SURGICAL ALIGNMENT SYSTEM, APPARATUS AND METHOD OF USE
A surgical positioning system is provided that includes a radiolucent grid having a plurality of dimensioned radio-opaque lines corresponding to surgical variables and a substrate connect to or integral with the radiolucent grid. This system is used to obtain subject specific data from an image of a subject obtained during a surgical procedure by following the steps of: providing a radiolucent grid having a plurality of dimensioned radio-opaque lines relating to surgical variables; placing the subject on a substrate; and obtaining subject specific data from an image of said subject. This invention related to an apparatus made of a radiolucent grid having a plurality of dimensioned radio-opaque lines relating to surgical variables and a sealable radiolucent container sized to receive the grid.
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This continuation-in-patent application claims the benefit of U.S. provisional patent application Ser. No. 61/525,259 filed Aug. 19, 2011 and PCT/US12/51512 application filed Aug. 18, 2012 under 35 U.S.C. §111(a) (hereby specifically incorporated herein by reference).
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENTNone.
REFERENCE TO SEQUENCE LISTING, A TABLE FOR A COMPUTER PROGRAM LISTING, COMPACT DISC APPENDIXNone.
FIELD OF THE INVENTIONThe present invention relates to a fluoroscopic alignment apparatus and system and method to use this apparatus in various orthopedic applications, such as, an anterior total hip arthroplasty.
BACKGROUND OF THE INVENTIONMany of the radiographic parameters essential to total hip arthroplasty (THA) component performance, such as wear, and stability, can be assessed intraoperatively with fluoroscopy. However even with intraoperative fluoroscopic guidance, the placement of an implant may still not be as close as desired by the surgeon. For example, malpositioning of the acetabular component during hip arthroplasty can lead to problems. For the acetabular implant to be inserted in the proper position relative to the pelvis during hip arthroplasty requires that the surgeon know the position of the patient's pelvis during surgery. Unfortunately, the position of the patient's pelvis varies widely during surgery and from patient to patient.
Various devices have been suggested to reduce malpositioning of these surgical components. For example, a transverse acetabular ligament has been suggested as a qualitative marker of the orientation of the acetabulum. (Archbold H A, et al., The Transverse Acetabular Ligament; an Aid to Orientation of the Acetabular Component During Primary Total Hip Replacement: a Preliminary Study of 1000 Cases Investigating Postoperative Stability, J Bone Joint Surg BR. 1906 July; 88(7):883-7. However, it has been suggested that the acetabulum may be deteriorated due to arthritis. Others have proposed using a tripod device that uses the anatomy of the ipsilateral hemi pelvis as the guide to position the prosthetic acetabular component. U.S. Patent Publication Number 19090306679. This instrument has three points. The first leg is positioned in the area of the posterior inferior acetabulum, a second leg is positioned in the area of the anterior superior iliac spine and a third leg is positioned on the ileum of the subject. U.S. Patent Publication Number 19090306679. However, a need exists in the industry for a device that is not implantable or invasive and is adaptable to a variety of applications.
SUMMARY OF THE INVENTIONA surgical positioning system is provided that includes a radiolucent grid having a plurality of dimensioned radio-opaque lines corresponding to surgical variables and a substrate connect to or integral with the radiolucent grid. This system is used to obtain subject specific data from an image of a subject obtained during a surgical procedure by following the steps of: providing a radiolucent grid having a plurality of dimensioned radio-opaque lines relating to surgical variables; placing the subject on a substrate; and obtaining subject specific data from an image of said subject. This invention also provides an apparatus made of a radiolucent grid having a plurality of dimensioned radio-opaque lines relating to surgical variables and a sealable radiolucent container sized to receive the grid. This embodiment simplifies the sterilization, if required of the grid plate between surgical applications.
In another embodiment, the substrate is an operating room table mat and the grid is integrated into the operating room table mat to form a dimensioned grid mat. The dimensioned grid mat has at least one aperture in a top surface sized to accommodate a positioning device. The positioning device is sized to project through and above the top surface of the dimensioned grid mat, wherein the position of a subject on the mat can be maintained in a selected position with the at least one positioning device.
