Patent Description:
Arthrodesis refers to surgical fixation of a joint, ultimately resulting in bone fusion. An arthrodesis procedure induces ankylosis performed to relieve pain or provide support in a diseased or injured joint. Tibiotalocalcaneal ("TTC") or tibiocalcaneal ("TC") arthrodesis is a salvage procedure for the treatment of joint disease or pain and dysfunction due to arthritic ankle and subtalar joints, e.g., Charcot disease. In performing ankle and subtalar arthrodesis, the surgeon may wish to achieve anatomic alignment, pain relief, and a stable, plantigrade foot. Secure fixation while preserving the surrounding soft tissue can also contribute to a successful outcome.

Anatomic alignment, pain relief, stabilization, or other desired surgical outcomes may require cutting or other bone removal to form a cavity, wedge, or other space within or between bones for alignment and repositioning of the bones. Accurate postioning and formation of cuts in the bones is essential for ensuring proper relief and treatment of Charcot disease or other arthrodesis. Current systems for forming cuts present infection risks, slow tissue healing, and requires the use of frames and/or burrs that is time consuming and requires long incision paths.

Document <CIT> relates to an adjustable tibial osteotomy jig that comprises a goniometer, and the goniometer further comprises first and second arms, each arm having a base, wherein a pivot movably connects the arms at their bases, and wherein a thumb-screw and knob locking devices are provided for locking the arms of the goniometer in a pre-determined angular relationship, and wherein a proximal cutting guide is slidably mounted on the first arm, and a distal cutting guide is slidably mounted on the second arm, wherein each of the cutting guides has a transverse slot extending therethrough to define a cutting surface, and one or more holes extending therethrough.

Document <CIT> relates to an anatomic external fixation device.

Document <CIT> relates to a guiding tool with adjustable guide surface.

Document <CIT> relates to a tool for upper tibia osteotomy.

In some embodiments, a surgical guide is disclosed. The surgical guide includes a first guide arm extending from a first end to a second end on a first longitudinal axis. The first guide arm defines a first plurality of openings sized and configured to receive a first guide element therethrough. A second guide arm extends from a first end to a second end on a second longitudinal axis. The second guide arm defines a second plurality of openings sized and configured to receive a second guide element therethrough. A pivot element couples the first end of the first guide arm to the first end of the second guide arm such that an angular distance between the first guide arm and the second guide arm can be adjusted in a first plane.

In various embodiments, a surgical method is disclosed. The surgical method includes a step of positioning a surgical guide adjacent to a bone. The surgical guide includes a first guide arm extending substantially on a first longitudinal axis and defining a first plurality of openings, a second guide arm extending substantially on a second longitudinal axis and defining a second plurality of openings, and a pivot element coupling the first guide arm to the second guide arm. A first guide element is inserted through a selected one of the first plurality of openings defined by the first guide arm. The first guide arm and the second guide arm are pivoted about the pivot element to adjust an angular distance between the first guide arm and the second guide arm. A second guide element is inserted through a selected one of the second plurality of openings defined by the second guide arm. A wedge osteotomy is formed in the bone. The first guide element and the second guide element are configured to position a cutting guide for forming the wedge osteotomy.

In various embodiments, a surgical guide is disclosed. The surgical guide includes a first guide arm extending from a first end to a second end on a first longitudinal axis. The first guide arm defines a first plurality of openings sized and configured to receive a first guide element therethrough. A second guide arm extends from a first end to a second end on a second longitudinal axis. The second guide arm defines a second plurality of openings sized and configured to receive a second guide element therethrough. A first slide element is coupled to the first end of the first guide arm. A first extension element extends from a first end to a second end on a third longitudinal axis and defining a first adjustment slot extending substantially on the third longitudinal axis. The first slide element is positioned at least partially within the first slot and is slideable on the third longitudinal axis. A second slide element coupled to the first end of the second guide arm. A second extension element extends from a first end to a second end on a fourth longitudinal axis and defines a second adjustment slot extending substantially on the fourth longitudinal axis. The second slide element is positioned at least partially within the second slot and is slideable on the fourth longitudinal axis. A pivot element couples the first end of the first extension element to the first end of the second extension element such that an angular distance between the first guide arm and the second guide arm can be adjusted in a first plane.

The invention is directed to a surgical guide according to claim <NUM>. Further embodiments of the invention are recited in the dependent claims.

The features and advantages of the present invention will be more fully disclosed in, or rendered obvious by the following detailed description of the preferred embodiments, which are to be considered together with the accompanying drawings wherein like numbers refer to like parts and further wherein:.

