Abstract: The invention relates to a method for surgical application of a glenoid anchor of a shoulder joint prosthesis and instruments advantageously used in the method. The method includes making a delto-pectoral incision providing a delto-pectoral access to a shoulder joint; with the delto-pectoral access being suitable for inserting at least one machining tool; and making a trans-deltoid incision providing a trans-deltoid access to the humeral head; with the trans-deltoid access being suitable for inserting a stem of a machining instrument to be mounted on the machining tool for machining the glenoid cavity.

Abstract: A decompression device and method for removing marrow and other fluid from an intramedullary canal. The decompression device includes a cannula having a channel that allows fatty marrow to pass therethrough. A first port extends from the device and is in operable connection to a vacuum source that creates suction for removing fluid from the intramedullary canal. In some embodiments, one or more fenestrations are disposed along the second end of the cannula to expedite the removal of the fluid. In operation, the cannula is inserted into the intramedullary canal of a femur. Once fatty marrow is removed from the intramedullary canal, the cannula is removed and a reaming device is inserted into the femur. In this way, the fatty marrow is removed prior to the reaming procedure in order to prevent these fluids from traveling to the lungs causing blockage that leads to severe cardiorespiratory and vascular dysfunction.

Abstract: The present invention relates to an osseous pin (1) for bone fracture fixation. The pin comprises a threaded front section (2) and an unthreaded rear section (3). The threaded front section is configured with two or more kerfs (4) to facilitate breaking of the pin at any one of said kerfs. The present invention also relates to a guide sleeve for use in insertion of the osseous pin (1) into bone fragments at a bone fracture and breaking of said pin at the kerf (4) closest to the entrance site of the pin into the bone fragments. The present invention also relates to an extraction member for use in extraction of the osseous pin (1) from bone fragments at a healed bone fracture and a kit, comprising said components.

Abstract: A tool for use with a surgical robotic manipulator that comprises an energy applicator including a shaft extending along an axis between a proximal end and a distal end. The shaft has a retention surface and an ejection surface. A tool assembly comprises a support structure to support the energy applicator and an axial connector assembly arranged to engage and releasably lock the energy applicator to the support structure in a locked state via the retention surface. The tool assembly is also configured to apply an ejection force to the energy applicator to provide a tactile indication to the user that the energy applicator is not fully engaged by the axial connector assembly if a suitable force is not provided by the user to overcome the ejection force and place the energy applicator in the locked state.

Abstract: A system (200) and method (600) for identifying cutting tools for use during a surgical procedure are described. For example, the system includes a cutting tool assembly (210) including a shaft (212) having a cutting element (214) and at least one identifying feature (216) that uniquely corresponds to the cutting element. The system further includes a drive assembly (220) including a reference pin (224), a motor (230) mechanically connected to the drive assembly, a control unit (240) configured to activate the motor to move the cutting tool assembly such that the reference pin engages with the at least one identifying feature, a sensor system (226) configured to determine positioning information related to the reference pin when the reference pin engages the at least one identifying feature, and a computing unit (250) configured to receive the positioning information from the sensor system and identify the cutting element based upon the position information.

Abstract: Embodiments of the invention include an orthopedic milling machine for preparing a glenoid bone. The milling machine uses a hub and a sleeve. The hub includes reliefs arranged to cut or mill the bone and the sleeve couples to the hub to transfer rotational motion to the hub. The hub has an axial bore sized to receive an orthopedic guide pin. The hub also has a lateral passage slot that allows the hub to move laterally towards the guide pin in order to place the guide pin within the axial bore.

Abstract: An electrosurgical probe includes an elongated shaft assembly having a proximal end, a distal end, and a longitudinal axis. A distal housing is mounted on the distal end of the shaft and optionally includes a laterally open window where a plane of the window is generally perpendicular to the longitudinal axis of the shaft. An interior channel extends axially through the shaft and further through an interior of the housing to the window in the housing. An electrode member with a serrated or other elongated edge may extend longitudinally across the window and may be configured to reciprocate the elongated edge longitudinally relative to the window.

Abstract: A bone removal device, including: an elongated shaft having a longitudinal axis, a distal end and a proximal end; a bone borer having a distal drilling tip configured to drill into a bone tissue and at least one proximal reamer, wherein the bone borer is movably coupled to a distal end of the elongated shaft, wherein the bone borer is configured to move between a drilling state in which the drilling tip is placed in contact with bone tissue, and reaming states in which the at least one proximal reamer is placed in contact with the bone tissue.

