Patent Publication Number: US-2010121325-A1

Title: Hybrid intramedullary fixation assembly and method of use

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation-in-part application of Non-Provisional application Ser. No. 12/456,808, filed Jun. 23, 2009, which claims the benefit of Provisional Application No. 61/132,932, filed Jun. 24, 2008, the entire contents of which are herein incorporated by reference. 
    
    
     FIELD OF THE INVENTION 
     This invention relates to the field of orthopedic implant devices, and more particularly, to a hybrid intramedullary fixation assembly comprising a screw and plate fixation assembly used for internal fixation of angled joints, bones and joint reinforcement, such as the bones in the foot. 
     BACKGROUND OF THE INVENTION 
     Orthopedic implant devices, such as intramedullary nails, plates, rods and screws are often used to repair or reconstruct bones and joints affected by trauma, degeneration, injury, deformity and disease, such as injuries to the tarsometatarsal joint caused by accidents or falls or Charcot arthropathy caused by diabetes in some patients. 
     Injuries to the tarsometarsal joint occur in athletics, from minor twisting injuries when stepping unevenly, to more violent injuries that may occur in motor vehicle accidents or falls, while charcot arthropathy (or Charcot foot) is a destructive process affecting many regions including joints of the foot and ankle in diabetics. This condition causes bony fragmentation, dislocation, and fractures that eventually progresses to foot deformity, bony prominences, ulceration and instability of the foot. Charcot arthropathy can affect any joint in the body but is often seen in the feet affecting the metatarsal, tarsometatarsal and tarsal joints and frequently causes the foot to lose its arch or curvature, and joint stability, thus resulting in “flat footedness” in the mid-foot region. 
     Surgery is required for the majority of the tarsometarsal injuries. The treatment of tarsometatarsal injuries is usually done by reduction of the fraction or dislocation by means of screws that are inserted internally into the bones across the joints. These can be inserted through multiple punctures made on the skin without resorting to incisions on the foot. On the other hand, early treatment for Charcot foot includes the use of therapeutic footwear, immobilization of the foot and/or non-weight bearing treatment. Surgical treatments include orthopedic fixation devices that fixate the bones in order to fuse them into a stable mass. These orthopedic implant devices realign bone segments and hold them together in compression until healing occurs, resulting in a stable mass. 
     Various implants have been utilized for surgical treatment, including bone screws. While these devices allow fixation and promote fusion, they do not reinforce the joint nor do they restore the arch in a Charcot foot. Instead, the physician must estimate the arch and manually align the bones and deliver the screws to hold the bones in place, while reducing bone purchase. Intramedullary nails and/or a plate with a lag screw too have deficiencies. These intramedullary nails also do not reconstruct an arch that is lost due to Charcot foot disease nor do they reinforce the tarsometatarsal joint. 
     Moreover, infections and wound complications are a major concern in aforementioned procedures. Wound closure is technically demanding for the surgeon, and devices that add surface prominence, such as plates or exposed screws, add to the difficulty by requiring greater tissue tension during incision reapproximation. This increases the risk of postoperative wound infections and dehiscence that may ultimately result in limb amputation. 
     There is therefore a need for a hybrid intramedullary fixation assembly and method of use that overcomes some or all of the previously delineated drawbacks of prior fixation assemblies. 
     SUMMARY OF THE INVENTION 
     An object of the invention is to overcome the drawbacks of previous inventions. 
     Another object of the invention is to provide a novel and useful intramedullary fixation assembly that may be utilized to treat bones in a mid-foot region. 
     Another object of the invention is to provide joint reinforcement of the mid-foot region by utilizing a hybrid intramedullary screw and plate assembly. 
     Another object of the invention is to provide a system for treating deteriorating bones in a mid-foot region. 
     Another object of the invention is to provide a method for reinforcing the bones in the foot by delivering a plate and screw fixator that can be coupled to bones in a patient&#39;s foot. 
