Classifications

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  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
  • A61B17/86—Pins or screws or threaded wires; nuts therefor
  • A61B17/8625—Shanks, i.e. parts contacting bone tissue
  • A61B17/863—Shanks, i.e. parts contacting bone tissue with thread interrupted or changing its form along shank, other than constant taper
• • A—HUMAN NECESSITIES
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  • A61B17/15—Guides therefor
• • A—HUMAN NECESSITIES
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  • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
  • A61B17/1635—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for grafts, harvesting or transplants
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  • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
  • A61B17/1662—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body
  • A61B17/1684—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the shoulder
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  • A61B17/17—Guides or aligning means for drills, mills, pins or wires
  • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
  • A61B17/1778—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the shoulder
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  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
  • A61B17/86—Pins or screws or threaded wires; nuts therefor
  • A61B17/8605—Heads, i.e. proximal ends projecting from bone
• • A—HUMAN NECESSITIES
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  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
  • A61B17/86—Pins or screws or threaded wires; nuts therefor
  • A61B17/864—Pins or screws or threaded wires; nuts therefor hollow, e.g. with socket or cannulated
• • A—HUMAN NECESSITIES
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  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
  • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
  • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
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  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
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  • A61F2/30721—Accessories
  • A61F2/30749—Fixation appliances for connecting prostheses to the body
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  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
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• • A—HUMAN NECESSITIES
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  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
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  • A61F2/4601—Special tools for implanting artificial joints for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
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  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
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  • A61F2/4644—Preparation of bone graft, bone plugs or bone dowels, e.g. grinding or milling bone material
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  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B2017/567—Joint mechanisms or joint supports in addition to the natural joints and outside the joint gaps
• • A—HUMAN NECESSITIES
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  • A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
• • A—HUMAN NECESSITIES
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  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
  • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
  • A61B2017/681—Alignment, compression, or distraction mechanisms
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61B2034/101—Computer-aided simulation of surgical operations
  • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/28—Bones
  • A61F2002/2835—Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• • A—HUMAN NECESSITIES
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  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
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  • A61F2/4603—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof
  • A61F2002/4625—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
  • A61F2002/4627—Special tools for implanting artificial joints for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument

Definitions

• the invention relates to the field of surgical instruments participating in a so-called Latarjet surgical procedure and in particular to the adaptations of said instruments in order to optimize said procedure.
• the shoulder joint is known to be the body with the greatest range of motion. Shoulder instability is a common condition that can be treated with surgical stabilization.
• the so-called Lartajet procedure (known by the name of the surgeon who first described it) is known, which consists in making a section of the coracoid (which is a natural growth or apophysis on the edge).
• upper scapula with the muscle that fits over it (called coraco-biceps).
• coraco-biceps The fibers of the subscapularis muscle are separated into two branches to open a middle slit in the longitudinal direction.
• the anterior wall of the scapula, exposed through the subscapular, is sharpened.
• the severed portion of the coracoid is passed through the subscapularis muscle.
• the section of the coracoid is positioned on the anterior wall of the scapula so as to have its lateral edge in continuity with the articular surface of the glenoid. It is then fixed in this position by two bi-cortical screws, that is to say reaching the posterior wall of the scapula.
• document US2016 / 0374694 describes a system and method for coupling a graft to a bone.
• a graft preparation tool can be used to place one or more holes in a graft and an offset measurement tool can be used to determine the distance of the hole (s) from an edge of the graft to align with a portion of the bone.
• One or more complementary holes can then be created in the bone and screws applied through the holes to couple the graft to the bone.
• the instrumental system for fixing a bone graft on the scapula is remarkable in that it includes a positioning instrument which comprises:
• a drilling barrel including a first hole and a second hole separated by a distance and sized for the passage and guidance of a bone drilling bit.
• the approximation of the jaws by means of a translational movement allows reception and tightening of the bone graft optimized compared to those offered by pliers with pivoting branches. Indeed, the rotation of the jaws defines a different reception and tightening according to the size of the graft, which the design of the positioning instrument of the invention avoids. In addition, the size of such a clamp is reduced which allows a much better use and a much better visual control by the operator.