Abstract: A flip cutter and drill instrument and method of antegrade drilling and retrograde cutting using such an instrument. The flip cutter and drill instrument is provided with a drill which has a multi-blade configuration and which engages an inner tube or inner member of the instrument to articulate between at least a first “straight” position (for example, about parallel to the longitudinal axis of the instrument) when the instrument is in the drilling mode, and at least a second “flip” position (for example, a non-parallel position relative to the longitudinal axis of the instrument) when the instrument is in the cutting mode.

Abstract: The present invention relates to a negative pressure wound closure system and methods for using such a system. Preferred embodiments of the invention facilitate closure of the wound by preferentially contracting to provide for movement of the tissue. Preferred embodiments can utilize tissue grasping elements to apply a wound closing force to the tissue.

Abstract: This disclosure relates to assemblies and methods for repairing bone defects. The assemblies disclosed herein may be utilized for determining a dimension of a surgical site and removing bone prior to positioning a graft and/or implant at the surgical site.

Abstract: A surgical rotational cutting tool, a surgical kit and a method of preparing a femur to receive a stem of a femoral prosthetic. The tool includes a longitudinal axis and a shaft extending along the longitudinal axis, which has a proximal end and a distal end. The tool also includes a head located at the distal end of the shaft. The head includes a pointed distal tip, a bone contacting outer surface having a portion which curves inwards toward the longitudinal axis as it approaches the tip, and a plurality of flutes. The edges of distal parts of neighboring pairs of the flutes meet to define a plurality of cutting edges which extend proximally from the pointed distal tip. A proximal part of each flute extends proximally across the curved portion.

Abstract: Cranial perforator (1) comprising a rotating element (10) capable of being fixed to a driving element, a first drill-head (20) and a second drill-head (30), clutch means (50) disposed on the first drill-head (20) and the rotating element (10) means of disengagement (60) from a engaged position of the first drill-head (20) to an idle position of the first drill-head (20) and a casing (40) fixed at one of its extremities to the rotating element (10) and partly encasing the second drill-head (30).

Abstract: Disclosed is a guide for a flexible bone drill, including: a first body provided internally with a through channel; a second, internally hollow body, into which said first body can be inserted; said second body being provided with a through hole suitable to be placed in fluidic connection with the internal through channel of said first body; and said second body and said first body sliding relative to one another to vary the relative position of the hole with respect to said through channel. Other aspects are described and claimed.

Abstract: According to one example, a for revision knee arthroplasty is disclosed. According to this example, the method can include shaping a bone of a patient to create one or more recesses therein, selecting a stem provisional, disposing the stem provisional within the one or more recesses, and assembling in vivo the stem provisional with both a first provisional component configured to simulate a shape of one of a tibial tray implant or a femoral implant and a second provisional component configured to simulate a shape of at least one of a sleeve component, a cone component or a keel component of an implant.

Abstract: A patient matched instrument is disclosed. The patient matched instrument includes a body having an interior patient matched surface; a cutting slot extending through at least a portion of the body; a first paddle extending from the body; and a second paddle spaced apart from the first paddle and extending from the body; and wherein at least one of the first paddle and the second paddle further comprises a hook.

Abstract: A ventricular guide for ventriculostomy which includes a curved base plate, an upstanding support member which extends upwardly from the base plate and an upper support member which extends transversely from the upper end of the upstanding member. A first tubular guide, having a bore extending therethrough, is secured to one end of the upper support member. A second tubular guide, having a bore extending therethrough is secured to the other end of the upper support member. The bores of the tubular guides may have a drill bit, needle or catheter extending downwardly therethrough.

Abstract: A revision is performed on a bone. A first cutting tool is placed over a rod inserted into the bone such that the rod extends through a cannula of the first cutting tool. The inserted rod is curved within the bone. A hole is formed in the bone with the first cutting tool placed over the curved rod.