In another embodiment, the grid is not a complete table or is not integrated into a complete table, but is an independent extension which adapts to any operating room table and/or integrates into, or adapts with, a mobile leg positioner.
In another embodiment, disposable sterile, or non-sterile, fluoroscopic grid-drape for use intraoperatively, independent of, within, or as an integral part of C-arm drape/sleeve/cover, to determine angulation and alignment of implants and/or limbs is provided.
In another embodiment, disposable sterile, or non-sterile, fluoroscopic grid having the ability to attach to the C-arm image intensifier by means of any method, such as magnets, suction cups/devices/tapes, clamps, and straps is provided. This includes method of grid attachment to the C-arm image intensifier or any other plate/sleeve/apparatus using adhesives of any type.
In another embodiment, use of radiopaque ink methods and technology to print a grid pattern for use in any musculoskeletal surgical procedure are provided. The radiopaque ink printing can be applied to any suitable and appropriate substrate.
All designs and embodiments include sterile/non-sterile, and disposable/non-disposable applications.
The drawing shows schematically a fluoroscopic alignment plate apparatus and method of use according to an example form of the present invention. The invention description refers to the accompanying drawings:
The present invention may be understood more readily by reference to the following detailed description of the invention. It is to be understood that this invention is not limited to the specific devices, methods, conditions or parameters described herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the claimed invention. Also, as used in the specification including the appended claims, the singular forms “a,” “an,” and “the” include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” or “approximately” one particular value and/or to “about” or “approximately” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another embodiment.
These and other aspects, features and advantages of the invention will be understood with reference to the detailed description herein, and will be realized by means of the various elements and combinations particularly pointed out in the appended claims. It is to be understood that both the foregoing general description and the following detailed description of the invention are exemplary and explanatory of preferred embodiments of the inventions, and are not restrictive of the invention as claimed. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.
The present invention, provides an apparatus and method for determining and measuring leg length, offset, and cup position during arthroplasty surgery by using a radiolucent dimensioned grid plate positioned under the patient in conjunction with X-ray to measure surgical variables, such as, hip implant position to determine the relative leg length and offset measurements for the implant. Arthroplasty surgery includes, for example: hip (anterior approach), hip (posterior approach), knee, ankle, elbow, and shoulder. The present invention includes an embodiment for trauma applications. Trauma surgery includes any and all bone fractures.
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In this radiolucent dimensioned grid plate 1, two grid lines form a V and are angled at 45 degrees to the vertical and horizontal. In this dimensioned grid plate 1, these two lines represent a guide 3 for quantifying the abduction angle of an acetabular cup used during an arthroplasty procedure. However, the desired angle for the guide 3 relates to the type of implant. Metal on metal implants use a 40 degree angle of abduction, while polyethylene based articular surfaces use a 45 degree angle. The left half side of the radiolucent dimensioned grid plate apparatus 19 is a mirror image of the right hand side. The radiolucent dimensioned grid plate 1 can have the following radio opaque markings (any and all methods of etching or marking): Two 45 degree angled radio opaque guide lines 3; two elliptical etchings which represent the proper version of the acetabular component 8 adjacent and cephalad to the 45 degree lines with a distance of approximately 19 cm from the apex of the two 45 degree lines (correlates to average standardized measurements of human pelvis between the radiolucent lines representing the quadrilateral surface, the roof of the obturator foramen, and the fossa acetabulae (the “teardrop”)); numbers representing the vertical lines with zero being the midline and the numbers counted off in both medial and lateral directions from zero 10; letters of the alphabet on both sides of the grid representing the horizontal (x-axis) 9; and an image of an anatomical feature, such as a pelvis outline. All these grid lines and markings guide the physician in defining the orientation for insertion of the implants and specifically determining and measuring leg length, offset, cup placement, and femoral head center of rotation and mechanical axis of lower limb.
