Patent Document

CROSS-REFERENCE 
       [0001]    This application claims the benefit of U.S. Provisional Patent Application No. 60/866,920 entitled “Surgical Station for Orthopedic Reconstructive Surgery,” filed Nov. 22, 2006, which disclosure is incorporated herein by reference. 
     
    
     INCORPORATION BY REFERENCE 
       [0002]    All publications and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference. 
       BACKGROUND OF THE INVENTION 
       [0003]    The invention relates to a limb holding device designed to immobilize, retract, and stabilize the upper extremities of the human anatomy during reconstructive orthopedic surgery. An arc cannula can be provided as a guide for using burrs and drills to access target tissue or bone. 
         [0004]    Currently available limb supporting devices for arthroscopic surgery include that described in U.S. Pat. No. 5,027,799 to Laico et al. The device is a limb holding device designed to be attached to an operating table to immobilize a patient&#39;s arm or leg during arthroscopic surgery or the like. U.S. Pat. No. 5,785,057 to Fischer for Medical Positioning Devices describes an apparatus for positioning an upper appendage portion of a body of a patient with respect to an operating room table having a mattress covering at least a portion of the operating room table and a leaf portion moveable out of a coplanar position with respect to a remaining portion of the operating room table during a surgical procedure. U.S. Pat. No. 6,221,036 to Lucas for Support for a Limb of a Body describes a support having a sheet of flexible material with longitudinal looks running along the sides of the sheet. The loops are releasably and securely attached with rods to the sides of a base for the support. 
       SUMMARY OF THE INVENTION  
       [0005]    The invention is directed to an immobilization device, or surgical station, that is non-invasive, non-implantable and skin contacting only. The device immobilizes, retracts and stabilizes the limbs of the human anatomy during orthopedic surgery. In addition, tension applied to the extremities is used to help reduce and stabilize fractures during surgery. An arc cannula acts as a guide to the physician or surgical technician when using tools to access target tissue or bone or implanting devices within the bone, such as those tools and devices described in the following copending applications: U.S. application Ser. No. 60/866,976 filed Nov. 22, 2006, to Phillip Jobson for SURGICAL TOOLS FOR USE IN DEPLOYING BONE REPAIR DEVICES; U.S. application Ser. No. 60/867,011 filed Nov. 22, 2006 to Phillip Jobson for BONE REPAIR IMPLANT WITH CENTRAL RATCHETING GUIDEWIRE; PCT Appln. No. PCT/US06/18704 for Minimally Invasive Actuable Bone Fixation Devices, Systems and Methods of Use by Charles L. Nelson et al.; U.S. patent application Ser. No. 11/383,279 filed May 15, 2006 by Charles Nelson et al. for Methods of Using Minimally Invasive Actuable Bone Fixation Devices; U.S. patent application Ser. No. 11/383,275 filed May 15, 2006 by Charles Nelson et al. for Minimally Invasive Actuable Bone Fixation Devices Having a Retractable Interdigitation Process; and U.S. patent application Ser. No. 11/383,269 filed May 15, 2006 by Charles Nelson et al. for Minimally Invasive Actuable Bone Fixation Devices. 
         [0006]    In some embodiments, the invention is a surgical station that allows immobilization, retraction, preparation, and articulation of a target anatomy during orthopedic surgery. The station provides straps and tie down anchors that rigidly immobilize the anatomy. It has a platform that slides in the x-y plane, along positive and negative x and positive and negative y axes. The station provides rotation of the limb about the x axis. 
         [0007]    One aspect of the invention provides a limb supporting apparatus adaptable for use during orthopedic surgery on a patient&#39;s limb, comprising a platform base, an appendage rest supported by the platform base, an access port, and a curved cannula supported by the access port. The platform base has a plurality of connection elements adapted to connect components to the platform base at a plurality of connection locations. The appendage rest and access port and other accessories are adapted to connect to the platform base at a plurality of connection locations. 
         [0008]    In some embodiments the appendage rest comprises an appendage rest base and an appendage rest platform, wherein the appendage rest platform engages the appendage rest base, such that the platform may rotate. The appendage rest base has a plurality of connection elements adapted to connect the appendage rest to a plurality of connection locations on the platform base. The appendage rest platform may have radiopaque markers provided to assist a surgeon in guiding tools and devices within the bone. 