• This optimization facilitates the implementation of a simultaneous drilling of the bone graft and the scapula hosting it.
• one of the two branches is equipped with a preformed extension of a support surface against the glenoid articular surface in order to position the bone graft on the scapula.
• the positioning means makes it possible to guide, by means of said holes, not only the drilling operation of the graft but also the guidance of the drilling operation of the bone hosting the transplant.
• the advantage of this technical characteristic is to allow the operations of drilling the graft and those of the bone without manipulation of the graft between operations.
• Another advantage of this technical characteristic is to allow to perform the operations of drilling the graft and those of the bone at the same time. The operating time is then reduced.
• the invention avoids all the drawbacks associated with poor positioning of the holes made in the graft with those made in the bone receiving the graft since said holes are made without manipulation of the graft or at the same time.
• the graft placement accuracy is then improved.
• said piercing barrel is positioned between said branches.
• said two branches are connected together by at least one transverse connecting rod, the position of at least one branch relative to this rod being adjustable, so that the 'spacing between the two branches is adjustable.
• said two branches are interconnected by at least two transverse and parallel connecting rods so as to form a sliding link allowing a first branch to approach the other.
• said piercing barrel is crossed by the two connecting rods so as to form a sliding link of transverse axis and is provided with a longitudinal lumen in which the shaft of the second ends of two rods of identical length, the first end of each rod being pivotally linked, respectively, to a different branch so that the axis of the holes of the drilling barrel is in the median plane separating the two branches .
• This characteristic makes it possible to systematically position the drilling barrel and the axes of the holes to be drilled that it defines, in the median plane defined by the two jaws.
• the axes of the holes to be drilled are thus systematically well positioned.
• said two branches comprise at their distal end, a locking means and tensioning the position of the branches receiving the bone graft between the jaws equipping their proximal end.
• This bone graft can be a coracoid previously removed but can also be an external quarter of clavicle, a piece of iliac crest, a bank bone, a bone substitute, ...
• the instrumental system further comprises an instrument for removing and / or preparing a graft to be removed or already removed which comprises two branches equipped at their proximal end with a jaw opposite which the graft is positioned, said ends being preformed with a first flat surface to define a first cutting plane for the purpose of separating the graft from the bone to which it is attached, both branches approaching each other by a translational movement.
• an instrument for removing and / or preparing a graft to be removed or already removed which comprises two branches equipped at their proximal end with a jaw opposite which the graft is positioned, said ends being preformed with a first flat surface to define a first cutting plane for the purpose of separating the graft from the bone to which it is attached, both branches approaching each other by a translational movement.
• said sampling instrument comprises a second flat surface substantially orthogonal to the first cutting plane to define a second cutting plane or else a referencing plane for the purpose of surfacing the portion of graft coming into contact with the portion of bone intended to receive said graft.
• This characteristic is particularly advantageous in that it predetermines the positioning of a cutting plane relative to the second, which optimizes the positioning of the surfaces of the graft resulting from said cuts.
• the advantage of this technical characteristic is to secure and facilitate the uncovering of the surface of the graft coming into contact with the bone which is to accommodate said graft, which promotes good contact between the surface of the graft and the host bone and graft consolidation.
• said two branches are interconnected by two transverse and parallel connecting rods, the position of at least one branch relative to these rods being adjustable, so that the 'spacing between the two branches is adjustable.
• said two branches comprise at their second end, a means of blocking and tensioning the position of the branches receiving the bone graft between the jaws equipping their proximal end .
• said sampling instrument comprises a central body crossed by the two connecting rods so as to form a sliding link of transverse axis and formed with a longitudinal lumen in which evolves the shaft of the second ends of two links of identical length, the first end of each link being pivotally connected, respectively, to a different branch so that the central body is in the median plane separating the two branches.
• Said central body further comprises in its upper part a piercing barrel whose axis is substantially parallel to the first plane surface of the branches.
