Method and apparatus for use in operating on a bone

• US 6,086,593 A
• Filed: 06/30/1998
• Issued: 07/11/2000
• Est. Priority Date: 06/30/1998
• Status: Expired due to Term

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Peter M. Bonutti
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): Shai, Daphna
• Application Number:
  US09/109,126
• Time in Patent Office: 742 Days
• Field of Search: 606/79, 606/83, 606/84, 606/85, 606/86, 606/87, 606/69, 606/73, 128/898
• US Class Current: 606/87
• CPC Class Codes: A61B 17/8004 with means for distracting or compressing the bone or bones
• CPC Class Codes: A61B 17/8061 specially adapted for particular bones A61B17/70 and A61B17/74 take precedence
• CPC Class Codes: A61B 17/8095 Wedge osteotomy devices
• CPC Class Codes: A61F 2/30 Joints
• CPC Class Codes: A61F 2/30734 Modular inserts, sleeves or augments, e.g. placed on proximal part of stem for fixation purposes or wedges for bridging a bone defect
• CPC Class Codes: A61F 2002/30108 Shapes

Abstract

The relationship between first and second portions of a bone in a patient'"'"'s body is changed by moving a wedge member into a slot formed in the bone. Force is applied against hard cortical bone by the wedge member. This force pivots the first portion of the bone relative to the second portion of the bone about an axis extending through bone interconnecting the first and second portions of the bone. As the wedge member moves into the bone, a side surface of the wedge member is moved into alignment with an outer side surface of the bone. The wedge member is fixedly connected with the bone. The wedge member is rigid so that the bone can immediately be load bearing. One or more openings may be provided in the wedge member to enable bone to grow through the wedge member. The wedge member may contain a material which promotes growth of bone through the wedge member.

Claims

1. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of moving a central portion of a thin leading edge of a wedge member through a layer of hard cortical bone into engagement with soft cancellous bone with portions of the thin leading edge of the wedge member on opposite sides of the central portion in engagement with the layer of hard cortical bone, continuing movement of the wedge member relative to the bone, interrupting movement of the wedge member relative to the bone with the central portion of the thin leading edge of the wedge member in engagement with soft cancellous bone and with opposite end portions of the thin leading edge of the wedge member in engagement with the layer of hard cortical bone, and, thereafter, transmitting force between the layer of hard cortical bone and the thin leading edge of the wedge member.

2. A method as set forth in claim 1 wherein said step of continuing movement of the wedge member relative to the bone includes moving at least one of the end portions of the leading edge of the wedge member out of engagement with the layer of hard cortical bone and back into engagement with the layer of hard cortical bone.

3. A method as set forth in claim 1 wherein said step of continuing movement of the wedge member relative to the bone includes sliding opposite major side surfaces of the wedge member on the soft cancellous bone and on the outer layer of hard cortical bone with areas on the major side surfaces of the wedge member which engage the soft cancellous bone being disposed between areas on the major side surfaces of the wedge member which engage the hard cortical bone.

4. A method as set forth in claim 1 wherein said step of continuing movement of the wedge member relative to the bone includes effecting relative movement between the first and second portions of the bone under the influence of force transmitted from the wedge member to the layer of hard cortical bone.

5. A method as set forth in claim 1 further including the step of growing bone through openings in the wedge member while the central portion of the thin leading edge of the wedge member is in engagement with soft cancellous bone and the opposite end portions of the thin leading edge of the wedge member are in engagement with the layer of hard cortical bone.

6. A method as set forth in claim 1 wherein said step of transmitting force between the layer of hard cortical bone and the thin leading edge of the wedge member is performed while the spatial relationship between the first and second portions of the bone remains constant.

7. A method as set forth in claim 1 wherein said steps of moving a central portion of the thin leading edge of the wedge member through a layer of hard cortical bone and continuing movement of the wedge member relative to the bone includes moving an opening which extends through the wedge member from a location offset to one side of the soft cancellous bone to a location in which the opening through the wedge member is aligned with the soft cancellous bone to enable soft cancellous bone to grow through the opening in the wedge member.

8. A method as set forth in claim 1 wherein the wedge member includes a pair of opposite major side surfaces which extend between the thin leading edge of the wedge member and a thick trailing edge of the wedge member, said step of interrupting movement of the wedge member relative to the bone being performed with the layer of hard cortical bone being disposed in engagement with the opposite major side surfaces of the wedge member along continuous surface areas which extend between the thin leading edge of the wedge member and the thick trailing edge of the wedge member.