Abstract: A system for decorticating at least one bone surface includes an elongated soft tissue protector, an elongated drive shaft and a cutter. The elongated soft tissue protector has a bore extending therethrough. The bore has a non-circular lateral cross-section, a maximum lateral extent and a minimum lateral extent. The cutter may be located on or near a distal end of the drive shaft. The cutter has a non-circular lateral cross-section, a maximum lateral extent and a minimum lateral extent. The maximum lateral extent of the cutter is greater than the minimum lateral extent of the bore but is no greater than the maximum lateral extent of the bore. The bore of the soft tissue protector is configured to slidably receive the cutter therethrough. Other systems and methods for decorticating at least one bone surface are also provided.

Abstract: A surgical positioning system including a rotation guide slide and a rotation guide pointer configured to be coupled to the rotation guide slide. The rotation guide pointer includes a base and a pointer extension. The base includes protrusion and a hole extending through the base and the protrusion where the protrusion is sized and configured to be received within a channel such that the rotation guide pointer can translate parallel to a plane defined by the first side of the rotation guide slide. The hole is sized and configured to receive a screw to fix the position of the rotation guide pointer relative to the rotation guide slide, with the protrusion configured to expand when the screw is advanced in the hole.

Abstract: Various surgical devices and methods are disclosed herein. Also disclosed is multi-component prosthesis, which can be used as an ankle prosthesis. One of the disclosed surgical alignment systems includes a guide arm, a ratchet arm frame configured to be coupled slidably to the guide arm, a ratchet arm configured to be coupled to the ratchet arm frame, and a sagittal sizing guide body configured to be coupled to the ratchet arm. The sagittal sizing guide body includes a first radiopaque object disposed at a first position and a second radiopaque object disposed at a second position that is spaced apart from the first position.

Abstract: An all-suture suture anchor system includes an all-suture anchor, an inserter, and a specially designed drill. The drill is used to enlarge the hole and create a pocket under the bone surface from the pre-drilled hole. The created pocket is intended to accommodate the expansion of the anchor when deployed into the bone, generating a true mechanical interference under the bone surface. The anchor is loaded on the inserter and placed at full length vertically inside the drilled hole. While holding the inserter on top of the drilled hole, so that a feature on the inserter keeps the anchor to a desired depth below the bone surface, tension is applied to the suture limb that is connected to the bottom end of the anchor. This tensioning step causes the length of the anchor to contract vertically and the anchor is simultaneously expanded circumferentially to fill the pocket previously created by the drill.

Abstract: Disclosed are improved orthopedic tools and methods for use during orthopedic surgical procedures, including joint arthroplasty and joint replacement procedures. More specifically, disclosed herein are improved apparatus for preparing bone and/or soft tissue of the spine and/or other regions for implantation of intervertebral implants.

Abstract: Various torque-limiting surgical driver devices, systems, and methods are disclosed. The surgical driver can include a body, a motor that is configured to rotate a drill bit engaged with the surgical driver, and a processor configured to control operation of the surgical driver. The surgical driver can have torque-limiting functionality, such as by monitoring the amount of torque applied to a drill bit and reducing or stopping rotation of the drill bit when certain torque-limiting criteria are met.

Abstract: A locator-pin for positioning a pedicle screw in a bone, comprising a pin body, a distal portion comprising a trocar tip shaped to penetrate a bone by pressing and/or percussing and a proximal portion equipped with a first fixing member to fix, during use, to an insertion pin-carrier and a second fixing member to fix, during use, to a removal pin-carrier, the two fixing members being different, wherein the first fixing member is able to transmit at least an axial push parallel to an axis of a locator-pin, and the second fixing member is able to transmit at least an axial draw parallel to the axis of the locator-pin and at least one sense of rotation around the axis of the locator-pin. Systems comprising the locator-pin and methods of recovering a positioned locator-pin.

Abstract: The present invention provides a handheld robot for orthopedic surgery and a control method thereof. The handheld robot of the present invention includes a main body, a grip, a kinematic mechanism, a tool connector, a tool, a force sensor and a positioning unit. The handheld robot of the present invention combines the position/orientation information of the tool acquired by the positioning unit with the force/torque information acquired by the force sensor, and utilizes the combined information to adjust the position of the tool so as to keep the tool within the range/path of a predetermined operation plan. In this way, the precision of the orthopedic surgery can be enhanced, and the error occurred during the surgery can be minimized.