     In a first non-limiting aspect of the invention, an intramedullary fixation assembly for joint stabilization is provided and includes a plate member having a plurality of apertures, where the plate member comprises a first elongated portion and a second curved portion. The assembly further includes a plurality of metatarsal screws for coupling the plate member to the first elongated portion and to the metatarsal bone. An intramedullary screw member coupled to the first elongated portion applies compression to the tarsometarsal joint and a plurality of medial screws coupled to the second curved portion stabilizes the joint. 
     In a second non-limiting aspect of the invention, a method for reinforcing a tarsometarsal joint in a mid-foot region comprises six steps. Step one includes making a Medial Lis Franc incision in the mid-foot region of the human foot in order to gain access to the tarsometarsal joint. Step two includes Gunstocking the foot to expose the articular surface and removing the articulating cartilage. Step three includes inserting metatarsal screws into the tarsometatarsal plate member and into the metatarsal to anchor the metatarsal screws. Step four includes inserting the intramedullary screws into the tarsometarsal joint and applying compression. Step five includes inserting medial-lateral screws into the bones in the mid-foot region. The sixth step includes closing the incision, thereby reinforcing the tarsometarsal joint in the mid-foot region. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       A further understanding of the invention can be obtained by reference to a preferred embodiment set forth in the illustrations of the accompanying drawings. Although the illustrated embodiment is merely exemplary of systems and methods for carrying out the invention, both the organization and method of operation of the invention, in general, together with further objectives and advantages thereof, may be more easily understood by reference to the drawings and the following description. The drawings are not intended to limit the scope of this invention, which is set forth with particularity in the claims as appended or as subsequently amended, but merely to clarify and exemplify the invention. 
       For a more complete understanding of the invention, reference is now made to the following drawings in which: 
         FIG. 1  is a perspective view of a fixation system according to a preferred embodiment of the invention. 
         FIG. 2  is a perspective view of a proximal screw member used in the fixation system shown in  FIG. 1  according to the preferred embodiment of the invention. 
         FIG. 3A  is a perspective view of a distal member used in the fixation system shown in  FIG. 1  according to the preferred embodiment of the invention. 
         FIG. 3B  is a perspective cross-sectional view of the distal member shown in  FIG. 3A  according to the preferred embodiment of the invention. 
         FIG. 4  is a perspective view of the instrument member used in the fixation system shown in  FIG. 1  according to the preferred embodiment of the invention. 
         FIG. 5  is a perspective view of the assembled intramedullary fixation assembly inserted into the bones of a patient&#39;s foot according to the preferred embodiment of the invention. 
         FIG. 6  is a side view of the assembled intramedullary fixation assembly shown in  FIG. 5  according to the preferred embodiment of the invention. 
         FIG. 7  is a flow chart illustrating the method of coupling the intramedullary fixation assembly shown in  FIGS. 1-6  to tarsal and metatarsal bones in a patient&#39;s foot according to the preferred embodiment of the invention. 
         FIG. 8  is a perspective view of an assembled intramedullary fixation assembly according to an embodiment of the invention. 
         FIG. 9  is a perspective top view of an assembled intramedullary fixation assembly shown in  FIG. 8  according to an embodiment of the invention. 
         FIG. 10  is another view of the assembled intramedullary fixation assembly shown in  FIGS. 8-9  according to an embodiment of the invention. 
         FIG. 11  is a perspective front view of a tarsometatarsal plate member used in the fixation assembly shown in  FIGS. 8-10  according to the embodiment of the invention. 
         FIG. 12  is top view of the tarsal-metatarsal plate member shown in  FIGS. 8-11  according to an embodiment of the invention. 
         FIG. 13  is a flow chart illustrating the method of coupling the intramedullary fixation assembly shown in  FIGS. 8-12  to bones in the mid-foot region according to an embodiment of the invention. 