9. A method as set forth in claim 1 wherein said step of continuing movement of the wedge member relative to the bone includes engaging the layer of hard cortical bone at a location ahead of the thin leading edge of the wedge member with a screw and transmitting force through the screw to the wedge member.

10. A method as set forth in claim 1 further including the step of fixedly connecting the wedge member with the layer of hard cortical bone to hold the wedge member against movement relative to the bone.

11. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of forming a slot in the bone to at least partially separate the first portion of the bone from the second portion of the bone, forcing a wedge member into the slot in the bone with a thin edge of the wedge member leading and a thick edge of the wedge member trailing to move the first portion of the bone from a first orientation relative to the second portion of the bone to a second orientation relative to the second portion of the bone, fixedly connecting the wedge member with the bone, and transmitting force between the first and second portions of the bone through the wedge member while the first portion of the bone is in the second orientation and while the wedge member is held against movement relative to the bone.

12. A method as set forth in claim 11 wherein said step of fixedly connecting the wedge member with the bone includes fixedly connecting the wedge member with the first portion of the bone with a first connector and fixedly connecting the wedge member with the second portion of the bone with a second connector after performing said step of forcing the wedge member into the slot in the bone.

13. A method as set forth in claim 11 wherein the wedge member tapers from a thick edge portion to a thin edge portion and has a side edge portion which extends between the thick edge portion and thin edge portion of said wedge member, said step of forcing the wedge member into the slot in the bone includes moving the side edge portion of the wedge member into alignment with the bone.

14. A method as set forth in claim 11 wherein said step of forming a slot includes forming a slot having an opening which is formed in a major portion of the periphery of the bone, said step of transmitting force between the first and second portions of the bone through the wedge member includes transmitting force between peripheral portions of the bone and opposite sides of the wedge member at areas which are coextensive with the opening to the slot.

15. A method as set forth in claim 11 wherein the step of forming a slot includes forming a slot having an opening which extends inward from an outer side surface of the bone, said step of forcing a wedge member into the slot includes moving an outer side surface on the wedge member into alignment with the outer side surface of the bone, said step of fixedly connecting the wedge member with the bone being performed with the outer side surface on the wedge member aligned with the outer side surface of the bone.

16. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of providing a wedge member which tapers from a thick edge to a thin edge and has a side surface which extends from one end of the thin edge, along the thick edge, to an end of the thin edge opposite from the one end, said side surface of said wedge member has a configuration corresponding to the configuration of a portion of an outer side surface of the bone, and moving the first portion of the bone relative to the second portion of the bone by moving the wedge member into the bone to a position in which the side surface of the wedge member is aligned with the outer side surface of the bone.

17. A method as set forth in claim 16 wherein said step of moving a first portion of the bone relative to a second portion of the bone includes applying force to the bone with the wedge member and pivoting the first portion of the bone relative to the second portion of the bone about an axis extending through a portion of the bone interconnecting the first and second portions of the bone.

18. A method as set forth in claim 16 further including the steps of fixedly connecting the wedge member with the first portion of the bone and fixedly connecting the wedge member with the second portion of the bone.

19. A method as set forth in claim 16 wherein the wedge member includes a pair of major surfaces which extend between the thick and thin edges of said wedge member, said side surface of said wedge member extends between said major surfaces of said wedge member, said step of moving the first portion of the bone relative to the second portion of the bone by moving the wedge member into the bone includes applying force against the first and second portions of the bone with the major surfaces of the wedge member.

20. A method as set forth in claim 16 wherein said step of moving the first portion of the bone relative to the second portion of the bone by moving the wedge member into the bone includes engaging the bone with a screw and transmitting force from the screw to the wedge member.

21. A method of changing the relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of forming an opening in the bone at a location between the first and second portions of the bone, moving a wedge member into the opening, said step of moving the wedge member into the opening includes rotating the wedge member about an axis which extends through thick and thin end portions of the wedge member, and pivoting the first portion of the bone relative to the second portion of the bone about an axis extending through bone interconnecting the first and second portions of the bone under the influence of force transmitted from the wedge member to the first portion of the bone as the wedge member is rotated.

22. A method as set forth in claim 21 further including the step of fixedly connecting the thick end portion of the wedge member to the first and second portions of the bone after having performed said step of rotating the wedge member.

23. A method of changing the spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of forming an opening in the bone at a location between the first and second portions of the bone, moving a wedge member which tapers from a thick end portion to a thin end portion into the opening with the thin end portion of the wedge member leading, engaging bone interconnecting the first and second portions of the bone with a screw member, and rotating the screw member relative to the wedge member, said step of moving the wedge member into the opening includes transmitting force from the screw member to the wedge member while rotating the screw member.

