# US 10,499,961 B2 · Entry portal navigation > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,499,961 B2 - Document ID: US10499961B2 - Status: Granted - Kind: B2 - Application number: 14/402,448 - Filed: 2012-05-23 - Published: 2015-08-06 - Granted: 2019-12-10 - Earliest claimed: 2012-05-23 - Assignees: Stryker European Holdings I, LLC - Applicants: Bernd Simon; Arno Blau - Inventors: Bernd Simon; Arno Blau - Web page: https://patentgrep.com/patent/US10499961B2 ## CPC - A61B 17/744: {the longitudinal elements coupled to an intramedullary nail} - A61B 34/10: Computer-aided planning, simulation or modelling of surgical operations - G16H 50/50: for simulation or modelling of medical disorders - A61B 17/1725: {for applying transverse screws or pins through intramedullary nails or pins} - A61B 2034/102: {Modelling of surgical devices, implants or prosthesis} - A61B 2034/105: {Modelling of the patient, e.g. for ligaments or bones} - A61B 2034/107: {Visualisation of planned trajectories or target regions} - A61B 2034/108: {Computer aided selection or customisation of medical implants or cutting guides} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA ## Abstract A method and a corresponding device is proposed, for determining a location on a bone surface and for performing a simulation of an insertion of an implant based on the determined location. The simulation may comprise the steps of identifying an implantation axis of the bone in the first image, and aligning a visualization of the implant with the implantation axis, with respect to the determined location. ## Claims ### Claim 1 A method for assisting an insertion of an implant, the method comprising the steps of: determining a location on a bone surface in a first image generated from a first direction by means of an imaging unit; performing a first simulation of an insertion of an intramedullary rod based on the determined location, the first simulation comprising: identifying an implantation axis of the bone in the first image, aligning a virtual visualization of the intramedullary rod with the implantation axis, with respect to the determined location; comparing the positioning of the virtual visualization of the intramedullary rod according to the simulated insertion with an optimal virtual visualization of the intramedullary rod overlaid on the first image on an intended positioning; determining a deviation between the positioning of the virtual visualization of the simulated insertion and the positioning of the optimal virtual visualization of the intramedullary rod; resecting the bone after making a determination that the deviation falls within a predetermined range; and inserting the intramedullary rod into the resected bone at the determined location. ### Claim 2 (depends on 1) The method of claim 1, further comprising the steps of: identifying the location, determined in the first image, in a second image generated based on a bone model showing the bone from a second direction, and performing a second simulation of an insertion of the intramedullary rod based on the identified location, the second simulation comprising: identifying the implantation axis of the bone in the second image, and aligning a virtual visualization of the intramedullary rod with the implantation axis, with respect to the identified location. ### Claim 3 (depends on 1) The method of claim 1, further comprising the steps of: identifying the location, determined in the first image, in a second image generated from a second direction by means of the imaging unit, and performing a second simulation of an insertion of the intramedullary rod based on the identified location, the second simulation comprising: identifying the implantation axis of the bone in the second image, and aligning a virtual visualization of the intramedullary rod with the implantation axis, with respect to the identified location. ### Claim 4 (depends on 1) The method of claim 1, wherein the first simulation further comprises the step of: introducing a virtual visualization of a locking screw which may be implanted in combination with the intramedullary rod, and with respect to a positioning of the intramedullary rod. ### Claim 5 (depends on 1) The method of claim 1, further comprising the step of: if the deviation is within a predetermined range, identifying the determined location as entry point for an insertion. ### Claim 6 (depends on 1) The method of claim 1, wherein the location is automatically determined. ### Claim 7 (depends on 3) The method of claim 3, wherein the second direction is perpendicular to the first direction. ### Claim 8 (depends on 5) The method of claim 5, wherein the intended positioning includes a depth and a rotation of the intramedullary rod relative to the bone. ### Claim 9 (depends on 5) The method of claim 5, wherein the intended positioning includes a length of a locking screw. ### Claim 10 (depends on 1) The method of claim 1, wherein the first image is an X-ray image. ### Claim 11 A method for assisting an insertion of an implant, the method comprising: obtaining a first image of the bone generated from a first direction by means of an imaging unit; determining a location on a bone surface in the first image; performing a first simulation of an insertion of an intramedullary rod based on the determined location, the first simulation comprising: identifying an implantation axis of the bone in the