This description of the exemplary embodiments is intended to be read in connection with the accompanying drawings, which are to be considered part of the entire written description. In the description, relative terms such as "lower," "upper," "horizontal," "vertical,", "above," "below," "up," "down," "top," "bottom," "proximal," "distal," "superior," "inferior," "medial," and "lateral" as well as derivative thereof (e.g., "horizontally," "downwardly," "upwardly," etc.) should be construed to refer to the orientation as then described or as shown in the drawing under discussion. These relative terms are for convenience of description and do not require that the apparatus be constructed or operated in a particular orientation. Terms concerning attachments, coupling and the like, such as "connected," 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. Like elements have been given like numerical designations to facilitate an understanding of the present subject matter.

As used herein, the term "substantially" denotes elements having a recited relationship (e.g., parallel, perpendicular, aligned, etc.) within acceptable manufacturing tolerances. For example, as used herein, the term "substantially parallel" is used to denote elements that are parallel or that vary from a parallel arrangement within an acceptable margin of error, such as +/- <NUM>°, although it will be recognized that greater and/or lesser deviations can exist based on manufacturing processes and/or other manufacturing requirements.

In various embodiments, a surgical guide is disclosed. The surgical guide includes a first guide arm extending from a first end to a second end along a first longitudinal axis. The first guide arm defines a first plurality of openings sized and configured to receive a first guide element therethrough. A second guide arm extends from a first end to a second end along a second longitudinal axis. The second guide arm defines a second plurality of openings sized and configured to receive a second guide element therethrough. A pivot element couples the first end of the first guide arm to the first end of the second guide arm such that an angle between the first guide arm and the second guide arm can be adjusted in a first plane.

<FIG> illustrate an adjustable surgical guide 100a, in accordance with some embodiments. The surgical guide 100a includes a first guide arm 102a and a second guide arm 102b. Each of the guide arms 102a, 102b includes a body <NUM> extending between a proximal end 106a and a distal end 106b substantially along a longitudinal axis 150a, 150b. The body <NUM> of each guide arm 102a, 102b further extends between an upper surface 108a and a lower surface 108b and is defined by a perimeter wall <NUM>. The perimeter wall <NUM> can define any suitably shape, such as, for example, a rectangular perimeter, an oval perimeter, etc. In some embodiments, a guide block <NUM> is coupled to an outer perimeter wall 112b of the body <NUM> of each of the guide arms 102a, 102b.

In some embodiments, each of the guide arms 102a, 102b defines a plurality of guide holes 114a, 114b extending from the upper surface 108a to the lower surface 108b. For example, in the illustrated embodiment, the first guide arm 102a defines a first plurality of guide holes 114a arranged parallel to the first longitudinal axis 150a and the second guide arm 102b defines a second plurality of guide holes 114b arranged parallel to the second longitudinal axis 150b. Although specific embodiments are illustrated, it will be appreciated that the first and second plurality of guide holes 114a, 114b can extend through any suitable portion of respective first and second guide arms 102a, 102b. The guide holes 114a, 114b are each sized and configured to receive a guide element, such as a k-wire, a screw, etc., therethrough. The guide element provides a reference point for one or more additional guides, such as a cutting guide, couple to the guide element for subsequent surgical procedures.

In some embodiments, each of the guide holes 114a, 114b are defined by a guide extension 116a, 116b extending from an inner surface 112a of the body <NUM>. The guide extensions 116a, 116b define bumps (or peaks) extending from the body <NUM>. In some embodiments, each of the guide extensions 116a, 116b defines a sloped guide surface <NUM> surrounding the guide hole 114a, 114b to guide a cutting element, such as a k-wire or burr, into the guide hole 114a, 114b. In some embodiments, the guide extensions 116a, 116b are alternated with cutouts 118a, 118b (or valleys). The guide extensions 116a of the first guide arm 102a are sized and positioned to fit within the cutouts 118b of the second guide arm 102b. Similarly, the guide extensions 116b of the second guide arm 102b are sized and positioned to fit within the cutouts 118a of the first guide arm 102b. The guide extensions 116a, 116b and the cutouts 118a, 118b allow the guide arms 102a, 102b to be interlocked in a flush arrangement.

In some embodiments, the first guide arm 102a includes a third plurality of guide holes 122a and/or the second guide arm 102b includes a fourth plurality of guide holes 122b. The guide holes 122a, 122b extend from the first surface 108a to the second surface 108b through a guide block <NUM> extending from an outer perimeter surface 112b of the body <NUM>. Each of the guide holes 122a, 122b is sized and configured to receive a fixation element, such as a k-wire, therethrough. The guide holes 122a, 122b are configured to guide the fixation element to a predetermined position on the bone. In some embodiments, the guide holes 122a, 122b are positioned on an axis substantially parallel to and offset from the longitudinal axis 150a, 150b and/or the first/second plurality of holes 114a, 114b of the respective guide arm 102a, 102b, although it will be appreciated that the guide holes 122a, 122b may be arranged in any pattern and extend through any portion of the guide body <NUM> and/or the guide block <NUM>.