• the same tool sharing the same branches and the same jaws implements the positioning instrument and the sampling and / or preparation instrument.
• Such a configuration thus solves the problems of changing the device to go from the cutting operation to the drilling operation as well as those linked to the displacement of the graft. Indeed, such a device allows the surgeon to cut, align and pierce the coracoid and fix the graft previously prepared on the scapula. It also makes it possible to position the graft on the scapula and to use the holes in the graft as a positioning template for drilling means or to pierce in the same drilling operation, the graft and the scapula.
• said jaws of at least one of the instruments are preformed to accommodate prefabricated jaws selected from among a plurality of jaws offering a range of shapes and dimensions adapted to the shapes and dimensions of 'a coracoid or other graft.
• said jaws of at least one of the instruments are preformed according to the shapes and dimensions of the patient's bones.
• the jaw adopts a configuration adapted to the shape and dimensions of the patient's coracoid or other graft.
• the bearing surface against the glenoid articular surface of the positioning instrument is selected from a plurality of bearing surfaces offering a range of shapes and dimensions adapted to the shapes and dimensions of a portion of the glenoid surface.
• the support surface against the glenoid articular surface of the positioning instrument is preformed according to the shapes and dimensions of the patient's bone.
• the support surface adopts a configuration adapted to the shape and dimensions of a portion of the glenoid articular surface.
• the subassemblies coming into contact with the bones for tightening and / or referencing purposes are fixed detachably from the rest of the means (retaining or positioning) to which they belong.
• the piercing barrel of at least one of the instruments is selected from a plurality of barrels offering guide holes adapted to the dimensions of a coracoid or other graft.
• At least one of the guide holes of a piercing barrel of at least one of the instruments is preformed according to the shape and dimensions of the patient's bones.
• the guidance of at least one of the holes to be produced adopts a configuration adapted to the shape and dimensions of the patient's coracoid or other graft and / or the patient's scapula.
• the instrumental system is then broken down between common parts and parts that are part of a prefabricated game or manufactured according to the measurement and / or modeling of the anatomy, bone and soft tissues. , and coming to be fixed from time to time in the common parts.
• the entire instrumental system is designed and manufactured to adapt to the anatomy, bone and soft tissue, of a single patient.
• the instrumental system of the invention comprising all or part of the characteristics described above provides guidance to surgeons to secure the stages of the operations implemented. It is understood that the instrumental system of the invention can be used for all or part of the Latarjet procedure.
• a particularly advantageous characteristic of the method, which can be implemented by the instrumental system of the invention is that it consists in positioning by means of a positioning instrument a bone graft on the scapula and in piercing said bone graft at the same time as the scapula with the help of piercing guns carried by the same positioning instrument.
• the method Prior to the use or manufacture of the instrumental system and as an alternative or in addition to a configuration where several sets of prefabricated parts must be selected according to the anatomy of the patient, the method provides for an operation of acquisition of patient images (radiography, scanner, MRI, etc.).
• Such a data acquisition phase is accompanied by a measurement phase on this data.
• These measurements lead either to determining the positioning of prefabricated instruments by replicating the measurements using references placed on the instruments, or to selection from a set of prefabricated parts.
• the data acquisition phase is accompanied by a three-dimensional reconstruction phase of the scapula then by a simulation phase of all or part of the stages of the operations to be carried out.
• This simulation can be used by the practitioner during the implementation of the actual operation, the invention further comprising the use of a means of guidance in augmented or mixed reality.
• a guidance means comprises a screen positioned in the visual field of a user of the system and an information processing unit including an algorithm capable of allowing the superimposition of real visual elements, perceived directly or indirectly through a camera by the user, and virtual visual elements defined in a frame of reference associated with said real visual elements.
• the use of the guide means consisting in supplying, in the form of virtual visual elements, the position and orientation information of, at least one stage of the operation, among the preparation of the graft and the positioning of the graft on the scapula.