The radiolucent dimensioned grid plate 1 can be enclosed on either side in an epoxy resin that is both transparent and with a plurality of support plates 4 to form the radiolucent dimensioned grid plate apparatus 19. The epoxy creates a complete seal for the metal to prevent corrosion and support cleanability of the radiolucent dimensioned grid plate apparatus 19. Other manufacturing processes known to those skilled in the art include: laser etched: etched, then filled with radio-opaque marker in etched negative areas, then sandwiched; molded: with metal on support plates 4; using tungsten as the radio-opaque material for use in grid lines and numbers; sandwich deposition: printing process (like circuit boards); CNC Machined: back filled and radio-opaque decal: use of radio-opaque ink placed on support plates 4.
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The slot 13 is configured with scalloped sides or edges that allow the radiolucent dimensioned grid plate 1 to be indexed at a plurality of positions. The central axis pin 11 has a central axis pin groove 21 about which the radiolucent dimensioned grid plate 1 will rotate. The central axis pin groove 21 will further have a series of countersunk grooves 22 for engagement of spring-loaded ball 23 (for location of rotational position of the dimensioned grid plate 1 relative to the outer support plates. Furthermore, the radiolucent dimensioned grid plate 1 translates in a medial lateral direction along the central axis pin 11. This translational movement is achieved by utilizing countersunk grooves 26 with a spring-loaded device (SLD) 24 having a uniform groove and countersunk slot configuration. The indexing is accomplished by a translation/rotational mechanism 25. The central axis pin 11 has the ability to translate along the medial-lateral slot 13 and engage in any one of a series of positions in the medial lateral direction. This is accomplished by having a plurality of spring-loaded device 25 used in conjunction with a plurality of corresponding countersunk slots 26. This rotation is accomplished by the configuration of the medial lateral slot 13.
The slot 13 is made of a plurality countersunk grooves 26 that are configured to retain the central axis pin 11. Additionally, the surface opposite 30 one of the plurality of countersunk grooves 26 is configured to retain a spring-loaded device 24. A plurality of spring-loaded devices 24 mediate the movement of the radiolucent dimensioned grid plate 1. The spring-loaded device 25 releasably holds the central axis pin 11 in the selected scalloped or notched position. The engagement/disengagement position and force will be determined based upon spring-loaded device holding capacity. The central axis pin 11 can be fluted longitudinally 22 which allows a rotational detent action as the patient (on the radiolucent dimensioned grid plate apparatus 19) is rotated in the horizontal plane about the central axis pin 11.
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The dimensioned grid plate apparatus 19 can also be used for an anterior approach procedure. The Hilgenreiner's line 31 is a line drawn horizontally through the superior aspect of both triradiate cartilages. It should be horizontal, but is mainly used as a reference for Perkin's line and measurement of the acetabular angle.
The radiolucent dimensioned grid plate apparatus 19 has an extension in the caudad direction that has enough distance to allow the grid to lock onto the operating room table 72 and then also ensure that the radiolucent dimensioned grid plate apparatus 19 is directly behind (posterior) the patient's 27 pelvis. The extension piece has a slot or cut out 5 that matches the diameter of the peg (not shown) on the operating room table 72 that is being used. The peg (not shown) is fixed to the table and so by locking the peg to the plate there will be no motion of the radiolucent dimensioned grid plate apparatus 19 relative to the patient 27 during the surgery. In testing that was performed, tables that are conducive to the direct anterior approach were used. The radiolucent dimensioned grid plate apparatus 19 and method can be used on any radiolucent operating room table.
For a posterior surgical approach,
Leg length: In quantifying leg length discrepancy, the patient's anatomical landmark(s) can be geometrically dimensioned relative to the grid lines. For example, points on the grid line drawn through the bottom of the ischium may be viewed as points on the grid marked along the H grid line. The proximal aspect of the left and right lesser trochanters may be viewed as points on the grid marked as G3 and F3 respectively.
The distance measured counting or using the grid squares between the ischial axis grid line and the respective two lesser trochanter points (G3 and F3 for example) is the leg length discrepancy. Alternatively, a surgeon's preference may be to use points on the grid marking the greater trochanter in conjunction with the grid lines through the obturator foramina.
