Image-guided fracture reduction

• US 20030181918A1
• Filed: 02/11/2003
• Published: 09/25/2003
• Est. Priority Date: 02/11/2002
• Status: Active Grant

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Terrill-Grisoni, Lauralan, Castleman, David, Smothers, Crista, Kahler, David Marc
• Granted Patent: US 7,237,556 B2
• Time in Patent Office: Days
• US Class Current: 606/86
• CPC Class Codes: A61B 17/72 Intramedullary pins, nails or other devices A61B17/744 takes precedence
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2068 using pointers, e.g. pointers having reference marks for determining coordinates of body points
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 6/547 involving tracking of position of the device or parts of the device

Abstract

Embodiments of the present invention include products and methods for reducing fractures with the aid of image guidance. In one embodiment, products and methods are directed to reduction for the placement of an intramedullary nail.

Claims

1. A method of aligning segments of a fractured bone, comprising:

attaching a first reference to a first segment of a fractured bone;

recording a position and orientation of the first reference relative to a first datum;

recording a position and orientation of the first segment relative to a second datum;

locating the first segment relative to the first reference;

attaching a second reference to a second segment of a fractured bone;

recording a position and orientation of the second reference relative to a third datum;

recording a position and orientation of the second segment relative to a fourth datum;

locating the second segment relative to the second reference;

attaching a third reference to a reducer operable to align segments of a fractured bone;

recording a position and orientation of the third reference relative to a fifth datum;

locating the reducer relative to the third reference;

inserting the reducer into a medullary canal of the first segment;

aligning the reducer with a representation of the second segment; and

inserting the reducer into a medullary canal of the second segment,

wherein the reducer is used to assist aligning the segments of the fractured bone.

2. The method of claim 1, wherein the recording a position and orientation of the first reference comprises viewing the first reference with an infrared camera.

3. The method of claim 1, wherein the recording a position and orientation of the first segment comprises capturing a fluoroscopic image of the first segment.

4. The method of claim 1, wherein the locating the first segment relative to the first reference comprises continuously tracking the first reference until the reducer is aligned.

5. The method of claim 1, wherein the recording a position and orientation of the second reference comprises viewing the second reference with an infrared camera.

6. The method of claim 1, wherein the recording a position and orientation of the second segment comprises capturing a fluoroscopic image of the second segment.

7. The method of claim 1, wherein the locating the second segment relative to the second reference comprises continuously tracking the second reference until the reducer is aligned.

8. The method of claim 1, wherein the first datum, second datum, third datum, fourth datum, and fifth datum are a common datum.

9. The method of claim 1, wherein the first datum, second datum, third datum, fourth datum, and fifth datum are related to one another by calculable transforms.

10. The method of claim 1, wherein the recording a position and orientation of the third reference comprises viewing the third reference with an infrared camera.

11. The method of claim 1, wherein the aligning the reducer with a representation of the second segment comprises aligning the second segment relative to the first segment, wherein the reducer is inserted in the first segment.

12. The method of claim 1, wherein the aligning the reducer with a representation of the second segment comprises aligning the reducer relative to the second segment.

13. The method of claim 1, wherein the attaching a third reference to a reducer comprises attaching a third reference to an at least partially flexible reducer.

14. The method of claim 13, wherein the attaching a third reference to a reducer comprises attaching a third reference to at least partially flexible reducer that comprises one or more location elements.

15. The method of claim 14, further comprising:

recording a position and orientation of the one or more location elements relative to the third reference attached to the at least partially flexible reducer; and

locating the one or more location elements relative to the third reference.

16. The method of claim 15, further comprising:

establishing the orientation of the one or more location elements.

17. The method of claim 15, further comprising:

applying a force to the at least partially flexible reducer in order to impart at least partial rigidity to the reducer.

18. A method of aligning segments of a fractured bone comprising:

inserting a reducer operable to align segments of a fractured bone into a medullary canal of a first segment of fractured bone;

attaching a reference to a second segment of a fractured bone;

recording a position and orientation of the reference relative to a first datum;

recording a position and orientation of the second segment relative to a second datum;

locating the second segment relative to the reference;

attaching a reducer reference to the reducer;

recording a position and orientation of the reducer reference relative to a third datum;

locating the reducer relative to the reducer reference;

aligning the reducer with a representation of the second segment; and

inserting the reducer into a medullary canal of the second segment,

wherein the reducer is used to assist aligning the segments of the fractured bone.

19. The method of claim 18, wherein the recording a position and orientation of the reference comprises viewing the reference with an infrared camera.

20. The method of claim 18, wherein the recording a position and orientation of the second segment comprises capturing a fluoroscopic image of the second segment.

21. The method of claim 18, wherein the locating the second segment relative to the reference comprises continuously tracking the reference until the reducer is aligned.

22. The method of claim 18, wherein the first datum, second datum, and third datum are a common datum.

23. The method of claim 18, wherein the first datum, second datum, and third datum are related to one another by calculable transforms.

