Distal targeting of locking screws in intramedullary nails

• US 20040034355A1
• Filed: 07/18/2002
• Published: 02/19/2004
• Est. Priority Date: 07/18/2002
• Status: Active Grant

• Current Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Original Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Inventors: Govari, Assaf, Dayan, Avinoam, Davison, Dale G., Ferro, Thomas G.
• Granted Patent: US 7,060,075 B2
• Time in Patent Office: Days
• US Class Current: 606/72
• CPC Class Codes: A61B 17/1707 using electromagnetic effects, e.g. with magnet and external sensors
• CPC Class Codes: A61B 17/1725 for applying transverse screws or pins through intramedullary nails or pins
• CPC Class Codes: A61B 2090/397 electromagnetic other than visible, e.g. microwave

Abstract

In a distal targeting system a hand-held location pad is integral with a guide section for a drill or similar surgical instrument, and has a plurality of magnetic field generators. A sensor, such as a wireless sensor, having a plurality of field transponders, is disposed in an orthopedic appliance, such as an intramedullary nail. The sensor is capable of detecting and discriminating the strength and direction of the different fields generated by the field generators. Control circuitry, preferably located in the location pad is responsive to a signal of the sensor, and determines the displacement and relative directions of an axis of the guide section, and a bore in the orthopedic appliance. A screen display and optional speaker in the location pad provide an operator-perceptible indication that enables the operator to adjust the position of the guide section so as to align its position and direction with the bore.

Claims

1. A distal targeting system for determining the location and orientation of an instrument relative to a target, comprising:

a movable guide assembly for guiding an instrument toward a target;

a plurality of field generators in said guide assembly that generate known distinguishable fields in response to drive signals;

one or more sensors disposed at known locations with respect to said target that generate sensor signals in response to said fields, said sensors having known alignments with an axis of said target;

a signal processor responsive to said drive signals and said sensor signals for producing three location coordinates of a point on said guide assembly and two orientation coordinates of an axis of said guide assembly; and

a display responsive to said signal processor that provides an indication of a location of said point with respect to said target and of an alignment between said axis of said guide assembly and said axis of said target.

2. The distal targeting system according to claim 1, wherein said display is integral with said guide assembly.

3. The distal targeting system according to claim 1, wherein said display comprises a ball-and-crosshairs indication.

4. The distal targeting system according to claim 1, wherein said sensors are wireless sensors.

5. The distal targeting system according to claim 1, further comprising:

a control unit; and

a plurality of external field generators responsive to control signals of said control unit, wherein external fields generated by said external field generators provide power to said sensors.

6. The distal targeting system according to claim 5, wherein said external fields further provide said drive signals to said field generators in said guide assembly.

7. The distal targeting system according to claim 1, wherein said indication comprises five positional and orientation coordinates.

8. The distal targeting system according to claim 1, wherein said target comprises a hollow appliance, and said sensors are insertable therein.

9. The distal targeting system according to claim 8, wherein said target comprises an intramedullary nail.

10. The distal targeting system according to claim 1, wherein said sensors are integral with said target.

11. The distal targeting system according to claim 10, wherein said target comprises an intramedullary nail.

12. The distal targeting system according to claim 1, further comprising a plurality of locating elements having location field detectors therein, said locating elements being disposed at known locations with respect to a fixed frame of reference, wherein said signal processor is responsive to said locating elements to determine a corrected indication of said location of said point.

13. A distal targeting system for determining the location and orientation of an instrument relative to a target, comprising:

a movable guide assembly for guiding the instrument toward the target;

a plurality of field generators in said guide assembly that generate known distinguishable fields in response to drive signals;

one or more sensors disposed at known locations with respect to said target that generate sensor signals in response to said fields, said sensors having known alignments with an axis of said target;

a signal processor responsive to said drive signals and said sensor signals for producing three location coordinates of a point on said guide assembly and two orientation coordinates of an axis of said guide assembly; and

a location pad attached to said guide assembly and moveable therewith, responsive to said signal processor that provides a quantitative indication of a distance and a location of said point with respect to said target and of an alignment between said axis of said guide assembly and said axis of said target.

14. The distal targeting system according to claim 13, wherein said sensors are wireless sensors.

15. The distal targeting system according to claim 13, further comprising:

a control unit; and

a plurality of external field generators responsive to control signals of said control unit, wherein external fields generated by said external field generators provide power to said sensors.

16. The distal targeting system according to claim 15, wherein said external fields further provide said drive signals to said field generators in said guide assembly.

17. The distal targeting system according to claim 13, wherein said quantitative indication comprises five positional and orientation coordinates.

18. The distal targeting system according to claim 13, wherein said target comprises a hollow appliance, and said sensors are insertable therein.