         [0009]    In some embodiments a longitudinal stabilizer engages a plurality of locations along the length of the platform base distal to the appendage rest. The longitudinal stabilizer provides traction to an end of the patient&#39;s limb. 
         [0010]    In some embodiments, the access port comprises an access port base that engages the platform base, a height adjustable cannula access carrier, and a cannula access carrier that rotates coplanar to the platform base. The access port base engages the platform base at a plurality of engagement locations. 
         [0011]    Another aspect of the invention provides a method of performing an orthopedic procedure as follows: immobilize the limb on an appendage rest of a platform base; align a curved cannula supported by an access port with a target bone; and perform a procedure on the target bone through the cannula. A distal end of the limb may be aligned with a distal end of the appendage rest. The appendage rest connection elements are engaged to fewer then all of the connection elements adapted to the platform base. The limb is secured to the immobilizing support apparatus in a plurality of locations along the length of the limb, and traction may be applied to the limb. The appendage rest platform may be rotated. The access port engages the platform base at a plurality of engagement locations. In some embodiments, alignment of the cannula comprises adjusting the height of a cannula access carrier to vertically align the cannula and rotating the access carrier in the horizontal plane to align the cannula with the target. The invention allows surgeons to plan, adjust and visualize the trajectory of the access port in the bone before it is cut while at the same time provides means for immobilization of the patient&#39;s limb. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS  
         [0012]    The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which: 
           [0013]      FIG. 1  is an illustration of a surgical station in use. 
           [0014]      FIGS. 2   a - 2   d  are: a bottom view of a surgical station access port; a top view of a surgical station access port; an overall view of a surgical station access port; a section of a surgical station access port. 
           [0015]      FIG. 3   a  is an appendage rest for a surgical station 
           [0016]      FIG. 3   b  is a section of an appendage rest of a surgical station. 
           [0017]      FIG. 4  is an overall view of a longitudinal stabilizer portion of the surgical station. 
           [0018]      FIG. 5  is an overall view of an assembled surgical station having all of the components featured in  FIGS. 1-4 . 
           [0019]      FIG. 6  is an image of a portion of an arm on a surgical station of the invention with radiopaque markers used for guidance visible to a user. 
           [0020]      FIG. 7  is a view of a portion of an arm on a surgical station of the invention with a cannula engaging the target. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0021]      FIG. 1  illustrates a surgical station  100  for use in orthopedic reconstructive surgery. The surgical station  100  has a platform  110  or platen. The station is positioned within a plane, shown by the x-y-z coordinates, and is substantially rectangular in length  1  and width w. Additionally, the station  100  is adapted to provide a plurality of components each of which can achieve its own optimal height h. The station also has a side that is proximal A to the patient (i.e., relatively closest to the core of a patient&#39;s body) and distal B to the patient (i.e., a side that is furthest away from the core of the patient and toward which the end of the patient&#39;s engaged appendage approaches). Additionally, there is an interior side D and an exterior side C. These orientations are provided as a guide to appreciating the location of a particular component of the device relative to, for example, the patient, the operating table, and/or the surgeon. 
         [0022]    As depicted in  FIG. 1 , an example of a surgical station according to the invention, the platform is adapted to such that its lower side E rests on a surface, such as an operating table. A plurality of channels  112 ,  112 ′ and apertures  114  are provided to facilitate connecting adjustable and relocatable pieces onto the platform. An access port  120 , shown in more detail in  FIG. 2 , is provided that is adapted to engage the platform  10 . The access port  120  is configured to be adjustable in height by, and to provide cannula access  122 / 222  which is adapted to engage a target portion of the anatomy of a patient to facilitate access to target bone during orthopedic reconstructive surgery. A threaded shaft  124  is provided that engages an access port base  126  and a cannula access carrier  128 . The shaft engages a threaded aperture in each of the base  126  and carrier  128  to facilitate turning the shaft  124 . 
         [0023]    An appendage rest  140  is also provided, shown in more detail in  FIG. 3 , which supports, for example, the arm of a patient undergoing surgery. The rest  140  has a base  342  adapted to engage the platform, such as by using a tongue-and-groove arrangement. As depicted the rest  140  slides onto the surgical station platform with the tongue-and-groove engaging mechanism at a non-parallel angle to the limb of the patient being supported and/or the long axis of the anatomical rest. 
