Patent Description:
This disclosure relates generally to surgical tools, and more specifically to apparatuses and methods for correcting hallux valgus angle.

Hallux valgus deformities in the human foot relate to a condition in which the first (great) toe has a deviated position leaning in towards the second toe. The first metatarsal deviates towards the mid-sagittal plane, and the great toe deviates away from the mid-sagittal plane. This is often accompanied by a bump due to a swollen bursal sac or a bony anomaly on the metatarsophalangeal joint.

A variety of non-surgical methods are used to treat hallux valgus, but in cases of continued pain or visible deformity, the patient may seek a surgical correction of the condition. Surgical methods may include removing the bony enlargement of the first metatarsal, realigning the first metatarsal bone relative to the adjacent metatarsal bone, and/or straightening the great toe relative to the first metatarsal and adjacent toes.

One such method of treating hallux valgus deformities is known as a Lapidus procedure. In a Lapidus procedure, the first metatarsal is realigned and then the first tarsal-metatarsal joint is fused to decrease the movement of the joint. This straightens the first metatarsal and toe to reduce or eliminate the hallux valgus deformity. <CIT> discloses an orthopedic device that can be used for compression or distraction of bone parts. The orthopedic device comprises an elongated body having first end and a second end. A first arm member extends away from the first end in a direction transverse to the elongated body. The first arm member can be integrally formed with the body or otherwise attached to the elongated body. A second arm member transversely extends away from the elongated body. The second arm member is configured with a base portion that is configured and adapted to movably engage the elongated body allowing the second arm member to be longitudinally movable along the elongated body to accomplish compression or distraction function of the device. Locking sleeve attachments are hingeably connected to the outer ends of the first and second arm members by a biaxial hinge block. The locking sleeves are configured for receiving and locking on to an elongated pin and the biaxial hinge block is configured to allow each of the locking sleeve to swivel in two different directions with respect to its corresponding arm member about two orthogonally oriented axes.

The present invention is an apparatus for correcting bunion deformity, as defined in claim <NUM>. The other claims recite advantageous features of the apparatus. In one aspect, an apparatus for correcting bunion deformity includes an elongated member, a first arm member, a second arm member, and a rotation guide. The elongated member extends from a first end to a second end. The first arm member has an arm axis and is coupled to the first end of the elongated member and extends in an orthogonal direction from the elongated member so that the arm axis extends in the orthogonal direction. The second arm member is configured to engage the elongated member such that the second arm member can translate along the elongated member between the first and second ends of the elongated member. The second arm member includes an attachment portion configured to translatably engage the elongated member and an extension extending from the attachment portion in the same orthogonal direction as the first arm member and a distal end of the extension is configured to engage a bone during use. The rotation guide is coupled to the first arm member such that the rotation guide is configured to rotate with respect to the first arm member, the rotation guide defining a bore having a longitudinal axis and configured to receive a k-wire along the bore's longitudinal axis. The rotation of the rotation guide with respect to the first arm member causes the longitudinal axis to rotate about a rotation axis.

In another aspect, an apparatus for correcting bunion deformity includes an elongated member, a first arm member, a second arm member, a rotation guide, and a locking mechanism. The elongated member extends from a first end to a second end. The first arm member has an arm axis and is coupled to the first end of the elongated member and extends in an orthogonal direction from the elongated member so that the arm axis extends in the orthogonal direction. The first arm member is configured to rotate about an arm axis extending from a first end of the first arm member to a second end of the first arm member. The second arm member is configured to engage the elongated member such that the second arm member can translate along the elongated member between the first and second ends of the elongated member. The second arm member includes an attachment portion configured to translatably engage the elongated member and an extension extending from the attachment portion. The rotation guide includes an arcuate portion engaged with the first arm member such that the rotation guide is configured to rotate with respect to the first arm member about a rotation axis. The rotation guide defines a bore configured to receive a k-wire. The locking mechanism is configured to selectively restrict rotation of the first arm member about the arm axis and rotation of the rotation guide about the rotation axis.

