Patent Publication Number: US-2022233385-A1

Title: Modular patient positioning system

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This is a division of U.S. patent application Ser. No. 15/386,290, entitled “MODULAR PATIENT POSITIONING SYSTEM”, filed Dec. 21, 2016, which is incorporated herein by reference. U.S. patent application Ser. No. 15/386,290 is a continuation-in-part 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. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     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. The system also allows for controlling the anatomic positions, such as flexion/extension, abduction and adduction, elevation/depression, rotation and distraction/compression of various joints or bones, such as the hip or knee. 
     SUMMARY OF THE INVENTION 
     The invention in one form is directed to a modular patient positioning system including: a first pegboard having at least one first pegboard hole defined therein; a second pegboard rotatably coupled to the first pegboard and having at least one second pegboard hole defined therein, the first pegboard and second pegboard lying along a common plane in a first configuration and the first pegboard and second pegboard lying along different planes in a second configuration, whereby a first body portion and a second body portion of a patient&#39;s body may be positioned and supported in different planes by having the first pegboard support the first body portion and the second pegboard support the second body portion; and a leg positioner including a mounting structure for mounting the leg positioner on the second pegboard and positioning a leg in a predetermined position relative to the second pegboard. The mounting structure of the leg positioner allows for adjusting at least one of axial rotation, abduction/adduction, elevation/depression, or flexion/extension of at least a portion of the leg. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The above-mentioned and other features and advantages of this invention, and the manner of attaining them, will become more apparent and the invention will be better understood by reference to the following description of embodiments of the invention taken in conjunction with the accompanying drawings, wherein: 
         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 a 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. 2  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 to position a patient&#39;s body in a laterally upright configuration. 
         FIG. 14A-14C , show other exemplary embodiments of an MPPS, these exemplary embodiments including various 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 ).  FIG. 18D  shows the use of a leg positioner for flexing, e.g., a knee, during surgery thereon.  FIG. 18E  shows peg-using structures for use with a leg positioner to vary the position of the leg positioner and thereby adjust the amount of flexion/extension and/or distraction/compression of at least a portion of the leg. 
         FIG. 18F  and  FIG. 18G  show a different structure of a leg positioner that can be used to achieve one or more of various anatomical positionings. 
         FIG. 18H  shows yet another exemplary embodiment for adjusting the amount of flexion/extension and/or distraction/compression of at least a portion of the leg based upon the position of the leg positioner relative to the end of a pegboard. 
         FIG. 18I  shows an alternative exemplary embodiment of  FIG. 18H . 
         FIG. 18J  shows an alternative embodiment of a leg positioner that allows for adjusting the amount of axial rotation of a leg/hip/knee during an orthopedic surgery. 
         FIG. 18K  and  FIG. 18L  and  FIG. 18M  show how the axial rotation of the leg can be varied using the alternative leg positioner of  FIG. 18J . 
         FIG. 18N  shows an alternative means by which the position of a leg during surgery can be adjusted. 
         FIG. 19A ,  FIG. 19B , and  FIG. 19C , show the exemplary embodiments of  FIGS. 18A, 18B, and 18C , respectively in side views. 
         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. 
         FIG. 23  shows a person, the median sagittal plane of that person, and the various exemplary anatomical directions in which a leg to be operated on can be moved. 
         FIG. 24A  shows at least one of axial rotation, abduction/adduction, elevation/depression, distraction/compression or flexion/extension of at least a portion of the leg being adjusted. 
         FIG. 24B  shows at least two of axial rotation, abduction/adduction, elevation/depression, distraction/compression or flexion/extension of at least a portion of the leg being adjusted. 
         FIG. 24C  shows at least three of axial rotation, abduction/adduction, elevation/depression, distraction/compression or flexion/extension of at least a portion of the leg being adjusted. 
         FIG. 24D  shows all of axial rotation, abduction/adduction, elevation/depression, distraction/compression or flexion/extension of at least a portion of the leg being adjusted. 