24. A method as set forth in claim 23 further including the step of pivoting the first portion of the bone relative to the second portion of the bone about an axis which extends through the portion of the bone interconnecting the first and second portions of the bone under the influence of force transmitted from the wedge member to the first portion of the bone while moving the wedge member into the opening and rotating the screw member.

25. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of applying force against the first and second portions of the bone with a wedge member, moving the first portion of the bone relative to the second portion of the bone under the influence of force applied against the first portion of the bone by the wedge member, and growing bone between the first and second portions of the bone through the wedge member.

26. A method as set forth in claim 25 further including the step of maintaining the wedge member stationary relative to the first and second portions of the bone while growing bone through the wedge member.

27. A method as set forth in claim 25 wherein the wedge member has major side surfaces which engage the first and second portions of the bone and a minor side surface which extends between said major side surfaces, said method further including the step of moving the wedge ember to a position in which the minor side surface of the wedge member is aligned with an outer side surface of the bone during performance of said step of moving the first portion of the bone relative to the second portion of the bone.

28. A method as set forth in claim 25 wherein said wedge member tapers from a thick end portion to a thin end portion, said wedge member being disposed in engagement with hard cortical bone along surface areas which extend between the thin end portion and the thick end portion of the wedge member upon completion of said step of moving the first portion of the bone relative to the second portion of the bone, said step of growing bone between the first and second portions of the bone through the wedge member includes growing hard cortical bone through the surface areas which extend between the thin end portion and the thick end portion of the wedge member.

29. A method as set forth in claim 25 wherein said step of applying force against first and second portions of the bone with a wedge member includes pulling the wedge member into an opening between the first and second portions of the bone.

30. A method as set forth in claim 25 wherein said step of applying force against the first and second portions of the bone with a wedge member includes rotating the wedge member relative to the first and second portions of the bone about an axis which extends through the wedge member.

31. A method as set forth in claim 25 wherein the wedge member tapers from a wide end portion to a thin end portion, said step of growing bone between the first and second portions of the bone through the wedge member includes growing bone through a portion of the wedge member disposed between the wide end portion and the thin end portion of the wedge member.

32. A method as set forth in claim 25 wherein the wedge member tapers from a thick end portion to a thin end portion, said step of applying force against the first and second portions of the bone includes pivoting the first portion of the bone relative to the second portion of the bone about an axis extending through bone interconnecting the first and second portions of the bone with the thin end portion of the wedge member extending parallel to the axis.

33. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of forming an opening in a portion of the patient'"'"'s body tissue to at least partially expose the bone, moving the second portion of the bone relative to the first portion of the bone, said step of moving the second portion of the bone relative to the first portion of the bone includes applying force to hard cortical bone with a wedge member, said step of applying force to hard cortical bone with a wedge member includes applying force to hard cortical bone with a wedge member having a plurality of openings through which bone can grow, closing the opening in the patient'"'"'s body tissue with the wedge member disposed in engagement with the hard cortical bone, and, thereafter, transmitting force between the first and second portions of the bone through the wedge member.

34. A method as set forth in claim 33 wherein said wedge member tapers from a thick end portion to a thin end portion, said wedge member being disposed in engagement with the hard cortical bone along a surface area which extends between the thin end portion of said wedge member and the thick end portion of said wedge member upon completion of said step of moving the second portion of the bone relative to the first portion of the bone and during performance of said step of transmitting force between the first and second portions of the bone through the wedge member.

35. A method as set forth in claim 33 wherein said step of moving the first portion of the bone relative to the second portion of the bone includes pivoting the first portion of the bone relative to the second portion of the bone about an axis extending through bone interconnecting the first and second portions of the bone.

36. A method as set fourth in claim 33 wherein the wedge member is formed of a porous material, said method further includes growing bone through openings defined by the porous material of the wedge member.

37. A method as set forth in claim 33 wherein the wedge member is formed of bone, said method further includes growing bone through openings defined by the bone forming the wedge member.

38. A method as set forth in claim 33 further including the step of providing bone growth promoting material in said wedge member to promote growth of bone through the openings in the wedge member.

39. A method as set forth in claim 33 further including the step of positioning bone growth promoting material in a compartment in said wedge member to promote growth of bone.

40. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of providing a wedge member which tapers from a thick edge to a thin edge and has a side surface which extends from one end of the thin edge, along the thick edge, to an end of the thin edge opposite from the one end, said side surface of said wedge member has a configuration corresponding to the configuration of a portion of an outer side surface of the bone, and moving the first portion of the bone relative to the second portion of the bone by moving the wedge member into the bone to a position in which the side surface of the wedge member is aligned with the outer side surface of the bone, the wedge member has a plurality of openings to enable bone to grow through said wedge member while the side surface of the wedge member is aligned with the outer side surface of the bone.

41. A method as set fourth in claim 40 wherein the wedge member is formed of a porous material, said method further includes growing bone through openings defined by the porous material of the wedge member.

42. A method as set forth in claim 40 wherein the wedge member is formed of bone, said method further includes growing bone through openings defined by the bone forming the wedge member.

43. A method as set forth in claim 40 further including the step of providing bone growth promoting material in said wedge member to promote growth of bone through the openings in the wedge member.

44. A method as set forth in claim 40 further including the step of positioning bone growth promoting material in a compartment in said wedge member to promote growth of bone.

45. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of applying force against the first and second portions of the bone with a wedge member, said step of applying force against first and second portions of the bone with the wedge member includes applying force against hard cortical bone with opposite sides of the wedge member, moving the first portion of the bone relative to the second portion of the bone under the influence of force applied against the first portion of the bone by the wedge member, and growing bone between the first and second portions of the bone through the wedge member, said step of growing bone between the first and second portions of the bone includes growing soft cancellous bone through openings in the opposite sides of the wedge member.

46. A method as set fourth in claim 45 wherein the wedge cancellous bone through openings in opposite sides of the wedge member includes growing bone through openings defined by the porous material of the wedge member.

47. A method as set forth in claim 45 wherein the wedge member is formed of bone, said step of growing soft cancellous bone through openings in opposite sides of the wedge member includes growing bone through openings defined by the bone forming the wedge member.

48. A method as set forth in claim 45 further including the step of providing bone growth promoting material in said wedge member to promote growth of bone through the openings in the wedge member.

49. A method as set forth in claim 45 further including the step of positioning bone growth promoting material in a compartment in said wedge member to promote growth of bone.

50. A method as set forth in claim 45 wherein said wedge member tapers from a thick end portion to a thin end portion, said wedge member being disposed in engagement with the hard cortical bone along a surface area which extends between the thin end portion of said wedge member and the thick end portion of said wedge member upon completion of said step of moving the first portion of the bone relative to the second portion of the bone and during performance of said step of growing soft cancellous bone through openings in opposite sides of said wedge member.

51. A method set forth in claim 45 wherein said step of applying force against the first and second portions of the bone with a wedge member includes pulling the wedge member into an opening between the first and second portions of the bone.

52. A method as set forth in claim 45 wherein the hard cortical bone has a first portion which is disposed along one side of the bone and second and third portions which are disposed along opposite sides of the bone which extend transverse to the one side of the bone, said step of applying force against hard cortical bone with opposite sides of the wedge member includes engaging the first, second and third portions of the hard cortical bone with the wedge member.

53. A method as set forth in claim 45 wherein said step of applying force against hard cortical bone with opposite sides of a wedge member includes rotating the wedge member relative to the hard cortical bone about an axis which extends through the wedge member.

54. A method as set forth in claim 45 wherein the wedge member tapers from a thick end portion to a thin end portion, said step of applying force against hard cortical bone with opposite sides of a wedge member includes moving the wedge member toward an axis extending through cortical bone interconnecting the first and second portions of the bone with the thin end portion of the wedge member extending parallel to the axis extending through cortical bone.

55. A method as set forth in claim 45 wherein said step of moving the first portion of the bone relative to the second portion of the bone includes pivoting the first portion of the bone relative to the second portion of the bone about an axis extending through bone interconnecting the first and second portions of the bone.

56. A method as set forth in claim 45 further including the steps of forming an opening in a portion of the patient'"'"'s body tissue to at least partially expose the first and second portions of the bone, closing the opening in the patient'"'"'s body tissue with the wedge member disposed in engagement with the first and second portions of the bone, and, thereafter, transmitting force between the first and second portions of the bone through the wedge member.

57. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of applying force against the first and second portions of the bone with a wedge member, moving the first portion of the bone relative to the second portion of the bone under the influence of force applied against the first portion of the bone by the wedge member, promoting growth of bone through said wedge member by providing bone growth promoting material in the wedge member, and growing bone between the first and second portions of the bone through the wedge member.

58. A method as set forth in claim 57 further including the step of maintaining the wedge member stationary relative to the first and second portions of the bone while growing bone through the wedge member.