In some embodiments, the first guide arm 102a is coupled to the second guide arm 102b by a pivot element <NUM>. The pivot element <NUM> is configured to limit respective movement of the first guide arm 102a and the second guide arm 102b to a single plane, such as, for example, a first plane intersecting (e.g., defined by) each of the longitudinal axes 150a, 150b. In some embodiments, the pivot element <NUM> is configured to allow movement of the first guide arm 102a with respect to the second guide arm 102b to adjust an angle Θ<NUM> defined in the first plane between the first guide arm 102a and the second guide arm 102b. The angle Θ<NUM> may be adjusted from a minimum angle to a maximum angle. For example, in some embodiments, the first guide arm 102a and the second guide arm 102b may be adjusted from a minimum angle of <NUM>° (i.e., the first guide arm 102a aligned in the same direction as the second guide arm 102b) to a maximum angle of <NUM>° (i.e., the first guide arm 102a aligned in an opposite direction as the second guide arm 102b). Although specific embodiments are discussed herein, it will be appreciated that the pivot element <NUM> can be configured to continuously and/or discretely adjust the angle Θ<NUM> within any predetermined range, such as, for example, <NUM>-<NUM>°, <NUM>-<NUM>°, <NUM>-<NUM>°, <NUM>-<NUM>°, and/or any other suitable range of angles.

In some embodiments, the pivot element <NUM> includes a first pivot arm 132a and a second pivot arm 132b coupled by a pin <NUM>. The first pivot arm 132a and the second pivot arm 132b are pivotally coupled such that an angle (e.g., Θ<NUM>) between the first pivot arm 132a and the second pivot arm 132b can be adjusted. For example, in the illustrated embodiment, the first pivot arm 132a includes a first coupling portion 136a sized and configured to fit within a second coupling portion 136b of the second pivot arm 132b. The second coupling portion 136b defines a first arm 152a spaced apart from a second arm 152b to define a coupling channel <NUM> therebetween. The coupling channel <NUM> is sized and configured to receive the first coupling portion 136a therein. When the first coupling portion 136a is positioned between the first and second arms 152a, 152b of the second coupling portion 136b, pin holes <NUM> defined in each of the first and second coupling portions 136a, 136b are aligned. The pin holes <NUM> are sized and configured to receive a pin <NUM> therein. The pin <NUM> couples the first coupling portion 136a to the second coupling portion 136b in a pivoting (or hinged) engagement. Although specific embodiments are discussed herein, it will be appreciated that any suitable coupling mechanism that provides pivoting movement of the first pivot arm 132a with respect to the second pivot arm 132b may be used, and is within the scope of this disclosure. In some embodiments, the pivot element <NUM> defines at least one hole (not shown) extending therethrough sized and configured to receive a k-wire, burr, or other element therethrough.

Each of the pivot arms 132a, 132b define a guide connection portion 138a, 138b coupled to and/or formed integrally with the respective first and second coupling elements 136a, 136b. The guide connection portions 138a, 138b each define a channel or opening <NUM> extending from a first surface <NUM> into the guide connection portion 138a, 138b. The channel <NUM> is sized and configured to receive a portion of a respective guide arm 102a, 102b therein. In some embodiments, the guide arm 102a, 102b is coupled to the guide connection portion 138a, 138b by a releasable locking mechanism <NUM>. For example, in the illustrated embodiment, the releasable locking mechanism <NUM> includes an extension <NUM> extending from the guide connection portion 138a, 138b and defining a channel <NUM> therethrough. The channel <NUM> extends into and intersects the channel <NUM> extending into the guide connection portion 138a, 138b. The interior surface of the channel <NUM> is threaded. A locking element <NUM> is positioned at least partially within the channel <NUM>.

As shown in <FIG>, in some embodiments, the locking element <NUM> includes a threaded shaft <NUM> extending from an unthreaded head <NUM>. The locking element <NUM> can be tightened and/or locked against the surface of the guide arm 102a, 102b to maintain the guide arm 102a, 102b in a fixed position with respect to the guide connection portion 138a, 138b. For example, in the illustrated embodiment, the threaded shaft <NUM> is rotatably interfaced with the internal threads of the channel <NUM> to tighten the locking element <NUM> against a respective guide arm 102a, 102b, although it will be appreciated that any suitable locking mechanism <NUM>, such as a permanent and/or fixed locking mechanism, can be used to couple the guide arms 102a, 102b to respective guide connection portions 138a, 138b. In other embodiments, the pivot arms 132a, 132b are formed integrally with the guide arms 102a, 102b.

In use, and as described in greater detail below, the adjustable surgical guide 100a is configured to guide insertion of a one or more guide elements, such as a k-wire, into the least one bone. A cut can be formed in a bone using one or more guide holes 114a, 114b and/or additional cutting guides coupled to one or more guide elements. For example, in some embodiments, a first guide arm 102a of the adjustable surgical guide 100a is positioned adjacent to a bone to position a first guide element in the bone. The guide element can include any suitable guide element, such as, for example, a k-wire. The guide element can be positioned based on pre-operative imaging, simultaneous imaging, and/or using any other method.