         FIG. 25A  shows a common leg/knee positioning used during an orthopedic surgery. 
         FIG. 25B  shows how, by using the exemplary leg positioners described herein, the positioning of  FIG. 25A  can be achieved and in a more secure manner. 
         FIG. 26  shows a pivot system that can be used with the adjustable pegboard systems described herein for use in controlling the amount of abduction/adduction. 
         FIG. 27  shows how the pivot system of  FIG. 26  is set up. 
         FIGS. 28A and 28B  show a first exemplary way of how the pivot system of  FIGS. 26, 27  can be used, respectively. 
         FIG. 28C  shows a pivot system similar to the pivot system of  FIGS. 26-28B  but including a board that is not a pegboard. 
         FIGS. 29A and 29B  show a second exemplary way of how the pivot system of  FIGS. 26, 27  can be used, respectively. 
         FIG. 29C  shows a way of how the pivot system of  FIG. 28C  can be used. 
         FIGS. 30A, 30B, 30C, and 30D  depict an alternative exemplary embodiment for a mounting structure that allows for varying the position or elevation of the knee. 
     
    
    
     Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate embodiments of the invention and such exemplifications are not to be construed as limiting the scope of the invention in any manner. 
     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. 
     During orthopedic surgeries, it can be useful to move different body parts in different ways to cause different anatomic features (e.g. muscles or the trochanters) to, for example: tighten or loosen, become more or less prominent, or “move out of the way” of intended surgical incisions. Body parts can be moved in a variety of ways to achieve different anatomical positionings. Common exemplary terms used to describe anatomical movements include: flexion/extension, abduction and adduction, elevation/depression, rotation, and distraction/compression. 
     Some various ways in which body parts can be moved will be described with reference to  FIG. 23 , which shows a person and the median sagittal plane of that person, and  FIGS. 24A-D . 
     As shown by arrow A-A of  FIG. 23 , a person&#39;s leg and thus also the person&#39;s foot, can be rotated about the axis of the leg (i.e., femur/tibia axis). As used herein, this type of movement will be called axial rotation. 
     As shown by arrow B-B of  FIG. 23 , a person&#39;s leg can be pivoted generally about the hip/femoral head/acetabulum), to vary the angle between the axis of the leg (i.e., femur/tibia axis) and the median sagittal plane, resulting in potentially easier surgical procedures. As used herein, this type of movement will be called abduction/adduction. 
     As shown by arrow C-C of  FIG. 23 , a person&#39;s foot/lower leg (tibia) can be moved in a direction parallel to the leg axis (femur/tibia axis) towards or away from the body trunk. During this type of movement, several other movements may occur, depending up how or whether different body parts are constrained. For example, there can be knee flexion/extension; hip flexion/extension, knee distraction/compression, or knee distraction/compression. When allowing these types of movements, the angle of the femoral head within the acetabulum will change, resulting in potentially easier surgical procedures. As used herein, this type of movement will be called flexion/extension. 
     As shown by arrow D-D of  FIG. 23 , a person&#39;s leg can be pivoted in a generally vertical plane, about the femoral head/acetabulum axes while the axis of the leg (femur/tibia axis) and the median sagittal plane remaining substantially parallel, resulting in potentially easier surgical procedures. As used herein, this type of movement will be called elevation/depression. 
     Accordingly, by performing any of the movements described above, the positioning of various anatomical hip features can be made more or less prominent or moved out of the way of surgical incisions, as desired by the surgical method to be used on that patient&#39;s hip and resulting in potentially easier surgical procedures. 
     For example, in a first exemplary embodiment, at least one of axial rotation, abduction/adduction, elevation/depression, distraction/extraction or flexion/extension (see e.g.  FIG. 24A ) are adjusted. 
     In a second exemplary embodiment, at least two of axial rotation, abduction/adduction, elevation/depression, distraction/extraction or flexion/extension (see e.g.  FIG. 24B ) are adjusted. 