Abstract: An orthopedic trial apparatus (100) including an orthopedic component (110) having a distal shaft portion (112) positionable within a passage in a bone and a proximal shaft portion (114) extending from the distal shaft portion, and a proximal trial assembly (120) engaged with the proximal shaft portion of the orthopedic component. The proximal trial assembly includes a proximal spacer (130) component and a proximal trial component (150). The proximal spacer component is rotationally engaged with the proximal shaft portion of the orthopedic component to substantially prevent relative rotation therebetween about a longitudinal axis. The proximal trial component is axially coupled to the proximal spacer component to prevent disengagement of the proximal trial component from the proximal spacer component while permitting selective rotation of the proximal trial component relative to the proximal spacer component about the longitudinal axis.

Abstract: A medical device is disclosed for cutting an object in a body lumen, including: a rotatable drive shaft; and a rotatable rotation structure which is connected to the drive shaft, the rotation structure including: a proximal portion; a distal portion; and a constricted portion provided between the proximal portion and the distal portion, the constricted portion including: a first tapered portion which includes a first cutting portion and decreases in diameter toward the distal side; a second tapered portion which includes a second cutting portion and decreases in diameter toward the proximal side; and a bottom portion which is provided between the first tapered portion and the second tapered portion.

Abstract: An orthopaedic reamer includes a shell and a cutting tooth arrangement formed in the shell. The cutting tooth arrangement includes a cutting tooth having a predefined profile with a cutting edge having a cutting depth, and a depth-of-cut feature positioned forward of the cutting tooth, relative to a direction of movement of the shell at the location of the cutting tooth. The depth-of-cut feature has a control depth which controls a cutting depth of the cutting tooth during surgery.

Abstract: A kit (4000, 5100) including a guiding system and a cannulated bone material removal device, the bone material removal device (4004, 5200) having a longitudinal shaft (4024, 5202) and comprising on the longitudinal shaft a radially expandable cutting portion (4028, 5208) having a longitudinally-oriented cutting edge (2124), the radial expansion comprising an increase of a cross-sectional diameter of the bone material removal device at the longitudinal position of the expandable cutting portion; and the guiding system including an arcuate element (4008, 5102), a guiding element (4010, 5104) configured to be attached to the arcuate element, and a cannula (4002, 5106), slidably insertable into a portion of the arcuate element; wherein the bone material removal device is axially displaceable within said cannula. The kit can be used in anterior cruciate ligament (ACL) reconstruction.

Abstract: A robotic system and methods for performing spine surgery are disclosed. The system comprises a robotic manipulator with a tool to hold a screw and to rotate the screw about a rotational axis. The screw is self-tapping and has a known thread geometry that is stored by a controller. A navigation system tracks a position of a target site. Movement of the robotic manipulator is controlled to maintain the rotational axis of the surgical tool along a planned trajectory with respect to the target site based on the tracked position of the target site. In autonomous or manual modes of operation, the rotational rate of the screw about the rotational axis and/or an advancement rate of the screw linearly along the planned trajectory is controlled to be proportional to the known thread geometry stored in the memory.

Abstract: A system and method for creating a cavity with a drill assembly provides a powered drill shaft assembly having an articulating tip and a position sensor along the drill shaft; a drill motor assembly with a rotational motor, linear actuator, torque sensor, rotation sensor, electrical resistance sensor and a controller unit having a plurality of programs providing user interface and controlling the operation of the powered drill arrangement; a shroud for the drill shaft with a water port; and a computer software package that combines user specifications with sensor data to control activation and displacement of the drill with a user interface, controls the motor for rotational speed and drilling depth, and gives sensor status, and a display displaying status of a drilling procedure and an image from an imaging device, and that is programmable for a set of parameters for a drilling procedure.

Abstract: A bone harvester and bone marrow removal system. The bone harvester can include a body defining a channel extending longitudinally therethrough from a distal to a proximal portion of the body. The distal portion can include a cutting tip. Bone marrow may be drawn through the channel.

Abstract: A drill bit (100) having a longitudinal axis (101) and to be rotated about the axis (101) in a drilling direction (102) to perform a drilling operation. The drill bit (100) comprises a body (120) having a longitudinal length with a proximal end (121) and a distal end (122). The body (120) has a diameter. A tapered tip (110) extends from the proximal end (121) and terminates in an apex (111) at an end of the drill bit (100). The drill bit (100) also comprises a plurality of flutes (140) with each flute (140) extending helically along the body (120) into the tip (110). The drill bit (100) also comprises a land (150) between each of the flutes (140) and extends to the tip (110). The drill bit (100) also comprises a plurality of tip faces (190) on the tip (110) and extends from a corresponding land (150) to the apex (111), where each of the tip faces (190) has a tip face leading edge (173) and a tip face trailing edge (174).

