Abstract:
A bone cutting guide may include a support that contains a shaft movable relative to the support. The shaft may carry a guide member having one or more cut guides through which a clinician inserts a cutting member to cut bone positioned under the guide cut guides. In operation, a clinician may fixate the support of the bone cutting guide to a bone and translate the guide member until the one or more cut guides are positioned at a desired cut location. The clinician may then perform a cut through the cut guide. In some examples, the bone cutting guide includes additional components, such as bridging member or secondary cut guide, to provide additional functionality.

Description:
RELATED APPLICATION 
       [0001]    This application claims the benefit of U.S. Provisional Application Ser. No. 62/100,641, filed Jan. 7, 2015, the entire contents of which are hereby incorporated by reference. 
     
    
     TECHNICAL FIELD 
       [0002]    This disclosure relates generally to devices and methods for positioning and cutting bones. 
       BACKGROUND 
       [0003]    Bones, such as the bones of a foot, may be anatomically misaligned. In certain circumstances, surgical intervention is required to correctly align the bones to reduce patient discomfort and improve patient quality of life. 
       SUMMARY 
       [0004]    In general, this disclosure is directed to bone cutting guide systems and techniques for cutting bones. In some examples, a bone cutting guide includes a main body, or support, that houses a shaft that can translate relative to the main body. The shaft may have a main guide member positioned on the end of the shaft. The main guide member may define opposed guide surfaces configured to receive a cutting member. For example, the cutting member may be inserted between the opposed guide surfaces and bounded within a range of movement by the guide surfaces, causing the cutting member to be directed at a cutting location under the guide surfaces. Additionally or alternatively, the main guide member may define a single cutting surface/plane. The cutting surface/plane may be a surface against which a clinician can position a cutting member and then guide the cutting member along the cutting surface/plane to perform a cutting operation. 
         [0005]    The main body of the bone cutting guide can include fixation members, such as fixation pins or apertures, that allow the main body to be fixated on or adjacent a bone to be cut. For example, in use, a clinician may fixate the main body to a bone (e.g., a first metatarsal). Thereafter, the clinician may translate the main guide member having at least one cutting guide surface (e.g., opposed cutting guide surfaces) relative to the fixed main body. The clinician can translate the main guide member by sliding or rotating the shaft housed within the main body, e.g., causing the distal end of the shaft and main guide member carried thereon away from or towards the main body. Once suitably positioned, the clinician may or may not lock the location of the shaft and perform one or more cuts through the guide surfaces of the main guide member. 
         [0006]    In some configurations, the bone cutting guide also includes a bridge component that can form a bridge over a section of bone, such as a joint between adjacent bones (e.g., first metatarsal-medial cuneiform joint). For example, the bridge component may have a proximal end that is attachable to the main guide member carried on the shaft attached to the main body and a distal end separated by one or more rails. The proximal end may be insertable between the opposed cutting guide surfaces of the main guide member, e.g., such that the proximal end of the bridge can be inserted between the guide surfaces after performing a cut through the guide surfaces. The distal end of the bridging member can include fixation members, such as fixation pins or apertures, that allow the distal end of the bridging member to be fixated to bone. In one application, the distal end of the bridging member is fixated to a different bone than the bone the main body is fixated to such that the bridging member spans a joint. In such applications, joint spacing may be expanded or contracted by translating the shaft carried by the main body. 
         [0007]    In addition to or in lieu of providing a bridging member, in some additional configurations, the bone cutting guide may include a secondary guide member. The secondary guide member can be positioned distally of the main guide member and may also include guide surfaces, such as opposed guide surfaces forming a channel sized and shaped to receive a cutting member. The secondary guide member may facilitate making a second bone cut distal of a location where a first bone cut is made using the main guide member. 