     In a third exemplary embodiment, at least three of axial rotation, abduction/adduction, elevation/depression, distraction/extraction or flexion/extension (see e.g.  FIG. 24C ) are adjusted. 
     In a fourth exemplary embodiment, all of axial rotation, abduction/adduction, elevation/depression, distraction/extraction or flexion/extension (see e.g.  FIG. 24D ) are adjusted. 
     As used herein, “of the leg” or “a portion of the leg” can comprises any of anatomical features of the leg, including, but not limited to: foot, angle, tibia, fibular, knee, femur, hip and the anatomical features the comprise the angle, knee, and hip joints. 
     The structure by which these various movements can be carried out are described below. 
       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 pegboard 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. 
     As can be seen in  FIG. 1A , the first pegboard  25  has a pair of opposite first lateral edges and a first longitudinal end portion between the first lateral edges. The second pegboard  30  similarly has a pair of opposite second lateral edges and a second longitudinal end portion between the second lateral edges that is rotatably coupled to the first longitudinal end portion of the first pegboard  25 . The first longitudinal end portion and the second longitudinal end portion may each have respective protrusions that interlock with corresponding recesses of the other end portion so the pegboards  25 ,  30  are immovable in a lateral direction relative to one another while still being rotatable. 
     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 T1 of the surgical table T by a clamp C. The second pegboard  30  is supported in the raised position by a rotatable portion T2 of the surgical table T and may or may not be clamped to rotatable portion T2. 
     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 T1 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 T1 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 pegboard 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 U1 and provides unobstructed access to a second part of the patient&#39;s upper body U2, 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 pegboard 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 pegboard 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 pegboard holes  35  of the first pegboard  25  or second pegboard  30  and pegboard 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 pegboard 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 T1 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 T2 of the surgical table T and may or may not be clamped to rotatable portion T2. 
       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 portion of a leg, such as a knee or hip during surgery, a leg positioner  300  may be used. 
     A first exemplary embodiment of a leg positioner is shown in  FIG. 18D  and  FIG. 18E . In this exemplary embodiment, peg holes located along a line oblique to the lateral or longitudinal axes of the pegboard may have a center to center distance of d1. Peg holes located along the lateral or longitudinal axis of the peg board may have center to center distances of d2. Typically, d2&gt;d1. Leg positioner  300  includes a boot  310  having a foot receiving portion  310   b  for receiving the foot and leg receiving portion  310   a  for receiving the lower portion of the leg whose knee or hip is being operated on. Pegs  85  are attached to the boot  310  so that the boot  310  can be fixed to pegboard  30   b  in a desired position that provides the desired flexion/extension and/or distraction/compression on the knee or hip, when pegboard  30   b  is adjusted. While not necessary, a mounting 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 directly attached thereto can be used to attach the foot to the pegboard to assist in flexing/extending and/or distracting/compressing the knee or hip. 
     In  FIG. 18E , mounting block  90  and its associated pegs are attached to leg receiving portion  310   a . In  FIG. 18E , there are typically just one set of pegs  85  protruding in a direction opposite to the foot receiving portion. 
     In  FIG. 18F , block  90  and its associated pegs are attached to foot receiving portion  310   b . In  FIG. 18F , there are typically multiple sets of pegs  85 ′ protruding at least in directions both perpendicular to the foot receiving portion and parallel to the foot receiving portion (perpendicular to the leg receiving portion). 
     These two different ways in which pegs  85  are attached to boot  310  result in different ways in which boot  310  may be mounted to the pegboard (see  FIGS. 18K, 18L , and accompanying description. 
       FIG. 18F  and  FIG. 18G  show a different structure of a leg positioner  300 ′ and a mounting structure that can be used to achieve one or more of the various anatomical positionings described above. 
     In  FIG. 18F  and  FIG. 18G , as with  FIG. 18E , the amount of flexion/extension can be adjusted based upon the position of the leg positioner relative to the end of the pegboard. The further away from the end of pegboard that the pegs of the leg positioner are inserted into the pegboard, the greater the flexion/extension and/or distraction/compression of the knee or hip. 