     
    
    
     DETAILED DESCRIPTION 
     The invention may be understood more readily by reference to the following detailed description of preferred embodiment of the invention. However, techniques, systems, and operating structures in accordance with the invention may be embodied in a wide variety of forms and modes, some of which may be quite different from those in the disclosed embodiment. Consequently, the specific structural and functional details disclosed herein are merely representative, yet in that regard, they are deemed to afford the best embodiment for purposes of disclosure and to provide a basis for the claims herein, which define the scope of the invention. It must be noted that, as used in the specification and the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly indicates otherwise. 
     Referring now to  FIG. 1 , there is shown a fixation system  100  which is made in accordance with the teachings of the preferred embodiment of the invention. As shown, the fixation system  100  includes an intramedullary fixation assembly  110 , comprising a proximal screw member  130  and a distal member  140 . Proximal screw member  130  is provided on proximal end  135  of assembly  110  and is coupled to a distal member  140  that is provided on the distal end  145  of the fixation assembly  110 . Also, proximal screw member  130  makes a fixed angle  150  with distal member  140  and this angle  150  determines the angle for arch restoration. Moreover, fixation system  100  includes instrument  120  that is utilized to couple intramedullary fixation assembly  110  to the bones, in one non-limiting example, in the mid-foot region (not shown). It should be appreciated that in one non-limiting embodiment, intramedullary fixation assembly  110  may be made from a Titanium material, although, in other non-limiting embodiments, intramedullary fixation assembly  110  may be made from SST, PEEK, NiTi, Cobalt chrome or other similar types of materials. It should also be appreciated that intramedullary fixation assembly  110  may be utilized for the internal fixation of other bones in the human body. 
     As shown in  FIG. 2 , proximal screw member  130  is generally cylindrical in shape and extends from first bulbous portion  202  to second tapered end  204 . End  204  has a diameter that is slightly smaller than diameter  226  of bulbous portion  202 . Additionally, bulbous portion  202  has a taper, such as a Morse taper, with a width that decreases from end  211  to end  212 . The taper allows for a locked interference fit with tapered aperture  316  when tapered bulbous portion  202  is combined with tapered aperture  316 , shown and described below. Moreover, bulbous portion  202  is generally circular and has a generally hexagonal torque transmitting aperture  208  that traverses length  210  of bulbous portion  202 . However, a star-shaped aperture, a square-shaped aperture, or any other shaped aperture may be utilized without departing from the scope of the invention. Torque transmitting aperture  208  is utilized to transmit a torque from bulbous portion  202  to tapered end  204  by rotating bulbous portion  202 . 
     Further, proximal screw member  130  has a first smooth exterior portion  206  extending from end  212  of bulbous portion  202 . Portion  206  comprises an internal aperture  214  that longitudinally traverses portion  206  in direction  201 . Portion  206  terminates into a second generally tubular portion  216 . Portion  216  may comprise internal circular aperture  220  that longitudinally traverses inside portion  216 . Internal circular aperture  220  is aligned with apertures  214  and  208  along axis  203  to form a continuous opening (i.e., a cannula) from bulbous portion  202  to end  204 . The continuous opening or cannula is provided to interact with a guide wire (not shown) by receiving the guide wire within the continuous opening thereby positioning and locating the proximal member  130 . In other non-limiting embodiments, the proximal member  130  may be provided without apertures  220  and  214  (i.e., the proximal member is solid). 
     Furthermore, tubular portion  216  has a plurality of circular threads, such as threads  218 , which are circumferentially disposed on the external surface of portion  216  and, with threads  218  having an external diameter  224 . Portion  216  may also be provided with a self-tapping leading edge  222  to provide portion  216  with the ability to remove bone material during insertion of proximal screw member  130  into bone. It should be appreciated that the length of the proximal member  130  may be selected of varying lengths to allow a surgeon to fuse different joints in a foot (not shown). 