• the phases of data acquisition and three-dimensional reconstruction of the scapula are accompanied by a phase of modeling of all or parts of the instrumental system to be in contact with the bones. concerned of the patient.
• This modeling leads either to selection from a set of prefabricated parts or to dedicated manufacturing (by machining, molding, manufacturing additive .%) of at least one element among the reference surfaces coming into contact with the part of bone to be clamped or on which the device (s) will be supported and the guides of the holes to be produced.
• the method comprises the following operations:
• a preoperative planning comprising the following operations:
• Figure 1 is a schematic drawing of a perspective view of an embodiment of a positioning instrument according to the invention.
• Figure 2 is a schematic drawing of an exploded perspective view of the positioning instrument of Figure 1;
• Figure 3 is a schematic drawing of a perspective view of an embodiment of a sampling and / or preparation instrument according to the invention.
• Figure 4 is a schematic drawing illustrating the removal of the
• Figure 5 is a schematic drawing illustrating the instrument of Figure 3 receiving the bone graft from the sample illustrated in Figure 4 and positioned for resurfacing;
• Figure 6 is a schematic drawing of a perspective view illustrating the positioning of the bone graft on the scapula using the instrument of Figure 1;
• Figure 7 is a schematic drawing of a front view illustrating the
• Figure 8 is a schematic drawing of a perspective view of another embodiment according to the invention of a tool forming a sampling and / or preparation instrument provided with a central piercing barrel;
• Figure 9 is a diagram of the main phases of the process leading to the creation of an instrumental system and / or a fixation method, according to the invention, specific to a patient.
• the positioning instrument referenced 100 as a whole has two branches 110 and 120 arranged one opposite the other and having two ends 111 and 112 for the branch 110 and 121 and 122 for branch 120.
• the ends 112 and 122 arranged opposite are each preformed with a jaw 113 and 123 between which the graft G is positioned (cf. FIGS. 7 and 8).
• This instrument 100 is designed so that the two branches 110 and 120 approach or move away from one another by a translational movement symbolized by the double arrow F1.
• the positioning instrument 100 further comprises a piercing barrel 130 including a first hole 131 and a second hole 132 substantially parallel and separated by a distance and dimensioned for the passage and guidance of bone piercing bits.
• the branch 110 extends beyond the preformed jaw portion 113 with an extension 140 preformed with a bearing surface 141 against the glenoid surface in order to position the bone graft G on the scapula S before its simultaneous piercing with the scapula.
• the instrument 100 comprises two transverse and parallel connecting rods 150 and 160.
• a first end of said rods 150 and 160 is fixed to a first branch 110 and the second branch 120 is preformed with guide sleeves to allow it to slide along the rods 150 and 160 and thus spread or approach the jaws 113 and 123.
• said drilling barrel 130 is positioned between said branches 110 and 120 so that the axes of the holes 131 and 132 are disposed respectively on either side of the plane defined by the axes of the parallel rods 150 and 160.
• the approximation or spacing of the two branches 110 and 120 is carried out manually.
• the movement can be implemented by means of a third rod comprising two threaded portions each engaged in a different branch.
• said two branches 110 and 120 have at their second end 111 and 121, a locking and tensioning means which connects them. According to the preferred but nonlimiting embodiment illustrated, it is a rack latch 170.
• the blocking can be implemented by means of a thumb wheel cooperating with a threaded portion of one of the transverse rods.
• the instrument for removing and preparing a graft referenced 200 as a whole has the same configuration as the positioning instrument, that is to say that it forms a clamp whose branches approach or move away in a translational movement according to the double arrow F2.
• the instrument 200 has two branches 210 and 220 arranged one facing the other and having two ends 211 and 212 for the branch 210 and 221 and 222 for the branch 220.
• the ends 212 and 222 arranged opposite are each preformed with a jaw 213 and 223 between which the graft G (to be removed or removed) is positioned (cf. FIGS. 5 and 6).
• the ends 212 and 222 arranged facing each other are further preformed on at least one face different from that supporting the jaws 213 and 223 but near the latter, notches 214 and 224. These notches 214 and 224 serve as a marker for positioning the graft G between the jaws 213 and 223.