Also described herein but being not part of the invention, a method for correcting bunion deformity includes inserting a k-wire into a first metatarsal. The method further includes engaging an engagement portion of a second arm member with a second metatarsal. The method further includes sliding a rotation guide over the k-wire such that the k-wire is disposed in a bore of the rotation guide, the rotation guide rotatably coupled to a first arm member. The method further includes inserting an elongated member through an attachment portion of the second arm member, the elongated member having a first end and a second end, wherein the first arm member is coupled to the first end. The method further includes reducing a first distance between the first arm member and the second arm member to reduce a second distance between the first metatarsal and the second metatarsal. The method further includes rotating the rotation guide with respect to the first arm member to rotate the first metatarsal about a longitudinal axis of the first metatarsal.

In another aspect, an apparatus for correcting bunion deformity includes an elongated member, a first arm member, a second arm member, and a rotation guide. The elongated member extends from a first end to a second end. The first arm member is coupled to the first end of the elongated member and extends from the elongated member. The first arm member includes an arcuate portion defining a slot and at least one contact arm configured to contact a first bone during use. A track is defined between the arcuate portion and the at least one contact arm. The second arm member is configured to engage the elongated member such that the second arm member can translate along the elongated member between the first and second ends of the elongated member. The second arm member includes an attachment portion configured to translatably engage the elongated member and an extension extending from the attachment portion. A distal end of the extension is configured to engage a second bone during use. The rotation guide is coupled to the arcuate portion of the first arm member and is at least partially disposed in the track defined by the arcuate portion the at least one contact arm such that the rotation guide is configured to rotate with respect to the arcuate portion. The rotation guide defines a bore having a longitudinal axis and configured to receive a k-wire along the bore's longitudinal axis. Rotation of the rotation guide with respect to the first arm member causes the longitudinal axis to rotate about a rotation axis. The rotation guide is spaced apart from the first bone during use.

These and other features and advantages of the apparatuses and methods described herein will be more fully disclosed in, or rendered obvious by, the following detailed description of the preferred embodiments, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts.

This description of preferred embodiments is intended to be read in connection with the accompanying drawings, which are to be considered part of the entire written description of this invention. The drawing figures are not necessarily to scale and certain features of the invention may be shown exaggerated in scale or in somewhat schematic form in the interest of clarity and conciseness. In the description, relative terms such as "horizontal," "vertical," "up," "down," "top," and "bottom" as well as derivatives thereof (e.g., "horizontally," "downwardly," "upwardly," etc.) should be construed to refer to the orientation as then described or as shown in the drawing figure under discussion. These relative terms are for convenience of description and normally are not intended to require a particular orientation. Terms including "inwardly" versus "outwardly," "longitudinal" versus "lateral" and the like are to be interpreted relative to one another or relative to an axis of elongation, or an axis or center of rotation, as appropriate. Terms concerning attachments, coupling and the like, such as "connected" and "interconnected," refer to a relationship wherein structures are secured or attached to one another either directly or indirectly through intervening structures, as well as both movable or rigid attachments or relationships, unless expressly described otherwise.

The apparatuses described herein are configured for use in correction of bone deformities. Although the apparatuses can be used to correct deformities of any bone, they are particularly well-suited for use in correcting increased intermetatarsal angle between the first and second metatarsals of the foot. The apparatuses can be used in what is known as a Lapidus procedure. In addition, the apparatuses can be used to rotate the first metatarsal about a longitudinal axis of the first metatarsal to further realign the anatomy of the foot.

In one embodiment, as shown in <FIG>, an apparatus <NUM> for correcting a bunion deformity includes an elongated member <NUM>, a first arm member <NUM>, a second arm member <NUM>, and a rotation guide <NUM>. The apparatus <NUM> also includes a locking mechanism <NUM> that includes a locking post <NUM> and a knob <NUM>.