         [0008]    In one example, a bone cutting guide is described that includes a support defining an inner cavity and a shaft disposed at least partially within the inner cavity, where the shaft is translatable within the inner cavity relative to the support. The bone cutting guide also includes a main guide member located on an end of the shaft, where the main guide member includes a first guide surface defining a first plane and a second guide surface defining a second plane, and where the first plane is parallel to the second plane. 
         [0009]    In another example, a method for cutting bones is described. The method includes fixing a support to a bone and aligning a main guide member to be positioned at a location to be cut. The method further includes making a first cut at the location to be cut by inserting a cutting member through a space defined between a first guide surface of the main guide member and a second guide surface of the main guide member. 
         [0010]    The details of one or more examples are set forth in the accompanying drawings and the description below. Other features, objects, and advantages will be apparent from the description and drawings, and from the claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0011]      FIG. 1  is a side view of an embodiment of a bone cutting guide, with some components shown in an exploded view. 
           [0012]      FIG. 2  is a perspective view of the bone cutting guide of  FIG. 1 . 
           [0013]      FIG. 3A  is a perspective view of the bone cutting guide of  FIG. 1  with a bridge component attached to a main guide member. 
           [0014]      FIGS. 3B-3D  are top plan view illustrations of a bone cutting guide with different example connecting blocks. 
           [0015]      FIG. 3E  is a side plan view of a bone cutting guide and an exemplary support. 
           [0016]      FIG. 4  is a perspective view of the bone cutting guide of  FIG. 1  assembled. 
           [0017]      FIG. 5  is another perspective view of the bone cutting guide of  FIG. 4 . 
           [0018]      FIG. 6  is a further perspective view of the bone cutting guide of  FIG. 4 . 
           [0019]      FIG. 7  is a perspective view of a bone cutting guide support fixed to a bone. 
           [0020]      FIG. 8  is a top view of the bone cutting guide support fixed to the bone of  FIG. 7 . 
           [0021]      FIG. 9  is a perspective view of the bone cutting guide support fixed to the bone of  FIG. 7  with a location of the main guide member adjusted. 
           [0022]      FIG. 10  is a perspective view of a bridge component attached to the main guide member of the support of  FIG. 7  with a fixation structure attached to the bridge component. 
           [0023]      FIG. 11  is a perspective view of the fixation structure pinned across a bone. 
           [0024]      FIG. 12  is another perspective view of the pinned fixation structure of  FIG. 11 . 
           [0025]      FIG. 13  is a perspective view of the assembled bone cutting guide fixed to bones. 
           [0026]      FIG. 14  is a further perspective view of the assembled bone cutting guide of  FIG. 13 . 
           [0027]      FIG. 15  shows a perspective view of the assembled bone cutting guide of  FIG. 13  with a secondary guide member translated along rails of the bridge component. 
           [0028]      FIG. 16  is an additional perspective view of the assembled bone cutting guide of  FIG. 15 . 
       
    
    
     DETAILED DESCRIPTION 
       [0029]    The following detailed description is exemplary in nature and is not intended to limit the scope, applicability, or configuration of the invention in any way. Rather, the following description provides some practical illustrations for implementing exemplary embodiments of the present invention. Examples of constructions, materials, and dimensions are provided for selected elements, and all other elements employ that which is known to those of ordinary skill in the field of the invention. Those skilled in the art will recognize that many of the noted examples have a variety of suitable alternatives. 
         [0030]    Embodiments of the present invention include a bone cutting guide. In an exemplary application, the bone cutting guide can be useful during a surgical procedure, such as a bone alignment, osteotomy, fusion procedure, and/or other procedures where one or more bones are to be cut. Such a procedure can be performed, for example, on bones (e.g., adjacent bones separated by a joint or different portions of a single bone) in the foot or hand, where bones are relatively smaller compared to bones in other parts of the human anatomy. In one example, a procedure utilizing the bone cutting guide can be performed to correct an alignment between a metatarsal (e.g. a first metatarsal) and a cuneiform (e.g., a first cuneiform), such as a bunion correction. An example of such a procedure is a lapidus procedure. In another example, the procedure can be performed by modifying an alignment of a metatarsal (e.g. a first metatarsal). An example of such a procedure is a basilar metatarsal osteotomy procedure. 