Offset. The offset of the femoral component is the distance from the center of rotation of the femoral head to a line bisecting the long axis of the stem: In a similar technique to leg length, offset can be quantified. Corresponding radiographic points identified on the patient's left and right pelvis and proximal femur can be measured with the grid lines and blocks. The difference between the left and right measurements will quantify the offset mismatch and provide the surgeon with a numerical number to allow restoration of proper offset.
Pelvic Acetabular Implant commonly referred to as the “cup”: The optimal position of the acetabular component can be determined using the radiolucent dimensioned grid plate apparatus 19 as an alignment and measurement device. The radiolucent dimensioned grid plate apparatus 19 has a 45 degree angled metal line 3. The radiographic image will display the trial or final implanted acetabular cup positioned in the acetabulum relative to the 45 degree guide line 3 that will be superimposed on the image. The cup position can then be adjusted based upon image feedback until correct positioning of the final implant is determined.
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The Y axis 35 is the center line that creates a mirror image of grid and reference lines on either side of it, thus allowing use for either a left or a right leg application 49 marks the center of the femoral head location. The proximal pelvic section of the device also has two 45 degree lines that intersect at the center of the femoral head point 49. These same lines can also be used to quantify femoral neck angle 51. The knee section 48 is made of a grid pattern matching that of radiolucent dimensioned grid plate apparatus 19. Similarly, the ankle section 47 is made of a grid pattern matching that of radiolucent dimensioned grid plate apparatus 19. The knee section has a central x-axis 42. Similarly, the ankle section 47 has central x-axis 43. The knee grid section 48 has two 3 degree lines 46 for use in quantifying alignment as needed.
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In another embodiment, deformity correction works much the same as the trauma description above. An existing deformity is evaluated against the patient's contralateral side. The radiolucent dimensioned grid plate apparatus 19 is used to ensure that the bone length and alignment correlate to the contralateral side. The radiolucent dimensioned grid plate apparatus 19 allows the surgeon to evaluate whether the osteotomy is sufficient to correct alignment and/or length intraoperatively, as well as making it visually easier to plan a correction procedure by using the grid to obtain pre-operative radiographs (i.e., surgeon does not have to draw his own lines and angles on plain radiographs to try to determine the appropriate amount of bone to remove and/or cut and re-angle).
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The same protocol can be followed in a non-sterile environment before, during, and/or after any surgical event. The combination of the radiolucent grid 100 within a sterile pouch, bag, or container 104 is referred to as the grid plate assembly 106. The radiolucent dimensioned grid plate assembly 106, in one embodiment, is positioned on top of a patient 27. The surgeon can move the radiolucent dimensioned grid plate assembly 106 as fluoroscopic images are taken. The radiolucent dimensioned grid plate assembly 106 can be adjusted intraoperatively.
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More specifically, in a sterile environment during any surgical procedure, a radiolucent grid 100 is incorporated into a sterile disposable C-arm sleeve, pouch, bag, cover, or container 104. The sterile sleeve, pouch, bag, cover, or container 104 can be manufactured of any suitable material, such as high density polyethylene or low density polyethylene. The sleeve, pouch, bag, container 104 can be sealed with the radiolucent grid 100 enclosed within to form a radiolucent grid assembly 106. The radiolucent grid assembly 106 can be integrated into the sleeve, pouch, bag, cover, or container 104 and placed over the C-arm image intensifier 162 in a standard sterile manner in preparation for C-arm use. The same protocol can be followed in a non-sterile environment before, during, and/or after any surgical event.