As shown in <FIG>, the elongated member <NUM> extends from a first end <NUM> to a second end <NUM>. The elongated member <NUM> includes a plurality of ratchet teeth <NUM>. As will be described further herein, the second arm member <NUM> is configured to selectively engage the plurality of ratchet teeth <NUM> to restrict translation of the second arm member <NUM> along the elongated member <NUM>. As shown in <FIG>, the elongated member <NUM> includes a bore <NUM> at its first end <NUM>.

The first arm member <NUM> is shown in more detail in <FIG>. As shown in <FIG>, the first arm member <NUM> has an arm axis <NUM> extending from a first end <NUM> of the first arm member <NUM> to a second end <NUM> of the first arm member <NUM>. As shown in <FIG>, the first arm member <NUM> is coupled to the first end <NUM> of the elongated member <NUM> with the first end <NUM> of the first arm member <NUM> adjacent the elongated member <NUM>. When coupled to the elongated member <NUM>, the first arm member <NUM> extends away from the elongated member <NUM> so that the arm axis <NUM> of the first arm member <NUM> extends away from the elongated member <NUM> (e.g., in an orthogonal direction relative to the length of the elongated member <NUM>). As shown in <FIG>, the first arm member <NUM> includes grooves <NUM> on the external surface of the first arm member <NUM>. As will be described further herein, in use, the rotation guide <NUM> rides in the external grooves <NUM> and the external grooves <NUM> constrain and guide the rotation of the rotation guide <NUM>. As shown best in <FIG>, the first arm member <NUM> also includes a bore <NUM> extending therethrough. As will be described further herein, the bore <NUM> is configured to allow passage of the locking post <NUM>, as shown in <FIG>. The second end <NUM> of the first arm member <NUM> includes two prongs 133a, 133b separated by a gap. The grooves <NUM> may be defined in the prongs 133a, 133b.

As shown in <FIG>, the rotation guide <NUM> includes a wire retainer <NUM> and an arcuate portion <NUM>. As shown in <FIG>, the wire retainer <NUM> includes a body <NUM> and a bore <NUM> extending through the body <NUM>. The bore <NUM> is sized and configured to receive a k-wire therein. The bore <NUM> can be any appropriate diameter to receive the appropriately sized k-wire. The bore <NUM> defines a longitudinal axis <NUM>. The wire retainer <NUM> also includes a bone engagement face <NUM>. The bone engagement face <NUM> can be shaped to conform to the bone. For example, the bone engagement face <NUM> can be concave, as shown in <FIG>. The bone engagement face <NUM> is at an end of the body <NUM> that has a larger diameter than other portions of the body <NUM>.

The arcuate portion <NUM> is shown in more detail in <FIG>. The arcuate portion <NUM> includes an inner face <NUM>, an outer face <NUM>, and a slot <NUM> extending therebetween. As shown in <FIG>, the first arm member <NUM> is slidably received in the slot <NUM> for enabling rotation of the arcuate portion <NUM> with respect to the first arm member <NUM>. Alternatively, or additionally, the first arm member <NUM> can move along the arcuate portion <NUM> within the slot <NUM>. In at least one embodiment, as shown in <FIG>, the slot <NUM> is open at one end. In such embodiments, as described in more detail below, the wire retainer <NUM> is coupled to the arcuate portion <NUM> at the open end of the slot <NUM>. The inner face <NUM> and the outer face <NUM> are curved and each define a portion of a cylinder. A rotation axis <NUM> is defined at the center of the cylinder. The radius of the inner face <NUM> and outer face <NUM> can be chosen to provide the appropriate spacing and clearance during use. For example, in one embodiment, the outer face <NUM> has a radius of between <NUM> inches and <NUM> inches. In another embodiment, the inner face <NUM> has a radius of approximately <NUM> inches.