         [0031]      FIGS. 1, 2, and 3A  show an embodiment of a bone cutting guide  20  with some components of the bone cutting guide  20  shown in an exploded view.  FIG. 1  is a side view of the bone cutting guide  20 , while  FIGS. 2 and 3A  are perspective views of the bone cutting guide  20 . The bone cutting guide  20  can include a support  30  which defines an inner cavity  40  ( FIG. 2 ). In one embodiment, the support  30  can include a first fixation aperture  50 A and a second fixation aperture  50 B, each of which can extend through the support  30  and receive fixation pins  60 A and  60 B, respectively, such that the fixation pins  60 A and  60 B extend through the support  30  via the fixation apertures  50 A and  50 B. In the embodiment shown, the fixation pins  60 A and  60 B have a threaded first end adapted to threadingly engage with a bone, and allow the support  30  to be translated along a longitudinal axis of both pins  60 A and  60 B. In the illustrated embodiments, the fixation apertures  50 A and  50 B are located on opposite longitudinal ends of the support  30 , but in other embodiments the fixation apertures  50 A and  50 B can be located at various positions on the support  30 . 
         [0032]    The support  30  can further include one or more extensions  70 A and/or  70 B protruding generally radially out from the support  30 , which may define a concave surface configured to receive a generally cylindrical bone portion. In the embodiment shown, fixation aperture  50 B is provided with an extension member  72  which can be threadingly coupled to the support  30 . Such an extension member  72  can be adjusted relative to the support  30  to allow the support to become parallel with a longitudinal axis of a bone, if desired. In such embodiments, the support  30  can rest on a bone via the extensions  70  A/B and extension member  72  in a position generally parallel to the bone. Fixation pin  60 B may be received within an internal aperture of the extension member  72 . As shown, apertures  74 A and B, such as tapered apertures, may be provided proximal to extensions  70  A and B. Such apertures may extend through the support at a skewed angle relative to the longitudinal axis of the support, and may be used to engage a clamping instrument or receive fixation pins. 
         [0033]    The support  30  can also include a slot  80  formed on at least a portion of a surface of the support  30 . As illustrated in the embodiment of the cutting guide  20  shown in  FIG. 3A , the slot  80  can extend in a surface of the support  30  between fixation apertures  50 A and  50 B. A securing component  90  can be configured to translate along the slot  80  relative to the support  30 . For example, the securing component  90  can have a first end with a diameter greater than a diameter of a second opposite end, such that the first end of the securing component  90  is supported by the slot  80  (e.g., the first end has a diameter greater than a radial width of the slot  80 ) while the second end of the securing component  90  is positioned within the slot  80  (e.g., the second end has a diameter less than a radial width of the slot  80 ). 
         [0034]    The inner cavity  40  of the support  30  can have a shaft  100  positioned at least partially within the inner cavity  40 . The shaft  100  can be configured to translate within the inner cavity  40  relative to the support  30 , such that an end of the shaft  100  can be made to project out from the inner cavity  40 . The shaft  100  may define a slot  105  which may be aligned with the slot  80  defined by the support  30 . This slot  105  may receive the pin  60 A to reduce interference when the shaft  100  translates. Furthermore, the shaft  100  can include a securing aperture  110  which can be configured to receive at least a portion of the securing component  90 . In one embodiment, both the second end of the securing component  90 , within the slot  80 , and the securing aperture  110  can be threaded to allow the securing component  90  to mate with the securing aperture  110 . Such a configuration can allow the shaft  100  to be fixed, such as by compressing a surface of the support  30  that defines the slot  80 , and thus prevented from translating within the inner cavity  40 , relative to the support  30 . In another embodiment, the securing component  90  can be threadingly engaged with the support  30  to act against the shaft  100  to prevent the shaft  100  from traveling with the cavity  40  when desired. 