24. The method of claim 18, wherein the recording a position and orientation of the reducer reference comprises viewing the reducer reference with an infrared camera.

25. The method of claim 18, wherein the locating the reducer relative to the reducer reference comprises calculating the location based on a predetermined relationship between the reducer and the reducer reference.

26. The method of claim 18, wherein the inserting a reducer operable to align segments of a fractured bone into a medullary canal of a first segment of fractured bone comprises inserting an at least partially flexible reducer.

27. The method of claim 26, wherein the inserting a reducer operable to align segments of a fractured bone into a medullary canal of a first segment of fractured bone comprises inserting an at least partially flexible reducer that comprises one or more location elements.

28. The method of claim 27, further comprising:

recording a position and orientation of the one or more location elements relative to the reducer reference; and

locating the one or more location elements relative to the reducer reference.

29. The method of claim 28, further comprising:

establishing the orientation of the one or more location elements.

30. The method of claim 28, further comprising:

applying a force to the at least partially flexible reducer in order to impart at least partial rigidity to the reducer.

31. A method of aligning segments of a fractured bone, comprising:

inserting a reducer operable to align segments of a fractured bone into a medullary canal of a first segment of fractured bone;

attaching a first reference to the first segment;

recording a position and orientation of the first reference relative to a first datum;

recording a position and orientation of the first segment relative to a second datum;

locating the first segment relative to the first reference;

attaching a second reference to a second segment of a fractured bone;

recording a position and orientation of the second reference relative to a third datum;

recording a position and orientation of the second segment relative to a fourth datum;

locating the second segment relative to the second reference;

aligning the first segment with a representation of the second segment; and

inserting the reducer into a medullary canal of the second segment,

wherein the reducer is used to assist aligning the segments of a fractured bone.

32. The method of claim 31, wherein the recording a position and orientation of the first reference comprises viewing the first reference with an infrared camera.

33. The method of claim 31, wherein the recording a position and orientation of the first segment comprises capturing a fluoroscopic image of the first segment.

34. The method of claim 31, wherein the locating the first segment relative to the first reference comprises continuously tracking the first reference until the first segment is aligned.

35. The method of claim 31, wherein the recording a position and orientation of the second reference comprises viewing the second reference with an infrared camera.

36. The method of claim 31, wherein the recording a position and orientation of the second segment comprises capturing a fluoroscopic image of the second segment.

37. The method of claim 31, wherein the locating the second segment relative to the second reference comprises continuously tracking the second reference until the first segment is aligned.

38. The method of claim 31, wherein the first datum, second datum, third datum, and fourth datum are a common datum.

39. The method of claim 31, wherein the first datum, second datum, third datum, fourth datum are related to one another by calculable transforms.

40. The method of claim 31, wherein the inserting a reducer operable to align segments of a fractured bone into a medullary canal of a first segment of fractured bone comprises inserting an at least partially flexible reducer comprising two or more location elements.

41. The method of claim 40, further comprising:

recording a position and orientation of the two or more location elements relative to any specified reference point;

locating the two or more location elements relative to the specified reference point.

42. The method of claim 41, further comprising:

establishing the orientation of the two or more location elements.

43. The method of claim 41, further comprising:

applying a force to the at least partially flexible reducer in order to impart at least partial rigidity to the reducer.

44. A method of enabling reduction of a fractured bone by virtually representing at least one fractured segment of the bone and virtually representing an instrument for aligning two or more segments comprising:

recording a position and orientation of a first segment of the bone;

tracking the position and orientation of the first segment;

recording a position and orientation of the instrument for aligning the segments;

tracking the position and orientation of the instrument; and

indicating through a virtual representation to a user that alignment has been achieved such that the instrument may be engaged with the first segment and a second segment.

45. The method of claim 44, wherein the recording a position and orientation of the first segment comprises storing data in a computer, the data numerically representing a three-dimensional position and orientation of the first segment.

46. The method of claim 45, wherein the tracking the first segment comprises calculating changes to the data responsive to changes in the position and orientation of the first segment.

47. The method of claim 44, wherein the recording a position and orientation of the instrument for aligning the segments comprises storing data in a computer, the data numerically representing a three-dimensional position and orientation of the instrument.

48. The method of claim 47, wherein the tracking the instrument for aligning the segments comprises calculating changes to the data responsive to changes in the position and orientation of the instrument for aligning the segments.

49. The method of claim 44, wherein the indicating that alignment has been achieved comprises indicating that the first segment and the instrument are aligned.

50. The method of claim 44, further comprising:

recording a position and orientation of a second segment of the bone.

51. The method of claim 50, further comprising:

tracking the position and orientation of the second segment.

52. The method of claim 51, wherein the indicating that alignment has been achieved comprises indicating that the first segment, the second segment, and the instrument are aligned.

53. The method of claim 51, wherein the act of indicating that alignment has been achieved comprises indicating that the first segment and the second segment are aligned.