After coupling the first guide arm 102a to the bone, an angle Θ<NUM> between the first guide arm 102a and the second guide arm 102b can be adjusted to position the second guide arm 102b at predetermined position on the bone. For example, in some embodiments, the angle Θ<NUM> between the first guide arm 102a and the second guide arm 102b can be adjusted to any suitable angle within a predetermined range of angles, such as, for example, between <NUM>-<NUM>°, <NUM>-<NUM>°, <NUM>-<NUM>°, <NUM>-<NUM>°, and/or any other suitable range of angles. A second guide element is inserted through at least one hole 122b extending through the second guide arm 102b.

After coupling the guide elements to the bone, and as described in greater detail below, the adjustable surgical guide 100a is removed from the surgical site and at least one cutting guide is coupled to one or more of the first guide element and the second guide element. A cutting instrument, such as a burr, saw, etc., may be positioned through the cutting guide and one or more cuts formed in the bone. In some embodiments, the adjustable surgical guide includes one or more openings sized and configured to guide the cutting instrument to a predetermined position and/or within a predetermined area of the bone. The cutting instrument forms a cut in the bone, for example, to form a wedge cut, osteotomy, and/or other cut in the bone. In some embodiments, the one or more openings include a slot sized and configured to position a blade or other cutting instrument along a predetermined axis to form a resection cut in the bone.

<FIG> illustrates an embodiment of an adjustable surgical guide 100b including guide arms 202a, 202b defining a plurality of scallop guides <NUM>, in accordance with some embodiments. The adjustable surgical guide 100b is similar to the adjustable surgical guide 100a discussed in conjunction with <FIG>, and similar description is not repeated herein. Each of the guide arms 202a, 202b of the adjustable surgical guide 100b includes a plurality of scallop guides <NUM> sized and configured to position a guide element within a hole 114a, 114b defined in the center of each of the scallop guides <NUM>.

In some embodiments, each of the scallop guides <NUM> includes an inner surface <NUM> defining a sloped, or scalloped, funnel. A guide hole 114a, 114b is positioned at the apex (or lowest point) of the sloped inner surface <NUM>. In some embodiments, the inner surface <NUM> is configured to control motion of a surgical instrument, such as, for example, a burr inserted through a guide hole 114a, 114b. In the illustrated embodiment, the scallop guides <NUM> formed in the first guide arm 202a are aligned with the scallop guides <NUM> formed in the second guide arm 202b. It will be appreciated that each of the guide arms 202a, 202b can include a greater or lesser number of scallop guides <NUM> aligned with and/or offset from scallop guides <NUM> in the other of the guide arms 202a, 202b.

<FIG> illustrate an embodiment of an adjustable surgical guide 100c including first and second guide arms 302a, 302b each defining slots 310a, 310b sized and configured to receive one or more sliding guide elements 312a-312d therein, in accordance with some embodiments. The adjustable surgical guide 100c is similar to the adjustable surgical guide 100a discussed in conjunction with <FIG>, and similar description is not repeated herein. In some embodiments, each of the guide arms 302a, 302b defines a slot 310a, 310b extending substantially along the longitudinal axis 150a, 150b of the respective guide arm 302a, 302b. In the illustrated embodiment, the slot 310a, 310b extends substantially from a proximal end 106a of each guide arm 302a, 302b to a distal end 106b of each guide arm 302a, 302b, although it will be appreciated that the slots 310a, 310b can extend over any portion of the respective guide arm 302a, 302b and is within the scope of this disclosure.

In some embodiments, each slot 310a,310b is sized and configured to receive one or more sliding guide elements 312a-312d therein. Each of the sliding guide elements 312a-312d include a guide portion <NUM> coupled to a locking portion <NUM>. The guide portion <NUM> includes an extension <NUM> (see <FIG>) sized and configured to extend through a slot 310a, 310b of the respective guide arm 302a, 302b. The locking portion <NUM> is coupled to the extension <NUM>. In some embodiments, the locking portion <NUM> is configured to maintain the sliding guide element 312a-312d in a fixed position within the slot 310a, 310b. For example, in some embodiments, the guide portion <NUM> of each of the sliding guide elements 312a0-312d includes a first surface configured to abut the respective guide arm 302a, 302b on a first side. The locking portion <NUM> includes a second surface configured to abut the respective guide arm 302a, 302b on a second side. When the locking portion <NUM> is tightened to the guide portion <NUM> (for example, by rotating the locking portion <NUM> to engage threads formed on the extension <NUM>), the first and second surfaces form a friction lock that prevents movement of the slideable guide element 312a-312d within the slot 310a, 310b.