As shown in <FIG>, the wire retainer <NUM> is coupled to the arcuate portion <NUM> at the open end of the slot <NUM> such that the longitudinal axis <NUM> of the bore <NUM> intersects the rotation axis <NUM> of the arcuate portion <NUM>. In at least one embodiment, the longitudinal axis <NUM> is orthogonal to the rotation axis <NUM>. Further, in one embodiment, when assembled, one or both of the longitudinal axis <NUM> and the rotation axis <NUM> intersect the arm axis <NUM>. The wire retainer <NUM> can be coupled to the arcuate portion <NUM> by any appropriate method. For example, the wire retainer <NUM> can be coupled to the arcuate portion <NUM> by welding, bonding, or any other appropriate method. In an alternative embodiment, the wire retainer <NUM> and the arcuate portion <NUM> are integrally formed, for example by casting, injection molding, or additive manufacturing (e.g., <NUM>-D printing).

As shown in <FIG>, the second arm member <NUM> includes an attachment portion <NUM> and an extension <NUM>. The attachment portion <NUM> is configured to translatably engage the elongated member <NUM>. In one embodiment, the attachment portion <NUM> includes a passage <NUM> configured to receive the elongated member <NUM>. The extension <NUM> extends away from the elongated member <NUM>, for example in an orthogonal direction with respect to the elongated member <NUM>. In one embodiment, the extension <NUM> extends in the same orthogonal direction as the arm axis <NUM> of the first arm member <NUM> such that they are parallel. The distal end of the extension <NUM> (i.e., the end of the extension <NUM> opposite the attachment portion <NUM>) is configured to engage a second bone during use. The extension <NUM> includes a concave portion <NUM> shaped to conform to the second bone. The concave portion <NUM> can have a variable radius such that the radius increases nearer the end of the extension <NUM>. In addition, a protrusion <NUM> protrudes from the extension <NUM> such that, when the second arm member <NUM> is engaged with the elongated member <NUM>, the protrusion <NUM> extends toward the second end <NUM> of the first arm member <NUM> (i.e., parallel to the elongated member <NUM>). Alternatively, the protrusion <NUM> can extend toward the rotation axis <NUM>. In use, the protrusion <NUM> is configured to contact the top of the second bone. In one embodiment, the extension <NUM> is tapered, as shown best in <FIG> such that the extension <NUM> comes to a point at the end farthest from the elongated member <NUM>. The tapering and pointed configuration of the extension <NUM> allows it be inserted through a small incision during use.

The second arm member <NUM> is configured to engage the plurality of ratchet teeth <NUM> of the elongated member <NUM> to control the distance between the second arm member <NUM> and the first arm member <NUM>. Any appropriate means for engaging the plurality of ratchet teeth <NUM> can be used. In one embodiment, a button <NUM>, shown in <FIG>, is coupled to the second arm member <NUM> and configured to engage the plurality of ratchet teeth <NUM>. The button <NUM> is disposed in a recess <NUM> (shown in <FIG>) in the attachment portion <NUM> of the second arm member <NUM>. The button <NUM> includes a passage <NUM> configured to receive the elongated member <NUM>. The button <NUM> also includes one or more teeth <NUM> adjacent the passage <NUM> and configured to engage one or more of the ratchet teeth <NUM>. The button <NUM> also includes slots <NUM>. As shown in <FIG>, during assembly, pins <NUM> are inserted through holes <NUM> (shown in <FIG>) in the attachment portion <NUM> and into the slots <NUM>. When the button <NUM> is depressed, the interaction of the pins <NUM> and the slots <NUM> guide translation of the button <NUM>. In at least one embodiment, a biasing member <NUM>, such as a coil spring, biases the button <NUM> to a position in which the tooth <NUM> is engaged with the elongated member <NUM>.