     As shown in  FIGS. 3A-3B , distal member  140  of the preferred embodiment is generally tubular in shape and tapers from a first end  302  to a second end  304  (i.e. end  302  has a diameter  306  that is slightly larger than diameter  308  of end  304 ). However, in another non-limiting embodiment, distal member  140  has a constant width from first end  302  to second end  304 . Further, first end  302  is generally semi-spherical in shape and has an internal circular aperture  316 , which traverses end  302  along direction  301  (i.e. end  302  is generally “donut” shaped). Additionally, circular aperture  316  emanates from surface  322 , such that portion  310  has a generally tapered aperture  316  provided in portion  310 . Circular aperture  316  comprises slope  320  from first end  302  to end  322  of portion  310 . Further, aperture  316  is aligned along axis  303 , which is offset from horizontal axis  305  of distal member  140 . Axis  303  forms an angle  150  with horizontal axis  305  that determines the angle for arch restoration, as shown in  FIG. 3A . Angle  150  may be any angle greater than 90 degrees and less than 180 degrees. Tapered aperture  316  when combined with tapered bulbous portion  202 , shown in  FIG. 2 , creates a locked interference fit between proximal member  130  and distal member  140 . First end  302  has a plurality of substantially similar grooves  326  and  328 , which form an “L-shape” with surface  330  of end  302 . Grooves  326  and  328  are provided to receive instrument  120  of fixation system  100 , which is later described. In other non-limiting embodiments, other similar instruments may be provided to be received within grooves  326  and  328 . 
     Distal member  140  further comprises a generally smooth portion  310  coupled to end  302 . Portion  310  has a generally hexagonal shaped aperture  312 , which opens into aperture  316  and which longitudinally traverses through portion  310  in direction  301 . In other non-limiting embodiments, a star-shaped aperture, a square-shaped aperture, or any other shaped aperture may be utilized. Circular aperture  316  has a diameter  314  that is slightly larger than external diameter  224  of portion  216  and  206  of proximal screw member  130 , with portions  216  and  206  being slidably received within aperture  316  of portion  310 . Aperture  316  has a diameter that is smaller than diameter  226  of bulbous portion  202 . 
     Portion  310  of distal member  140  terminates into a second generally cylindrical portion  318  which has a plurality of threads  324 , which are circumferentially disposed on the external surface of portion  318 . Portion  318  has an internal circular aperture  326  which is longitudinally coextensive with portion  318  in direction  301 . Circular aperture  326  aligns with aperture  312  to form a continuous opening from end  302  to end  304 . 
     As shown in  FIG. 4 , instrument  120  is illustrated for coupling proximal screw member  130  to distal member  140 . Particularly, instrument  120  includes a handle portion  402  coupled to a rod portion  404 . Rod portion  404  emanates from handle portion  402  at end  406  and terminates into a rectangular planar portion  408  at end  410 . Planar portion  408  is aligned along axis  401  and is fixably coupled to a generally cylindrical tubular portion  412  (i.e., an aiming device). Portion  412  traverses portion  408  from top surface  414  to bottom surface  416 . Further, tubular portion  412  is aligned along dissimilar axis  403 , forming an angle  405  with axis  401 . Also, tubular portion  412  has a through aperture  420  that longitudinally traverses portion  412  along axis  403 . 
     Planar portion  408  is coupled to planar portion  422 , with portion  422  having a width slightly smaller than width of portion  408 . Portion  422  terminates into a generally “U-shaped” portion  424  with portion  424  being orthogonal to portion  422 . Further, portion  424  has a plurality of substantially similar sides  426  and  428  which are provided to be slidably coupled to grooves  326  and  328  of distal member  140 . 
     In operation, sides  426  and  428  of instrument  120  are received in respective grooves  326  and  328  of distal member  140 , of  FIGS. 3A-3B , thereby slidably coupling distal member  140  to instrument  120 . In this position, axis  303  of aperture  316  is aligned along substantially the same axis as axis  403  of instrument  120 . Proximal screw member  130  is coupled to distal member  140  by slidably coupling portions  206  and  216  through aperture  420  of tubular portion  412 . Tubular portion  412  guides proximal screw member  130  through internal aperture  420  and into aperture  316  on surface  322  and may also guide a Kirschner wire (K wire) or a drill. Proximal screw member  130 , of  FIG. 2 , travels into bone as portions  216  and  206  travel further through aperture  316  at end  302  until bulbous portion  202  is restrained by surface  322  and end  302 . Aperture  316 , being tapered along axis  303 , causes proximal screw member  130  to form an angle  150  with distal member  140 , with proximal member  130  being aligned along an axis  303 , which is substantially the same axis as axis  403  of tubular portion  412  of instrument  120 . 