         [0035]    On an end of the shaft  100 , a main guide member  120  can be disposed. In some embodiments the main guide member  120  can be integral with the shaft  100 , or in other embodiments the main guide member  120  and the shaft  100  can be separate components coupled together. The main guide member  120  can have a first guide surface  130 A and a second guide surface  130 B, and in some embodiments the main guide member  120  can include blocks  140 A and/or  140 B. The first and second guide surfaces  130 A and  130 B can be adjacent surfaces facing one another with a space defined between the first and second guide surfaces  130 A and  130 B. For example, the first guide surface  130 A can be a surface of the main guide member  120  immediately opposite a surface of the main guide member  120  that interfaces with the shaft  100 , and the second guide surface  130 B can be a surface of the main guide member  120  immediately opposite a surface of the main guide member  120  that includes blocks  140 A and  140 B. 
         [0036]    In the illustrated embodiment, the second guide surface  130 B contains a gap, such that the second guide surface  130 B is not a single, continuous surface. In other embodiments, the second guide surface  130 B can be a single, continuous surface lacking any such gap. The first guide surface  130 A defines a first plane, while the second guide surface  130 B defines a second plane. As shown, the first guide surface  130 A and the second guide surface  130 B can be configured such that the first plane is parallel to the second plane, with the space between. In further embodiments (not illustrated), the guide surfaces  130 A and  130 B can be configured such that the first and/or second planes are skewed. 
         [0037]    As previously noted, a surface of the main guide member  120  can include one or more blocks  140 A and  140 B, either integral with the main guide member  120  or as separate components attached to the main guide member  120 . As shown, the blocks  140 A and  140 B can be on a surface on a side of the main guide member  120  furthest from the interface with the shaft  100 . In other applications, the blocks  140 A and  140 B can be located at various other positions on the main guide member  120 . The blocks  140 A and  140 B can include fixation apertures  150 A and  150 B respectively. The fixation apertures  150 A and  150 B extend through the blocks  140 A and  140 B and provide a location for configuring additional fixation pins to, for example, position a bone or bones. 
         [0038]    As shown in  FIGS. 3B-3D , the main guide member  120  and at least one block  140 A can assume other configurations. In  FIG. 3B , the block  140 A includes fixation apertures  150 A and B and is spaced from the guide surfaces a distance via connecting flanges  154 A and  154 B. In the embodiment of  FIG. 3B , the fixation apertures  150 A and B are positioned in a line substantially parallel to the guide surfaces. In  FIG. 3C , the orientation of the fixation apertures  150 A and B is substantially perpendicular to the guide surfaces. In  FIG. 3D , only one fixation aperture  150 A is provided. 
         [0039]    Another embodiment of a support  30  is depicted in  FIG. 3E . In  FIG. 3E , the support  30  has at least one (e.g., two) fixation aperture  156 A and  156 B formed in its side to receive fixation pins. Such apertures can also be included on the opposite side of the support (not shown). In some embodiments, the fixation apertures  156 A and  156 B can be positioned in a line substantially parallel with a longitudinal axis of the support, and can extend in a direction substantially perpendicular to the longitudinal axis of the support. In certain embodiments, the apertures extend at an angle, such as about 20 degrees, from vertical. In such embodiments, the support  30  can be placed on a dorsal surface and after a first cut or cuts, can be rotated about a pin extending though one of the fixation apertures  156 A and  156 B to rotate the support relative to the bone and first cut or cuts. The support can then be further pinned to the bone and an additional cut or cuts can be made at a desired angle relative to the first cut or cuts. 