         [0024]    A longitudinal stabilizer  160 , such as a finger traction device, is provided on the platform  110  at or near an end. The stabilizer engages the platform using a suitable mechanism, such as a tongue-and-groove engaging mechanism ( 162 ,  112 ) that is adapted to be slidably positioned along the length of the platform  110 . The stabilizer is adapted to secure an end of a limb of a patient while maintaining sufficient tension to avoid rotational movement. A ratchet mechanism  164  is an example of one mechanism provided to engage the patient and provide sufficient tension. 
         [0025]    Turning now to  FIGS. 2   a - 2   d , the surgical station access port  220  is depicted. A curved cannula  222  is provided that is adapted to extend from the access port  220  toward the patient to deploy and support tools and surgical devices. As described above, the access port  220  is adjustable in height in order to optimally position the curved cannula during use. The height is adjusted with the threaded shaft  124 . Engaging pins  230  are provided that engage the platform  110 . Once the base  226  is in place and the pins  230  are positioned within apertures on the base, the access port  220  can be locked in place by engaging one or more knobs  232 . In an alternative embodiment, the pin  230  can be a threaded screw that engages a threaded female aperture on the base. Other configurations and adjustment mechanisms can be employed without departing from the scope of the invention. 
         [0026]      FIG. 3  illustrates an appendage rest  340 . The rest  340  has an appendage rest base  342  adapted to engage the platform  110 , such as by using a tongue-and-groove mechanism. An immobilization and stabilization appendage rest platform  344  is adapted to engage the base. Radiopaque markers can be provided, e.g. embedded within the platform, to facilitate determination of target pathway within the immobilized bone for tools and or devices deployed. The platform  344  can further have curved supports  346 ,  346 ′ that engage the base  342  and allow the platform to be rotated such that the horizontal plane encompassing the appendage engaging surface of the platform may or may not be parallel to the horizontal plane encompassing the base  342 . Threaded knobs  348  have tips  350  that are pressed against platform  110  to lock the platform in place. 
         [0027]    As illustrated in  FIG. 4  a longitudinal stabilizer  460  is provided. The stabilizer engages the platform at or near an end with a suitable mechanism, such as a T-slot feature (the transverse  462  portion depicted). A ratchet mechanism  464  is provided that engages a pawl  466  to enable the system to achieve linear motion of the engaged appendage in a direction to stabilize it. A post  468  is provided that is configured to be positioned to engage one set of a plurality of matched apertures to enable the height of the post to be adjusted for a particular patient. 
         [0028]      FIG. 5  illustrates a surgical station with an appendage positioned on an appendage rest  540  therein wherein the fingers are engaged with finger traps  570  that are connected to the longitudinal stabilizer  560  and secured using the ratchet mechanism to pull the fingers toward the stabilizer. (The tissue surrounding the bones has been omitted from  FIG. 5  for purposes of illustration.) An additional appendage anchor  580  is provided which assists in securing the appendage at a proximal location to the surgical station. Thus the appendage may be secured at a relatively distal location by securing the distal part of the limb to longitudinal stabilizer and at a proximal most section (depicted as the upper arm of a skeleton in  FIG. 5 ) to the proximal securement device, which is also adapted to adjustably engage the platform  510 . 
         [0029]      FIG. 6  is an image of a portion of an arm positioned on a surgical station for orthopedic surgery. A radiopaque marker  680  used to assist a surgeon in guiding tools and devices (such as implant  684 ) within the bone  682  are depicted. The curve of the marker enables the surgeon to match the shape of a metaphyseal hub component of a repair device  684  (such as that described in U.S. application Ser. No. 60/867,011), during the surgical procedure and to predict the trajectory the reamer will follow as guided by access port  220 . From the above descriptions it can be appreciated that the surgery station permits adjusting the height and angle of various components relative to the base of the station. Additionally, translation of the patient&#39;s appendage can be achieved by, for example, adjusting the position (i.e., the plane in which it sits) of the appendage rest platform relative to the position of the base. 
         [0030]      FIG. 7  illustrates an access port  720  positioned on a surgical station in relation to an arm  721  that is immobilized on and secured to an appendage rest  740  wherein a cannula access carrier  728  engages a cannula  722  with a target portion of the arm. The cannula is used to guide reaming and drilling tools over a predetermined trajectory and it can also be used to pass tools and devices to and into the arm. 
         [0031]    While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention.

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