In some embodiments, the guide portion <NUM> defines a guide hole <NUM> extending therethrough. The guide hole <NUM> is sized and configured to receive a guide element, a cutting element, and/or any other suitable element therethrough. For example, in some embodiments, at least one guide hole <NUM> is sized and configured to receive a guide element such that the guide element is coupled to a bone at a predetermined location. In some embodiments, a guide element and/or a cutting element may be inserted through a guide hole and the sliding guide element 312a-312d may be subsequently traversed through the slot 310a, 310b to select a position for insertion with respect to the bone along an axis parallel to the axis of the guide arm 302a, 302b and/or the slot 310a, 310b.

In some embodiments, one or more of the guide arms 302a, 302b includes a second guide portion 330a, 330b extending along a longitudinal axis 350a, 350b disposed at a predetermined angle α, β with respect to the longitudinal axis 150a, 150b of the respective guide arm 302a, 302b. For example, in the illustrated embodiment, each of the guide arms 302a, 302b includes a second guide portion 330a, 330b extending along a third longitudinal axis 350a and a fourth longitudinal axis 350b, respectively, each positioned at an angle of about <NUM>° with respect to the respective first or second longitudinal axis 150a, 150b. The second guide portion <NUM> defines a second slot 332a, 332b sized and configured to receive a sliding guide element 312a-312d therein. The second slot 332a, 332b is configured to guide the sliding guide element 312a-312d along the third or fourth longitudinal axis 350a, 350b. For example, in some embodiments, the second slot 332a, 332b positions a sliding guide element 312a-312d such that a guide element can be located within the bone at an angle α, β with respect to a guide element positioned within the bone by a sliding guide element 312a-312d positioned within the first slot 310a, 310b.

In some embodiments, the first slot 310a, 310b and the second slot 332a, 332b are coupled to form a continuous adjustment slot 334a, 33b configured to allow continuous movement of a slideable guide element 312a-312b along a first axis 150a, 150b and/or a second axis 350a, 350b depending on the position of the slideable guide element 312a-312d within the continuous adjustment slot <NUM>. Although embodiments are illustrated with a single continuous adjustment slot 334a, 334b including a first slot 310a, 310b and a second slot 332a, 332b, it will be appreciated that the guide arms 302a, 302b can define any number of continuous and/or discrete slots.

<FIG> illustrate an adjustable surgical guide 100d including multiple position and angle adjustments, in accordance with some embodiments. The surgical guide 100d is similar to the surgical guides 100a, 100b, 100c discussed in conjunction with <FIG>, and similar description is not repeated herein. The surgical guide 100d includes a first extension arm 402a having a first guide arm 426a extending therefrom and a second extension arm 402b having a second guide arm 426b extending therefrom. The first extension arm 402a and the second extension arm 402b are coupled by a pivot element <NUM>. As discussed above with respect to the surgical guide 100a, the pivot element <NUM> is configured to adjust a first angle Θ<NUM> in a first plane between the first extension arm 402a (or the first guide arm 426a) and the second extension arm (or the second guide arm 426b). As discussed in greater detail below, in some embodiments, the pivot element <NUM> is configured to adjust a second angle Θ<NUM> between the first extension arm 402a and a lateral adjustment arm <NUM> and a third angle Θ<NUM> between the second extension arm 402b and the lateral adjustment arm <NUM> in the first plane.

Each of the extension arms 402a, 402b includes a body <NUM> extending substantially along a first longitudinal axis 450a or a second longitudinal axis 450b, respectively. The body <NUM> extends between an upper surface 422a and a lower surface 422b and is defined by a side wall <NUM>. Each extension arm 402a, 402b defines a slot 416a, 416b extending from the upper surface 422a through the body <NUM> to the lower surface 422b. Each slot 416a, 416b is sized and configured to receive a threaded connector <NUM> of a respective guide arm 426a, 426b, therethrough. Each of the extension arms 402a, 402b include a proximal portion sized and configured to couple to a respective guide connection portion 438a, 438b of the pivot element <NUM>. The extension arms 402a, 402b can be retained within the guide connection portion 438a, 438b using any suitable retention mechanism, such as a friction retention, a threaded retention, the use of tightening element, and/or any other suitable retention mechanism.

In some embodiments, a guide arm 426a, 426b is slideably coupled to a respective one of the extension arms 402a, 402b. Each of the guide arms 426a, 426b extend from a proximal end 428a to a distal end 428b. The first guide arm 426a extends substantially along a third longitudinal axis and the second guide arm 426b extends substantially along a fourth longitudinal axis 450d. The guide arms 426a, 426b each include a body <NUM> extending between a first surface 429a and a second surface 429b and defined by a sidewall <NUM>. A plurality of guide holes <NUM> extend from the first surface 429a to the second surface <NUM>. In the illustrated embodiments, each of the guide holes <NUM> extends along an axis that is perpendicular to the longitudinal axis 450c, 450d of the respective guide arm 426a, 426b, although it will be appreciated that the guide holes <NUM> can extend through the guide arms 426a, 426b at any suitable angle and are within the scope of this disclosure. Although the guide holes <NUM> are illustrated extending from a first surface 429a to a second surface 429b, it will be appreciated that the guide holes <NUM> can also extend from a third surface 429c to a fourth surface 429b.