As shown in <FIG>, the locking post <NUM> includes a shaft <NUM> having a threaded end <NUM> configured to engage the knob <NUM>. As shown in <FIG>, at the opposite end of the shaft <NUM>, the locking post <NUM> has locking tabs <NUM> extending from the shaft <NUM>. When the apparatus <NUM> is assembled, the locking tabs <NUM> are disposed in the space between the prongs 133a, 133b at the second end of the first arm member <NUM> (see <FIG>). Because the locking tabs <NUM> are disposed between the prongs 133a, 133b, the locking post <NUM> and the first arm member <NUM> rotate together. As will be described in more detail herein, when the knob <NUM> is rotated (e.g., in a clockwise or counterclockwise direction), the locking post <NUM> is pulled upward and the locking tabs <NUM> contact the arcuate portion <NUM> of the rotation guide <NUM> to restrict rotation of both the first arm member <NUM> and the rotation guide <NUM>. The locking tabs <NUM> include a curved top surface to provide a smooth contact surface for engaging the arcuate portion <NUM>. As shown in <FIG>, the locking post <NUM> also includes a reduced diameter section <NUM>. As shown in <FIG>, when assembled, a retainer <NUM>-such as a pin, set screw, or ball detent-coupled to the knob <NUM> is disposed in the reduced diameter section <NUM> to prevent inadvertent disassembly of the knob <NUM> and the locking post <NUM>.

As described above, when assembled, the first arm member <NUM> is configured to rotate around the arm axis <NUM> and the rotation guide <NUM> is configured to rotate around the rotation axis <NUM>. When the knob <NUM> is rotated to tighten the locking post <NUM>, the locking tabs <NUM> contact, and apply an upward force on, the inner face <NUM> of the arcuate portion <NUM>. This force causes the outer face <NUM> of the arcuate portion <NUM> to come into contact with the top of the grooves <NUM> of the first arm member <NUM>. The rotation guide <NUM> is thereby locked in place relative to the first arm member <NUM> to prevent rotation about the rotation axis <NUM>. In addition, this upward force also causes the top of the first arm member to be pressed against the elongated member <NUM>, thereby restricting rotation of the first arm member <NUM> about the arm axis <NUM>. The locking mechanism <NUM> can be held in this locked configuration by the engagement of the threads of the locking post <NUM> and knob <NUM>. Alternatively, or additionally, additional methods of securing the locking mechanism <NUM> can be used.

Additional embodiments of an apparatus for correcting bunion deformities are shown in <FIG> and <FIG>. Aspects of these embodiments may be similar to those of apparatus <NUM> and duplicative description is not repeated herein. In these figures and the accompanying description, the leading digit of the relevant reference number has been incremented (e.g., <NUM>, <NUM>, <NUM>). While the features or aspects of these additional embodiments may be similar to the description above, they need not be identical. In addition, features of the various embodiments can be combined. Furthermore, the embodiments of <FIG> can include features or components shown or described with reference to <FIG> and not shown in <FIG> and vice versa.

As shown in <FIG>, the apparatus <NUM> includes an arcuate portion <NUM> that is integrally formed with, or fixedly coupled to, the first arm member <NUM>. The rotation guide <NUM> is slidably coupled to the arcuate portion <NUM>. As shown in the top view of <FIG>, the arcuate portion includes a slot <NUM> within which the rotation guide <NUM> is partially disposed. As shown in <FIG>, the rotation guide <NUM> includes a nut <NUM>, a wire retainer <NUM>, and a sleeve <NUM>. The wire retainer <NUM> includes a bore <NUM> configured to receive a k-wire. The retainer <NUM> extends through the slot <NUM> and engages the nut <NUM>, for example via a threaded connection. The sleeve <NUM> at least partially surrounds the wire retainer <NUM> on the side of the arcuate portion <NUM> opposite the nut <NUM>. The sleeve <NUM> engages one or more of ratchet teeth <NUM> (shown in <FIG>) on the arcuate portion <NUM> to restrict translation of the rotation guide <NUM> along the arcuate portion <NUM>. The rotation guide <NUM> can also include a biasing member <NUM>, such as a spring, biasing the sleeve <NUM> toward a position in which the sleeve <NUM> is engaged with the ratchet teeth <NUM>. In order to change the position of the rotation guide <NUM>, the user can pull the sleeve <NUM> away from the arcuate portion <NUM> to disengage the sleeve <NUM> from the ratchet teeth <NUM>.