first image, using a virtual visualization of the intramedullary rod at the determined location; obtaining a second image of the bone generated from a second direction by means of the imaging unit; identifying the location, determined in the first image, in the second image based on a bone model showing the bone from the second direction; performing a second simulation of an insertion of the intramedullary rod based on the identified location, the second simulation comprising: identifying the implantation axis of the bone in the second image, aligning a virtual visualization of the intramedullary rod with the implantation axis of the second image, with respect to the identified location; comparing the positioning of the virtual visualization of the intramedullary rod according to the simulated insertion with an optimal virtual visualization of the intramedullary rod overlaid on the first and second images on an intended positioning; determining a deviation between the positioning of the virtual visualization of the simulated insertion with the positioning of the optimal virtual visualization of the intramedullary rod; resecting the bone after making a determination that the deviation falls within a predetermined range; and inserting the intramedullary rod into the resected bone at the determined location. ### Claim 12 (depends on 11) The method of claim 11, wherein at least one of the first and second simulations further comprises: introducing a virtual visualization of a locking screw which may be implanted in combination with the intramedullary rod and with respect to a positioning of the intramedullary rod. ### Claim 13 (depends on 12) The method of claim 12, further comprising: if the deviation is within a predetermined range, identifying the determined location as entry point for an insertion. ### Claim 14 (depends on 11) The method of claim 11, wherein the second direction is perpendicular to the first direction. ### Claim 15 (depends on 3) The method of claim 3, wherein at least one of the first and second simulations further comprises the step of: introducing a virtual visualization of a locking screw which may be implanted in combination with the intramedullary rod and with respect to a positioning of the intramedullary rod. ### Claim 16 (depends on 3) The method of claim 3, further comprising the steps of: wherein the step of determining the deviation includes determining the deviation of the positioning of the intramedullary rod and/or of a locking screw according to a simulated insertion based on the first simulation or based on the first and second simulations from an intended positioning, and if the deviation is within a predetermined range, identifying the determined location as entry point for an insertion. ### Claim 17 A device for assisting an insertion of an implant, the device comprising: a monitor for visualizing an image of a bone; a pointing device including a tip and a shaft for determining a location on a bone surface in the image, which location is a possible entry point, the tip being radiopaque; and a processing unit adapted for performing a simulation of an insertion of an intramedullary rod into the bone with respect to the determined location, the simulation including identifying an implantation axis of the bone in the image, aligning a virtual visualization of the implant with the implantation axis, with respect to the determined location, comparing the positioning of the virtual visualization of the intramedullary rod according to the simulated insertion with an optimal virtual visualization of the intramedullary rod overlaid on the first image on an intended positioning, and determining a deviation between the positioning of the virtual visualization of the simulated insertion and the positioning of the optimal virtual visualization of the intramedullary rod, wherein a visualization of the intramedullary rod is shown in relation to the bone in the image. ### Claim 18 (depends on 17) The device of claim 17, further comprising a database for storing at least one visualization of the intramedullary rod. ### Claim 19 (depends on 18) The device of claim 18, further comprising an imaging unit for generating images of the bone from different directions. ### Claim 20 (depends on 19) The device of claim 19, wherein the image is an X-ray image. ### Claim 21 (depends on 1) The method of claim 1, wherein before the step of inserting, the method further comprises the steps of: determining a second location different from the previously determined location on the bone surface in the first image; performing a second simulation of an insertion of the implant based on the determined second location, the second simulation comprising: identifying a second implantation axis of the bone in the first image, aligning a second virtual visualization of the implant with the second implantation axis, with respect to the determined second location; comparing a the positioning of the second virtual visualization of the implant and/or of a sub-implant according to the second simulated insertion with the optimal virtual visualization of the implant overlaid on the first image on an intended positioning. ### Claim 22 (depends on 11) The method of claim 11, wherein the virtual visualization of the sub-implant according to the simulated insertion protrudes outside of a boundary of the bone surface in at least one of the first and second images.