In some embodiments, each guide arm 426a, 426b is coupled to a respective extension arm 402a, 402b by a pivoting slide element <NUM>. The pivoting slide element <NUM> includes a pivot element <NUM> comprising a first pivot connector <NUM> formed integrally with a proximal end <NUM> of the guide arms 426a, 426b and a second pivot connector <NUM> comprising a connection extension <NUM> sized and configured to extend through the slot 416a, 416b. The first pivot connector <NUM> is coupled to the second pivot connector <NUM> by a pivot pin <NUM> extending through holes formed in each of the pivot connectors <NUM>, <NUM>. In some embodiments, the pivot element <NUM> allows adjustment of an angle Θ<NUM>, Θ<NUM> between a guide arm 426a, 426b and a respective one of the extension arms 402a, 402b in a plane defined by the longitudinal axis 450a, 450b of the respective extension arm 402a, 402b and the longitudinal axis 450c, 450d of the respective guide arm 426a, 426b. In various embodiments, the angles Θ<NUM>, Θ<NUM> can be any angle within a predetermined range of angles, such as, for example, any angle within a range of <NUM>°-<NUM>°, <NUM>°-<NUM>°, <NUM>°-<NUM>°, and/or any other suitable range of angles.

In some embodiments, each of the pivot elements <NUM> includes a connection extension <NUM> extending through the slot 416a, 416b. The connection extension <NUM> is configured to slideably couple the guide arm 426a, 426b to the respective extension arm 402a, 402b. For example, in the illustrated embodiment, the connection extension <NUM> includes a threaded shaft extending from the second pivot connector <NUM>. The threaded shaft is configured to threadably couple to internal threads of a locking element <NUM>. The locking element <NUM> is threaded onto the threaded shaft and maintains the connection extension <NUM> within the slot 416a, 416b. The position of the guide arm 426a, 426b along a longitudinal axis 450a, 450b defined by the respective extension arm 402a, 402b can be adjusted by sliding the connection extension <NUM> within the slot 416a, 416b. In some embodiments, the locking element <NUM> can be tightened to lock the position of the targeting arm 426a, 426b within the slot <NUM>.

In some embodiments, each guide arm 426a, 426b is configured to rotate about the respective longitudinal axis 450c, 450d of the guide arm 426a, 426b. For example, in the illustrated embodiment, the second pivot connector <NUM> includes a threaded connection extension <NUM> extending through the slot <NUM>. The locking element <NUM> can be loosened to allow rotation of the guide arm 426a, 426b about the respective longitudinal axis 450c, 450d. After setting an angle of rotation of the guide arm 426a, 426b, the locking element <NUM> is tightened to fix the rotational position of the guide arm 426a, 426b at the selected angle of rotation γ<NUM>, γ<NUM>. The angle of rotation γ<NUM>, γ<NUM> can include any suitable angle of rotation, such as, for example, any angle between <NUM>°-<NUM>°. In some embodiments, the selected angle of rotation γ<NUM>, γ<NUM> can be adjusted by rotating each of the guide arms 426a, 426b with respect to the pivot element <NUM> such that the selected angle of rotation γ<NUM>, γ<NUM> of the guide arms 426a, 426b can be adjusted to position the guide arms 426a, 426b at any angular position with respect to the pivot element <NUM>. Although embodiments are discussed herein including rotatable guide arms 426a, 426b, it will be appreciated that the guide arms 426a, 426b can have a fixed rotational orientation with respect to the extension arms 402a, 402b, in some embodiments.

In some embodiments, the adjustable surgical guide 100d includes a lateral adjustment arm <NUM> including a body <NUM> extending substantially along a fifth longitudinal axis 450e from a first end 466a to a second end 466b. The body <NUM> extends between a first surface 464a and a second surface 464b and is defined by a perimeter wall <NUM>. In some embodiments, one or more guide holes <NUM> extend through the body <NUM> from the first surface 464a to the second surface 464b. The guide holes <NUM> are sized and configured to receive a guide element and/or any other suitable element therethrough. The lateral adjustment arm <NUM> is configured to provide lateral movement of the pivot element <NUM> and the extension arms 402a, 402b parallel to the fifth axis 450e.

For example, in some embodiments, the pivot element <NUM> is coupled to the lateral adjustment arm <NUM> by a lateral adjustment component <NUM>. The lateral adjustment component <NUM> includes a body <NUM> configured to slideably contact the first surface 464a of the longitudinal adjustment arm <NUM>. A slide element <NUM> is coupled to the body <NUM> and is configured to maintain the body <NUM> in contact with the first surface 464a. The slide element <NUM> can be positioned within a slot <NUM> defined in the lateral adjustment arm <NUM> and/or in contact with the second surface 464b of the lateral adjustment arm <NUM>.