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The dimensioned grid mat 122 is manufactured of foam or any operating room table material that adheres to patient comfort and safety standards. The dimensioned grid mat 122 may be fixed or connected to the substrate such as operating room table 127, by any method and device to ensure secure fastening and locking of the dimensioned grid mat 122 to the operating room table 127. This may include straps, VELCRO (Velcro Industries B.V.) screws, tie-downs, clamps, and any other fixation or holding jig. Further, this dimensioned grid mat 122 includes any and all geometries of operating room table designs. The dimensioned grid mat 122 may be perforated with a plurality of apertures 123 in any pattern that is conducive to allow positioning of the patient by using positioning devices 124 of any geometry. In this embodiment, at least one aperture 123 in the grid 122 is sized to receive or accommodate a positioning device 124. The positioning device 124 projects above the top surface 128 of the mat and is configured to maintain the position of the subject relative to the radiolucent grid 100 or grid mat 122. There is a central post 135 of the operating table
The plurality of positioning devices 124 can be used to facilitate the positioning of the radiolucent grid 100 relative to the patient 27. The positioning device 124 are rods or tubes that allow for appropriately positioning and holding the patient 27 securely to allow for accurate imaging and visualization of the patient 27 anatomy relative to the operating room table 127 and dimensioned grid mat 122.
The positioning device 124 can be added to an aperture 123 configured to receive the positioning device 124 or in an alternative embodiment the aperture 123 is configured to accommodate the positioning device 124 and the positioning device 124 is attached to the grid and telescopes out of the aperture 123.
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In another embodiment, a plurality of pegs 145 can be used to prevent a pelvic collapse during surgery and to maintain pelvic area centered on the operating room table 127, while non-supported parts allow for collapse to help with the stability and comfort. The plurality of pegs 145 can be adjusted to accommodate width and the height of a patient's pelvis. A plurality of pegs 145 can be used to position a flap 147 configures to form a raised area that can stabilize or immobilize a body part during surgery.
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Use of radiopaque ink methods (pad, sheet printing) and technology (medical inks, metal inks, tungsten inks), or templating and stenciling methods, to print a grid pattern with surgical variables for use in any musculoskeletal surgical procedure-particularly, hip replacement, shoulder replacement, knee replacement, and all bone fracture reductions for example a tibial plateau fracture is shown. The radiopaque ink printing is applied to any suitable and appropriate substrate such as acrylic, polycarbonate, polypropylene, or polyethylene materials.
Clinical Study Example: This retrospective cohort study reviews postoperative radiographic findings of 160 consecutive primary total hip athroplasties performed through an anterior supine approach with the aid of intraoperative fluoroscopy. The control group was 100 total hip athroplasties performed without the radiolucent dimensioned grid plate apparatus 19. The study group was 54 total hip athroplasties performed with the use of the radiolucent dimensioned grid plate apparatus 19 to aid in assessing acetabular component inclination, femoral offset, and leg length. Femoral offset, component abduction and leg length differences were measured by two readers blinded to the group status. Surgeon aims included an inclination angle of 40-45 degrees and a leg length and offset equal to the contralateral side. Additionally, the two groups were assessed for differences in demographics and clinical outcomes including complications such as dislocation and symptomatic leg length discrepancy.
Results: Inclination angle averaged 42 degrees (SD 1.5 degrees) for the grid group compared to 45 degrees (SD 4 degrees). Femoral offset averaged +1.5 mm (SD 1 mm) compared to the contralateral side for the grid group compared to −1 mm (SD 3 mm) for the control group. Leg length differences averaged +1.5 mm (SD 1 mm) compared to the contralateral side for the grid group compared to −1 mm (SD 3 mm) for the control group.
There were no statistically significant differences in age, gender, BMI or dislocation rate between groups. However, the group using the dimensioned grid plate apparatus 19 had a lower rate of symptomatic leg length discrepancy than the control group.
Conclusions. While intra-operative use of fluoroscopy to guide femoral offset, leg length and acetabular inclination is helpful, a radiopaque guide with abduction angle references can be helpful to improve precision and accuracy in accomplishing the orthopedic surgeon's goals.
While the invention has been described with reference to preferred and example embodiments, it will be understood by those skilled in the art that a variety of modifications, additions and deletions are within the scope of the invention, as defined by the following claims.
Claims
1. A surgical positioning system comprising:
- a radiolucent grid having a plurality of dimensioned radio-opaque lines corresponding to surgical variables and a substrate connect to or integral with the radiolucent grid.
2. The system of claim 1 wherein the substrate is selected from the group of: an operating room table mat, operating room table, a mobile positioning device and a surgical drape.