59. A method as set forth in claim 57 wherein said step of applying force against first and second portions of the bone with the wedge member includes applying force against hard cortical bone with opposite sides of the wedge member, said step of growing bone between the first and second portions of the bone includes growing soft cancellous bone through openings in the opposite sides of the wedge member.

60. A method as set forth in claim 57 wherein the wedge member has major side surfaces which engage the first and second portions of the bone and a minor side surface which extends between said major side surfaces, said method further including the step of moving the wedge member to a position in which the minor side surface of the wedge member is aligned with an outer side surface of the bone during performance of said step of moving the first portion of the bone relative to the second portion of the bone.

61. A method as set forth in claim 57 wherein said wedge member tapers from a thick end portion to a thin end portion, said wedge member being disposed in engagement with hard cortical bone along surface areas which extend between the thin end portion and the thick end portion of the wedge member upon completion of said step of moving the first portion of the bone relative to the second portion of the bone, said step of growing bone between the first and second portions of the bone through the wedge member includes growing hard cortical bone through the surface areas which extend between the thin end portion and the thick end portion of the wedge member.

62. A method as set forth in claim 57 wherein said step of applying force against first and second portions of the bone with a wedge member includes pulling the wedge member into an opening between the first and second portions of the bone.

63. A method as set forth in claim 57 wherein said step of applying force against the first and second portions of the bone with a wedge member includes rotating the wedge member relative to the first and second portions of the bone about an axis which extends through the wedge member.

64. A method as set forth in claim 57 wherein the wedge member tapers from a wide end portion to a thin end portion, said step of growing bone between the first and second portions of the bone through the wedge member includes growing bone through a portion of the wedge member disposed between the wide end portion and the thin end portion of the wedge member.

65. A method as set forth in claim 57 wherein the wedge member tapers from a thick end portion to a thin end portion, said step of applying force against the first and second portions of the bone includes pivoting the first portion of the bone relative to the second portion of the bone about an axis extending through bone interconnecting the first and second portions of the bone with the thin end portion of the wedge member extending parallel to the axis.

66. A method as set forth in claim 57 further including the steps of forming an opening in a portion of the patient'"'"'s body tissue to at least partially expose the first and second portions of the bone, closing the opening in the patient'"'"'s body tissue with the wedge member disposed in engagement with the first and second portions of the bone, and, thereafter, transmitting force between the first and second portions of the bone through the wedge member.

67. A method as set fourth in claim 57 wherein the wedge member is formed of a porous material, said step of growing bone between the first and second portions of the bone through the wedge member includes growing bone through openings defined by the porous material of the wedge member.

68. A method as set forth in claim 57 wherein the wedge member is formed of bone, said step of growing bone between the first and second portions of the bone through the wedge member includes growing bone through openings defined by the bone forming the wedge member.

69. A method as set forth in claim 57 wherein said step of providing bone growth promoting material in the wedge member includes the step of positioning bone growth promoting material in said wedge member to promote growth of bone through openings in the wedge member.

70. A method as set forth in claim 57 wherein said step of providing bone growth promoting material in the wedge member includes the step of positioning bone growth promoting material in a compartment in said wedge member to promote growth of bone.

71. A method as set forth in claim 57 wherein said step of providing bone growth promoting material in the wedge member includes the step of positioning bone growth promoting material in an opening which extends between opposite major sides of the wedge member.

72. A method as set forth in claim 57 wherein said wedge member tapers from a thick end portion to a thin end portion, said wedge member being disposed in engagement with the hard cortical bone along a surface area which extends between the thin end portion of said wedge member and the thick end portion of said wedge member upon completion of said step of moving the first portion of the bone relative to the second portion of the bone and during performance of said step of growing bone between the first and second portions of the bone through the wedge member.

73. A method as set forth in claim 57 wherein said step of applying force against the first and second portions of the bone with a wedge member includes applying force to hard cortical bone with a wedge member having a plurality of openings through which bone can grow.

74. A method as set forth in claim 57 wherein said step of applying force against the first and second portions of the bone with a wedge member includes pulling the wedge member into an opening between the first and second portions of the bone.

75. A method as set forth in claim 57 wherein said step of applying force against the first and second portions of the bone with a wedge member includes rotating the wedge member relative to the bone about an axis which extends through the wedge member.

76. A method as set forth in claim 57 wherein the wedge member tapers from a thick end portion to a thin end portion, said step of applying force against the first and second portions of the bone with a wedge member includes moving the wedge member toward an axis extending through cortical bone interconnecting the first and second portions of the bone with the thin end portion of the wedge member extending parallel to the axis extending through cortical bone.

77. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of forming an opening in a portion of the patient'"'"'s body tissue to provide access to the bone, moving the second portion of the bone relative to the first portion of the bone, said step of moving the second portion of the bone relative to the first portion of the bone includes applying force to hard cortical bone with a wedge member, closing the opening in the patient'"'"'s body tissue with the wedge member disposed in engagement with the hard cortical bone, and, thereafter, transmitting force between the first and second portions of the bone through the wedge member.

78. A method as set forth in claim 77 wherein said wedge member tapers from a thick end portion to a thin end portion, said wedge member being disposed in engagement with the hard cortical bone along a surface area which extends between the thin end portion of said wedge member and the thick end portion of said wedge member upon completion of said step of moving the second portion of the bone relative to the first portion of the bone and during performance of said step of transmitting force between the first and second portions of the bone through the wedge member.

79. A method as set forth in claim 77 wherein said step of applying force to hard cortical bone with a wedge member includes pulling the wedge member into an opening between the first and second portions of the bone.

80. A method as set forth in claim 77 wherein the hard cortical bone has a first portion which is disposed along one side of the bone and second and third portions which are disposed along opposite sides of the bone which extend transverse to the one side of the bone, said step of applying force to hard cortical bone with the wedge member includes engaging the first, second and third portions of the hard cortical bone with the wedge member.

81. A method as set forth in claim 77 wherein said step of applying force to hard cortical bone with a wedge member includes rotating the wedge member relative to the hard cortical bone about an axis which extends through the wedge member.

82. A method as set forth in claim 77 wherein the wedge member tapers from a thick end portion to a thin end portion, said step of applying force to hard cortical bone with a wedge member includes moving the wedge member toward the axis extending through cortical bone interconnecting the first and second portions of the bone with the thin end portion of the wedge member extending parallel to the axis extending through cortical bone.

83. A method as set forth in claim 77 wherein said step of moving the first portion of the bone relative to the second portion of the bone includes pivoting the first portion of the bone relative to the second portion of the bone about an axis extending through the bone interconnecting the first and second portions of the bone.

84. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of providing a wedge member formed of bone, forming an opening in a portion of the patient'"'"'s body tissue to obtain access to the first and second portions of the bone in the patient'"'"'s body, moving the second portion of the bone relative to the first portion of the bone, said step of moving the second portion of the bone relative to the first portion of the bone includes applying force to the first and second portions of the bone in the patient'"'"'s body with the wedge member formed of bone, closing the opening in the patient'"'"'s body tissue with the wedge member formed of bone disposed in engagement with the first and second portions of the bone in the patient'"'"'s body, and, thereafter, transmitting force between the first and second portions of the bone in the patient'"'"'s body through the wedge member formed of bone.

85. A method as set forth in claim 84 wherein said wedge member formed of bone tapers from a thick end portion to a thin end portion, said wedge member formed of bone being disposed in engagement with the hard cortical bone which forms part of the first and second portions of the bone in the patient'"'"'s body along a surface area which extends between the thin end portion of said wedge member formed of bone and the thick end portion of said wedge member formed of bone upon completion of said step of moving the second portion of the bone in the patient'"'"'s body relative to the first portion of the bone in the patient'"'"'s body and during performance of said step of transmitting force between the first and second portions of the bone in the patient'"'"'s body through the wedge member formed of bone.

86. A method as set forth in claim 84 wherein said step of applying force to the first and second portions of the bone in the patient'"'"'s body with a wedge member formed of bone includes applying force to hard cortical bone with a wedge member formed of bone.

87. An apparatus for use in changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said apparatus comprising a wedge member which is formed of bone and is movable into an opening in the bone in the patient'"'"'s body to apply force which is transmitted to the first and second portions of the bone in the patient'"'"'s body and expands the opening, said wedge member formed of bone has first and second major sides which transmit force to the first and second portions of the bone in the patient'"'"'s body, said first and second major sides of said wedge member formed of bone extend at an acute angle to each other and extend between a thin edge portion and a thick edge portion of said wedge member formed of bone, said wedge member formed of bone having a minor side which extends between said first and second major sides.

88. An apparatus as set forth in claim 87 further including a connector which connects said wedge member formed of bone with at least one of the first and second portions of the bone in the patient'"'"'s body.