Abstract: Methods and apparatus are disclosed for selecting a lens control mode for a camera in external magnetic fields or other types of non-magnetic interference. In embodiments, when the camera is activated, a test of a position sensor for the camera lens is performed by moving the camera lens through a range of positions and collecting values from the sensor. In embodiments, the sensor readings are analyzed to determine conditions such as (a) whether the sensor is saturated by an external magnetic field or non-magnetic interference, (b) whether the sensor's readings are within an error margin, and (c) whether a computed position offset for the sensor is valid. Based on the analysis, the camera is placed into a first control mode where movement of the lens is controlled using the position sensor, or a second control mode where lens movement is controlled without the position sensor.

Abstract: A reamer shaft extension includes a shaft positioned between a first end having a first coupling and a second end having a second coupling. The first coupling of each reamer shaft extension is selectively couplable with the second coupling of another reamer shaft extension such that a select amount of reamer shaft extensions are assembled together to form a reamer shaft extension assembly for use in a reaming procedure. Each reamer shaft extension further has a sufficiently short enough length such that each reamer shaft extension is insertable within a sterilization tray for use in a sterilization procedure.

Abstract: An orthopedic instrument for knee arthroplasty includes an anterior-posterior sizer assembly, a tensor assembly and a rotation mechanism. The sizer assembly includes a stylus, a sizer body including medial and lateral posterior feet extending substantially perpendicularly from the sizer body, and a sizer slider that can slide relative to the sizer body along a medial-lateral direction relative to a patient's knee. The tensor assembly includes a tensor frame having a central portion, medial and lateral wings extending at an angle from the central portion, and medial and lateral posterior feet extending substantially perpendicularly to the central portion. The rotation mechanism includes a portion coupled to the tensor frame of the tensor assembly and a portion coupled to the sizer body. The rotation mechanism is configured to rotate the medial and lateral posterior feet of the sizer body relative to the tensor frame toward a lateral side of the patient's knee.

Abstract: An actuation system of a transfer case includes a face cam, a motor, a gear reduction assembly, and an intermediate rotating member. The face cam includes a first member and a second member, and rotation of the first member relative to the second annular causes the first member or the second annular member to displace axially relative to the other member for selective operation of a torque transfer mechanism of the torque transfer device. The gear reduction assembly includes a first planetary gear set that increases torque from the motor by a first ratio, and a second planetary gear set that increases torque from the first planetary gear set by a second ratio and is coaxial with the first planetary gear set and the motor. The intermediate rotating member is rotated by the gear reduction assembly and rotates the first annular member for selective operation of the torque transfer mechanism.

Abstract: A medical or dental device for determining a bone's quality by cutting a thread into the bone with a rotating threaded element comprises a control unit having a measurement circuit configured: (i) to determine values of the motor current via a first electrical contact device with which the motor drive is supplied for rotational drive of the threaded element that can be connected to the motor drive, the current values being a measure of the bone's quality; (ii) to monitor and/or to determine the penetration depth of the threaded element into the bone, and (iii) to generate measurement signals which show the relationship between the penetration depth and the determined current values or parameters derived therefrom, and to transmit these signals to a display unit, which displays the relationship between the determined current values or parameters derived therefrom, in particular the bone's quality, and the penetration depth.

Abstract: A method of anchoring soft tissue to a suitable bone site, using a soft suture anchor, includes steps of disposing the soft suture anchor on a shaft of an inserter, and securing a proximal end of a tensioning suture limb, extending proximally from the soft suture anchor, to structure in a handle of the inserter, so that it is maintained in place at a first level of holding tension (Thold). The inserter shaft is inserted into a bone hole at a desired procedural site, so that the soft suture anchor is positioned at a location where it is to be anchored. A further step involves actuating a control mechanism in the inserter handle to move the structure proximally to apply a second level of deployment tension (Tload) to the tensioning suture limb.