         [0040]    In addition to the support  30 , the bone cutting guide  20  can include a bridge component  160 . As shown in  FIG. 3A , the bridge component  160  can attach to the main guide member  120 . In particular, in some applications of the bone cutting guide  20 , the bridge component  160  can have a geometry that allows the bridge component  160  to attach to the main guide member  120  between the first and second guide surfaces  130 A and  130 B through an interference fit. Optionally, a locking mechanism can be provided to lock the bridge component to the main guide member, such as a locking tab, screw, pin, cam, etc. For example, the bridge component  160  may have a planar member  165  (shown in  FIG. 2 ) that is received within the gap between the surfaces  130 A and  130 B and an extending block  166  (shown in  FIG. 2 ) adapted to extend into the surface gap of  130 B. In other applications, the bridge component  160  can be coupled to the main guide member  120  by any attachment mechanism, such as screws or clamps. The bridge component  160  can include rails  170 A and  170 B, each extending out from the bridge component  160  in a same general direction. In other embodiments, the rails  170 A and  170 B can extend out from the bridge component  160  at different angles. 
         [0041]    The bone cutting guide  20  can also include in some embodiments a fixating structure  180 . The fixating structure  180  can be supported on the rails  170 A and  170 B. For example, the fixating structure  180  can include apertures  185 A and  185 B to receive the rails  170 A and  170 B, respectively. The fixating structure  180  can be secured to the rails  170 A and  170 B, such that the fixating structure  180  is obstructed from translating along the rails  170 A and  170 B, by turning or otherwise actuating an actuator  186  of the fixating structure  180 , which moves a lock (not shown) to act against the rails. Furthermore, the fixating structure  180  can also include one or more fixation apertures  190 A and/or  190 B. Fixation apertures  190 A and  190 B extend through fixating structure  180  and can be located on opposite ends of the fixating structure  180 , at a skewed angle, and serve to receive fixation pins or other means for stabilizing the bone cutting guide  20  across a targeted anatomy and/or positioning a bone or bones. 
         [0042]    Additionally, the bone cutting guide  20  can have a secondary guide member  200 . The secondary guide member  200  can be supported on the rails  170 A and  170 B. For example, the secondary guide member  200  may include slots  205 A and  205 B to receive the rails  170 A and  170 B such that the secondary guide member  200  is supported thereon. The secondary guide member  200  can also have a third guide surface  210 A and a fourth guide surface  210 B. The third and fourth guide surfaces  210 A and  210 B can be adjacent surfaces facing one another with a space defined between the third and fourth guide surfaces  210 A and  210 B. In the illustrated embodiments, third and fourth guide surfaces  210 A and  210 B are single, continuous surfaces that do not include a gap, but in other embodiments third and/or fourth guide surfaces  210 A and  210 B can include a gap. The third guide surface  210 A defines a third plane, while the fourth guide surface  210 B defines a fourth plane. As shown, the third guide surface  210 A and fourth guide surface  210 B can be configured such that the third plane is parallel to the fourth plane, with the space between. In further embodiments (not illustrated), the guide surfaces  210 A and  210 B can be configured such that the third and/or fourth planes are skewed. Further, the third and/or fourth guide surfaces may be parallel to or skewed with respect to the first and/or second guide surfaces, such that the cutting guide can be adapted to make parallel cuts or angular cuts or cut shapes (e.g. a chevron shape). In some embodiments, the secondary guide member  200  can be locked to the rails  170 A and/or  170 B with a locking screw, cam, pin, etc. In the embodiment shown in  FIG. 3A , an aperture  214  is provided to receive a locking mechanism and/or an accessory, such as a handle. 