The apparatus <NUM> also includes a locking mechanism <NUM> that includes a knob <NUM> and a locking post <NUM>. The locking post <NUM> is threadably coupled to the knob <NUM> and extends through a bore in the elongated member <NUM>. The locking post <NUM> is coupled to the first arm member <NUM> such that the locking post <NUM> and first arm member <NUM> rotate together. The locking post <NUM> and first arm member <NUM> can be coupled in any appropriate manner. For example, a pin <NUM> can be used to couple the locking post <NUM> and first arm member <NUM>, as shown in <FIG>. The first arm member <NUM> is able to rotate about arm axis <NUM> when the locking mechanism <NUM> is in an unlocked configuration. In order to lock the rotation of the first arm member <NUM>, the user rotates the knob <NUM> to tighten the first arm member <NUM> against the elongated member <NUM>. The locking mechanism <NUM> can be held in the locked configuration by the frictional forces between the threads or, additionally or alternatively, other means of retention such as a pin or ratchet teeth can be used.

In another embodiment, shown in <FIG>, an apparatus <NUM> includes a first arm member <NUM> and a rotation guide <NUM>. The first arm member <NUM> includes an arcuate portion <NUM> defining a slot <NUM> (shown in <FIG>). As shown in <FIG>, the rotation guide <NUM> includes a nut <NUM> and a retainer <NUM>. The nut <NUM> includes a bore 340a and the retainer includes an axially aligned bore 340b. The bores 340a, 340b are configured to receive a k-wire therein. As shown best in the cross-sectional view of <FIG>, the retainer <NUM> and nut <NUM> are threadably engaged and at least one of the retainer <NUM> and nut <NUM> extend through the slot <NUM> of the arcuate portion <NUM>. In order to lock the rotation guide <NUM> in position, the threaded engagement of the retainer <NUM> and the nut <NUM> is tightened (e.g., by clockwise or counterclockwise rotation) to press the nut <NUM> against the inner face <NUM> of the arcuate portion <NUM> and the retainer <NUM> against the outer face <NUM> of the arcuate portion <NUM>. The retainer <NUM> can include a recess for receiving a driving tool to assist with tightening of the retainer <NUM>.

Apparatus <NUM> includes a locking mechanism <NUM> to lock rotation of the first arm member <NUM>. The locking mechanism <NUM> includes a knob <NUM> and a threaded rod (not shown). The threaded rod is rigidly coupled to the knob <NUM> and extends through a bore in the elongated member <NUM>. The threaded rod is threadably coupled to the first arm member <NUM>. In order to lock the rotation of the first arm member <NUM>, the user rotates the knob <NUM> to tighten the first arm member <NUM> against the elongated member <NUM>.

In another embodiment, shown in <FIG>, the apparatus <NUM> further includes contact arms <NUM>. The contact arms <NUM> are positioned such that, when the apparatus <NUM> is in use, the contact arms <NUM> are in contact with the patient (e.g., the first metatarsal). While <FIG> illustrate a first contact arm <NUM>-<NUM> and a second contact arm <NUM>-<NUM>, it should be understood that the apparatus <NUM> can include only a single contact arm <NUM> or more than two contact arms <NUM>. A track <NUM> is defined between the contact arms <NUM> and the arcuate portion <NUM>. The nut <NUM> of the rotation guide <NUM> translates within the track <NUM> formed between the contact arms <NUM> and the inner face <NUM> (shown in <FIG>) of the arcuate portion <NUM>. As a result, the nut <NUM> is not in contact with the patient during use. Instead, during rotation of the first metatarsal (e.g. first metatarsal <NUM> shown in <FIG>), the bone is in contact with the contact arms <NUM>. This can provide a number of advantages including increasing the surface area of contact between the bone and the first arm member <NUM> to distribute the force applied to the bone during reduction of the intermetatarsal angle. In various embodiments, the contact arms <NUM> have a concave inner face to provide a smooth surface for rotation of the bone and to further increase the contact area with the bone. In some embodiments, the contact arms <NUM> are concentric with the arcuate portion <NUM>.