3. The system of claim 1 wherein the substrate is an operating room table mat and said grid is integrated into said operating room table mat to form a dimensioned grid mat, said dimensioned grid mat having at least one aperture in a top surface sized to accommodate a positioning device, said positioning device sized to project through and above said top surface of the dimensioned grid mat, wherein the position of a subject on said mat can be maintained in a selected position with said at least one positioning device.
4. The system of claim 3 further comprising an operating room table with a top surface, wherein said grid is adjacent to said operating room table top surface.
5. The system of claim 1 wherein the substrate is an operating room table and said grid is integrated into said operating room table to form a grid table assembly.
6. The system of claim 5, wherein the said operating room table mat includes at least one aperture in a top surface sized to accommodate a positioning device, said positioning device sized to project through and above said top surface of the operating room table mat, wherein the position of a subject on said surface of the grid table assembly can be maintained in a selected position with said at least one positioning device.
7. The system of claim 5, wherein the assembly further comprises at least one internal positioning peg contacting the operating room table and the operating room table mat to from a raised area configured to stabilize a body part of the subject.
8. The system of claim 1 wherein the substrate is a mobile positioning device and further comprises a leg holder device configured to hold a subject's leg in place during surgery.
9. The system of claim 1 further comprising an apparatus to facilitate the positioning of said grid relative to a subject, wherein said grid comprises a plurality of support plates configured to retain said grid, and wherein the apparatus to facilitate the positioning of said grid is a medial-lateral slot in said plate; and a central axis pin connected to at least one of said plurality of support plates, wherein said medial-lateral slot is configured to retain a central axis pin and to allow medial-lateral translation of the grid plate relative to a horizontal line of said support plates and to rotate around the axis of said central axis pin wherein the medial-lateral slot is comprised of a plurality countersunk grooves that are configured to retain said central axis pin.
10. An apparatus comprising:
- a radiolucent grid having a plurality of dimensioned radio-opaque lines relating to surgical variables and a sealable radiolucent container sized to receive the grid.
11. The apparatus of claim 10 wherein said container is a C-arm cover.
12. A method to obtain subject specific data from an image of a subject obtained during a surgical procedure comprising:
- providing a radiolucent grid having a plurality of dimensioned radio-opaque lines corresponding to surgical variables and a substrate connect to or integral with the radiolucent grid;
- placing the subject on a substrate; and
- obtaining subject specific data from an image of said subject.
13. The method of claim 12 wherein said wherein the data consists of: a leg length, an off-set and a cup position; and further comprising the step of adjusting the placement of a prosthetic device during an arthroplasty based on the subject specific data.
14. The method of claim 12 further comprising the steps of placing the radiolucent grid having a plurality of dimensioned radio-opaque lines relating to surgical variables in a sealable radiolucent container sized to receive the grid to form a grid assembly; and positioning said grid assembly over the C arm intensifier of an X-ray machine.
15. The method of claim 12 wherein the data consists of: obtaining of a “Y” axis corresponding to an anatomical axis of said subject and an “X” axis corresponding to an angle related to an abnormality, and further comprises the step of adjusting the orthopedic abnormality based on the subject specific data.
16. The method of claim 12 wherein said “x” axis is selected from the group consisting of: a proximal femoral angle, a lateral distal femoral angle, a medial proximal fibular angle and a distal tibial angle.
17. A method to print a radio-opaque grid pattern on a radiolucent substrate comprising:
- printing a radio-opaque dimensioned grid corresponding to surgical variables on a radiolucent substrate.
18. The method of claim 17 wherein the surgical variables are selected for the group consisting of: specific reference angles, length, positioning or targeting.
19. The method of claim 17 wherein said substrate is a surgical drape.
Type: Application
Filed: Feb 17, 2014
Publication Date: Dec 10, 2015
Applicant: OrthoGrid Systems, LLC (Boise, ID)
Inventors: Erik Noble Kubiak (Salt Lake City, UT), Colin Edward Poole (Boise, ID), Richard Boddington (Austin, TX), Edouard Saget (Boise, ID)
Application Number: 14/181,887