         [0043]      FIGS. 4-6  illustrate perspective views of the embodiment of the bone cutting guide  20 , described with respect to  FIGS. 1-3 , as assembled. In the embodiment illustrated in  FIGS. 4-6 , the bridge component  160  is attached to the main guide member  120  and both the fixating structure  180  and secondary guide member  200  are supported along the rails  170 A and  170 B of the bridge component. In one application, the secondary guide member  200  can be supported on the rails  170 A and  170 B at a location along the rails  170 A and  170 B between the fixating structure  180  and the main guide member  120 . Additionally shown in  FIGS. 4-6  are fixation pins  220 A and  220 B received within fixation apertures  190 A and  190 B such that the fixation pins  220 A and  220 B extend through the fixating structure  180 . In some applications of the bone cutting guide  20 , it may be desirable to provide the fixation pins  220 A and  220 B at an angle other than 90 degrees relative to a top surface of the fixating structure  180  by configuring the fixation apertures  190 A and  190 B to extend through the fixating structure  180  at a skewed angle to guide the fixating pins  220 A and  220 B. Fixation pins  220 A and  220 B can be used, for example, for stabilizing the bone cutting guide  20  across a targeted anatomy and/or positioning a bone or bones. 
         [0044]    Embodiments of the bone cutting guide  20  can be useful in operation for temporarily positioning a bone or bones and guiding a cutting of a bone or bones at a targeted anatomy. Bone cutting can be useful, for instance, to facilitate contact between leading edges of adjacent bones, separated by a joint, or different portions of a single bone, separated by a fracture, such as in a bone alignment and/or fusion procedure. As such, embodiments of the present invention include methods for temporarily fixing an orientation of a bone or bones, such as during a surgical procedure, and guiding cutting at desired bone locations. In the embodiments described, cuts are made to bone with respect to the cutting guide, and the bones can be positioned for an additional surgical step, such as bone plating, after the cuts have been made. 
         [0045]      FIGS. 7-16  illustrate steps of an embodiment of a method for temporarily positioning and cutting a bone or bones using the bone cutting guide  20 . Specifically,  FIGS. 7 and 8  show a perspective and top view, respectively, of the support  30  fixed to a bone  230  (e.g. a first metatarsal). The support  30  is placed on the bone  230 . For embodiments of the bone cutting guide  20  that include the extensions  70 A and  70 B, the extensions  70 A and  70 B can be used to at least partially straddle the bone  230  and consequently provide both greater stability to the support  30  on the bone  230  and anatomical alignment of the support  30  on a longitudinal axis of the bone  230  (e.g., the slot  80  is generally parallel to the longitudinal axis of the bone  230 ). Extension member  72  can be adjusted to a desired distance from support  30 . Further, in some embodiments it can be desirable to align and fix the support  30  along the longitudinal axis of the bone  230  using the fixation pins  60 A and  60 B. The pin  60 A can be inserted through the fixation aperture  50 A such that an end of the pin  60 A protrudes out from the fixation aperture  50 A adjacent the bone  230 . The pin  60 A can then be fixed to the bone  230 . Similarly, the pin  60 B can be inserted through fixation aperture  50 B and fixed on an end to the bone  230 . In this manner, the support  30  can be fixed in place to and aligned along the longitudinal axis of the bone  230 . 
         [0046]    In addition to fixing the support  30  to the bone  230 , the main guide member  120  can be aligned such that the main guide member  120  is positioned at a location where a bone (e.g., the bone  230 ) is to be cut. In one embodiment, the main guide member  120  can be positioned at the location where a bone is to be cut by appropriately positioning and fixing the support  30 , e.g., such that the support  30  is fixed to the bone  230  at a location along bone  230  that results in the main guide member  120  being positioned at the location where a bone is to be cut. In some embodiments, a joint alignment blade (not shown) is inserted though the main guide member and into a joint space to help align the main guide member in a desired position. Further, in certain embodiments, a provisional fixation pin (not shown) can be inserted through a bone of interest and into an adjacent bone (e.g., though a first metatarsal and into a second metatarsal) to provide additional stability during the procedure. 
