include additional pegboards for supporting various other body portions. For example, in  FIG. 8  an arm pegboard  100  is shown that can be connected to the second pegboard  30 . In  FIG. 8 , the arm pegboard  100  extends outwardly beyond side edges of the second pegboard  30  and surgical table T, and may support an arm positioning member  200 ″ and a patient&#39;s arm for being operated on as shown in  FIG. 10B . As shown in  FIG. 10A , an arm positioning member  200 ′ that can be connected to the pegboard by pegs can support the patient&#39;s arm outwardly. 
     As shown in  FIG. 9A , pegs  85  may be permanently affixed to the arm (or other additional) pegboard to be received in the peg holes  35  of the first pegboard  25  or second pegboard  30 . As shown in  FIG. 9B , pegs  85  may be permanently affixed to the first pegboard  25  or second pegboard  30  to be received in the peg holes  35  of the additional pegboard  100 . Yet further, as shown in  FIG. 9C , the pegs  85  may be separate elements that are received in the peg holes  35  of the first pegboard  25  or second pegboard  30  and peg holes  35  in the additional pegboard  100 . 
     As shown in  FIG. 10A , when a first exemplary arm pegboard with a first exemplary positioning member  200 ′ does not extend beyond the edges of the second pegboard  30  and the surgical table T, a patient&#39;s arm may be supported/stabilized in a first operating position while surgery on the supported arm or opposite shoulder is performed. As shown in  FIG. 10B , when a second exemplary arm pegboard with a second exemplary positioning member  200 ″ extends beyond the edges of the second pegboard  30  and the surgical table T, the patient&#39;s arm may be supported in a different operating position and/or flexed or relaxed. These multiple positions allow for proper positioning and support on a patient&#39;s arm/wrist/hand during surgery thereon. For sake of convenience, as used in the disclosure and claims “arm” shall be construed to be any body portion below the shoulder, including but not limited to, upper arm, elbow, lower arm, wrist, hand, or fingers. Similarly “leg” shall be construed to cover any body portion between the tips of the toes and the hip/pelvis. 
     Another feature that the MPPS may include is schematically shown in  FIGS. 11A, 11B, 11C , wherein at least one of the pegboards  25 ,  30  has a cut-out  125  therein. This cutout allows an x-ray film (or cassette) X to be inserted into the area of the cut-out  125  for taking an unobstructed x-ray of the patient, i.e., without the blocking of the dense solid portions of the pegboard. As shown in  FIG. 11B , a thin radiolucent cover  130  may be positioned over the cut-out  125  for receiving the x-ray film X thereunder while supporting the patient&#39;s body so there is no contact between the x-ray film X and the patient&#39;s skin. In  FIG. 11C , the single pegboard of  FIG. 1B  is provided with cutout  125 . 
     Another feature that the MPPS may include is shown in  FIG. 12A ,  FIG. 12B ,  FIG. 12C . This feature includes a generic patient positioning member  200  used to cover at least two pegs  85  being used to retain the portion of the patient&#39;s upper body that is to be operated on in a desired surgical position. Conventionally, in prior art methods, one peg, in combination with tape, is used to position the pad and retain it in its proper position. As shown in  FIG. 12A ,  FIG. 12B ,  FIG. 12C  the positioning member  200  comprises a positioning pad  201  (also known in the art as cushion or pillow). The positioning pad  201  has an upper portion  202  and a lower portion  203 ; the upper portion  202  for contacting a portion of the patient&#39;s body; and the lower portion  203  having a plurality of blind holes  210  for receiving pegs  85 . 
     The positioning member  200  can be used either in combination with an MPPS having a first pegboard  25  and second pegboard  30  or with a conventional full-sized pegboard ( FIG. 1B ). For example, as shown in  FIG. 13 , the MPPS may include at least one pegboard  25 ′ for positioning on a surgical table and supporting a portion of a patient. Positioning member  200  aligns a portion of a patient&#39;s body in a surgical position. The positioning member has a plurality of holes  210  in a lower portion thereof. A plurality of pegs  85  are positioned in peg holes  35  at locations where it is desired to position the positioning member  200 . The positioning member  200  is then placed over the plurality of pegs  85 , by the pegs  85  being received in the holes  210  in the lower portion of the positioning member  200 . Conventionally, in prior art methods, positioning pads are fixed with tape to the table or pegboard to retain it in its proper position, or pads are wrapped around a single peg when the patient is fixed in a lateral position.  FIG. 14A ,  FIG. 14B , and  FIG. 14C  show other exemplary configurations for positioning member  200 , useful with different and specific surgical procedures on various body parts. 
       FIG. 15A  and  FIG. 15B  show an exemplary embodiment of an MPPS for facilitating surgery on a patient&#39;s neck and/or shoulder areas. In this exemplary embodiment, a first set of pegs  85   a  are used to attach another (e.g., neck) pegboard  105  to the upper portion/free end of the second pegboard  30 . A second set of pegs  85   b  protrude from the neck pegboard  105  on each side of the patient&#39;s neck. Finally, positioning members  200  are placed over pegs  85   b , as previously described. This configuration allows for a neck/shoulder positioning that is comfortable to both the doctor and patient. 