The first contact arm <NUM>-<NUM> and the second contact arm <NUM>-<NUM> define a slot <NUM> between them to allow passage of a k-wire <NUM> (shown in <FIG>) or other pin through the bores 340a, 340b (shown in <FIG>) in the rotation guide <NUM>, through the slot <NUM>, and into a bone, such as the first metatarsal. The k-wire <NUM> can translate within the slot <NUM> as the rotation guide <NUM> is rotated to rotate the bone.

In the embodiment shown in <FIG>, the contact arms <NUM> are coupled to the arcuate portion <NUM> of the first arm member <NUM>. The contact arms <NUM> can be connected to the arcuate portion <NUM> by a connecting portion <NUM> at the end of the arcuate portion <NUM> away from the elongated member <NUM>. The contact arms <NUM> extend from a first end <NUM> coupled to the connecting portion <NUM> to a second, free end <NUM> nearer the elongated member <NUM>. Alternatively, in other embodiments (not shown), the contact arms <NUM> can be coupled to a portion of the first arm member <NUM> that is nearer the elongated member <NUM> (i.e., the top of the arcuate portion <NUM>).

<FIG> shows the apparatus <NUM> with the rotation guide <NUM> in a first position toward the bottom of the arcuate portion <NUM> and the track <NUM>. This may be approximately the position of the rotation guide <NUM> prior to rotation of the first metatarsal in the frontal plane (i.e., about a longitudinal axis). <FIG> shows the rotation guide <NUM> in a second position nearer the top of the arcuate portion <NUM> and track <NUM>. This may be approximately the position of the rotation guide <NUM> after rotation of the first metatarsal in the frontal plane (i.e., about a longitudinal axis).

It should be understood that other embodiments illustrated herein-such as the apparatus <NUM> shown in <FIG> and the apparatus <NUM> shown in <FIG>-can include contact arms such that the rotation guide is spaced apart from the first metatarsal during use. For example, in the embodiment shown in <FIG>, contact arms may extend from the first arm member <NUM>. In the embodiment shown in <FIG>, contact arms may extend from first arm member <NUM> (e.g., from the arcuate portion <NUM>).

In another aspect, a method of using the apparatuses previously described is provided. The apparatuses can be used in the correction of hallus valgus angle, bunion deformities, and/or an increased intermetatarsal angle. Such an intermetarsal angle <NUM> is shown in <FIG>. Steps of use of the apparatus <NUM> are shown in <FIG>. One of skill in the art would appreciate that the other embodiments described herein can be used in a similar fashion.

As shown in <FIG>, a k-wire <NUM> is inserted into a first metatarsal <NUM>. In one embodiment, the k-wire <NUM> is inserted in a medial to lateral orientation. The k-wire <NUM> can be, for example, inserted into the head of the first metatarsal <NUM>. In one embodiment, the k-wire <NUM> is inserted orthogonal to a longitudinal axis of the first metatarsal <NUM>.

As also shown in <FIG>, the extension <NUM> of the second arm member <NUM> is brought into engagement with a second metatarsal <NUM>. The concave portion <NUM> (see <FIG>) contacts the lateral side of the second metatarsal <NUM>. Further, the protrusion <NUM> contacts the superior side of the second metatarsal <NUM> such that the protrusion <NUM> extends toward the first metatarsal <NUM>.

As shown in <FIG>, the bore <NUM> (see <FIG>) of the wire retainer <NUM> is slid over the k-wire <NUM> to couple the rotation guide <NUM> to the first metatarsal <NUM>. Further, as shown in <FIG> and <FIG>, the elongated member <NUM>, coupled to the rotation guide <NUM> via the first arm member <NUM>, is engaged with the attachment portion <NUM> of the second arm member <NUM>. The first arm member <NUM> is brought closer to the second arm member <NUM> until the bone engagement face <NUM> of the rotation guide <NUM> contacts the first metatarsal <NUM>, as shown in <FIG>. In other embodiments, such as when the apparatus <NUM> is used, the method can include bringing the contact arms <NUM> into contact with the first metatarsal <NUM> with the rotation guide <NUM> spaced apart from the first metatarsal <NUM>.