In some embodiments, a pivot connector <NUM> extends from the body <NUM>. The pivot connector <NUM> defines a pivot pin hole <NUM> sized and configured to receive the pivot pin <NUM> therethrough. The pivot pin <NUM> couples the pivot element <NUM> to the lateral adjustment component <NUM>. For example, in the illustrated embodiment, the pivot pin <NUM> extend through the pivot pin hole <NUM> and is coupled to the locking element <NUM>.

In some embodiments, the slide element <NUM> can be moved laterally within the slot <NUM> to move the pivot element <NUM> and, by extension, the extension arms 402a, 402b. In some embodiments, the slide element <NUM> is coupled to the body <NUM> by a locking pin <NUM> having a head <NUM> in contact with the slide element <NUM> and a shaft <NUM> extending through the body <NUM> of the lateral adjustment component <NUM>. A locking element <NUM> defines an internal channel <NUM> having internal threads configured to engage the threads of the locking pin <NUM> to fix the position of the slide element <NUM> within the slot <NUM>.

In some embodiments, the pivot pin <NUM> is configured to allow rotation of the pivot element <NUM> to adjust a second angle Θ<NUM> between the first extension arm 402a (or first guide arm 426a) and the horizontal adjustment arm <NUM> and a third angle Θ<NUM> between the second extension arm 402b (or second guide arm 426b) and the horizontal adjustment arm <NUM>. For example, in some embodiments, the locking element <NUM> can be loosened with respect to the pivot pin <NUM> such that the pivot element <NUM> is able to rotate about the pivot pin <NUM> with respect to the pivot connector <NUM>. Rotational movement of the pivot element <NUM> adjusts the second angle Θ<NUM> between the first extension arm 402a and the lateral adjustment arm <NUM> and the third angle Θ<NUM> between the second extension arm 402b and the lateral adjustment arm <NUM> while maintaining the first angle Θ<NUM> between the first and second extension arms 402a, 402b. Although embodiments are illustrated with a rotatable pivot element <NUM>, it will be appreciated that the rotational angle of the pivot element <NUM> may be fixed with respect to the pivot connector <NUM> and adjustments of the angles Θ<NUM>, Θ<NUM>, and Θ<NUM> may be accomplished solely by movement of the extension arms 402a, 402b with respect to each other.

<FIG> illustrates a method <NUM> of forming a cut in a bone, in accordance with some embodiments. At step <NUM>, an adjustable surgical guide 100d is positioned adjacent to a bone. Although embodiments are discussed herein with respect to the adjustable surgical guide 100a-100d, it will be appreciated that any of the surgical guides 100a-100d discussed above can be used in conjunction with the method <NUM> and such use is within the scope of this disclosure. In some embodiments, an adjustable surgical guide 100a includes a first guide arm 102a extending substantially on a first longitudinal axis 150a and defining a first plurality of openings 114a, a second guide arm 102b extending substantially on a second longitudinal axis 150b and defining a second plurality of openings 114b, and a pivot element <NUM> coupling the first guide arm 102a to the second guide arm 102b. In some embodiments, a temporary fixation element, such as a k-wire, may be inserted through a hole defined through the pivot element <NUM>, such as a hole extending through a pivot pin <NUM>, to maintain the adjustable surgical guide 100a at a predetermined position with respect to the bone.

At optional step <NUM>, a first guide element is inserted through a selected one of the first plurality of openings 122a defined by the first guide arm 102a. For example, in some embodiments, a first guide element, such as a k-wire, is inserted through a selected one of the holes 122a defined in the first guide arm 102a. The first guide element can be coupled to a bone, for example, prior to and/or after insertion of the first guide element through the selected one of the plurality of holes 122a to define a first reference point for a wedge osteotomy to be formed in the bone.

At optional step <NUM>, the first guide arm 102a and the second guide arm 102b are pivoted about the pivot element <NUM> to adjust the angle Θ<NUM> between the first guide arm 102a and the second guide arm 102b within the first plane. In some embodiments, pivoting the first guide arm 102a and the second guide arm 102b includes increasing and/or decreasing the first angle Θ<NUM> between the first guide arm 102a and the second guide arm 102b to define the width of a wedge osteotomy to be formed in a bone.

At optional step <NUM>, a longitudinal position of a first guide arm 426a, a second guide arm 426b, and a pivot element <NUM> is adjusted along a third longitudinal axis 450e. For example, in some embodiments, the adjustable surgical guide 100d includes a lateral adjustment arm <NUM> defining a slot <NUM>. The slot is configured to receive a slide element <NUM> therein. The slide element <NUM> is coupled to the pivot element <NUM> and is configured to move the pivot element <NUM> laterally along the third longitudinal axis 450e. In some embodiments, the lateral adjustment arm <NUM> is coupled to the bone by a third guide element prior to and/or subsequent to adjusting the lateral position of the pivot element <NUM>.