     In operation, and as best shown in  FIGS. 5 ,  6  and  7 , the fixation system  100  utilizes the intramedullary fixation assembly  110  for treating and fixating the deteriorated and damaged or fractured bones in the human foot  500 . This restores the arch in a human foot  500  by coupling the intramedullary fixation assembly  110  to the human foot  500  of a left leg. In one-non limiting example, and as shown in  FIG. 5 , the intramedullary assembly  110  is coupled to the medullary canals of the first metatarsal  502 , medial cuneiform  504 , navicular  506  and talus bone  508 . Talus bone  508  makes up part of the ankle joint where the threaded portion  216  of the proximal screw member  130  of the intramedullary assembly  110  is threadably coupled. The medial cuneiform  504  and navicular  506  bones are most affected by Diabetic Charcot foot disorder that causes deterioration and collapse of the arch of the foot  500 . It should be appreciated that the intramedullary assembly  110  may be used within each of the five rays, with a ray representing a line drawn from each metatarsal bone to the talus. The angulation in the smaller rays will be smaller than the two rays (i.e., a line from the first and second metatarsal bones to the talus bone). Also, the diameter of distal member  140  will decrease from the large ray to the small ray. In one non-limiting example, the angulation may be any angle greater than 90 degrees and less than 180 degrees. For example, the angle for the first ray may be 150-170 degrees and the angles for the other rays may be 160-175 degrees. 
     As shown in  FIGS. 6 and 7 , the intramedullary fixation assembly  110  may be utilized to reconstruct an arch in a mid-foot region of a human foot  500 . As shown, the method starts in step  700  and proceeds to step  702 , whereby a Dorsal Lis Franc incision (i.e., mid-foot incision) (not shown) is made in foot  500  in order to gain access to the joint. In step  704 , the joint capsule is separated by “Gunstocking” foot  500  in direction  601  (i.e., the foot  500  is bent mid-foot) to expose the articular surface  602  and the articulating cartilage is removed. Next, in step  706 , the intramedullary canal is reamed and the distal member  140  is inserted into the intramedullary canal (not shown) of the metatarsal  502 . In other non-limiting embodiments, the distal member  140  may be inserted by impaction, by press fit, by reaming a hole in the intramedullary canal (not shown) or substantially any other similar strategy or technique. 
     Next, in step  708 , the instrument  120  is coupled to the distal member  140  by coupling sides  426  and  428  of instrument  120  to respective grooves  326  and  328 . In step  710 , initial positioning of the proximal member  130  is assessed with the use of a guide wire through portion  412  (i.e., aiming device). Next, in step  712 , a countersink drill is inserted through portion  412  and the proximal cortex is penetrated. In this step, a cannulated drill or guide wire is used to pre-drill the hole through the joints selected for fusion. In step  714 , the proximal screw member  130  is inserted over the guide wire and into the distal member  140 . Particularly, the proximal member  130  is inserted through tubular portion  412  (i.e., aiming device), causing proximal member  130  to travel through internal longitudinal aperture  420 , into distal member  140  and further into bones  504 ,  506  and  508  until rigid connection with the tapered aperture  316  is made, thereby compressing the joint. In one non-limiting embodiment, a locking element (not shown) such as a plate or a washer is coupled to end  302  of the intramedullary fixation assembly  110  to further secure proximal threaded member  130  to distal member  140 . Next, in step  716  the instrument  120  is removed and the dorsal Lis Franc (i.e., mid-foot) incision is closed. The method ends in step  718 . 