       FIGS. 18H and 18I  show other exemplary embodiments for adjusting the amount of flexion/extension based upon the position of the leg positioner relative to the end of the pegboard. 
     In  FIG. 18H , leg positioner  300  is mounted to a slidable block  500 , which forms part of the mounting structure and is slidably mounted to a track  510  in the pegboard (the area in which the track is mounted need not have pegboard holes). 
     Accordingly, in  FIG. 18H , the position of  300  can be adjusted by varying the position relative to the end of pegboard at which slidable block  500  is locked or clamped. The further away from the end of pegboard that slidable block  500  is locked or clamped, the more flexion/extension of the knee and hip. The leg positioner  300  can be fixed to slidable block  500  by pegs ( FIG. 18H ) or directly fixed to slidable block  500  ( FIG. 18I ). In this exemplary embodiment, board  600  may have pegholes, not have pegholes, or be omitted entirely, wherein the patient&#39;s upper body lies directly upon the surgical table. 
       FIG. 18J  shows an alternative embodiment of leg positioner  300 ′ that allows for adjusting the amount of axial rotation of a leg/hip/knee during an orthopedic surgery. In  FIG. 18J , the mounting structure includes an optional mounting block  90 ′ located on foot receiving portion  310   b , such as it is in  FIG. 18F , but different from as shown in  FIG. 18E , where mounting block  90  is located on leg receiving portion  310   a . Mounting block  90 ′ can have additional pegs  85 ′ and  85 ″ protruding therefrom in a variety of directions. Preferably pegs  85 ′,  85 ″ come in adjacent pairs for stability and rotation prevention. The pair of pegs  85 ′ may have a center-to-center distance of d1. The pair of pegs  85 ″ may also have a center-to-center distance of d1. The pair of pegs  85  may have a center-to-center distance of d2. As previously mentioned, d2&gt;d1. These dimensions are used when corresponding to a peg board, such as exemplified relative to  FIG. 18D . If mounting block  90 ′ is square or rectangular, pegs  85 ′ and pegs  85 ″ can protrude from the sides of the mounting block  90 ′. For increased flexibility of rotation amount, it is preferred that at least three sets of pegs can be provided. Two sets of pegs  85 ′ are to be substantially perpendicular to each other. The third set of pegs  85 ″ are to be oblique relative to the axes of both the sets of pegs  85 ′. This oblique orientation may be achieved by mounting the pegs on an oblique wall  91 ′ of mounting block  90 ′. 
       FIG. 18K  and  FIG. 18L  and  FIG. 18M  show how the axial rotation of the leg can be varied using the alternative leg positioner  300 ′ of  FIG. 18J . 
     In  FIG. 18K , by positioning pegs  85 ′ that are parallel to the plane of the foot into the desired pegboard holes, the leg will be positioned with no rotation and the foot substantially perpendicular to the pegboard. 
     In  FIG. 18L , by positioning pegs  85 ′ that are perpendicular to the plane of the foot into the desired pegboard holes, the leg will be positioned with 90 degrees of rotation and the foot substantially parallel to the pegboard. 
     In  FIG. 18M , by positioning pegs  85 ″ that are oblique with the other pegs  85 ′ into the desired pegboard holes, the foot and leg will be positioned with an angle between 0-90 degrees of rotation (e.g. the oblique angle). The oblique wall  91 ′ of mounting block  90 ′ also provides additional stability to the pegs  85 ″. 
     In  FIG. 18N , by having the longitudinal axis of peg  85  be at an oblique angle with block  90 ′, leg positioner  300  will be non-parallel to peg board  30 ; thereby elevating the knee. Such a positioning can be advantageous to surgery on the leg, etc. 
       FIG. 25A  shows a common leg/knee positioning used during an orthopedic surgery. The patient&#39;s leg is bent and the lower leg placed under the non-bent leg. This causes flexion/extension and other movements, such as distraction/compression in the bent leg, that make surgery thereon easier. 