19. The distal targeting system according to claim 18, wherein said appliance comprises an intramedullary nail.

20. The distal targeting system according to claim 13, wherein said sensors are integral with said target.

21. The distal targeting system according to claim 20, wherein said target comprises an intramedullary nail.

22. The distal targeting system according to claim 13, further comprising a plurality of locating elements having location field detectors therein, said locating elements being disposed at known locations with respect to a fixed frame of reference, wherein said signal processor is responsive to said locating elements to determine a corrected indication of said location of said point.

23. A distal targeting system for determining the location and orientation of an instrument relative to a target, comprising:

a hand-held movable guide assembly for guiding the instrument toward the target;

a plurality of field generators in said guide assembly that generate known distinguishable fields in response to drive signals;

a plurality of sensors disposed at known locations with respect to said target that generate sensor signals in response to said fields, said sensors having known alignments with an axis of said target;

a signal processor disposed in said guide assembly responsive to said drive signals and said sensor signals for producing three location coordinates of a point on said guide assembly and two orientation coordinates of an axis of said guide assembly; and

a location pad disposed in said guide assembly, responsive to said signal processor that provides a quantitative indication of a distance and a location of said point with respect to said target and of an alignment between said axis of said guide assembly and said axis of said target, said location pad having a visual display for providing said quantitative indication.

24. The distal targeting system according to claim 23, wherein said display is integral with said guide assembly.

25. The distal targeting system according to claim 23, wherein said display comprises a ball-and-crosshairs indication.

26. The distal targeting system according to claim 23, wherein said sensors are wireless sensors.

27. The distal targeting system according to claim 23, wherein said visual display further provides a qualitative indication of a misalignment between said axis of said guide assembly and said axis of said target.

28. The distal targeting system according to claim 23, further comprising:

a control unit; and

a plurality of external field generators responsive to control signals of said control unit, wherein external fields generated by said external field generators provide power to said sensors.

29. The distal targeting system according to claim 28, wherein said external fields further provide said drive signals to said field generators in said guide assembly.

30. The distal targeting system according to claim 23, wherein said quantitative indication comprises five positional and orientation coordinates.

31. The distal targeting system according to claim 23, wherein said target comprises a hollow appliance, and said sensors are insertable therein.

32. The distal targeting system according to claim 31, wherein said appliance comprises an intramedullary nail.

33. The distal targeting system according to claim 23, wherein said sensors are integral with said target.

34. The distal targeting system according to claim 33, wherein said target comprises an intramedullary nail.

35. The distal targeting system according to claim 23, further comprising a plurality of locating elements having location field detectors therein, said locating elements being disposed at known locations with respect to a fixed frame of reference, wherein said signal processor is responsive to said locating elements to determine a corrected indication of said location of said point.

36. A distal targeting system for determining the location and orientation of an instrument relative to a target, comprising:

a movable guide assembly for guiding the instrument toward the target;

a plurality of field generators in said guide assembly that generate known distinguishable fields in response to drive signals;

one or more sensors disposed at known locations with respect to said target that generate sensor signals in response to said fields, said sensors having known alignments with an axis of said target;

a signal processor disposed in said guide assembly responsive to said drive signals and said sensor signals having a first output responsive to a difference between a location of said target and a location of said guide assembly and second output responsive to a difference between a direction of an axis of said guide assembly and a direction of said axis of said target; and

a display disposed in said guide assembly responsive to said signal processor that provides a qualitative indication of said first output and said second output.

37. The distal targeting system according to claim 36, wherein said display is integral with said guide assembly.

38. The distal targeting system according to claim 36, wherein said display comprises a ball-and-crosshairs indication.

39. The distal targeting system according to claim 36, wherein said sensors are wireless sensors.

40. The distal targeting system according to claim 36, further comprising:

a control unit; and

a plurality of external field generators responsive to control signals of said control unit, wherein external fields generated by said external field generators provide power to said sensors.

41. The distal targeting system according to claim 40, wherein said external fields further provide said drive signals to said field generators in said guide assembly.

42. The distal targeting system according to claim 36, wherein said target comprises a hollow appliance, and said sensors are insertable therein.

43. The distal targeting system according to claim 42, wherein said target comprises an intramedullary nail.

44. The distal targeting system according to claim 36, wherein said sensors are integral with said target.

45. The distal targeting system according to claim 44, wherein said target comprises an intramedullary nail.

46. The distal targeting system according to claim 36, further comprising a plurality of locating elements having location field detectors therein, said locating elements being disposed at known locations with respect to a fixed frame of reference, wherein said signal processor is responsive to said locating elements to determine a corrected indication of said location of said target.