     It should be appreciated that a plurality of intramedullary fixation assemblies, such as intramedullary fixation assembly  110 , may be inserted into any of the bones of a foot  500  such as, but not limited to the metatarsal, cuneiform, calcaneus, cuboid, talus and navicular bones, in order to restore the natural anatomical shape of the arch of the foot  500 . Thus, the fixation system  100 , in one non-limiting embodiment, is utilized to couple the intramedullary fixation assembly  110  to the foot  500 , which causes the metatarsal  504 , medial cuneiform  504 , navicular  506  and talus  508  bones to be aligned to the proper anatomical shape of an arch when assembled within foot  500 . It should be appreciated that the intramedullary fixation assembly  110  is delivered through a dorsal midfoot incision, thereby reducing the disruption to the plantar tissues and/or the metatarsal heads while at the same time minimizing the tension on the skin. This allows for improved wound closure, reduced operating room time, reduction in the number of incisions required and reduction in the total length of incisions. It should also be appreciated that in other non-limiting embodiments, the intramedullary assembly  110  may be utilized with graft material (i.e., autograft, allograft or other biologic agent). 
     Referring now to  FIGS. 8-10 , there is shown a hybrid intramedullary fixation assembly  800  comprising a tarsometatarsal plate member  810  (hereinafter “TMT plate member  810 ”) and fixation screws, which is made in accordance with the teachings of an alternate embodiment of the invention. As shown, the TMT plate member  810  is anatomically designed for the first ray, however, the TMT plate member  810  may be designed to be accommodated on any of the other four rays in the human foot  805 . The TMT plate member  810  is coupled to the human foot  805  (shown in  FIGS. 8 and 9 ) through a combination of intramedullary screws  835 ,  840 ,  845  and polyaxial locking screws  850 ,  855 , and  860 , in order to reinforce the Tarsometatarsal Joint in the human foot  805 . In other non-limiting embodiments, a non-locking screw may be utilized in lieu of the locking screws  850 ,  855 , and  860 . Further, the TMT plate member  810  receives the intramedullary screw  835  in order to couple the TMT plate member  810  to each of the metatarsal  815 , the medial cuneiform  820 , the navicular  865 , and the talus  870  bones. 
     Further, and as shown in  FIG. 9 , the TMT plate member  810  is coupled to the medial cuneiform  820 , intermediate cuneiform  905 , the lateral cuneiform  910 , and the cuboid  915  through a medial screw, such as, for example, the intramedullary screw  845 . A second medial screw, such as, the intramedullary screw  840  is also coupled to the medial cuneiform  820 , the navicular  875  (shown in  FIG. 8 ), and the cuboid  915  to reinforce the tarsometarsal joint. The TMT plate member  810  also receives polyaxial locking screws  850 ,  855 , and  860  in order to couple the TMT plate member  810  to the metatarsal  815 . It should be appreciated that intramedullary screws  835 ,  840 ,  845  and polyaxial locking screws  850 ,  855 , and  860  may vary in length in order to accommodate bones of varying sizes. It should also be appreciated that the intramedullary fixation assembly  800  may be used within each of the five rays, with a ray representing a line drawn from each metatarsal bone to the talus  870 . The intramedullary fixation assembly  800 , including the screws may be made from a Titanium material, although, in other non-limiting embodiments, intramedullary fixation assembly  800  may be made from SST, PEEK, NiTi, Cobalt Chrome or other similar types of materials. It should also be appreciated that intramedullary fixation assembly  800  may be utilized for the internal fixation of other bones in the human body, such as for example, the hand bones. 