         [0047]    In some applications, a location of the main guide member  120  relative to the longitudinal axis of the bone  230  can be adjusted without necessitating movement of the support  30 . To accomplish this, the shaft  100  at least partially within the inner cavity  40  can be translated relative to the support  30  as shown in the perspective view of  FIG. 9 . As shown, the main guide member  120  has been translated along the longitudinal axis of the bone  230  a distance D as a result of the shaft  100  being moved the same distance D. Once the main guide member  120  is positioned at the location to be cut, the securing component  90  can be translated along the slot  80  such that the securing component  90  is aligned with securing aperture  110 . The securing component  90  can then be fixed within the securing aperture  110  such that the shaft  100  is fixed relative to the support  30 . 
         [0048]    After the main guide member  120  has been positioned at the location to be cut, a cutting member (e.g. a saw blade) can be inserted through the space defined between the first guide surface  130 A and the second guide surface  130 B to cut, for example, the bone  230 . The guide surfaces  130 A and  130 B can serve to direct the cutting member to the location of the bone  230  to be cut, which in many applications can be a precise location. The break or window defined in the second guide surface  130 B can assist in visualizing the portion of the bone  230  being cut. 
         [0049]    In some embodiments, the main guide member  120  can be used to make additional cuts. In such embodiments, the securing component  90  can be loosened and the shaft  100  can be translated within the cavity to a desired position. The securing component  90  can be then be fixed within the securing aperture so the shaft is again fixed relative to the support  30 . In some embodiments, fixation pins may be inserted through fixation aperture  150 A and/or  150 B and into the bone  230  to further stabilize the main guide member. After the main guide member  120  has been repositioned at the location to be cut, a cutting member (e.g. a saw blade) can be inserted through the space defined between the first guide surface  130 A and the second guide surface  130 B to cut, for example, the bone  240 . The guide surfaces  130 A and  130 B can serve to direct the cutting member to the location of the bone  240  to be cut. 
         [0050]    In some applications, it may be desirable to provide additional, temporary fixation of the bone  230  to allow for more accurate cutting. As best seen again in  FIG. 9 , blocks  140 A and  140 B can provide a means for additionally positioning the bone  230 . Fixation pins can be inserted through the fixation aperture  150 A and/or  150 B and into the bone  230  to temporarily position the bone  230  and/or adjacent bone  240  for cutting. In other applications, blocks  140 A and  140 B may not be necessary. 
         [0051]    As shown in the perspective view of  FIG. 10 , once the bone  230  has been cut the bridge component  160  can optionally be attached to the main guide member  120 . In one embodiment, the bridge component  160  can have a geometry that allows the bridge component  160  to attach to the main guide member  120  between the first and second guide surfaces  130 A and  130 B through an interference fit, while in other embodiments the bridge component  160  can attach to the main guide member  120  by other attachment means. The rails  170 A and  170 B of the bridge component  160  can be arranged such that the rails  170 A and  170 B extend out from the bridge component  160  on a side of the bridge component  160  opposite the support  30 . The rails  170 A and  170 B can serve to support additional components of the bone cutting guide  20 . 
         [0052]    One such component of the bone cutting guide  20  that can be supported on the rails  170 A and  170 B is the fixating structure  180 .  FIG. 10  shows the fixating structure  180  attached to the rails  170 A and  170 B. In one embodiment, the fixating structure  180  can have holes or slots for receiving the rails  170 A and  170 B such that the fixating structure  180  can translate along the rails  170 A and  170 B to a desired position. The fixating structure  180 , for example, can also be secured to the rails  170 A and  170 B in a manner that prevents translation of the fixating structure  180  when desired by actuating the actuator  186 . 
         [0053]      FIGS. 11 and 12  illustrate perspective views of the fixating structure  180  with the fixation pins  220 A and  220 B received through the fixation apertures  190 A and  190 B ( 190  B is shown in, e.g.,  FIG. 2 ). Fixation apertures  190 A and  190 B can be on opposite ends of the fixating structure  180  as shown. Fixation pins  220 A and  220 B can be fixed to a bone  240  (e.g. a first cuneiform as illustrated) to provide stability for the bone cutting guide  20  and/or to position the bone  240 . After the pins  220 A and  220 B are set, the fixating structure  180  can be translated with respect to the rails  170 A and  170 B and the support  30  to a desired position to compress or expand the space between the bones  230  and  240  as needed. The position of the bones can be locked by securing the fixating structure  180  against the rails  170 A and  170 B. In other embodiments, such compression or expansion can be achieved by moving the shaft  100  relative to the support  30  and reengaging the securing component  90  at the new desired position. 