Subsequently, a distance <NUM> between the first arm member <NUM> and the second arm member <NUM> is reduced, thereby reducing the distance between the head of the first metatarsal <NUM> and the second metatarsal <NUM>. This is continued until the desired intermetatarsal angle <NUM> is achieved. As the intermetatarsal angle <NUM> is decreased, the first arm member <NUM> rotates about the arm axis <NUM> (see <FIG>) to accommodate the changing angle <NUM> (see <FIG>) of the k-wire <NUM> with respect to the elongated member <NUM> in the plane orthogonal to the arm axis <NUM>.

With the intermetatarsal angle <NUM> in the desired position, the rotation guide <NUM> can be rotated about the rotation axis <NUM> to rotate the first metatarsal <NUM> from a first rotational position, shown in <FIG>, to a second rotational position, shown in <FIG>. Rotation of the rotation guide <NUM> rotates the first metatarsal <NUM> substantially around a longitudinal axis of the first metatarsal <NUM>. In other words, the first metatarsal <NUM> is rotated in the frontal plane. This frontal plane rotation brings the first metatarsal <NUM> into proper alignment including, for example, by positioning the sesamoids under the metatarsal head. In so doing, the k-wire <NUM> acts as a lever to rotate the first metatarsal <NUM>. With the first metatarsal <NUM> in the desired position, the knob <NUM> can be tightened to restrict rotation of the first arm member <NUM> and the rotation guide <NUM>. In embodiments, such as those shown in <FIG> and <FIG>, the retainer <NUM> of the rotation guide <NUM> can also be tightened to restrict movement of the rotation guide <NUM> with respect to the arcuate portion <NUM>. It should be understood that the frontal plane rotation of the first metatarsal <NUM> can be done before, during, or after reduction of the intermetatarsal angle. In some instances, as the intermetatarsal angle is reduced, the geometry of the interfacing faces of the first metatarsal and the cuneiform causes the metatarsal to rotate in the frontal plane (i.e., about the longitudinal axis of the first metatarsal).

Bone screws, plates, or other hardware and implants can then be used to secure the position of the first metatarsal <NUM>, as would be understood by one of skill in the art.

Claim 1:
An apparatus (<NUM>; <NUM>; <NUM>) for correcting bunion deformity, the apparatus comprising:
an elongated member (<NUM>; <NUM>; <NUM>) extending from a first end (<NUM>) to a second end (<NUM>);
a first arm member (<NUM>; <NUM>; <NUM>) having an arm axis (<NUM>; <NUM>) and coupled to the first end of the elongated member and extending from the elongated member (<NUM>, <NUM>, <NUM>) in a direction orthogonal to the length of the elongated member (<NUM>, <NUM>, <NUM>) so that the arm axis extends in the orthogonal direction, wherein the first arm member extends from a first end (<NUM>) to a second end (<NUM>), the first end being rotatably coupled to the first end (<NUM>) of the elongated member, the arm axis extending from the first end to the second end of the first arm member, and wherein the first arm member is configured to rotate about the arm axis;
a second arm member (<NUM>) configured to engage the elongated member such that the second arm member can translate along the elongated member between the first and second ends of the elongated member, the second arm member including an attachment portion (<NUM>) configured to translatably engage the elongated member and an extension (<NUM>) extending from the attachment portion in the same orthogonal direction as the first arm member, wherein a distal end of the extension is configured to engage a bone during use; and
a rotation guide (<NUM>; <NUM>; <NUM>) coupled to the first arm member such that the rotation guide is configured to rotate with respect to the first arm member, the rotation guide defining a bore (<NUM>; <NUM>; 340a, 340b) having a longitudinal axis (<NUM>) and configured to receive a k-wire along the bore's longitudinal axis;
wherein rotation of the rotation guide with respect to the first arm member causes the longitudinal axis to rotate about a rotation axis (<NUM>).