Abstract: The present disclosure relates to an arthroscopic resection device. The device includes an outer member including a hub, an inner member including a hub, the inner member housed within the outer member, a tube coupled to the outer member, and means for allowing longitudinal movement of the outer member relative to the inner member, the means coupled to the tube. A method of tissue repair and other arthroscopic resection devices are also disclosed.

Abstract: A posterior cervical fixation system includes a facet lock comprising an elongate member having distal and proximal ends. A tapered wedge projects axially from the distal end and defines a wedge axis, the wedge being sized and configured for insertion into a facet joint of a cervical spine. The facet lock includes opposing first and second dovetail recesses. The system further includes a tubular guide having distal and proximal ends and a lumen extending therethrough along a central axis. The tubular guide has a plurality of dovetail projections extending exteriorly outwardly, each dovetail projection terminating in an engagement surface that is spaced respectively at a different radial distance from the central axis. Each dovetail projection is configured for individual releasable attachment to one of the facet lock first or second dovetail recesses to selectively space the wedge axis and the central axis at different distances for lateral mass screw placement.

Abstract: Apparatus for drilling a hole in material, the apparatus comprising: an angled drill guide comprising a curved distal section, a less-curved proximal section, and a lumen extending therebetween, wherein the less-curved proximal section comprises a flat extending therealong for reducing the effective diameter of the less-curved proximal section so as to minimize interference between the angled drill guide and the side wall of an access cannula.

Abstract: Disclosed are devices and methods for creating a bore in bone. The devices and methods described involve controlling the drive and measuring the drilling energy of a working tool such that a user can avoid injuries to surrounding structures.

Abstract: A modular femoral prosthesis for use during performance of a hip revision procedure includes a proximal body component, a distal stem component, and a locking bolt. Surgical instruments and methods for use in implanting such a modular femoral prosthesis are disclosed.

Abstract: Various implant systems and methods of implantation are disclosed herein. The systems and methods allow a surgeon to accurately determine a suitable fastener trajectory for attaching certain components of the implant system to bone. In this manner, an appropriate fastener trajectory can be selected and used during a surgical procedure to ensure better purchase and attachment of the various components of the implant system to the bone.

Abstract: A surgical method utilizes a cutting blade having a thickness along a cutting edge of between about 0.0005 inch and about 0.020 inch and preferably between about 0.001 inch and 0.010 inch. The blade is moved in contact with relatively hardly tissues which are disposed adjacent to softer tissues at a surgical site in a patient. The blade is ultrasonically vibrated during the moving of the blades, whereby the hard tissue is cut with a modicum of damage being inflicted on the soft tissue.

Abstract: A system is provided for preparing prosthetic hip implantation. The system includes a first broach, a second broach, and a trial neck having a body portion and a neck portion. A proximal end of the first broach comprises a first base having a first maximum area. The body portion can be releasably coupled to the proximal end of the first broach so as to define a first offset between a medial end of the neck portion and a longitudinal axis of the first broach, or releasably coupled to the proximal end of the second broach so as to define a second offset between the medial end of the neck portion and a longitudinal axis of the second broach. The first offset is smaller than the second offset.

Abstract: Examples of robotically controlled planar cutting systems and methods for controlling cutting systems to prepare bone tissue in surgical procedures, are generally described herein. Applicable surgical procedures for the robotically controlled cutting systems and methods include procedures involving the preparation (e.g., removal, surfacing) of bone tissue, such as is performed in knee arthroplasties. In an example, a robotically controlled planar cutting system can include a housing, a cutting element disposed in the housing, and a cutting control mechanism in communication with a robotic controller to control operation of the cutting element to machine a planar surface. The cutting element can be exposed and retracted relative to the housing and can include a plurality of cutting implements arranged to machine the planar surface.

Abstract: A drill guide includes a body, a stabilizing member, a tubular guide sleeve, and an engagement member. The body includes a first channel aligned with a longitudinal axis and a second channel transverse to the longitudinal axis. The first channel is dimensioned to receive the sleeve, while the second channel is dimensioned to receive an engagement member. The engagement member is adapted to move within the second channel between an engaged position, where the engagement member inhibits proximal motion of the sleeve, and a second position, where motion of the sleeve is not inhibited. An alignment member is further mounted to the distal end of the sleeve that includes a distally extending member, spaced from the sleeve. In use, the distally extending member may be employed to exert a force upon a bone or other tissue lateral to the longitudinal axis for improved positioning of the bone or tissue.