54. The method of claim 44, wherein the recording a position and orientation of the instrument for aligning the segments and the tracking the position and orientation of the instrument comprise recording and tracking an at least partially flexible reducer.

55. The method of claim 54, wherein the recording a position and orientation of the instrument for aligning the segments and the tracking the position and orientation of the instrument comprise recording and tracking an at least partially flexible reducer that comprises one or more location elements.

56. The method of claim 55, wherein the tracking the position and orientation of the instrument comprises:

recording a position and orientation of the one or more location elements; and

tracking the position and orientation of the one or more location elements.

57. The method of claim 56, further comprising:

establishing the orientation of the one or more location elements.

58. The method of claim 56, further comprising:

applying a force to the at least partially flexible reducer in order to impart at least partial rigidity to the reducer.

59. A method of aligning segments of a fractured bone comprising:

inserting a reducer operable to align segments of a fractured bone into a medullary canal of a first segment of fractured bone;

attaching a reference to a second segment of a fractured bone;

recording a position and orientation of the reference relative to a first datum;

recording a position and orientation of the second segment relative to a second datum including detecting at least a portion of the second segment through the skin of a patient;

locating the second segment relative to the reference;

attaching a reducer reference to the reducer;

recording a position and orientation of the reducer reference relative to a third datum;

locating the reducer relative to the reducer reference;

generating an image that comprises a representation of the second segment and a representation of the reducer;

aligning the reducer with the second segment by viewing the generated image and moving the first segment and the reducer relative to the second segment; and

inserting the reducer into a medullary canal of the second segment in order to align the segments.

60. An instrument operable with an image-guided surgical navigation system for aligning fractured segments of a bone comprising:

an elongated body; and

a reference coupled to the elongated body for enabling the instrument to be located by the image-guided surgical navigation system;

wherein the reference has a predefined physical relationship with the elongated body such that by observing the position and orientation of the reference relative to one or more of the fractured segments, the position and orientation of the elongated body relative to one or more of the fractured segments can be determined.

61. The instrument of claim 60, wherein the elongated body is tubular.

62. The instrument of claim 60, wherein the elongated body is solid.

63. The instrument of claim 60, wherein the elongated body is greater than half the greatest length of the fractured bone.

64. The instrument of claim 60, wherein the elongated body is less than or equal to half the greatest length of the fractured bone.

65. The instrument of claim 60, wherein the elongated body is substantially straight.

66. The instrument of claim 60, wherein the elongated body is curved.

67. The instrument of claim 60, wherein the elongated body is substantially the same curvature as an implant to be used to fix the bone segments in place.

68. The instrument of claim 60, wherein the reference comprises an energy-reflecting surface wherein the reflected energy is detected by a sensor.

69. The instrument of claim 60, wherein the reference comprises an energy-emitting component that wherein the energy is detected by a sensor.

70. The instrument of claim 60, wherein the reference is removably coupled to the elongated body.

71. The instrument of claim 60, wherein the reference is symmetrically coupled to the elongated body such that the instrument can be effectively used on either side of a patient.

72. The instrument of claim 60, wherein the reference is asymmetrically coupled to the elongated body such that the instrument is more effectively useable on one side of a patient.

73. The instrument of claim 60, wherein the reference is releasably movable relative to the elongated body such that the instrument can be effectively used on either side of a patient by moving the reference among two or more predetermined positions.

74. The instrument of claim 60, wherein the reference is releasably movable between positions located at ninety degree intervals around the elongated body

75. The instrument of claim 60, further comprising a handle coupled to one end of the elongated body.

76. The instrument of claim 60, further comprising a curved tip.

77. The instrument of claim 60, wherein the elongated body is at least partially flexible.

78. The instrument of claim 77, wherein the at least partially flexible elongated body comprises one or more location elements.

79. The instrument of claim 78, wherein the on or more location elements can be sensed in location actively or passively.

80. The instrument of claim 78, wherein the one or more location elements can be sensed in location using one or more of the following techniques:

infrared, visual, reflective, sound, ultrasound, radio wave, mechanical wave, magnetic, electromagnetic, electrical, x-ray, GPS systems or chips, transponder, or transducer.

81. The instrument of claim 76, wherein the at least partially flexible elongated body comprises a feature that imparts at least partial rigidity to the reducer.

82. A system for enabling reduction of a fractured bone operable to virtually represent at least one fractured segment of the bone and virtually represent an instrument for aligning the at least one fractured segment comprising:

a first reference coupled to the at least on fractured segment;

a second reference coupled to the instrument;

a detector operable to collect position and orientation information regarding the at least one fractured segment and the instrument;

a data processing device operable to store position and orientation information about the at least one fractured segment and the instrument, and to calculate virtual positions of the at least one fractured segment and the instrument based upon inputs from the detector; and

an indicator device for notifying a user of the relative positions of the at least one fractured segment and the instrument.