89. An apparatus as set forth in claim 87 further including an opening which extends between said first and second major sides of said wedge member formed of bone, said opening having a first side surface which extends parallel to said thin edge portion of said wedge member formed of bone and a second side surface having a configuration similar to the configuration of said minor side of said wedge member formed of bone, said second side surface being smaller than said minor side of said wedge member formed of bone.

90. An apparatus as set forth in claim 87 wherein said first and second major sides of aid wedge member formed of bone define a plurality of openings through which bone can grow.

91. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of applying force against the first and second portions of the bone with a wedge member, moving the first portion of the bone relative to the second portion of the bone under the influence of force applied against the first portion of the bone by the wedge member, and moving the wedge member to a position in which surface areas on the wedge member are aligned with surface areas on opposite sides of the bone.

92. A method as set forth in claim 91 further including the step of maintaining the wedge member stationary relative to the first and second portions of the bone while growing bone through the wedge member.

93. A method as set forth in claim 91 wherein said step of applying force against first and second portions of the bone with the wedge member includes applying force against hard cortical bone with opposite sides of the wedge member, said method further includes the step of growing bone through openings in opposite sides of the wedge member.

94. A method as set forth in claim 93 further including the step of promoting growth of bone through the openings in the wedge member by providing bone growth promoting material in the wedge member.

95. A method as set forth in claim 91 wherein the wedge member has major side surfaces which engage the first and second portions of the bone and a minor side surface which extends between said major side surfaces, said step of moving the wedge member to a position in which surface areas on the wedge member are aligned with surface areas on opposite sides of the bone includes moving the wedge member to a position in which the minor side surface of the wedge member is aligned with an outer side surface of the bone.

96. A method as set forth in claim 91 wherein said wedge member tapers from a thick end portion to a thin end portion, said wedge member being disposed in engagement with hard cortical bone along surface areas which extend between the thin end portion and the thick end portion of the wedge member upon completion of said step of moving the wedge member to a position in which surface areas on the wedge member are aligned with surface areas on opposite sides of the bone.

97. A method as set forth in claim 91 wherein said step of applying force against first and second portions of the bone with a wedge member includes pulling the wedge member into an opening between the first and second portions of the bone.

98. A method as set forth in claim 91 wherein the wedge member tapers from a wide end portion to a thin end portion, said method further includes growing bone through a portion of the wedge member disposed between the wide end portion and the thin end portion of the wedge member while the surface areas on the wedge member are aligned with the surface areas on opposite sides of the bone.

99. A method as set forth in claim 91 wherein the wedge member tapers from a thick end portion to a thin end portion, said step of applying force against the first and second portions of the bone includes pivoting the first portion of the bone relative to the second portion of the bone about an axis extending through bone interconnecting the first and second portions of the bone with the thin end portion of the wedge member extending parallel to the axis.

100. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of applying force against the first and second portions of the bone with a wedge member, moving the first portion of the bone relative to the second portion of the bone under the influence of force applied against the first portion of the bone by the wedge member, and thereafter, transmitting an external force applied against the patient'"'"'s body between the first and second portions of the bone through the wedge member.

101. A method as set forth in claim 100 further including the step of maintaining the wedge member stationary relative to the first and second portions of the bone while growing bone through the wedge member.

102. A method as set forth in claim 100 wherein said step of transmitting an external force applied against the patient'"'"'s body between the first and second portions of the bone through the wedge member includes transmitting force between hard cortical bone and opposite sides of the wedge member.

103. A method as set forth in claim 100 further including the step of promoting growth of bone through the wedge member by providing bone growth promoting material in the wedge member.

104. A method as set forth in claim 100 wherein the wedge member has major side surfaces which engage the first and second portions of the bone and a minor side surface which extends between said major side surfaces, said method further including the step of moving the wedge ember to a position in which the minor side surface of the wedge member is aligned with an outer side surface of the bone.

105. A method as set forth in claim 100 wherein said wedge member tapers from a thick end portion to a thin end portion, said wedge member being disposed in engagement with hard cortical bone along surface areas which extend between the thin end portion and the thick end portion of the wedge member upon completion of said step of moving the first portion of the bone relative to the second portion of the bone.

106. A method as set forth in claim 100 wherein said step of applying force against first and second portions of the bone with a wedge member includes pulling the wedge member into an opening between the first and second portions of the bone.

107. A method as set forth in claim 100 wherein said step of applying force against the first and second portions of the bone with a wedge member includes rotating the wedge member relative to the first and second portions of the bone about an axis which extends through the wedge member.

108. A method as set forth in claim 100 wherein the wedge member tapers from a wide end portion to a thin end portion, said method further includes growing bone through a portion of the wedge member disposed between the wide end portion and the thin end portion of the wedge member.