       FIG. 25B  shows how, by using the exemplary leg positioners described herein, the positioning of  FIG. 25A  can be achieved and in a more secure manner (by the boot being secure relative to the pegboard/table and the foot being secure relative to the boot). Furthermore, strap S can be used to secure a knee in position, freeing up a nurse that typically is dedicated to holding the knee in place. 
     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 U2 are supported and different portions of the patient&#39;s upper body U1 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 . 
       FIG. 26  shows a mounting structure including a pivot system that can be used with, for example, the legs positioners  300 ,  300 ′ and adjustable pegboard systems described above for use in controlling the amount of abduction/adduction. The pivot system includes a pivot support  500 . Pivot support  500  comprises a main body  510 . A pivot peg  520  protrudes in a first direction from a first side and first end of main body  510 . A mounting bar  550  protrudes in a second direction, generally opposite from the first direction, from a second side and second end of main body  510 . A clamp (not shown) is used in combination with mounting bar  550  to attach pivot support  500  to a surgical table or pegboard. Typically, when in use, the first direction is upwards and the second direction is downwards. 
       FIG. 27  shows how the pivot system is set up. In  FIG. 27 , a pegboard is provided. Pivot peg  520  is received within a pegboard hole of the pegboard, generally at a corner of the pegboard, and at least partially supported by main body  510 . During use, the patient&#39;s acetabulum will be positioned generally close to (or overlaying) the pivot peg  520  such that pivoting the pegboard about the pivot peg pivots of the femur within the generally stationary acetabulum (see  FIG. 24D ). Additionally, as shown in  FIGS. 29A, 29B, and 29C , mounting block  1000  can replace support block  90 . Adjustable rotatable tension clamps  1010 ,  1020  can be used to vary the positioning or orientation of leg positioner  300 . 
       FIGS. 28A, 28B  and  FIGS. 29A, 29B , show how the pivot system of  FIGS. 26, 27  is used. In  FIGS. 28A and 29A , the leg pegboard is generally parallel to the longitudinal axis of the main board  600  and therefore the leg to be operated on will also be generally parallel to the axis of the main pegboard as well as the patient&#39;s median sagittal plane. The leg to be operated will typically not lie in the plane of the main board  600  (e.g.  FIG. 17 ) because if it were to lie in the plane of the main board  600 , it would not be possible for the pivoting pegboard to pivot, because the main board  600  or other leg pegboard would be an obstruction. Note that main board  600  may have pegholes, not have pegholes, or be omitted entirely, wherein the patient&#39;s upper body lies directly upon the surgical table.  FIGS. 28C and 29C  show a similar pivot system that includes a pivotable board that is not a pegboard, i.e., that does not have pegholes. 
     In  FIGS. 28B and 29B , the leg pegboard is pivoted about pivot peg  520  at some desired angle relative to the axis of the main board  600  and the patient&#39;s median sagittal plane. Therefore, the leg to be operated on will also be at the desired angle relative to the axis of the main board  600  and the patient&#39;s median sagittal plane. Accordingly, the amount of rotation of the femur relative to the acetabulum can be adjusted, resulting in potentially easier surgical procedures. Note that main board  600  may have pegholes, not have pegholes, or be omitted entirely, wherein the patient&#39;s upper body lies directly upon the surgical table. 
       FIGS. 30A, 30B, 30C, and 30D  depict an alternative exemplary embodiment for a mounting structure that allows for varying the position or elevation of the knee. In this exemplary embodiment, positioner  1000  with pegs receivable in peg board holes, receives a sphere  1100 . Lever  1200  applies or releases a locking grip on sphere  1100 . Leg positioner  300  is attached to sphere  1100  through mounting block  90 ′″. With this exemplary embodiment, a wide range of motion (ROM) of leg positioner  300  is available. 
     While this invention has been described with respect to at least one embodiment, the present invention can be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this invention pertains and which fall within the limits of the appended claims.