         [0054]      FIGS. 13 and 14  show perspective views of the bone cutting guide  20  assembled to include the secondary guide member  200 . The secondary guide member  200  can be supported on the rails  170 A and  170 B. In one embodiment, the slots  205 A and  205 B of the secondary guide member  200  can receive the rails  170 A and  170 B such that the secondary guide member  200  can translate along the rails  170 A and  170 B to a desired position. As illustrated, the secondary guide member  200  can be located along the rails  170 A and  170 B between the fixating structure  180  and the bridge component  160 . 
         [0055]    The secondary guide member  200  can be positioned at a location where a second bone cut is to be made. A cutting member (e.g. a saw blade) can be inserted through the space defined between the third and fourth guide surfaces  210 A and  210 B to cut, for example, the bone  240 . The guide surfaces  210 A and  210 B can serve to direct the cutting member to the location of the bone  240  to be cut, which in many applications can be a precise location. As illustrated, the cut made using the secondary guide member  200  (e.g. to bone  240 ) will be a cut that is generally parallel to the cut made using the main guide member  120 . However, in other embodiments components of the bone cutting guide  20  (e.g. rails  170 A and  170 B) can be configured such that the cut made using the secondary guide member  200  is an angular cut (i.e. not parallel) relative to the cut made using the main guide member  120 . 
         [0056]      FIGS. 15 and 16  illustrate the bone cutting guide  20  as described previously, with the secondary guide member  200  translated along the rails  170 A and  170 B. The secondary guide member  200  can be translated along the rails  170 A and  170 B to precisely locate the secondary guide member  200  at the location to be cut (e.g. on bone  240 ). In the embodiment illustrated, the secondary guide member  200  can be shaped such that a portion of the secondary guide member  200  can overlap, or sit on top of, the bridge component  160 . Such a configuration can be useful, for example, where the second cut made using the secondary guide member  200  is desired to be close to the first cut made using the main guide member  120  (e.g. portions of bones  230  and  240  interfacing at a joint). 
         [0057]    When the bone  230  and/or bone  240  have been cut and positioned as desired, the bone cutting guide  20  can be removed. In some embodiments, the cutting guide  20  is temporarily removed from the fixation pins and cut bone is removed from the area. In certain embodiments, an autograft or other compound is delivered to the area of the bone cuts. Optionally, the guide may then be reset on the bones over the fixation pins and the shaft  100  can be translated within the cavity to adjust the relative position of the bones (e.g., to compress them together). The securing component  90  can be then be fixed within the securing aperture so the shaft is again fixed relative to the support  30 . A bone plate may optionally be applied across the joint while the bones are held in the longitudinally fixed position by the cutting guide. After the plate is applied, the bone cutting guide and the fixation pins may be removed. Removing the bone cutting guide  20  can include removing all fixation pins and the support, and, in some embodiments, can include removing the bridge component, along with the fixation structure and secondary guide member  200 . In certain embodiments, a second bone plate may optionally be applied across the joint. In a specific embodiment, the two bone plates are applied about 90 degrees from each other around the circumferences of the bones (e.g., at a dorsal side and a medial side). 
         [0058]    Thus, embodiments of the invention are disclosed. Although the present invention has been described with reference to certain disclosed embodiments, the disclosed embodiments are presented for purposes of illustration, and not limitation, and other embodiments of the invention are possible. One skilled in the art will appreciate that various changes, adaptations, and modifications may be made without departing from the spirit of the invention.