109. A method as set forth in claim 100 wherein the wedge member tapers from a thick end portion to a thin end portion, said step of applying force against the first and second portions of the bone includes pivoting the first portion of the bone relative to the second portion of the bone about an axis extending through bone interconnecting the first and second portions of the bone with the thin end portion of the wedge member extending parallel to the axis.

110. An apparatus for use in changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said apparatus comprising a wedge member which is movable into an opening in the bone to apply force which is transmitted to the first and second portions of the bone and expands the opening, said wedge member having first and second major side surfaces which transmit force to the first and second portions of the bone upon movement of said wedge member into the opening in the bone, and bone growth promoting material disposed on said wedge member to promote growth of bone between said wedge member and said first and second portions of the bone.

111. An apparatus as set forth in claim 110 wherein said wedge member includes compartment means disposed between said first and second major side surfaces for holding bone growth promoting material and a plurality of passages which extend between said compartment means and said first and second major side surfaces.

112. An apparatus as set forth in claim 110 further including a screw member which extends through a portion of said wedge member, said screw member having an end portion which extends past said thin edge portion of said wedge member in a direction away from said thick edge portion of said wedge member, and thread means disposed on said end portion of said screw member for engaging the bone.

113. An apparatus as set forth in claim 110 further including fastener means for fixedly connecting said wedge member with the first and second portions of the bone.

114. An apparatus as set forth in claim 110 wherein said wedge member is formed of a porous material to enable bone to grow into said wedge member.

115. An apparatus as set forth in claim 110 wherein said first and second major side surfaces of said wedge member have peripheral edge portions with a configuration which is the same as a cross sectional configuration of the bone adjacent to the opening in the bone.

116. A method of changing a spatial relationship between first and second portions of a bone in a patient'"'"'s body, said method comprising the steps of moving a wedge member through a layer of hard cortical bone into engagement with soft cancellous bone with portions of the wedge member in engagement with the layer of hard cortical bone, interrupting movement of the wedge member relative to the bone with the wedge member in engagement with soft cancellous bone and the layer of hard cortical bone, and, thereafter, transmitting force between the layer of hard cortical bone and the wedge member while the wedge member is in engagement with the soft cancellous bone.

117. A method as set forth in claim 116 wherein said step of moving a wedge member through a layer of hard cortical bone into engagement with soft cancellous bone includes moving a portion of the wedge member out of engagement with the layer of hard cortical bone and back into engagement with the layer of hard cortical bone.

118. A method as set forth in claim 116 wherein said step of moving a wedge member through a layer of hard cortical bone into engagement with soft cancellous bone includes sliding opposite major side surfaces of the wedge member on the soft cancellous bone and on the layer of hard cortical bone with areas on the major side surfaces of the wedge member which engage the soft cancellous bone being disposed between areas on the major side surfaces of the wedge member which engage the hard cortical bone.

119. A method as set forth in claim 116 wherein said step of moving a wedge member through a layer of hard cortical bone into engagement with soft cancellous bone includes effecting relative movement between the first and second portions of the bone under the influence of force transmitted from the wedge member to the layer of hard cortical bone.

120. A method as set forth in claim 116 further including the step of growing bone through openings in the wedge member while the wedge member is in engagement with soft cancellous bone and the wedge member is in engagement with the layer of hard cortical bone.

121. A method as set forth in claim 116 wherein said step of transmitting force between the layer of hard cortical bone and the wedge member is performed while the spatial relationship between the first and second portions of the bone remains constant.

122. A method as set forth in claim 116 wherein said steps of moving a wedge member through a layer of hard cortical bone includes moving an opening which extends through the wedge member from a location offset to one side of the soft cancellous bone to a location in which the opening through the wedge member is aligned with the soft cancellous bone to enable soft cancellous bone to grow through the opening in the wedge member.

123. A method as set forth in claim 116 wherein the wedge member includes a pair of opposite major side surfaces, said step of interrupting movement of the wedge member relative to the bone being performed with the layer of hard cortical bone being disposed in engagement with the opposite major side surfaces of the wedge member along continuous surface areas which extend between a leading edge of the wedge member and a trailing edge of the wedge member.

124. A method as set forth in claim 116 further including the steps of engaging the layer of hard cortical bone with a screw and transmitting force through the screw to the wedge member.

125. A method as set forth in claim 116 further including the step of fixedly connecting the wedge member with the layer of hard cortical bone to hold the wedge member against movement relative to the bone.