       FIG. 16A  shows another exemplary embodiment of an MPPS. In  FIG. 16A , MPPS  10 ′ is similar to the MPPS  10  of  FIG. 1 . The difference between MPPS  10 ′ and MPPS  10  is that MPPS  10 ′ has one of pegboards  25 ,  30 , divided into two, separately rotatable pegboard parts, e.g.,  30   a ,  30   b . Furthermore, in  FIG. 16B , pegboard part  30   b  is not hinged to the rest of the pegboard  25 . In  FIG. 16B , pegboard parts  30   b  may be clamped to the surgical table T in manners previously described. Typically pegboard parts  30   a ,  30   b  will each have substantially the same width, and their combined width will be substantially equal to the width of the other pegboard, e.g.,  25 . 
       FIG. 17  shows the exemplary embodiment of the MPPS of  FIG. 16A  in a configuration for surgery on a portion of a patient&#39;s lower body and positioned on a surgical table, similar to  FIG. 3A ,  FIG. 3B , and  FIG. 3C . In  FIG. 17 , MPPS  10 ′ is supported on (by) a surgical table T (schematically shown). First pegboard  25  may be clamped to a first, typically fixed-position part T 1  of the surgical table T by a clamp C. The second pegboard portions  30   a ,  30   b , are supported in a raised or lowered position by a rotatable portion T 2  of the surgical table T and may or may not be clamped to rotatable portion T 2 . 
       FIG. 18A ,  FIG. 18B ,  FIG. 18C  each schematically show the exemplary embodiment of the MPPS  10 ′ of  FIG. 16  in positions for conducting surgery on one of a patient&#39;s legs ( FIG. 18A ), a patient&#39;s knee ( FIG. 18B ), and/or both of a patient&#39;s legs ( FIG. 18C ). Note that this functionality is useful because often, when a leg is being operated on, it may be angled in an up or down positioning to check rotation, provide visibility to all portions of the joint, and extend or relax muscles and ligaments. For clarity,  FIG. 19A ,  FIG. 19B , and  FIG. 19C , show the exemplary embodiments of  FIGS. 18A, 18B, and 18C , respectively in side view. 
     In  FIG. 18A , the patient&#39;s hip is generally aligned with the pivot axis between the first pegboard and the second pegboard. Therefore, pivoting of the pegboards cause either tensioning or extension (extend or relax) of the hip muscles. In  FIG. 18B , the patient&#39;s knee is generally aligned with the pivot axis between the first pegboard and the second pegboard. Therefore, pivoting of the pegboards cause either tensioning or extension (extend or relax) of the knee muscles. To further accurately position a knee during surgery, a leg positioner  300  may be used. This leg positioner structure is shown in  FIG. 18D  and  FIG. 18E . Leg positioner  300  includes a boot  310  for receiving the foot and lower portion of the leg whose knee is being operated on. Pegs  85  are attached to the boot so that the boot can be fixed to pegboard  30   b  in a desired position that provides the desired flexion on the knee, when pegboard  30   b  is adjusted. While not necessary, a stabilization block  90  may also be provided to ease the shearing forces on pegs  85 . While not shown, it is possible that a surgical boot having a peg attached thereto can be used to attach the foot to the pegboard to assist in flexing or extending the knee. The leg positioner  300  and arm positioner  200 ′ ( FIG. 10A ) can be attached to the pegboards in substantially the same ways. 
       FIG. 20  shows the exemplary embodiment of the MPPS of  FIG. 16  in a configuration for performing surgery on an upper portion of a patient&#39;s body. The details of this embodiment are generally the same as those of  FIG. 1 , except for the fact that second pegboard  25  is formed by two second pegboards  30   a ,  30   b.    
       FIG. 21A  and  FIG. 21B  are rear views similar to those of  FIG. 7A  and  FIG. 7B , respectively, where different portions of the patient&#39;s upper body U 2  are supported and different portions of the patient&#39;s upper body U 1  are unobstructed for surgery thereon. Reference to  FIG. 7A  and  FIG. 7B  will generally inform the reader of the features and functionality of  FIG. 21A  and  FIG. 21B . 
       FIG. 22  is a rear view, similar to the rear views of  FIG. 21A  and  FIG. 21B , but showing where MPPS  10 ′ is configured to support substantially the entire upper body U. Again, reference to  FIG. 7A  and  FIG. 7B  will generally inform the reader of the features and functionality of  FIG. 22 . 
     The embodiments shown and described above are only examples. Therefore, many such details are neither shown nor described. Even though numerous characteristics and advantages of the present technology have been set forth in the foregoing description, together with details of the structure and function of the present disclosure, the disclosure is illustrative only, and changes may be made in the detail, especially in decorative and structural matters of shape, size and arrangement of the parts within the principles of the present disclosure up to, and including the full extent established by the broad general meaning of the terms used in the claims. It will therefore be appreciated that the embodiments described above may be modified within the scope of the claims.