47. A distal targeting system for determining the location and orientation of an instrument relative to a target, comprising:

a movable guide assembly for guiding the instrument toward the target;

a magnet disposed at a known location with respect to said target and having a known alignment with an axis of said target;

a plurality of field detectors in said guide assembly producing field detector signals responsive to a field of said magnet;

a signal processor disposed in said guide assembly responsive to said field detector signals having outputs representative of a difference between a location of said target and a location of said guide assembly and a difference between a direction of an axis of said guide assembly and a direction of said axis of said target; and

a display disposed in said guide assembly responsive to said signal processor that provides a first indication of said difference between said location of said target and a second indication of said difference between said direction of said axis of said guide assembly.

48. The distal targeting system according to claim 47, wherein said display is integral with said guide assembly.

49. The distal targeting system according to claim 47, wherein said first indication and said second indication comprise a ball-and-crosshairs display.

50. The distal targeting system according to claim 47, wherein said target comprises a hollow appliance, and said magnet is insertable therein.

51. The distal targeting system according to claim 50, wherein said appliance comprises an intramedullary nail.

52. The distal targeting system according to claim 47, wherein said magnet is integral with said target.

53. The distal targeting system according to claim 52, wherein said target comprises an intramedullary nail.

54. The distal targeting system according to claim 47, further comprising a plurality of locating elements having location field detectors therein, said locating elements being disposed at known locations with respect to a fixed frame of reference, wherein said signal processor is responsive to said locating elements to determine a corrected indication of said location of said target.

55. A distal targeting system for determining the location and orientation of an instrument relative to a target, comprising:

a movable guide assembly for guiding the instrument toward the target;

one or more first field elements in said guide assembly;

one or more second field elements disposed at known locations with respect to said target, said first field elements and said second field elements being sensors or field generators, wherein at least one of said first field elements and said second field elements is a said sensor, said field generators generating known distinguishable fields in response to drive signals, and said sensors producing sensor signals in response to said fields, said sensors having known alignments with an axis of said target;

one or more third field elements, said third field elements being said field generators;

a signal processor responsive to said drive signals and said sensor signals for producing three location coordinates of a point on said guide assembly and two orientation coordinates of an axis of said guide assembly; and

a display responsive to said signal processor that provides an indication of a location of said point with respect to said target and of an alignment between said axis of said guide assembly and said axis of said target.

56. The distal targeting system according to claim 55, wherein said first field elements are said field generators, and said second field elements are said sensors, said second field elements being responsive to distinguishable fields of said first field elements and said third field elements.

57. The distal targeting system according to claim 55, wherein said first field elements are said sensors, and said second field elements are said field generators, said first field elements being responsive to distinguishable fields of said second field elements and said third field elements.

58. The distal targeting system according to claim 55, wherein said first field elements and said second field elements are said sensors.

59. The distal targeting system according to claim 58, wherein said first field elements and said second field elements are wireless and powered by fields of said third field elements.

60. The distal targeting system according to claim 55, wherein said display is integral with said guide assembly.

61. The distal targeting system according to claim 55, wherein said display comprises a ball-and-crosshairs indication.

62. The distal targeting system according to claim 55, wherein said sensors are wireless sensors.

63. The distal targeting system according to claim 55, wherein said indication comprises five positional and orientation coordinates.

64. The distal targeting system according to claim 55, wherein said target comprises a hollow appliance, and said sensors are insertable therein.

65. The distal targeting system according to claim 64, wherein said target comprises an intramedullary nail.

66. The distal targeting system according to claim 55, wherein said sensors are integral with said target.

67. The distal targeting system according to claim 66, wherein said target comprises an intramedullary nail.

68. The distal targeting system according to claim 55, further comprising a plurality of locating elements having location field detectors therein, said locating elements being disposed at known locations with respect to a fixed frame of reference, wherein said signal processor is responsive to said locating elements to determine a corrected indication of said location of said point.

69. A method for determining the location and orientation of an instrument relative to a target, comprising the steps of:

generating one or more distinguishable fields;

sensing a strength and an orientation of each of said fields at known locations with respect to said target;

providing a movable hand-held guide assembly for directing said instrument to said target;

providing a display on said assembly, said display indicating a location of a point of said assembly relative to said target and of an alignment between an axis of said assembly and an axis of said target; and

after performing said step of sensing, calculating three location coordinates of said point relative to said target.

70. The method according to claim 69, wherein said display indicates said location of said point using a ball-and-crosshairs indication.

71. The method according to claim 69, wherein said step of sensing is performed in using wireless sensors.

72. The method according to claim 71, wherein said target comprises a hollow appliance, and said wireless sensors are insertable therein.

73. The method according to claim 71, wherein said target comprises an intramedullary nail.

74. The method according to claim 71, wherein said wireless sensors are integral with said target.

75. The method according to claim 69, wherein said display indicates five positional and orientation coordinates.

76. The method according to claim 69, wherein said step of generating is performed by generating said fields in a proximity of said target, and said step of sensing is performed remote from said target.

77. The method according to claim 69, wherein said step of generating is performed by generating said fields remote from said target, and said step of sensing is performed in a proximity of said target.