• the instrument 200 comprises two transverse and parallel connecting rods 250 and 260.
• a first end of said rods 250 and 260 is fixed to a first branch 210 and the second branch 220 is preformed with guide sleeves to allow its sliding along the rods 250 and 260 and thus spread or approach the jaws 213 and 223.
• said two branches 210 and 220 have at their second end 211 and 221, a locking and tensioning means which connects them. According to the preferred but nonlimiting embodiment illustrated, it is a rack latch 270.
• FIGS. 4, 5, 6 and 7 illustrate several stages of a so-called Latarjet procedure implemented by the instruments 100 and 200 described above.
• an advantage of the new characteristics of the instruments is to implement a process which is remarkable in that it consists in positioning by means of the positioning instrument 100 a bone graft G on the scapula S and to pierce said bone graft G at the same time as the scapula S with the help of the piercing guns 130 carried by the same positioning instrument 100.
• FIGS. 4 to 7 illustrate such a process with the coracoid being removed beforehand to have a bone graft G to be fixed as illustrated in FIGS. 4 and 5.
• the jaws 213 and 223 take the coracoid or bone graft G along its length to clamp it across its width.
• the practitioner can use the surfaces 215 and 225 as a cutting plane.
• FIG. 5 illustrates the position of the coracoid or G bone graft at the time of resurfacing.
• the coracoid is returned to the forceps.
• the harvesting instrument was loosened and the graft taken from the coracoid is returned therein (the underside becomes the top, resected side retracted first into the jaws) to have easier access to the surface to be resurfaced.
• the coracoid or bone graft G is taken in its thickness to be clamped in its width. Once blocked between the jaws 113 and 123, the positioning means is positioned in abutment against the scapula using its extension 140. The simultaneous drilling of the graft G and of the scapula S can then start.
• FIG. 8 illustrates a different embodiment of the coracoid preparation tool.
• the tool 300 with the branches 310 and 320 and the jaws 313 and 323 implements the sampling and / or preparation instrument.
• the tool further comprises a central body 330 crossed by the two connecting rods so as to form a sliding connection of transverse axis and formed with a longitudinal slot in which the shaft of the second ends of two rods of identical length moves. , the first end of each link being pivotally connected, respectively, to a different branch so that the central body is in the median plane separating the two branches.
• Said central body 330 further comprises in its upper part a piercing barrel 340 whose axis is substantially parallel to the planar surface 315 and 325 of the branches. These characteristics make it possible to systematically position the central body 330, its barrel 340 and the guide axis of the bore 341, in the median plane defined by the two jaws. The axis of the hole to be drilled is thus systematically well positioned. This variant makes it possible to pierce the graft with the sampling and / or preparation instrument.
• FIG. 9 illustrates the process comprising, before the selection or the manufacture of all or part of the instruments, a preoperative planning comprising the following operations:

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• 2019
  • 2019-12-20 FR FR1915286A patent/FR3090314B1/fr not_active Expired - Fee Related
  • 2019-12-20 EP EP19842401.2A patent/EP3897421A1/de not_active Withdrawn
  • 2019-12-20 WO PCT/IB2019/061211 patent/WO2020129019A2/fr not_active Ceased
  • 2019-12-20 EP EP19842885.6A patent/EP3897410A2/de not_active Withdrawn
  • 2019-12-20 FR FR1915359A patent/FR3090313A1/fr not_active Ceased
  • 2019-12-20 WO PCT/IB2019/061203 patent/WO2020129014A1/fr not_active Ceased
  • 2019-12-23 US US16/724,886 patent/US11291487B2/en active Active
  • 2019-12-23 US US16/724,965 patent/US11406435B2/en active Active
• 2022
  • 2022-03-17 US US17/655,241 patent/US20220211421A1/en not_active Abandoned
  • 2022-06-30 US US17/809,939 patent/US20220346849A1/en not_active Abandoned

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