     As shown in  FIGS. 11-12 , TMT plate member  810  has a generally “L-shaped” body. Particularly, TMT plate member  810  has a first generally flat and elongated member  1105  traversing from a first end  1110  to a second end  1115 . End  1115  emanates and terminates into a second generally curved member  1120 , which is provided to wrap around the medial cuneiform bone  820  (shown in  FIGS. 8-9 ). End  1115  is further raised to accommodate the proximal head (not shown) of the metatarsal bone  815 , although in other non-limiting embodiments, end  115  may be substantially flat to accommodate the other rays in the human foot  805  (shown in  FIGS. 8-9 ). TMT plate member  810  further includes a plurality of holes  1125 ,  1130 , and  1135  on the elongated member  1105 , which are provided to receive a plurality of polyaxial locking screws  850 ,  855 , and  860  (shown in  FIGS. 8-10 ) in order to threadably couple TMT plate member  810  to the metatarsal  815  (shown in  FIGS. 8-10 ). TMT plate member  810  further includes a plurality of holes  1140 ,  1145 , and  1150 , which are provided to receive intramedullary screw  835 ,  845 , and  840  respectively (shown in  FIGS. 8-9 ). In other non-limiting embodiments, a non-locking screw may be utilized in lieu of the locking screws  850 ,  855 , and  860 . 
     As shown in  FIGS. 9 and 13 , the intramedullary fixation assembly  800  may be utilized to reinforce the tarsal-metatarsal joint in a mid-foot region of a human foot  805 . As shown, the method starts in step  1300  and proceeds to step  1302 , whereby a Medial. Lis Franc incision (i.e., mid-foot incision) (not shown) is made in human foot  805  in order to gain access to the metatarsal  815  and medial cuneiform  820  bones. In step  1304 , the joint capsule is separated by “Gunstocking” foot  805  (i.e., the foot  805  is bent mid-foot) to expose the articular surface  875  and the articulating cartilage is removed. Next, in step  1306 , the TMT plate member  810  is positioned on top of the metatarsal  815  and the metatarsal screws, such as polyaxial locking screws  850 ,  855 , and  860  are inserted into the metatarsal  815  and into the TMT plate member  810  to anchor the TMT plate member  810 . 
     Next, in step  1308 , initial positioning of the intramedullary screw  835  is assessed the intramedullary screw  835  is inserted into the human foot  805  and compression is applied to lock the TMT plate member  810  to the metatarsal  815 , the medial cuneiform  820 , the navicular  865 , and the talus  870  bones. In one non-limiting embodiment, the positioning of the intramedullary screw member  835  is assessed with the use of a guide wire and a countersink drill is inserted to pre-drill a hole in the metatarsal  815  and medial cuneiform  820 . Next, in step  1310 , medial-lateral screws, such as screws  840  and  845  are inserted to reinforce the tarsometatarsal joint by locking the TMT plate member  810  to the medial cuneiform  820 , intermediate cuneiform  905 , the lateral cuneiform  910 , the cuboid  915 , and the navicular  875  respectively. Next, in step  1312 , medial Lis Franc (i.e., mid-foot) incision is closed. The method ends in step  1314 . 
     It should be appreciated that a plurality of intramedullary fixation assemblies, such as intramedullary fixation assembly  800 , may be inserted into any of the bones of a human foot  805  such as, but not limited to the metatarsal, cuneiform, calcaneus, cuboid, talus and navicular bones, in order to stabilize the joints in the foot  805 . It should be appreciated that the intramedullary fixation assembly  800  is delivered through a medial midfoot incision, thereby reducing the disruption to the plantar tissues and/or the metatarsal heads while at the same time minimizing the tension on the skin. This allows for improved wound closure, reduced operating room time, reduction in the number of incisions required and reduction in the total length of incisions. It should also be appreciated that in other non-limiting embodiments, the intramedullary assembly  800  may be utilized with graft material (i.e., autograft, allograft or other biologic agent). 
     It should be understood that this invention is not limited to the disclosed features and other similar method and system may be utilized without departing from the spirit and the scope of the invention. 
     While the invention has been described with reference to the preferred embodiment and alternative embodiments, which embodiments have been set forth in considerable detail for the purposes of making a complete disclosure of the invention, such embodiments are merely exemplary and are not intended to be limiting or represent an exhaustive enumeration of all aspects of the invention. The scope of the invention, therefore, shall defined solely by the following claims. Further, it will be apparent to those of skill in the art that numerous changes may be made in such details without departing from the spirit and the principles of the invention. It should be appreciated that the invention is capable of being embodied in other forms without departing from its essential characteristics.