At optional step <NUM>, a longitudinal position of the first guide arm 426a and/or the second guide arm 426b is adjusted with respect to the pivot element <NUM>. For example, in some embodiments, each of the first guide arm 426a and the second guide arm 426b include a slide element <NUM> disposed through a slot <NUM> defined by a respective extension arm 402a, 402b coupled to the pivot element <NUM>. Each of the extension arms 402a, 402b and the corresponding slot <NUM> extend substantially along a longitudinal axis 450a, 450b. In some embodiments, a locking element <NUM> is coupled to the slide element <NUM> and can be tightened to fix the position of the guide arm 426a, 426b within the slot <NUM> and/or can be loosened to allow adjustment of the guide arm 426a, 426b within the slot <NUM>.

At optional step <NUM>, an angle of the first guide arm 426a and/or the second guide arm 426b is adjusted with respect to a pivot plane defined by the pivot element <NUM>. For example, in some embodiments, the first guide arm 426a comprises an angular pivot element <NUM> configured to selectively adjust the angle between the longitudinal axis 450c of the first guide arm 426a or the longitudinal axis 450d of the second guide arm 426b and the pivot plane. In some embodiments, the pivot plane includes a plane defined by the longitudinal axes 450a, 450b of the guide arm connectors 432a, 432b of the pivot element <NUM>.

At optional step <NUM>, a second guide element is inserted through a selected one of the second plurality of openings 122b defined by the second guide arm 102b. For example, in some embodiments, a second guide element, such as a k-wire, is inserted through the selected one of the holes 122b defined in the second guide arm 102b. The second guide element is coupled to a bone to define a second point of reference for a wedge osteotomy to be formed in the bone.

At step <NUM>, a cutting guide is inserted through one or more of the guide holes 114a, 114b, <NUM>, <NUM>, extending through a portion of the adjustable surgical guide. The cutting instrument, such as a burr, is sequentially inserted into the one or more guide holes 114a, 114b, <NUM>, <NUM> to form a wedge osteotomy in the bone. In some embodiments, a cut may be formed in the bone by pivoting and/or rotating the cutting instrument within a guide hole 114a, 114b, such as, for example. within a range of motion defined by a scallop guide <NUM>.

<FIG> illustrates a method 500a of forming a cut in a bone using an adjustable surgical guide having at least one slideable guide element, in accordance with some embodiments. Steps <NUM>-<NUM> of the method 500a are similar to steps <NUM>-<NUM> of the method <NUM> discussed above in conjunction with <FIG>, and similar description is not repeated herein. At step <NUM>, the position of at least one slideable guide element <NUM> within a slot <NUM> defined by one of a first guide arm 302a or a second guide arm 302b is adjusted. The slideable guide element <NUM> can include a locking element <NUM> that is loosened to allow movement of the slideable guide element <NUM> within the slot <NUM>. After repositioning the slideable guide element <NUM>, the locking portion <NUM> can be retightened to fix the position of the slideable guide element <NUM> within the slot <NUM>. For example, in some embodiments, the guide portion <NUM> of each of the sliding guide elements <NUM> a first surface configured to abut the guide arm 302a, 302b on a first side. The locking portion <NUM> includes a second surface configured to abut the guide arm 302a, 302b on a second side. When the locking portion <NUM> is tightened to the guide portion <NUM> (for example, by rotating the locking portion <NUM> to engage threads formed on the extension <NUM>), the first and second surfaces form a friction lock that prevents movement of the slideable guide element <NUM> within the slot <NUM>. The method 500a proceeds to step <NUM> and continues through the method steps discussed above with respect to method <NUM>.

Claim 1:
A surgical guide (100d), comprising:
a first guide arm (102a, 402a, 426a) extending from a first end to a second end on a first longitudinal axis (150a, 450a), the first guide arm defining a first plurality of openings (114a, <NUM>) sized and configured to receive a first guide element therethrough;
a second guide arm (102b, 402b, 426b) extending from a first end to a second end on a second longitudinal axis (150b, 450b), the second guide arm defining a second plurality of openings (114b, <NUM>) sized and configured to receive a second guide element therethrough; and
a pivot element (<NUM>, <NUM>) coupling the first end of the first guide arm to the first end of the second guide arm such that an angular distance between the first guide arm and the second guide arm can be adjusted in a first plane, and further comprising:
a lateral adjustment arm (<NUM>) extending from a first end (466a) to a second end (466b) on a third longitudinal axis (450e), the lateral adjustment arm defining a slot (<NUM>) extending substantially along the third longitudinal axis; and
a slide element (<NUM>) coupled to the pivot element and sized and configured to be received within the slot, wherein the slide element is configured to provide movement of the pivot element on the third longitudinal axis and within the first plane; and
a locking element (<NUM>) coupled to the slide element, wherein the locking element is configured to selectively fix a position of the slide element within the slot.